TV’s Relationship to Mental Retardation and Autism

(Photo: Library of Congress)

TV is bad for children.  Wait, no it’s not.  Yes, it is!   And it’s really bad for their hearts!

Here’s the latest paper on the topic, from Michael Waldman, Sean Nicholson, and Nodir Adilov.  Using a natural experiment to rule out the possibility of reverse causation, the authors find “a strong negative correlation between average county-level cable subscription rates when a birth cohort is below three and subsequent mental retardation diagnosis rates, but a strong positive correlation between the same cable subscription rates and subsequent autism diagnosis rates.”  

In other words, TV watching decreases the rate of mental retardation but increases the rate of autism.  The authors hypothesize that, consistent with earlier research, “for the typical child television watching at age two improves cognitive development and decreases diagnoses of mental retardation.”

In contrast, TV might be particularly bad news for kids vulnerable to autism:

[W]e believe the most likely explanation is that there is a genetically vulnerable group for which early childhood television watching serves as a trigger for autism. It has long been known that autism has a strong genetic component (see e.g., Rimland (1964) and Folstein and Rutter (1977)). So one explanation for our autism results is that at least for some children diagnosed with autism it is not the genetics alone which triggers the condition, but rather the genes create a vulnerability to autism that is sometimes triggered by early childhood television watching.

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  1. Heidi says:

    Not the most compelling correlation I’ve ever seen. Isn’t it also likely that children with autism just really enjoy (fixate on) television? Perhaps they are not autistic because they watch a lot of TV, but rather they watch a lot of TV because they are autistic.

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    • PD says:

      The correlation to autism is not to TV watching, but cable subscription rates. I doubt autistic kids are the ones ordering the cable subscription.

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    • Sherri says:

      Totally agree with you, Heidi, and this study further compells one to think that those on the Autism Spectrum (even children) are just more inclined to be attracted to watching television (correlation, not causation): “Teens With Autism Preoccupied With TV, Video Games: Study” http://healthfinder.gov/news/newsstory.aspx?Docid=661168

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      • Guest Speaker says:

        Sherri,

        You (understandably along with many other non quants) are completely missing the point of the methodology in the study. It’s a natural experiment.

        It’s a longitudinal time-series dataset: take two counties and measure the rate of autism in both (t), then make cable TV available in one county (but not the other – that’s our control), and see how the autism rate goes up in the county with cable TV (t+1) but stays the same in the county without cable TV.

        Now replicate this lots and lots of counties over decades (e.g. maybe our ‘control country’ above at time t and t+1 suddenly becomes ‘treated’ with cable TV at t+n, and whooo – the autism rate goes up).

        You see, this way, cable TV comes first – that’s our treatment – and autism rates come second. The cable TV became available to each country, so it is essential an “exogenous” treatment (it has absolutely nothing to do with autistic kids being drawn to TV).

        Of course correlation isn’t causation, but with panel (time series) econometrics, we can get pretty darn close to causality.

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  2. CS says:

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    • Jack Skellington, ESQ says:

      Hi, CS:

      —–Utter nonsense. Do these researchers understand that this kind of sloppy research affects (and can potentially harm) real people, already dealing with child development issues?—-

      It’s not particularly sloppy, actually. I’m going to assume you didn’t read the paper. If you did, could you explain the portion of the methodology you take issue with?

      —–As the parent of an autistic child, I’m deeply offended by such a cavalier approach to the topic.—–

      I say this with all respect and empathy: Your experience as a parent to a child diagnosed with autism couldn’t be less relevant here. One of the most dangerous phenomenons of recent times is the societal validation of people’s opinions simply because of their proximity to an event.

      You gain no special insight into the epidemiology of autism by parenting an autistic child. You do acquire an almost insurmountable personal bias, but that doesn’t add value to the discussion, it removes it.

      —-I would also suggest that Freakonomics blog editors treat some subjects with a little more sensitivity.—-

      I would suggest this is an astonishingly selfish point of view? Is there really any other group in modern times treated more gently and with more respect than the parents of autistic children? You could fill libraries with the softball puffy news reports of how noble parents of autistic children are and how tirelessly they work to care for their special magic fragile children.

      That’s not the reality, though, is it? The reality is that autistic children are just children. Some are special, some are average, some are decidedly below average, in every quantifiable way. The same is true of, of course, of their parents. Some parents of Autistic children are enlightened genius saint-like beings. Some of them are sadistic rapists and murderers. Just like the rest of the population.

      To stay on point, an economics blog that was sensitive to the populations being studied in a paper would have no posts. Have enough self respect to argue the merits of something you disagree with. Your present appeal to pity is useless and embarrassing for us all.

      Hi, Heidi

      —-Not the most compelling correlation I’ve ever seen. Isn’t it also likely that children with autism just really enjoy (fixate on) television? Perhaps they are not autistic because they watch a lot of TV, but rather they watch a lot of TV because they are autistic.—-

      I think these are interesting points. Given the nature of Autism diagnoses in the time-frame of the study, I think another important question is if the correlation is actually that households with more TV viewership are more likely to investigate a diagnosis of Autism (and thus end up with more diagnosed children by virtue of *opportunities to diagnose* as opposed to an actual per capita increase in symptoms). It “feels” like this may be the case, it would be interesting to attempt to control for that (but astonishingly difficult, given how hard it is to quantify).

      Hi, Dianne,

      —-Sorry, but this tv correlation and autism causation is hogwash – as is the genetics theory. I have identical twins – one with autism and one not – same genes. I believe autism’s cause is an assualt of some sort on the immune system from a virus or other environmental agent—-

      See above comments about being the parent of an Autistic child and it’s lack of impact on the importance of your opinion.

      Also: In the future, you may want to avoid beginning proclamations as to the nature of a disease with phrases like “I believe”. I believe that many people who value a degree of intellectual rigor will stop reading right about at the second “e” in believe.

      —-I would say that kids with autism are visually motivated and driven – so they are drawn to the TV and computers. Lots of kids & adults think visually in pictures and have photographic memories. So kids with autism are drawn to the TV.—–

      I would say that’s a wild guess on your part. “Photographic Memory” is a long disproved concept best reserved for TV sit-coms and mystery novels. Autistic people, by diagnostic definition (which is likely changing, incidentally) tend to focus more intently on individualistic non social activities. If they are “drawn to TV”, it’s likely a function of this characteristic moreso than the visual images. I’d guess that you find that your autistic twin is also “drawn to” other individual activities that don’t involve visual stimulus. Repeating memorized words, perhaps. Just a guess, of course.

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      • RNS says:

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      • karl says:

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      • Jack Skellington, ESQ says:

        Hi, RNS

        —-Jack, while you work on debating this to the hilt and crushing “every point deemed biased by an Autistic parent”, care to elaborate on your contribution to this paper or the article?—-

        No contribution beyond reading the paper. I found it fairly average, but not particularly methodologically weak. Outside of this post specifically, I’ve grown a little weary with what clearly seems (to me as someone who works as a healthcare economist) to be the over-diagnosis of autism spectrum related disorders and the accompanying societal reaction.

        We could discuss the various incentives that have led to that over-diagnosis, but this probably isn’t the best place.

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    • Guest Speaker says:

      Hi CS,

      I’m sorry if this is a difficult topic for you, but it seems a lot of people here are having difficulty understanding the anger in your response.

      I have someone in my family with a mental illness (it’s different, I know, but it serves to get my point across). Every time I see research done on it, I’m ecstatic, no matter how implausible it seems or how much I may disagree with it. It’s one more avenue explored, which may be further supported or disproved over time. Yay!

      But you need to understand that no subject should be taboo for social scientists. It stunts the development of society, no matter how uncomfortable it may make us. There is nothing wrong with looking at ourselves like the higher primates we are in order to better understand ourselves.

      There are likely many paths than can lead to autism (and frankly there are likely many ‘kinds’ of autism, each with their own mechanisms and causes). Could it be that sitting in front of the boob tube at a young age limits active social interaction and the development of social skills, leading to autism? i.e. it is simply one of many risk factors?

      Social scientists speak in terms of ‘R-squared’ – namely how much of phenomenon Y does X account for? Often it’s only a little bit. The rest of the explanation for phenomenon Y could be other variables in the model that we have yet to discover or put together. It’s a huge mess of interactions, contingencies, and path dependency. That’s about the best modern science can do until we fully understand the underlying mechanism of autism.

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  3. Diane says:

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    • James says:

      And I would say – likewise based on a sample size of one, namely myself – that there are autistic spectrum people who dislike TV (I’ve never owned one), and are attracted to computers primarliy because we can make a more than decent living writing software.

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    • Guest Speaker says:

      A lot of people here are missing the point of the research methodology – it’s a natural experiment, which means the ‘treatment’ (availability of cable tv) is exogenous (imposed from outside the system). The kids aren’t ordering cable tv themselves because they are ‘drawn to it’.

      By comparing rates in separate counties over time, unobserved heterogeneity, like the socio-economic status of the parents or the kinds of local doctors, is largely controlled for. While the authors can’t say for certain that tv ’causes’ autism, there is evidence for a link between tv and the rate of autism diagnosis in an area.

      e..g one possibility (relating to the ‘rate of diagnosis’ as opposed to actual autism): parents get crappy cable news channels that report a lot on autism, then pressure doctors into an autism diagnosis.

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  4. Dutch says:

    People that can’t afford cable probably can’t afford the tests required for a diagnosis. I’d like to know the rate of car ownership to autism. Basically, the more you can afford, the more likely you are to engage the services of a professional.

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    • Enter your name... says:

      Of course, the public schools are required to provide such testing for free, so the personal ability to pay for testing might not matter in the end. It might change the age at which the label is settled, but that’s probably it.

      There are other factors, though. Rates vary noticeably by community for reasons that probably have more to do with the person in charge of ordering the testing and the incentives to tick the box for “please give us a tiny bit of extra funding because this child with some other, non-autistic disability has a few minor behaviors that happen to appear in autistic kids”.

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    • nobody.really says:

      I think Dutch has something here.

      Autism is the only disease I know that correlates with the WEALTH of the parents. So I suspect the variable “rate of cable subscriptions” is merely a proxy for the variable “parental wealth.” Actually watching TV may have nothing to do with the correlation.

      Now, WHY does autism correlate with parental wealth? Yeah, maybe it’s because only affluent parents can afford the diagnosis, or are open to pursuing such a diagnosis. But I believe I’ve seen a longitudinal study that controlled for these explanations. I’m left with the hypothesis that attributes that help make people wealthy (in today’s techological society) are also attributes that make them more likely to have autistic kids.

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      • Jack Skellington, ESQ says:

        —-Now, WHY does autism correlate with parental wealth? Yeah, maybe it’s because only affluent parents can afford the diagnosis, or are open to pursuing such a diagnosis. But I believe I’ve seen a longitudinal study that controlled for these explanations. I’m left with the hypothesis that attributes that help make people wealthy (in today’s techological society) are also attributes that make them more likely to have autistic kids.—-

        Hi, Nobody (My children love your work in Good Night Moon)

        This is a really “squishy” point you make, that Autism diagnosis are higher in wealthier populations and that there’s some underlying causality in that. First, it presupposes that there actually are any “attributes” that “make people wealthy”, which is an arguable point.

        That aside, let’s just unload all of the popular conceptions around the increase in Autism diagnosis, generally. This is a list of my perceptions of what currently shapes the debate, not in any way a list of things I find have credence:

        1. Labeling for care: Many support services/health insurance providers etc, require a “listed” diagnosis before resources can be released.

        2. The Illusion of Parental Control: Modern parents, particularly at higher levels of income, have come to believe they wield an enormous amount of influence on their children’s behaviour. Because of this, they view any outcome not in line with their own expectations as the result of some sort of externality. If Jimmy doesn’t do well at school, he must have ADHD, if Jimmy is painfully shy, he must have Asbergers, etc. They seek clinical labeling to deflect guilt. Once they acquire said labeling they frequently seek further causality (vaccines, diet, etc) to find a source of usefulness (to educate others, a cause to “fight” against, a cure through some non standard therapy, etc). The human mind’s pattern recognition engine hates randomness.

        3. The Environment is Increasingly Toxic: The increase in diagnosis is legitimate and caused by GMOs or air pollution, or BPA, etc.

        4. Ersatz Munchausen by Proxy: Parents want to feel “special” and “needed” and seek any flaw in their children to attempt to gain the sympathy and social status afforded by parenting a “special” child, and seek diagnosis, perhaps even exaggerating symptoms, coaching children etc.

        5. Clinicians don’t Build Summer Homes by Not Diagnosing: The idea that there’s a financial incentive for providers to offer a diagnosis in hope of future income from patients rather that report that a child is “shy”, but non deviant from norms.

        6. Drug Companies Can’t Sell Solutions Unless There Are Problems: See above applied to pharma instead of clinical practice.

        7. Media Saturation/”Web MD Syndrome”: So many resources have been spent on “awareness” campaigns, and the visceral nature of reporting on autistic children is so attractive to media outlets, that parents perceive the likelihood of Autism in children as vastly higher than it actually is and act accordingly, falling into one of the other behaviours listed, without malice.

        Was one of these what you had in mind?

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    • Megan says:

      Or the type of parents who order cable were more unhealthy during conception and pregnancy, or families who order cable spend more time indoors in toxic environments etc. the correlation is great…it’s a lead. And then from there the factors related, like the ones I mentioned and undoubtedly more, can be researched. A piece of the puzzle! I’m the mon of 2 asd kids….and they both watched tons of tv as babies because I was overwhelmed, born at home, never vaccinated them. Research is great. It’s weird people get upset at research….it’s not about our feelings as parents….it’s about looking for answers and that takes exploring options.

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  5. IE says:

    We might be sitting on a gold mine of data that may help accelerate this research and/or perhaps point to other directions.
    Google has accumulated an enormous database of internet user behavior over the last decade. Among other things they store search history for users, along with the records of what videos the users watched on YouTube.

    So if we look at the users who search for autism-related items (doctors, treatment, support groups, etc.) and check whether they had been actively watching toddler-age videos on YouTube 1-2 years earlier, it’s possible that we may find a correlation.

    This TV-trigger theory may or may not be a long shot, but there could be other environmental factors that contribute to autism. And it could be possible to identify them by mining the Google search history database.
    E.g. were the parents of autistic kids more likely to google for house paint before the birth? For new carpet? For artificial fireplace logs? No matter how ridiculous these ideas sound, at this point we are don’t know what environmental factors contribute to autism. Any correlation may hold a clue to solving this $35 billion per year problem.

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  6. Allie says:

    I don’t know if this study is necessarily accurate because it is based on cable subscriptions. I think that children with autism, like most children, seem to watch a lot of television, but just based on cable subscriptions, the correlation is not very clear.

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  7. Dani says:

    I remember reading somewhere that there’s a correlation between amounts of rainfall and autism rates. Maybe people in rainy areas are more likely to have cable TV.

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  8. HV Cheah says:

    Actually, I had a question in mind kind of related to this: how much of published medical information is actually reliable? Considering they seem to self-contradict every few months.

    Did our forefathers really live healthier lives so that they were in rugged good health and lived to a ripe old age without need for all our present-day medicines and suppliments? Is our health really in such a bad state? Or is any of it just plain, good ol’ fearmongering?

    So, really, how reliable is all of this?

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    • Enter your name... says:

      Well, I wouldn’t want to attempt to answer your main question, but I can tell you that back in 19th century, before industrial agriculture, when everything was 100% organic because there were no other options, Americans were very concerned about how awful their diets were, how impure and unhealthy the food was, how sickly the next generation was going to be because of poor diets, etc. The writings from the time sound very much like the writing of today, only with certain keywords changed.

      Rev Graham (of the Graham cracker, which was originally an unsweetened whole wheat cracker) would not have been so popular if people hadn’t been concerned. In American culture, a healthy diet is a sign of moral fitness, not of physical fitness.

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    • Jack Skellington, ESQ says:

      —-I remember reading somewhere that there’s a correlation between amounts of rainfall and autism rates. Maybe people in rainy areas are more likely to have cable TV.—-

      Hi, Dani.

      I read somewhere that people who can’t cite properly frequently misunderstand the implications of correlation not equaling causation and over use the concept as if it were some sort of “magic bullet” that made all social science research useless.

      JSTOR, probably.

      —-Actually, I had a question in mind kind of related to this: how much of published medical information is actually reliable? Considering they seem to self-contradict every few months.

      Did our forefathers really live healthier lives so that they were in rugged good health and lived to a ripe old age without need for all our present-day medicines and suppliments? Is our health really in such a bad state? Or is any of it just plain, good ol’ fearmongering?

      So, really, how reliable is all of this?—-

      Hello, Cheah,

      When you say “this” I tend to think you mean science reporting. If you do, the answer is that it’s fairly useless. Very preliminary pre-published results are reported as fact, self selecting narratives evolve (20 studies showing red wine is beneficial are reported, 20 studies showing it isn’t are ignored, etc).

      If, instead, you mean science, generally, contradiction is the point. Research generates results, results are reviewed and sometimes replicated, sometimes not, sample set grow, methodologies evolve, etc. It’s easy to arrive at a conclusion that science never moves forward, or that no problem is solved or well understood, but it’s really not the case. It just takes time and an understanding of the process to evaluate what’s been learned.

      Ask all of the people you know who suffer from Smallpox or Polio how effective medical science has been.

      Our forefathers wen’t particularly healthy, quite the opposite. They tended to die at much earlier ages, for many more reasons. Part of the perception that modern health is in decline is likely related to the fact that so many people live so much longer than they used to. It seems like more people have cancer now, in part, because many of them would have been decades dead from other presently treatable causes.

      There’s also an argument to be made that diagnostic tools have outstripped much of their clinical usefulness. We diagnoses a great many “serious” diseases (cancer, etc) that, if undiagnosied would never present symptomatically. This likely raises the perception that overall health is in decline.

      That said, medicine is far from perfect, medical research as well. There are (many) incentives for bad practice of both, and terrible things sometimes happen.

      On balance, though, medicine and medical research have been an enormous boon to quality of life for everyone on the planet.

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