ADHD Coach Jane

How to Un-Fry a Video Addict

by Michele Alperin

In today’s households, where video stimulation is rampant, scenes like the following are hardly unusual. A child or teenager gets home from school and sits down to “relax” with a video game, promising that he will start his homework soon. As time marches on and parents see no movement toward homework, they start to nag. Voices get louder, the parents threaten no more computers or videos on school days. Eventually the parents have had enough and turn off the video game system or computer. The result is not pretty. “The kid has a meltdown and does no homework,” says Jane Milrod, ADHD coach and founding director of CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder) of Princeton-MercerCounty.

In research published in 2009 in “Psychological Science,” Douglas Gentile found that 8.5 percent of children ages 8 to 18 who use video games do so in a way that is addictive, according to the standards established for pathological gambling. Milrod describes some warning signs of this video game addiction: “You’re not interested in anything but the game, and you become absolutely enraged and crazy when it is taken away from you. You also experience decreased pleasure in daily activities such as walking or eating; you can’t even enjoy a conversation because you are thinking how much you want to be gaming.” Other potential signs include not doing schoolwork on time, refusing to go to school, or neglecting personal hygiene.

So why do some children get hooked? “It’s fast, cheap, and quick,” says Milrod. “Like McDonald’s for the brain. You’re given a task, it lasts seconds, and then you’re given a reward.” This sets the brain up to expect almost constant rewards that require little effort, which does not happen in the real worlds of school and later of work. The gaming world, which Milrod characterizes as “the easy dopamine squirt of a fast-moving reward box,” bears little resemblance to the 3-D reality of life, where rewards tend to be slow in coming, if at all. “Work in the real world requires deprivation and delayed gratification,” says Milrod.

Children who are immersed in the pure pleasure and positive reinforcement of video gaming, make a simple deduction, which to them is oh so rational: “Why do something that takes so long to get rewarded for?” Homework then falls by the wayside, grades drop, and children even withdraw from social interaction with their peers.

ADHD children may be particularly susceptible to this scenario. They have a deficit in the reward pathway of the brain and already require a smaller window between activity and reward. The rewards from gaming, then, are particularly alluring to them. Gaming may also be more harmful to them because many already have a hard time with executive functioning — getting started, sustaining activity, setting realistic goals and sticking to them, and knowing when to stop — and the immediate rewards from gaming make it harder for them to shift to academic work or even to enjoying the pleasure of a sunny day.

Milrod will be joined by chiropractic neurologist Vincent Kiechlin in a program titled “The Neurological Impact of TV, Computers, and Gaming on the AD/HD Brain,” Wednesday, October 27, 7 to 9 p.m., at the Riverside School gym, 58 Riverside Drive. The event, sponsored by CHADD of Princeton-Mercer County, will also include a panel of parents who will share their experiences of reducing their children’s screen time.

Kiechlin has a somewhat different perspective on the effects of visual stimulation on children, looking in particular at how it affects the brain. In teenagers, the most primitive motivational regions of the brain, those involving thirst, hunger, and sex, are particularly active, producing the hormones that promote the secondary bodily characteristics of adulthood. These same regions are stimulated by the visual input that teenagers receive from video games, computers, and the like.

Overstimulation of these regions not only causes teens to be more emotional, but may also diminish the development of newer layers of the brain that enable people to delay self-gratification, have empathy with others, and even be horrified when someone is beaten. “The way our brain grows, the middle parts that we are born with start growing and feeding new layers that are stacked on the original layers,” says Kiechlin. “As new layers grow and are fed from the older layers, the new layers inhibit the older layers.”

One sign of this development is when children forsake older toys for ones more appropriate to their current brain development.

When the limbic layers are overstimulated, however, the brain makes more connections in that region. “It physically changes the brain,” says Kiechlin. “If you are constantly on machines, there is a thickening of the more primitive regions of the brain.” As these areas are overstimulated, the newer regions find it harder to inhibit the older ones. With video games, then, says Kiechlin, “Children don’t want to stop because they don’t have enough inhibitions to the limbic system.” Further, he adds, learning requires children to use the newer parts of their brains. “If the emotional is more dominant, you can have difficulty using those parts,” he says.

Not only do video screens directly stimulate the limbic region, but they also limit a person’s movement, which can have its own negative effects. “Motor activity is one of the largest stimulators of brains to grow new layers,” says Kiechlin.

Kiechlin and Milrod offer some suggestions to parents who are pulling their hair out over children who are addicted to video games and ignoring the rest of their lives:

Set up a contract. The parents need to sit down with their child at a family meeting in a peaceful, non-confrontational way, not in the heat of the moment, says Milrod. The contract will spell out the behavioral expectations as well as the reward for good behavior, which may be video and screen time, money, automobile usage, or a dinner out. But the centerpiece and linchpin of this contract is: no video until homework is done.

For a child who has been addicted to video games and removed himself from normal activities, the contract should also promote lifestyle changes. It might, for example, set a half hour of exercise as a reasonable exchange for a half hour of video game usage. Or it might require a child to join a religious youth group or do a specified amount of community service, or get a job. “This will help replace this lifestyle where there is low human contact,” says Milrod. “Part of the problem is that video games are so isolating that you become separate from other human beings and less of a functioning person. To rebuild your brain, you have to rebuild your social interactions.”

The contract also needs to specify amounts of television, Internet, and video game usage. Some parents allow none during the school week. Others may allow a limited amount once homework is done.

The first step is to take complete control over their children’s visual input, including Internet connections, iPhones, televisions, gaming systems, and computers. Luckily many supports are available: plug locks; cards with magnetic stripes that can be swiped to turn on electronic components for a specified amount of time — without parents having to get in the middle; OpenDNS to block gaming sites or Facebook; or arranging with Verizon to block Internet usage and limit how much texting children can do.

Another contract stipulation may be that the child report each day what homework has been assigned and then show the parents the finished products. Only when the parents are certain the schoolwork has been completed will they release control over the electronic input.

Different approaches work for different families, says Milrod. “You have to see what works with your family’s values.”

Once children learn that if they finish their homework, then they can play a video game, three things happen, says Milrod. First, they learn how to take better care of themselves. Second, they are learning what delayed gratification means. Third, you are setting up a different kind of brain patterning for them, not dependent on rapid, immediate rewards.

Make sure parents serve as role models. Sometimes Milrod hears despairing parents tell her, “I love my TV, that’s my addiction.” But parents need to shift their behavior as an example to their child. It may not be easy for them, says Milrod, but once they see the danger to the child, most are willing to make those changes.

Get your child to join extracurricular school activities, especially encouraging those that involve movement and stimulate the brain. “It could even be a painting class,” says Kiechlin. “You’re doing something — using your muscles to create a visual image. As a chiropractor, Kiechlin understands the role that gravity, and hence posture, plays in stimulating the growth of the brain. When his children are doing their homework on the computer, he will place a wobble board in front of the computer to promote movement.

Milrod, an ADHD child herself, learned to compensate and despite struggles in elementary, middle, and high school graduated Phi Beta Kappa, with high honors, from Rutgers University with a major in history and a minor in French.

For 20 years, she had a perfect job for an ADHD person; she was a head hunter. This and other perfect jobs — salesperson, operations manager, emergency room doctor, ambulance driver — all provide constant stimulation, requiring a person to do 100 things at once, she says.

When she had her own children, she looked at herself with new eyes and realized that both her father, in sales, and her mother, who worked in an optometrist’s office and also had a business at home, were also ADHD. To help guide her own children, Milrod began to seek more information and was mentored by Katherine McGavern, whose children were 10 years ahead of Milrod’s. “I didn’t want them to suffer the way I suffered,” says Milrod. “There were so many obstacles to overcome with the school system, and it was difficult finding the right kind of support for my children’s needs.”

Milrod decided to launch the Princeton-Mercer County chapter of CHADD, which had been dormant for seven years. In June, 2006, Milrod trained to become a certified CHADD parent to parent educator. As she taught more classes, people increasingly came to her for help and guidance. “They pulled me into becoming coach and being more hands-on in helping,” she says. “The way I see the role of a coach is like a nurse to a doctor. I am to a psychologist and a psychiatrist the daily dose of support they do not have the time to provide.”

When parents do not have a coach, they are asked on weekly visits to a helping professional to do certain interventions with their children every day. But for most parents this is not so easy, both because they have other responsibilities and because inevitably the interventions create a power struggle with their children. That’s where a coach like Milrod steps in. She will text and E-mail reminders to children, call them several times a week, and meet with them once a week. “To make shifts in behavior it is a minute-by-minute proposition,” she says. “You can’t do it once a week or once a month, and you need a partner in the struggle.”

Kiechlin, whose practice is based at 601 Ewing Street, grew up in Matawan. His father was an accountant. The course of Kiechlin’s life was changed by a motor vehicle accident he suffered at age 18. A couple of years later, when he was a premed at St. Peter’s College, majoring in biology, and still experiencing problems with his back from the accident, he happened to meet up with a chiropractor at a school health fair. The chiropractor helped him with his back pain and, as a result, Kiechlin himself decided to go to the Los Angeles College of Chiropractic, where he graduated in 1988.

A later life experience sent him back to a chiropractic neurology program run by the Carrick Institute for Graduate Studies in Hartford, Connecticut. “My son was born with a club foot, and I remember looking at his foot and thinking, ‘That’s a neurological problem for sure,’” says Kiechlin. Whereas the orthopedist saw it as only a foot problem, he thought the cause was too much contraction in his son’s calf. To learn more, Kiechlin went back to school and became board certified in 2003 in chiropractic neurology, which focuses on repairing imbalances that result in brain and nervous system dysfunction.

Kiechlin has four children, ages four to 10, and he has no video games at home.

Although a contract can effect a miraculous improvement, often a teenager remains unhappy, even as his grades improve. One family of a third grader who did no homework and was not sleeping well decided on a total lockdown. As a result, the boy started reading and playing with other toys, even though he at first refused to do homework. Eventually, with the cooperation of the school and some reduction in demands, his behavior changed and his mood improved.

Another was a teenager who was a gaming addict who was making Ds and Fs. After his parents took away everything, including his iPhone, he would come home and sleep. Although he was in danger of failing and having to repeat a year when Milrod started to work with him, by the end of the year his homework production had picked up and he was earning Bs and Cs. Milrod says, “He never came around to saying, ‘Thank you for taking away my screens,’ but he was happy and relieved his grades improved.”

For Milrod what is important is getting the message out to adults, children, and parents that videos, screens, and television are far from benign influences, particularly on an ADHD person. “It’s as if you were bringing a diabetic child into a world where all you give them is sugar, bananas, and orange soda,” she says.

Attention Deficit Disorder Lecture and Discussion, Children and Adults with Attention-Deficit Hyperactivity Disorder,RiversideSchool,58 Riverside Drive,Princeton. Wednesday, October 27, 7 to 9 p.m. “The Neurological Impact of TV, Computers, and Gaming on the AD/HD Brain” presented by Vincent Kiechlin, a chiropractic neurologist. Facilitated group discussions follow. 609-683-8787.

Reprinted from the October 27, 2010, issue of U.S. 1 Newspaper
What’s New in Princeton & Central New Jersey?