mind’s eye,” or the ability to hold and manipulate incoming information in the mind. Difficulties with attention and executive functioning, which are largely governed by the brain’s frontal lobe, have a profound impact on quality of life — affecting everything from academic and career achievement to the success of relationships.
Attention and executive functioning are largely dependent on dopamine and another brain chemical (or neurotransmitter), norepinephrine. These two neurotransmitters are the same chemicals that attention-deficit drugs seek to increase. Our brains need not just an adequate supply of these chemicals, but they also require them to 1) be active in the appropriate areas, 2) bind to adequately sensitive receptors, and 3) strike a balance with other brain chemicals, such as serotonin. These functions are sensitive to stress of any kind and can also be impacted by lack of proper sleep.
Whether related to ESS or not, what do attention difficulties look like? The child or teen with poor executive functioning …
• has difficulty with multistep directions and executing tasks that require planning and prioritizing, like school projects or applying for college or a job.
• loses homework even when completed or forgets to turn it in.
• has trouble keeping track of things, including time and personal belongings.
• is easily overwhelmed and becomes frustrated by small demands.
• exhibits paralyzing procrastination and avoidance of chores, and will have a “hard time getting started” on homework (especially “busy work”) and paperwork in general.
• has trouble staying on task, perhaps even with tasks or routines he or she is familiar with, like getting ready for school or bed.
• displays a lack of attention to detail, such as completing chores or homework in a sloppy or haphazard manner, keeping his or her room “like a disaster zone,” or shoving everything into a backpack and never cleaning it out.
• appears “lazy” or “unmotivated” and can’t tolerate delayed gratification.
• tends to be impulsive, acts before thinking things through, and disregards consequences of actions.
• often will not perform up to his or her academic potential, particularly in later school years.
It’s critical to understand that anything that impacts attention also impacts executive functioning. Attention difficulties are, of course, the hallmark of attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD*). Because screen-time affects dopamine regulation, frontal lobe activity, sleep, and stress levels, ESS can look exactly like ADD — and will almost certainly worsen ADD if it preexists. Furthermore, children with attention symptoms are drawn to electronics precisely because they are stimulating; I’ve yet to meet a child with attention problems who doesn’t love screen devices. The two tend to go hand in hand.
Here is a very typical example: Suzanne, a friend from high school, once contacted me about her son, Justin. Justin had become moody, was struggling academically, and was disruptive and defiant in the classroom. Suzanne reported that Justin didn’t seem to enjoy playing anything but video games anymore; he had lost his natural “sense of curiosity” and “thirst for knowledge.” Justin’s teacher and his dad both felt Justin had ADHD and wanted him to see a psychiatrist. Suzanne, however, wanted to first get rid of the video games and other electronics before even considering medication, and she convinced his dad to wait while she tried the electronic fast.
Sure enough, within the first week of the fast, Suzanne noticed that Justin’s mood improved. By the end of the month, her son had turned things around at school and was playing healthy activities again, and all discussions about Jason having ADHD were dropped. Eventually, Suzanne let Justin play video games again on a very limited basis, but she learned to immediately pull them back if she noticed mood or attention changes.
Video Games and Learning: The Attention Paradox
Parents often wonder, “Why is it that my child can pay attention to a video game — but to nothing else?!” Likewise, when I tell parents that gaming worsens focus, they often respond, “But I thought video games improved his attention.” Why the confusion?
Attention is interest-based and driven by stimulation. Children with attention issues are drawn to video games and screens precisely because they can focus on them; the games provide sufficient stimulation for a dopamine surge, and thus gaming may be considered “self-medicating.”15 In fact, studies have shown that ADD medications actually curb cravings for and amount of video game play,16 presumably because these medications raise dopamine levels.
But what about using the attention-grabbing stimulation of video games and other screen-based methods to enhance learning in the classroom? The excitement about using electronic media to engage students has led to a rush to implement electronic learning tools, despite their poor track record in studies. Essentially, what teachers are finding is that they work — until they don’t. Soon enough, the novelty wears off, and more and more stimulation is required for focus. Meanwhile, the added stimulation contributes to dysregulation and a worsening of attention in general. When a child reports finding non-screen activities “boring,” this should be a red flag to parents and educators — it means the child’s brain has become used to an unnaturally high level of stimulation.
Further confusing the issue of attention, learning, and gaming is the highly touted finding that gaming can modify visual attention.17 This is different than the executive attention issues we’ve been discussing related to “getting things done.” An example of visual attention would be scanning an environment and visually picking out a target. Both the scientific and lay media have speculated that playing video games could “improve surgical skills,” and that better visual attention skills could perhaps boost the potential to “become a pilot,” “be a sharpshooter,” or “improve driving skills.”
But I would argue that it doesn’t matter if gaming improves visual attention if it also worsens executive attention, impulse control, and frustration tolerance. Overgeneralizing and overemphasizing the visual attention effect is dangerous and misleading. The idea that gaming might improve the driving skills in teenage boys is laughable — not to mention inconsistent with research, which finds that gamers tend to be more reckless drivers.18 And someone who can shoot well but has poor impulse control is not welcome in the military, for obvious reasons. Finally, aside from the fact that pilots and surgeons are a fraction of a percent of the population, you can bet that to persevere in career paths with such long and intense training, pilots and surgeons virtually always have highly superior executive functioning.
There now exists a large body of research implicating screen-time in the development of attention problems, and the earlier the exposure, the stronger the effect.19 Although many of the studies have focused on television, more recently video games and Internet use have been implicated as well.20 As I’ve said, interactive screen-time seems to have a much more potent detrimental effect on attention and executive functioning than passive screen-time, perhaps because the interactivity promotes higher levels of arousal, and because the proximity of the screen causes more severe melatonin suppression and circadian disruption. (EMFs may also be a factor; see the appendix.) Several studies support this distinction. A 2007 study conducted in Germany that allowed children an evening of either excessive television or computer game use found that the gaming group suffered significantly altered sleep patterns and impaired cognition when measured the following day, while the television group showed some sleep inefficiency but no change in cognitive performance.21 Similarly, a large study published in 2010 that followed children over a two-year period found that total screen-time predicted attention problems, but that video game playing was more predictive than television viewing when the factors were looked at separately.22
It is also becoming increasingly clear that the relationship between screen-time and attention problems is one of causation — not mere association or “self-selection.” In a landmark study, researchers followed more than three thousand Singapore children and adolescents