MR. DEREK MCGINTYThanks for joining us. I'm Derek McGinty sitting in for Diane Rehm. She is on vacation. You know, a few years ago, I was chatting with my then teenage nephew on Facebook and his responses started coming more and more slowly and then it hit me. He had, like, eight conversations all going at the same time, which then I understood what we all know. Kids will often take this technology a lot farther than we old folks can imagine.

MR. DEREK MCGINTYWell, the problem is, of course, sometimes they go too far. We all know young people who just can't seem to let go of their smartphones or for whom Saturday afternoon away from the Xbox has become the ultimate sacrifice. But when does obsession become addiction and how would you know the difference and is digital addiction really a thing? Well, it is apparently really a problem, no matter what you call it and my guests are here to talk about that.

MR. DEREK MCGINTYCecilia Kang is a reporter with the New York Times. Ed Spector is a psychologist. They're both here in the studio. Joining us via the telephone from Pennsylvania, Kimberly Young with the Center for Internet Addiction and from Fall City, Washington, Hilarie Cash is with reSTART, which is a rehab facility that treats digital media dependency. We are going to really enjoy this conversation and even more so if we get some of your calls and questions and emails.

MR. DEREK MCGINTYThe phone number here is 800-433-8850. The email address is drshow@wamu.org. Or you can find us on Facebook or you can send us a tweet. Welcome to all four of you. Good to have you with us.

MS. CECILIA KANGThanks for having us.

MS. HILARIE CASHGreat to be here.

MS. KIMBERLY YOUNGThanks for having me.

MCGINTYYou know, Cecilia, I'll start with you. You've written about his and digital addiction or whatever you want to call it, it is a thing, right?

KANGWell, it certainly is a thing in that you're hearing a lot of concern from parents and from children, too, that there is something going on with the inability to just take it -- extract themselves from their smartphones, from their gaming consoles, from the internet in general. The internet has become such a huge all-consuming part of our lives and particularly for youth and the concern that you hear anecdotally and also with growing complaints and concerns is that perhaps the internet is fostering something that's too hard.

KANGIt's too hard for children to be able to make decisions, rational decisions, to break away from. And the Common Sense Media Organization did a recent poll on whether the internet is addictive. And that is very controversial, as you said, the idea of whether it's addictive or compulsive or whatever -- however you want to describe it. But in their poll, which was quite interesting, of 1200 people, 60 percent of parents said they believe their kids are addicted to their phones. And 50 percent of teens surveyed agreed with their parents.

MCGINTYWell, just because parents and kids say they're addicted, that doesn't mean it really is a thing, does it, Ed?

MR. EDWARD SPECTORNo, not all. And, in fact, we don't actually have officially a diagnosis of a digital addiction or an internet addiction. We have a proposed one in the most recent book that has all the diagnoses from the American Psychiatric Association. So they said, hey, if this is a thing, then this is what you should study. But we don’t yet have something to label yet.

MCGINTYBut it is such a problem that Kimberly Young has -- is actually with the Center For Internet Addiction. So, obviously, you've seen this. Is it just the very young that are affected by this, Kimberly?

YOUNGWell, no. It's interesting. I've been studying this for two decades and in the 1990s, it was very different. There was definitely an online life and an offline life. You were dealing with dialup modems and big clunky computers and today, you're looking at smartphones and tablets and portable technology. And now, the difference is that before it was much more adult oriented and now, children, even infants, are exposed to this technology. As an example, just something like the iPad bouncy seat, which is something where children, very infant, can be exposed to tablets.

YOUNGAnd so I think the problems are starting much younger in the two decades that I've seen. While internet addiction isn't recognized officially by the United States, it is recognized by many other countries and the World Health Organization. So from a global perspective, the U.S. seems to be lagging behind.

MCGINTYWhat about the gender balance here? In the past, we've heard that it's mostly boys. Is that still the case?

YOUNGI think it depends on what the medium or application is. For example, we treat a lot of young males addicted to, say, video games and online multi-user role-playing games, but maybe for women, young girls, it's much more about social media. So it kind of -- it goes along traditional gender lines, if you think about it, but it really just depends on what the activity is that they're addicted to.

MCGINTYAll right. Let's talk to Hilarie Cash. You've got an actual rehabilitation center in Fall City. Tell us why you founded that and who your customers are -- or your patients, I should say.

CASHI founded it because there was no place that was specifically set up to help young people who were, in my opinion, addicted or in their own opinion or -- and their family's opinions at least struggling, whatever we wanted to call it. They were having trouble with it and there was no place that was really designed where they could go and really keep -- stay away long enough to let their brains go through the withdrawal process, come back to normal functioning, figure out how they wanted to live their lives, make up some skill deficits that they might exhibit and sort of be able to move on with their lives.

CASHSo there was no -- they just needed a tailored program for it.

MCGINTYYou're talking about withdrawal and those things that are actually associated with addiction. Has it been your experience that -- or do you know whether or not there's actual chemical changes in the brain going on?

CASHWell, the research is indicating that there are chemical changes in the brain when somebody begins to exhibit the signs and symptoms that we associate with addiction. So -- and those changes in the brain look very similar to the changes that go on with chemical addiction. So -- yeah.

MCGINTYOkay. Ed Spector, you wanted to get in there?

SPECTORYeah, I would jump in on that. A recent survey of 18 different studies looking at the morphological changes of people who meet, actually, Kimberly Young's criteria that she established showed that the morphological and functional changes that we see in heroin addicts or correspondingly happening to people who meet that criteria for digital addiction...

MCGINTYWhat kind of changes are we talking about?

SPECTORSo dopamine is the main neurotransmitter that's implicated and we have circuitry that's meant for reinforcement and for sort of how we find encouragement and motivation. And those centers and that circuitry is largely the reason why addicts act like an addict.

MCGINTYAll right. Let's talk about this. I'll be honest and say, I like to game. I went downstairs in my basement last night and played on my Xbox One for about 35 minutes, right, and then that was it.

SPECTORExcellent.

MCGINTYI'd had enough. What's the difference between what I did and what someone who has trouble controlling this would do?

SPECTORWell, certainly one of the major differences between regular behaviors and behaviors where someone really doesn't have moderation, is that they can't control themselves. So they can't stop and they keep needing more. So while you, after a certain amount of time, say, yeah, I need to get some sleep and I'm tired and I have a lot of responsibilities tomorrow -- and also, this is just kind of boring. I've been doing this for half an hour. You know, there is a group of people where that really doesn't happen and so they keep going and going.

SPECTORSo the clients who come to see me are playing 10, 12 hours a day and they're only stopping because someone's stopping or because they're just, you know, exhausted and falling asleep.

MCGINTYCecilia Kang.

KANGYou know, one of the tricky things about labeling this as addiction is whether it's the internet as a medium or actually the gaming that you're describing, Derek and Ed, that's addictive. What is -- so it's hard to separate the two. Is it the activity that people are doing it online that's drawing people into this compulsive behavior and inability to stop, even if they know the negative consequences or is it the medium itself? So that's why, I think, a lot of folks who study this, a lot of psychology experts, they sort of bristle at the idea of the internet itself being addictive.

KANGBut perhaps there needs to be further study on whether the activity should be labeled as addictive. And, in fact, this diagnostic and statistical manual of mental disorders, the bible of sort of psychology on mental disorders, has said that while the internet has not included internet as an addiction, it did say gaming online should be reviewed further.

MCGINTYI want to ask Kimberly Young what she thinks about that.

YOUNGWell, yes, I mean, it's the debate that's been going on, like I said, for two decades. And I think you have a problem with semantics or terminology in the field because a lot of times compulsive behavior is interchanged for addictive behavior and there's not really a lot of difference. Some people would argue that there is. I think when the DSM, the taskforce tried to put together the latest psychiatric disorders, internet gaming disorders actually listed in there as a condition for further study and that was because of all the research out of China, Taiwan, Korea where internet addiction is widely accepted.

YOUNGOr sometimes people even say screen addiction. To Cecilia's point, I mean, is it the device? Is it the screens? Is it, you know, how do we term even the internet screen technology addictions. You know, we are debating quite a bit on what to call this phenomenon, but the underlying problem is that so much research has been done in academic journals looking at not only what Ed talked about with dopamine, but actually functional changes in the brain when you have gamers that are addicted and they light up on, say, functional MRIs versus those that aren't addicted and they don't.

YOUNGSo we know that there's something physical to this phenomenon. We know that there's a set of behaviors consistent with what we would consider other addictions, such as alcoholism or chemical dependencies because it's those same receptors and those same -- the dopamine neurotransmitter that's being affected. So we're seeing something consistent.

MCGINTYAll right. A lot more questions to ask about this. We want to hear from you. Our phone number, 800-433-8850. You just heard the voice of Kimberly Young, a psychologist and founder of the Center From Internet Addiction. She's on the phone from Pennsylvania. Also on the phone with us, from Fall City, Washington, Hilarie Cash, co-founder and chief clinical officer of reSTART, a rehab center for digital media dependency.

MCGINTYHere in the studio, Cecilia Kang covering technology for the New York Times, and Ed Spector, a psychologist in private practice in Bethesda, Maryland. I'm Derek McGinty and you're listening to "The Diane Rehm Show."

MCGINTYWelcome back. I'm Derek McGinty, sitting in for Diane Rehm. We're talking digital addiction, dependency, compulsive behavior. However you want to frame it, it's a real issue, and it's something that my guests have expertise in. Let's go to Megan in Cleveland, Ohio, to talk about it. And Megan, are you there?

MEGANYes, I'm there, thank you, thanks for taking my call.

MCGINTYSure, go ahead.

MEGANTwo quick comments. First, my brother actually has a diagnosed Internet addiction, and he's specifically addicted to online music and online games. And we...

MCGINTYHow are you addicted to online music? What does that mean, exactly?

MEGANHe, I mean, he has other issues, as well, but he is addicted to downloading thousands of files of music and listening to that music specifically online, and I think for him it's a dual addiction because he gets to read about the artists and write blog posts while he's listening to it. But, I mean, this goes on all day, every day. I mean, he'll be up in his room on his laptop for five hours doing this, and he went to, last year, an addiction specialist, but the person had never experienced someone with this sort of technology before, and at least in this area, I know my parents have had a really hard time finding someone to help him with his specific addiction, but he said it is an addiction, he was going through withdrawal.

MEGANI mean, it's real, and I remember telling people, and people would laugh, like, oh, it's the computer, it's not a drug, but it is in a way like a drug because he was showing the same behaviors with the computer that someone might with alcohol, so...

MCGINTYAll right, I want -- let me turn to Kimberly Young. Is this a familiar story to you?

YOUNGWell, it is. And, you know, both can't find therapists or practitioners who understand and treat this because it is still relatively new, I mean, we're only talking about something that might be two decades old at the most, so depending on, you know, how the field -- you know, in America we have a more grassroots effort. We have to look at the research, we have to look at a lot more before we will include this as a disorder and before it would be something reimbursable.

YOUNGSo from our own health care system, it takes a lot longer to get even real diagnoses included in the DSM. But the other part of what she had talked about was things like music. And, you know, the part is when she shares her story with other people, other people sort of laughing at it or minimizing it, and I think that's the other thing. Culturally we just haven't caught up to the reality that this can be a very serious problem for families, and we don't offer the infrastructure.

YOUNGA few people, like Hillarie and Ed, are offering treatment, but, you know, those are still kind of a handful of folks.

MCGINTYHillarie, how would you deal with a case like the one we just heard described?

CASHI'm just going to assume that this young man is an adult, and if he's an adult, he could come into our existing program. It's essentially a retreat center where he would be away from all digital media for a minimum period of 45 days, and usually the average length of stay there is 55, and during that time he'd be getting physically healthy, a fitness program, good food, lots of sleep. He'd be getting social experiences because right now it sounds like he might be isolating in front of his screen and not getting enough social experience. So he'd be getting lots of social experience and opportunity to be developing skills that he might be lacking in, skills for regulating his emotions, social skills and so forth.

CASHAnd by the time he left, we -- as long as he agreed, and it sounds like he knows he has a problem and actually wants help, he would really take all of that in and kind of be ready for -- to go in a fresh way, this time with a plan in hand of how he's going to reconnect with digital screens because he's going to have to use the Internet, it's the modern era, he can't avoid it entirely. In this respect it's like a food addiction. He's going to have to learn how to consume digital media in a healthy way, and hopefully he'll be -- have a plan for doing that.

MCGINTYYou know, Hillarie, one of the things that is a real problem, and we talk about how this is not really recognized, and that is insurance will not pay the tens of thousands of dollars it would cost to spend 55 days at your center, correct?

CASHCorrect, this is something which only people with enough means to pay for it can do, which is a pity.

MCGINTYI see you nodding, Ed.

SPECTORYeah, I mean, in general it's not available to most people to go to a program like that, and it's not realistic for them to take...

MCGINTYSo what do you do?

SPECTORSo I see people outpatient, so I see them once a week. I do similar things, not -- I don't have the luxury of having them in complete control in my, you know, sort of place of work, but what I would start with is a very thorough evaluation to understand why is this young man doing what he's doing, why is being so compulsive about these two particular things and what might be driving that because how can you help someone if you really don't know what's driving it.

SPECTORYou've got to get at the ideology of, you know, is this young man, does he have other -- a compulsive disorder like obsessive-compulsive disorder, and he's hoarding these, you know, sort of songs? Is he autistic, and as a result this is his perseverative interest? There are many different roads to this problem. And if you don't understand the ideology, you're really not going to make a lasting change.

YOUNGI think Ed makes a really good point about understanding the ideology and whether -- so you're -- the brother was diagnosed with a technology addiction, and I'm just envisioning whether it would be labeled a -- what kind of addiction it would be labeled if he could not stop himself from going into the record store and buying LP after LP after LP and writing about it by hand or in a different era.

YOUNGAnd it's a hard thing again to extrapolate what is the medium and -- what is a problem with the medium and what is a problem with activity and all the other variables around the activity.

MCGINTYWhat do we understand about how this works? I mean, you get an idea that gambling addicts are maybe addicted to the thrill of it, right. Winning and losing isn't even the most important thing, it's just a thrill they get. We know about alcoholism, we know about drug addiction. What is the thrill that comes through the digital media that people seem to get addicted to?

SPECTORI think it really highlights a very important point, which is it's different depending on what the ideology is. So if you have a compulsive tendency, then that's what's driving the behavior. If you have attention deficit hyperactivity disorder, then you have a hard time controlling what you're doing and shifting behaviors, so you get stuck on, and then you look up, and it's 3:00 in the morning, and you haven't done your homework, or you haven't done stuff like that.

SPECTORSo there's -- you know, depending on what the ideology is, it's really going to explain the behavior, and it's going to be different depending on what those causes are.

MCGINTYCecilia Kang?

KANGCan I just...

YOUNGIf I could add something about what I've seen a lot, especially with younger children, is the role of the family in ideology, just to kind of pick up where Ed left off a little bit. There's much more of a context for, say, divorced families, and a child's looking for attention or, you know, some kind of companionship during that transitional time, so they might go online. Or a big area that I've found is just this issue of escape. Underlying a lot of addiction seems to be this element of I can escape from problems or bad feelings I'm having.

YOUNGSo whether you're a child or an adult, you know, a lot of Internet addiction is driven by I can create, say, an avatar in a game, and I can obtain a lot of, you know, kind of leadership skills or reward systems through the game, but in real life I have low self-esteem, I don't feel good about myself, so with a click of a button, there's an awful lot of power and prestige that might come just psychologically through the activity of playing.

MCGINTYAll right, let's go back to our phones -- go ahead.

KANGI would like to also just add a little bit of a comment, as well. And I agree with everything that Ed and Kimberly are saying. So what -- but the thing I wanted to add is that when you get -- take a child who is very young, who begins let's say gaming and building an online persona through a community and so forth, they're -- what happens is that they invest so much time in gaming, and most of the guys I work with are gamers, that they really build their identities around that, and they don't develop their identities in other areas.

KANGAnd one of the things that is most difficult for them is to really realize that they've -- that out in the real world, not in that online universe that is so escapist and rewarding, to begin building a new identity, and that's quite difficult to do.

MCGINTYYou know, that almost sounds like science fiction, the idea that people would get so entranced by the online world that they wouldn't want to be in the real world, but I guess these days it's very real now.

SPECTORAnd in fact I have a group for my patients, there's 50 patients in this group, and we do social things, and they've named it InReal, in real life, and the reason is, you know, we take them -- we go rock climbing once a week, we -- there's a Dungeons & Dragons board game night, there's a game night, there's bowling, there's, like, we go to movies. It's all about in real life, and they're trying to get out of these man caves that they live in and remember what the sun is, you know, and really get that dopamine functioning appropriately again.

MCGINTYCatherine in Washington, D.C., you're on the air.

CATHERINEYes, and I really just want to thank you all so much for bringing this up because it has been such a struggle in my family for over two years with -- my 14-year-old son has had a serious addiction with just, he gets an iPod or anything, and we take it away from him for punishment, then he goes, and he lies to us and steals it back or goes and gets a friend to take it. So I guess what I'm hearing maybe is that, I don't maybe what would be your suggestion for just a parent who's just out of her wits, and I know we're going to -- I'm going to go look for therapy for him, but it just -- and for our family, but it's just -- what do you do?

MCGINTYShe sounds overwhelmed.

SPECTORYeah, one of the sort of preliminary things you can do as you look at your family's sort of structure and how you're doing things is instead of focusing on the punitive and the taking away is to just focus on adding more and more enriched activities, sort of filling in that time that would be technology with other activities. So don't have a 12-hour Saturday just wide open that your kid is going to beg you for technology for but to really have family time, to have structured activities that they're doing and they're connected with, and have that be the expectation.

SPECTORI've avoided a lot of very sort of tumultuous, divisive family situations by simply adding. So we're not even talking about taking away. We're just adding, like, well, what are you going to do Tuesday night, I want you to sign up for one athletic activity, I want you to, you know, sign up for something that involves helping other people socially, I want you to, you know, get your license, I want you to -- we add things.

MCGINTYCatherine, is that something you think you could do?

CATHERINEYes, I mean, my son is already -- I have involved in, like, martial arts, and I'm asking them to please do everything to just push him more into it because he needs more structure. But yeah, that sounds great. Thank you guys so much.

MCGINTYThank you so much for calling, Catherine, and we appreciate you sharing your story. We are talking about Internet, digital addiction, obsessive behavior, still looking for an exact definition, but I think we're getting the idea as our conversation moves forward. Here in the studio with me is Cecilia Kang, she covers technology for The New York Times, Ed Spector is a psychologist in private practice in Bethesda, Maryland. Joining us via the telephone from Pennsylvania is Kimberly Young, psychologist and founder of the Center for Internet Addiction, and by phone from Falls City, Washington, is Hilarie Cash, co-founder and chief clinical officer of reSTART, a rehabilitation center that treats digital media dependency.

MCGINTYI'm Derek McGinty, and you're listening to the Diane Rehm Show. We'll go back to our phone lines, and Josh in Lansing, Michigan, you're on the air. Go ahead, Josh. Josh, are you there? There you go.

JOSHYes, yes, sorry. Can you hear me now?

MCGINTYYeah, that was my fault.

JOSHOkay, so I just wanted to talk a little bit about my personal experience with addiction, and my addiction was video games. And I know there's a big culture of, like, people who drop out of college, and they, you know, live off, like, parents and their money, or their apartment, and they spend, you know, the entire day, 16 hours, you know, just playing video games all day while they're, like, watching TV on the side. And I was definitely sort of in the same boat for a while.

JOSHAnd, well, what my situation was a little bit different, I was going to grad school, and they were paying me to go to grad school, and during the entire time, I was actually just, you know, staying in my apartment and not doing anything but just playing games. Eventually, you know, that's changed. I don't -- I'm not addicted to the video games anymore. But that's because a lot of significant things happened.

JOSHYou know, I ended up dropping out of grad school, and I had to get a job so that I could, you know, sustain myself, and I got a girlfriend, and a whole bunch of things sort of pushed that out of my life.

MCGINTYWell Josh, how did you overcome that? And my second question would be what was your mentality. I mean, how did you feel or think when you were sitting in your apartment all day? Did you have a sense that maybe I shouldn't be doing this, but I can't stop? I mean, what was -- how were you feeling?

JOSHYeah, I definitely knew that I shouldn't be doing it. A lot of the games now, they have, like, counters for how long you play. And, you know, you could see that you've played this game at consecutive hours for, like, two years, and you know that you've been playing way too long. And so you would see something like that, and you would think, oh, you know, I should probably stop doing this because I have wasted two actual years of my life, not counting sleep, just completely playing this game. So you always sort of have that in the back of your mind.

JOSHBut, you know, the games are just really rewarding, you know, and a lot of things in real life aren't quite as rewarding. And, you know, so you do something in the game, you work real hard for it, and you actually get a reward. A lot of times in real life, you know, you work really hard for something, and no one's there to give you a reward, and so that sort of, you know...

MCGINTYAll my panelists are nodding their heads as you're describing this. Ed, why don't you go first, Ed?

SPECTORJosh, first of all, I'm just really appreciative that you called. It's sort of missing in this conversation is actually people who are going through this. So I'm really glad you called. You know, and one of the -- your story actually really highlights an important thing that most parents don't do and most people don't do, which is really important, which is to actually monitor what you're doing because if you know how many hours you're clocking in, it really does change behavior.

SPECTORSo if you count how many calories you eat, it changes your -- you know, what your choices are. If you count every dollar you spend, it changes your spending habits. And if we were to use all of these great apps and software packages out there that will track you and keep track of how many hours you're doing, it does in fact help you sort of realize what you're doing to yourself.

SPECTORAnd so one of the first, you know, recommendations that I'll make with a family is for the kid or the young adults to start just monitoring and just pay attention, well, how many hours did you log this week. Really, 50? That's a lot. Let's talk about it.

MCGINTYLet me ask Kimberly Young, in your experience is thing something people can overcome on their own that way?

YOUNGAbsolutely. I think there's different degrees of this addiction. You have people that are compulsive checkers to those that, you know, as is being described, play these games for, like, 10, 12 hours. So I think self-monitoring, I think if you're aware that you have a problem, oftentimes even when you look at alcoholism, there are alcoholics that can stop and go cold turkey on their own. Others need more help, more guidance, more therapy.

YOUNGSome of it is the admission that I have a problem. One of the interesting things I've been doing lately, and this is by invitation, is going directly into these gaming communities not as a gamer but as a kind of a chat session, talking directly with gamers who, as described, you know, spend all this time on the game, don't have jobs, get kicked out of college, have to move back home and don't have any means, and oftentimes it's their parents saying, well, look, you have to do something with your lives.

YOUNGAnd so they're acknowledging on some level, yes, I have a problem, and if we can hear somebody give us some help, that -- that actually spurs sometimes a lot of people to get off the computer and go do some healthier things.

MCGINTYAll right, Kimberly Young is on the phone, she's with the Center for Internet Addiction. Also on the phone, Hilarie Cash with reSTART, a rehab center for digital media dependency. Here in the studio, psychologist Ed Spector and New York Times reporter Cecilia Kang. I'm Derek McGinty, sitting in for Diane Rehm. You're listening to "The Diane Rehm Show."

MCGINTYI'm Derek McGinty. Welcome back. I'm sitting in for Diane Rehm. And we're talking internet addiction. If your questions have not been answered during today's show, we're gonna continue this conversation on our Facebook page after the program. We're gonna have a live Q&A with one of our guests here, psychologist Edward Spector. He specializes in the healthy use of digital technology. So go to Facebook.com/TheDianeRehmShow and you can post your questions and he will answer them.

MCGINTYIn the meantime, we have some questions from you on Twitter already. It's sort of ironic that we're talking about addiction and then, of course, we're using the internet to make this happen. But I think that's part of the issue. James asks the question, "Are games like Pokeman Go helping or making things worse?"

SPECTORPokemon Go is just fascinating to me. I think it's probably the most innovative thing that's happened in the technology world for good or evil in terms of having both this conflagration of massive interest, just numbers of people using this combination of technology and software to do extraordinary things. You know, when you have a video game that comes out and two weeks later political candidates are saying how they're gonna use it to get people to vote, you've sort of changed the landscape entirely, for good or for evil.

SPECTORI've clients who lost five pounds a week running around…

MCGINTYWow.

SPECTOR…because they're catching these pokemon.

MCGINTYI'm gonna have to get the Pokemon Go on my phone, I think, if that -- if it helps you lose five pounds a week. But let me ask Hilarie Cash, out at restart, the rehab center, did you cringe a bit when you heard about this game? Did you worry that perhaps this would be, as the tweet suggested, a bad thing for the problem?

CASHWell, I really have mixed feelings about it. On the one hand I really enjoy hearing the stories that are coming out about the people who are really get out and having fun with it and being physically active, rather than stuck indoors, and families that are having fun playing it together and so forth. So I'm seeing some really nice, positive things happening with it.

CASHBut I also was just last evening talking with some people who were describing watching parents with young children and the parents were pursuing the pokemon characters. And this young child was trying so hard to get their parents' attention. And the parents were completely ignoring the kid.

MCGINTYOh, wow.

CASHAnd so it's just, you know, another example of the ways in which these games have their good and their bad aspects. And I think that Pokemon Go is just introducing us to a wave of things going forward. There will be many games coming out and some of which will not be nearly as sort of benign and pro-social as Pokemon Go is.

MCGINTYYeah, I we should note that, Ed, you like to play games yourself. You're a gamer. You have…

SPECTORI, yeah, I'm definitely of the tribe. It's the reason why people -- mostly my male clientele will come and see me, is they'll come in, they'll talk about a game, and I'll know it because I've played it. And that's a part of being approachable. I have a credibility that will start them on a path of, like, yeah, I do this, too. But I also, you know, have a very vibrant life and you have to live with moderation.

MCGINTYSo did you get into this practice because you're a gamer? Or did you become…

SPECTORDefinitely.

MCGINTY…a game because you got into this practice?

SPECTORNo. Definitely I was of the tribe long before I was a psychologist, in terms of playing the games. Of course I did so in moderation. And it just was a natural fit. And this sort of -- this practice really sort of came about just because of that natural fit.

MCGINTYLet's go to this email from Jerry in Indianapolis, who says, "What has not been discussed is the fact that light from TV and computer monitors is stimulating to the brain and just prevents sleep, concentration, etcetera."

SPECTORDefinitely. The blue light -- and it gets more and more intense as we get better monitors and, you know, higher definition gamings. And that, of course, is affecting our brain significantly. And it's -- some of it's -- we're all giant guinea pigs for, you know, this science experiment that we're doing in terms of what the long-term effects are.

MCGINTYYou know, you mentioned the science experiment. A lot of us believed or maybe still believe that this online world would be essential to the education of the modern child. Right? I mean, is there a mixed message in there somewhere?

KANGThere's…

YOUNGWell, you know (unintelligible)…

MCGINTYLet me let -- Kimberly, you go ahead. And then you go after that Cecilia.

YOUNGWell, I was gonna say, there's a lot of new research coming out, especially by early childhood development psychologists, saying that actually the technology does not enhance areas such as creativity. It, you know, one of the studies that I recently read -- and it was sponsored by one of the technology firms -- was a series of psychologists looking at various uses of tablets and mobile educational games with very young children.

YOUNGAnd it actually found that with learning, it was only like rote memorization that it was really good for. But when you talk about creativity, old-fashioned things like crayons and a blank sheet of paper still worked a lot better because it wasn't fostering that. Or reading skills were on the decline because when young children first learn to read a book, it's much more linear.

YOUNGIt's much more -- you need a lot more concentration skills. Where oftentimes with tablets, they're just scanning, skimming and scrolling. They're not actually getting the same attentional exercise, you know, with their brains that they would with actually reading a book.

MCGINTYBut if -- even if that is true, how do you turn back the clock on this stuff? I mean, we're teaching four-year-olds to code. We are, you know, as you pointed out, a lot of our young people tablets. How do you go back to reading and drawing with crayons? I don't…

YOUNGWell, and I think that's the bigger problem, is that, you know, I don't think we can turn back the clock, but we can try to better educate parents. I mean, a large part of my work lately is working more directly with school systems and parents groups and really trying to educate them on some of these dangers. And really working a lot on parenting. You know, it's a lot more complicated, I would say, today, then it was many years ago before all this technology was so accessible. So I think that's some of the ways we can try to help.

MCGINTYCecilia?

KANGYou know, speaking as a parent of a young teen and a nine-year-old, it is more complicated today. And the mixed message is is that technology is important, is important to our future and our economy on the one hand. And people that -- our kids should get really interested in STEM studies and things that will advance innovation. And the other message is, but don't play too much.

KANGAnd you, you know, the limits are no screen time during the week and only on the weekend. The result in my house is that at 7:00 in the morning, on a Saturday morning, I find my son sometimes waking up and the first thing he does is he goes for the iPad.

MCGINTYWow.

KANGAnd so there's -- there are these kinds of mixed messages, as to also, you know, within the classroom itself, in that 7 in 10 teachers assign homework online. A lot of schools are moving to 1 to 1 iPad or laptop use. Meaning one device per child. And the idea is that technology is important for efficiency, also for learning, for collaboration. There are also studies that show a lot of benefits to technology in the classroom as well. And so you're giving kids laptops, Chrome books, smartphones to take home, to sometimes sleep with.

KANGYou know, a lot of kids put their smartphones under their pillows. They -- as alarm clocks and also 'cause they don't want to miss a text. On the other hand you're saying, but you got to regulate yourself. So it's asking a lot of children, who are still developing. Their minds are still developing. And they don't have the regulation mechanisms that adults have.

MCGINTYWell, speaking of regulations, and there are some who've put out sort of age limits or suggestions for how to handle media with kids. For example, none at all from the age of zero to three. And there's other things out there. Any of you familiar with that?

YOUNGYes. And I think it's the American Academy of Pediatricians that has guidelines, but only really, you know, up until certain ages. I think it's much more complicated as the child gets, say, beyond three years old. And now is, you know, as Cecilia points out rightfully so, they go into school systems where they're being encouraged to use this technology and then they come and their parents are saying, but we don't want you to use it too much. And it really -- it becomes very confusing.

YOUNGAnd it -- sometimes it's on a case-by-case basis. And one other small piece to his is also how much the parents model using technology. You know, oftentimes I might talk about trying to find tech-free time at home for everybody just to sit and talk without devices. And there are some parents that say, but I need my phone for work all the time. And that's legitimate, but on the other hand, that's also modeling that kind of neediness, I suppose, with technology.

CASHI'd like to talk for a moment about the resources that are out there for parents. Because there actually are some excellent books and websites that really are chockablock full of good information, researched-based information on how to set appropriate limits with kids. And one book is Victoria Dunckley's book, "Reset Your Child's Brain," which I highly recommend. Another is a website called ZoneIn.ca. Cris Rowan has done -- is an occupational therapist who's put together a really excellent website.

CASHAnd there are other excellent books. Nicholas Kardaras is coming out with a book called, "The Glow Kids," which is going to really be very helpful for parents who are struggling their way through how to really do it right with their kids, as best as we can all advise them.

MCGINTYLet's take a phone call from Geri in Yonkers, N.Y. Thanks for waiting, Geri.

GERIHi. I was just calling because I have two children who are -- who suffer from stuff, from special needs. And my youngest, who's six years old, he's the one who really has the addiction to the phone and the internet. I actually have to hide them at a certain time of the day. And he has really bad tantrums. And we have a full day of activities. It's not like we're not doing anything. We're at the park. I have to hide them when we go to the park.

GERIIf we go swimming, I have to hide the phone. So, you know, I remember being a child and having a choice on activities. But I feel like the cellphone, the internet, they actually steal the focus away from the children. They're designed to make them zone into it. It's almost like they're on -- in a trance. So I would like to get information on how, you know, to help him.

MCGINTYKimberly, what do you think?

YOUNGWell, I think, you know, again, she raises the same point. She did mention something, he had special needs. And that's one of the things that I know I've been finding, that, you know, children with special needs, autistic kids, Asperger Syndrome, seem to have a propensity to gravitate towards this technology. And from the research that I've seen, a lot of it is because of this element going back to what I said earlier about escape.

YOUNGWhen they go online it's an equalizer. They don't have to have the same social skills that they would in real life, as they do in the virtual world that they sort of interact with and create inside the computer screen. And so a lot of times when you're asking them to set time limits, they say, but you're taking away something they're very emotionally attached to. That is probably when you…

MCGINTYHence the tantrums and that sort of thing.

YOUNG…really do need to seek out more therapy and not handle it alone.

MCGINTYHilarie Cash, you mentioned any number of resources. Is there anything specific to handling a young child, as was described by Geri in Yonkers?

CASHWell, yes. I do think this book, "Reset Your Child's Brain," is a really excellent book that might be of help to this parent. There is some good parent coaches. I don't know if Ed does parent coaching. He may beyond his state, but there are parent coaches like Kim McDaniel, Chris Mulligan, who are both situated in California who are, I think maybe like Ed, willing to do parent coaching. Perhaps Kimberly is willing to. I'm not able to because of my state laws.

CASHBut finding -- I think Kimberly is exactly right. It's really important not to try to do this alone. And so if this parent can find someone to do some of that coaching and parenting -- get parenting help from it's gonna be very, very useful to her.

MCGINTYI'm Derek McGinty and you're listening to "The Diane Rehm Show." Ed, go ahead.

SPECTORYeah, the one thing that I would add to this is if there's one thing I've learned about the work that I've done here in this particular field is that there's a real need to go very case-by-case. So general information only goes so far. Once you have special needs in the picture you really need someone who's gonna look very carefully at your particular child's situation and help you come up with something that works for you and comes up -- that works with -- for your family as well.

SPECTORSo the general information can only go so far. And you should be pretty cautious about what you read in a book or on a website that's meant for a mass audience because you know your child better than anyone. And there are some kids who can handle having an iPad at the age of eight. There are some who are still not gonna be able to handle the responsibility at 15. And you have to make that judgment call knowing the child, not just in a generic way.

MCGINTYYou know, speaking of judgment calls. Here's an email from someone named Manuel, who says, "My grandson is significantly autistic in the real world, but has a rich and outreaching internet life. Is this an example of dependence or is his ability to communicate online deeply and emotively a positive tool in dealing with his autism?"

SPECTORYeah, I mean autism really is its own category with this problem. So when I know someone's coming in and that's diagnosis, my expectations shift dramatically. And what I'm -- the way that I'm understanding the problem changes dramatically as well. As I think Kimberly Young mentioned, when you have autism your social skills are very much not a strength. And when you're online, you're not relying on the non-verbal cues, you're not having to deal with a lot of the social stuff that's hard for you. And so you can really excel.

MCGINTYSo this could be a positive thing?

SPECTORWell, it's a plus and a minus. It's a crutch, but it's also a fabulous way for someone who's very limited to have a vibrant social life.

KANGWhat's different about the internet and what it's done for kids, as opposed to other technological transformations, like the phone and then the TV, and the radio, is the ability to communicate with other kids. And I've heard from teens who are LGBTQ, for example, who are able to communicate in rural areas with others who aren't in their community, feeling not alone. That's a real benefit. There are great advantages to technology for sure.

KANGAnd I would like to offer just a little bit of comfort in this conversation because I think the vast majority of folks who listen may detect -- may have some concern and anxiety about the amount of screen time that their kids have or the amount of attention that they put on gaming and the inability -- and the arguments that arise from trying to, you know, get your kid off the gaming.

KANGBut the -- a little historical perspective. Every single time there is a new big technology, the printing press, for example. There was a big outcry about, oh, my gosh, we're gonna have information overload. How are we gonna deal with all this information? This was during Shakespearian times, you know. And with the radio, with the TV itself. I remember my kids -- my parents regulating how much TV I could watch. And I watched a ton of TV.

MCGINTYRight.

KANGAnd this is not to say that this conversation -- that there is not real problems with compulsion, but every time there is a big transformation in the medium, in the platform, there is the same sort of anxiety. So if that offers a little bit of comfort, there is a historical arc to this.

MCGINTYBut the key question, the key, I guess, component of this would be the balance. Right? Yes. Enjoy it, use it, but don't go crazy. And if you are going too far, you're gonna probably have to get some help, if not from a psychologist like Ed here, perhaps even you might have to go as far as a rehab center, like Hilarie Cash runs out here in Washington state. I want to thank all our guests for being here. As I mentioned Hilarie Cash, co-founder, chief clinical officer of reSTART, the rehab center that treats digital media dependency.

MCGINTYAlso, Kimberly Young is a psychologist and founder of The Center of Internet Addiction. She's on the phone with us from Pennsylvania. Here in the studio, Cecilia Kang, covering technology for The New York Times, and Edward Spector, psychologist in private practice in Bethesda, Md. And if your questions have not been answered during today's show, we are continuing this conversation on our Facebook page right after the program is done.

MCGINTYWe'll have a live Q&A with Ed Spector, as we mentioned, he's a psychologist. He specializes in this sort of thing. Go to Facebook.com/TheDianeRehmShow and post your questions. And he will provide answers hopefully. I'm Derek McGinty sitting in for Diane Rehm. I want to thank you for listening.