A continuum of visual sensitivity

Even readings outside the red zone may indicate the need for caution.

If a neurologist tells you that you don’t need to worry about seizures from electronic screen exposure, because you’re not photosensitive, what does that really mean?

It means that when you were tested for your response to a white strobe light, an EEG didn’t detect a particular abnormal electrical pattern in your brain. (I’ve noted some limitations of this procedure elsewhere.) Epileptology looks for yes or no, typically relying on EEG to rule out epilepsy. If yes, possibly medicate; if no, it’s not a case the clinician will pursue.

It does not indicate that bright flashing and/or patterns from electronic screens don’t adversely affect your brain function.

Researchers have gradually come to consensus on exactly what the EEG must look like to indicate photosensitive epilepsy (the photoparoxysmal response): certain spike/wave patterns that appear in both brain hemispheres. In arriving at these criteria, researchers excluded three other types of EEG abnormalities that in prior research “qualified” as a photoparoxysmal response. Epilepsy researchers aren’t certain what the significance of these other abnormalities is, but because the other patterns cannot conclusively be associated with epileptic seizures, there’s little interest in further research.

So these other EEG abnormalities from photic stimulation don’t count, in current neurology practice, and nobody would even tell you about them if they were found in your EEG. You’d be told the EEG was normal, period. But what if these other abnormalities were a sign that neurological function is in fact disturbed by visual stimuli, but not to the point of a seizure?

Let’s say you had one of the three other EEG abnormalities (which you wouldn’t know about, because the EEG was deemed normal). Maybe these indicate that you’re vulnerable to symptoms of a visual-overload-not-to-the-point-of-seizures syndrome. Neurologists have been examining the overlap between epilepsy, photosensitive epilepsy, and migraines. More about this in a future post, but actually there are many overlapping symptoms and correct diagnosis can be difficult. So if video game exposure or photic stimulation produces headaches and visual disturbances, and an inconclusive EEG, it may be that the visual overload is triggering migraines. Or perhaps the exposure is triggering another form of hyperexcitability in the brain’s visual cortex, which has been termed visual stress. While research has been done on this, it’s not part of a conventional neurology practice.

What about patients with more subtle or mood-related symptoms of a visual-overload-not-to-the-point-of-seizures problem? Who is treating these patients? Could be psychiatrists and psychologists, who view altered behavior and cognitive function through the lens of their respective training. Because there’s such a dearth of research of the gray areas of brain dysfunction following exposure to electronic screens, mental health providers have no basis for treating these patients for anything but mental health disorders. It’s clear that more research is needed and that more effects on the brain will be uncovered. One intriguing paper explores the contribution of fluorescent lighting to agoraphobia. The SpongeBob study published last year showed diminished executive function in children who viewed the cartoon.

In her Psychology Today blog, psychiatrist Victoria Dunckley recently posted a compelling piece about the effects on her patients of electronic screen time. She recommends creating a diagnostic category called Electronic Screen Syndrome to identify a dysregulation of mood, attention, or arousal level due to overstimulation of the nervous system by electronic screen media. She has seen dramatic improvements in hundreds of patients’ mood, behavior, and cognition after they go on an “electronic fast.” (Some have underlying psychiatric diagnoses, some don’t.) Maybe these patients were having very subtle seizures from electronic screens. Maybe the effects on the nervous system weren’t quite what epileptology defines as seizures. Either way, many kids exposed to electronic screens are experiencing diminished quality of life (as are their families) for a problem that medicine has not yet acknowledged.

SpongeBob study sparks flat earth fervor

see his photos at https://picasaweb.google.com/114409847749593224448

photo by EJ Hill

The SpongeBob study in the current issue of Pediatrics, showing poorer executive function immediately after children watched the popular cartoon, sure got noticed!

Hundreds of postings, comments, snippets, and even some thoughtful articles have so far appeared in response. Not surprisingly, many found fault with the findings for one reason or another. I’m closely following the reaction to this study, because as more information about seizures and video games makes its way into public discussion, the very same responses will no doubt be recycled.

The essence of the study was that fast-paced cartoon animation, unlike slower cartoons, has a short-term impairing effect on the attention span and self-control function of young children. Although the sample size was small at 60 children, the study methodology was very straightforward and it stood up to the rigorous peer review required for publication in a leading medical journal. The authors had no discernible conflicts of interest, and the findings were described in an accompanying editorial as robust. At the very least parents should acknowledge that these findings deserve to be considered and need to be followed up with more investigation.

But we live in times of rampant cynicism and skepticism, hearing of seemingly endless and conflicting studies informing us that something we frequently do or eat is unhealthy, and of researchers ultimately not only disproven but discredited. So there was a lot of pushback. Some who took exception to the study thought it was passing judgment on the cartoon’s content, as against its visual presentation qualities. Others dismissed the findings out of hand because of flaws they find in the investigative method. And some just didn’t want to hear about it.

People who sounded off and dismissed the study based on an identifiable argument can be divided into these categories:

1. We adults and our grown children who grew up watching cartoons and other goofy programs are proof that there’s nothing to worry about.

  • Studies finding that fast-paced cartoons make kids unfocused are “poppycock.” We watched Woody Woodpecker and played with unsanitary plastic toys– Akron, OH West Side Leader
  • If SpongeBob were as damaging as they claim, the millions of kids who grew up glued to this 12-year-old megahit would be barely functioning today. For the most part, on good days, my kids are. Boston Herald
  • It is probably a mistake to despair. I may not know anything about cartoon sponges, but I am a parent and my children grew up happily without committing major felonies. It is a fair guess that they, too, were exposed at an early age to the SpongeBobs of their day.Pittsburgh Post-Gazette
  • as a SpongeBob-loving mother of two kids, one now in high school, the other in college, I can’t fathom that watching SpongeBob has hurt my offspring.Washington Post
  • We shudder to contemplate what tests administered to young fans of The Three Stooges might have yielded when Moe, Larry and Curly were in their prime.Newburyport, MA Daily News

Two problems with this argument: The study carefully quantified the pace of the fast and slow cartoons using the number of scene changes per minute. Classic cartoons had significantly fewer scene changes and didn’t create the same type of visual overstimulation as SpongeBob and other contemporary cartoons. In addition, the study makes clear that it looked only at the effects immediately after the cartoons were viewed, and it draws no conclusions about the long-term effects.

2. Problems with the study methodology.

  • …how is this study even remotely scientific or representative of the young population? 60 kids, 9 minutes of SpongeBob and you test them immediately after??? – comment posted to Discover Magazine
  • Before getting parents in an uproar, we’d like to see this study done on 8 to 10 year olds, to get a more realistic assessment of how SpongeBob affects the kids that really watch the show. – Philadelphia Inquirer
  • Having 60 non-diverse kids, who are not part of the show’s targeted demo, watch 9 minutes of programming is questionable methodology. It could not possibly provide the basis for any valid findings that parents could trust. – Nickleodeon spokesperson
  • The study also doesn’t indicate if the children were tested later after having some time to calm down from the excitement of the show, leaving open the question of whether the effects last at all. The researchers do not break down their results by gender either… – Yahoo! Contributor Network

Any clinical study, particularly the first of its type, needs to focus on a specific question that can show measurable results. The investigators begin with a hypothesis and set up a way to test it under controlled conditions. All studies have limitations. A standard component of any piece of scientific research is an acknowledgement by the authors of the limitations of the study, because no study can claim to represent all possible situations or populations.  Therefore, the authors do not presume that their results apply to children of other ages or backgrounds, and they do not claim to have shown anything other than immediate effects.

Studies cost money, and so initial (pilot) studies to prove a concept are typically done on a small group of participants. If the results show there is merit to the hypothesis, funding for a larger study is the next step, typically. More children, more age groups, more diverse population, more data points collected, such as the effects half an hour after viewing, etc.

3. We can’t draw conclusions when the total viewing time was a mere 9 minutes, which is not representative of typical viewing habits.

  • though the point of the study may have been that it only takes a few minutes of SpongeBob to warp your child’s brain, I’d argue that a few minutes, or even a whopping half-hour episode, is a tiny portion of a child’s day.Salon
  • I’m skeptical that any 9 minutes of TV viewing can cause attention problems. Even the full show wouldn’t phase me or change my view that a half-hour cartoon can do anything harmful…This study is flaky to say the least.Babble blog
  • Just take it in moderation…You’ve probably got more issues if you’re studying these cartoons rather than just watching them. – Lehigh Valley, PA Express-Times

Yes, well, the purpose of the study was to see if fast-paced cartoons have an immediate effect on cognitive function. If 9 minutes causes changes in function, does it matter if that’s a small portion of your child’s day? Why not consider how many 9-minute periods there are in a child’s daily dose of media?

It’s not just about SpongeBob, it’s about the health issues related to all the visual media that overload our children’s nervous systems. In the case of video games, many studies have already shown that for some children, 9 minutes is more than enough exposure to bring on a seizure. While the SpongeBob study should cause parents to pay closer attention to the visual qualities of everything their children watch, there lots of folks who just aren’t listening.

[For more of EJ Hill’s photos, see https://picasaweb.google.com/114409847749593224448]

Another “take” on the SpongeBob study

This analysis by a seizure safety detection tool for video material identifies the frames in a SpongeBob sequence that failed to meet safety guidelines. Click to enlarge.

Although the headline writers have had a bit too much fun with the story, it’s gratifying to see all the media interest in the just-published Pediatrics study showing the immediate effects of a SpongeBob cartoon on kids’ brain function. (In case you’ve been living in a pineapple under the sea, children in the study showed impaired executive function — attention and self-control — immediately after viewing SpongeBob for just nine minutes.)

Refreshingly, the study was not interested in the cartoon’s thematic content or the societal values the content might promote. Instead it set out to determine the immediate effects of extremely active animation on the cognition and self-regulation functions handled by the prefrontal lobes. The fast pace of the SpongeBob cartoon, involved rapid scene changes compounded by nearly constant character movement within each scene. As a companion paper in the same journal issue points out, “media is a public health issue, and harm-reduction approaches are what is needed. Steering children and adolescents toward safe or even health-promoting media activities must be a goal…”

The study authors speculate that, “in addition to the pacing…the onslaught of fantastical events that was also present in the fast-paced show might have further exacerbated EF [executive function]. Whereas familiar events are encoded by established neural circuitry, there is no such circuitry for new and unexpected events, which fantastical events often are. Encoding new events is likely to be particularly depleting of cognitive resources…”

Seizure-inducing flash/flicker and patterns and unexpected/fantastical are commonly found in video games, cartoon animation, music videos, TV content and advertising. So it’s not much of a leap to consider the impact of the frenetic pace and visually taxing experience of high-powered video games on children’s neural circuits — as they simultaneously process the imaginary world onscreen.

I doubt that many SpongeBob video clips comply with the guidelines for prevention of visually induced seizures. With the Harding Flash and Pattern Analyzer, I tested the only SpongeBob clip I was able to download, and, as the screen capture shown above illustrates, the cartoon failed to meet the guidelines. In other words, the active cartoons are visually taxing in a way that includes the qualities of light, pattern, and flash that can trigger seizures. Wonder how many of the 4-year olds had abnormal EEG firings while watching SpongeBob…even a quick burst of abnormal electrical rhythm in the brain that doesn’t develop into a clinical seizure can produce cognitive and other functional impairment.