Volume 2, #10, April 2004

Last Words

by Betsy Davenport, PhD

How to read/hear the news of the latest research/quasi-research

There’s been a pretty big hoopla just lately over television watching and AD/HD. This began when it was widely reported in popular media that “watching television before the age of 3 increases the chances that children will develop attentional problems at age 7,” or at least this was what was quoted as having been said by Dr. Dimitri Christakis, the author of a study done at the University of Washington in Seattle.

We’ll revisit this particular bit of “news” and the accompanying fancy-dancing in a minute, but the purpose of this column is not so much to dissect this recent study, but to use it as an example of how research can be either flawed or limited, or both, and therefore easily misleading; and then, how those who report to us about the research, having been misled, or out of ignorance of the flaws and/or limitations, can mislead us even more.

So when we finally hear or read something about it (even though our gut may say, “No way,” and be correct [and, if we’ve got AD/HD, it can as often go the other way, too, and our gut has its say, and is wrong]) we must first question whether we’ve just got in on the end of a massive game of “Telephone”. Then we’ve got to inquire about the accuracy of the reporting, whether in the translation from scientific language to newspaper language or to videospeak there was a loss of accuracy.

Finally, we must have a look at the information ourselves – and by “information,” I don’t necessarily mean the research paper, but an actual interview with one of the researchers, or a short cruise through a medical website with your antennae extended – to see of what sort the limitations are, whether the flaws are significant to the outcome, and consider the possibility that the researcher and/or the reporter has come to implausible or uncertain conclusions. This recent newsmaker gives us a perfect example to learn on.

Go back to the first paragraph, above. Dr. Christakis is quoted using the words “…children will develop attentional problems…” Note he does not say, “… AD/HD…” and he does say, “…develop…” Current scientific understanding has it that AD/HD is a heritable condition which a person either has, or doesn’t have. It may express itself at an early or later age, but so far as we know, it doesn’t “develop.” So far, Dr. C. is doing all right, in the AD/HD department (which, we may as well admit, is the department where most of the knickers are in a knot; one doesn’t hear much from the television industry, because the research about toddlers and television is old, and reputable, and includes everything from late language development to late literacy with some short attention span studies thrown in for good measure).

So the interchangeability of the terms “attention” and “AD/HD” seems maybe to have begun farther down the line, like maybe with the media (Psssssst: don’t reporters watch a lot of television? Don’t they have to?).

But Dr. C., if we can believe news reports quoted him accurately, did lead reporters down the primrose path by saying true things that aren’t necessarily related. For example, he is quoted as saying, in reference to AD/HD, that many parents may believe their children are just "born that way," but the home environment can also play a key role in the development of the disorder. (That was a paraphrase of a paraphrase by a reporter, so we can’t be positive Dr. C. is now suggesting that AD/HD can develop in the home environment when aided and abetted by permissive television use, but it’s beginning to sound suspiciously like that. Read on for more.)

Next he says that, “Nurture profoundly influences Nature -- you're born with genetic predispositions, and then your environment really shapes them… there's every reason to believe that early experiences can profoundly affect the brain." Well, this is hardly news, that the answer to “Nature, or Nurture?” is that that the two have a reciprocal relationship, each influencing the other. So while Dr. C.’s statement isn’t untrue, we also know at least two other very important, and relevant, things he didn’t include (or, to be fair, it might be he did, but that reporters failed to include it in their reporting) in describing his research.

First, while as he says, the environment affects a developing brain, so does a brain (or its owner) affect its environment. What a certain child will be interested in doing; what her parents will be able to manage in terms of hours spent together if that toddler might happen to have very high stimulation needs, or be more phlegmatic and unmotivated; what an irritable child will discover in the environment that is soothing; or if a child concentrates best with some background noise or activity – all these are variables which might influence a household to keep a television on more than its adult members had ever thought or planned to.

The child whose impulse control doesn’t develop naturally and who strikes her mother every time she’s within range is a child whose quirky brain is alienating those in her environment who she loves and needs; and therefore is so unrestful to be with for long periods of time that her parents are suffering, relationships will fracture, and the only humane thing to do is pull together a very good evaluation team (at age two?), or in the meantime, maybe a little more television will tide everyone over as an anesthetic.

Second, we know now that the environment (e.g., “bad” parenting, and, by extension -- it would seem – and this research, while interesting, proves nothing to the contrary – other factors like a lot of television) cannot cause AD/HD.

But one thing invariably leads to another, and on hearing “AD/HD,” news reporters everywhere must have gone to their data banks, looked up AD/HD, and come up with the following, to flesh out their story: experts estimate that between 4 percent and 12 percent of U.S. children may be affected by Attention Deficit Hyperactivity Disorder (ADHD). How that relates to research on "attentional problems", isn't specified. The research had found a relationship, an association, between viewing time and “attentional problems.” Reporting the incidence of AD/HD is of marginal value; and it’s of negative value if not explicated and differentiated from the vague “attentional problems” named by Dr. C. and his colleagues in Seattle.

The whole area is, in fact, clouded over, made murkier; the employment of one term in place of another has the insidious effect of diverting our focus from the paltry bit of evidence that lots of television for tiny youngsters is associated with attentional problems later on.

And wait – there’s more. Look up at that paragraph preceding, again. “Associated with” does not mean “causes,” or “is caused by.” Because I am wearing a red shirt and it is raining today does not constitute evidence that the rain caused my shirt to be red; nor does it suggest that wearing red causes rain.

Furthermore, and some might be quite ready to call this nit picking, or hyperfocus on detail; but when it comes to science, it’s all in the details. Kind of like baking. Look back one paragraph to that estimate. “Between 4 percent and 12 percent” is a pretty wide margin. Suppose we’re making a cake and the recipe called for “between 4 and 12 tablespoons of salt. ”.
See?

Now Dr. Christakis, who works in the Department of Pediatrics at the University of Washington, and is therefore presumably no slouch in the brain wattage department, has to have known his research would create in people’s minds the exact connections it is creating. He is not, in early reports, anyway, doing anything at all to disabuse anyone of their confusion. In fact, he links “attentional problems” and “AD/HD” enough times that the average consumer of news isn’t going to make any distinctions. Many well educated adults with AD/HD have been perplexed by this study and its reporting, as well. It’s hard to dismiss a fellow with a string of letters after his name with a research grant funded by the Robert Wood Johnson Foundation among others, and who holds a position of some stature at the University of Washington.

CHADD did a nice job of reporting on the reporting on the write-up of the research, writing that “the study concludes that ‘early exposure to television was associated with subsequent attentional problems.’ However, the authors emphasize that ‘we cannot draw inferences from these associations. It could be that attentional problems lead to television viewing rather than vice versa.’ The authors do believe that inattention should be added to previously studied harmful consequences of excessive television viewing.” (Bingo!! There’s the bias: in spite of the caution that inferences cannot legitimately be drawn about the nature of the associations, they go on to do just that, by as much as calling problems with attention one more among the many ills generated by excessive television watching. Woops! Will Dr. Christakis receive another grant for such a study?)

CHADD goes on: “The authors acknowledge the ‘high heritability’ of AD/HD and acknowledge that current research is appropriately ‘focused on the structural and neurochemical features of the brain’ as well as the ‘structural and operational neurologic features of the central nervous system.’ The authors observe that ‘environmental exposures, including types and degrees of stimulation, affect the number and the density of neuronal synapses.’ The authors of the Pediatrics study call for additional research, including replication of their work and a study of TV content.”

In conclusion, let me point out a few of the more obvious flaws in how the research was conducted in the first place. In order to obtain the data they needed, it seems Dr. Christakis and his researchers examined data gathered by a “major government survey” of nearly 1,300 children and youth. They compared rates of TV watching during the first three years of life to the later development of attention problems at age 7. One wonders about this word, "development," and whether it is an example of imprecise thinking; since these children were not observed on a regular basis, one is safe only in saying that attentional problems appeared. They didn’t gather their own data, and the data they used was gathered for some other purpose, and they had no control over the methods used or the accuracy of its tabulation.

Moreover, these data were generated from retrospective reporting by parents; that is, parents were asked to think back and recall how much television their children had watched prior to the age of three. Collection of data like that can, and should, be done in the present, with parents or a third party, keeping a simple daily log, thus ensuring accuracy, and removing a good deal of doubt about the very data on which an already controversial study is based.

Since AD/HD is so often found among family members, a thorough family history for each child in the study should be taken into account.

Now I want to go back, one more time, to the findings Dr. C. reports: “For each additional daily hour of television that young children watched on average, the risk of subsequently having attentional problems was increased by almost 10,” Christakis is said to have said. Do the math: this would mean that 1- to 3-year-olds watching 8 hours of television a day… yup, D. Christakis was quoted as saying these poor babies “would have an 80 percent higher risk of attentional problems compared to a child who watched zero hours.”

Two things are gnawing at me, here. First, all the adults I know with AD/HD who never watched television when toddlers or children (I am one of those) – what if they had? Would they be so many times worse off?? Or, as some have suggested (my brother among them, decades ago, and for his own reasons), would a daily dose of television have had a salutary effect, instead? Perhaps Dr. Christakis will study that, next.

Second, what’s really getting to me are all those hours of noise. Never mind the kids for a second; as the mother in this house, I could not have borne the racket for more than about ten minutes a day, let alone ten hours. And then, I can’t help wondering just who these pips are who are watching all that television in the first place. I do know that two year olds do an awful lot of watching, which is why daycare for age mates isn’t a very good idea, and mixing ages is better: two year olds have been found (through research!) to do so much watching, in fact, that what they do most of in daycare is watch and copy, so if they spend their days with other two year olds, what kind of behavior do you think they are watching and copying, while the few adults in their lives are trying mightily to haul them along into civilized living?

I think we’ve squeezed about all we can out of this. We don’t know much about much because we weren’t there, either at the interviews with the researchers, or when the stories got put together for the papers and radio and television. What we do know, and have got to remember, is that people, no matter how many letters they have after their names, are still human, and therefore fallible, and that goes for us, too. So while it’s easy and amusing to point at the northwest section of the nation where Seattle is located, and smirk, I can tell you, I’ve had a devil of a time writing this and being fair, not jumping to conclusions based on insufficient evidence, and asserting my opinion just because it suits me better than the facts or than not knowing.

We’ve got to use our heads; and when our Brains take a hike, press our good-enough Minds into service, or slow down and wait until we have our wits about us again before we run off at the mouth, stick our foot in, and live long enough (what, an hour?) to regret it.

Next: April 2004 Online Newsletter >>