The introduction is also posted on Spotify as a podcast by “Gerry at The Health Equation”
You can search Spotify for “Gerry at The Health Equation”
Or use the link below
https://podcasters.spotify.com/pod/show/gerrygaj
Below is the specific link
Gerry Gajadharsingh writes:
“In clinics, classrooms and family homes, a quiet but profound shift has been taking place in childhood health. Increasing numbers of children now present with impaired attention, emotional volatility, anxiety, low mood, disrupted sleep and declining academic performance. These symptoms are often rapidly framed as neurodevelopmental disorders — most commonly ADHD — and managed accordingly with stimulant or psychotropic medication. Yet, as Dr Sanjiv Nichani’s work so clearly illustrates, this prevailing narrative may be incomplete. What is increasingly being labelled as pathology may, in many cases, represent a predictable adaptive response of the developing brain to chronic digital overstimulation, reduced physical movement and sustained physiological stress.
Drawing on three decades of paediatric clinical experience, Nichani describes what he terms a “screendemic” — a pattern of acquired attentional and emotional dysregulation linked to excessive exposure to fast-paced digital media from increasingly early ages. Crucially, this is not presented as a vague cultural concern but as a phenomenon supported by neuroimaging, behavioural data and population-level trends. The article highlights observable changes in brain regions governing attention, emotional regulation and motivation, alongside the erosion of foundational developmental inputs such as movement, social interaction and sensory-rich play. From a functional medicine perspective, this represents not disease in the classical sense, but systemic imbalance — a mismatch between environmental demands and the biological requirements of the developing nervous system.
Central to this discussion is the concept of neuroplasticity. The same plasticity that allows screens to condition dopamine pathways, fragment attention and elevate stress responses also confers a remarkable capacity for recovery. Nichani’s argument — that a subset of childhood attention disorders may be “acquired” rather than innate — reframes both diagnosis and treatment. Rather than defaulting to long-term pharmacological intervention, he points towards targeted lifestyle inputs, particularly physical movement, as a means of restoring autonomic balance, recalibrating neurochemistry and supporting healthy brain development. Exercise, in this context, is not a lifestyle adjunct but a biological signal capable of upregulating growth factors, normalising neurotransmitter function and reducing cortisol-driven stress physiology.
This article therefore sits at the intersection of conventional paediatrics, neuroscience and functional medicine. It challenges us to reconsider whether we are adequately addressing root causes or merely managing downstream effects. For clinicians, parents and policymakers alike, the implications are significant: if excessive screen exposure can dysregulate the brain, then appropriately prescribed movement, environmental modification and behavioural change may offer a safer, more sustainable route to mental health — one that aligns with how the nervous system is designed to develop and adapt.
Breathing, the autonomic nervous system and neurodevelopment
One of the most powerful — and often overlooked — diagnostic and therapeutic tools I use in clinical practice is the assessment of breathing behaviour, particularly through capnometry and heart rate variability (HRV) monitoring. These tools allow us to evaluate how breathing patterns directly influence the autonomic nervous system and, in turn, how autonomic imbalance contributes to many of the neurodevelopmental and behavioural presentations now so commonly labelled as pathology.
The autonomic nervous system plays a central regulatory role in brain development, emotional control and attention. In simple terms, it governs the balance between the sympathetic nervous system — responsible for vigilance, arousal and the stress response — and the parasympathetic nervous system, which supports rest, digestion, recovery and emotional regulation. In healthy development, children move fluidly between these states. However, in many children presenting with anxiety, attention difficulties, emotional volatility and sleep disturbance, we see a nervous system that has become persistently biased towards sympathetic dominance.
Breathing behaviour is one of the most direct modulators of this system. Rapid, shallow, upper-chest breathing — commonly observed in screen-exposed, anxious or overstimulated children — lowers carbon dioxide tolerance, disrupts acid–base balance and impairs oxygen delivery at a cellular level through its effect on the Bohr response. This creates a state of physiological stress even in the absence of an external threat. The brain interprets this internal signal as danger, reinforcing hypervigilance, poor impulse control and reduced cognitive flexibility.
From a neurodevelopmental perspective, this matters profoundly. The developing brain is exquisitely sensitive to internal physiological cues. Chronic dysregulation of breathing and autonomic tone can interfere with maturation of the prefrontal cortex, limbic system integration and vagal tone — all of which are critical for attention, emotional regulation and social engagement. In functional terms, many children diagnosed with ADHD, anxiety or behavioural disorders are operating in a body that is continually signalling “threat”, even while sitting quietly in a classroom.
What makes this particularly compelling is that breathing is also a therapeutic lever. Unlike many interventions, it is both measurable and trainable. By optimising breathing patterns — encouraging slower nasal breathing, appropriate tidal volumes and improved carbon dioxide tolerance — we can downregulate excessive sympathetic activity and restore parasympathetic influence. HRV monitoring often shows measurable improvements as breathing behaviour normalises, reflecting increased vagal tone and greater autonomic flexibility.
This is where neuroplasticity becomes clinically meaningful. Just as repetitive screen exposure can condition maladaptive neural pathways, consistent changes in breathing behaviour can retrain the nervous system towards stability. Improved autonomic regulation supports better sleep architecture, enhanced attentional capacity, reduced emotional reactivity and improved stress resilience. Importantly, this is not a passive process; it requires repetition, consistency and behavioural change — precisely the conditions under which the nervous system remodels itself.
Medications undoubtedly have their place, particularly in cases of primary neurodevelopmental disorder. However, it is encouraging to see clinicians such as Dr Nichani advocating for lifestyle and behavioural interventions that address upstream drivers rather than downstream symptoms. Breathing retraining, alongside movement, reduced screen exposure and environmental modification, aligns squarely with a functional medicine approach: restoring physiological balance so that neurological function can normalise.
In many cases, when we change the signals the body sends to the brain, the brain responds accordingly.”
Further reading:
https://www.thehealthequation.co.uk/heart-rate-variability-hrv-and-capnometry/
https://www.thehealthequation.co.uk/breathwork-breathing-re-training/
The Times — Fraser Nelson
Can children’s ‘acquired ADHD’ be reversed by cutting screen time?
Can children’s ‘acquired ADHD’ be reversed by cutting screen time? Dr Sanjiv Nichani has been a consultant at Leicester Children’s Hospital for three decades — and he believes smartphones and tablets are reshaping young brains Dr Sanjiv Nichani has worked as a consultant paediatrician at Leicester Children’s Hospital for over 30 years, specialising in the care of critically ill children. After beginning his medical career in Mumbai, he trained at Great Ormond Street Hospital in London and in Los Angeles before settling in the East Midlands. Alongside intensive care, his general clinics — treating skin conditions, asthma and allergies — have given him a ringside view of a troubling new phenomenon. He calls it the “screendemic”: a surge in anxiety, depression, attention disorders and social withdrawal among children and adolescents.
This, he insists, is neither anecdotal nor imagined. It is real — and increasingly supported by measurable, screen-induced anatomical and neurochemical changes in the developing brain. Nichani, a lifelong practitioner of shotokan karate, makes a point of asking young patients about their hobbies. Over time, he noticed that this simple question often provoked visible discomfort among children he suspected were heavily reliant on phones or tablets. “I’ve lost count of the number of times a teenager would shift very uncomfortably in their chair when I asked about hobbies,” he says. “Parents would look at me almost pleadingly — please ask them this question. The answer was usually: nothing.” What followed was a familiar pattern. Children retreating to their rooms, spending hours on apps. Altered personality. Poor sleep. Falling academic performance. Increased impulsivity and irritability.
Most weeks in his Leicester clinic, Nichani encounters variations of the same story: a withdrawn teenager whose grades are deteriorating; a ten-year-old unable to concentrate, with parents requesting ADHD medication; or a child who once played football but now scrolls on their phone until 2am. Two decades ago, he says, such cases were unusual. Today, they dominate waiting lists. But it was the youngest patients who first set off alarm bells. “They’d walk in with normal coordination and normal mobility,” he recalls. “But they couldn’t say a word. They had this glazed look.” When Nichani trained as a paediatrician 40 years ago, non-verbal children without a clear genetic diagnosis — such as cerebral palsy or chromosomal abnormalities — were rare. Now, he was seeing them regularly. When he asked about life at home, the answer was strikingly consistent: these toddlers were spending the majority of their waking hours in front of a screen.
The rise of ‘acquired ADHD’ A generation ago, children arrived at clinics with bruised knees and stories of weekend football matches. Today, many present with anxiety, insomnia and impaired concentration. Nichani believes smartphones lie at the heart of the problem — and he is sufficiently concerned to be lobbying Westminster. What distinguishes him from many critics of screen culture, however, is that he does not stop at diagnosis. He believes there is a cure. Screen exposure, he argues, has created a form of “acquired ADHD” — a condition that mimics classical ADHD but is driven by chronic digital overstimulation rather than congenital neurodevelopmental differences. Crucially, unlike primary ADHD, this version is reversible. “Brain scans show changes in the same emotional and attentional circuits affected in primary ADHD,” he explains. “The danger is that parents of children with genuine ADHD often give them devices to keep them calm — but that can worsen the underlying condition, because screens affect exactly the same parts of the brain.” ADHD medications are designed to stimulate under-active neural circuits and restore balance. For children born with ADHD, this can be effective. But for screen-addicted children, Nichani argues, the problem is not under-stimulation but distortion. Their dopamine systems have been trained to expect constant novelty. Attention circuits are not weak — they are simply under-used. Adding stimulant medication, he warns, risks compounding the problem. “There is strong evidence that once children start medication, many remain on it into adult life,” he says. “They stay on this treadmill of antidepressants and stimulants. With ten-minute GP appointments, there’s rarely time to explore alternatives.
” Yet the brain, he insists, is remarkably adaptable. “What we call disease is often imbalance. And the brain has an extraordinary capacity to recalibrate through neuroplasticity.” Movement as medicine At first glance, Nichani’s prescription — less screen time, more physical activity — may sound quaint, even nostalgic. But he insists it is underpinned by cutting-edge neuroscience. It forms the basis of his book Movement Is Medicine: The Therapeutic Effect of Physical Activity on Mental Health Disorders in Children and Young People. Chronic screen exposure, he explains, is associated with shrinkage of the hippocampus — the brain’s hub for mood regulation and memory. By contrast, aerobic exercise stimulates the release of brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1), which act like fertiliser for the brain, supporting neurogenesis and restoring balance. Exercise also normalises disrupted neurochemistry. It raises serotonin (mood regulation), dopamine (motivation and focus) and GABA (calming), while lowering cortisol, the stress hormone elevated by digital overload. This, Nichani notes, mirrors precisely what psychiatric medications aim to achieve. “Physical activity works on the same circuits as the drugs,” he says. “But without the side effects.”
His prescription is modest: 30 to 45 minutes of movement, three times a week. The effects, he says, are often striking — improved sleep, better attention, stabilised mood and reduced irritability. “Movement is the medicine the brain was built for.” Screens, schools and society Since smartphones became ubiquitous, international test scores in maths and science have fallen across more than 80 countries. While the causes are debated — with some attributing declines to pandemic disruptions — few deny the profound digitisation of childhood. Ofcom reports that children aged 8 to 14 now spend an average of three hours a day on screens, much of it on YouTube and Snapchat.
NHS mental health referrals have surged, and the number of undergraduates reporting a mental health disorder has increased six-fold over 15 years. Nichani argues that the problem begins far earlier. Babies’ brains, he says, develop through movement, touch, song and human interaction. When a “digital nanny” replaces these inputs, neural wiring suffers. Studies show that even GCSE students check their phones every 13 minutes while doing homework. Social media algorithms, he adds, are increasingly linked to despair, self-loathing and addiction-like behaviours. He is unimpressed by the argument that this is simply generational panic. “We are the adults in the room,” he says. “We don’t let children drink alcohol or drive cars because we understand the risks. Screens are no different.” What parents can do Nichani advocates a “five-a-day” framework for screen use, tailored by age, and believes schools should ban smartphones entirely.
He supports recent moves by countries such as Australia to restrict under-16s’ access to social media, noting that platforms like TikTok are far more tightly regulated for children in China than elsewhere. Change, he acknowledges, is difficult — especially for time-poor or single parents. Youth clubs are closing. School sports provision is shrinking. Children socialise online rather than outdoors. “That has contributed significantly to this perfect storm,” he says. “But if you want your child to be healthy, you can make it happen. Riding a bike, jumping on a trampoline, walking the dog, going to the park or playing football — none of this has to be expensive. Ultimately, parents have to lead by example.” Nichani practises what he preaches. At 63, he has just earned his fifth black belt in karate. When I meet him at St Pancras station, he runs up the escalators — because, he explains, that is simply what he always does. His zeal is obvious, but his argument does not rely on enthusiasm alone. He presents what he believes is an irrefutable body of evidence — not just about the disease, but about the cure.
If screens can rewire a generation’s brains, he suggests, then movement — properly prescribed — may be able to rewire them back.