Problem

Managing child behavior in school settings poses potential injury risk, to both staff and students, resulting in increased use of questionable practices. In the past decade, schools have witnessed an unprecedented rise in the medication of children, use of seclusion rooms, and the need of physical restraint. To protect children with behavior problems and their staff, it is imperative that schools take proactive measures by establishing effective child behavior interventions and policies.

Rationale

20 years ago children played outside, walked or rode their bikes to school, and watched 1-2 hours television per day. Today elementary-aged children are exposed to an average of 8 hours per day of combined technologies, resulting in an epidemic of physical, mental, social and academic disorders, often described as “behaviors” (Zone’in Fact Sheet). As children connect more and more to technology, they are disconnecting from humanity at an alarming rate. In Canada, 30% of children enter school developmentally delayed (Kershaw P. 2009), and 14.3% have a diagnosed mental illness (Waddell C. 2007). With the majority of media content now containing violent images (Anderson, C. 2008), managing child aggression in schools, has put both students and staff at risk for significant injuries.

Policy

The following ten evidenced based interventions should be implemented by schools for a six month period, prior to any behavioral diagnosis, medication, or use of seclusion rooms or restraints.

Procedure

The attached “Schools Operating Safely (SOS) – Policy and Procedures” form can be used by school administrations as a guideline to determine proactive interventions to manage escalating child behaviors, thereby reducing risk of injury to students and staff. Potential funding for SOS equipment can be obtained through applications to pharmaceutical and/or technology production corporations.

Evaluation

Implementation of the “Schools Operating Safely” policy should not only reduce risk of injury to students and staff, but also will serve to improve student’s physical, mental, social and academic performance. Therefore, school measurement of the following outcomes are suggested, following an initial baseline data gathering period: attention and learning ability, printing output speed, obesity, developmental delay, behavior, office referrals, school fights, suspensions and grades.

Research

Alphabetical – http://www.zoneinworkshops.com/research/foundation-series-workshops-2/

Topic Fact Sheet – http://www.zoneinworkshops.com/fact-sheet/zonein-fact-sheet/

© Zone’in Programs Inc. 2009

Children engage in an average of eight hours per day of combined technology use (television, movies, video games, internet, iPods, cell phones), causing health impairments and delays in development affecting student productivity in school (1). 14.3% of Canadian children have a diagnosed mental illness (2), 15% are developmentally delayed (3), and 15% obese (4). Child aggression caused by media violence has teachers and parents struggling to manage complex and confusing child behaviors in classrooms and at home (5). Elementary schools are allowing computers to take precedence over playgrounds, recess and gym time, removing an essential opportunity for physical activity and social contact with peers (6).

While research indicates comprehension and memory are compromised with screen reading (7), schools continue to increase their use of computer use by creating the “virtual” classroom. While research shows the ability to print is integral to achieving literacy and improves performance in all academic subjects (8), primary teachers are spending only 14 minutes per day in printing instruction (9), causing continued decline in Canadian literacy (10). Without any existing research to support its widespread use, technology is wreaking havoc on the entire education system, eroding child health, literacy and the ability of children to succeed.

Children have not biologically evolved to accommodate technology’s sedentary yet chaotic existence, and the sustainability of Canadian children is now in question. Connection to technology has disconnected children from what they need to grow and succeed: movement, touch, nature, and connection with other humans. Research shows children need to move to learn (11). Stimulation to the vestibular, proprioceptive and tactile sensory systems promotes development of core posture, bilateral coordination of the body and eyes, praxis (ability to perform planned movement patterns), as well as achieves of optimal arousal states for learning. Playgrounds, gyms and classrooms can be re-designed to ensure children receive adequate sensory stimulation to optimize motor development and learning. By managing balanced use of technology with achievement of critical factors for child health and academic success, Canadian schools become leaders on the world stage of child health and literacy.

Balanced Technology Management Initiatives

Partnerships formed between Zone’in Programs Inc. and government sectors, health units, schools, and technology production corporations, will serve to enact necessary social change to ensure the future sustainability and success of Canadian children. The following Balanced Technology Management Initiatives are proposed for 2009/10. Outcomes measures are decreased obesity, enhanced developmental milestones, decreased child mental illness and use of psychotropic medication, decreased child aggression, improved academic performance, and increased child literacy.

Health, Education and Social Government Initiatives

1. Regulate minimum standards for school playground structures, access to nature, and inclusion of vestibular, proprioceptive and tactile equipment and strategies for gyms and classrooms with consultation from Cris Rowan, pediatric occupational therapist and certified sensory specialist.
2. Educate government personnel in the health, education and social sectors regarding the impact of technology overuse on child health and academic performance through distribution of Zone’in Newsletter and participation in the Zone’in Foundation Series Workshops.
3. Sponsor a one week “unplug” campaign in schools, community and health units.
4. Regulate and legislate control of media violence in television, movies, internet and video games according to recommendations by the American Academy of Pediatrics Committee on Media Public Education.

Health Professional Initiatives

1. Take a routine family technology usage history and use the Zone’in Rx Pad.
2. Provide parents and caregivers with research based practical information using educational brochures, PSA’s, media articles.
3. Educate the general public regarding child technology overuse by training pediatric occupational therapists as Zone’in Instructors for public workshops.
4. Follow the Unplug – Don’t Drug protocol of supporting a 3 month family “unplug” trial prior to behavior diagnosis and medication.

School Initiatives

1. Educate school personnel regarding the impact of technology overuse on child health and academic performance through distribution of Zone’in Newsletter and participation in the Foundation Series Workshops.
2. Add printing back to curriculum and build foundation skills with developmentally relevant strategies using the Zone’in and Move’in Programs.
3. Spending freeze on technology and diversion of allocated funds to ensure playground structures meet minimum standards for child development, detailed in June 2009 Zone’in Newsletter.
4. Regulate use of technology in school settings e.g. limitations for screen reading, internet access, video games, iPod and cell phone use, and prohibit use during recess, lunch and gym times.
5. Stop telling parents their child has ADHD and needs medication, and ensure daily access to “green space” for attention restoration.
6. Instruct students regarding appropriate use of technology with reference to overuse, balanced use, aggression, cyberbullying and sextexting using the Live’in Resource Guide and the Unplug’in Game.

Technology Production Corporation Initiatives

1. Inclusion of consumer educational literature with all technology products regarding possible risk of technology addiction and risk of child aggression.
2. Development of an online help network for children with technology addictions including informative articles, blog forum, video clips.
3. Reduction of violent content in media (television, movies, video games, internet) to no more than one “intentional harm” incident per 10 minute period.
4. Inclusion of Balanced Technology Management recommendations for homes and schools on technology production corporation websites, product literature and in advertising created in conjunction with Cris Rowan.
5. Participation in research regarding the effects of technology use on child health and academic performance.
6. Fiscal support to communities and schools that purchase technology products to be used for playground, gym and classroom equipment, as well as for access to nature, music, arts, theatre and dance, to counteract the negative effects of technology on children.

Balanced Technology Management Champion Status

Governments, health units, schools and technology production corporations that achieve above noted Balanced Technology Management Initiatives will receive Zone’in Programs Inc. Balanced Technology Management Champion Status. BTM Champion Status is a stamp of approval that can be placed on websites or product literature, assuring parents that the government, health unit, school or technology product in question, meets the minimum health and academic standards for balanced technology management use by children.

Should your organization wish to participate with Zone’in Programs Inc. in implementation of Balanced Technology Management Initiatives, please contact Cris Rowan using below contact information to arrange a meeting.

Supporting Research

1. Rideout VJ, Vandewater EA, Wartella EA. Zero to six: electronic media in the lives of infants, toddlers and preschoolers. Menlo Park (CA): Kaiser Family Foundation; Fall 2003.
2. Waddell C, Hua JM, Garland O, DeV. Peters R, McEwan K. Preventing Mental Disorders in Children: A Systematic Review to Inform Policy-Making. Canadian Journal of Public Health. 2007; 98(3): 166-173.
3. Hamilton S. Screening for developmental delay: Reliable, easy-to-use tools. Journal of Family Practice. 2006; 55 (5): 416-422.
4. Tremblay MS, Katzmarzyk PT, Willms JD. Temporal trends in overweight and obesity in Canada, 1981-1996. International Journal of Obesity. 2002; 26(4): 538-543.
5. Anderson CA, Berkowitz, L, Donnerstein E, Huesmann LR, Johnson JD, Linz D, Malamuth NM, Wartella E. The Influence of Media Violence on Youth. Psychological Science in the Public Interest. 2003; 4:81-110.
6. Information received from Foundation Series Workshop participant comments.
7. Mangen, A. Hypertext fiction reading: haptics and immersion. Journal of Research. 2008; 31(4):404-419.
8. Graham S, Harris K, Mason L, Fink-Chorzempa B, Moran S, Saddler B (2008) How Do Primary Grade Teachers Teach Handwriting? A National Survey. To be published in Reading and Writing: An Interdisciplinary Journal.
9. Graham S, and Weintraub N. (1996) A Review of Handwriting Research: Progress and Prospects from 1980 to 1994. Educational Psychology Review, 8, 7-87.
10. National Center for Education Statistics, 2005. Available at: http://nces.ed.gov/.
11. Ratey JJ, Hagerman E (2008). Spark: The Revolutionary New Science of Exercise and the Brain. Little, Brown and Company, New York.

Cris Rowan, BScOT, BScBi, SIPT, Approved Provider for AOTA
CEO for Zone’in Programs Inc. and Sunshine Coast Occupational Therapy Inc.
6840 Seaview Rd. Sechelt, BC, Canada V0N3A4
604-885-0986 p, 604-885-0389 f
info@zonein.ca, www.zonein.ca

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Designed for Technology and Pharmaceutical Corporations

I. Executive Summary

The past decade has witnessed an epic explosion in child technology use, with child technology addictions on the rise. Critical milestones for child motor and sensory development are not being met, resulting in inadequate foundation skills required for school entry. Simultaneous child physical, psychological and behavior disorders are becoming more apparent, often accompanied by the prescription of psychotropic medication. Research documented impact of these disorders on child health and academic performance indicates the need for immediate child health initiatives.

An integral component to ensure implementation and success of these child health initiatives is a partnering of health and education sectors with corporations. Companies that would benefit from this partnership would be those involved in technology production e.g. television, computers, internet, videogames, iPods, cell phones. As physical, psychological and behavior disorders resulting from technology addictions are often medicated, pharmaceutical corporations would also benefit from partnering with health and education sectors committed to enhancing child health.

This partnership between corporations and health and education sectors has been termed the Linking Corporations and Communities Initiative, designed to create sustainable futures for children. The Linking Corporations and Communities Initiative will require corporate assistance in planning, implementing and funding child health initiatives. Contributions by corporations could be applied to implementation of technology reduction initiatives such as the Creating Sustainable Futures Program, or through funding of school or community programs that promote child health and wellness (nature outings, safe parks). The purpose of the Linking Corporation and Communities Initiative is to counteract the negative effects of technology on child physical, psychological and behavioral health and academic performance, through creating rewarding and tax beneficial partnerships with corporations.

II. Problem Statement

Throughout most of human history child engagement in rough and tumble outdoor play and imaginary games resulted in the achievement of adequate sensory, motor and attachment development required for attention and learning. Much of this active play has been replaced by technology use. Today’s average household media environment includes three TV’s, three DVD players, two videogame consoles, three iPods, two cell phones and one computer. Children now average 8.0 hours per day TV, internet and videogame use, with over 65% of children using TV’s in their bedrooms. ‘Baby TV’ now occupies 2.2 hours per day for the 0-2 year old population, and 4.5 hours per day for 3-5 year olds and is causally linked to developmental delays. This situation has prompted France to ban its broadcasters from airing TV shows aimed at children under three years of age. Canadian children were recently granted a “D” grade for inactivity in 2008 by Active Healthy Kids Canada, citing TV and videogames as the primary cause. TV and videogame use accounts for 60% of childhood obesity, and is now considered a North American ‘epidemic’. Although rigorous research is still lacking, preliminary studies indicate increases in attention difficulty, poor academic achievement, aggression and sleep impairment which may be attributable to childhood technology overuse.

Prevalence statistics regarding developmental disabilities in young children are a challenge for researchers due to early detection difficulties. Only 55-65% of developmental disabilities are detected prior to school age entry. 6% of US children have speech and language impairment, 8% a learning disability, 7% ADHD and 0.5% Autism with 13.2% accessing special education assistance. A 2006 Canadian study reported one in six children have a developmental disability, with Autism prevalence now 1 in 160 in Canada. Data from the 1988 National Health Interview Survey reported 17% of US children had a developmental disability, resulting in 1.5 times more physician visits, 3.5 times more hospital days, twice the number of lost school days and a 2.5 fold increase in the likelihood of repeating a school grade compared to a non-developmentally disabled child. A 2006 US study reported 32% of children admitted to inpatient pediatric ward demonstrated a developmental disability. In 1996, 10% of Canadian children ages 7-13 years were obese, with estimated economic costs of $1.8 billion. In 2004, just eight years later, this number is 50% higher with a prevalence of obesity at fully 15% of the Canadian child population.

Recent studies also document a rise in psychological disorders in children reporting increasing incidence of bipolar disorder, depression and anxiety. Associated behaviors may be confusing for parents, teachers and physicians, and could be easily misunderstood, possibly resulting in psychiatric diagnosis and prescription of psychotropic medication. Between 1991 and 1995, prescriptions for psychotropic medications in the 2 – 4 year old toddler population, as well as in children and youth tripled. 80% of this medication was prescribed by family physicians and pediatricians. 28-30% of children receiving psychotropic medication are on multiple medications. Limited high quality evidence guiding appropriate dosing and inexperience in documentation of long term effects of these prescriptions in children may mean that these children undergo unquantified risks.

III. Rationale

In primitive times, human beings engaged in physical labor, and sensory stimulation was natural and simple. Rapid advances in technology and transportation have resulted in a physically sedentary society with high frequency, duration and intensity of sensory stimuli. These environmental changes are happening faster than human being’s ability to adapt and evolve. Children who immerse themselves in virtual reality may exhibit signs of sensory deprivation, as they become disconnected from the world of physical play and meaningful interactions. Canadian parents spend an average 3.5 minutes per week participating in meaningful conversation with their children. Overuse of TV and videogames may result in children lacking essential connection with themselves, others and nature. Three critical factors for healthy physical and psychological child development are movement, touch and connection to other humans. Developing children require 3-4 hours per day of active rough and tumble play to achieve adequate stimulation to the vestibular, proprioceptive and tactile sensory systems. This type of sensory input ensures normal development of posture, bilateral coordination and optimal arousal states. Infants with low tone, toddlers failing to reach motor milestones, and children who are unable to pay attention or achieve basic foundation skills for literacy, are frequent visitors to pediatric physiotherapy, occupational therapy and speech and language clinics. The use of safety restraint devices such as infant bucket seats and toddler carrying packs and strollers, have further limited movement, touch and connection, as have TV and videogames. Many of today’s parents perceive outdoor play is ‘unsafe’, limiting essential developmental components usually attained in outdoor rough and tumble play. Dr. Ashley Montagu reports that when children lack touch and human connection, they may respond by ‘turning in’ (anxiety, depression) or ‘turning out’ (aggression) (50). These complex behaviors may be confusing for parents, teachers and physicians, possibly leading psychiatric diagnosis and subsequent prescription of psychotropic medication.

In 2001 the American Academy of Pediatrics issued a policy statement recommending that children less than two years of age should not watch any TV or videogames. They further recommended that children older than two should restrict usage to one hour per day if they have any physical, mental or social problems, and two hours per day maximum if they don’t. Dr. Dimitri Christakis found that each hour of TV watched daily between the ages of 0 and 7 years equated to a 10% chance of attention problems by age seven years. Further evidence suggests some parents may have technology addictions. Adult Internet Addiction has been proposed for inclusion in the Diagnostic and Statistical Manual 5th Edition. This fact supports possible implementation of school based technology reduction programs. A randomized controlled trial of a 6-month classroom curriculum to reduce TV and videogame use resulted in statistically significant relative decreases in obesity. While no one can argue the benefits of advanced technology in today’s world, connection to these devices may have resulted in a disconnection from what society should value most, children. Rather than hugging, playing, rough housing, and conversing with children, parents are increasingly resorting to providing their children with more videogames, TV’s in the car, iPods, and cell phone devices, creating a deep and widening chasm between parent and child.

IV. Goals

The Linking Corporation and Communities Initiative is designed to provide planning, implementation and funding assistance for initiatives to improve child physical, psychological and behavioral health, with subsequent improvements in academic performance. The Linking Corporation and Communities Initiative will be the major funding source for the Creating Sustainable Futures Program, a school-based technology reduction program, as well as a funding source for adjunct programs e.g. free admission to recreation centers, creation of safe parks, nature outings.

Short term measurable goals will be reduction in use of non-school related technology e.g. TV, videogames and internet. Long term goals will be improvement in children’s physical, psychological and behavioral health with subsequent impact on academic performance. Measurement of long term goals will be evidenced by reduction in incidence of child diagnosis and medication, and improved academic scores (see Outcome Measures – Section VI).

V. Proposed Solution

The Linking Corporation and Communities Initiative will raise awareness regarding the negative effects of technology addictions, and will also provide intervention programs for elementary aged children in a school and community-based settings. The school and community-based Linking Corporation and Communities Initiative, proposed by Cris Rowan, pediatric occupational therapist and CEO of Zone’in Programs Inc., brings together a unique team of “players” in the child health, education and technology fields. Through corporate assistance with planning, implementing and funding of child health and education initiatives, the Linking Corporation and Communities Initiative will serve to reduce the impact of technology and child physical, psychological and behavioral health and academic performance. The Linking Corporation and Communities Initiative will also reduce the incidence of child diagnosis and medication, a pervasive and costly epidemic. The Linking Corporation and Communities Initiative provides a unique opportunity for technology and pharmaceutical corporations to enhance their public image, and become leaders on the child health initiative forefront, by fostering a balance between technology and a healthy lifestyle for children.

As TV and videogame addictions are largely undetected by health and education professionals, and impact significantly on the physical, mental and behavioral health of children, education regarding child technology addictions is the first step toward addressing these needs. Provision of effective tools and techniques through yearly school-based technology reduction programs, will ensure long term technology reduction. This education, tools and techniques can best be implemented through the Creating Sustainable Futures Program. Possible examples of adjunct programs for corporate funding are school nature outings, weekend camping trips, free child admission to community recreation centers, free bus passes for children, building of safe parks, and creation of Zone’in gyms in northern communities where weather prohibits outdoor play.

The Linking Corporations and Communities Initiative will commence following a pilot Creating Sustainable Futures Program planned for 2009. Following program revisions, Creating Sustainable Futures District Advisory Committees will be formed, with representatives from health and education sectors, as well as participating technology and pharmaceutical corporations. Companies who wish to become involved in the Linking Corporations to Communities Initiative are directed to contact Cris Rowan, CEO Zone’in Programs Inc. (contact information Section X).

VI. Outcome Measures

The Linking Corporation and Communities Initiative is designed to improve children’s physical, psychological and behavioral health through reduction in use of technology, and participation in alternate activities and exploration of nature. Outcomes measure assessments will be performed on a yearly basis.

• Technology reduction – pre and post measurements will be obtained regarding non-school related technology usage for TV, videogames, hand-held gaming devices, internet, iPods, and cell phones (and any new technology released prior to this initiative).
• Improvements in physical health - pre and post incidence statistics will be obtained from health government regarding incidence of physician visits by children, and from both health and education governments regarding diagnosis of physical disorders related to sedentary lifestyle e.g. obesity, diabetes, coordination disorders.
• Improvements in psychological health – pre and post incidence statistics will be obtained from both health and education governments regarding diagnosis of psychological disorders e.g. depression, anxiety, bipolar disorder, sleep impairments and subsequent prescription of psychotropic medication.
• Improvements in behavioral health – pre and post incidence statistics will be obtained from both health and education governments regarding diagnosis of behavioral disorders e.g. ADHD, autism.

VII. Program Evaluation

The Linking Corporation and Communities Initiative will be piloted in a single school district per province or state for a one year period, in conjunction with the Creating Sustainable Futures Program. Following collation of evaluation data, possible revisions may be required in intervention components. Province or state wide administration of the Linking Corporation and Communities Initiative and the Creating Sustainable Futures Program subsequent to program revisions will be at the discretion of the District Creating Sustainable Futures Program Advisory Committee.

VIII. Final Statement

In conclusion, evidence suggests that North American parents allow young children extended periods of technology use. Further evidence suggests that technology overuse is causally linked to increased incidence of child physical, mental and behavioral disorders, as well as poor academic performance and declining literacy. Parents, teachers and therapists are increasingly presenting children to physicians for assessment of complex physical, mental and behavior disorders that may be linked to the physical inactivity and sensory hypostimulation inherent in this use of technology, often resulting in psychotropic medication prescription.

Children are our future. There is no sustainable future in virtual reality.

IX. Author Biography

Cris Rowan is a pediatric occupational therapist and sensory specialist with expertise in the impact of technology on child development. Having worked in a school setting for over a decade, Cris is committed to easing the job of learning for children. Cris is a well-known speaker and author to teachers, parents and therapists throughout North America on topics of sensory integration, learning, attention, fine motor skills and the impact of TV and videogames on children’s neurological development. Cris has a BSc’s both in Occupational Therapy and in Biology, is a SIPT certified sensory specialist, and has Approved Provider status by both the American and Canadian Occupational Therapy Associations, and Autism Community Training. As CEO of Zone’in Program Inc., Cris has provided over 200 keynotes and workshops, publishes the monthly Zone’in Development Series Newsletter, created the Zone’in, Move’in and Unplug’in educational programs for schools and homes, and started Zone’in Training Programs for registered occupational therapists. Cris has written numerous articles for media and international journals, and has been interviewed on national public radio and TV. Cris is author of the Unplug – Don’t Drug policy initiative, the Creating Sustainable Futures Program and the Linking Corporations and Community initiative. Cris is currently writing her book Disconnect to Reconnect – Counteracting the Effects of Technology to Improve Child Performance at School and Home.

X. Contact Information

Cris Rowan, BScOT, BScBi, SIPT, Approved Provider for AOTA
CEO Zone’in Programs Inc
6840 Seaview Rd.
Sechelt, BC V0N3A4
604-885-0986 p, 604-885-0389 f, 604-740-2264 c
crowan@zonein.ca
www.zonein.ca

The past decade has witnessed an epic explosion in child technology use (TV, videogames, internet, cell phones, iPods). Simultaneously childhood physical, psychological and behavior disorders are increasing, often accompanied by the prescription of psychotropic medication. Critical milestones for child motor and sensory development are not being met, resulting in inadequate foundation skills for school entry. The impact of media violence on child aggression has now been classified as a public health risk. Research documented negative impact of technology overuse on child health and academic performance indicates the need for implementation of technology management programs as school-based interventions. The Canadian Health, Education and Children Ministries could take pro-active measures to address technology overuse by implementing the Creating Sustainable Futures Program (CSFP). Designed by a pediatric occupational therapist, the CSFP has three components: 1) occupational therapist instructor training, 2) community workshops by occupational therapists for parents, teachers and health professionals, and 3) school-based Zone’in, Move’in, Unplug’in and Live’in program implementation for elementary aged children. CSFP implementation would involve a pilot study, evaluation and redesign phase, followed by possible province wide implementation. The Creating Sustainable Futures Program would require input, support and collaboration from representatives of all three Ministries through formation of the CSFP Tri-Ministerial Advisory Committee.

II. Problem Statement

Throughout most of human history child engagement in rough and tumble outdoor play and imaginary games resulted in the achievement of adequate sensory, motor and attachment development required for attention and learning (1-3). Today’s average household media environment includes three TV’s, three DVD players, two videogame consoles, three iPods, two cell phones and one computer (4). Children now average 8 hours per day combined technology use, with 75% of children using TV’s in their bedrooms (5). ‘Baby TV’ now occupies 2.2 hours per day for the 0-2 year old population, and 4.5 hours per day for 3-5 year olds and is causally linked to developmental delays (6,7). This situation has prompted France to ban its broadcasters from airing TV shows aimed at children under three years of age (8). Canadian children were granted a “D” grade for inactivity in 2008 by Active Healthy Kids Canada, citing TV and videogames as the primary cause (9). TV and videogame use accounts for 60% of childhood obesity, and is now considered a North American ‘epidemic’ (10,11). Media violence has been classified as a public health risk due to the causal relationship to child aggression (12). Studies indicate increases in ADHD, attention difficulty, poor academic achievement, and sleep impairment are associated with technology overuse (13-16). Researchers state that children who overuse technology have underdeveloped frontal lobes, impaired working memory, reduced impulse control and inability to empathize with others; impacting gravely on their ability to learn and function in a traditional school environment (17).

Prevalence statistics regarding developmental disabilities in young children are a challenge for researchers due to early detection difficulties. Only 55-65% of developmental disabilities are detected prior to school age entry (18). 6% of US children have speech and language impairment, 8% a learning disability, 7% ADHD and 0.5% Autism with 13.2% accessing special education assistance (19). A 2006 Canadian study reported one in six children have a developmental disability (20), with Autism prevalence now 1 in 160 in Canada (21). Data from the 1988 National Health Interview Survey reported 17% of US children had a developmental disability, resulting in 1.5 times more physician visits, 3.5 times more hospital days, twice the number of lost school days and a 2.5 fold increase in the likelihood of repeating a school grade compared to a non-developmentally disabled child (22). A 2006 US study reported 32% of children admitted to inpatient pediatric ward demonstrated a developmental disability (23). In 1996, 10% of Canadian children ages 7-13 years were obese, with estimated economic costs of 1.8 billion (24). In 2004, just eight years later, this number is 50% higher with a prevalence of obesity at fully 15% of Canadian children (25).

Recent studies document a rise in psychological disorders in children reporting increasing incidence of bipolar disorder, depression and anxiety (26-29). A 2007 Canadian study reported 14% of children have a diagnosed mental health disorder (30). Associated behaviors may be confusing for parents, teachers and physicians, and could be easily misunderstood, possibly resulting in psychiatric diagnosis and prescription of psychotropic medication (31-34). Between 1991 and 1995, prescriptions for psychotropic medications in the 2 – 4 year old toddler population, as well as in children and youth tripled (35-37). 80% of this medication was prescribed by family physicians and pediatricians (38). 28-30% of children receiving psychotropic medication are on multiple medications (39). Limited high quality evidence guiding appropriate dosing and inexperience in documentation of long term effects of these prescriptions in children may mean that these children undergo unquantified risks (40-43).

III. Rationale

In primitive times, human beings engaged in physical labor, and sensory stimulation was natural and simple. Rapid advances in technology and transportation have resulted in a physically sedentary society with high frequency, duration and intensity of sensory stimuli (44). These environmental changes are happening faster than human being’s ability to adapt and evolve. Children who immerse themselves in virtual reality may exhibit signs of sensory deprivation, as they become disconnected from the world of physical play and meaningful interactions. Canadian parents spend an average 3.5 minutes per week participating in meaningful conversation with their children (45). Overuse of TV and videogames may result in children lacking essential connection with themselves, others and nature (46). Three critical factors for healthy physical and psychological child development are movement, touch and connection to other humans (47,48). Developing children require 2-3 hours per day of active rough and tumble play to achieve adequate stimulation to the vestibular, proprioceptive and tactile sensory systems (49). This type of sensory input ensures normal development of posture, bilateral coordination and optimal arousal states (50). Infants with low tone, toddlers failing to reach motor milestones, and children who are unable to pay attention or achieve basic foundation skills for literacy, are frequent visitors to pediatric physiotherapy, occupational therapy and speech and language clinics (51). The use of safety restraint devices such as infant bucket seats and toddler carrying packs and strollers, have further limited movement, touch and connection, as have TV and videogames. Many of today’s parents perceive outdoor play is ‘unsafe’ (52), limiting essential developmental components usually attained in outdoor rough and tumble play. Dr. Ashley Montagu reports that when children lack touch and human connection, they may respond by ‘turning in’ (anxiety, depression) or ‘turning out’ (aggression) (53). These complex behaviors may be confusing for parents, teachers and physicians, possibly leading psychiatric diagnosis and subsequent prescription of psychotropic medication.

In 2001 the American Academy of Pediatrics issued a policy statement recommending that children less than two years of age should not watch any TV or videogames (54). They further recommended that children older than two should restrict usage to one hour per day if they have any physical, mental or social problems, and two hours per day maximum if they don’t (55). Dr. Dimitri Christakis found that each hour of TV watched daily between the ages of 0 and 7 years equated to a 10% chance of attention problems by age seven years (56). Further evidence suggests some parents may have technology addictions (57). Adult Internet Addiction has been proposed for inclusion in the Diagnostic and Statistical Manual 5th Edition (58). This fact supports possible implementation of school based technology reduction programs. A randomized controlled trial of a 6-month classroom curriculum to reduce TV and videogame use resulted in statistically significant relative decreases in obesity (59). While no one can argue the benefits of advanced technology in today’s world, connection to these devices may have resulted in a disconnection from what society should value most, children. Rather than hugging, playing, rough housing, and conversing with children, parents are increasingly resorting to providing their children with more videogames, TV’s in the car, iPods, and cell phone devices, creating a deep and widening chasm between parent and child.

IV. Challenges

For Parents

Busy parents neglect children (60). Family connection to TV and videogames has caused a disconnection from each other. Children don’t know who they are anymore, as they identify more and more with characters on the screen. As use of violent media in the home correlates with family violence (61), family conflict is on the rise. Many adults have defaulted to being virtual parents, as life gets busier and parent connection with children and partners gets put on the back burner. As children’s physical, mental and social health continue to decline, parents respond with replacing the dining room table with the big screen, and installing TV’s in cars, kitchens and bedrooms. Health professionals need to be educated regarding TV and videogame addiction identification and treatment, and pass this information onto young parents (62). Parents need to understand the possible child behaviors associated with technology overuse, as well as the long term implications of diagnosing and medicating young children.

For Teachers

Teachers also have a large role to play in the diagnosis and medication of young children. Many parents report they have been told by their child’s school system that either the parents seek medical help, or they will put their child in a special education class (63). Teachers who have children on medication in their class will be the first to say these drugged children become more ‘manageable’, a further incentive to medicate more students, and contrary to popular belief, teachers may be surprised to know that Ritalin does not improve long term academic performance, results in lower grades over time, higher drop out rates, and lower university entrance (64). The Canadian education system supports physical and mental diagnoses with increased funding (65). Child achievement may also be a factor in the prescription of some psychotropic medication, due to the perception that some drugs enhance performance or give children that ‘edge’ they apparently need to succeed. Education professionals need to be informed regarding behaviors associated with TV and videogame addictions, and redesign programs and school environments to accommodate, not medicate, child behaviors.

For Physicians

Physicians and pediatricians have become the gatekeepers for diagnosing behavior, a necessary first step for school categorization to qualify for additional Canadian Ministry of Education funding. Physicians and pediatricians are provided incentives by pharmaceutical companies to support increased prescription of psychotropic medication to the general public, including children. Free drug samples, carnival-type gala dinners, subsidized holidays, are but a few of the ways drug companies get into the homes of unsuspecting parents, and lunch boxes of children. Parents and teachers might be shocked to learn that they are giving their children adult medications, for which there are no child dosage guidelines, nor long term studies (66,67). One option physicians may wish to consider when evaluating children for these concerns may be a program of lessening exposure to technology. Known as Unplug – Don’t Drug, a system that is fully explained at www.zonein.ca. Such a trial would require child and family undergo a three month period of unplugging from all forms of technology such as TV, videogames, iPods, computers and cell phones (other than as required for school and work purposes). Current practice would suggest that unless clear safety issues are present, such a trial may be beneficial prior to prescription of psychotropic medication. An Unplug – Don’t Drug trial may provide physicians and families with essential information regarding family environment and lifestyle, at the same time reducing the likelihood of further psychiatric or behavioral evaluation and treatment.

For Researchers

University researchers also unknowingly participate in this diagnosis and medication trend of young children. Advances in medical imaging technology have resulted in research initiatives focused on determining the genetic, anatomical or neurochemical cause for behavior, rather than looking at a child’s environment. Different parenting styles and TV and videogame usage should be required research parameters in far more studies. Nurture does change nature, and an abnormal CAT scan can be just as much due to poor parenting as genetics. Government could sponsor research initiatives that investigate environmental parameters regarding TV and videogame addictions and subsequent diagnosis and medication. Funding of studies that focus on parenting styles, level of attachment between parent and child, amount of time parent spends with child, family TV and videogame usage (frequency, duration, intensity of violence), and TV and videogame correlation with diagnosis and medication would be a few suggestions. Investigation of technology use in children with Autism, ADHD, depression, bipolar disorder, anxiety diagnostic categories would also be beneficial.

For Pharmaceutical Companies

Pharmaceutical company advertising for psychotropic drugs for children is now common place in parent, gardening and home magazines, showing well behaved children happily doing their homework. Preying on parents, the US pharmaceutical industry is a multimillion dollar annual business that has a mission to medicalize child behavior by advertising prescription medication to not only the health and education professionals, but now to parents (68). All advertising of medications in lay public magazines should be prohibited. All monetary and other types of rewards by pharmaceutical companies to physicians, pediatricians, child psychiatrists, and university researchers should be strictly prohibited.

V. Proposed Solution

The following school-based Creating Sustainable Futures program is proposed by Cris Rowan, pediatric occupational therapist and CEO of Zone’in Programs Inc. As TV, videogame and internet addictions are largely undetected by health and education professionals, and impact significantly on the mental and physical health and behavior of children, the proposed Creating Sustainable Futures program will be a first line initiative to address this pervasive and costly epidemic. The Creating Sustainable Futures program will serve to raise awareness regarding the negative effects of technology addictions, and will also provide intervention programs for elementary aged children in a school-based setting.

The school-based Creating Sustainable Futures has three components:

1. Occupational Therapist Instructor Training

The CSFP employs a “train the trainer” model where Cris Rowan will train and certify approximately 5-8 occupational therapists per province (or state) over a three day period. Following an internal evaluation procedure, qualified therapists will receive certification to teach three one-day Foundation Series Workshops to parents, as well as health and education professionals in their designated provincial or state region.

2. Foundation Series Workshops

The Foundation Series Workshops provide research based information regarding sensory and motor development (day one), attachment theory and the impact of technology on the developing child (day two), and restructuring of classroom, gym, recess and community settings to improve student performance (day three).

3. School Programs

Each school will be provided with the following three programs to address developmental delays, behavior challenges and technology addictions, to be implemented in every grade K to grade six classroom on a yearly basis.

Zone’in – improves sensory processing and attention through teaching self regulation.
Move’in – fine motor assessment and intervention to improve printing and reading skill.
Unplug’in – develops performance skills necessary for technology self-management.
Live’in – resource guide for schools and homes manage technology balance.

VI. Outcome Measures

The Creating Sustainable Futures Program is designed to improve children’s physical, psychological and behavioral health through balanced use of technology, as well as participation in alternate activities and exploration of nature. Outcomes measure assessments will be performed on a yearly basis.

• Technology reduction – pre and post measurements will be obtained regarding school and non-school related technology usage for TV, videogames, hand-held gaming devices, internet, iPods, and cell phones (and any new technology released prior to this initiative).
• Improvements in physical health – pre and post incidence statistics will be obtained from health government regarding incidence of physician visits by children, and from both health and education governments regarding diagnosis of physical disorders related to sedentary lifestyle e.g. obesity, diabetes, coordination disorders.
• Improvements in psychological health – pre and post incidence statistics will be obtained from both health and education governments regarding diagnosis of psychological disorders e.g. depression, anxiety, bipolar disorder, sleep impairments and subsequent prescription of psychotropic medication.
• Improvements in behavioral health – pre and post incidence statistics will be obtained from both health and education governments regarding diagnosis of behavioral disorders e.g. ADHD, autism.
• Reduction in aggression – referrals to the office or administration can be monitored, as well as incidents of bullying and fights.

VII. Program Evaluation

The Zone’in Training, Workshops, and Programs will be piloted in a single school district per province or state for a one year period. Zone’in occupational therapy instructors will receive ongoing support and monitoring by Cris Rowan through monthly meetings, as well as Foundation Series Workshop participant evaluation summary report. Foundation Series Workshops will be evaluated by instructor using post-session participant questionnaires. School programs will be evaluated using pre/post student, teacher and administration questionnaires addressing improvements in student attention ability, printing and reading output speeds, and reduction in home and school technology use. Following collation of evaluation data, possible revisions may be required in one or all of the three intervention components. Province or state wide administration of the Creating Sustainable Futures programs subsequent to program revisions will be at the discretion of the CSFP Tri-Ministerial Advisory Committee.

VIII. Final Statement

In conclusion, evidence suggests that North American parents allow young children extended periods watching TV, using the internet or playing videogames. Further evidence suggests that this increased technology use is causally linked to increased incidence of child physical, mental and behavioral disorders, as well as poor academic performance and declining literacy. Parents, teachers and therapists are increasingly presenting children to physicians for assessment of complex behavior disorders that may be linked to the physical inactivity and sensory hypostimulation inherent in this use of technology, often resulting in psychotropic medication prescription. Children are our future. There is no sustainable future in virtual reality.

IX. Author Biography

Cris Rowan is a pediatric occupational therapist and sensory specialist with expertise in the impact of technology on child development. Having worked in a school setting for over a decade, Cris is committed to easing the job of learning for children. Cris is a well-known speaker and author to teachers, parents and therapists throughout North America on topics of sensory integration, learning, attention, fine motor skills and the impact of TV and videogames on children’s neurological development. Cris has a BSc’s both in Occupational Therapy and in Biology, is a SIPT certified sensory specialist, and has Approved Provider status by both the American and Canadian Occupational Therapy Associations, and Autism Community Training. Cris is author to the Unplug – Don’t Drug Policy Initiative and the Linking Corporations to Communities Initiative. Over the past decade, Cris has provided over 200 keynotes and workshops, is an expert reviewer for the Canadian Family Physician Journal, publishes the monthly Zone’in Development Series Newsletter, created the Zone’in, Move’in, Unplug’in and Live’in educational programs for schools and homes, and recently started Zone’in Training Programs for registered Occupational Therapists. Cris chairs the BCSOT Pediatric and Sensory Integration Special Interest Groups, has written numerous articles for media and international journals, and is writing a book Disconnect to Reconnect – Counteracting the Effects of Technology to Improve Child Performance at School and Home.

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XI. Contact Information

Cris Rowan, BScOT, BScBi, SIPT, Approved Provider AOTA
CEO Zone’in Programs Inc
6840 Seaview Rd.
Sechelt, BC V0N3A4
604-885-0986 p, 604-885-0389 f
info@zonein.ca
www.zonein.ca

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