Screen time and ADHD: Looking for the connection

THE sight of a toddler playing on a mobile phone may seem cute and clever to some people.

However, to researchers looking into causes of attention deficit hyperactivity disorder (ADHD), there is more than meets the eye.

While no clear link has been found between children’s screen time and ADHD, growing evidence shows that mobile phone use can lead to developmental problems by the time they reach school age.

There is certainly enough to suggest keeping phones away from children in their early years.

While ADHD has specific diagnostic criteria, in simple terms it means a disorder that manifests in children with symptoms of hyperactive and impulsive behaviour and a lack of focused attention.

ADHD affects many aspects of a child’s development – cognitive, academic, behavioural, emotional and social.

There may also be co-existing conditions such as depression, autism spectrum disorders or anxiety disorders. Children with ADHD are also at higher risk of being subject to prejudice, discrimination and stigmatisation.

No exact causes of the disorder have been identified. As it is not a reportable disease like certain infectious illnesses, recorded incidence in children varies depending on the population studied and the testing methods used. It is also less recognised in countries where awareness and identification by caregivers is lower.

Genetic and environmental factors have been considered possible causes of ADHD. Influences such as diet, sleep deficiency, head trauma in children, tobacco use during pregnancy and maternal depression all may play a secondary or transient role, but none have been proved conclusively.

A 2013 study on children between 6 and 11 years old in South India identified more than 10 percent as having ADHD.

A 2019 study in Kerala state set out to explore the prevalence of ADHD among the same age group. It found that the children who screened positive for probable ADHD – nearly 23 percent – also tended to have higher rates of reported screen time, averaging more than one hour per day.

As that study was based on a questionnaire for parents of children receiving outpatient hospital care, and diagnosis was made using an abbreviated scale for ease of administering the test and rapid screening, the results must be seen as preliminary.

A 2021 study also showed that preschool-aged children diagnosed with ADHD had more average screen-time exposure than the recommended duration. Researchers also noted an increased severity of ADHD in children with increased screen time.

These studies all came before the Covid-19 pandemic, when the use of digital devices like mobile phones by children was lower compared to what it was today.

A recent study suggests that greater screen time among 1-year-old children was associated with developmental delays in communication and problem-solving at ages 2 and 4.

Until the role of increased screen time as a contributing factor in ADHD is better understood, limiting children’s exposure is advised, due to its likely effects on communication and cognitive function.

World Health Organization (WHO) guidelines recommend no screen exposure for children under 2 years old, and not more than one hour of screen time for children between ages 2 and 4.

Current treatment methods for ADHD vary from medications to psychosocial interventions, alone or in combination. Caregivers also play an integral role in identifying and managing ADHD, as early diagnosis and treatment are crucial in navigating better outcomes.

Awareness of the disorder is a vital first step towards changing perceptions and increasing acceptance of ADHD as a disorder that can be managed. One study has shown that lowering a child’s perceived levels of stigma may support greater adherence to medical treatment.

Although it cannot be concluded that increased screen time leads to ADHD, there is sufficient evidence to identify the risk, and the need to take action to protect children’s health.

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Dr Aby Dany Varghese is Professor, Department of Paediatrics at Nitte University (Deemed to be), KS Hegde Medical Academy, Mangalore, Karnataka, India.