Key points

Introduction

Over the past several decades, scholars have hypothesized that increasing exposure to media content endemic to our technologically-saturated world overwhelms the capacities of our primitive brains. The exponential increase in available digital information has reached unprecedented dimensions. The amalgamation of the data from billions of individuals, as well as extensive business and governmental information repositories comprise the massive global datasphere projected to surpass 175 Zettabytes by 2025. Herbert Simon’s prescient insight from 5 decades ago resonates within this context: “What information consumes is rather obvious: it consumes the attention of its recipients. Hence, a wealth of information creates a poverty of attention and a need to allocate it efficiently.” Efficiently allocating attentional resources is increasingly critical in contemporary society’s media-rich environment.

Children’s and adolescents’ cognitive faculties are immature, less able to grasp long-term consequences, and may be most at risk by this asymmetry between information and attention. Developing brains are more susceptible to distractions, including digital ones, which threaten to undermine their productivity and skill development. Educational pursuits are the most obvious casualty of digital distractions, especially as smartphone availability has proliferated and schoolwork is increasingly done via computers. ^, It is difficult for academic texts to compete with the stimulation these devices provide through platforms like social media. The presence of a smartphone can be particularly disruptive to cognitive tasks, ^, and seems to have a direct negative effect on academic performance. ^,

As ultra-social primates, children’s and adolescents’ attention is naturally drawn to culturally relevant and social information. Youth copy or adapt behaviors they observe; and see themselves and the world differently when much of their experience and social life flows through the lens of social media. This is especially true for children and teens who typically spend most of their waking hours online.

Children and adolescents require guidance regarding how and where to devote their limited attentional reserve. Young people’s attention is being pulled in more directions than ever, and there is a good reason for concern. Social media’s influence on the enculturation of youth displaces the influences of parents, schools, and other societal forces. Rapid technologic advancements and financial incentives, along with the democratization, proliferation, and accessibility of social media content all facilitate this process.

Amid an intricate confluence of media and culture, Pegrum and colleagues introduced the concept of digital disarray. Digital disarray refers to the combination of digital distraction with digital disorder (ie, the widespread circulation of online misinformation) and digital disconnection (ie, lack of engagement due in part to a negative view of the world and one’s place in it), with eroded trust in online informations and institutions. Combined, these elements can produce disorientation and detachment from oneself and others.

Attentional literacy is a meta-concept encompassing heightened self-awareness and honed focus. Attentional literacy draws inspiration from principles of mindfulness, advocating intentional awareness, and discouraging premature conclusions. By distancing individuals from reactive or habitual judgments, space is created for calm, rational analysis, and informed choices, enabling effective navigation of an environment rife with powerful distractions. Attentional literacy fosters a neutral, analytical, less biased approach to evaluate digital information. This concept emphasizes the need to manage our finite attentional resources and account for human irrationality. Parents and other caretakers can use the concept of attentional literacy as a lens to judge what guardrails will effectively protect youth from harm associated with social media and other distractions. Clinicians must respond to the need for attentional literacy by helping families effectively address digital distractions and related challenges.

Human information processing systems

Human attention and information processing systems, integral to achievement, are susceptible to various limitations—processing speed, working memory, and sustainability. Eric Charnov’s “marginal value theorem,” originally a theory in foraging biology, has been applied to information-seeking, highlighting digital behavioral patterns that echo animal foraging activities.

Human sensory systems—sight, smell, taste, touch, and hearing—evolved to preferentially detect survival-critical cues in our environment. Prioritization of vital inputs means increased attention is paid to signs of danger, social conflict, sex, and food. Children learn to notice what others perceive as necessary, further guiding the direction of attention. Personal experience also strongly influences application of attention. The brain creates a coherent experience by ordering information from an array of sensory inputs. Even during periods of directed focus (eg, during the act of reading), humans continue to monitor our environment, creating susceptibility to interruptions and distractions.

Smartphones, in particular, facilitate constant access to stimulating distractions. Imagine a child attempting a challenging reading assignment. A notification appears as a flash on the screen accompanied by a familiar vibration and sound. The student wonders what that notification could be and who it might be from. His spotlight of attention is no longer focused on his reading assignment.

Interruptions, such as this notification, disrupt the top-down processing of the assignment via bottom-up awareness of the smartphone notification. Top-down refers to higher cortical areas of the brain directing focus whereas bottom-up represents the range of internal and external sensory input coming from the environment rather than directed by higher brain functions. Humans continuously manage bottom-up processing to discern whether each sensory input demands an immediate response.

Our broad lantern of attention scans our surroundings. However, environmental scanning comes at the cost of intermittently disrupting the spotlight of focus shining on the task at hand. In the case of the student, shifting focus to the incoming text disrupts the attention required to make progress on schoolwork. Switching to and from the primary task creates inefficiency as it drains cognitive resources, reducing accuracy, and productivity.

Humans have a limited ability to control the spotlight of our attention, especially in a distracting environment. One of the biggest distractions for contemporary youth comes from social media. The powerful pull of social media is not a revelation. Humans are social creatures. Our internal “sociometer” automatically processes and prioritizes status, fairness, and group affiliation, influencing our social interactions. Status-conscious young people naturally wish to keep abreast of the interactions and interests of their peers, including trends in youth culture. They seek to both join with peers and demonstrate their individuality.

The percentage of youth aged 13 to 17 who engage in multiple social media interactions daily increased from 34% in 2012 to 70% in 2018. This trend of increasing social media engagement has continued as of 2022, when 95% of 13 to 17 y olds reported using social media. Youth interact with social media more frequently and for longer periods than ever before, so it is increasingly essential to understand how these experiences impact their minds and behaviors.

In one study, researchers observed that when studying, students with access to the internet maintained focus on an academic assignment for just 6 min before switching tasks to a high-tech distractor. Task-switching comes with a high cost to efficiency and productivity, and parallels engagement with the brief, fast-paced videos featured on social media platforms popular with youth.

This quick repeated switching of focus is often called “multitasking.” Rapid task switching leads to feelings of productivity, even though relatively little has been achieved. Moreover, research has shown multitasking and attention problems are highly interrelated, and suggest that media multitasking may progressively impair capacity to maintain attention, leading to greater use of multitasking in a vicious cycle. Social media interactions are highly stimulating and appeal to humans social instincts, in contrast to goal-oriented tasks such as academic work, which require repeated practice of effortful focus.

Nomophobia , as the fear of being without a phone connection, is commonplace in today’s youth. Young people have become so accustomed to easily accessible, fast-paced entertainment that 76% of Greek students aged 18 to 25 endorse moderate to severe nomophobia; 81% of the time these youth used their smartphones was for social media. This research suggests young people are overly attached to technology, risking wide-scale disruption of focus, task completion, and learning.

Patterns of heavy smartphone use in 7th to 12th graders have been associated with poorer academic performance. At one of the United States (US) universities, researchers demonstrated that one additional hour of daily smartphone usage lowered the current term grade point average by 0.15 points on average. Academic problems result from a confluence of factors, but digital distraction appears to be a standout. In an analysis of 159 American high school students, findings suggested students were distracted during homework about 38% of the time, constituting an estimated 204 h per year of unintentionally engaging with distractions while attempting schoolwork.

Rising numbers of people are reporting difficulty focusing. Attention-deficit/hyperactivity disorder (ADHD) diagnoses have become increasingly prevalent over recent decades alongside the growing influence of screen technology. The increased rates of ADHD likely relate to better recognition of neurocognitive deficits, greater knowledge about and trust in treatments, and decreased stigma surrounding the disorder. Yet increasing complaints of poor attention may also reflect a response at scale to the overuse of distracting technology that weakens youths’ ability to focus. ^, Increased exposure to digital media has been correlated with attention problems, although the nature and magnitude of this association have been disputed.

There seems to be bi-directional interaction, whereas excessive social media and other screen exposure erodes focus, and those with difficulty sustaining attention are in turn, especially susceptible to excessive use of social media. ^, Regardless of the mechanism of distraction, youth can benefit from exercising attentional literacy during times of intended productivity. By bringing to conscious attention instances of distraction, individuals are empowered to redirect their spotlight of attention back to the task at hand.

ADHD has been linked to more frequent and problematic use of social media. Problematic social media use is an enduring preoccupation with and inability to refrain from using social media. Problematic use interferes with school, social, and/or family functioning, and is explored in detail in this issue by Vidal and colleagues. The complexity of attention-related complaints in youth with high degrees of media exposure makes it difficult for clinicians to differentiate the degree that attention problems represent primary neurobiologic disorders from that which results from distracting environmental stimuli. The capacity of stimulant medication to facilitate more measured use of social media in individuals with ADHD is unknown, yet it seems plausible that improving core ADHD symptoms may moderate social media habits.

Misinformation, tribalism, and the attention economy

Most online information is accurate, but online misinformation and disinformation are increasingly prevalent. Misinformation is defined as inaccurate information that the producer believes is accurate. Disinformation is inaccurate information that the producer knows is false. Both are becoming commonplace, leading our current era to be labeled the “misinformation age.” This change is caused in part by economic factors combined with human tribalism, and the resultant thought bubbles or echo chambers of like-minded individuals insulated from differing opinions.

Regulating the information to which young people are exposed is a challenge dating back to ancient times. Plato, in his 375 BCE. Republic, advised that children should only be exposed to simple stories emphasizing civic and personal virtues. Today, the task of controlling information exposure for children and adolescents is far more daunting amid the massive array of unfiltered, objectionable content delivered by the internet.

While Plato expressed concern regarding fictional stories, children are increasingly exposed to non-fiction material (eg, “the news”). This is of concern, as news stories have become increasingly negative over time. ^, Humans pay disproportionate attention to negative news due to our inherent negativity bias. Negative information stimulates a greater response from our defensive minds, making frightening or upsetting information especially impactful and memorable. This suggests audiences are drawn to crimes, tragedies, and institutional failures more than stories of progress, peace, and success. Combined with a morbid news environment, negativity bias leaves news consumers, including children, not better informed but excessively informed about negative events.

Legacy media and news prior to the advent of the internet were governed by regulatory mechanisms to protect younger audiences (eg, ratings, time-of-day restrictions, and channel segregation). News reports always reflect the values and prejudices of broadcasters, but fact-based, impartial journalism was more esteemed in pre-internet years. Few regulatory mechanisms exist to protect youth from inappropriate content online. These factors make excluding marketing, misinformation, and developmentally inappropriate content nearly impossible. Financial interests and advertising strongly influence which content children and adolescents are exposed to online, prioritizing engaging viewers over information quality. Conversely, credible civic- and health-minded organizations are not structured to maximize engagement and struggle to compete.

The nature of information dissemination on social media compounds the issue of misinformation, as false news spreads faster than accurate news. Young people need to be taught to discern the truth from misinformation and disinformation. Resistance to deception is greatest in those who recognize their vulnerability to persuasion and can discern intent to manipulate their opinion.

A 2022 Reuters Digital Report showed that consumer trust in news has fallen in the US to 26%, the lowest of any country surveyed (p 15). This report also found that younger audiences place less value on impartial journalism (p 19).

Today’s adolescents, deeply engaged with social media, are exposed by algorithms to highly-curated news stories that reflect their interests, biases, and attitudes. This algorithm curation increases engagement but may have the secondary effect of reinforcing excessively negative opinions and tribal beliefs. These may increase distorted perceptions and undue confidence that there are no viable alternative viewpoints. Compared to previous generations, today’s youth express more distress about hearing facts or opinions they do not like.

Amplifying these concerns is the increase in visual misinformation , in the form of manipulated or mischaracterized photos, charts, and videos. The most popular social media posts for young people are pictures and videos, which are significantly more likely to receive engagement than text alone. Posted videos or photos have an especially powerful potential to influence children and adolescents. Allan Paivio’s dual coding theory posits that processing a combination of written and visual representations of an idea leads to better recall than written representation alone. Visual content arouses emotions more powerfully than text, and can enhance persuasive impact.

Images, misleading or not, are more likely to remain in individuals’ minds and influence their beliefs. Recent findings regarding health misinformation indicate that graphics draw more attention, are more easily recalled, and are a common source of health misinformation. Content creators using state-of-the-art software create fake videos and graphics which are increasingly realistic and liable to fool viewers. Deepfakes are a manipulation technique that allows any 2 identities to be swapped both in their facial image and voice. New editing technologies like deepfakes can be used to create videos portraying any individual engaging in any activity, in a manner difficult to discern from reality.

Another aspect of visual misinformation is the systematic misrepresentation of the human body as depicted in social media. During human evolution and up until the widespread use of mirrors, a culture preoccupied with self-appearance was impossible. Contemporary youth culture values regularly taking and viewing self-directed photos called “selfies.” The idealized, often augmented, and carefully curated photos posted on social media lead viewers to believe their peers are more attractive than they actually are, and feel worse about their own appearance in comparison. Low body satisfaction is, in turn, associated with the susceptibility to depression, anxiety, eating disorders, gender dysphoria, and body dysmorphic disorder.

Social media thus drives focus on other people’s physical appearance and self-consciousness about how one appears on social media. Exposure to a large quantity of idealized faces and bodies, that is, visual misinformation, and social media-curated over-valuing of appearance combine to create a “perfect storm” of stressors, especially for teen girls.

For all these reasons, our “misinformation age” fosters distrust and uncertainty among youth. Misinformation and over-exposure to negative news and age-inappropriate topics can instill anxieties by emphasizing failures and danger, fostering mistrust in institutions.

Digital disarray

Digital disarray is a state of heightened distraction, information overload, diminished institutional trust, and resulting disconnection from oneself and others thought to be prevalent among today’s youth. This state stems partly from exposure to excessive information via highly distracted digital environments, which undermines logical, precise thinking.

Digital disarray is influenced by other societal trends, such as delayed parenting, smaller families, delayed age of adulthood, and social isolation. Youth now face increased rates of depression, anxiety, and self-harm, particularly among heavy social media users and those with worldviews emphasizing grievances such as social disparities. ^, Limiting social media use to 30 min per day for 3 weeks was found to decrease loneliness, anxiety, and fear of missing out in college students compared to controls.

Social media functions to bring people together. However, its popularity has exacerbated political and cultural polarization, likely through divisive rhetoric (eg, highly emotional language, us vs them demonization, sensationalism, and exaggerations of crisis or harm). In such contexts, where extreme and hostile voices are rewarded with attention and praise, the full range of perspectives (eg, reasonable moderates) is driven into silence. Similar dynamics occur with adolescents, who are increasingly pressured into displaying support for ideologic and political causes on social media.

Within ideologically or identity-aligned communities, attacks on those outside the group tend to increase in-group status. Thus, expressions of emotional narrow-minded reasoning trump humble inquiry or acknowledgment of value in other viewpoints. ^, Social media creates an ecology where endorsing misinformation is often rewarded with prestige.

Within institutions, this phenomenon has led to what Jonathan Haidt calls structural stupidity , in which identity, ideology, and tribalism degrade intellectual exchange. Even formerly trustworthy academic, government, and professional organizations can become purveyors of misinformation. Structural stupidity can occur in schools at every level. When vital societal institutions are dysfunctional, their imprudent policies adversely affect children and contribute to a breakdown in trust across society. Resultant mistrust in societal institutions, combined with constant distraction, fosters the disengagement characteristic of digital disarray.

Multifaceted Solutions

Teaching attentional literacy

Attentional literacy is crucial for today’s youth to function in the face of overwhelming information. It refers to the deliberate and skillful direction of attention while maintaining awareness and focus. Its conception drew inspiration from principles of mindfulness, advocating intentional awareness and discouraging premature judgments.

By distancing individuals from reactive or habitual judgments, space is created for emotional calm, contemplative analysis, and informed choices. This enables the successful application of attention in the face of powerful distractions. Attentional literacy instills an unbiased, neutral, analytical, basis for evaluating online information.

Attentional literacy requires a basic understanding of the dynamics of human cognition and employs strategies to safeguard limited mental resources. Cultivating attentional literacy in children requires families, schools, and other caretakers to promote habits and practices that protect limited cognitive resources. Older children can gradually exercise increased agency and independent decision-making regarding their attention.

Young people spend more and more time online for education, work, and leisure, increasing opportunities for distraction. An awareness of limited attentional resources supports intentional use of time, which for many will result in less time on social media. Digital minimalism endeavors to bolster personal autonomy and well-being via prudent and constrained online interactions. Limiting social media to only selected devices, such as a single tablet or the computer, may reduce distraction and temptation to over-engage.

Attentional literacy utilizes techniques to maximize focus, reduce strain, and gradually build productivity skills. Setting timers to limit work into “chunks” is one common strategy. Short bouts of intensive exercise and other “micro breaks” result in small but significant benefits in reducing fatigue, boosting vigor, and increasing overall performance.

Teaching digital literacy

Effectively navigating social media and other online spaces demand critical thinking and problem-solving skills. Young people benefit from having the capability to assess and utilize data sets and to comprehend how algorithms shape online experiences. Skills to collect, create, transform, and safely use digital information are acquired gradually by school-age children.

Schools can teach developmentally appropriate digital literacy skills via specifically designed curriculums or integration into existing lesson plans. Part of the curriculum should be devoted to identifying online misinformation. This would involve helping children to recognize their own vulnerability to persuasion, detect manipulative intentions, and understand how emotions can mislead reasoning. ^,

Cognitive reflection tests are simple questions which demonstrate humans’ tendency to use mental shortcuts to arrive at answers. The experience of making errors in response to simple questions highlights the value of deliberate, thoughtful cognitive processes over impulsive, habitual thinking patterns. Participating in a cognitive reflection test can help young people challenge the tendency to adopt on intuitive but incorrect assumptions.

Other techniques include prioritizing credible resources over more convenient ones (eg, popular social media posts). Young people benefit efforts to check multiple sources and assess for bias or financial influence. They should understand the difference between more reliable sources (eg, a scientific authority) and less reliable ones (a nonexpert influencer).

Today’s youth must be taught to navigate online safety, relationships, and privacy. They should be aware that others may track their online behavior in order to manipulate or even harm them. Parents and other caretakers have always been responsible for keeping children physically safe. Some safety risks (eg, child predators) have migrated online, particularly in social media spaces.

Teaching constructive disagreement

As digital citizens, children and adolescents must develop the skills needed to participate in free and open exchange of ideas. Novel approaches are required to help them engage in productive dialogues across diverse perspectives.

Constructive disagreement refers to a respectful, humble, productive manner of debating ideas, allowing for reasonable intellectual exchange. Constructive disagreement is the functional opposite of acrimonious, tribal conflict often seen on social media. Constructive disagreement is characterized by respect for other opinions, polite language, an ethical approach to disputes, and criticizing ideas rather than the person espousing them. The cultures of science and medicine have long-held formal and informal rules to promote rigorous and respectful scholarly exchange. The principles of these longstanding traditions can prevent tribalism, increase the productive exchange of ideas, and combat misinformation.

Children and adolescents should be taught that certain group dynamics can inhibit free and open exchange and lead to self-censorship. As families, schools, and communities raise the next generation of social media participants, we should aim to instill a humble tone of online dialogue and openness to varied perspectives.

Children can be taught the principles of constructive disagreement as a core component of digital citizenship. Explicitly teaching these values and courteous language creates a standard for respectful engagement.

Similarly, the leadership of medical professional organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, should utilize principles of constructive disagreement to safeguard scholarly dialogue and prevent structural stupidity.

Recommendations

It has become imperative for parents and other caretakers to actively monitor children’s environmental distractions and social media’s influence on socialization. Our propensity to learn naturally and automatically from our environment endows us with inherited cultural wisdom, for millennia guiding us in foraging, identifying potable water sources, and safeguarding against threats. More than ever, allowing our youth unregulated access to developmentally inappropriate and distracting content across social media is potentially dangerous.

To respond to risks to youth posed by information overload, misinformation, and disinformation necessitates a comprehensive approach involving various stakeholders.

Institutions

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  Schools can implement measures to enhance students’ attentional literacy and critical thinking skills, emphasizing the ability to evaluate and verify information.

  
  
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  Schools should consider removing phones from the classroom and limiting unnecessary screen devices from a teen’s workspace.

  
  
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  Schools should foster an environment conducive to respectful dialogue, encouraging open discussions, and exchanges of diverse perspectives to help counter the spread of misinformation and encourage critical analysis.

  
  
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  Government, academic, and scientific institutions can use their neutrality and credibility to counter financial and tribal interests by promoting balanced information, building spaces for constructive disagreement, and supporting online protections for youth.

  
  
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  Medical organizations should enact policies to ensure the production of trustworthy information via reforms that decrease group-think, increase open scholarly dialogue, and circumvent structural stupidity.

Clinicians

The recommendations below are meant to aid in improving the priorities indicated ( Table 1 ).

Table 1

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