“Watching TV for three hours a day will not harm your children”, The Independent reports. However, The Daily Express contradicts this, saying “Too much television turns children into monsters”. In this case, The Independent is closer to the truth.

It has long been said that too much TV or video games could be bad for children. The study reported in the news set out to discover whether there is any truth in this belief.

It was a large UK study, tracking children aged from five to seven years of age, to see what – if any – effect TV viewing and video game playing had on their behaviour, attention span, emotions and peer relationships.

• Researchers found that regularly watching three hours a day was linked to a tiny increase in ‘conduct problems’ (essentially ‘being naughty’) after adjusting for many factors. This was just one of many outcomes the researchers examined. There was no evidence that TV viewing affected other issues, including hyperactivity, emotions and peer relationships.
• Interestingly, there was also no association between time spent playing video games and any emotional or behavioural problems.

How much TV should my child watch?

Unlike some other countries, including the US, there is no official UK recommendation on how much TV a child should watch. (Editor’s Note: click here for US screen time guidelines from the American Academy of Pediatrics)

A common sense approach suggests ‘everything in moderation’. Many programmes aimed at children are now designed to be stimulating or educational, so you may want to think about what programmes your kids watch, as well as how much. However, other activities such as regular exercise, playing with others, and reading are also important to their development.

Read more about exercise guidelines for children and play ideas and reading tips for children.

Where did the story come from?

The study was carried out by researchers from the Medical Research Council/SCO Social and Public Health Sciences Unit at the University of Glasgow. It was funded by the UK Medical Research Council.

The study was published in the peer-reviewed journal Archives of Disease in Childhood. This article was open-access, meaning that it is available free online.

The media reported this story from two opposing angles, with headlines either suggesting that watching TV does not harm children (The Independent, and BBC News), or concentrating on the small increase in conduct problems and suggesting that TV watching is linked to behavioural problems or that children are naughtier (The Daily Telegraph and the Daily Mail).

While a case could be made that the Telegraph and Mail’s headlines are accurate at face value – there was a very small increase in naughty behaviour – the tone of their headlines are not really a fair reflection of the findings of the study. However, the Daily Express claim that TV turns ‘kids into monsters’ is totally inaccurate.

What kind of research was this?

This was a cohort study. It aimed to determine whether there was a link between the amount of time spent watching TV and playing computer games at five years of age, and changes in psychosocial adjustment at seven years of age.

Cohort studies are the ideal study design for this type of research, although they cannot show causation. For example, in this study we cannot be sure that TV watching causes the increase in conduct problem score, as it could be that other factors, called confounders, are responsible for the link.

What did the research involve?

Mothers of 11,014 children in the UK Millennium Cohort study (a study of a sample of children born between September 2000 and January 2002) were asked questions about their children’s behaviour.

They were asked the typical time during term-time spent watching television and playing electronic games when children were five years of age. This was categorised into:

• None
• Less than one hour per day
• Between one and less than three hours
• Three hours to less than five hours
• Between five hours and less than seven hours
• Seven hours or more per day

Using the ‘Strengths and Difficulties Questionnaire’, when children were five and seven years of age, researchers assessed:

• Conduct problems
• Emotional symptoms
• Peer relationship problems
• Hyperactivity/inattention
• Prosocial behaviour (helpful behaviour)

The researchers collected information on maternal characteristics, family characteristics and family functioning (potential confounding factors), including:

• Mother’s ethnicity, education, employment, and physical and mental health
• Family’s household income
• Family composition
• Warmth and conflict in the mother-child relationship at three years of age – as assessed by interview
• Frequency of parent-child joint activities at five years of age
• “Household chaos” – a psychological term used to describe how chaotic or not daily life in the house tends to be in terms of issues such as sticking to set routines, household noise and how crowded the house is

The researchers also collected information on the child’s characteristics at five years of age, including:

• Cognitive development (assessed by the researchers)
• Whether they had a long-term illness or disability (reported by the mother)
• Sleeping difficulties
• The amount of physical activity they performed
• Negative attitudes at school

The researchers then looked to see if there was an association between time spent watching television and playing electronic games and psychosocial problems, after adjusting for maternal characteristics, family characteristics and functioning, and child characteristics.

What were the basic results?

Almost two-thirds of children in this study watched between one hour and three hours of TV per day aged five years old, with 15% watching more than three hours of TV and very few children (<2%) watching no TV. The majority of children played computer games for less than one hour per day, with 23% of children playing for one hour or more.

Initially, the researchers found that exposure to either TV or games for three hours or more was associated with an increase in all problems, and three hours or more of TV with reduced prosocial behaviour. However, after maternal and family characteristics, child characteristics and family functioning were adjusted for, the researchers found that:

• Watching TV for three hours or more per day at five years of age, compared to watching television for under an hour, predicted a 0.13 point increase (95% confidence interval (CI) 0.03 to 0.24) in conduct problems at seven years of age (after adjusting for the amount of time spent playing computer games).
• No association between time spent watching TV and emotional symptoms, peer relationship problems, hyperactivity/inattention and prosocial behaviour was found.
• The amount of time spent playing electronic games was not associated with any emotional or behaviour problems.
• When television watching and time spent playing electronic games were considered together, it was again found that three hours or more per day of screen time was associated with a 0.14 point increase (95% CI 0.05 to 0.24) in conduct problems compared to scores for those who watched less than an hour, but that screen time was not associated with emotional symptoms, peer relationship problems, hyperactivity/inattention or prosocial behaviour.
• There was no evidence that screen time had different effects on boys and girls.

The researchers report that the relationships remain the same when current (at age seven years) screen time was adjusted for.

How did the researchers interpret the results?

The researchers concluded that “TV but not electronic games predicted a small increase in conduct problems. Screen time did not predict other aspects of psychosocial adjustment.” The researchers go on to add that further work is required to establish the cause of these relationships.

Conclusion

This large UK cohort study has found that watching TV for three hours or more daily at five years predicted a small increase in conduct problems between the ages of five and seven years compared to watching TV for under an hour (0.13 point increase, on average). However, the time spent watching TV was not linked to hyperactivity/inattention, emotional symptoms, peer relationship problems, or prosocial behaviour.

The time spent playing electronic games was not associated with any emotional or behavioural problems.

Strengths of this study include the fact that it was large and well designed. It also accounted for many of the potential “confounding” factors (although there may still be others that weren’t accounted for), and examined TV/video/DVD watching (considered passive activities) and playing computer games (active activities) separately, which many previous studies have failed to do.

However, this study does have a significant limitation in that it relied on the mother’s reporting of both watching TV or playing computer games, and the child’s emotional and behavioural problems.

Although increased television watching was associated with an increase conduct problem score, it is not known whether the minimal point increases in average score for this sample between the ages of five and seven would actually make any noticeable difference to an individual child’s overall functioning and behaviour.

The study also suggests that family characteristics and functioning, and child characteristics also play an important role in the development of emotional and behavioural problems and that it may not be down to TV viewing alone.

Adjusting for confounders such as family composition, mother-child relationship and child’s activity levels had a significant effect on the initial results. This arguably suggests that these types of factors may have a considerable influence on how a child develops, rather than TV watching.

Given the lack of significant associations found between TV viewing and game playing and child psychosocial problems, no conclusive answers can be drawn from this study alone.

Further work is required to examine the child and family characteristics which could be targeted to improve outcomes.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Watching TV for three hours a day will not harm your children”, The Independent reports. However, The Daily Express contradicts this, saying “Too much television turns children into monsters”. In this case.

Links to Headlines

• Watching TV for three hours a day will not harm your children, parents told. The Independent, March 26 2013
• TV time ‘does not breed badly behaved children’. BBC News, March 26 2013
• Too much television turns children into monsters, British study finds. Daily Express, March 26 2013
• More than three hours of TV ‘makes youngsters naughtier by the age of seven’. Daily Mail, March 26 2013
• Television link to behaviour problems in young children. The Daily Telegraph, March 25 2013

Links to Science

• Parkes A, Sweeting H, Wight D, Henderson M. Do television and electronic games predict children’s psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study. Archives of Disease in Childhood. Published online March 25 2013

“Being bullied regularly by a sibling could put children at risk of depression when they are older,” BBC News reports.

A new UK study followed children from birth to early adulthood. Analysis of more than 3,000 children found those who reported frequent sibling bullying at age 12 were about twice as likely to report high levels of depressive symptoms at age 18.

The children who reported sibling bullying were also more likely to be experiencing a range of challenging situations, such as being bullied by peers, maltreated by an adult, and exposed to domestic violence. While the researchers did take these factors into account, they and other factors could still be having an impact. This means it is not possible to say for certain that frequent sibling bullying is directly causing later mental health problems. However, the results do suggest that it could be a contributor.

As the authors suggest, interventions to target sibling bullying, potentially as part of a programme targeting the whole family, should be assessed to see if they can reduce the likelihood of later psychological problems.

Where did the story come from?

The study was carried out by researchers from the University of Oxford and other universities in the UK. The ongoing cohort study was funded by the UK Medical Research Council, the Wellcome Trust and the University of Bristol, and the researchers also received support from the Jacobs Foundation and the Economic and Social Research Council.

The study was published in the peer-reviewed medical journal Pediatrics. The article has been published on an open-access basis so it is available for free online.

This study was well reported by BBC News, which reported the percentage of children in each group (those who had been bullied and those who had not) who developed high levels of depression or anxiety. This helps people to get an idea of how common these things actually were, rather than just saying by how many times the risk is increased.

What kind of research was this?

This was a prospective cohort study that assessed whether children who experienced bullying by their siblings were more likely to develop mental health problems in their early adulthood. The researchers say that other studies have found bullying by peers to be associated with increased risk of mental health problems, but the effect of sibling bullying has not been assessed.

A cohort study is the best way to look at this type of question, as it would clearly not be ethical for children to be exposed to bullying in a randomised way. A cohort study allows researchers to measure the exposure (sibling bullying) before the outcome (mental health problems) has occurred. If the exposure and outcome are measured at the same time (as in a cross sectional study) then researchers can’t tell if the exposure could be contributing to the outcome or vice versa.

What did the research involve?

The researchers were analysing data from children taking part in the ongoing Avon Longitudinal Study of Parents and Children. The children reported on sibling bullying at age 12, and were then assessed for mental health problems when they were 18 years old. The researchers then analysed whether those who experienced sibling bullying were more at risk of mental health problems.

The cohort study recruited 14,541 women living in Avon who were due to give birth between 1991 and 1992. The researchers collected information from the women, and followed them and their children over time, assessing them at intervals.

When the children were aged 12 years they were sent a questionnaire including questions on sibling bullying, which was described as “when a brother or sister tries to upset you by saying nasty and hurtful things, or completely ignores you from their group of friends, hits, kicks, pushes or shoves you around, tells lies or makes up false rumours about you”. The children were asked whether they had been bullied by their sibling at home in the last six months, how often, what type of bullying and at what age it started.

When the children reached 18 they completed a standardised computerised questionnaire asking about symptoms of depression and anxiety. They were then categorised as having depression or not and any form of anxiety or not, based on the criteria in the International Classification of Diseases (ICD 10). The teenagers were also asked whether they had self-harmed in the past year, and how often.

The researchers also used data on other factors that could affect risk of mental health problems, collected when the children were eight years of age or younger (potential confounders), including any emotional or behaviour problems at age seven, the children’s self-reported depressive symptoms at age 10, and a range of family characteristics. They took these factors into account in their analyses.

What were the basic results?

A total of 3,452 children completed both the questionnaires about sibling bullying and mental health problems. Just over half of the children (52.4%) reported never being bullied by a sibling, just over a tenth (11.4%) reported being bullied several times a week, and the remainder (36.1%) reported being bullied but less frequently. The bullying was mainly name calling (23.1%), being made fun of (15.4%), or physical bullying such as shoving (12.7%).

Children reporting bullying by a sibling were more likely to:

• Be girls
• To report frequent bullying by peers
• To have an older brother
• To have three or more siblings
• To have parents from a lower social class
• To have a mother who experienced depression during pregnancy
• To be exposed to domestic violence or mistreatment by an adult
• To have more emotional and behavioural problems at age seven

At 18 years of age, those who reported frequent bullying (several times a week) by a sibling at age 12 were more likely to experience mental health problems than those reporting no bullying:

• 12.3% of the bullied children had clinically significant depression symptoms compared with 6.4% of those who were not bullied
• 16.0% experienced anxiety compared with 9.3%
• 14.1% had self-harmed in the past year compared with 7.6%

After taking into account potential confounders, frequent sibling bullying was associated with increased risk of clinically significant depression symptoms (odds ratio (OR) 1.85, 95% confidence interval (CI) 1.11 to 3.09) and increased risk of self-harm (OR 2.26, 95% CI 1.40 to 3.66). The link with anxiety did not reach statistical significance after adjusting for potential confounders.

How did the researchers interpret the results?

The researchers concluded that “being bullied by a sibling is a potential risk factor for depression and self-harm in early adulthood”. They suggest that interventions to address this should be designed and tested.

Conclusion

The current study suggests that frequent sibling bullying at age 12 is associated with depressive symptoms and self-harm at age 18. The study’s strengths include the fact that it collected data prospectively using standard questionnaires, and followed children up over a long period. It was also a large study, although a lot of children did not complete all of the questionnaires.

The study does have limitations, which include:

• As with all studies of this type, the main limitation is that although the study did take into account some other factors that could affect the risk of mental health problems, they and other factors could still be having an effect.
• The study included only one assessment of bullying, at age 12. Patterns of bullying may have changed over time, and a single assessment might miss some children exposed to bullying.
• Bullying was only assessed by the children themselves. Also collecting parental reports, or those of other siblings, might offer some confirmation of reports of bullying. However, bullying may not always take place when others are present.
• The depression assessments were by computerised questionnaire, this is not equivalent to a formal diagnosis of having depression or anxiety after a full assessment by a mental health professional, but does indicate the level of symptoms a person is experiencing.
• A large number of the original recruited children did not end up completing the questionnaires assessed in the current study (more than 10,000 of the 14,000+ babies starting the study). This could affect the results if certain types of children were more likely to drop out of the study (e.g. those with more sibling bullying). However, the children who dropped out after age 12 did not differ in their sibling bullying levels to those who stayed in the study, and analyses using estimates of their data did not have a large effect on results. Therefore the researchers considered that this loss to follow-up did not appear to be affecting their analyses.

While it is not possible to say for certain that frequent sibling bullying is directly causing later mental health problems, the study does suggest that it could be a contributor. It is also clear that the children experiencing such sibling bullying are also more likely to be experiencing a range of challenging situations, such as being bullied by peers, maltreated by an adult, and exposed to domestic violence.

As the authors say, the findings suggest that interventions to target sibling bullying, potentially as part of a programme targeting the whole family, should be assessed to see if they can reduce the likelihood of later psychological problems.

Read more about bullying, how to spot the signs and what to do if you suspect your child is being bullied (or is a bully themselves).

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Summary

“Being bullied regularly by a sibling could put children at risk of depression when they are older,” BBC News reports. A new UK study followed children from birth to early adulthood. Analysis of more than 3,000 children found.

Links to Headlines

• Sibling bullying increases depression risk. BBC News, September 8 2014
• Lasting toll of bullying by a sibling: Brothers or sisters who are regularly picked on ‘more likely to be depressed or take an overdose’. Daily Mail, September 9 2014

Links to Science

• Bowes L, Wolke D, Joinson C, et al. Sibling Bullying and Risk of Depression, Anxiety, and Self-Harm: A Prospective Cohort Study. Published online September 8 2014