Too Much Television? Prospective Associations Between Early Childhood Televiewing and Later Self-reports of Victimization by Sixth Grade Classmates

Preschool children's screen time during the COVID-19 pandemic: associations with family characteristics and children's anxiety/withdrawal and approaches to learning

With schools closed due to the COVID-19, many children have been exposed to media devices for learning and entertainment, raising concerns over excessive screen time for young children. The current study examined how preschoolers' screen time was associated with their family characteristics and anxiety/withdrawal and approaches to learning during the COVID-19 pandemic. Participants were 764 caregivers of 3- to 6-year-old children (mean age = 59.07 months, SD = 12.28 months; 403 boys and 361 girls) from nine preschools in Wuhan, China, where the pandemic started. The effects of family characteristics on children's screen time during the pandemic outbreak and the associations between screen time and children's anxiety/withdrawal and approaches to learning were examined using path analysis. The results showed that children who spent more time on interactive screen use (e.g., playing with tablets) showed higher levels of anxiety/withdrawal and fewer positive learning behaviors. Unexpectedly, children who spent more time on noninteractive screen use (e.g., watching TV) showed lower levels of anxiety/withdrawal. Additionally, children's screen time was related to family characteristics: children living in more chaotic families with fewer screen time restrictions spent more time on screen use after the pandemic outbreak. The findings suggest that young children's frequent use of interactive screens, such as tablets and smartphones, might be harmful to their learning and wellbeing during the pandemic. To mitigate the potential negative effects, it is essential to manage the screen time of preschoolers by establishing rules for their interactive screen use and improving the household routines related to the overall screen use.

Ontario COVID-19 and Kids Mental Health Study: a study protocol for the longitudinal prospective evaluation of the impact of emergency measures on child and adolescent mental health during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has impacted the mental health (MH) of children, adolescents and parents. Whereas youth with MH disorders and neurodevelopmental disorders (NDD) may be at higher risk for exacerbations in emotional and behavioural distress, children and adolescents without pre-existing MH disorders or NDD may also experience MH deterioration due to increases in stress, changes in health behaviours, loss of activities/school closures or loss of resources. Little is known about the impact of the COVID-19 emergency measures (EMs) on children's MH over the course of the pandemic.

METHODS AND ANALYSIS

Longitudinal study of four well-established, pre-existing cohorts in Ontario (two recruited in clinical settings, two recruited in community settings). Primary outcomes include the impact of EMs on six MH domains: depression, anxiety, irritability, inattention, hyperactivity and obsessive-compulsive behaviours. Risk and protective factors related to youth MH profiles and trajectories will be identified. In addition, the effects of school mitigation strategies, changes in MH services and family factors (ie, parental MH, economic deprivation and family functioning) on children's MH will be examined. Data will be collected via repeated online survey measures selected to ensure reliability and validity for the proposed populations and distributed through the pandemic periods.

ETHICS AND DISSEMINATION

The study was approved by institutional research ethics boards at participating research sites. Results will be disseminated through a robust knowledge translation partnership with key knowledge users. Materials to inform public awareness will be co-developed with educators, public health, and MH and health service providers. Connections with professional associations and MH advocacy groups will be leveraged to support youth MH policy in relation to EMs. Findings will further be shared through conference presentations, peer-reviewed journals and open-access publications.

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

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

The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review

Evidence suggests that excessive screen time in early childhood is related to children's physical and mental health. This study aimed to review the relationships between screen media use and several health indicators in infants, toddlers, and preschoolers. A systematic search was conducted by two independent reviewers on PubMed, Web of Science, Embase, and Cochrane Library to identify the eligible studies, with an end date of 13 August 2019. Included studies (published in English) were peer-reviewed and met the determinate population (children aged 0-7 years with screen media exposure and related health outcomes). The AHRQ, NOS, and the Cochrane Handbook were used to evaluate the cross-sectional study, cohort study, and RCT, respectively. A meta-analysis and narrative syntheses were employed separately. Eighty studies (23 studies for meta-analysis) met the inclusion criteria for the systematic review. Strong evidence of the meta-analysis suggested that excessive screen time was associated with overweight/obesity and shorter sleep duration among toddlers and preschoolers. Excessive screen use was associated with various health indicators in physical, behavioral, and psychosocial aspects. Better-quality research on newer media devices, on various kinds of contents in young children, and on dose-response relationships between excessive screen use and health indicators are needed to update recommendations of screen use.

Correlates of sedentary time in young children: A systematic review

Background: Young children appear to spend large portions of their waking time being sedentary. Understanding the correlates of sedentary time would assist in developing effective interventions among young children. The purpose of this systematic review was to summarize the current literature on the correlates of objectively measured sedentary time in young children aged 1-5.99y. Methods: This review was registered with PROSPERO (registration no. CRD42017081374) and aligned with the PRISMA Statement for systematic reviews. Five electronic databases (MEDline, CINAHL Complete, PsycINFO, SportDiscus, Scopus) were searched up to October 26, 2017 for studies investigating correlates of sedentary time measured using objective devices. A semiquantitative approach was used to synthesize data. Results: Forty-five studies were retrieved comprising 13,430 participants, and 84 correlates of sedentary time in young children were evaluated. The associations between sex, sleep habits, daily patterns (childcare vs. non-childcare hours), childcare type and sedentary time were indeterminate. Thirty-nine correlates were consistently unrelated. Forty-one potential correlates were examined in too few studies (<4) to make confident conclusions. Parental sedentary behaviour was reported 3 times and maternal sedentary behaviour was reported once. Out of these four studies, three were positively associated with child sedentary time. Conclusions: Despite reviewing 45 studies that evaluated associations for 84 correlates, this review was unable to identify any consistent correlates of sedentary time in young children. Additional research is needed in this area to provide robust evidence of the correlates of sedentary time in young children, particularly for those examined in only a small number of studies.

Prospective associations between television in the preschool bedroom and later bio-psycho-social risks

BACKGROUND

North American child media guidelines suggest screen-free zones without offering clear evidence and alternative harm-reduction strategies. Our hypothesis is that having a bedroom television during the preschool years will be prospectively associated with mental and physical health risks in adolescence.

METHODS

Participants are from a prospective-longitudinal birth cohort of 907 girls and 952 boys from the Quebec Longitudinal Study of Child Development. Child outcomes at ages 12 and 13, measured by multiple sources, were linearly regressed on having a bedroom television at age 4.

RESULTS

Bedroom television at age 4 predicted a higher body mass index at age 12 (standardized B = 0.10, p < 0.001), more unhealthy eating habits at age 13 (B = 0.10, p < 0.001), higher levels of emotional distress (B = 0.12, p < 0.001), depressive symptoms (B = 0.08, p < 0.001), victimization (B = 0.07, p < 0.001), physical aggression (B = 0.09, p < 0.001), and lowers levels of sociability (B = -0.09, p < 0.001) at age 12, above and beyond pre-existing individual and family factors.

CONCLUSION

The bedroom as a screen-based preschool zone does not bode well for long-term cardio-metabolic wellness, mental health, and social relationships.

Prospective associations between toddler televiewing and subsequent lifestyle habits in adolescence

BACKGROUND

Watching television is a common pastime for very young children. High exposure may negatively influence physical and mental health outcomes. Not much is known about how early exposure relates to lifestyle choices in adolescence.

OBJECTIVE

To estimate how toddler televiewing is subsequently associated with lifestyle indicators at adolescence.

METHODS

Participants are 986 girls and 999 boys from the Quebec Longitudinal Study of Child Development birth cohort (Canada). Child self-reports lifestyle habits at age 13 that were linearly regressed on parent-reported televiewing at age 2 while adjusting for potential confounders.

RESULTS

Every 1 h 13 m increase in daily televiewing was prospectively associated with a 8.2% increased risk of unhealthy eating habits (unstandardized b = 0.05; 95% CI, 0.02 to 0.07), 10.1% decrease in eating breakfast on weekdays (unstandardized b = -0.06; 95% CI, -0.09 to -0.04), 13.3% increase in BMI (unstandardized b = 0.38; 95% CI, 0.26 to 0.50), 4.7% decrease in student engagement (unstandardized b = -0.07; 95% CI, -0.14 to -0.004), and 5.8% increase in concurrent screen time (unstandardized b = 0.06; 95% CI, 0.02 to 0.11). Post hoc simulations of noncompliance with AAP recommendations support their implementation.

CONCLUSIONS

Excessive toddlerhood televiewing was prospectively associated with less optimal health and self-invested behavioral dispositions. Lifestyle habits not only affect metabolic risk but may also influence personal success outcomes. These independent relationships, observed more than a decade later, suggest a need for better parental awareness of the way children invest their limited waking hours could affect their long-term life course trajectories.

Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years)

Background

The purpose of this systematic review was to examine the relationships between sedentary behaviour (SB) and health indicators in children aged 0 to 4 years, and to determine what doses of SB (i.e., duration, patterns [frequency, interruptions], and type) were associated with health indicators.

Methods

Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, 1 month to 4.99 years), intervention/exposure and comparator (durations, patterns, and types of SB), and outcome/health indicator (critical: adiposity, motor development, psychosocial health, cognitive development; important: bone and skeletal health, cardiometabolic health, fitness, risks/harm). The quality of the evidence was assessed by study design and outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results

Due to heterogeneity, meta-analyses were not possible; instead, narrative syntheses were conducted, structured around the health indicator and type of SB. A total of 96 studies were included (195,430 participants from 33 countries). Study designs were: randomized controlled trial (n = 1), case-control (n = 3), longitudinal (n = 25), longitudinal with additional cross-sectional analyses (n = 5), and cross-sectional (n = 62). Evidence quality ranged from “very low” to “moderate”. Associations between objectively measured total sedentary time and indicators of adiposity and motor development were predominantly null. Associations between screen time and indicators of adiposity, motor or cognitive development, and psychosocial health were primarily unfavourable or null. Associations between reading/storytelling and indicators of cognitive development were favourable or null. Associations between time spent seated (e.g., in car seats or strollers) or in the supine position, and indicators of adiposity and motor development, were primarily unfavourable or null. Data were scarce for other outcomes.

Conclusions

These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years, but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling. Additional high-quality research using valid and reliable measures is needed to more definitively establish the relationships between durations, patterns, and types of SB and health indicators, and to provide insight into the appropriate dose of SB for optimal health in the early years.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4849-8) contains supplementary material, which is available to authorized users.

Clinical and psychological effects of excessive screen time on children

Over recent years, screen time has become a more complicated concept, with an ever-expanding variety of electronic media devices available throughout the world. Television remains the predominant type of screen-based activity among children. However, computer use, video games and ownership of devices, such as tablets and smart phones, are occurring from an increasingly young age. Screen time, in particular, television viewing, has been negatively associated with the development of physical and cognitive abilities, and positively associated with obesity, sleep problems, depression and anxiety. The physiological mechanisms that underlie the adverse health outcomes related to screen time and the relative contributions of different types of screen and media content to specific health outcomes are unclear. This review discusses the positive and negative effects of screen time on the physiological and psychological development of children. Furthermore, recommendations are offered to parents and clinicians.

Functional gastrointestinal disorders in Greek Children based on ROME III criteria: identifying the child at risk

BACKGROUND

Functional gastrointestinal disorders (FGIDs) are a common, diverse group of disorders of unknown etiology, resulting in significant socieconomic burden. In this study, we aimed to assess the prevalence of FGIDs in children aged 6-18 years and examine their association with various demographic and socioeconomic parameters.

METHODS

This was a school-based, cross-sectional study approved by the relevant government authorities. Informed consent was obtained by the legal representatives of all children who participated. Diagnoses of FGIDs were based on the Greek official translation of the ROME-III questionnaire. Demographic and socioeconomic information were also collected.

KEY RESULTS

A total of 1588 children (51.8% females, mean age: 12.9±2.8 years) were included. The overall prevalence of any-FGID was 23.1% (95% CI: 21.1-25.2). The most common FGIDs were functional constipation, n=231 (13.9%), abdominal migraine, n=84 (5.6%), aerophagia, n=58 (3.5%), and irritable bowel syndrome, n=48 (3.0%). Multiple logistic regression analysis on the probability of any-FGID identified physical exercise, TV-exposure, victimization, gender, parental educational level, number of children at home and number of adults at home as significant covariates for any-FGID in the final model.

CONCLUSIONS AND INFERENCES

FGIDs affect approximately 1 in 4 school-aged children in Greece. The following characteristics are associated with a higher probability of any-FGID: female gender, living in a non-nuclear household, victimization, lower parental education level, infrequent physical activity, and high television exposure.

Prospective associations between televiewing at toddlerhood and later self-reported social impairment at middle school in a Canadian longitudinal cohort born in 1997/1998

BACKGROUND

Using a large Canadian population-based sample, this study aimed to verify whether televiewing in toddlerhood is prospectively associated with self-reported social impairment in middle school.

METHOD

Participants are from a prospective-longitudinal birth cohort of 991 girls and 1006 boys from the Quebec Longitudinal Study of Child Development. Child self-reported ratings of relational difficulties at age 13 years were linearly regressed on parent-reported televiewing at age 2 years while adjusting for potential confounders.

RESULTS

Every additional 1 h of early childhood television exposure corresponded to an 11% s.d. unit increase in self-reported peer victimization [unstandardized β = 0.03, 95% confidence interval (CI) 0.02-0.04], a 10% s.d. unit increase in self-reported social isolation (unstandardized β = 0.04, 95% CI 0.03-0.05), a 9% s.d. unit increase in self-reported proactive aggression (unstandardized β = 0.02, 95% CI 0.01-0.03) and a 6% s.d. unit increase in self-reported antisocial behavior (unstandardized β = 0.01, 95% CI 0.01-0.01) at age 13 years. These results are above and beyond pre-existing individual and family factors.

CONCLUSIONS

Televiewing in toddlerhood was prospectively associated with experiencing victimization and social withdrawal from fellow students and engaging in antisocial behavior and proactive aggression toward fellow students at age 13 years. Adolescents who experience relational difficulties are at risk of long-term health problems (like depression and cardiometabolic disease) and socio-economic problems (like underachievement and unemployment). These relationships, observed more than a decade later, and independent of key potential confounders, suggest a need for better parental awareness of how young children invest their limited waking hours.

The prominent role of the cerebellum in the learning, origin and advancement of culture

BACKGROUND

Vandervert described how, in collaboration with the cerebral cortex, unconscious learning of cerebellar internal models leads to enhanced executive control in working memory in expert music performance and in scientific discovery. Following Vandervert's arguments, it is proposed that since music performance and scientific discovery, two pillars of cultural learning and advancement, are learned through in cerebellar internal models, it is reasonable that additional if not all components of culture may be learned in the same way. Within this perspective strong evidence is presented that argues that the learning, maintenance, and advancement of culture are accomplished primarily by recently-evolved (the last million or so years) motor/cognitive functions of the cerebellum and not primarily by the cerebral cortex as previously assumed. It is suggested that the unconscious cerebellar mechanism behind the origin and learning of culture greatly expands Ito's conception of the cerebellum as "a brain for an implicit self."

RESULTS

Through the mechanism of predictive sequence detection in cerebellar internal models related to the body, other persons, or the environment, it is shown how individuals can unconsciously learn the elements of culture and yet, at the same time, be in social sync with other members of culture. Further, this predictive, cerebellar mechanism of socialization toward the norms of culture is hypothesized to be diminished among children who experience excessive television viewing, which results in lower grades, poor socialization, and diminished executive control.

CONCLUSION

It is concluded that the essential components of culture are learned and sustained not by the cerebral cortex alone as many traditionally believe, but are learned through repetitious improvements in prediction and control by internal models in the cerebellum. From this perspective, the following new explanations of culture are discussed: (1) how culture can be learned unconsciously but yet be socially in sync with others, (2) how the recent evolutionary expansion of the cerebellum was involved in the co-evolution of earliest stone tools and language-leading to the cerebellum-driven origin of culture, (3) how cerebellar internal models are blended to produce the creative, forward advances in culture, (4) how the blending of cerebellar internal models led to human, multi-component, infinitely partitionable and communicable working memory, (5) how excessive television viewing may represent a cultural shift that diminishes the observational learning of internal models of the behavior of others and thus may result in a mild, parallel version of Schmahmann's cerebellar cognitive affective syndrome.