Brief Report: Television Viewing and Risk for Attention Problems in
Carlin J. Miller,1,4PHD, David J. Marks,2PHD, Scott R. Miller,2,4PHD, Olga G. Berwid,1,3MA,
Elizabeth C. Kera,1,3MA, Amita Santra,1,3MA, and Jeffrey M. Halperin,1,2,3PHD
1Department of Psychology, Queens College, City University of New York,2Division of Child and Adolescent
Psychiatry, The Mount Sinai School of Medicine,3Neuropsychology Doctoral Subprogram, Graduate Center,
City University of New York, and4Department of Psychology, University of Windsor
problems and hyperactivity in preschool children.
hyperactivity and impulsivity, objectively measured activity level, and parental estimation of early television
exposure were collected for a sample of preschool children. Separate linear regression analyses were
conducted with parent and teacher behavioral ratings and objectively assessed activity level as outcome
variables.Results Results indicated that after controlling for demographic factors (i.e., age, sex, and SES),
television exposure accounted for a significant proportion of the variance in teacher ratings of inattentive/
hyperactive behaviors, as well as objectively measured activity level.
replicate those from a recent, highly publicized study indicating a correlation between television exposure
and attention-deficit/hyperactivity disorder (ADHD)-associated behaviors. However, it remains unclear as
to whether elevated levels of television viewing are the cause or result of ADHD symptoms.
This study examined whether high levels of television viewing are associated with attention
Methods Parent and teacher ratings of inattention,
Conclusions These findings partially
Key words ADHD; preschool; television.
Attention-deficit/hyperactivity disorder (ADHD) is among
the most common psychiatric disorders in children
(Lahey et al., 1994) and represents a significant factor
in many referrals for psychological evaluations (Demaray,
Schaefer, & Delong, 2003). There is a wealth of research
to suggest that ADHD is a multifactorial disorder with
both genetic and nongenetic/environmental contributing
One environmental factor that has received recent
attention is television viewing during early childhood.
After controlling for a number of risk factors, a recent
study reported that television viewing at ages 1 and 3
years predicted attention problems at 7 years of age
(Christakis, Zimmerman, DiGiuseppe, & McCarty, 2004).
These findings generated considerable media attention.
Nevertheless, an important limitation of that study was
the index of attention problems, which was based on
five questions that were unlikely to truly capture
the characteristics of ADHD. Parents were asked if
the child had ‘‘difficulty concentrating,’’ was ‘‘easily
confused,’’ was ‘‘impulsive,’’ had ‘‘trouble with obses-
sions,’’ or was ‘‘restless.’’ Scoring for each item was
collapsed into a dichotomous system, and children
were classified into groups of those with and without
attention problems with the cutoff score of 1.2 standard
deviations above the mean on the index of attention
problems. Although the authors noted that this was
not equivalent to a diagnosis of ADHD, symptoms
were assumed to be consistent with an ADHD diagnosis.
In a subsequent study, a Danish research group was
robust assessment of ADHD-related behaviors (Obel
et al., 2004).
Television is a ubiquitous part of life for many
families and young children spend considerable time
watching television (Certain & Kahn, 2002). As such,
knowledge regarding the relationship between the amount
of early television viewing to attentional and behavioral
All correspondence concerning this article should be addressed to Carlin J. Miller, PHD, Department of Psychology,
University of Windsor, 193 Chrysler Hall South, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4. E-mail:
Journal of Pediatric Psychology 32(4) pp. 448–452, 2007
Advance Access publication September 30, 2006
Journal of Pediatric Psychology vol. 32 no. 4 ? The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: email@example.com
by guest on June 9, 2013
functioning, and potentially the emergence of ADHD,
is of considerable public health concern.
In light of the equivocal nature of the previous
findings and the omnipresent nature of television in
contemporary society, we sought to replicate the findings
in a sample of children where we could use more
comprehensive and valid ratings, as well as an objective
measure of ADHD-related behaviors while controlling
for a limited number of demographic factors. Specifically,
we examined the relationships of parent and teacher
ratings, as well as objectively measured activity level,
to early television viewing.
One hundred and seventy children (105 boys, 65 girls)
were recruited from community preschools as part of
a longitudinal study of young children at risk for ADHD.
Children were recruited using ADHD checklists com-
pleted by parents and teachers, with those in the control
group exhibiting three or fewer symptoms of ADHD
(n¼54), and those at-risk for ADHD exhibiting at least
six symptoms of inattention or hyperactivity/impulsivity
by either parent or teacher report (n¼116). The mean
age for the sample was 4.31 years (SD¼0.51 years;
range¼2.90–5.87). Among the participants, 37.1% were
non-Hispanic Caucasian, 7.6% were African American,
16.5% were of Asian descent, 14.1% were Hispanic,
and 24.7% were of ‘‘other or mixed ethnicity’’ according
to demographic data obtained from the parents. The
families were of primarily middle class status with a mean
SES score of 61.70 (SD¼17.32) on a measure of socio
economic prestige (Nakao & Treas, 1994), although
a wide distribution of economic levels were represented
(range¼20–97). Mean estimated IQ, based on the
Information subtest of the Wechsler Preschool and
Primary Scales of Intelligence – Revised (Wechsler,
1989), was within the average range with a scaled score
of 10.87 (SD¼3.17); estimated FSIQ?80 was required
for inclusion in the study.
Children and their parents participated in a full
assessment battery as part of the larger study. There were
no gender or ethnic restrictions, but both the children
and their parents were required to be English-speaking.
Children diagnosed with mental retardation, a pervasive
developmental disorder, a diagnosed neurological dis-
order (e.g., epilepsy), or those who were taking systemic
medication for a chronic medical condition were excluded
from participation. The larger project from which this
study was derived was approved by the Queens College
Institutional Review Board, and parents gave informed
consent for their child to participate.
Information about the amount of time participants
typically spent watching television was gathered during
a semistructured interview. Parents were asked to
estimate the average number of hours their child spent
watching television or videos during both a typical
weekday and weekend day. To calculate the mean
hours of daily television exposure, the typical weekday
time was multiplied by five (number of weekdays per
week) and the typical weekend day time was multi-
plied by two (number of weekend days per week). The
two values were added and then divided by seven to
calculate the average number of hours spent watching
television during a typical day. The mean number of
hours spent watching television per day in this sample
procedure was the same as that used by Christakis
and colleagues (Christakis et al., 2004).
Parents and teachers were asked to complete checklists
based on ADHD symptoms listed in the DSM-IV as part
of the child’s participation in the project. The checklists
consisted of the 18 ADHD behaviors listed in DSM-IV,
which were rated on a 4-point scale (0¼not at all;
1¼just a little; 2¼pretty much; and 3¼very much).
Raters were asked to rate behavior over the last 6 months.
Ratings were summed across questions separately for
each informant yielding total possible scores from 0
to 54. The mean DSM-IV teacher checklist sum was
15.80 (SD¼16.80; range¼0–51). The mean DSM-IV
parent checklist sum was 16.78 (SD¼12.29; range
0–53). Previous research indicates that this type of
checklist is a reliable and valid assessment tool for
appropriate for use with diverse populations (Reid
et al., 1998). Child’s age was modestly, but significantly,
correlated with parent (r¼.15, p¼.05) but not teacher
(r¼.05; p>.10) reports of ADHD symptoms. Parent and
teacher reports were significantly correlated with each
other (r¼.54, p<.001).
Each child’s motor activity during the 2hr standardized
one-on-one assessment session was recorded using
two solid-state actigraphs worn around the waist and
nondominant ankle. Theactigraphs utilizeinternal
Television Viewing and Attention Problems
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accelerometers to record number of movements per unit
time. Descriptive statistics for activity in 1min epochs
were generated separately for each child’s ankle and
waist actigraph. Previous research suggests that recorded
activity level can be reliably measured using actigraphs
and is correlated with parent and teacher reports
of activity level (Reichenbach, Halperin, Sharma, &
Newcorn, 1992). Actigraphs have also been found to
discriminate between hard-to-manage preschool boys
from controls (Campbell, Pierce, March, Ewing, &
Szumowski, 1994), as well as clinically referred youth
with and without ADHD (Halperin, Matier, Bedi, Sharma,
& Newcorn, 1992).
Waist and ankle actigraph data were combined by
calculating the mean of the waist and ankle medians for
each child. This procedure was chosen to reduce the
number of dependent variables and to reflect the child’s
global activity level. When data from only ankle or waist
actigraph were available because of equipment malfunc-
tion (16 participants), regression equations based on the
entire sample were used to estimate the likely mean.
Composite actigraph scores obtained in the laboratory
were significantly correlated
p<.001) and parent (r¼.23, p<.01) ADHD ratings.
Regression equations were constructed with variables
entered hierarchically in blocks with pairwise deletion
of missing variables. For each outcome variable (summary
parent-reported ADHD symptoms, and actigraph data),
three demographic variables (age, sex, and SES) were
entered in the first block as covariates, and television
viewing was entered in the second block. Both the
amount of unique variance explained in the outcome
variable and the standardized beta coefficients were of
Results from the three regression equations are presented
in Table I. The demographic covariates accounted for
7.4% (p¼.008) of the variance in parent ratings
of ADHD symptoms. Television viewing accounted for
another 2.1% (p¼.06) of the variance in parent ratings.
Likewise, the demographic covariates accounted for
11.5% (p<.001) of the variance in teacher ratings of
ADHD behaviors and television viewing accounted for
an additional 5.3% (p¼.002) of the variances in teacher
ratings. In contrast to subjective ratings, demographic
covariates accounted for only 1.1% (p>.10) of the
variance in activity level as measured by the actigraphs;
television viewing added 4.2% (p¼.01) to the variance
Post hoc analyses were conducted to determine
whether dividing the ratings from the ADHD checklists
into separate inattention and hyperactivity–impulsivity
components would shed further light on the findings.
However, results did not differ from DSM ADHD
ratings submitted to the regression model as a unitary
This study examined whether demographic factors and
television viewing are associated with inattention and
hyperactivity in preschool children. These relationships
were examined using parent and teacher reports, as well
as objectively measured activity level. The results were
similar to the findings of Christakis and colleagues
(Christakis et al., 2004). Although demographic char-
acteristics accountfor some
behaviors, television viewing was significantly associated
with objectively measured activity level, as well as
teacher reports of these behaviors, after adjusting for
Table I. Summary of Regression Results
R2change Total R2
Beta weights reflect predictive influence of each variable in the final equation.
?p<.05, **p<.01, ***p<.001.
Miller et al.
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demographic variables. Parent reports were only margin-
ally associated with television viewing.
Despite using a different study design, the similarity
of our findings to those of the recent study is notable.
Using a large, epidemiologically sound sample, Christakis
and colleagues demonstrated a predictive relationship
between television viewing and later parent-rated atten-
tion problems. Both studies employed the same measure
of television viewing. However, perhaps owing to the
smaller and more manageable sample size, we were
able to use more comprehensive measures of ADHD
behaviors, which were obtained both from parents
and teachers, as well as objective laboratory measures of
activity level. Taken together, the findings from the two
studies clearly indicate an association between television
viewing and reports of behavioral difficulties associated
Due to our cross-sectional design, inferences regard-
ing causation and direction of effects must be made
extremely cautiously. Thus, it is difficult to determine
whether high levels of television viewing cause greater
inattention and overactivity, or whether being more active
and oftentimes troublesome results in children being
‘‘attended to’’ by the television in increasing amounts
because children with attention problems and high levels
of activity are perceived by parents to be more difficult to
parent (Barkley, 1995).
Due to their longitudinal study design, Christakis
et al. (2004) interpreted their findings to indicate that
elevated levels of television viewing resulted in attention
problems. However, even within the context of a
longitudinal design, this type of causal inference must
be viewed cautiously. It is well-known that the behaviors
associated with ADHD are quite stable, and that these
children are very ‘‘difficult to manage’’ during the
preschool years (Campbell et al., 1994). As such, it is
quite likely that those in their sample who were most
inattentive at 7 years of age were also difficult to manage
earlier. As such, it is still possible that they were in front
of the television during the preschool years more than
their peers as a result of their difficult behavior. This
potential confound could be teased out if behavioral
ratings were also available from early childhood in these
Yet, it is not unreasonable to posit a relationship
between excessive television viewing and later attentional
difficulties. Activities such as television viewing are
highly reinforcing to children, with minimal requirements
of effortful processing (Shiffrin & Schneider, 1984).
In view of neurodevelopmental processes, such as
synaptic pruning and dendritic aborization, which are
highly experience dependent, it would not be surprising
to find adverse cognitive consequences, such as inatten-
tion, linked to excessive television viewing. However,
in view of its very early onset and the high proportion
of variance accounted for by genes (Swanson et al.,
2001), we believe that it is unlikely that television viewing
has a formidable role in the emergence of ADHD.
On the other hand, one also needs to consider the
possibility that more difficult children spend more time
watching television because of their behavioral difficulties.
As described above, children with ADHD are far more
difficult to manage than typically developing preschoolers;
as such, television can provide a break for overwhelmed
or underskilled parents. The fact that the association with
television viewing was observed on both subjective and
objective measures indicates that these difficulties are
not specific to the perception of a particular person.
A confluence of factors related to the child’s behavior
may influencethe amount
First, the television could serve as a surrogate babysitter
for the parent. In addition, it is well-known that
children with ADHD are highly responsive to continuous
reinforcement (Wigal et al., 1998) and that they
oftentimes do not appear inattentive or hyperactive in
settings that provide high levels of interesting stimulation.
As such, not only would parents of children with ADHD
be reinforced by their child’s television viewing, but the
children also are likely to gravitate to such stimulation.
Such a scenario could be quite concerning as children
enter school and expect high levels of stimulation in
the classroom environment similar to what they experi-
ence while watching television.
The limitations of this study do not diminish the
veracity of the positive, and potentially disturbing,
association between television viewing and ADHD-related
behaviors as assessed via parent and teacher ratings.
It is likely that many physicians, teachers, and other
professionals who work with families of young children
encourage parents to seek activities other than television
viewing for their preschool children. However, this
recommendation may have particular importance to
parents of children with behavioral difficulties because
of their tendency for social isolation and their need
for the development of social skills.
This research was supported by NIMH grant # R01
The authors would like to acknowledge the invaluable
Television Viewing and Attention Problems
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assistance of Laura Bart, Taneka Wellington, and William
Conflict of Interest: None declared.
Received March 7, 2006; revisions received June 7, 2006
and August 23, 2006; accepted September 11, 2006
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