Smartphone and social media harms: why we failed in our duty of care

Dear Editor

We write in response to your editorial entitled ‘Smartphone and social media harms: why we failed in our duty of care’ (Abbasi, 2025). As you observe, the show “Adolescence” has injected urgency into discussions about online harms to teenagers. We commend your article and the series for highlighting this issue.

In “Adolescence”, we are first presented with the incongruence of a 13 year old killer. This is a rare phenomenon but not a new one, which understandably attracts public attention. In the UK, there have been homicides perpetrated by children under 13 years every few decades: Mary Bell (1968); Thompson and Venables (1993). None of these children had mobile phones or unfettered access to the internet, underlining the importance of looking more deeply into the reasons behind such tragic events. Loeber and Farrington (2000) suggest 2% of homicides by juveniles in the US between 1980 and 1997 were by children under 12 years. We are concerned that these rare events have influenced public opinion such that the Minimum Age of Criminal Responsibility in England and Wales (at 10 years) remains much lower than that recommended by the United Nations.

Society may be tempted to focus blame for violence on easily identifiable, single factors. This can include the impact of online bullying on smartphones or the attractions of toxic masculinity for lonely boys, who lack strong masculine support and attention as they go into adolescence. However, causes of violence are multi-factorial (Adshead, 2024). The existence and interaction of individual, family, peer and societal factors is well rehearsed in the academic literature. For example, exposure to four or more kinds of childhood adversity, (especially neglect and emotional abuse), is a known risk factor for violence (Baglivio et al, 2014; Fox et al, 2015). Equally, childhood adversity and/or social isolation can render a young person more susceptible to risky on line material.

More positively, early interventions for children, and their parents, can make a real difference to young people’s risk of future violence. There is a wealth of evidence that a range of programmes, both holistic and health focused, based in a range of settings in the community, can improve a young person’s psychological sense of security and protect them from social isolation and disconnection. Sadly, such services are either overloaded or degraded. Yet they can provide toe holds for both age appropriate child development and digital education, as recommended by Goodyear and colleagues (2025) in the same issue as your editorial.

More controversially still, “Adolescence” concludes by sympathetically depicting the experience of the perpetrator’s family after the killing. The publicity surrounding such cases in real life is often profoundly negative and hostile to families at an extremely difficult time. Families can experience competing emotions of love and concern for their child and horror at what they have done, as vividly described by the mother of one of the Columbine killers (Klebold, 2016). Siblings can be innocent casualties of the aftermath of this kind of event too (Bartlett et al, 2018). Assuming rehabilitation is the goal, families can be an important support to child killers post conviction as we prepare them for a crime-free adult life. Families need support not judgement at these times.

We are grateful this debate has begun. We call for a review of the Minimum Age of Criminal Responsibility as we are out of line with the international consensus. We highlight the need for more support services both to prevent harms that can lead to serious violence and to help children and their families to rehabilitate when the unspeakable has occurred.

Yours sincerely
Dr Gwen Adshead, Consultant Forensic Psychiatrist, West London NHS Trust
Dr Annie Bartlett, Professor of Offender Care, City St George’s, University of London
Dr Heidi Hales, Consultant Adolescent Forensic Psychiatrist, Betsi Cadwaladr University Health Board

References
Abbasi, K. (2025) Smartphone and social media harms: why we failed in our duty of care. BMJ: 389: r658. Smartphone and social media harms: why we failed in our duty of care | The BMJ
Loeber, R. & Farrington, D.P. (2000) Young children who commit crime: Epidemiology, developmental origins, risk factors, early interventions, and policy implications. Development and Psychopathology. 12: 737-762.
Adshead, G (2024, in press) Four questions about violence: The 2024 BBC Reith Lectures. Lecture 1: is violence normal? London, Faber.
Baglivio, M.T., Wolff, K.T., Piquero, A.R. and Epps, N. (2015). The relationship between adverse childhood experiences (ACE) and juvenile offending trajectories in a juvenile offender sample. Journal of Criminal Justice, 43(3): 229-241.
Fox, B.H., Perez, N., Cass, E., Baglivio, M.T. and Epps, N (2015) Trauma changes everything: Examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders. Child abuse & neglect, 46: 163-173.
Goodyear VA, James C, Orben A, Quennerstedt M, Schwartz G, Pallan M. (2025) Approaches to children’s smartphone and social media use must go beyond bans. BMJ;388:e082569 Approaches to children’s smartphone and social media use must go beyond bans | The BMJ
Klebold, S. (2016) A Mother’s Reckoning. Crown Publishers: United States
Bartlett, A., Warner, L. & Hales, H. (2018) Young people’s secure care: Professionals’ and parents’ views of its purpose, placements and practice. NHS Gateway. secure-settings-for-young-people-a-national-scoping-exercise-paper-3-interview-report.pdf