Creating Sustainable Futures Program

I. Executive Summary

The past decade has witnessed an epic explosion in child technology use (TV, videogames, internet, cell phones, iPods). Simultaneously childhood physical, psychological and behavior disorders are increasing, often accompanied by the prescription of psychotropic medication. Critical milestones for child motor and sensory development are not being met, resulting in inadequate foundation skills for school entry. The impact of media violence on child aggression has now been classified as a public health risk. Research documented negative impact of technology overuse on child health and academic performance indicates the need for implementation of technology management programs as school-based interventions. The Canadian Health, Education and Children Ministries could take pro-active measures to address technology overuse by implementing the Creating Sustainable Futures Program (CSFP). Designed by a pediatric occupational therapist, the CSFP has three components: 1) occupational therapist instructor training, 2) community workshops by occupational therapists for parents, teachers and health professionals, and 3) school-based Zone’in, Move’in, Unplug’in and Live’in program implementation for elementary aged children. CSFP implementation would involve a pilot study, evaluation and redesign phase, followed by possible province wide implementation. The Creating Sustainable Futures Program would require input, support and collaboration from representatives of all three Ministries through formation of the CSFP Tri-Ministerial Advisory Committee.

II. Problem Statement

Throughout most of human history child engagement in rough and tumble outdoor play and imaginary games resulted in the achievement of adequate sensory, motor and attachment development required for attention and learning (1-3). Today’s average household media environment includes three TV’s, three DVD players, two videogame consoles, three iPods, two cell phones and one computer (4). Children now average 8 hours per day combined technology use, with 75% of children using TV’s in their bedrooms (5). ‘Baby TV’ now occupies 2.2 hours per day for the 0-2 year old population, and 4.5 hours per day for 3-5 year olds and is causally linked to developmental delays (6,7). This situation has prompted France to ban its broadcasters from airing TV shows aimed at children under three years of age (8). Canadian children were granted a “D” grade for inactivity in 2008 by Active Healthy Kids Canada, citing TV and videogames as the primary cause (9). TV and videogame use accounts for 60% of childhood obesity, and is now considered a North American ‘epidemic’ (10,11). Media violence has been classified as a public health risk due to the causal relationship to child aggression (12). Studies indicate increases in ADHD, attention difficulty, poor academic achievement, and sleep impairment are associated with technology overuse (13-16). Researchers state that children who overuse technology have underdeveloped frontal lobes, impaired working memory, reduced impulse control and inability to empathize with others; impacting gravely on their ability to learn and function in a traditional school environment (17).

Prevalence statistics regarding developmental disabilities in young children are a challenge for researchers due to early detection difficulties. Only 55-65% of developmental disabilities are detected prior to school age entry (18). 6% of US children have speech and language impairment, 8% a learning disability, 7% ADHD and 0.5% Autism with 13.2% accessing special education assistance (19). A 2006 Canadian study reported one in six children have a developmental disability (20), with Autism prevalence now 1 in 160 in Canada (21). Data from the 1988 National Health Interview Survey reported 17% of US children had a developmental disability, resulting in 1.5 times more physician visits, 3.5 times more hospital days, twice the number of lost school days and a 2.5 fold increase in the likelihood of repeating a school grade compared to a non-developmentally disabled child (22). A 2006 US study reported 32% of children admitted to inpatient pediatric ward demonstrated a developmental disability (23). In 1996, 10% of Canadian children ages 7-13 years were obese, with estimated economic costs of 1.8 billion (24). In 2004, just eight years later, this number is 50% higher with a prevalence of obesity at fully 15% of Canadian children (25).

Recent studies document a rise in psychological disorders in children reporting increasing incidence of bipolar disorder, depression and anxiety (26-29). A 2007 Canadian study reported 14% of children have a diagnosed mental health disorder (30). Associated behaviors may be confusing for parents, teachers and physicians, and could be easily misunderstood, possibly resulting in psychiatric diagnosis and prescription of psychotropic medication (31-34). Between 1991 and 1995, prescriptions for psychotropic medications in the 2 – 4 year old toddler population, as well as in children and youth tripled (35-37). 80% of this medication was prescribed by family physicians and pediatricians (38). 28-30% of children receiving psychotropic medication are on multiple medications (39). Limited high quality evidence guiding appropriate dosing and inexperience in documentation of long term effects of these prescriptions in children may mean that these children undergo unquantified risks (40-43).

III. Rationale

In primitive times, human beings engaged in physical labor, and sensory stimulation was natural and simple. Rapid advances in technology and transportation have resulted in a physically sedentary society with high frequency, duration and intensity of sensory stimuli (44). These environmental changes are happening faster than human being’s ability to adapt and evolve. Children who immerse themselves in virtual reality may exhibit signs of sensory deprivation, as they become disconnected from the world of physical play and meaningful interactions. Canadian parents spend an average 3.5 minutes per week participating in meaningful conversation with their children (45). Overuse of TV and videogames may result in children lacking essential connection with themselves, others and nature (46). Three critical factors for healthy physical and psychological child development are movement, touch and connection to other humans (47,48). Developing children require 2-3 hours per day of active rough and tumble play to achieve adequate stimulation to the vestibular, proprioceptive and tactile sensory systems (49). This type of sensory input ensures normal development of posture, bilateral coordination and optimal arousal states (50). Infants with low tone, toddlers failing to reach motor milestones, and children who are unable to pay attention or achieve basic foundation skills for literacy, are frequent visitors to pediatric physiotherapy, occupational therapy and speech and language clinics (51). The use of safety restraint devices such as infant bucket seats and toddler carrying packs and strollers, have further limited movement, touch and connection, as have TV and videogames. Many of today’s parents perceive outdoor play is ‘unsafe’ (52), limiting essential developmental components usually attained in outdoor rough and tumble play. Dr. Ashley Montagu reports that when children lack touch and human connection, they may respond by ‘turning in’ (anxiety, depression) or ‘turning out’ (aggression) (53). These complex behaviors may be confusing for parents, teachers and physicians, possibly leading psychiatric diagnosis and subsequent prescription of psychotropic medication.

In 2001 the American Academy of Pediatrics issued a policy statement recommending that children less than two years of age should not watch any TV or videogames (54). They further recommended that children older than two should restrict usage to one hour per day if they have any physical, mental or social problems, and two hours per day maximum if they don’t (55). Dr. Dimitri Christakis found that each hour of TV watched daily between the ages of 0 and 7 years equated to a 10% chance of attention problems by age seven years (56). Further evidence suggests some parents may have technology addictions (57). Adult Internet Addiction has been proposed for inclusion in the Diagnostic and Statistical Manual 5th Edition (58). This fact supports possible implementation of school based technology reduction programs. A randomized controlled trial of a 6-month classroom curriculum to reduce TV and videogame use resulted in statistically significant relative decreases in obesity (59). While no one can argue the benefits of advanced technology in today’s world, connection to these devices may have resulted in a disconnection from what society should value most, children. Rather than hugging, playing, rough housing, and conversing with children, parents are increasingly resorting to providing their children with more videogames, TV’s in the car, iPods, and cell phone devices, creating a deep and widening chasm between parent and child.

IV. Challenges

For Parents

Busy parents neglect children (60). Family connection to TV and videogames has caused a disconnection from each other. Children don’t know who they are anymore, as they identify more and more with characters on the screen. As use of violent media in the home correlates with family violence (61), family conflict is on the rise. Many adults have defaulted to being virtual parents, as life gets busier and parent connection with children and partners gets put on the back burner. As children’s physical, mental and social health continue to decline, parents respond with replacing the dining room table with the big screen, and installing TV’s in cars, kitchens and bedrooms. Health professionals need to be educated regarding TV and videogame addiction identification and treatment, and pass this information onto young parents (62). Parents need to understand the possible child behaviors associated with technology overuse, as well as the long term implications of diagnosing and medicating young children.

For Teachers

Teachers also have a large role to play in the diagnosis and medication of young children. Many parents report they have been told by their child’s school system that either the parents seek medical help, or they will put their child in a special education class (63). Teachers who have children on medication in their class will be the first to say these drugged children become more ‘manageable’, a further incentive to medicate more students, and contrary to popular belief, teachers may be surprised to know that Ritalin does not improve long term academic performance, results in lower grades over time, higher drop out rates, and lower university entrance (64). The Canadian education system supports physical and mental diagnoses with increased funding (65). Child achievement may also be a factor in the prescription of some psychotropic medication, due to the perception that some drugs enhance performance or give children that ‘edge’ they apparently need to succeed. Education professionals need to be informed regarding behaviors associated with TV and videogame addictions, and redesign programs and school environments to accommodate, not medicate, child behaviors.

For Physicians

Physicians and pediatricians have become the gatekeepers for diagnosing behavior, a necessary first step for school categorization to qualify for additional Canadian Ministry of Education funding. Physicians and pediatricians are provided incentives by pharmaceutical companies to support increased prescription of psychotropic medication to the general public, including children. Free drug samples, carnival-type gala dinners, subsidized holidays, are but a few of the ways drug companies get into the homes of unsuspecting parents, and lunch boxes of children. Parents and teachers might be shocked to learn that they are giving their children adult medications, for which there are no child dosage guidelines, nor long term studies (66,67). One option physicians may wish to consider when evaluating children for these concerns may be a program of lessening exposure to technology. Known as Unplug – Don’t Drug, a system that is fully explained at www.zonein.ca. Such a trial would require child and family undergo a three month period of unplugging from all forms of technology such as TV, videogames, iPods, computers and cell phones (other than as required for school and work purposes). Current practice would suggest that unless clear safety issues are present, such a trial may be beneficial prior to prescription of psychotropic medication. An Unplug – Don’t Drug trial may provide physicians and families with essential information regarding family environment and lifestyle, at the same time reducing the likelihood of further psychiatric or behavioral evaluation and treatment.

For Researchers

University researchers also unknowingly participate in this diagnosis and medication trend of young children. Advances in medical imaging technology have resulted in research initiatives focused on determining the genetic, anatomical or neurochemical cause for behavior, rather than looking at a child’s environment. Different parenting styles and TV and videogame usage should be required research parameters in far more studies. Nurture does change nature, and an abnormal CAT scan can be just as much due to poor parenting as genetics. Government could sponsor research initiatives that investigate environmental parameters regarding TV and videogame addictions and subsequent diagnosis and medication. Funding of studies that focus on parenting styles, level of attachment between parent and child, amount of time parent spends with child, family TV and videogame usage (frequency, duration, intensity of violence), and TV and videogame correlation with diagnosis and medication would be a few suggestions. Investigation of technology use in children with Autism, ADHD, depression, bipolar disorder, anxiety diagnostic categories would also be beneficial.

For Pharmaceutical Companies

Pharmaceutical company advertising for psychotropic drugs for children is now common place in parent, gardening and home magazines, showing well behaved children happily doing their homework. Preying on parents, the US pharmaceutical industry is a multimillion dollar annual business that has a mission to medicalize child behavior by advertising prescription medication to not only the health and education professionals, but now to parents (68). All advertising of medications in lay public magazines should be prohibited. All monetary and other types of rewards by pharmaceutical companies to physicians, pediatricians, child psychiatrists, and university researchers should be strictly prohibited.

V. Proposed Solution

The following school-based Creating Sustainable Futures program is proposed by Cris Rowan, pediatric occupational therapist and CEO of Zone’in Programs Inc. As TV, videogame and internet addictions are largely undetected by health and education professionals, and impact significantly on the mental and physical health and behavior of children, the proposed Creating Sustainable Futures program will be a first line initiative to address this pervasive and costly epidemic. The Creating Sustainable Futures program will serve to raise awareness regarding the negative effects of technology addictions, and will also provide intervention programs for elementary aged children in a school-based setting.

The school-based Creating Sustainable Futures has three components:

1. Occupational Therapist Instructor Training

The CSFP employs a “train the trainer” model where Cris Rowan will train and certify approximately 5-8 occupational therapists per province (or state) over a three day period. Following an internal evaluation procedure, qualified therapists will receive certification to teach three one-day Foundation Series Workshops to parents, as well as health and education professionals in their designated provincial or state region.

2. Foundation Series Workshops

The Foundation Series Workshops provide research based information regarding sensory and motor development (day one), attachment theory and the impact of technology on the developing child (day two), and restructuring of classroom, gym, recess and community settings to improve student performance (day three).

3. School Programs

Each school will be provided with the following three programs to address developmental delays, behavior challenges and technology addictions, to be implemented in every grade K to grade six classroom on a yearly basis.

Zone’in – improves sensory processing and attention through teaching self regulation.
Move’in – fine motor assessment and intervention to improve printing and reading skill.
Unplug’in – develops performance skills necessary for technology self-management.
Live’in – resource guide for schools and homes manage technology balance.

VI. Outcome Measures

The Creating Sustainable Futures Program is designed to improve children’s physical, psychological and behavioral health through balanced use of technology, as well as participation in alternate activities and exploration of nature. Outcomes measure assessments will be performed on a yearly basis.

  • Technology reduction – pre and post measurements will be obtained regarding school and non-school related technology usage for TV, videogames, hand-held gaming devices, internet, iPods, and cell phones (and any new technology released prior to this initiative).
  • Improvements in physical health – pre and post incidence statistics will be obtained from health government regarding incidence of physician visits by children, and from both health and education governments regarding diagnosis of physical disorders related to sedentary lifestyle e.g. obesity, diabetes, coordination disorders.
  • Improvements in psychological health – pre and post incidence statistics will be obtained from both health and education governments regarding diagnosis of psychological disorders e.g. depression, anxiety, bipolar disorder, sleep impairments and subsequent prescription of psychotropic medication.
  • Improvements in behavioral health – pre and post incidence statistics will be obtained from both health and education governments regarding diagnosis of behavioral disorders e.g. ADHD, autism.
  • Reduction in aggression – referrals to the office or administration can be monitored, as well as incidents of bullying and fights.

VII. Program Evaluation

The Zone’in Training, Workshops, and Programs will be piloted in a single school district per province or state for a one year period. Zone’in occupational therapy instructors will receive ongoing support and monitoring by Cris Rowan through monthly meetings, as well as Foundation Series Workshop participant evaluation summary report. Foundation Series Workshops will be evaluated by instructor using post-session participant questionnaires. School programs will be evaluated using pre/post student, teacher and administration questionnaires addressing improvements in student attention ability, printing and reading output speeds, and reduction in home and school technology use. Following collation of evaluation data, possible revisions may be required in one or all of the three intervention components. Province or state wide administration of the Creating Sustainable Futures programs subsequent to program revisions will be at the discretion of the CSFP Tri-Ministerial Advisory Committee.

VIII. Final Statement

In conclusion, evidence suggests that North American parents allow young children extended periods watching TV, using the internet or playing videogames. Further evidence suggests that this increased technology use is causally linked to increased incidence of child physical, mental and behavioral disorders, as well as poor academic performance and declining literacy. Parents, teachers and therapists are increasingly presenting children to physicians for assessment of complex behavior disorders that may be linked to the physical inactivity and sensory hypostimulation inherent in this use of technology, often resulting in psychotropic medication prescription. Children are our future. There is no sustainable future in virtual reality.

IX. Author Biography

Cris Rowan is a pediatric occupational therapist and sensory specialist with expertise in the impact of technology on child development. Having worked in a school setting for over a decade, Cris is committed to easing the job of learning for children. Cris is a well-known speaker and author to teachers, parents and therapists throughout North America on topics of sensory integration, learning, attention, fine motor skills and the impact of TV and videogames on children’s neurological development. Cris has a BSc’s both in Occupational Therapy and in Biology, is a SIPT certified sensory specialist, and has Approved Provider status by both the American and Canadian Occupational Therapy Associations, and Autism Community Training. Cris is author to the Unplug – Don’t Drug Policy Initiative and the Linking Corporations to Communities Initiative. Over the past decade, Cris has provided over 200 keynotes and workshops, is an expert reviewer for the Canadian Family Physician Journal, publishes the monthly Zone’in Development Series Newsletter, created the Zone’in, Move’in, Unplug’in and Live’in educational programs for schools and homes, and recently started Zone’in Training Programs for registered Occupational Therapists. Cris chairs the BCSOT Pediatric and Sensory Integration Special Interest Groups, has written numerous articles for media and international journals, and is writing a book Disconnect to Reconnect – Counteracting the Effects of Technology to Improve Child Performance at School and Home.

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XI. Contact Information

Cris Rowan, BScOT, BScBi, SIPT, Approved Provider AOTA
CEO Zone’in Programs Inc
6840 Seaview Rd.
Sechelt, BC V0N3A4
604-885-0986 p, 604-885-0389 f