HOMEResourcesArchive of Brown Newsletter
| The influence of television and visual electronic media on brain development |
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| By Mary G. Burke, M.D. Over the last decade, numerous studies have demonstrated that visual electronic media, such as television, videos, computer games and video games, influence children's behavior. The most unequivocal findings are the links between media exposure and violence (Bushman and Anderson 2001). Visual electronic media (VEM) have also been linked to obesity and consumerism (Villani 2001). Some of the most persuasive studies have been prospective case/control studies showing that decreasing exposure to VEM decreases in aggression in all settings in school boys (Robinson et al. 2001). Currently, one in six 2-to 3-year olds has a television in his or her bedroom. The average preschooler spends more than four hours daily in front of a screen (Jordan and Woodard 2001), while the average American child watches up to forty hours a week of visual media (Bushman and Anderson 2001)! This astounding behavioral change has occurred in little more than fifty years. The studies listed above, and many others, have shown what some believe to be a causal relationship between VEM over-exposure and behavioral deterioration. What might be the underlying neurodevelopmental mechanisms? In order to explore this further, I will describe a case from my practice, one of many in which psychiatric symptoms were either caused by, or exacerbated by, media overexposure. A case study Charles is a six-year-old referred by his school for severe, apparently impulsive aggression without remorse that threatens his school placement. Prior testing had revealed attention deficit/hyperactivity disorder (ADHD) and possible sensory integration difficulties. He has limited peer relations. He watches three to four hours of television daily, including prior to school. His mother hastens to add that he watches only G-rated programs. His mother feels that television keeps him happy, and she does not think she can stand his anger and disappointment if she curtails it. In the playroom, he shows an angry relationship with his mother. He is interested in all the animals and toys, but is disappointed in the lack of movie and action figures - e.g. the lions are simply lions, instead of Simba and Scar. He selects some astronauts and aliens, and stages a repetitive battle in which the words "Jar Jar Binks" and "Jedi" feature prominently. While he does not resist my efforts to join him, he seems unable to integrate me into his game, and his play does not evolve. He has a flat affect, and in particular seems devoid of joy. His fine motor skills are mildly delayed. This example raises several important questions. Has over-exposure to media stories reduced Charles' capacity to generate his own story, or even to freely play? The development of symbolic thought is crucial in the maturation of both the cognitive and affective systems. The capacity to imagine, rather than act, allows the child to solve problems mentally and to regulate himself under everyday stressors, when he does not have access to his parents. Charles entered into play therapy with me, and over six months his parents reduced his "screen time" to four hours/week. His symbolic play blossomed, filled with rich imaginary themes, intense affect (including delight) and flexibility. This capacity allowed him to manage many stressors in his life with new strategies, and his aggressive behavior declined markedly. Reviewing the literature I now want to briefly review some of the recent literature on brain development and discuss the implications of this body of work regarding television and young children. In brief, these sources synthesize a large body of research demonstrating that:
One does not have to be a brain surgeon to see how VEM interfere directly with all of these essential developmental processes! VEM are non-contingent and are lacking in the capacity to modulate their vitality. They include only two sensory modes -visual and auditory -with the latter being clearly secondary in interest to the child. They are highly stimulating, being both noisy and filled with rapidly changing, exaggerated facial expressions. While watching VEM, children are often alone, and tend not to turn to their parents for soothing when scared. With more and more time spent in front of a screen, children have less opportunities to experience "inter-subjectivity." We have to be concerned that this loss impairs our childrens' empathy and capacity to form social relationships. VEM and the young brain Let us turn again to Charles, to rethink how VEM may be affecting him. When watching, he is barraged by constantly changing faces, offering a rapid series of affective cues. However, his own response to those cues has no impact on what happens next. The TV characters will never respond contingently to him. This raises the concern that overexposure to VEM is blunting the development of this child's empathy. Implicit, or procedural memory is acquired without the conscious experience of learning, and encompasses the how of relationships (Siegel). Optimally, such memories - which John Bowlby called "internal working models" of relationships, are laid down during contingent interactions with care-givers. During these moments of "intersubjectivity," the child feels understood and learns to empathize. The framework for moral behavior, the outgrowth of empathy, is similarly laid down implicitly. However, if one dominant source of input to the child is the purely visual input of VEM, the child's neurological mechanisms for relatedness may never be engaged. We can also wonder whether Charles' visual system is over-stimulated at the expense of the other systems that need development at this age, including the sensory-motor and the self-regulatory. The integrative activities that a young child should be enjoying - banging, building, experimenting with causality, texture, motion, balance, smell, etc. - are neglected. This exacerbates his underlying learning and motor difficulties. Lastly, in this child and in others, the use of VEM to provide gratification prevents his parents from accurately gauging his need for nurturing vs. autonomy. If Charles turns to the TV for soothing when he is disturbed, his parents will never realize the extent of his anxieties (and he will never gain a model that other people can help him manage his anxieties). To his parents he appears independent; they do not learn how to foster his autonomy through developmentally appropriate challenges. Charles thus has a much more limited experience of mastery and consequently a diminished self-confidence. Is there any other evidence suggesting that excess VEM use is directly affecting the brain? Another clue comes from the field of neurology and comparisons with Pick's disease. In this dementing illness, degeneration of the fronto-temporal regions of the brain leads to a decline in empathy and an increase in socially inappropriate behavior. The affected regions of the brain - that is, the pre-frontal cortex, the orbito-frontal cortex and the temporal lobes - are precisely those that are important in the development of self-regulation and social relatedness, as described by Siegel and others. Patients with Pick's disease show, for a transient period in their decline, an increase in visual creativity and a preoccupation with visual detail. In summary, the concerns about VEM are that they overstimulate the visual system at the expense of other sensory systems. They deprive the child of necessary social interactions that foster self-regulation and contradict the child's innate ability to recognize the significance of facial affect. They arouse the child, but in a situation where he lacks the means for appropriate containment of his arousal and they blunt his capacity for generating symbols and imaginary problem-solving. They interfere with the development of autonomy and they prevent his parents from accurately understanding his need for nurturing vs. mastery, while blurring the distinction between the two for Charles himself. Preventing damage Does exposure to VEM inevitably cause behavioral symptoms? Clearly not. Factors that mitigate against it - both theoretically and empirically -include moderation in use, family activities, attuned, contingent parental behavior and opportunities for a large repertoire of alternative activities, including those that enhance the experience of mastery. (A list of activities for young children can be found at acap.org. The American Academy of Pediatrics' "Media Matters", Work Packet for Clinicians, is available from the AAP, at 847 228-5005, or at www.aap.org.) The other good news is that VEM-induced changes in behavior and mental processes are reversible (Robinson). As clinicians, the cheapest, least invasive and least risky intervention we can prescribe to the families is to turn off the TV and play together. Because the role of VEM in the house is so accepted, it is usually only necessary to educate parents in order to help them reduce their media dependency and their children's behavioral problems. In those rare cases where parents are resistant, it often indicates their own discomfort with intimacy away from the screen. We now have three generations of American TV-watchers. It is plausible that parents who place no limits on media were themselves overexposed as children. Perhaps they have less capacity to tolerate the demands of their own children. Is such media dependence symptomatic of underlying disturbance, or purely secondary? I believe it is both. Avoidance of social relations, with increased time spent with VEM, is frequently characteristic of the modern manifestations of a number of psychiatric entities, including depression, a variety of anxiety disorders, and certain psychotic disorders. However, VEM also wield a specific, addictive power over vulnerable individuals, bringing with them predictable declines in social behavior. References Bushman B, Anderson C: Media violence and the American public: scientific facts versus media misinformation. American Psychologist 2001; 56(6/7):477-489. Jordon A, Woodard E: Electronic childhood: the availability and use of household media by 2- to 3-year-olds. Zero to Three 2001; 22(2):4-9. Robinson TN, Wilde ML, et al.: Effects of reducing children.s television and video game use on aggressive behavior: a randomized controlled trial. Arch Pediatr Adolesc Med 2001;155(1):13-14. Siegel D: The Developing Mind. Guilford Press: New York, 1999 Villani S: Impact of media on children and adolescents: a 10-year review of the research. J Am Acad Child and Adolesc Psych 2001; 40(4):392-401. Mary G. Burke, M.D., is a family psychia-trist practicing in San Francisco, California. For more information and to see a complete bibliography, visit our website at www.manisses.com/CABL.htm. |