An editorial in the latest American Academy of Pediatrics journal, Pediatrics, recommends adding an additional “S” to the HEADSSS acronym to become HEADS4. The revised acronym would equate to: home life, education, activities, drugs, sexual activity, safety, suicide and/or depression, and social media.
Highlights from the editorial:
- Because aberrant social media use may mirror addiction, management may warrant approaches typically used in substance abuse care, such as screening, brief intervention and referral to treatment.
- Social networking has emerged as a potentially addictive cornerstone of teenage life; it now warrants systematic assessment by practitioners.
- HEADSSS remains helpful, but the additional “S” for social media can operate as a tool for patient education and risk stratification.
- Social media questions should be implemented into the routine clinical assessment of adolescents.
A potential framework for questions to assess patients’ social media practices:
All pediatric patients > 11 years should be asked the following:
- Which social media site and/or apps do you regularly use?
- How long do you spend on social media sites and/or applications in a typical day?
- Concerning response: > 120 minutes per day.
- Practical tip: Most smartphones track the total time spent in each application. Ask the patient if they would be willing to follow these instructions to get a more accurate response.
- iOS instructions: Settings -> Battery -> clock icon -> scroll down to “Battery Usage.” May also download the applications listed below from the App Store.
- Android instructions: will need to download an application that tracks usage. Free options in the Google Play store include “QualityTime,” “BreakFree” and “Checky.”
- Do you think you use social media too much?
- If yes, ask if they have tried any strategies to remedy it.
- Does viewing social media increase or decrease your self-confidence?
- Have you personally experienced cyberbullying, sexting or an online user asking to have sexual relations with you?
- Depending on the patient, the clinician may need to describe what these are.
If screening raises concern, potential next steps may include the following:
- Crafting a family media plan
- Follow-up appointments
- Behavioral health referral
