"Cable in the Crib: A Systematic Review of Screen Media and its Effect on Children" – November 2007

Photo by Annalog85 (Stock.Xchng)

Photo by Annalog85 (Stock.Xchng)

Introduction

The octogenarian woman coos with pride as my infant’s eyes fix on the wide screen television in her living room. Immediately, however, her granddaughter enters the room and furiously clicks at the television remote. The screen goes black as the mother and daughter argue in their native Persian dialect.

This argument continues across America. Parents, grandparents, educational entertainment producers, economists, developmental psychologists—all interested parties seem unable to agree on what is best for our children. While clinical studies show some potential positive effects of educational television for older children, most research clearly identifies the adverse psychological effects of television viewing in children under two years old—infants and toddlers (Thakkar, Garrison, Christakis, 2006). Some popular media skeptics, however, claim improved overall cognition for infants as young as three months old (Savage, 2007). Is television bad for young brains or not? If it is, why do parents continue to prop their tiny ones in front of the screen? After a systematic review of literature, I believe current research lacks sufficient data targeting infants and toddlers.

First, we must examine data from current clinical research to determine how much television children really are watching. I will compare conditions in the 1970s to the latest data from the 21st century. Next, a systematic review of literature will reveal results from current research regarding television’s true effects on infants and toddlers. I will examine the contrast between statistical information from academic research and its dissemination into popular media sources. Lastly, we will briefly examine how hopeful skeptics and scientists propose the future should look.
Literature Review

A broad spectrum review of literature unveils the ubiquity of television viewing in the United States of America and the alarming disparity between viewing guidelines offered by pediatricians and actual actions of parents. Further secondary research clearly identifies significant evidence of various adverse effects on infants and toddlers.

Thirty years ago, television viewing patterns of infants and toddlers mirrored those of their parents. Typically only one television set warmed the living room, if the family owned a television. In those homes with TVs, families reported watching up to six hours per day. Infant and toddler viewing patterns mirrored those of their parents (Hollenbeck, 1978).

In sharp contrast, nearly every American household owns a television today. 99.5% of households with children under two years old owned an average of 2.53 televisions per household in one study. Video and/or DVD players were also nearly universal, 80% of homes owned computers, and approximately 50% of households also owned at least one video game console (Vandewater et al., 2007)

In the last three decades, televisions have multiplied, spreading into our bedrooms, our kitchens, into nearly every niche available. Our modern world pulses with fast-moving images, lights and sounds. Media technology continues to advance at a remarkable rate, infiltrating into the eyes and ears of every urban-dwelling human being. A morning commute on a public train or bus reveals this fact, with countless individuals watching video podcasts or the previous night’s primetime show on handheld devices. And televisions—lately appearing in a myriad of sizes as thin, panoramic LCD and plasma flat screens—now hang on walls in waiting rooms, swing out from hidden compartments in automobiles, and pacify passengers in airplanes, trains and high-rise elevators with brief news clips and weather information.

Perhaps most significantly, however, an explosion in television programming and visual media produced and marketed specifically to children under two years old has occurred in recent years (Dennison et al., 2003). “These children are growing up in a media-saturated environment with almost universal access to television, and a striking number have a television in their bedroom. Media and technology are here to stay and are virtually guaranteed to play an ever-increasing role in daily life, even among the very young” (Vandewater et al., 2007). From Baby Einstein videos to the Teletubbies, a multi-billion dollar industry now revolves around marketing visual electronic media to infants and toddlers (Wallis and Park, 2006).

When the young children’s media boom began in the late 1990s, the American Academy The AAP’s Committee on Public Education recommended parents limit television viewing to two hours per day or less for children two years old and older. Pediatricians were advised to tell parents to “discourage television viewing for children younger than 2 years, and encourage more interactive activities that will promote proper brain development, such as talking, playing singing, and reading together” (2001). of Pediatrics (AAP) recognized the need for caution with new technology.

Despite these warnings, infants and toddlers continue to watch television frequently. Approximately 40% of infants are regular viewers by three months old; by two years old 90% of the toddler population watches television (Zimmerman, Christakis, Meltzoff, 2007, 476). Parents defy—or perhaps ignore—AAP’s advice, and allow their infants under a year old to view over an hour each day. By 24 months many toddlers already meet or exceed the maximum viewing time of two hours (Yasgur, 2001). These figures only include direct television, DVD and video viewing at home as reported by parents in surveys. In other words, these statistics may only calculate a fraction of actual viewing time; they do not account for incidental exposure to parental viewing, video games, LCD screens in family vehicles or television viewed outside the home either with childcare providers, in stores or doctor’s offices.

And yet the evidence against early television viewing continues to grow. A recent systematic review of twelve studies concluded that while television viewing of educational-based content may have some positive effects on older children, no studies suggest improvements for infants and toddlers. Most studies to date only gather information through telephone or longitudinal studies; very little population based, clinical research on the very young actually exists (Thakkar, Garrison, Christakis, 2006).

Due to the drastic changes in visual electronic media in the last 5 years, I restricted my own review of clinical literature to studies conducted in 2003 or later. Furthermore, I limited my review only to studies that published data regarding adverse psychological development effects specific to infants and toddlers. Although intriguing and equally alarming, I excluded literature which examined physiological effects such as obesity, decreased physical activity, etc.

When filtering for primary research focused on infant and toddler specific data, my review yielded only seven studies which included these criteria, one of which is the systematic review mentioned above. One other study detailed the effects of sleep problems among television viewing infants, which the authors linked to several developmental challenges (Thompson and Christakis, 2005). The remaining five studies explored the following developmental issues: the effect of repetition on imitation during infancy (Barr et al., 2007), attentional problems (Christakis et al., 2004; Zimmerman and Christakis, 2007), sensitivity to interpersonal timing (Striano, Henning, and Stahl, 2006) and vocabulary acquisition (Krcmar, Grela and Lin, 2007).

Thompson and Christakis explored the effect of television viewing on sleep patterns in children under three years old. Using the National Survey of Early Childhood Health, a cross-sectional survey of 2068 children, Thompson and Christakis found a strong association between the number of hours of television viewed and irregular sleep patterns. These irregular patterns were not limited to nighttime sleep, but also included naps during the day. “This was independent of many other factors that could affect a child’s sleep schedule, such as household and demographic factors, maternal health, and family interactions, as well as parental ability to maintain regular mealtimes.” In their discussion, the authors stressed the importance of the connection between sleep problems and subsequent psychological and physiological problems, citing several studies which demonstrate the correlation between irregular sleep patterns in children and mood, behavior and learning problems (2005).

Barr et al. investigated the “video deficit effect,” a phenomena in which infants and toddlers demonstrate delayed learning abilities of multi-step tasks when viewing television. Hundreds of studies—including Albert Bandura’s landmark ‘Bobo doll’ study of children imitating televised acts of aggression (Bandura, Ross and Ross, 1963)—have proven the behavior learning power of television. Barr and her colleagues, however, discovered that increased, repetitive television viewing may actually impair task learning. After viewing a demonstration of an adult dismantling a toy three times, most toddlers were capable of completing the task themselves. Remarkably, toddlers who viewed the same televised demonstration six times showed a significantly decreased ability to dismantle the toy on their own. It seems that children, once acclimated to the stimulus, begin to limit the level of cognition involved in their viewing. In their general discussion, the authors discuss the danger of television’s “impoverished 2D input” and the negative effects of contingent-free pacing on television, in which actions continue without cue or reaction from child (Barr et al., 2007).

Christakis and Zimmerman examined the longitudinal effects of early television viewing on later attention problems. “In contrast to the pace with which real life unfolds and is experienced by young children, television can portray rapidly changing images, scenery, and events. It can be overstimulating yet extremely interesting” (Christakis et al. 2004). They pulled data for over 2500 children, aged either 12 months or 36 months. An analysis of the television viewing habits of these children showed a significant correlation between early viewing and diagnosis of Attention Deficit Hyperactivity Disorder at seven years old. For one year olds, an increase of one standard deviation (2.91 hours of television viewed per day) coincided with a 28% increase in the likelihood of ADHD diagnosis at seven years old, even when controlling for maternal substance abuse and psychopathology, socioeconomic status and gestational age (Zimmerman & Christakis, 2007).

Researchers in 2006 hoped to determine if the delayed responses, like those common to communication via visual electronic media, have an effect on interpersonal timing. Striano, Henning and Stahl recognized infant sensitivity to communication timing as early as 3 months. Furthermore, the issue of contingency—consistent, timely reactions to actions—plays heavily in interpersonal communication. Television viewing seems to have an appreciably negative effect on this factor of communication. When infants interacted with their mothers via double closed-circuit television, infants detected the delay and lost interest in their mothers more rapidly than those who interacted with their mothers in person (Striano, Henning and Stahl, 2006).

A recent study conducted at Wake Forest University and the University of Connecticut Toddlers in two groups, aged 15-21 months or 22-24 months old, were taught five novel words through live presentation (joint reference), live presentation via satellite, recorded presentation, and children’s television show format. “Overall, the toddlers were most successful in learning novel words in the joint reference condition. They were significantly less successful in the children’s program condition.” Age played an even greater role; whereas all subjects learned novel vocabulary from live presentations, children under 22 months were not able to learn any novel words by viewing the televised children’s show (Krcmar, 2007). tested language acquisition by toddlers through various teaching modalities.

My survey of popular literature yielded countless additional articles, with such incendiary titles as “Is Big Bird Bad for Baby?” (Savage, 2007) and “Blame It on Teletubbies” (Wallace and Park, 2006). These articles varied widely in opinion and presentation of information. Popular print media, along with clinical research, seems to actively seek evidence against television viewing. Attacks on vogue children’s toys and ‘educational entertainment’ dominated popular articles, with several scathing attacks targeted specifically at infant and toddler television shows like the Teletubbies (Wallace and Park, 2006). Other articles denounced the wildly popular Baby Einstein videos, which are marketed to infants as young as 3 months, citing recent studies that show language impediments and decreased vocabulary in young viewers (Interlandi, 2007).

While all popular media articles included arguments regarding infant and toddler viewing, as well as citations of empirical data, only the seven clinical studies included in my review were actually relevant to children under 2 years old. Possibly due to the dearth of available data, the focus on infants and toddlers decreased markedly as research disseminated to the masses. Counterpoints referred to children of any age, ranging from infancy to late adolescence, as members of the same demographic.

A few bold skeptics assert that television and modern media technology make our children smarter; instead, attentional problems and other developmental lags are caused by the dull, mindless stimuli of school and parents. According to Steven Johnson, today’s television plot lines are more complex and require advanced cognition and logical reasoning. Video games develop coordination, teamwork, and economic common sense (Johnson, 2005). Unfortunately, very little empirical evidence supported his optimistic ideas. Nonetheless, while this best-selling author’s book title Everything bad is good for you: How today’s pop culture is actually making us smarter may serve simply to incite readership, some truth may beneath his rather unscientific hypotheses.

Indeed, even Dimitri Christakis and Frank Zimmerman have followed Johnson’s lead. These two prominent researchers, known as vehement critics of television viewing, have recently penned a book for the general public. The elephant in the living room: Make television work for your kids offers parents of infants and toddlers sound information regarding television and sensible ways to create interactive learning opportunities from television time (Christakis and Zimmerman, 2006).

Their novel received such widespread interest that Christakis continues in this vein with his work in professional journals. A shift from apprehension to action is apparent in the title of his latest academic publication, “Can We Turn a Toxin Into a Tonic? Toward 21st-Century Television Alchemy.” In this brief secondary research article, Christakis encourages clinicians to expand research for all ages, especially the very young. He offers advice to reduce the harmful effects of television by limiting viewing time, increasing contingent parent/child interaction during viewing, and considering media content. Furthermore, he encourages pediatricians to act as realists, encourage parents to take active roles in their child’s television viewing by using the aforementioned methods, and no longer simply depend upon the AAP’s viewing recommendations (Christakis, 2007).
Research Approach

Initially, I wanted only to know the effects of television on infants and toddlers, positive and negative. By compiling recent research into a literature review, I hoped to offer other psychologists and sociologists a comprehensive view of the current research. On the personal level, I hoped to complete the requirements of this course and glean important information to help better raise my eight month old daughter. Only strict limitations of preparation time, fast access to information, and a personal dearth of knowledge on the subject controlled my research.

I sought only reflexive knowledge, not intending to propose answers or solutions in the process. I did not assume that I would discover critical gaps in research that would change my objectives. After several weeks of research, however, I kept confronting the truth: regardless of warnings and convincing clinical evidence, parents still allow their children to watch television. In today’s world, television is not alone, either. Visual electronic media can be found everywhere, a constant stream of stimulation flowing into our children’s senses. I felt compelled to demand more information from the academic world.

I hoped to describe the condition of today’s infant and toddler in relation to visual electronic media. While I used an oft cited study from the late 1970s, I focused my research entirely within the 21st century. I want to categorize the effects and evaluate the risks associated with increased viewing times. I also hope to offer some explanations to parents’ behavior and the increase in television for infants and toddlers.

I have offered a professional tone, creating a paper for intellectual colleagues and university professors. Instead, I would prefer addressing parents with this paper, informing them of the risks of their behavior. For parents, I would not write with such an academic voice, but instead with one of a compassionate compatriot of the parenting world. I also could not easily address the topic with such an objective stance, cold and distant from the findings of my research.

For the negative effects of television viewing, I collected almost exclusively quantitative data. Empirical information was crucial to establishing a clear pattern of harmful impacts imparted upon the very young; I wanted clear numbers and facts to illuminate danger. For counterpoints, however, I felt comfortable to gather information based on the quality and logic of their arguments, with or without a foundation of statistical evidence. Furthermore, popular media sources and secondary research articles—which I excluded from my initial professional literature review—were permitted to include contrarian opinions.
Conclusion

At first glance, modern parents appear unaware—or worse, they exhibit blatant disregard—of the developmental risks associated with television viewing. Lower socioeconomic status, maternal age, single parenthood and other demographic factors have been associated with increased viewing times in infants and toddlers. Regardless of these factors, however, “three-fourths of [the] parents believed that television and videos could improve their child’s vocabulary, and 70% believed that TV and/or videos could improve their child’s imagination” (Yasgur, 2001).

Television screens continue flashing images into the eyes of the very young. And neither clinician nor neo-Luddite would contest the growing omnipresence of visual electronic media in our lives. Again and again, we witness the detrimental effects of television viewing among infants and toddlers, but television—or some comparable form of visual technology—is here to stay.

The simplest answer comes easily; stop infants and toddlers from watching television immediately. Our society, however, does not easily permit this maxim. If they indeed cause detriment to infant and toddler development, we must seek evidence and methods to mitigate the damage. Future research must explore deeper into the effects of particular content and variations in viewing times. We must also determine if the negative effects of television emerge from the content, the exposure time, or the delivery device—changes to modern LCD and plasma screens, etc. may create a different set of effects altogether. As our technology advances, we should continue to monitor its changes on the viewer.

And perhaps parents and optimistic skeptics have greater foresight than clinicians; positive effects may lie within the range of television’s effects. Even television’s mightiest opponents now accept that we cannot realistically demand parents restrict all visual electronic media from their children. Watching television together, creating opportunities for interfamilial dialogue and ‘learning moments’ may offer benefits to the young. We cannot discredit media altogether without first seeking creative solutions for today’s challenges.
References

American Academy of Pediatrics Committee on Public Education. 2001. Children, adolescents and television. Pediatrics, 107 no. 2: 423-426.

Bandura, A., D. Ross, and S.A. Ross. 1963. Imitation of film mediated aggressive models. Journal of Abnormal and Social Psychology 66: 3–11.

Barr, R., et al. 2007. The effect of repetition on imitation from television during infancy. Developmental Psychobiology 49, no. 2: 196-207.

Burke, M.G. 2003. The influence of television and visual electronic media on brain development. The Brown University Child and Adolescent Behavior Newsletter, July: 1, 6-7.

Yasgur, B.S. 2001. Parents see TV as beneficial for infants and toddlers. Family Pratice News, January 15. http://findarticles.com/p/articles/mi_m0BJI/is_2_31/ai_70649956/pg_1(accessed October 12, 2007).

Christakis, D.A. 2007. Can We Turn a Toxin Into a Tonic? Toward 21st-Century Television Alchemy. Pediatrics vol. 120, 3:647-648.

Christakis, D.A. et al. 2004. Early television exposure and subsequent attentional problems in children. Pediatrics 113 no. 4: 708-713.

Christakis, D.A. and F. Zimmerman. 2006. The elephant in the living room: Make television work for your kids. Emmaus, PA: Rodale Press.

Dennison, B.A. 2004. An intervention to reduce television viewing by preschool children. Arch Pediatr Adolesc Med 158:170-176.

Hollenbeck, A.R. 1978. Television viewing patterns of families with young infants. Journal of Social Psychology 105:259-264.

Interlandi, J. 2007. Turn it off, baby. Newsweek 150, no. 8/9: 14-14.

Johnson, S. 2005. Everything bad is good for you: How today’s pop culture is actually making us smarter. New York: Riverhead Books.

Krcmar, M., B. Grela, and K. Lin. 2007. Can toddlers learn vocabulary from television? An experimental approach. Media Psychology 10, no. 1: 41-63.

Savage, Luiza Ch. 2007. Is big bird bad for baby? Maclean’s 120, no. 7: 46-47.

Striano, Tricia, A. Henning, and D. Stahl. 2006. Sensitivity to interpersonal timing at 3 and 6 months of age. Interaction Studies 7, no. 2: 251-271.

Thakkar, R.R., M.M. Garrison, and D.A. Christakis. 2006. A systematic review for the effects of television viewing by infants and preschoolers. Pediatrics 118, no. 5: 2025-2031.

Thompson, D.A. and D.A. Christakis. 2005. The association between television viewing and irregular sleep schedules among children less than 3 years of age. Pediatrics 116: 851-856.

Vandewater, E.A. et al. 2007. Digital childhood: Electronic media and technology use among infants, toddlers and preschoolers. Pediatrics 119: 1006-1015.

Wallis, Claudia, and Alice Park. 2006. Blame It on Teletubbies. Time 168, no. 18: 65-65.

Zimmerman, F. and D.A. Christakis. 2007. Associations between content types of early media exposure and subsequent attentional problems. Conference Papers — International Communication Association : 1.

Zimmerman, F., D.A. Christakis and A.N. Meltzoff. 2007. Television and DVD/Video Viewing in Children Younger Than 2 Years. Arch Pediatr Adolesc Med 161:473-479.

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