Last year, the American Academy of Pediatrics (AAP) updated its guidelines on how much access children should have to electronic devices amid growing concerns among parents of the effects of electronic media. Yet extrapolation of the evidence linking television and behavior may obscure potentially more subtle and diverse effects. Recent developments in work with interactive devices represent an increased understanding of how children learn and the importance of social interaction.
Concerns over the mental effects of electronic devices have been largely driven by fears that the prevalence of conditions such as attention-deficit/hyperactivity disorder (ADHD) seem to follow their adoption. In 2011, the U.S. Centers for Disease Control and Prevention (CDC) reported an increase of 33% in ADHD prevalence among children from 1997 to 2008. A 2016 follow-up study by the CDC found the increase continued to 2012, but then began to fall through 2015 among children of poorer families, although that reduction was not reflected in wealthier homes.
From 1999 onward, a number of studies looked at heavy television use by young children and identified possible effects on their development. Dr. Dimitri Christakis, director of the Center for Child Health, Behavior, and Development at Seattle Children's Hospital, says: "We found that the more television children watched at age three, the more likely they were to have attention problems." The fast-changing images and sounds in many television programs that are made to capture the attention of young children "condition the mind to a reality that doesn't exist," he notes.
The question is whether such a link extends to portable devices, says Dr. Danielle Erkoboni-Wilbur, a pediatrician at St. Christopher's Hospital for Children in Philadelphia. "When those studies on behavior were done, technology just meant television. There is nothing that's formally in the literature linking those outcomes to portable digital media."
A 2015 study by pediatrician Dr. Hilda Kabali and colleagues at the Einstein Medical Center in Philadelphia found much of the average child's time with portable devices is spent watching online TV, rather than using interactive applications. However, as less passive experiences become more common over time, they may have different effects on children's behavior.
Says Christakis, "I think the touchscreen interactive experience that began with the iPad is, for the lack of a better word, a transformative technology. It's the interactivity that makes it different. With traditional media, a child never thinks or says 'I did it': it's a completely passive experience. But it's so gratifying to make something happen by touching an object on the screen."
"What we are finding in our lab is that these devices command attention much better than other things. It can make it more difficult for parents to interact with their children," Christakis adds. "I tend to think of the effects being mediated through two different pathways. One is the direct pathway, which is the actual content. Interactive media could lead to the same kind of overstimulation as fast-paced TV, although being interactive, it means the child can control the pacing in a way that isn't possible with television.
"There is also the indirect pathway, which works through displacement. This is about what could they be doing that they aren't, whether it's singing, reading, or going outside to play. Even if someone developed the perfect app that was perfectly paced and shown to be beneficial, if children used that app eight hours a day, we would recognize that behavior as being a problem," Christakis adds.
Christakis is concerned about the addictiveness of applications on tablets and smartphones, and the potential for them to eat too far into the child's daytime activities. "I tell parents to limit time on interactive devices to no more than 30 minutes. People ask, 'How do I know?' I came up with that limit when we looked at what people have done in the past, using techniques such as time diaries. Children in the pre-iPad days typically spent a maximum of 20–30 minutes a day with a particular toy, but they will often spend much more time than that with an iPad game; there is something very different about the experience.
"The makers of many of these games design them to be addictive. We live in an attentional economy, so apps writers are often trying to get people drawn in and get people addicted," Christakis adds.
Alexis Hiniker, a Ph.D. candidate in Human Centered Design and Engineering at the University of Washington, says parents quickly detect over-addictive apps. "A lot of the families we talked to, they said 'we tried X but it was so hard to get them to put it away that we had to take it away'. They had to go cold turkey. So we find apps that are super-grabby are not successful, at least when it comes to younger children."
Taking the device away inevitably causes tension. Hiniker's own work involves finding ways to design apps for children that make it easier to set limits on usage time without causing tantrums when device time has to stop. "Our approach was to look at what is helpful to children in acquiring self-regulation. We found if children have explicit opportunities to make plans, they will take more ownership over their behavior," she explains.
The Plan & Play system trialed by Hiniker lets children work out how long they want to spend on an activity before starting. "As they are playing, we surface that information back to them and remind them of what their plan was.
"In terms of practical considerations for industry, I would love to see design for things like parental controls shift to include these ideas, [and] move away from lockout mechanisms that simply force children to do other things."
Erkoboni-Wilbur says a focus on designing devices and apps for children can avoid the potential for harm and make them support better development. "There are a variety of futures in front of us. We can see how easy it is for technology to isolate folks, but we do see pointers in research as to what causes great outcomes; what we can do to optimize technology to improve developmental outcomes."
Allison Druin, a professor in the College of Information Studies at the University of Maryland, College Park, agrees: "Technology, as with any tool in a person's life, is either going to amplify the challenges or support the strengths. We have the situation where autistic kids finally feel comfortable socially because they have this technology bridge, but there is also the potential to amplify inattention."
One underappreciated limitation of screen-based devices that has emerged in studies is their two-dimensional (2D) nature. That realization is helping to bolster research on how children learn. Research by developmental psychologist Rachel Barr and colleagues at Georgetown University revealed infants find it more difficult than older children and adults to translate learning from the 2D space to three dimensions.
"We call it the transfer deficit. A very common problem in learning in general is when we have take something from one context to another. What you are faced with on the screen is different to what you are faced with in the real world," Barr says. "We need to understand that this transfer deficit is important. Children can seem to be digital natives when they use these devices so easily, but it's actually more cognitively demanding to learn from them."
What makes it easier for children to learn is what Barr calls the "social scaffold." The Georgetown researchers showed this effect in an experiment based on a jigsaw-like puzzle. Researchers demonstrated the game to half the children. The other half only viewed a "ghost version": a puzzle that assembles itself onscreen without human intervention. When given the tablet to solve the puzzle, the young children who only saw the ghost version were often unable to complete the exercise. "We gave them the touchscreen and they were baffled, but if someone showed them first, they were really good at it."
Barr points to a 2014 study performed by Northwestern University doctoral candidate Courtney Blackwell (now a research assistant professor of medical social sciences at Northwestern's Feinberg School of Medicine) with kindergarten-age children at three schools in Chicago as another example of the social scaffold in action, this time with children working together. At the beginning of the school year, children at one location received an iPad, another school did not supply them at all, and a third gave iPads to pairs of students. Those who shared devices scored higher on literacy tests than the other two groups.
"This human ability is really quite an amazing one that we have. We can take information from someone and link information really quite rapidly," Barr says. "There is something about a person helping you that is different, but the device itself can often seem so compelling. I wonder if maybe parents sometimes think maybe the device can teach them better," Barr adds.
Researchers such as Christakis insist parents should resist the temptation to believe the device will be better at teaching and to be confident in what they can bring to the situation. "One has to keep in mind that our brains have evolved over millennia; they are contingent on social interaction. Every time we are interacting with a child, we are laying down new synapses and making new connections in the brain."
Erkoboni-Wilbur concludes: "The message that we are focusing on is that technology can be a social experience. We need to guide it away from being an isolated type of interaction. We are really encouraging parents to sit down together and learn with technology. Parents and their children, teachers and children, children and their peers; experience it as a social medium, and enhance that social interaction."
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