Read this article published on the Cercle Psy website.

Unable to concentrate at school, impulsive, your child can’t keep still. And he spends a lot of time in front of the TV or video game console. Does this explain it? Interview with Bruno Harlé, child psychiatrist at Le Vinatier Hospital in Bron.

Children’s hyperactivity and attentional difficulties worry parents and teachers alike. But what exactly are they?

By definition, « hyperactivity » refers to a child who moves around a lot, based on three dimensions: motor hyperactivity, impulsivity and difficulty concentrating. Hyperactivity is a disorder when it permanently interferes with the quality of school and family life. Hyperactive » children are the 5% who move the most for their age group. Since the DSM-IV*, moving around a lot has been equated with attention disorders, hence the name ADHD, for Attention Deficit Hyperactivity Disorder. In this name, one cause is assumed: attention deficit. This idea appeals to those who believe that a child’s agitation is not the result of a problem with education or emotional interactions with the environment, and to those who promote drug treatment. Methylphenidate (1) is sold as an attention deficit disorder medication, but it acts on several levels. It’s obviously more acceptable to call it an attention medication than, say, an « obedience pill ». Inserting « attention deficit » into the name of the disorder is highly questionable: according to American researchers specializing in the neuroscience of attention, such as Michael Posner (2), attentional disorders are highly inconsistent in children labelled « ADHD ». Even « executive functions « *, increasingly incriminated by some authors, are not good markers of ADHD. Many « ADHD » children are characterized by a lack of motivation and ability to delay gratification. This is not to say that no « ADHD » child has attention problems, but for each one, several factors are involved in varying proportions. ADHD is therefore a misnomer!

Do screens affect children’s attention span?

It’s not just attention that is affected by screens, but also motivation, the ability to defer gratification, language, and last but not least, sleep, which is essential for memorization. Research findings are virtually unanimous: massive exposure to screens has a significant negative influence on the development of these cognitive functions. This problem is often underestimated, if not denied. It is a public health issue, since a majority of children can be considered highly exposed. The cognitive effects of screens are relatively independent of content quality. Several longitudinal studies show a direct link between the duration of exposure to screens – television and video games – and a child’s future attention difficulties. For example, a child who « consumes » an hour of television every day will be twice as likely to have an attention deficit when he or she reaches elementary school (3). Similarly, a child in elementary school who « consumes » an hour of television a day will have a 50% greater risk of developing an attentional disorder in adolescence, given his or her initial attentional difficulties (4). Moreover, it’s not just a question of knowing whether screens are good or bad, it’s also a question of assessing what the child isn’t doing during screen time, what researchers call « stolen time » for other, more developmentally beneficial activities.

I think we’re overlooking another factor when it comes to hyperactivity. In my consultations, I’ve noticed that some children have major difficulty being alone. For these children, screens act as « presence simulators ». British psychoanalyst Donald Winnicott made the acquisition of the « ability to be alone » a key process in psychological development. It seems clear to me that screen consumption doesn’t help these children: at best, it masks their problem and relieves parents of very demanding children. In the event of hospitalization, half an hour’s quiet time in their room is sometimes the hardest thing for these children to bear! In short, while the difficulties of these restless children have a variety of origins, the massive consumption of screens plays a deleterious role in their psychological development.

Why is it that some children stay attentive to a video game for hours on end, while others have trouble concentrating for a few minutes on a math problem?

This has sometimes been called the « paradoxical attention » of the hyperactive child. And yet there’s nothing paradoxical about it: all you have to do is get away from the dogma of « attention deficit ». The motivation is obviously not the same, and the gratification is not of the same nature. As for attention, in both cases, it’s not at all the same components that are involved. In the first case, the child’s attention is drawn to the light stimuli on the screen, in what is known as the bottom-up vigilance orientation system. This module of the attentional system is functional at birth. In the second case, when the child works on a math problem, it’s a matter of voluntary control: the top-down system of directed attention. It is the child who decides to focus his or her attention. The child’s motivation, ability to tolerate frustration induced by the difficulty of the task, or capacity to solve the problem without the presence of an adult, are then mobilized. This system develops, and the child must learn to master it.

Screens overexcite the bottom-up system, and prevent the development of the top-down system, which is invaluable for learning at school. It’s precisely the top-down system that we need to help develop. Many children seek help for attention problems at school, even though they exhaust their attentional resources watching cartoons in the morning, before school!

So the origin of hyperactivity is partly environmental, not genetic?

Because studies have highlighted the « genetic heritability » of hyperactivity, many texts aimed at parents and even doctors assert that it is « proven » that hyperactivity is genetic in origin, and that emotional relationships or upbringing are not to be examined. Yet heritability says absolutely nothing about the relationship between nature and nurture. Let me explain: there are diseases whose genetic heritability is high, but for which the environment plays a major role. For example, tuberculosis, an infectious disease, has a high genetic heritability! The notion of heritability misleads most people, including doctors. An article by researchers François Gonon and David Cohen highlights this confusion (5).

« Attention deficit » and « genetic heritability » are two of the three arguments often used to tip the causal balance in favor of the innate, whereas the environment, in the broadest sense, plays an essential role in the development of attentional stability. The third argument used by proponents of innate development is based on imaging studies. In most cases, however, these studies fail to differentiate between innate and acquired. While there are good arguments for a genetic involvement in ADHD, it would be fair to say that it is probably very modest in most cases. It’s important to emphasize the factors of early relationship quality and emotional stability, which are essential conditions for the development of effective emotion regulation and correct self-esteem. What’s more, we can no longer afford to ignore the cognitive effects of massive exposure to screens. With Michel Desmurget, Director of Neuroscience Research at Inserm, we published an article on this subject in 2012, aimed at paediatricians (6). There are many other well-documented environmental factors, but the importance of screen-based media in children’s lives, the size of the negative short- and long-term effects, and the possibility for adults to act on exposure time, seem to us to be good arguments for taking this problem seriously!

Why has the number of children with ADHD increased over the last few decades?

The human child’s environment has changed dramatically: mothers return to work very soon after giving birth, pressure to attend school has increased, as has exposure to screens, sleep time has decreased, children are bombarded with solicitations and stimuli ill-suited to their age, entertainment is over-valued to the detriment of a taste for effort… According to the latest figures, in the United States, almost 20% of boys between the ages of 14 and 17 are diagnosed with ADHD (7).

Let’s develop the question of screens alone. In just a few decades, screens of all kinds have multiplied. In France, a majority of children and teenagers spend more time a year watching television than listening to teachers (8). In the United States, children aged between 8 and 18 spend seven hours and forty minutes a day in front of a screen, mainly for entertainment purposes (9).

On January 17, 2013, the French Academy of Sciences published an opinion aimed at the general public (10).. Its authors play down children’s exposure to screens, even encouraging it. What do you think?

Their recommendations, which run counter to the scientific literature and the positions of several major health institutions, took us by surprise! In this Opinion, the slightest positive element in favor of screens is developed with emphasis, most of them being purely speculative. Conversely, the negative effects highlighted by scientific publications are downplayed. A simple analysis of the rhetoric allows us to deduce the bias of the authors. This publication glorifies these media, and fails to make the general public aware of what current scientific research says about the effects of computer use on children. What’s more, indecent weight is given to the work of a single researcher who defends the use of violent games. Yet this researcher acknowledges that these games have a deleterious effect on school learning. The known effects on physical health are not even mentioned.

A careful reading of the Avis allows us to highlight its errors, which is what I did with Michel Desmurget and social psychology professor Laurent Bègue. We sent Le Monde (11) a text co-signed by some fifty experts in social and cognitive psychology, neuroscience and sociology. Either the authors of the Avis are poorly informed about research, or they have consciously chosen to ignore it, for various reasons… No one can ignore the colossal financial stakes behind the praise given to new technologies. It would be wrong to think that our criticisms necessarily come from « technophobes ». For my part, I’m an experienced computer user. The cognitive and emotional development of children deserves more respect than that accorded to it by the « experts » chosen by the Académie.