Ethical Human Psychology and Psychiatry, Volume 12, Number 1, 2010
60 © 2010 Springer Publishing Company
Unplug — Don’t Drug:
A Critical Look at the Inﬂ uence
of Technology on Child Behavior
With an Alternative Way of Responding
Other Than Evaluation and Drugging
Zone’in Programs Inc., and
Sunshine Coast Occupational Therapy Inc.
Sechelt, British Columbia, Canada
The past decade has seen an increase in personal use of electronic technology, with
childhood television and video game use similarly increasing. Critical milestones for
child motor and sensory development are not being met. Simultaneously, there is an
increasing incidence of childhood physical, psychological, and behavior disorders, often
accompanied by the prescription of psychotropic medication. One in six children exhibit
signs of poor health, mental stress, or problems at school. Exposure to an average of
8 hours per day of various forms of technology use has resulted in a physically sedentary
yet chaotically stressed existence for Canadian children. The detrimental effects of tech-
nology use on critical milestones for child development are reviewed. This commentary
by a pediatric occupational therapist outlines issues of concern for parents, family physi-
cians, and pediatricians related to these trends and offers a novel treatment approach:
Unplug — Don’t Drug.
Keywords: developmental delay; child behavior management; technology addictions;
overmedication of children; balanced technology management
A 7-year-old boy was brought to his family physician’s ofﬁ ce by his mother at the urging
of his school. In attendance was his four 4-year-old sister. Discussion with the boy’s
mother indicated that although his reading was at age level, the boy apparently had
great difﬁ culty producing school work and listening or paying attention in class and
was reportedly “disruptive” and “aggressive.” The mother stated that her son had few
friends, preferring instead to spend his time alone in his room watching television or
playing video games. Initial assessment indicated that the son appeared pale with dark
circles under his eyes, slightly obese, lethargic, and noncommunicative. Following a
short period of questioning, the son became confrontational and combative with both
the physician and his mother, abruptly leaving the physician’s ofﬁ ce and returning to the
Reviewing the Impact of Technology on Child Development and Behavior 61
waiting room. As the mother began to apologize for her son’s behavior, the physician
began to take notice of the boy’s 4-year-old sister, who was positioned behind the mother.
When questioned regarding her daughter’s health, the mother responded that the daugh-
ter frequently became upset and demonstrated high anxiety when experiencing normal
everyday events. The mother went on to report that her daughter woke frequently in the
night “screaming,” was overly sensitive to noise and light, and appeared to be “hooked”
on cartoons— watching up to 6 hours per day.
CHILD HEALTH AND ACADEMIC PERFORMANCE
It wasn’t all that long ago that children were brought to their family physicians for fractures
or lacerations sustained from falling out of trees or off bicycles. Today’s ofﬁ ce visits are dif-
ferent. Physicians are now assessing and treating a variety of physical, psychological, and
behavioral disorders in children that appear to be escalating at an alarming rate. One in
six Canadian children have a diagnosed developmental disability (Hamilton, 2006), one
in six are obese (Canadian Institute of Health Research, 2004), and 14.3% have a diag-
nosed psychiatric disorder (Waddell Hua, Garland, DeV, & McEwan, 2007). School-based
occupational therapists observe increasing referrals of students to family physicians by their
teachers for either attention impairments or learning difﬁ culties. Subsequent child behav-
iors associated with these problems may be confusing for parents and teachers as well as
the medical community and could be easily misunderstood, possibly resulting in psychiatric
diagnosis and prescription of psychotropic medication (Mandell et al., 2008; Mukaddes,
Bilge, Alyanak, & Kora, 2000; Ruff 2005). Between 1991 and 1995, prescriptions for psy-
chotropic medications in the 2- to 4-year-old toddler population, as well as in children and
youth, tripled (dosReis et al., 2005; Goodwin, Gould, Blanco, & Olfson, 2001; Zito et al.,
2000; Zito et al., 2002), with 80% of this medication prescribed by family physicians and
pediatricians (Zito et al., 2003). Twenty-eight percent to 30% of children receiving psycho-
tropic medication are on multiple medications (dosReis, 2005). Limited evidence guiding
appropriate dosing and inexperience in the documentation of long-term effects of these
prescriptions in children may mean that these children undergo unquantiﬁ ed risks (Rosack,
2003; Kirsch & Antonuccio, 2004; Thomas, Conrad, Casler, & Goodman, 2006).
MEETING DEVELOPMENTAL MILESTONES
Throughout most of human history, child engagement in rough-and-tumble outdoor
play resulted in the achievement of adequate sensory and motor development required
for attention and learning (Ayres, 1972; Pelligrini & Bohn, 2005; Tannock, 2008).
Increased usage of advanced technology has resulted in a physically sedentary society
with sensory stimuli consisting of high frequency, duration, and intensity (Louv, 2005).
Parents now spend 40% less time with their children than they did in the 1970s
(Castro & Hewlett, 1991), impacting attachment development and socialization train-
ing. Children now immerse themselves for long durations in a virtual and often violent
world, disconnecting from the world of physical play and meaningful interactions. In
occupational therapy settings, children who overuse technology have described physical
sensations of “body shaking,” rapid heart rate and breathing, and hyperacute vision and
hearing. As these symptoms are typically associated with chronic high-adrenalin states
in adults, one cannot help but wonder if technology overuse is creating chronic stress
states in children. The three critical factors for healthy physical and psychological child
development are movement, touch, and connection to other humans (Insel & Young,
2001; Korkman, 2001; Montagu, 1972). Developing children require 3 to 4 hours per
day of unstructured, active rough-and-tumble play to achieve adequate stimulation to
the vestibular, proprioceptive, and tactile sensory systems (National Association for
Sport and Physical Education, 2002). This type of sensory input ensures normal devel-
opment of core posture, bilateral coordination, and optimal arousal states (Braswell &
Rine, 2006). 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 now frequent visitors to pediatric physiotherapy, occupational therapy, and speech
and language therapy clinics.
TECHNOLOGY USAGE STATISTICS
North American children now average 8 hours per day using a combination of non–
school-related technologies (television, video games, movies, the Internet, cell phones,
iPods, and other devices), with over 65% of children having televisions in their bedrooms
(Nielsenwire, 2009; Rideout, Vandewater, & Wartella, 2003; Roberts, Foehr, Rideout, &
Brodie, 1999). Active Healthy Kids Canada gave Canadian children a grade of D for
inactivity, citing television and video games as the primary cause (Active Healthy Kids
Canada, 2008). “Baby television” now occupies 2.2 hours per day for the 0- to 2-year-old
population and 4.5 hours per day for 3- to 5-year-olds, and 60% of households have the
television on all day (Nielsenwire, 2009; Rideout et al., 2003), as do a growing number of
restaurants, cars, and even physicians’ waiting rooms. Parents who perceive outdoor play
as “unsafe” allow higher usages of technology, further limiting access to developmental
components usually attained in outdoor rough-and-tumble play (Burdette & Whitaker,
2006 ). Continuous use of technology has pervaded 21st-century society, but at what cost
to child health and academic performance?
IMPACT OF TECHNOLOGY ON CHILD HEALTH
AND ACADEMIC PERFORMANCE
Technology overuse by young children is associated with developmental delays ( Thakkar,
Garrison, & Christakis, 2006; Zimmerman, Christakis, & Meltzoff, 2007), prompting
France to ban its broadcasters from airing television shows aimed at children under 3 years
of age (Canadian Broadcasting Corporation, 2008). Incidence of infant “ﬂ at head” has
increased 600% in the past 5 years, with over two-thirds of physiotherapists in the United
States reporting increasing incidence of infant “low tone” and subsequent failure to reach
motor milestones ( Jennings, 2005). Television and video game use is evidenced to be a
factor accounting for 60% of childhood obesity and is now considered a North American
“epidemic” by physicians (Tremblay & Willms, 2005; Strauss & Pollack, 2001). Addi-
tional studies indicate technology overuse by children may be associated with attention
Reviewing the Impact of Technology on Child Development and Behavior 63
difﬁ culties, poor academic achievement, and sleep impairment (Christakis & Zimmerman,
2007; Hancox, Milne, & Poulton, 2005; Paavonen, Pennonen, & Roine, 2006). Dr. Dimi-
tri Christakis found that each hour of television watched daily between the ages of 0 and
7 years equated to a 10% chance of attention problems by age 7 years (Christakis, Zimmer-
man, DiGiuseppe, & McCarty, 2004). While physical exercise has been repeatedly shown
to signiﬁ cantly improve academic performance (Ratey & Hagerman, 2008) and access to
“green space” signiﬁ cantly reduces attention deﬁ cit/ hyperactivity disorder and improves
attention (Faber Taylor, Kuo, & Sullivan, 2001; Kuo & Faber Taylor, 2004), schools con-
tinue to allow unrestricted technology use during recess and are allowing playgrounds to
fall into disrepair. While no one can argue the beneﬁ ts of advancing technology in today’s
world, many children are spending their days alone in dark rooms perfecting the “art of
killing.” Desensitized to violence and lacking empathy, today’s child who overuses tech-
nology is hardwiring his or her brain for violent high-speed and fast-paced action, resulting
in an unprecedented rise in child aggression, violence and crime (Anderson & Gentile,
2007; Anderson et al., 2008; Buchanan, Gentile, Nelson, Walsh, & Hensel, 2002; Murray
et al., 2006). In the United States, the Academies of Physicians, Pediatricians, Psycholo-
gists, and Psychiatrists have joined with the American Medical Association to classify
media violence as a public health risk because of its impact on child aggression, with even-
tual plans to legislate the regulation of media violence allowed for viewing by children
(Anderson et al., 2003). Neural pathway formation in children who overuse technology
is “short-circuiting” the frontal cortex, permanently altering the way children think and
behave, creating unimaginable problems for the education and penal systems (Small &
Vorgan, 2008; Ybarra et al., 2008). Twenty-ﬁ ve percent of elementary-aged children have
been cyberbullied (verbally bullied online), increasing their risk of carrying a weapon to
school by eight times (Kowalski & Limber, 2007; Ybarra, Diener-West, & Leaf, 2007).
Young children who “sextext” (e-mail nude photos using cell phones) are being arrested
for distribution of child pornography (Garﬁ nkle, 2008). These “crimes of technology”
indicate that many children do not have the maturity or the parental guidance to use
technology in a safe and responsible manner.
GUIDELINES AND RECOMMENDATIONS
In 2001, the American Academy of Pediatrics (AAP) released a policy statement rec-
ommending that children less than 2 years of age not watch any television or play any
video games (AAP, 2001). The AAP further recommended that children older than 2
should restrict usage to 1 to 2 hours per day (AAP, 2006). Relying on parents to impose
technology restrictions on their children may not be effective, as child technology usage
patterns often follow that of their parents (Jordan, Hersey, McDivitt, & Heitzler, 2006).
Furthermore, evidence suggests some parents may have technology addictions (Horvath,
2004). Adult Internet addiction has been proposed for inclusion in the ﬁ fth edition of
the Diagnostic and Statistical Manual of Mental Disorders (Block, 2008). These conditions
support consideration of a routine family technology usage history by primary care physi-
cians, pediatricians, child psychologists, and psychiatrists. One option physicians may
wish to consider when assessing and treating children who overuse technology might be
an initial recommendation of lessening exposure to technology while also encouraging
adequate movement, touch, and human connection. Known as “balanced technology
management,” recommendations might follow the guideline of an “hour in equals an
hour out”; for example, every hour of technology use is balanced with activities that
children need for healthy development and academic success. When assessing children
with signiﬁ cant psychiatric or behavior disorders who also overuse technology, physicians
might consider recommending a technology “family unplug” prior to lengthy diagnos-
tic procedures and/or use of psychotropic medication. Such a trial could require child
and family undergo a 3-month period of unplugging from all forms of technology, such
as television, video games, movies, iPods, the Internet, and cell phones (other than as
required for school and work purposes). Achieving balance between critical factors for
child growth and success, with use of technology, may reduce the increasing trend to
evaluate and medicate child behavior. See Figure 1.
In conclusion, evidence suggests that parents and schools allow young children extended
periods of unrestricted access to various forms of technology. Further evidence suggests
FIGURE 1. For physicians: Prescription pad graphic.
Reviewing the Impact of Technology on Child Development and Behavior 65
that parents are increasingly presenting their children to physicians for assessment of
complex behavior disorders that may be linked to the physical inactivity and sensory
hypostimulation inherent in the overuse of technology. Physician routine monitoring of
technology use through application of a family technology usage history would be a start
toward achieving eventual balanced technology management and signiﬁ cantly improve
the health and academic performance of children. Children with high technology usage
may beneﬁ t from a technology “unplug” trial of 1 month prior to behavior diagnosis and
prescription of psychotropic medication. Medical professionals may consider support of
school-based media literacy programs, which have proven effective in reducing technol-
ogy use and obesity (Robinson, 1999). Recommendations for family disconnection from
technology and reconnection with each other and nature would go a long way toward
reversing these worrisome societal trends.
Active Healthy Kids Canada. (2008). 2008 report card. Retrieved December 12, 2009, from http://
American Academy of Pediatrics. (2001). Committee on public education: Children, adolescents
and television. Pediatrics, 107 (2), 423– 426.
American Academy of Pediatrics. (2006). Committee on communications, children, adolescents
and advertising. Pediatrics, 118 (6), 2562–2569.
Anderson , C. A., Berkowitz, L., Donnerstein, E., Huesmann, L. R., Johnson, J. D., Linz, D., et al.
(2003). The inﬂ uence of media violence on youth. Psychological Science in the Public Interest,
Anderson, C., & Gentile, D. (2007). Violent video game effects on children and adolescents . Oxford:
Oxford University Press.
Anderson , C. A., Sakamoto, A., Gentile, D. A., Ihori, N., Shibuya, A., Yukawa, S., et al. (2008).
Longitudinal effects of violent video games on aggression in Japan and the United States.
Pediatrics, 122 (5), 1067 –1072.
Ayres, J. A. (1972). Sensory integration and learning disorders . Los Angeles: Western Psychological
Block, J. J. (2008). Issues for DSM -V: Internet addiction. Journal of Clinical Psychiatry, 67 (5),
82 – 826.
Braswell , J., & Rine, R. (2006). Evidence that vestibular hypofunction affects reading acuity in chil-
dren , International Journal of Pediatric Otorhinolaryngology, 70 (11), 1957–1965.
Buchanan, A. M., Gentile, D. A., Nelson, D. A., Walsh, D. A., & Hensel, J. (2002). What goes
in must come out: Children’s media violence consumption at home and aggressive behaviours at
School. Paper presented at the International Society for the Study of Behavioural Develop-
ment Conference, Ottawa, Ontario, Canada. Available: http://www.mediafamily.org/research/
Burdette, H. L., & Whitaker, R. C. (2006). A national study of neighborhood safety, outdoor play,
television viewing, and obesity in preschool children. Pediatrics, 116, 657– 662.
Canadian Broadcasting Corporation. (2008, August 20). France pulls plug on TV shows aimed
at babies . Retrieved December 12, 2009, from http://www.cbc.ca/world/story/2008/08/20/
Canadian Institutes of Health Research. (2004). Addressing childhood obesity: The evidence for action
[Evidence report January 12, 2004]. Retrieved December 12, 2009, from http://www.cihr-irsc.
Castro, J., & Hewlett, S. A. (1991, August 26). Watching a generation waste away. Time, p. 10.
Christakis, D. A., & Zimmerman, F. J. (2007). Violent television during preschool is associated with
antisocial behavior during school age. Pediatrics, 120, 993 – 999.
Christakis, D. A., Zimmerman, F. J., DiGiuseppe, D. L., & McCarty, C. A. (2004). Early television
exposure and subsequent attentional problems in children. Pediatrics, 113 (4), 708 –713.
dosReis, S., Zito, J. M., Safer, D. J., Gardner, J. F., Puccia, K. B., & Owens, P. L. (2005). Multiple
psychotropic medication use for youths: A two-state comparison. Journal of Child and Adolescent
Psychopharmacology, 15 (1), 68 –77.
Faber Taylor, A., Kuo, F. E., & Sullivan, W. C. (2001). Coping with ADD: The surprising connec-
tion to green play settings. Journal of Environment and Behavior, 33 (1), 54 –77.
Garﬁ nkle, S. (2008, December 10). Sex + text = sextexting . Retrieved December 12, 2009, from
Goodwin, R., Gould, M. S., Blanco, C., & Olfson, M. (2001). Prescription of psychotropic medica-
tions to youth in ofﬁ ce-based practices. Psychiatric Services, 52 (8), 1081–1087.
Hamilton, S. (2006). Screening for developmental delay: Reliable, easy-to-use tools. Journal of
Family Practice, 55 (5), 416 – 422.
Hancox, R. J., Milne, B. J., & Poulton, R. (2005). Association of television during childhood
with poor educational achievement. Archives of Pediatric and Adolescent Medicine, 159 (7),
614 – 618.
Horvath, C. W. (2004). Measuring television addiction. Journal of Broadcasting and Electronic Media,
48 (3), 378 –398.
Insel, T. R., & Young, L. J. (2001). The neurobiology of attachment. Nature Reviews Neuroscience,
Jennings, J. T. (2005). Conveying the message about optimal infant positions. Physical and Occupa-
tional Therapy in Pediatrics, 25 (3), 3 –18.
Jordan, A. B., Hersey, J. C., McDivitt, J. A., & Heitzler, C. D. (2006). Reducing children’s
television-viewing time: A qualitative study of parents and their children. Pediatrics, 118 (5),
Kirsch, I., & Antonuccio, D. (2004, February). FDA testimony on the efﬁ cacy of antidepressants
with children. Retrieved December 12, 2009, from http://www.ahrp.org/risks/SSRI0204/
Korkman, M. (2001). Introduction to the special issue on normal neuropsychological development
in the school-age years. Developmental Neuropsychology, 20 (1), 325–330.
Kowalski, R. M., & Limber, S. P. (2007). Electronic bullying among middle school students. Journal
of Adolescent Health, 41, S22–S30.
Kuo, F. E., & Faber Taylor, A. (2004). A potential natural treatment for attention-deﬁ cit/ hyper-
activity disorder: Evidence from a national study. American Journal of Public Health, 94 (9),
Louv, R. (2005). Last child in the woods: Saving our children from nature-deﬁ cit disorder . New York:
Mandell, D. S., Morales, K. H., Marcus, S. C., Stahmer, A. C., Doshi, J., & Polsky, D. E. (2008). Psy-
chotropic medication use among Medicaid-enrolled children with autism spectrum disorders.
Pediatrics, 121 (3), 441– 449.
Montagu, A. (1972). Touching: The human signiﬁ cance of the skin (2nd ed.). New York: Harper & Row.
Mukaddes, N. M., Bilge, S., Alyanak, B., & Kora, M. E. (2000). Clinical characteristics and treat-
ment responses in cases diagnosed as reactive attachment disorder. Child Psychiatry and Human
Development, 30 (4), 273–287.
Murray, J., Liotti, M., Ingmundson, P., Mayberg, H., Pu,Y., Zamarripa, F., et al. (2006). Children’s
brain activations while viewing televised violence revealed by fMRI. Media Psychology, 8 (1),
Reviewing the Impact of Technology on Child Development and Behavior 67
National Association for Sport and Physical Education. (2002). Active start: A statement of physical
activity guidelines for children from birth to age 5 (2nd ed.). Retrieved December 12, 2009, from
Neilsenwire. (2009). Americans watching more TV than ever: Web and mobile video up too . Retrieved
December 12, 2009, from http:// blog.nielsen.com/nielsenwire/online_mobile/americans-watch
Paavonen, E. J., Pennonen, M., & Roine, M. (2006). Passive exposure to TV linked to sleep prob-
lems in children. Journal of Sleep Research, 15, 154 –161.
Pelligrini, A. D., & Bohn, C. M. (2005). The role of recess in children’s cognitive performance and
school adjustment. Educational Researcher, 34 (1), 13–19.
Ratey, J. J., & Hagerman, E. (2008). Spark: The revolutionary new science of exercise and the brain . New
York: Little, Brown.
Rideout, V. J., Vandewater, E. A., & Wartella, E. A. (2003). Zero to six: Electronic media in the lives of
infants, toddlers and preschoolers. Menlo Park, CA: Kaiser Family Foundation.
Roberts, D. F., Foehr, U. G., Rideout, V. J., & Brodie, M. (1999). Kids and media @ the millennium:
A comprehensive national analysis of children’s media use. Menlo Park, CA: Kaiser Family
Robinson, T. (1999). Reducing children’s television viewing to prevent obesity. Journal of the
American Medical Association, 282 (16), 1561–1567.
Rosack, J. (2003). Prescription data on youth raise important questions. American Psychiatric
Foundation — Clinical and Research News, 38 (3), 1– 3.
Ruff, M. E. (2005). Attention deﬁ cit disorder and stimulant use: An epidemic of modernity. Clinical
Pediatrics, 44 (7). 557– 563.
Small, G., & Vorgan, G. (2008). iBrain: Surviving the technological alteration of the modern mind .
New York: HarperCollins.
Strauss, R. S., & Pollack, H. A. (2001). Epidemic increase in childhood overweight, 1986 –1998.
Journal of the American Medical Association, 286 (22), 2845 –2848.
Tannock, M. T. (2008). Rough and tumble play: an investigation of the perceptions of educators and
young children. Journal of Early Childhood Education, 35, 357–361.
Thakkar, R. R., Garrison, M. M., & Christakis, D. A. (2006). A systematic review for the effects of
television viewing by infants and preschoolers. Pediatrics, 118, 2025–2031.
Thomas, C. P., Conrad, P., Casler, R., & Goodman, E. (2006). Trends in the use of psychotropic
medications among adolescents, 1994 to 2001. Psychiatric Services, 57 (1), 63– 69.
Tremblay, M. S., & Willms, J. D. (2005). Is the Canadian childhood obesity epidemic related to
physical inactivity? International Journal of Obesity, 27, 1100 –1105.
Waddell , C., Hua, J. M., Garland, O., DeV, Peters R., & McEwan, K. (2007). Preventing mental
disorders in children: A systematic review to inform policy-making. Canadian Journal of Public
Health, 98 (3), 166 –173.
Ybarra, M. L., Diener-West, M., & Leaf, P. J. (2007). Examining the overlap in internet harassment
and school bullying: Implications for school intervention. Journal of Adolescent Health, 41,
Ybarra, M. L., Diener-West, M., Markow, D., Leaf, P. J., Hamburger, M., & Boxer P. (2008). Linkages
between internet and other media violence with seriously violent behavior by youth. Pediatrics,
122 (5), 929– 937.
Zimmerman, F. J., Christakis, D. A., & Meltzoff, A. N. (2007). Television and DVD/video view-
ing in children younger than 2 years. Archives of Pediatric Adolescent Medicine, 161 (5),
Zito , J. M., Safer, D. J., dosReis, S., Gardner, J. F., Boles, M., & Lynch F. (2000). Trends in the
prescribing of psychotropic medications to preschoolers. Journal of the American Medical Asso-
ciation, 283, 1025–1030.
Zito, J. M., Safer, D. J., dosReis, S., Gardner, J. F., Boles, M., & Lynch F. (2002). Rising prevalence
of antidepressants among U.S. youth. Pediatrics, 109 (5), 721–727.
Zito, J. M., Safer, D. J., dosReis, S., Gardner, J. F., Magder, L., Soeken, K., et al. (2003). Psychotropic
practice patterns for youth. Archives of Pediatric and Adolescent Medicine, 157 (1), 17–25.
Correspondence regarding this article should be directed to Cris Rowan, CEO, Zone’in Programs Inc.
and Sunshine Coast Occupational Therapy Inc., 6840 Seaview Road, Sechelt, British Columbia
V0N3A4, Canada. E-mail: firstname.lastname@example.org