Screen the screens

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

By Margot Bertelsmann

Studying children’s 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. Screen time can isolate children from real-life social interactions and remove their opportunities to practise building relationships. Huge chunks of screen time is linked to depression and a decrease in general wellbeing.  A lot of exposure to screens can 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 – as the pandemic has taught us. Screens (TVs and tablets) have some uses, and some educational value, in some situations, say these proponents.

And in each of the abovementioned cases, it’s the 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.

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, age-appropriate app on an iPad. (This is crucial as yet another study has found that as children age over five they tend to choose entertainment rather than educational apps for themselves…)

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).

The irony is that if you worry about screen time and your child, you’re most likely the parent who doesn’t have to.

Does your child NEED an iPad?

Jennifer Senior, author of All Joy And No Fun: The Paradox of Modern Parenting, says parents nowadays feel we fail in our duties unless we offer absolutely every opportunity to our children. So, before we know whether we may be wrong or right about the essentialness of the tablet to future life, how can we deny our precious snowflake the iPad that “all” their friends have?

Should you bow to private-school pressure and buy Junior an iPad as soon as you can afford it? Not at all, says Prof Andre Venter, a paediatric neuro-developmentalist and professor at the University of the Free State. “Most research has been done with television watching. But it is important to realise that few skills used in screen entertainment transfer to useful abilities in the real world.”

You don’t need to feel that your child is missing out on key educational opportunities if he doesn’t have a tablet. “There really is no advantage to starting (iPad exposure) too soon. Explorative, interactive and structured as well as unstructured play are far more important,” says Prof Venter. “So does it do harm? If controlled, probably not. Does it give your child an edge? Probably not.” Prof Venter says technological skills are easily learnt at any stage of junior school.

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.

Some US sources claim one in five boys in the US has attention deficit and hyperactivity disorder (ADHD), and that the rate of ADHD among children is 11 percent ­- 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 ADHD has a genetic basis, but, says a US professor of paediatrics, Dr Dimitri Christakis, “given that our genes have not changed appreciably in that timeframe, it is likely that there are environmental factors that are contributing to this rise.”

So we are either getting much better at spotting ADHD, or suddenly overdiagnosing it, or something else is causing ADHD rates to skyrocket. Screens seem an obvious culprit.

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 found that children 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. Dr 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,” writes Klass. In fact, heavy screen users were nearly twice as likely to suffer from an attention span disorder. It could be causal, or it could point to a yet-unstudied third factor: disinterested parenting or a chaotic home life, disruptive life events or traumas, or genetic factors, for instance, all could collude with other factors, including screen time, to spew out an ADHD diagnosis in later life.

At least one study, published in 2007 by Elizabeth Lorch and Richard Milich in the journal Media Psychology, found most differences in TV watching behaviour between ADHD and other children were accounted for by family or environmental factors (such as whether the child had a TV in his room), rather than by the ADHD diagnosis, although another study by Lorch found that ADHD children had more trouble understanding and retelling the story they watched (which, as Milich explains, points to the difficulty ADHD children have with understanding social relationships).

Visions of the future

If this sounds “down” on tech, we should share a success story. Tablet use has revolutionised the lives of some families living with nonverbal children, some of whom have managed to communicate dramatically beyond their verbal abilities using an iPad and a communication app. See the Nieder family’s story as an example.

“Benefits for typically developing children are limited, but of course diaries, tables, apps which help with structure, communication and learning can be of some value to children with specific needs,” admits Prof Venter. Families affected by autism or ADHD, deafness or speech delays, and other conditions can use tablets judiciously, and the potential to revolutionise a child’s life cannot be ignored. Please do targeted research if you believe your child may qualify.

We might imagine technology that will one day operate intelligently with the brains of its users. An iPad game of the future might regulate its output in response to the dopamine levels it reads as it scans the player’s brain. In the less-distant future, especially now that we understand the problem, games may be produced that aim to help children develop social skills, not hinder them, a game that delivers the yearned-for dopamine hit every time a character reacts in the “best possible” way when solving  social problem, for instance.

A game that reads cues from the gameplayer and amends itself – sounds crazy, right? Well, we just don’t know what the future holds – and we regularly get our predictions wrong, as author Jennifer Senior points out in a TED talk (available on YouTube). Senior recalls how US parents of her parents’ generation believed that learning Japanese was what would give their children a competitive advantage when they grew up – a prediction that proved completely false. It’s worth remembering just how many of our parenting predictions do.

Mediate against the screen seep

  • Watch with your kids!

Studies that show the link between TV time and poor family functioning don’t specify whether the family watches together and what the content of the shows is. Make TV time an occasion or treat or together time, not (always just) a babysitter. Be firm in banning inappropriate shows. Just because a programme is certified “all ages” does not mean your child can understand the context of a soap opera or even a sitcom. Stick to children’s shows for children, and avoid cartoons with dark or violent themes, especially if you notice your child acting out aggressively.

  • Set a daily screen limit

A child might have a set “iPad time” as part of his daily routine. Set a timer or allow one programme of a particular length, then don’t be afraid to enforce the limit consistently.

  • Have screen-free zones

Ensure that there are spaces where your child can be away from TV, suggests the AAP, by not having TV in your child’s bedroom (if your child has his own bedroom). Turn the TV off in shared spaces too.

  • Vet the apps and games

Your child might pester you to play Transformers but he really doesn’t need to. He could be as engaged in a puzzle game – especially if that’s all that’s on offer! Simply google “best apps for a 2/3/4 year old boy/girl”, and you’ll get excellent suggestions.

  • Control the password

Be clear the tablet belongs to you, not your child. Avoid unauthorised game downloading and in-app purchases by making sure only you know your app store password.

  • Do other things

Actively look for other activities to do with your children. It’s more effort, but it’s worth it!

This article was first published in Your Baby magazine, a Media24 title, and is republished here with kind permission of the editor.

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