Читать книгу Reset Your Child's Brain - Victoria L. Dunckley MD - Страница 8
ОглавлениеSOMETHING WICKED THIS WAY COMES
Several months ago, a colleague I barely knew pulled me aside as I passed by her in the hallway at work. “Can I talk to you?” she whispered urgently. Without waiting for an answer, she launched into the litany of problems she was having with her eight-year-old son, Ryan. Over the past year, Ryan had become increasingly depressed, irritable, and isolated. Meltdowns and tears over seemingly minor incidents had become a daily occurrence. He was spending less time with his friends, preferring to remain alone in his room for hours, playing games on his cell phone. He was failing nearly every subject in school, and his teachers felt frustrated with his distractibility and lack of organization.
Ryan had been evaluated and treated by two child psychiatrists and three therapists over a six-month period. He was first given a diagnosis of attention deficit disorder, then high-functioning autism, and finally bipolar disorder. He was on his fourth medication trial, but his mother felt each regimen only made him worse.
“I don’t know what to do at this point,” she said, frowning. “I feel like something’s being missed. I wanted your opinion about all this medication.”
Sidestepping the medication question, I explained to her that I see children with Ryan’s “problem” every day, and I gave her some background on how electronic screen devices irritate the brain and overstimulate the nervous system, especially in children. And I advised her to try a seemingly radical — yet simple — plan before considering any more changes: to remove all video games, handheld electronic devices, computers, and cell phones from Ryan’s possession for three weeks — in essence, to put Ryan on an “electronic fast.”
As we talked further, the explanation began to make sense to her, especially when it occurred to her that Ryan had received his first cell phone — a “smart” one at that — the year before, shortly before the onset of his troubles. Desperate for some improvement, my colleague immediately took action and stuck to the plan I outlined.
Four weeks later, she sought me out and excitedly reported that Ryan was doing “much, MUCH better.” Her face, body, and even her speech seemed more relaxed. She was inspired enough to continue the “electronic abstinence,” and six months later, Ryan would be weaned off all medication. His grades had improved, and he was playing outside with his friends again.
“He’s back to himself,” she told me proudly.
Why had Ryan been so significantly misdiagnosed, even by well-respected professionals — two of whom were faculty at a major academic institution in Los Angeles? And why had he been placed on so many medications, none of which seemed to help? Unfortunately, Ryan’s experience with receiving ineffective mental health treatment is hardly unique. But before we get to the underlying reasons, consider some emerging trends in childhood mental health disorders. In a mere ten-year span from 1994 to 2003, the diagnosis of bipolar disorder in children increased forty-fold.1 Childhood psychiatric disorders such as ADHD (attention deficit hyperactivity disorder), autism spectrum disorders, and tic disorders are on the rise.2 Between 2002 and 2005, ADHD medication prescriptions rose by 40 percent.3 Mental illness is now the number one reason for disability filings for children, representing half of all claims filed in 2012, compared to just 5 to 6 percent of claims twenty years prior.4
Now consider that this rise in childhood psychosocial and neurodevelopmental issues has increased in lockstep with the insidious growth of electronic-screen exposure in daily life. Not only are children exposed to ever-increasing amounts of screen-time at home and in school, but exposure is beginning at ever-younger ages. Children aged two to six now spend two to four hours a day screen-bound — during a period in their lives when sufficient healthy play is critical to normal development.5 Computer training in early-years education — including in preschool — has become commonplace, despite lack of long-term data on learning and development.6 And according to a large-scale survey conducted by the Kaiser Family Foundation in 2010, children ages eight to eighteen now spend an average of nearly seven and a half hours a day in front of a screen — a 20 percent increase from just five years earlier.7
Handheld and mobile devices account for most of the more recent growth. These devices compound toxicity due to the fact that they are held closer to the eyes and body, are used more frequently throughout the day, and tend to be used during activities that previously facilitated conversation (such as riding in the car and eating out). From 2005 to 2009, cell phone ownership among children nearly doubled; about one-third of ten-year-olds now have their own mobile phone.8 Two-thirds of American teens now own cell phones, and 70 percent own an iPad, tablet, or similar device with Internet capability.9 And according to a 2010 Nielsen report, US teens text over four thousand times a month, or about 130 times a day.10
No doubt, modern-day life presents unique challenges to children’s brains, minds, and social development for parents and clinicians alike that have never been encountered before. The explosion of Internet use, video gaming, cell phone use, and texting is a relatively new phenomenon, and the full implications of such excessive technology exposure have yet to be played out. As I write this, the iPad and other tablets have taken us by storm in just a few short years. Meanwhile, despite a growing body of evidence that suggests electronic screen media exposure inherently causes harm — beyond simply wasting time or being sedentary — much of the research on this development remains disparate, highly technical, or overly focused on limited concerns, such as violent games or Internet addiction. Review of the research on “typical” use is difficult to evaluate, in part because what is typical is constantly evolving, and in part because relevant studies are being conducted in a variety of fields, ranging from sociology to quantum physics, making findings difficult to assimilate.
Adding to the confusion is the unfortunate fact that the public receives conflicting messages about electronic media’s effects on the brain from the press on a nearly daily basis. People have no way of easily determining whether a particular study is considered methodologically sound, whether any of the researchers had financial conflicts of interest, whether the media sensationalized the findings, or whether they’re hearing about a study so prominently because of a heavily funded and carefully orchestrated press release. As such, it’s difficult to get a sense of what the balance of unbiased research shows. Parents are given vague advice to “moderate” usage and are often led to believe that limiting screen-time only applies to video game play. They’re told to avoid violent games, but that educational games might give a child an “edge” over peers or even enhance his or her intelligence. They’ve heard of Internet and gaming addiction, but they are encouraged to feel safe if their child does not meet strict addiction criteria.
Nevertheless, many parents sense intuitively that electronic screen activity has unwanted effects on their children’s behavior and mood, but they are unsure what to do about it. They feel helpless because of the sheer prevalence of electronic devices, at home and at school. At the same time, parents are acutely aware that it has become increasingly common for families to have at least one “problem child” who is suffering from enough dysfunction that a parent or teacher seeks help. Since the child’s struggles frequently include meltdowns, falling grades, or loss of friendships, parents feel increasingly desperate to find answers now.
So, what’s really happening to our children? Like Ryan, many youngsters exhibit ill-defined but disruptive symptoms that baffle clinicians, teachers, and parents alike, leading to premature or wrong diagnoses in a misguided attempt to name the problem and take action. In a word, these children are dysregulated — that is, they have trouble modulating their emotional responses and arousal levels when stressed. In fact, in 2013, a controversial new diagnosis — Disruptive Mood Dysregulation Disorder, or DMDD — debuted in the long-awaited fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The presentation of a child with chronic irritability, poor focus, rages, meltdowns, and truly disruptive oppositional-defiant behavior has become disturbingly commonplace, and there is legitimate concern that these children are being misdiagnosed with bipolar disorder or other conditions and being prescribed antipsychotic medication.11 In the face of an increase in such diagnoses, psychiatrists felt it was necessary to define a new disorder that more accurately matches these children’s symptoms, despite a lack of definitive proof that these symptoms indeed represent a true, organic mental health disorder.
But what if this “disorder” characterized by dysregulation is not some mysterious new plague, but environmentally related? If we ask ourselves, “What has been the biggest change in our children’s environment compared to only one generation ago?” the answer is not gluten, pesticides, plastics, or food dye,* but the advent of the Internet, cell phones, and wireless communication. Might DMDD really be merely a by-product of constant bombardment from electronic screen devices, causing the brain to short-circuit?
And what if systematic removal of such screen devices provided much-needed relief, almost immediately?
A Doctor’s Journey
I first became aware of the negative effects of screen-time in the early 2000s while working with particularly sensitive patients. These were children with psychiatric disorders complicated by psychological trauma. Some of these kids lived in group homes, others were in foster care, and still others had been adopted into a new family. Regardless of their current situation, they all shared a number of symptoms due to universal changes the brain and body make when presented with repeated trauma — namely, a “hair trigger” response to perceived stress that put their little bodies into a nearly constant state of fight-or-flight. This state was marked by emotional reactivity, trouble following direction, meltdowns over small frustrations, and high physiological arousal (getting “revved up” easily).
Through regular observation of these sensitive children over months and years, I discovered that even small amounts of video game play triggered this fight-or-flight response — the same response we were trying to assuage with therapy and blunt with medication. I started advising parents and group home staff to avoid letting these children have any video game play altogether. These kids had enough strikes against them — why add fuel to the fire? Although my advice was often met with resistance, when the intervention was followed, many of the more egregious symptoms abated quite rapidly.
One especially striking intervention occurred in a residential treatment facility where I worked with the children (and their staff) on site. Every week when the treatment team met, I’d be barraged with all the unfortunate events that had taken place over the previous week and pressured to make changes in medication to alter the children’s behavior. Each “house” at this center had video game consoles that were used as incentives for good behavior, and every week I’d hear things like, “Jacob hit Robert over the head while they were playing a video game together on Saturday.” Or “Joaquin was the only kid in the house who had good behavior on Wednesday, so we rewarded him with some video game play, but he wound up becoming really agitated and threw a chair.”
I’d often get exasperated and ask things like, “Why do we even have video games in the house in the first place?” Most of the time my complaints fell on deaf ears, but one day some of the staff from one house approached me after the weekly meeting and said they also suspected that the games were a problem. The house leaders had held a meeting and decided they wanted to try removing the games to see if it helped keep the whole house calmer. Sure enough, one month later, the number of “special incident reports” (which were reserved for severe behaviors like overt aggressive acts) for that house dropped by one-third. Interestingly, staff also noticed that the children stopped asking about the games fairly quickly and turned naturally to healthier activities. Years later, one of the male staff who had initiated the removal of the games contacted me to ask if I was still working on increasing awareness about using this intervention and offered to write a testimonial. The dramatic difference it had made in the behavior of the children in his house stayed with him.
Another group of patients I discovered early on to be sensitive to video game play were those with tics or Tourette syndrome.* In these children, overactive areas of the brain were causing involuntary motor activity. The exacerbation of symptoms caused by video games in this group was even more obvious. With some of these children, gaming increased their overall tic frequency and severity, and with others the tics would ratchet up whenever the child actually played the game or used the computer. As with the trauma patients, removal of the video games often produced significant relief and sometimes helped us avoid medication altogether.
For all of these children, there was something about playing video games that seemed to exacerbate both neurological and psychological symptoms by putting the brain and body into overdrive. Although my initial observations and efforts focused specifically on video games, over time it became apparent that fight-or-flight reactions occurred with other interactive screen devices as well, such as laptops and smartphones. Eventually, I found these effects were noticeable not just in children with major psychiatric disturbances, but also in children with “plain-old” ADHD symptoms. Ultimately, I realized even “typical” children (without any diagnoses) could experience less extreme but nonetheless disruptive symptoms — which meant it wasn’t just highly sensitive children or those with psychiatric disorders who were vulnerable to adverse effects, but potentially any child.
Feeling certain I was on to a significant connection, I began prescribing video game restriction more widely and more strictly — with startling results. While perhaps only a minority of children are truly “addicted” to video games, I observed how the vast majority of children exhibited certain symptoms surrounding game play — symptoms strikingly similar to amphetamine exposure — that resolved within days or weeks of complete abstention. I watched what happened before and after the intervention, which I came to call an electronic fast, tracked objective measures (like grades or homework completion), and observed what happened when parents inevitably “reintroduced” screens. I paid attention to what it took to convince parents that the fast was worthwhile, what anxieties they had about how to do it, and what impact my delivery had. I learned by watching the children over long periods what worked and what didn’t, and I noticed how their development would grow by leaps and bounds when screens were most restricted. I also saw how screen-time had a sneaky way of reinserting itself into families’ lives, and that — much like management of diet or finances — screen-time management was an ongoing process.
Importantly, I realized that the more information the parents had and the better they understood the underlying mechanisms connecting screen-time and symptoms, the better they were at regulating exposure, and the more quickly they could get a handle on problems before they spun out of control. When I set up an online course based on my experience (dubbed “Save Your Child’s Brain”), I received dozens of emails from mothers around the world, and I learned from those examples, too. Many of the mothers said they intuitively thought screens might be the cause of their child’s symptoms but that their concerns had been ignored by their child’s doctor or therapist. Hearing about the experiences of other parents helped them to stick to their guns and lose the screens, and I was encouraged that my message was resonating and having such a positive effect.
Perhaps serendipitously, even as I was continuing to counsel parents about reducing their children’s exposure to electronic screens, I began experiencing pronounced electronic screen sensitivity myself! If I spent several hours writing, and especially if I was on the Internet for extended periods poring over studies, I’d wind up feeling spacey, forgetting things, lashing out at my husband, and sleeping poorly. I’d even experience a rash on my face around my eyes if I used my laptop for an extended period of time. By necessity, I was forced to find ways to make my brain and body tolerate the time I needed to work at my computer; fortunately, I devised numerous helpful strategies, which I’ll discuss in chapter 10.
Finally, about five years ago I began expanding my studies into the fascinating world of integrative medicine. Integrative practitioners learn to look at patients in a holistic manner, and they systematically uncover environmental influences — such as diet, lack of exercise, or exposure to toxins — that may be triggering and maintaining a patient’s symptoms. Modifying these factors not only reduces aggravation, it frees up the body to self-heal. In general, for most chronic conditions, integrative clinicians favor natural methods over pharmaceuticals; they do prescribe medications, but they seek to use them sparingly. This is because, aside from nasty side effects we can see, we are now discovering that many medications (including psychotropics) deplete various nutrients or cause some other metabolic imbalance in the brain or body. In psychiatry, it’s often the case that medication solves one problem but produces another. For example, medications that help with attention often cause sleep problems, and medications that address mood often cause lethargy or weight gain. Thus, the importance of avoiding unnecessary medication in children — whose brains and bodies are more sensitive — cannot be overstated. This is not to say psychiatric medications are never appropriate for children; indeed, they serve an important role. But they should be used conservatively, always with risks and benefits in mind, and always in conjunction with other interventions that minimize the need for them. And they certainly shouldn’t be used merely to counteract overstimulation arising from environmental influences that are within our control.
It is astonishing how much chronic disease is caused by lifestyle choices. But while it takes more energy, both on the physician’s and the patient’s part, to heal in a natural, integrated fashion rather than just getting a quick fix with a prescription, it is equally astonishing how much can be reversed.
How to Use This Book
This book is intended to expose and explain how interactive screen-time creates and exacerbates psychiatric symptoms, and it provides parents with a practical, proven solution to reverse such changes. Part 1 introduces the phenomenon I call Electronic Screen Syndrome (ESS) — a constellation of symptoms from exposure to electronic screen media characterized by a state of hyperarousal (fight-or-flight) and mood dysregulation — and it examines case studies ranging from the severely emotionally disturbed child to the high-functioning child with isolated behavior or social issues. We’ll explore how screen devices interface with a child’s physiological systems, altering brain chemistry, arousal level, hormones, and sleep, ultimately interfering with thinking, mood, behavior, and social skills. We’ll see how these changes can eventually masquerade as full-blown psychiatric disorders, whether the child has any underlying disorders or not, and create growing dysfunction across multiple dimensions, as well as how a “screen-liberated” brain improves over the weeks, months, and years to come.
Part 2 provides the detailed, step-by-step plan I’ve used with hundreds of children and parents to minimize and reverse the harmful effects of ESS. This proven four-week program consists of a week-long preparation phase and a three-week electronic fast, and it can effectively “reset” a child’s brain. Much of the plan is dependent on proper planning and structure, and you’ll receive plenty of practical instruction on how to set yourself up for success, as well as how to handle any pitfalls you may encounter, such as handling resistance from others. You’ll also learn how to navigate screen-time after the Reset, both in the immediate aftermath and over the long haul. Part 3 addresses concerns parents inevitably bring up as they embark on the program — what to do about school-related screen-time, how to protect children if complete lack of screen exposure isn’t possible, and how to build community awareness. There are also three appendices: one outlines screen-time’s various physiological effects in table format; one describes the potential health effects of electronic-related radiation; and one answers the most frequently asked questions I hear from parents.
Although you may be tempted to jump right to the Reset itself (part 2), to get the most out of the book and maximize the program’s effectiveness, I suggest you read part 1 first. The more you understand about the nature of ESS, the more conviction and motivation you’ll have to follow through. If you are eager to get right to it, though, you could read part 1 during the first week of the fast. My hope is that this book empowers you to take action and inspires you to implement a treatment strategy that’s effective, broad-reaching, 100 percent safe, and essentially free.
So what you can you expect from the Reset? Based on utilizing a strict electronic fast in over five hundred children, teens, and young adults, and observing the changes during and following the fast, I have found that in children with diagnosed psychiatric disorders, about 80 percent will show marked improvement (symptom reduction of at least 50 percent) across all psychiatric symptom and diagnostic categories. In children without an underlying disorder, the percentage may be even higher, and of those who respond positively, about half will show a complete resolution of symptoms (that is, cessation of tantrums, chronic irritability, poor focus, and so on), and the other half will show marked improvement. You can expect to see a happier child with better focus and organization, improved compliance, and more mature social interactions. Beyond relief from the worst aspects of ESS, my goal for your child is not just symptom relief, but optimization of brain, mind, and social development.
* Admittedly, these are all offenders of mental health, but they do not constitute the biggest change in one generation.
* Tourette syndrome is characterized by two or more motor and one or more vocal tics.
