Problematic smartphone use: What can teenagers and parents do to reduce use?

In the study by Carter et al (2024), 657 16- to 18-year-olds were included from five schools in England and found an association between anxiety, depression and problematic smartphone use, a pattern of behaviour which resembles a behavioural addiction.1 Qualitative data from a younger sample revealed that while teenagers valued their smartphones for school and connection with family and friends, they recognised that smartphones impacted time spent on school work, with family and friends, and pursuing hobbies.2 So what to do? The good news is that teenagers are already trying to limit their smartphone use: further findings from the same sample but not reported in Carter et al 2024 were that 625 (95%) had used at least one smartphone reduction strategy. The most popular strategies were putting the smartphone on Silent (78.1%, n = 513), turning off the notifications (74.1%, n = 487) and using 'Do not disturb' or 'Airplane' mode (67.9%, n = 446). (Supplementary Table S1) The strategies rated the most effective were: 'Do not disturb' (73.5%, n = 328/446); turning off the notifications (65.7%, n = 320/487); and leaving the smartphone in another room at bedtime (58.8%, n = 130/221). The least effective were those that restricted access to specific Apps (38.6%, n = 97/251); using a locked box during revision (36.0%, n = 27/75); and turning on greyscale (32.0%, n = 32/100). Participants also rated parents taking the Smartphone away at night (37.5%, n = 62/165) as least effective, which may reflect that this was imposed rather than a shared plan. We have previously surveyed a large study of 18- to 24-year-olds and found the same strategies were effective.3 The teenagers' perception that preventing notifications—via switching them off or putting the phone in silent was effective is supported by evidence.4 In a study of children and young people, they received a median of 237 notifications per day.5 The impact of notifications has been shown to reduce cognitive performance, and a randomised controlled trial found removing notifications reduced anxiety and depression.4 A contributing factor may be poor sleep caused by smartphone use at night, which has been suggested to blur the distinction between day and night due to continued use into the night.5 What can parents or carers do? Although the parental impulse may be to remove the smartphone entirely, there is scant evidence to support this. Restrictions have been found to raise family tension between parents and adolescents and was counter-productive.6 Rather, the relationship between parent and adolescent is key: Fostering a partnership where the harms and benefits to parents and adolescents are openly discussed was more likely to be effective as it acknowledges both adolescents' drive to individuation and their relative inexperience. Beyond the family, local norms in communities, schools and peer groups are likely to influence usage. Legislation is being used to influence this, for example, there is a French law outlining when employees can and cannot send emails to employees. Similar strategies may be effective if communities of parents and adolescents came together to reduce the feeling of missing out. Guidance may include families to not use devices at meal times and agree time at night to collectively stop using them. A further pressing need is to reduce access to harmful content, unfortunately there is little evidence of effective interventions. On the one hand, the smartphone may act as a social leveller allowing differing socioeconomic groups access to the same content (e.g., educational material), but in some likely to suffer negative consequences. The Adolescent Brain Cognitive Development (ABCD) study found differences in usage patterns across genders and age with minoritised groups exhibiting increased prevalence of video game and social media addiction.7 One of the thorny problems inherent in school-level public health interventions for problematic smartphone usage is balancing the benefit of inclusion with the potential for harm. Practically, a risk of reducing smartphone use, particularly social media use, is of social exclusion in a peer group where much social engagement and interchange occurs via smartphones. This 'collective action problem' is vividly conveyed by a microeconomic study where university students who used social media platforms stated that they would require a median payment of $30 to give up TikTok or Instagram for a month, but were willing to pay a median of $10 if they and others gave it up.8 Thus, to tackle this a broader change in social norms may be necessary and studies on social strategies need to be prioritised. There are particular groups whose relationship with smartphones warrant special attention, such as neurodiverse populations. For example, there appears a link between worsening symptoms of ADHD and frequent notifications.9 Success of generic reduction strategies should be studied in this group, and parents given early advice about the prevention of problematic smartphone development. For people with autism, the picture may be more complex, as many report that digital social interaction makes them feel more confident and secure. The prevalence of problematic smartphone use in adolescents with autism is unknown and the relative harms and benefits should be explored, in order to provide advice taking into account their particular preferences and challenges. In those with body dissatisfaction (extending to body dysmorphic disorder), social media has been linked to worsening symptoms.10 It is interesting that intrusive thoughts and fear of negative evaluation were found to be mediating factors as this raises a question of how clinicians understand the compulsive behaviour and address it. Is it an 'addiction' type pattern or part of an anxiety disorder? Would problematic smartphone use subside with treatment of body dysmorphic disorder or is it a complicating factor which needs to be an additional focus of a care plan? As things stand, for general populations, the clinician can recommend measures to reduce use, for example, silent mode or switching off notifications, removal of the smartphone during agreed times, and the importance of interpersonal safety and open sharing about smartphone use in the parent–child relationship as measures with at least some evidence base to support them. The fact that the measures reported here are those which peers have found helpful are likely to make them more acceptable to adolescents. More broadly, schools and communities of parents should be looking to address problematic smartphone usage in both adults and young people. Nicola J. Kalk: Conceptualization; supervision; writing – original draft. Johnny Downs: Writing – review and editing. Bruce Clark: Writing – review and editing. Ben Carter: Writing – original draft; conceptualization; methodology; formal analysis. We would like to thank Sarah Holloway. This paper represents independent research funded in part by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care (BC). NK's research time is supported by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. The funder had no role in the study design, data collection, data analysis, data interpretation or writing of the report. All authors declare no conflicts of interest. 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