Zone’in Workshops

Unplug’in Program

Program Development

The Unplug’in Program was originally designed by Cris Rowan, pediatric occupational therapist and sensory specialist, to help raise awareness regarding the impact of technology use on children, and offer a tool for parents and teachers to use to reduce technology use. Unplug’in is designed to be used in conjunction with the Zone’in and Move’in Programs in home or school based settings. Unplug’in was intended for ages 5-12 years, in order to help young children attain a balance between technology use, with achieving critical factors for child development and academic performance. Cris recognized that she needed to address the salient cause for sensory impairments and motor delays – child overuse of technology. Cris utilized the Model of Human Occupation frame of reference in the initial design of the Unplug’in Program prototype, which emphasizes the importance of performance skill development to enable motivation to engage in activities. Cris then identified four critical dimensions for child performance skill development as self, others, nature and spirit. Working with a core team of 12 children, the game board was designed and To Do, What If, Unplug’in and Journey Card questions were determined to best achieve performance skill development in the We, Me, Earth and Spirit dimensions.

Prototype Testing

Prior to prototype testing, Cris met with a team of Resource Teachers, Occupational Therapists and parents regarding what parameters should be met with the final Unplug’in Program, and they responded with the following requests:

  • No DVD, as this would defeat the purpose!
  • Game-type product, self exploratory in nature
  • No requirement for teacher or parent preparation time
  • Kid-driven to optimize motivation
  • FUN!

Prototype testing was carried out in three separate schools in a total of eight elementary classrooms. Evaluations by parents, teachers and students resulted in extensive revisions to game board design, game rules, card and game square content and wording. The final version of Unplug’in was released December 15, 2008.

Supporting Research

ADHD Drug Linked to Suicide Attempts: Health Canada. CBC News July 3, 2008. Available at: http://www.cbc.ca/health/story/2008/07/03/adhd-drug-warning.html. 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. 29 of these patients recovered, three had not by December 31, 2007, and one patient died. Data was not available for the remaining 22 patients. Among the 55 suicide attempts, 43 were among children between the ages of 6 and 17. Health Canada advises health-care professionals to warn patients who are on ADHD medications, as well as their families and other caregivers, to be on the lookout for changes in mood, behaviour and feelings.

American Academy of Pediatrics, Committee on Communications (2006) Children, Adolescents, and Advertising. Pediatrics Vol 118 No 6, 2562-2569. This paper points out that exposure of children to TV advertising correlates with obesity, poor nutrition, and cigarette and alcohol use.

American Academy of Pediatrics: Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder. Pediatrics. 2001; 108(4):1033-1044. This guideline contains the following recommendations for the treatment of a child diagnosed with ADHD:

  • Primary care physicians should establish a treatment program that recognizes ADHD as a chronic condition.
  • The treating clinician, parents, and child, in collaboration with school personnel, should specify appropriate target outcomes to guide management.
  • The clinician should recommend stimulant medication and/or behavioural therapy as appropriate to improve target outcomes in children with ADHD.
  • When the selected management for a child with ADHD has not met target outcomes, clinicians should evaluate the original diagnosis, use of all appropriate treatments, adherence to the treatment plan, and presence of coexisting conditions.
  • The clinician should periodically provide a systematic follow-up for the child with ADHD. Monitoring should be directed to target outcomes and adverse effects, with information gathered form parents, teachers and the child.

American Academy of Pediatrics, Committee on Public Education (2001) Children, Adolescents, and Television. Pediatrics Vol 107(2), 423-426. This policy statement describes the negative effects of television viewing as violent or aggressive behavior, substance use, sexual activity, obesity, poor body image, and decreased school performance. This statement recommends no TV or videogames for toddlers under the age of 2, and a limit of 1-2 hours per day for children.

American Physiotherapy Association. Lack of Tummy Time Shown to Hinder Achievement of Developmental Milestones. 2008. Available at: http://www.bio-medicine.org/medicine-news-1/Lack-of-Time-on-Tummy-Shown-to-Hinder-Achievement-of-Developmental-Milestones–Say-Physical-Therapists-25084-1/. Out of 400 physiotherapists surveyed, two-thirds say they’ve seen an increase in early motor delays in infants over the past six years. Those physical therapists who saw an increase in motor delays said that the lack of “tummy time,” or the amount of time infants spend lying on their stomachs while awake, is the number one contributor to the escalation in cases. APTA spokesperson Judy Towne Jennings, PT, MA, a physical therapist and researcher from Fairfield, Ohio, said, “We have seen first-hand what the lack of tummy time can mean for a baby: developmental, cognitive, and organizational skills delays, eye-tracking problems, and behavioral issues, to name just some complications.” She added, “New parents are told of the importance of babies sleeping on their backs to avoid SIDS, but they are not always informed about the importance of tummy time.” Jennings explains that because new parents now use car seats that also serve as infant carriers – many of which fasten directly into strollers and swings without having to remove the baby from the seat — this generation of babies spends prolonged periods of time in one position.

Anand S, Krosnick JA. Demographic Predictors of Media Use Among Infants, Toddlers and Preschoolers. American Behavioral Scientist. 2005; 48(5):539-561. As children aged from 6 month to 3 to 5 years, they increased their use of all media. Income and gender had no effect on use of media. Young children with less-educated mothers and fathers watched significantly more television. Full-time employment of parents was associated with less media use, while retired parents was associated with increased media use. Children living with married adults spent more time watching TV, but less time playing video games than children living with adults of some other marital status.

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. In the short term, media violence can increase aggression by priming aggressive thoughts and decision processes increasing physiological arousal, and triggering an 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.

Anderson C, Gentile D. Violent Video Game effects on Children and Adolescents. Oxford: Oxford University Press; 2007. Studied effects of violent video games and found even violent cartoons increased aggression in 9-12 year old children. Violent 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, behave more aggressively in every day life. Third study looked at 430 grade 3-5 students and found increase video game exposure resulted in increase verbal and physical abuse. Also found higher aggression and low social skills resulted in rejection by peers. Video game time was found to be a negative predictor of grades. Violent videogames can cause people to have more aggressive thoughts, felings, behaviors; and decrease empathetic, helpful behaviors with peers.

Breggin PR. Talking Back to Ritalin: What Doctors Aren’t Telling You About Stimulants for Children. Monroe ME, Common Courage Press, 1998. A must read book for all parents and teachers who think children should be taking Ritalin.

Boyle CA, Decoufle P, Yeargin-Allsopp M. Prevalence and Health Impact of Developmental Disabilities in US Children. Pediatrics. 1994; 93(3):399-403. Data from the 1988 National Health Interview Survey-Child Health Supplement reports 17% of children in the US were reported to have a developmental disability.

Buchanan AM, Gentile DA, Nelson DA, Walsh DA, Hensel J. What goes in must come out: Children’s Media Violence Consumption at Home and Aggressive Behaviours at School. Paper presented at the International Society for the Study of Behavioural Development Conference, Ottawa, Ontario, Canada. Available online at: www.mediafamily.org/research/report_issbd_2002.shtml. Young children most vulnerable to media violence due to are more impressionable, can’t distinguish between fantasy and reality, cannot discern motives for violence, learn by observing and imitating.

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. This study reports that mother’s perceptions of safety was related to their children’s TV viewing time.

Children and Electronic Media. A Collaboration of the Woodrow Wilson School of Public and International Affairs at Princeton University and the Brookings Institution. 2008; 18(1):1-253. Available at: http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=674322.
Key findings for future research considerations include:

  • Media content matters: while media content designed to promote pro-social behaviour does in crease social capabilities, some entertainment and news programs instill anxiety and fear in children.
  • Media multi-tasking is at an all time high, creating problems for analysis.
  • Marketing and advertising are influential and integral parts of children’s daily lives and many of the products marketed to children are unhealthy.

Christakis D and Zimmerman F (2007) Violent Television During Preschool Is Associated With Antisocial Behavioural During School Age. Pediatrics Vol 120, 993-999. This study concluded that violent television programming was associated with an increased risk for antisocial behaviour for boys, but not for girls.

Christakis D, Zimmerman F, DiGiuseppe and McCarty C (2004) Early Television Exposure and Subsequent Attentional Problems in Children. Pediatrics Vol 113, 708-713. This study reports that for every one hour of television watched per day, there is a 10% increase in attention problems by the age of 7 years.

Committee on Public Education. Media Violence. 2001; 108:1222-1226. Six prominent medical groups (American academy of Pediatrics, American Academy of Child & Adolescent Psychiatry, American Psychological Association, American Medical Association, American Academy of Family Physicians and the American Psychiatric Association warn of these significant risks of media violence on child health:

  • Increased anti-social and aggressive behaviour
  • Desensitization to violence
  • Viewing the world as violent and mean
  • Fear of being harmed
  • Nightmares
  • Desire to see more violence in entertainment and real life
  • Viewing violence as an acceptable way to resolve conflict

Violence (homicide, suicide, trauma) is a leading cause of death for children, more than disease, cancer or congenital disorders.

David-Ferdon C, Feldman Hertz M. Electronic Media, Violence, and Adolescents: An Emerging Public Health Problem. Journal of Adolescent Health. 2007; 41:S1-S5. Report from Center for Disease Control and Prevention panel of experts convened in September 2006 support argument that electronic aggression is an emerging public health problem in need of additional prevalence and etiological research to support the development of effective prevention programs.

DeBerardis D, D’Albenzio A, Gambi F, Sepede G, Valchera A, Conti CM, Fulcheri M, Cavuto M, Ortolani C, Salerno RM, Serroni N, Ferro FM. Alexithymia and Its Relationships with Dissociative Experiences and Internet Addiction in a Nonclinical Sample. CyberPsychology & Behavior. 2008; doi:10.1089/cpb.2008.0108. Difficulty identifying feelings, higher dissociative experiences, lower self esteem, and higher impulse dysregulation were associated with higher incidence of internet addiction in 312 undergraduate student population.

Faber Taylor A, Kuo FE, Sullivan WC. Coping With ADD – The Surprising Connection to Green Play Settings. Journal of Environment and Behavior. 2001; 33(1):54-77. Greenness of play setting is related to ADD symptom severity. Children need “attention restorative” environments. Attention Restoration Therapy (Kaplan 1995) proposes that children need to rest voluntary attention (as in school) with involuntary attention (as in recess, play and nature).

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-e150. Although authors found a significant linear increase in pervasive developmental disorder prevalence during the period of this study, thimerosal exposure was unrelated to the increasing trend in pervasive developmental disorder prevalence.

Ghassemzadeh L, Shahraray M, Moradi A. Prevalence of Internet Addiction and Comparison of Internet Addicts and Non-Addicts in Iranian High Schools. CyberPsychology & Behavior. 2008: doi:10.1089/cpb.2007.0243. Internet addicts are lonelier and have lower self-esteem and poorer social skills that moderate users.

Hamilton S. Screening for Developmental Delay: Reliable, Easy to Use Tools. Journal of Family Practice. 2006; 55(5):416-422. One out of six children has a developmental disability e.g. language impairment 6%, ADHD 7%, mild mental retardation 2%, learning disability 8%, cerebral palsy 0.2%, Autism 0.5%. 13.2% of school aged children are in special education in the U.S. 65% of developmental disabilities escape detection prior to school entry, despite frequent well-child visits. Developmental disabilities are associated with poorer health status, higher rate of school failure, in-grade retention and special education placement. Author offers the following practice recommendations:

  • Do not rely on clinical judgment only for developmental milestone review for the timely identification of developmental delays.
  • Screen children for developmental delays regularly with cost and time effective screens such as the Ages and Stages Questionnaire and Parents Evaluation of Developmental Status.
  • Refer children with suspected delays promptly for comprehensive developmental assessment and early intervention.

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. This study concluded that television viewing in childhood and adolescence is associated with poor educational achievement by 26 years of age.

Healy J (1999) Endangered Minds: Why Children Don’t Think and What We Can Do About It. Simon and Schuster Publishing Company.

Healy J (1998) Failure to Connect: How Computers Affect Our Children’s Minds – For Better or For Worse. Simon and Schuster Publishing Company.

Horvath C (2004) Measuring Television Addiction. Journal of Broadcasting and Electronic Media Vol 48(3), 378-398. Information from this paper was used in the design of the Zone’in “TVVG Help Module for Parents and Teachers”.

Huesmann LR. The Impact of Electronic Media Violence: Scientific Theory and Research. Journal of Adolescent Health. 2007; 41: S6-13. 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. Children spend 8 hours per day combined media use, non-school related. Authors state the impact of violent electronic media on public health is second only to the impact of cigarette smoking on lung cancer.

Institute of Medicine. Childhood Obesity in the United States: Facts and Figures. September 2004 Fact Sheet. Over the past three decades the childhood obesity rate has more than doubled for preschool children aged 2-5 years and adolescents aged 12-19 years, and it has more than tripled for children ag3d 6-11 years. At present (Sept. ’04) 9 million children over the age of 6 years are obese.

Jordan A, Hersey J, McDivitt J and Heitzler C (2006) Reducing Children’s Television-Viewing Time: A Qualitative Study of Parents and Their Children. Pediatrics Vol 118, 1303-1310. This study profiles barriers to reducing TV viewing time such as parents using TV as a safe and affordable distraction, parent’s own heavy TV viewing patterns, the prominent role TV plays in the family’s day to day routine, and a belief that children should spend their leisure time as they wish.

Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM. The Prevalence and Correlates of Adult ADHD in the United States: Results for the National Comorbidity Survey Replication. American Journal of Psychiatry. 2006; 163:716-723. Prevalence of adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed and non-Hispanic white. This study calls for increased efforts to increase detection and treatment of adult ADHD. Although this study did not reveal a funding source, read following New York Times article implicating Dr. Joseph Biederman and Dr. Thomas Spencer in payments of $1.6 million of unreported income from pharmaceutical corporations over a 6 year period.

Ko HC, Kuo FY. Can Blogging Enhance Subjective Well-Being Through Self-Disclosure? CyberPsychology & Behavior. 2008: doi:10.1089/cpb.2008.0163. As blogger share their inner thoughts with others through writing, they may gain social support and improve their social integration. Self-disclosure through blogging may serve as the core of building intimate relationships.

Kowalski RM, Limber SP. Electronic Bullying Among Middle School Students. Journal of Adolescent Jealth. 2007; 41:S22-30. Surveyed 3,767 grade 6, 7, 8 students who attended six schools in the US and 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.

Kuo FE, Faber Taylor A. A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder: Evidence from a National Study. American Journal of Public Health. 2004; 94(9):1580-1586. Studies have shown inner city children suffer from ADHD at three times the rate of children in rural areas. Green outdoor activities reduced ADHD symptoms significantly more than did activities conducted in other non-green settings.

Landhuis C, Poulton R, Welch D and Hancox R (2007) Does Childhood Television Viewing Lead to Attention Problems in Adolescence? Pediatrics Vol 120, 532-537. This study found that not only does childhood television viewing contribute to attention problems in adolescence, but that these effects may be long lasting.

Lumeng JC, Appugliese D, Cabral HJ, Bradley RH, Zuckerman B. Neighborhood Safety and Overweight Status in Children. Archives of Pediatrics and Adolescent Medicine. 2006; 160(1):25-31. This study reports 15.8% of 6-11 year old children are overweight. Parents of children who were overweight perceived their neighborhood as significantly less safe that parents of children who were not overweight.

Miller AR, Lalonde CE, McGrail KM, Armstrong RW. Prescription of Methylphenidate to Children and Youth, 1990-1996. Journal of the Canadian Medical Association. 2001; 165(11):1489-1494.
The rate of methylphenidate prescription for children increased from 1.0 per 1000 in 1990 to 4.7 per 1000 in 1996. Pediatricians and psychiatrists wrote 23% and 21% of prescriptions, while general practitioners wrote 56%. Many of the children who received more than 10 prescriptions had more than 4 physicians. Persistence with therapy was more likely when a psychiatrist provided the initial prescription, or with involvement of more than one specialty.

Mistry KB, Minkovitz CS, Strobino DM, Borekowski DLG. Children’s Television Exposure and Behavioral and Social Outcomes at 5.5 years: Does Timing of Exposure Matter? Pediatrics. 2007; 120(4):762-769. Sustained television viewing was associated with behavioural outcomes. Concurrent television exposure was associated with fewer social skills. Having a television in the bedroom was associated with sleep problems and less emotional reactivity at 5.5 years.

Mukaddes N, Bilge S, Alyanak B, Kora M (2000) Clinical Characteristics and Treatment Responses in Cases Diagnosed as Reactive Attachment Disorder. Child Psychiatry and Human Development Vol 30(4), 273-287. This study was conducted on 15 children with RAD who were misdiagnosed with PDD, and found that 66.6% of RAD children were exposed to 7.26 hours of TV use per day with age of onset at 7.16 months, and conclude that “excessive TV exposure might be a form of neglect that is specific for RAD patients”.

Murray J, Liotti M, Ingmundson P, Mayberg H, Pu Y, Zamarripa f, Liu Y, Woldorff M. Gao J, and Fox P (2006) Children’s Brain Activations While Viewing Televised Violence Revealed by fMRI. Media Psychology Vol 8 No 1, 25-37. fMRI’s of eight children showed that TV violence viewing recruits a network of brain regions involved in the regulation of emotion, arousal and attention, episodic memory encoding and retrieval, and reports that extensive TV violence viewing may result in a large number of aggressive scripts stored in long-term memory in the posterior cingulated, which facilitates rapid recall of aggressive scenes that serve as a guide for overt social behavior.

National Center for Health Statistics, April 2006. Prevalence of Overweight Among Children and Adolescents: United States 2003-2004. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_child_03.htm. This study reports 17% of children and adolescents ages 2-19 years are overweight. Overweight increased form 7.2 to 13.9% among 2-5 year olds and from 11 – 19% among 6-11 year olds between 1988-94 and 2003-2004. Among adolescents aged 12-19, overweight increased form 11- to 17% during the same period.

Nelson M, Neumark-Stzainer D, Hannan P, Sirard J and Story M (2006) Longitudinal and Secular Trends in Physical Activity and Sedentary Behavior During Adolescence. Pediatrics Vol 118 No 6 1627-1634. This study documents increased computer use correlates with decreased physical activity.

Nunez-Smith M, Wolf E, Mikiko Huang H, Chen P, Lee L, Emanuel EJ, Gross, CP. Media and Child and Adolescent Health: A Systematic Review. Available online at http://www.commonsensemedia.org/sites/default/files/NunezSmith%20CSM%20media_review%20Dec%204.pdf. 173 research efforts going back to 1980 were analyzed and rated, showing 80% of the studies showed a link between a negative health outcome and media hours or content. Negative health outcomes were as follows: obesity, smoking, sexual behaviour, drug use, alcohol use, low academic achievement and ADHD.

Orzack, Maressa with McLean Hospital in Belmont Massachusetts and Computer Addiction Services says 40% of the 8.5 million videogame players are addicted. Other addictions are 5-10%.

Paavonen E, Pennonen M and Roine M (2006) Passive Exposure to TV Linked to Sleep Problems in Children. Journal of Sleep Research Vol 15, 154-161. This study documents that active TV viewing was correlated with sleep-wake transition disorders.

Paulose-Ram R, Safran MA, Jonas BS, Quiping F, Orwig D. Trends in Psychotropic Medication Use Among U.S. Adults. National Center for Health Statistics. April 2006. Available at: http://www3.interscience.wiley.com/journal/114113714/abstract?CRETRY=1&SRETRY=0. Psychotropic medication use increased from 6.1% in 1988-1994 to 11.1% in 1999-2002, due to a three-fold increase in anti-depressant use.

Petersen AC, Kube DA, Palmer FB. High Prevalence of Developmental Disabilities in Children Admitted to a General Pediatric Inpatient Ward. Journal of Developmental and Physical Disabilities. 2006; 18(3):307-318. Authors report that assessing the prevalence of developmental disabilities is difficult due to developmental status not often recorded in inpatient or outpatient settings. This study found that 31% of children admitted to an inpatient pediatric ward in the U.S. had a developmental disability.

Pliszka S, Bukstein O et al. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2007; 46(7):894-921. This parameter discusses the clinical evaluation for ADHD, comorbid conditions associated with ADHD, research on the etiology of the disorder and psychopharmacological and psychosocial interventions for ADHD. Dr. Pliszka receives “research support” from Shire, McNeil Pediatrics and Eli Lilly Pharmaceutical corporations, and Dr. Bukstein receives “research support” from Cephalon, Forest, McNeil Pediatrics, Shire, Eli Lilly and Novartis Pharmaceutical corporations. Aforementioned pharmaceutical corporations manufacturer ADHD medications.

Researchers Fail to Reveal Full Drug Pay. The New York Times June 8, 2008. Available at: http://www.nytimes.com/2008/06/08/us/08conflict.html. A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators. By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants. Like Dr. Biederman, Dr. Wilens belatedly reported earning at least $1.6 million from 2000 to 2007, and another Harvard colleague, Dr. Thomas Spencer, reported earning at least $1 million after being pressed by Mr. Grassley’s investigators. But even these amended disclosures may understate the researchers’ outside income because some entries contradict payment information from drug makers, Mr. Grassley found. In one example, Dr. Biederman reported no income from Johnson & Johnson for 2001 in a disclosure report filed with the university. When asked to check again, he said he received $3,500. But Johnson & Johnson told Mr. Grassley that it paid him $58,169 in 2001.

Rideout V, Vandewater E and Wartella E (2003) Zero To Six: Electronic Media In The Lives of Infants, Toddlers and Preschoolers. The Henry J Kaiser Family Foundation Report, California. This report documents the recent explosion of electronic media targeted at the very youngest of children 0-6 years of age, and states that 99% of homes have a TV, 36% have a TV in their bedrooms, 50% have a videogame player, and 73% have a computer. Despite the fact that the American Academy of Pediatrics recommends toddlers under the age of 2 years should not use ANY electronic media, 68% use electronic media daily, 25% have TV’s in their bedrooms and average use is 2 hours 5 minutes per day. Regarding extent of TV usage, children are less likely to read in high use homes, TV use is not income dependent, but that there is less usage in homes where one parent holds a college degree.

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. The Henry J Kaiser Family Foundation Report, California. This report documents that children spend on average 6.5 hours per day of combined media use (TV, videogames, computers), and 32% of 2-7 year olds and 65% of 8-18 year olds have TV’s in their bedrooms.

Robinson TN. Reducing Children’s Television Viewing to Prevent Obesity. JAMA. 1999; 282(16):1561-1567. Children in one elementary school received an 18 lession, 6 month classroom curriculum to reduce television, videotape and video game use with significant relative decreases in body mass index, as well as decreases in reported television viewing and meals eaten in front of the television.

Robinson JP, Martin S. What Do Happy People Do? Journal of Social Indicators Research. 2008; 89:565-571. People who report they are not happy watch over 30% more TV hours per day than people who report they are happy. Authors question why people engage in an activity that makes them unhappy, and answer that TV is an opiate, and a refuge for unhappy people. Authors state that while addictive activities produce momentary pleasure, they also produce long-term misery and regret. People most vulnerable to addiction tend to be socially or personally disadvantaged, with TV becoming their opiate.

Shao-I C, Jie-Zhi L, Der-Hsiang H. Video Game Addiction in Children and Teenagers in Taiwan. CyberPsychology and Behavior. 2004; 7(5):571-581. Video game addiction can be statistically predicted on measures of hostility and poor academic achievement.
Thakkar R, Garrison M and Christakis D (2006) A Systematic Review for the Effects of Television Viewing by Infants and Preschoolers. Pediatrics Vol 118, 2025-2031. This study points out that although viewing educational programs broadens young children’s knowledge, viewing of cartoon content has a negative effect on children’s attentional abilities.

Small G, Vorgan G. IBrain: Surviving the Technological Alteration of the Modern Mind. New York: Harper Collins Publisher; 2008. Exposure to digital technologies changes how the brain works e.g. the way we read, learn and interact with each other. Reading facial expression during conversation impacts on social skill ability. Reading comprehension requires analysis, which takes time. Author questions whether online readers will needed added instruction to attain comprehension.

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. This study reports that the total number of hours of TV watched per day was associated with irregular nap and bedtime schedules.

Tremblay MA, Willms JD. Is the Canadian Childhood Obesity Epidemic Related to Physical Inactivity? International Journal of Obesity. 2003; 27:1100-1105. One third of children in the US and Canada are considered to be overweight.Both organized and unorganized sport and physical activity are negatively associated with being overweight (10-24% reduced risk) or obese (23-43% reduced risk), while watching TV and video game use are risk factors for being overweight (17-44% increased risk) or obese (10-61% increased risk).

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. This research showed that family conflict is positively related to violent electronic media use, and that family tensions will be reflected in children’s interest in media with violent content.

Waldman M, Nicholson S and Adilov N (2006) Does Television Cause Autism? Cornell University, New York. This study showed that heavy TV use prior to age 3 years positively correlates to increase in prevalence of Autism.

Washington Post by Anthony Faiola May 27, 2006. When Escape Seems Just a Mouse Click Away. Available at: http://www.washingtonpost.com/wpdyn/content/article/2006/05/26/AR2006052601960.html
2.4 % of S. 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 S. Koreans dies 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. 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”.

Welch MG, Northrup RS, Welch-Horan TB, Ludwig RJ, Austin AL, Jacobsen JS. Outcomes of Prolonged Parent-Child Embrace Therapy Among 102 Children with Behavior Disorders.
Children with behavior disorders, and their families, were guided for a 16 hour period over 2 consecutive days through intense PPCE therapy, with instruction to continue PPCE therapy at home for a period of one year. Results showed that PPCE Therapy resulted in significant and prolonged improvements in symptomatic behavior in a majority of children.

Willard NE. The Authority and Responsibility of School Officials in Responding to Cyberbullying. Journal of Adolescent Health. 2007; 41:S64-65. Online cyberbullying most often occurs off campus, but may result in on site altercations. Author explores authority and responsibility of school officials regarding cyberbullying.

Worthen MR. Education Policy Implications from the Expert Panel on Electronic Media and Youth Violence. Journal of Adolescent Health. 2007; 41:S61-63. Educators and education policy makers should be concerned regarding the effects of media on youth behavior due to internet bullying is correlated with school behavior problems and that media literacy programs may mitigate the negative effects of electronic media on youth.

Ybarra ML, Diener-West M, Leaf PJ. Examining the Overlap in Internet Harassment and School Bullying: Implications for School Intervention. Journal of Adolescent Health. 2007; 41:S42-S50. Youth who reported being harasses online were 8 times more likely to carry a weapon to school in the past 30 days. Authors advocate for schools to be aware of the possible linkages between school behavior and online harassment.

Yen JY, Yen, CF, Chen CS, Tang TC, Ko CH. The Association between Adult ADHD Symptoms and Internet Addiction among College Students: The Gender Difference. CyberPsychology & Behavior. 2008: doi:10.1089/cpb.2008.0113. ADHD was the most associated symptom of Internet Addiction, followed by impulsivity. Authors suggest college students should be surveyed and treated for ADHD to reduce risk of Internet Addiction, and strategies for internet addiction should be provided to students with ADHD.

Young Children With Disabilities in Canada. The Well-Being of Canada’s Young Children: Government of Canada Report, Chapter 6, 2003. In 2001, the rate of disability for less than 4 years of age was 1.6%, 5-9 years 3.7% and 10-14 years 4.2%.

Zimmerman F, Christakis D and Meltzoff A (2007) Television and DVD/Video Viewing in Children Younger Than 2 Years. Archives of Pediatric Adolescent Medicine Vol 161 No 5, 473-479. This study showed that by 3 months of age, 40% of children regularly watched television, DVD’s or videos, and by 24 months 90%. Average duration rose form 1 hour per day for children less than one year old to 1.5 hours by 24 months.

Zimmerman F and Christakis D (2007) Associations Between Content Types of Early Media Exposure and Subsequent Attentional Problems. Pediatrics Vol 120, 986-992. This study showed that viewing of television prior to age 3 was significantly associated with attention problems.

Zhang Lihui. Family, School and Friends: Correlates of Canadian Youth Outcomes. PhD Candidate Thesis, Department of Economics, Dalhousie University. May 2008. At the family level, parental education, supervision and peer influence are found to be the most import determinants for youth outcome. At the school level, “cooperation” through group activities in class is the single most important associate with youth outcomes in academic performance and lower aggression and youth crime. More generous social assistance is correlated with more crime for youth.

Zhang Lihui. Why are American Teenagers More Violent Than Their Canadian Peers? PhD Candidate Thesis, Department of Economics, Dalhousie University. May 2008. American teenagers are three times more violent than their Canadian peers. Mother being a teenager at child’s birth, non-intact family, low family income, mother’s education level and number of hours of television use are predictors of youth violence.