addiction to gaming and screen time is a real thing. We see it in the brains. The root cause is pain, either physiological pain or psychological pain.

But screen use stops coming into them more stress, but it doesn't reduce stress. Although their brain perceives that as, oh, I'm relaxed a little bit.

They can pause the stress coming in through their cup, but it's not reducing. So it is not coping skills. That's how I teach my clients. Unfortunately, that's an ineffective coping skill.

Welcome to Demystifying Pans and Pandas, the podcast where we uncover the mysteries, breakthroughs, and hope behind these life altering conditions. I'm Dr.

Nancy O'Hara, a board certified pediatrician, educator, an advocate with over three decades of experience. helping children and families navigate the challenges of neurodevelopmental and neuropsychiatric conditions, especially PANS and PANDAS.

These disorders can feel overwhelming, but here we'll break down the science, explore transformative treatments, and share stories of resilience and recovery.

If you've ever wondered what's possible for your child or how to find answers, this is the place to start. Let's dive in. Hi, everybody. It's Dr. Nia O'Hara and welcome back to Demystifying Pan's Pandas.

I'm really excited to welcome Koichi Tanji to the podcast today. I heard Koichi lecture at MedMaps, our medical academy of pediatrics and special needs, and he really distilled all of the problems with screens and the developmental mind and how screens affect pediatric behavior in this digital era.

And I really wanted him to come on and talk about that. So Kochi, thank you so much for being here. Thank you for having me. My pleasure joining this.

Yeah. So again, let's dive into screen time. What's the average screen-time now, sort of post-COVID, as well as pre-Covid in our children? Right, for when it comes to screen time, it is a two-part, right?

You know, a lot of parents and clients themselves claim, oh, this is for school, school use computer. But so we need to separate it out with recreational use, such as YouTube, social media.

I mean, YouTube overlap is just for fun. Let's say, you know video games, Social media, that average screen-time for recreational-use before pandemic was four hours.

for adolescents, adolescents. Right? And after pandemic, it jumped to almost eight hours a day. Eight hours. A day? Right. We can imagine the impact of it, right?

Yeah. Well, eight for school, let's say, or 10 hours and eight hour sleep, hopefully. And then eight of screen time that consume entire day or maybe 24 hours night off.

Wow. The pandemic, it's probably more understandable, right? Cause we are locked down. We had limited access to socializing and stuff. But after that's lifted, there's no longer there, but still to this day, average screen time for adolescent age is about eight hours still.

And how do you distinguish overuse, which eight hours is definitely overused to me versus addiction to screens? Yeah. So that's the important part. A lot of, uh, you know, I took it as more like a dismissive comments of everybody's addicted.

This is like, a new normal, right? But I disagree with that. Not everybody is addicted, and the difference in part is how does that use impacting their social interaction, academic occupation.

You know, so those starting to get into, if they're starting impair relationship, prioritize over internet use, then building relationship or work or school, which is common for kids, you know kids.

And then that get in to arena of actual addiction. And I heard, I was listening to something on the radio the other day talking about AI and how young people are even having relationships with an AI type person online.

And that just seemed very scary to me. Yeah. I have that concern too of like a next phase is not just the internet now getting to the AI. and then again, probably no one has, but I don't have, Right, absolutely.

So from your perspective, what's the behavioral and mental health impact of all this chronic digital stimulation? Right. So common symptom is really easy to get frustrated and angry.

Over bottom is the trigger usually. Well, I have nothing to do because their brain is relying on a custom to keep stimulating from the screen, right? You know, high dopamine.

High dopamine stimulated. When they don't have that stimuli, really suffer, you know. when they were little, kids had creativity. Right? Made fun from, literally from adult's perspective, nothing.

Just cardboard and pen and paper, but they were creative and they could, you know, create the joy from it. But they lost that. Sure. It's teenager thing, But also it's the getting to more and more prominent.

Well, going out with friends is boring. Going with, Going out, with family is a boring, that's because I'm teenager. but interesting thing that I see is when they reduce screen time, when, You know recover from that, They're happy to go out with parents.

They are happy too. So it wasn't the age, it's the symptom, you know? Wow. And do you see that in younger children too, as a symptom in them also? Not just teenagers?

Yeah. You know, according to study, like a heavy gamers and excessive screen use associated up to like almost like 66% of, people have inattentiveness or attention deficit.

You know, so, but that's a concern. Really easy to get bored, difficult to stay on task, right? And then they need to stimulate all the time. So yeah, that is for sure.

Anxiety is really correlated, you know? Pandemic fatigue, Right? That was actually study was doing during the pandemic time, is it a lockdown or is what else was causing the Pandamic fatigue and skyrocketing anxiety and depression rates?

Yeah, absolutely. And then they did a study about restricting social media use during still lockdown was happening and for less than 30 minutes a day.

Then all aspects of pandemic fatigue recovered or improved significantly. So was it the lockdown or it actually increased screen time secondary to the lock down?

Right. What about executive function or cognition? You mentioned attention and anxiety, but what about actual cognition. Yeah. So like a cognitive delay, speech delay.

Language delay is associated with it. And now I think a newer study is showing average screen time by age one is if it's including FaceTime with family member is averaged one hour a day, that increase the diagnosis of getting autism double by three.

Face time use early in life increase their risk of autism. Well controlled for all other factors. Right. So that's the topic that I brought up in the MEDMAPS.

Yes, a lot of like, you know, I think we need to separate out the different type of autism instead of putting all one bucket, right? Because some of them are truly biomedical cause.

The number of autism diagnosis creeping up, yes, it's some environmental toxins and physiological and then many things associated with it, but subpopulation bringing up the number so high is potentially due to excessive screen use.

Okay. And you also mentioned neuroimaging findings in heavy gamers, users. Talk about that a little bit. Yeah, in the study showing a functional MRI, like a brain structure, right, that they look at from imaging, and then the heavy gamer's brain structurally altered.

And how they altered is very much similar with someone with substance use disorder. So, you know, part of the brain for executive functioning is shrinking and the other area, there's imbalance.

Basically similar finding with somebody with Substance Use Disorder. Right. And so very similar, it's another addictive thing. It may not be addiction to smoking or drugs, but addiction, to gaming and screen time is a real thing, we see it in the brains.

Yeah. Wow. So what's the drivers that may be hidden or not of the increase in these diagnosis? Do you think screen-time is one of them? And talk about that a little bit more.

Yeah, I think though, when they're studying, i think Massachusetts general study, is data is showing, yes, entire amount of like, well they separate into two types of autism, who has physiological, like a physical illness, together with behavioral symptoms of Autism.

who doesn't have much of physical, you know, like a food allergy, stomach pain and those things are not there, but there they have traits of autism to the point they meet the criteria of diagnostic to receive ASD diagnosis.

That population is really growing high. And then we still, we don't know exactly, but the hint is they don' have physical symptoms, generally less, and they have anxiety and inattentiveness is the main chief complaint to come to our door.

And usually they receive later onset, later diagnosis after age 10. You know, so that more like a sitting feeling overlap of screen dependence. Yeah. As they get a little older, they have more freedom and they're spending a lot more.

And then potentially the interaction issue, anxiety and those autistic traits starting to become more prevalent. Yeah, let's talk a little bit more about the anxiety, because, you know, we certainly have a lot of neurodivergent people who might say that, well, this helps my anxiety.

This makes me feel better. Or people with pans pandas, the children that I deal with, it distracts me, certainly. Yes. but it helps me to feel better.

And why can you say that the screen time may be causing anxiety versus I'm doing the screentime because I have anxiety? Address that a little bit. Yeah.

You know, similar with other addiction case, the root cause is pain, either physiological pain or psychological pain. Pain includes stressor. You know, a lot of neurodivergent kids went through traumatic experience too, and high stress, I understand that, you know I'm empathetic about it.

But at the same time, it's really tough conversation might be, but screen use stops coming into them more stress but it doesn't reduce stress. Although their brain perceives that as, oh, i'm relaxed a little bit.

Yes, they can pause the stress coming in through their cup, but it's not reducing. So it is not coping skills. That's how I teach my clients. Unfortunately, that's ineffective coping skill.

Right. And do you differentiate, you mentioned initially the difference between screen time for school, screen-time for work, we're all on it for these days as you and I are right now, versus the gaming, the social media, and that sort of thing.

Does that get differentiated in the neuroimaging finding, in anxiety, or is any screen time negative for all of us? I think, though, the study was showing the recreational use, right?

So they can tease apart, is it 100% accurate, how much is work, you know, recreational? I mean, there's a limitation to that. However, they define the gaming use as recreational outside of school.

I have to be on the computer for 8 hours a day. Is my brain addicted? Usually, most of the cases not. I never heard anybody, my clients addicted to Canvas like a learning management system, you know, right?

Or work platform. Although it's a possibility though, like workaholic self-claiming individual may feel that way, but usually they don't prioritize that over relationship or other activities.

Right. So it's that interference with the activities of daily living that's such a differentiator. And as you've said, there's an intentional design in gaming and social media to almost create this.

Talk about that. Yeah, so nowadays, you know, the video game, maybe you have seen, it's not the same as original Nintendo type of video games. You know in the back then was extension of just a digitalized version of board game kind of impression, but now it is really well designed.

Massive data behind it and then even psychologists involved to come up with the way to hook their brain greater than their capacity right basically what it means is brain is telling them I'm tired I am exhausted but they design in the way that still they hook and they cannot get off of the platform how they do that is one skill is called randomization of reward like when they're playing micro reward happens could be light, could sounds, actual reward in the game like a point or whatever and then they design in a way it's not predictable.

That would draw hyper-focus from our nervous system standpoint to keep paying attention and they cannot stop. So that's one mechanism of how these video game hook.

Is that the reward loop kind of thing you're talking about? Yes. What about reinforcement schedules? What does that mean in gaming and social media? Yeah, so like, yes, right?

Certain days of the time, they have to be on to claim the, you know, items, et cetera. That's a very common way. So they are, again, really getting so smart to the point it's really scary.

And then I live in Bellevue, Washington. There's lot of people working in tech field. There's a video game company, Microsoft, Amazon, and then I have encountered a group of game designer developers.

Did they actually raise the concern? I ethically don't feel good of how we design this way, because that will hook. the really vulnerable young age clients or kids to be on this for beyond just the physiologically capable limits.

Right. And what about the conditioning? Like, is there any of that? I feel there is, even with the few games I play, you know, to keep my brain sharp.

We almost become conditioned in a lot of ways, right? Yeah, I think so too. You know, even adults, Right? I mean, everybody has probably awareness that my relationship to screen is not optimal, because constantly checking for no good reason.

Without phone buzzing, they just check. We just checked. And then psychology behind it, part of it is fear of missing out. They tend to have a fear that everybody's talking about, I'm left out, that's another challenge with parents and teenagers.

Well, without this, like I cannot join the group. I can not talk to my friends. Ill be alienated. Right. That fear missing is a big one. How do you counteract that?

Yeah, so that's like pros and cons, right? And yes, you might be up to date with what people are talking about. And then, but do you think doing that will give you greater connection with other people?

When clients are getting into the actual addiction scenario, usually they feel more lonely. More they do use, they thought they're connecting with people.

but actually they feel a lot more lonely and isolated. Because again, they're all prioritized screen over actual socializing activities. So yeah, I definitely empathize the challenge with it.

But at the same time, the direction they are heading is literally really damaging to their life and career. Absolutely. And, and beyond the neurobiology of it, social media also influences several other things, risk taking, sexuality, you know, talk about those maybe unsafe practices.

Yeah, it's a very hard fact or statistic to learn for parents especially is right now, I think possibly this data is getting a little older, but average time, average year age that kids is exposing to porn is now 10. 10 years old.

Right. And then that will impact them really negatively, as you can imagine. And I have a few clients, you know, courage enough to brought it up to me.

I, not that I want to get rid of the gaming for the sake of gaming addiction, but this is bothering me because parents may not know that like those devices and console have a setting to change and go to internet without supervision.

You know, there's no parent restriction so they can access to those contents. And initially those are started with curiosity. Other friends showed it up, you know showing up to them and then they're like, Oh, what is this?

You know, initially was curiosity, but getting to the deeper struggle and whole of that side of like a damage, sexuality, you know what it means to be like, in the healthy relationship.

That idea is really impacted by that. Right, so a child may click on a picture or something inadvertently, accidentally, or out of curiosity, as you said, but then part of the design is that what you click in it, you get more of what click-on, right?

And I think that happens for us, whether it be reading about politics, it's the way it is designed, and I We even as adults don't understand that intentional design of it and it takes us more down a rabbit hole of getting more and more of what we may initially believe or just be curious about and getting Correct, Koichi?

Yes, yes. Definitely, you know, getting smarter and then the common topic come up to my door is YouTube. YouTube is so smart. Once you watch something, the recommendation is, so great that drove their attention.

Well, I was gonna only watch 20 minutes and they'll stretch it out to two hours, three hours and realize seven hours in some clients. Yeah. Yeah, so how do you first recognize screen dependence, screen addiction?

How do recognize that in a child or adolescent? Yes, so how I do it, you know, it's the when I ask about bro, bro this bring this up top, and you don't that's topic and then healthy individual even like a client younger age kids.

They say, yeah, It's not good. I need to walk on it. Or yes, that is too much, but I can control. That's a healthy mind. But when somebody's already getting to a little bit towards like addiction side, they say like, no, it's fine.

I have no issue. Like starting with denial. It's, you know, normalized. Everybody's doing it. Otherwise I'll be left out. That is already like you, know like a flag, I would say, like 80, 90% of kids respond that way.

And then to have a full awareness. Yeah, actually I don't have control and this is impacting me negatively. Average in my experience takes about six months.

Just to get into the door of like, well, I want to improve seriously in a meaningful way. Yeah. So, so is the first step just awareness by the adults in the room and by.

The adolescent, if they're there. Yes, education part is where we are in the society is to bring more awareness. That's how I think. Maybe other practitioners have different perspective, but I, think most important work is, to share awareness about negative impact of accessible screen use.

And are you then treating it the same as other substance use disorders? Very similar. Yeah. But in one way, it's harder than substance or alcohol, let's say.

Because it is everywhere and then… Well, first in the morning, somebody drink alcohol. You know, probably their partner or friends look at it like, oh, that sounds not healthy.

When first thing in morning check phone and play video game, I don't know if they have awareness about… You shouldn't do that. You know? Right. Right?

Like, that's a normal thing. So that is… Another barrier is the lack of public awareness, how this is impacting their life. Right, right. And abstinence, you know, certainly if you're an alcoholic and have understanding of that and awareness of and can choose to choose abstinent or NAA or whatever, that's great.

You know? It's like don't go to the candy store. But with screens, Even if we don't want to be addicted to it, in our day and age, it's almost we can't avoid it.

You know, whether it be school or work or just talking on our phones, It's right there. So I can imagine that the pulling back from it is so much harder.

It is very challenging. Yes. But the reassuring part, all my clients went through abstinent period. They don't regret. None. Zero. You know, they looking back and then without that, I'm not here today.

I, um, presenting differently. It's a, uh, it's really awakening call to realize. I was in the different headspace and then actually I do like current state.

Right. So how do you help your clients to do that? I mean, and again, if it's not teenagers, do work with parents to help them help their children? So talk about that.

Yeah, definitely parents are important work. Important work? Let me put it that way. And let's say common scenario. I'm stereotyping a little bit but like generally speaking, you know, mother is on board but the father maybe not agreeing with it.

So like parents already they have different view about how this is impacting them. Again, I'm a little stereotype in the gender but that can certainly reverse but generally I hear more of that.

And that is really challenging. Kids get mixed messages. If mom is like, no, listen to Dr. Koichi, this is real, impacting you. But then going to his home and they're like oh, fine.

Right? And just, you know, make sure you stop a certain time, do this. And that makes Mrs. Really challenging. So yes, it's crucial to have conversation with parents, especially, uh, the clients are really young.

Yeah. Yeah. And, and I can also see the modeling of the behavior. You know, as parents, we may not want our children to do it, but there we are on our phones.

Right. Or, or on a computer as we're telling them, you know you're too addicted or you are spending too much time on it. That must be a big part of it too.

How do you handle that with parents? Yes. I highly encourage to to it with, entire family. That would be really supportive, you know? And how much are they willing to make change?

Generally they are, though. And then they'll realize, they can emphasize how hard it is to reduce and control. You know, a lot of time I hear from parents, I bring it up like, how often do you eat healthy meal or just eat, exercise?

It's like I want to do this. I should have done that, but I don't have time, I'm not being like really aggressive in this way, but gently remind them, is it the lack of time or we don't know to this date or to these days like how to manage time.

My point is, can you check your iPhone or phone? How many hours you're on YouTube, social media website? And usually like four hours, three hours. Yeah.

Can we trim that even like one hour and then do exercise? Yeah, right. It's an awareness part, really. Right. Right. And is that how you approach it? Like you try to decrease it or is it, you know, like when I talk about diets, often I'll talk decreasing first before we try go really off of it.

Or we may cold turkey it how do you approached that? Is it decreasing or cold Turkey? Yeah. So that's how I decide is whether this is actually addiction case or excessive use case.

Okay. If it's excessive used and there are room to kind of improve by reducing it or put the restriction on, put a schedule on et cetera. But when somebody is getting to just the full state of addiction state, abstinence is almost necessarily.

Okay. Yeah. And I've also heard you talk about Jomo, not FOMO. What is JOMo mean? Yeah, joy of missing out. and then my clients ended up realizing it.

I feel great that have no awareness about what's going on in the school with other people in drama, right? And they feel good. They don't feel stressed because negative side of getting too much exposure to either news or, you know, like a sad story, et cetera, is their emotion become numb.

as a coping mechanism. Because they cannot be sad or angry every single time, right? Hearing news. So they become numb. When there's a joyful moment happens, they're also accustomed to be feeling numb.

So they may not feel as much of negative, but they don't feel much as positive either. That's a really hard state to being in. Yeah. And so true of an addictive type with any type of addiction.

You're kind of explaining the same thing with others that can be addicted to substances. Right, yes. So let's step back a little bit because I really want to understand the difference between the impact on an adult brain like you or I versus the developing brain versus The developing neurodivergent brain.

Yes, or the anxious brain so talk about each of those a bit Right. So, impact to the, you know, how it happens is usually adults perceive, they themselves have played certain video game, maybe a similar or same kind, and then from their own experience, from an adult's perspective, They assume, I get it, it's addictive, but it is not as bad.

They may come to a conclusion. But when it comes to developing brain, the impact is really different. It's a lot stronger, And then it'll hook them deeper.

I mean, when we think about smoking, alcohol, drug use, we have awareness this is not good for their pediatric, right? Because we are educated, and we know enough about it.

But when it comes to screen use that risk is the same, but still lacking awareness. And then we as adults don't see it different. I see differently or same difficulty.

Let me put it this way, you know, they, as if they treat, this is just benign based on their experience, but it's as risky as drug and alcohol. Right.

And is the developing brain in a child that is predisposed, to be autistic, maybe genetically or have that susceptibility, is that differently, different than a trial that may not be predesposed?

So that's a more newer area and maybe, you know, a practitioner who is geared towards like a genetics of addiction. Probably they can help, shine the lights, which would be great.

You know there are certain like dopamine receptor mutation or genetic traits makes the people more susceptible for addiction and there is a gene I think associated with it.

So those individuals with family history, I mean, similar with substance use disorder, yeah, it has greater risk. Then when it comes to neurodivergent brain, they have another layer of challenge because they tend to have physiological reason to be anxious.

Like, you know, MAPs teach certain gut dysbiosis and, and you, know pans and pandas certainly will physiologically induce anxiety. And then they don't know how to cope with it.

And I hope they're working with a doctor like Dr. Ohara, but not accessible to all people right now. So they do not know to deal with. The only way that they can find is use the screen to distract their mind.

Right. They have a different layer, right? They are not just being mindful about screen use, they need support to reduce anxiety. Otherwise, it's really, really tough for them.

Right, right. And I think as a practitioner, you know, I ask about mold, tick exposures, infections, diet and stooling. But I also think we need to be asking more specific questions about screen time, and really be looking at How many hours a day is that going on?

Because I do see that, you know, when parents try to take away the phone or put that down, the rage, anxiety really increases. And I think we have to understand why that's happening.

How do you talk about family's tips to instill that fixed mindset? Yeah, so fixed mindset versus gross mindset, right? Video games certainly encourage their perspective to become more fixed mindsets, like outcome driven.

Right? If the outcome is not positive, might as well not even try. You know, that's the pattern that we do see. And then, certainly need guidance, but stopping screen even like a three to four weeks, then they do realize different side of them.

They're more resilient, they can cope better. They can handle boredom. They could be more creative. Boredom is great. That's how I teach. boredoms make you more creatve.

And intelligence is about pattern recognition. So when they get bored, they're starting finding the pattern more, pay attention to more. So that's definitely a piece of it, you know, by so many things to be discussed, but that is a common thing we discuss in terms of like gross mindset and fixed mindset.

Right. Do you have any practical tips to help families that want to start to reduce this, that don't really feel it's an addiction yet, But want decrease the use?

Yeah, so definitely have a conversation and awareness. You know, that's definitely a must. But also, putting the schedule is really important. Instead of, all right, you only use two hours, they're using, let's say, six hours.

Now, what are they going to do with the four hours? Right? They'll suffer. They don't know what to and then very difficult to go through boredom with it.

So they're going to fill up the schedule in advance. You can do this, you can't do that. And they may say a lot of things they are interested in, but put those on their schedule.

So, they can go to sports, meeting, whatever. That way, They have less free time just sitting in front of a computer or phone by themselves. kid that says, these are my friends, you know, I am now homeschooled or I'm doing online school or, this is the only way I can connect with my friend.

How do you discuss that with families? Yeah, I mean, first of all, when to intervene is definitely if it's starting to impact negatively, right? So when they can go to still like complete the home school task, they get sleep still on time, generally, or eating okay, you know, and then that's okay.

Right. But when there not doing the schoolwork, there're not do anything, then classical sign is night and day flip. They wake up at night and they play game throughout the night.

During the day, they do sleep. Even when somebody has, you know, neurodivergent traits and then they really drawn to screen, when they can sleep at nigh, even though need some guidance, hey, stop in 30 minutes and end up stop and can't sleep, that's really positive prognosis with those individuals.

That's really common. They're poor hygiene, they don't want to shower, or they want a brush teeth. It's somehow really hard for them. And then night and day flip.

If I see those three traits, I think abstinence at some point is important. And how do you help families to, you know, if you have a small child, families are very busy.

They have three, four, five children. Do you recommend that people totally turn off the Wi-Fi, at a certain time of night? Do have any other practical tips like that that you helped families do?

Yeah, so more family gathering, board game time, you know, those are really helpful. Yeah. But that's an assumption that family has good connection, right?

Not all families are in that way, unfortunately, Right? So that is another limiting factor. but when they can, just come up as you do as an entire family is great.

You know this is like our choice at night after 10 o'clock. We'll stop Wi-Fi, you know, we stop using screen. That would be great approach, but sometimes sibling who's generally doing okay, they may not agree with that.

So it's a tough conversation and needs to be creative. How about this? How bout that? So individualize in each case. Right. And I think that's so important because each family, each case is different, and we do need to individualize not just our medical care, but also what you're talking about here with screens.

Yes, exactly. Yeah. So it's not, I don't want anybody listen to this or we have to cut everything out. Otherwise negative outcome is waiting. I mean, it it a little too simplified.

Yes. It's negative in general, if it is too much, but you know, to get to that point of controlling screen use, we need to be careful of how to implement.

Right. And let's talk a little bit more about the developing brain, because do you see ages, you know, that are like, it should be this much at this age, this, much, at, or, I understand what you said and totally agree about, the FaceTime early on in life, but what about between that three and 13 where most of my patients lie?

That's the biggest area of pans-pandas and that level of anxiety. Talk specifically about that age group. Yes, there are guidance about like, you know, two hours a day of recreational use, for those age, or it could be one hour, but I don't pay too much attention about the total duration of use.

It's more like can they stop when they're supposed to stop? That is the most important part. Because boiling down addiction is difficulty with boundary to self and others.

So I decided or family or parents told them two hours. And then if they can stop within two, hours, great shape. If they didn't do that for three and four, they're in the healthiest state.

Then somebody has house rule, home rule of like a one hour a day, and they always stop at one, hour and 30 minutes. Total exposure is less, right? Because only spend one and a half than four hours But when they cross that boundary, that's a trace of dependency.

And that is my guidance usually to clients. Can you stop when you're supposed to stop? Even like a five minute matters. Okay. So how do you learn or relearn those boundary skills?

Right, so that's a lot of therapy, you know, Saiku educated about those topics. So that is a lots of counseling. I'm a counselor too, I do that weekly and talk about things and how hard it is.

Somehow I thought… I stop at 1 hour and 50, but realize it's 2 hours and 15. And then they give up. Might as well I go 2 hour 50 because I already crossed that line.

Right? Right. So those are the things. Yeah. I see that you made a mistake, But let's not go all the way out. That's a really crucial skill. Damage control.

When they make a Might as well drink everything today and then restart over. Instead, just stop. Can you stop when you realize? You know, those things is, uh, I don't know if I'm answering question now, but just a lot of them coming up.

No, no, that's really interesting because, you know that realization, You, know I had this goal set for myself. I didn't meet it, but now can I reset and stop now?

I think that's a very important piece, you know, as opposed to, all right, I already messed up today. Let me drink five more beers or whatever. That's sort of the analogy that you're saying, having that awareness as a child, if you can, and as an adolescent, certainly as parent too.

Right? Mm-hmm. Right, right. Yeah. And when they're still like in elementary school, generally, they are physically, when the go aggressive, parents can still manage.

That's why I highly suggest to work on this, and the earlier the better. Because when you get to teenage, adolescent age, physically when we go to really aggressive because of the withdrawal symptoms, it's just out of hands.

Then where do we get help? Very limited. Yeah. Right. But I see it even in the younger kids that I take care of, that three to thirteen again, you know, when the parents want to take it away because it's time for dinner, or excuse me, homework, You know, to leave to go to grandma's or school or whatever, they get very angry, very agitated.

And that's a sign that this is a real negative. How in that moment do you work with families to get through that rage or that very intense anxiety? Yeah, so when they even just go through screen fasting of two weeks, the first time generally improved is the aggressiveness and anger.

It's interesting. I don't know why it's the 1st symptom to improve is generally they get easier. They still get grumpy, but not escalating to the point like the past.

So 2-3 weeks of abstinence and then give the feedback. How's your mood? Would you get upset? And a lot of clients say like, no, but they don't attribute to like a screen fasting.

They tend to say, like that's because nothing bothered me this week. Right. Cause there's no reason to be upset. But in the past there was two no reasons to upset, they were upset though.

So those awareness, huh, all right, maybe true. And then that exercise generally takes about six months to get, alright, now I see this is negative truly to me and I choose not to go back to this way.

Right. Are there different approaches with neurodivergent clients, fact-based approaches, other approaches that you use? Study is very limited, but yeah, so, you know, I come up with my own creativity.

And yes, a lot of stress that they are trying to cope with, screen, that needs to be addressed. That's my kind of expertise in counseling is to feed voice of them.

Right? Sometimes I talk to school, communicate, you know, how they're feeling to a school. Because that's the, we know it's expressive. Output is the challenge, most part, not the input.

They have actually greater input than average, but output is less than an average usually. So that gap frustrated them so bad. Right. And that why being the voice of them to express their concern and feeling is really validating and reduce the stress.

So you're saying that you do that with the clients that work with? Yes. Okay. So they're unable, they may feel it, but they are unable to express it. They're more aware of it but less able to expression the emotion from it?

Is that what you are saying? Yeah, so like, you know, they have a struggle with how to kind of elaborate how they're feeling. So I guide them to, express how their actually feeling, usually they can, if it's open-ended question, it is very difficult for neurodivergent brain.

How was this week? How's today? You know? how was school? Very difficult. Usually in those scenario, I give like a, almost like multiple choice. Did you feel this, that or this?

And then they say closer one is that, but a little bit different in this way. Now I get more better picture, right? So it was not good week. Not because of the homework was a lot more, But the teacher, how they treat them was, not right.

So those things I learned more and then we like understand and became more empathetic about their struggle. Right. And really understanding where each client, each person is coming from.

I mean, not to overgeneralize. You know, I don't want people that may be listening to say we're saying that about all neurodivergent people or all people with autism or anxiety.

It needs to be very individualized. These are just some generalizations. Wow. Now, are there any other clinical considerations or treatment considerations that we haven't talked about, Koichi, that you want to mention?

Yeah, so when people first learn about screen addiction, they tend to assume, all right, that's because of screen use, early exposure. But that is a great overlapping in knowledge from, you know, Dr.

Ohara. If it's like a panzen panda is driving this, we got to treat that. Otherwise, it mimics addiction but it is different kind of cause. Right. So that's the part.

Maps can provide a lot of helpful information to parents so they can understand why my kids are behaving this way. Is this truly developed addiction versus underlying is physiological?

My work is, you know, hard to explain, but when I see clients, I kind of decide how much is psychological, how many is physiological. Based on like a presence of a tick, like obsessive tendency, and how they talk.

That's how kind, oh, this is more like physiological, let's look at organic acid one. Do you screen body versus like, okay, This is a more, screen-dependent.

Let's work on more counseling side a lot more. And that's, that how I treat clients. It takes all of us being detectives. That's our role in trying to figure it out.

It's all so fascinating, Koichi. I really appreciate your time. And if somebody wanted to reach out to you or find out more from you, how would they reach you?

Yeah, we have an email for me directly and Dr. O'Hara, can you put that on like info for this podcast? It will be in the info, for the podcast, absolutely.

And you can have that for everybody and any last words of wisdom or hope or anything from your experience you want to leave the families or practitioners with.

So I have about 100 clients recover from this. And then again, I said it earlier, but none of them regret what they went through, although it was hard.

Then also, a lot of people did believe I could not connect with friends without the screen, But they do realize actually they can. So that's hopefully empowering for clients listening to this and family.

It's really hard for parents to kind of remove them from potential social interaction, but they can connect more in a meaningful way and closely without screen actually.

So, that is my message to clients and families. Yeah, there is hope. You can do it. And let's try to decrease that eight hours of social media and gaming and screen time in our teenagers and also for our families with younger kids.

Start now in trying to increase it as much as possible. Yeah, it's such an important topic, Koichi. And thank you so much for joining us today. Really appreciate it.

I hope to see you again soon. Yeah. My pleasure. Thank you for having me. I hope you're walking away with insights, tools, and hope to help you and your child on this journey.

If you found today's conversation valuable, be sure to subscribe so you never miss an episode. Share this podcast with anyone who might need it. It could be the lifeline they're searching for.

And if you have a moment, leaving a review helps us reach even more families who deserve answers. Also, for more information, training, and community, check out our website, drohara.com and join our annual membership.

And remember, every step forward, no matter how small, brings us closer to healing and understanding. Until next time, be present, Be hopeful, And we look forward to seeing you next on Demystifying Pan's Pandas.

Koichi Tanji, ND, LMHC, FMAPS

When Screen Time Starts Looking Like Addiction