Screen the screens

MANN BERTELS T MARGO BY

Should our kids’ digital exposure be managed?

Love or hate it, electronic entertainment is a part of your child’s life. But you must manage the exposure and spot warning signs, especially with the rising rates of ADHD

Studying our relationship with technology seems to be a preoccupation of psychology today, although it yields few indisputable findings. We know the litany of woes that study after study reports when it comes to screens and our children. Don’t look away, we’ll briefly summarise: too much screen time makes our kids inactive, which can contribute to obesity or gross motor developmental delays. Huge chunks of screen time is linked to depression and a decrease in general wellbeing in adults and adolescents, but in children screen time can isolate them from real life social interactions and remove their opportunities to practise building relationships. A lot of exposure to screens may also lead to poor sleep, excessive snacking, behavioural issues such as acting out violence, and poor academic performance.

In the other corner are those who say a familiarity with technology is crucial for success in the modern world. Tablets are used in schools, and being comfortable with ever more sophisticated electronic devices will be a necessity by the time our children are adults. Screens (TVS, smartphones and tablets) have some uses, and some educational value, in some situations, say these proponents. And in each of the abovementioned cases, the argument is made that it’s kids who are already prone to being overweight and inactive, the socially awkward, or those who tend towards sadness and introspection who are more likely to self medicate by increasing their screen time, thus perpetuating a vicious cycle. This does not mean screen time is equally deleterious for everyone. Similarly, parents with “difficult” children may be more likely to “medicate” or manage their behaviour with screen time, which does not necessarily mean the screen is causing the behaviour.

Screens are not inherently bad – as long as their use is moderate and appropriate, and doesn’t serve to mask a deficit. A child who has time in his day for one-on-one loving interaction with a parent, opportunities to play outside with friends, or to lose himself

in concentration in a fantasy game, is a child who can also absorb the downtime of a carefully chosen and vetted, ageappropriate app on an ipad.

Be selective. Yet another study has found that as children age over five they tend to choose entertainment rather than educational apps for themselves. Although, says professor of clinical neuropsychology Carlin Miller of the University of Windsor, “I’m not sure that educational apps have enough research behind them for anyone to suggest that they are inherently superior to entertainment apps.”

The American Academy of Pediatrics was probably treading the middle ground between these opposing factions when it mandated its now famous “two hours a day” rule for screen time for children over the age of two. It seems reasonable and intuitive advice. But it is clear that it is widely ignored – and that’s where the problem lies (rather than, say, in the family who has the resources and motivation to participate in their children’s viewing habits). So the irony is that if you worry about screen time and your child, you’re most likely the parent who doesn’t have to.

TABLETS AND ADHD

A 2010 study by the Kaiser Family Foundation found that children aged between eight and 18 years old spent 7.5 hours a day with screens, be they TV, smartphones, or tablets, which is 20 percent up from 2005. That’s a vast amount of time! Whether the findings would be replicated in South Africa is questionable – most of our children don’t have that much access to screens – but we can assume that given the chance, children will spend as much time using screen entertainment as they possibly can.

American estimates are that somewhere between five and 11 percent of children in the US have attention deficit and hyperactivity disorder (ADHD) – a 40 percent rise in just ten years. In South Africa, “approximately four to five percent of children present with ADHD,” reported Shellack et al in the South African Pharmaceutical Journal in 2012.

We know that ADHD has a genetic basis, but such a sharp rise suggests environmental factors are also at play. So we are either getting much better at spotting ADHD, are overdiagnosing it, or something else is causing ADHD rates to skyrocket. Naturally, fingers are being pointed at screens. When we think about ADHD diagnoses and exposure to screens (both rising very fast) are we talking about causation, or just coincidental correlation? That’s the crucial question – and nobody knows for sure.

Screens may be especially compelling for ADHD sufferers. Most video games deliver lots of addictive short-term rewards (such as scoring points, moving up a level, bells and whistles and

fireworks), which triggers a release of the neurotransmitter dopamine in the brain’s reward centre. “Children with ADHD may find video games even more gratifying than other children do because their dopamine reward circuitry may be otherwise deficient,” Perri Klass wrote in The New York Times in 2010. One study tellingly found that children who had been medicated with a dopamine-regulating drug played fewer video games than before.

Screen games portray an environment that changes faster and is more stimulating than real life. US professor of paediatrics and author Dr Dimitri Christakis has been widely quoted saying that a child who lives inside the hectic environment of a screen game may “find the realities of the world underwhelming, understimulating.” Their subsequent boredom may manifest in an inability to focus and be quietly attentive. Another theory adds that children with ADHD are (already) highly rejected by their peers, and their escape into a pixellated world is therefore understandable, and self-reinforcing.

BUT DO SCREENS CAUSE ADHD?

“In a 2010 study in the journal Pediatrics, viewing more television and playing more video games were associated with subsequent attention problems in both schoolchildren and college undergraduates,” wrote Klass. In fact, heavy screen users were nearly twice as likely to suffer from an attention span disorder in that study.

Prof Miller’s research into the link between TV viewing and ADHD suggested that TV viewing did not predict attention problems, but that attention problems did in turn predict future TV viewing behaviour. “My interpretation of this data is that parents of kids who are difficult to parent (a common issue for parents of kids with ADHD) are firstly more likely to have ADHD themselves and so use more impulsive parenting strategies, and secondly need the break from chaos that TV provides when their child with ADHD is planted in front of it,” she says. “These are not bad parents. They just need help identifying and fixing the issue and they need their child to be less hyper and distractible. We spend a lot of time blaming parents without providing information about what the real issue is, where the resources are that might help, and providing constructive suggestions to improve everyone’s functioning.”

It’s more likely that stressed parents or a chaotic home life, disruptive life events or traumas, or genetic factors could all collude with other factors, including screen time, to spew out an ADHD diagnosis in later life.

Prof Miller believes that screens cannot inherently cause ADHD to develop. “Parents need to have a clear understanding that they do not cause this disorder, but their behaviour may influence the expression of the genetic risk their child carries,” she says. “A commonly cited issue is that children with ADHD do not learn to delay gratification. Paying attention is hard work. Staying on task is hard work. Keeping one’s hands to oneself is hard work. Children typically don’t automatically do what is hard. They need to acquire the skills to learn to control those impulses. Screen time doesn’t teach delay of gratification. It is through practice, through interactions with adults and peers, that kids learn to control impulses to get to bigger and more delayed rewards.”

Prof Miller says we used to be more practised at deferring rewards. “Past generations spent a lot of time teaching delay of gratification. There was little credit spending; you had to earn the money to pay for something. There were no internet purchases; you had to go to a store. Food required preparation and cooking. The television either wasn’t available or offered very few choices. Children had to learn from books. Parents could not hand a frustrated toddler a tablet. Teens had to call or walk to a friend’s house in order to interact with them. The world was a safer place, which meant children had more freedom to explore. And there was less time pressure because weekends

and holidays were time away from work for many. There was often a parent who was home during the day, which meant there was time for laundry and food preparation and homemaking, rather than the frantic rush every evening that most of us experience after a gruelling day at work.

“The changes in our culture have promoted distracted parenting and impulsive behaviour in childhood. Kids in front of the TV are just a symptom of the pull of electronic media over other things for all of us. I really don’t think it is causing ADHD. Rather, it isn’t teaching us how to pay attention to what is important.” So before you ban the screens completely, look at how to integrate them in a healthy way. YB