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Subject:\[EXTERNAL\] Autism and Screen Time: Special Brains, Special Risks Children with autism
are vulnerable to the negative effects of screen time.
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04-06-2024
P.R.D.D.C.)
PARENTS FORTHE RIGHTSOFDEVELOPMENTALLY DISABLED CHILDREN
CRAIGA. DURFEYFOUNDER OFP.R.D.D.C.
U.S. HOUSE OFCONGRESS H2404 - HONORING CRAIGDURFEY FOR HISFIGHT AGAINSTAUTISM
Ms. LORETTA SANCHEZ ofCalifornia.
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To whom it may concern.
1
Autism and Screen Time: Special Brains, Special Risks Children with autism are
vulnerable to the negative effects of screen time.
https://www.psychologytoday.com/us/blog/mental-wealth/201612/autism-and-
screen-time-special-brains-special-risks
Children with autism spectrum disorders (ASD) are uniquely vulnerable to various
brain-related impacts of screen time. These electronic “side effects” include
hyperarousal and dysregulation—what I call Electronic Screen Syndrome—as well
as technology addiction, to video games, internet, smartphones, social media,
and so on.
Why? Because a brain with autism has inherent characteristics that screen time
exacerbates. In truth, these impacts in occur in all of us, but children with autism
will be both more prone to experiencing negative effects and less able to recover
from them; their brains are more sensitive and less resilient.
As a framework for understanding these vulnerabilities, it’s helpful to know that
screen time—particularly the interactive kind—acts like a stimulant, not unlike
caffeine, amphetamines, or cocaine. Also know that children with autism are
often sensitive to stimulants of all kinds, whether pharmaceutical or electronic.
For example, children with autism and attention issues often can’t tolerate
prescribed stimulants, a standard treatment for ADD/ADHD. Stimulants tend to
make children with autism irritable, weepy, over-focused, more obsessive-
compulsive, and unable to sleep. Stimulants can also exacerbate tics, self-
injurious behaviors, aggression, and sensory issues.
Meanwhile, in families dealing with autism, there exist additional social and
emotional factors that contribute to technology overuse. First, families are often
dealing with highly disruptive behaviors that are quieted—at least in the short
term—by handing the child a device. Second, parents are told that “playing video
games is ‘normal.’ It’s something your son can do with other kids.” Third, parents
are encouraged to introduce technology early and often—especially if “he’s good
at computers.” Fourth, in-home and school behavior therapists often use video
games or other apps as reinforcers: “It’s the only thing that works with her!” And
lastly, parents and clinicians are routinely encouraged to try unproven screen-
based software claiming to reduce autistic behaviors or to improve social,
communication or reading skills.
Needless to say, education in this arena is sorely needed.
2
11 reasons children with autism are extra vulnerable to screen time
effects and tech addiction
1. Children with autism tend to have low melatonin and sleep
disturbances \[1\] and screen time suppresses melatonin and disrupts
sleep. \[2\] Aside from regulating sleep and the body clock, melatonin also
helps modulate hormones and brain chemistry, balances the immune
system, and keeps inflammation at bay.
2. Children with autism are prone to arousal regulation
issues, manifesting in an exaggerated stress response, emotional
dysregulation, or a tendency to be over or under-stimulated\[3\]; screen
time increases acute and chronic stress, induces hyperarousal, causes
emotional dysregulation, and produces overstimulation. \[4\]
3. Autism is associated with inflammation of the nervous system \[5\] and
screen time may increase inflammation by a variety of mechanisms
including increased stress hormones, suppressed melatonin, and non-
restorative sleep. \[6\] Light-at-night from screens also
suppresses REM sleep, aphase during which the brain “cleans house.”
7\]
4. The autistic brain tends to be underconnected—less integrated and
more compartmentalized \[8\]—and screen time hinders whole-brain
integration and healthy development of the frontal lobe.\[9\] In fact, in
tech addiction brain scan studies reveal reduced connectivity (via
reduced white matter) and atrophy of gray matter in the frontal lobe.
10\]
5. Children with autism have social and communication deficits, such as
impaired eye contact, difficulty reading facial expressions and body
language, low empathy, and impaired communication \[11\]; screen time
hinders development of these exact same skills—even in children and
teens who don’t have autism. \[12\] Screen time appears to directly
compete with social rewards, including eye contact—a factor essential
for brain development. \[13\] Lastly, screen viewing and even background
TV has been shown to delay language acquisition. \[14\]
3
6. Children with autism are prone to anxiety \[15\]—including obsessive-
compulsive traits, social anxiety—and screen time is associated with
increased risk for OCD and social anxiety \[16\] while contributing to high
arousal and poor coping skills. \[17\] Additionally, anxiety in autism has
been linked to abnormalities in serotonin synthesis and amygdala
activity \[18\] and both serotonin regulation and amygdala changes have
been implicated in screen time. \[19\]
7. Children with autism frequently have sensory and motor
integration issues \[20\] as well as tics; screen time has been linked to
sensori-motor delays and worsening of sensory processing \[21\], and can
precipitate or worsen vocal and motor tics due to dopamine release.
8. Individuals with autism are typically highly attracted to screen-based
technology and are not only at increased risk for developing video game
and other technology addictions, but are more likely to exhibit
symptoms with smaller amounts of exposure. \[22\] Male teens and young
adults with ASD are also at high risk for porn addiction, due to a
combination of social deficits, isolation, and excessive computer time,
and may develop romantic delusions or obsessions fueled by being
accustomed to immediate gratification and a lack of practicing in the
real world. At the same time, dopamine released by screen interaction
reinforces these obsessive “loops.”
9. Children with autism tend to have a fragile attention system,
poor executive functioning, and “reduced bandwidth” when processing
information \[23\]; screen time likewise fractures attention, depletes
mental reserves, and impairs executive functioning. \[24\]
10. Children with autism may be more sensitive to
EMFs (electromagnetic fields) emitted from wireless communications
e.g. WiFi and cell phone frequencies) as well as from the electronic
devices themselves. \[25\] At the cellular, molecular, and atomic level,
the pathology seen in autism mirrors the effects demonstrated in
research on the biological impacts of EMFs. Heightened sensitivity to
EMFs may be due to (and may worsen) immune abnormalities and
problems with barrier integrity in the gut and/or the brain.
4
11. Children with autism are at higher risk for psychiatric disorders of all
kinds, including mood and anxiety disorders, ADHD, tics and psychosis.
26\] Likewise, higher amounts of total screen time are associated with
higher levels of psychiatric disturbances, including mood and anxiety
disorders, ADHD, tics and psychosis. \[27\] Regarding psychosis, young
people with ASD who engage in daily screen time may experience
hallucinations, paranoia, dissociation, and loss of reality-testing. More
often than not, however, these scary symptoms resolve or greatly
diminish once devices are removed and don’t require
antipsychotic medication.
In addition to the above, screen time replaces the very things we know
to be critical to brain development: bonding, movement, eye contact,
face-to-face verbal interactions, loving touch, exercise, free play, and
exposure to nature and the outdoors. Reduced exposure to these factors
negatively impact brain integration, IQ, and resilience in all children.
In my own experience in working with children and adults with autism,
screen time can precipitate regression (loss of language or of social or
adaptive living skills), exacerbate repetitive behaviors, further restrict
interests, and trigger aggressive and self-injurious behaviors. I’ve even
seen regression occur when a communication device is introduced,
often when the parents are told to encourage “play” on the device so the
child can “get used to it.” The proliferation of the iPad and smartphones
has produced more problems and setbacks in my practice than any
other single factor.
As stressful and devastating as these experiences can be, so can
methodical elimination of screens be exciting and inspiring. Being
screen-free can enhance eye contact and language, increase flexibility
in thinking and behavior, expand interests, improve emotional
regulation and ability to stay on task, induce more restorative sleep, and
reduce anxiety and meltdowns.
Because the idea of eliminating screens can seem overwhelming, I
typically recommend parents do a four week “electronic fast” as an
experiment so they can get ataste of what the intervention can do.
5
Families track two to three problematic areas to provide objective
evidence, and are encouraged to document behaviors (such as screen
time tantrums and how the child plays). Even a few short weeks can
produce improvements that can be significant enough for the family to
decide to continue with screen elimination, in which case the benefits
will continue to build on one another.
Will the child still have autism? Yes, but it’spractically guaranteed that
he or she will feel, focus, sleep, behave, and function better. And
intriguingly, anecdotal evidence suggests this simple intervention may
be powerful enough to prevent, arrest or in some cases even reverse the
autism process if caught early enough; pilot studies testing this
intervention more formally are forthcoming. (Case studies illustrating
these phenomena will be the subject of a future post.)
When parents really grasp the science of what happens in the brain
when children interact with screen devices—and understand how these
things specifically impact autism—they are much better able to restrict
screens appropriately and are less swayed by social pressures. They
see” how screen time translates into certain symptoms in their child,
they prioritize brain-health over being tech-savvy, and appreciate that
every minute spent on a screen is a tradeoff.
Needless to say, education in this arena is sorely needed.
11 reasons children with autism are extra vulnerable to screen time effects and
tech addiction
1. Children with autism tend to have low melatonin and sleep disturbances \[1\]
and screen time suppresses melatonin and disrupts sleep. \[2\] Aside from
regulating sleep and the body clock, melatonin also helps
modulate hormones and brain chemistry, balances the immune system, and
keeps inflammation at bay.
2. Children with autism are prone to arousal regulation issues, manifesting in an
exaggerated stress response, emotional dysregulation, or a tendency to be over
or under-stimulated\[3\]; screen time increases acute and chronic stress, induces
hyperarousal, causes emotional dysregulation, and produces overstimulation. \[4\]
6
3. Autism is associated with inflammation of the nervous system \[5\] and screen
time may increase inflammation by a variety of mechanisms including increased
stress hormones, suppressed melatonin, and non-restorative sleep. \[6\] Light-at-
night from screens also suppresses REM sleep, a phase during which the brain
cleans house.” \[7\]
4. The autistic brain tends to be underconnected—less integrated and more
compartmentalized \[8\]—and screen time hinders whole-brain integration and
healthy development of the frontal lobe.\[9\] In fact, in tech addiction brain scan
studies reveal reduced connectivity (via reduced white matter) and atrophy of
gray matter in the frontal lobe. \[10\]
5. Children with autism have social and communication deficits, such as impaired
eye contact, difficulty reading facial expressions and body language, low
empathy, and impaired communication \[11\]; screen time hinders development of
these exact same skills—even in children and teens who don’t have autism. \[12\]
Screen time appears to directly compete with social rewards, including eye
contact—a factor essential for brain development. \[13\] Lastly, screen viewing and
even background TV has been shown to delay language acquisition. \[14\]
6. Children with autism are prone to anxiety \[15\]—including obsessive-compulsive
traits, social anxiety—and screen time is associated with increased risk for OCD
and social anxiety \[16\] while contributing to high arousal and poor coping skills.
17\] Additionally, anxiety in autism has been linked to abnormalities in serotonin
synthesis and amygdala activity \[18\] and both serotonin regulation and amygdala
changes have been implicated in screen time. \[19\]
7. Children with autism frequently have sensory and motor integration issues \[20\]
as well as tics; screen time has been linked to sensori-motor delays and
worsening of sensory processing \[21\], and can precipitate or worsen vocal and
motor tics due to dopamine release.
8. Individuals with autism are typically highly attracted to screen-based
technology and are not only at increased risk for developing video game and
other technology addictions, but are more likely to exhibit symptoms with smaller
amounts of exposure. \[22\] Male teens and young adults with ASD are also at high
risk for porn addiction, due to a combination of social deficits, isolation, and
excessive computer time, and may develop romantic delusions or obsessions
fueled by being accustomed to immediate gratification and a lack of practicing in
the real world. At the same time, dopamine released by screen interaction
reinforces these obsessive “loops.”
7
9. Children with autism tend to have a fragile attention system, poor executive
functioning, and “reduced bandwidth” when processing information \[23\]; screen
time likewise fractures attention, depletes mental reserves, and impairs
executive functioning. \[24\]
10. Children with autism may be more sensitive to EMFs (electromagnetic fields)
emitted from wireless communications (e.g. WiFi and cell phone frequencies) as
well as from the electronic devices themselves. \[25\] At the cellular, molecular,
and atomic level, the pathology seen in autism mirrors the effects demonstrated
in research on the biological impacts of EMFs. Heightened sensitivity to EMFs
may be due to (and may worsen) immune abnormalities and problems with barrier
integrity in the gut and/or the brain.
11. Children with autism are at higher risk for psychiatric disorders of all kinds,
including mood and anxiety disorders, ADHD, tics and psychosis. \[26\] Likewise,
higher amounts of total screen time are associated with higher levels of
psychiatric disturbances, including mood and anxiety disorders, ADHD, tics and
psychosis. \[27\] Regarding psychosis, young people with ASD who engage in daily
screen time may experience hallucinations, paranoia, dissociation, and loss of
reality-testing. More often than not, however, these scary symptoms resolve or
greatly diminish once devices are removed and don’t require
antipsychotic medication.
In addition to the above, screen time replaces the very things we know to be
critical to brain development: bonding, movement, eye contact, face-to-face
verbal interactions, loving touch, exercise, free play, and exposure to nature and
the outdoors. Reduced exposure to these factors negatively impact brain
integration, IQ, and resilience in all children.
In my own experience in working with children and adults with autism, screen
time can precipitate regression (loss of language or of social or adaptive living
skills), exacerbate repetitive behaviors, further restrict interests, and trigger
aggressive and self-injurious behaviors. I’ve even seen regression occur when a
communication device is introduced, often when the parents are told to
encourage “play” on the device so the child can “get used to it.” The proliferation
of the iPad and smartphones has produced more problems and setbacks in my
practice than any other single factor.
As stressful and devastating as these experiences can be, so can
methodical elimination of screens be exciting and inspiring. Being
screen-free can enhance eye contact and language, increase
8
flexibility in thinking and behavior, expand interests,
improve emotional regulation and ability to stay on task, induce more
restorative sleep, and reduce anxiety and meltdowns.
Because the idea of eliminating screens can seem overwhelming, I
typically recommend parents do a four week “electronic fast” as an
experiment so they can get ataste of what the intervention can do.
Families track two to three problematic areas to provide objective
evidence, and are encouraged to document behaviors (such as screen
time tantrums and how the child plays). Even a few short weeks can
produce improvements that can be significant enough for the family
to decide to continue with screen elimination, in which case the
benefits will continue to build on one another.
Will the child still have autism? Yes, but it’spractically guaranteed
that he or she will feel, focus, sleep, behave, and function better. And
intriguingly, anecdotal evidence suggests this simple intervention
may be powerful enough to prevent, arrest or in some cases even
reverse the autism process if caught early enough; pilot studies
testing this intervention more formally are forthcoming. (Case studies
illustrating these phenomena will be the subject of a future post.)
When parents really grasp the science of what happens in the brain
when children interact with screen devices—and understand how
these things specifically impact autism—they are much better able to
restrict screens appropriately and are less swayed by social
pressures. They “see” how screen time translates into certain
symptoms in their child, they prioritize brain-health over being tech-
savvy, and appreciate that every minute spent on a screen is a
tradeoff.
References
1\] J Melke et al., “Abnormal Melatonin Synthesis in Autism Spectrum Disorders,”
Mol Psychiatry 13, no. 1 (May 15, 2007): 90–98.
9
2\] Shigekazu Higuchi et al., “Effects of Vdt Tasks with a Bright Display at Night
on Melatonin, Core Temperature, Heart Rate, and Sleepiness,” Journal of Applied
Physiology (Bethesda, Md.: 1985) 94, no. 5 (May 2003): 1773–76.
3\] Matthew S. Goodwin et al., “Cardiovascular Arousal in Individuals with
Autism,” Focus on Autism and Other Developmental Disabilities 21, no. 2 (2006):
100–123; BA Corbett and D Simon, “Adolescence, Stress and Cortisol in Autism
Spectrum Disorders.,” OA Autism 1, no. 1 (March 1, 2013): 1–6.
4\] Marjut Wallenius, “Salivary Cortisol in Relation to the Use of Information and
Communication Technology (ICT) in School-Aged Children,” Psychology 1, no. 2
2010): 88–95; Amy E. Mark and Ian Janssen, “Relationship between Screen Time
and Metabolic Syndrome in Adolescents,” Journal of Public Health 30, no. 2 (June
1, 2008): 153–60; Gary S. Goldfield et al., “Video Game Playing Is Independently
Associated with Blood Pressure and Lipids in Overweight and Obese
Adolescents,” ed. Philippe Rouet, PLoS ONE 6, no. 11 (November 1, 2011):
e26643.
5\] Theoharis C. Theoharides, Shahrzad Asadi, and Arti B. Patel, “Focal Brain
Inflammation and Autism,” Journal of Neuroinflammation 10, no. 1 (2013): 46.
6\] Z. Ranjbaran et al., “The Relevance of Sleep Abnormalities to Chronic Inflammatory
Conditions,” Inflammation Research: Official Journal of the European Histamine
Research Society ... \[et Al.\] 56, no. 2 (February 2007): 51–57.
10
7\] Christian Cajochen et al., “Evening Exposure to a Light-Emitting Diodes (Led)-Backlit
Computer Screen Affects Circadian Physiology and Cognitive Performance,” Journal of
Applied Physiology (Bethesda, Md.: 1985) 110, no. 5 (May 2011): 1432–38.
8\] Marcel Adam Just, Timothy A. Keller, and Rajesh K. Kana, “A Theory of Autism Based
on Frontal-Posterior Underconnectivity,” Development and Brain Systems in Autism,
2013, 35–63.
9\] Cris Rowan, “Unplug—Don’t Drug: A Critical Look at the Influence of Technology on
Child Behavior With an Alternative Way of Responding Other Than Evaluation and
Drugging,” Ethical Human Psychology and Psychiatry 12, no. 1 (April 1, 2010): 60–68;
Victoria Dunckley, “Gray Matters: Too Much Screen Time Damages the Brain,”
Psychology Today, Mental Wealth, (February 27,
2014), http://www.psychologytoday.com/blog/mental-wealth/201402/gray-matters-t….
10\] Chuan-Bo Weng et al., “Gray Matter and White Matter Abnormalities in Online Game
Addiction,” European Journal of Radiology 82, no. 8 (August 2013): 1308–12.
11\] R. Adolphs, L. Sears, and J. Piven, “Abnormal Processing of Social Information from
Faces in Autism,” Journal of Cognitive Neuroscience 13, no. 2 (February 15, 2001): 232–
40.
12\] Yalda T. Uhls et al., “Five Days at Outdoor Education Camp without Screens
Improves Preteen Skills with Nonverbal Emotion Cues,” Computers in Human Behavior
39, no. 0 (October 2014): 387–92; Roy Pea et al., “Media Use, Face-to-Face
Communication, Media Multitasking, and Social Well-Being among 8- to 12-Year-Old
Girls,” Developmental Psychology 48, no. 2 (March 2012): 327–36.
11
13\] Karen Frankel Heffler and Leonard M. Oestreicher, “Causation Model of Autism:
Audiovisual Brain Specialization in Infancy Competes with Social Brain Networks,”
Medical Hypotheses 91 (June 2016): 114–22.
14\] Weerasak Chonchaiya and Chandhita Pruksananonda, “Television Viewing
Associates with Delayed Language Development,” Acta Pædiatrica 97, no. 7 (2008): 977–
82.
15\] Susan W. White et al., “Anxiety in Children and Adolescents with Autism Spectrum
Disorders,” Clinical Psychology Review 29, no. 3 (April 2009): 216–29.
16\] Jee Hyun Ha et al., “Depression and Internet Addiction in Adolescents,”
Psychopathology 40, no. 6 (2007): 424–30; Pea et al., “Media Use, Face-to-Face
Communication, Media Multitasking, and Social Well-Being among 8- to 12-Year-Old
Girls.”
17\] Christopher Mulligan, “The Toxic Relationship: Technology and Autism,”
2012, http://www.teenvideogameaddiction.com/The_toxicrelationshipautismandtec….
18\] D. C. Chugani et al., “Developmental Changes in Brain Serotonin Synthesis Capacity
in Autistic and Nonautistic Children,” Annals of Neurology 45, no. 3 (March 1999): 287–95;
Adolphs, Sears, and Piven, “Abnormal Processing of Social Information from Faces in
Autism.”
19\] Jun Kohyama, “Neurochemical and Neuropharmacological Aspects of Circadian
Disruptions: An Introduction to Asynchronization,” Current Neuropharmacology 9, no. 2
2011): 330; Klaus Mathiak and René Weber, “Toward Brain Correlates of Natural
Behavior: fMRI during Violent Video Games,” Human Brain Mapping 27, no. 12 (December
2006): 948–56.
12
20\] Geraldine Dawson and Renee Watling, “Interventions to Facilitate Auditory, Visual,
and Motor Integration in Autism: A Review of the Evidence,” Journal of Autism and
Developmental Disorders 30, no. 5 (2000): 415–421.
21\] Cris Rowan, “The Impact of Technology on Child Sensory and Motor Development,”
2010, http://www.sensoryprocessinginfo/CrisRowan.pdf.
22\] Micah O. Mazurek and Christopher R. Engelhardt, “Video Game Use and Problem
Behaviors in Boys with Autism Spectrum Disorders,” Research in Autism Spectrum
Disorders 7, no. 2 (February 2013): 316–24; Micah O Mazurek and Colleen Wenstrup,
Television, Video Game and Social Media Use Among Children with Asd and Typically
Developing Siblings,” Journal of Autism and Developmental Disorders 43, no. 6 (June
2013): 1258–71.
23\] Just, Keller, and Kana, “A Theory of Autism Based on Frontal-Posterior
Underconnectivity.”
24\] Edward L Swing et al., “Television and Video Game Exposure and the Development
of Attention Problems,” Pediatrics 126, no. 2 (August 2010): 214–21; Robert M. Pressman
et al., “Examining the Interface of Family and Personal Traits, Media, and Academic
Imperatives Using the Learning Habit Study,” The American Journal of
Family Therapy 42, no. 5 (October 20, 2014): 347–63; Angeline S Lillard and Jennifer
Peterson, “The Immediate Impact of Different Types of Television on Young Children’s
Executive Function,” Pediatrics 128, no. 4 (October 2011): 644–49.
25\] Martha R. Herbert and Cindy Sage, “Autism and EMF? Plausibility of a
Pathophysiological Link - Part I,” Pathophysiology: The Official Journal of the
International Society for Pathophysiology / ISP 20, no. 3 (June 2013): 191–209.
13
26\] Cecilia Belardinelli and Mahreen Raza, “Comorbid Behavioral Problems and
Psychiatric Disorders in Autism Spectrum Disorders,” Journal of Childhood &
Developmental Disorders 2, no. 2 (2016).
27\] Goran Mihajlovi et al., “Excessive Internet Use and Depressive Disorders,”
Psychiatria Danubina 20, no. 1 (March 2008): 6–15; Ju-Yu Yen et al., “The Comorbid
Psychiatric Symptoms of Internet Addiction: Attention Deficit and Hyperactivity Disorder
ADHD), Depression, Social Phobia, and Hostility,” The Journal of Adolescent Health:
Official Publication of the Society for Adolescent Medicine 41, no. 1 (July 2007): 93–98; J
Lee, K Lee, and T Choi, “The Effects of Smartphone and Internet/Computer Addiction on
Adolescent Psychopathology.” (166th Annual Meeting of the American Psychiatric
Association, San Francisco, CA,
2013), http://www.psychcongress.com/article/smartphone-addiction-linked-increa…-.
Email
About the Author
Victoria L. Dunckley, M.D. is an integrative child, adolescent and adult
psychiatrist, the author of Reset Your Child's Brain, and an expert on the
effects of screen-time on the developing nervous system.
Online:
My Website, Facebook, LinkedIn, Twitter
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