Last month I wrote about how interactive screen-time triggers the stress (fight or flight) response. Can video games stress the nervous system enough to cause mood changes? Tantrums? Explosive behavior? Let's look at a real-life case of video game rage.
Mikey is a ten year old boy with mild autism and ADHD, who was referred to me for explosive rages. The aftermath of his most recent episode, which occurred in the classroom, was captured in the photo here. The school district was insisting on a psychiatric evaluation: Was he bipolar? Did he need medication? The parents were fearful that taking this step would sentence their son to “being put on drugs.” They felt (correctly so) that his behavior could be managed if given the proper environment.
Since being male, autistic and having ADHD make one’s brain extra sensitive to electronic stimulation, I immediately inquired about screen-time habits. At home, Mikey was playing (non-violent) video games for several hours a day, as soon as he got home from school. When the family was out and about he was playing on his sister’s or dad’s iPhone. He also had computer time at school every day, and watched cartoons, which are more stimulating than other shows due to their intensely bright colors and rapidly changing scenes. Mikey had been gaming since age seven, but now played electronic games to the exclusion of all other interests. In the past year, he’d become increasingly resistant to doing homework, was more oppositional and defiant in general, and had starting escalating in his rages such that there was significant property destruction. Rages were typically provoked by being told no. There was no history of bipolar or other mood disorders in the family.
Diagnosis: Autism? Yes. ADHD? Of course. Could either of these cause rages? Yes. But also, he exhibited signs of what I call Electronic Screen Syndrome (ESS), which is characterized by a state of hyperarousal and emotional dysregulation from cumulative amounts of overstimulating screen-time. Could he have been bipolar? Perhaps, but there was no family history and other more obvious culprits were present. Bipolar disorder in children is actually quite rare and is over-diagnosed.
Solution: An electronic fast for four weeks, to both assess the impact of the electronics and to downshift his system to a place where he could start regulating himself again. (This kind of intervention is known as being both diagnostic and therapeutic, an obvious advantage.) The electronic fast usually means no interactive screen-time for four weeks, but in this case we removed television as well.
Luckily, this family was willing and ready to do whatever it took to calm their son’s nervous system. They went home and immediately planned how to restructure his time with screen-free activities. They bought Legos and puzzles and planned tennis and park outings. The extended family contributed as well so no one person would get burned out.
One month later, he’d had only one episode of aggression at home and was doing much better in the classroom. Medication was not needed, and we were able to work on supporting his mental health with natural supplements and good nutrition. One year later, he’d had zero—I repeat zero—incidents of aggression. There are no electronic game devices in the home now, and he has limited TV time on the weekends (no cartoons). He’s able to handle some computer time at school every week as well, but we make sure it’s not daily.
Considering the extent of the aggression and the safety issues involved, there’s a strong likelihood that if this child had gone to another doctor, he would have been put on antipsychotic medication unnecessarily. After all, his rages were extreme enough that he was putting himself and others in danger, repeatedly. It’s important to note that this child had played video games for several years before the effects culminated in overloading his system. This kind of history is typical, and can falsely lead parents and clinicians to believe that the games are not the problem because the child was tolerating them previously.
As discussed in a previous post, video games and other interactive screen-time activities are stressors. Therefore, when taking an integrative approach, these activities should be viewed as "propagating" or "mediating" factors that must be removed to restore mood, cognitive, and behavioral health. This electronic fast is a necessary first step that allows the nervous system to rest, rejuvenate, resynchronize, and reboot. Conversely, skipping this step means fighting an uphill battle.
This case may seem extreme, but mood dysregulation and severe tantrums have become increasingly common in the pediatric population. Fortunately, however, these behaviors are highly responsive to structured removal of the stimuli that triggered them to begin with.
Look at that photo again. What have you got to lose?
 Photo used with permission. Names and other identifying information have been changed.