Posts from — December 2008

The American Academy of Pediatrics has issued a new policy contradicting the American Heart Association’s: stance that children prescribed stimulant medication Schedule II drugs should get a heart screening or EKG prior to taking the drugs. The American Heart Association (AHA) cited the fact that approximately 2.5 million children taking these drugs are at risk of elevated blood pressure and increased heart rate.

The FDA recently insisted that a warning be placed on the medication’s labels indicating risks for sudden deaths in patients with heart problems. Approximately 20-30 sudden deaths have been reported related to stimulant medication in the US and Canada.

The longest study on families and their use of medication, the Multi-modal Treatment of ADHD Children (MTA) study also indicated other side-effects including decreased height and weight.

The American Academy of Pediatricians (AAP) has taken the stance that children taking stimulant medication do not need and ECG or EKG (electrocardiogram) tests because the rate of death is very small in respect of the overall number of children taking the medication. The AAP contends that EKGs are expensive [around $100] and could delay access to effective ADHD treatments which “could have serious implications.” The AAP does advocate careful physical examination, and a review of family history of heart problems including sudden death. It does not, however, advocate routine EKGs.

According to the Associated Press, policy co-author Dr. James Perrin, a Massachusetts General Hospital pediatrician said the academy’s policy makes clear that there’s no scientific evidence to support “this fairly dramatic practice change.”

This is a rather disconcerting stance for several reasons. The first reason is that there are no long-term data demonstrating the safety or risks of stimulant medication especially in conjunction with cardiovascular risk. Secondly, according to the AHA, children with heart abnormalities have a higher incidence of ADHD. Third, stimulant medications are known to decrease both height and weight in children.

It’s also perplexing that the APA advocated cholesterol drug treatment for children as young as 8 years old. Given this history, then it is not out of character for the APA to minimize heart risk.  

Recently, national media have declared war on TV, video games, and various other media.  Supported by a study performed by the National Institutes of Health (“NIH”), the news appears gloomy; these various media cause obesity, declining grades, etc.  I’ve even read some press that they may be related to childhood onset of diabetes (related to lack of exercise) and ADHD!

The NIH’s claims are alarming and necessitate a review of the method they employed to derive the claim they make that 80 percent of the studies reviewed have linked media use to negative health effects. I’ve said this before, when researchers review other researcher’s studies (study of study approach), generalizations are contrived that don’t necessarily convey actuality.  Granted, I’m not an advocate of chronic video game play, overuse of the Internet, TV, cell phone, or anything for that matter. Overuse is over use. Moderation is best. Overuse tends displace other healthier activities like taking walks, interacting with human beings face to face, or reading a good book.  So before chucking your Xbox out the window, let’s examine the flaws in this study a little more closely. Then, let’s discuss what actually is happening with video game use.

The NIH report was sponsored by sponsored by the nonprofit group Common Sense Media.  To be candid, I like this group.  It makes sense. Its mission statement reads:

Common Sense Media is dedicated to improving the media and entertainment lives of kids and families.

We exist because media and entertainment profoundly impact the social, emotional, and physical development of our nation’s children. As a non-partisan, not-for-profit organization, we provide trustworthy information and tools, as well as an independent forum, so that families can have a choice and a voice about the media they consume.

I’ve reviewed many of the 173 studies included in the NIH report. And while the NIH report conveys that media use impacts children’s health negatively, I am unable to find reliable data that justify this huge generalization.  This generalization was derived by lumping together research on movies, video games, cell phone usage, Internet usage, TV, movies, etc.  Unfortunately, when information is not disaggregated, it does not control for the way in which the media was used during the research or particular types of video games, movies, etc. For example, was the Internet use studied used for play, school research, or shopping?  Were the video games educational or entertainment? With the NIH’s method of aggregating data, we’ll never know.  Compounding this is the fact that research available on the impact of media like texting, social websites, etc. is nascent.

As I’ve noted many times before, children with ADHD tend to be pre-wired to concentrate on high stimulation and less able to control concentration on mundane tasks. This is neither a gift nor a blessing.  However, this coincides with the finding that children with ADHD had watched more TV as toddlers. This correlation often generates a great misconception (often propagated by the media) that TV-viewing causes ADHD. It would be more likely that the predication toward high-stimulation makes TV far more attractive to children with ADHD than playing with a stuffed toy or Legos.

The strongest correlations may be made with obesity and sexual behaviors.  Obesity is obvious; sedentary behavior (sitting in front of the TV or computer) would lead to obesity and many other diseases associated with obesity including diabetes.  Sexual behavior is obvious as well.  Watching others perform sexually whether under a mild TV-G rating or explicit pornography on the Internet, does impact the child watching. Most research indicates that children will experiment with intercourse or other sexual behavior in a correlation with their ability to access it via media.  Of course, what is not accounted for is the impact of parental influence (or lack thereof) and media exposure.

I’m frequently asked questions by parents about media and their children.  “Should I let my child play video games?” “How much TV is too much?”

Video games are not created equally. The most popular utilize compelling, sharp video imagery, fantasy, and violent action. I’m afraid the genie is out of the bottle. Whether you’re concerned about TV or video games, it is vital to first screen what your child is watching or playing.  Watching TV with them or watching them play their video games gives you the opportunity to discuss offensive, sexual, or violent material. You may object and censor their use or viewing of this material.

As a parent, you set the example as well. If you are sedentary, your child will likely be sedentary (as well as your pet). Play with your child, take them outdoors.

Treat video games like dessert. Dessert is given as a reward, and it is given in highly limited quantity.

So, even if research says correlations exist, you mustn’t dismiss the impact that you impart as parent. Study of study correlations often result in generalizations which may or may not be significant to your family.  As parent you are the decider – provided that you accept that role and are proactive.