Despite its widespread prevalence, Attention Deficit Hyperactivity Disorder (ADHD) is not well understood. As per global estimates, 1 out of 10 children suffers from ADHD, and yet, its symptoms are often confused with “attitude” problems and thus remain untreated. Parents with children who have ADHD often describe “lack of focus” or “laziness” as a recurring problem. Teachers may say “she is a very bright child but makes silly mistakes” or “he needs to concentrate better in class.” In the 21st century, ADHD has a new enemy: increased screen-usage. It is well-documented that children with ADHD often have an unhealthy relationship with screens, but to appreciate the devastating impact of unchecked amount of screen time, it is important to understand the science behind ADHD.
The brain has a chemical called ‘dopamine’ – it helps us get things done. Some children are born with dopamine deficiency, which has a crippling impact on their ability to start, organise, prioritise or complete a task. This in essence is ADHD. It is caused by a chemical deficiency and impairs the child’s ability to self-regulate. An ADHD brain is hardwired to seek stimulation. The stimulation is a biological need driven by low levels of dopamine. A mobile phone hence is the perfect accessory.
Healthy ways of getting stimulation and generating dopamine are through exercise, yoga, healthy nutrition or music. Video games and mobile phones on the other hand provide an unending supply of stimulation— much more than what is necessary, eventually making it harmful and addictive. For children with ADHD, this over-stimulation exacerbates self-regulation difficulties and causes a chain reaction of problems.
Younger children below the age of six with ADHD pose an interesting dilemma for parents. The child refuses to eat unless given a phone or an electrical gadget (the biological need for stimulation caused by lack of dopamine). To avoid dealing with a tantrum or general hyperactivity, a parent gives in. Excessive stimulation increases the intensity of the impairment (self-regulation) which in turn, creates even higher demands of access to phones and screen time. A vicious cycle has been created.
In such cases, children begin to disengage from activities which are important for their development. Preferring to spend time on a device rather than playing with toys or exploring the world around them. Delayed development of language skills, reading skills, social interaction and the ability to engage in conversations are common fallouts. Children with these deficits struggle in early school years, tending to have more frequent and intense tantrums.
Typical treatment for children with such delays would include parental training and occupational or developmental therapy.
“Loss of free will” is used in the context of drug addiction. It implies that a user cannot resist taking a drug. For children between the ages of 6 and 12 with ADHD, unregulated screen time is a drug-like substance which threatens to derail their academic, social and emotional well-being.
Lack of self-regulation leads to “screen addiction”. This might initially manifest in resisting doing homework and may reach a level where a child isolates him or herself (stays locked up in a room playing video games) and is unable to participate in activities that they thrived in earlier. This is the loss of free will.
Children who do not receive help to manage screen addiction may face a number of challenges in academic and non-academic spaces. In milder cases there could be a sharp drop in academic performance, social engagement, friendships and self-esteem. In more severe cases it can lead to school refusal, threatening behaviours with family members for continued access to screens and complete isolation where they refuse to speak with friends.
Treatment of screen addiction requires professional intervention.
The ADHD brain has a shorter attention span. As a result, it often needs to take breaks while doing a task. The break must be less stimulating than the task, otherwise the brain will choose the “break” over the task. We recommend a short walk, glass of water or a small snack to teenagers who are studying or working on tasks. These are healthy breaks which increase the ability of an adolescent to stay focused on the job.
However, when the break becomes a quick trip on the mobile phone, the overstimulation that the medium provides, makes it difficult to return to the original task. Given that there is a hardwired biological need for stimulation (to produce dopamine) the ADHD brain naturally turns to the easier alternative— screen time.
A vicious cycle sets in. As children spend more time on the screen, they can’t keep up with the skills needed to perform academically and hence get even more drawn to spend time on screens. Parents (and the child) start believing that this is a limitation (or a wilful choice), not realising that the root of the problem is biological. Teenagers become withdrawn. They stop speaking with friends, avoid or refuse going to school and start experiencing an acute loss of self-esteem, eventually resulting in low executive function, panic attacks and at times depressive states.
Psychiatric intervention is most often needed with treatment which could include medication and/or therapy.
AGES 0 - 6 YEARS
Absolutely no access to handheld devices without parental supervision.
Engage with your child on the content they are watching. This helps with cognitive development.
Build rules and regulations around screen time.
Keep a close watch on what content they are watching, searching and listening to.
Make sure they cannot download apps without your supervision.
Bark and Qustodio are helpful tools for monitoring.
Invite the older adolescent to share their screen time data.
Discuss how screen time impacts your productivity.
Encourage them to keep their room door ajar as much as possible but don’t enter the room too frequently.
A child and adolescent psychiatrist, Dr Pramit Rastogi is the medical director at STEPS Center for Mental Health in Gurugram.