Ask 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®

My children's school uses TV during rest time, lunch time, and recess--what should I do?

Q: At my children’s elementary school, TV is used every day in kindergarten during “rest time.” For the older students, how TV is used varies depending on the teacher or assistant teacher. Some use it during lunch to keep kids quiet or in lieu of recess when it’s raining or cold outside. Do you know of any research or writing in this area?
—Screens at School?, in Wilmington, DE

A: Dear Screens,

Unfortunately, research shows that TV is often used in schools or daycares as a way to keep kids quiet—not as a learning tool. That means that kids getting more screentime than parents think.

More importantly, TV isn’t helpful—and is likely a harmful addition—to the activities you mention:

• Use rest time for rest: Although TV can quiet kids, it doesn’t help them rest and will keep them from sleeping.
• Use lunch time be for eating...and socializing: Eating while watching TV makes kids less in tune with whether they’re hungry or full, exposes them to advertising, and gives them less time to socialize, which is an important part of school.
• Use recess for exercise: We also know how important physically active recess is—even on days when kids are stuck inside.

To address this issue, talk to your children’s teachers and to the school’s principal. Ask about the school’s policy on TV in classrooms, and ask how TV is integrated into the overall curriculum. Let them know that using TV to keep kids quiet during lunch or recess will not benefit the kids, and offer information to help them make better educational choices--and to use these technologies in ways that are positive in the classroom.

For more information, see this post: How can we get our 6-year-old's teacher to make better media choices in the classroom?

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®

Are static images on TV harmful to toddlers?

Q: When our 14-month-old son was born, his pediatrician told us to avoid screen time, so we do not allow him to watch TV and we rarely have it on while he is awake. But, we subscribe to a music service that streams through the TV. When the songs play, the album covers are shown on the TV screen. A friend told me that seeing the album covers has the same neurological effects as if he were watching a TV show. Another friend says that because the album covers are static images, there are no detrimental affects. Can you please clear this confusion up for us?
-Music Mystified, in Los Angeles, CA

A: Dear Mystified,

Your second friend—the one who says that the effects are reduced because the album covers are static images—is closer to right. Our brains are wired to pay attention to things that change in our environments. That’s why we turn to look when someone walks into the room or when the image on a TV shifts.

It’s also why screens can draw the attention of even young children who can’t yet understand what they’re seeing. The static image of an album cover almost certainly won’t hold your child’s attention in that way. However, he may turn to look each time the image changes, which could interrupt his play.

I would recommend watching your son while the music service is on. Does he turn away from what he’s doing to look at the screen? Does he pause in his play?

If so, a simple fix would be to see if your TV has a brightness control and, if so, to turn it all the way down. If it doesn’t, hang a sheet over the screen when your son is in the room. That should help reduce any distraction and allow him to focus on free play, which is one of the things he most needs.

Enjoy your media and use them wisely,
The Mediatrician®

Will media affect my 4-year-old's ability to pay attention?

Q: I’m wondering if you would consider the results of research that has examined relationships between media and inattention to be conclusive. It seems that even on this website, some researchers find a connection and some don’t. Do the results lean in one direction more than the other? I have a 4-year-old son who is following in his father’s media-obsessed footsteps, and my very serious concerns are going unheard.
-Anxious about Attention, Amherst, MA

A: Dear Anxious,

You’re right that individual studies on this topic have mixed results. But, as you imply, parents (and pediatricians) have to make decisions for their kids well before there’s definitive proof of what is healthful. My approach as a parent and recommendations as a pediatrician are based on what seems to be the safest route. In this case, if there is a chance that watching lots of TV may increase the risk of attention problems, that risk outweighs the benefits.

To be more specific, some studies do show that when kids are exposed to screen media in their early years, they may struggle with tasks that require attention when they are even a bit older and may display more behaviors associated with attention deficit/hyperactivity disorder. And perhaps more importantly, the research overall shows that it’s important to limit screentime and to use it in focused ways to help support children’s ability to pay attention.

That’s part of why it’s important to set media limits for your son. He needs lots of time to do other things—like play outside, eat dinner with you, read books, and explore his physical world. Including screen media in the list of activities can certainly be beneficial, when the content is designed for kids of his age, when it’s used in small quantities that match his attention span, and whem it doesn’t replace other important activities of daily life.

One way to approach your concerns about your son with his father wo  uld be to together observe how your child acts before, during, and after media use. What specifically do you see that worries you—even if it’s not directly related to attention? Is it that he asks constantly for more TV time? Is it that he can’t settle down after watching a show? Does he seem to behave more aggressively after than before? As the two of you observe and talk about this, think about how you usually make decisions for your son’s health, and apply those same principles to the question of media use.

Enjoy your media and use them wisely,
The Mediatrician®

Can reducing screen time help kids with attention disorders?

Q: For the past 6 weeks, we've not allowed our 7-year-old son to use video, TV, or the computer, and we have noticed a slight improvement in his hyperactivity. Do you think that keeping the screens off for a longer period of time will continue to improve his ability to focus?

-Milder without Media in Scranton, PA

A: Dear Milder,

Research shows that while screen media like TV and video games can contribute to symptoms of attention deficit and hyperactivity, they are not the only cause of attention disorders. Instead, attention disorders come from a combination of factors like genetics, educational strategies, discipline at home, and electronic screen media. Addressing any of these factors will help with the symptoms but probably won't solve the problem all together. 

Think of it this way: If your son’s stomach hurt every time he ate, his physician might suspect that he's allergic to milk. She might recommend that he stop eating all dairy for several weeks and then slowly reintroduce milk products, one food at a time. By conducting this somewhat controlled experiment, you could determine which foods are clearly linked to his stomachaches, and your son could avoid those. Although making that change wouldn't fix his allergy, staying away from the foods that make him feel sick would certainly help him feel better. 

You could do this same kind of thing with reintroducing screens to his routine.  If he is naturally hyperactive and removing screens is likely to help him (and it sounds like it is already helping!), then if you're planning on reintroducing screen media, do it slowly so that you can figure out just how much time is beneficial for him. 

Screens are just one of a whole variety of circumstances for you to work with. Just as you are experimenting with removing screens, it might be worth paying attention to how to behaves depending on the foods he eats and how much sleep he gets, as well as the amount of time he spends with friends, in school, and using media. Then respond to what you learn in a thoughtful and flexible way, by removing or changing those things that make his symptoms worse and increasing the behaviors that help him focus.

Enjoy your media and use them wisely,
The Mediatrician®

Are attention disorders connected to technology addiction?

 

Q:  Are impulsive children, or children with ADHD, more likely to develop technology addictions?
-Answers about ADHD in San Francisco, CA

A: Dear Answers,

This is a tricky subject for a very basic reason: Although diagnosed and treated as a serious problem in Asia and Europe, technology addiction, also known as video or internet addiction, is not a recognized diagnosis in the U.S. Part of the problem is that there are disagreements over the meaning of the term “addiction.” But to those struggling with these issues (with or without additional attention disorders) the name doesn’t matter—problematic use of technology can be disabling and potentially dangerous.

One 2008 study found that children with Attention Deficit Hyperactivity Disorder (ADHD) are more likely than children without ADHD to become unhealthily dependent on video games, though there is little explanation for why that might be the case. And whether exposure to electronic screen media affects kids’ attention is a question that is actively being investigated by our group and others. Recent  research suggests that those who spend more time with TV or video games are more likely to have attention problems. An earlier study found that adolescents who reported playing more than one hour of electronic games per day were more likely to demonstrate inattentive behavior and symptoms of ADHD. But does playing electronic games and watching TV contribute to attention problems? Or do kids with attention problems feel more confident using predictable screen media and therefore use them more—or both? It still isn’t clear from the research.

Regardless of which way the relationship works, this is another reason to heed the American Academy of Pediatrics recommendation that kids over 2 use no more than 1-2 hours of screen media per day. This way you can reduce the risk that screen media use might interfere with critical developmental tasks or displace a child’s essential daily activities like sleep, physical activity, and socialization. If you’re concerned about a child’s technology use, it’s important to seek help from a physician or mental health professional who is comfortable with these issues.

Enjoy your media and use them wisely,
The Mediatrician®