November 8, 2008

Click here to read Cris’s editorial in the Globe and Mail.

Read the complete article here

As child technology use patterns parallel that of their parents, a technology addicted child is likely to live in a high technology usage household. Parents need to determine how much technology is too much, and set limits. Parents should then model balancing technology use with other activities. Schools could sponsor a Technology Reduction Week where classrooms compete to reduce technology use.

Need help? Zone’in Mixed Signals Workshop offers participants information regarding family technology reduction strategies and profiles the TV and Videogame Reduction Module.

2. Reconnect with your children.

The root of addiction is a person who fears intimacy or fears attachment with others. Adults may benefit from exploring their past experiences of attachment with their parents, and think about how this experience may have affected how they relate to their own child or students. Practice effective communication skills with children by passing a Talking Stick. Surprisingly, most children when asked would actually prefer an activity with a parent or teacher’s undivided attention, over a new videogame.

Need help? Zone’in A Cracked Foundation Workshop offers participants information regarding parent-child attachment and profiles the Attachment Questionnaire.

3. Explore alternatives to technology as a class or family activity.

Not all children are interested in or value the same activities as adults. Fostering a tolerance for differences and respecting individual preferences can go a long way toward promoting children’s motivation to unplug.

Need Help? Have each family member make a list of ten realistic, inexpensive things to do by themselves, with a friend, with another family member, with a pet, indoors, and outdoors. Help children create a game, song, joke, poem, story or dance. Buy a book of games, create a story night, play wrestle, make up a play, build a fort of couch cushions, or family cooking night are but a few of a myriad of alternatives to technology use.

4. Enhance your child’s performance skills PRIOR to unplugging.

Children with technology addictions have poorly developed identities, social skills, relationship to nature and sense of spirit. Drastically or suddenly reducing technology with a child who has an addiction, will result in chaos at school and home, as the child is now alienated from what has become their whole meaning for living. Teachers and parents can help build performance skills by reading on!

Need help? Zone’in offers the new Unplug’in Game for school and home settings, a development tool to build performance skills prior to unplugging from technology.

5. Promote inner drive and self-responsibility in your children.

Children benefit from knowing their role in the big picture, and self esteem comes from being productive. Realistic challenges and expectations by parents and teachers promote defined roles for children, and provide a structure where they can begin to try out new skills. The way children accomplish new skills is by making mistakes, and children can reduce their fear of making mistakes through established daily periods of unstructured play, without judgment or criticism. When faced with a task that is perceived to be beyond a child’s skill level, frustration and poor self-esteem will be the result.

Need Help? Zone’in Mixed Signals Workshop offers participants the Child Inner Drive Directive for Schools and Homes – or – purchase the new Unplug’in Game.

6. Become informed regarding the negative effects of technology on physical and mental health.

Technology overuse is related to child attention problems, poor academics, aggression, family conflict, impaired sleep, developmental delays, attachment disorders, impaired body image, obesity and early sexuality. Family or classroom learning sessions could involve a review of the research literature or finding relevant articles in the paper, followed by group discussion. For example, the American Academy of Pediatrics recommends no more than two hours per day of combined technology use.

Need Help? Get informed by checking out the Zone’in website www.zonein.ca to watch the Reality Check video clip, read the Unplug – Don’t Drug policy initiative, review the research, and read loads of articles and sign up for the Zone’in Development Series Newsletter.

7. Ensure engagement in the three critical factors for child development - movement, touch and connection.

Children need to rough and tumble play 3-4 hours per day, and spend time connecting with their parent(s), teacher and other children, in order to achieve optimal physical and mental health. This type of play promotes adequate sensory development of the vestibular, proprioceptive, tactile and attachment systems needed for paying attention, printing and reading.

Need help? Zone’in Harnessing Energy and Back to Basics Workshops offer participants information regarding sensory and motor development– or – buy the new Zone’in and Move’in educational programs for schools and families.

8. Address your own perceptions of outdoor safety.

Parents’ perceptions of safety correlate with child time indoors in front of TV and videogames e.g. if a parent perceives the world as unsafe, that child will spend more time indoors using technology. Adults would be wise to remember back when they were children, playing outside all day with friends - building forts, riding bikes, climbing trees. Outdoor play is a biological need for children, and all children have a right to be physically and mentally active and healthy.

Need help? Zone’in Diminishing Returns workshop offers participants a variety of alternative options for ensuring ‘safe’ home and school activities to promote optimal physical and mental development, and provides the Productivity Designs for Classroom and Gym to improve student productivity.

9. Enhance creativity and imagination by rediscovering the art of play!

Children have become passive learners through being ‘spoon fed’ by the entertainment industry. While reading a book requires eye muscle skill and creative visual imagery, watching 2-D fixed distance TV and videogames delays eye muscle development and creativity. Imagination is imperative for creation of ‘content’ in academics. Children therefore need to be taught how to engage in creative indoor and outdoor play by their parents and teachers, if they are to excel at school.

Need help? Zone’in Why Children Can’t Sit Still workshop offers participants the Child Development Directive and the Nature Directive to optimize learning.

10. Schedule a balance between technology use and activities.

Follow the Zone’in Concept of an hour of ‘energy in’ (technology use) equals an hour of ‘energy out’ (movement, touch and connection). Make up a weekly schedule with designated time for technology balanced with time for movement, touch and connection. When beginning the technology unplug, it’s important to alternate between familiar, predictable, structured activities and novel activities. Structure and predictability can be calming for children undergoing a change, but can also get boring. Novelty while interesting, can overwhelm some children. The parent and teacher’s job is to skillfully dance the child between predictability and novelty during the initial unplug period.

Need Help? Zone’in Programs Inc. offers parents, teachers and therapists’ products, workshops and training to help address child technology addictions. See www.zonein.ca for more unplug information and suggestions.

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.

References

1. Ayres JA. Sensory integration and learning disorders. California: Western Psychological Services; 1972.
2. Pelligrini AD, Bohn CM. The role of recess in children’s cognitive performance and school adjustment. Educational Researcher. 2005; 34(1): 13-19.
3. Tannock MT. Rough and tumble play: an investigation of the perceptions of educators and young children. Journal of Early Childhood Education. 2008; 35: 357-361.
4. 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.
5. Roberts DF, Foehr UG, Rideout VJ, Brodie M. Kids and media @ the millennium: A comprehensive national analysis of children’s media use. Menlo Park (CA): Kaiser Family Foundation; 1999.
6. France pulls plug on TV shows aimed at babies [CBC online article Wednesday, August 20, 2008]. Available from: http://www.cbc.ca/world/story/2008/08/20/french-baby.html.
7. Christakis DA, Zimmerman FJ. Violent Television During Preschool Is Associated With Antisocial Behavior During School Age. Pediatrics. 2007; 120: 993-999.
8. Thakkar RR, Garrison MM, Christakis DA. A systematic review for the effects of television viewing by infants and preschoolers. Pediatrics. 2006; 118: 2025-2031.
9. Active Healthy Kids Canada [2008 report card on the internet]. Available from: http://www.activehealthykids.ca/Ophea/ActiveHealthyKids_v2/upload/AHKC-Short-Form-EN.pdf.
10. Tremblay MS, Willms JD. Is the Canadian childhood obesity epidemic related to physical inactivity? International Journal of Obesity. 2005; 27: 1100-1105.
11. Strauss RS, Pollack HA. Epidemic increase in childhood overweight, 1986-1998. JAMA. 2001; 286 (22) 2845-2848.
12. Zimmerman FJ, Christakis DA, Meltzoff AN. Television and DVD/video viewing in children younger than 2 years. Archives of Pediatric Adolescent Medicine. 2007; 161 (5): 473-479.
13. Hancox RJ, Milne BJ, Poulton R. Association of television during childhood with poor educational achievement. Archives of Pediatric and Adolescent Medicine. 2005; 159 (7): 614-618.
14. Paavonen EJ, Pennonen M, Roine M. Passive Exposure to TV Linked to Sleep Problems in Children. Journal of Sleep Research. 2006; 15: 154-161.
15. Murray J, Liotti M, Ingmundson P, Mayberg H, Pu Y, Zamarripa F, Liu Y, Woldorff M, Gao J, Fox P. Children’s brain activations while viewing televised violence revealed by fMRI. Media Psychology. 2006; 8 (1): 25-37.
16. Hamilton S. Screening for developmental delay: Reliable, easy-to-use tools. Journal of Family Practice. 2006; 55 (5): 416-422.
17. Fombonne E, Zakarian R, Bennett A, Meng L, McLean-Heywood D. Pervasive developmental disorders in Montreal, Quebec, Canada: Prevalence and links with immunizations. Pediatrics. 2006; 118(1): e139-150.
18. Quellette-Kuntz H, Coo H, Yu CT, Chudley A, Noonan A, Breitenbach M, Ramji N, Prosick C, Bedard A, Holden JJ. Prevalence of Pervasive Developmental Disorder in two Canadian provinces. Journal of Policy and Practice in Intellectual Disabilities. 2006; 3(3):164-172.
19. Boyle CA, Decoufle’ P, Yeargin-Alsopp M. Prevalence and health impact of developmental disabilities in US children. Pediatrics. 1994; 93 (3): 399-403.
20. Petersen MC, Kube DA,Palmer FB. High prevalence of children with developmental disabilities admitted to a general pediatric inpatient unit. Journal of Developmental and Physical Disabilities. 2006; 18 (3): 307-318.
21. 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.
22. Birmingham CL, Muller JL, Palepu A, Spinelli JJ, Anis AH. The cost of obesity in Canada. Canadian Medical Association Journal. 1999; 160:483-488.
23. Addressing childhood obesity: the evidence for action. Canadian Institutes of Health Research [Evidence report January 12, 2004]. Available from: http://www.cihr-irsc.gc.ca/e/23293.html.
24. Blaxill MF. What’s going on? The question of time trends in Autism. Public Health Reports. 2004; 119: 536-551.
25. The well-being of Canada’s young children [report on the internet]. Government of Canada; 2003. Cat. No.: RH64-20/2003, ISBN: 0-662-67443-X. Available from: http://www.socialunion.gc.ca/ecd/2003/RH64-20-2003E.pdf.
26. Mental Health: A Report of the Surgeon General, Overview of Mental Disorders in Children [report on the internet]. Available from: http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec2_1.html.
27. Mental Health in the United States: Prevalence of Diagnosis and Medication Treatment for Attention Deficit/Hyperactivity Disorder. Centre for Disease Control and Prevention. 2003. Available from: www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a2.htm.
28. Ruff, ME. Attention Deficit Disorder and stimulant use: An epidemic of modernity. Clinical Pediatrics 2005; 44 (7): 557-563.
29. Diller LH. Running on Ritalin: A Physician Reflects on Children, Society, and Performance of a Pill. New York: Bantam Books; 1999.
30. Welch MG, Northrup RS, Welch-Horan TB, Ludwig RJ, Austin CL, Jacobson JS. Outcomes of prolonged parent-child embrace therapy among 102 children with behavior disorders. Complementary Therapies in Clinical Practice. 2006; 12(1): 3-12.
31. Mukaddes NM, Bilge S, Alyanak B, Kora ME. Clinical characteristics and treatment responses in cases diagnosed as Reactive Attachment Disorder. Child Psychiatry and Human Development. 2000; 30 (4): 273-287.
32. Zito JM, Safer DJ, dosReis S, Gardner JF, Soeken K, Boles M, Lynch F. Rising prevalence of antidepressants among US youth. Pediatrics. 2002; 109 (5): 721-727.
33. Mandell DS, Morales KH, Marcus SC, Stahmer AC, Doshi J, and Polsky DE. Psychotropic medication use among medicaid-enrolled children with Autism Spectrum Disorders. Pediatrics. 2008; 121 (3): 441-449.
34. Zito JM, Safer DJ, dosReis S, Gardner JF, Boles M, Lynch F. Trends in the prescribing of psychotropic medications to preschoolers. JAMA. 2000; 283: 1025-1030.
35. Goodwin R, Gould MS, Blanco C, Olfson M. Prescription of psychotropic medications to youth in office-based practices. Psychiatric Serices. 2001; 52(8):1081-1087.
36. Zito JM, Safer DJ, dosReis S, Gardner JF, Magder L, Soeken K, Lynch F, Riddle M. Psychotropic practice patterns for youth. Archives of Pediatric and Adolescent Medicine. 2003; 157(1): 17-25.
37. dosReis S, Zito JM, Safer DJ, Gardner JF, Puccia KB, Owens PL. Multiple psychotropic medication use for youths: A two-state comparison. Journal of Child and Adolescent Psychopharmacology. 2005; 15(1): 68-77.
38. Rosack J. Prescription data on youth raise important questions. American Psychiatric Foundation – Clinical and Research News. 2003; 38 (3): 1-3.
39. Kirsch I, Antonuccio D. FDA testimony on the efficacy of antidepressants with children. February 2004. Available from: http://www.ahrp.org/risks/SSRI0204/KirschAntonuccio.php.
40. Thomas CP, Conrad P, Casler R, Goodman E. Trends in the use of psychotropic medications among adolescents, 1994 to 2001. Psychiatric Services. 2006; 57 (1): 63-69.
41. Nelson MC, Neumark-Sztainer DR, Hannan PJ, Sirard JR, Story M. Longitudinal and secular trends in physical activity and sedentary behavior during adolescence. Pediatrics. 2006; 118 (6): 1627-1634.
42. Martin Turcotte. Time spent with family during a typical workday 1986 to 2005. Statistics Canada. Catalogue No. 11-008. Available from: http://www.statcan.ca/english/freepub/11-008-XIE/2006007/pdf/11-008-XIE20060079574.pdf.
43. Louv, R. Last child in the woods: Saving our children from Nature-Deficit Disorder. New York: Algonquin Books; 2005.
44. Insel TR, Young LJ. The neurobiology of attachment. Nature Reviews Neuroscience. 2001; 2: 129-136.
45. Korkman M. Introduction to the special issue on normal neuropsychological development in the school-age years. Developmental Neuropsychology. 2001; 20 (1):325-330.
46. Schaaf RD, McKeon Nightlinger K. Occupational therapy using a sensory integrative approach: A case study of effectiveness. American Journal of Occupational Therapy. 2007; 61 (2): 239-246.
47. Braswell J, Rine R. Evidence that vestibular hypofunction affects reading acuity in children. International Journal of Pediatric Otorhinolaryngology. 2006; 70 (11): 1957-1965.
48. Jennings JT. Conveying the message about optimal infant positions. Physical and Occupational Therapy in Pediatrics. 2005; 25 (3); 3-18.
49. Burdette, HL, Whitaker RC. A national study of neighborhood safety, outdoor play, television viewing, and obesity in preschool children. Pediatrics. 2005; 116: 657-662.
50. Montagu, A. Touching: the Human Significance of the Skin 2nd Edition. New York: Harper and Row; 1972.
51. Children, adolescents and television. American Academy of Pediatrics, Committee on Public Education. Pediatrics. 2001; 107 (2): 423-426.
52. Children, adolescents and advertising. Committee on Communications, American Academy of Pediatrics. Pediatrics. 2006; 118 (6): 2562-2569.
53. Christakis DA, Zimmerman FJ, DiGiuseppe DL, McCarty CA. Early television exposure and subsequent attentional problems in children. Pediatrics. 2004; 113 (4): 708-713.
54. Horvath CW. Measuring television addiction. Journal of Broadcasting and Electronic Media. 2004; 48 (3): 378-398.
55. Block, JJ. Issues for DSM – V: Internet Addiction. Journal of Clinical Psychiatry. 2008; 67 (5): 821-826.
56. Robinson T. Reducing children’s television viewing to prevent obesity. JAMA. 1999; 282 (16): 1561-1567.

By Stephan Miller // Staff Writer

Read the article with Cris Rowan’s interview. ]]> http://www.zoneinworkshops.com/news/video-addicts-beware-madden-2009-hits-market-teens-in-print-2008/feed/ http://www.zoneinworkshops.com/news/virtual-games-real-addictions/ http://www.zoneinworkshops.com/news/virtual-games-real-addictions/#comments Thu, 23 Oct 2008 21:04:06 +0000 Amy http://www.zoneinworkshops.com/?p=596 SARAH BOESVELD
From Wednesday’s Globe and Mail
October 22, 2008 at 9:10 AM EDT

Read the article with Cris Rowan’s interview.

Continue reading the article on page 5 of OT Line, Fall 2008 Newsletter.

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 (1-3). Meeting these necessary developmental milestones is critical for achieving optimal physical and psychological health, as well as required for attention and learning. Three to four hours per day rough and tumble play is required for adequate stimulation to toddler and child vestibular, proprioceptive and tactile sensory systems (4,5). This sensory stimulation results in achievement of postural tone, muscle coordination and optimal arousal states needed for eventual occupational and academic performance (6.7). Today’s child now averages 6.5 hours per day TV 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 (8,9). This situation has prompted France to recently ban its broadcasters from airing TV shows aimed at children under three years of age (10). 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 (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). A 2006 study reported literacy rates fell in Canada for the first time in history (16).

A 2006 Canadian study reported one in six children have a developmental disability (17), with Autism prevalence now 1 in 160 in Canada (18). 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 (19). A 2006 US study reported 32% of children admitted to inpatient pediatric ward demonstrated a developmental disability (20). In 1996, 10% of Canadian children ages 7-13 years were obese (21), with estimated economic costs of 1.8 billion (22). In 2004, just eight years later, this number is 50% higher with a prevalence of obesity at fully 15% of Canadian children (23). TV and videogame use accounts for 60% of childhood obesity, with obesity is now considered a North American ‘epidemic’ (24,25).

Recent studies document a rise in psychological disorders in children reporting increasing incidence of bipolar disorder, depression and anxiety (26-29). 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 (30-33). Between 1991 and 1995, prescriptions for psychotropic medications in the 2 – 4 year old toddler population, as well as in children and youth tripled, resulting in a staggering 5% of the child population on these medications (34-36). 80% of this medication was prescribed by family physicians and pediatricians (37). 28-30% of children receiving psychotropic medication are on multiple medications (38). 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 (39-41). Estimated cost to the health care system for one child with a developmental, psychiatric or behavioral disorder would be $10,000 per year, and one child on psychotropic medication would be $1000 per year. While long term physical and psychological complications are unknown, research on the long term effects of Ritalin on rats has shown brain atrophy and ‘bizarre’ behaviors with early psychotropic medication use (42).

Extrapolation from previously cited research indicates estimated annual costs to the health care system to support children with developmental disabilities, psychiatric and behavioral disorders are $9.3 billion, obesity are $3 billion and medication costs are $0.3 billion, totaling $12.5 billion. Estimated annual costs to the education system for failing literacy are $10 billion (43) and educational support of children with developmental disabilities are $13 billion, totaling $23 billion. In summary, the total annual costs to the health and education sectors to address problems that strongly correlate with child technology addictions are $35.5 billion.

So what type of measures could health and education professionals take at this time to reduce overall spending in their respective sectors. 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 (44). 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 (45). Further evidence suggests some parents may have technology addictions (46). Adult Internet Addiction has been proposed for inclusion in the Diagnostic and Statistical Manual 5th Edition (47). These facts support 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 not only statistically significant reduction in technology use, but also showed relative decreases in obesity (48).

Health Professionals
While ensuring proper development and attachment is primarily the responsibility of parents, health professionals are frequently the first to detect delays in development and ‘abnormal’ behaviors in children, and could subsequently question parents regarding their family’s TV and videogame usage. Health professionals could follow this line of questioning with provision to parents of relevant information regarding the adverse effects of high technology usage on child development and behavior, and possibly recommend an ‘unplug’ trial if appropriate. Health professionals could train parents regarding strategies for TV and videogame reduction, as well as non-pharmaceutical strategies on how to manage behavior problems and developmental delays. Health professional can teach parents how to assist their children to balance TV and videogame use with movement. For example, allowing one hour of “box time” for one hour of hard physical outdoor work (bike up hill, haul wood, dig in garden), encouraging daily hugs, playful wrestling, nature games, and no TV in bedrooms or during dinner. Health professionals could advocate to researchers for addition of more environmental parameters in behavioral research, such as the role of technology use and differing parenting styles. Health professionals could also advocate for elimination of pharmaceutical advertising of psychotropic medication in parent, home and gardening magazines.

Education Professionals
Classroom teachers, special education staff, and school administrators are also early players in the identification of child development or behavior as ‘abnormal’, and often unknowingly create undue pressure on parents and physicians to pursue a diagnosis and medicate these students. Many parents have reported they have been told by their child’s school system that either the parents seek medical help for their child, or the school will put their child in a special education class (not desirable by any parent). Teachers who have children on medication in their classroom will be the first to say these medicated children become more ‘manageable’, a further incentive to refer more students for diagnosis and medication. Children on medication unfortunately don’t do as well as teachers and parents would like to think long term. Research shows children on psychotropic medication have lower academic scores, increased drop out rates from high school, lower paying jobs, and lower entrance into university. Another factor to consider in the present rise in diagnosis and medication of children is that the Canadian education system supports physical and mental diagnoses with increased funding, attractive to any school administration. Schools could implement yearly technology reduction programs, provide education to parents, as well as increase a child’s physical work in classrooms, gyms and at recess.

Zone’in supports home and school technology reduction with the new Unplug’in Game, TV and Videogame Reduction Module for Parents and Teachers, Unplug’in information brochure, and the Foundation Series Workshops for health and education professionals.

References

1. Ayres JA. Sensory integration and learning disorders. California: Western Psychological Services; 1972.
2. Pelligrini AD, Bohn CM. The role of recess in children’s cognitive performance and school adjustment. Educational Researcher. 2005; 34(1): 13-19.
3. Tannock MT. Rough and tumble play: an investigation of the perceptions of educators and young children. Journal of Early Childhood Education. 2008; 35: 357-361.
4. Schaaf RD, McKeon Nightlinger K. Occupational therapy using a sensory integrative approach: A case study of effectiveness. American Journal of Occupational Therapy. 2007; 61 (2): 239-246.
5. Braswell J, Rine R. Evidence that vestibular hypofunction affects reading acuity in children. International Journal of Pediatric Otorhinolaryngology. 2006; 70 (11): 1957-1965.
6. Insel TR, Young LJ. The neurobiology of attachment. Nature Reviews Neuroscience. 2001; 2: 129-136.
7. Korkman M. Introduction to the special issue on normal neuropsychological development in the school-age years. Developmental Neuropsychology. 2001; 20 (1):325-330.
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20. 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.
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The past decade in pediatric occupational therapy has witnessed the emergence of two escalating childhood trends, technology addictions and the medication of behavior. While research is in it’s infancy regarding causal links between these two trends, we do know kids are spending more time in front of TV, and less time socializing with their parents and playing outdoors with friends. Subsequently, the critical factors for child development of movement, touch and connection are not being met, resulting in child maldevelopment and a rise in a host of physical and mental disorders that the health and education systems are only just beginning to detect, much less understand. As 21st century child diagnosis such as ADHD, Autism, anxiety, depression, and obesity often result in the use of medication, one can only wonder if we are indeed medicating child behavior associated with technology addictions. The following commentary by a pediatric occupational therapist provides professionals with a review of current research regarding the effects of technology on child development, and documents the rising incidence of child diagnosis and medication. This commentary also suggests a possible alternative to child diagnosis and medication by ‘unplugging’ children from technology, and proposes the Unplug – Don’t Drug policy initiative for consideration by health and education professionals. The complete Unplug – Don’t Drug policy initiative submitted to the Canadian College of Physicians and Surgeons, as well as health and education governments in June 2008, can be viewed in it’s entirety at www.zonein.ca.

While today’s parents might think it is okay for their young children to sit for long periods and watch TV or play videogames, they don’t appear to be as comfortable with the resulting ‘behaviors’, e.g. inactivity or hyperactivity. Child behavior has become an increasingly complex and confusing phenomenon, enlisting the costly consultative services of not only physicians, pediatricians and psychiatrists, but also psychologists, behavior consultants, counselors, and occupational therapists. Parents and teachers often look to health and education professionals for help, who in turn refer to family physicians and pediatricians. 80% of child diagnosis and medication prescription is performed by family physicians and pediatricians (1). Prescription of ADHD medications to elementary children has quadrupled in the past decade, and tripled in the two to four year old population (2,3). In the last five year period, use of anti-depressants, anti-anxiety and sedative medication has also tripled for elementary aged children (4-9).

Why? At 6.5 hours per day average TV and videogame use, Canadian children have reached what could be termed ‘addiction’ level status (10,11), being granted an “D” grade for inactivity in 2008 by Active Healthy Kids Canada (12). Over 65% of elementary children, and 35% of toddlers, have TV’s in their bedrooms, increasing obesity rates by 30% (13,14). Existing causal research regarding the impact of technology overuse on children indicates correlation with an increase in attention difficulty, poor academic performance, aggression, obesity, sleep disorders, early sexuality, and poor body image (15-19). These preliminary findings have resulted in the American Academy of Pediatrics to issue a policy statement in 2004, stating that children under the age of two years should not be exposed to any technology, and those older than age two should use no more than two hours technology per day (20). Dr. Dimitri Christakis found that for every one hour of TV watched per day between the ages of 0 and 7 year, equates to a 10% increase in attention problems by age seven years (21). This means that children who watch the national average of 6.5 hours per day have a 65% chance of attention problems by age seven. Yet these facts don’t seem to deter parents from restricting technology usage. Why is this? Quite possibly it’s because parents themselves have technology addictions. Adult Internet Addiction has been proposed for inclusion in the Diagnostic and Statistical Manual 5th Edition (22,23). While no one can argue the benefits of advanced technology in today’s world, the subsequent busy and harried lives technology has caused, has resulted in a ‘disconnection’ from what society should value most, children. Children are suffering a slow and painful death as a result, sliding into a world of isolation, loneliness and despair. Poor sleep, attention deficit and low academics adds further insult to injury, as children struggle with fluctuating arousal states and fragile self esteem. Rather than hugging, playing, rough housing, and talking to children, parents are instead buying them more videogames, TV’s for the car, and the latest iPod, creating a deep and widening chasm.

What is the role of the occupational therapist in this escalating crisis? Understanding child neurological development helps to delineate the possible correlation between TV and videogame addictions in children, and subsequent physical and mental wellness. For generations, human beings have engaged in heavy work, and sensory stimulation was nature-based and calming. Families moved and worked together to survive; chopping wood, hauling water, plowing fields. Today’s families are different. Advances in technology and transportation have resulted in a physically sedentary family that is bombarded with chaotic and complex sensory stimulation. While TV’s, videogames and computers may be compelling and interesting, overuse of technology is causing sensory deprivation and a “disconnect” from the real world. Movement, touch and human connection are all critical factors for healthy, early child development, and are essential elements for attaining optimal physical and mental health. Today’s TV and videogame addicted child is essentially deprived of movement, touch and human connection, possibly resulting in a host of physical and mental disorders. A developing child needs adequate stimulation to the vestibular (balance), tactile (touch) and proprioceptive (muscle) sensory systems for normal neurological development. If children don’t get enough swinging, running, and jumping, by climbing trees, riding bikes and outdoor play, they will have difficulty with muscle coordination, postural tone and attaining optimal arousal states. Today’s TV and videogame addicted children lack essential connection with themselves, others and nature – termed The Triple Disconnect. Young children are visually motivated, and often cannot distinguish themselves from screen images, thus failing to establish their own identity necessary for establishing healthy body image and a sense of self. Physical play with others is an integral ingredient for socialization with others, as well as facilitates motor skill development – and no, Wii is not ‘physical play’. Due to parent perception that outdoor play is ‘unsafe’ (24), Nature Deficit in today’s child is profound (25), further limiting essential developmental components attained in outdoor rough and tumble play. When children respond by ‘turning in’ (anxiety, depression) or ‘turning out’ (aggression, violence), their resulting behavior is confusing and could be easily misunderstood, ending in possible mental diagnosis and prescription of psychotropic medication. As these children grow into adolescence, they are faced with additional problems. If they are lucky, they can avoid possible long term negative effects of psychotropic medication and addiction through selling it. The most popular drug on the street presently is Ritalin (26). The consequences of long term psychotropic medication use is unknown at this time, but could be postulated to be grim to say the least. Teen violence, incarceration and suicide rates are higher now than ever, with preliminary studies showing positive correlation with psychotropic medication use (31). The consequences of medicating young children will likely never have favorable outcomes.

So what type of preventative measures could physicians, occupational therapists, mental health workers, teachers, and parents take at this time, as alternatives to medicating child behavior? While ensuring proper development and attachment is primarily the responsibility of parents, health and education professionals are frequently the first to detect ‘abnormal’ behaviors in children, and could subsequently question parents regarding their family’s TV and videogame usage. Professionals could follow this line of questioning with provision to parents of relevant information regarding the adverse effects of high technology usage, and possibly recommend an ‘unplug’ trial if appropriate. Professionals can educate parents and children regarding balancing technology with movement, by recommending every hour of technology use should balance with an hour of physical activity (bike up hill, haul wood, dig in garden). Encouraging daily hugs, playful wrestling, nature games, and no TV in bedrooms or during dinner will go a long way toward growing a healthy and happy child. Schools could increase physical work with desk isometrics (hand or chair push), or by increasing student participation in outdoor recess and gym time using heavy work-type activities (tug of war, climbing ropes). Remember when we used to play outside all day…running, jumping, building forts, climbing trees, riding bikes till dark? Our children have the right to a safe and healthy lifestyle too. Children are our future, and we are destroying everyone’s future by drugging children with TV, videogames and psychotropic medication. So before considering medicating a child, health care and education professionals may want to first consider parent education and support of the more healthy and natural three month ‘unplug’ alternative.

Biography
Cris Rowan is a pediatric occupational therapist SIPT certified sensory specialist, with BSc’s in OT and biology. Cris is CEO of Zone’in Programs Inc www.zonein.ca, providing products, workshops and training to reverse the impact of technology on child development. Cris is editor of the Zone’in Development Series Newsletter, and has just completed the new Unplug’in Game to help kids develop occupational performance skills needed to unplug from technology. For additional information, contact info@zonein.ca or crowan@zonein.ca.

References

1. Ruff, M (2005) Attention Deficit Disorder and Stimulant Use: An Epidemic of Modernity. Clinical Pediatrics Vol 44 pg 557.
2. Zito, J, Safer D, dosReis S, Gardner J, Boles M, Lynch F (2000) Trends in the Prescribing of Psychotropic Medications to Preschoolers.
3. Centre for Disease Control and Prevention (2003) Mental Health in the United States: Prevalence of Diagnosis and Medication Treatment for Attention Deficit/Hyperactivity Disorder. www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a2.htm.
4. Rosack J (2003) Prescription Data on Youth Raise Important Questions. American Psychiatric Foundation – Clinical and Research News Vol 38 No 3 pp1-3.
5. Thomas C, Conrad P, Casler R, Goodman E (2006) Trends in the Use of Psychotropic Medications Among Adolescents, 1994 to 2001. Psychiatric Services Vol 57 No 1 pp63-69.
6. Antonuccio D, Burns D, Danton W (2002) Antidepressants: A Triumph of Marketing Over Science? Prevention and Treatment, Vol 5 No 1, July 2002 pages 1-21.
7. Mandell D, Morales K, Marcus S, Stahmer A, Doshi J, and Polsky D (2008). Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders. Pediatrics Vol 121 No 3 pp e441-e449.
8. Kirsch I and Antonuccio D (2004) FDA Testimony On the Efficacy of Antidepressants With Children.
9. Michael K and Crowley S (2002) How Effective are Treatments for Child and Adolescent Depression? A Meta-Analytic Review. Clinical Psychology Review, Vol 22 pages 247-269.
10. Roberts D, Foehr U, Rideout V, Brodie M (1999) Kids and Media at the New Millennium: A Comprehensive National Analysis of Children’s Media Use.
11. Horvath C (2004) Measuring Television Addiction. Journal of Broadcasting and Electronic Media Vol 48(3), 378-398.
12. Active Healthy Kids Canada 2008 Report Card gave Canadian children a grade “D” for physical activity and recommends ‘unplugging’ kids from technology. http://www.activehealthykids.ca/Ophea/ActiveHealthyKids_v2/upload/AHKC-Short-Form-EN.pdf.
13. Institute of Medicine of the National Academies (September 2004) Fact Sheet. http://www.iom.edu/Object.File/Master/22/615/Fact%20Sheet%20-%20Schools%20FINALBitticks.pdf.
14. Rideout V, Vandewater E and Wartella E (2003) Zero To Six: Electronic Media In The Lives of Infants, Toddlers and Preschoolers.
15. American Academy of Pediatrics, Committee on Communications (2006) Children, Adolescents, and Advertising. Pediatrics Vol 118 No 6, 2562-2569.
16. Christakis D and Zimmerman F (2007) Violent Television During Preschool Is Associated With Antisocial Behavioural During School Age. Pediatrics Vol 120, 993-999.
17. Vandewater E, Lee J and Shim M (2005) Family Conflict and Violent Electronic Media Use in School-Aged Children. Media Psychology Vol 7 No 1, 73-86.
18. Hancox R, Milne B and Poulton R (2005) Association of Television During Childhood With Poor Educational Achievement. Archives of Pediatric and Adolescent Medicine Vol 159 No 7, 614-618.
19. Thompson, D and Christakis D (2005) The Association Between Television Viewing and Irregular Sleep Schedules Among Children Less Than 3 Years of Age. Pediatrics Vol 116, 851-856.
20. American Academy of Pediatrics, Committee on Public Education (2001) Children, Adolescents, and Television. Pediatrics Vol 107(2), 423-426.
21. Christakis D, Zimmerman F, DiGiuseppe and McCarty C (2004) Early Television Exposure and Subsequent Attentional Problems in Children. Pediatrics Vol 113, 708-713.
22. Castro J and Hewlett SA (1991) Watching a Generation Waste Away. Time Magazine Monday August 26, 1991.
23. Block, J (2008) Issues for DSM – V: Internet Addiction. American Journal of Psychiatry Vol 165 March pg 306-307.
24. Burdette, H and Whitaker R (2005) A National Study of Neighborhood Safety, Outdoor Play, Television Viewing, and Obesity in Preschool Children. Pediatrics Vol 116, 657-662.
25. Louv, Richard (2005) Last Child in the Woods – Saving Our Children From Nature-Deficit Disorder.
26. Ruff, M (2005) Attention Deficit Disorder and Stimulant Use: An Epidemic of Modernity. Clinical Pediatrics Vol 44 pg 557.
27. The Tragic Consequences of Drugging Children. 2 hour film documentary by Gary Null (2007). http://articles.mercola.com/sites/articles/archive/2007/09/20/the-tragic-consequences-of-drugging-our-children.aspx.

September 9, 2008

Vancouver BC – Zone’in Programs Inc would like to announce the release of the timely and innovative Unplug’in game, which addresses TV and videogame addictions in children. The premise of the board game is that kids are stuck in a TV, and need to gain points to get out. By playing Unplug’in, kids experience skill building in the Me, We, Earth and Spirit dimensions, necessary for an eventual ‘unplug’. Traveling between dimensions, kids pick up points by answering questions, and use Journey Cards, Do’in Cards, What Ifs Cards and Unplug’in Cards to enhance imagination, provide alternative activities to TV and videogames, problem solve, and create awareness about technology usage. The Unplug’in game is for ages 5-12, and can be played with 1-5 players in either school or home settings.

Unplug’in is the brain child of pediatric occupational therapist Cris Rowan, CEO of Zone’in Programs Inc, a corporation addressing the effects of technology on child performance through offering products, workshops and training programs. Unplug’in can be ordered online at www.zonein.ca.

Biography
Media can visit Cris Rowan’s website www.zonein.ca which has a media kit, research section and a number of published articles on the impact of technology on child development. Cris authored the Unplug – Don’t Drug policy initiative for Canadian physicians and health government, and has performed over 200 parents and teacher workshops through out North America. Cris is finishing a book titled A Cracked Foundation: Repairing the Damage of Technology on Child Development and can be contacted for an interview on her cell 604-740-2264.

Cris Rowan, BScOT, BScBi, SIPT
CEO Zone’in Programs Inc
6840 Seaview Rd.
Sechelt, BC V0N3A4
604-885-0986, 604-885-0389 fax, 604-740-2264 cell
crowan@zonein.ca