By JANE E. BRODY

Excessive use of computer games among young people in China appears to be taking an alarming turn and may have particular relevance for American parents whose children spend many hours a day focused on electronic screens. The documentary “Web Junkie,” to be shown next Monday on PBS, highlights the tragic effects on teenagers who become hooked on video games, playing for dozens of hours at a time often without breaks to eat, sleep or even use the bathroom. Many come to view the real world as fake.

Chinese doctors consider this phenomenon a clinical disorder and have established rehabilitation centers where afflicted youngsters are confined for months of sometimes draconian therapy, completely isolated from all media, the effectiveness of which remains to be demonstrated.

While Internet addiction is not yet considered a clinical diagnosis here, there’s no question that American youths are plugged in and tuned out of “live” action for many more hours of the day than experts consider healthy for normal development. And it starts early, often with preverbal toddlers handed their parents’ cellphones and tablets to entertain themselves when they should be observing the world around them and interacting with their caregivers.

In its 2013 policy statement on “Children, Adolescents, and the Media,” the American Academy of Pediatrics cited these shocking statistics from a Kaiser Family Foundation study in 2010: “The average 8- to 10-year-old spends nearly eight hours a day with a variety of different media, and older children and teenagers spend more than 11 hours per day.” Television, long a popular “babysitter,” remains the dominant medium, but computers, tablets and cellphones are gradually taking over.

“Many parents seem to have few rules about use of media by their children and adolescents,” the academy stated, and two-thirds of those questioned in the Kaiser study said their parents had no rules about how much time the youngsters spent with media.

Parents, grateful for ways to calm disruptive children and keep them from interrupting their own screen activities, seem to be unaware of the potential harm from so much time spent in the virtual world.

“We’re throwing screens at children all day long, giving them distractions rather than teaching them how to self-soothe, to calm themselves down,” said Catherine Steiner-Adair, a Harvard-affiliated clinical psychologist and author of the best-selling book “The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age.”

Before age 2, children should not be exposed to any electronic media, the pediatrics academy maintains, because “a child’s brain develops rapidly during these first years, and young children learn best by interacting with people, not screens.” Older children and teenagers should spend no more than one or two hours a day with entertainment media, preferably with high-quality content, and spend more free time playing outdoors, reading, doing hobbies and “using their imaginations in free play,” the academy recommends.

Heavy use of electronic media can have significant negative effects on children’s behavior, health and school performance. Those who watch a lot of simulated violence, common in many popular video games, can become immune to it, more inclined to act violently themselves and less likely to behave empathetically, said Dimitri A. Christakis of the Seattle Children’s Research Institute.

In preparing an honors thesis at the University of Rhode Island, Kristina E. Hatch asked children about their favorite video games. A fourth-grader cited “Call of Duty: Black Ops,” because “there’s zombies in it, and you get to kill them with guns and there’s violence … I like blood and violence.”

Teenagers who spend a lot of time playing violent video games or watching violent shows on television have been found to be more aggressive and more likely to fight with their peers and argue with their teachers, according to a study in the Journal of Youth and Adolescence.

Schoolwork can suffer when media time infringes on reading and studying. And the sedentary nature of most electronic involvement — along with televised ads for high-calorie fare — can foster the unhealthy weights already epidemic among the nation’s youth.

Two of my grandsons, ages 10 and 13, seem destined to suffer some of the negative effects of video-game overuse. The 10-year-old gets up half an hour earlier on school days to play computer games, and he and his brother stay plugged into their hand-held devices on the ride to and from school. “There’s no conversation anymore,” said their grandfather, who often picks them up. When the family dines out, the boys use their devices before the meal arrives and as soon as they finish eating.

“If kids are allowed to play ‘Candy Crush’ on the way to school, the car ride will be quiet, but that’s not what kids need,” Dr. Steiner-Adair said in an interview. “They need time to daydream, deal with anxieties, process their thoughts and share them with parents, who can provide reassurance.”

Technology is a poor substitute for personal interaction.

Out in public, Dr. Steiner-Adair added, “children have to know that life is fine off the screen. It’s interesting and good to be curious about other people, to learn how to listen. It teaches them social and emotional intelligence, which is critical for success in life.”

Children who are heavy users of electronics may become adept at multitasking, but they can lose the ability to focus on what is most important, a trait critical to the deep thought and problem solving needed for many jobs and other endeavors later in life.

Texting looms as the next national epidemic, with half of children aged 12 to 17 sending and receiving 60 or more text messages a day, Amanda Lenhart of the Pew Research Center found in a study released in 2012. An earlier study by researchers at JFK Medical Center found that teenagers send an average of 34 texts a night after they get into bed, adding to the sleep deprivation so common and harmful to them. And as Ms. Hatch pointed out, “as children have more of their communication through electronic media, and less of it face to face, they begin to feel more lonely and depressed.”

There can be physical consequences, too. Children can develop pain in their fingers and wrists, narrowed blood vessels in their eyes (the long-term consequences of which are unknown), and neck and back pain from being slumped over their phones, tablets and computers.

The American Academy of Pediatrics and the Canadian Society of Pediatrics state infants aged 0-2 years should not have any exposure to technology, 3-5 years be restricted to one hour per day, and 6-18 years restricted to 2 hours per day (AAP 2001/13, CPS 2010). Children and youth use 4-5 times the recommended amount of technology, with serious and often life threatening consequences (Kaiser Foundation 2010, Active Healthy Kids Canada 2012). Handheld devices (cell phones, tablets, electronic games) have dramatically increased the accessibility and usage of technology, especially by very young children (Common Sense Media, 2013). As a pediatric occupational therapist, I’m calling on parents, teachers and governments to ban the use of all handheld devices for children under the age of 12 years. Following are 10 research-based reasons for this ban.
1. Rapid brain growth
Between 0 and 2 years, infant’s brains triple in size, and continue in a state of rapid development to 21 years of age (Christakis 2011). Early brain development is determined by environmental stimuli, or lack thereof. Stimulation to a developing brain caused by overexposure to technologies (cell phones, internet, iPads, TV), has been shown to be associated with executive functioning and attention deficit, cognitive delays, impaired learning, increased impulsivity and decreased ability to self-regulate, e.g. tantrums (Small 2008, Pagini 2010).
2. Delayed Development
Technology use restricts movement, which can result in delayed development. One in three children now enter school developmentally delayed, negatively impacting literacy and academic achievement (HELP EDI Maps 2013). Movement enhances attention and learning ability (Ratey 2008). Use of technology under the age of 12 years is detrimental to child development and learning (Rowan 2010).
3. Epidemic Obesity
TV and video game use correlates with increased obesity (Tremblay 2005). Children who are allowed a device in their bedrooms have 30% increased incidence of obesity (Feng 2011). One in four Canadian, and one in three U.S. children are obese (Tremblay 2011). 30% of children with obesity will develop diabetes, and obese individuals are at higher risk for early stroke and heart attack, gravely shortening life expectancy (Center for Disease Control and Prevention 2010). Largely due to obesity, 21st century children may be the first generation many of whom will not outlive their parents (Professor Andrew Prentice, BBC News 2002).
4. Sleep Deprivation
60% of parents do not supervise their child’s technology usage, and 75% of children are allowed technology in their bedrooms (Kaiser Foundation 2010). 75% of children aged 9 and 10 years are sleep deprived to the extent that their grades are detrimentally impacted (Boston College 2012).
5. Mental Illness
Technology overuse is implicated as a causal factor in rising rates of child depression, anxiety, attachment disorder, attention deficit, autism, bipolar disorder, psychosis and problematic child behavior (Bristol University 2010, Mentzoni 2011, Shin 2011, Liberatore 2011, Robinson 2008). One in six Canadian children have a diagnosed mental illness, many of whom are on dangerous psychotropic medication (Waddell 2007).
6. Aggression
Violent media content can cause child aggression (Anderson, 2007). Young children are increasingly exposed to rising incidence of physical and sexual violence in today’s media. “Grand Theft Auto V” portrays explicit sex, murder, rape, torture and mutilation, as do many movies and TV shows. The U.S. has categorized media violence as a Public Health Risk due to causal impact on child aggression (Huesmann 2007). Media reports increased use of restraints and seclusion rooms with children who exhibit uncontrolled aggression.
7. Digital dementia
High speed media content can contribute to attention deficit, as well as decreased concentration and memory, due to the brain pruning neuronal tracks to the frontal cortex (Christakis 2004, Small 2008). Children who can’t pay attention can’t learn.
8. Addictions
As parents attach more and more to technology, they are detaching from their children. In the absence of parental attachment, detached children can attach to devices, which can result in addiction (Rowan 2010). One in 11 children aged 8-18 years are addicted to technology (Gentile 2009).
9. Radiation emission
In May of 2011, the World Health Organization classified cell phones (and other wireless devices) as a category 2B risk (possible carcinogen) due to radiation emission (WHO 2011). James McNamee with Health Canada in October of 2011 issued a cautionary warning stating “Children are more sensitive to a variety of agents than adults as their brains and immune systems are still developing, so you can’t say the risk would be equal for a small adult as for a child.” (Globe and Mail 2011). In December, 2013 Dr. Anthony Miller from the University of Toronto’s School of Public Health recommend that based on new research, radio frequency exposure should be reclassified as a 2A (probable carcinogen), not a 2B (possible carcinogen). American Academy of Pediatrics requested review of EMF radiation emissions from technology devices, citing three reasons regarding impact on children (AAP 2013).
10. Unsustainable
The ways in which children are raised and educated with technology are no longer sustainable (Rowan 2010). Children are our future, but there is no future for children who overuse technology. A team-based approach is necessary and urgent in order to reduce the use of technology by children. Please reference below slide shows on www.zonein.ca under “videos” to share with others who are concerned about technology overuse by children.
Problems – Suffer the Children – 4 minutes
Solutions – Balanced Technology Management – 7 minutes
The following Technology Use Guidelines for children and youth were developed by Cris Rowan, pediatric occupational therapist and author of Virtual Child; Dr. Andrew Doan, neuroscientist and author of Hooked on Games; and Dr. Hilarie Cash, Director of reSTART Internet Addiction Recovery Program and author of Video Games and Your Kids, with contribution from the American Academy of Pediatrics and the Canadian Pediatric Society in an effort to ensure sustainable futures for all children.

Technology Use Guidelines for Children and Youth