Article

Sleeping, TV, Cognitively Stimulating Activities, Physical Activity, and ADHD Symptom Incidence in Children: A Prospective Study

Authors:
  • University of Zurich, Epidemiology, Biostatistics and Prevention Institute
  • RTI Health Solutions, Barcelona, Spain
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Objective: To analyze associations between time spent sleeping, watching TV, engaging in cognitively stimulating activities, and engaging in physical activity, all at 4 years, and (1) attention-deficit/hyperactivity disorder (ADHD) symptoms and (2) behavior problems, both assessed at 7 years, in ADHD-free children at baseline. Method: In total, 817 participants of the Infancia y Medio Ambiente birth cohort, without ADHD at baseline, were included. At the 4-year follow-up, parents reported the time that their children spent sleeping, watching TV, engaging in cognitively stimulating activities, and engaging in physical activity. At the 7-year follow-up, parents completed the Conners' Parent Rating Scales and the Strengths and Difficulties Questionnaire, which measure ADHD symptoms and behavior problems, respectively. Negative binomial regression models were used to assess associations between the activities at 4 years and ADHD symptoms and behavior problems at 7 years. Results: Children (48% girls) spent a median (p25-p75) of 10 (10-11) hours per day sleeping, 1.5 (0.9-2) hours per day watching TV, 1.4 (0.9-1.9) hours per day engaging in cognitively stimulating activities, and 1.5 (0.4-2.3) hours per day engaging in physical activity. Longer sleep duration (>10 hours per day) was associated with a lower ADHD symptom score (adjusted incidence rate ratio = 0.97, 95% confidence interval, 0.95-1.00). Longer time spent in cognitively stimulating activities (>1 hours per day) was associated with lower scores of both ADHD symptoms (0.96, 0.94-0.98) and behavior problems (0.89, 0.83-0.97). Time spent watching TV and engaging in physical activity were not associated with either outcomes. Conclusion: A shorter sleep duration and less time spent in cognitively stimulating activities were associated with an increased risk of developing ADHD symptoms and behavior problems.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... There are 3 different versions of the SDQ according to whom answers the questionnaire: parents, teachers, or self-reported, the latter only for children aged 10-16 years. 21 A cohort study 22 published in 2018 aimed to assess the relationship between time spent watching TV and behavioral and emotional problems using a sample of Spanish children aged 4 years at baseline and 7 years at the end of the follow-up. This study concluded that there was no association between time spent watching TV and the development of behavioral and emotional problems. ...
... Our results are in contrast with a cohort study 22 published in 2018 of a sample of school-aged children from 2 regions of Spain, which showed no association between time spent watching TV and risk of behavioral problems. This discrepancy might be due to the fact that this research only included TV time to compute the screen time variable. ...
Article
Objective: To assess the relation between leisure screen time and emotional and behavioural problems in Spaniards aged 4-14 years. Study design: This cross-sectional study used a representative sample of children aged 4-14 years included in the 2017 Spanish National Health survey (n=4,073). Emotional and behavioural problems of children were assessed through the Parental Strengths and Difficulties Questionnaire. Daily leisure screen time in minutes was categorized as: 0-59, 60-119, 120-179, and ≥180. We calculated adjusted prevalence ratios (aPR) and their 95% confidence intervals (95% CI) of being at risk of developing emotional and behavioural problems. Associations were adjusted for potential confounding variables. Results: Children spending 180 minutes or more of daily leisure screen time compared with children spending less than one hour were more likely to be at risk of developing emotional and behavioural problems: aPR≥180: 2.19 (95% CI 1.53,3.14), emotional symptomology: aPR≥180: 2.09 (95% CI 1.37,3.18), conduct problems aPR≥180: 1.85 (95% CI 1.34,2.54), peer problems aPR≥180: 1.78 (95% CI 1.15,2.75) and to behave less prosocially: aPR≥180: 2.20 (95% CI 1.43,3.37). Conclusions: We have found significant associations between daily leisure screen time and emotional and behavioural problems in Spanish children between 6 and 14 years. However, these findings should be confirmed in cohort studies, so institutions might consider including screen time as a new risk factor for children.
... An unhealthy diet combined with limited physical activity is associated with a higher risk of chronic diseases later in life (Booth et al., 2012). Sleeping problems and less time spent in activities that stimulate cognitive function have a big impact on developing ADHD and behavior problems (Peralta et al., 2018) . With that being said, ADHD is individually associated with one mode of behavior, with several variables that may be interrelated. ...
Article
Full-text available
Eating habits of individuals with learning and behavioral difficulties is an important and emerging area of nutrition expertise. An unhealthy diet, combined with limited physical activity, is linked with an increased risk of chronic diseases and a lower quality of life. The study aims to review in a systematic way evidence on: (a) the relationship between diet quality and ADHD; and (b) the effect of three lifestyle factors, physical activity, quality of sleep, and stress on children and adults with ADHD. In December 2020, we searched for relevant articles in PubMed and Scopus. The studies included were those that assessed diet, physical activity, sleep, and stress, of children and adults with ADHD. We identified a total of eighteen studies with an invasive and observational approach that matched our research criteria. Fourteen of these studies were included in the meta-analysis. The pooled analysis showed that a high-diet quality decreases the prevalence of ADHD in children (OR: 0.43, 95% CI: 0.28-0.70), while a poor diet quality is associated with an increased risk of ADHD in both children and adults (OR: 2.24, 95% CI: 1.49-3.65). Also, a poor lifestyle indicates a higher prevalence of ADHD in both children and adults (OR: 1.90, 95% CI: 1.43-2.61). This study is limited to its ability to extract data from some of the included studies while sampling was limited due to the absence of studies in adults with ADHD. The present study suggests that a high-quality diet with increased consumption of fruits, vegetables, and fish, may be protective against ADHD in children. On top of that, a poor-quality diet with higher consumption of sugar, sweetened drinks, and junk food, as well as a lifestyle that is characterized by reduced sleep and physical activity can be associated with increased risk of ADHD, for both children and adults. The current domain needs more experimental data
... To date, there is no consensus regarding the direction of the sleep-ADHD association, despite evidence showing that sleep deprivation and sleep disturbances have known cognitive emotional and behavioural effects that mimic ADHD (Coogan and McGowan 2017;Mehta et al. 2019;Tso et al. 2019), and that early sleep disturbances are associated with an increased risk of ADHD later in life (Armstrong et al. 2014;Gregory et al. 2017;Peralta et al. 2017;Carpena et al. 2019;Tso et al. 2019). The TSMR analyses showed a 743 744 745 746 747 748 749 750 751 752 753 754 755 756 757 758 759 760 761 762 763 764 765 766 767 768 769 770 771 772 773 774 775 776 777 778 779 780 781 782 783 784 785 786 787 788 789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 816 817 818 819 820 821 822 823 824 825 826 827 828 829 830 831 832 833 834 835 836 837 838 839 840 841 842 843 844 845 846 847 848 causal effect of insomnia, daytime napping, and short sleep duration on ADHD. ...
Article
Full-text available
Objectives To evaluate the shared genetic components, common pathways and causal relationship between ADHD and sleep-related phenotypes Methods We used the largest genome-wide association summary statistics available for attention-deficit/hyperactivity disorder (ADHD) and various sleep-related phenotypes (insomnia, napping, daytime dozing, snoring, ease getting up, daytime sleepiness, sleep duration and chronotype). We estimated the genomic correlation using cross-trait linkage disequilibrium score regression (LDSR) and investigated the potential common mechanisms using gene-based cross-trait metanalyses and functional enrichment analyses. The causal effect was estimated using two-sample Mendelian randomization (TSMR), using the inverse variance weighted method as the main estimator. Results A positive genomic correlation between insomnia, daytime napping, daytime dozing, snoring, daytime sleepiness, short and long sleep duration, and ADHD was observed. Insomnia, daytime sleepiness, and snoring shared genes with ADHD, that are involved in neurobiological functions and regulatory signaling pathways. The TSMR supported a causal effect of insomnia, daytime napping, and short sleep duration on ADHD, and of ADHD on long sleep duration and chronotype. Conclusion Comorbidity between sleep phenotypes and ADHD may be mediated by common genetic factors that play an important role in neuronal signaling pathways. A causal effect of sleep disturbances and short sleep duration on ADHD reinforced their role as predictors of ADHD.
... Considering screen time, children with more ADHD symptoms (n = 82, 9-12 years) and screen time before bedtime tended to have shorter sleep times on weekends (Tong et al., 2018). A longitudinal study (n = 817) where parent rated sleep, TV watching, physical activity and engaging in cognitively stimulating activities at 4 years and ADHD screener and behavioral questionnaire at 7 years was investigated among a cohort, found that shorter sleep duration and less time spent in cognitively stimulating activities were associated with increased risk of developing ADHD symptoms and behavioral problems (Peralta et al., 2018). ...
Article
Objective Children and adults with ADHD often report sleep disturbances that may form part of the etiology and/or symptomatology of ADHD. We review the evidence for sleep changes in children with ADHD. Methods Systematic review with narrative synthesis assessing sleep and circadian function in children aged 5 to 13 years old with a diagnosis of ADHD. Results 148 studies were included for review, incorporating data from 42,353 children. We found that sleep disturbances in ADHD are common and that they may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep. Conclusion Sleep disturbance may represent a clinically important feature of ADHD in children, which might be therapeutically targeted in a useful way. There are a number of important gaps in the literature. We set out a manifesto for future research in the area of sleep, circadian rhythms, and ADHD.
... Physical activity data were collected through a population-validated survey [23] by asking parents how much time their child spent in organized or non-organized physical activities outside of school. The variable was dichotomized with the healthy choice being more than the median number of Metabolic Equivalents (METs) in each respective cohort. ...
Article
Full-text available
Background: We aimed to assess how lifestyle factors such as diet, sleep, screen viewing, and physical activity, individually, as well as in a combined score, were associated with neuropsychological development in pre-school age children. Methods: We conducted a cross-sectional study in 1650 children of 4 years of age, from the Environment and Childhood Project (INMA) population-based birth cohorts in four regions of Spain. Children were classified per a childhood healthy lifestyle score (CHLS) with a range of 0 to 4 that included eating in concordance with the Mediterranean diet (1 point); reaching recommended sleep time (1 point); watching a maximum recommended screen time (1 point); and being physically active (1 point). The McCarthy Scales of Children's Abilities (MSCA) were used to test neuropsychological development. Multi-adjusted linear regression models were created to assess the association with the lifestyle factors individually and as a combined score. Results: CHLS was not associated with MSCA general cognitive score (1-point increment = -0.5, 95% CI: -1.2, 0.2). Analyzed by separate lifestyle factors, physical activity had a significant negative association with MSCA score and less TV/screen time had a negative association with MSCA score. Conclusion: In this cross-sectional study, a combined score of lifestyle factors is not related to neuropsychological development at pre-school age.
... 17 A recent study found that more time spent on cognitively stimulating activities decreases the risk of developing behavioral disorders and other symptoms that are detrimental to children's learning. 31 Our experimental study has high ecological validity since it was developed within the school environment; it has demonstrated success by comparing exergames with the content of ordinary school PE classes, besides that, systematic observation of the classes did not reveal unusual events that would affect the data and the experiment results. This study's findings corroborate with Lwin and Malik, 32 pointing out that exergames in PE are more effective than traditional classes, influencing cognitive factors and social behaviors related to physical activity. ...
Article
Objective: We aimed to confirm whether the practice of exergames produces an effect on children's mood states during school physical education (PE) classes. Materials and methods: The children were allocated to experimental group (EG) and control group (CG). The EG performed exergames during PE classes, and the CG attended regular school PE classes. The Brunel Mood Scale, which evaluates six mood dimensions (tension, mental confusion, anger, vigor, depression, and fatigue), was used to assess the children's moods before (pre) and immediately after the third lesson (acute effect). Results: The practice of exergames during PE classes produced an acute effect on children's moods. The results indicated that playing exergames helped to increase vigor (P < 0.01; effect size [ES]: 0.50; confidence interval [CI]: 0.16-0.84) and fatigue (P < 0.01; ES: 0.50; CI: 0.16-0.84). Conclusion: Three exergame sessions produced an acute effect and improved children's moods during school PE classes. More research is needed to evaluate the long-term effect of exergames on children and adolescents.
Article
Full-text available
This article explores how human development is constrained by collective and personal meaning-making processes. The empirical work of the study is grounded in interviews with children and educational staff at a Danish youth club and concerns children’s selection, personalization, and (re)construction of various “TikTok-trends” through the digital media, TikTok. With empirical examples from both the children and the educational staff, the analytical work is anchored in James Mark Baldwin’s theoretical conceptualization of persistent imitation. It will be argued that children’s persistent imitation is guided by and may diverge from historical and cultural meanings with a twofold attention to the “TikTok-community” and the educational staff. Here, the notion of “inappropriate” imitation, or development, will be unfolded as a resistant meaning construction in the tension field between what is being promoted by the collective and what is imitated by the child. Following this, it will be argued that the social guidance creates developmental ruptures and stability during ontogeny.
Article
Importance: Currently, there is a lack of consensus in the literature on the association between screen time (eg, television, video games) and children's behavior problems. Objective: To assess the association between the duration of screen time and externalizing and internalizing behavior problems among children 12 years or younger. Data sources: For this systematic review and meta-analysis, MEDLINE, Embase, and PsycINFO databases were searched for articles published from January 1960 to May 2021. Reference lists were manually searched for additional studies. Study selection: Included studies measured screen time (ie, duration) and externalizing or internalizing behavior problems in children 12 years or younger, were observational or experimental (with baseline data), were available in English, and had data that could be transformed into an effect size. Studies conducted during the COVID-19 pandemic were excluded. Of 25 196 nonduplicate articles identified and screened for inclusion, 595 met the selection criteria. Data extraction and synthesis: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Extracted variables were child age, sex, and socioeconomic status; informants and measurement type for screen time and behavior problems; study publication year; and study design and quality. Data were extracted by 2 independent coders and were pooled using a random-effects model. Main outcomes and measures: The primary outcome was the association of screen time duration with externalizing (eg, aggression, attention deficit/hyperactivity disorder symptoms) and internalizing (eg, depression, anxiety) behaviors or diagnoses. Results: Of the 595 full-text articles assessed for eligibility, 87 studies met all inclusion criteria, comprising 98 independent samples and 159 425 participants (mean [SD] age, 6.07 [2.89] years; 83 246 [51.30%] male). Increased duration of screen time had a small but significant correlation with more externalizing problems (90 samples; r, 0.11; 95% CI, 0.10-0.12) and internalizing problems (43 samples; r, 0.07; 95% CI, 0.05-0.08) in children. Several methodological moderators explained between-study heterogeneity. There was evidence of significant between study heterogeneity (I2 = 87.80). Conclusions and relevance: This systematic review and meta-analysis found small but significant correlations between screen time and children's behavior problems. Methodological differences across studies likely contributed to the mixed findings in the literature.
Article
Importance: Pediatric guidelines suggest that infants younger than 2 years avoid screen time altogether, while children aged 2 to 5 years receive no more than 1 hour per day. Although these guidelines have been adopted around the world, substantial variability exists in adherence to the guidelines, and precise estimates are needed to inform public health and policy initiatives. Objective: To derive the pooled prevalence via meta-analytic methods of children younger than 2 years and children aged 2 to 5 years who are meeting guidelines about screen time. Data sources: Searches were conducted in MEDLINE, PsycINFO, and Embase up to March 2020. Study selection: Studies were included if participants were 5 years and younger and the prevalence of meeting (or exceeding) screen time guidelines was reported. Data extraction and synthesis: Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive the mean prevalence rates. Main outcomes and measures: Prevalence of meeting screen time guidelines. Results: From 63 studies, 95 nonoverlapping samples with a total of 89 163 participants were included. For children younger than 2 years, the pooled prevalence of meeting the screen time guideline (0 h/d) was 24.7% (95% CI, 19.0%-31.5%). Moderator analyses revealed that prevalence of meeting screen time guidelines varied as a function of year of data collection (increased over time), measurement method (higher when questionnaires compared with interview), and type of device use (higher when a combination of screen use activities compared with television/movies only). For children aged 2 to 5 years, the mean prevalence of meeting the screen time guideline (1 h/d) was 35.6% (95% CI, 30.6%-40.9%). Moderator analyses revealed that the prevalence of meeting screen time guidelines varied as a function of type of device use (higher when screen time was television/movies only compared with a combination of screen use activities). Conclusions and relevance: The findings of this meta-analysis indicate that only a minority of children 5 years and younger are meeting screen time guidelines. This highlights the need to provide support and resources to families to best fit evidence-based recommendations into their lives.
Article
Full-text available
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
Preprint
Full-text available
Study Objectives: To evaluate the level of shared genetic components between attention-deficit/hyperactivity disorder (ADHD) and sleep phenotype, common pathways between them and a possible causal relationship between traits. Methods: We used summary statistics of the largest genome-wide association studies available for ADHD and sleep-related phenotypes including insomnia, napping, daytime dozing, snoring, ease getting up, daytime sleepiness, sleep duration and chronotype. We estimated the genomic correlation between ADHD and sleep-related traits using cross-trait LD-score regression and investigated potential common mechanisms using gene-based cross-trait metanalyses and functional enrichment analyses. The causal effect between the sleep related traits and ADHD was estimated with two sample Mendelian randomization (TSMR), using the Inverse Variance Weighted method as the main estimator. Results: Positive genomic correlation between insomnia, daytime napping, daytime dozing, snoring, daytime sleepiness, short and long sleep duration, and ADHD were observed. Insomnia, sleep duration, daytime sleepiness, and snoring shared genes with ADHD, which were involved in neurobiological functions and regulatory signaling pathways. The TSMR approach supported a causal effect of insomnia, daytime napping, and short sleep duration on ADHD, and of ADHD on long sleep duration and chronotype. Conclusion: Our findings suggest that the comorbidity between sleep phenotypes and ADHD may be mediated by common genetic factors with an important role on neuronal signaling pathways. In addition, it may also exist a causal effect of sleep disturbances and short sleep duration on ADHD, reinforcing the role of these sleep phenotypes as predictors or early markers of ADHD.
Article
This study examined the longitudinal effect of preschool children’s media exposure and maternal depression on first-grade children’s school adjustment and the mediating effect of attention problem. Longitudinal data from the Panel Study of Korean Children (PSKC) collected by the Korea Institute of Child Care and Education (KICCE) was used to examine this hypothetical model. The subjects of the study included 2,150 children (1,091 boys and 1,059 girls) and their mothers across 2013 (5 yrs.) through 2015 (7 yrs.). The Structural Equation Model (SEM) was estimated using SPSS 25.0 and Amos 25. The results of this study were as follows. First, higher level of preschool children’s media exposure and maternal depression were related to higher attention problems after a year and lower level of children’s school adjustment during first-grade. Second, preschool children’s media exposure and maternal depression had an indirect effect on first-grade children’s school adjustment via attention problem. The results of this study will provide supporting evidence to many educators and parents for the implementation of effective practices for first-grade children to enhance their school adjustment. Furthermore, this study emphasizes the importance of maternal psychological wellbeing and the risk of indiscriminate media exposure during early childhood on first-grade’s school adjustment.
Article
Background: Several previous meta-analyses have investigated the association between sleep quality and attention-deficit/hyperactivity disorder (ADHD). To examine the relationship between short or long sleep duration and ADHD, a meta-analysis of observational studies was conducted. Methods: The PubMed, EMBASE, and Cochrane Library databases were systematically searched in March 2019 to retrieve observational studies. A random-effects model was used to analyze meta-estimates of sleep duration. Three evaluators independently reviewed and selected the articles based on pre-determined selection criteria. Results: Of 1466 articles retrieved, 10 observational epidemiological studies, comprising six case-control studies and four prospective cohort studies, were included in the final analysis. Short sleep duration was significantly linked to ADHD compared with average sleep duration (odds ratio [OR] or relative risk [RR] 1.28 [95% confidence interval (CI) 1.16-1.41]), and especially with hyperactivity (OR/RR 1.60 [95% CI 1.18-2.17]). Subgroup meta-analyses according to various factors, such as study design, number of participants, methodological quality, and adjustment for smoking status and education, yielded consistent results. A significant association between long sleep duration and ADHD was not observed. Limitations: Publication bias and substantial heterogeneity due to the diverse measurement tools used to determine ADHD were observed. Lack of prospective cohort studies was another limitation. Conclusion: Short sleep duration was associated with ADHD in the current meta-analysis. Clinicians may need to be more aware of this association.
Article
Full-text available
Media, from television to the "new media" (including cell phones, iPads, and social media), are a dominant force in children's lives. Although television is still the predominant medium for children and adolescents, new technologies are increasingly popular. The American Academy of Pediatrics continues to be concerned by evidence about the potential harmful effects of media messages and images; however, important positive and prosocial effects of media use should also be recognized. Pediatricians are encouraged to take a media history and ask 2 media questions at every well-child visit: How much recreational screen time does your child or teenager consume daily? Is there a television set or Internet-connected device in the child's bedroom? Parents are encouraged to establish a family home use plan for all media. Media influences on children and teenagers should be recognized by schools, policymakers, product advertisers, and entertainment producers. Pediatrics 2013;132:958-961.
Article
Full-text available
Objective The aim of this systematic review and meta-analysis was to examine the evidence for the effectiveness of exercise interventions on attention deficit hyperactivity disorder (ADHD)-related symptoms such as inattention, hyperactivity/impulsivity, anxiety and cognitive functions in children and adolescents. Method Five databases covering the period up to November 2014 (PubMed, Scopus, EMBASE, EBSCO [E-journal, CINAHL, SportDiscus] and The Cochrane Library) were searched. Methodological quality was assessed using the Cochrane tool of bias. Standardized mean differences (SMD) and 95% confidence intervals were calculated, and the heterogeneity of the studies was estimated using Cochran’s Q-statistic. Results Eight randomized controlled trials (n = 249) satisfied the inclusion criteria. The studies were grouped according to the intervention programme: aerobic and yoga exercise.The meta-analysis suggests that aerobic exercise had a moderate to large effect on core symptoms such as attention (SMD = 0.84), hyperactivity (SMD = 0.56) and impulsivity (SMD = 0.56) and related symptoms such as anxiety (SMD = 0.66), executive function (SMD = 0.58) and social disorders (SMD = 0.59) in children with ADHD. Yoga exercise suggests an improvement in the core symptoms of ADHD. Conclusions The main cumulative evidence indicates that short-term aerobic exercise, based on several aerobic intervention formats, seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function and social disorders in children with ADHD.
Article
Full-text available
Importance This study used longitudinal data to examine potential associations between hours of television viewing and sleep duration in children.Objective To examine the association between hours of television viewing and sleep duration in preschool and school-aged children.Design, Setting, and Participants Longitudinal, multicenter study among birth cohorts in Menorca, Sabadell, and Valencia from the Spanish Infancia y Medio Ambiente (environment and childhood) project. The study sample included 1713 children (468 from Menorca, 560 from Sabadell, and 685 from Valencia).Exposure Parent-reported child television viewing duration measured in hours per day at 2 and 4 years of age in Sabadell and Valencia and at 6 and 9 years of age in Menorca.Main Outcomes and Measures Parent-reported child sleep duration measured in hours per day at 2 and 4 years of age in Sabadell and Valencia and at 6 and 9 years of age in Menorca.Results In cross-sectional analysis, children with longer periods of television viewing reported at baseline (≥1.5 hours per day) had shorter sleep duration. Longitudinally, children with reported increases in television viewing duration over time (from <1.5 to ≥1.5 hours per day) had a reduction in sleep duration at follow-up visits. Results were similar when examining television viewing duration as a continuous variable, with each 1 hour per day of increased viewing decreasing sleep duration at follow-up visits (β = −0.11; 95% CI, –0.18 to −0.05). Associations were similar when television viewing duration was assessed during weekends and after adjusting for potential intermediate factors (child executive function and attention-deficit/hyperactivity disorder symptoms) and confounders (child physical activity level, parental mental health status, maternal IQ, and maternal marital status).Conclusions and Relevance Children spending longer periods watching television had shorter sleep duration. Changes in television viewing duration were inversely associated with changes in sleep duration in longitudinal analysis. Parents should consider avoiding long periods of daily television exposure among preschool and school-aged children.
Article
Full-text available
Background Screen entertainment for young children has been associated with several aspects of psychosocial adjustment. Most research is from North America and focuses on television. Few longitudinal studies have compared the effects of TV and electronic games, or have investigated gender differences. Purpose To explore how time watching TV and playing electronic games at age 5 years each predicts change in psychosocial adjustment in a representative sample of 7 year-olds from the UK. Methods Typical daily hours viewing television and playing electronic games at age 5 years were reported by mothers of 11 014 children from the UK Millennium Cohort Study. Conduct problems, emotional symptoms, peer relationship problems, hyperactivity/inattention and prosocial behaviour were reported by mothers using the Strengths and Difficulties Questionnaire. Change in adjustment from age 5 years to 7 years was regressed on screen exposures; adjusting for family characteristics and functioning, and child characteristics. Results Watching TV for 3 h or more at 5 years predicted a 0.13 point increase (95% CI 0.03 to 0.24) in conduct problems by 7 years, compared with watching for under an hour, but playing electronic games was not associated with conduct problems. No associations were found between either type of screen time and emotional symptoms, hyperactivity/inattention, peer relationship problems or prosocial behaviour. There was no evidence of gender differences in the effect of screen time. Conclusions TV but not electronic games predicted a small increase in conduct problems. Screen time did not predict other aspects of psychosocial adjustment. Further work is required to establish causal mechanisms.
Article
Full-text available
This statement describes the possible negative health effects of television viewing on children and adolescents, such as violent or aggressive behavior, substance use, sexual activity, obesity, poor body image, and decreased school performance. In addition to the television ratings system and the v-chip (electronic device to block programming), media education is an effective approach to mitigating these potential problems. The American Academy of Pediatrics offers a list of recommendations on this issue for pediatricians and for parents, the federal government, and the entertainment industry.
Article
Full-text available
Clear associations of sleep, cognitive performance, and behavioral problems have been demonstrated in meta-analyses of studies in adults. This meta-analysis is the first to systematically summarize all relevant studies reporting on sleep, cognition, and behavioral problems in healthy school-age children (5-12 years old) and incorporates 86 studies on 35,936 children. Sleep duration shows a significant positive relation with cognitive performance (r = .08, confidence interval [CI] [.06, .10]). Subsequent analyses on cognitive subdomains indicate specific associations of sleep duration with executive functioning (r = .07, CI [.02, .13]), with performance on tasks that address multiple cognitive domains (r = .10, CI = [.05, .16]), and with school performance (r = .09, CI [.06, .12]), but not with intelligence. Quite unlike typical findings in adults, sleep duration was not associated with sustained attention and memory. Methodological issues and brain developmental immaturities are proposed to underlie the marked differences. Shorter sleep duration is associated with more behavioral problems (r = .09, CI [.07, .11]). Subsequent analyses on subdomains of behavioral problems showed that the relation holds for both internalizing (r = .09, CI [.06, .12]) and externalizing behavioral problems (r = .08, CI [.06, .11]). Ancillary moderator analyses identified practices recommended to increase sensitivity of assessments and designs in future studies. In practical terms, the findings suggest that insufficient sleep in children is associated with deficits in higher-order and complex cognitive functions and an increase in behavioral problems. This is particularly relevant given society's tendency towards sleep curtailment. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Article
Full-text available
Attention deficit hyperactivity disorder (ADHD) affects around 1-3% of children. There is a high level of comorbidity with developmental and learning problems as well as with a variety of psychiatric disorders. ADHD is highly heritable, although there is no single causal risk factor and non-inherited factors also contribute to its aetiology. The genetic and environmental risk factors that have been implicated appear to be associated with a range of neurodevelopmental and neuropsychiatric outcomes, not just ADHD. The evidence to date suggests that both rare and multiple common genetic variants likely contribute to ADHD and modify its phenotype. ADHD or a similar phenotype also appears to be more common in extreme low birth weight and premature children and those exposed to exceptional early adversity. In this review, the authors consider recent developments in the understanding of risk factors that influence ADHD.
Article
Full-text available
Television viewing has been associated with greater subsequent attention problems in children. Few studies have examined the possibility of a similar association between video games and attention problems, and none of these has used a longitudinal design. A sample of 1323 middle childhood participants were assessed during a 13-month period by parent- and child-reported television and video game exposure as well as teacher-reported attention problems. Another sample of 210 late adolescent/early adult participants provided self-reports of television exposure, video game exposure, and attention problems. Exposure to television and video games was associated with greater attention problems. The association of television and video games to attention problems in the middle childhood sample remained significant when earlier attention problems and gender were statistically controlled. The associations of screen media and attention problems were similar across media type (television or video games) and age (middle childhood or late adolescent/early adult). Viewing television and playing video games each are associated with increased subsequent attention problems in childhood. It seems that a similar association among television, video games, and attention problems exists in late adolescence and early adulthood. Research on potential risk factors for attention problems should be expanded to include video games in addition to television.
Article
Full-text available
Few studies have examined the benefits of regular physical activity, and risks of sedentary behaviour, in young children. This study investigated associations between participation in sports and screen-entertainment (as components of physical activity and sedentary behaviour), and emotional and behavioural problems in this population. Cross-sectional analysis of data from 13470 children (50.9% boys) participating in the nationally representative UK Millennium Cohort Study. Time spent participating in sports clubs outside of school, and using screen-entertainment, was reported by the child's mother at child age 5 years, when mental health was also measured using the Strengths and Difficulties Questionnaire. 45% of children did not participate in sport clubs and 61% used screen-entertainment for >/= 2 hours per day. Children who participated in sport had fewer total difficulties; emotional, conduct, hyperactivity-inattention and peer relationship problems; and more prosocial behaviours. These relationships were similar in boys and girls. Boys and girls who used screen-entertainment for any duration, and participated in sport, had fewer emotional and behavioural problems, and more prosocial behaviours, than children who used screen-entertainment for >/= 2 hours per day and did not participate in sport. Longer durations of screen-entertainment usage are not associated with mental health problems in young children. However, our findings suggest an association between sport and better mental health. Further research based on longitudinal data is required to examine causal pathways in these associations and to determine the potential role of this and other forms of physical activity in preventing mental health disorders.
Article
Full-text available
Previous research has suggested that television (TV) viewing may be associated with increased behavioral and emotional problems in children. However, there are few prospective studies targeted for its association with outcomes of children under 3 years old. The purpose of this study was to exam the association between children's early TV exposure at ages 18 and 30 months and the behavioral and emotional outcomes at age 30 months. We analyzed data collected prospectively in the Japan Children's Study. TV exposure was assessed by mothers' report at infant ages of 18 and 30 months. The outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ). Analysis of Covariance was used to estimate the effect of TV exposure on behavioral and emotional outcomes. The percentage of children who watched TV 4 hours or more per day was 29.4% at age 18 months, 24.5% at age 30 months, and 21% at both ages. Hyperactivity-inattention at age 30 months was positively associated with TV exposure at age 18 months, whereas prosocial behavior was negatively associated with hours of exposure even after adjustment. However, there were no significant differences in SDQ subscales according to daily hours of TV viewing at age 30 months. Daily TV exposure at age 18 months was associated with hyperactivity-inattention and prosocial behavior at age 30 months. However, the directly casual relation was not proved in the present study. Additional research considering the TV program content and exposure timing are needed to investigate the causal relation between TV viewing and behavioral outcome.
Article
Full-text available
The regression models appropriate for counted data have seen little use in psychology. This article describes problems that occur when ordinary linear regression is used to analyze count data and presents 3 alternative regression models. The simplest, the Poisson regression model, is likely to be misleading unless restrictive assumptions are met because individual counts are usually more variable ("overdispersed") than is implied by the model. This model can be modified in 2 ways to accomodate this problem. In the overdispersed model, a factor can be estimated that corrects the regression model's inferential statistics. In the second alternative, the negative binomial regression model, a random term reflecting unexplained between-subject differences is included in the regression model. The authors compare the advantages of these approaches.
Article
Full-text available
Epidemiological studies have repeatedly established adverse health effects due to long-term exposure to ambient air pollution. The Swiss Study on Air Pollution and Lung Disease in Adults (SAPALDIA) published a -3.14% decrease in forced vital capacity (FVC) per 10 microg x m(-3) increment in particulate matter (particles with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)). Compared to the within-subject variability of FVC, the effect may be considered small. This individual (or clinical) perspective is, however, misleading. The purpose of this study was to demonstrate the public health relevance of apparently "small" effects, using the impact of PM10 on FVC as an example. The scenario compares a population A, exposed to an annual mean PM10 of 20 microg x m(-3), with a population B exposed to 30 microg x m(-3) mean PM10. A shift of -3.14% in the population distribution of FVC increases the number of subjects in the lower tail of the distribution. In population B a relative increase was expected of 47% (16-91%) in the prevalence of "FVC <80% predicted", (i.e., from 5.17 to 7.59% and 5.88 to 8.65% among males and females, respectively). The relative increase in the prevalence of "FVC <70% predicted" (approximately 1% of population) was 63% (30-98%, males) and 57% (21-86%, females). An epidemiological estimate of a change in the mean value of the population distribution should not be misinterpreted as an effect on the individual level. However, the impact of a 10 microg x m(-3) increase in particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) on the number of subjects with a clinically relevant reduction in lung function is quantitatively important.
Article
Full-text available
The aim of the study was to investigate the associations between longitudinal sleep duration patterns and behavioral/cognitive functioning at school entry. Hyperactivity-impulsivity (HI), inattention, and daytime sleepiness scores were measured by questionnaire at 6 years of age in a sample of births from 1997 to 1998 in a Canadian province (N=1492). The Peabody Picture Vocabulary Test--Revised (PPVT-R) was administered at 5 years of age and the Block Design subtest (WISC-III) was administered at 6 years of age. Sleep duration was reported yearly by the children's mothers from age 2.5 to 6 years. A group-based semi-parametric mixture model was used to estimate developmental patterns of sleep duration. The relationships between sleep duration patterns and both behavioral items and neurodevelopmental tasks were tested using weighted multivariate logistic regression models to control for potentially confounding psychosocial factors. Four sleep duration patterns were identified: short persistent (6.0%), short increasing (4.8%),10-hour persistent (50.3%), and 11-hour persistent (38.9%). The association of short sleep duration patterns with high HI scores (P=0.001), low PPVT-R performance (P=0.002), and low Block Design subtest performance (P=0.004) remained significant after adjusting for potentially confounding variables. Shortened sleep duration, especially before the age of 41 months, is associated with externalizing problems such as HI and lower cognitive performance on neurodevelopmental tests. Results highlight the importance of giving a child the opportunity to sleep at least 10 hours per night throughout early childhood.
Article
Background: Collaboration is a key facilitator of cognitive development in early childhood; this review evaluates which factors mediate the impact of collaborative interactions on cognitive development in children aged 4-7 years. Methods: A systematic search strategy identified relevant studies (n = 21), which assessed the role of ability on the relationship between collaboration and cognitive development. Other factors that interact with ability were also assessed: gender, sociability/friendship, discussion, age, feedback and structure. Results: Immediate benefits of collaboration on cognitive development are highlighted for same-age peers. Collaborative interactions are beneficial for tasks measuring visual perception, problem-solving and rule-based thinking, but not for word-reading and spatial perspective-taking. Collaboration is particularly beneficial for lower-ability children when there is an ability asymmetry. High-ability children either regressed or did not benefit when paired with lower-ability participants. Conclusions: Overall, the studies included within this review indicate that brief one-off interactions can have a significant, positive effect on short-term cognitive development in children of infant school age. The longer-term advantages of collaboration are still unclear. Implications for practice and future research are discussed.
Article
Objective: The objective was to conduct a scientifically rigorous update to the National Sleep Foundation's sleep duration recommendations. Methods: The National Sleep Foundation convened an 18-member multidisciplinary expert panel, representing 12 stakeholder organizations, to evaluate scientific literature concerning sleep duration recommendations. We determined expert recommendations for sufficient sleep durations across the lifespan using the RAND/UCLA Appropriateness Method. Results: The panel agreed that, for healthy individuals with normal sleep, the appropriate sleep duration for newborns is between 14 and 17 hours, infants between 12 and 15 hours, toddlers between 11 and 14 hours, preschoolers between 10 and 13 hours, and school-aged children between 9 and 11 hours. For teenagers, 8 to 10 hours was considered appropriate, 7 to 9 hours for young adults and adults, and 7 to 8 hours of sleep for older adults. Conclusions: Sufficient sleep duration requirements vary across the lifespan and from person to person. The recommendations reported here represent guidelines for healthy individuals and those not suffering from a sleep disorder. Sleep durations outside the recommended range may be appropriate, but deviating far from the normal range is rare. Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being.
Article
The present study aimed at identifying the full range of mental disorders comorbid to attention-deficit/hyperactivity disorder (ADHD) in children and adolescents (age 4-17) diagnosed in Danish psychiatric hospitals between 1995 and 2010. A total of 14,825 patients were included in the study and comorbid disorders diagnosed concurrent with ADHD were identified. Associations of comorbid disorders with sex, age, and other mental disorders were investigated by logistic regression analysis. In the total sample, 52.0 % of the patients had at least one psychiatric disorder comorbid to ADHD and 26.2 % had two or more comorbid disorders. The most frequent comorbid disorders were disorders of conduct (16.5 %), specific developmental disorders of language, learning and motor development (15.4 %), autism spectrum disorders (12.4 %), and intellectual disability (7.9 %). Male sex was generally associated with an increased risk for neuropsychiatric disorders while female sex was associated more frequently with internalizing disorders. The analysis of associations between the various comorbid disorders identified several clusters highlighting the differential developmental trajectories seen in patients with ADHD. The study provides evidence that comorbidity with mental disorders is developmentally sensitive. Furthermore, the study shows that particular attention should be given to patients with neurodevelopmental disorders such as autism and intellectual disability in future longitudinal analyses. These disorders are very frequent in patients with ADHD, and the affected patients might follow a different course than patients without these disorders.
Article
Bedtime resistance and night waking are common sleep problems throughout childhood, especially in the early years. These sleep problems may lead to difficulties in neurobehavioral functioning, but most research into childhood sleep problems has not emphasized the importance of the developmental context in which disruptions in neurobehavioral and daytime functioning occur. We review the development of sleep as well as executive functioning (EF) in childhood and suggest that EF may be particularly vulnerable to the effects of these common childhood sleep problems because of its prolonged course of maturation. Behavioral problems associated with common sleep problems suggest poor self-regulation in the context of sleep loss, and developing EF skills play important roles in self-regulation. A research agenda that considers a developmental approach to sleep and sleep problems in the context of childhood EF performance is outlined to promote future research in this area. Turnbull K; Reid GJ; Morton JB. Behavioral sleep problems and their potential impact on developing executive function in children. SLEEP 2013;36(7):1077-1084.
Article
Background Sleep duration is known to be associated with depression and attention deficits in children, though the majority of studies have focused on adolescents. Attention problems and depressive symptoms related to sleep factors have not been studied simultaneously in the non-clinical child population before. Methods Sleep quantity, adverse bedtime behaviour, daytime sleepiness, poor attention and symptoms of depression were assessed using self-report measures. The participants were 11 years old (n = 439). ResultsShort sleep duration during the school week is related to poor attention and high depression. It is not a significant predictor of low attention and high depression symptoms in logistic regression analyses. Instead, adverse bedtime behaviour and daytime sleepiness predict them highly significantly. Conclusions Short sleep duration is related to poor attention and depressive symptoms as suggested by previous work. However, the significant role of other sleep-related factors calls for further research.
Article
Objective To determine whether the amount, type, and patterns of television viewing predict the onset or the persistence of externalizing problems in preschool children. Design Longitudinal study of a prospective population-based cohort in the Netherlands. Setting Parents reported time of television exposure and type of programs watched by children. Externalizing problems were assessed using the Child Behavior Checklist at 18 and 36 months. Participants A population-based sample of 3913 children. Main Exposure Television viewing time, content, and patterns of exposure (at 24 and 36 months) in children with and without preexisting problems to assess the incidence and persistence of externalizing problems. Main Outcome Measures Externalizing problems at 36 months. Results Program content and time of television exposure assessed at 24 months did not predict the incidence of externalizing problems at 36 months (odds ratio, 2.24; 95% CI, 0.97-5.18). However, the patterns of exposure over time reflecting high levels of television viewing were associated with the incidence of externalizing problems (odds ratio, 2.00; 95% CI, 1.07-3.75) and the persistence of the preexisting externalizing problems (2.59; 1.03-6.55). Conclusions Our study showed that high television exposure increases the risk of the incidence and the persistence of externalizing problems in preschool children.
Article
The Conners' Parent Rating Scales (CPRS) have undergone a considerable amount of scrutiny—and subsequent refining, reshaping, and revising—since their development in 1970. While such longitudinal scrutiny has ultimately led to a more reliable, valid assessment tool, it has left behind a wake of literature filled with misinformation and ambiguity. Multiple versions of the Conners' Rating Scales (CRS), their misuse, and inaccurate reporting by researchers have created a body of literature that is difficult to interpret and misleading to both researchers and clinicians. This review is aimed at clarifying issues regarding the proper use of the CPRS as both a diagnostic instrument and a research tool.
Article
A novel behavioural screening questionnaire, the Strengths and Difficulties Questionnaire (SDQ), was administered along with Rutter questionnaires to parents and teachers of 403 children drawn from dental and psychiatric clinics. Scores derived from the SDQ and Rutter questionnaires were highly correlated; parent-teacher correlations for the two sets of measures were comparable or favoured the SDQ. The two sets of measures did not differ in their ability to discriminate between psychiatric and dental clinic attenders. These preliminary findings suggest that the SDQ functions as well as the Rutter questionnaires while offering the following additional advantages: a focus on strengths as well as difficulties; better coverage of inattention, peer relationships, and prosocial behaviour; a shorter format; and a single form suitable for both parents and teachers, perhaps thereby increasing parent-teacher correlations.
Article
Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. Play also offers an ideal opportunity for parents to engage fully with their children. Despite the benefits derived from play for both children and parents, time for free play has been markedly reduced for some children. This report addresses a variety of factors that have reduced play, including a hurried lifestyle, changes in family structure, and increased attention to academics and enrichment activities at the expense of recess or free child-centered play. This report offers guidelines on how pediatricians can advocate for children by helping families, school systems, and communities consider how best to ensure that play is protected as they seek the balance in children's lives to create the optimal developmental milieu.
Article
The purpose of this study was to compare long-term school outcomes (academic achievement in reading, absenteeism, grade retention, and school dropout) for children with attention-deficit/hyperactivity disorder (AD/HD) versus those without AD/HD. Subjects included 370 children with research-identified AD/HD from a 1976-1982 population-based birth cohort (N = 5718) and 740 non-AD/HD control subjects from the same birth cohort, matched by gender and age. All subjects were retrospectively followed from birth until a median age of 18.4 years (AD/HD cases) or 18.3 years (non-AD/HD controls). The complete school record for each subject was reviewed to obtain information on reading achievement (last available California Achievement Test reading score), absenteeism (number/percentage of school days absent at each grade level), grade retention (having to repeat an entire grade in the subsequent school year), and school dropout (failure to graduate from high school). Median reading achievement scores at age 12.8 years (expressed as a national percentile) were significantly different for AD/HD cases and non-AD/HD controls (45 vs 73). Results were similar for both boys and girls with AD/HD. Median percentage of days absent was statistically significantly higher for children with AD/HD versus those without AD/HD, although the difference was relatively small in absolute number of days absent. Subjects with AD/HD were three times more likely to be retained a grade. Similarly, subjects with AD/HD were 2.7 times more likely to drop out before high school graduation (22.9%) than non-AD/HD controls (10.0%). The results of this population-based study clearly demonstrate the association between AD/HD and poor long-term school outcomes.
The worldwide prevalence of ADHD: a systematic review and metaregression analysis
  • Polanczyk