Too Much TV Linked to Aggression, Inattention in Kids

Deborah Brauser

October 04, 2012

October 4, 2012 — Preschool-aged children who watch too much television may be at increased risk of developing externalizing problems such as aggression or inattention, new research suggests.

A population-based study of almost 4000 children in the Netherlands showed that high levels of television viewing over time were significantly linked to both the incidence of externalizing problems and the persistence of preexisting problems.

"In this study, a reasonably small group of some 300 children already had some behavioral problems (a bit oppositional, aggressive, inattentive) when they were 2 years old. We could show that these problems worsen if they watch more than 1 hour of TV a day," coinvestigator Henning Tiemeier, MD, PhD, from the Department of Child and Adolescent Psychiatry at Erasmus University Medical Center in Rotterdam, the Netherlands, told Medscape Medical News.

Dr. Henning Tiemeier

"Thus, not only do problems arise but if your child is problematic, TV watching may make matters worse," said Dr. Tiemeier.

He noted that this is an important topic to which all clinicians, including those in the United States, should give attention.

"Clinicians should address the problem that many children are 'nursed' by a TV and that a TV keeps irritable or oppositional children quiet. But it does not replace a parent or nanny," said Dr. Tiemeier.

"And I see no reason why this association should be different in the US. On average, young children watch more TV in the US than in Europe, and the content is similar (or similarly inappropriate) for young children."

The study is published in the October issue of the Archives of Pediatrics and Adolescent Medicine.

Discourage Media Use

As reported at the time by Medscape Medical News, the American Academy of Pediatrics (AAP) announced an updated policy statement at their 2011 National Conference that discouraged media use, including turning off the television, for children younger than 2 years.

"Kids should learn from play, not from a TV screen," said Ari Brown, MD, a private practice pediatrician from Austin, Texas, who was head of the AAP Council of Communications and Media at the time.

However, past research has shown that between 17% and 48% of children younger than 4 years do not comply with the AAP's recommendations, report the current investigators.

"Currently, despite the high prevalence of TV viewing among preschool children, little is known about the effects of TV exposure on subsequent externalizing problems," they write.

Generation R is an ongoing study that has followed a cohort of children from Rotterdam "from fetal life onwards." In the study, mothers of these children have reported in great detail about their family life and parenting, as well as the child's well-being.

For this analysis, the investigators examined data on 3913 of these children.

"Watching much TV has often been linked to behavioral problems in children. But we knew that even very young children often watch more than an hour of TV per day. In Generation R, we had asked mothers repeatedly about this TV pattern," reported Dr. Tiemeier.

In addition to time of television exposure, parents also reported the type of programs that were watched by their children at the age of 24 months and at the age of 36 months.

The Dutch version of the Child Behavior Checklist was used to assess externalizing problems when the children were 18 months of age and again when they were 36 months of age.

The main outcome measures were the incidence or persistence of these behavioral problems at 36 months.

TV Targets

TV viewing patterns over time showed that overall high exposure was significantly associated with the incidence of externalizing problems (unadjusted odds ratio [OR], 2.62; adjusted OR, 2.0). It was also linked to the continuation at 36 months of preexisting problems found at 18 months (adjusted OR, 2.59).

Interestingly, neither program content nor time of television exposure at 24 months predicted incidence of these problems at 36 months.

"Although few children had an increase in exposure between 24 and 36 months, the effect of increased TV viewing on the persistence of externalizing problems was strong in children with preexisting problems (OR, 5.99)," add the investigators.

They write that children of this age "are a major target audience of the TV market in Western societies." And they note that the best advice is for parents to follow the AAP's recommendations to discourage TV viewing in young children.

"Perhaps in doing so not only will externalizing problems be reduced but also associated problems such as obesity and other negative outcomes may be prevented," conclude the researchers.

The Generation R study was supported by the Erasmus University Medical Center Rotterdam and by a grant from the Netherlands Organization for Health Research and Development. The current analysis was supported by grants from the Netherlands Organization for Scientific Research and from the Sophia Foundation for Medical Research. Dr. Henning and 6 of the 9 study authors have disclosed no significant financial relationships. One of the remaining authors reports having received funding from the National Institute of Mental Health and the National Institute of Diabetes and Digestive and Kidney Disease, and the other author reports receiving remuneration as a contributing editor for the Achenbach System of Empirically Based Assessment.

Arch Pediatr Adolesc Med. 2012;166:919-925. Abstract