Does screen time increase the risk of ADHD in children?

Let’s begin with questions many parents have in mind:

• Does watching a lot of TV increase the risk of my child developing attention deficit hyperactivity disorder (ADHD)?
• Do educational games on tablets increase my child’s risk of developing ADHD?
• What is true and what is myth when it comes to the relationship between a child’s screen-time exposure and ADHD?”

One of the biggest concerns many parents today have relates to whether we should limit, or restrict our children’s screen time, since nowadays, children may be exposed to screen time from multiple sources, including TVs, smartphones, tablets, and video game consoles.

My children enjoy screen time, and organizing their day to avoid screens altogether, in favor of other activities or quiet time is difficult.  For most parents, including me, deciding whether and how we should limit or restrict a child’s screen time is not an easy task.

Parents want guidelines, and to understand, whether too much screen time can cause ADHD in their children, and if so, how much screen time is too much?

Facts about ADHD.

The video below presents 5 facts about ADHD:

Too much screen time and ADHD type symptoms in children.

If you are like me and a lot of parents, you probably allow your children some screen time so they can be mesmerized for a while, and you can take a few moments to catch your breath, get some alone time, or even prepare dinner for your family.

Research studies indicate that the amount of screen time children are exposed to increases their high of developing ADHD or certain ADHD like symptoms.  The Tamana et al., (2019) study examined the hypothesis that preschool-aged children between the ages of 2-5 who are exposed to over 2 hours a day of screen time would exhibit clinically significant ADHD type behavioral problems.  

The results of the study indicated that, compared to children whose screen time is limited to 30 minutes a day, children who had screen time exposure of greater than two hours a day were 5 times more likely to report behavioral problems related to inattention and 7.7 more likely to meet the criteria for having ADHD, adjusting for other factors (Tamana et al., 2019).

The Xie et al., (2020) study found that, as compared to children who were exposed to screen time of less than 60 minutes per day, children between the ages of 3-6 years old who were exposed to screen time of more than 60 minutes per day were more likely to have behavioral problems, such as ADHD symptoms, with the risk being less among females. 

The study indicated that boys have longer screen time than girls, and that children of single parents, children who are the only child, and children left with nannies had higher screen time exposure (Xie et al., 2020).

Given the findings of the research studies discussed above, it seems parents should limit screen time.  However, should screen time be limited when our children are watching educational programs on TV or playing games that claim to support their development on their tablets?

According to Guare (2018), well-designed television programs such as Sesame Street have shown efficacy and can  “improve cognitive, literacy and social outcomes” for children aged 3-5 years old, as do the related apps from Sesame Workshop and PBS.  However, most applications on tablets  in the “educational” category do not have evidence of efficacy, and may not meet criteria to support the development of younger children.  Guare (2018) also recommended that when children are engaged with screens, parents interact with their children, such as by asking them questions about what they’re viewing

In summary, the studies reviewed indicate that parents should try to limit screen time of  young children aged 2-5, to no more than 30 minutes a day or 60 minutes a day (Tamana et al., 2019, Xie et al., 2020).  In addition, parents should choose well-designed educational programs and apps, like the Sesame Street television show and related apps, and should strive to supervise and interact with their children during their screen time.

Controversy over whether screen time causes ADHD

Phil (2019) discusses questions raised by the Tamana et al., (2019) study, which showed a relationship between excessive screen time in children between the ages of 3-5 years old and behavioral issues such as inattention, and increased risk of meeting the criteria for ADHD.  Specifically, Phil notes that the Tamana et al., (2019) study had its critics, such as certain media companies that told parents not to worry so much about screen time, and these conflicting messages leave parents confused about what to do (Phil, 2019). 

By: Tony Alter

Phil (2019) points out that Tamana et al., (2019) study is a good study and does not indicate that screen time causes ADHD, but rather the study showed an association between screen time and behaviors associated with ADHD, like attentional problems and impulsivity.  Phil (2019) notes that digital dependency may be what is causing damaging psychological effects, and screen time may serve as a measure for that digital dependency.  Ultimately, Phil notes that the evidence of the harms of screen time is growing, and that ignoring the problem, or disputing the results of a study, will not make that problem go away (Phil, 2019).

What can we do?

Screen time in excess of 30 or 60 minutes appears to increase the risk of a child meeting the criteria for having ADHD, and having ADHD like symptoms such as inattention and impulsivity.

What can we do as parents to reduce excess screen time risk?

As parents we should:

• set sensible limitations on how long and when our children can have screen time.
• avoid using TVs and screens as a babysitter for children younger than 5 years old.
• interact with our children, and encourage them to engage actively with others, rather than passively with screens.
• read to our children and explore the outdoors with them, and engage our children in social activities such as dancing, swimming, or sports.

Activities without screens to do with kids:

References

Guare, C., Sprinkle, N., & Kulman, R., Ph.D, R. (2018, October 10). The truth about TV and ADHD. ADDitude. https://www.additudemag.com/adhd-and-tv/

Phil, R. D. (2019, June 22). Does excessive screen time cause ADHD? Psychology Today. https://www.psychologytoday.com/us/blog/digital-world-real-world/201906/does-excessive-screen-time-cause-adhd

Tamana, S. K., Ezeugwu, V., Chikuma, J., Lefebvre, D. L., Azad, M. B., Moraes, T. J., Subbarao, P., Becker, A. B., Turvey, S. E., Sears, M. R., Dick, B. D., Carson, V., Rasmussen, C., Pei, J., & Mandhane, P. J. (2019). Screen-time is associated with inattention problems in preschoolers: Results from the CHILD birth cohort study. PLOS ONE, 14(4), e0213995. https://doi.org/10.1371/journal.pone.0213995

Xie, G., Deng, Q., Cao, J., & Chang, Q. (2020). Digital screen time and its effect on preschoolers’ behavior in China: Results from a cross-sectional study. Italian Journal of Pediatrics, 46(1). https://doi.org/10.1186/s13052-020-0776-x

KOAA 5. (2019, July 19). Your Healthy Family: Kid screen time can lead to ADHD [Video]. YouTube. https://www.youtube.com/watch?v=38zNV2eM3eQ

Psych2Go. (2019, February 20). 5 Interesting Facts About ADHD [Video]. YouTube.https://www.youtube.com/watch?v=uW6e50NYlWE&lc=Ugy9caVdGvhZQu7hQHZ4AaABAg

WhatsupMoms. (2020, November 11). PLAY/ 4 No prep ways to Entertain Kids (Without          Screens) [Video]. YouTube. https://youtu.be/KeHeJ5EmhdA

Medication Administration Errors in Nursing

Medication administration errors in the healthcare setting continue to be a leading cause of patient injury and death.

What are medication administration errors?

Medication administration errors are a common occurrence in the healthcare setting. Human error plays a major role in in these events. For nurses, there are Five Rights of Medication administrations: Right patient, right medication, right dose, right time, and right route. Any time this medication rights are not followed, a medication administration error may occur. A medication administration error can lead to significant injury to a patient or even death.

(SwisslogInspire)

Why does medication Administration Errors Happen?

There are many factors that play a significant role in contributing to medication errors. A study in 2018 used a questionnaire to ask nurses their thoughts about factors that contribute to medication errors (Lee & Lee, 2021). The questionnaire found that many nurses agree that the kind of safety climate at the medical facility, culture of the nursing organization, education levels of the nurses are factors that can increase the risk of having a medication error (Lee & Lee, 2021). Nurse who do not have a clear understanding of the medication they are administering can be at greater risk for having a medication administration error. Martin et al. (2019) conducted an observational study that explored the different units in a hospital that had the highest risk of medication administration errors. This study found that the Trauma unit and emergency department, both high stress units with high-risk patients had an increased number of medication administration errors (Martin et al., 2019).

Are there Systems in Place to Help Reduce Medication Administration Errors?

With the many factors that can contribute to medication errors, having systems in place can help reduce these mistakes and create safer patient care. Collecting data by conducting studies related to medication errors is one way that can help establish this better medication administration systems. One way to collect this data and improve medication administration systems is having healthcare professionals report medication errors. A study in 2010 asked fifty-six medical professionals to fill out different scenarios about various medication administration errors (Sarvadikar et al., 2010). This study found that nurses and pharmacists are the most likely to report less serious and very serious medication errors (Sarvadikar et al., 2010). Reporting medication mistakes and analyzing why and how they happened can help researchers and medical professionals reduce these mistakes from happening in the future. These reports have led to new systems being instated into hospitals.

One creation is the Electronic Medication Administration Record (eMAR). The eMAR has many benefits; a study conducted in 2019 in Canada surveyed five-hundred and fifty-four nurses. The nurses survey answers showed that benefits of the eMAR are that it provides better access to important patient information, helps reduce medication incidents, and helps nurses have better time management (Fei et al., 2019). Another system that has greater impacted better medication administration is the barcode system. The barcode system allows nurses to scan medications into the eMAR before administering the medication. This helps to ensure that the right patient is receiving the right medication. Although the barcode system is not completely mistake proof, it has shown to decrease medication administration errors. Lunt et al. (2020) conducted a questionnaire where fifty-five emergency department nurses in Canada were asked about the barcode system being installed in their emergency department. Many of the nurse agreed that the barcode system was easy to master but, the barcode system is not always practical for the emergency department; a high risk setting where medication decisions may need to be made quickly, without scanning them into a system. Although there are no medication administration systems that are completely without faults, it is important to keep improving these systems and using them to the best of their ability in order to prevent medication administration errors.

What can Patients Do To Prevent Medication Administration Errors?

Patients put a lot of trust into their nurses to provide the right care and give the correct medication. Although nurses go to school and must take an exam before they are licensed to practice, medication errors can still happen. So, what can patient do to help prevent these errors? Patient can help by being their own advocate; writing down the medications they take at home and reviewing them with their nurse as well has the healthcare team. During medication administration, patients show ask questions about the medications they are being given. This will help educate the patient about their medication and allow the nurse to take a double check at the medication they are giving. Patients have the right to advocate for themselves and work with their nurses to review their medications and prevent mistakes and medication errors.

References

Fei, L., Robinson, J., & Macneil, A. (2019). Case study: Using electronic medication administration record to enhance medication safety and improve efficiency in long-term care facilities. Canadian Journal of Nursing Leadership, 32(2), 102–113. https://doi.org/10.12927/cjnl.2019.25958

Fomuso, L. (2020). How to prevent becoming a victim of  Medication Errors/Dr. Lusia Fomuso/ TEDxPleasantGrove – youtube.com. Youtube.com. Retrieved February 23, 2022, from https://www.youtube.com/watch?v=h7ok9TzEHys

Lee, H. Y., & Lee, E.-K. (2021). Safety climate, nursing organizational culture and the intention to report medication errors: A cross-sectional study of hospital nurses. Nursing Practice Today. https://doi.org/10.18502/npt.v8i4.6704

Lunt, C., & Mathieson, K. (2020). Emergency department nurses attitudes toward barcode medication administration. Canadian Journal of Emergency Nursing, 43(1), 6–11. https://doi.org/10.29173/cjen17

Martín, M. Á., García, M. M., Silveira, E. D., Martin-Aragón, S., & Vicedo, T. B. (2019). Medication errors in the care transition of trauma patients. European Journal of Clinical Pharmacology, 75(12), 1739–1746. https://doi.org/10.1007/s00228-019-02757-3

Sarvadikar, A., Prescott, G., & Williams, D. (2010). Attitudes to reporting medication error among differing healthcare professionals. European Journal of Clinical Pharmacology, 66(8), 843–853. https://doi.org/10.1007/s00228-010-0838-x

SwisslogInspire. (n.d.). 5 rights of medication. Swisslog Healthcare. Retrieved February 23, 2022, from https://www.swisslog-healthcare.com/en-gb/company/blog/5-rights-of-medication

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