Healthy Interactions

Supporting Research Literature

American Academy of Pediatrics, Committee on Communications (2006) Children, Adolescents, and Advertising. Pediatrics Vol 118 No 6, 2562-2569. This paper points out that exposure of children to TV advertising correlates with obesity, poor nutrition, and cigarette and alcohol use.

American Academy of Pediatrics, Committee on Public Education (2001) Children, Adolescents, and Television. Pediatrics Vol 107(2), 423-426. This policy statement describes the negative effects of television viewing as violent or aggressive behavior, substance use, sexual activity, obesity, poor body image, and decreased school performance. This statement recommends no TV or videogames for toddlers under the age of 2, and a limit of 1-2 hours per day for children.

Antonuccio D, Burns D, Danton W (2002) Antidepressants: A Triumph of Marketing Over Science? Prevention and Treatment, Vol 5 No 1, July 2002 pages 1-21. The authors of this paper performed a meta-analysis of the Food and Drug Administration database of 38 controlled trials on 6,944 patients used in the initial approval for the most popular anti-depressants (fluoxetine, paroxetine, sertraline, venlafaxine, nefazadone and citalopram). Kirsch I, Moore T, Scoboria A, and Nicholls S (2002) found that antidepressants demonstrated and clinically negligible advantage over inert placebo, and state how these results are surprising because they come from studies underwritten by drug manufacturers. Doesn’t this imply that it is an ‘industry standard’ to assume that drug trials by pharmaceutical companies are essentially biased (C. Rowan comment)? The meta-analysis goes on to state that these finding do not appear to justify the popularity of anti-depressants, which may have been fueled in part by publication bias and outstanding marketing. This paper reports that the US pharmaceutical industry is a $250 million annual business, of which $19 million goes to advertising, making it the most profitable industry in America, number one in return on revenues, return on assets, and return on equity (Fortune 2000). Surprised? Read on. The pharmaceutical industry had a combined lobbying and campaign contribution budget of $197 million in 1999 and 2000 alone, larger that any other industry (Wayne and Peterson 2001), and has 625 registered lobbyists (more than there are members of congress)!

Block, J (2008) Issues for DSM – V: Internet Addiction. American Journal of Psychiatry Vol 165 March pg 306-307. This editorial advocates for inclusion of Internet Addiction into the upcoming fifth edition of the psychiatric Diagnostic and Statistical Manual. Conceptually the diagnosis is a compulsive-impulsive spectrum disorder that involves online and offline computer usage, and consists of three subtypes: excessive gaming, sexual preoccupations and email/text messaging. All of the variants share the following four components: 1) excessive use 2) withdrawal 3) tolerance 4) negative repercussions.

Burdette, H and Whitaker R (2005) A National Study of Neighborhood Safety, Outdoor Play, Television Viewing, and Obesity in Preschool Children. Pediatrics Vol 116, 657-662. This study reports that mother’s perceptions of safety was related to their children’s TV viewing time.

Castro J and Hewlett SA (1991) Watching a Generation Waste Away. Time Magazine Monday August 26, 1991. This interview with Janice Castro, author of When the Bough Breaks: The Cost of Neglecting Our Children, highlights concerns about the family, and reports that Americans treat their children like “excess baggage” and view children rearing as “some sort of expensive hobby”. Castro reports 60% of working moms have no maternity leave, parents spend 40% less time with their children than 15 years ago, 24% of children grow up without fathers, teen suicides have tripled since 1960, one third of students drop out prior to finishing high school, and since ’71 we have seen psychiatric hospital admissions increase from 16,000 to 263,000 (of which 80% have no fathers). Castro ends the interview by stating “Only a society that cherishes its children deserves to survive”.

Christakis D and Zimmerman F (2007) Violent Television During Preschool Is Associated With Antisocial Behavioural During School Age. Pediatrics Vol 120, 993-999. This study concluded that violent television programming was associated with an increased risk for antisocial behaviour for boys, but not for girls.

Christakis D, Zimmerman F, DiGiuseppe and McCarty C (2004) Early Television Exposure and Subsequent Attentional Problems in Children. Pediatrics Vol 113, 708-713. This study reports that for every one hour of television watched per day, there is a 10% increase in attention problems by the age of 7 years.

Diller LH (1999) Running on Ritalin: A Physician Reflects on Children, Society, and Performance of a Pill. Published by Bantam Publishing. Dr. Diller, a Pediatrician explores the escalation of diagnosis of American children with ADHD and treatment with Ritalin, and highlights how research often obscures social or environmental factors. Dr. Diller points out that it is misleading to hold that Ritalin’s success in treating ADHD children means that ADHD can be reduced to biological phenomenon, to chemical imbalance. Diller convincingly suggests that part of the reason that many wish to portray ADHD as a purely ‘neurobiological’ disorder and Ritalin is the ‘cure’ is political. As victims of biology, children and adults diagnosed with ADHD become legally entitled to rights not given to others. But so what? If Ritalin helps those diagnosed with ADHD perform better, what difference does it make whether it treats the causes of ADHD or just the symptoms? Diller’s answer is that America should be concerned because the 700% increase in Ritalin use points to societal imbalance that prescribing the drug covers up: “The surge in ADHD diagnosis and Ritalin treatment is a warning to society that we are not meeting the needs of our children”. Whether or not one entirely accepts Diller’s argument is that American psychiatrists have ignored the evidence against Ritalin’s effectiveness as a cure for ADHD, this is an important book for anyone interested in the narcoticising of America’s youth.

Elkind D (2007) The Hurried Child: Growing Up Too Fast Too Soon. Published by Da Capo Press, New York City, USA. David Elkind has often been referred to as the voice of parenting reason, calling our attention to the crippling effects of hurrying our children through life. He shows that by blurring the boundaries of what is age appropriate, by expecting-or imposing-too much to soon, we force our children to grow up too fast, to mimic adult sophistication while secretly yearning for innocence. Dr. Elkind provides a detailed, up to the minute look at the internet, classroom culture, school violence, movies, television, and a growing societal instability to show parents and teachers where hurrying occurs and why. He offers parents and teachers insight, advice and hope for encouraging healthy development while protecting the joy and freedom of childhood.

Field T, Ironson G, Scafidi F, Nawrocki T, Gonclaves A, Burman I, Pickens J, Fox N, Schanberg S Kuhn C (1996) Massage Therapy Reduces Anxiety and Enhances Eeg Pattern of Alertness and Math Computations. Journal of Neurocsience, Vol 86, Issue 3 & 4, pages 197-205. This study reports that two 15 minute massages per week to a group of 26 adults raised frontal delta power (suggesting relaxation), decreased frontal alpha and beta power (suggesting increased alertness), increased speed and accuracy on math exams, lowered anxiety, lower salivary Cortisol levels, lower depression scores on the Chronic POMS Depression Scale.

Fisher R and Fisher S (1996) Antidepressants for Children – Is Scientific Support Necessary? The Journal of Nervous and Mental Disease Vol 184 No 2 pages 99-102. This article is concerned with issues pertaining to the degree to which clinical therapeutic decisions can reasonably depart from the best available scientific data, and state that ambiguity exists as to how much freedom practitioners have to accept or reject the existing scientific paradigm.

Goodwin R, Gould M, Blanco C, Olfson M (2001) Prescription of Psychotropic Medications to Youths in Office-Based Practice. Psychiatric Services Vol 52 No 8 pp 1081-1087. The study reports 84.8% of prescriptions for psychotropic medications were provided by general practitioners or pediatricians. 53.9% of psychotropic medications prescribed were stimulants, 30% antidepressants, 7.2% anxiolytics, 7.2% antipsychotics, 12.7% mood stabilizers.

Hancox R, Milne B and Poulton R (2005) Association of Television During Childhood With Poor Educational Achievement. Archives of Pediatric and Adolescent Medicine Vol 159 No 7, 614-618. This study concluded that television viewing in childhood and adolescence is associated with poor educational achievement by 26 years of age.

Healy J (1999) Endangered Minds: Why Children Don’t Think and What We Can Do About It. Simon and Schuster Publishing Company.

Healy J (1998) Failure to Connect: How Computers Affect Our Children’s Minds – For Better or For Worse. Simon and Schuster Publishing Company.

Healy J (1990) Endangered Minds: Why Children Don’t Think – and What We Can Do About It. Simon and Schuster Publishing Company, New York. An awesome ‘text book’ and a ‘must read’ for all educators and parents regarding the escalating educational crisis for our children resulting from TV and videogames. Dr. Healy reviews neurological research and analyzes current educational practices, and makes numerous recommendations for how to get our educational systems and our children back on track.

Hewlett SA (1992) When the Bow Breaks: The Cost of Neglecting Our Children. Published by HarperCollins Publishing Co., Toronto, Canada. Sylvia Ann Hewlett is an economist, consultant, lecturer and a volunteer with homeless children and has written a powerful, extensively researched and often shocking book that explores the plight of the vast number of our children today. She delves into a multitude of problems – substance abuse, emotional instability and broken homes that contribute to parental and public neglect. Hewlett also outlines ways society can help to rectify this situation, including educational reform, changes in the workplace, and government policies. The author’s approach to the harsh reality of neglect stirs the emotions and will no doubt cause a public reaction. This book is of great interest to professionals and general readers, as it is a well documented; compelling study that fully analyzes a nation wide problem.

Horvath C (2004) Measuring Television Addiction. Journal of Broadcasting and Electronic Media Vol 48(3), 378-398. Information from this paper was used in the design of the Zone’in “TVVG Help Module for Parents and Teachers”.

Jordan A, Hersey J, McDivitt J and Heitzler C (2006) Reducing Children’s Television-Viewing Time: A Qualitative Study of Parents and Their Children. Pediatrics Vol 118, 1303-1310. This study profiles barriers to reducing TV viewing time such as parents using TV as a safe and affordable distraction, parent’s own heavy TV viewing patterns, the prominent role TV plays in the family’s day to day routine, and a belief that children should spend their leisure time as they wish.

Kirsch I and Antonuccio D (2004) FDA Testimony On the Efficacy of Antidepressants With Children. Review of this testimony indicates that there are a total of 12 published randomized clinical trials in the entire world literature regarding the efficacy of antidepressant use with children. 8 of these 12 trials failed to find any significant benefit of medication over placebo, and the other 4 that did show benefit were clinician rated, not patient rated measures. This testimony also reports that overall, the effects of antidepressant medication on children is actually weaker than in adults.

Landhuis C, Poulton R, Welch D and Hancox R (2007) Does Childhood Television Viewing Lead to Attention Problems in Adolescence? Pediatrics Vol 120, 532-537. This study found that not only does childhood television viewing contribute to attention problems in adolescence, but that these effects may be long lasting.

Louv, Richard (2005) Last Child in the Woods – Saving Our Children From Nature-Deficit Disorder. Algonquin Books of Chapel Hill, NY and Thomas Allen and Son Limited, Canada. In his groundbreaking work about the staggering divide between children and the outdoors, journalist and child advocate Richard Louv directly links the absence of nature in the lives of today’s wired generation to some of the most disturbing childhood trends: the rise in obesity, attention disorders and depression. This is the first book to bring together a body of research indicating that direct exposure to nature is essential for healthy childhood development and physical and emotional health. More than just raising the alarm, Louv offers practical solutions to heal the broken bond.

Mandell D, Morales K, Marcus S, Stahmer A, Doshi J, and Polsky D (2008). Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders. Pediatrics Vol 121 No 3 pp e441-e449. This study reports that 56% of Medicaid-Enrolled children with diagnosed Autism were taking one psychotropic medication, and 20% were taking > three. Use was common even in children 0-2 years old (18%) and 3-5 years old (32%). Neuroleptic drugs were the most common class (31%), followed by antidepressants (25%) and stimulants (22%). Children who lived in countries with lower percentage of white residents were less likely to use medication.

Mate’ G (2008) In the Realm of Hungry Ghosts: Close Encounters with Addition. Published by Knopf Canada Publishing, Toronto. Dr. Maté’s book eloquently offers a more sympathetic and informed view of human addictions. Dr. Maté looks at the root causes of addiction, applying a clinical and psychological view to the physical manifestation and offering some enlightening answers for why people inflict such catastrophe on themselves. He takes aim at the hugely ineffectual US led war on drugs, challenging the wisdom of fighting drugs instead of aiding the addicts.

Mental Health: A Report of the Surgeon General, Overview of Mental Disorders in Children. This paper describes the general categories of mental disorders in children, assessment and treatment strategies, and goes into depth regarding psychopharmacology treatments stating that 1) there are no short or long term studies regarding safety and efficacy of psychotherapeutic medication in children, 2) there is limited information regarding the pharmacokinetics (drug concentrations in body over time), and 3) combined effectiveness of drugs and psychosocial treatments is rare. This report goes on to say that when the FDA approves a medication for general population use, approval is based on studies conducted on adults only. Therefore when a practitioner prescribes an “off label” drug for a child, the practitioner is required to “guess” the dosage parameters. Due to reluctance by the pharmaceutical companies to perform drug research on children as it was reportedly too “costly”, the US Congress subsequently passed the FDA Modernization Act 1999 Title 21 USC 505A (g) to create financial incentives for pharmaceutical companies to perform clinical research on children.

Michael K and Crowley S (2002) How Effective are Treatments for Child and Adolescent Depression? A Meta-Analytic Review. Clinical Psychology Review, Vol 22 pages 247-269. The authors of this paper reviewed and analyzed comprehensive sample 38 studies from 1980 – 1999 on the psychosocial and pharmacological treatment of child and adolescent depression and showed that while the psychosocial interventions provided moderate to large treatment gains, the pharmacological interventions were not effective in treating depressed children and adolescents.

Mistry K, Minkovitz, Strobino D and Borzekowski D (2007) Children’s Television Exposure and Behavioural and Social Outcomes at 5.5 Years: Does Timing of Exposure Matter? Pediatrics Vol 120, 762-769. This study reports that by the age of 5.5 years 41% of children had televisions in their bedrooms, and that television exposure was associated with fewer social skills, and poor sleep.

Mukaddes N, Bilge S, Alyanak B, Kora M (2000) Clinical Characteristics and Treatment Responses in Cases Diagnosed as Reactive Attachment Disorder. Child Psychiatry and Human Development Vol 30(4), 273-287. This study was conducted on 15 children with RAD who were misdiagnosed with PDD, and found that 66.6% of RAD children were exposed to 7.26 hours of TV use per day with age of onset at 7.16 months, and conclude that “excessive TV exposure might be a form of neglect that is specific for RAD patients”.

Murphy-Berman V and Wright G (1987) Measures of Attention. Perceptual and Motor Skills Vol 64 pages 1139-1143. This study measured vigilance and reaction time independently and reports that these are two separate skills. Authors also report that children with faster reaction time could handle a faster presentation of stimuli on the vigilance task, and suggest that children self-pace to match their actual attention capabilities.

Murray J, Liotti M, Ingmundson P, Mayberg H, Pu Y, Zamarripa f, Liu Y, Woldorff M. Gao J, and Fox P (2006) Children’s Brain Activations While Viewing Televised Violence Revealed by fMRI. Media Psychology Vol 8 No 1, 25-37. fMRI’s of eight children showed that TV violence viewing recruits a network of brain regions involved in the regulation of emotion, arousal and attention, episodic memory encoding and retrieval, and reports that extensive TV violence viewing may result in a large number of aggressive scripts stored in long-term memory in the posterior cingulated, which facilitates rapid recall of aggressive scenes that serve as a guide for overt social behavior.

Nelson M, Neumark-Stzainer D, Hannan P, Sirard J and Story M (2006) Longitudinal and Secular Trends in Physical Activity and Sedentary Behavior During Adolescence. Pediatrics Vol 118 No 6 1627-1634. This study documents increased computer use correlates with decreased physical activity.

Paavonen E, Pennonen M and Roine M (2006) Passive Exposure to TV Linked to Sleep Problems in Children. Journal of Sleep Research Vol 15, 154-161. This study documents that active TV viewing was correlated with sleep-wake transition disorders.

Pelligrini A. and Bohn C. (2005) The Role of Recess in Children’s Cognitive Performance and School Adjustment. Educational Researcher Vol 34 No 1, 13-19. This study reports that providing breaks over the course of a child’s school day enhances their ability to attend and learn. This study also reports that kindergarteners’ playground social behaviour was a significant factor in first grade achievement, and discussed that the playground may be the only area where “latch-key” kids get to socialize with their peers. This study support Zone’in premise that children learn first with their bodies, then their brain, and supports Zone’in recommendations that children should employ a variety of movement techniques to optimize learning.

Rideout V, Vandewater E and Wartella E (2003) Zero To Six: Electronic Media In The Lives of Infants, Toddlers and Preschoolers. The Henry J Kaiser Family Foundation Report, California. This report documents the recent explosion of electronic media targeted at the very youngest of children 0-6 years of age, and states that 99% of homes have a TV, 36% have a TV in their bedrooms, 50% have a videogame player, and 73% have a computer. Despite the fact that the American Academy of Pediatrics recommends toddlers under the age of 2 years should not use ANY electronic media, 68% use electronic media daily, 25% have TV’s in their bedrooms and average use is 2 hours 5 minutes per day. Regarding extent of TV usage, children are less likely to read in high use homes, TV use is not income dependent, but that there is less usage in homes where one parent holds a college degree.

Roberts D, Foehr U, Rideout V, Brodie M (1999) Kids and Media at the New Millennium: A Comprehensive National Analysis of Children’s Media Use. The Henry J Kaiser Family Foundation Report, California. This report documents that children spend on average 6.5 hours per day of combined media use (TV, videogames, computers), and 32% of 2-7 year olds and 65% of 8-18 year olds have TV’s in their bedrooms.

Rosack J (2003) Prescription Data on Youth Raise Important Questions. American Psychiatric Foundation – Clinical and Research News Vol 38 No 3 pp1-3. This interview with Julie Zito’s regarding her 2003 study reports that psychotropic prescriptions for children and adolescents rose between 200% and 300% between 1987 and 1996, and that between 5.9% and 6.3% of all youth were prescribed at least one psychotropic medication. Extrapolation for an additional 250% increase for the next ten year period from 1997 to 2006 would yield figures of between 14.75% and 15.75%. Interview with Peter Jensen, MD advocates for increased education and training of family practitioners, and points out the problems of attaining accurate psychiatric diagnosis for children, as there are only 7,500 child and adolescent psychiatrists in the US, and 12-17 million children and adolescents with psychiatric problems (20% of < 18 year old population).

Ruff, M (2005) Attention Deficit Disorder and Stimulant Use: An Epidemic of Modernity. Clinical Pediatrics Vol 44 pg 557. An excellent article that raises many pertinent questions regarding the prevalent drugging of ‘borderline’ ADHD children, and advocates for increased research into environmental as opposed to biological medication justification. Great lines are “When did prescribing stimulants go from success to excess”, “Nature is designed for and needs nurture”, with reference to parents of ADHD children “The apple doesn’t fall far from the tree, and if the tree subsists with suboptimal soil and moisture, it will not produce good fruit”, “We are an impulsive, impatient culture with a free-floating sense of time urgency that feeds on rapidly changing trends”, “The brain allocates neural real estate, depending on what we use most”. Dr. Ruff is concerned that if we are already giving stimulants to borderline ADHD children, will we also give them the new Alzheimer memory enhancer drugs as well? Dr. Ruff eloquently points out that if we ban physical performance enhancing drugs for athletes, shouldn’t we also ban academic enhancing drugs for students? Dr. Ruff goes on to state “Researchers should be required to reveal just how much compensation, in the course of a year, they are afforded by the drug companies. We may then be able to better assess the merit of their conclusions and recommendations”.

Spotts P (2003) Chemical Kids. The Christian Science Monitor, March 6, 2003 edition. This author looks at some of the reasons behind the trend in over-prescribing psychotropic medications to children listed as: research explosion in the 80′s and 90′s caused a shift toward attributing kid’s behavioral problems to physiological causes with subsequent medication prescription, skyrocketing healthcare costs caused outsourcing of psychiatric services to for-profit clinics who found drugs cheaper than counseling, physician pressure from teachers and parents. This article points out that up to 25% of ADHD diagnoses are actually children who have a sleep disorder.

Thakkar R, Garrison M and Christakis D (2006) A Systematic Review for the Effects of Television Viewing by Infants and Preschoolers. Pediatrics Vol 118, 2025-2031. This study points out that although viewing educational programs broadens young children’s knowledge, viewing of cartoon content has a negative effect on children’s attentional abilities.

Thomas C, Conrad P, Casler R, Goodman E (2006) Trends in the Use of Psychotropic Medications Among Adolescents, 1994 to 2001. Psychiatric Services Vol 57 No 1 pp63-69. This study reports that rates oif visits that resulted in psychotropic prescription increased from 3.4% in 1994-1995 to 8.3% in 2000-2001, and reports that by 2001, one out of every ten office visits for adolescent males resulted in a psychotropic medication prescription.

Thompson, D and Christakis D (2005) The Association Between Television Viewing and Irregular Sleep Schedules Among Children Less Than 3 Years of Age. Pediatrics Vol 116, 851-856. This study reports that the total number of hours of TV watched per day was associated with irregular nap and bedtime schedules.

Vandewater E, Lee J and Shim M (2005) Family Conflict and Violent Electronic Media Use in School-Aged Children. Media Psychology Vol 7 No 1, 73-86. This research showed that family conflict is positively related to violent electronic media use, and that family tensions will be reflected in children’s interest in media with violent content.
Waldman M, Nicholson S and Adilov N (2006) Does Television Cause Autism? Cornell University, New York. This study showed that heavy TV use prior to age 3 years positively correlates to increase in prevalence of Autism.

Walson P (1999) Patient Recruitment: US Perspective. Pediatrics Vol 104 No 3 pages 619-622. This paper describes the difficulties in patient recruitment of children for clinical drug trials as the following: identification of eligible patient population, explaining the study, obtaining true informed consent, maintaining ethical standards, recruiting adequate, representative sample, retaining subjects until study completion, and minimizing the risk/benefit ratio. I suppose it would be difficult to convince a parent they should enroll their child in a clinical trial of a drug that has not been proven effective (C. Rowan comment).

Welch M, MD (1989) Holding Time. Published by Simon and Schoester, New York. In this fascinating book written by Dr. Martha Welch, child psychiatrist and president of The Mothering Center at Cos Cob, Connecticut describes a technique called ‘forced holding’, where the mother holds the child close to her on her lap, as if she were nursing the child, and doesn’t let go! Even if the child squirms and screams, the mother hangs onto the child, maintaining essential eye contact and repeating to the child ‘I love you’ over and over again. While this technique has met mixed reviews, it does offer interesting information regarding the mother child connection, and offers families with children with Autism an alternative technique for establishing bonding.

Zimmerman F, Christakis D and Meltzoff A (2007) Television and DVD/Video Viewing in Children Younger Than 2 Years. Archives of Pediatric Adolescent Medicine Vol 161 No 5, 473-479. This study showed that by 3 months of age, 40% of children regularly watched television, DVD’s or videos, and by 24 months 90%. Average duration rose form 1 hour per day for children less than one year old to 1.5 hours by 24 months.

Zimmerman F and Christakis D (2007) Associations Between Content Types of Early Media Exposure and Subsequent Attentional Problems. Pediatrics Vol 120, 986-992. This study showed that viewing of television prior to age 3 was significantly associated with attention problems.

Zito, J, Safer D, dosReis S, Gardner J, Boles M, Lynch F (2000) Trends in the Prescribing of Psychotropic Medications to Preschoolers. Journal of the American Medical Association Vol 283 No 8 pp 1025-1030. This study reports a dramatic increase in the prescription of psychotropic medication between 1991 and 1995 to two to four year old children; 28.2-fold for Clonidine (sedative), 3.0-fold for stimulants, and 2.2-fold for antidepressants. Authors report that these findings are “remarkable, in light of the limited knowledge base that underlies psychotropic medication use in very young children”. This study reports reasons for increased use are: expanded diagnostic criteria, more girls being treated for ADHD, greater acceptance for using biological treatment for behavioral disorders, expanded role of school and preschool personnel in identifying medical needs. Authors report grave concerns regarding the rise of prescriptions for Clonidine in conjunction with Ritalin due to lack of studies.