The restaurant is overrun with children. Some kids are antsy, others are well-behaved, but a good number of them have one thing in common: their heads are facing down, as they play games on smartphones and tablets.
Oh, and 1-in-10 have ADHD.
According to the Centers for Disease Control and Prevention, in the U.S. alone, over six million children aged 4 to 17 have, at some point, been diagnosed with Attention Deficit Hyperactivity Disorder. Before 1990, less than 5 percent of school-age kids were thought to have the condition, but data from the CDC reported that, in the two decades since, those numbers more than doubled to 11 percent, making it the most common childhood behavioral disorder.
It has become an epidemic.
Meanwhile, according to the Kaiser Family Foundation, children, on average, spend nearly seven and a half hours each day staring at those tiny displays, up 20 percent from just five years ago, leading some experts to believe the surge of ADHD diagnosis coincides with the skyrocketing use of mobile devices, the New York Times reported.
To be clear, these findings are correlations, and not causal links. But to understand any relation between the two, we need to explore how our gadgets are affecting the developing minds of our children.
Let’s go back to our restaurant and shine a spotlight on that 1-in-10 kid with ADHD. Since boys with the condition outnumber girls, we’ll call him Josh.
Josh is playing Minecraft. His head is down, his attention rapt, his eyes riveted on the display. He looks like every other child his age, but as he plays on the tablet, his mind is processing information in a much different way than the other kids running around the room.
If we could scan his brain, we would see that his mind is working harder to absorb the barrage of sensations, and that increased neural activity makes it more difficult for him to focus on any one task. In fact, his ability to concentrate on the game, and not anywhere else, is a hallmark sign of hyperactivity.
It might look like concentration, but it isn’t — at least not in the way we think of it. According to Christopher Lucas, associate professor of child psychiatry at New York University School of Medicine, Josh’s focus on video games and television isn’t the same form of attention he’ll need to thrive in school and life.
“It’s not sustained attention in the absence of rewards,” he told the New York Times. “It’s sustained attention with frequent intermittent rewards.”
When kids play games, they rack up points, move to higher levels and unlock characters and goodies, and their brains are rewarded by one thing: dopamine, a neurochemical that’s released every time they “win.” That sensation of pleasure is often the reason they love electronics, and some experts even believe they seek out gadgets because they have problems with their natural dopamine systems.
Medication, like Ritalin, attempts to control ADHD by increasing dopamine activity, the Wall Street Journal reported, so when Josh plays Minecraft, it’s as if he’s self-medicating, giving his brain that extra boost of pleasure that his internal circuitry doesn’t release.
That’s why separating Josh from excessive use of his iPad isn’t easy. To make matters worse, when kids with ADHD are ridiculed and ostracized, the isolation sends them back to those gadgets, and they end up developing an emotional dependency to their consistent electronic companions that extends beyond dopamine.
When Josh is utterly focused on the iPad, he keeps constant eye-contact with the display. But without it — or his computer or portable gaming console — he’s a handful. That’s because it’s far easier for him to find solace in screens. They don’t shun him. They give him a place to escape and become a different person.
“They can also create false personas about themselves that are more positive than is realistic and thus make virtual friends online better than in person,” Russell Barkley, a clinical professor of psychiatry and pediatrics at the Medical University of South Carolina, said.
More than anything, Josh would benefit from taking an electronic “time-out.” But ironically, he can’t pull himself away.
No one knows the origins of ADHD. Its symptoms, of course, have been among us for as long as recorded history. But the modern study of the condition was only brought to the laboratory, from the realm of punishment, within the last century.
In 1902, George Frederic Still, the father of British pediatrics, presented a study to the Royal College of Physicians in London about a group of 20 children, who were “excessively emotional or passionate… and had little inhibitory volition.”
According to PBS, he had noticed a pattern of behavioral issues appearing in children before the age of eight, occurring in three times as many boys than girls, and afflicting those even raised in decent, stable households. The disorder, he concluded, might be related to biological traits inherited from families, similar to conditions like depression and alcoholism.
His theory was groundbreaking.
Before then, uncontrollable behavior was merely chalked up to a failure of moral conduct by the child, or bad teaching by the parent. Or both. And the prescribed “treatment” was often physical punishment.
Then, in 1934, Eugene Kahn and Louis Cohen extended Still’s research and published a study in the New England Journal of Medicine that described a biological link to hyperactivity. And as scientists began to suspect that neurology, rather than the devil, was causing the behavior, a different method of observation emerged.
In the ’60s, when researchers began to study families, especially children, it became clear that the syndrome was in some way connected to genetics. A decade later, the condition had been defined to include not only hyperactivity, but also subtle signs like being impulsive or distracted. By then, scientists understood that the use of medication could improve, but not cure, the imbalance.
ADHD continues to elude science. Like autism, there is no conclusive test to diagnose it, so doctors must learn by observing for one of several developmental or behavioral problems, such as depression or bipolar disorder.
Researchers are reluctant to say whether there is a direct link between gadgets and ADHD, but there are strong parallels between the upswing in diagnoses and an increase of screen time. One important finding: children and young adults who overdo TV and video games are nearly twice as likely to suffer from a variety of attention span disorders, according to the Journal Pediatrics.
“ADHD is 10 times more common today than it was 20 years ago,” Dimitri Christakis, a George Adkins Professor of Pediatrics at the University of Washington in Seattle, said. “Although it is clear that ADHD has a genetic basis, given that our genes have not changed appreciably in that timeframe, it is likely that there are environmental factors that are contributing to this rise.”
In other words, while the disorder tends to run in families, gadgets may also play a role in the condition.
Part of the problem is the fragmented, action-packed nature of electronic media. Christakis found that fast-paced TV shows increased the risk of attention issues. And when the children adapt to those speeds, they struggle to pay attention in the slower pace of life because it’s less stimulating and rewarding.
When Josh puts down his iPad, his brain finds the real-world underwhelming compared to his virtual realms.
Take a closer look at his beloved Minecraft: the game operates on its own day and night schedule, so he experiences three days’ worth of action within one hour. When he goes back to life, he literally feels a drag, like the feeling we get from stepping off a movable walkway at the airport.
Christakis, though, concedes the science is still emerging. “If I thought I knew the answer definitively, as to what was causing ADHD,” he said, “I wouldn’t still be doing research.”
ADHD isn’t a short-term condition. While sufferers often outgrow the symptoms, others — like high-profile Olympic swimmer Michael Phelps — must learn to deal with it well into adulthood. And the continued bombardment of technology requires changes in the way we deal with, accommodate and even think about the condition.
“There continues to be, in the media and the public, this idea of ADHD as an overblown problem that’s being over-treated,” William Barbaresi, director of the Developmental Medicine Center at Boston Children’s Hospital, told Forbes. “We have to create a system that’s designed to treat ADHD as chronic health issue, not just a kid disorder.”
But some experts believe the growing attachment to our gadgets is actually part of the solution. “Maybe the kids’ focus on games could be used to draw them out as a way of developing social skills,” Stephen Shore, author of “Beyond the Wall,” told me. After being non-verbal until the age of four, he was diagnosed with “strong autistic tendencies.” Today, he’s a professor of special education at Adelphi University.
Rather than look at the issue as a problem, Shore believes we need to view it as a challenge. “These games are compelling to the kids,” he said. “Instead of battling to eliminate them, we could use them to actually develop social skills.”
In the end, the first step to finding a cure to ADHD is to understand its causes and conditions, and one piece of the puzzle, it seems, is to determine the impact of technology on kids like Josh, and let him enjoy his iPad, instead of being inadvertently harmed by it.