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| EDITORIAL |
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| Year : 2018 | Volume
: 64
| Issue : 3 | Page : 131-133 |
Internet for child mental health: Boon or bane
S Aggarwal1, S Karande2
1 Department of Psychiatry, NH SRCC Children's Hospital, 1-1A, Keshavrao Khadye Marg, Mumbai, Maharashtra, India
2 Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| Date of Web Publication | 11-Jul-2018 |
Correspondence Address:
Dr. S Aggarwal
Department of Psychiatry, NH SRCC Children's Hospital, 1-1A, Keshavrao Khadye Marg, Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jpgm.JPGM_57_18
How to cite this article:
Aggarwal S, Karande S. Internet for child mental health: Boon or bane. J Postgrad Med 2018;64:131-3 |
Internet for public use in India was launched on 15th August 1995 by Videsh Sanchar Nigam Limited (VSNL).[1] In 2005, following the formulation of a government broadband policy, internet usage accelerated. According to the latest reports issued by the Telecom Regulatory Authority of India, there are 324.89 million internet subscribers in the country.[2] Approximately 35% of internet users in India are adolescents.[3] With an ever-increasing number of young users, the internet has revolutionized education and social communication.[4] Children and adolescents of 21st century are more connected, aware of the latest developments in various fields, and have access to academic and recreational material that would be inaccessible without internet.[2],[4]
| :: Advantages | |  |
Electronic media learning (e-learning) which is defined as the knowledge and acquisition of skills using electronic technologies such as computer and internet-based courseware, is becoming increasingly popular.[4] It offers multiple advantages over in-person classroom learning including flexibility with time, learning materials, and the pace and place of learning.[4] There is an additional advantage of joining discussions in the bulletin board threaded discussion areas at any hour with more personalized discussions with the course moderator than the classroom setting permits.[4] Furthermore, e-learning accommodates different learning styles and facilitates learning through a variety of activities and helps in improving internet and computers skills, thus aiding learners throughout their lives and careers and making them more responsible as the onus of course completion is on them.[4] E-learning has been an effective tool to develop the education sector in India. In 2004, an e-learning project “EDUSAT” was launched in India that utilized 150,000 ground terminals in the country to provide education to all the sections of the society.[4] Digital India campaign launched in 2015 is likely to further benefit the education sector by bringing elements such as live instruction, video content delivery, student-to-student interactions via videoconferencing, and remote test administration to traditional classrooms.[4]
Internet exposes us to varied ideas and provides us with the means to express our creativity by allowing our potential to engage in a range of experiences, which are otherwise impossible to do in the real world.[5] The benefits of internet use for children and adolescents can also be seen in the domain of healthcare. There are times when it is difficult for young people to express their health concerns to family members and family doctors due to the fear of breaches in confidentiality and getting intimidated by the brevity of doctors.[6] A study showed the benefits of e-mail correspondence to bypass these difficulties.[7] This study analyzed the content of 62,794 emails received by UK-hosted and doctor-led adolescent health website, Teenage Health Freak (http://www.teenagehealthfreak.org). In the study, young people were found to be more open about their health concerns with parents and doctors when communication occurred via email.[7]
| :: Concerns and Disadvantages | | |
There is no consensus among experts on an ideal age at which internet usage should start. In a recent study conducted in three private schools in Gwalior, Madhya Pradesh, 38.66% out of 300 students surveyed started using internet before 12 years of age with a median age of 13 years.[3] In 2011, a survey conducted by the global security technology firm McAfee in ten major cities across India revealed 62% of affluent children in the age group of 4–12 years had an e-mail ID, while 58% of them had an account on social networking sites.[8] The popular social media platforms such as Facebook, Instagram, and Snapchat require the minimum age to be 13 for opening user accounts. However, under the Indian Contract Act anyone who is not 18 years of age cannot enter in a legal contract, which is a requirement for opening social media accounts. Furthermore, there is no internet protection law for children mandating schools and libraries to implement adequate internet safety measures for the protection of children and adolescents. Thus, laws in India are not able to offer sufficient protection to young users from substantial threats to their privacy and safety caused by bullying and harassment occurring online, adolescent relationship abuse, and the inherent risks that can arise with the disclosure of private information in a public space.
Interpersonal relationships of adolescents has changed following the advent and rampant use of internet.[9] One of the most important developmental tasks of adolescent age is to establish interpersonal connections with their peers, parents, siblings, and other adults outside the family unit.[9] Peer communication among adolescents has been depersonalized in recent times due to the replacement of face-to-face or voice-to-voice communication by writing using an electronic medium.[9] However the peer and social networks of adolescents have widened due to internet.[9] It has become much easier for them to join common interest groups that would have been difficult to do otherwise.[9] On the flip side adolescents can also encounter racism and hate messages due to their online communications.[9] A review of risk and protective factors for self-harm in 12–25-year age group in low- and middle-income countries showed that having friends in real life protects against self-harm.[10] Another review of mental health studies in Indian adolescents over the last ten years suggested that parental involvement in the lives of adolescents offers protection against mental health problems.[11] These findings highlight the emotional and psychological benefits of actual interpersonal connections and offer strong reasons to balance virtual connections with real interpersonal connections.
Some studies have shown that excessive use of computers can contribute towards obesity and poorly developed social skills.[12] In a systematic review, the impact of bedtime use of a media device by children was significantly associated with inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness increasing the likelihood of adverse mental health outcomes.[13] Problem behaviors related to internet use and electronic gaming (when these activities interfere with a young person's daily activities) by young people have been linked to mental disorders and risk-taking behavior.[14] A recent spate of suicides in children and adolescents due to the e-game 'Blue Whale Challenge' is a case in point.[15]
| :: Guidelines for Parents and Physicians | | |
The policies, guidelines, and recommendations guiding internet use in children and adolescents are dependent on information on the current trends and pattern of use. In 2015, a collaborative effort by UNICEF and London School of Economics and Political Science “the global kids online project” was launched.[15],[16] The initiative gathered cross-nation evidence on internet use by children, and tried to identify the risks and benefits of the same.[16] The focus was on collecting information from countries where internet use has become more rampant in recent times. As part of this study, children between 9 and 17 years of age in South Africa, Republic of Philippines, and Serbia and between 13 and 17 years of age in Argentina were interviewed. Internet was most frequently accessed from the home setting, and the use of mobile devices was the most common way to gain access. Younger internet users in the study had lesser internet skills and required more support with digital safety measures. The participants received support from their friends if something upsetting happened over the internet. The researchers concluded that improvement in supervised school access to internet for children could help in maximizing education and information benefits of internet and allow younger children to develop their internet skills, a notable area of deficit identified in the study.[16] The findings of this study are very relevant to the Indian context, and could help parents and educational institutes make better choices for children.
It is important for physicians and parents to be adequately aware of the potential benefits and risks of internet to use it to their advantage. An assessment of the time spent on computer should be a part of physician's assessment of any child, especially when presenting with aggressive behavior.[12] Physicians should also be aware of the latest trends of internet communication among adolescents and children, questionable internet sites that could adversely affect the behavior of young people, and the impact of internet on the psychosocial health of children.[12] Unless the physicians are aware of the scope of internet-related issues, they cannot adequately guide the parents. Physicians should encourage families to develop a shared understanding of internet usage.[12] The rules of appropriate internet behavior should be discussed with children before they are introduced to the internet world.[17] In the initial phases, it might be advisable to explore the internet under parental supervision, especially for younger children.[12] Parental restriction of the internet, which consists of either prohibiting or limiting the internet usage of children and adolescents, has been shown to have a positive effect in reducing the risks associated with internet usage.[16],[17] In addition, it reduces internet addiction which is defined as the pathological state of overindulging in internet-related activities and the total amount of time spent online, especially among children with low self-control.[16],[17] A central location of the computer to allow supervised access with passwords is advisable. It is important for the internet to not be used as a substitute teacher or an electronic nanny by parents. Further, consistency around these rules needs to be maintained across various settings.[17]
| :: Further Recommendations | | |
The restrictions on internet usage by children and adolescents should be balanced with their need to access the internet to keep abreast with the latest developments in various fields. Any recommendation to guide parents, education, and health professionals should take into account the needs and rights of children in the context of internet usage. Finally, it is important to use robust evidence rather than popular beliefs to achieve the maximum benefits of internet.[16]
| :: References | | |
| 1. | Consultation Paper on QOS of dialup Access Network for Internet TRAI. Archived from the original on 08 th October 2001.  |
| 2. | Telecom Subscription Data as on 30 th September. TRAI Archived from the original on 21 st November 2017. |
| 3. | Bhatia M, Rajpoot M, Dwivedi V. Pattern of internet addiction among adolescent school students of a North Indian city. Int J kCommunity Med Public Health 2016;3:2459-63. |
| 4. | Kumar A. E-Learning: A Tool for Education in Rural India. Asia Pac Business Rev 2007;3:113-22. |
| 5. | Skinner H, Biscope S, Poland B, Goldberg E. How adolescents use technology for health information: Implications for health professionals from focus group studies. J Med Internet Res 2003;5:e32. [ PUBMED] |
| 6. | Jacobson L, Richardson G, Parry-Langdon N, Donovan C. How do teenagers and primary healthcare providers view each other? An overview of key themes. Br J Gen Pract 2001;51:811-6. [ PUBMED] |
| 7. | Harvey K, Churchill D, Crawford P, Brown B, Mullany L, Macfarlane A, et al. Health communication and adolescents: What do their emails tell us? Fam Pract 2008;25:304-11. [ PUBMED] |
| 8. | |
| 9. | Subrahmanyam K, Greenfield P. Online communication and adolescent relationships. Future Child 2008;18:119-46. |
| 10. | Aggarwal S, Patton G, Reavley N, Sreenivasan SA, Berk M. Youth self-harm in low- and middle-income countries: Systematic review of the risk and protective factors. Int J Soc Psychiatry 2017;63:359-75. |
| 11. | Aggarwal S, Berk M. Evolution of adolescent mental health in a rapidly changing socioeconomic environment: A review of mental health studies in adolescents in India over last 10 years. Asian J Psychiatr 2015;13:3-12. [ PUBMED] |
| 12. | Impact of media use on children and youth. Paediatr Child Health 2003;8:301-6. |
| 13. | Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. Association between portable screen-based media device access or use and sleep outcomes: A systematic review and meta-analysis. JAMA Pediatr 2016;170:1202-8. [ PUBMED] |
| 14. | Rikkers W, Lawrence D, Hafekost J, Zubrick SR. Internet use and electronic gaming by children and adolescents with emotional and behavioural problems in Australia – results from the second Child and Adolescent Survey of Mental Health and Wellbeing. BMC Public Health 2016;16:399. |
| 15. | Mukhra R, Baryah N, Krishan K, Kanchan T. 'Blue Whale Challenge': A game or crime? Sci Eng Ethics [Epub 2017 Nov 11]. |
| 16. | Byrne J, Kardefelt Winther D, Livingstone S, Stoilova M. Global Kids Online Research Synthesis, 2015-2016. UNICEF Office of Research-Innocenti, Florence. 2016; Innocenti Research Report no. IRR_2016_0. |
| 17. | Lee SJ. Parental restrictive mediation of children's internet use: Effective for what and for whom? New Media Soc 2012;15:466-81. |
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