What Causes ADHD?

The Truth About TV and ADHD

Does watching too much TV put kids at risk for ADHD? What about educational games on the iPad? The American Academy of Pediatrics’ newest recommendations regarding screen time reflect a shift in culture — and in medical research.

Boy with ADHD laying on couch and pointing remote control at screen while watching TV
Boy with ADHD laying on couch and pointing remote control at screen while watching TV

Screens are an inevitable part of growing up — and parenting — today. They are a valuable reward and motivational tool. They are also dangerous time wasters that separate our kids, mentally and physically, from the people and experiences in their lives.

For most parents, screen time is a tricky (if not guilt-ridden) topic. For parents of children with ADHD, it takes on added gravity and controversy, thanks to these ever-lingering questions: Does screen time cause ADHD? Does screen time worsen ADHD symptoms?

The short answer is that it depends on who you ask. Let’s shake it all out and get to the scientific truth of the matter behind ADHD and TV.

TV

If you’re like a lot of parents, you’ve probably used your television as a babysitter. 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 Ninjago to mesmerize your child.

This parental reliance on TV as nanny starts early. According to 2009 statistics released by Neilsen, “children ages 2-5 spend 32 hours a week in front of a TV — watching television, DVDs, DVR and videos, and using a game console. Kids ages 6-11 spend about 28 hours a week in front of the TV.” 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) urged parents to eliminate all TV viewing for children under age two. That changed in the Fall of 2016, when the AAP lifted the ban on screens for kids under the age of two with two big caveats: screens should be used in conjunction with human interaction and they should be used in moderation

In babies, science suggests that exposure to TV can negatively affect brain development. Thus, the AAP still advises parents to refrain from using screens until 18 months of age. Until age 2, the AAP recommends limiting screen use to the occasional video chatting.

“The chief factor that facilitates toddlers’ learning from commercial media (starting around 15 months of age) is parents watching with them and reteaching the content,” according to the new AAP guidelines. “Emerging evidence shows that at 24 months of age, children can learn words from live video-chatting with a responsive adult or from an interactive touchscreen interface that scaffolds the child to choose the relevant answers.”

“Well-designed television programs, such as Sesame Street, can improve cognitive, literacy, and social outcomes for children 3 to 5 years of age and continue to create programming that addresses evolving child health and developmental needs (eg, obesity prevention, resilience). Evaluations of apps from Sesame Workshop and the Public Broadcasting Service (PBS) also have shown efficacy in teaching literacy skills to preschoolers. Unfortunately, most apps parents find under the “educational” category in app stores have no such evidence of efficacy, target only rote academic skills, are not based on established curricula, and use little or no input from developmental specialists or educators.”

In other words, parents should stick to evidence-based learning programs like Sesame Street and other PBS programs, and interact with their child while he or she is watching TV. In addition, kids between the ages of 2 and 5 should get no more than one hour of screen time per day.

For kids 6 and older, the AAP recommends setting family guidelines around a healthy lifestyle that includes physical activity, good eating habits (including family meals), adequate sleep, and face-to-face time with friends and family. 1-2 hours per day is a good rule of thumb, depending on your child’s age.

The ADHD-TV Controversy

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.


Keep Calm and Mom (Or Dad!) On


Understandably, this study unleashed a firestorm of controversy. Parents of kids with attention deficit disorder (ADHD) worried: Should they beat themselves up over all those episodes of Dora the Explorer? Does TV-viewing cause ADHD? Should screens be banned all together? 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.

For one, the study linked TV viewing to general attention problems, rather than to diagnosed ADHD. Study participants were never asked whether their children had ADHD. Instead, the study tracked five kinds of attention difficulties, including “obsessive concerns” and “confusion,” neither of which are core ADHD symptoms.

Secondly, the study did not 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 pose a challenge. They add that parents of these children might turn to the TV for relief more frequently than do parents of kids who have less trouble staying focused.

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

What Can We Do?

Still, the Seattle study was 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 solo TV use for children 5 years and younger
  • Remember that their brains develop better through human interaction rather than through passive activity
  • Read together, sing songs, play games

How Can We Change?

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 game play, and computer and app 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. 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 ADHD. These children need a quiet space.”

What Should We Watch?

Remember that what your child watches matters as much as the amount of time he spends in front of a screen. James M. Perrin, M.d., an associate professor of pediatrics at Harvard Medical School and director of pediatrics at Massachusetts General Hospital in Boston, recommends shows that tell a story over the course of at least 5 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 television set in his bedroom.

Is TV an OK Incentive?

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 Dr. Patrick Kilcarr, Ph.D., a clinical psychologist at Georgetown University in Washington, D.C., 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.


Quick Viewer’s Guide

Time it: Limit TV time to no more than one to two hours per day.

Read all about it: Discourage random channel surfing in favor of informed viewing. Sit down with your child and a TV schedule, and encourage her to decide what to watch based on a show’s topic and the program description.

Do it together: When possible, watch TV with your kids. Talk about what you see and help them see the difference between the show and the commercials.

Eat TV-free dinners: Try not to eat meals in front of the television. Take the opportunity to spend time together as a family.

Lead by example: As your child’s main role model, curtail your own screen time if you expect him to do the same. Turn off your set and invite your child to go for a walk or help out in the kitchen.

Know the system: Most television programs carry a rating indicating the appropriate age-range for the audience. Read more about the TV Parental Guidelines online at www.tvguidelines.org.

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