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

The Association Between Screen Time Exposure and Autism Spectrum Disorder-Like Symptoms in Children

Research problem Advances in technology have ensured its inevitable integration in our life. Children, being at a vulnerable age period of development, are spending more time on electronic devices. Some studies reported negative effects on sleep, physical health such as obesity and vision problems, and behavioral changes such as aggressive behavior with exposure to violent media content. Research significance We will study the effect of using electronic devices on communication skills in children in Saudi Arabia. Our findings can be used to raise awareness on this matter. Research objectives The aim of our study is to examine the association between screen time and social communication skills among children of four years to six years of age in Saudi Arabia. Research methodology A cross-sectional study was conducted to investigate the relationship between social skills development and screen time by using a validated Arabic version of the Social Communication Questionnaire (SCQ). The sample in this study consists of 308 children from four to six years of age. Research results The results showed that the hours spent using the electronic device were significantly associated with having an SCQ score ≥ 15 (P < 0.05). A high SCQ score was prevalent in 19.7% (n = 31) of children who spent >3 hours using an electronic device compared to 10.2% (n = 5) and 7.84% (n = 8) of children who spent an hour or <2 hours using electronic devices, respectively. Conclusion Our study highlighted a significant association between the daily hours spent on devices and having an SCQ score above 15, which suggests a deficit in social skill development and having autism spectrum disorder-like symptoms.

Association of High Screen-Time Use With School-age Cognitive, Executive Function, and Behavior Outcomes in Extremely Preterm Children

Importance

Both preterm birth and increased screen time are known to be associated with an increase in risk of developmental and behavioral sequelae. The association between high screen time or a television or computer in the bedroom in early school age and adverse cognitive, executive function, language, and behavior outcomes of extremely preterm children (EPT) is not well understood.

Objective

To assess the association of high screen time with cognition, language, executive function, and behavior of EPT children aged 6 to 7 years; a second objective was to examine the association between high screen time and rates of structured physical activity and weight.

Design, Setting, and Participants

This cohort study was a secondary analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial Neuroimaging and Neurodevelopmental Outcomes school-aged cohort and includes 414 EPT children born between February 1, 2005, and February 28, 2009, and evaluated in between 2012 and 2016 at ages 6 years 4 months to 7 years 2 months. The study was conducted from July 7, 2012, and August 15, 2016, and data were analyzed between December 10, 2018, and April 1, 2021.

Exposures

Cohorts included children exposed to low (≤2 hours per day) vs high (>2 hours per day) amounts of screen time and by the presence (no vs yes) of a television/computer in the bedroom.

Main Outcomes and Measures

In addition to growth parameters, assessments included the Wechsler Intelligence Scale for Children-IV, the Behavior Rating Inventory of Executive Function, the Developmental Neuropsychological Assessment, the Conners 3rd Edition-Parent Short-Form, and the Social Communication Questionnaire.

Results

Of the 414 children included in the analysis, 227 (55%) were boys; mean (SD) birth weight was 870.6 (191) g. A total of 238 children (57%) had high screen time and 266 (64%) had a television/computer in their bedroom. In multivariable linear regressions adjusted for center, male sex, gestational age, and social determinants of health, high screen time was independently associated with the following mean (SE) test score changes: lower full-scale IQ (-3.92 [1.64]; P = .02); an increase in association with deficits in executive functions, including metacognition (8.18 [3.01]; P = .007), global executive function (7.49 [2.99]; P = .01), inhibition (-0.79 [0.38]; P = .03), and Conners 3rd Edition-Parent Short-Form inattention (3.32 [1.67]; P = .047). A television/computer in the bedroom was associated with an increase in inhibition (-0.80 [0.39]; P = .04) and hyperactivity/impulsivity (3.50 [1.75]; P = .046) problems.

Conclusions and Relevance

The findings of this study suggest that high screen time contributes to adverse cognitive, executive function, and behavior outcomes at ages 6 to 7 years in children born at less than 28 weeks. These findings support the need for clinicians to have heightened awareness of the risks for EPT children and discuss both the benefits and risks of screen time with families.

Parent language with toddlers during shared storybook reading compared to coviewing television

This study compares parent language directed at their toddlers while coviewing toddler-directed television and while storybook reading. Participants were 15- or 30- month-old children and their parent. A quantitative analysis of parent language revealed that it is more frequent, rich, and complex during reading relative to television viewing regardless of child age; although parents used more complex language and more diverse words with older children. The difference between media held even when the storybook text read aloud was not considered in the analysis. Consistent with the results of earlier research, shared book reading produces more and richer verbal interactions with toddlers than coviewing television and is thus more likely to positively influence early language development.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Infant media use: A harm reduction approach

There are a myriad of potentially harmful developmental outcomes associated with infant digital media use. Studies revealing risk associated with early media use have informed the current American Academy of Pediatrics (AAP) recommendations that discourage most digital media use among children under 18 months of age. Recent research advances, however, suggest potential benefits of technology engagement in this age group. Additionally, surveys of parents reveal that most infants engage with digital media for at least 30 min a day, exceeding the AAP recommendations. In response to these discoveries and cultural trends, some scholars have made compelling cases to adapt the AAP guidelines for infants. A helpful model for developing infant digital media use guidelines for families may be the harm reduction approach. The intent of this review is to suggest adaptations to the AAP guidelines for infant media engagement using a harm reduction framework. This review describes the challenge of restrictive guidelines, briefly summarizes the harm reduction approach, provides a review of risks and benefits associated with infant media use in each developmental domain (physical, cognitive, and socioemotional), summarizes correlates of infant screen media use, and examines intervention strategies for reducing screen time. The paper concludes with examples of possible adaptations to current AAP infant media use recommendations using harm reduction and bioecological frameworks.

Exposure to screens and children's language development in the EDEN mother-child cohort

Studies in children have reported associations of screen time and background TV on language skills as measured by their parents. However, few large, longitudinal studies have examined language skills assessed by trained psychologists, which is less prone to social desirability. We assessed screen time and exposure to TV during family meals at ages 2, 3 and 5–6 years in 1562 children from the French EDEN cohort. Language skills were evaluated by parents at 2 years (Communicative Development Inventory, CDI) and by trained psychologists at 3 (NEPSY and ELOLA batteries) and 5–6 years (verbal IQ). Cross-sectional and longitudinal associations were assessed by linear regression adjusted for important confounders. Overall, daily screen time was not associated with language scores, except in cross-sectional at age 2 years, where higher CDI scores were observed for intermediate screen time. Exposure to TV during family meals was consistently associated with lower language scores: TV always on (vs never) at age 2 years was associated with lower verbal IQ (− 3.2 [95% IC: − 6.0, − 0.3] points), independent of daily screen time and baseline language score. In conclusion, public health policies should better account for the context of screen watching, not only its amount.

Longitudinal Associations Between Screen Use and Reading in Preschool-Aged Children

BACKGROUND AND OBJECTIVES

The home literacy environment has been identified as a key predictor of children's language, school readiness, academic achievement, and behavioral outcomes. With the increased accessibility and consumption of digital media, it is important to understand whether screen use impacts off-line enrichment activities such as reading or whether reading activities offset screen use. Using a prospective birth cohort, we examined reading and screen use at 24, 36, and 60 months to elucidate the directional association between screen use and reading over time.

METHODS

This study included data from 2440 mothers and children in Calgary, Alberta, drawn from the All Our Families cohort. Children's screen use and reading activities were assessed via maternal report at age 24, 36, and 60 months. Sociodemographic covariates were also collected.

RESULTS

Using a random-intercepts cross-lagged panel model, which statistically controls for individual-level confounds, this study revealed that greater screen use at 24 months was associated with lower reading at 36 months (β = -.08; 95% confidence interval: -0.13 to -0.02). In turn, lower reading at 36 months was associated with greater screen use at 60 months (β = -.11; 95% confidence interval: -0.19 to -0.02). Covariates did not modify the associations.

CONCLUSIONS

A reciprocal relationship between screen use and reading was identified. Early screen use was associated with lower reading activities, resulting in greater screen use at later ages. Findings emphasize the need for practitioners and educators to discuss screen use guidelines and encourage families to engage in device-free activities to foster early literacy exposure.

From screen time to the digital level of analysis: a scoping review of measures for digital media use in children and adolescents

OBJECTIVES

This scoping review aims to facilitate psychometric developments in the field of digital media usage and well-being in young people by (1) identifying core concepts in the area of "screen time" and digital media use in children, adolescents, and young adults, (2) synthesising existing research paradigms and measurement tools that quantify these dimensions, and (3) highlighting important areas of need to guide future measure development.

DESIGN

A scoping review of 140 sources (126 database, 14 grey literature) published between 2014 and 2019 yielded 162 measurement tools across a range of domains, users, and cultures. Database sources from Ovid MEDLINE, PsycINFO and Scopus were extracted, in addition to grey literature obtained from knowledge experts and organisations relevant to digital media use in children. To be included, the source had to: (1) be an empirical investigation or present original research, (2) investigate a sample/target population that included children or young persons between the ages of 0 and 25 years of age, and (3) include at least one assessment method for measuring digital media use. Reviews, editorials, letters, comments and animal model studies were all excluded.

MEASURES

Basic information, level of risk of bias, study setting, paradigm, data type, digital media type, device, usage characteristics, applications or websites, sample characteristics, recruitment methods, measurement tool information, reliability and validity.

RESULTS

Significant variability in nomenclature surrounding problematic use and criteria for identifying clinical impairment was discovered. Moreover, there was a paucity of measures in key domains, including tools for young children, whole families, disadvantaged groups, and for certain patterns and types of usage.

CONCLUSION

This knowledge synthesis exercise highlights the need for the widespread development and implementation of comprehensive, multi-method, multilevel, and multi-informant measurement suites.

The epidemiology of cognitive development

The epidemiology of cognitive development is an approach essentially based on large observational studies, which examines individual differences in cognitive abilities throughout childhood and their determinants. Although different in terms of methodology and main interests from developmental psychology, cognitive epidemiology offers complementary viewpoints on cognitive development and addresses fundamental research questions of interest to developmental psychologists. The present paper depicts the contributions of the epidemiological approach to the field of cognitive development and highlights the methodological advances that have made such contributions possible. We discuss the stability and developmental trajectories of cognitive functions, their main predictors, the complex interplay between environmental and genetic predictors, and the relationships between the different domains of cognition from birth to adulthood.

Parents and Mobile Devices, from Theory to Practice: Comparison between Perception and Attitudes to 0-5 Year Old Children's Use

Pediatrics associations recommend avoiding the use of mobile devices (MDs) in children aged 0–2 years and limiting them to one hour per day for children aged 3–5 years. This study aimed to explore public risk perception on MDs use by children aged 0–5 years and attitudes of parents to children’s use. Participants were recruited on a voluntary basis by social media using a self-administered survey. The study included 3115 participants, most of whom were parents of children aged under 5 years (n = 1901; 61%). Most of the respondents (74%) considered that MDs use could be harmful for children’s health. The awareness on a correct use did not always translate into avoiding MDs use as recommended, especially in parents of children aged 0–2 years. Half of the sample (54%) received or sought information on risks related to MDs use. The most consulted information sources were the web (78%), and pediatricians in only 22% of cases. Understanding the determinants of parents’ risk perception and behavior is necessary to design effective family-based interventions in order to guide parents to a moderate and more careful use of MDs by their children. To do so, public health actions must aim to strengthen awareness about conscious use of MDs.

Toddler word learning from contingent screens with and without human presence

While previous studies have documented that toddlers learn less well from passive screens than from live interaction, the rise of interactive, digital screen media opens new perspectives, since some work has shown that toddlers can learn similarly well from a human present via video chat as from live exposure. The present study aimed to disentangle the role of human presence from other aspects of social interactions on learning advantages in contingent screen settings. We assessed 16-month-old toddlers' fast mapping of novel words from screen in three conditions: in-person, video chat, and virtual agent. All conditions built on the same controlled and scripted interaction. In the in-person condition, toddlers learned two novel word-object associations from an experimenter present in the same room and reacting contingently to infants' gaze direction. In the video chat condition, the toddler saw the experimenter in real time on screen, while the experimenter only had access to the toddler's real-time gaze position as captured by an eyetracker. This setup allowed contingent reactivity to the toddler's gaze while controlling for any cues beyond these instructions. The virtual agent condition was programmed to follow the infant's gaze, to smile, and to name the object with the same parameters as the experimenter in the other conditions. After the learning phase, all toddlers were tested on their word recognition in a looking-while-listening paradigm. Comparisons against chance revealed that toddlers showed above-chance word learning in the in-person group only. Toddlers in the virtual agent group showed significantly worse performance than those in the in-person group, while performance in the video chat group overlapped with the other two groups. These results confirm that in-person interaction leads to best learning outcomes even in the absence of rich social cues. They also elucidate that contingency is not sufficient either, and that in order for toddlers to learn from interactive digital media, more cues to social agency are required.

Growing Up in a Digital World Digital Media and the Association With the Child's Language Development at Two Years of Age

Digital media (DM), such as cellphones and tablets, are a common part of our daily lives and their usage has changed the communication structure within families. Thus, there is a risk that the use of DM might result in fewer opportunities for interactions between children and their parents leading to fewer language learning moments for young children. The current study examined the associations between children’s language development and early DM exposure.

Participants: Ninety-two parents of 25months olds (50 boys/42 girls) recorded their home sound environment during a typical day [Language ENvironment Analysis (LENA)] and participated in an online questionnaire consisting of questions pertaining to daily DM use and media mediation strategies, as well as a Swedish online version of the MacArthur Communicative Development Inventory, which includes a vocabulary scale as well as a grammar and pragmatics scale.

Results: Through correlations and stepwise regressions three aspects of language were analyzed. The child’s vocabulary was positively associated with interactional turn-taking. The child’s vocabulary and grammar were negatively associated with the likelihood of parent’s device use during everyday child routines and the amount of TV watched by the child. The child’s pragmatic development was also positively associated with the parent’s device use in child routines but also with the parent’s joint media engagement (JME), as well as the child’s gender (where girls perform better).

Conclusion: Our study confirms that specific aspects of the 2-year old’s DM environment are associated with the child’s language development. More TV content, whether it is viewed on a big screen or tablet, is negatively associated with language development. The likelihood of parents’ use of DM during everyday child routines is also negatively associated with the child’s language development. Positive linguistic parental strategies such as interactional turn-taking with the child, JME, and book reading, on the other hand, are positively associated with the child’s language development.

High-dose electronic media use in five-year-olds and its association with their psychosocial symptoms: a cohort study

OBJECTIVES

This study investigated the frequency of electronic media (e-media) usage by preschool children and the risks of high-dose e-media use on young children's psychosocial well-being.

DESIGN

Longitudinal associations between e-media use at 18 months and psychosocial symptoms at 5 years of age were studied, as well as cross-sectional associations between e-media use and psychosocial symptoms at 5 years.

SETTING

Between 2011 and 2017 in Finland.

PARTICIPANTS

Children aged 5 years (n=699).

PRIMARY AND SECONDARY OUTCOME MEASURES

Children's psychosocial symptoms were determined at the age of 5 years using the parent-reported questionnaires Five-to-Fifteen (FTF) and the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

Based on our results, 95% of the preschool children exceeded the daily recommended use of e-media set by health professionals. Our results indicate that increased screen time at 5 years of age is associated with a risk of multiple psychosocial symptoms (OR 1.53-2.18, 95% CI 1.05 to 3.34, p<0.05), while increased levels of e-media use at 18 months was only associated with FTF peer problems (OR 1.59, 95% CI 1.04 to 2.41, p=0.03). Moreover, high-dose use of electronic games at the age of 5 years seems to be associated with fewer risks for psychosocial well-being than programme viewing, as it was only associated with SDQ hyperactivity (OR 1.65, 95% CI 1.08 to 2.51, p=0.02).

CONCLUSION

Increased screen time has multiple risks for children's psychosocial well-being. These risk factors seem to be significant in the long term, and are related to problems in children's socio-emotional development later on. Health professionals and paediatricians have an important role as communicators of the current research results on the safe usage time of e-media for families, and enhancing parents' skills as regulators of children's safe e-media use. More research is needed on the family conditions of high-dose e-media users.

COVID-19 pandemic impact on children and adolescents' mental health: Biological, environmental, and social factors

Since the Coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was announced, we had an unprecedented change in the way we organize ourselves socially and in our daily routine. Children and adolescents were also greatly impacted by the abrupt withdrawal from school, social life and outdoor activities. Some of them also experienced domestic violence growing. The stress they are subjected to directly impacts their mental health on account of increased anxiety, changes in their diets and in school dynamics, fear or even failing to scale the problem. Our aim is to bring up a discussion under different aspects and to alert public health and government agents about the need for surveillance and care of these individuals. We hope that the damage to their mental health as a result of the side effect of this pandemic can be mitigated by adequate and timely intervention.

Media exposure and language for toddlers from low-income homes

In the current study, we examined whether the quantity of toddlers' exposure to media was related to language skills and whether meeting the American Association of Pediatrics (AAP) recommendations of limiting media exposure to one hour or less per day was related to language skills. We examined these associations in a sample of toddlers (N = 157) living in low-income homes. Toddlers were about two years of age (M = 28.44 months, SD = 1.48 months) during the first visit when parents reported on toddlers' exposure to media in the home. Toddlers were about three years of age (M = 33.61 months, SD = 1.06 months) during the second visit when direct measures of toddlers' expressive and receptive language and receptive vocabulary skills were completed. Controls were child gender, race, mothers' education, marital status, work status, and center-based child care. Results indicated that more frequent exposure to media was related to lower expressive language, but not receptive language or receptive vocabulary. The predictor of AAP recommendation was not significantly related to any child language outcomes. These results suggest that media exposure may be related to the displacement of language-enhancing activities during a critical time for toddlers' language development. However, the AAP media recommendation of one hour may not be related to language development.

Prosocial television and prosocial toddlers: A multi-method, longitudinal investigation

How screen use might affect early childhood outcomes is an important question for parents, but existing research is patchy. In particular, screen time is often examined in relation to sleep and aggression, but much less is known about its links with prosocial behaviour. To address this gap, we conducted semi-structured observations and interviews / questionnaires with both mothers and fathers in a sample of 195 (predominantly affluent and educated) British families tracked across three time-points, when the first-born child was 14-, 24-, and 36-months old. We also applied an objective coding scheme to assess the relative frequency of prosocial behaviour in the programmes and films children were watching at age 24-months. While our results showed no overall associations between prosocial behaviour and either screen time or screen content, there were interaction effects. Specifically, children whose favourite programmes were slow-paced and rich in prosocial content were particularly likely to show developmental gains in sharing. We discuss these findings in terms of their implications for parents, researchers, and policy makers.

Home Language Activities and Expressive Vocabulary of Toddlers from Low-SES Monolingual Families and Bilingual Immigrant Families

Children from low-SES (socioeconomic status) and minority language immigrant families are at risk of vocabulary difficulties due to the less varied and complex language in the home environment. Children are less likely to be involved in home language activities (HLA) in interaction with adults in low-SES than in higher-SES families. However, few studies have investigated the HLA variability among low-SES, minority language bilingual immigrant families. This longitudinal study analyzes the frequency and duration of HLA and their predictive roles for expressive vocabulary acquisition in 70 equivalent low-SES monolingual and bilingual toddlers from minority contexts. HLA and vocabulary were assessed at 24 and 30 months in the majority language (Italian) and in total (majority+minority language) using parent and teacher reports. The frequency and duration of HLA in interaction with adults in total, but not in the majority language, at 24 months were similar for the two groups. These activities uniquely accounted for expressive vocabulary at 30 months, after accounting for total vocabulary at 24 months, in both groups. In conclusion, a minority-majority language context is not an additional risk factor for vocabulary acquisition if HLA is considered in interaction with adults in both languages. HLA are proximal environmental protective factors for vocabulary acquisition.

Screen Time and Autism: Current Situation and Risk Factors for Screen Time Among Pre-school Children With ASD

Objective: To investigate the current status of screen time in children with ASD, its correlation with autistic symptoms and developmental quotient (DQ), and the factors affecting screen time. Method: One hundred ninety-three Chinese children with ASD were recruited. We collected the demographic and screen time data using a questionnaire. The ASD core symptoms and developmental quotient (DQ) were measured by the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Autism Diagnostic Observation Schedule-Second Edition (ADOS-2), Griffiths Development Scales-Chinese Language Edition (GDS-C), and Chinese Children's Parent-Child Relationship Questionnaire (CPCIS). Then, we analyzed the correlations between the screen time of children with ASD and the ABC, CARS, ADOS, GDS-C DQs, and CPCIS scores. Linear regression was used to analyze the risk factors that affect screen time. Results: The children's average daily screen time was 2.64 ± 2.24 h. Forty eight percent children were exposed to two or more types of electronic devices. Their favorite activity of screen time was watching cartoons. Only 34% children spent screen time accompanied by parents and with communication. 50.26% children had no screen time before sleeping. The screen time of children with ASD had a negative correlation with the GDS-C CQ (r = -0.234, P = 0.001) and the CPCIS score (r = -0.180, P = 0.012) and a positive correlation with the CARS score (r = 0.192, P = 0.009). A low father's education level (P = 0.010), less restriction of the child's screen time by the guardian (P = 0.001), greater caregiver screen time (P < 0.001), the use of the screen as a tool for child rearing (P = 0.001), and the child's ownership of independent electronic equipment (P = 0.027) are risk factors for long screen time in children with ASD. Conclusion: The screen time of children with ASD in China is higher than the recommended standard, and the current situation is serious. The screen time of ASD children is related to their autism symptoms, DQ and parent-child interaction. Low paternal education levels, less restriction of children's screen time by guardians, greater guardian screen time, the use of screens in child rearing, and children's ownership of independent electronic equipment can lead to an increase in children's screen time. These findings may have implications for family intervention strategies.

Risks and Protective Factors Associated With Mental Health Symptoms During COVID-19 Home Confinement in Italian Children and Adolescents: The #Understandingkids Study

Objective: To identify risk and protective factors for mental health symptoms associated with lifestyle changes caused by home confinement in pediatric subjects and in children and adolescents with a neuropsychiatric disorder. Study design: This was a prospective, cross-sectional study conducted from May 10 to May 31, 2020. Two online anonymous surveys were developed: population-based and clinical-based (children with neuropsychiatric disorders). Outcomes included emotional and behavioral symptoms, as assessed by psychometric scales (BPSC, PPSC, PSC, CES-DC and SCARED, respectively), and lifestyle changes during home confinement (i.e., physical activity, screen time, home schooling, reading). Results: The sample included 9,688 pediatric subjects, and 289 children and adolescents with a neuropsychiatric disorder. The presence of siblings was a protective factor in all ages. In pre- and school children: male sex, a diagnosis of autism, residency in highly affected areas, high parental educational level or job loss, and screen time (>2 h/day) were risk factors. Physical activity, home-schooling, reading, talking with other people were protective factors. Residency in highly affected areas, a diagnosis of mood disorder, parental job loss, and screen time, were associated with a worsening of the depressive symptoms, whereas physical activity, talking with other people, playing with parents were protective activities. Screen time was also a risk factor for anxiety symptoms, while physical activity, reading and talking with other people were protective factors. Conclusions: This study identified risk and protective factors for mental health symptoms associated with lifestyle changes caused by COVID-19 home confinement to promote mental well-being in pediatrics during pandemic times.

Digital Devices Use and Language Skills in Children between 8 and 36 Month

Background: Over the past decade, the use of digital tools has grown and research evidence suggests that traditional media and new media offer both benefits and health risks for young children. The abilities to understand and use language represent two of the most important competencies developed during the first 3 years of life through the interaction of the child with people, objects, events, and other environmental factors. The main goal of our study is to evaluate the relationship between digital devices use and language abilities in children between 8 and 36 month, also considering the influence of several factors. Materials and Methods: We conducted a cross-sectional observational study on digital devices use and language abilities in260 children (140 males = 54%) aged between 8 and 36 months (mean = 23.5 ± 7.18 months). All the parents completed a self-report questionnaire investigating the use of digital devices by their children, and a standardized questionnaire for the assessment of language skills (MacArthur-Bates). Linear regression analysis was used to evaluate the relation between different variables. Subsequent moderation analysis were performed to verify the influence of other factors. Results: We found a statistically significant negative relation between the total daily time of exposure to digital devices and the Actions and Gestures Quotient (ß = -0.397) in children between 8 and 17 months, and between the total daily time of exposure to digital devices and Lexical Quotient (ß = -0.224) in children between 18 and 36 months. Gender, level of education/job of parents, modality of use/content of digital device did not significantly affect the result of the regression analysis. Conclusion: In our study we found that a longer time of exposure to digital devices was related to lower mimic-gestural skills in children from 8-17 months and to lower language skills in children between 18 and 36 months, regardless of age, gender, socio-economic status, content, and modality of use. Further studies are needed to confirm and better understand this relation, but parents and pediatricians are advised to limit the use of digital devices by children and encourage the social interaction to support the learning of language and communication skills in this age group.

Characteristics of Children's Media Use and Gains in Language and Literacy Skills

Media use could be detrimental to children's language and literacy skills because it may displace other language-enhancing activities like shared reading and caregiver-child interactions. Furthermore, the extent to which children use media with adults (joint media engagement), the extent to which they use interactive media (apps/games), and the time of the day and week during which media use occurs may attenuate any negative effects. The current study examines the relation between characteristics of children's media use and gains in first graders' language and literacy skills. Children (N = 488) completed direct assessments of language and literacy skills in the spring of kindergarten and the spring of first grade. Parents reported how many hours children used both interactive and non-interactive media during different times of the day on the most recent weekday and weekend day and responded to items about the extent to which they engage with their children during media use. A quadratic relationship between media use and language gains showed that a moderate amount of media use was related to larger language gains, whereas high use was related to smaller gains. For literacy, an interaction between media use and joint media engagement showed a small negative effect of media use at low levels of joint media engagement and little to no relation between media use and literacy gains at higher levels of joint media engagement. Children's language and literacy skills were not predicted by either the proportion of media time that was spent with apps/games or morning and weekday media use. These results show that moderate amounts of media use may not be a negative influence on children's developing language skills, whereas high levels may displace other language-enhancing activities. Additionally, joint media engagement may play an important buffering role in the relation between media use and early literacy skills, aligned with current recommendations encouraging co-viewing.

Characteristics of Children's Media Use and Gains in Language and Literacy Skills

Media use could be detrimental to children's language and literacy skills because it may displace other language-enhancing activities like shared reading and caregiver-child interactions. Furthermore, the extent to which children use media with adults (joint media engagement), the extent to which they use interactive media (apps/games), and the time of the day and week during which media use occurs may attenuate any negative effects. The current study examines the relation between characteristics of children's media use and gains in first graders' language and literacy skills. Children (N = 488) completed direct assessments of language and literacy skills in the spring of kindergarten and the spring of first grade. Parents reported how many hours children used both interactive and non-interactive media during different times of the day on the most recent weekday and weekend day and responded to items about the extent to which they engage with their children during media use. A quadratic relationship between media use and language gains showed that a moderate amount of media use was related to larger language gains, whereas high use was related to smaller gains. For literacy, an interaction between media use and joint media engagement showed a small negative effect of media use at low levels of joint media engagement and little to no relation between media use and literacy gains at higher levels of joint media engagement. Children's language and literacy skills were not predicted by either the proportion of media time that was spent with apps/games or morning and weekday media use. These results show that moderate amounts of media use may not be a negative influence on children's developing language skills, whereas high levels may displace other language-enhancing activities. Additionally, joint media engagement may play an important buffering role in the relation between media use and early literacy skills, aligned with current recommendations encouraging co-viewing.