“Screen Time” by Dr. Casey Hoffman at the Infant Mental Health Breakfast
 
The March 7, 2014 infant mental health breakfast (sponsored by  the group formerly known as DVG-WAIMH) featured a fascinating, CE credit-bearing, presentation on “screen time” and its impact on infants and young children. The presenter was Dr. Casey Hoffman, child clinical psychologist at CHOP. Her presentation title was “Screen time in early childhood: Promoting parent-child relationships in the digital age.” This post is a summary of the presentation and discussion.

Dr. Hoffman began her presentation with some concerning figures.  The average age for beginning TV/screen watching in the United States is 5 months. Ninety percent of children under age 2 years watch TV. Half of the young children in the U.S. live in homes where the television is turned on more than 6 hours each day. Seventy percent of children have TV sets in their bedrooms. Watching TV is the most common activity (so to speak) for young children, after eating. The average number of hours watched per day is 4.4 in homes. 3.2 in center-based day care, and 5.5. in home-based day care.

But, as was noted several times during the morning, one of the reasons for this heavy use is that parents generally believe they are doing the right thing by facilitating screen use. They think that this kind of screen exposure will make their children “smart”. This belief persists in spite of the recommendations made by the American Academy of Pediatrics in 1999 and again in 2011: that all forms of screen use are inappropriate for children under 2 – a position that, as several members of the audience noted, is somewhat weakened by the almost universal presence of TV screens in doctors’offices. 

When parents say they believe screen use is beneficial and makes kids “smart”—in contradiction to the AAP recommendation—where do they get this idea? A major source is the marketing of screen media, targeting parents of
young children, who often depended on  ages for use of media as suggested by marketers. Product packages may
recommend media as appropriate for babies from 6 months. Parents become convinced that there are suitable media presentations for infants and toddlers, as claimed by the 24-hour “Baby TV” channel. Marketing materials call such media
”learning activities” and imply that a baby without access to these may be “left out” developmentally. They also state that media are intended to be used for the shared experience of parents and babies (although this is not usually what
happens). 

A report by the Kaiser Family Foundation in 2005 stated that 58% of the parents surveyed thought that available material was“educational” for babies. Most did not watch with the baby, but took the opportunity to do something else. They felt that the screen was calming for the baby and that intent watching for longer and longer periods indicated that the baby was
developing a longer attention span and getting “smarter”. One mother was surprised that her baby seemed to have language delays even though he watched “Baby Einstein” every day.

Is there any support for the marketing claims? No, and in fact the highest levels of infant learning may be incompatible with screen use. The Campaign for Commercial-Free Childhood brought to the FTC a complaint of fraud against the leading marketer, the “Baby Einstein” company, and forced the manufacturers to back down to some extent. Refunds were given to purchasers who applied, but the company did not admit deceptive marketing and couched the issue in terms of “customer satisfaction”. 

What problems are associated with infant screen use? Why does exposure to new information on the screen not “make babies smarter”?The researchers Anderson and Pempek (2005; see below for reference) used the term “video deficit effect” to describe the additional time needed for infants to learn material from a screen, as compared to learning from a live model. Part of the problem is that infants do not readily generalize from the two-dimensional screen image to the three-dimensional real world. Neither have they developed the ability for symbolic representation that lets them see the equivalence between the small, flat screen image and what they see around them (DeLoache & Chiong, 2009; see below). 

Infants’ natural ways of learning involve not only the visual experience that is so crucial to adult learning,  but also movement and touch, often using the mouth as well as the hands. Despite the occasional chomps infants give to screen devices, this kind of exploration really not be done with a screen image.

Caregivers contribute to infant learning in ways that screen devices cannot imitate (so far, at least). A critical contribution is scaffolding, observing what is easy or difficult for the child and providing just enough support to enable the child to be successful with more difficult tasks. An everyday example is providing a spoon or finger food for a baby who wants to
self-feed but cannot handle a fork. Scafolding can involve hastening or slowing an activity in response to a child’s needs at the moment, or asking a series of questions to guide a sequence of tasks, as needed.

Some aspects of baby learning have to do with infants’ sensory and motor abilities, which facilitate active learning through real experience, but do not fit well with learning from a screen. As has been shown by Smith, Yu, and Pereira (2011; see below), sitting is a breakthrough to examination of objects and learning from them (and, notably, the average age for starting infant screen use is prior to the average age for sitting alone!). Linda Smith and her colleagues have talked about “good naming moments” when infants are likely to learn the names of objects. These are times when the sitting baby
holds an object not far from her face  (because her arms are short) and has it in the center of her visual field. The holding position helps to stabilize the child’s head and give a clear view of the object. Object names experienced during these situations are learned more quickly than is the case when the object is being held by the mother. Pretend play is also encouraged by handling and looking at objects.

So, here we are: there is plenty of evidence that playing with real objects is better for learning than watching a screen, and that interacting with a real person involves experiences that can’t occur when watching someone on a screen. How, then, do we encourage young parents to abandon the screen use that has been sold to them by clever but deceptive marketing? Discussion at the infant mental health breakfast presentation focused on the idea that it does not work merely to tell parents not to do something. A good substitute must be offered, whether it’s singing, talking, reading aloud, or playing games like pat-a-cake. Unfortunately, many young parents do not believe they can teach their children anything worthwhile, and they need help to see  how many important things they have taught and will teach in the future. A final and important point is that we need not try to get parents to go  at one step from 24 screen hours a day to none at all. Anything that reduces screen use, and increases interactions with the real world, is a step in the right direction.

References

Anderson, D., & Pempek, T. (2005). American Behavioral Scientist, 48,505-522.

DeLoache, J., & Chiong, C. (2009). Babies and baby media. American Behavioral Scientist, 52, 1115-1135.

Smith,L. Yu, C. & Pereira, A. (2011). Not your mother’s view: The dynamics of infant visual experience. Developmental
           Science, 14, 9-17.

Improving Outcomes for Children

The Delaware Valley Group’s February 7, 2014 breakfast meeting heard a lively and informative presentation by Kimberly Ali, Director of Operations for the Children & Youth Division of the Philadelphia Department of Human Services. Ms. Ali’s topic was “Improving Outcomes for Children: A Community-Based Approach to Child Welfare”. The program Improving Outcomes for Children (IOC) is one to which a gradual administrative transition is being made, with the hope that reducing the present number of people involved in case management will provide better outcomes and prevent the loss of communication that has sometimes ended in tragedy. Further information on this topic may be found at www.phila.gov/dhs/.
 
IOC is a community-neighborhood approach that is intended to promote safety, permanency, and well-being for children who are at risk of being abused or neglected, and/or of delinquency. This is to be managed through work with ten Community Umbrella Agencies (CUAs), each associated with a Philadelphia police district; some of these are in place and active, while others will be coming on-line for some months. The familiarity of the CUAs with their own neighborhoods is expected to benefit at-risk families, as each CUA will be in a position to know connections between families, schools, churches, and so on. Because each of the ten CUAs will take most of the responsibility for cases in its area, DHS will be able to concentrate on other important support, investigative, and training work, rather than overseeing the hundreds of   service contracts previously in use. DHS is adding investigators and has added nurses under the IOC plan.

CUAs will be responsible for risk assessment, safety assessment, safety plans, a single case plan, all safety and quality visits, and services required by the service plan. They will also use preventive programming to strengthen and support families in their neighborhoods, a task for which they will be well fitted because of their engagement with their own communities. 
 
An important point in the IOC program is the intention to maintain children and youth in their own homes whenever possible, and to make any needed placements within the community, with kin or with other people known to the child. This point about placements is an important one for children of any age. For the youngest children, placement with a familiar person helps to maintain attachments and trust and to reduce the trauma of separation. For school-age children, staying near friends and in the same school eases the transition both emotionally and educationally, and of course prevents the need for additional painful changes when the child is reunited with the family. (IOC focuses on birth through 5 years, but children’s service plans must take into account future needs.)

Ms. Ali addressed the issue of evaluating foster parents when placement is advisable. Whether a foster parent is a blood relative or a neighbor in the community, screening is required for the foster parent and anyone in the household over 14 years of age. These individuals cannot be approved for the placement if they have frequent criminal records or if they
have histories of prohibited offenses. These include aggravated assault, child endangerment, sex offenses, and drug offenses within the last five years.  Partners of proposed foster parents must also go through foster parent
training.  
 
Ms. Ali also addressed the issue of use of evidence-based practice (EBP) methods by the CUAs. She noted that in the past the Federal government has reimbursed only when children are in placement, not for provision of in-home services to keep them in their homes. Now, however, there are arrangements such that when money is saved on placements by keeping children in their homes, DHS can now reinvest that money into other services as long as those services are EBPs.

As Ms. Ali noted, the IOC program is still in transition, and more CUAs will be brought in over the next months. We hope to hear more about this and will invite Ms. Ali to come back in a year for an update. 

After each meeting... Jean Mercer will provide updates and information from the meeting... Please feel to add comments or ask her questions... Thank you!

We have received many requests to develop a mechanism for folks to share information.  Here is our first such effort... a Blog.  While we are not sure how this may work yet, here it is for your use.  Maybe this will be a space to make announcements, seek support, or simply share experiences?  Remember, this is an Open page that can be seen by everyone on the web.  We think it is important to note that we will have to remove any blogs that seem inappropriate or that share family names, for example.  Otherwise, we hope this will be a helpful resource for us all!