Isabel Fattal: In the years since you last published this book, technology became a dominant part of parents’ and toddlers’ lives. You argue in the book that people are always afraid that social changes will have a negative effect on toddlers, but that often, with time, this fear is proven unfounded. Do you think this will happen with current concerns about technology?

Alicia Lieberman: I do. I think that any pressure, any new source of stress, adds to the difficulty that parents and children have in negotiating [family] relationships and negotiating the world. For example, the data shows that when working mothers are committed to their work, and find meaning and satisfaction in their work, and have working conditions that enable them to balance their work life and their family life, working is not a risk factor for children. When mothers are feeling that the work conditions are so demanding, so oppressive, that it comes at the expense of their ability to pay attention to their children … then it does have a negative impact.

Divorce [is another] example. When the most major researcher in divorce, Mavis Hetherington, began studying divorce in the 1970s, she thought it was cause and effect: Parents get divorced, [which has a negative effect on] children. Thirty years later, she realized that it depends on: What are the mediating factors, moderating factors, social circumstances? How do the parents get along after divorce, how do they talk about each other to the child? All kinds of emotionally charged conditions that are much more predictive than the single factor of divorce. The same thing will happen with screen time and media.

Fattal: How does this theory map onto the way that parents should approach technology?

Lieberman: When mothers and fathers feel so overwhelmed about their circumstances that they use the tablets as substitutes for themselves, then their children are essentially alone with these inanimate objects. They are not engaging in reciprocal interpersonal relationships. But parents [can also] use screen time as an aid, not as a persistent substitute. I have seen children and parents who move back and forth between the use of the tablet, the same way that you use a book or a toy … something that will give the child time alone to enjoy an individual activity while the parent is doing something else, but not as a substitute for relationships.

Fattal: How have shifts in public mental-health discourse over the past 25 years affected toddlers?

Lieberman: There is an increasing understanding of how out-of-control behaviors or withdrawn behaviors—intense separation anxiety, persistent sleeping problems, inconsolable tantrums, aggression, emotional or social withdrawal—can be traced to stress and trauma that nobody has asked about. There are studies showing that when one goes to community behavioral-health clinics and looks at the diagnoses given to children in the 2-to-5 age range, the predominant diagnoses are ADHD and behavioral problems. But when one asks the parents, ‘What happened to your child?’ and one is asking systematically about accidents, frightening separations, violence in the community, violence in the home, [many] of those children have been exposed to traumatic circumstances that very clearly can be connected to symptoms. There is a group of people that is carrying that knowledge, and we are doing our best to disseminate it. We’ve come a long way, but it is by no means incorporated yet in all the systems of care that need to know about this frame.