Associations Between Screen Use and Child Language Skills: A Systematic Review and Meta-analysis

Youth Screen Media Activity Patterns and Associations With Behavioral Developmental Measures and Resting-state Brain Functional Connectivity

OBJECTIVE

Screen media activity (SMA) consumes considerable time in youth's lives, raising concerns about the effects it may have on youth development. Disentangling mixed associations between SMA of youth and developmental measures should move beyond overall screen time and consider types and patterns of SMA. This study aimed to identify reliable and generalizable SMA patterns among youth and examine their associations with behavioral developmental measures and developing brain functional connectivity.

METHOD

Three waves of Adolescent Brain and Cognitive Development (ABCD) data were examined. The Lifespan Human Connectome Project in Development (HCP-D) was interrogated as an independent sample. ABCD participants included 11,876 children at baseline. HCP-D participants included 652 children and adolescents. Youth-reported SMA and behavioral developmental measures (neurocognitive performance, behavioral problems, psychotic-like experiences, impulsivity, and sensitivities to punishment/reward) were assessed with validated instruments. We identified SMA patterns in the ABCD baseline data using K-means clustering and sensitivity analyses. Generalizability and stability of the identified SMA patterns were examined in HCP-D data and ABCD follow-up waves, respectively. Relations between SMA patterns and behavioral and brain (resting-state brain functional connectivity) measures were examined using linear mixed effects modeling with false discovery rate (FDR) correction.

RESULTS

SMA data from 11,815 children (mean [SD] age = 119.0 [7.5] months; 6,159 [52.1%] boys) were examined; 3,151 (26.7%) demonstrated a video-centric higher-frequency SMA pattern, and 8,664 (73.3%) demonstrated a lower-frequency pattern. SMA patterns were validated in similarly aged HCP-D youth. Compared with the lower-frequency SMA pattern group, the video-centric higher-frequency SMA pattern group showed poorer neurocognitive performance (β = -.12, 95% CI [-0.08, -0.16], FDR-corrected p < .001), more total behavioral problems (β = .13, 95% CI [0.09, 0.18], FDR-corrected p < .001), and more psychotic-like experiences (β = .31, 95% CI [0.27, 0.36], FDR-corrected p < .001). The video-centric higher-frequency SMA pattern group demonstrated higher impulsivity, more sensitivity to punishment/reward, and altered resting-state brain functional connectivity among brain areas implicated previously in cognitive processes. Most of the associations persisted with age in the ABCD data, with more participants (n = 3,378, 30.4%) in the video-centric higher-frequency SMA group at 1-year follow-up. A social communication-centric SMA pattern was observed in HCP-D adolescents.

CONCLUSION

Video-centric SMA patterns are reliable and generalizable during late childhood. A higher-frequency video entertainment SMA pattern group showed altered resting-state brain functional connectivity and poorer developmental measures that persisted longitudinally. The findings suggest that public health strategies to decrease excessive time spent by children on video entertainment-related SMA are needed. Further studies are needed to examine potential video-centric/social communication-centric SMA bifurcation to understand dynamic changes and trajectories of SMA patterns and related outcomes developmentally.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

The association between screen media quantity, content, and context and language development

This study investigates the influence of the quantity, content, and context of screen media use on the language development of 85 Saudi children aged 1 to 3 years. Surveys and weekly event-based diaries were employed to track children's screen use patterns. Language development was assessed using JISH Arabic Communicative Development Inventory (JACDI). Findings indicate that the most significant predictor of expressive and receptive vocabulary in 12- to 16-month-olds was screen media context (as measured by the frequency of interactive joint media engagements). In older children (17- to 36-month-olds), more screen time (as measured by the amount of time spent using screens, the prevalence of background TV at home, and the onset age of screen use) had the highest negative impact on expressive vocabulary and mean length of utterance. These findings support health recommendations on the negative effects of excessive screen time and the positive effects of co-viewing media with children.

Reducing harm and promoting positive media use strategies: new perspectives in understanding the impact of preschooler media use on health and development

Most children grow up in homes with easy access to multiple screens. Screen use by children between the ages of 0 to 5 has become a worldwide preoccupation. In the present narrative review, we examine child and parent screen use and its contribution to physical, cognitive, and social developmental outcomes. As research has mostly focused on the adverse consequences of screen media, we aim to depict both the negative and the positive influences of screen usage. To provide a more nuanced portrait of the potential benefits and harms of screen use, we examine how consequences of media use vary according to the content of media (ex., educational, violent), context (ex., using screens during mealtimes), and the nature (ex., passive vs active use) of child screen use. Our review supports existing screen time guidelines and recommendations and suggests that media content, the context of use, and the nature of child use, as well as the parent's own screen use, be considered clinically. Future research should seek to clarify how these dimensions jointly contribute to child screen use profiles and associated consequences. Finally, child sex, behavioral/temperamental difficulties, and family adversity appear to contribute to child screen use and its consequences and should be considered in future research. Suggestions for harm-reduction approaches are discussed.

[Impact of electronic devices used at an early age on language]

Background

The acquisition of language in infants is largely the result of the process of brain maturation, as well as environmental stimulation. Currently, society is in an era of technology and use of electronic devices from an early age.

Objective

The aim of this study was to demonstrate if the amount of time of use of electronic devices in children under 5 years of age affects language development.

Methods

An observational, comparative, survey-type study was carried out in 269 infants of both sexes, with an age range of 6 to <60 months. The language development section of the Child Development Scale (EDI) was used. A logistic regression was performed to determine the strength of association between the factors to be studied.

Results

269 participants were included, of which 224 (83.2%) presented their level of neurological maturation, 44 infants (16.4%) presented laged development and one (0.4%) was classified as having developmental delay. It was found that the number of daily hours that an electronic device is used behaved as a risk factor by increasing the risk of delayed language development by 1.37 times for each hour of exposure (OR: 1.37, CI95%: 1.15-1.62).

Conclusions

It was shown that a greater number of hours of use of electronic devices is a risk factor for delayed language development in children under 5 years of age. Therefore, it is vital to limit its use in this population.

Children's Use of Evaluative Devices in Response to the Global TALES Protocol

INTRODUCTION

It has been well established that the function of sharing personal narratives is to inform the listener about what the event meant to the narrator, for example, by using a range of evaluative devices. The use of these evaluative devices may reflect a person's understanding of the differences between one's own mind and others, by expressing their beliefs, emotions, thoughts, and desires. This paper investigates children's use of evaluative devices when producing personal narratives in response to the six emotion-based prompts contained in the Global TALES protocol (excited, worried, annoyed, proud, problem situation, something important). It addresses three research questions: (1) What types and proportions of evaluative devices do 10-year-old English-speaking children use in response to the six prompts contained in the Global TALES protocol and are there differences in performance between boys and girls? (2) What are the correlations between the different types of evaluative devices? (3) Does children's use of evaluative devices differ depending on the type of prompt used?

METHODS

Eighty-two native English-speaking ten-year-old children from three English-speaking countries (Australia, New Zealand, and the USA) participated. None of the children had been identified with language and/or learning difficulties. Children's personal narratives were transcribed and analysed for the use of 12 evaluative devices: compulsion, internal emotional states, evaluative words, intensifiers, mental states, causal explanations, hypotheses, objective judgements, subjective judgements, intent, negatives, and repetition.

RESULTS

Results showed that children use a high number of evaluative devices, with "intensifiers" and "evaluative words" used most frequently. There were few effects for sex, apart from girls using a wider range of evaluative devices than boys. We found moderate to large correlations between most devices, with factor analysis revealing three factors we labelled "causality," "hypothesis," and "judgement." Although there were significant overall effects for prompt type on the use of evaluative devices, there was no clear pattern when inspecting responses to individual prompts.

CONCLUSION

The results from this study shed light on children's use of evaluative devices to convey the meaning of their personal narratives in response to six different prompts tapping into different emotions. Moving beyond appraising children's structural language skills when narrating their personal experiences may enhance the understanding of interpersonal and intrapersonal aspects of theory of mind, which may inform clinical practices, such as individualized goal setting and intervention choices.

24 h Activity Guidelines in Children and Adolescents: A Prevalence Survey in Asia-Pacific Cities

This study aimed to examine the prevalence of adherence to 24 h activity guidelines in children and adolescents from Asia-Pacific cities. In 1139 children aged 5-18 years, moderate-to-vigorous physical activity (MVPA), screen viewing time (SVT), sleep duration, child weight, height, sex, and age were parent-reported. Descriptive statistics were used to assess the number of guidelines met, and prevalence of adherence to activity guidelines by city and child sex. Prevalence of meeting all three 24 h activity guidelines was low across all countries (1.8-10.3%) (p < 0.05). Children from Thiruvananthapuram, India had the highest [10.3% (95% CI: 6.0-17.0)], while those from Tokyo, Japan had the lowest prevalence [1.8% (95% CI: 0.5-7.0)] of meeting all three guidelines. The highest prevalence of meeting individual MVPA, SVT and sleep guidelines was found in India [67.5% (95% CI: 58.8-75.1)], Kelaniya, Sri Lanka [63.2% (95% CI: 58.7-67.4)] and Kowloon, Hong Kong [59.4% (95% CI: 51.1-65.3)], respectively. Overall, a higher prevalence of boys met all three guidelines, compared to girls [5.9% (95% CI: 4.1-8.1) vs. 4.7% (3.1-6.6), p = 0.32]. The prevalence of adhering to all three activity guidelines was low in all five participating cities, with a higher proportion of boys meeting all guidelines.

Language in educational apps for pre-schoolers. A comparison of grammatical constructions and psycholinguistic features in apps, books and child directed speech

Language in touchscreen apps could be useful as an additional source of children's language input, alongside child directed speech (CDS) and books. Here we performed the first analysis of language in apps, as compared with books and CDS. We analysed language in 18 of the most popular educational apps targeting pre-schoolers and compared their language content to children's books and CDS with respect to types of constructions and psycholinguistic features of words. We found that apps contained lower frequency words and had lower lexical diversity compared to CDS, and shorter utterances compared to books. Apps may thus provide an enriched supplementary form of input for young children, due to containing less frequent words. However, apps do not expose children to a high proportion of questions and complex sentences, both of which are crucial for supporting child's development of structurally rich constructions.

Early Screen-Time Exposure and Its Association With Risk of Developing Autism Spectrum Disorder: A Systematic Review

Autism spectrum disorder (ASD) is a neurological deficit in brain functions that prevents a child from having a normal social life like his peers. It results in the inability to interact and communicate with others. Unsurprisingly, the alarming increase in screen-time exposure in children has become even more of a concern. Electronic devices are a double-edged sword. Despite their benefits, they have many potential hazards to children's neurological development. Previous studies have investigated the effects of unsupervised screen time and its impact on white matter development during the early years of life of children. The white matter has an important role in the development of neurological functions. This systematic review aims to qualitatively analyze the literature available on early screen time exposure and its association with the risk of developing ASD. This systematic review implemented the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, PubMed Central (PMC), Google Scholar, and Cochrane Library databases were searched for data in the recent six years. A total of 27,200 articles were identified using the MeSH and keywords through four selected databases. Search results revealed 70 from PubMed, 17,700 from Google Scholar, zero from Cochrane Library, and 9,430 from PubMed Central. After applying filters and screening the results by title and abstract and then by full text, 11 studies fulfilled the criteria to be included in the review. We found that the longer the period of screen exposure, the higher the risk that the child may develop ASD. Further, the earlier the child is exposed to screens, the higher the risk of developing ASD in children compared to children exposed later.

COVID-19 and bilingual children's home language environment: Digital media, socioeconomic status, and language status

Input is considered crucial in bilingual children's language development. This is especially true for bilingual children's mother tongue language learning given its common reduction in input opportunities due to the dominance of one language within society, as seen in countries and regions from Wales to Singapore. Previous studies tend to focus on the quantity and quality of conventional active communication and resources (e.g., speaking and reading with parents) on bilingual children's language development, and substantially, fewer studies have explored this topic from the perspective of digital media. However, the COVID-19 pandemic has accentuated the critical role of digital media in various aspects of life, including bilingual children's home language environment. Thus, to holistically understand bilingual children's daily language input patterns, it is imperative to explore both their conventional and digital media input resources. The current study focuses on English-Mandarin bilingual children in Singapore and would like to explore (1) whether their conventional and digital media language environments have been affected by the COVID-19 pandemic and (2) whether the societal status of a language and familial socioeconomic status (SES) would affect bilingual children's conventional and digital media input. Survey data from 162 parents of English-Mandarin bilingual preschoolers (3 to 6 years old) were used to explore the two research questions. Two online parental questionnaires were employed for data collection. One-way repeated-measures MANOVA and path models were used to address the questions. The results indicated that input patterns from nuclear family members had not been affected by COVID-19; however, the amount and frequency of conventional and digital media materials and activities increased significantly since COVID-19. Higher-SES families possessed more conventional materials and conducted conventional activities more often, while lower-SES families possessed more digital media materials. Both conventional and digital media materials and activities were richer in English than in Mandarin. Higher-SES families perceived digital media usage for learning to be of less importance than lower-SES families. The implications for early bilingual learning following COVID-19 are discussed.

Screen time and preschool children: Promoting health and development in a digital world

COVID-19 transformed the family media environment and spurred research on the effects of screen media exposure and use on young children. This update of a 2017 CPS statement re-examines the potential benefits and risks of screen media in children younger than 5 years, with focus on developmental, psychosocial, and physical health. Four evidence-based principles-minimizing, mitigating, mindfully using, and modelling healthy use of screens-continue to guide children's early experience with a rapidly changing media landscape. Knowing how young children learn and develop informs best practice for health care providers and early years professionals (e.g., early childhood educators, child care providers). Anticipatory guidance should now include child and family screen use in (and beyond) pandemic conditions.

Digital Devices Use and Fine Motor Skills in Children between 3-6 Years

(1) Background: The principal aim of our research was to explore the relationship between digital devices use and fine motor skills in children aged three to six years and to explore the effect of some socio-demographic factors. (2) Methods: we enrolled 185 children aged between three to six years. The parents of all the participants fulfilled a questionnaire to explore the digital device use, and their children performed a standardized test to assess fine motor skills (APCM-2). We performed the Spearman correlation test to explore the relationship between different variables. (3) Results: the children spent an average of 3.08 ± 2.30 h/day on digital devices. We did not find a significant association between the time of use of digital devices and fine motor skills (p = 0.640; r = -0.036). The youngest children experienced digital tools earlier than older ones (p < 0.001; r = 0.424) and they were also the ones who used digital tools more time afterwards (p = 0.012; -0.202). The children who had working parents spent more time on digital devices (p = 0.028; r = 0.164/p = 0.037; r = 0.154) and used digital devices earlier (p = 0.023; r = 0.171). (4) Conclusions: This data suggest that it would be useful to monitor the use of digital tools, especially in the very first years of life. Future studies are needed to further explore this topic.

Patterns of preschool children's screen time, parent-child interactions, and cognitive development in early childhood: a pilot study

BACKGROUND

The primary objective of this study was to explore the feasibility of a virtual study protocol for a future longitudinal study, including recruitment, study measures, and procedures. The secondary objective was to examine preliminary hypotheses of associations, including 1) the correlations between total duration and patterns of screen time and cognitive development, and 2) the differences in quality of parent-child interactions for two screen-based tasks and a storybook reading task.

METHODS

Participants included 44 children aged 3 years and their parents from Edmonton, Alberta and surrounding areas. Children's screen time patterns (i.e., type, device, content, context) were parental-reported using a 2-week online daily diary design. Children's cognitive development (i.e., working memory, inhibitory control, self-control, and language) was measured virtually through a recorded Zoom session. Parent-child interactions during three separate tasks (i.e., video, electronic game, and storybook reading) were also measured virtually through a separate recorded Zoom session (n = 42). The quality of the interactions was determined by the Parent-Child Interaction System (PARCHISY). Descriptive statistics, Intra-class correlations (ICC), Spearman's Rho correlations, and a one-way repeated measures ANOVA with a post-hoc Bonferroni test were conducted.

RESULTS

All virtual protocol procedures ran smoothly. Most (70%) participants were recruited from four 1-week directly targeted Facebook ads. High completion rates and high inter-rater reliability in a random sample (Diary: 95% for 13/14 days; Cognitive development: 98% 3/4 tests, ICC > 0.93; Parent-child interactions: 100% for 3 tasks, Weighted Kappa ≥ 0.84) were observed for measures. Across cognitive development outcomes, medium effect sizes were observed for five correlations, with positive correlations observed with certain content (i.e., educational screen time) and negative associations observed for total screen time and certain types (show/movie/video viewing) and contexts (i.e., co-use). Medium and large effect sizes were observed for the differences in parent-child interaction quality between the three tasks.

CONCLUSIONS

The virtual study protocol appeared feasible. Preliminary findings suggest it may be important to go beyond total duration and consider type, content, and context when examining the association between screen time and cognitive development. A future longitudinal study using this virtual protocol will be conducted with a larger and more generalizable sample.

Early language outcomes in Argentinean toddlers: Associations with home literacy, screen exposure and joint media engagement

This study aimed to analyse the contribution of mothers' home literacy beliefs and practices and the quantity and quality of screen media exposure on Argentinean toddler's language. In addition, we considered parent-child joint engagement, as well as adult scaffolding behaviours during the use of electronic devices. A total of 465 mothers of 18-36 months old children completed an online survey including: the MacArthur Bates CDI, home literacy, screen exposure, joint engagement and scaffolding questionnaires. We observed positive effects of literacy beliefs, PC times and verbal scaffolding on language outcomes. TV exposure contributed negatively to vocabulary and, along with educational content, to sentence use. Shared reading and screen media experiences can be an opportunity for language stimulation, provided there is dialogue and joint engagement. Passive screen exposure and inadequate content may be detrimental for toddlers' language outcomes, probably by displacement of socially significant interactions.

Outdoor Play as a Mitigating Factor in the Association Between Screen Time for Young Children and Neurodevelopmental Outcomes

Importance

Whether the association between higher screen time in infancy and later suboptimal neurodevelopment can be mitigated by frequency of outdoor play is unknown.

Objective

To investigate whether higher screen time at age 2 years is associated with neurodevelopmental outcomes at age 4 years and whether this association is mediated by frequency of outdoor play at age 2 years 8 months.

Design, Setting, and Participants

Participants were a subsample of the Hamamatsu Birth Cohort Study for Mothers and Children (HBC Study, N = 1258). Children were born between December 2007 and March 2012 and followed up from 1 year 6 months to 4 years. The analysis was conducted from April 2021 to June 2022.

Exposures

Screen time longer than 1 hour a day at age 2 years was coded as higher screen time.

Main Outcomes and Measures

Standardized scores for communication, daily living skills, and socialization domains of the Vineland Adaptive Behavior Scale, second edition, at age 4 years were used (mean [SD], 100 [15]). The mediating factor was frequency of outdoor play at age 2 years 8 months, with 6 or 7 days per week coded as frequent outdoor play.

Results

Of 885 participants, 445 children (50%) were female; mean (SD) screen time per day was 2.6 (2.0) hours. Causal mediation analyses revealed that higher screen time at age 2 years was associated with lower scores in communication at age 4 years (nonstandardized coefficient b = -2.32; 95% CI, -4.03 to -0.60), but the association was not mediated by frequency of outdoor play. Higher screen time was also associated with lower scores in daily living skills (b = -1.76; 95% CI, -3.21 to -0.31); 18% of this association was mediated by frequency of outdoor play. Frequency of outdoor play was associated with socialization (b = 2.73; 95% CI, 1.06 to 4.39), whereas higher screen time was not (b = -1.34; 95% CI, -3.05 to 0.36).

Conclusions and Relevance

Higher screen time at age 2 years was directly associated with poorer communication at age 4 years. It was also associated with daily living skills, but frequency of outdoor play at age 2 years 8 months alleviated it, suggesting outdoor play mitigated the association between higher screen time and suboptimal neurodevelopment. Future research should specify the nature of the associations and intervention measures, enabling targeted interventions that reduce the potential risk in screen time.

Primary Care Counseling of Parents Regarding Childhood Screen Media Use

Parental beliefs and motivation are instrumental in improving childhood digital media use (DMU). Parents (n = 611) completed questionnaires about childhood DMU assessing knowledge, interest in counseling, motivation to change, self-efficacy, and beliefs. Less than a third correctly recognized screen time limits. Twenty-seven percent received childhood DMU information from a doctor, while 46% stated they would like such information. Only 2% had a doctor-recommended DMU plan. Interest in DMU topics, motivation to improve, and management self-efficacy were moderate. Top negative beliefs were addiction to DMU (52%), sleep problems (39%), obesity (33%), social skills (33%), and inappropriate content (32%). Differences between age categories existed for social (48%, P = .01) and language (14%, P = .01) concerns (highest for toddlers), attention concerns (27%, P = .02; highest in preschoolers), and depression (13%, P < .001) and low self-esteem (8%, P = .04; highest in teens). Findings support further development of approaches to address DMU, tailored by age-specific common parental views.

Validation of a touchscreen assessment tool to screen for cognitive delay at 24 months

AIM

To validate a touchscreen assessment as a screening tool for mild cognitive delay in typically developing children aged 24 months.

METHOD

Secondary analysis of data was completed from an observational birth cohort study (The Cork Nutrition & Microbiome Maternal-Infant Cohort Study [COMBINE]), with children born between 2015 and 2017. Outcome data were collected at 24 months of age, at the INFANT Research Centre, Ireland. Outcomes were the Bayley Scales of Infant and Toddler Development, Third Edition cognitive composite score and a language-free, touchscreen-based cognitive measure (Babyscreen).

RESULTS

A total of 101 children (47 females, 54 males) aged 24 months (mean = 24.25, SD = 0.22) were included. Cognitive composite scores correlated with the total number of Babyscreen tasks completed, with moderate concurrent validity (r = 0.358, p < 0.001). Children with cognitive composite scores lower than 90 (1 SD below the mean, defined as mild cognitive delay) had lower mean Babyscreen scores than those with cognitive scores equal to or greater than 90 (8.50 [SD = 4.89] vs 12.61 [SD = 3.68], p = 0.001). The area under the receiver operating characteristic curve for the prediction of a cognitive composite score less than 90 was 0.75 (95% confidence interval = 0.59-0.91; p = 0.006). Babyscreen scores less than 7 were equivalent to less than the 10th centile and identified children with mild cognitive delay with 50% sensitivity and 93% specificity.

INTERPRETATION

Our 15-minute, language-free touchscreen tool could reasonably identify mild cognitive delay among typically developing children.

Associations of parental attitudes and health behaviors with children's screen time over four years

BACKGROUND

Parents are significantly important in shaping the screen use of children within a family system. This study aimed to examine the associations of Chinese children's screen time (ST) over four years with parents' attitudes toward their own screen use and physical activities (PA) and health behaviors including their ST, PA, cigarette smoking, and alcohol drinking.

METHODS

The current study utilized data from two waves (2011 and 2015) of the China Health and Nutrition Survey (CHNS), including 1,941 mother-father-child triads in 2011 and 2,707 mother-father-child triads in 2015 (with children aged 0-17-years-old). The ST of children and the parental attitudes and health behaviors were measured via self-report or proxy-report (for children under 6 years old) questionnaires. Pool-OLS regression models were used to assess the associations of parental attitudes and health behaviors with the ST of children. Moderation models were built to assess whether these associations depended on the gender, age, and family income of children, as well as whether paternal and maternal influences were moderated by the other parent. A multilevel cross-lagged panel model (CLPM) was used to assess parental influences on children's ST over four years.

RESULTS

Paternal ST (β = 0.09, p < 0.001), maternal ST (β = 0.10, p < 0.001), and paternal alcohol drinking (β = 0.30, p < 0.05) were positively associated with children's ST. In addition, maternal smoking had a positive association with girls' ST (β = 0.53, p < 0.05). Moreover, the association between maternal ST and children's ST was observed to decline as family income increased (β = -0.03, p < 0.001). Paternal ST had a larger positive association with children's ST when the ST of mothers exceeded 14 h/week (β = 0.06, p < 0.05). Furthermore, lagged associations were found between paternal attitudes toward PA (β = -1.63, p < 0.05) or maternal cigarette smoking (β = 1.46, p < 0.05) and children's ST measured four years later.

CONCLUSION

Children establish a healthy lifestyle within the family system. From the perspective of the healthy family climate, the current study suggests that future programs for reducing children's ST should be built through an integrative approach with special attention to parental attitudes and health behaviors.

Associations of excessive screen time and early screen exposure with health-related quality of life and behavioral problems among children attending preschools

BACKGROUND

Both excessive screen time and early screen exposure have been linked to children's health outcomes, but few studies considered these two exposures simultaneously. The aim of this study was to explore the independent and interactive associations of excessive screen time and early screen exposure with health-related quality of life (HRQOL) and behavioral problems among Chinese children attending preschools.

METHODS

A cross-sectional study of 4985 children aged between 3 and 6 years was conducted in Chengdu, China. Each parent has finished an online questionnaire regarding their children's screen use, HRQOL, and behavioral problems. Children with screen time over 1 h/day were considered as having excessive screen time. Early screen exposure was defined if the children had started using screen-based media before the age of 2 years. HRQOL was assessed by the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0), while behavioral problems were confirmed with the 48-item Conners' Parent Rating Scale (CPRS-48).

RESULTS

Of the 4985 children (2593 boys and 2392 girls) included, the mean age was 4.6 (SD: 1.0) years. After adjustment for confounders and early screen exposure, excessive screen time was significantly associated with worse HRQOL scores in all dimensions and summary scales, as well as each type of behavioral problems (all p values < 0.05). We also found that compared to children with later initiation of screen exposure, those with screen use before the age of 2 years had significantly lower emotional functioning score (β: - 2.13, 95%CI: - 3.17, - 1.09) and psychosocial health summary score (β: - 0.82, 95%CI: - 1.54, - 0.10) of HRQOL, as well as higher risks of conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive, and hyperactivity index, which were independent of excessive screen use. Furthermore, there were significant interactive effects of excessive screen time and early screen exposure on emotional functioning domain of HRQOL scores and conduct problems.

CONCLUSION

Excessive screen time and early screen exposure are two independent and interactive factors to children's HRQOL and behavioral problems. Our findings support current guidelines to limit screen exposure in children. Appropriate screen use may represent an important intervention target to improve children's HRQOL and reduce their behavioral problems.

A Skill Acquisition Perspective on the Impact of Exergaming Technology on Foundational Movement Skill Development in Children 3-12 Years: A Systematic Review and Meta-analysis

BACKGROUND

Sedentary, digital screen time in children represents a major concern due to its detrimental effect on children's development. Nowadays, however, advances in technology allow children to actively interact with a digital screen using their whole body (e.g., exergaming), providing potential for movement learning. Exergaming technology may prove valuable in supporting children's development of foundational movement skills (FMS).

OBJECTIVE

To examine the impact of exergaming technology on the development of FMS in children 3-12 years through a skill acquisition lens.

METHODS

Systematic review and meta-analysis were conducted following the PRISMA guidelines. Web of Science, PubMed, PsycINFO and SPORTDiscus databases were searched between 2007 and 2022. Studies were eligible if they conducted an exergaming intervention to improve FMS in typically developing children aged three to twelve with a control group, using a baseline and post-intervention assessment design. FMS outcomes were pooled with a random effects model.

RESULTS

Nine trials (4 RCTs, 2 cluster RCTs and 3 non-randomized trials) of varying methodological quality (2 had low, 6 had some concerns, and 1 had a high risk of bias) were included, with a total of 783 participants. FMS outcome measures across studies comprised object control skills, locomotor skills, coordination, agility, balance and balance-related skills. The meta-analysis included showed a small positive effect in favor of the exergaming intervention (r = 0.24 [95% confidence interval: 0.11-0.36]).

CONCLUSION

Our results indicate that screen-based technology that requires an active engagement of the child can promote the development of FMS. Considering that FMS are the foundation of a child's physical, mental, health and academic development, this finding could lead to a reshaping of the perception of digital screen-based technology and the role this should play in children's lives. We speculate that the observed benefits most likely depend upon the quality of information-movement coupling specificity and the motor learning strategies built into the exergame and/or the intervention design. We do not believe this is dependent on the type of FMS being performed or the amount of practice. We recommend therefore that future research should examine how practitioners (school teachers, coaches and parents) can facilitate the interaction between a child and exergaming technology.

Assessment of Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic: A Systematic Review and Meta-analysis

IMPORTANCE

To limit the spread of COVID-19, numerous restrictions were imposed on youths, including school closures, isolation requirements, social distancing, and cancelation of extracurricular activities, which independently or collectively may have shifted screen time patterns.

OBJECTIVE

To estimate changes in the duration, content, and context of screen time of children and adolescents by comparing estimates taken before the pandemic with those taken during the pandemic and to determine when and for whom screen time has increased the most.

DATA SOURCES

Electronic databases were searched between January 1, 2020, and March 5, 2022, including MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials. A total of 2474 nonduplicate records were retrieved.

STUDY SELECTION

Study inclusion criteria were reported changes in the duration (minutes per day) of screen time before and during the pandemic; children, adolescents, and young adults (≤18 years); longitudinal or retrospective estimates; peer reviewed; and published in English.

DATA EXTRACTION AND SYNTHESIS

A total of 136 articles underwent full-text review. Data were analyzed from April 6, 2022, to May 5, 2022, with a random-effects meta-analysis.

MAIN OUTCOMES AND MEASURES

Change in daily screen time comparing estimates taken before vs during the COVID-19 pandemic.

RESULTS

The meta-analysis included 46 studies (146 effect sizes; 29 017 children; 57% male; and mean [SD] age, 9 [4.1] years) revealed that, from a baseline prepandemic value of 162 min/d (2.7 h/d), during the pandemic there was an increase in screen time of 84 min/d (1.4 h/d), representing a 52% increase. Increases were particularly marked for individuals aged 12 to 18 years (k [number of sample estimates] = 26; 110 min/d) and for device type (handheld devices [k = 20; 44 min/d] and personal computers [k = 13; 46 min/d]). Moderator analyses showed that increases were possibly larger in retrospective (k = 36; 116 min/d) vs longitudinal (k = 51; 65 min/d) studies. Mean increases were observed in samples examining both recreational screen time alone (k = 54; 84 min/d) and total daily screen time combining recreational and educational use (k = 33; 68 min/d).

CONCLUSIONS AND RELEVANCE

The COVID-19 pandemic has led to considerable disruptions in the lives and routines of children, adolescents, and families, which is likely associated with increased levels of screen time. Findings suggest that when interacting with children and caregivers, practitioners should place a critical focus on promoting healthy device habits, which can include moderating daily use; choosing age-appropriate programs; promoting device-free time, sleep, and physical activity; and encouraging children to use screens as a creative outlet or a means to meaningfully connect with others.

New insights in pediatrics in 2021: choices in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine

In this review, we report the developments across pediatric subspecialties that have been published in the Italian Journal of Pediatrics in 2021. We highlight advances in allergy and immunology, critical care, endocrinology, gastroenterology, genetics, hematology, infectious diseases, neonatology, neurology, nutrition, palliative care, respiratory tract illnesses and telemedicine.

Interactive technology use and child development: A systematic review

BACKGROUND

There is mixed evidence regarding the impact of interactive digital devices on child development. Tentatively some studies suggested that the use of digital devices may correlate negatively with language, executive function, and motor skills. However, attempts to amalgamate this evidence has been limited related to the available number of experimental and cohort studies that have evaluated the impact of digital technology use on child development. We conducted this review to determine the impact of interactive digital devices on child development among children aged 7 years or younger. Interactive technology has been defined as methods, tools, or devices that users interact with in order to achieve specific tasks.

DATA SOURCE

To carry out this systematic review, databases CINAHL, MEDLINE, Embase, PsychINFO, Scopus and Google Scholar were searched for relevant studies.

STUDY SELECTION

We used the Joanna Briggs Institute methodology for systematic reviews.

DATA EXTRACTION

Data extraction and synthesis was carried out by two reviewers and checked by a third reviewer. Studies were stratified into tiers depending on the level of evidence provided and the domain of development assessed.

RESULTS

Fifty-three studies were eligible for inclusion in the review, 39 Tier 1 (randomized controlled trials and quasi-experimental studies) and 16 Tier 2 (descriptive studies). Children's use of interactive digital technology was positively associated with receptive language and executive function and negatively associated or unrelated to motor proficiency. Other critical aspects informing the evidence, such as dose of exposure, intensity, or duration, were inconsistently reported, making estimates of exposure tentative and imprecise.

CONCLUSION

The studies included in this review were predominantly correlational or comparative in nature and focuses on cognitive domains of learning rather than a specific developmental outcome. It is difficult to generalize our findings beyond the digital devices or applications that have been evaluated by earlier studies. The contextual factors that may moderate the relationship require elaboration in future studies.

Young Children and Screens: Guidelines for Intervention during the Perinatal Period from the French National College of Midwives

Screens and digital media are increasingly present in family environments. This article reports the published data about children's screen use in France and elsewhere. We next synthesize the scientific literature on the relations between screen use and child development and then summarize current national and international guidelines about children's screen use before the age of 5 years. Based on these elements, we propose clinical practice guidelines for counseling women during the perinatal period. Précis: Current knowledge on children's screen use and its relationship to their development is summarized including guidelines and suggestions to help parents monitor screen use.

The Family Level Assessment of Screen Use-Mobile Approach: Development of an Approach to Measure Children's Mobile Device Use

BACKGROUND

There is a strong association between increased mobile device use and worse dietary habits, worse sleep outcomes, and poor academic performance in children. Self-report or parent-proxy report of children's screen time has been the most common method of measuring screen time, which may be imprecise or biased.

OBJECTIVE

The objective of this study was to assess the feasibility of measuring the screen time of children on mobile devices using the Family Level Assessment of Screen Use (FLASH)-mobile approach, an innovative method that leverages the existing features of the Android platform.

METHODS

This pilot study consisted of 2 laboratory-based observational feasibility studies and 2 home-based feasibility studies in the United States. A total of 48 parent-child dyads consisting of a parent and child aged 6 to 11 years participated in the pilot study. The children had to have their own or shared Android device. The laboratory-based studies included a standardized series of tasks while using the mobile device or watching television, which were video recorded. Video recordings were coded by staff for a gold standard comparison. The home-based studies instructed the parent-child dyads to use their mobile device as they typically use it over 3 days. Parents received a copy of the use logs at the end of the study and completed an exit interview in which they were asked to review their logs and share their perceptions and suggestions for the improvement of the FLASH-mobile approach.

RESULTS

The final version of the FLASH-mobile approach resulted in user identification compliance rates of >90% for smartphones and >80% for tablets. For laboratory-based studies, a mean agreement of 73.6% (SD 16.15%) was achieved compared with the gold standard (human coding of video recordings) in capturing the target child's mobile use. Qualitative feedback from parents and children revealed that parents found the FLASH-mobile approach useful for tracking how much time their child spends using the mobile device as well as tracking the apps they used. Some parents revealed concerns over privacy and provided suggestions for improving the FLASH-mobile approach.

CONCLUSIONS

The FLASH-mobile approach offers an important new research approach to measure children's use of mobile devices more accurately across several days, even when the child shares the device with other family members. With additional enhancement and validation studies, this approach can significantly advance the measurement of mobile device use among young children.

Screen Time of Preschool-Aged Children and Their Mothers, and Children's Language Development

Although children’s increased screen time has been found to associate with poorer language development, it is open to question which part of language ability screen time specifically associates with. Our aim was to examine the association between children’s screen time (alone and together with a parent), mothers’ screen time, and the different domains of children’s language skills. Mothers reported their children’s (N = 164, aged 2.5 to 4.1 years) screen time and their own on a weekday and a day off. Children’s lexical, phonological, morphological, receptive, and general language abilities were measured using validated tests. The connections between children’s and mothers’ screen time and children’s language skills were analyzed using correlation analyses and linear regression models. The more the children used screen time alone, or the greater the amount of the mothers’ screen time, the weaker the children’s lexical and general language abilities when the children’s age, maternal education level, and birth order were controlled for. We also found cumulative, negative links to the children’s lexical and general language abilities when the amount of their screen time alone and the amount of the mothers’ screen time were simultaneously included in the regression model. The results suggest that it is important to restrict both children’s screen time spent alone and mothers’ screen time.

Impact of Meeting Early Hearing Detection and Intervention Benchmarks on Spoken Language

This study compared preschool spoken language outcomes for children with hearing loss who met Early Hearing Detection and Intervention (EHDI) guidelines to those who did not, as well as to compare outcomes for those who met current EHDI guidelines to those who met earlier benchmarks. Finally, the predictive role of meeting each component of the guidelines was evaluated relative to language outcomes. Children who met the EHDI guidelines had higher language scores than those who did not; however, there was no difference between children who met the current guidelines and those who met the earlier benchmarks. Entering early intervention by six months of age was the only unique predictor of spoken language outcomes. The findings suggest that EHDI programs should target increasing the number of children with hearing loss who meet the current 1-3-6 benchmarks with a particular focus on enrollment in early intervention by six months.

Mothers' Perceptions of Children's Screen Use During the COVID-19 Lockdown in Israel

The contemporary parenting challenge of regulating children's screen time became even more difficult during the coronavirus pandemic (COVID-19). The current research addresses the characteristics of this challenge and explores mothers' perceptions regarding their children's screen use, through two consecutive studies. Study 1 included 299 mothers of elementary school children, who were asked to complete questionnaires regarding their children's screen habits. Mothers were also asked about their own attitudes towards screens, as parents, and about their personal feelings of frustration and guilt. Study 2 replicated this procedure among a new sample of 283 mothers who also completed validated scales assessing their sense of parental competence and authority style. Retrospective reports of mothers indicated that, during the lockdown, entertainment use of screens increased by 73% among 4^th-6^th graders and by 108% among 1^st-3^rd graders. Educational use increased by 86% in both age groups. Mothers' guilt increased as well and was predicted by children's entertainment use (but not educational use), after accounting for demographic variables and mothers' attitudes. Other factors, such as parenting style and having at-least one child with a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), were associated with entertainment use (regardless of the COVID-19 lockdown). Factors that were found to moderate the lockdown effect were mothers' attitudes towards screens and parental confidence. The findings are discussed in the context of parents' efforts to regulate their children's screen use.

Raising the Child-Do Screen Media Help or Hinder? The Quality over Quantity Hypothesis

Screen media are ubiquitous in human life across all age, cultural and socioeconomic groups. The ceaseless and dynamic growth of technological possibilities has given rise to questions regarding their effect on the well-being of children. Research in this area largely consists of cross-sectional studies; experimental and randomized studies are rare, which makes drawing causative conclusions difficult. However, the prevailing approach towards the use of screen media by children has focused on time limitations. The emerging evidence supports a more nuanced perspective. It appears that the older the child, the more important how the screen media are used becomes. Concentrating on the quality of the screen, time has become increasingly relevant in the recent COVID-19 pandemic, which necessitated a transfer of educational and social functioning from real-life to the digital world. With this review, we aimed at gathering current knowledge on the correlations of different screen media use and development outcomes, as well as providing an overview of potential benefits that new technologies may provide to the pediatric population. To summarize, if one cannot evade screen time in children, how can we use it for children's maximum advantage?

Is children's speech development changing? Preliminary evidence from Australian English-speaking 3-year-olds

Purpose: Around 9% of children have difficulty acquiring intelligible speech despite typical sensory, neuro-motor and cognitive function. Speech-language pathologists (SLPs) rely on descriptions of children's speech errors to identify speech sound disorder (SSD) and determine intervention targets and goals. Existing normative data, however, need re-evaluation to reflect changes in populations and the language learning environment. This research evaluates whether developmental phonological patterns widely accepted as describing typical acquisition predict speech errors in a recent sample of pre-school children.Method: In 2015, 99 neurotypical children aged 3;0-3;8 years;months were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP). Their performance was compared to studies describing speech development by children of the same age for phone repertoire and phonological patterns.Result: There were differences for both measures. Phone repertoire differences were marginal, but changes in phonological pattern use were unexpected. Suppression of three developmental phonological patterns (stopping of fricatives, final consonant deletion and voicing contrasts) was delayed compared to previous norms. Atypical consonant cluster reduction, sometimes considered a marker for disorder, was observed in 10% of children.Conclusion: There were qualitative differences in the speech development of the 2015 cohort of children compared to previous developmental norms. Valid and current normative data are necessary for the accurate identification of children needing intervention. The differences we found reinforce the need for regular updating of assessment tools, as well as greater understanding of how children's language learning environments are changing and potentially influencing speech development.

The Impact of Digital Screen Time on Dietary Habits and Physical Activity in Children and Adolescents

Background: Over the last few decades, the time children spend using electronic devices has increased significantly. The aim of the study was to evaluate the impact of screen time on dietary behaviors and physical activity in children and adolescents. Methods: An online survey was conducted among parents of preschool and school-aged children during the COVID-19 lockdown in Poland. There were 3127 surveys used in the analysis. Results: Survey responses referred to 1662 (53%) boys and 1465 (47%) girls, with a mean age of 12.1 ± 3.4 years. During a routine weekday, most children (71%) spent >4 h on educational activities using electronic devices, and 43% of children spent 1−2 h using devices for recreational purposes. The majority of children (89%) were exposed to screens during meals, and ate snacks between main meals (77%). There was an association between screen time and the exposure to screens during meals, and between screen time and time spent performing physical activity. Conclusions: This study revealed that the majority of children were exposed to screens during meals, which is a risk factor of obesity. The promotion of the judicious use of digital devices and healthy dietary habits associated with the use of screens may be an important component of obesity prevention strategies.

Electronic screen device usage and screen time among preschool-attending children in a suburban area of Sri Lanka

Background

Excessive use of screen devices and screen time are increasing health problems in children. We aim to describe the electronic screen device usage and determine the factors associated with their use among preschool-attending children in a suburban population in Sri Lanka.

Methods

A cross-sectional study was conducted in a suburban Medical Officer of Health area of Sri Lanka from January to March 2020. All children aged between 36–59 months attending ten randomly selected preschools were recruited. Data were collected using a parent-administered questionnaire and analysed using binary logistic regression in SPSS. The prevalence of electronic device usage, the average time spent on each device, and factors associated with individual device usage were analysed.

Results

A total of 340 children (Male-48%; mean age-50.1 ± 6.9 months) were recruited. Electronic devices were used by 96% of children. The most common devices were the television (87%) and the smartphone (63%). Of the children who used electronic devices, 60% exceeded the recommended screen time limit of one hour per day, 21% used devices for more than two hours per day, and 51% commenced using devices by two years of age. The higher education level of the father was independently associated with the use of smartphones and laptops and daily screen time of more than one hour (p < 0.05 for all). Male sex and being the only child were significantly associated with the use of smartphones, whereas maternal employment was associated with the use of laptops (p < 0.05 for all).

Conclusions

Electronic screen devices were used by 96% of preschool-attending children, and over 60% used them for more than the recommended daily upper limit of one hour. Higher paternal education, maternal employment and being the only child were significantly associated with electronic screen device use.

Screen time and developmental and behavioral outcomes for preschool children

BACKGROUND

One pressing question in the field of pediatrics is whether a dose-response relation is observed between hours of screen time and child outcomes. This study examined the association between hours of screen time (≤1 vs 2 vs ≥3 h/day) and children's developmental and behavioral outcomes.

METHODS

This study included data from 1994 mothers and children in Calgary, Canada, drawn from the All Our Families cohort. At 36 months, children's screen time (h/day), behavior problems, developmental milestones, and vocabulary acquisition were assessed via maternal report. Socio-demographic factors and baseline levels of performance at 24 months were included as covariates.

RESULTS

Compared to ≤1 h/day (47%; n = 935), children using screens 2 h (36%; n = 725) or ≥3 h/day (17%; n = 333) had an increased likelihood of reported behavioral problems (adjusted odds ratio (AOR) 1.30-1.90), delayed achievement of developmental milestones (AOR 1.41-1.68), and poorer vocabulary acquisition (AOR 1.94).

CONCLUSIONS

At 36 months, an association was observed between screen time and children's developmental, language, and behavioral outcomes, suggesting that duration of screen time is associated with poor child development outcomes. Findings provide support for screen time guidelines and emphasize the need for childcare professionals to discuss screen time guidelines with families.

IMPACT

International guidelines recommend that preschoolers spend no more than 1 h/day viewing screens. Research is needed to determine if there is a relation between screen time levels and child developmental and behavioral outcomes. Compared to ≤1 h/day, children viewing screens 2 or ≥3 h/day had an increased likelihood of behavioral problems, delayed achievement of developmental milestones, and poorer vocabulary acquisition. Findings highlight the association between duration of screen time and factors of child development.

Associations between screen time and cognitive development in preschoolers

OBJECTIVES

To examine the cross-sectional associations between screen time and cognitive development in preschoolers.

METHODS

Participants were 97 preschoolers (36 to 60 months) in Alberta and Ontario, Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. The time that children spent watching television, videos or DVDs (television time) or playing video or computer games (video game time) on a television, computer, or portable device was assessed using a parental questionnaire. Television time and video game time were summed to calculate total screen time. Adherence to the screen time recommendation (≤1 hour/day) of the Canadian 24-Hour Movement Guidelines was calculated. Expressive vocabulary and working memory were assessed using the Early Years Toolbox. Due to the distribution of working memory, it was categorized as a binary variable based on the median score. The associations between screen time and cognitive development were examined using mixed models (expressive vocabulary) or generalized mixed models (working memory).

RESULTS

Screen time was not associated with expressive vocabulary. Preschoolers who had higher total screen time were less likely to have better working memory (OR=0.52; 95%CI:0.31, 0.88), despite the null associations for television time (P=0.155) and video game time (P=0.079). Preschoolers who met the screen time recommendation were more likely to have higher working memory capacity (OR=3.48; 95%CI:1.06, 11.47), compared to those who did not meet the recommendation.

CONCLUSION

Limiting total screen time to no more than one hour per day may facilitate working memory development in preschoolers. Screen time may be unrelated to expressive language development in this age group.

Association of Screen Time With Internalizing and Externalizing Behavior Problems in Children 12 Years or Younger: A Systematic Review and Meta-analysis

Importance

Currently, there is a lack of consensus in the literature on the association between screen time (eg, television, video games) and children's behavior problems.

Objective

To assess the association between the duration of screen time and externalizing and internalizing behavior problems among children 12 years or younger.

Data Sources

For this systematic review and meta-analysis, MEDLINE, Embase, and PsycINFO databases were searched for articles published from January 1960 to May 2021. Reference lists were manually searched for additional studies.

Study Selection

Included studies measured screen time (ie, duration) and externalizing or internalizing behavior problems in children 12 years or younger, were observational or experimental (with baseline data), were available in English, and had data that could be transformed into an effect size. Studies conducted during the COVID-19 pandemic were excluded. Of 25 196 nonduplicate articles identified and screened for inclusion, 595 met the selection criteria.

Data Extraction and Synthesis

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Extracted variables were child age, sex, and socioeconomic status; informants and measurement type for screen time and behavior problems; study publication year; and study design and quality. Data were extracted by 2 independent coders and were pooled using a random-effects model.

Main Outcomes and Measures

The primary outcome was the association of screen time duration with externalizing (eg, aggression, attention deficit/hyperactivity disorder symptoms) and internalizing (eg, depression, anxiety) behaviors or diagnoses.

Results

Of the 595 full-text articles assessed for eligibility, 87 studies met all inclusion criteria, comprising 98 independent samples and 159 425 participants (mean [SD] age, 6.07 [2.89] years; 83 246 [51.30%] male). Increased duration of screen time had a small but significant correlation with more externalizing problems (90 samples; r, 0.11; 95% CI, 0.10-0.12) and internalizing problems (43 samples; r, 0.07; 95% CI, 0.05-0.08) in children. Several methodological moderators explained between-study heterogeneity. There was evidence of significant between study heterogeneity (I2 = 87.80).

Conclusions and Relevance

This systematic review and meta-analysis found small but significant correlations between screen time and children's behavior problems. Methodological differences across studies likely contributed to the mixed findings in the literature.

TV, computer, tablet and smartphone use and autism spectrum disorder risk in early childhood: a nationally-representative study

Background

Screen media use in early childhood has largely increased in recent years, even more so during the COVID-19 epidemic, and there is much discussion regarding its influence on neurodevelopment, including Autism Spectrum Disorder (ASD).

Methods

We examined the relationship between use of TV, computer, tablet and smartphone at age 2 years and risk of ASD assessed in telephone-based questionnaires among 12,950 children participating in the nationally representative ELFE (‘Etude Longitudinale Française sur les Enfants’) birth cohort study in France.

Results

In inverse-probability weighted (IPW) multinomial regression analyses, children’s weekly or daily screen media use was associated with an increased likelihood of an intermediate risk of ASD (IPW-controlled OR for weekly use:1.07, 95% CI 1.02—1.12; IPW-controlled OR for daily use:1.05, 95% CI 1.02—1.08) but inversely associated with a high risk (IPW-controlled OR for weekly use: 0.60, 95% CI 0.50—0.73; IPW-controlled OR for daily use: 0.75, 95% CI 0.62—0.91), as ascertained by the M-CHAT. This was confirmed when studying TV as well as computer/tablet exposure separately.

Conclusions

Overall, our nationally-representative study conducted among a large sample of 2-year-old children, indicates a complex relationship between screen exposure and ASD risk.

Screen time and health issues in Chinese school-aged children and adolescents: a systematic review and meta-analysis

Backgrounds

Many literature reviews summarized relationships between screen time and child health, but they only included a few studies conducted in Chinese children and adolescents. The potential influence of screen time may vary by social context. The current systematic review and meta-analysis aimed to evaluate relationships between screen time and health issues among Chinese school-aged children and adolescents.

Methods

Peer-reviewed articles written in Chinese and English were retrieved from CNKI, Wanfang, PubMed, Embase, and Web of Science from inception to June 2020. The Downs & Black checklist was applied to assess study quality. Meta analyses used random effect models and mixed effects model to calculate pooled adjusted odds ratios and 95% confidence intervals. Heterogeneity, sensitivity, and publication bias were assessed using Q and I² statistics, “one-study removed” analysis, the funnel plot, trim and fill analysis, and classical fail-safe N, respectively.

Results

In total, we identified 252 articles reporting 268 studies with unique samples. These studies investigated relationships between screen time and health issues of adiposity, myopia, psycho-behavioral problems, poor academic performance, cardiometabolic disease risks, sleep disorder, poor physical fitness, musculoskeletal injury, sub-health, and miscellaneous issues of height and pubertal growth, injury, sick leave, and respiratory symptoms. Proportions of studies reporting positive relationships with screen time were lowest in adiposity (50.6%) and higher in myopia (59.2%) and psycho-behavioral problems (81.8%). Other health issues were examined in 10 or less studies, all of which had more than half showing positive relationships. The pooled odds ratio from 19 studies comparing health risks with the screen time cutoff of 2 hours per day was 1.40 (95% CI: 1.31 to 1.50, I² = 85.9%). The pooled effect size was 1.29 (95% CI: 1.20 to 1.39) after trimming 7 studies for publication bias adjustments.

Conclusions

Findings exclusively generated from Chinese school-aged children and adolescents resonate those mainly from western countries. Evidence suggests that higher levels of screen time are related with greater risks of various health issues, although the relationships appear to be weak and intertwined with other confounding factors. Future studies need to investigate health-specific dose effects and mechanisms of screen time.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-13155-3.

Preschool Minority Children's Persian Vocabulary Development: A Language Sample Analysis

This study linked background TV and socioeconomic status (SES) to minority children’s Persian vocabulary development. To this end, 80 Iranian preschool children (aged 5–6 years old) from two minority groups of Arabs and Turks were selected using stratified random sampling. They were simultaneous bilinguals, i.e., their mother tongue was either Arabic or Azari and their first language was Persian. Language sample analysis (LSA) was used to measure vocabulary development through a 15-min interview by language experts (PhD in applied linguistics). The LSA measures included total number of utterances (TNU), total number of words (TNW), total number of new words (NDW), and mean length of utterance (MLU). A series of independent-samples t test, paired-samples t test, and repeated measures MANOVA tests were ran to examine data. Results showed significant improvements in children’s vocabulary scores from pretest to posttest for all children. In addition, high-SES children scored higher on the vocabulary measures in pretest and posttest. Moreover, background TV was associated with higher means in the TNW and the NDW in groups. The researchers concluded that background TV may be related to higher vocabulary scores in low-SES families as it may compensate for some linguistics gaps in these families including lower amount of child-parent interaction, play, and parents’ level of literacy.

Global Prevalence of Meeting Screen Time Guidelines Among Children 5 Years and Younger: A Systematic Review and Meta-analysis

IMPORTANCE

Pediatric guidelines suggest that infants younger than 2 years avoid screen time altogether, while children aged 2 to 5 years receive no more than 1 hour per day. Although these guidelines have been adopted around the world, substantial variability exists in adherence to the guidelines, and precise estimates are needed to inform public health and policy initiatives.

OBJECTIVE

To derive the pooled prevalence via meta-analytic methods of children younger than 2 years and children aged 2 to 5 years who are meeting guidelines about screen time.

DATA SOURCES

Searches were conducted in MEDLINE, PsycINFO, and Embase up to March 2020.

STUDY SELECTION

Studies were included if participants were 5 years and younger and the prevalence of meeting (or exceeding) screen time guidelines was reported.

DATA EXTRACTION AND SYNTHESIS

Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive the mean prevalence rates.

MAIN OUTCOMES AND MEASURES

Prevalence of meeting screen time guidelines.

RESULTS

From 63 studies, 95 nonoverlapping samples with a total of 89 163 participants were included. For children younger than 2 years, the pooled prevalence of meeting the screen time guideline (0 h/d) was 24.7% (95% CI, 19.0%-31.5%). Moderator analyses revealed that prevalence of meeting screen time guidelines varied as a function of year of data collection (increased over time), measurement method (higher when questionnaires compared with interview), and type of device use (higher when a combination of screen use activities compared with television/movies only). For children aged 2 to 5 years, the mean prevalence of meeting the screen time guideline (1 h/d) was 35.6% (95% CI, 30.6%-40.9%). Moderator analyses revealed that the prevalence of meeting screen time guidelines varied as a function of type of device use (higher when screen time was television/movies only compared with a combination of screen use activities).

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis indicate that only a minority of children 5 years and younger are meeting screen time guidelines. This highlights the need to provide support and resources to families to best fit evidence-based recommendations into their lives.

Association between screen time and cumulating school, behavior, and mental health difficulties in early adolescents: A population-based study

Early adolescents may daily spend excessive screen-time (with television viewing, computer/console gaming, discussion forums/chatting online, internet surfing, doing homework, and electronic mails) while its association with cumulating several school-behavior-mental-health difficulties (SBMDs) (poor-academic-performance, being obese, alcohol/tobacco/cannabis/other-illicit-drugs use, suffered violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms, and suicide attempt) is poorly addressed. We investigated this association among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed a questionnaire including socioeconomic features, daily screen-time for various screen-based activities (coded 1=<2/2=2-4/3=≥5 h; daily-total-screen-time level DSA_total was defined as their sum and categorized into 4 levels: 6-7/8-9/10-12/≥13), various SBMDs and the time of their onset during the life course (their cumulated number SBMD_score was categorized into 5 levels: 0/1/2/3-4/≥5). Logistic regression modeling showed that the DSA_total was strongly associated with all SBMDs (gender-age-adjusted odds ratio reaching 8.28, p < 0.001) and SBMD_score (gender-age-adjusted relative risk reaching 11.60, p < 0.001, pseudo R² = 0.039). These associations remained strongly significant when controlling for socioeconomic adversities (contributions 20-38%). The proportion of subjects without each SBMD steadily decreased with age according to DSA_total levels. These findings help to understand the impacts of high DSA_total on SBMDs in early adolescents and identify at-risk adolescents for prevention and care.

Children's screen use and school readiness at 4-6 years: prospective cohort study

Background

The primary aim of this study was to determine if screen use in early childhood is associated with overall vulnerability in school readiness at ages 4 to 6 years, as measured by the Early Development Instrument (EDI). Secondary aims were to: (1) determine if screen use was associated with individual EDI domains scores, and (2) examine the association between screen use and EDI domains scores among a subgroup of high screen users.

Methods

This prospective cohort study was carried out using data from young children participating in a large primary care practice-based research network in Canada. Logistic regression analyses were run to investigate the association between screen use and overall vulnerability in school readiness. Separate linear regression models examined the relationships between children’s daily screen use and each separate continuous EDI domain.

Results

A total of 876 Canadian participants participated in this study. Adjusted logistic regression revealed an association between increased screen use and increased vulnerability in school readiness (p = 0.05). Results from adjusted linear regression demonstrated an association between higher screen use and reduced language and cognitive development domain scores (p = 0.004). Among high screen users, adjusted linear regression models revealed associations between increased screen use and reduced language and cognitive development (p = 0.004) and communication skills and general knowledge domain scores (p = 0.042).

Conclusions

Screen use in early childhood is associated with increased vulnerability in developmental readiness for school, with increased risk for poorer language and cognitive development in kindergarten, especially among high users.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12629-8.

Association Between Physical Activity, Screen Time and Sleep, and School Readiness in Canadian Children Aged 4 to 6 Years

OBJECTIVE

School readiness is strongly associated with a child's future school success and well-being. The primary objective of this study was to determine whether meeting 24-hour movement guidelines (national physical activity, sedentary behaviors, and sleep recommendations) was associated with school readiness measured with mean scores in each of the 5 developmental domains of the Early Development Instrument (EDI) in Canadian children aged 4 to 6 years. Secondary objectives include examining the following: (1) the association between meeting 24-hour movement guidelines and overall vulnerability in school readiness and (2) the association between meeting individual physical activity, screen use and sleep recommendations, and overall school readiness.

METHODS

A prospective cohort study was performed using data from children (aged 4-6 years) who participated in a large-scale primary care practice-based research network.

RESULTS

Of the 739 participants (aged 5.9 + 0.12 years) in this prospective cohort study, 18.2% met the 24-Hour Movement Guidelines. Linear regression models (adjusted for child/family demographic characteristics, number of siblings, immigration status, and annual household income) revealed no evidence of an association between meeting all 24-hour movement guidelines and any of the 5 domains of the EDI (p > 0.05). Adjusted linear regression models revealed evidence of an association between meeting screen use guidelines and the "language and cognitive development" (β = 0.16, p = 0.004) domain, and for the sleep guideline, there was a statistically significant association with the "physical health and well-being" (β = 0.23, p = 0.001), the "language and cognitive development" (β = 0.10, p = 0.003), and the "communication skills and general knowledge" (β = 0.18, p < 0.001) domain.

CONCLUSION

Early lifestyle interventions targeting screen use and sleep may be beneficial for improving a child's readiness for school.

Screen Time as a Mechanism Through Which Cumulative Risk is Related to Child Socioemotional and Developmental Outcomes in Early Childhood

Socio-demographic risks are associated with higher child screen time and higher screen time is associated with poor socioemotional and developmental health. Existing studies have not examined children's screen time as a mechanism through which distal risks may be associated with child outcomes. In the current study, we examined whether two proximal factors, screen time and parenting quality, mediate the relation between distal cumulative risk and child outcomes. Participants (N = 1992) were drawn from a birth cohort of mothers and their children (81% white; 46% female). Mothers reported on cumulative risk factors (maternal income, education, depression, stress, marital status, housing instability, unemployment, and maternal history of childhood adversity) during the prenatal period. Parenting quality (ineffective/hostile, positive interactions) and children's screen time (hours/week) were assessed when children were three years of age. Child socioemotional (internalizing and externalizing problems) and developmental (achievement of developmental milestones) outcomes were measured at five years of age. Path analysis revealed indirect effects from cumulative risk to internalizing symptoms and achievement of developmental milestones via screen time. Indirect effects were observed from cumulative risk to internalizing and externalizing behavior via hostile parenting behavior. Over and above the effects of parenting, screen time may be a factor that links structural forms of social disadvantage during the prenatal period to child socioemotional and developmental outcomes. Due to modest effect sizes of screen time, it remains the case that child socioemotional and developmental health should be conceptualized within the context of distal cumulative risk factors such as caregiver psychological and material resources.

Family Factors Associated with Hands-On Play and Screen Time During the COVID-19 Pandemic

Background

Parent–child interactions are crucial for child development. The COVID-19 pandemic has negatively affected mental health and increased parenting challenges impacting parent–child functioning.

Objective

This study examined parent factors related to more and less enriching child activities during the pandemic through Bronfenbrenner’s Ecological Systems framework.

Methods

A convenience sample of parents (N = 708), primarily mothers (n = 610; 87.4%) aged 35.59 years old (SD = 5.59; range = 21–72), with children ages 2–8 years completed an online questionnaire between April 14-June 1, 2020. Participants mostly resided in Canada, had an income of > $100,000, and identified as White (82.4%). Parent–child activities were measured as total weekly time and combined time across activities within two categories: hands-on play and screen time. Bivariate correlations informed blockwise linear regression models.

Results

For families with childcare needs, parental anxiety was associated with higher total hands-on play, combined hands-on play, and combined screen time. Families without childcare needs indicated parenting stress was associated with lower total hands-on play and combined hands-on play, and higher supervised screen time. Family structure and indices of socioeconomic status were also predictive of activities across childcare needs and child ages.

Conclusions

To promote high-quality parent–child interactions and positive developmental outcomes during the pandemic, childcare needs and parent wellbeing should be supported, while evidence-based guidelines for child screen time should be further researched in this context.

Screen time and early childhood development in Ceará, Brazil: a population-based study

Background

Globally, children’s exposure to digital screens continues to increase and is associated with adverse effects on child health. We aimed to evaluate the association of screen exposure with child communication, gross-motor, fine-motor, problem-solving, and personal-social development scores.

Methods

We conducted a population-based, cross-sectional study with cluster sampling among children 0–60 months of age living in the state of Ceará, Brazil. Child screen time was assessed by maternal report and the World Health Organization (WHO) recommendations were used to define excessive screen time exposure. Child development was assessed with the Brazilian Ages and Stages Questionnaire. Generalized linear regression was used to determine the association of screen exposure with developmental outcomes. We also examined the potential non-linear relationship of screen time with development scores using spline analyses.

Results

A total of 3155 children 0–60 months of age had screen time exposure evaluated and 69% percent were identified as exposed to excessive screen time. This percentage of excess screen time increased with child age from 41.7% for children 0–12 months to 85.2% for children 49–60 months. Each additional hour of screen time was associated with lower child communication (standardized mean difference (SMD): -0.03; 95% CI: − 0.04, − 0.02), problem solving (SMD: -0.03; 95% CI: − 0.05, − 0.02) and personal-social (SMD: -0.04; 95% CI: − 0.06, − 0.03) domain scores.

Conclusions

Excess screen time exposure was highly prevalent and independently associated with poorer development outcomes among children under 5 years of age in Ceará, Brazil.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12136-2.

The negative effects of new screens on the cognitive functions of young children require new recommendations

Television studies have shown that some negative effects of screens could depend on exposure time, but more importantly on the characteristics of the child, the type of content viewed, and the context in which it is viewed. Studies on newer screens show that these factors are still valid but new ones now play a negative role: portable screens increase the duration of exposure and lowered the age at which exposure begins. More worryingly, new screen persuasive designs and dark patterns largely used incite more frequent use, attracting the attention of children and parents, resultantly interfering deeply in parent/child relationships. In this text we suggest that current academic recommendations have to be more broadly shared but also that new recommendations are needed: especially to advise parents not to let their screen interactions compete with real interactions with their child which are the core of learnings (especially language) and emotional regulations but also of their security.