3 Recommendations
3.1 General recommendations (see also age-specific recommendations)
These recommendations are consensus of the guideline group and are partly based on literature [1–5]
| Parents should be informed and supported, so that … | Consensus strength | |
|---|---|---|
| 1. | … their children engage in sufficient physical leisure activities in accordance with age-appropriate guidelines. | Strong consensus |
| 2. | … they can create media-free periods in which the family undertakes activities together. | Strong consensus |
| 3. | … they do not to use screen media during meals, especially shared meals, and do not to eat while using screen media. | Consensus |
| 4. | … there are neither any mobile screen media in the room while sleeping, nor - if at all possible – any stationary screen media either, such as TV sets or computers. | Consensus |
| 5. | … they do not allow allow their children to use screen media in the last hour before bedtime. | Strong consensus |
| 6. | … their children get adequate sleep, undisturbed by active or passive media use (depending on the child’s age). | Strong consensus |
| 7. | … their mornings before school and kindergarten spent as free of screen media as possible. | Strong consensus |
| 8. | … they do not use screen media for reward, punishment or calming. | Consensus |
| 9. | … they can support and guide their children in a variety of modes of communication, even without electronic devices (personal conversations, telephone calls, letters, etc.). | Consensus |
| 10. | … they can agree in writing on clear rules regarding the usage time of screen media and implement these rules together. There may be deliberate exceptions, but these should also be recorded in writing. | Consensus |
| 11. | … they can organize screen time differently for children of different ages in the same family. | Consensus |
| 12. | … before introducing mobile devices with Internet capability, a “mobile phone usage contract” should be agreed with the children, taking into account the liability situation if the parents are the owners of the device and allow the child to use it. | Consensus |
| 13. | … they know about Internet access controls and to use them to protect children from age-inappropriate content and excessive consumption. | Strong consensus |
| 14. | … distractions caused by screen media during homework are avoided and that these are only used for the intended purpose. | Strong consensus |
| 15. | … they follow the age recommendations of the media and not to go below them. The developmental age must be taken into account and, if in doubt, a higher starting age should be chosen. | Consensus |
| 16. | … they are aware of the risk of problematic use of online media (including possible addiction), they regularly reflect on the screen use of adolescents, if necessary together, and, if in doubt, they use acknowledged self-tests and, if necessary, seek professional help. | Consensus |
| 17. | … they give preference to ad-free offerings when consuming moving images and turn off the sound or the entire screen during any advertising breaks. | Consensus |
| 18. | … they independently provide appropriate sexual education for their children before they are confronted with sexual content through media use. | Consensus |
| 19. | … they coordinate and discuss the existing rules regarding the use of screen media with other people in the children’s lives besides the parents, so that they can be consistently followed. | Consensus |
| 20. | … they can build up a network of trusted people who can serve as a contact point for you and your children in times of difficulties. | Consensus |
| 21. | … they can address the issue of screen media in educational institutions, e.g. as a focus topic for parents’ evenings, in order to implement concerted education/prevention with the educational institutions and within the respective class communities. | Strong consensus |
| 22. | … they are aware of the need to be interested in their children’s digital activities and to monitor them critically. | Strong consensus |
| 23. | … they are aware of the need to put away screen media when not in use, if necessary storing it in an inaccessible and invisible place (“Out of sight, out of mind!”). | Strong consensus |
| 24. | … they avoid remote controls and voice controls as much as possible and do not make them inaccessible to their children. | Consensus |
3.2 Age-specific recommendations
These recommendations are consensus of the guideline group and are partly based on literature [1–5]
As the child gets older, it is appropriate to move from a directive to a dialogic implementation of the following recommendations. In individual cases, individual standards must be applied with regard to the suggested usage time of screen media. This applies in particular to usage that serves creative, educational and self-development-related purposes.
| Parents should be informed and supported, so that … | Consensus strength | |
|---|---|---|
| 0 to 3 years | ||
| 25. | … they keep children under 3 years of age away from any passive and active use of screen media. | Consensus |
| 3 to 6 years | ||
| 26. | … if they want to introduce their children aged 3 to 6 to the use of screen media, they allow this for a maximum of 30 minutes on individual days, and not without the parents being present. They should ensure that the content is of high quality and should discuss the content. The age recommendations should be adhered to and content should be checked in advance to ensure it is suitable for the child. | Consensus |
| 6 to 9 years | ||
| 27. | … they allow children aged 6 to 9 to use screen media for a maximum of 30 to 45 minutes on individual days; they use high-quality content, whenever possible together with their children, and discuss it afterwards. The age recommendations should be adhered to and content should be checked in advance for suitability for the child. | Consensus |
| 28. | … they do not grant children under 9 years of age even supervised free access to the Internet. | Consensus |
| 29. | … they do not provide children under 9 years of age with their own games console. | Strong consensus |
| 9 to 12 years | ||
| 30. | … they allow children aged 9 to 12 to use screen media for a maximum of 45 to 60 minutes a day in their free time; that the content involved is of high quality; that whenever possible they use these media together with their children, and discuss it afterwards. The age recommendations should be adhered to and content should be checked in advance for suitability for the child. | Consensus |
| 31. | … they do not allow their children to have their own smartphone until they are at least 9 years old (better yet, 12 years old), and that this access is limited. | Consensus |
| 32. | … they allow only supervised Internet access to children between the ages of 9 and 12. | Consensus |
| 12 to 16 years | ||
| 33. | … they allow young people aged 12 to 16 to use screen media for leisure purposes for a maximum of 1-2 hours a day and until 9 p.m. at the latest. The age recommendations should be observed and content should also be checked in advance for suitability for the child. Adolescents should receive continued supported in terms of content. | Consensus |
| 34. | … they have regular discussions with young people to reflect on the time and content they spend on media, including content related to their own life goals. Young people should be encouraged to observe for themselves how media consumption affects their concentration, social behavior, fitness, personality, school grades, etc. | Consensus |
| 35. | … they grant only limited Internet access to young people aged 12 to 16. | Consensus |
| 36. | … they use acknowledged self-tests in cases of excessive Internet use, and seek professional help if necessary. | Consensus |
| 16 to 18 years | ||
| 37. | … they can set rules for the use of screen media in leisure time depending on the level of maturity (e.g. on an evening before an exam); a guideline value can be 2 hours a day. The age recommendations should be observed. Parents should be there to support and have regular discussions for reflection. | Strong consensus |
| 38. | … they provide young people aged 16 and over with unrestricted access to the Internet. Experience shows that even 16 to 18-year-olds can find it very difficult to limit their screen media consumption to a healthy level. Many of them still require intensive support. | Strong consensus |
| 39. | … in cases of excessive Internet use, they carry out an acknowledged media-related self-test together with the young person and seek professional help as early as possible. | Strong consensus |
3.3 Recommendations for digital distance learning
These recommendations are consensus of the guideline group
| Parents and teachers should be informed and supported, so that … | Consensus strength | |
|---|---|---|
| 40. | … they avoid digital distance learning whenever possible. In primary schools, digital distance learning should be reduced to a minimum. Instead, analogue materials with learning tasks for parents and children should be used, which are sent in both directions by post or in digital form (e.g. printouts/scans). In secondary schools (secondary levels I and II), digital distance learning is possible to a limited extent, with the majority of students expected to use analogue media to complete their tasks. |
Consensus |
| 41. | … they do not simply transfer the timetables of face-to-face teaching 1:1 to digital teaching. In primary schools, digital distance learning should not exceed 60 minutes of screen time per day. In secondary schools (secondary levels I+II), digital distance learning should not exceed 120 minutes of screen time per day. |
Consensus |
| 42. | … they can create a salutogenic teaching concept, including exercise balance, eye hygiene, interaction with nature, art and social issues. Children should be given lots of suggestions for screen-free work. Breaks should be taken regularly and more frequently in digital distance learning. | Strong consensus |
| 43. | … they encourage children to engage in screen-free activities outside of digital lessons. | Strong consensus |
| 44. | … make sure that devices provided by schools for digital distance learning also include a time limit and filter software, in order to prevent their being used beyond class time and/or for content that is detrimental to development. | Consensus |
| 45. | … all opportunities for face-to-face teaching or support are used, should – for example during a pandemic – digital distance learning be necessary even taken into consideration. | Consensus |
| 46. | … they are aware of the danger of problematic media use among students and can take appropriate measures. | Consensus |
3.4 Recommendations in times of pandemic
These recommendations are consensus of the guideline group
| Parents and teachers should be informed and supported, so that … | Consensus strength | |
|---|---|---|
| 47. | … they can create temporary special regulations for the use of screen media for the family during pandemics. | Strong consensus |
| 48. | … they can enable more activities in nature, in the local social environment and in the creative field during a pandemic. | Strong consensus |
| 49. | … during and after pandemic times, they can carry out health-promoting, resource- and resilience-promoting prevention programs with their children/students, or convey the content. | Strong consensus |
| 50. | … at the end of pandemic times, they can reduce the use of screen media to pre-pandemic levels and consciously establish media-free periods. | Strong consensus |
3.5 Recommendations for parents and siblings as role models
These recommendations are consensus of the guideline group
| Parents and siblings should be informed and supported, so that … | Consensus strength | |
|---|---|---|
| 51. | … they regularly reflect on their own usage behavior and adapt it if necessary. | Strong consensus |
| 52. | … they are aware of their own role model function for active and passive screen use. | Strong consensus |
| 53. | … they refrain from using screen media in the presence of younger family members. | Consensus |
| 54. | … in situations where the use of screen media in the presence of children and young people cannot be avoided in their free time (e.g. for work-related reasons), alternative activities can be provided beforehand. The necessity of using screen media should be explained to the children. | Consensus |
| 55. | … in case of excessive Internet use, they can carry out an acknowledged media-related self-test and, if necessary, seek professional help. | Consensus |
3.6 Procedure in case of dysregulated screen media use
Depending on the severity of the dysregulation and the age of the affected person, the therapist who is primarily contacted must decide individually and on a case-by-case basis what kind of help the family needs. Many families need basic counseling and lack the right information (e.g. that excessive media consumption is detrimental to children’s development). Initially, and thus at an “information level”, the person/department contacted can initially fill any gaps in knowledge, answer questions, and motivate with appropriate information materials and in a counseling session. If there is sufficient information and the issue is the failure to implement it, an “intervention level” has been reached.
First of all, the reasons that lead to “acting against better judgment” must be understood. Depending on what these reasons are, the choice of professional help is then made. One family will need a social worker to enable the implementation of rules at home, in another family a major psychosocial problem may be the reason why the parents or, for example, the single parent are exhausted and therefore no longer able to act consistently. And in other cases, impulse control disorders or ADHD may be the cause and appropriate therapy may be necessary.
Psychoeducation, behavioral therapy and, if necessary, drug therapy must be initiated by specialists in special outpatient clinics, counseling centers or specialized practices (doctors, psychotherapists, social therapists, educators, etc.) and often supervised over a longer period of time. In very rare cases, a one-off short consultation is sufficient. The problem is often multidimensional, exists for several years before counseling is desired, and dysregulated or even addictive media consumption is only one visible sign of a much larger problem.
To define “addictive use,” the criteria for “Internet Gaming Disorders” are to be used in an adapted manner and applied to media behavior: The revised DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), published by the American Psychiatric Association, includes “Internet Gaming Disorder” as a research diagnosis. For this to be the case, five of the following criteria must be met over a period of 12 months:
ongoing involvement with internet or online games
Withdrawal symptoms when online gaming is not available
Development of tolerance with the need to spend increasing time on online games
unsuccessful attempts to stop participating in online gaming
Loss of interest in previous hobbies or activities as a result of online gaming
Persistent, excessive online gaming despite knowledge of the psychosocial problems
Deceiving family members, therapists, or others about the true extent of online gaming
Using online games to escape or alleviate negative emotions (such as feelings of helplessness, guilt or anxiety)
Endangerment or loss of important relationships, jobs, education or career opportunities due to online gaming
This is immediately applicable to adolescents, and for younger children it can be adapted as follows:
Engaging with media for a significant amount of time per day (several times the recommended time)
Withdrawal symptoms from media ban
Difficulty quitting
Fixation on media
Lack of other age-appropriate activities and relationships with peers
Media only or frequent alternative to end negative emotions
Behavioral therapy with the promotion of family support and parent training are effective but also costly necessary measures; in individual situations, other therapies should also be considered. It should be noted that although the child/young person is usually affected themselves, they cannot be treated alone. The media behavior of the entire family must be recorded and usually changed for everyone so that a fundamental change is even possible in the child/young person (see parental recommendations).
A structured daily schedule with clearly defined and age-appropriate times is often the first step. Clear times for media use must be ritualized, learned and consistently implemented. When the device is not in use, it is recommended that the device be kept out of the children’s reach (keeping it in the “cell phone bed”; locking the device away, etc.). Care should be taken to avoid “passive media consumption”, i.e. watching with parents or older siblings, even during lessons. Families often need guidance, support and supervision in order to be able to offer alternative games.
In individual cases where the situation escalates to a crisis, particularly in cases of addictive use, inpatient stays are also necessary. A warning should be given against “radical withdrawal treatments” in cases of existing addictive use without therapeutic support in an outpatient setting, as the resulting destabilization often cannot be prevented on an outpatient basis. The action plan in Figure 3.1 is intended to help with this assessment.
| Recommendations for dealing with dysregulated screen media use | Consensus strength | |
|---|---|---|
| 56. | As a basis, the person/family/organization providing advice should first be provided with appropriate information materials. In the subsequent consultation, knowledge gaps should be closed, questions answered and motivation provided. | Strong consensus |
| 57. | If sufficient information is available and the implementation of the information has failed, psychoeducation, behavioral therapy and, if necessary, medicinal therapy should be initiated by experts and supported over a longer period of time. | Consensus |
| 58. | The media behavior of the entire family should be recorded and, if necessary, changed for everyone so that a fundamental change can be made among the children/young people. | Consensus |
| 59. | In individual cases of addictive media use culminating in crises, inpatient treatment may be indicated. | Consensus |