Zone’in Workshops

Pediatric occupational therapist Cris Rowan highlights the impact of technology overuse on child physical, mental, social and academic performance.

Disney refunds Baby Einstein DVD’s.  Canadian Pediatric Society warns no TV for children under 2, and only 1-2 hours per day over age two.  What are the ramifications of unrestricted technology use by children?

Bio, contact info, and pic at the end of Fact Sheet.  Media kit and quotes on website www.zonein.ca.

Zone’in Fact Sheet

Reviewing the impact of technology on child development, behavior, and academic performance.

• 30% of children will enter kindergarten developmentally delayed
• 14.3% of Canadian, and 20% of US children, have been diagnosed with a mental illness
• 15% of children are obese
• 20% of children require special education assistance

Impact Statement

The past decade has seen an increase in personal electronic technology, with childhood TV, internet, video game, cell phone and iPod use similarly increasing.  Critical milestones for child motor and sensory development are not being met, impacting on foundation skills for literacy and academic performance.  Simultaneously there is an increasing incidence of childhood physical, psychological and behavior disorders, often accompanied by the prescription of psychotropic medication.  Media violence is now been classed as a public health risk due to causal links to child aggression.  Research regarding technology’s detrimental effects on critical milestones for child development, behavior, and academic performance are reviewed. Considerations for parents, teachers, health professionals, government, researchers and technology production corporations related to these trends are outlined.  Suggestions are made for health and education professionals regarding implementation of school based technology management programs, and an Unplug – Don’t Drug policy.

Technology Use Overview

• 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, and children now average 8 hours per day TV and videogame use, with over 65% of children using TV’s in their bedrooms (4).
• ‘Baby TV’ now occupies 2.2 hours per day for the 0-2 year old population, and television occupies 4.5 hours per day for 3-5 year olds, and 6.5 hours per day for elementary aged children and is causally linked to developmental delays (5).  This situation has prompted France to ban its broadcasters from airing TV shows aimed at children under three years of age (6).
• 173 research efforts going back to 1980 were analyzed and rated, showing 80% of the studies showed a link between the following negative health outcomes and media hours or content: obesity, smoking, sexual behavior, drug use, alcohol use, low academic achievement and ADHD (8-12).
• 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 (13).
• Passive and active TV watching results in irregular sleep patterns and sleep/wake transition disorders (14).
• Canadian children were granted a “D” grade for inactivity in 2008 by Active Healthy Kids Canada, citing TV and videogames as the primary cause (15).
• TV and videogame use accounts for 60% of childhood obesity, and is now considered a North American ‘epidemic’ (16,17).
• American Physician, Pediatrician, Psychiatrist and Psychologist Associations in 2001 declared media violence a Public Health Risk, stating violence is the leading cause of death in children (18).

Developmental Delays and Obesity

• A joint study was recently released by the BC Business Council, and University of BC researchers with Human Early Learning Partnership showing that just under 30% of BC children entering kindergarten are “developmentally vulnerable” – lacking in those basic skills they need to thrive in school and in the future.  This study, entitled A Comprehensive Policy Framework for Early Human Capital Investment in BC states “Economic analyses reveal this depletion (in human capital) will cause BC to forgo 20% GDP growth over the next 60 years, costing the provincial economy a sum of money that is 10 times the total provincial debt load.” (19)
• American Physiotherapy Association reports two-thirds of over 400 members surveyed report they’ve seen an increase in early motor delays in infants over the past six years (20).
• A 2006 Canadian study reported one in six children have a developmental disability with only 55-65% of developmental disabilities are detected prior to school age entry (21).
• Data from the 1988 National Health Interview Survey reported 17% of U.S. children had a developmental disability with 6% of child population having language impairment, 8% a learning disability, 7% ADHD and 0.5% Autism with 13.2% accessing special education assistance, 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).
• 9% of US children age 8-15 years meet criteria for ADHD (23).
• Sensory Processing Disorder affects 1 in 20 children www.SPDFoundation.net.
• A 2006 US study reported 32% of children admitted to inpatient pediatric ward demonstrated a developmental disability (24).
• In 1996, 10% of Canadian children ages 7-13 years were obese, with estimated economic costs of 1.8 billion (25).  In 2004, just eight years later, this number is 50% higher with a prevalence of obesity at fully 15% of Canadian children (26).
• US study reports obesity incidence in 2 to 5 year old toddlers increased from 2.1% to 5.0% in boys and 4.8% to 10.8% in girls over a 6 year period (27).

Psychological Disorders and Psychotropic Medication

• Recent studies document a rise in psychological disorders in children reporting increasing incidence of ADHD, autism, bipolar disorder, depression and anxiety (28-31).
• 2007 mental illness statistics for children in Canada show that 14.3% of children have a diagnosed mental health disorder with anxiety disorders 6.4%, ADD or ADHD 4.8%, conduct disorders 4.2%, depressive disorders 3.5%, substance abuse 0.8%, autism spectrum disorders 0.3%, obsessive compulsive disorders 0.2%, eating disorders 0.1%, schizophrenia 0.1%, bipolar disorder <0.1% (32).
• There are no reliable, valid, or replicable studies showing genetic evidence for any psychiatric disorders, including ADHD, Autism, bipolar disorder, schizophrenia, depression or anxiety. (33)
• People who report they are not happy watch over 30% more TV hours per day than people who report they are happy (34).
• Television exposure and total media exposure in adolescence are associated with increased odds of depressive symptoms in young adulthood, especially in young men (35).
• Behaviors associated to technology overuse may be confusing for parents, teachers and physicians, and could be easily misunderstood, possibly resulting in psychiatric diagnosis and prescription of psychotropic medication (36-39).
• Dr. David Stein reported at the International Center for the Study of Psychiatry and Psychology conference in October 2009 that 32% of children ages 0-18 years covered by Blue Cross insurance are currently on 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 (40-42).  80% of this medication was prescribed by family physicians and pediatricians (43).
• 28-30% of children receiving psychotropic medication are on multiple medications, with minimal knowledge regarding drug interactions or long term toxicity (44).
• 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 (45-48).
• Dr. Peter Breggin reported at the International Center for the Study of Psychiatry and Psychology conference in October 2009 that ADHD medication causes permanent neurotransmitter changes due to receptor down regulation, resulting in depletion of the transmitter the drug was originally designed to increase.  New psychotropic medication molecular structure has added fluoride and chloride ions to improve long acting ability, which are proven to be toxic with long term (> 4 months) administration to cell mitochondria causing eventual cell death.  ADHD medication results in growth retardation and 20% brain shrinkage, appetite loss, 50% depression, 50% Obsessive Compulsive Disorder, Tardive Dyskinesthesia, and alcohol and cocaine abuse. Psychotropic medication decreases spontaneity and increases obsessive compulsive disorder, two traits which are ALWAYS interpreted as “improvement” by the educational system.
• Research regarding stimulant medication with children is rife with conflict.  Studies have low validity and reliability ratings, and findings can rarely be replicated.  Clinical trials are generally small in sample size (30-40 children), and on children older than FDA approved regulations, resulting in prevalent “off label” prescribing.  Clinical trials are conducted for no longer than 4-8 week periods, which is insufficient to document any toxicological side effects, and authors state “Neither the long-term effectiveness nor the long-term safety of stimulant medications has ever been demonstrated”. (49)
• Three year follow-up of treated ADHD subjects showed increases in heart rate, and/or systolic and diastolic blood pressure in 20% of children taking stimulants for ADHD (50).

• Health Canada warns that Atomoxetine (Strattera), a drug commonly used to treat ADHD disorder in children, has been linked to 189 reported adverse reactions as of December 31, 2007, including 55 suicide attempts of which 43 were among children between the ages of 6 and 17 (51).
• Two world-renowned Harvard child psychiatrists Dr. Joseph Biederman and Dr. Thomas Spencer, whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children, found in a 2006 study increased prevalence of adult ADHD and call for increased detection and treatment (52).  Senator Charles E. Grassley implicated these same researchers in payments of $1.6 million of unreported income from pharmaceutical corporations over a 6 year period (53).
• Although “off label” marketing of psychotropic medication and suppression of negative results of drug trials are illegal, they are widely accepted practices by pharmaceutical companies (54).
• Studies have shown that access to “green space” for 20 minutes per day significantly reduced ADHD symptoms, yet drug use continues to climb.  Inner city children suffer from ADHD at three times the rate of children in rural areas (55).

Missing Critical Factors for Child Development

• 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 (56).
• 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 (57).
• Canadian parents spend an average 3.5 minutes per week participating in meaningful conversation with their children (58).
• Overuse of TV and video games may result in children lacking essential connection with themselves, others and nature.  Child now fear nature, limiting outdoor play which is essential for achieving sensory and motor development (59).
• Three critical factors for healthy physical and psychological child development are movement, touch and connection to other humans (60,61).
• 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 (57).  This type of sensory input ensures normal development of posture, bilateral coordination and optimal arousal states (62,63).
• Scottish study reports toddlers aged 3 years engaged in only 20 minutes per day of moderate to vigorous physical activity, which correlated with a decline in total energy expenditure and sedentary behavior.  Study identifies TV, video games, strollers as “culprits” (64).
• 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 (65).
• 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’, even though most crimes against children are instigated by family members (66), 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) (67).

Academic Performance

• Students with greater than 15 minutes per day of recess had teacher reports of better classroom behavior.  30% of 3^rd graders had little or no recess (< 15 minutes per day) and 40% of schools surveyed had cut back at least one daily recess period. Since the 1970’s, children have lost 12 hours per week in free time (68).
• There is a positive correlation between physical activity and seven categories of cognitive performance: perceptual skills, intelligence quotient, achievement, verbal tests, math tests, developmental level, and academic readiness.  Studies show that a reduction of 240 minutes per week of academic class time, replaced with increased time for PE, led to higher math scores.  Adding PE time alone does not improve grades, it’s vigorous exercise that improves cognition e.g. climbing walls, exercise bikes, tread mills, dancing (69).
• In 1994 and 2003, comparative literacy studies of Canada, Germany, the Netherlands, Poland, Sweden, Switzerland and the United States were completed covering four literacy domains – prose (reading and  understanding text information e.g. stories, editorials), document (locating text information e.g. maps, schedules), and numeracy (understanding math embedded in text e.g. weather and loan interest charts) and problem solving. Participants were ranked on five levels, with level one being the lowest.  15% of Canadians scored in level one, and only 50% reached level three.  Canadians scored in the middle of the pack, and results were the same for 1994 and 2003 (70).

• More than eight million students in grades 4-12 read below grade level, and while they can decode, they cannot comprehend what they read.   Between 1971 and 2004, the reading level of America’s 17 year olds showed not improvement at all.  40% of high school graduates lack the literacy skills employers seek.  Early exposure to print is largest predictor of reading ability (71).
• Comparative study of digital (screen) reading vs. print reading reports the following problems with screen reading:
  • Attention: clicking and scrolling disrupt attention and disturb mental appreciation
  • Comprehension: reader lacks both completeness and constituent parts
  • Memory: change in physical surroundings has a negative effect on memory
  • Learning: doesn’t allow required time and mental exertion
  • Meaning:  isn’t a physical dimension, loss of totality

Mangen Quote: “The digital hypertext technology and its use of multimedia are not open      to the experience of a fictional universe where the experience consists of creating you           own mental images.  The reader gets distracted by the opportunities for doing something      else” (72).

• Literacy is defined as competency in handwriting, reading and communication skill. A foundation in spoken language competence in the early years, is important for the successful achievement of literacy, academic and social competence (73).
• Printing is a precursor to reading and speech fluency, and poor handwriting skill is related to language disorders.  Motor planning required for automatic letter production when printing “maps” the sensorimotor cortex for eventual visual letter recognition for reading, and word finding for oral sentence production (74).
• Rowan, C. 2007. Children who cannot print are essentially illiterate.  Teacher misperception that the computer will replace the need to print, is unfounded and shortsighted.  Slow printing speed resulting from inadequate teaching of letter and number formation, impacts on every subject and is the leading cause of illiteracy.
• ADHD should be re-termed “attention inconsistency”, as these children have episodic attention ability.  Attention Restorative Theory has three tenants: 1) attention ability is subject to fatigue and restoration 2) voluntary and interesting tasks are less fatiguing than involuntary and uninteresting tasks 3) attention ability is subject to environment modifications (75).
• Dyslexia can be artificially induced by teaching whole word method reading, and cured by teaching phonic reading. (76)
• Exposure to “green space” results in a significant reduction in ADHD, in both areas of impulse control and attention ability.  Nature not only has attention restorative benefits, but also activates all the senses to enhance multi-sensory learning ability (77,78).

Media Violence

• Violent media is a public health threat. A review of 50 years of research on the impact of violence in TV, movies, videogames and internet concludes that watching media violence significantly increases the risk that a viewer or videogame player will behave aggressively in both the short and the long term. 60% of TV programs contain violence and 40% contain heavy violence.  Most videogames contain violence.  Video game ratings are a poor indicator of content and constitute conflict of interest, as the rating process is performed by the video game industry.  Authors state the impact of violent electronic media on public health is second only to the impact of cigarette smoking on lung cancer (79).
• In the short term, media violence can increase aggression by priming aggressive thoughts and decision processes increasing physiological arousal, and triggering a tendency to imitate observed behaviors.  In the long-term, repeated exposure can produce lasting increases in aggressive thought patterns and aggression-supporting beliefs about social behaviors, and can reduce individuals normal negative emotional responses to violence (80).
• Studies regarding the effects of violent video games on children found even violent cartoons increased aggression in 9-12 year old children.  Violence is defined as doing intentional harm to another, not how graphic or gory the game is.  Increased exposure to violent videogames results in more pro-violent attitudes, hostile personalities, less forgiveness, belief that violence is typical, and causes children to behave more aggressively in their every day life (81).
• Young children are most vulnerable to media violence as they are more impressionable, can’t distinguish between fantasy and reality, cannot discern motives for violence, and learn by observing and imitating (82).

Cyberbullying

• Survey of 3,767 grade 6, 7, 8 students who attended six schools in the US found 11% had been electronically bullied and 4% indicated they had bullied a victim in the past month.  Half of the electronic bully victims reported not knowing the perpetrator’s identity (83).
• Youth who reported being harasses online were 8 times more likely to carry a weapon to school in the past 30 days (84).
• While online cyberbullying occurs off campus, resulting altercations happen on site (85).
• Internet bullying is correlated with school behavior problems, and media literacy programs may mitigate the negative effects of electronic media on youth (86).

Technology Addiction Prevalence

• A Harris Interactive Poll in the US release in April 2007 found that 8.5% of youth gamers could be classified as “pathological” or “clinically addicted” to playing video games.  A British survey of gamers indicated 12% reported being “addicted”. 2.4 % of South Korea from ages 9 – 39 have video game addiction according to a government funded survey.  Another 10.2% were found to be borderline cases at risk of addiction.  Addiction was defined as an obsession with playing electronic games to the point of sleep deprivation, disruption of daily life and a loosening grip on reality, depression and with drawl when not playing.  10 South Koreans died in 2005 from disruption in blood circulation caused by prolonged use.  S. Korea has government funded counseling and clinics for gamers. Most addictive video games are the MMORPG’s massively multiplayer online role playing games (87).
• Difficulty identifying feelings, higher dissociative experiences, lower self esteem, and higher impulse dysregulation were associated with higher incidence of internet addiction (88).
• ADHD was the most associated symptom of Internet Addiction, followed by impulsivity (89).
• Internet addicts are lonelier and have lower self-esteem and poorer social skills than moderate users (90).
• Video game addiction can be statistically predicted on measures of hostility and poor academic achievement (91).  12% of boys and 8% of girl video game players exhibit pathological patterns of play, and fit the DSM IV category of addiction.  Study also showed that pathological gamers are twice as likely to have ADD or ADHD (92).

Costs of Technology Overuse to the Health and Education Sectors

• 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, 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.

Considerations and Recommendations

• 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 (93), and 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 (94).
• Further evidence suggests some parents may have technology addictions (95), and Adult Internet Addiction has been proposed for inclusion in the Diagnostic and Statistical Manual 5th Edition (96).
• Mounting research evidence suggests that childhood is the optimal time to influence determinants of social and emotional wellbeing (97), with recent research demonstrating that prevention programs in childhood can reduce the prevalence of mental disorders, while also addressing causal factors.  For example targeted parent training within disadvantaged families can significantly reduce subsequent prevalence of behavior disorders in children, while also improving educational and social outcomes (98).
• These facts support implementation of school based technology management programs, teaching children how to balance activities they need to grow and succeed, with technology use.  A randomized controlled trial of a 6-month classroom curriculum to reduce TV and video game use resulted in not only statistically significant reduction in technology use, but also showed relative decreases in obesity (99).
• With researchers advocating for increased services for children to address increasing prevalence of child mental health disorders (100), and solid evidence that many of these disorders may be related to technology overuse, it seems warranted that the medical profession may want to consider an Unplug – Don’t Drug policy where prior to costly diagnosis and medication of child behavior, the child and family undergo a three month technology unplug trial.  Alternatively, the medical profession may consider routine technology usage histories for all their clients.

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Biography – Cris Rowan

Cris Rowan is an impassioned occupational therapist who has first-hand understanding and knowledge of how technology can cause profound changes in a child’s development, behavior and their ability to learn.

Cris received her Bachelor of Science in Occupational Therapy in 1989 from the University of British Columbia, as well as a Bachelor of Science in Biology, and is a SIPT certified sensory integration specialist.  Cris is a member in good standing with the BC College of Occupational Therapists, and an approved provider with the American Occupational Therapy Association, the Canadian Association of Occupational Therapists, and Autism Community Training. For the past fifteen years, Cris has specialized in pediatric rehabilitation, working for over a decade in the Sunshine Coast School District in British Columbia.

Cris is CEO of Zone’in Programs Inc. offering products, workshops and training to improve child health and enhance academic performance. Cris designed Zone’in, Move’in, Unplug’in and Live’in educational products for elementary children to address the rise in developmental delays, behavior disorders, and technology overuse.  Cris has performed over 200 Foundation Series Workshops on topics such as sensory integration, attention and learning, fine motor development, printing and the impact of technology on child development for teachers, parents and health professionals throughout North America.  Cris has recently created Zone’in Training Programs to train other pediatric occupational therapists to deliver these integral workshops in their own community.  Cris is an expert reviewer for the Canadian Family Physician Journal, authors the monthly Zone’in Development Series Newsletter and is author of the following initiatives: Unplug – Don’t Drug, Creating Sustainable Futures Program, and Linking Corporations to Community. Cris is author of a forthcoming book Disconnect to Reconnect – How to counteract the negative effects of technology to improve child performance at school and home.

Cris is a proud mom of Canadian Navy Submariner Officer Matt, and resides in Sechelt, British Columbia on the Sunshine Coast with her equestrian daughter Katie, husband Ian, as well as two dogs, three cats, a bird and a horse. Cris loves the outdoors and spends a great deal of time with her family exploring the natural beauty of her community.

Cris Rowan, OT (Reg), BScOT, BScBi, SIPT, Approved Provider for ACTBC, AOTA and CAOT
CEO Zone’in Programs Inc. and Sunshine Coast Occupational Therapy Inc.
6840 Seaview Rd.  Sechelt  BC  V0N3A4
604-885-0986 O, 604-740-2264 C, 604-885-0389 F
crowan@zonein.ca
websites: www.zonein.ca, www.suncoastot.com