ADHD, screen time and self-regulation: What parents need to know

Featured expert

Dr. Tyler Womack, Psychology

 Dr. Tyler Womack is a licensed psychologist at Rady Children’s Health Orange County.  She completed her doctoral program at the University of California, Riverside, and her pediatric psychology fellowship at Rady Children’s. Dr. Womack specializes in providing therapy and diagnostic evaluations to children and adolescents with neurodevelopmental disabilities.

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Transcription

Melanie Cole, MS: Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Rady Children’s Health. I’m Melanie Cole. And today, we’re talking about ADHD and self-regulation. Joining me is Dr. Tyler Womack, she’s a licensed neurodevelopmental pediatric psychologist at Rady Children’s Health Orange County.

Dr. Womack, thank you so much for joining us today. So today’s digital environment is dizzying. I mean, when we think of screen time, social media, constant connectivity, is this making it harder for our children to manage their emotions and self-regulate, or is it helping them to focus on certain things?

Tell us what this is doing to our kids.

Tyler Womack, PhD: Yeah, that’s a great question. So first, I think it’s important to start by recognizing that screens aren’t inherently bad. Nowadays children use technology for so many different reasons. They use it for school, to connect with friends and family, to play games, watch videos, or they’re even using it to learn new skills or explore their interest.

So technology can be a really useful tool. The goal isn’t necessarily to eliminate screen time altogether. However, it is about understanding how children are using screens and how that might be affecting them. That being said, what research has found is that there are associations between higher levels of screen use and behavioral or mental health concerns in children.

That includes things like higher levels of anxiety, depression, aggression, and hyperactivity. One thing though to keep in mind is that association doesn’t necessarily mean that screen time directly is causing these difficulties, but it does raise important questions about how our increasingly digital environment may be influencing children’s behavior, attention, and ability to regulate their emotions

Melanie Cole, MS: Yeah, that’s so interesting, isn’t it? I mean, it really is an interesting field of study today when we think about all of the social media and digital life that our kids are just connected to. So what should parents watch for? If they’re really concerned about ADHD, what are some of those red flags that say, “You know, hyperactivity disorder, this is, this is not something that I think is supposed to happen”?

Tyler Womack, PhD: Yeah. So symptoms of ADHD can include a couple things. So some of the symptoms includes inattention, which is not being able to focus. It can also include hyperactivity, or in other words, really excessive movement that’s not fitting to the setting. So for example, at school, if they’re supposed to be sitting down during circle time and the child is having a hard time sitting and listening, that might be a concern.

It can also include impulsivity, or in other words, doing things in the moment without really thinking it through. ADHD does normally present and is diagnosed in childhood. And when there’s a diagnosis of ADHD, there’s actually three different types. One of them is a predominantly inattentive type, the other is a predominantly hyperactive or impulsive type, or the third is a combined presentation where a child is presenting with both.

a question that I often get is whether or not too much screen time can cause ADHD. And the short answer is that we don’t have enough evidence to say that screen time necessarily causes ADHD. Instead, ADHD is a neurodevelopmental condition, and it has a really strong genetic component. And it’s actually associated with differences in the brain development and functioning.

It’s not something that we can simply attribute to a child spending too much time on a phone, tablet, or computer. However, too much screen time can be associated with behaviors that look similar to ADHD. So kind of like I mentioned before, if there’s too much screen time use, at times kids might be a little bit more at risk for being a little bit more inattentive, being a little bit more hyperactive, or having a hard time staying focused.

So while we shouldn’t jump to the conclusion that technology gives a child ADHD, it is worth paying attention to how digital media might be affecting their behavior. And then looking beyond that and just seeing, are they also having these troubles in other situations? So for it to be ADHD, the child should be having trouble with these things across settings, so they would most likely be having a really hard time at school, having a hard time when they’re out in the community, and then also at home as well.

Melanie Cole, MS: Thank you for that, doctor, and really for giving us those red flags and what parents should be looking out for. And as you said, you know, with school, a lot of that is online too. So now screen time and what used to be defined as screen time is completely different today. And it looks different because some of this is, you know, mandatory for school.

Now, one of the things I noticed when my son was young and playing video games and such was he became frustrated when I asked him to stop or put it down or, you know, to transition away from screens or those preferred activities. When is that a typical reaction, and when might it point to a larger issue with attention, impulsivity, self-regulation?

Because we’ve all seen the videos of these kids that scream if you take away their iPad, or they have to stop playing video games, not to mention taking even our teens off of social media and taking their phones away. When do we worry that that’s just what’s going on with kids today and that might be something bigger?

Tyler Womack, PhD: I think the first thing to recognize is that it’s completely normal for children to become frustrated when they’re asked to stop doing something they enjoy. So like imagining a child, for example, who’s in the middle of a favorite video game or watching a really entertaining show when a parent says, “Okay, time to turn it off,” they might try to protest.

They might try to negotiate, like, “Oh, just give me five more minutes,” or they might express that they’re upset. So those reactions by themselves aren’t necessarily a cause for concern. However, what I would say is important to look at is the intensity of the reaction, how frequently it happens, and how well the child’s able to recover.

So for example, does the child get upset but eventually transition with some support, or are they having these really prolonged, intense tantrums almost every time that they’re asked to stop, to the point that it’s significantly disrupting family routines? If those reactions are happening frequently, it may be worth taking a closer look at the child’s ability to regulate their emotions and manage transitions, and also to consider whether or not the amount of screen time they’re getting as well as the quality of screen time that they’re getting is appropriate for them.

 one thing I also wanted to point out is that not all digital use is created equal. We have to consider what children are doing on their devices, not just how much time they’re spending on them. So for example, using a tablet as you said, to do schooling or complete an educational activity, or if they’re using it to do FaceTime to connect with a family member or friend, is very different from spending hours playing maybe, like, a highly stimulating video game or just scrolling through an endless stream of short videos.

So really the content, the purpose, and whether screen use is interfering with their sleep, physical activity, or social interactions, or all other daily routines is what matters as well. So that’s also something I’d be keeping in mind when considering the child’s reaction to the limit on screen time.

Melanie Cole, MS: That’s a great point, Dr. Womack. Is it interfering with their sleep, with their ability to get done the tasks of the day that they do need to get done? Because it really can do that. So what are some healthy ways that families can help children build this emotional regulation to self-regulate the coping skills that they would need in this world that’s filled with a constant barrage of digital stimulation and distractions

Tyler Womack, PhD: So a really helpful resource is the American Academy of Pediatrics. They actually have a tool online where you can plan out your family media usage. And so what I wanna do is talk a little bit about what are some good ways to support your child’s emotional regulation by having some of these boundaries in place.

So, one of the things I’d recommend, for example, is making sure to establish consistent rules and routines. So children often do better when they know what to expect and what is expected for them. so for example, having a predictable routine for things like when are we getting ready in the morning, completing homework, and at what time are we doing the screen time?

It’s also important to note that children typically respond better when they have to transition from screens to something that’s not super demanding. So for example, I would usually have a child do homework first and then have the screen time, because doing the screen time and then going to homework is gonna be much harder for the child ’cause then they went from something really enjoyable to something that most likely is not something as enjoyable for them.

 Another thing that’s important to be mindful of is how we’re responding to the child’s behavior. So we wanna recognize and praise behaviors that we wanna see more often rather than giving attention when the child is being disruptive. So for example, if your child is using words to explain their frustration instead of, like, screaming or tantruming you can say something like, “I see you’re really upset, but I really appreciate you telling me how you feel.”

Because that’s an example of some good emotional regulation if they’re able to just verbally express how they’re feeling about it. It’s also helpful to work with children as well to have places where maybe the screen time would not be used at all. So for example, in a child’s bedroom, it could be a no screen time zone, as well as during family mealtimes, that could also be a no screen time zone.

The reason being is that for bedtime, usually screens can really affect sleep quality. And so making that a place where a child cannot necessarily use their screen can be really helpful for their bedtime. And then making sure that they’re not using it at mealtimes can also be helpful for making sure that families are connecting with each other and having that quality time together.

 And then another way that can be important to support kiddos is to also, maybe have them transition to another activity that’s enjoyable but doesn’t necessarily involve screen time. So for example, maybe after your child has had their 30 minutes of screen time, then they’re expected to turn it off, but then they might be transitioning to something enjoyable like playing with toys or maybe going out for a walk or something else that is not using screen time but is also something that they would enjoy to make that transition a little bit easier for them.

Melanie Cole, MS: Dr. Womack, you’re giving us so many great, really usable tips, really usable ideas that parents can start to do today to really help them to distinguish whether or not the kid’s activity level or hyperactivity is really something that they should be concerned about, or if it’s just because this barrage of social media and constant digital movement that we’ve got in front of us now.

When is it time to call in the professionals such as yourself? What would you like parents to know about recognizing those red flags that you mentioned, and then to whom do they turn? What’s their next step?

Tyler Womack, PhD: I think something that is important to recognize is, again, how big are these reactions that children are having to the lack of screen time? And then also, is this occurring in other parts of their lives? So for example, like at school, are teachers teachers maybe reporting that your child is having a hard time sitting still during activities they’re supposed to, or does it seem like they’re easily distracted or having a difficult time staying organized? And then at home, beyond just the screen time, does it seem like in general when they are being told to do something or asked to sit or asked to wait, are they having a really hard time managing their reactions to some of those moments?

 if you’re noticing these types of behavioral challenges that are across settings and seems to be really impairing them in different ways, like maybe it’s impairing them at school or with their friendships or being able to get through their daily routines at home, that’s when I would say that there is a concern beyond just the use of screen time.

My recommendation would to be make sure that you’re getting in contact with the child’s professionals, so that includes their pediatrician. It can also include their school staff as well. And so for your pediatrician I would let them know your concerns. At that point, they may recommend that your child undergo a formal evaluation to determine if there are concerns like for ADHD or if there’s other developmental concerns.

And then at the school setting you can also express those concerns and then see whether or not your child might be eligible for extra supports if it is really impacting their academics. Dr. Womack, thank you so much for joining us today and really telling us about the world in which we live and our children and self-regulation, which is such an important resilient tool for our children to learn now and how to identify when it’s concerning. Thank you again for joining us.

Melanie Cole, MS: And for more information, you can visit radychildrens.org. Thank you so much for tuning into Long Live Childhood, a pediatric health and wellness podcast brought to you by Rady Children’s Health. Together, we can keep kids happy, healthy, and thriving. If you enjoyed today’s episode, please consider downloading, subscribing, rating, and reviewing Long Live Childhood on Apple Podcasts, iHeartRadio, Spotify or Pandora.

Your support truly means a lot. Thank you so much for joining us today. Until next time

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