Frequent Intermittent Rewards

Excerpt from "Fixated by Screens, but Seemingly Nothing Else," by Perri Klass, M.D., The New York Times, May 9, 2011:

Is a child’s fascination with the screen a cause or an effect of attention problems — or both? It’s a complicated question that researchers are still struggling to tease out.

The kind of concentration that children bring to video games and television is not the kind they need to thrive in school or elsewhere in real life, according to Dr. Christopher Lucas, associate professor of child psychiatry at New York University School of Medicine. “It’s not sustained attention in the absence of rewards,” he said. “It’s sustained attention with frequent intermittent rewards.”

The child may be playing for points accumulated, or levels achieved, but the brain’s reward may be the release of the neurotransmitter dopamine. Children with A.D.H.D. may find video games even more gratifying than other children do because their dopamine reward circuitry may be otherwise deficient.

Indeed, at least one study has found that when children with A.D.H.D. were treated with methylphenidate (Ritalin), which increases dopamine activity in the brain, they played video games less. The authors suggested that video games might serve as a kind of self-medication for these children.

So increased screen time may be a consequence of A.D.H.D., but some researchers fear it may be a cause, as well. Some studies have found that children who spend more time in front of the screen are more likely to develop attention problems later on.

In a 2010 study in the journal Pediatrics, viewing more television and playing more video games were associated with subsequent attention problems in both schoolchildren and college undergraduates.

The stimulation that video games provide “is really about the pacing, how fast the scene changes per minute,” said Dr. Dimitri Christakis , a pediatrician at the University of Washington School of Medicine who studies children and media. If a child’s brain gets habituated to that pace and to the extreme alertness needed to keep responding and winning, he said, the child ultimately may “find the realities of the world underwhelming, understimulating.”