Television viewing has been associated with greater subsequent attention problems in children. Few studies have examined the possibility of a similar association between video games and attention problems, and none of these has used a longitudinal design.
A sample of 1323 middle childhood participants were assessed during a 13-month period by parent- and child-reported television and video game exposure as well as teacher-reported attention problems. Another sample of 210 late adolescent/early adult participants provided self-reports of television exposure, video game exposure, and attention problems.
Exposure to television and video games was associated with greater attention problems. The association of television and video games to attention problems in the middle childhood sample remained significant when earlier attention problems and gender were statistically controlled. The associations of screen media and attention problems were similar across media type (television or video games) and age (middle childhood or late adolescent/early adult).
Viewing television and playing video games each are associated with increased subsequent attention problems in childhood. It seems that a similar association among television, video games, and attention problems exists in late adolescence and early adulthood. Research on potential risk factors for attention problems should be expanded to include video games in addition to television.
Re: Poor Measurement, Poor Controls and Spurious Results in Swing et al. (2010)
Our recent article in Pediatrics did not overlook studies that contradict our hypotheses or conclusions (Swing, Gentile, Anderson, & Walsh, 2010). In fact, we cited three studies that did not find a significant association between television and attention problems (Anderson, Levin, & Lorch, 1977; Obel et al., 2004; Stevens & Mulsow, 2006). We did not discuss research on video games and aggression as this topic was not relevant for the current paper. Ferguson and Ceranoglu criticize us for failing to include research on other effects of video games, such as the work on video games and visual attention. We briefly addressed this research in a footnote, citing four such studies (Castel, Pratt, & Drummond, 2006; Dye, Green, & Bavelier, 2009; Green & Bavelier, 2003; Green & Bavelier, 2006). As stated in this footnote:
“Other studies have identified improvements in visual attention after repeated video game playing; however, it should be noted that these improvements in visual attention consist of the rapid and accurate extraction and processing of information from the visual field, abilities quite distinct from the attention problems that are associated with disorders such as ADHD” (Swing et al., 2010, p. 215).
We do not doubt that video games can also produce desirable effects such as improved visual attention, but those effects do not bear on the results of the current studies or other related studies of television, video games, and attention problems. Regrettably, the shared use of the word “attention” to refer to very different processes contributes to this confusion. In the visual attention studies, for example, attention may refer to the ability to notice and to shift attention to rapid changes in the periphery of the visual field; in classroom attention studies, attention refers to the ability to focus on the task at hand, which includes the ability to ignore extraneous stimuli (such as irrelevant changes in the periphery of the visual field).
The dose-related short term effects found by Tahiroglu et al. (2010) are interesting. It is not clear how those results could be seen to contradict the results of the present study. Though Tahiroglu et al. were examining short term (as opposed to long term) effects, the overall direction of their findings was consistent with our own.
Ferguson and Ceranoglu also take issue with the attention measure used in the middle childhood sample. Though the Childhood Behavior Checklist or Conners' Rating Scale are useful for measuring attention problems, asking teachers to complete a 113 item scale (or even 28 or 59 items for the Conners' Rating Scale for teachers) for each student in their class was not possible in this study for practical reasons (Aschenbach, 2001; Conners, Sitarenios, Parker, & Epstein, 1998). The scale that was used included in the middle childhood sample used items that were conceptually similar to some of the items found on the CBCL or Conners' Rating Scale.
Swing et al. (2010) items:
Has difficulty staying on task
Has difficulty paying attention
Often interrupts other children's work
Compare to sample CBCL items:
Fails to finish things he/she starts
Inattentive or easily distracted
Disturbs other pupils
Compare to sample Conners' Rating Scale items:
Fails to finish things - short attention span
Inattentive, easily distracted
Disturbs other children
The items we used showed good inter-item reliability (alphas of 0.91 and 0.92) and showed strong test-retest correlations, even between different raters and after a 13 month delay (betas over 0.50 in all General Linear Models). Further, the bivariate correlation between television/video game exposure and the attention problem items used in the middle childhood sample was nearly identical (r = 0.23) to the bivariate correlation found in the adolescent/young adult sample (r = 0.27). This adolescent/young adult correlation is based on more extensive measures: the Adult ADHD Self-Report Scale, the Brief Self-Control Scale, and the Barratt Impulsiveness Scale-11 (Kessler et al., 2005; Tangney, Baumeister, & Boone, 2004; Patton, Stanford, & Barratt, 1995). This suggests that the attention measure used in the middle childhood sample did not produce an inflated estimate of the association between television/video games and attention problems. Indeed, when shorter scales yield problems it typically is because they tend to produce lower reliabilities and underestimates of effect sizes.
Ferguson and Ceranoglu also claim that we did not use a sufficient number of control variables. Though including more control variables can be informative, the present study did include some important variables as covariates; specifically sex, grade, and attention problems at wave 1. Including earlier attention problems is particularly useful because it removes a great deal of the variance that is due to factors such as those Ferguson and Ceranoglu mention (home environment, school quality, parent education, poverty, and genetic risk) as well as any other factors that had influenced attention problems prior to the beginning of the study. Though it would be useful to include additional covariates in future studies, it is also important to note that this approach makes analyses increasingly conservative, removing some variance that actually is due to television and video games and potentially producing an underestimate of the causal effect of television and video games on attention problems.
Ferguson and Ceranoglu argue that the size of the effects found are small enough to be dismissed as trivial or unimportant. We would agree that effect sizes such as those from the structural equation model (beta = 0.10) and the General Linear Models, which tended to be slightly smaller, can be considered statistically small effects. However, we disagree that they are trivial. The debate on the importance of small effects is beyond the scope of this reply, but it is important to note that top scholars (e.g., Abelson, 1985; Rosenthal, 1990) argue that statistically small effects can have considerable practical consequences if the outcomes are important and a large population is affected, both of which are the case here.
As is clear in our article and related discussions, we believe that important questions about television and video game effects on attention problems remain, and that more studies are needed to draw stronger conclusions about the causality of this association. Designs with more control variables, interventions, or other experimental assignments would be particularly valuable. As ours is the first published longitudinal study of video game playing and attention problems, this association especially needs to be replicated. Differences based on genre or other features of television shows and video games may be important moderators of the associations we found. We also hope that readers understand the meaning of our findings in relation to effect size. The way in which many small to moderate risk factors cumulatively influence the same psychological outcome is often not adequately appreciated, particularly among the general public. Most behavioral problems do not result from a single "smoking gun" type of cause.
In sum, we believe that our studies make important contributions to the understanding of the association between television, video games, and attention problems. It is misguided to discourage and dismiss research on these topics, particularly when most research to date has found evidence consistent with a causal effect of television and video games on attention problems. Though further evidence will be needed to reach strong conclusions, early evidence of potential risk is valuable to scientists, health professionals, and parents particularly when the risk can be reduced at a relatively low social cost (e.g., recommendations, voluntary parental restrictions).
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Conflict of Interest:
Poor Measurement, Poor Controls and Spurious Results in Swing et al. (2010)
We write to make readers aware of limitations and omissions in the methodology and conclusions of the Swing et al (2010) study of video games and attention. We focus our comments on the childhood sample, given that attention problems don’t suddenly occur in adulthood.
First, the literature review overlooks a number of recent studies that contradict their views on the relationship between video games and aggression (see Ferguson, 2010; Sherry, 2007 for reviews), as well as studies suggesting that video games are more likely to increase, not decrease, attention and cognition (see Spence and Feng, 2010 for a review). A more complex relationship exists between video game play duration and cognitive effects, as a recent report on children with ADHD showed a dose-related short term effect of video game play duration on their cognitive outcomes (Tahiroglu et al., 2010).
Second, the authors puzzlingly failed to use any of the clinically well-validated measures of attention problems, such as the Child Behavior Checklist (Achenbach & Rescorla, 2001) and the Conners Rating Scale (Conners, Sitarenios, Parker & Epstein, 1998). Instead, they relied upon an ad-hoc 3-item scale with no known validity. It’s also unclear why the authors relied solely on teacher reports, failing to include parent reports that arguably would be based on greater familiarity with the child, and again chose not to employ existing validated measures (teacher versions of the CBCL and Conners exist).
Third, the authors make no attempt to control for other commonly measured relevant variables that may influence attention such as home environment, school quality, parent education, or poverty, genetic risk, etc. This omission is especially concerning when correlational effects are very weak (as they are in this study). It is quite possible that any effects found are spurious, and would disappear in a better controlled study.
Fourth, all standardized regression coefficients for children in the study are less than .10. This indicates that the overlap in variance between media use and attention is less than 1%. Even taking these findings a face value (setting aside concerns about measures and control variables), these are weak effect sizes without practical significance, effectively no different from zero (Cohen, 1992; Ferguson, 2009). The authors appear to rationalize these trivial effects by suggesting that some important medical effects are similarly small in size. This assertion has been proven false (Block & Crain, 2007; Ferguson, 2009b).and was based on confused attempts to convert the common medical odds ratio and relative risk measures into the Pearson “r” coefficient familiar to psychologists. The statistics used are now known to grossly underestimate the medical effects.
In sum, these findings are unable to support the weight that Swing et al. (2010) attempt to place on them, and give no cause for concern to clinicians, educators or parents.
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Tahiroglu, A.Y., et al., Short-term effects of playing computer games on attention. J Atten Disord. 13(6): p. 668-76.
Conflict of Interest: