Potential Risk of Harm from Content Exposure

Extreme, inappropriate, and harmful content continues to be easily and widely accessible by children and adolescents. This can be spread through direct pushes, unwanted content exchanges, and algorithmic designs. In certain tragic cases, childhood deaths have been linked to suicide- and self-harm-related content and risk-taking challenges on social media platforms.^{45, 46} This content may be especially risky for children and adolescents who are already experiencing mental health difficulties.⁴⁷ Despite social media providing a sense of community for some, a systematic review of more than two dozen studies found that some social media platforms show live depictions of self-harm acts like partial asphyxiation, leading to seizures, and cutting, leading to significant bleeding.⁴⁸ Further, these studies found that discussing or showing this content can normalize such behaviors, including through the formation of suicide pacts and posting of self-harm models for others to follow.

Social media may also perpetuate body dissatisfaction, disordered eating behaviors, social comparison, and low self-esteem, especially among adolescent girls.^{49, 50, 51, 52} A synthesis of 20 studies demonstrated a significant relationship between social media use and body image concerns and eating disorders, with social comparison as a potential contributing factor.⁴¹ Social comparison driven by social media is associated with body dissatisfaction, disordered eating, and depressive symptoms.^{53, 54, 55, 56} When asked about the impact of social media on their body image, nearly half (46%) of adolescents aged 13–17 said social media makes them feel worse, 40% said it makes them feel neither better nor worse, and only 14% said it makes them feel better.⁵⁷

Additionally, roughly two-thirds (64%) of adolescents are “often” or “sometimes” exposed to hate-based content.⁵⁸ Among adolescent girls of color, one-third or more report exposure to racist content or language on social media platforms at least monthly.²⁴ In a review of 36 studies, a consistent relationship was found between cyberbullying via social media and depression among children and adolescents,⁴⁰ with adolescent females and sexual minority youth more likely to report experiencing incidents of cyberbullying.^{59, 60} Nearly 75% of adolescents say social media sites are only doing a fair to poor job of addressing online harassment and cyberbullying.⁶¹

In addition, social media platforms can be sites for predatory behaviors and interactions with malicious actors who target children and adolescents (e.g., adults seeking to sexually exploit children, to financially extort them through the threat or actual distribution of intimate images, or to sell illicitly manufactured fentanyl).^{62, 63, 64} Adolescent girls and transgender youth are disproportionately impacted by online harassment and abuse, which is associated with negative emotional impacts (e.g., feeling sad, anxious or worried).^{65, 66} Nearly 6-in-10 adolescent girls say they’ve been contacted by a stranger on certain social media platforms in ways that make them feel uncomfortable.²⁴

Potential Risk of Harm from Excessive and Problematic Use

Excessive and problematic use of social media can harm children and adolescents by disrupting important healthy behaviors. Social media platforms are often designed to maximize user engagement, which has the potential to encourage excessive use and behavioral dysregulation.^{67, 68, 69, 70} Push notifications, autoplay, infinite scroll, quantifying and displaying popularity (i.e., ‘likes’), and algorithms that leverage user data to serve content recommendations are some examples of these features that maximize engagement. According to one recent model, nearly a third (31%) of social media use may be attributable to self-control challenges magnified by habit formation.⁷¹ Further, some researchers believe that social media exposure can overstimulate the reward center in the brain and, when the stimulation becomes excessive, can trigger pathways comparable to addiction.^{68, 72} Small studies have shown that people with frequent and problematic social media use can experience changes in brain structure similar to changes seen in individuals with substance use or gambling addictions.^{73, 74} In a nationally representative survey of girls aged 11–15, one-third or more say they feel “addicted” to a social media platform.²⁴ Over half of teenagers report that it would be hard to give up social media.² Nearly 3-in-4 teenagers believe that technology companies manipulate users to spend more time on their devices.⁶⁸ In addition, according to a survey of 8th and 10th graders, the average time spent on social media is 3.5 hours per day, 1-in-4 spend 5+ hours per day and 1-in-7 spend 7+ hours per day on social media.³¹

Excessive and problematic social media use, such as compulsive or uncontrollable use, has been linked to sleep problems, attention problems, and feelings of exclusion among adolescents.^{43, 75, 76, 77} Sleep is essential for the healthy development of adolescents. A systematic review of 42 studies on the effects of excessive social media use found a consistent relationship between social media use and poor sleep quality, reduced sleep duration, sleep difficulties, and depression among youth.⁴² Poor sleep has been linked to altered neurological development in adolescent brains, depressive symptoms, and suicidal thoughts and behaviors.^{78, 79, 80} On a typical weekday, nearly 1-in-3 adolescents report using screen media until midnight or later.⁵⁸ While screen media use encompasses various digital activities, social media applications are the most commonly used applications by adolescents.⁵⁸

In a recent narrative review of multiple studies, problematic social media use has also been linked to both self-reported and diagnosed attention-deficit/hyperactivity disorder (ADHD) in adolescents, although more research is necessary to understand whether one causes the other.⁸¹ A longitudinal prospective study of adolescents without ADHD symptoms at the beginning of the study found that, over a 2-year follow-up, high-frequency use of digital media, with social media as one of the most common activities, was associated with a modest yet statistically significant increased odds of developing ADHD symptoms (OR 1.10; 95% CI, 1.05-1.15).⁸² Additionally, social media-induced fear of missing out, or “the pervasive apprehension that others might be having rewarding experiences from which one is absent,”⁸³ has been associated with depression, anxiety, and neuroticism.⁸⁴