The Crisis of Childhood ADHD

 By: Makenzie Babcock

The average child, by the age of eight, will have spent nearly one full year of 24-hour days on discretionary, non-school related, screen devices (Sigman, 2019). This time has increased fifty-one percent between 2008 and 2017 and is on the rise (Sigman, 2019).  Screens are replacing the time that children would have been spending outside or socializing in real life.  What is concerning is the effect this is having on children.  Screen time plays a role in the development or awakening of Attention-Deficit/Hyperactivity Disorder (ADHD) in children by reducing attention spans, increasing impulsivity, and raising their scores on ADHD diagnostic criteria through the Child Behavior Checklist (CBCL).

 Attention-Deficit/Hypersensitivity Disorder (ADHD) is a mental or emotional disorder that involves difficulty sustaining attention, hyperactivity, and impulsivity (Ra et al., 2018).  Nongenetic environmental factors can increase the prevalence of ADHD symptoms in children, but these same environmental factors can contribute to whether a child develops ADHD at all (Ra et al., 2018).  By nongenetic environmental factors, I mean the perverse amount of discretionary screen time and digital media children consume.  This media can lead to the awakening of ADHD behavior in children who may have seemed as if they did not have ADHD.  It is imperative that parents cut back their child’s screen time so they will have an easier time navigating and thriving in their adult life. 

Short Attention Spans

Screen time is associated with short attention spans in adolescence.  In a longitudinal study involving children starting at ages five, seven, nine, and eleven, it was concluded that childhood television viewing of an average of two hours per day or more contributed to attention problems in adolescence (Landhuis et al., 2007). These results were based on reports from the children, their parents, and teachers once the children had reached ages 13 to 15 (Landhuis et al., 2007).  These results were taken after considering and controlling for factors such as gender, cognitive ability, early attention problems, and socioeconomic status of the children.  Another study examined the association between time on video games in addition to television time and attention problems in children in middle childhood.  They found that there was a strong association between attention problems and screen usage of more than two hours per day even when earlier attention problems were statistically controlled (Swing et al., 2010).  In another more recent study, it was found that children exposed to high amounts of screen time (more than two hours per day) were 5.9 times more likely to report inattentive behavioral problems compared with children with less than thirty minutes per day (Rasmussen et al., 2019).  These three studies show that discretionary screen time of two hours or more affects the attention spans of developing children negatively.

Impulsivity

Children who spend more time on screens exhibit high impulsivity rates which in turn correlate with more prevalent and severe ADHD symptoms.  Impulsivity is one of the core features of ADHD that drives the behavioral impairments associated with the cognitive disorder (Wallace et al., 2023).  A study was conducted with around four thousand Canadian high school students for five consecutive years to measure their impulsivity levels in relation to the student’s screen time.  A statistically significant positive association was found between impulsivity, ADHD symptoms and time spent watching television, using social media, and playing video games (Wallace et al., 2023).  Through this longitudinal study over five years, impulsivity was demonstrated to be a strong indicator of a relationship between screen time and ADHD symptoms (Wallace et al., 2023).  This increase in impulsivity through screen time leads to more severe ADHD symptoms as the child grows older, which, in turn, leads to the higher likelihood the child will awaken ADHD. Since impulsivity influences ADHD symptoms, interventions that focus on managing impulsivity could help control ADHD symptoms to improve quality of life.

High ADHD Scoring

Screen time overall increases a child’s ADHD test score.  A study in Canada, with a sample size of around three thousand five hundred children, used questionnaires to examine the relationship with screen time and ADHD (Rasmussen et al., 2019).  At baseline and follow-up parents were asked about family and child characteristics, nutrition, and stress.  At three- and five-year follow-up visits, they were asked about the child’s screen time, sleep quality, physical activity, and behavior.  The Child Behavior Checklist (CBCL) preschool version was completed by the parents.  This checklist measures many behavioral problems in early childhood and includes five other scales, one of which is for attention deficit/hyperactivity (ADHD) problems.  The DSM-ADHD scale was also used as an accurate measure of ADHD diagnosis.  Higher scores indicate greater behavioral problems with high clinical significance.

 

Figure2: Amount of screen time in hours/day reported by parents at three and five-years

 

It was found that children, at either age of three or five, who were exposed to more screen time-specifically more than two hours per day- showed a significant increase in behavioral problems compared to children who consumed less than thirty minutes per day (Tamana et al., 2019).  These children had higher behavioral scores in all categories, with the association of screen time being greater than any other risk factor including sleep, parenting stress, and socio-economic factors.

Conclusion

Screen time reduces children’s attention spans and increases impulsivity, both of which are closely linked to ADHD behaviors. Additionally, increased screen time is associated with higher scores on ADHD diagnostic criteria, reflecting more severe behavioral symptoms.  Overall, the broad claim that screen time plays a role in the development or awakening of ADHD in children is supported.  The research showed that screen time, especially over two hours a day, is detrimental to children’s behavioral development.  The behaviors observed in children with high amounts of screen time correlate with those seen in children with ADHD.  It can be inferred that high amounts of screen time in childhood may worsen existing ADHD symptoms or trigger previously dormant ADHD in children.  Further research is necessary to determine whether or not screen time actually causes ADHD in children, as the existing evidence is inconclusive.  wDespite this, it is still very important for parents to regulate the amount of screen time their developing child consumes because it could affect long-term behaviors and impulses that could be detrimental to their overall quality of life.

 

References

Ghosh, A., Maidul Islam SK, & Oza, R. (2024). Screen time and effects on attention deficient hyperactivity disorder in children - a systematic review. Asian Journal of Medical Sciences, 15(5), 269–277. https://doi.org/10.71152/ajms.v15i5.539

Landhuis, C. E., Poulton, R., Welch, D., & Hancox, R. J. (2007). Does childhood television viewing lead to attention problems in adolescence? results from a prospective longitudinal study. Pediatrics, 120(3), 532–537. https://doi.org/10.1542/peds.2007-0978

Ra, C. K., Cho, J., Stone, M. D., De La Cerda, J., Goldenson, N. I., Moroney, E., Tung, I., Lee, S. S., & Leventhal, A. M. (2018). Association of digital media use with subsequent symptoms of attention-deficit/hyperactivity disorder among adolescents. JAMA, 320(3), 255. https://doi.org/10.1001/jama.2018.8931

Sigman, A. (2019). A movement for movement. https://www.api-play.org/wp-content/uploads/sites/4/2019/01/API-Report-A-Movement-for-Movement-A4FINALWEB.pdf (Figure 1)

Swing, E. L., Gentile, D. A., Anderson, C. A., & Walsh, D. A. (2010). Television and video game exposure and the development of attention problems. Pediatrics, 126(2), 214–221. https://doi.org/10.1542/peds.2009-1508

Tamana, S. K., Ezeugwu, V., Chikuma, J., Lefebvre, D. L., Azad, M. B., Moraes, T. J., Subbarao, P., Becker, A. B., Turvey, S. E., Sears, M. R., Dick, B. D., Carson, V., Rasmussen, C., Pei, J., & Mandhane, P. J. (2019). Screen-time is associated with inattention problems in preschoolers: Results from the Child Birth Cohort Study. PLOS ONE, 14(4). https://doi.org/10.1371/journal.pone.0213995 (Figure 2)

Wallace, J., Boers, E., Ouellet, J., Afzali, M. H., & Conrod, P. (2023). Screen time, impulsivity, neuropsychological functions and their relationship to growth in adolescent attention-deficit/hyperactivity disorder symptoms. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-44105-7

                                                                    About the Author

I am a nursing student at Franciscan University of Our Lady of the Lake and am pursuing a minor in psychology.  I am very passionate about determining when children should be given medications, as I believe overmedicating children causes many problems for them as they grow into adulthood.  I am interested in exploring ways to heal naturally, using drugs only when necessary. My purpose in this is to address the core problem to cure and/or prevent, rather than merely maintaining the issue with medication.