SCREEN EXPOSURE AND ADHD IN CHILDREN

Attention Deficit Hyperactivity Disorder (ADHD), which is neurodevelopmental disorder characterized by attentional difficulties, impulsiveness, and hyperactivity as its main symptoms​ (Hill et al., 2020)​. This is the most common behavioral disorder among children and the cases have been continually increasing​ (Felt et al., 2014)​, however the exact causes of it are still unknown. All we know is that it’s a mix of environmental and genetic risk factors. One of the environmental risk factors that researchers looked up is screen exposure. Although the World Health Organization has recommended that screen time should be avoided for kids under age 2, and no more than an hour for kids between 2 and 4 years old​ (Ophir et al., 2021)​, the amount of time that children spend in front of screens has been dramatically increasing over the past 20 years​ (Hill et al., 2020)​. This restriction stated by WHO is due to the huge negative effects that screen exposure can have on the development of children. In order to protect the kids and avoid detrimental outcomes we should monitor and minimize exposure to risk factors and look for gathering more information for more effective prevention and intervention programs. Therefore, this paper aims to look more into the risk factor of screen exposure and the possible moderation effect of the type of content and its purpose. 

First, understanding ADHD in children is crucial in order to notice it and learn how to deal with it in different settings such as home and school. ADHD usually starts before age 12 in children. The early symptoms that can be predicted involve a difficult temperament, irritability, excessive activity, and poor sleep quality (Israel, Malatras, & Wicks-Nelson, 2020). In school, those children are often misunderstood by teachers and peers, they seem unmotivated to study because of the attention and hyperactivity difficulties, as they find it hard to stay put in one place, start or finish assignments, they also keep forgetting or losing their homework. With their peers they often face problems with inhibiting themselves and not interrupting others, they also tend to be careless about hurting others due to their hyperactivity, plus they usually don’t pay attention to others when they speak to them, all of this combined make it hard for children to perform academically and to make friends which lead them to be excluded and even bullied. Also worth mentioning that there are 3 subtypes of ADHD according to DSM 5, predominantly inattentive (ADHD-I) which involves more symptoms of inattention, predominantly hyperactive\impulsive, and the combined one that includes all symptoms of both types and is the most severe type (Israel, Malatras, & Wicks-Nelson, 2020). The combined and inattentive types are the obvious ones in contrast to the inattentive type that may go unnoticed by others, that’s why parents and teachers must pay close attention to the kids’ behaviors. And of course, not every behavior that involves a kind of inattention or hyperactivity is deemed to be ADHD (Israel, Malatras, & Wicks-Nelson, 2020). In order to be diagnosed with ADHD, the symptoms must be persistent for at least 6 months, cause significant impairment in the daily functioning of children at home and at school, as I mentioned the child must have difficulties academically and socially. Due to the challenges that the child faces, raising awareness and educating caregivers, teachers and all those who are in direct contact with children about ADHD is crucial for a better development and adjustment of the child and it also allows the professional or caregiver to avoid many stressful situations because they would know how to manage. Moreover, education about the risk factors of ADHD will help parents to avoid exposing the child to them because it’s not only about genetics (Israel, Malatras, & Wicks-Nelson, 2020). Thus, a fundamental understanding of ADHD and its impacts on the different areas of life to better deal with these children and ensure they have a better life quality. 

Besides genetic factors, the environment plays a key role in ADHD development. Starting from the womb, the baby is vulnerable to many environmental risk factors that the mother is exposed to. Exposure during pregnancy to stress, contaminated food, inflammation, autoimmune diseases, and any pollutant or toxin is associated with higher risks of developing ADHD in the child​ (Yusuf Ali et al., 2022)​. Nutritional deficiency of the mother too, like zinc deficiency and anemia was also found to be highly correlated. A pregnant mother with depression symptoms also puts the baby at risk for developing ADHD symptoms​ (Yusuf Ali et al., 2022)​. After birth, the environmental risk factors are all around the corner too, such as being neglected by caregivers and having an insecure attachment to them​ (Schroeder & Kelley, 2009)​. Interestingly chaotic households, meaning disorganized homes, were also found to have an association​ (Agnew-Blais et al., 2022)​. Parenting style is one crucial key factor. Children diagnosed with ADHD were living in families with lots of conflicts. More interestingly, their parents also set less limits than the parents of those non diagnosed, in part because limit setting help teaching children self-regulation which is lacking in ADHD kids. A poor communication among family members and low expressiveness also put the child at risk​ (Schroeder & Kelley, 2009)​. Another important risk factor that is gaining researchers’ attention in this era of rising technology is screen exposure​ (Schroeder & Kelley, 2009)​. These findings shed light on the environmental factors that should get attention from everyone in the child’s surrounding and also should be included in the prevention and intervention programs. 

Screen exposure was found to be associated with increasing the likelihood of ADHD in children. Children diagnosed with ADHD spend significantly more time in front of the screens than the non-diagnosed ones at 18 months of age. On average, it’s more than twice the number of undiagnosed kids​ (Hill et al., 2024)​. Also, children that had lots of symptoms of ADHD but did not have symptoms to meet the criteria described in DSM 5 for the diagnosis, were exposed to high amounts of screen time. Those children also had some developmental issues in the expressive language​ (Hill et al., 2024)​. A study done in turkey on infants between 0-36 months old found that exposing the child to screens even for less than an hour had a significant relation with ADHD regardless of the purpose whether for feeding the kid, distracting him, or even for language development​ (Gunuc, 2023)​.  

Some of the mechanisms through which screen exposure might increase the risk of getting ADHD involve sleep patterns and attentional abilities. Children who watch screens for more than an hour sleep little and their sleep is of poor quality, especially evening screen exposure​ (Cavalli et al., 2021)​. This sleep disturbance in turn is a significant risk factor of ADHD. As it has great effects on attentional abilities, irritability, frustration, which are key symptoms of ADHD​ (Cavalli et al., 2021)​. There is also a moderate relationship between stimulating and fast paced screen exposure and attention difficulties in an immediate and long-term manner. It was found that watching a cartoon as short as 9 minutes long has an immediate effect on children’s attentional abilities and early screen exposure in general has long term effects on cognitive abilities and especially attention ​(Jourdren et al., 2023)​. Whilst some think that educational content has positive effects, that’s unfortunately not the case. Research found that educational content in part due to the abundant information it contains, the rapid changing of scenes and the absence of interactivity which deprives the child of real-life application of what he’s learning, is a significant predictor of rising ADHD risks ​(Wu et al., 2024)​. Entertaining content is also just as risky because of the intensive colors and movements and the presence of violent and highly stimulating scenes. However, interestingly, it was found that interactive videos might help in increasing attentional abilities in children and they are actually used in therapy to enhance attention in children with ADHD, but the time must also be limited, no excessive exposure is allowed ​(Wu et al., 2024)​. Overall, these insights highlight that the type of media content does matter but also insists on sticking to the time limits. 

In conclusion, there is indeed a significant effect of screen exposure on the increase of the likelihood of ADHD in children, and that effect is persistent no matter the purpose or the type of content, except for the interactive type of videos within time limits. Therefore, awareness must be raised in caregivers and teachers so that they get educated on how to prevent ADHD and how to deal with it if it’s already present. This ensures that children can adjust well in their environments despite the challenges and difficulties that this disorder puts them through from infancy to adulthood.  

REFERENCES 

​​Agnew-Blais, J. C., Wertz, J., Arseneault, L., Belsky, D. W., Danese, A., Pingault, J. B., Polanczyk, G. V., Sugden, K., Williams, B., & Moffitt, T. E. (2022). Mother’s and children’s ADHD genetic risk, household chaos and children’s ADHD symptoms: A gene–environment correlation study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 63(10), 1153–1163. https://doi.org/10.1111/jcpp.13659  

​Cavalli, E., Anders, R., Chaussoy, L., Herbillon, V., Franco, P., & Putois, B. (2021). Screen exposure exacerbates ADHD symptoms indirectly through increased sleep disturbance. Sleep Medicine, 83, 241–247. https://doi.org/10.1016/J.SLEEP.2021.03.010  

​Felt, B. T., Biermann, B., Christner, J. G., Kochhar, P., & Van Harrison, R. (2014). Diagnosis and Management of ADHD in Children. In Am Fam Physician (Vol. 90, Issue 7). www.aafp.org/afp . 

​Gunuc, S. (2023). Investigation of the relationships between ADHD risk and digital screen exposure in children aged 4–11: A large population study in Turkey. Psychology in the Schools, 60(4), 1262–1278. https://doi.org/10.1002/pits.22839  

​Hill, M. M., Gangi, D., Miller, M., Rafi, S. M., & Ozonoff, S. (2020). Screen time in 36-month-olds at increased likelihood for ASD and ADHD. Infant Behavior and Development, 61. https://doi.org/10.1016/j.infbeh.2020.101484  

​Hill, M. M., Gangi, D. N., & Miller, M. (2024). Toddler Screen Time: Longitudinal Associations with Autism and ADHD Symptoms and Developmental Outcomes. Child Psychiatry and Human Development. https://doi.org/10.1007/s10578-024-01785-0  

​Israel, A. C., Malatras, J. W., & Wicks-Nelson, R. (2020). Abnormal child and adolescent psychology: With DSM-5 updates (7th ed.). Routledge. 

​Jourdren, M., Bucaille, A., & Ropars, J. (2023). The Impact of Screen Exposure on Attention Abilities in Young Children: A Systematic Review. Pediatric Neurology, 142, 76–88. https://doi.org/10.1016/J.PEDIATRNEUROL.2023.01.005  

​Ophir, Y., Rosenberg, H., & Tikochinski, R. (2021). What are the psychological impacts of children’s screen use? A critical review and meta-analysis of the literature underlying the World Health Organization guidelines. Computers in Human Behavior, 124, 106925. https://doi.org/10.1016/J.CHB.2021.106925  

​Schroeder, V. M., & Kelley, M. L. (2009). Associations between family environment, parenting practices, and executive functioning of children with and without ADHD. Journal of Child and Family Studies, 18(2), 227–235. https://doi.org/10.1007/s10826-008-9223-0  

​Wu, J.-B., Yang, Y., Zhou, Q., Li, J., Yang, W.-K., Yin, X., Qiu, S.-Y., Zhang, J., Meng, M., Chen, J., & Chen, Z. (2024). The associations between Screen Time, Screen Content, and ADHD risk based on the evidence of 41494 children from Longhua district, Shenzhen, China. MedRxiv, 2024.10.12.24315388. https://doi.org/10.1101/2024.10.12.24315388  

​Yusuf Ali, A., Inyang, B., Koshy, F. S., George, K., Poudel, P., Chalasani, R., Goonathilake, M. R., Waqar, S., George, S., Jean-Baptiste, W., & Mohammed, L. (2022). Elements That Influence the Development of Attention Deficit Hyperactivity Disorder (ADHD) in Children. Cureus. https://doi.org/10.7759/cureus.27835