The Truth About TV & ADHD

Is watching TV linked to a rise in attention deficit hyperactivity disorder (ADHD)? Here's what you should know about the causes of ADHD in children.

by Nicole Sprinkle

If you're like a lot of parents, you've probably used your television as a baby-sitter. Anxious to grab a few moments to fix dinner, straighten up, or take a breather, you've turned to the flashy colors and graphics of SpongeBob or Rugrats to mesmerize your child.

The reliance on TV as nanny starts early. Typical 1-year-olds watch an average of two hours a day. Three-year-olds absorb three hours of tube time daily, and by the time they're of school age, 30 percent of U.S. children have a television in their room.

For years, the American Academy of Pediatrics (AAP) has urged parents to eliminate all TV viewing for tots under age 2 and to limit screen time (including computer use) for older kids to no more than an hour or two a day. Too much TV can negatively affect brain development, AAP doctors fear, especially in babies, whose brains are growing rapidly. Still, researchers have never established a causal link between TV viewing and attention span.

Until now.

As reported in the journal Pediatrics in April 2004, researchers at Children's Hospital in Seattle found that the more television a child watches between the ages of 1 and 3, the greater his or her likelihood of developing attention problems by age 7. More specifically, for each extra hour per day of TV time, the risk of concentration difficulties increases by 10 percent, compared with that of a child who views no TV at all. Excessive viewing was associated with a 28 percent increase in attention problems.

Anxious for Answers

Understandably, the study unleashed a firestorm of controversy. Parents of kids with attention deficit disorder (ADD ADHD) worried: Should they beat themselves up over all those episodes of Dora the Explorer? Does TV-viewing cause ADD? Should they allow their kids to watch TV at all? Sorting out the answers requires a closer look at the study itself and what it did and didn't prove.

The lead researcher, Dimitri Christakis, M.D., an associate professor of pediatrics at the University of Washington and co-director of the school's Institute for Child Health, admits that his study was limited. He based his research on a previous survey of about 1,300 mothers who recalled the television habits of their children in early childhood. Such after-the-fact reporting is considered highly fallible because parents often over- or underreport the amount of TV watched.

What's more, the study linked TV viewing to general attention problems, rather than to diagnosed ADD. Study participants were never asked whether their children had Attention Deficit Disorder. Instead, the study looked at five kinds of attention difficulties, including "obsessive concerns" and "confusion," neither of which are core ADD symptoms.

Nor did the study consider the kinds of programs children watched. Educational programs, such as Blue's Clues or Mr. Rogers, which have a slower pace, rely on storytelling, and avoid rapid zooms, abrupt cuts, and jarring noises, weren't differentiated from more aggressive programming. Neither did the researchers consider whether TV viewing and attention difficulties presented a chicken-or-egg situation. Some critics suggest that younger children with pre-existing attention deficits may be drawn to watching TV, while solving simple puzzles or concentrating on games would be an uphill battle. They add that parents of these children might turn to the TV for relief more frequently than parents of kids who have less trouble staying focused.

The bottom line: Cancel the guilt trip. Plenty of kids who watch little or no TV are diagnosed with Attention Deficit Disorder, and an abundance of evidence points to a genetic connection. The researchers themselves stated that, based on their findings, TV does not cause ADD.

The Brain Drain

Still, their work is a wake-up call. According to Dr. Christakis, the rapidly moving images on TV and in video games may rewire the brains of very young children, making it difficult for them to focus on slower tasks that require more thought. Others say that TV may, at least temporarily, idle the centers in the pre-frontal cortex that are responsible for organizing, planning, and sequencing thought.

So where does this leave parents? The answer, of course, is that we need to set reasonable limits. Stick as closely as possible to the AAP guidelines. Avoid TV - to the extent possible - for children 2 years old and younger. Remember that their brains develop better through human interaction rather than through passive activity. Read together, sing songs, play games. If your toddler is in day care, make sure the television isn't a constant presence there either.

This article comes from the February/March 2005 issue of ADDitude.

To read this issue of ADDitude in full, purchase the back issue and SUBSCRIBE NOW to ensure you don't miss a single issue.

The Truth About TV & ADD, Part 2

For older kids, the task is trickier. Though the Academy has not issued specific TV-viewing recommendations for children with ADD, James M. Perrin, M.D., an associate professor of Pediatrics at Harvard Medical School and director of pediatrics at Massachusetts General Hospital in Boston, says, "Given how distracting television is, it's very hard to believe that it's good for kids with AD/HD to watch much of it."

Bye-Bye, Tube Time

You may curtail your child's viewing time gradually, but the ultimate goal should be no more than one or two hours a day. Include TV, video and DVD viewing, video game play, and computer use in your calculations - and enforce your rules. Using a timer can help. To ease the adjustment, offer alternatives: Take your kids swimming, go skating together, invite neighborhood kids over for touch football, or encourage your child to take up a hobby or a musical instrument.

Involve your child in setting up the family's TV schedule. Have her select a few favorite programs and plan them as an activity. If they are broadcast in the mid-afternoon, consider recording them to watch on weekends. Discourage mindless channel surfing. (Consider ditching the remote altogether and putting the cable box up high.) Enforce your rules, such as, No TV until homework is finished.

Assess your own TV habits as well, and keep the TV off until you want to watch a specific program. Never leave it on as background noise. If a program isn't worth your undivided attention, turn it off. "TV is not a white noise that you can easily ignore," Dr. Perrin says. "Eliminating distractions is an important aspect of treating ADD. These children need a quiet space."

It's Show Time

Remember that what your child watches matters as much as the amount of time he spends in front of a screen. Dr. Perrin recommends shows that tell a story over the course of at least five to 10 minutes. These include science and nature programs, such as Nova, and educational videos, which, of course, have no commercial disruptions. Avoid programs with jarring special effects. Whenever possible, make TV time an interactive experience. Watch with your child and ask questions about the action to help him become a more active, discriminating viewer. Don't permit your child to have a personal television set in his bedroom.

If you have children of different ages, you face a special challenge. An older child is unlikely to give up watching her favorite shows for the sake of a younger sibling. Be especially vigilant about the time each child spends in front of the TV, as well as the content of what he's watching. To manage the TV viewing in his home, Dr. Patrick Kilcarr, Ph.D., a clinical psychologist at Georgetown University in Washington, D.C., put a set in the basement for his teenage sons. (Three of his five children have ADD.) The basement set is off-limits to the younger kids. They're not allowed in the basement without asking, and the older sons are expected to help enforce the rules. The upstairs TV is programmed to permit only Nickelodeon or the History Channel on Saturdays, and his teens risk being grounded if they switch that TV to channels that are not appropriate for the little ones.

Bonus TV Time

Using TV as a reward is another gray area. Most experts believe that television time can be a legitimate payoff for a child who's doing his homework, avoiding trouble at school, and sticking to his schedule. As Kilcarr says, "TV has a place in the hierarchy of a child's life." Kids simply need to realize that there's a time and place for TV, rather than seeing it as a source of constant entertainment. Kilcarr, for instance, allows his children to watch a half-hour of TV or a video in the evening, once they've finished their homework and sports practice. However, TV shouldn't be the only kind of reward. Offer alternatives: an hour at the skateboard park, a walk together to get an ice cream, or a new book.

Minimizing TV time increases a parent's responsibility to devise other activities. This is tough for those juggling jobs, two or more children, or the zillion other daily tasks that make life the pressure cooker it can be. But Kilcarr sees a developmental advantage in cutting out TV: Children get the chance to use time on their own. Getting to this point may take a while and it may require some prodding, but, ultimately, your child will develop ways to entertain himself. Everyone benefits.

As ADD awareness increases and research into the effects of television on children progresses, experts may indeed find more definitive links. In the meantime, it's essential to exercise caution where television and kids are concerned. You may be surprised at just how little your children really miss the TV if you help them fill their time with more interesting activities that speak to their passions.

This article comes from the February/March 2005 issue of ADDitude.

To read this issue of ADDitude in full, purchase the back issue and SUBSCRIBE NOW to ensure you don't miss a single issue.