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Current Psychiatry Reports

, 20:113 | Cite as

Ethical Considerations for Mental Health Clinicians Working with Adolescents in the Digital Age

  • Nicole Sussman
  • Sandra M. DeJong
Psychiatry in the Digital Age (J Shore, Section Editor)
  • 81 Downloads
Part of the following topical collections:
  1. Topical Collection on Psychiatry in the Digital Age

Abstract

Purpose of Review

Adolescents’ use of digital technologies is constantly changing and significantly influences and reflects their mental health and development. Technology has entered the clinical space and raises new ethical dilemmas for mental health clinicians. After an update on this shifting landscape, including a brief review of important literature since 2014, this article will demonstrate how core ethical principles may be applied to clinical situations with patients, using vignettes for illustration.

Recent Findings

The vast majority of adolescents (95%) across all demographic groups can access smartphones (Anderson et al. 2018•). Technology use in mental health is also expanding, including a proliferation of “apps.” While qualitative data from technology experts reports overall positive effects of technology (Anderson and Rainie 2018), concern about its potential negative impact on youth mental health remains high, and an association between technology use and depression is strong. Internet addiction, online sexual exploitation, and accessing illicit substances through the “dark net” pose additional clinical and legal concerns. In this context, clinicians have an ethical responsibility to engage in education and advocacy, to explore technology use with teen patients and to be sensitive to ethical issues that may arise clinically, including confidentiality, autonomy, beneficence/nonmaleficence, and legal considerations such as mandated reporting.

Summary

New media and digital technologies pose unique ethical challenges to mental health clinicians working with adolescents. Clinicians need to stay abreast of current trends and controversies about technology and their potential impact on youth and engage in advocacy and psychoeducation appropriately. With individual patients, clinicians should watch for potential ethical dilemmas stemming from technology use and think them through, with consultation as needed, by applying longstanding core ethical principles.

Keywords

Digital ethics Adolescent psychiatry Social media Technology Mental health Internet 

Notes

Compliance with Ethical Standards

Conflict of Interest

Nicole Sussman is employed by Cambridge Health Alliance.

Sandra M. DeJong is a board member of the Psychiatry Residency in Training Examination of the American College of Psychiatrists, a committee member of the American Academy of Child and Adolescent Psychiatry, employed by Cambridge Health Alliance and receives royalties from Elsevier for a book on e-Professionalism.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Twenge JM. IGen: Why Today’s Super-Connected Kids Are Growing up Less Rebellious, More Tolerant, Less Happy-- and Completely Unprepared for Adulthood (and What That Means for the Rest of Us). New York: Atria Books; 2017. Highlights generational differences and the unique cultural differences of youth today to improve understanding of how technology has shaped the way they think, behave, and feel. Google Scholar
  2. 2.
    • Anderson M, Jiang J. Teens, Social Media & Technology 2018. Pew Research Center, May 31, 2018. Available at http://assets.pewresearch.org/wp-content/uploads/sites/14/2018/05/31102617/PI_2018.05.31_TeensTech_FINAL.pdf (accessed June 27, 2018). Recent and detailed report of changes in trends in teen use o f social media and technology.
  3. 3.
    DeJong SM. What makes online and digital media different? In blogs and tweets, texting and friending – social media and online professionalism in healthcare. San Diego, CA: Elsevier; 2014.Google Scholar
  4. 4.
    Anderson J and Rainie L. Stories from experts about the impact of digital life. Pew internet research center, 2018. Available at http://www.pewinternet.org/2018/07/03/stories-from-experts-about-the-impact-of-digital-life. (Accessed August 20, 2018).
  5. 5.
    Lanier J. Who owns the future? New York: Simon & Schuster Paperbacks; 2014.Google Scholar
  6. 6.
    •• American Academy of Child and Adolescent Psychiatry. Code of Ethics. 2014. This is the professional code for child and adolescent psychiatrists and an essential ethical framework for clinicians working in child and adolescent mental health. Other disciplines (e.g. social work, psychology, nursing) should consult their respective codes. Google Scholar
  7. 7.
    Morris B. The new tech avengers. The Wall Street Journal June 29, 2018. Available at https://www.wsj.com/articles/the-new-tech-avengers-1530285064. (Accessed August 23, 2018).
  8. 8.
    Bakker D, Kazantzis N, Rickwood D, Richard N. Mental health smartphone apps: review and evidence-based recommendations for future developments. JMIR Mental Health 2016; 1;3(1).CrossRefGoogle Scholar
  9. 9.
    Carrns A. 2013. Free apps for nearly every health problem, but what about privacy?. The New York times. Available at http://www.nytimes.com/2013/09/12/your-money/free-apps-for-nearly-every-health-problem-but-what-about-privacy.html. Accessed August 20, 2018.
  10. 10.
    Torous J, Roberts LW. The ethical use of mobile health technology in clinical psychiatry. J Nerv Ment Dis. 2017;205:4–8.CrossRefGoogle Scholar
  11. 11.
    American Medical Association. AMA Adopts Principles to Promote Safe, Effective mHealth Applications. November 16, 2016. Available at https://www.ama-assn.org/ama-adopts-principles-promote-safe-effective-mhealth-applications. Accessed August 23, 2018.
  12. 12.
    American Psychiatric Association. App Evaluation Model. Available at https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/app-evaluation-model. Accessed August 23, 2018.
  13. 13.
    Gold J. Screen-smart parenting: how to find balance and benefit in your child’s use of social media, apps, and digital devices. New York: The Guilford Press; 2015.Google Scholar
  14. 14.
    Uhls YT. Media moms and digital dads: A fact-not-fear approach to parenting in the digital age. Brookline, MA: Bibliomotion; 2015.Google Scholar
  15. 15.
    • Common Sense Media. Common Sense Education. Digital Citizenship. K-12 Digital Citizenship Curriculum Scope and Sequence. Available at https://www.commonsense.org/education/scope-and-sequence. Accessed August 23, 2018. Multiple versions of Digital Citizenship Curriculum for different developmental ages.
  16. 16.
    Elizabeth Englander, Executive director Massachusetts aggression reduction center, Bridgewater State University, written communication, august 19th, 2018.Google Scholar
  17. 17.
    Cybersecurity Guide for State and Local Law Enforcement. June 2016. Available at https://cchs.gwu.edu/sites/g/files/zaxdzs2371/f/downloads/NCAPCybersecurityGuide-2016.pdf Accessed August 20, 2018.
  18. 18.
    •• Common Sense Media. Available at https://www.commonsensemedia.org/. Accessed July 18, 2018. Excellent resource and extensive library of movies, TV, music, apps ,and games that are rated and reviewed for content and appropriateness for kids and teens of various ages.
  19. 19.
    •• American Academy of Pediatrics Council on Communications and Media. Media use in school-aged children and adolescents. Pediatrics 2016;138(5). Available at http://pediatrics.aappublications.org/content/138/5/e20162592. Accessed July 18th, 2018. Overview of the risks and benefits of social media use, gives explicit recommendations for parents, and has links to an interactive web-based tool for families to use to create their own media use plan.
  20. 20.
    •• Gabrielli J, Marsch L, Tanski S. TECH parenting to promote effective media management. Pediatrics. 2018;142(1). Offers specific behavioral approaches to discussing, monitoring, and implementing limits on media use in the home):e20173718.CrossRefGoogle Scholar
  21. 21.
    • American Academy of Child and Adolescent Psychiatry (AACAP). Facts for Families: Social Media and Teens. March 2018. Available at https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Social-Media-and-Teens-100.aspx. Accessed July 18, 2018. Gives practical advice for parents to encourage safe use of social media.
  22. 22.
    •• Mayhew A, Weigle P. Media engagement and identity formation among minority youth. Child Adolesc Psychiatric Clin N Am. 2018;27(2):269–85 Explores the role of digital media as a medium for racism and discrimination and these effects on the formation of social identity in minority youth.CrossRefGoogle Scholar
  23. 23.
    •• Carson NJ, Gansner M, Khang J. Assessment of digital media use in the adolescent psychiatric evaluation. Child Adolesc Psychiatric Clin N Am. 2018;27(2):133–43 Full of practical examples of how to ask adolescents and their caregivers about digital media use.CrossRefGoogle Scholar
  24. 24.
    • Fisher CE, Appelbaum PS. Beyond Googling: The Ethics of Using Patients' Electronic Footprints in Psychiatric Practice. Harvard Review of Psychiatry 2017;25(4):170–179. Considers electronic communications a “digital phenotype”, a source of collateral information, and explores many important considerations in reviewing electronic information. Also discuss emerging use of metadata to track activity and outcomes in mental health treatment. Google Scholar
  25. 25.
    • Seroussi A, Bonnici D, Leong GB, Weinstock R. Ethical and legal considerations for psychiatry regarding adolescents and technology use. In: Adolescent sexual behavior in the digital age. New York City, NY: Oxford University Press; 2014. p. 315–45. Provides an overview of biomedical ethics and the various areas where ethical dilemmas arise in working with adolescents. Google Scholar
  26. 26.
    •• Reich MD. The interplay of media violence effects and behaviorally disordered children and adolescents. Child Adolesc Psychiatric Clin N Am. 2018;27(2):193–202 Raises important topics to consider when working with youth with externalizing problems and offers examples of questions to explore their understanding and the meaning of the media they engage with.CrossRefGoogle Scholar
  27. 27.
    Boydell KM, Hodgins M, Pignatiello A, Teshima J, Edwards H, Willis D. Using technology to deliver mental health services to children and youth: a scoping review. J Can Acad Child Adolesc Psychiatry. 2014;23:87–99.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Jelenchick LA, Eickhoff J, Zhang C, Kraninger K, Christakis DA, Moreno MA. Screening for adolescent problematic internet use: validation of the problematic and risky internet use screening scale. Acad Pediatr. 2015;15(6):658–65.CrossRefGoogle Scholar
  29. 29.
    Moreno MA, Arseniev-Koehler A, Selkie E. Development and testing of a 3-item screening tool for problematic internet use. J Pediatr. 2016;176:167–72.CrossRefGoogle Scholar
  30. 30.
    Rafla M, Carson NJ, DeJong SM. Adolescents and the internet: what mental health clinicians need to know. Current Psychiatry Reports 2014;16(9). Comprehensive overview of the many domains by which internet use can affect teens and provides a biopsychosocial formulation juxtaposed with the 4Ps in considering the role internet use can play with psychiatric disorder. Also, offers resources for further reading, 472. Google Scholar
  31. 31.
    Bickham DS. The influence of violent media on aggression in adolescents. Adolescent Medicine. 2016;27(2):276–90.Google Scholar
  32. 32.
    Brockmyer JF. Playing violent video games and desensitization of violence. Child Adolesc Psychiatric Clin N Am. 2015;24:65–77.CrossRefGoogle Scholar
  33. 33.
    • American Academy of Pediatrics Committee on Committee on Communications and Media. Virtual Violence. Pediatrics 2016;138(1). Available at http://pediatrics.aappublications.org/content/early/2016/07/14/peds.2016-1298. Accessed August 16th, 2018. Discusses robustness of scientific literature linking media violence to aggression, the public health implications, and offers specific ways the entertainment industry should alter the portrayal of violence.
  34. 34.
    Ferguson CJ. Do angry birds make for angry children? A meta-analysis of video game influences on Children’s and adolescents’ aggression, mental health, prosocial behavior, and academic performance. Perspect Psychol Sci. 2015;10(5):646–66.CrossRefGoogle Scholar
  35. 35.
    Lenhart A, Smith A, Anderson M, Duggan M and Perrin A. Teens, technology and friendships. Pew Research Center, August 6, 2015. Available at http://www.pewinternet.org/files/2015/08/Teens-and-Friendships-FINAL2.pdf. Accessed August 23, 2018.
  36. 36.
    Basu D, Dalal PK. Twenty years of internet addiction quo Vadis? Indian J Psychiatry. 2016;58(1):6–11.CrossRefGoogle Scholar
  37. 37.
    • Marchant A, Hawton K, Stewart A, Montgomery P, Singaravelu V, Lloyd K, et al. A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: the good, the bad and the unknown. PLoS One. 12(8):e0181722 Review of 46 independent studies (51 articles) investigating internet use and self-harm or suicidal behavior, with particular attention on differentiating content that correlates to either positive or negative influences. Offers mechanisms of perceived influence of various social media outlets.CrossRefGoogle Scholar
  38. 38.
    Przybylski AK, Weinstein N, Murayama K. Internet gaming disorder: investigating the clinical relevance of a new phenomenon. Am J Psychiatr. 2017;174(3):230–6.CrossRefGoogle Scholar
  39. 39.
    O’Reilly M, Dogra N, Whiteman N, Hughes J, Eruyar S, Reilly P. Is social media bad for mental health and wellbeing? Exploring the perspectives of adolescents. Clin Child Psychol Psychiatr. 2018:1–13.Google Scholar
  40. 40.
    • Twenge JM, Martin GN, Campbell WK. Decreases in psychological well-being among American adolescents after 2012 and links to screen time during the rise of smartphone technology. Emotion. 2018;18(6):765–80 Analyzed >1 million responses from national survey of adolescents (MtF Survey) to determine trends in psychological well being and then discusses how the influence of economic factors, electronic communication, and behavior have contributed to changes observed.CrossRefGoogle Scholar
  41. 41.
    • Marino C, Gini G, Vieno A, Spada MM. The associations between problematic Facebook use, psychological distress and well-being among adolescents and young adults: a systematic review and meta-analysis. J Affect Disord. 2018;226:274–81 Meta-analysis of 23 independent samples representing 13,929 participating that sought to quantify strength of relationship between problematic Facebook use and psychological distress and well-being in the general population. Found positive correlation between problematic Facebook use and psychological distress, which was higher for young adults than adolescents. CrossRefGoogle Scholar
  42. 42.
    • Jiang, J. How Teens and Parents Navigate Screen Time and Device Distractions. Pew Research Center, August 22, 2018. Available at http://assets.pewresearch.org/wp-content/uploads/sites/14/2018/08/21153052/PI_2018.08.22_teens-screentime_FINAL.pdf. Accessed August 23, 2018. Explores teen and parent views on device use in the home including psychological attachment to devices, amount of use, and efforts to limit use.
  43. 43.
    Mcgee ME, Dingle AD, Edelsohn GA. Review of the revised 2014 American Academy of Child and Adolescent Psychiatry code of ethics. J Am Acad Child Adolesc Psychiatry. 2016;55(4):257–61.CrossRefGoogle Scholar
  44. 44.
    Saleh FM, Grudzinskas A, Judge A. Adolescent sexual behavior in the digital age: considerations for clinicians, legal professionals, and educators. Oxford: Oxford University Press; 2014.CrossRefGoogle Scholar
  45. 45.
    • Cyberbullying Research Center. Bullying Laws Across America. Available at https://cyberbullying.org/bullying-laws. Accessed August 4th, 2018. List of harassment and cyberbullying laws by state. Website also has information about research and prevention of cyberbullying.
  46. 46.
    • Hinduja S, Patchin JW. State Sexting Laws: A Brief Review of State Sexting and Revenge Porn Laws and Policies. Available at http://cyberbullying.org/state-sexting-laws.pdf. Accessed August 4, 2018. List of states and corresponding legislation related to “sexting” and “revenge porn” laws as of 2015.
  47. 47.
    Lorang M, McNiel DE, Binder R. Minors and sexting: legal implications. J Am Acad Psychiatr Law. 2016;44(1):73–81.Google Scholar
  48. 48.
    American Medical Association Council on Ethical and Judicial Affairs’. Professionalism in the Use of Social Media. 2010. Available at https://www.ama-assn.org/sites/default/files/media-browser/public/about-ama/councils/Council%20Reports/council-on-ethics-and-judicial-affairs/i10-ceja-professionalism-use-social-media.pdf. Accessed August 24, 2018.
  49. 49.
    Federation of State Medical Boards Special Committee on Ethics and Professionalism. Model Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice. April 2012. Available at https://www.fsmb.org/globalassets/advocacy/policies/model-guidelines-for-the-appropriate-use-of-social-media-and-social-networking.pdf. Accessed August 24, 2018.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cambridge Health Alliance/Harvard Medical SchoolCambridgeUSA

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