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Television and Video Game Exposure and theDevelopment of Attention Problems
WHAT’S KNOWN ON THIS SUBJECT:
Television exposure isassociated with attention problems in children.
WHAT THIS STUDY ADDS:
The association of video games andattention problems is similar to the association of television andattention problems. These associations appear in middlechildhood and late adolescence/early adulthood.
abstract
OBJECTIVES:
Televisionviewinghasbeenassociatedwithgreatersub-sequentattentionproblemsinchildren.Fewstudieshaveexaminedthepossibility of a similar association between video games and attentionproblems, and none of these has used a longitudinal design.
METHODS:
A sample of 1323 middle childhood participants were as-sessed during a 13-month period by parent- and child-reported televi-sion and video game exposure as well as teacher-reported attentionproblems. Another sample of 210 late adolescent/early adult partici-pants provided self-reports of television exposure, video game expo-sure, and attention problems.
RESULTS:
Exposuretotelevisionandvideogameswasassociatedwithgreater attention problems. The association of television and videogamestoattentionproblemsinthemiddlechildhoodsampleremainedsignificant when earlier attention problems and gender were statisti-cally controlled. The associations of screen media and attention prob-lems were similar across media type (television or video games) andage (middle childhood or late adolescent/early adult).
CONCLUSIONS:
Viewing television and playing video games each areassociated with increased subsequent attention problems in child-hood. It seems that a similar association among television, videogames, and attention problems exists in late adolescence and earlyadulthood. Research on potential risk factors for attention problemsshould be expanded to include video games in addition to television.
Pediatrics
2010;126:214–221
AUTHORS:
Edward L. Swing, MS,
a
Douglas A. Gentile,PhD,
a,b
Craig A. Anderson, PhD,
a,c
and David A. Walsh,PhD
b
a 
Department of Psychology, Iowa State University, Ames, Iowa; 
b
National Institute of Media and the Family, Minneapolis,Minnesota; and 
c 
Center for the Study of Violence, Ames, Iowa 
KEY WORDS
attention deficit, television, video games
ABBREVIATIONS
ADHD—attention-deficit/hyperactivity disorderASRS—Adult ADHD Self-Report ScaleBSCS—Brief Self-Control ScaleBIS-11—Barratt Impulsiveness Scale 11OR—odds ratioCI—confidence intervalAAP—American Academy of Pediatricswww.pediatrics.org/cgi/doi/10.1542/peds.2009-1508doi:10.1542/peds.2009-1508Accepted for publication Apr 15, 2010Address correspondence to Edward L. Swing, MS, Iowa StateUniversity, W112 Lagomarcino Hall, Department of Psychology,Ames, IA 50011-3180. E-mail: eswing@iastate.eduPEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).Copyright © 2010 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE:
The authors have indicated they have no financial relationships relevant to this article to disclose.
 
Attention problems, often manifestedin the form of attention-deficit/hyper-activity disorder (ADHD), are associ-ated with negative outcomes for chil-dren and adolescents, includingpoorer school performance and in-creased aggression.
1,2
Research hasexamined exposure to television andvideo games in childhood and adoles-cenceasapotentialriskfactorforsub-sequent attention problems.
3–18
It hasbeenhypothesizedthatmosttelevisionshows are so exciting that childrenwho frequently watch television havemore difficulty paying attention to lessexciting tasks (eg, school work).
3
Oth-ers have hypothesized that becausemost television programs involverapid changes in focus, frequentexposure to television may harmchildren’s abilities to sustain focuson tasks that are not inherentlyattention-grabbing.
14
Most research on media and attentionhaslookedexclusivelyattelevision,yetthere are conceptual reasons to sus-pect that video games could show asimilar pattern. Many video gamesseem to share many features (eg, highexcitement, rapid changes in focus)that have been identified as potentiallyrelevant to the television associationwith attention problems, making asimilar association between videogame playing and attention problemsplausible. Most cross-sectional stud-ies (single time point) have found tele-vision exposure to be associated withgreaterattentionproblems.
4–7
Longitu-dinalstudiesoftelevisionviewinghavegenerally found a similar link, provid-ing evidence that television viewing isa risk factor for subsequent attentionproblems
3,8–11
; however, a few studieshave not found a statistically signifi-cant association (single time point orlongitudinal) between television view-ing and attention problems.
12–14
Fewerstudies to date have examined the pos-sibilitythatvideogamescanproduceasimilar increase in attention prob-lems. Some single time point studiesfound an association between videogame playing and attention problemsand/or ADHD diagnoses.
10,17,18
Otherstudies associated violent televisionand/orvideogameplayingwithpoorerexecutive functioning and proactivecognitive control, which may be re-lated to attention problems.
19,20
Moreresearch is clearly needed to examinethe effects of video game playing onattention problems, particularly by us-ing longitudinal designs.*Although some research has indicatedthat television increases attentionproblems only among children in thefirst 3 years of life,
3,11
others have notfoundevidenceforthisearlychildhoodvulnerability.
10
Some other studieshave found prospective effects of tele-vision exposure on attention problemsin adolescent samples, providing addi-tional evidence that television viewingmay increase attention problems be-yondearlychildhood.
8,9
Giventhesedif-fering findings, more longitudinal re-search is necessary to provide a morecomplete picture of the ages at whichscreen media can influence attentionproblems. Furthermore, only 1 pub-lished study has examined televisionexposure in relation to attention prob-lems beyond age 16.
9
More researchwith samples of late adolescents andadults would be valuable in establish-ing the persistence of the associationof television exposure and attentionproblems into late adolescence andearly adulthood. These studies ad-dressed 3 questions: (1) Are both tele-visionandvideogameexposuresasso-ciated with greater concurrentattention problems? (2) Are televisionand video game use associated withchanges in attention problems overtimeinmiddlechildhood?(3)Areasso-ciations of television and video gameexposures with attention problemsdifferent in middle childhood com-pared with late adolescence/earlyadulthood?
METHODS
Participants
This research includes 2 samples of males and females: 1 sample frommiddle childhood and another samplefrom late adolescence/early adult-hood. Table 1 displays sample sizes,gender composition, and age rangesfor these 2 samples. The middle child-hood sample was recruited from 10schools in 2 Midwestern US states. Thedata for this sample were collected aspart of the SWITCH obesity preventionproject.
25
Thisinterventionhad3majorgoals: reducing screen media expo-sure, increasing physical activity, andincreasing fruit and vegetable con-sumption. These children were third-grade (430), fourth-grade (446), andfifth-grade (423) students at the initial
*Otherstudieshaveidentifiedimprovementsinvisualattentionafterrepeatedvideogameplaying
21–24
;how-ever, it should be noted that these improvements invisual attention consist of the rapid and accurate ex-traction and processing of information from the vi-sual field, abilities quite distinct from the attentionproblemsthatareassociatedwithdisorderssuchasADHD.
TABLE 1
Sample Characteristics
Characteristic SampleMiddleChildhoodLateAdolescence/Early AdulthoodAge range, y 6–12
a
18–32
b
Sample size 1323 210Female gender, % 53 60Study design Longitudinal Single time pointTime lag betweenfirst and lastassessments,mo13 NA
NA indicates not applicable.
a
Age is reported as measured at the first wave of datacollection. A total of 98.8% of this sample was between 8and11yearsatthistime.Analysisthatexcludedthosewhowere younger than 8 or older than 11 did not differ mean-ingfully from analysis that used the full sample; therefore,participants of all ages were included in the reportedanalyses.
b
A total of 96.2% of this sample was between 18 and 24yearsatthetimeofassessment.Excludingthosewhowereolder than 24 years did not meaningfully change the re-sults of the analyses; therefore, participants of all ageswere included in the reported analyses.
ARTICLES
 
assessment (mean age: 9.6 years). Re-ports were collected from children,parents, and teachers at 4 points dur-ing a 13-month period (only 3 timepoints include all measures).† The 13-month follow-up rates for children,parents, and teachers were 86%, 70%,and 88%, respectively.Thelateadolescent/earlyadultsampleconsisted of undergraduate studentsfrom a large public research univer-sity in the Midwestern United States(mean age: 19.8 years). This samplewas assessed in a single laboratorysession. These participants wererecruited from introductory psychol-ogy courses and received partialcourse credit for their participation.All ethical procedures of the AmericanPsychological Association were fol-lowed, and local institutional reviewboard approval was obtained.
Television and Video GameExposure
Both samples completed similar mea-sures of television viewing and videogame playing.
26
Television exposurewas based on the average time spenton weekdays during 4 time periods (6
AM
to 12
PM
, 12
PM
to 6
PM
, 6
PM
to 12
AM
,and 12
AM
to 6
AM
) and separately onweekends during those same 4 timeperiods.Thesequestionswerethenre-peated for video game exposure. In themiddle childhood sample, both par-ents and children completed thesequestions regarding the child’s weeklytelevision and video game exposure.‡For the late adolescent/early adultsample, only self-reports of televisionand video game exposure werecompleted.
Attention Problems
Attention problems were assessed inthe childhood sample by teacher re-port. Teachers answered 3 items thatmeasured attention problems in theclassroom on a 5-point scale, with re-sponses ranging from “never true” to“almost always true” (eg, “This child:has difficulty staying on task; has diffi-culty paying attention; often interruptsother children’s work.”). These itemsshowed good internal reliability (
.91 at time 1 and .92 at time 4). Atten-tion problems were assessed in thelate adolescent/early adult sample byusingacompositeof3self-reportmea-sures: the Adult ADHD Self-ReportScale (ASRS; 18 items), the Brief Self-ControlScale(BSCS;13items),andtheBarratt Impulsiveness Scale (BIS-11;30 items).
27–29
The ASRS, BSCS, andBIS-11 all showed good internal reli-ability coefficients (
.89, .85, and.84, respectively) in this sample. Miss-ing values on these scales were re-placed with mean response for theitem for participants who were miss-ing no more than 20% of the items onthe scale. The ASRS is intended as ascreening tool for ADHD, showing con-vergent validity with clinical ADHD di-agnosis,suggestingaclearconceptuallink to attention problems.
26
De-creased ability to exert self-controland a tendency to behave in more im-pulsive ways are viewed by some re-searchers as a central impairment inADHD,
30
suggesting the potential use-fulness of measures of trait self-control (BSCS) and impulsiveness(BIS-11) in identifying those with atten-tion problems. In this sample, theASRS, BSCS, and BIS-11 were highlycorrelated with each other (absolutevalues of 
r 
from 0.65 to 0.75), and allwere moderately correlated with self-reports of a past diagnosis with an at-tention disorder, such as attention-deficit disorder or ADHD (absolutevalues of 
r 
from 0.23 to 0.36). Eachscale total was converted to a stan-dard score, and these scores were av-eraged (with self-control reversed) toformameasureofattentionproblems.
RESULTS
To examine the strength of the overallassociation between various types of media exposure and concurrent atten-tion problems, we computed correla-tion coefficients among weekly televi-sion exposure, weekly video gameexposure, weekly total screen mediaexposure (ie, combined weekly televi-sion and video game exposure), andattention problems within the middlechildhood and late adolescent/earlyadult samples. Table 2 reports thesecorrelation coefficients and corre-sponding odds ratios (ORs).
31
§ Televi-sion exposure and video game expo-sure showed small to moderatecorrelationswithconcurrentattentionproblems in both samples (
r 
between0.17 and 0.23), with substantially over-lapping confidence intervals (CIs)across samples and type of screenmedia.Because the data from these samples(particularly the middle childhoodsample) are potentially relevant to theAmerican Academy of Pediatrics (AAP)recommendation that children spendnomorethan2hoursperdaywithtele-vision and video games combined, wecomputed logistic regressions com-paring the risk for being above the me-
†Correlational analyses for this sample are basedon a weighted average of the 3 time points contain-ing relevant data. Only the baseline and final as-sessment are used in longitudinal analyses. Theconcurrent and time-lagged associations of televi-sion, video games, and attention problems werenot meaningfully different between the interven-tion and control groups, so data that are based onthe full sample are used in all reported analyses.‡There was no a priori reason to consider 1 re-porter more accurate (children may have difficultyestimating or bias their responses, but parentsmay be unaware of their child’s behavior or simi-larly bias their responses), so an average weeklyamount was calculated by averaging the parentand child reports. Very similar results for the keyanalyses were obtained with only parent or onlychild reports of television/video game exposure.§These ORs correspond to a median split of themedia and attention variables. In other words,these ORs reflect the odds that a child or an ado-lescent/adultabovethemedianinaparticulartypeofmediaexposurewouldalsobeabovethemedianin attention problems.
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