From playing apps on the iPhone or iPad to sitting in front of a computer transfixed on role playing games and staring at a television to beat the next big boss in the latest video games, there's no doubt kids are spending a lot of hours playing video games. Experts from the Child Mind Institute delve into the effects playing video games may have on ADHD.
It has the makings of a paradox: Take a first-grader who can’t stay in his chair at school, who wears out his caregivers by being in constant motion, who jumps restlessly from one activity to another, who can’t seem to focus on parental directions or finish ordinary tasks like tying his shoes or putting away his toys. In short, you have a child who exhibits all the behaviors that point to ADHD—except that this child can sit in front of a video screen, transfixed, for hours. And when you tell him to turn off the game or the TV and come to dinner, you’d better be prepared for pushback.
Seeing this combination of behaviors prompts parents to wonder several things: Does playing video games, and imbibing digital media in general, actually cause ADHD? If video immersion doesn’t cause ADHD, does it exacerbate it? Or does the intent focus this child brings to video games suggest that he doesn’t have ADHD after all?
Cause and Effect
First, "there is no evidence whatsoever that TV or video games cause ADHD," explains Natalie Weder, M.D., a child and adolescent psychiatrist at the Child Mind Institute who has treated many kids with the disorder.
That said, super-fast-paced TV shows and video games do have a special appeal for kids who have ADHD. "If you think about SpongeBob, or a video game, there’s never a second when there’s nothing happening on the screen," Dr. Weder notes. "If you’re playing a video game, you have to immediately respond, otherwise you lose. You don’t have time to think. So kids with ADHD are very drawn to that, because it makes them have to pay attention. There are no gaps for them to start thinking about something else."
Video games effectively hold the attention of kids who find it very challenging to concentrate in the rest of their lives. "In fact, a child’s ability to stay focused on a screen, though not anywhere else, is actually characteristic of attention deficit hyperactivity disorder," writes Perri Klass, M.D., a pediatrician, in The New York Times. "There are complex behavioral and neurological connections linking screens and attention, and many experts believe that these children do spend more time playing video games...than their peers."
But the type of ‘paying attention’ happening when kids are absorbed in video games isn’t the same kind ‘paying attnention’ that other tasks require. "Continuous activity doesn’t mean sustained attention," points out Ron Steingard, M.D., a child and adolescent psychiatrist at the Child Mind Institute. "It looks like sustained attention, but the truth is that the task is changing so rapidly, short bursts of attention are all that’s involved. These games are constantly shifting focus, and there is instant gratification and reward."
It makes sense that kids with ADHD would find games more compelling than the average person. "It’s the perfect fit of the medium with the pathology," Dr. Steingard says. "Nothing else in life moves that quickly and rewards that spontaneously." Dr. Steingard points out that one theory developed by evolutionary biologists for the presence of ADHD in the gene pool is that early tribes needed people to man the periphery of the camp who would be hyper-vigilant to any sign of danger. Similarly, "video games throw stimuli at many different visual points, and to play well you have to be able to pay attention to all of them at the same time. If you’re too linear or methodical it won’t work."
Are these games addictive for children with ADHD, since presumably they trigger the release of dopamine? "Only in the sense that any pleasure is addictive," Dr. Steingard says. "Anything that makes you feel good drives the same circuit path—movies, books, red velvet chocolate cake—although some you have to work at harder than others."
Paying attention in school is one of those things that takes a lot more work to generate rewards, and the claim has been made by some researchers that ADHD symptoms in school—inattention, hyperactivity, and impulsivity—are actually exacerbated in kids who are exposed to a lot of TV and video games. The notion is that the constant stimulation and instant rewards of games raise the bar for kids to pay attention in normal, less stimulating situations.
An Iowa State University study of some 3,000 children and adolescents from Singapore, measured over three years, found that children who spent more time playing video games were more impulsive and had more attention problems. Researchers interpreted the findings to suggest that video game playing can "compound kids’ existing attention problems."
"Our data suggest that the children who already are most at risk for attention problems play the most games, which becomes a vicious cycle," says Douglas Gentile, an associate professor of psychology at Iowa State. But the study results don’t offer supporting evidence that there’s anything more than a link. Dr. Steingard says there’s no evidence of causality here.
That isn’t to say that kids spending an unlimited amount of time playing these games isn’t harmful, but it’s a different kind of harm. The problem is that all that screen time means time not spent doing other things more valuable for their development. "It takes time away from doing more creative or more learning-based activities," Dr. Weder says. "It takes time away from interaction with family and friends that helps them with their social skills."
Since social skills are a challenge for many kids with ADHD, who have trouble paying attention and reining in their impulsivity, the cost can be high. "It’s not healthy socially to spend a lot of time by yourself playing games in lieu of doing something with people," Dr. Steingard says. But he adds that this is a global concern—and not just for kids with ADHD. "No kid should spend unlimited time sitting in front of a screen in lieu of playing with other kids."
The American Academy of Pediatrics recommends an hour per day of total media screen time for elementary school children, and two hours for kids in secondary school. American children, Gentile says, currently average more than six hours of screen time per day.
Caroline Miller, mother of three, is the editorial director of Childmind.org, the website of Child Mind Institute in NYC. Access the full research report, “Video Game Playing, Attention Problems, and Impulsiveness: Evidence of Bidirectional Causality,” from the journal “Psychology of Popular Media Culture,” at nyspecialparent.com/video-report.