Prospective Associations Between Early Adolescent Problematic Screen Use, Mental Health, Sleep, and Substance Use

INTRODUCTION: There are limited large-scale, prospective analyses examining problematic (addiction-like) screen use and mental and behavioral health outcomes in early adolescents. This study aimed to determine the associations between problematic screen use and mental and behavioral health outcomes-such as depressive symptoms, suicidal behaviors, sleep disturbance, and substance use initiation-1 year later in a national cohort of children aged 11-12 years in the U.S. METHODS: Prospective cohort data from Adolescent Brain Cognitive Development Study participants who reported their screen use at ages 11-12 (Year 2, 2018-2020; N=8,119; 47.5% female; 43.8% racial/ethnic minority) were analyzed in 2025. Associations between problematic screen use (Social Media Addiction Questionnaire, Video Game Addiction Questionnaire, Mobile Phone Involvement Questionnaire, Year 2) and mental and behavioral health outcomes (Year 3) were determined using either linear or logistic regression analyses on the basis of the outcome, adjusting for potential confounders (Year 2). RESULTS: Problematic mobile phone use and social media use were prospectively associated with higher depressive, somatic, attention/deficit, oppositional defiant, and conduct problems scores; suicidal behaviors; sleep disturbance; and substance initiation. Problematic video game use was associated with higher depressive, attention/deficit, and oppositional defiant scores; suicidal behaviors; and sleep disturbance. CONCLUSIONS: Early adolescent problematic screen use is prospectively associated with poor mental and behavioral health outcomes 1 year later, extending prior cross-sectional findings. Clinicians can assess not only screen time but also problematic screen use and provide guidance to adolescents and parents, including the development of a family media plan.