Should we give different media guidance for young children with ADHD, autism?
JennyRadesky, M.D., FAAP
Mastering the Media
Every child develops his or her own relationship with media from the time of infancy.
However, researchers have hypothesized that some children are more “susceptible” to
the negative effects of media use and are more likely to develop problematic media
Several studies, for example, have shown that children with attention-deficit/hyperactivity
disorder (ADHD) and autism spectrum disorder (ASD) develop more excessive media use
habits in early childhood and school years than children without these neurodevelopmental
In clinic, providers often see this in the intense, fussy toddler whose parents calm
him down with a tablet; school-age children with ADHD whose preference for videogaming
starts to displace physical activity, sleep or homework; or anxious youngsters who
have nightmares after seeing a frightening YouTube video.
ADHD and ASD overlap in terms of difficulties with executive functioning, rigid thinking,
self-regulation and sensory symptoms; it is important to understand how media use
might worsen or improve some of these difficulties. For example, heavy media use may
displace important opportunities for social interaction, the types of play that build
executive functioning skills and learning how to calm oneself — skills that don’t
come easily to kids with ADHD and ASD. For children with ASD in particular, digital
media use can become a restricted interest or repetitive behavior that can be hard
to transition away from.
Yet, digital devices can serve as important tools when used as a communication device,
visual schedule, platform for creating social stories or immediate behavioral reinforcer.
Furthermore, many children with ADHD or ASD have a comorbid learning disability in
which keyboarding or audiobooks are extremely helpful.
Thus, the guiding principle for media use by children with ADHD or ASD should be to
use it as a tool to build skills, rather than viewing media use only as a highly preferred
activity or “rabbit hole” in which they get lost.
Here are some discrete points to use when advising parents:
Avoid violence. Some children with ASD or ADHD seek the sensory stimulation and emotional
arousal of vividly dramatic violence, but they often lack the emotional maturity to
understand what they are seeing and the interpersonal or societal implications. If
violence is encountered, help the child understand it.
Kids with ADHD or ASD have difficulties with flexible thinking; they tend to get stuck
on favorite things and can be demanding negotiators. Try to get them to be more flexible
about their media use by watching a new show with you, or take turns playing a favorite
app or game.
Use visual timers to enforce time limits. Most children with ADHD or ASD respond better
to visual prompts rather than verbal reminders (usually yelled from another room!).
Instead of using media as a calming tool when things are stressful in the house, make
a plan to use it as an intentional behavioral reinforcer. One approach is to allow
a certain number of minutes per day (e.g., 30 minutes) of tech time, but add 10-30
additional minutes when the child shows positive behaviors that you are working on.
If you don’t like the way your child acts after watching a show (e.g., becomes more
active, aggressive or self-stimulatory), eliminate that show from the rotation.
For children with ASD who quote scripted speech from media programs, try videos with
nonverbal characters (e.g., Pingu and Curious George).
When a child loves a media character to a repetitive degree, try to leverage it for
learning goals. For example, teach her to count, learn colors or recognize emotions
through Thomas the Train videos and books; watch Paw Patrol with the child and then make believe you are the characters.
Be aware that even though a child looks “focused” on a mobile device, the gamified
features (visual and sound effects, rewards) are entraining the child’s attention;
the child’s brain doesn’t actually have to do the work to sustain attention. Instead,
engage the child in multistep, hands-on activities or unstructured play to challenge
his brain to sustain focus and complete a task.
Show the child that digital devices are not just for streaming videos. Install creative
apps such as stop-motion animation or simple coding apps. Consider biofeedback or
relaxation apps to help children learn self-regulation skills.
Children with social skills deficits may gravitate toward multiplayer online video
games, since this type of social interaction feels more comfortable to them. This
should be discouraged due to safety and privacy concerns.
While providers can’t cover everything in a clinic visit, this overview may help start
a conversation about media use by children who experience the world a little differently.
Dr. Radesky is a member of the AAP Council on Communications and Media Executive Committee.