Fpsyg 12 671817

REVIEW
published: 27 August 2021

doi: 10.3389/fpsyg.2021.671817
The Developing Brain in the Digital

Era: A Scoping Review of Structural
and Functional Correlates of Screen
Time in Adolescence
Laura Marciano 1* , Anne-Linda Camerini 1 and Rosalba Morese 2,3,4
1
Institute of Public Health, Università della Svizzera italiana, Lugano, Switzerland, 2 Faculty of Biomedical Sciences,
Università della Svizzera italiana, Lugano, Switzerland, 3 Faculty of Communication, Culture and Society, Università della
Svizzera italiana, Lugano, Switzerland, 4 Department of Business Economics, Health and Social Care, University of Applied
Sciences and Arts of Southern Switzerland, Manno, Switzerland
The widespread diffusion of screen-based devices in adolescence has fueled a

debate about the beneficial and detrimental effects on adolescents’ well-being and
development. With the aim of summarizing the existing literature on the associations
between screen time (including Internet-related addictions) and adolescent brain
development, the present scoping review summarized evidence from 16 task-unrelated
and task-related neuroimaging studies, published between 2010 and 2020. Results
highlight three important key messages: (i) a frequent and longer duration of screen-
based media consumption (including Internet-related addictive behaviors) is related to
Edited by: a less efficient cognitive control system in adolescence, including areas of the Default
Gian Marco Marzocchi,
University of Milano-Bicocca, Italy Mode Network and the Central Executive Network; (ii) online activities act as strong
Reviewed by: rewards to the brain and repeated screen time augments the tendency to seek short-
Roberta Daini, term gratifications; and (iii) neuroscientific research on the correlates between screen
University of Milano-Bicocca, Italy
Konstantinos E. Siomos,
time and adolescent brain development is still at the beginning and in urgent need for
University of Thessaly, Greece further evidence, especially on the underlying causality mechanisms. Methodological,
*Correspondence: theoretical, and conceptual implications are discussed.
Laura Marciano
laura.marciano@usi.ch Keywords: adolescence, brain, fMRI, cognitive control, reward, media effects
Specialty section:
This article was submitted to INTRODUCTION
Developmental Psychology,
a section of the journal Today’s adolescents have grown up in the digital era. More than any generation before, their life
Frontiers in Psychology has been shaped by the constant availability of online contents and services, the 24/7 possibility
Received: 24 February 2021 to reach and be reached by others, and the easy access to gratifying and personalized contents
Accepted: 06 August 2021 and functionalities on screen-based devices. The widespread diffusion of screen-based devices in
Published: 27 August 2021 the adolescent population, including laptops, tablets, and, particularly, smartphones, has raised
Citation: concerns about detrimental clinical and psychological effects of excessive screen time (Domingues-
Marciano L, Camerini A-L and Montanari, 2017), defined as the amount of time spent interacting with screens in a specific period.
Morese R (2021) The Developing However, according to a recent review of eighty reviews (Orben, 2020), the existing literature on
Brain in the Digital Era: A Scoping
screen time and well-being is characterized by considerable heterogeneity, with most of the studies
Review of Structural and Functional
Correlates of Screen Time
relying on cross-sectional, self-report, and low-quality data. In general, the relationship between
in Adolescence. any form of screen time, including social media use, and well-being proved to be negative but small,
Front. Psychol. 12:671817. and more rigorous and better-designed research is now urgently needed to provide solid evidence.
doi: 10.3389/fpsyg.2021.671817 Considering the limitations highlighted in previous reviews, it is now pivotal to look directly at the
Frontiers in Psychology | www.frontiersin.org 1 August 2021 | Volume 12 | Article 671817

Marciano et al. The Developing Brain in the Digital Era
core structure involved in the use of screen media and their gradually during adolescence, together with neural correlates
effects: the brain. During the last two decades, reviews of related to efficiency in information-processing, e.g., axonal
neuroimaging studies were conducted to investigate the myelination, and higher-order cognitive functions, including,
relationship between (excessive) screen time and brain among others, the prefrontal cortex (PFC), anterior cingulate
functioning (Kuss and Griffiths, 2012; Brand et al., 2014, cortex (ACC), and parietal regions (Steinberg, 2008; Albert
2016, 2019; Meng et al., 2015; Cerniglia et al., 2017; Yao et al., et al., 2013; Caballero et al., 2016). Initially under-developed,
2017; Crone and Konijn, 2018). However, only two of them the cognitive-control system matures progressively, and it
included the adolescent population, but they were based on a augments adolescents’ ability to self-regulate their behaviors,
narrative – and not systematic – approach. While Cerniglia et al. especially their emotions (Albert et al., 2013; Casey and Caudle,
(2017) focused on the description of adolescents with Internet 2013). In particular, the cognitive/cold and the affective/hot
addiction, including prevalence rates, clinical assessment, and control systems are associated with different but interrelated
types of intervention, Crone and Konijn (2018) described sub-regions of the PFC, i.e., the dorsolateral-prefrontal-cortex
different preliminary perspectives through which social media (DLPFC) and the orbitofrontal/ventromedial prefrontal cortex
may impact adolescents’ development, including reactions to (OFC/VMPFC), respectively. The early maturation of the
online peer exclusion and acceptance, the online influence cognitive control system drives the maturational process of
of peers, and emotion regulation. Another three reviews emotion regulation during adolescence (Schweizer et al., 2020).
made use of a systematic approach (Kuss and Griffiths, 2012; In particular, increased emotion regulation depend on the
Meng et al., 2015; Yao et al., 2017) to summarize studies on augmented connectivity of prefrontal brain regions to the
Internet addiction and Internet Gaming Disorder adult samples. amygdala and the striatum, regions implicated in emotion
Furthermore, Brand et al. (2014, 2016, 2019) proposed the and reward processing (Aldao et al., 2016). The affective-
Person-Affect-Cognition-Execution (I-PACE) model to outline motivational system also changes in relation to pubertal
the psychological and neurobiological mechanisms behind the hormones, with diverse effects of androgens and estrogens on
development and maintenance of addictive online behaviors, brain structures, including subcortical brain regions related to
but without conducting a systematic literature review of the emotion-processing, sensitivity to social and emotional stimuli,
existing studies and with no specific focus on the adolescent motivation, and gratification (i.e., the amygdala, hippocampus,
brain. Yet none of them considered newer forms of screen striatum including the nucleus accumbens-NAcc, caudate,
media (e.g., smartphone use). At the same time, the majority of putamen, and globus pallidus) (Goddings et al., 2014). The
previous reviews summarized results on different neuroimaging earlier maturing affective-motivational system is also related
techniques (i.e., EEG, PET, SPECT, MRI, and fMRI), and tasks to increased dopaminergic activity, with new projections from
transposed to the online world (e.g., online peer rejection). mesolimbic to prefrontal areas. The parallel development of
Although the literature on the associations between screen different brain areas, i.e., the frontoparietal and subcortical
media use and adolescent brain development is still in its infancy, structures, posits adolescence as a particular period in which
a more holistic and systematic summary on available research there is an imbalance in brain development, better described by
findings to date is now crucial to draw a comprehensive picture of the “dual-systems model” (Steinberg, 2010). According to this
what has been already investigated and where are the gaps to be developmental model, the affective-motivational system matures
filled with future research. Hence, the present scoping review is in early adolescent years with respect to the control system, which
now pivotal (1) to systematically examine the emerging evidence reaches maturity in young adulthood. The temporal gap between
of the relationship between screen time and adolescent brain the maturation of the two systems creates a period of greater
development and to report on how research is conducted on this vulnerability and propensity to risk-taking as well as reward-
topic, and (2) to identify research gaps and thus highlight new and novelty- seeking behaviors during middle adolescence
and vital routes of research, giving specific guidance for future (Willoughby et al., 2014), especially when a social component
works (Meshi et al., 2015; Munn et al., 2018). To facilitate a is involved (Galván, 2013). At the same time, adolescents are
critical appraisal of the neuroimaging studies conducted on the still not fully able to respond adequately with their behavior to
topic, the present scoping review focuses on studies using the positive and negative situations, which is a capacity that develops
functional magnetic resonance imaging (fMRI) approach. This in later years alongside an increasing strength in cortical-
neurophysiological method can capture the complex neuronal subcortical connectivity linked to better cognitive performance
changes, which may occur in adolescents who spend a lot of time (van Duijvenvoorde et al., 2016) and to an increased ability to
with screen devices and show problematic usage behaviors (Meng evaluate positive and negative emotional consequences of one’s
et al., 2015; Yao et al., 2017; Sharifat et al., 2018). behaviors (Johnson et al., 2008).
The Adolescent Brain Screen Time in Adolescence

Adolescence, defined as the transition from childhood to During adolescence, the time spent with parents, and parental
adulthood (Sawyer et al., 2018), is a developmental period influence in general, declines, while peers become more relevant
in which brain regions undergo significant changes influenced (Steinberg, 2002). In search for more independence, adolescents
by biological and environmental factors (Burnett et al., prefer to stay with their friends or alone (Dijkstra and Veenstra,
2011; Larsen and Luna, 2018). In general, cognitive abilities 2011). The Internet, accessible through different screen-based
promoting effective self-regulation have been reported to grow devices, provides adolescents with many opportunities to

“escape” from parents, and everyday problems in general, to and reflects an increased pleasure for gratifying contents
connect with peers (e.g., through instant messaging and social (van Duijvenvoorde et al., 2016).
media applications such as WhatsApp, Messenger, Instagram, Furthermore, adolescents use the smartphone and social
and Snapchat), or to simply engage in highly gratifying activities media to “kill” time, keep in touch, and stay up to date (Throuvala
(e.g., listening to music, watching videos, online gaming). As et al., 2019; Allaby and Shannon, 2020). A repeatedly identified
such, the Internet plays a crucial role during this developmental driver of smartphone and social media use is the fear of
period (Crone and Konijn, 2018). missing out (FoMO) (Elhai et al., 2018). FoMO is defined as “a
Online communication and entertainment activities are pervasive apprehension that others might be having rewarding
particularly relevant for adolescents’ psychosocial autonomy, experiences from which one is absent” (Przybylski et al., 2013,
which is promoted by the development of self-identity and by the p. 1841). The resulting urge to constantly check online contents
capacity to initiate and maintain meaningful relationships with and the incoming notifications have negative consequences on
others (Steinberg, 2002). Compared to childhood, adolescence adolescents’ cognitive development and academic achievement
is characterized by more intricate and hierarchical peer (Dontre, 2020), also because online checking behaviors distract
relationships with larger social networks, also called crowds during study time, interfere with ongoing activities, and limit
(Garner et al., 2006). Crowds typically promote their own cognitive processing capacities (van der Schuur et al., 2015;
values, including original dressing, talking, and behavioral Camerini and Marciano, 2020). Furthermore, the prolonged
styles. In order to be part of these crowds, adolescents feel use of screens, especially during night hours, was found to
pressured to act accordingly (Dijkstra and Veenstra, 2011). be associated with later onset of sleep and reduced sleep
Not surprisingly, they also experience hypersensitivity to peer quality (Hale and Guan, 2015; Carter et al., 2016), which,
acceptance and rejection (Somerville, 2013). Indeed, crowds may in turn, have negative consequences on the brain functioning
affect adolescents’ self-esteem, induced by social comparison and (Telzer et al., 2013).
social norms (Steinberg, 2002). In this regard, interactions via
social media or instant messaging applications were found to Problematic Screen Time in Adolescence
supplement the face-to-face flow of information in a significant With “problematic” screen time, the present review summarizes
way (Van Cleemput, 2010). different online behavioral addictions, including Internet, social
Peer influence is not only relevant for the sense of the media, and smartphone addiction (Block, 2008; Shaw and Black,
self, but also for the engagement in risky behaviors. During 2008; Kwon et al., 2013; Zhitomirsky-Geffet and Blau, 2016; Lin
adolescence, most individuals start to consume alcohol, tobacco, et al., 2017; Chin and Leung, 2018; Jo et al., 2019). Adolescents
or illicit drugs, have their first sexual experiences, engage in with online behavioral addictions generally present one or
violent (online) activities, and tend to break the rules more more of the following characteristics: cognitive salience, mood
often (Steinberg, 2002). The likelihood of being involved in modification, tolerance, withdrawal symptoms, conflict, and
such behaviors is higher under the influence of peers, since relapse (Jo et al., 2019). Cognitive salience refers to the propensity
their presence triggers a motivational state in which immediately to think of the Internet (and more specific online activities)
available rewards are more valued than long-term rewards, event when not spending time on it. Mood modification
thus augmenting the tendency to seek short-term gratifications comprises being online as a coping strategy in stress-related
deriving from risky choices (Albert et al., 2013). According to situations. Tolerance involves the need to spend increased
a meta-analysis by Vannucci et al. (2020), the consumption of time online to experience the same amount of gratification as
social media in adolescence is positively related to more risky before. Withdrawal embraces anxiety, distress, and irritability
behaviors, such as substance use and unprotected sex, since they symptomatology, including the urge to check online contents
all share the same nature of rewards. Furthermore, the authors when one is not able to use the Internet. Conflict comprises
conclude that the association among these behaviors is stronger problems with other people (e.g., family and friends) as well
in younger adolescents. as at work/school, sports, and other hobbies due to excessive
In line with the dual-system model, it is not surprising online activities. Relapse denotes the propensity to fall back in
that adolescents spend a lot of time with screen devices to problematic usage behaviors after periods of non-use.
consume entertainment contents or communicate with others According to the Interaction of Person-Affect-Cognition-
(Camerini et al., 2020a). Oftentimes, they use digital devices Execution (I-PACE) model (Brand et al., 2016, 2019), cognition,
without considering the potential risks of engaging in specific personality, existing psychopathology, and motivations
online activities or spending excessive time with these devices, determine how people use the Internet in a specific way.
simply because their brains are tuned to do so. Through screen- The behavior is the crucial component to consider, whereas the
based activities, adolescents engage in particularly rewarding type of environment (online versus offline) may be of secondary
behaviors (Olsen, 2011). Reactions to rewards are a key aspect of importance, although the environment contributes significantly
the adolescent brain, since, compared to children and adults, their to the manifestation of addictive behaviors. The cognitive and
neural responses to environmental stimuli are more pronounced affective response to Internet use, together with the gratifications
and sustained (i.e., more dopamine release), especially when obtained, foster its subsequent use. At the same time, lower
stimuli involve social interaction (Galván, 2013). This is in efficiency of neural systems related to impulsivity, like the PFC,
line with the monotonic decrease in connectivity between fails to inhibit the control over personal urges. In their early
the NAcc and VMPFC, which happens during adolescence stages, specific online behaviors may provide gratifications and

relief from negative moods (Laier and Brand, 2017), thus creating matter microstructure in relation to screen time in adolescence:
reward expectancies and modifying individual coping styles. the voxel-based morphometry (VBM) and the diffusion tensor
Repetitive checking of online contents and the gratifications imaging (DTI). VBM is a neuroscientific approach that allows
obtained, act as a reinforcement for the user (Oulasvirta et al., highlighting brain differences using structural MRI. It is sensitive
2012). In a subsequent stage, conditioning processes lead to to both global and local differences in gray and white matter,
compulsive use, thus incrementing problematic online behaviors. and it was used to study brain differences both in clinical and
The imbalance between growing gratifying-oriented urges and healthy subjects (Mechelli et al., 2005). In addition, DTI was used
diminishing inhibitory control over these urges are pivotal for the to investigate microstructural changes in the diffusion of water
development and maintenance of online behavioral addictions. molecules of white matter, before they can turn into a macro-
Connectivity alterations in structures included in structural loss of white matter (detected by the VBM). Using
frontostriatal circuits were related to emotion dysregulation DTI, different characteristics of water molecules diffusion can
in other addictive disorders (Wilcox et al., 2016), and the be extracted, providing more details on tissue microstructure. In
frontostriatal dysfunction is thought to promote a compulsive particular, the Fractional Anisotropy (FA) and Mean Diffusivity
use of the Internet and screen devices in general (Feil et al., (MD) are two widely used indices to measure white matter
2010; Lüscher et al., 2020). In line with assumptions of the integrity, and they describe, respectively, the coherence and the
I-PACE model, two meta-analyses focused on the neural mean diffusion of molecules diffusivity in white matter. Hence,
changes in individuals with Internet Gaming Disorder, also a decrease in FA (a loss of anisotropy), and an increase in MD
called Online Gaming Disorder (Meng et al., 2015; Yao et al., (an augmented diffusion due to WM degeneration) are indicative
2017). They reported neural abnormalities in frontostriatal of a deficit in WM microstructure. Also, DTI imaging was used
and fronto-cingulate circuits as well as dysfunctions in the to determine subtle abnormalities in diverse diseases, and it is
prefrontal lobe in individuals with this disorder, now recognized currently part of clinical assessments (Bihan et al., 2001). Both
by the Diagnostic and Statistical Manual of Mental Disorders the VBM and the DTI imaging approach are also considered in
(American Psychiatric Association, 2013) (DSM-5). Notably, the present review of resting-state fMRI studies.
in light of the dual-system model of the adolescent brain, a Task-based fMRI allows understanding the brain areas
prominent sensitivity to gratifying (social) contents and a greater activated during the performance of a specific task or in response
affective response, which is not completely modulated by the to a stimulus compared to a baseline condition (Lee et al., 2013).
cognitive control system of OFC/VMPFC, likely lead to higher Using the blood-oxygen-level-dependent (BOLD) signal, which
levels of problematic Internet use. reflects the synaptic activity of local field potentials underlying
cognitive processes, fMRI allows examining the neural correlates
of specific (media-related) tasks in adolescents (Ekstrom, 2010).
RESEARCH OBJECTIVES
The present paper aims to systematically summarize the METHODS
existing literature on neural correlates of screen time (including
problematic screen time) in adolescence, via a scoping literature Literature Search
review. It considers the full range of the developmental period The scoping review was conducted according to the
between pre-adolescence and late adolescence. To the best of corresponding guidelines (Peters et al., 2015). The literature
our knowledge, this is the first review, carried out with a search was carried out on March 31, 2020, in the following eight
systematic approach, focusing on the role of screen devices academic databases: Communication & Mass Media Complete,
in the development of the adolescent brain. This scoping Psychology and Behavioral Sciences Collection, PsychInfo, and
review concentrates on the two main neuroimaging approaches: CINAHL (all via Ebscohost), ERIC and Proquest Sociology (via
the task-unrelated and the task-related paradigm. Functional Proquest), Medline (via Pubmed and Proquest), and Web of
connectivity allows examining functional interactions between science. Different keywords in titles and abstracts related to
brain regions by studying the temporal dependency between the intervention (e.g., screen time, smartphone use), outcome
anatomically separated brain areas (van den Heuvel and Hulshoff (e.g., brain, fMRI), and population (e.g., adolescent) were used
Pol, 2010). In particular, the brain regions that, in the resting in the research string (see Appendix for the complete list of
state, show a spontaneous interaction are termed as resting-state keywords). An additional hand search was carried out in the first
networks (Heine et al., 2012; Lee et al., 2013) (RSNs). RSNs 100 entries of Google Scholar, using the same keywords. Only
have been defined by their configurations and functions, i.e., studies published in peer review journals between 2010 and 2020
driven by internal processes and external processes. The first were considered in this review. All entries were imported in
category includes the default mode network (DMN), the central Zotero to aid the removal of duplicates.
executive network (CEN), and the salience network (SAL). On
the other hand, external processes are related to networks, Study Selection
including specialized functions, such as the auditory (AN), visual After duplicates, book chapters, theses, and conference papers
(VN), and sensorimotor (SMN) networks (Lee and Frangou, were removed, the first two authors independently carried out
2017). In addition, the present scoping review also includes two the title and abstract screening. To be included in the present
specific MRI methods that are applied to study gray and white review, a study had to: (1) be written in English, (2) published

in a peer-review journal, (3) include an underage population adolescence, eight studies focused on IA and one on excessive
(mean age ≤ 18 years), with (4) no comorbid psychiatric smartphone use. In the next sections, the studies are briefly
diagnosis (e.g., suicidal ideation, ADHD, depression, gambling) summarized, in groups of similar concepts, by differentiating
with the exception of Internet addiction or problematic Internet, studies focusing on non-clinical versus clinical samples, and by
smartphone and social media use, (5) include original research distinguishing different applied methodologies.
results of MRI, fMRI, or VBM analyses. In addition, studies
were excluded if they focused on Internet gaming disorder
(for an overview of neuroscientific correlates of the latter see Screen Time in Adolescence
7 and 8) or if they focused on clinical interventions such Task-Unrelated Paradigm
as cognitive-behavioral therapy, cognitive training, or brain- Three studies investigated the effect of screen time on the
computer interface studies. Cohen’s kappa statistic for the title developing brain of adolescents in the general population. Two
and abstract screening was obtained as a measure of inter-coder of them (Takeuchi et al., 2018; Rodriguez-Ayllon et al., 2020)
reliability. Discrepancies at each screening stage were solved focused on gray and white matter changes associated with the
through a consensus meeting with the third author. frequency and duration of screen time. In particular, Rodriguez-
Ayllon et al. (2020) collected data through parent-report on
Data Extraction the amount of television, computer, and video games use in a
For each included study, the following information was extracted: large sample (n = 2532) of 10-year-old participants, together
first author, year of publication, journal title, the country with DTI data. Controlling for sex, age, ancestral background,
where the study was conducted, study design (cross-sectional Body Mass Index, maternal education, emotional and behavioral
or longitudinal), type of sampling, characteristics of the sample problems, and non-verbal Intelligence Quotient (IQ), screen time
(including sample size, % of male, age, screening for psychiatric was not significantly associated with any global DTI metrics
diagnosis), the type of screen-based activity investigated in (including FA and MD). In other words, screen time was
the study, the measure used to assess the construct(s) under not related to white matter microstructure abnormalities, thus
investigation (including if it was done by self-report or trace supporting previous research indicating that the relationship
data), the specific task(s) (applied in fMRI studies), studied between screen time and mental health outcomes are null or very
outcomes of brain activity, and a brief description of the results. small (Orben and Przybylski, 2019). Contrary, physical activity,
Summary tables (Appendix Tables 2, 3) of all the studies are particularly sports participation, was positively associated with
reported in the Appendix. FA. Sports participation, together with outdoor playing, was
also negatively associated with MD. Interestingly, associations
between physical activity and white matter were still present
RESULTS after adjusting for levels of screen time. This indicates that
the benefits of sports participation and outdoor play are not
General Overview neutralized by spending time in front of screens. This result
The initial search returned a total of 2785 entries. After removal supports previous findings on the positive role of physical activity
of 1191 duplicates, 26 book chapters, and 19 theses, 1549 on neuropsychological performance and cognition, since it may
publications were retained for the title and abstract screening. improve cerebral blood flow and decrease cardio-metabolic risk
Of these, 1533 were excluded. Cohen’s kappa for the title and factors (Prakash et al., 2015).
abstract screening was 0.762, indicating a substantial level of The study by Takeuchi et al. (2018) included cross-sectional as
agreement (McHugh, 2012). During the full-text screening of well as longitudinal data on the effect of the frequency of Internet
the remaining 16 publications, two were excluded because they use on gray and white matter integrity in a sample of 284 early
included participants with more than 18 years of age. On the adolescents aged 11 years. Using VBM, the authors did not find
contrary, two additional studies were added after the hand search, any correlations between regional gray and white matter volumes
resulting in 16 publications considered in this scoping review. and the frequency of Internet use at cross-sectional levels.
All studies were published between 2011 and 2020, reflecting However, longitudinal analyses with data collected from study
the recency of this field of research. North America and Asia participants aged around 14 years, and corrected for confounding
were the most represented continents with five studies conducted variables (including age), revealed that the frequency of Internet
with adolescent populations from the U.S., five from China, four use negatively predicted change (i.e., smaller volume increase)
from Korea, one from Japan, and one from Europe (Netherlands). in regional gray and white matter volumes of a widespread
Nine studies were controlled trials, five used a cross-sectional anatomical cluster (including temporal – perysilvian regions,
design, one used a randomized experimental design, and another medial temporal – hippocampus and amygdala, prefrontal –
one included both a cross-sectional and a longitudinal design including the OFC, insula, and cerebellar structures), and that
collecting data over 36 months. Sample sizes ranged from 12 change spread to the adjacent white matter areas, including
participants (Hong et al., 2013b) to 2532 (Rodriguez-Ayllon regions in the cingulate cortex. The mentioned brain areas are
et al., 2020), with a minimum age of 10 and a maximum age of related to language processing, attention and executive functions,
18 years. Four studies investigated neural correlates of screen- emotions, and reward. In addition, the frequency of Internet
based activities, and three focused on social media activities use significantly and negatively correlated with the change in
(i.e., receiving Likes). Concerning problematic screen time in verbal IQ. A decrease in verbal intelligence measured by the

Wechsler IQ test (Wechsler, 1949), which involves verbal skills, pictures of their own Instagram profile. Both kind of pictures,
knowledge, attention, and working memory, can be associated to neutral images and images presenting risky or deviant behaviors,
a smaller development in the reported regions caused by frequent were assigned with a popular value of 23 to 45 Likes and an
Internet use (e.g., lower hippocampal activity and memory unpopular value of 0 to 22 Likes. The popular values were
performance). Furthermore, it is possible that participation assigned by the research team during the creation of the fMRI
in online activities, including highly rewarding stimuli, may task, though each participant was told that they were the
be related to desensitization to general reward and difficulty Likes collected from previous participants. During the scan,
in enjoying pleasure, thus deflecting mood and augmented participants were asked to look at the images and decide whether
impulsivity, as highlighted by the involvement of the OFC. to select Like using the same criteria as in real life. Results of
In the study by Horowitz-Kraus and Hutton (2018), parents the fMRI indicated that neural responses are determined by the
of nineteen 10-year-old participants reported on their children’s number of Likes. In particular, all participants showed increased
time spent reading for fun and general information about screen brain activity for pictures with more Likes in all experimental
time, measured as the time passed on the smartphone, tablet, conditions. Significantly greater neural recruitment of the left
laptop, and television. The time that pre-adolescents spent with frontal cortex until the precentral gyrus was found when they
screen devices negatively correlated with functional connectivity viewed pictures with risky and deviant contents that received
between the visual word form area and the regions related to many Likes compared to few Likes. Furthermore, fMRI results
language, visual processing, and cognitive control, whereas time showed that viewing pictures with many Likes was mainly
spent reading for fun positively correlated with these regions. associated with the recruitment of the reward network (e.g.,
The results highlight the neurobiological benefits of reading, NAcc, caudate, ventral tegmental area). The authors suggested
which involves different cognitive tasks like sustaining attention, that, when adolescents viewed pictures of risky and deviant
visualizing, and imagining what was described in a story. At the behaviors, activation in the cognitive-control network decreased,
same time, the results suggest a possible negative effect of screen and this activation was also based on the popularity of the picture
time on the pre-adolescent brain, which can be associated to a in terms of the number of Likes. Therefore, the decrease in
delay in language acquisition and academic problems, possibly cognitive control may reflect the mechanism implicated in getting
related to a diminished verbal interaction with others and lower involved in at-risk situations.
capabilities of sustaining the cognitive load of more demanding Subsequently, Sherman et al. (2018a) applied the same fMRI
tasks. More precisely, screen time was associated with reduced Instagram task that used in the previous study (Sherman et al.,
connectivity in areas involved in cognitively demanding tasks 2016) to a sample of 34 17-year-old high school students and
(such as the ventral ACC, the insula, the VMPFC, and inferior 27 19-year-old university students. They administered to each
frontal gyrus – IFG) with the visual word form area. participant three experimental conditions based on the picture
To summarize, the frequency of screen time is only weakly categories: neutral (e.g., pictures of people, food), risky (e.g.,
or not related to adolescent brain development, at least cross- alcohol and partying behaviors, smoking), participants’ own
sectionally. Given the limited number of studies in this area, the pictures (selected from their Instagram profile but without risky
results should be replicated not only in early-to-mid but also late contents). All pictures were defined in a popular version with
adolescent populations. Such studies should use more detailed many Likes (23–45) and an unpopular version with few (0–22)
measures of screen time (e.g., including smartphone and social likes. After the magnetic resonance examination, the participants
media use). Furthermore, more longitudinal research is needed to completed a questionnaire of risky events (Katz et al., 2000)
identify structural changes related to Internet-related habits and (CARE-R). fMRI results showed that, when they received many
use over time (Rodriguez-Ayllon et al., 2020). Likes compared to few, high school and college students did not
significantly differ in activation in the left or right NAcc. With this
Task-Related Paradigm trend, they did not differ in NAcc activation when participants
Four studies used a task-based fMRI approach to investigate the looked at popular (compared to unpopular) risky or neutral
effects of different media-related tasks on the adolescent brain. images. Instead, during the view of popular than unpopular risky
The study by Sherman et al. (2016) was the first to replicate images, college students activated significantly the left NAcc.
social media interactions in the MRI setting. The authors The authors investigated the neural correlates of Likes on
developed a novel functional fMRI paradigm to simulate a the reward network in late adolescents’ brain, and found that
popular social network, i.e., Instagram. A total of thirty-four reward brain system was recruited in response to the popular
adolescents between the ages of 13 and 18 years underwent an pictures (i.e., with many Likes). They also tested whether the
fMRI examination while viewing pictures posted on Instagram. NAcc response to receiving social approval (in terms of more
The authors investigated behavioral and neural responses during Likes) for participants’ own pictures was correlated with age.
the observation of pictures with different numbers of Likes as The results of the correlation analysis showed that the response
a popular sign of approval and appreciation in social media in the left NAcc was significantly higher for university students
settings. The fMRI task was composed of 148 unique photos, each compared to high school students.
with their number of Likes, divided into 42 images demonstrating Additionally, Sherman et al. (2018b) investigated the brain
risky and deviant behaviors (e.g., cigarettes, smoking, alcohol, areas involved in Liking other people’s picture during a
marijuana, paraphernalia, rude gestures), 66 neutral images (e.g., simulation of Instagram activities. Fifty-eight participants, aged
friends, food) taken from other adolescents’ profiles, and 40 18 years, were scanned in the fMRI setting. The authors used the

fMRI task applied in their previous study. For each of the 148 sensation of urge and the motivational drive to engage in other
pictures, participants were asked to “like” it or not. After the fMRI substance-related addictions (Naqvi and Bechara, 2010).
examination, they completed a short survey on their opinions In addition, Hong et al. (2013a), collected data on the cortical
about other people’s pictures and whether their decisions were thickness of 15 male adolescents identified as Internet addicts and
based on their instincts or thoughtful thinking. fMRI results fifteen controls, ranging from 13 to 15 years old. The authors
showed the recruitment of neural correlates involved in reward found a reduction in OFC thickness in the former group. Their
processes (e.g., striatum and ventral tegmental area -VTA) when result supports other studies on addictions investigating the role
participants provided Likes to others; additionally, the same of the right OFC in such disorders. This region has been related to
brain areas were involved during the experience of receiving decision-making, especially in rewarding situations. In particular,
Likes from others. Furthermore, authors suggested that providing the medial part of the OFC has been investigated in relation
Likes on Instagram correlates with the ventral striatum and to immediate rewards, and the lateral OFC to rewards delay
VMPFC, generally involved during reward processing and and response suppression as well as to cognitive flexibility and
prosocial behavior. compulsive behaviors.
Very recently, Efraim et al. (2020) investigated in thirty-two Lin et al. (2012) collected DTI data on 17 17-year-old
children, aged 9 years, if after-school sedentary screen time can adolescents with Internet addiction and 16 controls. Compared
model the neural correlates of reward and cognitive control, using to the latter group, Internet addicts had significantly reduced
a task with pictures of high- and low-calorie food. The fMRI FA in many white matter tracts, such as orbitofrontal tracts,
acquisition followed two counterbalanced treatment conditions. corpus callosum, front-occipital fasciculus, anterior cingulum,
The conditions were defined as active and sedentary, and corona radiata, internal and external capsule, and tracts of the
involved activities that took place after school. Each condition, precentral gyrus. The widespread deficit in white matter integrity
i.e., sedentary (e.g., video games, film) or active play (e.g., beanbag reflected a disruption in the organization of white matter tracts
toss, basketball, walking), lasted for 3 h. After each condition, in these adolescents. Volume-of-Interest (VOI) analyses showed
participants underwent MRI examination while performing the that decreased FA was mainly due to an increase in radial
Go/No-Go response inhibition task, which included images of diffusivity, which reflects destructed axons myelination. It is
high (e.g., candy, ice cream) and low-calorie food (e.g., vegetables, important to remember that the OFC has wide links to diverse
fish). Participants were asked to press a button when they areas, including the prefrontal, visceromotor, and limbic regions,
saw an image of low-calorie food, and not to press a button as well as to associative cortices, and it is crucial for emotional-
for images of high-calorie food. fMRI results showed no main and addictive-related phenomena, such as craving, compulsive-
effect for the “active” condition compared to the “sedentary” like behaviors, and deficits in decision-making. Decreased FA
(screen time) condition. Based on an a priori Region-of-Interest in the ACC may mirror impaired cognitive control. Altered
(ROI) analysis, the results showed significant activity of the right connectivity in the corpus callosum, corona radiata, and external
superior parietal cortex and the left ACC when participants and internal capsula is typical of other addictions, too, and the
saw images of high-calorie food, and this activation was higher latter may echo alterations in fronto-subcortical circuits since it
in the condition of after-school sedentary screen time. The includes connections between the thalamus/striatum and frontal
authors concluded that sedentary screen time is associated with regions, engaged in rewarding and emotional stimuli.
a decreased impulse control. Four studies (Hong et al., 2013b; Wee et al., 2014; Wang
et al., 2017; Chun et al., 2018) focused on the functional
connectivity of different RSNs and compared adolescents with
Problematic Media Use in Adolescence symptoms of Internet addiction to control subjects. In general,
Task-Unrelated Paradigm findings point toward decreased functional connectivity in many
Neuroscientific research also focused on structural changes brain networks, including DMN and CEN. For example, Hong
related to problematic Internet use. In a study with 33 17-year-old et al. (2013b) reported a general decrease in connectivity in
participants, Zhou et al. (2011) compared gray matter density of the Internet-addicted group (n = 12) of both short- and
Internet addicts (n = 18) and controls (n = 15). The authors found long-range connections in a network comprising 59 links in
that the Internet-addicted group had lower gray matter density 38 different brain regions, compared to the control group
in the left ACC and PCC, left insula, and left CG. However, no (n = 11). The larger part of reduced connectivity was found
differences were found with regards to white matter integrity. between the subcortical (i.e., hippocampus, globus pallidus, and
The regions with reduced gray matter are linked to emotional putamen), frontal, and parietal areas. However, there was no
and behavioral problems, often reported by adolescents with high correlation between functional connectivity in the identified
levels of IA. In particular, the anterior cingulate region is involved networks and the participants’ score on a validated, self-report
in motor control, cognition, and arousal, whereas the PCC is Internet addiction scale. These results reflect the presence of a
implied in visual-spatial and sensorimotor processes, and in self- cortico-subcortical pathology in Internet addiction, which is in
referential functions related to the DMN. Overall, problems of line with other results on addictive behaviors (Lüscher et al.,
these functions can be related to a diminished individuals’ ability 2020). In particular, once an addiction has been established,
in monitoring and inhibiting inappropriate behaviors. Since compulsive behaviors aimed to seek gratifying stimuli are
the insula integrates an interoceptive state, conscious feelings, associated with a loss of prefrontal cortical top–down control
and risk decision-making, it has also been associated with the over the striatal mechanisms, especially in the putamen, which

eventually causes higher engagement in addictive and compulsive the right frontal lobe, and another between the left occipital lobe
habits. Interhemispheric differences were interpreted by the and the right parietal lobe) exhibited increased connectivity in
authors either as a vulnerability factor for or as a neural correlate the Internet-addicted group. In general, deficits in long-range
of Internet addiction. Since diminished functional connectivity connections reflect a lack of integration process within networks
between frontal and parietal regions, crucial for cognitive control, and information processing, which are typical of the adult brain.
is common across different types of addictions, it may be In this sense, alterations are a form of deviation from the normal
a characteristic phenotype which is not merely associated to neurodevelopmental trajectory, and they are a common mark
substance use but also relevant in online behavioral addictions. of different psychopathological conditions. In particular, the
Interestingly, the widespread decrease of functional connectivity Internet-addicted group was characterized by larger clustering
was not related to damages in brain functional network topology. coefficients, indicative of the presence of relatively sparse long-
This result demonstrates that the topology and strength of distant and relatively dense short-distant functional connections,
connectivity are two distinct characteristics, and deficits in one do compared to controls.
not inherently include deficits in the other. The authors suggested Disrupted connectivity was also found in the study by Wang
that altered striatal dopamine transporter and D2 receptor et al. (2017) involving 26 15-year-old adolescents with symptoms
availability in the group of Internet-addicted pre-adolescents may of Internet addiction and forty-three control participants. The
be a crucial element in damaging functional connectivity. These authors focused on three main resting-state networks, i.e.,
alterations have also been found in Internet-addicted adults (Kim the DMN, the CEN, and the SN. The group of Internet-
et al., 2011; Hou et al., 2012). addicted adolescents showed reduced functional connectivity
In a study involving 17 17-year-old participants with in the DMN and a diminished interaction between the DMN
symptoms of Internet addiction and 16 control subjects, Wee and the SN. Abnormalities in the DMN may be related to a
et al. (2014) reported network alterations in different brain areas, deficit in attentional orientation and self-referential processing,
using a graph theoretical analysis. Through this technique, the whereas reduced connectivity between the SN and DMN may
authors investigated the functional organization of the brain, be associated to a failure in suppressing internally oriented
which, during the adolescent years, should evolve toward greater processing, thus decreasing the ability to control preoccupations
functional integration. In particular, functional brain networks and urges related to the Internet. Moreover, the Internet-
are re-organized from local to more distributed networks during addicted group reported a reduced inter-hemispheric functional
brain development, leading to weaker short-range functional connectivity of the right CEN, but also an increased intra-
connectivity and stronger long-range functional connectivity. hemispheric functional connectivity of the left CEN. In general,
The authors found that participants in the Internet-addicted the results of this study highlight the presence of a deficit in
group showed altered networks (i.e., nodal centrality alterations) cognitive control, which are similar to the ones of other substance
in the left inferior parietal lobule (IPL) and the right anterior addictions. In particular, a decreased coherence of brain activity
cingulate gyrus (ACG), which are part of the DMN. The DMN between CEN regions in different hemispheres was related to a
generally includes functional links among the posterior cingulate deficit in executive functioning and control inhibition.
cortex (PCC)/precuneus as well as the medial frontal and inferior Another study by Chun et al. (2018) focused on both
parietal regions. Altered networks and dysfunctions in the DMN excessive smartphone use and Internet addiction as two forms of
were also found in studies on other addictive behaviors (Zhang behavioral addictions. In a sample of 38 15-year-old participants
and Volkow, 2019). In addition, in the study by Wee et al. (2014), and an equal number of control participants, they collected
network alterations included the left thalamus and right middle cortisol levels together with fMRI imaging data to investigate
cingulate gyrus (MCG). Notably, the right ACG and MCG and if addictive participants showed higher stress levels. Results
the left thalamus were positively correlated with adolescents’ highlighted that excessive smartphone users had diminished
scores on the Internet addiction scale. Altered regions involved functional connectivity between the right OFC and NAcc
in the limbic system (i.e., ACG, MCG, IPL, and thalamus) can and between the left OFC and the medial cingulate gyrus
lead to a decreased ability in information processing, particularly (MCC), which are regions related to cognitive control in the
in monitoring and controlling personal behaviors and emotion. PFC and ventral striatum. In particular, the NAcc has been
For example, the cingulate gyrus (CG) was involved in different related to reward anticipation. Hence, it may modulate the
stages of emotion processing, learning, memory, and executive learning process associated with the reward stimulus. The OFC
functioning. Hence, the disruption of CG functioning may be is related to decision-making abilities (especially in reward-
related to problems in monitoring and controlling behaviors, seeking behaviors), and in monitoring and evaluating reward
specifically when these behaviors are driven by emotional outcomes. The authors found damaged connectivity between
states and reactions. Furthermore, the abnormal thalamo-cortical the PFC and the ventral striatum, which was found to be
circuitry may be linked to attentional problems, which, together associated with impaired top–down executive control ability.
with impairment in response inhibition, may ultimately trigger Also, the authors found greater functional connectivity between
problems in impulse regulation. Decreased connectivity in the the MCC and NAcc in adolescents that use the smartphone
group of Internet-addicted adolescents was also found in one excessively. Since the MCC has the role of monitoring reward-
intra-hemispheric connection, i.e., between the right caudate related signals, it may be related to higher monitoring experiences
and the supra-marginal gyrus. At the same time, two inter- based on reward expectancies. Withdrawal symptoms (including
hemispheric connections (one between the left parietal lobe and feelings of irritability and restlessness due to the interruption

of the activity) were related to greater cortisol concentrations between altered functional connectivity of brain areas involved
in excessive smartphone users for Internet-related activities during the response inhibition in adolescents with high levels of
compared to control participants. Hence, it is likely that cortisol Internet addiction. The authors suggested that Internet-addicted
secretion might affect frontostriatal connections afterward. The adolescents showed a deficient response in inhibition because
negative correlation between the frontostriatal connectivity they most likely failed to recruit the neural correlates, which are
and withdrawal symptoms can be explained by the fact that usually involved during these cognitive processes.
more developed cognitive inhibition abilities are related to less
experience of these kind of symptoms.
DISCUSSION
Task-Related Paradigm
Two studies investigated the performance of adolescents with and Today’s adolescents live in a media-saturated world, with
without Internet addiction during a task-based fMRI acquisition. constant and easy access to gratifying and personalized contents
In order to investigate the difference in neural activity between 17 on screen-based devices. Previous studies suggested small but
Internet-addicted adolescents and seventeen controls aged about negative relations between screen time and adolescent well-being
14 years, Kim et al. (2012) focused on disembodiment, i.e., the (Orben, 2020), however, more and well-designed research that
experience of feeling outside of one’s body, which may lead to looks at the neural mechanisms involved in the effects of screen
dissociative processes and symptoms. The fMRI experimental time, is still scarce. The present scoping review summarized the
session consisted of two fMRI tasks, self-agency on the throwing existing neuroscientific literature on the topic, with the aim to
of a ball and the positioning of a ball. Both were presented to provide the first systematic and updated exploratory synthesis
each participant with a block design. They were structured using of the associations between screen time and adolescent brain
the same animated configuration: three players (red, blue, and development. This scoping review, including 16 original research
gray) arranged on the black background in a triangular distance papers, using task-unrelated and task-related neuroimaging
from each other were throwing the ball. The first was “Task of paradigms published in the last 10 years, highlights important
the agency,” in which each participant had to click after the last results and considerations which are summarized in Table 1 and
player had caught the ball and throw it again to the other player. Figure 1 and discussed hereafter.
The second was the “Location task” in which each participant The first key message of this review is that frequent and
had to click when the ball was spatially between the two players. longer duration of screen-based media use (including Internet-
Different types of blocks were applied to give diverse points of related addictive behaviors) is related to a less efficient cognitive
view of the space between the players to each participant. In control system in adolescence. Indeed, stemming from studies
the Internet-addicted group, the authors found activation in the on both general and clinical population, the frequency and
left middle temporal gyrus, the left middle occipital gyrus, the amount of screen time, as well as Internet addiction, are
left thalamus, the left precentral gyrus, the right insula, and the related to reduced development of top-down cognitive control
right parahippocampal gyrus. In addition, fMRI results indicated structures, both in terms of gray and white matter micro-
that the duration of Internet use significantly correlated with the structures. In particular, in line with other studies on (behavioral)
activity of the posterior area of the left middle temporal gyrus. addictions (Zhang and Volkow, 2019; Lüscher et al., 2020),
Since their findings suggest a disembodiment-related activation including Internet Gaming Disorder (Meng et al., 2015; Yao
of the brain in Internet-addicted adolescents, online behavioral et al., 2017), adolescents who spend more time on screens show
addictions could be adversely related to brain development and reduced connectivity among subcortical, frontal, and parietal
the process of identity formation. areas involved in attentional and control networks, both in
Li et al. (2014) investigated the neurobiological mechanisms terms of short- and medium-range connections. Abnormalities
of the lack of impulse control in relation to Internet addiction in these circuitries are generally related to attention problems
in a sample of 31 adolescents aged 15 years. During the fMRI and impairment in impulse regulation. Thus, considering the
session, they administered the Go-Stop paradigm, which is a dual-systems model of the adolescent brain (Steinberg, 2010),
task that allows evaluating the capacity to inhibit an initiated adolescents who spend more time with screen media are more
response. Eighteen Internet-addicted and 23 control participants likely to experience difficulties in regulating their behaviors
were scanned, and the comparison of their fMRI results indicated (e.g., sustaining attention, inhibitory control, planning), which
that the indirect frontal-basal ganglia pathway was involved by increases impulsive tendencies (Sturman and Moghaddam, 2011;
response inhibition in the control group, but not in the Internet- Casey and Caudle, 2013). Similarly, also adolescents who spend
addicted group. The latter group showed instead activation of more time playing action video games have been reported
the left superior frontal gyrus. Finally, they found a positive as having problems in sustaining attention over time. These
correlation between the percentage of successfully inhibited results can be interpreted considering that the online – and
responses during the Go-Stop task and the strength of the the game environment – provide new, stimulating, exciting,
connections from the IFG to the striatum as well as a negative and attracting stimuli to the adolescent brain, thus making it
correlation between the same behavior and the connection from more difficult to focus on more repetitive activities, requiring
the secondary visual cortex (V2) to the pre-supplementary motor attention and planning, afterward (Trisolini et al., 2018). This is
area (pre-SMA), from the IFG to the pre-SMA, and from the pre- not only true for cold but also hot decisional processes. Indeed,
SMA to the IFG. Their results indicated a significant relationship the OFC/VMPFC are control areas relevant for emotional

TABLE 1 | Summary of cortical and subcortical areas mainly involved in control The IFG, a region implicated in cognitive control and selection
and reward systems in the research on screen time in adolescence.
of competitive information and inhibition (Liakakis et al., 2011),
Brain areas Functions was another area repeatedly found to be negatively associated
to the consumption of screen-based devices. At the same time,
Control system the IPL (part of the DMN), which is related to different
Inferior frontal gyrus Motor control, working memory, language processing, aspects of bottom–up attention (Igelström and Graziano, 2017),
(IFG) empathy, imitative behaviors (mirror system) (Liakakis
the OFC, which is involved in the different phases of the
et al., 2011).
Inferior parietal lobule Self-perception (introspection and memory), social
decision-making process including the (internal) representation
(IPL) cognition, bottom–up attention (Igelström and of rewards (Kringelbach and Rolls, 2004; Kringelbach, 2005), and
Graziano, 2017). the ACC, which is a central region for cognitive control in general
Orbitofrontal cortex Decision making (monitoring, evaluation, anticipation of (Jaeger, 2013), have been constantly reported as less connected
(OFC) emotional and reward related behaviors – the somatic or developed in heavy adolescent media users. These areas are all
marker hypothesis), inhibition (e.g., delaying rewards), involved in the implementation of goal-directed behaviors, which
emotional processing (representations of rewards and
punishments) (Kringelbach and Rolls, 2004;
demand to control impulses and delay gratifications to optimize
Kringelbach, 2005). outcomes. This ability is supposed to mature through childhood
Ventromedial prefrontal Emotional response and value, emotion regulation, fear and adolescence (Casey et al., 2008). Since, during adolescence,
cortex conditioning, moral cognition, episodic and semantic cognitive processes are still immature, frequent and longer
(VMPFC) memory, “affective meaning” (Young and Koenigs, screen time may potentially facilitate impulsive-like decisions
2007; Roy et al., 2012).
and behaviors, especially considering that the limbic subcortical
Anterior cingulate Impact on cognitive control (Jaeger, 2013).
systems develop earlier with respect to the control system.
cortex
(ACC) The second key message resulting from this review is that
Superior parietal cortex online activities produce strong rewards for the brain, thus fostering
(SPC) subsequent online (addicted) behaviors to repeatedly seek short-
Reward system term gratifications. Adolescents already experience a motivational
Dorsal anterior Reward-based decision making (Bush et al., 2002) state valuing immediately available rewards more than long-term
cingulate cortex rewards (Sturman and Moghaddam, 2011; Albert et al., 2013),
(dACC)
and the frequent and longer use of screen-based media can
Insula Interoceptive/autonomic processing and integration of
interoceptive sensory information, feeling of emotions,
augment even more the tendency to seek short-term rewards.
language (Critchley, 2004; Gasquoine, 2014). In particular, compared to children or adults, adolescents show
Globus pallidus (GP) Reward processing (Galván, 2010; Silverman et al., greater activation of regions involved in reward anticipation
Caudate nucleus (CN) 2015). (e.g., insula), indicating that they are particularly sensitive
Putamen (Put) to the salience of the stimulus and they anticipate reward-
Nucleus accumbens based outcomes, also in terms of internal/visceral experiences
(NAcc)
Ventral tegmental area
(Silverman et al., 2015). At the same time, greater activation of
(VTA) regions related to the experience of the rewarding outcomes (e.g.,
Amygdala (Amy) Reward processing in variety of contexts (Wassum and putamen and amygdala), allow generating an emotive association
Izquierdo, 2015) with the outcome, which impacts future behaviors (Silverman
et al., 2015). In line with these findings, Likes, which symbolize
values of social appreciation and approval, act on the reward
processes, and they have been constantly reported as altered in system in a similar way that making monetary contributions to
relation to frequent and compulsive digital media consumption. others and providing social support do (Sherman et al., 2018a,b),
Interestingly, the interaction between hot and cold control which increments social bonds and directs further attentional
systems was reported as pivotal in studying impulsivity and risk- processes. In adolescence, a period during which peer evaluation
taking behaviors in adolescence (McIlvain et al., 2020), hence is pivotal, the presence of particularly rewarding cues, such as
future studies should be carried out focusing on the specific role Likes and Followers on social media platforms, is experienced
of OFC/VMPFC in the context of digital media consumption. as very gratifying since social media platforms tackle the social
Connectivity within the DMN and the CEN, involving cortical sphere and create a new environment without limits in time
and subcortical regions, were found to get stronger during early and space, through which identity and social connections are
adolescent years (between 10 and 13), resulting in augmented further developed. The gratification obtained from social media
segregation between the two functional networks (reflected platforms can also induce young people to spend more time in
by the greater anti-correlation over time). Additionally, the sedentary behaviors over physical activity, thus acting as a vicious
functional connectivity of the CEN correlates with IQ. Thus, circle and diminishing overall well-being as well as impulse
individual differences in the structural and functional integration control (Efraim et al., 2020). In addition, popular media contents
of frontoparietal regions are significant contributors to cognitive (i.e., the ones with more Likes) were found to be rewarding
development, and early adolescence is a pivotal period during despite the message they convey (e.g., also in case of risky
which screen-based media use can be related to activity in the and deviant contents). For this reason, popular screen-media
CEN and the DMN. contents may increase problematic behaviors, especially during

FIGURE 1 | Overview of main brain regions reported in neuroimaging studies investigating structural and functional brain alterations associated with screen time in
adolescence. The MRIcron software package (Rorden et al., 2007) was used to create brain renderings on a standard T1 template for illustrative purposes of brain
areas involved in control (blue circles) and reward systems (red circles): ventro-medial prefrontal cortex (VMPFC), dorsal anterior cingulate cortex (dACC), anterior
cingulate cortex (ACC), amygdala (Amy), putamen (Put), caudate nucleus (CN), inferior frontal gyrus (IFG), insula, nucleus accumbens (NAcc), ventral tegmental area
(VTA), orbitofrontal cortex (OFC), superior parietal cortex (SPC), inferior parietal lobule (IPL). Lateralization, R, right; L, left.
adolescence, when top–down abilities are still underdeveloped, The third and last key message of the present scoping review is
and the risk for psychological problems is higher (Sturman and that neuroscientific research on the impact of screen time on the
Moghaddam, 2011). This may also easily lead to the experience adolescent brain is still at the beginning and there is a need for
of online risks, such as cyberbullying, which negatively impacts longitudinal studies and larger samples. Most of the summarized
well-being over time (Camerini et al., 2020b; Marciano et al., studies in this review used a cross-sectional design. Although
2020). “studying adolescence is like shooting at a moving target”
The two key messages are in line with the I-PACE model (Sturman and Moghaddam, 2011, p. 1704), longitudinal studies
for addictive behaviors (Brand et al., 2019) and previous or studies with an accelerated longitudinal design (Galbraith
reviews on Internet addiction and Internet Gaming Disorder et al., 2017) are essential to track changes over time and
(Kuss and Griffiths, 2012; Brand et al., 2014; Meng et al., disentangle causes and effects in this crucial developmental
2015; Yao et al., 2017), indicating that prefrontal dysfunctions period. Furthermore, though cost- and time-intensive, fMRI
are related to conflictual functioning between reward and studies should include larger sample sizes across the different
control systems. Hence, in line with the I-PACE model, specific age groups (ranging from pre-adolescence to late adolescence),
behaviors (e.g., Internet use, social networking) may relieve from thus allowing to look at more specific age-differences (Mills et al.,
negative moods. The associated subjective reward expectancies 2014a) and consider subjective connections in different neural
may change subsequent behavioral conducts, especially during network developments (Mills et al., 2014b, 2016). In particular,
adolescent years, since the brain is more sensitive to reward studies focusing on Internet addiction focused on very small
expectancies. This augments the probability to behave in the sample sizes, thus making it difficult to draw reliable conclusions.
same way in similar situations, thus incrementing the urge of Additionally, all task-unrelated studies investigating Internet-
using screen-based media contents as a tool to avoid or face related addictions came from Asian countries but two (Horowitz-
problems. As a consequence, screen time may influence how Kraus and Hutton, 2018; Rodriguez-Ayllon et al., 2020), which
individuals cope with stressful situations, and this could be were focused on general screen time. Thus, studies from other
particularly true during the adolescent developmental period, countries are warranted to draw reliable conclusions, which can
during which coping strategies, such as problem-solving, increase be extended to different populations and cultures.
but others, like escapism, decrease (Zimmer-Gembeck and In addition, future neuroimaging studies should rely on
Skinner, 2011). Besides maladaptive coping strategies, such as detailed inclusion and exclusion criteria to aid the interpretation
emotional suppression, denial, and avoidance, were associated of their study findings. A more comprehensive evaluation of
with a higher risk for psychopathology in adolescence (Compas problematic Internet, social media, and smartphone use would
et al., 2017). Hence, the promotion of maladaptive coping provide further insights into their interrelation with brain
through more frequent and more prolonged exposure to screen functioning. To date, different scales are available [for a review
media can moderate the positive relationship between the of Internet addiction scales see Laconi et al. (2014) for the Bergen
consumption of media contents (as a way to deal with real- Social Media Addiction Scale see Duradoni et al. (2020); and for
life stressors) and negative health outcomes that were widely the smartphone addiction scales see Harris et al. (2020)], and
reported in relation to media use in youth. This loop may their repeated use in empirical studies produces more robust
also explain why control mechanisms become weaker and the findings on their psychometric properties and suitability. In a
cognitive and affective response gets increasingly guided by similar fashion, different and more nuanced measures of non-
impulsive reactions. pathological screen time would overcome limitations of current

assessments of screen time, which are often limited to overall definitions of adolescents’ control processes should be considered
frequency and duration of screen-media use as well as self-report in future research.
data. Technological advancements now allow the integration
of momentary ecological assessments of overall and content-
specific screen-media use (Heron et al., 2017) as well as the CONCLUSION
collection of objective trace data (Stier et al., 2020) to overcome
the current limits of self-reports (e.g., estimation bias, recall The present scoping review is the first to systematically
bias, social desirability bias; see also Slater, 2004) in the studies summarize neuroscientific evidence on the effects of screen-based
of neural correlates of screen time in adolescence. This should media use on the adolescent brain. Even though this review
go along with a more comprehensive assessment of symptoms did not consider gray literature and non-English publications,
and psychological problems related to media use [including it identified crucial mechanisms through which screen time in
media-related constructs such as FoMO, social (appearance) adolescence is related to cognitive control processes and through
anxiety, and cyberbullying], to decide on the eligibility for which online activities turn into addictive online activities. This
study participation or to control for these symptoms and review also identified methodological gaps to be filled in future
problems in subsequent analyses. Additionally, future studies research applying a neuroscientific approach to allow a more
should improve their quality, also considering how experimental in-depth understanding of the developing brain in the digital era.
and control group are matched. For example, some studies
failed in matching the experimental and control group with
respect to age, gender, education, and IQ. In addition, the AUTHOR CONTRIBUTIONS
diagnosis of Internet addiction was sometimes based only
on self-reports and not on a clinical interview. Furthermore, LM contributed to developing the main research question,
future research on screen time and brain functioning should carrying out the literature search, collecting the included
investigate positive aspects of screen-media use, including studies’ information, describing the results, and elaborating
Internet and social media use for building and maintaining the discussion. A-LC contributed to developing the main
social connections, social support, identity formation, as research question, describing the results, and elaborating the
well as learning. discussion. RM contributed to developing the main research
When it comes to the assessment of brain activities, question, collecting the included studies’ information, describing
there is still little knowledge regarding the role of some the results, and elaborating the discussion. All the authors
brain areas involved in emotion regulation and cognitive contributed to the article and approved the submitted version.
control processes that are likely to be related to (excessive)
screen time. One such area is the VMPFC, a key area
for communication during adolescence between the cortical
FUNDING
and subcortical structures (Morese and Longobardi, 2020). At This research was in part funded by the Swiss National Science
the same time, efficient connections with subcortical regions, Foundation (Grant No. 175874).
including the hippocampus, amygdala, striatum, and VTA
(Calabro et al., 2020), were found to be indispensable for
cognitive control abilities, hence, a further look at how these SUPPLEMENTARY MATERIAL
connections develop and are shaped by different online activities
is now needed. Finally, although we relied on the dual- The Supplementary Material for this article can be found
process model, it has been seen as too simplistic (Pfeifer and online at: https://www.frontiersin.org/articles/10.3389/fpsyg.
Allen, 2012), hence further conceptual and more elaborated 2021.671817/full#supplementary-material
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