Journal Club/September 24, 2010. Swing et al. Television and video game exposure and the development of attention problems. Pediatrics 2010;126:214-221.David H. Rubin, MDDavid H. Rubin, MDChairman and Program Director, PediatricsChairman and Program Director, PediatricsSt Barnabas HospitalSt Barnabas HospitalProfessor of Clinical Pediatrics, Albert Professor of Clinical Pediatrics, Albert Einstein College of MedicineEinstein College of Medicine

OBJECTIVES OBJECTIVES

AimAim

Hypothesis Hypothesis

Methods/statisticsMethods/statistics

ConclusionConclusion

Competency based Competency based evaluationevaluation

COMPETENCY BASED EVALUATION

Review of competencies (pre-review of article)

Review of competencies (post-review of article)

Application of specific issues from article to each competency• Attempt to match issues from article

with specific competency

COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES

Medical KnowledgeMedical Knowledge • knowledge about the established knowledge about the established

and evolving biomedical, clinical, and evolving biomedical, clinical, and cognate (epidemiological and and cognate (epidemiological and social-behavioral) sciences and social-behavioral) sciences and their application to patient caretheir application to patient care

COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES

Patient CarePatient Care • family centered patient care family centered patient care

developmentally and age developmentally and age appropriate compassionate and appropriate compassionate and effective for treatment of health effective for treatment of health care problems and promotion of care problems and promotion of healthhealth

COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES

Practice Based LearningPractice Based Learning • investigation and evaluation of investigation and evaluation of

patient care, and the assimilation patient care, and the assimilation of scientific evidenceof scientific evidence

Communication SkillsCommunication Skills • interpersonal and communication interpersonal and communication

skills resulting in effective skills resulting in effective information exchange and learning information exchange and learning with patients, families and with patients, families and professional associatesprofessional associates

COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES

System Based PracticeSystem Based Practice • understanding systems of health understanding systems of health

care organization, financing, and care organization, financing, and delivery, and the relationship of delivery, and the relationship of one’s local practice and these one’s local practice and these larger systemslarger systems

ProfessionalismProfessionalism • carrying out professional carrying out professional

responsibilities, adherence to responsibilities, adherence to ethical principles, and sensitivity ethical principles, and sensitivity to diverse patient populationsto diverse patient populations

INTRODUCTIONINTRODUCTION Attention problems are associated Attention problems are associated

with with poorer school poorer school performance performance and and increased increased aggressionaggression

Is TV a risk factor for attention Is TV a risk factor for attention problems? Literature suggests:problems? Literature suggests:• TV is so exciting that children would TV is so exciting that children would

be bored with anything elsebe bored with anything else• TV may harm ability to sustain focusTV may harm ability to sustain focus

INTRODUCTIONINTRODUCTION Video games have a lot in Video games have a lot in

common with TVcommon with TV• High excitementHigh excitement• Rapid changes in focusRapid changes in focus

Cross sectional and longitudinal Cross sectional and longitudinal studies have found TV associated studies have found TV associated with attention problemswith attention problems

Few studies have examined Few studies have examined whether video games could have whether video games could have similar effectsimilar effect

INTRODUCTIONINTRODUCTION

At what age is the effect of TV and At what age is the effect of TV and attention problems?attention problems?• Prior studies have found effect in first 3 Prior studies have found effect in first 3

years of life and in adolescenceyears of life and in adolescence Current study addresses 3 Current study addresses 3

questionsquestions• Are both TV and video associated with Are both TV and video associated with

significant attention problems?significant attention problems?• Are both TV and video associated with Are both TV and video associated with

attention problems in middle childhood?attention problems in middle childhood?• Are both TV and video associated with Are both TV and video associated with

attention problems in late attention problems in late adolescence/early adulthood?adolescence/early adulthood?

METHODSMETHODS 2 age samples of males and 2 age samples of males and

femalesfemales• Middle childhood Middle childhood (10 schools in 2 (10 schools in 2

midwestern states; part of SWITCH midwestern states; part of SWITCH obesity prevention project; reports obesity prevention project; reports collected from parents, teachers, and collected from parents, teachers, and children at 4 points in 13 months)children at 4 points in 13 months)

• Late adolescence Late adolescence (undergraduate (undergraduate students from large school in midwest, students from large school in midwest, single lab session; self report at single lab session; self report at similar time periods)similar time periods)

METHODSMETHODS

TV and video game exposureTV and video game exposure• Both groups (TV and video) Both groups (TV and video)

completed similar questionscompleted similar questions• Middle childhood completed questions Middle childhood completed questions

with parentswith parents• Late adolescence completed self Late adolescence completed self

reportsreports

• TV and video exposure: average TV and video exposure: average time during 4 time periods during time during 4 time periods during weekdays and separately during weekdays and separately during same time periods on weekendssame time periods on weekends

METHODS METHODS

Attention problemsAttention problems• Childhood sampleChildhood sample by by

teacher reportteacher report• Good internal reliability; Good internal reliability;

= .91, .92= .91, .92

• Adolescent sample Adolescent sample self self report: Adult ADHD Self Report report: Adult ADHD Self Report Scale, Brief Self-Control Scale, Scale, Brief Self-Control Scale, Barratt Impulsive Scale Barratt Impulsive Scale

• Good internal reliability; Good internal reliability; = .89, .85, .84= .89, .85, .84

RESULTS

See Table 1 for sample characteristics

See Table 2: Correlation coefficients and odds ratios computed for• Weekly TV exposure• Weekly video game exposure• Weekly total screen exposure• Attention problems in 2 age groups

RESULTS

Logistic regression model comparing risk of being above median for attention problems and above and below the 2 hour AAP exposure recommendation• If exceeded AAP recommendations

above average in attention problems (OR: 1.67 (1.27, 2.21) and 2.23 (1.13, 4.391) (young and older groups)

RESULTS

General linear models- see Tables 3 and 4

DISCUSSION

Study demonstrates that risk of attention problems could be reduced if parents followed AAP recommendation of exposure to < 2 hours/day

Non violent, slower based educational content is less likely to cause attention problems

DISCUSSION/LIMITATIONS

Groups equivalent? Evaluation equivalent Comparison valid? Analysis correct? Conclusions based on data?

1. What is the major finding in this study (medical knowledge)?

2. What is the design of the study; what are the limitations and advantages of this methodology in the study (PBLI)?

3. What is the statistical analysis used in the study; is it appropriate? (PBLI).

4. Do you agree with the author’s methodology used in this study? Provide an explanation for your answer (PBLI).

5. Will the findings in this study alter your clinical practice? Provide an explanation for your answer (patient care).

COMPETENCY BASED QUESTIONS FOR

DISCUSSION

COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES

Medical KnowledgeMedical Knowledge • knowledge about the established knowledge about the established

and evolving biomedical, clinical, and evolving biomedical, clinical, and cognate (epidemiological and and cognate (epidemiological and social-behavioral) sciences and social-behavioral) sciences and their application to patient caretheir application to patient care

• Effect of prolonged TV and video Effect of prolonged TV and video exposure by ageexposure by age

COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES

Patient CarePatient Care • family centered patient care family centered patient care

developmentally and age appropriate developmentally and age appropriate compassionate and effective for compassionate and effective for treatment of health care problems treatment of health care problems and promotion of healthand promotion of health

• Presentation and management of disease Presentation and management of disease by ageby age

• Importance of information for family Importance of information for family regarding signs and symptoms of problemregarding signs and symptoms of problem

COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES

Practice Based LearningPractice Based Learning • investigation and evaluation of patient investigation and evaluation of patient

care, and the assimilation of scientific care, and the assimilation of scientific evidenceevidence

• Scientific evaluation of hypothesis, methods, Scientific evaluation of hypothesis, methods, and conclusion of articleand conclusion of article

Communication SkillsCommunication Skills • interpersonal and communication skills interpersonal and communication skills

resulting in effective information resulting in effective information exchange and learning with patients, exchange and learning with patients, families and professional associatesfamilies and professional associates

COMPETENCY COMPETENCY BASED OBJECTIVESBASED OBJECTIVES

System Based PracticeSystem Based Practice • understanding systems of health care understanding systems of health care

organization, financing, and delivery, organization, financing, and delivery, and the relationship of one’s local and the relationship of one’s local practice and these larger systemspractice and these larger systems

• Referral systems, consultation Referral systems, consultation

ProfessionalismProfessionalism • carrying out professional responsibilities, carrying out professional responsibilities,

adherence to ethical principles, and adherence to ethical principles, and sensitivity to diverse patient populationssensitivity to diverse patient populations

• Patient education in diverse culturesPatient education in diverse cultures