Unplug – Don’t Drug Policy Initiative

Unplug – Don’t Drug: An alternative approach to child behavior disorder assessment and treatment.

Abstract

The past decade has seen an increase in personal electronic technology, with childhood TV and videogame use similarly increasing. Critical milestones for child motor and sensory development are not being met. Simultaneously there is an increasing incidence of childhood physical, psychological and behavior disorders, often accompanied by the prescription of psychotropic medication. Technology’s detrimental effects on critical milestones for child development are reviewed. This commentary by a pediatric occupational therapist outlines issues of concern for parents, family physicians and pediatricians related to these trends, and offers a novel treatment approach: Unplug – Don’t Drug.

Commentary

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 6.5 hours per day TV and videogame use, with over 65% 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). Although rigorous research is still lacking, preliminary studies indicate increases in attention difficulty, poor academic achievement, aggression and sleep impairment may be attributable to childhood technology overuse (12-15).

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 (16). 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 (17). A 2006 Canadian study reported one in six children have a developmental disability (18), with Autism prevalence now 1 in 160 in Canada (19). 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 (20). A 2006 US study reported 32% of children admitted to inpatient pediatric ward demonstrated a developmental disability (21). In 1996, 10% of Canadian children ages 7-13 years were obese (22), with estimated economic costs of 1.8 billion (21). In 2004, just eight years later, this number is 50% higher with a prevalence of obesity at fully 15% of Canadian children (23).

Recent studies document a rise in psychological disorders in children reporting increasing incidence of bipolar disorder, depression and anxiety (24-27). 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 (28-31). Between 1991 and 1995, prescriptions for psychotropic medications in the 2 – 4 year old toddler population, as well as in children and youth tripled (32-34). 80% of this medication was prescribed by family physicians and pediatricians (35). 28-30% of children receiving psychotropic medication are on multiple medications (36). 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 (37-40).

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 (41). These environmental changes are 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 (42). Overuse of TV and videogames may result in children lacking essential connection with themselves, others and nature (43). Three critical factors for healthy physical and psychological child development are movement, touch and connection to other humans (44,45). 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 (46). This type of sensory input ensures normal development of posture, bilateral coordination and optimal arousal states (47). 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 and occupational therapy clinics (48). 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’ (49), limiting essential developmental components usually attained in outdoor rough and tumble play. Dr. 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 (51). 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 (52). 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 (53). Further evidence suggests some parents may have technology addictions (54). Adult Internet Addiction has been proposed for inclusion in the Diagnostic and Statistical Manual 5th Edition (55). 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 (56). 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.

In conclusion, evidence suggests that Canadian parents allow young children extended periods watching TV or playing videogames. Further evidence suggests parents are increasingly presenting their 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.

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.

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