Surrey Mental Health Clinic
​​​Dr Hafeez Mian  
BGS, MA, MEd, PhD 
Diplomate, International Academy of Behavioral Medicine, Counselling & Psychotherapy 


Helping ADJUST Sails
Mian, H. (2009). Cultural Differences and Counselling. Insights, pp 4-5 & 32


Watching Video Games Facilitates AD(H)D in Children (2013)
Dr. Hafeez Mian
MA, MEd, PhD, Diplomate IABMCP

It is well established that excessive television viewing has long been associated with having negative effects on children’s acquisition of social
skills development and academic achievement. Strasburger (2010) states that “significant exposure to media violence increases the risk of aggressive behaviour” and “reports of bombing, natural disasters, murders, and other violent crimes have the potential to traumatize young children” (p.1012). Video games are shockingly dreadful as well. The focus of this article is to share a brief synthesis of research confirming a correlation between Attention Deficit Hyperactivity Disorder (ADHD) and watching television and/or playing video games.  

Attention Deficit (Hyperactivity) Disorder is a common disorder among school age children. There is consensus among several researchers (for example, Nair, Ehimare, Beitman, & Lavin 2006; Barkley, 2007) that between 3 and 5 percent of the North American population is affected by AD(H)D[i]. Some researchers have reported even higher percentage, for example, between 3 and 7 percent. Yet others have reported that estimates vary between 1 and 20 percent depending on the criteria used. Even if we consider the most conservative research data, that is 3-5%, it means 2 million children in the United States alone. National Institute of Mental Health (2007) estimates it to be equivalent of 1 child per class of 25-30 children in the United States. 

Causes of AD(H)D have been historically diverse and many. Pre-1970 era believed the cause of AD(H)D as strictly biological. 1970’s gave rise to environmental theories such as allergic or toxic reactions to food additive. Since 1980’s a long line of new theories have been introduced. They include sugar theory, child raising theory, head injury theory, blood lead level theory, too much TV theory, bad home environment theory, etc. Most of these theories were actively disputed by research. Now-a-days neurochemical theory is the only enduringly supported theory. The bottom line at this time is that AD(H)D is a biochemical brain disorder, largely hereditary.  Whether or not it is fundamentally biological and/or hereditary, we cannot afford to dismiss the influence of our interaction with the environment we live in – social values, belief systems, societal influences, etc. Human behaviour is fundamentally the product of our interaction with the environment we live in. Hammerly (1982) states that we don’t live in a vacuum; we learn language and behaviour as a result of our interaction with the environment. It is, indeed, well established. We live wrapped in, we live within, and we interact with cultural fabric on a continuous basis. Anthropologists Kroeber and Kluckhohn (1952) have reported that their search of literature resulted in 164 definitions of the word culture.  It is, in general, a set of shared values, perceptions of reality, and shared symbols that people have by which their thinking and interpersonal relationships are conducted.  Culture is like a biological organism logically and systematically designed and although all parts of the organism have definite and independent functions, however, they must perform in unison.  According to Kroeber & Kluckhohn (1952):

Culture consists of patterns, explicit and implicit, of and for behavior acquired and transmitted by symbols, constituting the distinctive  

achievements of human groups, including their embodiments in artifacts; the essential core of culture consists of traditional (i.e., historically derived and selected) ideas and especially their attached values; culture systems may, on the one hand be considered as products of
action, and on the other as conditioning elements of further action (p.180).

I like to mention that there is no under developed culture – no culture is deficient in any way. Members of a different cultural group may do things differently; nonetheless, their daily life routines operate without any difficulty. The way we do everyday things is the most basic definition of culture. All of us continuously operate within a cultural environment. In fact, we are submerged in culture. There is no compelling evidence that social factors alone can create AD(H)D; however, literature draws our attention to smoking, allergies, artificial food additives, violence, abuse, and other emotional traumas, relationships with parents and/or caregivers and other features of a child’s environment as having profound effects on attention related and self-regulatory capacities of a child. We cannot afford to discount the powerful influences of culture on children’s behaviour. 

Our evolutionary understanding of AD(H)D from pre-1900 view of absent unitary concept of AD(H)D has come a long way. First half of the 20th
century saw Dr. George Still’s theory of 1902 of neurological disorder involving defect in moral control and social conduct to brain disease syndrome involving attention and impulse control which was followed by brain damage syndrome that involved distractibility which was treatable with psychotropic stimulants. The early part of the second half of the 20th century saw a historic leap in conceptualization and our focus shifted and deficits in attention and impulse control became more central to the disorder. It is interesting that observable behaviours, deemed problematic, remained the same --  memory problems, socially aggressive and disruptive behaviour, restlessness, inattention, impulsivity, hyperactivity, motivational deficits, etc.; however, our understanding of the causality has definitely evolved but not quite settled. We have, nevertheless, consensus on the diagnostic front (DSM-IV) and the crux of the criteria is that the symptoms must be developmentally inappropriate. 

In light of the aforementioned description, now let’s take a look at how television and video games, as environmental factors, contribute in the development of AD(H)D. Barry, Lyman and Klinger (2002) describes attention problems, generally manifest in the form of AD(H)D, are linked with negative outcomes including poor academic performance and increased aggression. Christakis, Zimmerman, DiGiuseppe, and McCarty (2005) and Miller, Marks, and Miller (2007) confirm the first important point: exposure to television and video games in childhood has a potential risk factor for subsequent attention problems. It has been hypothesized that most television shows are so exciting that children who frequently watch such exciting shows have more difficulty paying attention to less exciting tasks such as mathematics or school work in general. Yet others have drawn our attention to the second important point: Anderson, Levin and Lorch (1977), for example, have hypothesized that rapid changes in focus while watching television or playing video games may harm children’s ability to sustain focus on tasks that require focused attention such as school work where high level of reasoning and logic is fundamental ingredient required for analytical decision making. Johnson, Cohen,
Kasen, and Brook (2007) claim many video games and television programs share similar features such as high excitement images and rapid changes in focus which makes them potentially relevant and the association between them and attention problems plausible. There are indeed more longitudinal research studies linking television viewing, as compared to video games, with subsequent attention problems. However, there are single point research studies, for example, Bioulac, Arfi, and Bouvard (2008) and Gentile  (2009), confirming a correlation between video
game playing and attention problems and/or AD(H)D diagnoses. 

At this conjuncture, the brief and introductory synthesis of the relevant literature and research is indicative of not only that video game association to attention problems is similar in magnitude to the television association but also confirms that there is a correlation between TV/video games and attention problems. In addition, the amount of time spent playing video games is also associated with greater attention problems. The research at this stage clearly confirms the correlation between TV/video games and attention problems; nonetheless, it fails to confirm whether or not it makes a contribution in causing attention problems. But then again, it’s unjust expectation since there are scores of possibilities involving biological, hereditary, and environmental factors. Even with limitations, the current research and body of literature makes a significant contribution in extending and enhancing our knowledge of the subject. 

North American culture, most of the western cultures and some of the eastern cultures are bombarded with electronic gadgetry involving image display screens of all sizes and shapes and it is all around us. Some of us are watching U-Tube videos on our cellular phones as we go across an intersection. Very dare devilish! Can we eliminate electronic media from our lives? Sure, we can; that is, if we choose to do so. However, it won’t be very realistic. Our culture is driven by electronic media and we are surrounded with it. It has become an integral part of our lives. We cannot
escape it; however, we can reduce its use. In light of the current research about video games and its impact on young children in the form of AD(H)D certainly and clearly suggests that the risk of attention deficit can be reduced, if we decrease the amount of time we spend watching television and/or playing video games. American Academy of Pediatrics (2001, 2009) recommends that we limit our children’s exposure to television and video games to no more than 2 hours per day. Failure to monitor exposure to television and/or video games may result in a lot more school age children diagnosed with and suffering from AD(H)D and resultantly not being able to focus on the real objective of attending school:


Anderson, D.R., Levin, S.R., & Lorch, E.P. (1977). The effects of TV program pacing on the behavior of preschool children. AV Communication  

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Barkley, Russell A. (2007). ADHD in Adults: History, Diagnosis, and Impairments.

Barry, T.D., Lyman, R.D., & Klinger, L.G. (2002). Academic underachievement and attention-deficit/hyperactivity disorder: the negative impact of symptom severity on school performance. Journal of School Psychology, 40(3):259–283

Bioulac, S., Arfi, L., & Bouvard, M.P. (2008). Attention deficit/hyperactivity disorder and video games: a comparative study of hyperactive and control children. Eur Psychiatry. American

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Christakis, D.A., Zimmerman, F.J., DiGiuseppe, D.L., & McCarty, C.A. (2005). Early television exposure and subsequent attentional problems in children. Pediatrics, 113(4): 708–713

Gentile, D. A. (2009).  Pathological video game use among youth 8 to 18: A national study. Psychological Science, 20, 594-602.

Hammerly, H.  (1982). Synthesis in second language learning: An introduction to linguistics. Blain, WA: Second Language Publications.

Johnson, J.G., Cohen, P., Kasen, S., Brook, J.S. (2007). Extensive television viewing and the development of attention and learning difficulties
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Kroeber, A. L. & Kluckhohn, C.  (1952).  A review of culture: A critical review of concepts and definitions.  Papers
of the Peabody Museum of American Archeology and Ethnology, 47(1).  Cambridge, MA: Harvard University Press.

Miller, C.J., Marks, D.J., & Miller, S.R. (2007). Brief report: television viewing and risk for attention problems in preschool
children. Journal of Pediatric Psychology, 32(4), 448–452

Nair, J., Ehimare, U., Beitman, B.D., Nair, S.S., & Lavin, A. (2006). Clinical review: evidence-based diagnosis and treatment of ADHD in children. Mo Med, 103 (6): 617–621

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Strasburger, V. C.  (2010) Policy Statement from the American Academy of Pediatrics. Pediatrics, 126(5), 1012-1017.

[i] AD(H)D: It is meant to indicate that one can have ADD (Attention Deficit Disorder) with or without hyperactivity.