Ask the Mediatrician

How can I cut out TV time from my two-year-old's dinnertime routine?

Q: My husband and I were having difficulties preparing dinner with our two-year-old daughter in the kitchen, so we began letting her watch Curious George to keep her occupied. Initially this worked well; the show seems to have primarily positive content, and the two 15-minute segments entertained her while we cooked. We’ve been trying not to use the TV that way so much anymore, but when we leave it off, my little girl stands in front of the screen and cries, saying, “George! George!” Her crying often causes me to give in and let her watch the show, but I’m worried that this has become an unhealthy obsession…how can I effectively wean her off of the TV?
-Curious about George, in Boston, MA

A: Dear Curious,

First, don’t worry—your daughter’s behavior doesn’t mean that she is obsessed with Curious George or with TV. It just means that watching that show has become part of her transitioning-to-dinnertime routine. Having routines to help move from activity to activity can be very helpful for toddlers, who don’t have a clear sense of time and can’t quickly shift their attention, especially when they’re right in the middle of something.

This is a great opportunity to create a new pre-dinner routine that doesn’t center on TV. Try giving her books to read, or some different shapes of raw noodles to sort into bowls. Through a bit of trial and error, you can discover activities that will both allow you to cook dinner and meet your daughter’s developmental needs.

Although making this shift in her routine will be hard at first, be consistent with it, even when she cries for George. Let her know you understand that she’s upset, that that’s okay, and that we’re having reading or noodle time now. Eventually, she will settle into the new routine.

For some ideas on activities young children can do with minimal supervision, check out:

• http://www.pbs.org/parents/child-development/baby-and-toddler/

Enjoy your media and use them wisely,
The Mediatrician®

What can I do for my 15-year-old son, who has Asperger's and ADHD and seems addicted to video games?

Q: My son is 15 and displays symptoms of video game addiction, including lying and sneaking to try to gain access. He has Asperger’s and ADHD, and regardless of what medication regimen we try, the gaming obsession remains. I recently asked the psychiatrist to hospitalize him and treat him as they would other addicts, but they just changed his meds. Anyway, even if he were treated, he needs the computer for school. Do you have any advice for me?
-Dealing with Addiction, Orlando, FL

A: Dear Dealing with Addiction,

Unfortunately, more and more families share your story. Whether through sleep deprivation, anxiety, or social isolation, teens struggling with problematic video game or internet use are suffering, and their families are disrupted. And research shows that young people with ADHD may actually be more susceptible to problematic video game or internet use.

Part of why it’s so hard to find good treatment is that these symptoms have yet to be recognized as a formal psychiatric diagnosis in the U.S. (unlike in South Korea and China, where clinics, hospitals, and “detox” centers treat Internet Addiction Disorder). Still, there are steps you can take to help your son:

1. Keep working with mental health professionals. Make sure that his providers recognize and respect these particular problems.
2. Optimize his treatment. Just as youth with ADHD learn more effectively in the controlled computer environment than in the chaos of a classroom, they are also at higher risk for problematic internet behaviors. Similarly, the social awkwardness of Asperger’s syndrome feels more manageable online. That may be why there’s some evidence that problematic behaviors may decrease or disappear underlying issues are addressed in therapy and any medication is optimized.
3. Move his computer and internet access into common space. Your presence will help you help him regulate his computer behaviors. Be aware that smartphones and many portable digital players are wireless internet-capable, so treat them similarly.
4. Find diverse activities that fill his needs. Look for pursuits that have clear rules, and achievable goals, and that allow him to move at his own pace. Rock climbing or a martial art like tae kwan do or karate would build his mindfulness and self-discipline, while also providing exercise and positive social interaction.
5. Get him outside. Being immersed in nature has a calming and focusing effect. It can also be an effective context for treatment—wilderness therapy has worked wonders for some of my patients and could be a good option for your son.

Remember, too, that when used in moderation, computers and video games can help young people with ADHD and Asperger’s learn, grow, and thrive in ways that they cannot in more traditional educational and social contexts. For more information and resources, take a look at this website.

Enjoy your media and use them wisely,
The Mediatrician®

With video games, how can I help my kids know when enough is enough?

Q: I'm a pediatric nurse practitioner, and we have three boys ages 5, 7, and 9. Several parents/patients have told me that they have the same problem as I do enforcing video game time limits. Certain kids just seem “addicted” and can’t wait until they get more. Do you have any visual time charts, contracts, or other concrete examples of how to work with your kids on knowing when enough is enough? 
-PNP Parent in Bozeman, MT

A: Dear PNP Parent,

Try approaching this issue with a positive rather than restrictive approach. Instead of limiting video game time, focus on creating a daily schedule with your sons where there is enough time to do everything that is important to them.

Search online for “hourly calendars,” and print a copy for each child. Then, ask them to think about all the things they need to do in a day—like eating meals as a family, school, homework, active play (outside, if at all possible), spending time with friends, and getting enough sleep—and help them remember others that they forget. For each task, have them choose a color, think through how long it will take, and color in the time blocks needed.

They will see their time filling up with important activities, and they will see what time is still left. Talk about what they can do in that time. Perhaps they can spend some of it playing video games, but offer them attractive alternatives as well, like organized sports or hobbies. In this way, they will have some ownership of mindful, directed “down time” rather than simply sliding into video gaming.

By focusing on what they do want and need to do in their limited time, you can avoid making video games a forbidden fruit. Whatever choices they make, remember that they will learn from what they experience, so exercise your judgment about the content of any media they use.

• For information on video game addiction, take a look at this post: My 10-year-old son is miserable since I took away Call of Duty--what do I do?
• For ideas on creating a family media agreement, click here.

Enjoy your media and use them wisely,
The Mediatrician®

My 10-year-old son is miserable since I took away Call of Duty--what do I do?

Q: My 10 year old used to be an avid skateboarder and baseball player—until Call of Duty on XBOX Live arrived. I didn’t in my wildest dreams think that he would become addicted to a video game. I have a 21 year old who played all of the games but was never ruled by them. Since my awakening, I have removed the game, but my son is miserable. How long does it take to deprogram him?
—Problem Gaming, in Kansas City, MO

A: Dear Problem Gaming,

More and more young people are being referred to me for Internet or video game behaviors that are causing real problems in their lives. It sounds like your 10-year-old son falls into that category. Unfortunately, time away from the game may not be enough to deprogram him—he probably needs professional help.

Even though our healthcare system that doesn’t recognize video game addiction as a formal problem, there are still steps you can take to help your son. You’ve already taken the first step: removing the game (though if he is indeed addicted, he will find other ways to keep playing). The next step is to find and make an action plan with a therapist who understands this kind of problem.

In the meantime, when talking about this with your son, frame this as a health issue, not as an issue of misbehaving. Your son's excessive game play could be a symptom of another issue—like social anxiety or depression—and it could be his way of taking refuge in a world he can control. Explain that you see how miserable he is, and that although he may not understand yet, the goal here is not to punish him but to make his life better.

For more information about signs, symptoms, and treatment, click here. Also check out this related post: My teen daughter's addiction to technology is ruining our family life--what should I do?

Enjoy your media and use them wisely,
The Mediatrician®

Could my 14-year-old son's anxiety be related to playing video games?

Q: Is there a connection between excessive video game playing and increased anxiety levels? My son is 14 and has some basic anxieties like walking the dog at night that I feel are made worse by the first-person shooter games he plays. I’d love to understand if you have seen any connections here.
-Grappling with Gaming, in Westfield, NJ

A: Dear Grappling,

As a parent, you are the best monitor of your son’s well-being. If you have seen an increase in his anxiety that has paralleled his increase in first-person shooter (FPS) game play, then it is probably worth seeing what happens if he cuts back on or eliminates playing these games. Research supports what you are observing—it has found that children and adolescents frequently respond to media violence with increased fear and anxiety, because action entertainment makes violence seem more prevalent than it actually is.

Suggest that your son stop playing video games for a while. This will be easier said than done—he will not want to stop playing, and he will probably resist in every way he can. Talk about your concerns with him, and remind him that his resistance may, in fact, indicate that he might be developing an addictive relationship with gaming. If nothing else, he will stop because he wants to prove he can. Then pay attention to his behavior and see whether his anxiety diminishes.

If he doesn’t think he can stop gaming or the anxiety doesn’t go away—that is, if either piece is limiting his life in some way—then it would be good to have him evaluated by a therapist. And remember that anxiety can affect a teen’s well-being in subtler ways, such as through increased distraction, which could appear to be ADD/ADHD.

Finally, encourage your son to pursue other activities he enjoys. Increasing physical activity and getting outdoors can reduce anxiety and increase quality of life in all kinds of ways.

Enjoy your media and use them wisely,
The Mediatrician®

My teen daughter's addiction to technology is ruining our family life--what should I do?

Q: I am the mother of three daughters (15, 13, and 11). Although I try to set limits, technology is ruining my family life. My oldest daughter in particular is addicted to Facebook, Skype, texting, etc.—whenever I try to reduce or eliminate her access, she finds a way to be in touch with her friends. Plus, when she does interact with friends via technology, she gets anxious, which leads to increased use. What do you suggest?
-Anxious about Addiction, Metro West suburb, MA 

A: Dear Anxious,

As a teenager, your daughter is pursuing key developmental tasks through her media use—seeking experience, establishing individual identity, and connecting with peers. But the amount of time she is devoting to it, the exclusion of family, and the anxiety she is experiencing when interacting via technology—and the fact that she responds to it by increasing her use—are cause for concern and could be symptoms of addictive behavior. Although the formal diagnosis has not been established in this country, Internet Addiction Disorder is a recognized and serious problem in parts of Asia and Europe, and it is causing real problems for American adolescents and their families.

Address this issue quickly, directly, and with compassion. First, at a time when things are good and you are not in open conflict about your daughter’s media use, sit down and have a conversation with her. Ask how she feels about her media use. Listen to her. She may be unhappy or uncomfortable and may say so if she doesn’t feel criticized or attacked. Then, when the opportunity presents, tell her that she seems anxious when she communicates online, and that you are concerned for her. Ask her what she thinks might help.

It’s possible that she’s feeling lots of pressure to be constantly available. If she acknowledges that that’s the case, enlist her help in finding peace for herself and your family, but be prepared to help her with concrete guidance and boundaries. Offer to take the blame if her friends criticize her for not being available at all times—she can complain that mom takes the phone away to charge it between 9 pm to 6 am, or for even longer if she uses it too much. This way, she can save face while reducing her anxiety, as well as learning to manage her media use in the context of everything else she needs to do in a day.

It is possible, though, that she will resist any and all of your attempts to address the situation with her. If nothing you try works—if she really can’t stop and it continues to wreak havoc for her and your family—you may need to seek professional help.

Enjoy your media and use them wisely,
The Mediatrician®

How can I limit my teen’s Internet time without distracting him from homework or invading his privacy?

Q: My 16-year-old son uses the computer constantly at home in his room and almost always claims he is doing homework. He doesn’t want me to look over his shoulder and see what he is doing when I come into his room, and frankly, I want to allow him his privacy when he is on the computer, as well as in other areas of his life. I believe that he spends too much time on the computer, to the detriment of other activities such as time with family, reading, extracurricular activities, etc., but he disagrees and doesn’t want to be controlled by his parents. Any suggestions? 
-Computer confused mom, NY, NY

A: Dear Computer confused, 

I applaud your instincts to give your son the freedom to practice using the computer responsibly, as well as your concern that he may not be doing so. Giving him privacy can help him establish who he is, independent of you. But this privacy is not the given that many adolescents assume it is: It is, rather, a privilege of his impending adulthood that he must earn.

Physically, he is approaching adulthood fast, but his brain won’t catch up until his mid to late 20s—particularly the pre-frontal cortex, which is the part responsible for future thinking and understanding consequences. Developmentally, he is no more in a position to effectively control how much time he spends on the computer, or to understand the physical, psychological, and academic consequences of failing to do so, than he was to walk at 6 months old. That may be part of why you’re uneasy about how much time he spends on the computer. Indeed, recent research shows that the average American 8- to 18-year-old does do homework on the computer—for an average of 16 minutes a day. That's out of 1 hour 29 minutes total computer time, which includes 22 minutes of social networking and 17 minutes of playing games. 

Parenting him online as you do offline can give you a way to teach him to balance these different activities. As you would do when he is learning to drive, start with more supervision, and then allow him increasing freedom as he demonstrates the maturity to handle it. The first step is to move his (and possibly everyone’s) computer use into public family space. Explain that you are making this shift because you know that he wants to be a fully engaged member of the household. Part of that is bringing media use out of the bedroom, which lets him demonstrate for you that he knows how to manage it himself (which means coming to dinner when dinner is ready, finishing his homework, etc.).

In addition, bringing the computer into public space allows you to use that media with him. Ask him to teach you about something he does online, like Facebook or a game he loves. Your willingness to learn from him shows that you respect what he knows and who he is becoming—and can help lay the groundwork for future conversations about managing his media use.

Enjoy your media and use them wisely,
The Mediatrician®

Video games seem bad for my son, but he doesn't agree...what do I do?

Q: My older son has been haranguing me for months to allow him to get an Xbox 360. He currently has a Wii but has deemed the games “stupid,” which is exactly why I allowed him to get it (with misgivings). But the games for Xbox are generally so violent that I could come up with only one or two that I would allow.

All the research showing how gaming can improve certain skills doesn’t change my gut feeling that video games are bad for him—my son seems so crabby after he plays them, unlike after he has been reading, and I am disturbed by the almost junkie-like craving he has to play them. It seems to be true that “all of his friends” have them and are allowed to play hours of the most violent games out there. The issue costs us hours of conflict and family distress. I tell myself I am not technologically savvy, so maybe I just don’t “get it.” I am extremely confused as to what to do.

—Wii Can't Work it Out, in Seattle

A: Dear Wii, 

You raise many important issues in this question. First, your wariness around your son’s exposure to media violence is certainly warranted—there is a good deal of research into its potential harmful effects on kids. It sounds like a major part of the challenge with limiting his exposure, as is often the case, is that his friends play precisely the games you’d like him to avoid. That sets the expectation that he should be allowed to play these games. And it might even feel that way to you.

But let’s pretend for a moment that we’re talking about something more familiar than video games: fast food. If your son asked for fries at every meal, saying that all of his friends were eating them, it would probably feel easier to set limits because you are likely comfortable in your understanding of how fries at every meal can affect his health. Only recently do we have similar scientific evidence to help us make decisions about what media to feed children’s developing minds. Keeping that evidence front and center in your mind can help you orient yourself toward setting these limits.

That said, in the situation you’re describing, the question has expanded beyond whether to allow your son to play video games with violent content. Rather, his “junkie-like craving” to play them and his “crabbiness” after playing are important signs that he may have some addiction-like gaming issues that are interfering with his mental and social well-being. This kind of issue, which is common but not widely recognized in the U.S. (although it is recognized in Asia), likely can’t be addressed with standard limit setting. 

Instead, it is likely time to deal with this as you would with any dependency—by seeking professional psychological help. When your son challenges your concern for him, which he almost certainly will, ask him to demonstrate that he can limit his play to ½-1 hour a day, after all of his other obligations (like homework, a sit-down, media-free meal with family, physical activity, and a good night’s sleep) are taken care of. Being unable to do that should help demonstrate to him that he has a problem that needs addressing.

Enjoy your media and use them wisely,
The Mediatrician®

How do I ensure that my wired kids are being responsible citizens offline?

Q: My kids are attached to their cell phones and laptops, and it worries me that they're not paying as much attention to the world happening around them—just the other day, I heard about how Bill Nye the Science Guy collapsed, and no one came to his aid because they were taking photos of him and tweeting about it! What can I do to ensure my children don’t end up like these onlookers?  
- World-Mindful Mom in Henderson, NV

A: Dear Mom,

Yours is an excellent example of how the way we use media can insulate us from each other and from experiences, rather than encourage us to share our common humanity. If that report is accurate, it sounds like the audience members may have lost awareness of the difference between the constructed, controlled domain of media and the reality in which we live. They also may have gotten caught in the phenomenon of diffusion of responsibility—that is, given that so many people were present, they may have all assumed that someone else would respond to the emergency. So instead of being the reason that they didn’t respond, media may have simply been where they engaged their attention instead.

But that, too, is something to address. And to paraphrase Shakespeare, the fault, dear Brutus, is not in our media, but in ourselves. Media devices are not inherently problematic, and they don’t necessarily separate us from each other: Consider TV programs that research shows can help kids learn to play well with others. Bill Nye himself used television in other positive ways, to explain concepts that could not have been shared as effectively using other means. Rather than lecturing about the lives of bats or how cells divide, for example, he used his program to show us and tell us about science in a fun, fascinating way. 

The best way to make better citizens of ourselves and our children, both on- and off-line, is to be sophisticated and effective users of the media tools that we have at our disposal. This means using—and teaching others to use—all kinds of media in mindful, focused ways: to learn, to connect with each other, to communicate, and to create, and then to turn media off when the tasks we set out to do are complete. Offline, it means being engaged in and ready to react to what happens around us: When someone collapses in front of them, for example, teach them what to do, whether it be to check whether they’re okay or to call 911. And talk with them about how even when there are many people around, they should still take the responsibility of doing something to help. 

Need convincing that new media tools really have been used to connect us in powerful ways? 

• Check out the videos being created for the Playing for Change project, which brings a mobile recording studio around the world to record music and promote peace.
• This viral video, taken over the holidays, is a example of how technology can be used to organize and orchestrate a shared cultural experience—not only for those who happened to be in a food court in Ontario, Canada, on one particular November afternoon, but for the millions who have since viewed it on YouTube: 
  
    

Enjoy your media and use them wisely,
The Mediatrician®

 

Further thoughts on “Is my son addicted to Wikipedia?”

Recently, I answered a question from a mother who wanted to know whether she should be concerned that her teen son was spending several hours a day on Wikipedia. When the answer was featured on Ask the Mediatrician and discussed on the Center on Media and Child Health Facebook page, several readers challenged whether this boy's intense interest in Wikipedia or excessive internet time was really that bad compared to other things he could be doing. I agreed with many of these comments and realized that I had not made my thoughts totally clear.

I am so glad to see parents engaged in this issue, and I agree with many of the respondents that the Internet is a place where positive things can happen for media-savvy teens. As I mentioned in the original post, Wikipedia’s crowd-sourced content is extremely valuable for research purposes, especially when students understand the importance of evaluating the sources being used in the articles. In fact, I agree with the growing pushback among some thoughtful bloggers and educators who see Wikipedia, used correctly, as an important information source. As several commenters pointed out, the kind of in-depth exploration and clarification of entries described by this mother is an important aspect of using a source like Wikipedia.  Curious young people interested in research, academia, or literature can use it to detail, clarify and help shape the public’s understanding of topics in which they’re interested.

But this parent’s concern was not over Wikipedia as a source or even the internet as a place to spend time, but about her son’s behavior. He has problems with time management, sleeps poorly, and is clinically depressed. Her research led her to articles about internet addiction, but nothing on Wikipedia per se.

There is no scientific evidence that Wikipedia in particular or the internet in general have a negative effect on young people. However, new research published just this month reveals that kids who spend more than two hours per day watching TV or using a computer are more at risk for exhibiting psychological difficulties, regardless of whether they were sedentary or engaged in physical activity (although the risks of depression were even higher if they didn’t exercise regularly).

It is very difficult to know whether this particular teen I was answering the question about was affected by his screen media use or whether he took refuge in it. Do his online activities contribute to feeling out of control? Or are they an attempt to overcome anxiety or depression by working on a website which he could edit and help control?

As a pediatrician and health scientist, I don’t like labeling problematic internet use with the sensational and imprecise term “addiction.” (As a parent, I know how negative it sounds, especially as it relates to kids.) Television addiction, an equally inaccurate term, has long been discussed as a problem behavior, but neither it nor “internet addiction” currently meet established standards for formal psychiatric diagnoses as I’ve mentioned in a previous column. Some doctors say the term “pathological use of the internet” would be more accurate, even arguing that it merits inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the handbook of psychiatric and behavioral diagnoses. As both a clinician and a parent, I take a pragmatic rather than dogmatic approach: I really don’t care what it is labeled, but if a child’s internet use might be affecting his physical, mental or social health, it is worth a try to alter or eliminate that use and see whether the child improves. If there is no difference, the child’s issues may be unrelated or have preceded his media use. If things get better, the problem is taken care of.

There is still much to be learned about how we are affected by the way that we use media. Discussions such as these, where we share observations and experiences with the goal of greater understanding and control of our media environment, will be a key part of our efforts to improve our health and citizenship in the Media Age. Thanks to all our CMCH fans on Facebook who commented on this post. It is conversations like this that make Ask the Mediatrician the resource it is intended to be. Let’s keep the conversation going!

Enjoy your media and use them wisely,
The Mediatrician®