AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY

BY H. BARRY WALDMAN DDS, MPH, PHD AND STEVEN P. PERLMAN, DDS, MSCD, DHL (HON)

Recently one of us (HBW) was confronted by a dental student who claimed that we mistakenly marked her response wrong on a test question. She had checked her answer with Google and reported she was right. We consulted the law school R graduate faculty member who wrote the question and told us that, "Google was wrong" and explained the reasoning. We then spent time fruitlessly trying to explain to the student about the rationale for the proper answer and that "the computer was not God."

Unfortunately, the reality is that in today's world, we raise our children from the time they can hold an animated tablet and can press action buttons (while sitting in their carriage) until that two year old becomes an adult. The "baby" computer is more than a babysitter, companion and teacher. It becomes the child's "world" with seemingly all the answers and leaves one with a diminished need for direct companionship, a drive to explore other sources of information and discover the world beyond the immediacy of their own environment. In addition, texting is not an opportunity to hear voice tones, innuendos and the real feelings of others. Also, it may well be a mistaken response as the computer "corrects" words that are misspelled.

WHAT DOES THIS HAVE TO DO WITH YOUNGSTERS WITH SPECIAL NEEDS?

The impact of computer usage on the youngster with disabilities, as they grow into their teen years and beyond, is the same as for all children; only more so. The over challenged parent with a child with special needs may rely to a greater extent on "the computer as a child-sitter" in an effort to satisfy the needs and demands of other members of the household. Impact on the child with disabilities may well be limitations of inter personal experiences, exag geration of "the computer fictionalized world," lack of inter-personal communication and just about any of the multitude of stimuli which transform a youngster into an adult.

"Analyses indicated that participants with disabilities, mainly the ones with motor disability showed an increased use and dependence on technology. Although this suggests the importance for young people with disabilities of the Internet use, it also indicates that disability, especially motor disability may be a vulnerability factor for an abusive use." 1

"Children with autism spectrum disorders (ASD) are uniquely vulnerable to various brain-related... Why? Because a brain with autism has inherent characteristics that screen time exacerbates. In truth, these impacts occur in all of us, but children with autism will be both more prone to experiencing negative effects and less able to recover from them; their brains are more sensitive and less resilient." 2

"Any child can become "addicted" to computer games, but kids with ADHD seem to be at particular risk. Many of them have poor social or athletic skills, and this doesn't matter in the world of computer games. Such games level the playing field for children with ADHD. And kids bothered by distractibility in the real world are capable of intense focus (hyperfocus) while playing. The computer game "trance" is often so deep that the only way to get the player's attention is to shake her or "get in her face." 3

"The ease of access to endless information, without the limitations let young people with physical limitations experience changes in their life that otherwise may be difficult or even impossible for them…However, while the Internet has become a channel that promotes access to information and communication, as any other technological tools, its misuse and overuse can cause various personal and social problems…(The) internet (can) reduce the social circle and affect the psychological well-being, decreasing social activity and replacing the strong links by other weaker than traditional (arrangements)."1

A study in The American Journal of Drug and Alcohol Abuse found that as many as 8.2 percent of Americans may suffer from Internet addiction (IAD). Other studies estimate that the disorder may affect more than 18 percent of college-aged Internet users, according to the Internet Addiction: A Handbook and Guide to Evaluation and Treatment. While anyone can develop IAD, the majority of people who do so are males in their teens, twenties, and thirties. Some reports suggest that Internet addiction is a particularly acute problem in Asian countries.

South Korea may have as many as 680,000 young people ages 10 to 19 who are addicted to the Internet, according to a 2013 report from Reuters. 4

THEN THERE ARE COMPUTER GAMES

Computer game addiction generally refers to an excessive, unhealthy amount of time playing computer games. Rather than engaging in the real world, an addicted user devotes the majority of his or her time to gaming. The addicted gamer often isolates him/herself from others, ignores more important responsibilities, and is often obsessed with obtaining higher status / rankings / achievements in his/her favorite computer game. 5

There are some signs and behaviors that are almost always included in definitions of computer addiction, such as: • "Significant interference with school, work, or relationships • Often avoiding other commitments in order to keep playing • Frequently turning down social invitations in favor of gaming • Using most or all of one's free time for gaming • Regularly playing late into the night, which results in poor sleep habits • Loss of interest in previously enjoyed activities • Regular gaming "binges" of 8 hours or more nonstop." 5

AND THERE ARE CONSEQUENCES

Social: As a computer game addict spends more time gaming, he / she tends to spend less time interacting with others in person. As such, he / she may lack face-to-face human contact, experience isolation & loneliness, and the loss of friends or relationships.

Academic / Career: Children and teens who are addicted to computer games very often experience falling grades and decreased academic performance and dedication. Completing homework, studying for tests, and efforts during school become very low priorities. Adults who are addicted to computer games may experience a similar deterioration in work performance, job dedication, and career aspirations.

Financial: Adults and teens may spend large amounts of unaffordable money on new games, expansion packs, micro-transactions, service fees, and computer upgrades.

Family: Computer game addiction often leads to deterioration in family relationships. Tension and conflict between family members escalates as requests to cut back or stop are ignored. Parents of addicted children may disagree on how to address the problem, which may lead to frequent arguments and conflicts.

Health: Computer game addicts may neglect personal hygiene, have poor sleep habits, give up healthy physical activities, and may make meal decisions based on quick and easy preparation (so that gaming is not interrupted) rather than dietary needs.

Emotional / Psychological: Those addicted to computer games may experience depression mood, low self-esteem, social anxiety, low frustration tolerance, anger, and feelings of guilt and shame for not being able to control their gaming habits.5

CONNECTION FAILURE: The internet can reduce the social circle and affect the psychological well-being, decreasing social activity and replacing the strong links by other weaker than traditional arrangements.

HOW IS COMPUTER GAME ADDICTION TREATED?

Because computer game addiction is a new disorder in the world of mental health, treatments are not as well established as those for depression, anxiety, anger, etc. "Most interventions take a behavioral approach which involves changing how the addict thinks about the addiction (for example, recognizing that the game distortions are designed to convince the gamer that it is not a problem)." 5

Capio Nightingale Hospital, in central London, has launched the first addiction service which allows young people to go "cold turkey" from their technology compulsion.

"The service, which will be offered for children as young as 12, comes amid growing concerns about children's behaviour with technology which puts their health at risk and has led to police being called to sort out family disputes.

Children will be forced to go 'cold turkey' from their technology use as well as being encouraged to cut out any problem use, such as computer games, and restrict the time spent using their phone or computer.

They would also be taught face-to face social skills at a residential unit. It also encourages them to think about their relationship with their phone, computer games or social networking websites like Facebook and teaches them skills to help them to switch off." 6

HOW CAN COMPUTERS HELP CHILDREN WITH DISABILITIES?

More and more schools are moving away from segregated special education to partial or full inclusion. As a result, more students with disabilities are coming into the general education classroom. Many of these students need support for physical, cognitive, and other disabilities. In many ways, computers can be great help.

"When playing at the computer with young children with special needs, one of the best approaches is to use software that is errorless. That means that no matter what the children do, there are no right or wrong answers. Exploration and trial and error are the learning styles that are rewarded, with fun noises, humorous animations, great graphics, lots of music and natural sounding speech. All kinds of learning goes on and there just are no things to do wrong." 7

"Most children like to play computer games, and some are highly educational or otherwise beneficial. Your child's teacher may use math, phonics, and other computer games in his or her classroom. He or she may have a subscription to a site like Lumosity.com, where children can work on word-forming, math, recall, and other skills. For example, a child who struggles with dyslexia may benefit from Word Bubbles, a game that challenges players to think of as many words as possible that begin with a three-letter combination.

For older children, you can use certain social media games at home with supervision. For instance, Pearl's Peril and other hidden object games featured on Facebook can help children with visual disabilities or poor muscle tone, as they require visual acuity and a certain level of speed.

Children with disabilities such as dysgraphia (inability to write coherently) or forms of cerebral palsy that affect handwriting can benefit from programs or games that teach typing. Mavis Beacon Teaches Typing is a popular program in many schools, and many teachers have mini-games as options in their classrooms or in computer labs." 8

SO WHAT IS A GOOGLE?

"A googol is 10 to the 100th power (which is 1 followed by 100 zeros). A googol is larger than the number of elementary particles in the universe The term was invented by Milton Sirotta, the nine-year-old nephew of mathematician Edward Kasner, who had asked his nephew what he thought such a large number should be called. Such a number, Milton apparently replied after a short thought, could only be called something as silly as a 'googol.'" 9 •

WINNING STRATEGIES: More students with special needs are coming into the general education classroom, and computers can be great support for physical, cognitive, and other disabilities.

ABOUT THE AUTHORS: H. Barry Waldman, DDS, MPH, PhD is a SUNY Distinguished Teaching Professor, Department of General Dentistry, School of Dental Medicine, Stony Brook University, NY. Steven P. Perlman, DDS, MScD, DHL (Hon) is Global Clinical Director, Special Olympics, Special Smiles Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine.

References 1. Martinez. RS. Disability in young people, increases the risk of excessive internet use? Health and Addictions. 2014;151):15-24. 2. Dunckley VL. Psychology Today. Autism and screen time: special brains, special risks Available from: psychologytoday.com/us/blog/mental-wealth/201612/autism-and-screen-time-spe- cial-brains-special-risks Accessed August1, 2018. 3. Having ADHD does not define my child. Attitude. Available from: additudemag.com/prevent-screen-time-addiction Accessed August 1, 2018. 4. Carson-Dewitt R. What is internet addiction? Everyday-Health. Available from: everydayhealth.com/internet- addiction/guide/ Accessed August 1, 2018. 5. Conrad B. Computer game addiction - symptoms, treatment, & FAQs. Available from: techaddiction.ca/computer_game_addiction.html Accessed August 1, 2018. 6. Rehab clinic for children internet and technology addicts founded. The Telegraph. Available from: telegraph.co.uk news/health/children/7467200/Rehab-clinic-for-childrenwhatis.techtarget.com/definition/googol-and-googolplexinter- net-and-technology-addicts-founded.htm Accessed August 1, 2018. 7. Tanenhaus J. Computers and special needs: enhancing selfesteem and language. Available from: kidneeds.com/diag- nostic_categories/ articles/computers.htm Accessed August 2, 2018. 8. How computers can help children with disabilities. Available from: kgebamerica.com/how-computers-can-help-kids-with- disabilities Accessed August 2, 2018. 9. Whartis.com. googol and googolplex. Available from: whatis.techtarget.com/definition/googol-and-googolplex Accessed August 2, 2018.

AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE AND DENTISTRY The American Academy of Developmental Medicine and Dentistry (AADMD) was organized in 2002 to provide a forum for healthcare professionals who provide clinical care to people with neurodevelopmental disorders and intellectual disabilities (ND/ID). The mission of the organization is to improve the quality and assure the parity of healthcare for individuals with neurodevelopmental disorders and intellectual disabilities throughout the lifespan.