Parental Reports on Touch Screen Use in Early Childhood

Usability of a touchscreen assessment tool (TATOO) prototype for clinicians and typically developing children

PURPOSE

Touchscreen devices are widely used in modern life and have quickly become part of daily life for children, including during Occupational Therapy sessions for children with disabilities. Touchscreen Assessment Tool (TATOO) is a prototype application used to evaluate children's performance when using touchscreen devices. The purpose of this study, based on the logical user-centred interaction design framework, was to evaluate TATOO's usability for occupational therapists and typically developing children and to examine the correlations between their usability scores.

METHODS

A convenience sample of clinicians (N = 10) and children with typical development (N = 60) was recruited for this study. The usability assessment was conducted using the System Usability Scale (SUS) and semi-structured interviews for the clinicians, and the Short Feedback Questionnaire-Child (SFQ-Child) for the children.

RESULTS

The SUS scores (M ± SD = 85.5 ± 8.04, range = 70-97.5) indicated good ratings of TATOO's usability by clinicians; the SFQ-Child results showed children also rated its usability very highly, including all ages (4-10 years) and all tasks. The clinicians all expressed positive attitudes towards using TATOO, and no bias was found between the clinicians' usability scores and the children's usability feedback.

CONCLUSION

The TATOO is a user-friendly tool. Researchers and clinicians can benefit from the availability of an objective and low-cost assessment tool to promote their evaluation and intervention by providing more focussed individualized recommendations and adaptations. The study also suggests a model to follow when developing applications and evaluating their usability through a mixed-method approach to deepen understanding of the user's needs.Implications for rehabilitationTouchscreen Assessment Tool (TATOO) shows a user-friendly tool for assessing the different skills required to operate touchscreens interface.TATOO has the potential to become an essential objective and low-cost assessment tool for the clinician, in which the spread of touchscreens constantly increases.Researchers and clinicians can benefit from the availability of such tools to promote their evaluation and intervention by providing more focussed individualized recommendations and adaptations.TATOO will complement the assessment needs, as traditional fine motor assessment tools cannot capture the skills necessary to operate a touchscreen deviceThe study suggests a model to follow when developing applications and evaluating their usability through a mixed-method approach in order to deepen understanding of the user's needs.

Touchscreens can promote infant object-interlocutor reference switching

We re-examine whether the type of object played with influences parent-infant joint attention. A within-participants comparison of 24 parent-9-month-old dyads, used head-mounted eye-tracking to measure parental naming and infant attention during play with touchscreen apps on a touchscreen tablet or matched interactive toys. Infants engaged in sustained attention more to the toy than the tablet. Parents named objects less in toy play. Infants exhibited more gaze shifts between the object and their parent during tablet play. Contrasting previous studies, these findings suggest that joint tablet play can be more interactive than with toys, and raise questions about the recommendation that infants should not be exposed at all to such technology.

Sleep and Technology in Early Childhood

Research suggests that technology use is associated with poorer sleep outcomes among children less than 6 years of age. These associations are evident regardless of the type of technology studied, although evening exposure may have the greatest impact compared with technology use during other parts of the day. More work is needed, particularly given that technology use is relatively high among young children. Clinicians should assess patients' technology exposure, including before bedtime, to assess whether sleep issues stem from children's technology use. Moreover, clinicians should educate caregivers about the association between technology use and sleep problems among young children.

Adherence to 24-hour integrated activity guidelines among infants, toddlers and preschool children in Singapore

This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.

BENDI: Improving Cognitive Assessments in Toddlers and Children with Down Syndrome Using Stealth Assessment

Cognitive assessment is a fundamental step in diagnosing intellectual and developmental disabilities, designing interventions, and evaluating their impact. However, developed and developing countries have different access to tools designed for these purposes. Our goal was to develop a battery for cognitive assessment mediated by digital technology that allows the exploration of cognitive domains (inhibitory control, attention, motor ability, and context memory) in children with Down Syndrome (DS) in Chile. Four tasks, based on established experimental paradigms modified to provide a game-like experience, were tested in 68 children with DS from 20 months to 12 years of age. We present evidence of reliability based on internal consistency and split-half analyses, with results ranging from adequate to excellent. Regarding validity, factorial and correlational analyses show evidence consistent with what was theoretically expected of internal structure, convergence, and divergence with other measures. Expected age trajectories were observed as well. Our data offer evidence that supports the use of tasks based on touch-screen devices for cognitive assessment in the population with DS. The tasks also have a low cultural load, so they could be validated and used in other contexts without the need for an adaptation process.

Swipe, tap, read? Unveiling the effects of Touchscreen devices on Emergent Literacy Development in preschoolers

Emergent literacy skills are vital for children's reading and writing development. While touchscreen devices have been linked to enhanced emergent literacy in developed countries, their impact in low- and middle-income countries (LMICs), with limited access to quality apps, is underexplored. Thailand, classified as an upper-middle-income country, presents a unique context with its specific challenges in educational technology, which have not been extensively studied. This study examined the relationship between touchscreen device usage and emergent literacy development in Thai preschool children. Using a cross-sectional design, we analyzed data from 317 Thai children aged 5-6 years, assessing their emergent literacy skills and examining the association with touchscreen device usage through logistic regression analysis. Our findings showed that 79.5% of participants engaged with touchscreen devices, and there was an observed trend suggesting that exclusive tablet users might exhibit enhanced phonological awareness, letter naming, and rapid automatized naming skills. However, these potential improvements did not reach statistical significance when primary caregiver characteristics were taken into account. Our findings highlight the complexity of this relationship and underscore the need for further research to elucidate the potential influences of application quality and screen time engagement on emergent literacy, particularly in LMICs.

Reexamining models of early learning in the digital age: Applications for learning in the wild

Young children are growing up in an increasingly complicated digital world. Laboratory-based research shows it is cognitively demanding to process and transfer information presented on screens during early childhood. Multiple explanations for this cognitive challenge have been proposed. This review provides an updated comprehensive framework that integrates prior theoretical explanations to develop new testable hypotheses. The review also considers the how the research can be generalized to the "wild" where children engage with multiple commercial products daily. It includes real-world applications for improving children's learning and memory from screen-based media by adding supportive cues and reducing distraction and interference. The review concludes with a call for future collaborative research between researchers, content developers, and families to better understand age-related changes in both short-term and long-term learning from digital media. Finally, policy makers need to be involved to ensure equitable access and to create a safe digital space for all families.

Tool mastering today - an interdisciplinary perspective

Tools have coined human life, living conditions, and culture. Recognizing the cognitive architecture underlying tool use would allow us to comprehend its evolution, development, and physiological basis. However, the cognitive underpinnings of tool mastering remain little understood in spite of long-time research in neuroscientific, psychological, behavioral and technological fields. Moreover, the recent transition of tool use to the digital domain poses new challenges for explaining the underlying processes. In this interdisciplinary review, we propose three building blocks of tool mastering: (A) perceptual and motor abilities integrate to tool manipulation knowledge, (B) perceptual and cognitive abilities to functional tool knowledge, and (C) motor and cognitive abilities to means-end knowledge about tool use. This framework allows for integrating and structuring research findings and theoretical assumptions regarding the functional architecture of tool mastering via behavior in humans and non-human primates, brain networks, as well as computational and robotic models. An interdisciplinary perspective also helps to identify open questions and to inspire innovative research approaches. The framework can be applied to studies on the transition from classical to modern, non-mechanical tools and from analogue to digital user-tool interactions in virtual reality, which come with increased functional opacity and sensorimotor decoupling between tool user, tool, and target. By working towards an integrative theory on the cognitive architecture of the use of tools and technological assistants, this review aims at stimulating future interdisciplinary research avenues.

Screen technology exposure and infant cognitive development: A scoping review

PROBLEM

There has been some concern that screen exposure is harmful to an infant's cognitive development, but the effects of screen technologies on cognition are not fully understood. A scoping review was conducted to determine what evidence exists about screen exposure and cognitive development in children ages birth to 24 months.

ELIGIBILITY CRITERIA

Inclusion = 1) English language; 2) studies focusing on children under 24 months of age; 3) cognitive development; 4) screen exposure. Exclusion = 1) articles over 25 years old; 2) structure, function and physiology of the brain; 3) social development; 4) psychosocial development; 5) motor development; 6) abnormal development/mental health; 7) behavior; 8) content only, not screen exposure e.g., social media; 9) secondary sources.

SAMPLE

Ten studies met the inclusion criteria. Articles included one retrospective chart review, six longitudinal studies, two cross-sectional studies, and one prospective study.

RESULTS

Of the ten studies in this review, six reported correlations between screen exposure and cognitive delay, one study reported positive cognitive outcomes and three reported no significant positive or negative outcomes.

CONCLUSIONS

From the evidence in this scoping review, no causal relationship has been found between screen exposure and infant cognitive harm. Some correlations between screen exposure and cognitive delay were reported. Some positive cognitive outcomes were also reported.

IMPLICATIONS

Future research should focus on the context of screen viewing as opposed to dosage or exposure. More robust methodologies should be used to assess infant cognition and screen usage.

Role of female teachers of childhood education in directing children towards effective use of smart devices

This study endeavors to investigate the role of female teachers of childhood education in directing children towards the effective use of smart devices in developing their learning experiences. The sample of the study consisted of 83 female teachers in the northern region of Jordan, who were selected using the available sampling method. To achieve the aim of the study, a semi-structured interview was prepared and its validity and consistency were verified. The results shown that childhood education female teachers achieved advanced roles in directing children towards the effective use of smart devices, where effective direction towards the use of smart devices was represented in: directing children to self-organize their learning during using smart devices, directing children to acquire digital social interaction skills and directing them to learn innovation during using smart devices, with the importance of directing them to avoid the harms of using smart devices through preventive guidance. Moreover, the findings of the study revealed the importance of directing children to participate in various digital activities, as well as directing them to learn through digital applications that are purposeful and suitable to their mental capabilities. Based on the research findings, the study presented a number of relevant recommendations.

Effects of screen exposure on young children's cognitive development: A review

The past decade has witnessed a rapid increase in the use of screen media in families, and infants are exposed to screens at younger ages than ever before. The objective of this review is twofold: (1) to understand the correlates and demographic factors determining exposure to screens, including interactive screens, when available, and (2) to study the effects of watching screens and using touchscreens on cognitive development, during the first 3 years of life. We argue that the effects of screen viewing depend mostly on contextual aspects of the viewing rather than on the quantity of viewing. That context includes the behavior of adult caregivers during viewing, the watched content in relation to the child's age, the interactivity of the screen and whether the screen is in the background or not. Depending on the context, screen viewing can have positive, neutral or negative effects on infants' cognition.

Pediatric Preventive Care in Middle-High Resource Countries-The Padova Chart for Health in Children

Importance

The Padova Chart for Health in Children (PCHC) aims to gather the evidence of healthcare promotion and protection for chidren and adolescents (i.e., aged <18 y) into a single document in order to guide families, healthcare providers and social actors on healthy choices. No more than 2% of Europeans and North Americans aged <30 y have a healthy lifestyle. This, together with metabolic and brain plasticity during childhood, creates the ideal opportunity to implement preventive strategies. Guided interventions promoting healthy lifestyle in children and families therefore have a key role in abating the unprecedented pandemic of non-communicable diseases (NCDs) in adulthood.

Observations

The PCHC is divided into four sections: nutrition, cardiovascular health, respiratory health, and mental and social health. Each section is structured in an ALICE approach (assessment, lobbying, intervention, call-for-action, evaluation): assessment of necessity, describing relevance to healthcare; lobbying to identify those who can effect the proposed interventions; interventions involving family, school and peers; a call-for-action to define priorities among the proposed interventions; and objective evaluation measures that can be applied on a population basis.

Conclusions and Relevance

Interventions promoting health in childhood require joint action from multiple institutional, local and family representatives, with the shared goal of promoting health across the entire age group. These lifestyle interventions have the potential to change the lifetime risk trajectory for NCDs.

Touch Screen Device Usage and its Effect on Sleep among Young Children: Do Parents Delude Younger Generation Deliberately? Time to Ruminate and Impede this Technological Harm

CONTEXT

The American Academy of Pediatrics had recommended that children younger than 2 years should avoid digital media. However, in the Indian context, it was less explored.

AIMS

The study aimed to determine the relationship between touch screen device (TSD) usage and sleep of infants, toddlers.

METHODOLOGY

Using a cross-sectional design, 76 parents of infants and toddlers attending well-baby clinic of a tertiary care hospital in Eastern India were approached, and 57 parents who fulfilled the eligibility criteria were selected using a nonprobability convenient sampling technique. Data were collected using a pretested validated tool including TSD usage pattern, the brief infant sleep questionnaire. Descriptive statistics and Pearson correlation were used to analyze the data.

RESULTS

The mean age of TSD usage was 15.6 ± 5.8 months with a mean duration of 65 ± 9.6 min/day. Mothers (51%) reported circumstances to offer TSD was feeding the child. There was a significant negative relationship between night sleep and TSD usage among children (r = -0.35, P < 0.01).

CONCLUSIONS

TSD usage time significantly affects the nighttime duration of sleep of infants and toddlers. Parents to be educated on proper usage and ill effects of TSD to prevent sleep issues.

Usage time of touch screens in relation to visual-motor integration and the quality of life in preschooler children

Objectives

This study aims to examine the usage of touch screen time in relation to the visual-motor integration and the quality-of-life in preschool children. Additionally, we compare the difference between children who practiced sports and attended nursery with those who did not attend such activities.

Methods

This study includes a convenience sample of 100 preschool children aged between three and five years. The Peabody Developmental Motor Scale is used to assess visual-motor integration and the Arabic version of the Paediatric Quality of Life Inventory™ generic scale to assess the quality of life (QoL).

Results

The Pearson correlation coefficient equation reveals a negative significant correlation (p = 0.0001) between touch screen usage time and visual-motor integration (r = −0.37), physical (r = −0.38), psychosocial (r =−−0.55) and the QoL total score (r = −−0.48). Children who practiced sports showed lower visual-motor integration and higher QoL scores than those who did not. Children who attended nursery showed higher visual-motor integration and lower QoL scores than those who were not given the chance to attend these activities.

Conclusion

Based on the results of the current study, it can be concluded that increased touch screen usage time was found to adversely affect visual-motor integration and the QoL in preschool children. Practicing sports and attending nursery influence the visual-motor integration and the QoL.

Effects of Touchscreen Media Use on Toddlers' Sleep: Insights from Longtime ECG Monitoring

Wearable biomedical sensor technology enables reliable monitoring of physiological data, even in very young children. The purpose of the present study was to develop algorithms for gaining valid physiological indicators of sleep quality in toddlers, using data from an undisturbing and easy-to-use wearable device. The study further reports the application of this technique to the investigation of potential impacts of early touchscreen media use. Toddlers' touchscreen media use is of strong interest for parents, educators, and researchers. Mostly, negative effects of media use are assumed, among them, disturbances of sleep and impairments of learning and development. In 55 toddlers (32 girls, 23 boys; 27.4 ± 4.9 months; range: 16-37 months), ECG monitoring was conducted for a period of 30 (±3) h. Parents were asked about their children's touchscreen media use and they rated their children's sleep quality. The use of touchscreen media predicted the physiologically determined quality of sleep but not parent-reported sleep quality (such as sleep onset latency). Greater heart rate differences between restless sleep phases and restful sleep indicated poorer nighttime recovery in children with more frequent use of touchscreen media. The study demonstrates that the expert analysis of the ECG during sleep is a potent tool for the estimation of sleep quality in toddlers.

Improving Motor Skills in Early Childhood through Goal-Oriented Play Activity

Goal-oriented play activity encourages children to exercise and triggers the movement of body muscles. Active muscles are stronger, more agile, faster, and more powerful. Purpose: The purpose of this study is to determine that goal-oriented play activity in early childhood improves motor skills. Methods: Forty children aged 4.5–6 years old were recruited and took part in a set of training activities divided into Posts 1–5. To pass each post, a child had to run, walk on a balance beam, move sticks, throw and catch the ball, and arrange blocks. Training was given three times every week for 12 weeks. Data collected consisted of running 25 m, walking on the balance beam, throwing the ball as far as possible, locomotor movement, arranging cans, and bouncing the ball. Paired t and Wilcoxon signed-rank tests were used for analysis. Results: The results showed that there were significant differences in the motor skills evaluated pre- and post-training with p < 0.05. Conclusion: All six training activities conducted for 12 weeks provided significant improvements in the motor skills areas in children aged 4.5–6 years old.

Associations between touchscreen exposure and hot and cool inhibitory control in 10-month-old infants

Touchscreen use amongst young children has proliferated in recent years, yet little is known about the association between daily touchscreen exposure and inhibitory control in the first year of life. Previous research has found a negative association between the amount of television viewing and inhibitory control in early childhood, but it is unclear whether negative associations with screen use extend to touchscreens. The current study presents an exploratory analysis of the cross-sectional associations between inhibitory control and the amount of touchscreen use amongst 10-month-olds (n = 128-156). Touchscreen exposure was assessed via parent-report. In order to include a range of "hot" and "cool" aspects of inhibitory control, these skills were assessed using lab-based response inhibition and prohibition tasks as well as parent-reported observations of infants' inhibitory control abilities and broader regulatory behaviors. A "Cognitive Executive Function (EEFQ-CEF)" score (encompassing Inhibitory Control, Flexibility, and Working Memory items) was included as a secondary broader executive function construct to examine whether effects showed specificity to inhibitory control rather than executive functions more generally. Correlation analyses indicated no association between touchscreen exposure and the four indices of IC. However, a positive association was found for the amount of touchscreen exposure and EEFQ-CEF once accounting for sociodemographic variables. The implications of these findings and future directions are discussed.

Screens for infants and preschool children: Assessment of medical prevention with parents and assessment of exposure

BACKGROUND

Regarding the massive increase of interactive mobile screen household equipment and the omnipresence of television, many recommendations are in favor of a limitation of use, especially among the youngest.

OBJECTIVE

We aimed to evaluate the proportion of parents who report having discussed the subject of their child's exposure to screens during a consultation with a health professional. We also aimed to assess preschool exposure to television and mobile media devices, and to explore parents' views on the benefits and risks of exposing their children under 3 years old.

METHODS

A questionnaire was administered to parents of children aged 6 months to 3 years in a pediatric emergency ward and several nurseries. This observational, cross-sectional and multicenter study was conducted from January to May 2019.

RESULTS

We included 451 responses in the analyses. Only 99 (22.7%; 95% CI: 18.7-26.6) parents reported having discussed their child's exposure to screens with a doctor, on the initiative of the parents themselves for 52 households (53.1%; 95% CI: 43.2-62.9). Feelings of a benefit of screens on child learning concerned 134 (34.5%; 95% CI: 29.8-39.3) parents; 300 (68.5%; 95% CI: 64.1-72.8) said they were sufficiently informed about benefits and risks. In a typical week, 240 (53.7%; 95% CI: 49.1-58.3), 160 (35.8%; 95% CI: 31.3-40.2), and 58 (13.0%; 95% CI: 9.9-16.1) children were exposed at least once a week to television, smartphones, and tablets, respectively.

CONCLUSIONS

Our study showed that the theme of exposure to screens was hardly addressed by physicians in consultation. Our findings help target prevention messages, including fighting the widespread belief that media are beneficial to child development, emphasizing the importance of screen-free time (eating, going to bed, after waking up) and encouraging support and interaction during exposure in families who choose to expose their children.

Predictors for Screen Time Exposure among Children between 3 and 5 Years Old in Southern Brazil

BACKGROUND

The use of technology is an increasingly common practice among preschoolers. Little is known about the relationship between screen time exposure (STE) and aspects related to family and the environment.

AIM

The aim is to characterize STE in Brazilian children aged between 3 and 5 years. Furthermore, the objective of this study is to associate the STE of children and of their parents with sociodemographic variables.

METHODS

Children aged between 3 and 5 years from southern Brazil and their parents participated in this study. To investigate STE, the researchers developed a specific questionnaire. To compare STE between age groups, the Kruskal-Wallis test was performed, followed by Dunn's post hoc test. Spearman's correlation and linear regression were used to correlate the variables.

RESULTS

Children (n = 237) spend an average of 3.7 ± 0.8 h/day in front of screens. The STE of children had a moderately positive correlation with the STE of their parents (r = 0.4; p-value < 0.001). Only the variables of the children's and parents' STE had a significant and positive association. The model is significant (F = 6164, p-value < 0.001) and the residuals of the model met the necessary assumptions, with normal distribution, constant variance and without the presence of outliers.

CONCLUSION

Children in southern Brazil remain in front of screens four times longer than the recommended amount of time. It was also found that the STE of parents directly influences that of their children.

A novel measure of matching categories for early development: Item creation and pilot feasibility study

BACKGROUND

Many cognitive tests assess a limited developmental span, making longitudinal measurement for trials aimed at improving cognition challenging. Tests targeting transitional skills, which integrate foundational abilities into complex schemas, may be amenable to assessment across a wide developmental span. Furthermore, tablet-based tests permit computer adaptive testing (CAT), which is psychometrically more efficient and could increase testing motivation, especially for children with developmental delays. Such measures may be useful for research and clinical practice.

AIMS

Outline the creation of a novel, tablet-based concept formation test, and evaluate its feasibility in individuals with mental ages less than 24-months.

METHODS AND PROCEDURES

Item generation, user interface construction, and pre-piloting were conducted in consultation with subject matter experts. Item content and interface parameters underwent iterative revisions, resulting in the pilot test.

OUTCOMES AND RESULTS

We created and piloted a tablet-based test of concept formation suitable for CAT-based administration with items of increasing difficulty based on target salience. We show feasibility in individuals with mental ages less than 24-months-old.

CONCLUSIONS AND IMPLICATIONS

Tablet-based assessment of concept formation may be a useful outcome measure of an aspect of cognitive ability in young children. Future work will address optimizing the user interface and developing CAT administration.

Mobile Media and Young Children's Cognitive Skills: A Review

Though the use of mobile devices (eg, tablets, smartphones) by young children is pervasive and increasing, research relating children's use of mobile devices to their development is only beginning to emerge. Learning, language development, and self-regulation skills among children aged 0 to 5 are of particular interest to pediatric clinicians, researchers, parents, and policymakers, as these skills foreshadow important outcomes across the lifespan. Experimental research reviewed herein suggests that the interactivity allowed by mobile devices has benefits over passive viewing (for example, of television) for young children's learning and self-regulation, but studies of naturalistic use suggest increased use of mobile devices is associated with poorer language and self-regulation. Pediatric clinicians can be important sources of support for families endeavoring to navigate their children's use of mobile devices by providing advice and resources, such as communicating reasonable time limits and sharing sources of developmentally appropriate content. Future research should implement innovative, rigorous research designs and methods to clarify mechanisms underlying potential negative effects of naturalistic use of mobile devices by young children and investigate how content and context of young children's mobile-device use may influence relations between such use and children's skills.

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

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

Infant media use: A harm reduction approach

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

The origins of touchscreen competence: Examining infants' exploration of touchscreens

Infants' exposure to images presented on screens is increasing with the accelerating use of technology in society and at home. Touchscreen technology provides numerous interactive screen opportunities geared toward infants and toddlers. Touchscreens are unique in that they possess the 2D qualities of a picture, but a set of manipulation possibilities similar to, but distinct from, a 3D object. Research comparing infants' manual exploration of photographs, objects, and screen images has demonstrated that although 7-10-month-old infants direct different actions towards 3D objects, their exploration of screen images does not differ significantly from their exploration of 2D photographs (Ziemer & Snyder, 2016). The current investigation compares the ways in which 7-10-month-old infants and 15-18-month-old infants manually explore screen images, photographs, and objects. Infants in the older age group were shown examples of objects, photographs, and screen images presented within a well in a table with a Plexiglas® cover to create identical tactile feedback. Coders noted the presence or absence of appropriate actions displayed toward the various surfaces. Results were compared to data collected earlier (Ziemer & Snyder, 2016) to demonstrate the evolution of touchscreen competence across the first years of infant development. By 15-18 months, infants demonstrate an emerging repertoire of touchscreen-appropriate behaviors directed towards touchscreens that is not demonstrated by 7-10-month-old infants. Differences in haptic exploration suggest the beginnings of a touchscreen competence that enables infants to understand and interact with touchscreens in a new way.

Toddlers Using Tablets: They Engage, Play, and Learn

Although very young children have unprecedented access to touchscreen devices, there is limited research on how successfully they operate these devices for play and learning. For infants and toddlers, whose cognitive, fine motor, and executive functions are immature, several basic questions are significant: (1) Can they operate a tablet purposefully to achieve a goal? (2) Can they acquire operating skills and learn new information from commercially available apps? (3) Do individual differences in executive functioning predict success in using and learning from the apps? Accordingly, 31 2-year-olds (M = 30.82 month, SD = 2.70; 18 female) were compared with 29 3-year-olds (M = 40.92 month, SD = 4.82; 13 female) using two commercially available apps with different task and skill requirements: (1) a shape matching app performed across 3 days, and (2) a storybook app with performance compared to that on a matched paper storybook. Children also completed (3) the Minnesota Executive Functioning Scale. An adult provided minimal scaffolding throughout. The results showed: (1) toddlers could provide simple goal-directed touch gestures and the manual interactions needed to operate the tablet (2) after controlling for prior experience with shape matching, toddlers’ increased success and efficiency, made fewer errors, decreased completion times, and required less scaffolding across trials, (3) they recognized more story content from the e-book and were less distracted than from the paper book, (4) executive functioning contributed unique variance to the outcome measures on both apps, and (5) 3-year-olds outperformed 2-year-olds on all measures. The results are discussed in terms of the potential of interactive devices to support toddlers’ learning.

Parent-child interactions during joint engagement with touchscreen technology: A comparison of younger versus older toddlers

With a plethora of touchscreen apps aimed at young children, parents are receiving mixed messages about the appropriateness of such technology for their toddlers. The American Academy of Pediatrics (2016) advises limited engagement with digital media for this age group and encourages parents to co-engage with children when they are using screens. However, very little is known about parent-child interaction in the context of joint engagement with digital screen media in the toddler years. This study observed 56 toddlers (M = 32.5 months old; 53 % female) and a parent (52 mothers; 4 fathers) performing a 3-minute drawing task on a touchscreen tablet (digital condition), and on an Etch-A-Sketch (non-digital condition) using a repeated measures design. Observations were analysed using global ratings of dyadic interaction, comparing warmth, cooperation and conflict between digital and non-digital conditions. A mixed MANCOVA analysis, controlling for levels of daily usage of touchscreens, revealed lower levels of parent-child cooperation and warmth in the digital condition compared to the non-digital condition. In addition, there was a main effect of age with younger dyads displaying less cooperation overall, particularly in the digital condition where interactions were also less warm. Results suggest that co-engaging with digital technology can be a challenging and potentially emotionally charged context for both parents and young children. Younger toddlers, especially, may be more likely to experience less cooperative interactions when co-engaging with digital technology with a parent. Results are discussed in relation to developmental differences between 2- and 3-year olds, and the need for more nuanced guidance for parents supporting young children's interaction with digital media.

The Home Learning Environment in the Digital Age-Associations Between Self-Reported "Analog" and "Digital" Home Learning Environment and Children's Socio-Emotional and Academic Outcomes

We analyzed the association between the analog and the digital home learning environment (HLE) in toddlers' and preschoolers' homes, and whether both aspects are associated with children's social and academic competencies. Here, we used data of the national representative sample of Growing up in Germany II, which includes 4,914 children aged 0-5 years. The HLE was assessed via parental survey that included items on the analog HLE (e.g., playing word games, reading, and counting) and items on the digital HLE (e.g., using apps or playing with apps). Children's socio-emotional, practical life skills, and academic competencies were assessed via standardized parental ratings. Our results indicate that there are two dimensions of the HLE, an analog and a digital, that are slightly positively associated, especially in the toddler age group. For toddlers, only analog HLE activities were associated with better socio-emotional outcomes and practical life skills. However, interaction effects indicate that toddlers with less frequent analog HLE activities showed better socio-emotional skills in households with more frequent digital activities. For preschoolers, digital HLE activities were associated with weaker socio-emotional skills but higher academic skills, although the analog HLE shows higher effect sizes for the academic outcomes. Our study points out that analog and digital HLE activities seem to be partly associated, but not interchangeable. Further, they seem to be important variables that can explain individual differences in young children's socio-emotional, practical life, and academic competencies. However, digital media usage at home may also have negative effects on children's social-emotional competencies. This association needs to be investigated further.

Determining factors in children's screen time in early childhood

The use of media by children in early childhood is increasingly common, and it is necessary to investigate the determinants of screen time, which is understood as the total child screen exposure time, including television and interactive media. This is a descriptive, exploratory, and cross-sectional study conducted with 180 children between 24 and 42 months of age, allocated in Group 1, less than two hours daily screen exposure time; Group 2, daily screen exposure time equal to or more than two hours. Bivariate and binary logistic regression analyses were performed. Screen time determining factors studied were family environment, evaluated with the Family Environment Resource Inventory; socioeconomic factors; nutritional status and child development status, evaluated with the Bayley III test. As a result, 63% of children had daily screen time exceeding two hours, and television still is the main culprit for children screen exposure. We observed that screen time exposure was positively associated with family resources, economic level, and language development. However, only the last two factors explained the longer screen time.

Electronic Media and Early Childhood: A Review

BACKGROUND

This review summarizes the state of knowledge of use of new media on the development in early childhood in 6 sections: descriptive utilization data, psychosocial and emotional development, cognition and language, motor development, nutrition and sleep, and influence of parental media consumption.

METHODS

The review is based on a literature search of this topic in peer-reviewed journals. We included 87 articles, books, and book chapters. The used literature data bases were ERIC, PsycARTICLES, PsycINFO and PSYNDEX.

RESULTS

Manifold studies describe in young children's utilization data the pervasive nature of digital exposure and impressive usage times and availability. They confirm adverse influences of electronic media use (television, video games) on children's emotional and behavioral problems and well-being, e. g. on physical activity, sleep and obesity. In general a positive effect in sense of knowledge transfer of age could be found for high quality educational media, however predominantly the impact of media use at younger age was negative.

CONCLUSIONS

High frequent media use in early childhood is likely to have a negative impact on psychosocial development, positive effects such as knowledge transfer may be seen beyond the age of 18 months. As parental media use is a strong predictor of child media habits, reducing parental media use and enhancing parent-child interactions might be important areas to address when trying to change the media behavior of young children. In view of the scarcity of studies for early childhood, it is advisable to use digital play and communication devices cautiously and restrictively in this vulnerable development phase.

Longitudinal touchscreen use across early development is associated with faster exogenous and reduced endogenous attention control

Childhood screen time is associated with both attentional difficulties (for television viewing) and benefits (in action video gamers), but few studies have investigated today’s pervasive touchscreen devices (e.g. smartphones and tablets), which combine salient features, interactive content, and accessibility from toddlerhood (a peak period of cognitive development). We tested exogenous and endogenous attention, following forty children who were stable high (HU) or low (LU) touchscreen users from toddlerhood to pre-school. HUs were slower to disengage attention, relative to their faster baseline orienting ability. In an infant anti-saccade task, HUs displayed more of a corrective strategy of orienting faster to distractors before anticipating the target. Results suggest that long-term high exposure to touchscreen devices is associated with faster exogenous attention and concomitant decreases in endogenous attention control. Future work is required to demonstrate causality, dissociate variants of use, and investigate how attention behaviours found in screen-based contexts translate to real-world settings.

Sleep and Technology in Early Childhood

Research suggests that technology use is associated with poorer sleep outcomes among children less than 6 years of age. These associations are evident regardless of the type of technology studied, although evening exposure may have the greatest impact compared with technology use during other parts of the day. More work is needed, particularly given that technology use is relatively high among young children. Clinicians should assess patients' technology exposure, including before bedtime, to assess whether sleep issues stem from children's technology use. Moreover, clinicians should educate caregivers about the association between technology use and sleep problems among young children.

Does texting interrupt imitation learning in 19-month-old infants?

Observed disruptions to parent-child interactions during parental media use, such as texting, have been termed technoference. For example, when a language learning interaction was disrupted by a phone call, toddlers were less likely to acquire the word. Other studies demonstrated that parents often exhibit a still face while silently reading information on their cell phones. In the present study, the effect of a text interruption on infant imitation learning was examined. Parents demonstrated three target actions to their infants and then infants were given the opportunity to repeat those interactions. The actions were demonstrated four times. Text interruptions occurred before or between demonstrations. Performance of these groups was compared to a baseline control group where the infant did not see a demonstration of the target actions and a no-interruption group where the parents demonstrated the target actions four times without interruption. Parents were randomly assigned to three conditions, interruption-first condition, one-interruption condition, or three-interruptions condition. Infant behavior was measured during the interruptions. Across text interruption groups parents exhibited high levels of still face during the interruptions (77 %). However, infants in all 3 interruption groups performed significantly above the baseline control indicating learning despite the interruptions. Higher reported maternal reliance on the smartphone was related to poorer imitation performance overall. In contrast, when parents reported that they found it easier to multi-task infant imitation rates were higher. These findings indicate that infants can learn under conditions of brief technoference and that individual differences in family media ecology are associated with learning.

Infant screen media usage and social-emotional functioning

There has been little research on whether and how screen media usage affects social-emotional (SE) function prior to two years of age, even though early SE development is understood to be nurtured through interpersonal experience, mainly withthe primary caregiver. This study sought to characterise infant screen media usage and understand how it may link with concurrent SE function by testing associated effects on reducing parent-infant interaction and of parent psychological factors. Questionnaire responses from 327 UK-based parents of infants aged 6-24 months showed diverse usage in the amount of time spent on screen media ('screen time') and amount of parental involvement (co-sharing and co-referencing). Infants with possible SE delay experienced more screen time than those at low risk. The study tested three mediation models and found support for the displacement and not distancing hypothesis based on this community sample. While screen time predicted both SE competence and SE problems, reduced parent-infant play partially mediated the effect on SE competence. Parent depressed mood was positively linked with infant SE problems, but there was little evidence that increased screen time mediated this effect. Also, parent reflective function and attitudes toward parent-infant play were unrelated to screen time. Though longitudinal study is warranted, the findings implicate screen media usage as potentially directly and indirectly relevant when addressing infant mental health.

Concurrent validity of a touchscreen application to detect early cognitive delay

OBJECTIVE

To explore the ability of an interactive screening tool to identify cognitive delay in children aged 18 to 24 months.

DESIGN

Children were assessed using the Bayley Scale of Infant and Toddler Development-third edition (BSID-III) and a touchscreen measure of problem-solving (Babyscreen V.1.5). We examined the internal consistency and concurrent validity between the two measures. A BSID-III cognitive composite score (BSID-IIIcc) ≤1 SD below population mean was used to indicate a low average cognitive ability.

RESULTS

87 children with a mean (SD) age of 20.4 (1.3) months who experienced complications at delivery (n=53) and healthy age-matched controls (n=34) were included in the study. A moderate positive correlation between the BSID-IIIcc and the total number of tasks completed on the Babyscreen suggested reasonable concurrent validity (r=0.414, p<0.001). Children with a BSID-IIIcc ≤90 had lower median (IQR) Babyscreen score (7 (6, 8.5) vs 11 (8.5, 13); p=0.003) and a lower median (IQR) age-adjusted z-score (BST z-score) for number of items completed compared with those >90 (-1.08 (-1.5 to -0.46) vs 0.31 (-0.46 to 0.76); p=0.001). The area under the receiver operating characteristic curve for the prediction of a low normal BSID-IIIcc was 0.787 (CI 0.64 to 0.93). A BST z-score of <-0.44 yielded 82.4% sensitivity and 71.4% specificity in identifying children with cognitive delay.

CONCLUSIONS

A touchscreen-based application has concurrent validity with the BSID-IIIcc and could be used to screen for cognitive delay at 18-24 months of age.

Social inequalities in traditional and emerging screen devices among Portuguese children: a cross-sectional study

BACKGROUND

Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP).

METHODS

A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children's screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children's age, gender and family SEP (classified using father's educational degree).

RESULTS

Daily screen time was high both in children aged 3 to 5 and 6 to 10 years - 154 min/day (95% CI: 149.51-158.91) and 200.79 min/day (95% CI: 197.08-204.50), respectively - and the majority of children, independently of their gender, exceed the recommended 2 h/day of screen viewing. Children are still primarily engaging in screen time through television but the use of mobile devices, particularly tablets, were already high among 3 year-old children and increased with age. SEP was a negative predictor of screen time in the linear regression analysis, including after adjustment.

CONCLUSIONS

Considering the negative health impacts of excessive screen time, recognizing subgroups at risk of excessive screen time and identifying how each device is used according to age is fundamental to enable appropriate future interventions. The screen time in children aged 3-10 years is longer than the recommended, particularly among boys and in those children from lower SEP. Parents and policymakers should have in mind that children spend most of their screen time watching television but mobile devices are becoming extremely popular starting at a young age.

Quality of interactive media use in early childhood and child development: a multicriteria analysis

OBJECTIVES

(1) To develop an index that allows the measurement of the quality of interactive media used by children in early childhood. (2) To verify whether there is an association between the index and cognitive development, expressive language, and fine and gross motor development.

METHODS

A quantitative, cross-sectional, exploratory study with 103 children, aged 24 to 42 months, evaluated by the Bayley Scale of Infant and Toddler Development. The criteria for the index were selected from the literature: (1) media use by parents; (2) time of daily media use; (3) media type; (4) what do you use the media for; (5) who do you use the media with (6) monitoring (limits time, content, interacts during use); (7) purpose of use; (8) parents' opinion of the media. For development of the multicriteria index, the multi-attribute utility theory was applied, and Spearman correlation and simple linear regression (p<0.05) were used to verify the association between the index and child development.

RESULTS

The index showed a positive and significant correlation with child development in the following domains: language (r=0.40, p<0.001), cognitive (r=0.23, p=0.04), and fine motor=0.22, p=0.04). Simple linear regression analysis showed that the use of interactive media accounts for 22% of language development (p<0.001).

CONCLUSION

The multicriteria index developed to verify the quality of interactive media used by children in early childhood showed that it has the potential to be used. The positive and significant associations between the quality of interactive media use and child development was verified, mainly regarding language.

Screen Media: A Powerful Reinforcement

The use of screen media has significantly increased and several lifestyle consequences have occurred following this change. Screen media exposure is more common among younger age children. Multiple factors may be the reason for this; however, their use is likely reinforced. Parents seek support from screen media devices, which can help calm and occupy their children in a matter of minutes. However, resorting to electronic devices for instant relief is likely to persist due to both negative and positive reinforcement. Reinforcing screen media in this way will make the use of screen devices inextricable for parents and their children. Explaining the issue clearly and coming up with feasible solutions will help minimize the negative health effects of prolonged screen use, the general desirability of screen media devices, and also improve (and increase) healthy screen time habits in children.

CHILDREN'S USE OF INTERACTIVE MEDIA IN EARLY CHILDHOOD - AN EPIDEMIOLOGICAL STUDY

Objective:

To describe the prevalence of interactive media (tablets and smartphones) use by children aged two to four years old, as well as to characterize this use, and investigate habits, practices, parents’ participation and opinion about their child’s interactive media use.

Methods:

A cross-sectional study with 244 parents or legal guardians of children enrolled in daycare centers in a small Brazilian municipality was conducted. A questionnaire based on interactive media use and related habits were applied, and economic level was assessed. Children were divided into three different groups according to media use: Group 1 did not use (n=81); Group 2 uses up to 45 min/day (n=83) and Group 3 uses more than 45 min/day (n=80). Then, they were compared with regard to the sociodemographic variables and media use by the Chi-square test and Student’s t-test.

Results:

The prevalence of interactive media use was 67.2%, with a mean time of use of 69.2 minutes/day (confidence interval of 95% - 95%CI 57.1-81.2). The activities most performed were watching videos (55%), listening to music (33%) and playing games (28%). Most parents reported allowing media use in order to stimulate their child’s development (58.4%), accompanying them during use (75.2%), and limiting media time (86.4%).

Conclusions:

We observed high interactive media use prevalence. The predominant way of using these devices was marked by parent-child participation. Most parents reported believing in the benefits of interactive media. Passive activities were more frequent, with restricted time of use.

Trends in Digital Media Use in Korean Preschool Children

BACKGROUND

Children today are exposed to various media devices, and their usage of these is increasing. Prior studies have outlined forms of harm this can potentially cause. However, there has been little empirical research on the use of media devices among preschool children in Asia. The aim of this study was to examine and analyze longitudinal trends in media device use among Korean preschool children, focusing on the frequency of engagement, time spent with, and ownership of media devices, delineated by sex.

METHODS

Four hundred parents of children aged 2-5 years were invited to enroll. The baseline assessment, Wave 1, was conducted between December 2015 and June 2016, and follow-up assessments, Wave 2 and Wave 3, were conducted annually for the following 2 years. Time of media use, frequency of media use, and ownership of media devices (TV, tablet PCs, and smartphones) were investigated.

RESULTS

Ownership of tablet PCs increased significantly between Wave 1 and Wave 3 for boys and girls (corrected P < 0.001). Frequency of media use increased significantly between Wave 1 and Wave 3 only in boys' use of tablet PCs (mean difference 0.8 day/wk). Time of media use increased significantly between Wave 1 and Wave 3 for both sexes in all devices, measured by mean difference on weekdays and weekends (TV by 0.6 and 0.7 hr/day, tablet PCs by 0.6 and 0.8 hr/day, and smartphones by 0.4 and 0.4 hr/day). Children spent more time using media devices during weekends than on weekdays.

CONCLUSION

This study observed an increase in the tendency of media device use among preschool children in Korea. The patterns of use indicate that paying attention to the types of devices children use is needed, as well as vigilance on weekends.

Physical activity and sedentary behavior across three time-points and associations with social skills in early childhood

Background

The growth and development that occurs in early childhood has long-term implications, therefore understanding the relevant determinants is needed to inform early prevention and intervention. The objectives of the study were to examine: 1) the longitudinal associations of physical activity and sedentary behavior with social skills and 2) how physical activity and sedentary behavior track over three time-points.

Methods

Participants were from the Parents’ Role in Establishing healthy Physical activity and Sedentary behavior habits (PREPS) project. A total of 251 eligible toddlers and their parents participated at baseline in 2014/15 (time 1; 1.6 ± 0.2 years) and a sub-sample participated at 1-year (time 2; n = 79; 2.7 ± 0.3 years) and 2-year (time 3; n = 77; 3.7 ± 0.4 years) follow-ups. Sedentary time (≤25 counts/15 s), light-intensity physical activity (LPA; 26–419 counts/15 s), and moderate- to vigorous-intensity physical activity (MVPA; ≥420/15 s) were objectively measured with wGT3X-BT ActiGraph accelerometers, and standardized for wear time. Parents reported their children’s screen time (television/video, video/computer games) at all three time-points. Parents also reported on children’s social skills using the Adaptive Social Behavior Inventory (ASBI) at time-points 2 and 3, and comply (e.g., cooperates; 10 items), express (e.g., joins play; 13 items), and disrupt (e.g., teases; 7 items) subscales were created by summing items. Generalized estimating equations (GEE) were conducted to address objective one. Tracking coefficients (low: β1 < 0.30; moderate: β1 = 0.30–0.59; moderate-high: β1 = 0.60-0.90; high: β1 > 0.9) were conducted using GEE to address objective two.

Results

Across the study, screen time was negatively associated with express (b = − 0.068, 95%CI: -0.114, − 0.023) and comply (b = − 0.056; 95%CI: -0.094, − 0.018) scores and positively associated with disrupt scores (b = 0.004; 95% CI: 0.001, 0.006). Findings were similar for television/videos but less consistent for video/computer games. No associations were observed for physical activity. Screen time significantly tracked at moderate-high levels (β₁ = 0.63; 95% CI: 0.45, 0.81), while all other behaviors tracked at moderate levels (β₁ = 0.35–0.49; p < 0.01) over the three time-points.

Conclusions

Screen time was unfavorably associated with social skills across early childhood. Furthermore, all behaviors tracked at moderate to moderate-high levels from toddler to preschool ages. Therefore, promoting healthy physical activity and sedentary behavior patterns early in life, especially for screen time, may be important.