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

Early Childhood Screen Use Contexts and Cognitive and Psychosocial Outcomes: A Systematic Review and Meta-analysis

Importance

The multifaceted nature of screen use has been largely overlooked in favor of a simplistic unidimensional measure of overall screen time when evaluating the benefits and risks of screen use to early childhood development.

Objective

To conduct a systematic review and meta-analysis to examine associations of screen use contexts in early childhood with cognitive and psychosocial outcomes.

Data Sources

PsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science, and Scopus were searched from inception to December 31, 2023.

Study Selection

A total of 7441 studies were initially identified. Studies were included if they examined associations between a contextual factor of screen use among children aged 0 to 5.99 years and cognitive or psychosocial development. Observational, experimental, and randomized clinical trial study designs were included.

Data Extraction and Synthesis

All studies were independently screened in duplicate following PRISMA guidelines. Effect sizes of associations (r) from observational studies were pooled using random-effects 3-level meta-analyses. The remaining study designs were narratively synthesized.

Main Outcomes and Measures

Screen use contexts included content (child directed and age inappropriate), type (program viewing and game or app use), co-use (or solo use), background television, caregiver screen use during child routines, and purpose. Outcomes were cognitive (executive functioning, language, and academic skills) or psychosocial (internalizing and externalizing behavior problems and socioemotional competence).

Results

Overall, 100 studies (176 742 participants) were included, and of these, 64 observational studies (pooled sample sizes ranging from 711 to 69 232) were included in meta-analyses. Program viewing (n = 14; k = 48; r, -0.16; 95% CI, -0.24 to -0.08) and background television (n = 8; k = 18; r, -0.10; 95% CI, -0.18 to -0.02) were negatively associated with cognitive outcomes, while program viewing (n = 6; k = 31; r, -0.04; 95% CI, -0.07 to -0.01), age-inappropriate content (n = 9; k = 36; r, -0.11; 95% CI, -0.17 to -0.04), and caregiver screen use during routines (n = 6; k = 14; r, -0.11; 95% CI, -0.20 to -0.03) were negatively associated with psychosocial outcomes. Co-use was positively associated with cognitive outcomes (n = 8; k = 28; r, 0.14; 95% CI, 0.03 to 0.25).

Conclusions and Relevance

Findings show small to moderate effect sizes that highlight the need to consider screen use contexts when making recommendations for families, clinicians, and educators beyond screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.

Longitudinal associations between digital media use and ADHD symptoms in children and adolescents: a systematic literature review

Previous reviews have often shown a link between digital media ADHD symptom levels. However, longitudinal studies are needed to find stronger evidence of a causal effect as well as to determine the direction of effects. The aim of the present review (PROSPERO CRD42021262695) was therefore to provide a systematic review of studies meeting the following inclusion criteria: (1) include longitudinal data investigating associations between digital media (i.e., gaming and social media) and later ADHD symptoms or vice versa, (2) be published within the past 10 years (i.e., 2011 until June 2021), (3) be published in a peer-reviewed journal in English, and (4) include children or adolescents (age 0-17 years). After a systematic search in the Web of Science and PsycInfo databases, we included 28 studies, all with adequate or high quality. Results showed support for reciprocal associations between digital media and ADHD symptoms, with associations being more consistent for problematic use of digital media than for screen time. Thus, children with ADHD symptoms appear more vulnerable to developing high or problematic use of digital media (i.e., selection effects), and digital media also have effects on later ADHD symptom levels, either because of specific characteristics of digital media or because of indirect effects on, for example, sleep and social relations (i.e., media effects). However, it should be emphasized that further studies investigating potential moderators and mediators are needed if we are to better understand the complex associations between digital media and ADHD symptom levels.

Toddler's memory and media-Picture book reading and watching video content are associated with memory at 2 years of age

Memory develops across the course of the first years of life and is influenced by daily experiences, such as exposure to media like books and television. Memory as tapped by Deferred imitation (DI) requires that toddlers form a representation of the target actions that they can later use to reproduce the actions and in addition to measuring memory for real live events, it can also be used to measure memory for events viewed through media. Toddlers are frequently exposed to multiple forms of digital media in addition to more traditional forms of picture book reading. In a within-subjects design, memory was assessed with a DI task in 2-year-olds (n = 89) using the Frankfurt Imitation Test. Deferred imitation was assessed after live and video demonstrations. Parents completed a survey about children's media use. Picture book reading for less than 30 min a day predicted lower memory scores for actions demonstrated live. Watching video content for more than 1 h a day predicted lower memory scores for actions demonstrated on video. Results are interpreted in terms of individual differences in experiences of traditional and digital media and the development of symbolic understanding.

Exposure to Language in Video and its Impact on Linguistic Development in Children Aged 3-11: A Scoping Review

Early exposure to books can benefit language acquisition by expanding children's linguistic experience and engaging them in a shared activity (Nation et al. 2022; Dowdall et al., 2020). Video media (including television) could potentially fulfil a similar role by exposing children to new linguistic phenomena in an engaging setting. However, while many studies have examined the impact of screen-time on cognitive development (for a review see Kostyrka-Allchorne et al., 2017), the findings relating specifically to language remain unclear. The aim of this review is to understand how encountering language content in video media might impact a variety of language skills in children aged 3-11. This review maps the methods and findings of 93 studies that met preregistered criteria with the goal of understanding which factors impact learning outcomes following video exposure. Results from observational (N = 31) and experimental (N = 62) studies reveal a divided literature in which video viewing is linked to short-term benefits for learning specific linguistic structures from high-quality video media, as well as having negative or null long-term associations with standardised language measures. Results highlight various methodological difficulties and limitations faced by experimental and observational approaches and reveal the importance of video quality and viewing context for language learning.

The developmental pattern of native and non-native speech perception during the 1st year of life in Japanese infants

Language development during the 1st year of life is characterized by perceptual attunement: following language-general perception, a decline in the perception of non-native phonemes and a parallel increase in or maintenance of the perception of native phonemes. While this general pattern is well established, there are still many gaps in the literature. First, most evidence documenting these patterns comes from "Minority world countries" with only a limited number of studies from "Majority world countries", limiting the range of languages and contrasts assessed. Second, few studies test both the developmental patterns of native and non-native speech perception in the same group of infants, making it hard to draw conclusions on simultaneous decline in non-native and increase in native speech perception. Such limitations are in part due to the effort that goes into testing developing speech sound perception, where usually only discrimination of one contrast per infant can be tested at a time. The present study thus set out to assess the feasibility of assessing a given infant on their discrimination of two speech sound contrasts during the same lab visit. It leveraged the presence of documented patterns of the improvement of native and the decline of non-native phoneme discrimination abilities in Japanese, therefore assessing native and non-native speech perception in Japanese infants from 6 to 12 months of age. Results demonstrated that 76 % of infants contributed discrimination data for both contrasts. We found a decline in non-native speech perception evident in discrimination of the non-native /ɹ/-/l/ consonant contrast at 9-11, but not at 11-13 months of age. Additionally, a parallel increase in native speech perception was demonstrated evident in an absence of native phonemic vowel length discrimination at 6-7 and 9-11 months and a discrimination of this contrast at 11-13 months of age. These results, based on a simultaneous assessment of native and non-native speech perception in Japanese-learning infants, demonstrate the feasibility of assessing the discrimination of two contrasts in one testing session and corroborate theoretical proposals on two hallmarks of perceptual attunement: a decrease in non-native and a facilitation in native speech perception during the first year of life.

Mobile Media Content Exposure and Toddlers' Responses to Attention Prompts and Behavioral Requests

Importance

With personalized touch-screen tablets, young children can choose content and engage in play-like activities. However, tablets may also reduce shared engagement as the action of viewing or touching the screen is often not visible to nearby adults. This may impact communicative gazing and pointing, which is critical to the formation of shared awareness and in turn supports language development.

Objective

To assess the association of tablet media content with toddlers' responses to joint attention prompts and behavioral requests.

Design, Setting, and Participants

This cohort study took place at a behavioral research laboratory and included toddlers who were aged 18 to 32 months with neurotypical development who were recruited from a volunteer and community sample. Toddlers engaged with a real toy or 3 different types of tablet content (ie, viewing video of toy play, playing with a digital toy, or playing a commercial game) while an experimenter delivered joint attention prompts. Data were acquired from June 2021 November XX 2022, and data analysis occurred from January 2023 to May 2024.

Main Outcomes and Measures

Main outcomes included child response to joint attention (number of prompts with joint attention response per number of prompts delivered) and child response to behavioral request (ie, the prompt on which the child responded to the behavioral request). Measures included crossed random effects, Wald tests, and likelihood ratio tests.

Results

In this study, 63 toddlers were enrolled, and data from 62 were included (31 female [49%]; mean [SD] age, 26.1 [3.4] months; median [IQR] age, 25.0 [18.6-32.6] months). When toddlers were playing a commercial game on a tablet, they responded to fewer joint attention prompts (crossed random effects model, -0.15; 95% CI, -0.24 to -0.06 prompts) and male toddlers took longer to acknowledge a behavioral request (interaction of content and sex, -0.75; 95% CI, -1.36 to -0.17). The negative impact of the tablet game was larger as child age increased (τ = -2.30; 95% CI, -0.05 to 0; P = .03). Greater media use at home was associated with decreased responding to joint attention prompts during the tablet game (ρ = -0.47; P < .001), while better language skills were associated with more joint attention during play with a real toy (ρ = 0.31; P = .02).

Conclusions and Relevance

In this cohort study, a touch-screen tablet game was associated with decreased joint attention among toddlers and they were less likely to respond to a behavioral request. In a laboratory setting, it was difficult for toddlers to engage in social-communicative interactions with adults when using a tablet media device.

Impact of auditory environments on language outcomes in children with a cochlear implant

OBJECTIVES

To analyse the effects of auditory environments on receptive and expressive language outcomes in children with a CI.

DESIGN

A single-institution retrospective review was performed. The auditory environments included Speech-Noise, Speech-Quiet, Quiet, Music, and Noise. Hearing Hour Percentage (HHP) and percent total hours were calculated for each environment. Generalised Linear Mixed Models (GLMM) analyses were used to study the effects of auditory environments on PLS Receptive and Expressive scores.

STUDY SAMPLE

Thirty-nine children with CI.

RESULTS

On GLMM, an increase in Quiet HHP and Quiet percent total hours were positively associated with PLS Receptive scores. Speech-Quiet, Quiet, and Music HHP were positively associated with PLS Expressive scores, with only Quiet being significant for percent total hours. In contrast, percent total hours of Speech-Noise and Noise had a significant negative association with PLS Expressive scores.

CONCLUSIONS

This study suggests that more time spent in a quiet auditory environment positively influences PLS Receptive and Expressive scores and that more time listening to speech in quiet and music positively influences PLS Expressive scores. Time spent in environments recognised as Speech-Noise and Noise might negatively impact a child's expressive language outcomes with a CI. Future research is needed to better understand this association.

The association between screen time exposure and myopia in children and adolescents: a meta-analysis

OBJECTIVE

This study aimed to systematically review epidemiological evidence on associations between screen time exposure and myopia in children and adolescents, and to quantitatively evaluate summary effect estimates from existing literature.

METHOD

There were three online databases including PubMed, Embase, and Web of Science, for epidemiological studies on screen time exposure and myopia published before June 1, 2023. The risk of bias was assessed by the Newcastle Ottawa Scale (NOS) checklist. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the correlation between screen time exposure and myopia using random or fixed-effect models by exposure type (categorical/continuous). We also performed subgroup analysis by screen device type, study quality, geographic region, and research period.

RESULTS

We searched 7,571 records from three databases and identified 19 eligible studies, including 14 high-quality studies and 5 moderate-quality studies. Meta-analyses suggested that there was a statistically significant correlation between screen time (high vs. low) and myopia. The pooled ORs with 95%CIs were respectively 2.24 (1.47-3.42) for cross-sectional studies, and 2.39 (2.07-2.76) for cohort studies. We also found a significant association between continuous exposure to screen time (per 1 h/d increase) and myopia in cohort studies. The pooled ORs with 95%CIs were 1.07 (1.01-1.13). In subgroup analysis stratified by screen device type in cross-sectional studies, screen time exposures from computers (categorical: OR = 8.19, 95%CI: 4.78-14.04; continuous: OR = 1.22, 95%CI: 1.10-1.35) and televisions (categorical: OR = 1.46, 95%CI: 1.02-2.10) were associated with myopia, while smartphones were not. Although publication bias was detected, the pooled results did not show significant changes after adjustment using the trim and fill method.

CONCLUSION

Our findings support that screen time exposure was significantly associated with myopia in children and adolescents. Notably, screen time exposure from computers may have the most significant impact on myopia.

Home Learning Environment and Screen Time Differentially Mediate the Relationship Between Socioeconomic Status and Preschoolers' Learning and Behavioural Profiles

Environmental variables related to the home context, including home literacy and numeracy, screen exposure and Socioeconomic Status (SES) are potential risks or protective factors for children's academic achievements and behaviour. The present multi-informant study aims to contribute to this issue by investigating SES's direct and indirect relationships in early learning (i.e., literacy, numeracy, and cognitive) and behavioural skills within a large sample of young children. One parent and one teacher for each of 1660 preschoolers filled out a questionnaire investigating SES, tablet and TV use, home learning activities, behavioural problems/strengths (parents' questionnaire), and children's learning skills and behaviour (teachers' questionnaire). Results of path analysis showed that tablet time and home learning environment mediate the effect of SES on early learning as assessed by teachers; as for the home learning environment, it was also a mediator of the relationship between SES and behavioural problems. Implications of these results for research in the field and educational policies are discussed.

From temperament to YouTube: exploring the link between childhood temperament, YouTube usage patterns, and emotional/behavioral problems among children

BACKGROUND

YouTube is a widely used video sharing and social networking platform among children and adolescents. However, research on YouTube usage among this population remains scarce. Specifically, studies on factors that influence children and adolescents' usage are clinically significant but largely lacking. Additionally, few studies have examined the association between usage and emotional/behavioral problems, which is fundamental to smartphone research. Therefore, this study explored the relationship between early childhood temperament, subsequent YouTube usage patterns, and emotional/behavioral problems.

METHODS

The Kids Cohort for Understanding Internet Addiction Risk Factors in Early Childhood (K-CURE) is the first long-term prospective cohort study in Korea aimed at understanding the long-term effects of media exposure on young children. The study included 195 children aged 8-11 years enrolled in the K-CURE study. Caregivers, predominantly mothers, who voluntarily participated during their visits to community centers for children's mental health in Korea's major cities, completed a detailed self-administered survey. Childhood temperament was measured in 2018 when the children were 5-8 years old. Subsequent YouTube usage patterns and emotional/behavioral problems were assessed in 2021. Data were analyzed using frequency analysis, correlation analysis, and multiple linear regression.

RESULTS

The study found that 21.0% of children started using YouTube before age 4, with the most common onset age being 8-9 years (30.3%). These children used YouTube on average 4.8 days per week for 68.5 min per day. Early childhood persistence was negatively associated with the subsequent YouTube usage duration, and the age at first YouTube use was negatively correlated with subsequent usage frequency. Furthermore, a younger age at first YouTube use and higher usage frequency were significantly associated with increased emotional/behavioral problems.

CONCLUSIONS

In the YouTube environment, where content is automatically recommended based on user preferences, traits related to usage patterns may be associated with persistence, which is linked to self-regulation. Considering the current trend where children use smartphones, contents frequently for very short durations, our findings highlight the importance of self-regulation in the media usage of children who are still developing. Additionally, our results provide fundamental information for future YouTube studies and illustrate similarities and differences between smartphone and YouTube research.

The Neural Bases of Language Processing During Social and Non-Social Contexts: A fNIRS Study of Autistic and Neurotypical Preschool-Aged Children

Background

Little is known about how the brains of autistic children process language during real-world "social contexts," despite the fact that challenges with language, communication, and social interaction are core features of Autism Spectrum Disorder (ASD).

Methods

We investigated the neural bases of language processing during social and non-social contexts in a sample of N=20 autistic and N=20 neurotypical (NT) preschool-aged children, 3 to 6 years old. Functional near-infrared spectroscopy (fNIRS) was used to measure children's brain response to "live language" spoken by a live experimenter during an in-person social context (i.e., book reading), and "recorded language" played via an audio recording during a non-social context (i.e., screen time). We examined within-group and between-group differences in the strength and localization of brain response to live language and recorded language, as well as correlations between children's brain response and language skills measured by the Preschool Language Scales.

Results

In the NT group, brain response to live language was greater than brain response to recorded language in the right temporal parietal junction (TPJ). In the ASD group, the strength of brain response did not differ between conditions. The ASD group showed greater brain response to recorded language than the NT group in the right inferior and middle frontal gyrus (IMFG). Across groups, children's language skills were negatively associated with brain response to recorded language in the right IMFG, suggesting that processing recorded language required more cognitive effort for children with lower language skills. Children's language skills were also positively associated with the difference in brain response between conditions in the right TPJ, demonstrating that children who showed a greater difference in brain response to live language versus recorded language had higher language skills.

Limitations

Findings should be considered preliminary until they are replicated in a larger sample.

Conclusions

Findings suggest that the brains of NT children, but not autistic children, process language differently during social and non-social contexts. Individual differences in how the brain processes language during social and non-social contexts may help to explain why language skills are so variable across children with and without autism.

A brief tablet-based intervention benefits linguistic and communicative abilities in toddlers and preschoolers

Young children's linguistic and communicative abilities are foundational for their academic achievement and overall well-being. We present the positive outcomes of a brief tablet-based intervention aimed at teaching toddlers and preschoolers new word-object and letter-sound associations. We conducted two experiments, one involving toddlers ( ~ 24 months old, n = 101) and the other with preschoolers ( ~ 42 months old, n = 152). Using a pre-post equivalent group design, we measured the children's improvements in language and communication skills resulting from the intervention. Our results showed that the intervention benefited toddlers' verbal communication and preschoolers' speech comprehension. Additionally, it encouraged vocalizations in preschoolers and enhanced long-term memory for the associations taught in the study for all participants. In summary, our study demonstrates that the use of a ludic tablet-based intervention for teaching new vocabulary and pre-reading skills can improve young children's linguistic and communicative abilities, which are essential for future development.

Social interactions offset the detrimental effects of digital media use on children's vocabulary

Young children's rapid vocabulary growth during the first few years is supported by input during social interactions with caregivers and, increasingly, from digital media. However, the amount of exposure to both sources can vary substantially across socioeconomic classes, and little is known about how social interactions and digital media use together predict vocabulary in the first few years of life. The current study takes a first step toward examining whether increased social interactions with other individuals may buffer the potentially detrimental effects of digital media use on language among a socioeconomically diverse sample. 305 caregivers of children between 17 and 30-months completed questionnaires about their family demographics, their child's technology use, and the child's daily routines and social interactions. Findings suggest children who experience fewer human interactions and greater technology exposure have smaller vocabularies than their peers who socialize more and use less technology, and this disparity becomes greater as children get older. Moreover, the number of social interactions moderates the link between SES, digital media, and vocabulary such that the negative impact of digital media on vocabulary for children from low SES households can be offset with increased social interactions. Together, this suggests that increasing the amount of human interactions may serve as a protective factor for vocabulary outcomes in a world where digital media use is prominent.

Variability and patterns in children's media use and links with language development

AIM

Media use is widespread and rising, but how often and for what purpose young children use media varies, which has differential impacts on development. Yet little work has measured how and why children under 36 months use digital media or media's consequences for language.

METHODS

The current study measures how and why 17- to 30-month-old children use digital media and associations with their language abilities. The amount of use, type of activity and caregiver reasons for children's media use were then compared to the child's vocabulary and mean length of utterance.

RESULTS

About 17- to 30-month-old children are primarily exposed to TV/videos over other media forms, which are often used to occupy children. Video time (but not other activities) negatively predicts children's language. The negative impact of videos on vocabulary persists regardless of the reason for use, however, the effect of videos on expressive language may be tempered when videos are used for education or connecting.

CONCLUSION

Children under 36 months are using digital media at high rates. What they are doing and why they use media is critical to predict the effect it might have on language development. Further research and anticipatory guidance on the consequences of videos are needed.

Preschooler Screen Time During the Pandemic Is Prospectively Associated With Lower Achievement of Developmental Milestones

OBJECTIVE

The aim of this study was to assess the developmental risks associated with total screen time, and specifically newer mobile devices, in the context of the pandemic.

METHODS

This study uses parent-reported data from a prospective cohort of Canadian preschool-age children. The exposure variable is child daily screen time measured at the age of 3.5 years categorized as light (<1 hr/d), moderate (1-4 hr/d), or intensive (>4 hr/d) use (N = 315). Time spent on mobile devices was considered separately as a continuous variable. Our outcome is child global development scores, which combine assessments of communication, cognitive, personal-social, and motor skills measured at the age of 4.5 years using the Ages and Stages Questionnaire (ASQ) (N = 249, 79% retained). ASQ scores were dichotomized to distinguish children at risk of developmental delays (below the 15th percentile) from those not at risk. We estimate associations between child screen time and later global development using multiple regressions adjusted for child sex and temperament, and parent education. We also examine whether associations are moderated by child and parent characteristics.

RESULTS

Logistic regressions revealed that intensive users were more at risk of global developmental delays compared with light users (OR = 4.29, p = 0.020). Mobile device use was also associated with lower global scores (β = -3.064; p = 0.028), but not with risk of delays. We found no evidence that associations were moderated by child sex and temperament, or parent education.

CONCLUSION

The findings suggest that intensive screen time may be associated with delays in child global development. Early childhood professionals should encourage families with preschoolers to prioritize screen-free activities to promote optimal cognitive, language, social, and motor development.

Associations of screen use with cognitive development in early childhood: the ELFE birth cohort

BACKGROUND

The associations of screen use with children's cognition are not well evidenced and recent, large, longitudinal studies are needed. We aimed to assess the associations between screen use and cognitive development in the French nationwide birth cohort.

METHODS

Time and context of screen use were reported by parents at ages 2, 3.5 and 5.5. Vocabulary, non-verbal reasoning and general cognitive development were assessed with the MacArthur-Bates Communicative Development Inventory (MB) at age 2, the Picture Similarities subtest from the British Ability Scales (PS) at age 3.5 and the Child Development Inventory (CDI) at ages 3.5 and 5.5. Outcome variables were age-adjusted and standardized (mean = 100, SD = 15). Multiple imputations were performed among children (N = 13,763) with ≥1 screen use information and ≥1 cognitive measures. Cross-sectional and longitudinal associations between screen use and cognitive development were assessed by linear regression models adjusted for sociodemographic and birth factors related to the family and children, and children's lifestyle factors competing with screen use. Baseline cognitive scores were further considered in longitudinal analysis.

RESULTS

TV-on during family meals at age 2, not screen time, was associated with lower MB scores at age 2 (β [95% CI] = -1.67 [-2.21, -1.13]) and CDI scores at age 3.5 (-0.82 [-1.31, -0.33]). In cross-sectional analysis, screen time was negatively associated with CDI scores at ages 3.5 (-0.67 [-0.94, -0.40]) and 5.5 (-0.47 [-0.77, -0.16]), and, in contrast, was positively associated with PS scores (0.39 [0.07, 0.71]) at age 3.5. Screen time at age 3.5 years was not associated with CDI scores at age 5.5 years.

CONCLUSIONS

Our study found weak associations of screen use with cognition after controlling for sociodemographic and children's birth factors and lifestyle confounders, and suggests that the context of screen use matters, not solely screen time, in children's cognitive development.

Screen time and sleep duration in pediatric critical care: Secondary analysis of a pilot observational study

PURPOSE

Quantify and describe screen time (screen type, child engagement, adult co-viewing) in eight critically ill children and determine its association with sleep duration before (parent report) and during (actigraphy) a 24-h period in the PICU.

DESIGN AND METHODS

Exploratory secondary analysis of 24-h video and actigraphy recordings in eight children 1-4 years old in the PICU. Videos were coded for screen time using Noldus Observer XT® software. Screen time was compared to American Academy of Pediatrics recommendations (0 h/day <2 years, ≤1 h/day 2-5 years). Parents completed the Brief Infant Sleep Questionnaire-Revised-Short Form (BISQ-R-SF) to understand children's pre-hospital sleep. Actigraphy was used to measure PICU sleep duration. Associations between screen time and sleep were determined with bivariate analyses.

RESULTS

Average age was 23.1 months (SD = 9.7). Daily screen time was 10.7 h (SD = 7), ranging from 2.4 to 21.4 h. Children (15.1% of sampling intervals) and adults (16.3%) spent little time actively engaged with screen media. BISQ-R-SF scores ranged from 48.9 to 97.7. Children had an average of 7.9 (SD = 1.2) night shift (19:00-6:59) sleep hours. Screen time was associated with worse pre-hospital sleep quality and duration with large effect sizes (rs= -0.7 to -1) and fewer nighttime sleep hours with a medium effect size (rs= -0.5).

CONCLUSIONS

All children exceeded screen time recommendations. Screen time was associated with worse pre-hospital sleep quality and duration, and decreased PICU sleep duration. Large-scale studies are needed to explore PICU screen time and sleep disruption.

PRACTICE IMPLICATIONS

Clinicians should model developmentally appropriate screen media use in PICU.

Parental perspectives on the impact of screen time on the language skills of typically developing Indian children

PURPOSE

The overuse of screen-based devices results in developmental problems in children. Parents are an integral part of the children's language development. The present study explores the parental perspectives on the impact of screen time on the language skills of typically developing school-going children using a developed questionnaire.

METHODS

192 parents of typically developing children between 6 and 10 years of age participated in the study. Phase 1 of the study included the development of a questionnaire targeting the impact of screen devices on language development. The questionnaire was converted into an online survey and was circulated among the parents in Phase 2. Descriptive statistics were performed on the retrieved data and a chi-square test was done to determine the association between the use of screen devices across all language parameters.

RESULTS

Parents reported television and smartphones to be the most used type of device, with a large proportion of children using screen-based devices for 1-2 hours per day. Most parents reported children prefer watching screens mainly for entertainment purposes, occasionally under supervision, without depending on them as potential rewards. The impact of screen-based devices on language skills has been discussed under the semantics, syntax, and pragmatic aspects of language.

CONCLUSION

The findings of this study will help identify the existing trends in the usage of screen-based devices by children, thereby identifying potential contributing factors towards language delays. This information will also benefit in parental counselling during the interventional planning of children with language delays.

Mobile device screen time is associated with poorer language development among toddlers: results from a large-scale survey

BACKGROUND

Despite young children's widespread use of mobile devices, little research exists on this use and its association with children's language development. The aim of this study was to examine the associations between mobile device screen time and language comprehension and expressive language skills. An additional aim was to examine whether three factors related to the domestic learning environment modify the associations.

METHODS

The study uses data from the Danish large-scale survey TRACES among two- and three-year-old children (n = 31,125). Mobile device screen time was measured as time spent on mobile devices on a normal day. Measurement of language comprehension and expressive language skills was based on subscales from the Five to Fifteen Toddlers questionnaire. Multivariable linear regression was used to examine the association between child mobile device screen time and language development and logistic regression to examine the risk of experiencing significant language difficulties. Joint exposure analyses were used to examine the association between child mobile device screen time and language development difficulties in combination with three other factors related to the domestic learning environment: parental education, reading to the child and child TV/PC screen time.

RESULTS

High mobile device screen time of one hour or more per day was significantly associated with poorer language development scores and higher odds for both language comprehension difficulties (1-2 h: AOR = 1.30; ≥ 2 h: AOR = 1.42) and expressive language skills difficulties (1-2 h: AOR = 1.19; ≥ 2 h: AOR = 1.46). The results suggest that reading frequently to the child partly buffers the negative effect of high mobile device screen time on language comprehension difficulties but not on expressive language skills difficulties. No modifying effect of parental education and time spent by the child on TV/PC was found.

CONCLUSIONS

Mobile device screen time of one hour or more per day is associated with poorer language development among toddlers. Reading frequently to the child may have a buffering effect on language comprehension difficulties but not on expressive language skills difficulties.

Executive dysfunction as a possible mediator for the association between excessive screen time and problematic behaviors in preschoolers

Excessive screen time in children is a growing concern for parents and healthcare providers worldwide because it frequently leads to behavioral problems. Although executive dysfunction is proposed to be one of the contributing factors to maladaptive behaviors, little is known about the link between screen time and behaviors. This study aimed to identify whether executive dysfunction contributes to the negative behaviors of children exposed to excessive screen time. A cross-sectional study was conducted on preschool-aged children from public and private schools in Chiang Mai, Thailand. The parents/guardians of each child completed the questionnaires regarding clinical characteristics and screen time use, the Behavior Rating Inventory for Executive Function-Preschool (BRIEF-P), and the Strengths and Difficulties Questionnaire (SDQ). Children with more than one hour of media exposure per day were considered to have excessive screen time. Multivariable Gaussian regression was analyzed to compare the BRIEF-P and SDQ scores between the excessive and appropriate screen time groups. Causal mediation analysis was performed to examine the effects of total screen time on increasing behavioral problems with executive functioning as a mediator. A total of 1,126 preschoolers were included in the analyses. After controlling for age, sex, socioeconomic status, and maternal education, the excessive screen time group had significantly higher BRIEF-P global executive composite score than the appropriate screen time group (mean difference of global executive composite score = 1.49, 95% CI [0.12, 2.86], and p = 0.033). Concurrently, there were significant differences in externalizing behavior subscales and SDQ total difficulties scores between the excessive and appropriate screen time groups (mean difference of total difficulties score = 0.90, 95% CI [0.29, 1.50], and p = 0.004). A significant average causal mediation effect (ACME) of screen time on behavioral problems mediated through executive functioning was β = 0.28, 95% CI [0.13-0.44], which was more than half of the total effect (54.9%, 95% CI [37.4-100%]). The current study suggests that the increase in behavioral issues in preschoolers might be partly explained by the direct effect of excessive screen time and the mediating effect of impaired executive functioning. Our results may raise concerns about the necessity to limit screen time and monitor for executive function deficits and behavioral problems in young children with high screen time.

Screen Time and Parent-Child Talk When Children Are Aged 12 to 36 Months

Importance

Growing up in a language-rich home environment is important for children's language development in the early years. The concept of "technoference" (technology-based interference) suggests that screen time may be interfering with opportunities for talk and interactions between parent and child; however, limited longitudinal evidence exists exploring this association.

Objective

To investigate the longitudinal association between screen time and 3 measures of parent-child talk (adult words, child vocalizations, and conversational turns) when children are 12 to 36 months of age.

Design, Setting, and Participants

This Australian prospective cohort study used advanced speech recognition technology to capture young children's screen time and home language environment, on an average 16-hour day. Data were collected from 220 families once every 6 months in the family home when children were 12, 18, 24, 30, and 36 months of age, from January 1, 2018, to December 31, 2021. Statistical analysis took place from November 1, 2022, to July 31, 2023.

Exposure

Language Environment Analysis (LENA) technology provided automated counts of children's language environment and exposure to electronic noise. The exposure of interest was screen time, which was calculated based on manual coding of LENA electronic noise audio segments.

Main Outcomes and Measures

Three measures of parent-child talk were outcomes of focus: adult words, child vocalizations, and conversational turns. Separate models were run for each of the 3 outcomes and included adjustment for child sex, child age, maternal educational level, number of children at home, number of home activities, and primary caregiver's psychological distress.

Results

The study included 220 families (120 girls [54.6%]; mean [SD] gestational age of children, 39.3 [1.5] weeks; mean [SD] age of mother at childbirth, 31.3 [4.8] years). Adjusted linear mixed-effect models demonstrated that increases in screen time were associated with decreases in measures of parent-child talk. The largest decreases were seen at 36 months, when an additional minute of screen time was associated with a reduction of 6.6 (95% CI, -11.7 to -1.5) adult words, 4.9 (95% CI, -6.1 to -3.7) child vocalizations, and 1.1 (95% CI, -1.4 to -0.8) conversational turns.

Conclusion and Relevance

Findings of this study support the notion of technoference for Australian families, whereby young children's exposure to screen time is interfering with opportunities to talk and interact in their home environment. This finding has implications for interventions and supports aimed at promoting a language-rich home environment, with families needing support in understanding the potential association of screen time with opportunities for children and adults to talk and interact in their home environment.

Unsupervised Screen Exposure and Poor Language Development: A Scoping Review to Assess Current Evidence and Suggest Priorities for Research

Screen exposure has both negative and positive effects on the level of language skills a child acquires. The purpose of this review is to address current literature on the possible relationship between unsupervised screen exposure and language development in children and to provide recommendations to caregivers regarding screen exposure of children, taking into consideration the possible effects. A scoping review was conducted using the PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) database. A total of 590 articles were retrieved and considered for inclusion. Twenty-one articles were finally included and reviewed with an emphasis on language, communication, and executive skills as well as cognitive development. The negative effects of screen exposure for children outweigh the positive effects. The largest number of studies demonstrate that unsupervised screen exposure may negatively impact a child's language usage and cognitive and executive skills, disrupt playtime, and affect the quality of sleep. On the other hand, supervised screen use is associated with improved language skills. More evidence is needed on unsupervised exposure in children to new types of screens. As technology could play a significant role in schools in the future, additional research is required to create educational media for schoolchildren with specific guidelines.

A longitudinal study of the relationship between children's exposure to screen media and vocabulary development

AIM

This study addresses the scarcity of longitudinal research on the influence of screen media on children. It aims to explore the longitudinal relationship between children's vocabulary development and their exposure to screen media.

METHODS

The study, initiated in 2017, included 72 children (37 boys) in Östergötland, Sweden, at three key developmental stages: preverbal (9.7 months), early verbal (25.5 months) and preliterate (5.4 years). Parents completed online surveys at each time point, reporting their child's screen time. At 10 months and 2 years, age-appropriate vocabulary assessments were conducted online. At age 5, children's vocabulary was laboratory assessed.

RESULTS

Correlational analysis revealed a negative relationship between language scores and screen media use across all time points. Furthermore, a cross-lagged panel model demonstrated that screen media use showed significant continuity over time, with screen use at age 2 predicting language development at ages 2 and 5.

CONCLUSION

This longitudinal study, spanned from 9 months to 5 years of age, established a predictive negative association between children's exposure to screen media and their vocabulary development. These findings underscore the need to consider the impact of screen media on early childhood development and may inform guidelines for screen media use in young children.

Shut-up Toys for Second Language Learners: Impact of Digital Media on Early Adolescents' Private Speech Production in Individual and Collaborative Tasks

Researchers, parents, and policymakers from previous generations have recently expressed concern about the inevitable exposure of youngsters to digital media and its potentially detrimental effects on their development. Private speech is the overt audible self-talk people produce when engaged with challenging problem-solving tasks and is believed to aid in second language acquisition as reported (Vygotsky in Thought and language, MIT Press, 1962); (Winsler in Private Speech, Executive Functioning, and the Development of Verbal Self-Regulation, 2009). This qualitative case study explored private speech production in three young adolescents (two 11-year-olds and one 10-year-old) while completing an English as a foreign language task (Bingo! game) individually and collaboratively in physical and digital modes. Patterns of participants' private speech markers emerged from a thematic analysis of the transcribed oral interactions during eight sessions. The frequency of occurrence of the participants' private speech markers was reported and interpreted based on the emergent typology to compare collaborative and individual task completion in physical and digital modes. Regardless of the individual or collaborative nature of the task, private speech use decreased during the digital version of the game. However, collaborative tasks evoked more private speech from the participants regardless of modality. The findings of the study suggest digital media usage is likely to hinder private speech production for self-regulatory purposes in young adolescents, even in collaboration with peers.

The relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants: The mediating role of shared viewing and parent-child conversation

OBJECTIVE

To explore the relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants, and to examine whether shared viewing and parent-child conversation during screen exposure may play mediating role in that relationships.

METHODS

The sample included 437 infants aged 8 months from the Children's Health Department of Guiyang Maternal and Child Health Hospital during January 2022 to February 2023. The use of electronic screen devices was assessed using a screen exposure questionnaire. The Brigance Parent-child interactions Scale was used to assess parent-child interactions and the Putonghua Communicative Development Inventory (PCDI) scale was used to assess infants' word comprehension.

RESULTS

48.7% of infants were found to be using screens 1-2 days per week. There was a significant difference (p < 0.05) in the PCDI-comprehension scores of screen-exposed infants compared to non-screen-exposed infants. Shared viewing and parent-child conversation during screen exposure were positively associated with parent-child interactions (p < 0.05). Mediation analysis revealed that parent-child conversation fully mediated between screen exposure and PCDI-comprehension, but partially mediated between parent-child interactions and PCDI-comprehension.

CONCLUSIONS

Shared viewing and parent-child conversation during screen exposure may mediate between screen exposure and comprehension development. Shared viewing, parent-child conversation and parent-child interactions may be protective factors for screen exposure in comprehension development. Suggests that parents should accompany and communicate with their children when they use electronic screen devices to reduce the negative impact of screen exposure on children's comprehension.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

Associations between excessive screen time and school and out-of-school injuries among adolescents: A population-based study

Most adolescents spend excessive screen time (with television viewing, computer/console gaming, discussion forums/chatting online, internet surfing, doing homework, and electronic mails) which may impact the occurring of various types of school and out-of-school injuries. We assessed their associations and potential confounding factors among 1559 middle-school students from north-eastern France (mean age=13.5 ± 1.3). Participants 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 (TDST) was defined as their sum, categorized into <7/7-11/≥12), various injury types during the school-year, behavior and health difficulties (BHDs; alcohol/tobacco/cannabis/other illicit drugs use, suffered physical/verbal violence, sexual abuse, poor family-peer support, sleep difficulty, depressive symptoms, suicide attempt, and time at onset). Most subjects had TDST≥7 (82.3 %). There were dose-effect associations of TDST with school-physical/sports training, school-free-time, out-of-school-sports, and single/repeated injuries (sex-age-adjusted odds ratio reaching 4.45). BHDs explained up to 39 % of these associations. The frequency of subjects without various BHDs decreased with age since age 10 more quickly among the participants with both TDST≥7 and injury than among the others. Our findings may inform health care providers, parents, schools, and public policy that reducing elevated screen time is efficient to prevent injuries and BHDs among adolescents.

Cross-sectional and prospective associations between screen time and childhood neurodevelopment in two Brazilian cohorts born 11 years apart

BACKGROUND

The aim of this study was to investigate the associations between screen time from ages 2 to 4 years and child neurodevelopment at age 4.

METHODS

The participants were from the 2004 (N = 3787) and 2015 (N = 3604) Pelotas (Brazil) birth cohort studies. Childhood neurodevelopment was assessed at age 4 using the Battelle Development Inventory. The time children spent on screen devices was reported by their guardians at ages 2 and 4 years. Linear regression models were used to investigate the association of: (i) time spent on television at ages 2 and 4 years; (ii) time spent on other screens at age 4; and (iii) total screen time at age 4 (television + other screens) with childhood neurodevelopment at age 4.

RESULTS

Average daily screen time among children born in 2004 and those born in 2005 aged 4 years were 3.4 (SD: 2.4) and 4.4 h (SD: 2.9), respectively. Overall, few associations of very small magnitude between screen time and child neurodevelopment were observed. Television time at 2 years of age was statistically associated with lower neurodevelopment at 4 years of age in the 2015 cohort (β = -0.30, 95%CI = -0.55; -0.05). Conversely, television time (β = 0.17, 95%CI = 0.07, 0.26) and total screen time (β = 0.22, 95%CI = 0.13, 0.31) at age 4 were associated with higher neurodevelopment at age 4 in the 2004 cohort.

CONCLUSIONS

The findings of this study suggest that the amount of time spent on screen devices might not be associated with neurodevelopment of children under 5 years of age. The small magnitude and inconsistencies in the direction of associations did not find evidence to support the current guidelines for screen time at this age. Therefore, more studies, especially those with longitudinal data, are important to comprehend the true effect of screen time on neurodevelopment and other health outcomes.

The Relationship between Language and Technology: How Screen Time Affects Language Development in Early Life-A Systematic Review

Screen time refers to the amount of time a child is exposed to a screen, that is, television, computer, smartphone, or any other digital medium. Prolonged screen time in the first years of life may affect a child's cognitive abilities, especially language acquisition. A systematic review was conducted, following the PRISMA-P guidelines, with the aim to explore the available literature relating to the impact of screen time on children's language development. This review identified 18 articles. The articles reviewed showed that prolonged screen time and exposure to screens in the first 2 years of life can negatively affect language development and communication skills, in terms of comprehension and vocabulary range. In addition, overexposure to screens in the early years can affect overall cognitive development, especially attention to environmental stimuli, social experiences, problem solving, and communication with others, e.g., the alternance of rhythms and roles in a conversation. In conclusion, our systematic review supports the idea that preschool screen time has negative effects on children's cognitive and language development. Television seems to be the medium most detrimental to children's skills, as it is used in a passive manner and is often characterised by language and content that do not suit the child's processing mode. Future studies should increasingly focus on the digital media that children possess at an early age, such as mobile phones and tablets, and on how children relate to the online world, such as social networks.

Intelligence-Dependent Differential Effects of Media Exposure on Executive Function Changes in Children: A Population-Based Cohort Study With a Longitudinal Design

BACKGROUND

Excessive media use is known to be associated with executive dysfunction in children, but it's unclear whether this exposure can lead to long-term changes of executive function. This study aimed to investigate the association between media exposure and longitudinal changes in executive function within a population-based study, while considering the potential influence of intelligence.

METHODS

This study used data from 1,209 participants in the Panel Korea Study for Children. The children's media exposure was measured at ages 7 and 8, and executive function was evaluated annually from ages 7 to 10 using the Executive Function Difficulty Screening Questionnaire. Participants were grouped by media exposure level (low, medium, or high), and longitudinal changes in executive function were analyzed using linear mixed effects models. Subgroup analysis was conducted to investigate how executive function changes varied based on intelligence within each media exposure group.

RESULTS

Children with high media exposure (n = 97) had severer executive function difficulties than those with low (n = 141) or medium (n = 971) exposure in all waves. The high exposure group demonstrated persistent higher executive function difficulties up to age 10 after controlling for child gender, intelligence, parental education level and maternal depression. Children with intelligence quotient (IQ) ≤ 100 in the medium to high media exposure group had significantly more severe executive function difficulties than those with IQ > 100.

CONCLUSION

This study provided evidence of a longitudinal negative association between media exposure and executive function. The findings suggest that excessive media exposure may lead to long-term changes in executive function in children and highlight the importance of implementing targeted interventions and educational strategies to mitigate the potential negative effects of excessive media use, particularly for children with lower cognitive abilities.

Associations between Parental Factors and Children's Screen Time During the COVID-19 Pandemic in South Korea

This study investigated how parental depression, parental self-care, family conflict, and parental fear of COVID-19 are associated with children's screen time during the COVID-19 pandemic. Data were collected online among South Korean families, resulting in 246 parents (59% fathers) with children between 6 and 12 years of age. Path analysis and multi-group structural equation modelling of fathers and mothers were conducted. Parent's fear of COVID-19 was positively associated with parental depression. Parent's fear of COVID-19 and parental depression were negatively related to parental self-care, which was negatively linked to family conflict. Family conflict was positively associated with children's screen time. The relationships between parental factors and children's screen time were different for mothers and fathers. Our results show that multiple family dynamics interact with children's screen time, emphasizing the need to look beyond parenting practices in understanding the effects of COVID-19 pandemic on children's screen time.

Ground Rules for Preschooler Exposure to the Digital Environment: A Review of Studies

Background

The range of digital technologies that children use from an early age has expanded significantly. Most studies demonstrate that preschoolers now spend substantially longer on digital devices and start using them at a younger age. Finding a solution for this challenge has research merits and relevance, as the data on benefits and harm of early preschoolers' exposure to digital devices is contradictory. This poses a need to determine theoretically sound and practically validated criteria that could guide the duration and quality of children's exposure to the digital environment.

Objective

To review studies that contain recommendations on preschoolers' exposure to the digital environment, namely, exposure limits and evidence to justify the limitation of preschoolers' time on digital media.

Design

The analysis starts by identifying theoretical foundations that researchers use in their studies of children's behavior in the digital environment. This is followed by an overview of 40 studies that include research papers, official reports, and methodological recommendations made by healthcare and governmental organizations.

Results

The review identified the following ground rules for children's exposure to the digital environment: to provide for child's interaction with a digital device, to use educational applications that will develop skills appropriate to the child's age, to ensure mandatory supervision of children's engagement by an adult who limits the exposure according to child's age-related capabilities and creates conditions for active exploration of the real rather than a virtual world. Children's cognitive development suffers the most from passive intake of digital content.

Conclusion

The data herein can help to develop strategies to promote healthy and educational engagement of children with digital devices and media; however, the review highlights the insufficiency of psychophysiological research that would make it possible to practically validate the recommendations on the duration of preschoolers' exposure to the digital environment.

Managing Screen Use in the Under-Fives: Recommendations for Parenting Intervention Development

The impact of excessive screen use on children's health and development is a public health concern and many countries have published recommendations to limit and guide the use of screen media in childhood. Despite this, international studies report that the majority of parents and children do not adhere to screen use recommendations. Existing research aiming to understand children' screen use has largely focused on older children, and on demographic and structural aspects of the child's environment. Parents play a central role in determining young children's screen use and identify numerous barriers to developing healthy screen use practices with their children. However, no clear models exist that incorporate key parenting factors in understanding children's screen use, which presents an impediment to intervention development. Likewise, while some evidence exists for interventions to improve children's screen use behaviours, most are focused on older children and parental involvement has generally been limited. In this paper, we overview key factors associated with screen use in young children (< 5 years) and summarise the existing evidence base for interventions designed to support healthy screen use. This paper proposes a conceptual model linking aspects of parenting and the socio-ecological environment to young children's screen use. Our proposed model could be used to design longitudinal studies of screen use predictors and outcomes, and inform intervention development. Finally, the paper provides key recommendations for future research, intervention development and testing.

Screen Time and Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Importance

Contemporary studies raise concerns regarding the implications of excessive screen time on the development of autism spectrum disorder (ASD). However, the existing literature consists of mixed and unquantified findings.

Objective

To conduct a systematic review and meta-analyis of the association between screen time and ASD.

Data Sources

A search was conducted in the PubMed, PsycNET, and ProQuest Dissertation & Theses Global databases for studies published up to May 1, 2023.

Study Selection

The search was conducted independently by 2 authors. Included studies comprised empirical, peer-reviewed articles or dissertations published in English with statistics from which relevant effect sizes could be calculated. Discrepancies were resolved by consensus.

Data Extraction and Synthesis

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Two authors independently coded all titles and abstracts, reviewed full-text articles against the inclusion and exclusion criteria, and resolved all discrepancies by consensus. Effect sizes were transformed into log odds ratios (ORs) and analyzed using a random-effects meta-analysis and mixed-effects meta-regression. Study quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Publication bias was tested via the Egger z test for funnel plot asymmetry. Data analysis was performed in June 2023.

Main Outcomes and Measures

The 2 main variables of interest in this study were screen time and ASD. Screen time was defined as hours of screen use per day or per week, and ASD was defined as an ASD clinical diagnosis (yes or no) or ASD symptoms. The meta-regression considered screen type (ie, general use of screens, television, video games, computers, smartphones, and social media), age group (children vs adults or heterogenous age groups), and type of ASD measure (clinical diagnosis vs ASD symptoms).

Results

Of the 4682 records identified, 46 studies with a total of 562 131 participants met the inclusion criteria. The studies were observational (5 were longitudinal and 41 were cross-sectional) and included 66 relevant effect sizes. The meta-analysis resulted in a positive summary effect size (log OR, 0.54 [95% CI, 0.34 to 0.74]). A trim-and-fill correction for a significant publication bias (Egger z = 2.15; P = .03) resulted in a substantially decreased and nonsignificant effect size (log OR, 0.22 [95% CI, -0.004 to 0.44]). The meta-regression results suggested that the positive summary effect size was only significant in studies targeting general screen use (β [SE] = 0.73 [0.34]; t58 = 2.10; P = .03). This effect size was most dominant in studies of children (log OR, 0.98 [95% CI, 0.66 to 1.29]). Interestingly, a negative summary effect size was observed in studies investigating associations between social media and ASD (log OR, -1.24 [95% CI, -1.51 to -0.96]).

Conclusions and Relevance

The findings of this systematic review and meta-analysis suggest that the proclaimed association between screen use and ASD is not sufficiently supported in the existing literature. Although excessive screen use may pose developmental risks, the mixed findings, the small effect sizes (especially when considering the observed publication bias), and the correlational nature of the available research require further scientific investigation. These findings also do not rule out the complementary hypothesis that children with ASD may prioritize screen activities to avoid social challenges.

The Dark Side of Multimedia Devices: Negative Consequences for Socioemotional Development in Early Childhood

There is growing concern about the relationship between screen use by young children and negative effects on their development, as children with developmental and socioemotional impairments tend to have difficulties in their relationships and increased academic problems. The aim of our study was to analyse the relationship between the use of multimedia devices and paediatric symptoms in children below 5 years old. Data from 534 Portuguese parents of children aged from 18 to 57 months were collected via a self-report questionnaire. Children's daily exposure to multimedia devices was nearly 2 h per day. Paediatric symptoms were positively associated with watching television and screen time and negatively associated with parents' working hours. Touchscreen use was more frequent among girls and older children. Parents' working hours comprised the most significant predictor of paediatric symptoms. Our findings reinforce past findings on the adverse links between the use of multimedia devices and paediatric symptoms and also highlight the influence of other variables like the child's age and gender, as well as parental factors. The need to both create a more comprehensive framework regarding the long-term effects of multimedia device use and delineate effective strategies for prevention and intervention with parents and children is discussed.

Knowledge is power: Relationship between professional recommendations, maternal attitudes, and screen time exposure of infants

PURPOSE

The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend infants avoid screen media exposure, yet most infants are regularly exposed. This study aimed to explore screen exposure, maternal attitudes regarding screen media effects, and pediatricians' recommendations to better understand widespread screen media use with infants younger than 18 months of age in hopes of informing mitigation efforts.

DESIGN AND METHODS

Surveys consisting of 10 Likert-style questions were distributed real-time to a purposive sample of 193 mothers with infants 18 months of age or younger in Georgia, Pennsylvania, and New York.

RESULTS

Seventy-nine percent of infants exceeded AAP/WHO guidelines and 61% of respondents couldn't recall receiving pediatrician recommendations regarding screen exposure for their infant. Mothers with higher levels of education were associated with an accurate reflection of the adverse effects of screen usage on infant development (ANOVA; F = 10.122; df = 3; p < .001). Accurate maternal attitudes regarding adverse effects on infants was associated with less daily screen exposure (Spearman correlation; r = -0.428; p < .001).

CONCLUSIONS

Findings suggest that knowledge about adverse side effects of screen media usage with infants is associated with less daily exposure; and, that pediatricians may not routinely review guidelines for infants with their families, underscoring the importance of other methods of knowledge dissemination.

PRACTICE IMPLICATIONS

Nurses, as trusted healthcare providers, can provide counseling on infant screen media usage creating an opportunity for augmented knowledge dissemination across maternal demographics potentially leading to less screen exposure in this vulnerable population.

Media Parenting Scale for School-Aged Children (MEPA-20): Psychometric Properties of the Turkish Version

BACKGROUND AND PURPOSE

Media parenting refers to the strategies and behaviors parents use to interact with their children regarding the amount, content, and context of screen use. Children's media/screen use is a significant indicator of media parenting practices. Therefore, this study aimed to determine the psychometric properties of the Turkish version of the Media Parenting Scale for School-Aged Children (MEPA-20).

METHODS

This methodological study involved 524 parents with children aged 6-10 and was conducted between October 15, 2022, and February 15, 2023. In the data analysis, the Content Validity Index, Explanatory and Confirmatory Factor Analyses, Cronbach's alpha, Test-retest reliability, Hotelling T2 test, and item-total score correlation were used. The test-retest reliability analysis of the Turkish version of MEPA-20 was performed with 30 parents after 4 weeks.

RESULTS

MEPA-20 consists of 20 items and three sub-dimensions (active, restrictive, and over-protective mediation). The MEPA-20 Turkish version and its three factors were found to indicate acceptable levels of internal consistency and reliability. The three-factor construct validity of the MEPA-20 Turkish version determined with Explanatory Factor Analyses was successfully confirmed with Confirmatory Factor Analysis.

CONCLUSION

The MEPA-20 is a valid and reliable tool for assessing the media parenting practices of parents of children aged 6-10 years in the Turkish population.

PRACTICE IMPLICATIONS

Based on the impact of media parenting practices on child and family health, nurses should raise awareness and support parents regarding children's healthy screen use.

Consideration of Developmental Stage and the Debate on the Effects of Screens Use-Not All Things Are Created Equal

This Viewpoint discusses the role of childhood developmental stage in research evaluating the effects of screen use among youth and its application to practice, policy, and the public.

Screen Time and Developmental Performance Among Children at 1-3 Years of Age in the Japan Environment and Children's Study

Importance

It is unclear whether increased television (TV) and DVD viewing in early childhood from age 1 year decreases development or whether poor development increases TV/DVD viewing.

Objective

To investigate the directional association between TV/DVD screen time and performance on developmental screeners in children aged 1 to 3 years.

Design, Setting, and Participants

This longitudinal cohort study analyzed data from 57 980 children and mothers from a national birth cohort, the Japan Environment and Children's Study. Data were collected in collaboration with 15 regional centers across Japan. The mothers were recruited between January 2011 and March 2014. Analyses using random intercept, cross-lagged panel models were performed for children aged 1, 2, and 3 years. Of 100 303 live births, children with missing developmental screening test scores and screen time data, those with congenital diseases or cerebral palsy, and those diagnosed with an autism spectrum disorder were excluded. Statistical analyses were conducted from October 2022 to July 2023.

Exposures

TV and DVD screen time.

Main Outcomes and Measures

Child development at ages 1, 2, and 3 years was assessed via the mother's or guardian's report using the Ages and Stages Questionnaire, third edition.

Results

Of 57 980 included children, 29 418 (50.7%) were male, and the mean (SD) maternal age at delivery was 31.5 (4.9) years. A negative association between screen time and developmental scores was observed. Increased TV/DVD screen times at age 1 and 2 years were associated with lower developmental scores at age 2 and 3 years, respectively (2 years: β = -0.05; 95% CI, -0.06 to -0.04; 3 years: β = -0.08; 95% CI, -0.09 to -0.06). An obverse association was observed from the Ages and Stages Questionnaires, third edition, score in the communication domain at age 1 and 2 years to subsequent screen time (2 years: γ = -0.03; 95% CI, -0.04 to -0.02; 3 years: γ = -0.06; 95% CI, -0.07 to -0.04).

Conclusions and Relevance

In this study, increased TV/DVD screen time from age 1 year negatively affected later development. To reduce the negative consequences of excessive media use, researchers and health care professionals should encourage family media management and recommend social support for parents who tend to rely on the media.

Screen Time and Its Health Consequences in Children and Adolescents

Nowadays, children and adolescents are exposed to digital media (DM) from an early age. Therefore, specific guidelines have been published by the World Health Organization, whose aim is to limit daily screen time (ST) viewing. However, during the COVID-19 pandemic, a rise in DM use, and consequently ST viewing, was observed. More and more aspects of modern life are thought to be affected by excessive ST viewing. Accordingly, the aim of this review is to document the health effects of excessive ST viewing on children and adolescents. A narrative review was performed in searchable databases. In total, 43 original articles were considered. Excessive ST viewing was correlated with increased risk for obesity and other cardiometabolic risk factors, mental health, unhealthy dietary habits and eating disorders, and problems in development and child-parent relationships. Sleep, physical activity, eyesight, headaches, and the musculoskeletal system were negatively affected as well. However, the effect of ST was weighted by the type of media used and the way types of media were used. Other confounding factors were reported. There is evidence to suggest a negative correlation between excessive ST and youth health exists. Nevertheless, more research is needed if this correlation is to be established.

Exposure to Spoken Communication During the COVID-19 Pandemic Among Children With Cochlear Implants

Importance

School closures and other COVID-19-related restrictions could decrease children's exposure to speech during important stages of development.

Objective

To assess whether significant decreases in exposure to spoken communication found during the initial phase of the COVID-19 pandemic among children using cochlear implants are confirmed for a larger cohort of children and were sustained over the first years of the COVID-19 pandemic.

Design, Setting, and Participants

This cohort study used datalogs collected from children with cochlear implants during clinical visits to a tertiary pediatric hospital in Toronto, Ontario, Canada, from January 1, 2018, to November 11, 2021. Children with severe to profound hearing loss using cochlear implants were studied because their devices monitored and cataloged levels and types of sounds during hourly use per day (datalogs) and because their hearing and spoken language development was particularly vulnerable to reduced sound exposure. Statistical analyses were conducted between January 2022 and August 2023.

Main Outcomes and Measures

Daily hours of sound were captured by the cochlear implant datalogging system and categorized into 6 auditory scene categories, including speech and speech-in-noise. Time exposed to speech was calculated as the sum of daily hours in speech and daily hours in speech-in-noise. Residual hearing in the ear without an implant of children with unilateral cochlear implants was measured by pure tone audiometry. Mixed-model regression analyses revealed main effects with post hoc adjustment of 95% CIs using the Satterthwaite method.

Results

Datalogs (n = 2746) from 262 children (137 with simultaneous bilateral cochlear implants [74 boys (54.0%); mean (SD) age, 5.8 (3.5 years)], 38 with sequential bilateral cochlear implants [24 boys (63.2%); mean (SD) age, 9.1 (4.2) years], and 87 with unilateral cochlear implants [40 boys (46.0%); mean (SD) age, 7.9 (4.6) years]) who were preschool aged (n = 103) and school aged (n = 159) before the COVID-19 pandemic were included in analyses. There was a slight increase in use among preschool-aged bilateral cochlear implant users through the pandemic (early pandemic, 1.4 h/d [95% CI, 0.3-2.5 h/d]; late pandemic, 2.3 h/d [95% CI, 0.6-4.0 h/d]) and little change in use among school-aged bilateral cochlear implant users (early pandemic, -0.6 h/d [95% CI, -1.1 to -0.05 h/d]; late pandemic, -0.3 h/d [95% CI, -0.9 to 0.4 h/d]). However, use decreased during the late pandemic period among school-aged children with unilateral cochlear implants (-1.8 h/d [95% CI,-3.0 to -0.6 h/d]), particularly among children with good residual hearing in the ear without an implant. Prior to the pandemic, children were exposed to speech for approximately 50% of the time they used their cochlear implants (preschool-aged children: bilateral cochlear implants, 46.6% [95% CI, 46.5%-47.2%] and unilateral cochlear implants, 52.1% [95% CI, 50.7%-53.5%]; school-aged children: bilateral cochlear implants, 47.6% [95% CI, 46.8%-48.4%] and unilateral cochlear implants, 51.0% [95% CI, 49.4%-52.6%]). School-aged children in both groups experienced significantly decreased speech exposure in the early pandemic period (bilateral cochlear implants, -12.1% [-14.6% to -9.4%]; unilateral cochlear implants, -15.5% [-20.4% to -10.7%]) and late pandemic periods (bilateral cochlear implants, -5.3% [-8.0% to -2.6%]; unilateral cochlear implants, -11.2% [-15.3% to -7.1%]) compared with the prepandemic baseline.

Conclusions and Relevance

This cohort study using datalogs from children using cochlear implants suggests that a sustained reduction in children's access to spoken communication was found during more than 2 years of COVID-19 pandemic-related lockdowns and school closures.

Screen Time at Age 1 Year and Communication and Problem-Solving Developmental Delay at 2 and 4 Years

Importance

Whether some domains of child development are specifically associated with screen time and whether the association continues with age remain unknown.

Objective

To examine the association between screen time exposure among children aged 1 year and 5 domains of developmental delay (communication, gross motor, fine motor, problem-solving, and personal and social skills) at age 2 and 4 years.

Design, Participants, and Setting

This cohort study was conducted under the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Pregnant women at 50 obstetric clinics and hospitals in the Miyagi and Iwate prefectures in Japan were recruited into the study between July 2013 and March 2017. The information was collected prospectively, and 7097 mother-child pairs were included in the analysis. Data analysis was performed on March 20, 2023.

Exposure

Four categories of screen time exposure were identified for children aged 1 year (<1, 1 to <2, 2 to <4, or ≥4 h/d).

Main Outcomes and Measures

Developmental delays in the 5 domains for children aged 2 and 4 years were assessed using the Japanese version of the Ages & Stages Questionnaires, Third Edition. Each domain ranged from 0 to 60 points. Developmental delay was defined if the total score for each domain was less than 2 SDs from its mean score.

Results

Of the 7097 children in this study, 3674 were boys (51.8%) and 3423 were girls (48.2%). With regard to screen time exposure per day, 3440 children (48.5%) had less than 1 hour, 2095 (29.5%) had 1 to less than 2 hours, 1272 (17.9%) had 2 to less than 4 hours, and 290 (4.1%) had 4 or more hours. Children's screen time was associated with a higher risk of developmental delay at age 2 years in the communication (odds ratio [OR], 1.61 [95% CI, 1.23-2.10] for 1 to <2 h/d; 2.04 [1.52-2.74] for 2 to <4 h/d; 4.78 [3.24-7.06] for ≥4 vs <1 h/d), fine motor (1.74 [1.09-2.79] for ≥4 vs <1 h/d), problem-solving (1.40 [1.02-1.92] for 2 to <4 h/d; 2.67 [1.72-4.14] for ≥4 vs <1 h/d), and personal and social skills (2.10 [1.39-3.18] for ≥4 vs <1 h/d) domains. Regarding risk of developmental delay at age 4 years, associations were identified in the communication (OR, 1.64 [95% CI, 1.20-2.25] for 2 to <4 h/d; 2.68 [1.68-4.27] for ≥4 vs <1 h/d) and problem-solving (1.91 [1.17-3.14] for ≥4 vs <1 h/d) domains.

Conclusions and Relevance

In this study, greater screen time for children aged 1 year was associated with developmental delays in communication and problem-solving at ages 2 and 4 years. These findings suggest that domains of developmental delay should be considered separately in future discussions on screen time and child development.

Shyness and Socio-Emotional Adjustment among Young Chinese Children: The Moderating Role of Screen Time

The primary aim of the present study was to examine the potential moderating role of screen time in the links between shyness and indices of socio-emotional adjustment in young Chinese children. Participants were N = 211 children (112 boys, 99 girls) ages 43-66 months (M = 58.84 months, SD = 5.32) recruited from two public kindergartens in Shanghai, People's Republic of China. Mothers completed assessments of children's shyness and screen time, and both mothers and teachers completed measures of indices of children's socio-emotional functioning (prosocial, internalizing problems, learning problems). Among the results, shyness was positively associated with internalizing problems and negatively associated with prosocial behavior, whereas screen time was positively associated with internalizing problems. However, several significant shyness × screen time interaction effects were observed. The pattern of these results consistently revealed that at higher levels of screen time, links between shyness and indices of socio-emotional difficulties were exacerbated. Results are discussed in terms of the implications of shyness and screen time in early childhood.

Relationship Between Speech Delay and Smart Media in Children: A Systematic Review

The increasing prevalence of smart media usage among children has raised concerns about its potential impact on various aspects of child development. One such area of worry is speech delay, as early language acquisition is critical for cognitive, social, and educational development. The purpose of this systematic review was to investigate and synthesize available research data in order to determine the association between speech delay and the usage of smart media in children. To perform this systematic review, a thorough literature search was conducted using relevant keywords in electronic databases, such as PubMed, Scopus, PsycINFO, Google Scholar, Web of Science, and Embase. We included studies published during the last 10 years investigating the impact of smart media on children's speech delay using various research designs. The findings showed that extended exposure to electronic media for children was negatively associated with expressive vocabulary and language skills in children, in addition to decreased language scores and speech delays. Educational apps and shared media engagement with parents correlated with stronger language skills. The introduction of smart devices at a later stage of development (24 months of age and older) was associated with positive language development, whereas early introduction was associated with speech delay. However, six-month abstinence from devices led to speech improvement in the affected children. These findings highlight the need to balance interactive screen time and other forms of interaction to enhance speech development.

Screen media exposure and young children's vocabulary learning and development: A meta-analysis

This meta-analysis synthesizes research on media use in early childhood (0-6 years), word-learning, and vocabulary size. Multi-level analyses included 266 effect sizes from 63 studies (Ntotal  = 11,413) published between 1988-2022. Among samples with information about race/ethnicity (51%) and sex/gender (73%), most were majority White/Non-Hispanic and between 40%-60% female. Analyses revealed a small overall positive relation between screen media exposure and vocabulary (r = .23). Experimental studies yielded a small-to-medium effect (r = .30), with stronger effects for e-books than TV/video or games/apps, and non-significant effects for video chat. In correlational studies, there was no overall association between vocabulary size and naturalistic media exposure (r = .07), with the exception of naturalistic exposure to educational media (r = .17).

"They Can't Believe They're a Tiger": Insights from pediatric speech-language pathologist mobile app users and app designers

BACKGROUND

Children with communication disorders experience difficulty in one or more areas of articulation and speech, language, fluency, voice and social communication, and they work with speech-language pathologists (SLPs) to improve their communication. With the rise of adoption and use for mobile applications among special education and healthcare service providers, SLPs also have implemented, and for some, contributed to the design of, mobile applications (apps) during clinical practice. However, how these mobile apps are designed and implemented for clinicians to facilitate their clients' communication and learning experiences during therapy remains underinvestigated.

AIMS

This qualitative research study investigated how mobile apps were designed for clinicians to target assessment and intervention goals. Additionally, it focused on how clinicians adopted these apps while integrating therapy techniques to facilitate their clients' learning.

METHODS AND PROCEDURES

Informed by the Research, Practice, and Design for iPad Apps (iRPD) framework and the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with 37 licensed pediatric SLPs, including 23 SLPs who have used apps and 14 SLPs who have contributed to the design of their own mobile apps. Two rounds of qualitative coding via template analysis and thematic analysis were then used to analyse client and clinician characteristics, clinical practice, therapy tools, app characteristics, influential factors and app design and use recommendations.

OUTCOMES AND RESULTS

Results showed SLPs utilise different genres of assistive, educational and recreational game apps to support children's communication development when working with children who have diverse disorders and therapy needs across different age groups. SLPs who have designed their own apps emphasised the importance of following evidence-based practice, well-researched teaching methods and learning theories. Additionally, multiple financial, sociocultural, political and ethical factors contributed to the design, adoption and implementation of mobile apps during services.

CONCLUSIONS AND IMPLICATIONS

By understanding the clinician's app use practices situated in various therapy activities and techniques, we specified a list of design recommendations for app designers who are interested in creating mobile apps for supporting children's speech and language development. By bringing insights from both clinical practitioners as well as those with additional technical design backgrounds, this study contributes to the understanding of clinical practice needs and strategies and will lead to the most optimal app design and adoption practice to support the well-being of children with communication disorders.

WHAT THIS PAPER ADDS

What is already known on the subject Speech language pathologist (SLPs) implement mobile apps for clients with diverse therapy needs, and their app adoption and use are influenced by multifaceted factors. Although prior studies have reported SLPs' mobile app use, additional information is still needed. For example, the research literature does not include how specific technology is used during therapy practice, or specific details about challenges and needs in implementing and utilising the technology. Additional research also needs to include influential factors (e.g., financial, sociocultural, political, ethical) that are considered when selecting, implementing, assessing and designing an app. The lack of research in these areas directly affects the understanding of clinical mobile technology practices and further hinders clinicians' abilities to advocate for better clinical and design decisions towards identifying and implementing effective mobile apps that facilitate children's communication. What this study adds to existing knowledge This qualitative study is the first known empirical research that interviewed pediatric speech-language pathologists who have used and designed mobile apps for children who receive speech-language therapy across different clinical settings. By investigating experiences from clinician stakeholders to illustrate a holistic overview of app design and development to deployment, this study reported finding on (1) how clinicians use mobile apps to help children to participate in different therapy activities, and (2) a list of recommended design and development guidelines that informs the design and use of mobile apps that best support and motivate children to engage in therapy. What are the potential or actual clinical implications of this work? This study disseminates clinician-reported practices of app design and use with pediatric clients across different speech-language disorders, and identifies gaps and needs for clinicians and researchers who are interested in understanding the role of mobile technology in relationship to human communication and interaction. Additionally, the paper demonstrates that SLPs have instrumental roles rather than passive users in influencing the design and implementation of different genres of mobile apps through evidence-based clinical practice, and call for partnerships across clinicians, special educators and technologists to support children's communication development.

Parental Regulation of Parent and Child Screen-Based Device Use

Media use and screen time show both positive and negative effects on child development. Parents' behaviors, perceptions, and regulation of parent and child screen-based device (SBD) use may be critical understudied factors in explaining these mixed effects. We developed the Parent Screen-Based Device Use Survey (PSUS) to assess parental use of multiple SBDs (e.g., computers, phones, TVs) and tested its factor structure across two United States samples of mothers of children aged 2 to 6 years old (total N = 402). Subscales captured parental SBD use related to Discipline, Limit-Setting, Involvement, Child Care, Family Norms, Self-Regulation, Dysregulation, and Parenting Support, and showed good factor loadings and internal reliability. Validity was tested in relation to parent distress, parent executive function problems, and child behavior problems. Parental limit-setting and involvement were either unrelated to or related to fewer parent and child problems, whereas parental use of SBDs for self-regulation, child care, discipline, support, and family activities, as well as parents' more dysregulated use, were related to more parent and child problems. The PSUS holds promise in addressing the parental mechanisms that underlie media effects on child development.