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Losing focus

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Times Staff Writer

For Anna Boorstin and her three sons, television is a constant presence, “the background noise,” Boorstin says, to everyday domestic life. It is a source of pleasure and pacification, an urban substitute for outdoor exploration, a wellspring of chatter and drama that leaves the hands, the brain and some part of the senses free to do something else.

In her family’s Venice home, Boorstin turned on the TV while she nursed her babies and kept it on as the kids -- now 16, 13 and 10 -- grew. Now the TV stays on for much of the day.

Nervous energy, says Boorstin, seems to electrify the household, and it has resulted in at least one diagnosis of attention deficit disorder. Her eldest son, Nico, has ADD, and he tends to watch with a computer in his lap. Being in front of the TV “calms him,” says his mother.

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Boorstin wishes her middle son, Jakob, 13, would read more and watch less TV, but he has no attention problems, she reports. Jurri, the youngest, was “definitely in the bounce-off-the-walls category” as a little one, prompting a brief attempt at medication for attention problems.

Is there, as a recent study would suggest, a connection between all that TV and her sons’ attention difficulties? Boorstin suspects so.

“There’s a part of me that thinks I have on some level failed. And I’m sure some part of that is the TV,” Boorstin says. “I think it makes it easier to be passive than it does to become engaged. Entertainment comes very easily with minimal output to kids these days.”

It is a link that medical researchers have also suspected for some time. In 1999, that suspicion led the American Academy of Pediatrics, noting the proliferation of television programming aimed at babies, to recommend “no screen time” -- no computers, no videos, no television -- before a child’s second birthday.

But it was not until the publication last month of a study that followed about 2,600 kids from birth to age 7 that researchers were able to draw a firmer line between TV and rampant complaints -- from teachers, parents and physicians -- of attention problems among American kids.

The study showed that every average hour per day of television programming viewed by a child between the ages of 1 and 3 increased by 10% the probability that the child’s parent would report attention problems at age 7. “Limiting young children’s exposure to television as a medium during formative years of brain development may reduce children’s subsequent risk of developing [attention deficit and hyperactivity disorder],” concluded the study’s author, Dimitri A. Christakis of the University of Washington.

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Experts on learning disabilities -- even those who are deeply suspicious of TV -- warned that many other factors, chief among them genetic inheritance, are at work in the twin syndromes known as attention deficit disorder (ADD), and attention deficit and hyperactivity disorder (ADHD). Somewhere between 4% and 12% of American kids are believed to suffer from ADD or ADHD, and their behavior typically is marked by difficulty sustaining concentration, trouble organizing themselves and staying on task, and problems with impulse control.

In the last decade, the pace of ADD and ADHD diagnoses has risen dramatically. In the same period, fast-paced programming for children -- from “The Wiggles” and “Rugrats” to modern-day “Sesame Street” -- has begun to penetrate even households with babies. Several media organizations, including the Walt Disney Co. and Sesame Workshop, have launched major efforts to build and capture the baby-to-toddler audience for video and TV programming.

That concurrent blossoming of early TV exposure and a rise in attention problems has led many experts on early child development to surmise that heavy viewing -- especially at an early age -- may negatively affect the wiring of some kids’ brains, leading to attention problems later. The study published last month didn’t distinguish between TV shows aimed at young children and more general programming, but it did find that the incidence of attention problems rises as the level of television exposure increases and in cases where the onset of TV viewing is very early.

“Look, there’s smoke here. We need to pay attention to what’s happening out there in terms of kids’ viewing,” says Seattle pediatrician Donald Shifrin, who heads the pediatric academy’s public information committee and helped draft its “no screen time for babies” recommendation.

Earlier this month, a trio of Washington lawmakers underscored their rising concern about the effects of television on children -- and about the dearth of independent research to guide parents and physicians -- by introducing legislation that would set aside $100 million a year for new studies.

“Children today are exposed to more media than ever before,” says Sen. Hillary Rodham Clinton (D-N.Y.), who along with Sens. Sam Brownback (R-Kan.) and Joe Lieberman (D-Conn.), drafted the bill. “Parents need to know what effects such exposure has on their children, particularly very young children,” she adds.

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This week, the Kaiser Family Foundation will be briefing Congress on what is known -- and what is not -- about children and time spent in front of computer, television and video screens.

The next several years could bring new findings, as the federal government lays plans to launch the most comprehensive survey of American children ever undertaken, following a vast cross section of kids and gauging their lifestyles and their health status from birth to adulthood. Around the country, researchers are meeting to devise questions that could use that survey to clarify the relationship between a child’s “screen time” and indicators such as health, school readiness and social adjustment.

“This is a very exciting time,” says Ellen Wartella, one of the nation’s leading researchers on children and television and soon to be executive vice chancellor and provost of UC Riverside. “We’re asking questions not just about media’s effects but about children’s development and the role of media in that development. That’s a subtle but important difference.”

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Guilt and ambivalence

Television may bring households with children a dose of entertainment, the odd educational moment and a stretch of blessed peace to get dinner on the table. But with the publication of the new attention study, the cost for these benefits seemed to rise another notch, heaping new worries atop the guilt and ambivalence of parents with plugged-in kids.

First came the research linking televised violence and children’s aggression. Then came the warnings that TV’s constant barrage of advertising was turning our children into consumer automatons. In the last two years, we’ve been told that TV is making our children obese.

Guilt and ambivalence, Boorstin says with a sigh, are her constant viewing companions. Asked whether the most recent TV study has made her consider just pulling the plug, Boorstin says, “I think about it all the time.”

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But for all of our worry, have we turned off the TV?

Apparently not, according to a survey of more than 1,000 American families with young kids released by the Kaiser Family Foundation last October. Children younger than 6 are spending on average two hours a day in front of a screen, mostly watching TV or videos. Two out of three such children live in households where the television is on at least half of the day, whether anyone is watching or not, and 36% live in homes where the TV is on most or all of the time.

The Kaiser survey found that more than one in four American kids younger than 3 (and 43% of those between 4 and 6 years old) have a TV in their bedroom -- meaning they are far more likely to watch TV unsupervised.

And the TV habit is starting early for many American babies, Kaiser found. In spite of the pediatric academy’s recommendation, 43% of children younger than 2 watch TV every day, and about one in three American babies start watching TV before their first birthday.

“We know now that media is a huge part of the lives of kids at the earliest stages. Beyond that, we know very little,” says Vicky Rideout, director of the Kaiser foundation’s Program for the Study of Entertainment Media and Health.

But the existing research linking TV to attention problems points to trouble.

At a lab at the University of Massachusetts, psychologist Daniel Anderson has spent years watching 1-, 2- and 3-year-olds and their mothers play and interact from behind a one-way mirror. When a baby is classically engaged in exploration of a toy, his heart rate will fall, his little tongue may poke out and his eyes will be fixed upon the object of his scrutiny. He will hunch, his torso motionless, over the toy as his small fingers poke and prod. It may take several callings of his name to draw his attention from his investigations.

Babies whose play regularly looks like this are more likely to reach their developmental milestones on or ahead of schedule, and later will likely score higher on IQ tests.

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But with “Jeopardy” on in the background, the same baby’s heart rate may race, his eyes will likely dart around the room, and the attitudes of intent scrutiny are replaced with a restless, shifting motion. Compared with an hour playing in silence next to his mother, a toddler moves from one toy or activity to the next at roughly double the speed when the television is in the room, Anderson has found. And when he does appeal to mom for help, it will take more bleating to get her attention and he’ll get a shorter interaction, Anderson says.

“The TV is perpetually distracting” to children, Anderson says. “These are very young children, and so the parts of their brains that have to do with attention are not nearly as effective as older children or adults at filtering out background stimulation.”

When the TV is background noise, “their ability to sustain attention doesn’t have an adequate chance to develop,” Anderson says. That, he adds, may lead to problems of attention or other mental functioning as the child develops.

In Japan in 2001, another researcher looked inside older children’s brains and drew a similar conclusion. Ryuta Kawashima of Tohoku University used brain-imaging techniques to compare the brain activity of children playing Nintendo games with that of children doing a mental mathematics exercise for a half-hour. The images showed that playing Nintendo games stimulated primarily the parts of players’ brains that are involved in vision and movement. But subjects performing an exercise of mental arithmetic showed brain activity throughout the left and right hemispheres of the frontal lobe. In adults, these are the brain areas most involved in carrying out complex intellectual tasks, in learning and memory, and in judgment and impulse control.

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Gratification in an instant

When researchers chew over the meager findings on TV, kids and attention, they bump up quickly against two great unknowns: Does the age of the viewer matter, and will the content of the programming make a difference?

Like many researchers, Dr. Mark Mahone, a neuropsychologist and specialist in attention disorders, describes a child’s first two to three years as a “window” during which the brain, embryonic at birth, is turned on, wired up, shaped and ultimately edited by the experiences of her surroundings and her bonds to people. A baby learns from play with people and objects that a parent may withhold a smile, waiting for something more, and that blocks may not stay stacked under some conditions.

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But on television, changes come without any effort by the baby -- often in rapidly evolving images that last two to three seconds. Exposed to hours and hours of TV during this critical time, the developing brain may come to expect, and even prefer, the immediate reinforcement of TV images and the novelty of quick changes over the plodding effort involved in hands-on experience, says Mahone, of Johns Hopkins University’s Kennedy Krieger Institute.

This might make the brightest child lazy or inattentive, Mahone says. And heavy TV viewing in middle-childhood or even in the teen years, he adds, may also set up habits of mind that favor quick changes and instant gratification.

But a child’s genetic inheritance is likely the decisive factor in determining whether “attention problems” rise to a diagnosis of ADD or ADHD, Mahone says. In cases where a child has a family history of attention problems, frequent and early TV viewing may nudge that child toward a diagnosable condition. Without that genetic propensity, a child might endure a heavy diet without negative effects, Mahone says.

“I think what we’re talking about is perhaps exacerbating some preexisting predisposition.”

Through all the debate, the marketing of TV-for-babies continues. In 1997, the “Baby Einstein” line of videos, audio CDs and other media products were launched. Designed and marketed as brain boosters for babies and toddlers, the line was quickly snapped up by the Walt Disney Co., and a recent survey found that more than one in four households with a baby had at least one of its products. Baby Einstein’s website touts parents’ testimonials, including the assertion by a parent of a prematurely born infant that watching the Baby Einstein videos “helped increase JJ’s attention span.” The child is said to have begun watching when 2 months old.

Meanwhile, Sesame Workshop, the nonprofit organization that launched “Sesame Street” 35 years ago, is beginning to explore video products that it says could “help lay the foundation for language development and literacy in children from infancy through age 3.”

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Jennifer Kotler, the Workshop’s assistant director of research, says these young children are watching “Sesame Street” already, and the organization is wrestling with ways to make it age-appropriate for those pint-sized viewers.

“It’s a hard balance,” Kotler acknowledges, to juggle the “no screen time” recommendation with the fact of younger viewers. And while Kotler lauds the recent attention study as “a good start for a dialogue,” she says its failure to address the content of what young viewers watched limits its usefulness.

Kotler and many other researchers, including the University of Massachusetts’ Anderson, believe that a limited amount of TV made for children -- which keeps narratives simple and moves at a pace a small child can follow -- can help build attention skills, empathy and school readiness. But others contend that the medium of television itself -- a succession of bright, changing images, taken in passively -- leads to problems for kids. It is a central debate that, so far, remains unresolved. “The medium is not the message,” says Kotler. ADD specialist Mahone says the idea that television itself may harm some kids’ brains “is theoretically sound.” But he acknowledges, “there’s not much data to back it up.”

Jane Healy, author of “Endangered Minds” (Touchstone Books, 1990) has been deeply critical of those producing children’s programming, contending they have hooked a generation of kids on a technological crutch that makes them lazy, inattentive and unimaginative. Healy has assailed “Sesame Street” as contributing to a visual culture of jolting, jerky and eye-popping kids’ television that contributes to attention problems.

“Its substitution of surface glitz for substance has started a generation of children in the seductive school of organized silliness, where their first lesson is that learning is something adults can be expected to make happen as quickly and pleasantly as possible,” wrote Healy (no relation to this writer) in her widely read book.

Kotler counters that rigorous and ongoing research ensures that 3- to 5-year-old viewers understand and absorb the content of “Sesame Street” -- and that those children learn lessons in empathy and caring and have higher rates of school readiness at kindergarten.

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But it would take money and research devices not yet in hand to gauge the effects of “Sesame Street’s” stories and pacing on younger children, who are not yet able to speak well, adds Kotler. Meanwhile, she notes, the pace and format of “Sesame Street” have been downshifted and more simply organized in the last two years to reflect research on children’s attention spans.

In its promotions of Baby Einstein products, Disney notes that the videos, unlike programmed television, can be stopped and discussed by adults watching along with their intended viewers, and that the videos’ “gentle motion,” and “deliberate pacing” are suited to very young children. Neither the pediatric academy’s recommendation nor the recent study take account of those distinctions, the promotions state.

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A call for limits

Even as researchers scramble to fill in the blanks on kids and TV, the Shifrin says parents should heed what he calls the “early storm clouds” suggesting a link between TV and attention problems. Just as when parents assess the risks of letting their child ride a bike without a helmet or serve them a tuna sandwich (the subject of recent warnings about mercury), they should probably err on the side of conservatism and adopt viewing limits, Shifrin says.

For children with a genetic predisposition -- a family member with recognized attention problems -- these findings offer an even stronger warning for parents, Shifrin adds. “What’s the tipping point for youngsters? What tips them into that behavior? We don’t know,” he acknowledges. But when attention problems seem to run in the family and the TV is turned on early and often, “you’ve now taken your genetic inheritance and you’ve pushed it a bit.”

Anna Boorstin also believes that genetic inheritance has played a key role in her children’s attention levels. She describes herself as “a very easily bored person” who is restless unless doing several things at once. Her husband, Pieter Jan Brugge, she says, “was definitely ADD” as a child, bringing home report cards that said he paid more attention to a fly in the classroom than to the teacher. Her children, she says “were born who they are,” and television is part of their world. But she wonders whether the TV has evolved more quickly than her children’s ability to adapt.

And she keeps thinking about pulling the plug.

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(BEGIN TEXT OF INFOBOX)

Some parental guidance

Some parental guidance Are you caught in the middle? Your child wants to watch, you could use a few moments’ peace, and the experts are issuing warnings? Here are some tips for limiting the possibility of bad effects from TV.

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Children younger than 2

The American Academy of Pediatrics recommends no “screen time” for children younger than 2 -- no videos, no TV, no computer games. Read a book to the child instead, or play a game. Need to get dinner ready? Keep pans or plastic storage containers in a low drawer (away from burn risks) and let her explore.

Children 2 and older

Watch and talk with the kids: This allows you to monitor the quality of the programs they watch and to make TV viewing more interactive. Asking questions about the characters, the action and what will happen next assures you the programming is not above their heads and that they are learning from it.

Keep it quiet, keep it simple: For preschoolers in particular, fast-paced visuals, aggressive banter and lots of flashes and popping can be a dazing experience. Many children seem to grow accustomed to it -- and need more and more to stay tuned as they get older. Watch the pace, say experts, and listen to the dialogue, asking yourself (and your child) whether he can keep up with a show’s plot. For preschoolers, experts all embrace “Mr. Rogers’ Neighborhood” as the one show that moves at a pace a young mind can understand.

Videotapes (DVDs and TiVo) versus real-time TV: For young viewers particularly, experts prefer media that an adult can pause, fast-forward or rewind. Doing so allows for greater interaction between parent and child viewers. It allows advertisements -- which many young children do not understand as messages intended to sell a product -- to be omitted from view. And it fosters the sense of control over what will be watched. It also allows for favorite shows to be seen repeatedly -- and repetition is comforting to most young children.

Limit screen time: For all kids, less TV is more. The pediatric academy recommends no more than one to two hours per day of good-quality screen time for children older than 2. That puts a premium on choosing which programs to watch rather than tuning in and watching an endless stream of whatever’s on. Remember that “TV is a stranger,” says Donald Shifrin of the pediatric academy, and few parents would let a stranger come into their home and wander into a distant room with their kids to play alone. For parents of older kids seeking to limit time with TV, videos or computer games, a card-activated electronic monitor called “Time-Scout” (www.time-scout.com) keeps track of screen time and turns it off automatically when a child’s programmed limit has been reached.

Watch your kid: Observe how your child is behaving while watching TV and afterward, says “Endangered Minds” author Jane Healy. If you don’t like what you see, don’t let him watch it anymore, she adds. Better yet, just turn it off.

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