Vulnerable Children in a Digital Age

Vulnerable Children in a Digital Age Why Children From Hard Places Are More Susceptible to Harm from Technology, and What We Can Do to Help

TABLE OF CONTENTS

2

4

Forward: Jedd Medefind

6

Introduction

9

Key Points

10

Chapter 1: Trauma and Wellbeing: How Early Childhood Adversity Impacts Development • Too Much of a Good Thing: When the Stress Response Becomes Toxic (pg 13) • Adverse Childhood Experiences (ACEs) (pg 15)

20

Chapter 2: Danger Zone: How Digital Technology Rewires Vulnerable Minds • The Reality of Youth and Technology Use (pg 21) • The Influence of Technology on Brain Development (pg 24)

28

Chapter 3: Playing With Fire: Why Children From Hard Places are Vulnerable to Risks From Technology • How Technology & Early Adversity Interact (pg 29)

• Attachment (pg 32)

• Emotional Regulation (pg 35)

• Impulsivity and Inattention (pg 36)

• Anxiety and Depression (pg 38)

• Aggression (pg 39)

• Social Impairment (pg 41) • Poor Sleep (pg 42) • Risky Sexual Behavior (pg 44)

46

Chapter 4: Guidelines and Guardrails for Keeping Vulnerable Children Safe in a Digital World • Make a Plan (pg 48) • Set the Tone (pg 50) • Establish Boundaries (pg 52) • Talk About Tech Use (pg 56) • Don’t Use Technology to Reward or Placate (pg 58) • Introduce Alternatives (pg 60) • Spend More Intentional Time Together (pg 64) • Discover How To Play (pg 66) • Admit When Outside Help is Needed (pg 68)

70

Conclusion

3

The incredible productivity of factories. The fire-resistance of asbestos.

The luxury of fresh water delivered by lead-lined aqueducts in ancient Rome. Each of these technologies brought immense benefits. They also carried hazards that were little understood until long after they’d done much harm to those who used them.

Many of us suspect we may be in a similar place when it comes to screen technologies today. Certainly, there’s a lot we don’t know. But month after month, new studies reveal that screen time somehow connects to everything from increased anxiety … to diminished focus and memory … to loss of ability to read emotions on the face of a friend.

Some of this has to do with the content experienced on screens – from searing images of violence and pornography, to the insecurity and unkindness rampant on social media. But just as important is the medium itself. High stimulation, distraction and multi-tasking steadily rewires our brains. Over time, these neural changes shift the way we think.

Ultimately, this re-shapes our capacities and character as well.

Early evidence suggests that this may be particularly true for children who’ve faced trauma and loss. These precious girls and boys are often slower to develop the filters that help process complex stimuli and guard from dangers. So although formal studies always lag the latest technology, we can anticipate that tech-based hazards may be significantly amplified for children from hard places.

If that’s correct, adoptive and foster parents and leaders serving vulnerable children worldwide have every reason to be especially thoughtful about technology and its role in daily life. That’s why we’re here. We don’t wish to reject all the good technology provides. But we do desire to understand it better. Most of all, we want to be wise in choosing the place we’ll give screens and other technology in the lives of children we love…and in our own.

4

We cannot leave those decisions to the programmers, advertisers and designers that drive technology. They will always grasp for more. If we’re to harness the best of technology while guarding against its harms, it is up to us. And there’s no better time to start than today.

Jedd Medefind President Christian Alliance for Orphans

5

Introduction

6

A television runs for twelve hours a day in a baby room in an orphanage in Guatemala. A teenager in Poland streams video content onto her phone. In Morocco, boys in a behavioral correction facility use computers to work on their homework. In the United States, a middleschooler stays awake until midnight scrolling through social media.

Everyday technology use is a pervasive phenomenon with potential for both great good and tremendous harm. Technology can democratize information, give us new ways to learn and work, and provide access to a wealth of ideas and opportunities once reserved for a small portion of society. Simultaneously, technology comes with some likely, yet unknown risks.". Addiction,1 exploitation,2 behavioral problems,3 4 and altered relationships5 often accompany the experience of technology misuse. For the Christ follower, the harm can have an additional cost: it can impair the soul.

Perhaps most susceptible to these risks are those most vulnerable in general: children who have experienced early childhood adversity, especially those separated from parental care. Although the data about technology use and vulnerable children is somewhat limited, we know that children without the protection and guidance of a loving, permanent caregiver are at greater risk for a whole host of life challenges.

Protecting vulnerable children from harm must include consideration of the emerging opportunities and risks in our increasingly digital world. For the Christian, the stakes are even higher.

7

Note to reader Technology is no longer avoidable- it is ever-present. Technology doesn’t consider the previous experiences of a brain before wrapping its impact around every part of us and further rewiring previously vulnerable minds. This resource has been created for those who care for and about orphans and vulnerable children (OVC), with the aim of helping them empower and equip children and youth toward success and wellbeing. It will be especially helpful for caregivers, social workers, teachers, leaders in OVC-serving organizations, mentors, clinicians, and church leaders who seek to tailor their ministries in ways that benefit all children.

Our goal is to provide actionable knowledge from a scientific perspective, through a faith-based lense, to inform wise technological engagement for those serving or who have themselves experienced childhood adversity.

When considering behavior and outcomes, the impact of childhood adversity and technology use are tightly interwoven. In order to best communicate this relationship, this resource will offer a brief background on the neurological and behavioral changes related to trauma (chapter one) and technology use (chapter two). In chapter three, we will explore the intersection of these two factors, followed by recommend action steps for safe technology usage in chapter four.

This resource accompanies content from the 2019 OVC Applied Research & Best Practice Symposium, held in Louisville, KY in May 2019.

8

Key Points Why it matters for vulnerable children: • A history of childhood adversity places OVC at a greater risk for harm during technology misuse.

• A healthy, age-appropriate amount of technological use can avoid harm and promote the benefits of technology.

• Vulnerable children have the capacity to learn a life long model of appropriate technology use.

Why it matters to caregivers: • Everyone is susceptible to technological harm, including caregivers.

Caregivers are charged with protecting both themselves and OVC from technology misuse.

• Caregivers can use best practices in technology to enrich a child’s home, social and educational environments.

• To be an effective advocate, caregivers must intervene when technology is used in abusive, inappropriate, or harmful ways. This is applicable in your own family, classroom, or organization.

Why it makes a difference: • Technology is constantly adapting and so must we. These advancements provide an opportunity for both OVC and caregivers to strike a healthy balance.

Why Christians should pay attention: • We believe that our physical bodies are made in God’s true image6 and all minds and bodies have immense value and worth; scripture honors the human body because it is connected to our soul, and the way we use our bodies directly affects our life in Christ.7 • We know that intimate communion with fellow humans is intrinsic to who we are as image bearers;8 we fail to thrive in isolation.9 • We see that removing ourselves from our modern devices is the modern equivalent to God’s Sabbath rest.10 • We desire to see every child experience God’s unfailing love and know that God values children immensely.11

9

01 TRAUMA AND WELLBEING: How Early Childhood Adversity Impacts Development

Early childhood experiences can change brains, explain behaviors, and impact lifelong health and wellbeing. When a child experiences abuse, neglect, exposure to violence, exploitation, or familial instability early in life, his or her brain changes under the toxic stress of the circumstances.

Unfortunately, experiencing early childhood adversity is not uncommon:

150 million children worldwide have experienced the loss of one or both parents.

38% of children in the US under 17 have been exposed to violence, with the number rising to 68% for 14-17 year olds.12 Nearly one in four people has experienced emotional or physical neglect 13 A study of 13,000 people found that 25% of children had a substance abuse issue in their household, 18% had a caregiver who had a mental illness, and over 12% reported that their mother was

Number of Children per 1,000

treated violently14

All Maltreatment All Abuse All Neglect

25

21.3 19.5

20

18.5

17.6

15 12.7

12.1

10

12.3

9.9

8.5 6.4

05

14.7

5.1

8.8

7.7

9.1 7.5

6.1 3.7

0-2

3-5

6-8

9-11

12-14 15-17

Child’s Age (in years)

Figure 1. This chart from the Fourth National Incidence Study of Child Abuse and Neglect shows children experiencing early childhood adversity by age in years. 15

11

For orphaned and vulnerable children, who are without the protection and nurture of a stable primary caregiver, the risk of experiencing substantial early childhood adversity is significant. This hardship occurs during some of the most critical periods for psychological, physical, and emotional development.16, 17 Childhood adversity can lead to toxic stress, which is associated with weakened and abnormal brain architecture.18 Although the brain is invisible to the eye, the impact of childhood adversity on brain development may appear in how a child thinks, speaks, feels, and behaves.

12

Too Much of a Good Thing: When the Stress Response Becomes Toxic Stress is natural, normal, and needed for appropriate development.19 During periods of stress, a typical response is to either fight, flee, or freeze by sending blood to the limbs, increasing breathing, and accelerating heart rate. Once the event has passed, the body and brain then reverse these signals, returning back to a state of “rest and digest.�20 However, after experiencing repeated childhood adversity, the brain and body can produce this instantaneous protective response on a continuous loop leading to harmful, toxic stress levels.21 Stress can be characterized in one of three ways:22

13

Positive response: Vital to healthy development, and characterized by temporary elevations in heart rate and

POSITIVE

hormone release. Positive stress may result from the first day of school or riding a bicycle for the first time.

Tolerable response: May result from a more severe challenge or loss, such as the death of a loved one or car accident. The stress response is temporary and is

TOLERABLE

buffered by healthy, nurturing adult relationships that help the child to cope.

Toxic stress: Develops when a child experiences intense, frequent, and/or prolonged adversity without

TOXIC

the love, nurture, and support of a healthy, long-term care-giving relationship. Causes of toxic stress can vary from extreme poverty and discrimination to illness and abuse.23

Figure 2. Types of Stress (Adapted from Harvard Center on the Developing Child).

A stress response can become toxic depending on the intensity, timing, or duration of the experience. Children who undergo the same stressors react with varying degrees of severity; those with negative outcomes are at risk for altered brain architecture and developmental delays.24 Without the vital influence of a protective and nurturing caregiver relationship, toxic stress can override a child’s stress response system causing a constant state of distress.25, 26, 27 This impacts growth, learning, behavior, and relationships, areas in which orphans and children outside parental care are especially vulnerable.

14

Adverse Childhood Experiences (ACEs) Traumatic childhood events, also called Adverse Childhood Experiences (ACEs), frequently have considerable impacts on health and wellbeing throughout a person’s life.28 A landmark 1998 study generated a list of ten ACEs and found that the number of adverse events a person experiences before age eighteen is closely correlated with negative longterm consequences.29 While, many other experiences are considered adverse, most broadly fall under these categories.

Household Dysfunction

Abuse

Neglect

Physical

Physical

Mental Illness

Incarcerated Relative

Emotional

Emotional

Mother Treated Violently

Substance Abuse

Sexual

Divorce

Figure 3. Three types of ACEs: Abuse, neglect, and dysfunction. 30

15

Most people experience zero or one adverse events, and have few or no long-term consequences. However, as the number of ACEs a person experiences increases, so does his or her risk of health problems, emotional disorders, substance abuse, high-risk behaviors, and even early death.31 As shown by the figure below, adverse childhood experiences create a foundation for disruptions in brain development which can lead to cognitive impairments, high-risk behavior, disease, and functional limitations which can shorten a person’s life.32

Death Early Death Disease Disability, and Social Problems Adoption of Health-risk Behaviors

Social, Emotional, and Cognitive Impairment

Disrupted Neurodevelopment

Adverse Childhood Experiences Conception

Figure 4. Pathway by which adverse childhood experiences influence health and wellbeing through the lifespan.33

Although the original ACEs study did not highlight separation from parental care, all orphaned and vulnerable children are at risk for multiple ACEs.34 Simply being separated from parents and family of origin is an adverse childhood experience in itself, and lack of consistent care and supervision also increases susceptibility to other harm.35 16

As shown in Figure 5, there are numerous short and long term behavior and health issues directly tied to ACEs.36 The risk of behavioral and health issues increase as the number of ACEs increase.37 Although many of the most severe consequences are seen long-term, we don’t always have to wait to see the effects of adversity. Short-term consequences can include: Mental and behavioral health issues, adaptation and adjustment problems,38 lack of appropriate adjustment toward social situations, marked by inability to move beyond stress responses to a healthy level of functioning,39 40 inattentiveness,41 decreased critical thinking, planning, decision-making, and social interaction abilities, 42 problems with emotional learning,43 45 46 and delays in memory and learning.47 48

Behavior

Lack of Physical Activity

Smoking

Alcoholism

Drug Use

Missed Work

Physical & Mental Health

Severe Obesity

Diabetes

Depression

Suicide Attempts

STDs

Heart Disease

Cancer

Stroke

COPD

Broken Bones

Figure 5. Consequences of exposure to ACEs.49

17

While most parents and caregivers desire the best for all children, what many caregivers of children who have experienced early adversity do not know is that digital technology use has the potential to increase the negative physical, cognitive, and behavioral health consequences of childhood trauma.

01 Trauma and Wellbeing: How Early Childhood Adversity Impacts Development

18

Resources 1

The Changing Brain: Created to Heal-eBook CAFO Click Here »

2

How A Child’s Brain Develops Through Early Experiences NPSCC Click Here »

3

Experiences Build Brain Architecture Harvard Center on the Developing Child Click Here »

4

Toxic Stress Derails Healthy Development Harvard Center on the Developing Child Click Here »

5

How Childhood Trauma Affects Health Across a Lifetime Dr. Nadine Burke Harris Click Here »

19

02 DANGER ZONE: How Digital Technology Rewires Vulnerable Minds

The Reality of Youth and Technology Use “Children come to school having been deeply conditioned by the biases of television. There, they encounter the world of the printed word. A sort of psychic battle takes place, and there are many casualties—children who can't learn to read or won't, children who cannot organize their thought into logical structure even in a simple paragraph, children who cannot attend to lectures or oral explanations for more than a few minutes at a time. They are failures, but not because they are stupid.

They are failures because there is a media war going on, and they are on the wrong side—at least for the moment.”

-Neil Postman, Technopoly: The Surrender of Culture to Technology50

Digital technology cannot be simply defined;51 but for our purposes, it encompanses modern technologies that digitize information in sight or sound: anything with a screen, a listening or speaking capability, or the internet. No matter the age, from infancy52 through older adulthood,53 digital technology use is rising worldwide and being introduced at staggeringly young ages.54 This rise is no surprise. Since technology is readily available regardless of country or class, everyday tasks are done with greater ease than they once were. Now, children can go from iPhone in the car seat, to television during Sunday School, to speaking to Alexa in the living room, to an iPad for learning at Kindergarten.

Technology has simultaneously infiltrated and aided nearly every area of our lives across our global context, whether for an American family or a Nigerian village dweller. The ripple effects of digital technology have truly changed the world; altering the lives and minds of even the youngest among us.

21

In the US, mobile media use by 2- to 4-year-olds went from 39% to 80% between 2011 and 2013. In the UK, 51% of infants ages 6- to 11-months use a touch screen daily. (Canadian Paediatric Society, 2017) One in three internet users worldwide is under the age of 18.56 US adolescents between eleven and eighteen years old spend an average of over eleven hours per day with media. (Bailin, 2014) 25% of international students reported being “extreme internet users� during the weekends, more than 6 hours a day online, 16% reported similar use on school days. (OCED, 6)57

Average Time, in Minutes Per Day, Spent Using the Internet Outside of School.

2015 2012

Figure 6. The rise of digital technology use among 15-year-olds in 27 nations55

This graphic considers the rise in daily internet usage in a "typical" 15-year-old student across 27 countries. Average weekly internet usage went from 21 hours to 29 hours a week in three years.

22

Digital technology can be a powerful tool for progress. In the last decade, technological advancements have led to greater social connectivity, increased learning, and expanded opportunities for creative expression.58 59 60 61 62 63 64 65 However, these technological advancements also come with new risks and challenges, especially for those who have experienced ACEs.

23

The Influence of Technology on Brain Development In10 out of 10 children, technology use influences brain development during early childhood.66 67 While we can all sense the lure technology has over our adult minds, children are not mini- adults; the impact it has on them is much more foundational. During the first three years of life, the brain creates about 700 new neural connections (called synapses) every second.68 Synapse formation plays a critical role in learning and development, and consistent technology use changes the physical structure of the brain.

This impacts the way neurotransmitters, the chemicals that allow the brain to communicate and function.69 For young children experiencing rapid brain development, the potential negative impact of technology use on synapse formation and neurotransmitter development is substantial. Neural pathways are the glue that hold neurons together and the paths by which our minds communicate messages internally.

Technology influences a developing, already susceptible mind, and works by simultaneously reinforcing and neglecting specific neural pathways that direct what a person does. When a pathway is reinforced by repeated behavior, it becomes easier to repeat that behavior- essentially, it creates a habit. These pathways trigger specific behaviors and thoughts, and technology re-programs the mind, strengthening some pathways and ignoring others.

24

DOPAMINE (1): Excessive technology use increases the level of dopamine in the brain. Dopamine is a chemical that controls functions such as decision making, impulsivity, and responding to pleasure.69 When dopamine levels are consistently high, the brain’s sensitivity to dopamine lowers, and even more dopamine is necessary to experience pleasure.70 Behaviorally, this desensitization to dopamine produces an increase in the behavior leading to a release of dopamine.71 The impact of certain digital behaviors can have a dopamine effect similar to that of illicit drug use.72 NOREPINEPHRINE: Chronic, intense use of digital media can decrease blood levels of norepinephrine,73 a stress hormone that serves to mobilize the body for action.74 MELATONIN: Light emitted from screens has been shown to impact melatonin production, which can lead to disrupted sleep.

GRAY MATTER: Inappropriate technology use leads to atrophy of gray matter -- the part of the brain that houses neurons -- in key places, including regions thought to be responsible for cognitive control.75 76 77 WHITE MATTER: Technology overuse can lead to a reduction in white matter, which composes the communication pathways of the brain, and can be linked to behavioral concerns.78 FRONTAL LOBE (2): Technology addiction decreases function in the frontal lobe,79 which controls thinking, planning, decision-making, and social interaction.80 HIPPOCAMPUS (3): Continuous exposure to light is associated with hippocampal impairments in learning and memory, as well as later depressive symptoms.81

2 1

3

Figure 7. How technology affects the brain.

25

Technology use, particularly during critical early childhood periods of development, has the potential to significantly alter brain development.

In other words, technology has the power to “rewire” a child’s brain through unnatural stimulation and repeated exposure, and misuse may lead to developmental and health effects.82 The neurological changes to a child’s brain can be overt, but the soullevel effects can be hidden, not appearing until later years. With little souls already prone to wander, now secrecy, isolation, idolatry, and daily liturgies of consumption are influencing the formation of susceptible minds. While not all technologies shape poor behaviors, their effect on the soul cannot be quantified or backed with peer-reviewed research.

All children deserve wise technological engagement. However, because orphans and vulnerable children are already likely to have experienced the developmental impacts of trauma, any potential harms from technology should be carefully considered and mitigated.

02 Danger Zone: How Digital Technology Rewires Vulnerable Minds

26

Resources 1

2

Empowering Kids to Rise Above Technology Addiction Dr. Lisa Strohman Click Here » Children in a Digital World Unicef Click Here »

3

Addiction to Technology is Ruining our Lives Simon Sinek Click Here »

4

Our Brain’s Development in a Technological World Computer History Museum Click Here »

5

The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age Steiner-Adair and Barker Click Here »

27

03 PLAYING WITH FIRE: Why Children From Hard Places are Vulnerable to Risks From Technology Use & Abuse

Digital technology has the potential to affect the way children’s brains develop and function.83 84 85 86 87 89 90 91 92 Children who have experienced adversity and trauma are at greater risk for experiencing a wide range of challenges, therefore these children may also be uniquely susceptible to the potential negative impacts of digital technology misuse.93 94 95 96 97 98 99 Early childhood is a particularly important time of development in a child’s life. During the first year, a baby’s brain doubles in size; during the first three years of life, learning occurs more rapidly than at any other period.100 101 Safety and security during this sensitive period of development provides the foundation for building healthy brain function that will last a lifetime.102 Children need to be protected from exposure to adverse childhood experiences, as well as from unhealthy or excessive digital technology use.

How Technology & Early Adversity Interact Understanding the interaction between early adversity and technology misuse can help us better care for at-risk children. When children have already experienced adversity, the additional harms of technology misuse have the potential to further hinder resilience and wellbeing.103 104 105 106 107 In situations where both a history of early childhood adversity and an unhealthy use of technology are present, it can be difficult to determine whether negative outcomes are due to ACEs, technology misuse, combination of the two, or something else entirely. In one study of more than 300 adults, a history of adverse childhood experiences was significantly associated with more problematic media use, and participants with four or more ACEs were 2.6 times more likely to have problematic media use than those with fewer ACEs. Similarly, a study of 473 children showed that children with four or more ACEs were 3.2 times more likely to have problematic media use when compared to children with fewer ACEs. 29

It may be true that early trauma impacts brain structures and behaviors in ways that make children particularly drawn to patterns of technology misuse. This hypothesis is represented in Figure 8.

EARLY ADVERSITY

SUSCEPTIBILITY TO MISUSING TECHNOLOGY

BRAIN REWIRING

TECHNOLOGY MISUSE Figure 8. The Adversity-Technology Feedback Loop110

The Adversity-Technology Feedback Loop theory111 suggests that early adversity contributes to brain rewiring, making individuals more susceptible to technology addiction. When addiction occurs, it can lead to further brain rewiring, perpetuating the cycle.

The amount of overlap between consequences from early adversity and technology misuse is substantial and it is impossible to address all of the potential interactions. However, eight key areas stand out: attachment, affect regulation, impulse control, mood disorders, inattention, aggression, developmental delays, poor sleep, and risky sexual behavior.

30

8 Key Areas 1

Attachment

2

Emotional Regulation

3

Impulsivity and Inattention

4

Anxiety and Depression

5

Aggression

6

Social Impairment

7

Poor Sleep

8

Risky Sexual Behavior

31

Attachment For helpless babies moving from the safety and comfort of the womb to the cold and unfamiliar world outside it, survival literally depends on others. When a parent consistently meets a child’s needs across time, an emotional bond is formed, called “attachment.”112 113 Attachment is essentially the child’s trust that his or her needs will be met by an adult who will protect and nurture them.114 115 When children do not have a reliable and consistent caregiver, they cannot develop this bond. They may learn not to trust caregivers and other adults. Unfortunately, this perception that other individuals are unsafe or untrustworthy may lead to challenges with attachment.116 This lack of attachment, or unhealthy version of it, can make it difficult for children to form positive connections. This could impact their emotional relationships for the rest of their lives.117 118 119 Traumatic events have the potential to damage the emotional bond between parent and child or diminish the child's belief in the parent's capacity to protect them from harm. Research shows that a higher number of ACEs is linked to a greater likelihood of attachment disorders.120 121

In research examining the relationship between early adversity and problematic technology use, attachment was at least partially responsible for the relationship between adverse childhood experiences and problematic use of media.122 There could be multiple reasons for this. Children and adolescents who have unhealthy attachment may use technology, particularly social media and other internet resources, to “connect” with others.123 124 Children with unhealthy attachment may not be able to discriminate between “safe” and “unsafe” people, which in turn can compromise their safety and wellbeing online.125 A full social media roster of “friends” can create a false sense of relational support and may reduce the likelihood that a youth will invest time and energy into seeking healthy, mutually-affirming, in-person relationships.126 127 It could be something else entirely, but we know attachment can play a role in unhealthy technology use.

32

33

34

Emotional Regulation Emotional Regulation is the ability to tolerate intense emotions and manage them in ways that are healthy and socially appropriate.128 Consider a simple example: when a child takes another child’s toy, they may experience intense emotions of anger, frustration, or jealousy.

When a child has strong emotional regulation skills, he or she will be able to say “I was playing with that- please wait until your turn.” However, for a child with poor emotional regulation skills, this situation may result in yelling, crying, or physical aggression. Emotional regulation is another aspect of child mental health associated with ACEs and technology misuse.129 Traumatic experiences such as abuse, neglect, or separation from parental care can impact the way a child’s brain develops.130 When these ACE’s occur, a child’s neurobiological system adapts and “programs” itself to survive the stressful experience.131 132 When children respond abnormally to stress, the brain systems that regulate emotion, behavior, and thinking can be negatively impacted.

Poor emotional regulation is a risk factor for unhealthy technology use.

Technology, specially social media, can be used as a coping mechanism.134 Instead of internally processing feelings, which develops self-regulation, children may use technology to distract themselves; for example, “I’m feeling scared, so I’ll numb my feelings with technology.” Adolescents, especially females, are more likely to turn to the internet to cope with negative feelings.135 Poor emotional regulation is also a consequence of technology overuse.

Excessive screen-time and social media use is associated with lower selfesteem, feelings of isolation, socio-emotional delay in young adults.136 137 138 139

35

Impulsivity and Inattention Impulse control (the ability to resist urges or stop behaviors140), and inattention (the inability to maintain focus) are inter-related childhood wellbeing concerns related to ACEs and technology misuse. Impulse control and inattention are closely linked, as well developed impulse control helps us to avoid the temptations of distraction, allowing us to maintain our intended focus.

As adverse childhood experiences affect brain development, children who have experienced trauma are also more likely to develop impulsivity and inattention.141 Toxic stress decreases the functioning of the prefrontal cortex, which is the the part of the brain responsible for regulating self-control and focus. With the prefrontal cortex compromised, children experience problems in impulse control and inattention. 142 143 Attention problems are especially common in children who have experienced emotional abuse, emotional neglect, sexual abuse and physical neglect.144 145 Childhood inattention is associated with behavior problems, social difficulties, mental health challenges and lower educational attainment.146 147 The inability to control impulses and maintain attention is a risk factor for unhealthy technology use, and can lead to a compromised ability to regulate the desire to use technology. Lower impulse control is also associated with increased likelihood of addiction.148 149 150 Technology trains our brains to have short attention spans, always looking for more input and stimuli151 152 153 When children struggle to pay attention to a particular idea, they are more likely to experience boredom,154 which may lead to seeking stimulation, such as those from digital technology.

155 156 Children with inattention are more likely to be diagnosed with “probable internet addiction” or “definate internet addiction.”157

36

37

Anxiety and Depression Mood disorders, such as anxiety and depression, are critical mental health concerns related to ACEs and technology misuse. Anxiety disorders occur when a person experiences excessive worry, fear, and nervousness that impacts normal functioning.158 159 Major Depressive Disorder (“Depression�) typically presents as persistent sadness, low energy, and disinterest in activities or relationships a person once found valuable.160 161 Experiencing trauma during childhood greatly increases the likelihood of experiencing anxiety, depression, or both anxiety and depression.162 163 Anxiety and Depression are associated with unhealthy technology use in a number of ways.164 People with anxiety disorder may experience stress from using social media related to seeking approval and fearing judgment, to navigating privacy and negotiating social identity.165 The relationship between mental health diagnosis and excessive social media use differs by gender.166 A diagnosis of depression triggered higher social media use for girls, while anxiety triggered higher social media use for boys.167 Overuse of technology can worsen anxiety and depression. Excessive screen time is associated with decreases in self-esteem and psychological well-being and increases in depressive thoughts and psychological difficulties.168 169 Additionally, using multiple social media platforms is associated with increased symptoms of depression and anxiety.170 171

38

Aggression Aggression relates to both ACEs and technology misuse.172 173 174 175 Aggressive behaviors can take many forms, such as physical altercations, verbal threats, readiness to attack, and forcefulness about one’s own desires.176

Experiencing adversity may cause difficulties in processing emotion, which can result in aggressive behaviors.177 178 A history of trauma can make children’s “fight or flight” response more sensitive, and children may unnecessarily move into a self-protective mode.179 Children who struggle with aggression are more likely to engage in unhealthy technology use. Aggressive media may be more appealing to children who are prone to aggression because this type of content reinforces and normalizes their aggressive feelings and behaviors.180 181 Aggression is also a consequence of overuse of technology.182 Simply being exposed to violent media is associated with an increase in violent ideas and behaviors for children.183 184 When adolescents with aggression seek out aggressive media content, such as violent video games and television shows, this content may contribute to increased aggressive behavior.185 186 186 188

39

40

Social Impairment Childhood social impairment intersects with ACEs and technology misuse.189 190 Children who have social impairments struggle to interact with and form relationships with other people.191 192 193 Social impairments can be minor, such as shyness around new people, or serious, such as feelings of panic and fear when not alone. An example of minor social impairment might be a child who does well on independent math homework, but struggles to do the same problems when someone is watching. More serious social impairment, such as avoidance of eye contact and inability to be around others, may indicate a Social Anxiety Disorder (SAD), conduct disorder, or autism-spectrum disorder.194 Childhood trauma can negatively impact social development. Trauma impacts the physical and biological growth of the brain, nervous system, and endocrine system, which affect the way children process and respond to interactions with other people.195 196 In other words, ACEs affect the way children process social situations and feel about social situations.

Social impairment is a risk factor for unhealthy technology use.197 Abuse, neglect and abandonment early in life can perpetuate feelings of being unloved, unwanted, and unincluded.198 Unhealthy technology use can also make social impairments worse. Infants and toddlers whose daily routines involve excessive screen time face increased risk of socioemotional delays, including social impairments.199 For children who struggle socially, social media has the potential to publicly broadcast a private misunderstanding between friends, leading to shame, isolation, and further social withdrawal. 200 201 202 While technology overuse can increase social impairments, reducing and removing technology may improve social functioning.203 In a study where sixth grade students were removed from all technology at a camp setting, their ability to empathize and read emotions increased.204

41

Poor Sleep Poor sleep is associated with early adversity and technology misuse.205 How well children sleep depends on their environment; children who feel safe and protected will generally sleep better than children who do not feel safe; such as in an abusive home.206 207 Sleep problems can take many forms, from nighttime problems like difficulty falling asleep and nightmares, to daytime problems like inattention and memory challenges.208 209 210 211 212 213 Children who sleep poorly also impact parent or caretaker sleep and the sleep of other children in the home.214 Sleep related concerns are the most common consequence of childhood stress and trauma.215 216 217 218 219 220 In some individuals, stress can lead to increased anxiety, making it more difficult to fall asleep, stay asleep, and can lead to nightmares. However, others stress can lead to withdrawal and oversleeping as a coping mechanism.221 Childhood sleep issues are a risk factor for unhealthy technology use.

Individuals who have adverse childhood experiences are more prone to poor coping skills, such as using technology. 222 223 Children with ACEs are also more prone to addictive internet behaviors related to sleep and technology,224 and may report scheduling sleep around internet use or limiting sleep to use the internet.225 226 227 228

42

43

Risky Sexual Behavior Although common in young people who have experience early adversity, risky sexual behavior can have significant effects on physical, cognitive, and social wellbeing.229 230 Because childhood and adolescence creates a framework for beliefs and attitudes throughout the lifespan, it is important to consider the intersection of risky sexual behavior, childhood trauma, and technology misuse.

Childhood trauma and risky sexual behavior are closely linked.231 When children experience stress and adversity, this impacts their emotional development.232 233 Sexual behaviors, including consuming pornography, can provide an illusion of closeness and intimacy.234 235 This false sense of intimacy can be particularly appealing to young people who have experienced maltreatment or abuse. 236 237 238 Adolescents who have experienced physical or sexual abuse are particularly vulnerable to risky sexual behavior online.239 Teenagers engaging in online sexual behavior are more likely to have experienced greater adversities, be in poorer health, and have more sexual experience compared to teenagers who do not engage in sexual behavior online.240 Individuals who experienced trauma during childhood face greater risk of addiction, including sexual addiction.241 242 **Technology misuse and risky sexual behavior are closely related, particularly for explicit text messages and pornography. Sending explicit text messages, called sexting, involves using a cell phone to share sexually explicit messages, pictures or videos.244 Adolescents who participate in sexting are also more likely to engage in other forms of risky sexual behavior.245 246 Likewise with internet pornography, defined as sexually explicit material developed for the purpose of sexual arousal.247 Although exposure to pornography is

243

44

detrimental to developing minds,248 249 it is also extremely common, and over 70% of young adults see pornography before the age of 18.250 251 252 The effects can be devastating: pornography use was associated with more permissive sexual attitudes, greater experience with casual sexual behavior, more sexual aggression,253 and more sexual partners.254 While curiosity about sexuality is God-given, normal, and healthy for children and adolescents, loving parental guidance and supervision, as well as honesty and prayer with and for our children, is an important way to protect children from the harms of risky online sexual behavior.

03 Playing with Fire: Why Children From Hard Places are Vulnerable to Risks From Technology Use & Abuse

45

04 GUIDELINES AND GUARDRAILS FOR KEEPING VULNERABLE CHILDREN SAFE IN A DIGITAL WORLD

"Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect."

-Romans 12:2 Traumatic experiences change children’s brains, leaving them more vulnerable to harm from technology. However, just as trauma initially changes brain structure, new routines, healthy connections, and caregiver nurture can slowly heal and rebuild damaged parts of the brain.255 Because vulnerable children face significant risks of adverse experiences and technology misuse, appropriate boundaries are critical.

Adults have the potential to make a strong impact on the way children and youth interact with technology, and when caregivers monitor media use, children spend less time using technology.256 257 Guidance from caregivers and supportive adults has the potential to stop the cyclical damage caused by trauma and technology misuse, empowering children’s health, development and overall wellbeing.

As an emerging field of research, there is much yet to learn about how to protect and empower vulnerable children in a digital age. Already, science and practice suggest the following guidelines to minimize risk and maximize benefit of technology engagement in children from hard places.

47

Make A Plan “Failure to plan is planning to fail.� Creating a simple but comprehensive plan for technology use in your family, ministry, or group is the first step to guiding and protecting vulnerable children from its negative effects.

How to Create a Realistic Technology Plan Step 1.

CONSIDER the unique needs of each individual. Because a child’s safety and wellbeing is the primary focus, one child may have different technology privileges than another due to factors such as age, ability and maturity. Be sure to take into account individual technology activities (i.e. a teenager who uses a computer to complete schoolwork) and group technology needs (i.e. family movie night).

Step 2.

CREATE a realistic plan that clearly outlines boundaries for technology use, and consequences for technology use outside of those boundaries.

Remember to include all the places individuals might have screen time, including school and child care.257

Step 3.

REVIEW the plan regularly with all group members. Consider what is working, what is not working, and make changes as necessary. Use this plan to guide discussions and teach lessons around healthy technology use.

48

Questions for Consideration: 1) Do you have a media action plan for your family? For the children you work with? For your co-workers?

2) Whose voices are heard in the media plan you create? How can you actively involve everyone in this process?

3) What information do you need to gather to put a plan into place? Will you set aside dedicated time to pray about, think about, and develop this plan?

Resources 1

Family Media Plan Tool & Media Time Calculator American Academy of Pediatrics Click Here »

2

Family Media Agreement Common Sense Media Click Here »

3

Screen Time at Home: Healthy Habits Caring for Kids Click Here »

49

Set The Tone Attitudes and actions around digital technology use are learned. One of the greatest predictors of the way children use technology is the way their parents or caregivers use technology. Children and adolescents are acutely aware of the adults around them, which means each of us have the opportunity to model healthy boundaries in our engagement with technology. When setting boundaries and rules, remember to frame technology boundaries and rules as opportunities to put people first, rather than communicating technology as always bad.

How to Model Wise Technology Use Step 1.

Monitor how often you are using technology. Make a conscious effort to reduce or eliminate any of your own unhealthy technology habits.

Step 2.

Ask children closest to you for feedback about your technology habits.

Step 3.

Adjust your technology use as you learn. Admit mistakes or poor habits, and change behavior to facilitate the tone you want in your home or ministry.

50

Questions for Consideration: 1) What are your technology habits modeling to the children and youth around you?

2) What changes do you need to make?

3) What do the children around you say they see in your technology habits?

Resources 1

Am I Living a Screen-Balanced Life? Screen-Balance Quotient Test (SBQ) Straub Click Here »

2

Reclaiming Conversation: The Power of Talk in a Digital Age Sherry Turkle Click Here »

3

Habits of the High-Tech Heart Quentin Schultze Click Here »

51

Establish Boundaries Technology boundaries protect ourselves and those around us from the potential harms of overuse and misuse. Developing boundaries for children and adolescents helps protect young people from harm and, over time, can help them learn how to set their own healthy boundaries.

How to Set Healthy Boundaries for Technology Use Step 1.

Draw Boundaries. Creating rules, supervision, time limits, and boundaries on acceptable technology use has been shown to reduce time spent using technology and exposure to explicit, including sexually explicit, content online.158 159

Step 2.

Act in love. Don’t be manipulative or controlling. Never use aggression, guilt or shame to force a child or teen to reduce their media use. Instead, communicate positive long-term outcomes reducing technology use.

Step 3.

Consider social repercussions. When young people rely on technology to communicate with friends, reducing technology can also reduce their social connections. If you restrict screen time, consider the repercussions and brainstorm reasonable social alternatives beforehand.260 261 262

Step 4.

Consistency is key!263

52

On paper draw a big box. On the top-left side, write age 0, and on the top-right side, write age 18. Left to right, this is your child’s first 18 years with technology. Now, draw stairs diagonally from the bottom-left to the top-right. At some early point, you might introduce a tablet with coloring and educational games. Age 3 maybe. Or 5. Or 8. Whenever. One stair up. Then you introduce a tablet with educational videos, maybe age 6.

Next step up. Then at some point you introduce a family computer in the living room for writing projects. Maybe age 10. Step up. Then you will introduce a phone like the Gizmo, or a flip phone. Step up. Then you allow Google searches on the computer, for research. Maybe age 12. Step up.

Then perhaps at some point you introduce Facebook or messenger apps to connect with a few select friends, from the computer. Step up. And then comes the capstone, the smartphone — the final step up. Age 15 or 16 or 17 or I would suggest, 18. But you decide.264 -Tony Reinke

Questions for Consideration: 1) How are you fostering an environment where young people can connect to their peers away from screens?

2) How do you react when a child disregards limits? Do you use guilt, shame or aggression to force the behavior you want? What could you do instead?

3) What is one thing you can do to set up healthy boundaries with technology?

53

Resources

54

1

Parenting in the Age of Binge Watching Desiring God Click Here »

2

Healthy Digital Media Use Habits for Babies, Toddlers & Preschoolers American Academy of Pediatrics Click Here »

3

What Parents Can Do About technology Addiction at Home Young Click Here »

55

Talk About Tech Use Take an active approach to managing technology use. Talk about the potential advantages of reducing technology use and alternative ways they can spend their time. Teach good decision-making around technology use, progressively allowing independent choices in line with developmental stage.

How to have more Effective Technology Conversations using Active Mediation Step 1.

Discuss. Active technology mediation involves discussing and critically thinking about experiences with technology; proposing media restrictions as learning opportunities. Studies have shown that active mediation may not directly reduce media use, but may help manage negative consequences of technology use while reducing children’s vulnerability to negative outcomes, such as increased aggression or increased sexual activity.265 266

Step 2.

Stairstep Responsibility. Instruct and model good decision-making around technology, and offer more autonomy as a child grows. Over time, the goal is to prepare youth for adulthood by teaching them how to engage responsibly with technology.

Step 3.

Educate yourself. In order to have honest and productive conversations, it is important to stay up-to-date on new technologies, their capabilities and their recommended use.267

56

Questions for Consideration: 1) In what scenarios might talking about media be helpful for your family, group or organization?

2) How can you prepare a child to engage in the world of technology as an adult?

3) How will you stay up-to-date on new technologies?

Resources 1

Twelve Tips for Parenting in the Digital Age Desiring God Click Here »

2

Four Conversations Parents Should Have With Their Kids About Digital Devices Desiring God Click Here »

3

Talking About Sexting With Your Children American Academy of Pediatrics Click Here »

57

Don’t Use Technology to Reward or Placate Using technology to incentivize good behavior or to soothe an upset child may teach or reinforce unhealthy habits.

How to Move Beyond Technology Incentives Step 1.

Engagement Over Distraction: When a child cries, don’t hand him or her a device. Choose to engage instead of distract. Understand that a child’s cry is an opportunity for you to meet his or her needs, thus building and reinforcing a healthy child-adult relationship.

Step 2.

Managing Feelings: Rather than using technology to reward or placate, teach children to manage their emotions instead of ignoring or repressing them.268

Step 3.

Foster Internal Motivation: Using technology as a reward for schoolwork, chores, or other proactive engagement encourages children to work for an external reward, rather than the satisfaction of a job well done.

58

Questions for Consideration: 1) How have you used technology to reward or placate your children?

Yourself?

2) How will you replace technology with more effective and healthy reward systems?

3) How can you help children learn to manage emotions?

Resources 1

12 Ways Your Phone is Changing You Tony Reinke Click Here »

2

Screen Time Should NOT Be A Reward Screen Free Parenting Click Here »

3

An Age-by-Age Guide to Helping Kids Manage Emotions Sanya Pelini Click Here »

59

Introduce Alternatives “Technology enables us to treat interaction with the material world— people, places, things—as an abstraction. Getting our hands dirty, so to speak, with gardening, cooking, sewing, exercise, and the like, is a crucial way of restoring our sense of connection with the real world.”

-Rod Dreher When we set boundaries and limits on technology use, it is important to find healthy, fun activities to fill the time young people would have otherwise spent engaging with technology. This is particularly critical for young children as outside playing, reading, and talking with adults is associated with positive cognitive and language development.269 Introducing alternatives to technology use such as play is one way to move beyond conflict over boundaries and toward excitement for new activities and routines.

Outside play is a brain building exercise available to children of every age. Whether with peers, adults, or alone, play provides children a safe space to practice life skills without activating the stress response.270 This creative practice requires children to respond differently in new scenarios, which hard wires the mind to be more adaptable into adulthood.271 The developmental benefits gained when children engage with the real world and people around them are substantial. While technology activates reward systems, play engages the mind in a multidisciplinary way. Its’ unstructured272 environment bolsters resilience,273 cognition, social, and emotional development.274

60

How to Create Excitement Around Technology Alternatives Step 1.

Focus on what you CAN do, instead of what you can’t. Options like reading, outside activities, and playing games which can replicate the same rewarding benefits found from tech use.

Step 2.

Balance independent play and child-caregiver play. Find some alternatives that do not require constant supervision or direction.

Step 3.

Start small. One hour spent engaging in non-technological activities is a great first step... for both children and adults!

Questions for Consideration: 1) What age-appropriate alternatives do you currently use that your children enjoy?

2) What new alternatives can you introduce for the children?

3) How will you go about lowering tech time and increasing alternate activity time?

61

Resources

62

1

S.P.O.I.L. Them Daily Screen Free Parenting Click Here »

2

Last Child in the Woods Richard Louv Click Here »

3

Reset Your Child’s Brain Dr. Victoria Dunckley Click Here »

63

Spend More Intentional Time Together Be there. All there. Spend time without technology and make it easy for kids to connect with you and with each other. When you spend more intentional time together, children naturally have less time to spend on screens. We know it’s not possible to be present every second of the dayeven the best parents are attuned only around 30% of the time275 - but we also know it’s worth putting down our screens to look in little ones’ eyes.

• Start your day thoughtfully. Using a device during breakfast increases the likelihood of using a device during lunch or dinner.276 • Children want to be heard, seen, and acknowledged by a real person, not just through a screen or from behind a screen.

• Primary and secondary caregivers help build and support different aspects of children’s lives -- both play an important role and intentional time with both is valuable.277 • Ideas of time together could include: Family game time, walks, family workouts, coloring or painting as a family, family meal prep for the week, one-on-one time, trivia, reading together, dance party, building a fort, and more.

Questions for Consideration: 1) Do you use technology before or during breakfast? How could you make mealtime more intentional?

2) When during the day could you put aside technology and prioritize quality time? Give one or two concrete examples.

3) How can you thoughtfully create more intentional time with or for children in your role (as parent, caretaker, ministry leader, advocate, etc.)?

64

Remember: Presence is more important than a clean home, a phone call, or that text you have to respond to. The more you spend time with your kids, the more time they’ll want to spend with you!

Resources 1

The Tech-Wise Family Andy Crouch Click Here »

2

Liturgy of the Ordinary Tish Harrison Warren Click Here »

3

12 Ways to Ensure Your Kid is More Important Than Your Phone Motherly Click Here »

65

Discover How to Play When children come from hard places, it can be challenging to learn the carefree, creative structure of play. Barriers like trauma or intellectual and developmental disabilities might require higher support from adults to learn these play skills before they can be done alone or with peers.

Meet John, a 6 year old who has been recently adopted into the U.S. When he goes to school, his friends create magical worlds of pirates, camping, and mermaids. John is initially hesitant about his classmates.

These toys were never in his last home. Unsure of how to join in their games, John instead withdraws to a solitary activity, thus distancing himself from making friends. Several toys in his classroom are unfamiliar and while his classmates naturally play pretend games, John sticks with the activities he feels confident in.

John’s teacher tells his parents about this social isolation observed in the classroom. Together, they make a plan to teach him specific play skills that will encourage his attachment with parents, social skills, and ultimately help him learn how to have fun. They start by choosing specific play schemes that have a beginning, middle, and end. John’s parents choose activities that require at least one more person so that his parents and friends can participate.

Over the next few weeks, John learns how to play cashier, shopping, doctor, and camping. His parents start with one scheme at a time and break down each step within that scheme to teach John how it works.

They make sure to start small and then expand to more activities.

After John learned how to play, he felt confident enough to approach peers and finally understood what play looks like. The foundational knowledge his parents provided opened the door for John to access a critical component of healthy child development. Working on these specific skills brought John and his parents closer together because they

66

now had a shared activity to bond with. Once his peers realized that John wanted to play with them, they quickly accepted him into their social circle. Soon enough, he began to enjoy school because it was an opportunity to engage with friends, learn, and ultimately have fun.

Questions for Consideration: 1) What types of screen-free play do the children in your family or ministry enjoy?

2) What is are some independent play activities you can introduce?

3) What are some play activities you can engage in with your children?

Resources 1

Developmentally Appropriate Activities for All Ages Child Fun Click Here »

2

Tips to Select Toys for Children with Special Needs Move Forward PT Click Here »

3

Play at Different Ages and Developmental Stages familyeducation Click Here » 67

Admit When Outside Help is Needed There are some situations in which outside assistance is necessary- there is no shame in that, only great wisdom and courage in seeking needed support. While all OVC have a history of hardship, some children may additionally experience developmental, intellectual, emotional, mental or behavioral disorders. Thankfully, there are professional resources available to support caregivers, families, and clinicians.

How? • Gather resources on the best therapist for your child’s needs.

• Don’t be afraid to try. Go with your child.

• Commit to the process: financially, time-wise, and as a family or individual. Be willing to do the homework.

Questions for Consideration: 1) Do you have hesitations or fears surrounding seeking outside resources?

2) What are you willing to sacrifice to make this a priority for your family/child?

3) Are you willing to do the work necessary to help your child thrive?

68

Resources 1

Directory of Adoption Competent Professionals C.A.S.E. Click Here »

2

TBRI Practitioner List Karyn Purvis Institute of Child Development Click Here »

3

11 Signs That Your Child May Need a Therapist Cleveland Clinic Click Here »

04 Guidelines and Guardrails for Keeping Vulnerable Children Safe in a Digital World 69

Conclusion "I HAVE TOLD YOU THESE THINGS, SO THAT IN ME YOU MAY HAVE PEACE. IN THIS WORLD YOU WILL HAVE TROUBLE. BUT TAKE HEART! I HAVE OVERCOME THE WORLD.” -JOHN 16:33

Kids from hard places are more vulnerable to technology addiction and other negative outcomes related to technology. Trauma changes the structure of the brain, resulting in poor impulse control, attachment issues, problematic affect regulation, and mood disorders.

Technology also changes brain structure, reducing the amount of gray matter responsible for cognitive control and affecting the release of neurotransmitters responsible for experiencing emotions like happiness. When children whose brains are already vulnerable because of the adversity they have experienced are exposed to technology, they are disproportionately likely to become addicted to social media, pornography, and video games; these addictions themselves have negative outcomes like depression, early sexual activity, and physical and sexual aggression.

But there is hope.

God designed our brains to change and heal. With time and positive input, the work of trauma can slowly be undone.

God also designed us to be in relationship with each other, even -- and perhaps especially -- in this age of technology. We press into the hard places, ask good and thoughtful questions, set healthy boundaries, and pursue quality time with intensity and commitment. We pray for healing, understanding that change is usually a process and not a moment. We cling to Jesus’ words in John 10:10, “The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full.”

“You have made us for yourself, and our heart is restless until it rests in you.”

–St. Augustine

71

To aid you in the journey, here are a few examples of boundaries and goals that may help your family or ministry, many inspired by The TechWise Family : • Designate one tech-free room of the house as a sacred space • Verbally tell kids why you are using technology (for example “I have to send Grandma a message about dinner” or, “I have to write my book now”) • Choose not to have TVs in bedrooms • Keep one hour per day, one day per week, and one week per year completely technology free • Try to create more than you consume on any given day • No laptops or phones used in kids beds • Use a system like Circle, to help turn on or turn off the WiFi and view all usage, especially when parents aren’t home • In person is preferable to video calls, video calls are preferable to a phone call, and a phone call is preferable to text • Put down your screen and acknowledge people when they enter a room • When out of the home ask the question, “do I need my phone for this activity, or could it be left in the car so I can be more present?”

• Don’t passively turn on the television or video games • Charge all family phones outside the bedroom, in a public place, so it’s not a temptation right before bed or first thing in the morning • Whether creating or consuming digital media, the heart and motive is more important than what or how you are consuming it

72

73

Notes

74

75

1 Bailin, A., Milanaik, R., & Adesman, A. (2014). Health implications of new age technologies for adolescents: A review of the research. Current Opinion in Pediatrics, 26(5), 605–619.

2 Whittle H., Hamilton-Giachritsis C., Beech A., Collings G. (2013). A review of young people’s vulnerabilities to online grooming. Aggression and Violent Behavior, 18(1),135–146.

3 Coyne, S. M. (2016). Effects of viewing relational aggression on television on aggressive behavior in adolescents: A three-year longitudinal study. Developmental Psychology, 52(2), 284–295.

4 He, W., Qi, A., Wang, Q., Wu, H. Zhang, Z., Gu, R., & Luo, W. (2017). Abnormal reward and punishment sensitivity associated with Internet addicts. Computers in Human Behavior, 75, 678-683.

5 Talks at Google. (2015, October 30). Sherry Turkle: "Reclaiming Conversation" | Talks at Google [Video file]. Retrieved from https://www.youtube.com/watch?v=awFQtX7tPoI. 6 Gen 1:27, 1:31;(God is pleased,made in God’s image); John 1:14 (Trinity); 1 Thes. 5:23, Gen 2:7 (Body + Soul); Matt 10:29-31 (God’s care for our bodies).

7 Anderson, M.L. (2011). Earthen Vessels: Why Our Bodies Matter to Our Faith. Minneapolis: Bethany House.

8 Johnson, M. (n.d.). Perichoresis, The Person of Christ and...Pornography?: A Constructive Theological Essay. [In process.]

9 Volf, M. (1997). After Our Likeness: The Church as the Image of the Trinity. Grand Rapids: Eerdmans.

10 Genesis 2:1-3, Psalm 127:2, Mark 2:27, Hebrews 4:9-11 11 Psalm 127:3-5, Matthew 18:2-6, 10 12 Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2015). Prevalence of childhood exposure to violence, crime, and abuse: Results from the national survey of children’s exposure to violence. JAMA Pediatrics, 169(8), 746-754.

13 Harvard Center on the Developing Child. (n.d.). InBrief: The science of neglect. Retrieved from https://developingchild.harvard.edu/resources/inbrief-the-science-of-neglect-video/ 14 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 14, 4, 245-258.

15 Administration for Children and Families. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS-4). Retrieved from: https://www.acf.hhs.gov/sites/default/ files/opre/nis4_report_congress_full_pdf_jan2010.pdf 16 Zero to Three. (2019). Early Development & Well-Being. Retrieved from https://www. zerotothree.org/early-development 17 Mah, V. K. & Ford-Jones, E. L. (2010). Spotlight on middle childhood: Rejuvenating the ‘forgotten years.’ Paediatr Child Health. 17(2) 81-83.

18 Harvard Center on the Developing Child. (2005). Excessive Sleep Disrupts the Architecture of the Developing Brain: Working Paper 3. Retrieved from: https://developingchild. harvard.edu/wp-content/uploads/2005/05/Stress_Disrupts_Architecture_Developing_ Brain-1.pdf 19 Wilke, N., Morgan, M. & Pangborn, A. (2018). The Changing Brain: Created to Heal. Retrieved from https://issuu.com/christianalliancefororphans/docs/the_changing_brain_single_page 20 Harvard Health Publishing. (2011). Understanding the stress response: Chronic activation of this survival mechanism impairs health. Retrieved from https://www.health.harvard. edu/stayinghealthy/understanding-the-stress-response

76

Diamond, G. M., Lipsitz, J. & Hoffman, Y. (2013). Pathological Response to Ongoing Traumatic Stress. Peace and Conflict Journal of Peace Psychology, 19(2).

22 Franke, H. (2014). Toxic Stress: Effects, Prevention and Treatment. Children (Basel), 1(3) 390-402.

23 Harvard Center on the Developing Child. (n.d.) Key Concepts: Toxic Stress. Retrieved from: https://developingchild.harvard.edu/science/key-concepts/toxic-stress/ 24 Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic – pituitary – adrenocortical axis in humans. Psychological Bulletin, 133, 25–45.

25 Dobrova-Krol, N. A., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Cyr, C., & Juffer, F. (2008). Physical growth delays and stress dysregulation in stunted and non-stunte d Ukrainian institution-reared children. Infant Behavior and Development, 31(3), 539-553.

26 Dozier, M., Manni, M., Gordon, M. K., Peloso, E., Gunnar, M. R., Stovall-McClough, K. C., . . . Levine, S. (2006). Foster children’s diurnal production of cortisol: An exploratory study.

Child maltreatment, 11(2), 189-197.

27 Gunnar, M. R., Morison, S. J., Chisholm, K., & Schuder, M. (2001). Salivary cortisol levels in children adopted from Romanian orphanages. Development and Psychopathology, 13(3), 611-628.

28 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14 (4) 245-258.

29 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14 (4), 245-258.

30 Starecheski, L. (2015). Take the ACE Quiz- And learn what it does and doesn’t mean. National Public Radio. Retrieved from: https://www.npr.org/sections/healthshots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesntmean 31 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.

32 Brown, D.W., Anda, R.F., Tiemeier, H., Felitti, V.J., Edwards, V.J., Croft, J.B., Giles, W.H. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37(5) 389-396.

33 Centers for Disease Control and Prevention. (n.d.) About the CDC- Kaiser ACE Study.

Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/ about.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Fabout.html 34 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 4, 245-258.

35 Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., Anda, R. F. (2004).

Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders. 217- 225.

21

77

Frodl, T., Reinhold, E., Koutsouleris, N., Reiser, M., & Meisenzahl, E. M. (2010). Interaction of childhood stress with hippocampus and prefrontal cortex volume reduction in major depression. Journal of Psychiatric Research, 44(13), 799-807.

37 Campbell, J. A., Walker, R. J., Egede, L. E. (2016). Associations Between Adverse Childhood Experiences, High-Risk Behaviors and Morbidity in Adulthood. American Journal of Preventive Medicine, 50(3) 344-352.

38 Ha, Thao., Granger A., Douglas. (2016). Family relations, stress, and vulnerability: Biobehavioral implications for prevention and practice. Interdisciplinary Journal of Applied Family Studies, 65, 9-23.

39 Ha, Thao., Granger A., Douglas. (2016). Family Relations, Stress, and Vulnerability: Biobehavioral Implications for Prevention and Practice. Interdisciplinary Journal of Applied Family Studies, 65, 9-23.

40 McEwen, B. S. (2000). The neurobiology of stress: From serendipity to clinical relevance.

Brain Research, 886, 172 – 189.

41 The Science of Neglect. (n.d.). Retrieved from https://developingchild.harvard.edu/resources/the-science-of-neglect-the-persistent-absence-of-responsive-care-disrupts-thedeveloping-brain 42 Edmiston, E., Wang, F., Mazure, C., Guiney, J., Sinha, R., Mayes, L., & Blumberg, H. (2011).

Corticostriatal limbic gray matter morphology in adolescents with self-reported exposure to childhood maltreatment. Archives of Pediatric and Adolescent Medicine, 165(12), 10691077.

43 Mehta, M. A., Golembo, N. I., Nosarti, C., Colvert, E., Mota, A., Williams, S. C., . . . Sonuga-Barke, E. J. (2009, August). Amygdala, hippocampal and corpus callosum size following severe early institutional deprivation: The English and Romanian Adoptees study pilot.

Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19457047 44 Tottenham, N., Hare, T. A., Quinn, B. T., McCarry, T. W., Nurse, M., Gilhooly, T., . . . Casey, B. J. (2010, January 01). Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation. Retrieved from https://www.ncbi. nlm.nih.gov/pubmed/20121862 45 Tottenham, N., Hare, T. A., Millner, A., Gilhooly, T., Zevin, J. D., & Casey, B. J. (2011, March).

Elevated amygdala response to faces following early deprivation. Retrieved from https:// www.ncbi.nlm.nih.gov/pubmed/21399712 46 Gee, D. G., Gabard-Durnam, L. J., Flannery, J., Goff, B., Humphreys, K. L., Telzer, E. H., . . .

Tottenham, N. (2013, September 05). Early developmental emergence of human amygdala–prefrontal connectivity after maternal deprivation. Retrieved from https://www.pnas. org/content/early/2013/09/04/1307893110.short 47 Toxic Stress Disrupts Brain Architecture. (n.d.). Retrieved from https://developingchild. harvard.edu/resources/wp3/ 48 Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009, June). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Retrieved from https:// www.ncbi.nlm.nih.gov/pubmed/19401723\ 49 Starecheski, L. (2015). Take the ACE Quiz- And learn what it does and doesn’t mean. National Public Radio. Retrieved from: https://www.npr.org/sections/healthshots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesntmean 50 Postman, N. (1993). Technopoly. Vintage Books: New York.

51 Science Daily. (2014). Lower verbal test scores for toddlers who play non-educational games on touch screens. North Shore-Long Island Jewish Health Systems. Retrieved from: 36

78

https://www.sciencedaily.com/releases/2014/05/140503082728.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fliving_ well+%28Living+Well+News+--+ScienceDaily%29#.U2Yu-4vm8A8.email 52 Smith, A. (2014). Older Adults and Technology Use. Pew Research Center: Internet & Technology. Retrieved from: http://www.pewinternet.org/2014/04/03/older-adults-and-technology-use/ 53 Erikson Institute. (2018). Technology and Young Children. Retrieved from: https://www. erikson.edu/wp-content/uploads/2018/07/Erikson-Institute-Technology-and-Young-Children-Survey.pdf 54 OECD. (n.d.). Children & Young People’s Mental Health in the Digital Age. Retrieved from: http://www.oecd.org/els/health-systems/Children-and-Young-People-MentalHealth-in-the-Digital-Age.pdf 55 United Nations Children’s Fund (UNICEF) (2017). The state of the world’s children 2017: Children in a digital world. Retrieved from https://www.unicef.org/publications/files/ SOWC_2017_ENG_WEB.pdf.

56 http://www.oecd.org/els/health-systems/Children-and-Young-People-Mental-Health-inthe-Digital-Age.pdf 57 Kardefelt-Winther, D. (2017, December). How does the time children spend using digital technology impact their mental well-being, social relationships and physical activity? An evidence-focused literature review. Retrieved from https://www.unicef-irc.org/publications/pdf/Children-digital-technology-wellbeing.pdf.

58 Swist, T., Collin, P., McCormack, J., & Third, A. (2015, July). Social media and the wellbeing of children and young people: A literature review. Retrieved from http://www.uws.edu. au/__data/assets/pdf_file/0019/930502/Social_media_and_children_and_young_people.pdf 59 Albertson KM, Moreno MA, Garrison MM, Evans YN, Ahrens KR. Impacts of media on sexual behaviour and relationships among youth in foster care. Child & Family Social Work, 23, 88–96. https://doi.org/10.1111/cfs.12387.

60 Canadian Paediatric Society, Digital Health Task Force, Ottawa, Ontario (2017). Screen time and young children: Promoting health and development in a digital world. Paediatrics & Child Health, 22(8), 461-468. https://doi.org/10.1093/pch/pxx123 61 Canadian Paediatric Society, Digital Health Task Force, Ottawa, Ontario (2017). Screen time and young children: Promoting health and development in a digital world. Paediatrics & Child Health, 22(8), 461-468. https://doi.org/10.1093/pch/pxx123 62 Canadian Paediatric Society, Digital Health Task Force, Ottawa, Ontario (2017). Screen time and young children: Promoting health and development in a digital world. Paediatrics & Child Health, 22(8), 461-468. https://doi.org/10.1093/pch/pxx123 63 Elgersma, C. (2018, January 24). New Strategies to Get Kids to Create Media, Not Just Consume It. Retrieved from https://www.commonsensemedia.org/blog/new-strategies-toget-kids-to-create-media-not-just-consume-it 64 Radovic, A., Gmelin, T., Stein, B. D., & Miller, E. (2017). Depressed adolescents' positive and negative use of social media. Journal of adolescence, 55, 5-15.

65 Bergen, D. (2015). Potential effects of a technology pervasive world on young children’s brain development. Pediatrics & Therapeutics, 5:3.

66 Bavelier, D. Green, C. S., Dye, M. W. G. (2010). Children wired- for better and for worse.

Neuron, 67(5) 692-701.

67 Harvard Center on the Developing Child (n.d.). What is early childhood development?

A guide to the science. Retrieved from: https://developingchild.harvard.edu/resources/ five-numbers-to-remember-about-early-childhood-development/

79

Bergen, D. (2015). Potential effects of a technology pervasive world on young children’s brain development. Pediatrics & Therapeutics, 5:3.

69 Liu, M., & Luo, J. (2015). Relationship between peripheral blood dopamine level and internet addiction disorder in adolescents: A pilot study. International Journal of Clinical and Experimental Medicine, 8(6),.

70 Hou, H., Jia, S., Hu, S., Fan, R., Sun, W., Sun, T., & Zhang, H. (2012). Reduced striatal dopamine transporters in people with internet addiction disorder. Journal of Biomedicine and Biotechnology, 2012.

71 Liu, M., & Luo, J. (2015). Relationship between peripheral blood dopamine level and internet addiction disorder in adolescents: A pilot study. International Journal of Clinical and Experimental Medicine, 8(6).

72 Weinstein, A., & Lejoyeux, M. (2013). New developments on the neurobiological and pharmaco-genetic mechanisms underlying internet and videogame addiction. The American Journal on Addictions.

73 Zhang, H., Jiang, W., Lin, Z., Du, Y., & Vance, A. (2013). Comparison of Psychological Symptoms and Serum Levels of Neurotransmitters in Shanghai Adolescents with and without Internet Addiction Disorder: A Case-Control Study. PLoS ONE, 8(5).

74 Wood, B., Rea, M. S., Plitnick, B., & Figueiro, M. G. (2013). Light level and duration of exposure determine the impact of self-luminous tablets on melatonin suppression. Applied Ergonomics, 44(2), 237-240.

75 Wang, H., Jin, C., Yuan, K., Shakir, T. M., Mao, C., Niu, X., . . . Zhang, M. (2015). The alteration of gray matter volume and cognitive control in adolescents with internet gaming disorder. Frontiers in Behavioral Neuroscience, 9.

76 Zhou, Y., Lin, F., Du, Y., Qin, L., Zhao, Z., Xu, J., & Lei, H. (2011). Gray matter abnormalities in Internet addiction: A voxel-based morphometry study. European Journal of Radiology, 79(1), 92-95.

77 Yuan, K., Qin, W., Wang, G., Zeng, F., Zhao, L., Yang, X., . . . Tian, J. (2011). Microstructure Abnormalities in Adolescents with Internet Addiction Disorder. PLoS ONE, 6(6).

78 Lin, F., Zhou, Y., Du, Y., Qin, L., Zhao, Z., Xu, J., & Lei, H. (2012). Abnormal White Matter Integrity in Adolescents with Internet Addiction Disorder: A Tract-Based Spatial Statistics Study. PLoS ONE, 7(1).

79 Liu, J., Esmail, F., Li, L., Kou, Z., Li, W., Gao, X, Wang, Z., Tan, C., Zhang, Y., Zhou, S. (2013).

Decreased frontal lobe function in people with internet addiction disorder. Neural Regeneration Research, 8(34) 3225-3232.

80 Johnson, S.B., Blum, R. W., Giedd, J. N. (2009). Adolescent Maturity and the Brain: The Promise and Pitfalls of Neuroscience Research in Adolescent Health Policy. Journal of Adolescent Health, 45(3) 216-221.

81 Bedrosian, T. A. & Nelson, R. J. (2017). Timing of light exposure affects mood and brain circuits. Transl Psychiatry, 7(1). E1017.

82 Cheung, C. H., M., Bedford, R., Saez De Urabain, I., Karmiloff-Smith, A., Smith, T. J. (2017).

Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset. Sci Rep, 7:46104.

83 Liu, M., & Luo, J. (2015). Relationship between peripheral blood dopamine level and internet addiction disorder in adolescents: A pilot study. International Journal of Clinical and Experimental Medicine, 8(6).

84 Hou, H., Jia, S., Hu, S., Fan, R., Sun, W., Sun, T., & Zhang, H. (2012). Reduced striatal dopamine transporters in people with internet addiction disorder. Journal of Biomedicine and Biotechnology, 2012.

68

80

Weinstein, A., & Lejoyeux, M. (2013). New developments on the neurobiological and pharmaco-genetic mechanisms underlying internet and videogame addiction. The American Journal on Addictions.

86 Zhang, H., Jiang, W., Lin, Z., Du, Y., & Vance, A. (2013). Comparison of Psychological Symptoms and Serum Levels of Neurotransmitters in Shanghai Adolescents with and without Internet Addiction Disorder: A Case-Control Study. PLoS ONE, 8(5).

87 Wood, B., Rea, M. S., Plitnick, B., & Figueiro, M. G. (2013). Light level and duration of exposure determine the impact of self-luminous tablets on melatonin suppression. Applied Ergonomics, 44(2), 237-240.

88 Wang, H., Jin, C., Yuan, K., Shakir, T. M., Mao, C., Niu, X., . . . Zhang, M. (2015). The alteration of gray matter volume and cognitive control in adolescents with internet gaming disorder. Frontiers in Behavioral Neuroscience, 9.

89 Zhou, Y., Lin, F., Du, Y., Qin, L., Zhao, Z., Xu, J., & Lei, H. (2011). Gray matter abnormalities in Internet addiction: A voxel-based morphometry study. European Journal of Radiology,79(1), 92-95.

90 Yuan, K., Qin, W., Wang, G., Zeng, F., Zhao, L., Yang, X., . . . Tian, J. (2011). Microstructure Abnormalities in Adolescents with Internet Addiction Disorder. PLoS ONE, 6(6).

91 Lin, F., Zhou, Y., Du, Y., Qin, L., Zhao, Z., Xu, J., & Lei, H. (2012). Abnormal White Matter Integrity in Adolescents with Internet Addiction Disorder: A Tract-Based Spatial Statistics Study. PLoS ONE, 7(1).

92 Heim, C., Plotsky, P. M., & Nemeroff, C. B. (2004). Importance of studying the contributions of early adverse experience to neurobiological findings in depression. Neuropsychopharmacology, 29(4), 641-648.

93 The Science of Neglect. (n.d.). Retrieved from https://developingchild.harvard.edu/resources/the-science-of-neglect-the-persistent-absence-of-responsive-care-disrupts-thedeveloping-brain 94 Edmiston, E., Wang, F., Mazure, C., Guiney, J., Sinha, R., Mayes, L., & Blumberg, H. (2011).

Corticostriatal limbic gray matter morphology in adolescents with self-reported exposure to childhood maltreatment. Archives of Pediatric and Adolescent Medicine, 165(12), 10691077.

95 Frodl, T., Reinhold, E., Koutsouleris, N., Reiser, M., & Meisenzahl, E. M. (2010). Interaction of childhood stress with hippocampus and prefrontal cortex volume reduction in major depression. Journal of Psychiatric Research, 44(13), 799-807.

96 Lupien, S. J., De, M., De, S., Convit, A., Tarshish, C., Nair, N. P., . . . Meaney, M. J. (1998).

Cortisol levels during human aging predict hippocampal atrophy and memory deficits.

97 Toxic Stress Disrupts Brain Architecture. (n.d.). Retrieved from https://developingchild. harvard.edu/resources/wp3/ 98 Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009, June). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Retrieved from https:// www.ncbi.nlm.nih.gov/pubmed/1940172 99 Gilmore, J. H., Lin, W., Prasatwa, M. W., Looney, C. B., Vetsa, Y.S., Knickmeyer, R.C., ‌ Gerig, G. (2007). Regional gray matter growth, sexual dimorphism, and cerebral asymmetry in the neonatal brain. Journal of Neuroscience, 27(6), 1255-1260.

100 Harvard Center on the Developing Child. (2017) InBrief: The Science of Early Childhood Development. Retrieved from https://developingchild.harvard.edu/resources/inbrief-science-of-ecd/.

101 Huttenlocher, P. (2002). Neural Plasticity: The Effects of the Environment on the Development of the Cerebral Cortex. Cambridge, Massachusetts: Harvard University Press.

85

81

Greer, D. C. L. (2018). Screen media, prosocial behavior, and aggression: Does attachment moderate effects of exposure (Order No. 10816505). Available from ProQuest Dissertations & Theses A&I. (2043414701).

103 Bowlby, J. (1997). Attachment. Pimlico.

104 Babic, M. J., Smith, J. J., Morgan, P. J., Eather, N., Plotnikoff, R. C., & Lubans, D. R. (2017).

Longitudinal associations between changes in screen-time and mental health outcomes in adolescents. Mental Health and Physical Activity, 12, 124-131.

105 Hovens, J. G. F. M., Giltay, E. J., Wiserma, J. E., Spinhoven, P., Penninx, B. W. J. H., Zitman, F. G. (2012) Impact of childhood life events on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica, 126, 3 198-207.

106 Kajeepeta, S., Gelaye, B., Jackson, C. L. & Williams, M. A.(2015). Adverse childhood experiences are associated with adult sleep disorders: a systematic review. Sleep Medicine, 16, 3 320-330 107 Wilke, N. & Howard, M. (2019) Vulnerable Children in a Digital Age: The Relationship Between Early Adversity and Technology Use, Misuse, and Abuse (In Process). Christian Alliance for Orphans, McLean, VA. 108 Wilke, N. & Howard, M. (2019) Vulnerable Children in a Digital Age: The Relationship Between Early Adversity and Technology Use, Misuse, and Abuse (In Process). Christian Alliance for Orphans, McLean, VA. 109 Wilke, N. & Howard, M. (2019) Vulnerable Children in a Digital Age: The Relationship Between Early Adversity and Technology Use, Misuse, and Abuse (In Process). Christian Alliance for Orphans, McLean, VA. 110 Wilke, N. & Howard, M. (2019) Vulnerable Children in a Digital Age: The Relationship Between Early Adversity and Technology Use, Misuse, and Abuse (In Process). Christian Alliance for Orphans, McLean, VA. 111 Ainsworth, M. D. S. (1989). Attachments beyond infancy. American Psychologist, 8.

112 Bowlby, J. (1997). Attachment. Pimlico.

113 Ainsworth, M. D. S. (1989). Attachments beyond infancy. American Psychologist, 8.

114 Bowlby, J. (1997). Attachment. Pimlico.

115 Bowlby, J. (1997). Attachment. Pimlico.

116 Belsky, J. & Nezworski, T. M. (2015). Clinical Implications of Attachment. Routledge.

117 Chisholm, K., Carter, M. C., Ames, E. W., & Morrison, S. J. (1995) 118 Leslie, L. K., Hurlburt, M. S, Landsverk, J., Rolls, J. A., Wood, P. A., & Kelleher, K. J. (2003).

Comprehensive Assessments for Children Entering Foster Care: A National Perspective.

Pediatrics, 112(1), 134-142.

119 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 4, 245-258.

120 Murphy, A., Steele, M., Dube, S. R., Bate, J., Bonuck, K., Meissner, P., Goldman, H., Steele, H. (2014). Adverse Childhood Experiences (ACEs) Questionnaire and Adult Attachment Interview (AAI): Implications for parent child relationships. Child Abuse & Neglect, 38, 2 224-233.

121 Wilke, N. & Howard, M. (2019) Vulnerable Children in a Digital Age: The Relationship Between Early Adversity and Technology Use, Misuse, and Abuse (In Process). Christian Alliance for Orphans, McLean, VA. 122 Blackwell, D., Leaman, C., Tramposch, R., Osborne, C., Liss, M. (2017). Extraversion, neuroticism, attachment style and fear of missing out as predictors of social media use and 102

82

addiction. Personality and individual differences, 116(1) 69-72.

123 Lei, L., Wu, Y. (2007). Adolescents’ Paternal Attachment and Internet Use. CyberPsychology & Behavior. 10 (5).

124 Villani, S. (2001). Impact of media on children and adolescents: a 10-year review of the research. Journal of the American Academy of Child & Adolescent Psychiatry, 40(4), 392401.

125 Twenge, J. M. (2018). Amount of Time Online Is Problematic if It Displaces Face-to-Face Social Interaction and Sleep. Clinical Psychological Science.,.

126 Greer, D. C. L. (2018). Screen media, prosocial behavior, and aggression: Does attachment moderate effects of exposure (Order No. 10816505). Available from ProQuest Dissertations & Theses A&I. (2043414701).

127 Morris, N. W., & Reilly, N. P. (1987). Toward the self-regulation of mood: Theory and research. Motivation and Emotion, 11,3 215-249 128 Morris, N. W., & Reilly, N. P. (1987). Toward the self-regulation of mood: Theory and research. Motivation and Emotion, 11,3 215-249 129 McCrory, E., De Brito, S.A., Vinding, E. (2010). Research Review: the neurobiology and genetics of maltreatment and adversity. Journal of Child Psychology Psychiatry, 51(10) 1079-1095.

130 McCroy, E., De Brito, S. A., Vindig, E. (2012). The link between child abuse and psychopathology: A review of neurobiological and genetic research. J R Soc Med. 131 Teicher, M. H. (2000). Wounds that time won’t heal: The neurobiology of child abuse.

Cerebrum: The Dana Forum on Brain Science. 2(4). Retrieved from: http://citeseerx.ist.psu. edu/viewdoc/download?doi=10.1.1.454.896&rep=rep1&type=pdf 132 Blair, C. & Raver, C. C. (2012). Child Development in the Context of Anxiety: Experiential Canalization of Brain and Behavior. American Psychology, 67(4) 309-318.

133 Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media and adolescent wellbeing: A systematic narrative review. Children and Youth Services Review, 41, 27-36.

134 Schimmenti, A., Passanisi, A., Caretti, V., La Marca, L., Granieri, A., Iacolino, C., … Billieux, J. (2017). Traumatic experiences, alexithymia, and Internet addiction symptoms among late adolescents: A moderated mediation analysis. Addictive Behaviors, 64, 314–320.

135 Primack, B. A., Shensa, A., Sidani, J. E., Whaite, E. O., yi Lin, L., Rosen, D., ... & Miller, E. (2017). Social media use and perceived social isolation among young adults in the US. American Journal of Preventive Medicine, 53(1), 1-8.

136 Raman, S., Guerrero-Duby, S., McCullough, J. L., Brown, M., Ostrowski-Delahanty, S., Langkamp, D., & Duby, J. C. (2017). Screen Exposure During Daily Routines and a Young Child’s Risk for Having Social-Emotional Delay. Clinical Pediatrics, 56(13), 1244-1253.

137 Babic, M. J., Smith, J. J., Morgan, P. J., Eather, N., Plotnikoff, R. C., & Lubans, D. R. (2017).

Longitudinal associations between changes in screen-time and mental health outcomes in adolescents. Mental Health and Physical Activity, 12, 124-131.

138 Twenge, J. M., Martin, G. N., & Campbell, W. K. (2018). Decreases in Psychological Well-Being Among American Adolescents After 2012 and Links to Screen Time During the Rise of Smartphone Technology. Emotion, 18(6), 765-780.

139 van der Kolk, B. A. (2003) The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatry Clinics, 12 293-317.

140 Retrospective Reports of Childhood Trauma in Adults with ADHD. Journal of Attention Disorders, 9(4) 631-641.

83

van der Kolk, B. A. (2003) The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatry Clinics. 12 293-317.

142 A Guide to Toxic Stress. (n.d.) Harvard Center for the Developing Child. Retrieved from: https://developingchild.harvard.edu/guide/a-guide-to-toxic-stress/ 143 Retrospective Reports of Childhood Trauma in Adults with ADHD. Journal of Attention Disorders, 9(4) 631-641.

144 Fuller-Thompson, E., Lewis, D. (2015). The relationship between early adversities and attention-deficit/ hyperactivity disorder. Child Abuse & Neglect, 47 94-101.

145 Pingault, J., Tremblay, R. E., Vitaro, F., Carbonneau, R., Genolini, C., Falissard, B., Cote, S. M. (2011). Childhood Trajectories of Inattention and Hyperactivity and Prediction of Educational Attainment in Early Adulthood: A 16-Year Longitudinal Population-Based Study.

Psychiatry Research, 219(3) 707-709 146 Lundervold, A. J., Boe, T., Lundervold, A. (2017). Inattention in primary school is not good for your future school achievement- a pattern classification study. PLoSONE, 12(11).

147 Young, K. S. (1999). Internet addiction: Evaluation and Treatment. Student British Medical Journal, 7.

148 Sinha, R. (2008). Chronic stress, drug use and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 1. 105-130.

149 Christakis, D. A., Zimmerman, F. J., DiGiuseppe, D. L., & McCarty, C. A. (2004b). Early television exposure and subsequent attentional problems in children. Pediatrics, 113(4), 708–713.

150 Rosen, L. D., Carrier, L. M., Cheever, N. A. (2013). Facebook and texting made me do it: Media-induced task-switching while studying. Computers in Human Behavior, 29(3) 948958.

151 Christakis, D. A., Zimmerman, F. J., DiGiuseppe, D. L., & McCarty, C. A. (2004b). Early television exposure and subsequent attentional problems in children. Pediatrics, 113(4), 708–713.

152 George, Madeleine & A. Russell, Michael & Piontak, Joy & L. Odgers, Candice. (2017).

Concurrent and Subsequent Associations Between Daily Digital Technology Use and High‐ Risk Adolescents’ Mental Health Symptoms. Child Development, 89. 10.1111/cdev.12819.

153 Rotunda, R. J., Kass, S. J., Sutton, M. A., Leon, D. T. (2003). Internet Use and Misuse: Preliminary Findings from a New Assessment Instrument. Behavior Modification, 27(4) 484-504.

154 Rotunda, R. J., Kass, S. J., Sutton, M. A., Leon, D. T. (2003). Internet Use and Misuse: Preliminary Findings from a New Assessment Instrument. Behavior Modification, 27(4) 484-504.

155 Carr, N. (2011). The shallows: What the internet is doing to our brains. W. W. Norton & Company, Inc.: New York, New York.

156 Yoo, H. J., Cho, S. C., Ha, J., Yune, S. K., Kim, S. J., Hwang, J., Chung, A., Sung, Y. H., Lyoo, K. (2004). Attention deficit hyperactivity symptoms and internet addiction, Psychiatry Clin Neurosci, 58(5) 487-494.

157 Diagnostic and Statistical Manual of Mental Disorders.(2013). American Psychiatric Association. Fifth Edition.

158 Hovens, J. G. F. M., Giltay, E. J., Wiserma, J. E., Spinhoven, P., Penninx, B. W. J. H., Zitman, F. G. (2012) Impact of childhood life events on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica, 126, 3 198-207.

159 Diagnostic and Statistical Manual of Mental Disorders.(2013). American Psychiatric Association, Fifth Edition.

141

84

Hovens, J. G. F. M., Giltay, E. J., Wiserma, J. E., Spinhoven, P., Penninx, B. W. J. H., Zitman, F. G. (2012) Impact of childhood life events on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica, 126, 3 198-207.

161 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 4, 245-258. DOI: https://doi. org/10.1016/S0749-3797(98)00017-8 162 Chapman, D. P., Whitfield, C. L., Felitti, V.J., Dube, S. R., Edwards, V. J., Anda, R. F. (2003).

Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2004) 217-225.

163 Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17.

164 Calancie, O., Ewing, L., Narducci, L. D., Horgan, S., & Khalid-Khan, S. (2017). Exploring how social networking sites impact youth with anxiety: A qualitative study of Facebook stressors among adolescents with an anxiety disorder diagnosis. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 11(4).

165 Oberst, U., Wegmann, E., Stodt, B., Brand, M., & Chamarro, A. (2017). Negative consequences from heavy social networking in adolescents: The mediating role of fear of missing out. Journal of Adolescence, 55, 51-60.

166 Oberst, U., Wegmann, E., Stodt, B., Brand, M., & Chamarro, A. (2017). Negative consequences from heavy social networking in adolescents: The mediating role of fear of missing out. Journal of Adolescence, 55, 51-60.

167 Lin, L. Y., Sidani, J. E., Shensa, A., Radovic, A., Miller, E., Colditz, J. B., ... & Primack, B. A. (2016). Association between social media use and depression among US young adults.

Depression and Anxiety, 33(4), 323-331.

168 Babic, M. J., Smith, J. J., Morgan, P. J., Eather, N., Plotnikoff, R. C., & Lubans, D. R. (2017).

Longitudinal associations between changes in screen-time and mental health outcomes in adolescents. Mental Health and Physical Activity, 12, 124-131.

169 Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barrett, E. L., Sidani, J. E., Colditz, J. B., & James, A. E. (2017). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among US young adults. Computers in Human Behavior, 69, 1-9.

170 Sun, J., Liu, Q., & Yu, S. (2019). Child neglect, psychological abuse and smartphone addiction among Chinese adolescents: The roles of emotional intelligence and coping style.

Computers in Human Behavior,90, 74-83.

171 Reebye, P. (2005). Aggression During Early Years- Infancy and Preschool. The Canadian Child and Psychiatry Review, 14(1) 16-20.

172 Lee, V., Hoaken, P. N. S. (2007). Cognition, Emotion, and Neurobiological Development: Mediating the Relation Between Maltreatment and Aggression, 12(3) 281-298.

173 Slater MD, Henry KL, Swaim RC, Anderson LL. Violent media content and aggressiveness in adolescents: a downward spiral model. Communic Res. 2003; 30(6):713-736.

174 Coyne, S. M. (2016). Effects of viewing relational aggression on television on aggressive behavior in adolescents: A three-year longitudinal study. Developmental Psychology, 52(2).

175 Reebye, P. (2005). Aggression During Early Years- Infancy and Preschool. The Canadian Child and Psychiatry Review. 14(1) 16-20.

160

85

Shultz, D., Izard, C., Bear, G. (2004). Children’s emotion processing: Relations to emotionality and aggression. Development and Psychopathology, 16(2)371-387.

177 Lee, V., Hoaken, P. N. S. (2007). Cognition, Emotion, and Neurobiological Development: Mediating the Relation Between Maltreatment and Aggression. 12(3) 281-298.

178 Lee, V., Hoaken, P. N. S. (2007). Cognition, Emotion, and Neurobiological Development: Mediating the Relation Between Maltreatment and Aggression. 12(3) 281-298.

179 Coyne, S. M. (2016). Effects of viewing relational aggression on television on aggressive behavior in adolescents: A three‐year longitudinal study. Developmental Psychology, 52(2), 284–295.

180 Slater MD, Henry KL, Swaim RC, Anderson LL. Violent media content and aggressiveness in adolescents: a downward spiral model. Communic Res, 2003;30(6):713-736.

181 George, Madeleine & A. Russell, Michael & Piontak, Joy & L. Odgers, Candice. (2017).

Concurrent and Subsequent Associations Between Daily Digital Technology Use and High‐ Risk Adolescents’ Mental Health Symptoms. Child Development. 89. 10.1111/cdev.12819.

182 Slater MD, Henry KL, Swaim RC, Anderson LL. (2003) Violent media content and aggressiveness in adolescents: a downward spiral model. Communic Res, 30(6) 713-736.

183 Coyne, S. M. (2016). Effects of viewing relational aggression on television on aggressive behavior in adolescents: A three‐year longitudinal study. Developmental Psychology, 52(2), 284–295.

184 Coyne, S. M. (2016). Effects of viewing relational aggression on television on aggressive behavior in adolescents: A three‐year longitudinal study. Developmental Psychology, 52(2), 284–295.

185 Exelmans, L., Custers, K., & Van den Bulck, J. (2015). Violent video games and delinquent behavior in adolescents: A risk factor perspective. Aggressive Behavior, 41, 267-279.

186 Coyne, S. M. (2016). Effects of viewing relational aggression on television on aggressive behavior in adolescents: A three‐year longitudinal study. Developmental Psychology, 52(2), 284–295.

187 Exelmans, L., Custers, K., & Van den Bulck, J. (2015). Violent video games and delinquent behavior in adolescents: A risk factor perspective. Aggressive Behavior.

188 Rubin, K. H., Hymel, Mills, R. S. L. Sociability and Social Withdrawal in Childhood: Stability and outcomes. Journal of Personality, 54(2) 237-255.

189 Whang, L. S., Lee, S., Chang, G. (2004). Internet over-users’ psychological profiles: A behavior sampling analysis on internet addiction. CyberPsychology & Behavior. 6(2) 190 Rubin, K. H., Hymel, Mills, R. S. L. Sociability and Social Withdrawal in Childhood: Stability and outcomes. Journal of Personality, 54(2) 237-255.

191 Rubin, K. H., Hymel, Mills, R. S. L. Sociability and Social Withdrawal in Childhood: Stability and outcomes. Journal of Personality, 54(2) 237-255.

192 Rubin, K. H., Hymel, Mills, R. S. L. Sociability and Social Withdrawal in Childhood: Stability and outcomes. Journal of Personality, 54(2) 237-255.

193 Happe, F., Frith, U. (1996). Theory of mind and social impairment in children with conduct disorder. British Journal of Developmental Psychology, 14, 385-398.

194 Putnam, F. W. (2006). The impact of trauma on child development. Juvenile and family court journal, 57(1) 1-11.

195 Putnam, F. W. (2006). The impact of trauma on child development. Juvenile and family court journal, 57(1) 1-11.

196 Whang, L. S., Lee, S., Chang, G. (2004). Internet over-users’ psychological profiles: A behavior sampling analysis on internet addiction. CyberPsychology & Behavior, 6(2) 197 Whang, L. S., Lee, S., Chang, G. (2004). Internet over-users’ psychological profiles: A 176

86

behavior sampling analysis on internet addiction. CyberPsychology & Behavior, 6(2) 198 Raman, S., Guerrero-Duby, S., McCullough, J. L., Brown, M., Ostrowski-Delahanty, S., Langkamp, D., & Duby, J. C. (2017). Screen Exposure During Daily Routines and a Young Child’s Risk for Having Social-Emotional Delay. Clinical pediatrics, 56(13), 1244-1253.

199 Primack, B. A., Shensa, A., Sidani, J. E., Whaite, E. O., yi Lin, L., Rosen, D., ... & Miller, E. (2017). Social media use and perceived social isolation among young adults in the US. American journal of preventive medicine, 53(1), 1-8.

200 Calancie, O., Ewing, L., Narducci, L. D., Horgan, S., & Khalid-Khan, S. (2017). Exploring how social networking sites impact youth with anxiety: A qualitative study of Facebook stressors among adolescents with an anxiety disorder diagnosis. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 11(4).

201 Calancie, O., Ewing, L., Narducci, L. D., Horgan, S., & Khalid-Khan, S. (2017). Exploring how social networking sites impact youth with anxiety: A qualitative study of Facebook stressors among adolescents with an anxiety disorder diagnosis. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 11(4).

202 Uhls, Y. T., Michikyan, M., Morris, J., Garcia, D., Small, G. W., Zgourou, Greenfield, P. M. (2014). Five days at outdoor education camp without screens improves preteen skills with nonverbal emotion cues. Computers in Human Behavior, 39 387-392.

203 Uhls, Y. T., Michikyan, M., Morris, J., Garcia, D., Small, G. W., Zgourou, Greenfield, P. M. (2014). Five days at outdoor education camp without screens improves preteen skills with nonverbal emotion cues. Computers in Human Behavior, 39 387-392.

204 Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders, 5(3) 685-700.

205 Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders, 5(3) 685-700.

206 Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders, 5(3) 685-700.

207 Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders, 5(3) 685-700.

208 Pediatric Sleep Disorders. Stanford Health Care. Retrieved from: https://stanfordhealthcare.org/medical-conditions/sleep/pediatric-sleep-disorders.html 209 Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders. 5(3) 685-700.

210 Pediatric Sleep Disorders. Stanford Health Care. Retrieved from: https://stanfordhealthcare.org/medical-conditions/sleep/pediatric-sleep-disorders.html 211 Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders, 5(3) 685-700.

212 Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders, 5(3) 685-700.

213 Pediatric Sleep Disorders. Stanford Health Care. Retrieved from: https://stanfordhealthcare.org/medical-conditions/sleep/pediatric-sleep-disorders.html 214 Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders, 5(3) 685-700.

215 Chapman, D. P., Wheaton, A. G., Anda, R. F., Croft, J. B., Edwards, V. J., Liu, Y., Sturgis, S. L., Perry, G. S. Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine, 12(8) 773-779.

216 Rotunda, R. J., Kass, S. J., Sutton, M. A., Leon, D. T. (2003). Internet Use and Misuse.

Behavior Modification, 24(4) 484-504.

217 Chapman, D. P., Wheaton, A. G., Anda, R. F., Croft, J. B., Edwards, V. J., Liu, Y., Sturgis, S. L., Perry, G. S. Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine, 12(8) 773-779.

218 Chapman, D. P., Wheaton, A. G., Anda, R. F., Croft, J. B., Edwards, V. J., Liu, Y., Sturgis, S. L., Perry, G. S. Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine, 12(8) 773-779.

219 Chapman, D. P., Wheaton, A. G., Anda, R. F., Croft, J. B., Edwards, V. J., Liu, Y., Sturgis, S. L., Perry, G. S. Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine, 12(8) 773-779.

87

Sadeh, A. (1996) Stress, Trauma and Sleep in Children. Sleep Disorders, 5(3) 685-700.

Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 4, 245-258.

222 Brand, M., Laier, C., Young, K. S. (2014). Internet addiction: coping styles, expectancies and treatment implications. Frontiers in Psychology, 5(1256) 1-14.

223 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 4, 245-258.

224 Rotunda, R. J., Kass, S. J., Sutton, M. A., Leon, D. T. (2003). Internet Use and Misuse.

Behavior Modification, 24(4) 484-504.

225 Rotunda, R. J., Kass, S. J., Sutton, M. A., Leon, D. T. (2003). Internet Use and Misuse.

Behavior Modification, 24(4) 484-504.

226 Fuller, C., Lehman, E., Hicks, S. (2017) Bedtime use of technology and associated sleep problems in children. Global Pediatric Health, 4, 1-8.

227 Chapman, D. P., Wheaton, A. G., Anda, R. F., Croft, J. B., Edwards, V. J., Liu, Y., Sturgis, S. L., Perry, G. S. Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine, 12(8) 773-779.

228 Mirzaei, M., Ahmadi, K., Saadat, S., Ramezani, M. A. (2016). Instruments of high risk sexual behavior assessment: A systematic review. Mater Sociomed, 28(1) 46-50.

229 Mirzaei, M., Ahmadi, K., Saadat, S., Ramezani, M. A. (2016). Instruments of high risk sexual behavior assessment: A systematic review. Mater Sociomed, 28(1) 46-50.

230 Reyome, N. D. (2009). Childhood Emotional Maltreatment and Later Intimate Relationships: Themes from the Empirical Literature. Journal of Aggression, Maltreatment & Trauma, 19(2) 224-242.

231 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 4, 245-258.

232 Messman-Moore, T. L., Walsh, K. L., DiLillo, D. (2010). Emotion dysregulation and risky sexual behavior in revictimization. Child Abuse & Neglect, 34(12) 967-976.

233 Brain Heart World (n.d.) Discover the harmful effects of pornography. Retrieved from: https://brainheartworld.org/?_ga=2.26560127.396472889.15523238811043712440.1552150462 234 Struthers, W. M. (2009) Wired for Intimacy: How Pornography Hijacks the Male Brain.

IPV Books: Illinois.

235 Reyome, N. D. (2009). Childhood Emotional Maltreatment and Later Intimate Relationships: Themes from the Empirical Literature. Journal of Aggression, Maltreatment & Trauma, 19(2) 224-242.

236 Fight The New Drug. (2017) How Porn Kills Love. Retrieved from https://fightthenewdrug.org/how-porn-kills-love/ 237 Keane, H. (2004). Disorders of Desire: Addiction and Problems of Intimacy. Journal of Medical Humanities, 25(3) 189-204.

238 Jonsson, L. S., Priebe, G., Bladh, M., Svedin, C. G. (2014). Voluntary sexual exposure online among Swedish youth—social background, Internet behavior and psychosocial health.

Computers in Human Behavior, 30, 181–189.

220 221

88

Jonsson, L. S., Priebe, G., Bladh, M., Svedin, C. G. (2014). Voluntary sexual exposure online among Swedish youth—social background, Internet behavior and psychosocial health.

Computers in Human Behavior, 30, 181–189.

240 Felitti, V. J., Anda, R. F., Nordenberg, D. N., Williamson, D. F., Spliz, A. M,, Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 4, 245-258.

241 Mirzaei, M., Ahmadi, K., Saadat, S., Ramezani, M. A. (2016). Instruments of high risk sexual behavior assessment: A systematic review. Mater Sociomed, 28(1) 46-50.

242 Fight the new Drug. (n.d.). Overview of Fight the new Drug. Retrieved from: https:// fightthenewdrug.org/overview/ 243 What is Sexting? KidsHelpPhone Retrieved from: https://kidshelpphone.ca/get-info/ what-sexting/ 244 Houck, C. D., Barker, D., Rizzo, C., Hancock, E., Norton, A., & Brown, L. K. (2014). Sexting and sexual behavior in at-risk adolescents. Pediatrics, 133, 276–282.

245 What is Sexting? KidsHelpPhone Retrieved from: https://kidshelpphone.ca/get-info/ what-sexting/ 246 McManus M. (1986). Final report of the Attorney General’s Commission on Pornography. Nashville, TN: Rutledge Hill Press.

247 Owens, E. W., Behun, R. J., Manning, J. C., Reid, R. C. (2012). The impact of internet pornography on adolescents: A review of the research. Sexual Addiction and Compulsivity, 19(1). 99-122.

248 Flood, M. (2009). The harms of pornography exposure among children and young people. Child abuse review, 18(6) 384-400.

249 Sabina C., Wolak J., & Finkelhor D. (2008). The nature and dynamics of Internet pornography exposure for youth. CyberPsychology & Behavior, 11(6), 691–693.

250 Chyng Sun, Ana Bridges, Jennifer Johnson, and Matt Ezzell, “Pornography and the Male Sexual Script: An Analysis of Consumption and Sexual Relations,” Archives of Sexual Behavior 45, no. 4 (May, 2016): 983–94.

251 Sabina C., Wolak J., & Finkelhor D. (2008). The nature and dynamics of Internet pornography exposure for youth. CyberPsychology & Behavior, 11(6), 691–693.

252 Peter, J. & Valkenburg, P. M. (2016). Adolescents and Pornography: A Review of 20 Years of Research. The Journal of Sex Research, 4-5, 509-531.

253 Braun-Courville, D. K., Rojas, M. (2009). Exposure to sexually explicit web sites and adolescent sexual attitudes and behaviors. Journal of Adolescent Health, 45(2) 156-162.

254 Developing Resilience. (n.d.) Harvard Center on the Developing Child. Retrieved from: https://developingchild.harvard.edu/science/key-concepts/resilience/ 255 Padilla-Walker, L. M., Coyne, S. M., & Collier, K. M. (2016). Longitudinal relations between parental media monitoring and adolescent aggression, prosocial behavior, and externalizing problems. Journal of Adolescence, 46, 86–97.

256 Padilla-Walker, L. M., Coyne, S. M., & Collier, K. M. (2016). Longitudinal relations between parental media monitoring and adolescent aggression, prosocial behavior, and externalizing problems. Journal of Adolescence, 46, 86–97.

257 Canadian Paediatric Society, Digital Health Task Force, Ottawa, Ontario (2017). Screen time and young children: Promoting health and development in a digital world. Paediatrics & Child Health, 22(8), 461-468.

239

89

Collier, K. M., Coyne, S. M., Rasmussen, E. E., Hawkins, A. J., Padilla‐Walker, L. M., Erickson, S. E., & Memmott-Elison, M. K. (2016). Does parental mediation of media influence child outcomes? A meta-analysis on media time, aggression, substance use, and sexual behavior. Developmental Psychology, 52(5), 798–812.

259 Gentile, D. A., Reimer, R. A., Nathanson, A. I., Walsh, D. A., & Eisenmann, J. C. (2014). Protective effects of parental monitoring of children's media use: A prospective study. JAMA Pediatrics, 168(5), 479–484.

260 Valkenburg, P. M., Piotrowski, J., Hermanns, J., & de Leeuw, R. (2013). Developing and validating the Perceived Parental Media Mediation Scale: a self-determination perspective.

Human Communication Research, 39(4), 445e469.

261 Good, B., & Fang, L. (2015). Promoting smart and safe Internet use among children with neurodevelopmental disorders and their parents. Clinical Social Work Journal, 43(2).

262 Greer, D. C. L. (2018). Screen media, prosocial behavior, and aggression: Does attachment moderate effects of exposure (Order No. 10816505). Available from ProQuest Dissertations & Theses A&I. (2043414701). Retrieved from https://search.proquest.com/ docview/2043414701?accountid=11862 263 Valkenburg, P. M., Piotrowski, J., Hermanns, J., & de Leeuw, R. (2013). Developing and validating the Perceived Parental Media Mediation Scale: a self-determination perspective.

Human Communication Research, 39(4), 445e469.

264 Desiring God. (n.d.) Twelve Tips for Parenting in the Digital Age. Retrieved from: https:// www.desiringgod.org/articles/twelve-tips-for-parenting-in-the-digital-age 265 Collier, K. M., Coyne, S. M., Rasmussen, E. E., Hawkins, A. J., Padilla‐Walker, L. M., Erickson, S. E., & Memmott‐Elison, M. K. (2016). Does parental mediation of media influence child outcomes? A meta‐analysis on media time, aggression, substance use, and sexual behavior. Developmental Psychology, 52(5), 798–812.

266 Gentile, D. A., Reimer, R. A., Nathanson, A. I., Walsh, D. A., & Eisenmann, J. C. (2014). Protective effects of parental monitoring of children's media use: A prospective study. JAMA Pediatrics, 168(5), 479–484.

267 Good, B., & Fang, L. (2015). Promoting smart and safe Internet use among children with neurodevelopmental disorders and their parents. Clinical Social Work Journal, 43(2), 179188.

268 Raman, S., Guerrero-Duby, S., McCullough, J. L., Brown, M., Ostrowski-Delahanty, S., Langkamp, D., & Duby, J. C. (2017). Screen Exposure During Daily Routines and a Young Child’s Risk for Having Social-Emotional Delay. Clinical Pediatrics, 56(13), 1244-1253.

269 (Hart & Risley, 1995; Shimpi, Gámez, Huttenlocher, & Vasilyeva, 2007).

270 Wang, S., & Aamodt, S. (2012, September). Play, stress, and the learning brain. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574776/ 271 Pellis, M.|Pellis, S., C.|Himmler, V., & T., B. (2013, November 30). How Play Makes for a More Adaptable Brain: A Comparative and Neural Perspective. Retrieved from https://eric. ed.gov/?id=EJ1043959 272 MacDonald, K. B. (1993). Parent-child play: Descriptions and implications. Albany, NY: State University of New York Press.

273 Ginsburg, K. R. (2007, January 01). The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds. Retrieved from https://pediatrics.aappublications.org/content/119/1/182 274 Ginsburg, K. R. (2007). The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds. Pediatrics,119(1), 182-191.

275 Tronick, E. Z. & Gianino, A. F. (1986). Interactive mismatch and repair: Challenges to the 258

90

coping infant. Zero to Three, 6, 1-6.

276 Raman, S., Guerrero-Duby, S., McCullough, J. L., Brown, M., Ostrowski-Delahanty, S., Langkamp, D., & Duby, J. C. (2017). Screen Exposure During Daily Routines and a Young Child’s Risk for Having Social-Emotional Delay. Clinical Pediatrics, 56(13), 1244-1253.

277 Greer, D. C. L. (2018). Screen media, prosocial behavior, and aggression: Does attachment moderate effects of exposure (Order No. 10816505). Available from ProQuest Dissertations & Theses A&I. (2043414701). Retrieved from https://search.proquest.com/ docview/2043414701?accountid=11862 278 Crouch, A. (2017). The Tech-Wise Family: Everyday Steps for Putting Technology in its Proper Place. Baker Books: Michigan.

91

cafo.org/ovc

© 2019 Christian Alliance for Orphans