David H. Rubin, MD Chairman and Program Director, Pediatrics St Barnabas Hospital

1. Journal Club/September 24, 2010. Swing et al. Television and video game exposure and the development of attention problems. Pediatrics 2010;126:214-221. David H. Rubin, MD Chairman and Program Director, Pediatrics St Barnabas Hospital Professor of Clinical Pediatrics, Albert Einstein College of Medicine

2. OBJECTIVES • Aim • Hypothesis • Methods/statistics • Conclusion • Competency based evaluation

3. COMPETENCY BASED EVALUATION • Review of competencies (pre-review of article) • Review of competencies (post-review of article) • Application of specific issues from article to each competency • Attempt to match issues from article with specific competency

4. COMPETENCY BASED OBJECTIVES • Medical Knowledge • knowledge about the established and evolving biomedical, clinical, and cognate (epidemiological and social-behavioral) sciences and their application to patient care

5. COMPETENCY BASED OBJECTIVES • Patient Care • family centered patient care developmentally and age appropriate compassionate and effective for treatment of health care problems and promotion of health

6. COMPETENCY BASED OBJECTIVES • Practice Based Learning • investigation and evaluation of patient care, and the assimilation of scientific evidence • Communication Skills • interpersonal and communication skills resulting in effective information exchange and learning with patients, families and professional associates

7. COMPETENCY BASED OBJECTIVES • System Based Practice • understanding systems of health care organization, financing, and delivery, and the relationship of one’s local practice and these larger systems • Professionalism • carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient populations

8. INTRODUCTION • Attention problems are associated with poorer school performance and increased aggression • Is TV a risk factor for attention problems? Literature suggests: • TV is so exciting that children would be bored with anything else • TV may harm ability to sustain focus

9. INTRODUCTION • Video games have a lot in common with TV • High excitement • Rapid changes in focus • Cross sectional and longitudinal studies have found TV associated with attention problems • Few studies have examined whether video games could have similar effect

10. INTRODUCTION At what age is the effect of TV and attention problems? Prior studies have found effect in first 3 years of life and in adolescence Current study addresses 3 questions Are both TV and video associated with significant attention problems? Are both TV and video associated with attention problems in middle childhood? Are both TV and video associated with attention problems in late adolescence/early adulthood?

11. METHODS • 2 age samples of males and females • Middle childhood (10 schools in 2 midwestern states; part of SWITCH obesity prevention project; reports collected from parents, teachers, and children at 4 points in 13 months) • Late adolescence (undergraduate students from large school in midwest, single lab session; self report at similar time periods)

12. METHODS • TV and video game exposure • Both groups (TV and video) completed similar questions • Middle childhood completed questions with parents • Late adolescence completed self reports • TV and video exposure: average time during 4 time periods during weekdays and separately during same time periods on weekends

13. METHODS • Attention problems • Childhood sample by teacher report • Good internal reliability;  = .91, .92 • Adolescent sample  self report: Adult ADHD Self Report Scale, Brief Self-Control Scale, Barratt Impulsive Scale • Good internal reliability;  = .89, .85, .84

14. RESULTS • See Table 1 for sample characteristics • See Table 2: Correlation coefficients and odds ratios computed for • Weekly TV exposure • Weekly video game exposure • Weekly total screen exposure • Attention problems in 2 age groups

15. RESULTS • Logistic regression model comparing risk of being above median for attention problems and above and below the 2 hour AAP exposure recommendation • If exceeded AAP recommendations  above average in attention problems (OR: 1.67 (1.27, 2.21) and 2.23 (1.13, 4.391) (young and older groups)

16. RESULTS • General linear models- see Tables 3 and 4

17. DISCUSSION • Study demonstrates that risk of attention problems could be reduced if parents followed AAP recommendation of exposure to < 2 hours/day • Non violent, slower based educational content is less likely to cause attention problems

18. DISCUSSION/LIMITATIONS • Groups equivalent? • Evaluation equivalent • Comparison valid? • Analysis correct? • Conclusions based on data?

19. COMPETENCY BASED QUESTIONS FOR DISCUSSION 1. What is the major finding in this study (medical knowledge)? 2. What is the design of the study; what are the limitations and advantages of this methodology in the study (PBLI)? 3. What is the statistical analysis used in the study; is it appropriate? (PBLI). 4. Do you agree with the author’s methodology used in this study? Provide an explanation for your answer (PBLI). 5. Will the findings in this study alter your clinical practice? Provide an explanation for your answer (patient care).

20. COMPETENCY BASED OBJECTIVES • Medical Knowledge • knowledge about the established and evolving biomedical, clinical, and cognate (epidemiological and social-behavioral) sciences and their application to patient care • Effect of prolonged TV and video exposure by age

21. COMPETENCY BASED OBJECTIVES • Patient Care • family centered patient care developmentally and age appropriate compassionate and effective for treatment of health care problems and promotion of health • Presentation and management of disease by age • Importance of information for family regarding signs and symptoms of problem

22. COMPETENCY BASED OBJECTIVES • Practice Based Learning • investigation and evaluation of patient care, and the assimilation of scientific evidence • Scientific evaluation of hypothesis, methods, and conclusion of article • Communication Skills • interpersonal and communication skills resulting in effective information exchange and learning with patients, families and professional associates

23. COMPETENCY BASED OBJECTIVES • System Based Practice • understanding systems of health care organization, financing, and delivery, and the relationship of one’s local practice and these larger systems • Referral systems, consultation • Professionalism • carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient populations • Patient education in diverse cultures