Screen-time is associated with inattention problems in preschoolers: Results from the CHILD birth cohort study

Linking 24-hour movement behaviour guidelines to core symptoms and school engagement of youth with moderate/severe ADHD

BACKGROUND

The independent associations of physical activity (PA), sleep duration (SL), and screen time (ST) with health outcome measures have been well-documented among children and adolescents, but not in youth with moderate/severe ADHD. To this end, the present study aimed to investigate the associations between three components within 24-hour movement behaviour (24-HMB) framework and core symptoms and school engagement in youth with moderate/severe ADHD.

METHODS

This study used pooled data from the 2021-2022 U.S. National Survey of Children's Health, which included a nationally representative sample of 4797 youth aged 6-17 years. Logistic/Ordinal regressions examined associations between meeting 24-HMB guideline combinations and core symptoms and school engagement among youth with moderate/severe ADHD, adjusting for age, sex, family income, body mass index, and ethnicity.

RESULTS

Only 6.9% of youth with moderate/severe ADHD met all three 24-HMB guidelines. Compared to those meeting no guidelines, youth meeting all guidelines was beneficially associated with inattention symptoms (self-regulation: OR=0.44, 95%CI: 0.35-0.57; concentration: OR= 1.26, 95%CI: 1.01-1.55) and better performance of school engagement (caring about doing well: OR = 0.52, 95%CI: 0.41-0.65; completing homework: OR = 0.49, 95%CI: 0.39-0.62). Meeting the ST + SL guidelines was associated with significantly lower odds of hyperactivity/impulsivity symptoms (argument, OR = 1.33, 95% CI: 1.12-1.58; staying calm, OR = 0.59, 95% CI: 0.46-0.75) compared to those who met none of guidelines.

CONCLUSIONS

Meeting 24-HMB guidelines was associated with lower likelihood of ADHD core symptoms and greater likelihood of school engagement. Integrative "whole day" behavioural interventions warrant consideration for improving school engagement-related outcomes and reducing ADHD core symptoms in this vulnerable population.

Associations Between Preschooler Screen Time Trajectories and Executive Function

OBJECTIVE

To examine associations between preschooler screen time trajectories and executive functions and effortful control at age 5.

METHODS

Prospective, community-based convenience sample of 315 parents of preschoolers (54% male), studied at the ages of 3.5 (2020), 4.5 (2021), and 5.5 (2022). Parent-reported screen use at the ages of 3.5, 4.5, and 5.5 was used to estimate preschooler screen use trajectories. Using latent growth modeling, we identified low (mean=.9h/d, 23%), medium (mean=3.0h/d, 56%), and high (mean=6.38h/d, 21%) screen time groups. Children completed assessments of inhibitory control and cognitive flexibility at age 5.5. Both tasks are from the National Institute of Health Toolbox. Parents reported child effortful control at the age of 3.5 and 5.5 using the Children's Behavior Questionnaire, educational attainment, and parenting stress.

RESULTS

Children in the average (b=-5.24) and high (b=.9.30) screen time trajectories scored significantly lower on inhibitory control than those in the low screen time group. Children in the average and high screen time groups also scored higher than children in the low screen time group on cognitive flexibility (b=-4.50) and (b=-10.12), respectively. Finally, children in the average and high screen time groups scored lower than children in the low screen time groups on effortful control (b=-.41) and (b=-.61), respectively.

CONCLUSIONS

The present study shows that stability in high levels of screen use is common among preschoolers and may forecast higher risk of cognitive difficulty and lower levels of cognitive control by the time of school entry.

SUMMARY

High levels of preschooler screen use were associated with lower scores on assessments of inhibitory control, cognitive flexibility, and effortful control.

The Relationship Between Screen Use and preschoolers' Social-Emotional Problems Among Highly Educated Migrant Families: A One-Year Follow-Up Study

INTRODUCTION

The present study investigated the relationship between screen use and social-emotional problems in preschoolers aged 46 to 72 months from migrant families.

METHODS

The parents of 427 children completed the Ages and Stages Questionnaire: Social Emotional II (ASQ: SE II) and the survey on screen use at two time points (T1 and T2) with one-year interval.

RESULTS

There were no significant changes in preschoolers' social-emotional problems and screen use over one year. Preschoolers who exceeded 1 hr per day on screens at T1 increased the risk for social-emotional problems at T2. Those who had parental involvement at T1 reduced the risk for social-emotional problems at T2. Those who viewed educational content at T1 reduced the risk for social-emotional problems between T1 and T2.

DISCUSSION

These findings highlight the protective and risk factors of screen use independently predicted children's social-emotional problems from highly educated migrant families.

Screen time exposure and executive functions in preschool children

Increased screen time (ST) among preschool children is becoming a matter of concern globally. Although gadgets such as phones, tablets and computers might be of educational use in this population, excessive ST might impair cognitive function among preschoolers. As data on this topic in preschool children are scarce, this study sought to investigate the relationship between ST and executive functions (EFs) in this population. A total of 1016 preschool children aged 5-6 years (M = 70.8 months, SD = 4.5) were tested using the Developmental Neuropsychological Assessment (NEPSY-II) and the Dimensional Change Card Sort tests for cognitive flexibility (CF), visual working memory (WM), verbal WM, inhibition and motor persistence with parental consent, while ST was reported via a questionnaire completed by their mothers. Participants spent approximately 2 h in both active and passive ST per day, with boys spending much more time in active ST than girls. There was a very weak negative correlation between CF and both active and passive ST, and a weak negative correlation between verbal WM and both active and passive ST. Additionally, there was a very weak negative correlation between inhibition and passive ST on weekday. To ensure proper development of EFs in preschool children, ST should be limited to ≤ 1 h per day of high-quality educational/interactive content as previously determined by eminent pediatric institutions worldwide. Proven remedies that enhance EFs in children, such as physical activity and cognitive training, should be practiced regularly.

Screen time and childhood attention deficit hyperactivity disorder: a meta-analysis

OBJECTIVES

The association between screen time and attention deficit hyperactivity disorder (ADHD) has been controversial. This study sheds light on the contentious correlation between screen time and ADHD.

CONTENT

Until August 2022, electronic searches of the PubMed, Embase, and Web of Science databases were carried out. The combined effect value odds ratios (OR) and 95 % confidence interval (95 % CI) were calculated for the meta-analysis using Stata 12.0. There were 81,234 children in the nine studies that made up this meta-analysis which included 28,997 children with ADHD and 52,237 healthy controls. When compared with the screen time <2  h/d, the OR (95 % CI) value of screen time and ADHD in the screen time ≥2 h/d group was 1.51 (1.20-1.90).

SUMMARY AND OUTLOOK

Based on the current meta-analysis results, our study found a positive correlation between screen time and the risk of ADHD. Excessive screen exposure may significantly contribute to the development of ADHD in children. Therefore, it is necessary to reduce screen time per day in children to prevent the occurrence of ADHD.

Brief Report: Psychometric Properties of the Brief Problem Monitor-Parent (BPM-P) 6-18 in a Sample of Children Referred to an Autism Specialty Clinic

Detection and monitoring of emotional and behavior problems is a critical part of clinical care for children diagnosed with autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDDs), as well as a common focus of research. The Child Behavior Checklist (CBCL) is a well-established caregiver-report instrument that is used for screening and monitoring of emotional and behavior problems in individuals diagnosed with ASD and NDDs. However, it has over 100 items and can be time-consuming to complete. The Brief Problem Monitor Parent Report (BPM-P; Achenbach et al. 2011) includes a subset of the CBCL items and is intended for monitoring emotional and behavior problems. However, its validity has not been examined in ASD or NDD samples. Data from 302 children ages 6-18 years whose caregivers had completed the CBCL were drawn from a clinical research databank. Confirmatory factor analysis of the BPM-P three-factor structure had mixed findings. All BPM-P scales had acceptable internal consistency, and agreement between the BPM-P cutoffs and the corresponding CBCL clinical cutoffs was acceptable for the broad problem scales. The Attention scale demonstrated high sensitivity, but poor specificity. Results provide initial evidence that the BPM-P may be a useful alternative to the CBCL, producing comparable information for broad problems, while requiring much less time from caregivers. BPM-P users may want to consider the Attention scale separately due to poor specificity compared to the CBCL. These results will need to be replicated using larger samples and independent administrations of the BPM-P and the CBCL.

Association Between Television Viewing and Sensory Reactivity in Childhood: The Cross-Sectional InProS Study

BACKGROUND

Current evidence suggests a potential detrimental effect of increased television viewing on children's health, including sensory processing issues. Therefore, this study examined the association between television viewing time and atypical sensory reactivity (SR) in children aged from three to seven years.

METHODS

We evaluated data from the InProS cross-sectional study (n = 545). Daily television viewing was categorized into tertiles: ≤1.5, 1.5 to 2.5, and ≥2.5 hours. SR was evaluated using the Short Sensory Profile (SSP). Children with atypical SR were those with a global SSP score below 155, 30 for tactile sensitivity, 15 for taste/olfactory sensitivity, 13 for movement sensitivity, 27 for under-responsive/seeks sensation, 23 for auditory filtering, 26 for low energy/weak, and 19 for visual/auditory sensitivity. We used multiple Poisson regression models with robust variance to explore associations.

RESULTS

After adjusting for covariates, children who watched television 1.5 to 2.5 and ≥2.5 hours/day showed a higher prevalence of atypical global SR (prevalence ratio [PR]: 1.54; 95% confidence interval [CI]: 1.03 to 2.30; PR: 1.81; 95% CI: 1.19 to 2.76, respectively) and auditory filtering (PR: 1.50; 95% CI: 1.15 to 1.96; PR: 1.36; 95% CI: 1.01 to 1.83, respectively), compared with children who watched ≤1.5 hours/day. In addition, watching television ≥2.5 hours/day, compared with watching ≤1.5 hours/day, was associated with having atypical SR in movement sensitivity (PR: 1.73; 95% CI: 1.06 to 2.83), under-responsive/seeks sensation (PR: 1.31; 95% CI: 1.02 to1.69), and low energy/weak (PR: 2.02; 95% CI: 1.01 to 4.06).

CONCLUSIONS

The findings showed that television viewing ≥1.5 hours/day was associated with a higher prevalence of atypical SR in childhood. However, further longitudinal studies are required to confirm these results.

Does digital media use contribute to decreased expressive language skills of pre-school-aged children? An exploratory study in Portuguese children

PURPOSE/AIM OF THE STUDY

The purpose of this study was to analyse the relationship between digital media use and expressive language skills in the semantic and morphosyntactic domains, of pre-school-aged children (3 years-and-0 months to 5 years-and-11 months).

MATERIALS AND METHODS

Verbal oral expression (VOE) tasks of the Pre-school Assessment of Language Test (Teste de Linguagem-Avaliação da Linguagem Pré-Escolar) were administered to 237 pre-school children with no previous identified neurological or developmental conditions associated with language disorders to assess expressive language skills in the semantic and morphosyntactic domains. Parents completed a questionnaire about their children's medical conditions, development (using the milestones of the Survey of Well-being of Young Children and the Pre-school Paediatric Symptom Checklist), and exposure to screens (using ScreenQ). Correlations between VOE and continuous variables such as ScreenQ were computed and a regression model incorporating all variables significantly associated with total language verbal expression was created.

RESULTS

ScreenQ revealed a negative and significant correlation with children's verbal oral expression as well as significance in the regression model. Parents' education was the most significant predictor in this regression model.

CONCLUSIONS

This study emphasizes the importance of parents establishing limits for digital media use and promote good practices such as co-viewing.

Toddler Screen Time: Longitudinal Associations with Autism and ADHD Symptoms and Developmental Outcomes

Greater screen time is associated with increased symptoms of autism spectrum disorder (autism), attention-deficit/hyperactivity disorder (ADHD), and lower scores on measures of development in preschool-aged community samples. In the current longitudinal study, we examined screen time differences at 18 months of age based on clinically-defined outcomes (i.e., Autism, ADHD Concerns, Comparison) determined at age 3-5 years in a genetically-enriched sample based on family history, along with prospective associations between toddler screen time and preschool autism/ADHD symptoms and developmental achievement. Participants (n = 82) included children at high and low familial likelihood for autism and ADHD. Children with Autism and ADHD Concerns outcomes experienced significantly more screen exposure at 18 months than children without autism or elevated symptoms of ADHD. Greater screen time at 18 months was also associated with preschool symptoms of autism and ADHD and lower developmental achievement across the sample. Preschoolers with neurodevelopmental challenges experienced more screen exposure earlier in development than same-age peers, increasing potential for negative developmental impacts.

Are there associations between sedentary time inside and outside preschools with preschoolers' executive function?

Preschool children spend a large part of their day at school, and a large part of that time they spend in sedentary time. Although sedentary time negatively affects regions of the brain responsible for cognition, it is believed that the type of sedentary time performed can favor executive functions' performance. The present study explored the associations between sedentary time inside and outside preschools with executive function (EF) tasks in preschoolers. Seventy-three preschool children (60% girls; 55.0 ± 9.1 months of age) were objectively assessed for sedentary time and physical activity (PA) using accelerometers (wGT3X). EF was evaluated using the Go/No-Go paradigm through the Early Years Toolbox - YET. Go's inverse efficiency (IE) and the No-Go accuracy were analyzed. To establish possible associations between EF and sedentary time, a structural equation model was conducted after adjustments for sex, age, body mass index, and moderate-to-vigorous PA. A significant and positive association between sedentary time on weekend days and IE (b = 0.61; p < .001) was observed. The general model explained 52% of the variation in IE and 2.1% in the accuracy of No-Go. The sedentary time on weekend days seems to be related to worse EI. This result emphasizes a context-dependent association between time being sedentary and preschoolers' EF. Further investigations should focus on exploring the type of sedentary behavior children are engaged in different contexts.

A longitudinal study of breastmilk feeding duration, EEG power and early academic skills

BACKGROUND

The cognitive benefits of breastfeeding are widely recognized; however, its effects on brain development and later academic skills require further examination. This study aimed to examine the longitudinal relations between breastmilk feeding, neurophysiological changes, and early academic skills.

METHODS

In the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort, breastmilk feeding practices were collected every 3 months from 3 weeks to 18 months postpartum. Resting electroencephalography (EEG) was recorded at 18 months and power spectral density was derived. The outcomes were a set of early academic assessments administered at age 4 (n = 810). Structural equation modelling was used to investigate EEG power as a mediator between breastmilk duration and early academic skills.

RESULTS

Breastmilk feeding for ≥12 months was associated with better general knowledge, numeracy, and language at age 4 compared to shorter durations of breastmilk feeding (Cohen's d: 1.53-17.44). Linear regression showed that breastmilk duration was negatively and positively associated with low- (i.e., delta, theta) and high-frequency power (i.e., gamma), respectively (Cohen's f2: 0.03-0.09). After adjusting for demographic and child baseline covariates, a decrease in absolute and relative delta, as well as relative theta was associated with better general knowledge and numeracy (Cohen's f2: 0.16-0.25). Relative delta power provided an indirect path between breastmilk duration and early academic skills (x2: 18.390, p = 0.010; CFI: 0.978; TLI: 0.954; RMSEA: 0.040).

CONCLUSIONS

Extended breastmilk feeding is associated with reduced low-frequency power and better early academic skills, suggesting benefits to brain development. Additional research to confirm this finding is warranted.

Assessment of Risk of Behavioral Problems in Children Below Five Years in Relation to Screen Time: A Cross-Sectional Study

BACKGROUND

Excessive screen time is associated with developmental (mainly socio-cognitive and language) and behavioral problems more in children below five years than in older children and adolescents. The present study was conducted to determine the prevalence and pattern of exposure to excessive screen time in children below five years of age. It was also aimed at determining the prevalence of the risk of behavioral problems in these children in relation to their average daily screen time.

METHODOLOGY

This study was conducted as an observational descriptive study on children attending OPD in the Department of Pediatrics of a tertiary care medical college in central India over the study period of 12 months. Parents were enquired about their socio-demographic details, the daily average screen time of their child, details regarding screen time and exposures, associated factors, sleeping and eating habits, average time spent by parents with their children, and also the behavioral issues according to the preschool pediatric symptom checklist (PPSC). All these questions were asked of the parents and duly filled out by a single doctor. The IAP (Indian Academy of Pediatrics) screen time recommendation was used as a cut-off value for excessive screen time definition, which states screen time recommendations for children below two years and two to five years old.

RESULTS

The daily average screen time greater than one hour (exceeding the recommended guidelines) was found in 57.7% of children. Twenty-six percent of children were exposed to screen time before their first birthday. Among the study participants, 37.7% (n=95) of children were found to be at risk of behavioral problems as per PPSC score, with a mean PPSC score of 6.7±3.3 in these children. The daily average screen time of one to three hours was found in 39.3% of children, three to five hours in 13% of children, and more than five hours in 5.3% of children. The PPCS score was found to be significantly higher in children with higher average screen time, children using multiple devices as compared to single devices, children who preferred electronic devices or devices with toys as preferred sources of entertainment, children becoming restless when devices are not given, children having feeding and sleep issues, and children who spend less time with parents (p<0.05). Multivariate analysis revealed higher odds of behavioral problems in children having more screen time (1-3 hours OR: 1.536; 95% CI: 1.03-7.237; p=0.035, 3-5 hours OR: 2.022; 95% CI: 1.477-8.570; p=0.029, and >5 hours OR: 9.793; 95% CI: 2.065-46.447; p=0.004), children using multiple devices as compared to single devices (OR: 2.43; 95% CI: 1.194-4.95; p=0.014), and children whose parents spend less time with them (<3 hours OR:1.311; 95% CI: 1.02-2.77; p=0.012).

CONCLUSIONS

The present study found that almost all children below five years are exposed to digital devices, with the majority of children exceeding the recommended screen time guidelines, and they mostly use it for entertainment purposes. During this period, exposure of children to screens is significantly associated with the risk of behavioral problems. It was observed that excessive screen time, less time spent by parents with their children, and use of multiple devices are significant predictors of increasing risk of behavioral problems in children below five years.

Changes in parental attitudes toward attention-deficit/hyperactivity disorder impairment over time

Background

Over the last decades, the prevalence of Attention-deficit/hyperactivity disorder (ADHD) has increased. However, the underlying explanation for this increase remains unclear. We aimed to assess whether there has been a secular change in how parents perceive the impairment conferred by ADHD symptomatology.

Methods

Data for this study were obtained from the Child and Adolescent Twin Study in Sweden, involving 27,240 individuals whose parents answered a questionnaire when the children were 9 years old. We assessed the relationship between parentally perceived impairment caused by ADHD symptoms scores over time. The analysis was performed separately for five different birth cohorts, spanning three-year periods from 1995 to 2009 and for ADHD inattention and hyperactivity/impulsivity dimensions.

Results

We found a consistent upward trend of parents reporting impairment in relation to ADHD symptomatology across birth cohorts. Over a 12-year period, comparing those born 2007-2009 (assessed 2016-2018) with those born 1995-1997 (assessed 2004-2006), impairment scores increased by 27% at clinically relevant levels of ADHD symptomatology. Notably, when specifically evaluating the hyperactivity/impulsivity dimension, the disparity was even more striking, with an increase of up to 77%.

Conclusions

This study revealed a significant secular change in parental perception of impairment attributed to ADHD symptomatology over recent decades, providing new insights into the increased prevalence of ADHD. It underscores the need to better understand the factors that have contributed to the increased perception of impairment related to ADHD symptoms.

Factors Associated With Screen Time Among Preschool Children in Lima, Peru

OBJECTIVE

This study aims to identify factors associated with excessive screen time among preschoolers in Lima, Peru.

METHODS

Cross-sectional analysis from a 2019 panel study in Lima, Peru, was conducted focusing on women, aged 18 and above, who are mothers of 3- to 5-year-olds in mid-high and mid-low districts. There were two outcome variables: excessive TV and excessive electronic devices screen time, defined as ≥ 1 h of screen exposure for each one. Explored factors included the mother's age, education and wealth index and the children's age, sex, physical activity, day care attendance and ultra-processed food consumption. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between associated factors and excessive screen time using the GLM Poisson of with a logarithmic link.

RESULTS

Excessive TV screen time and electronic devices prevalence was 74% and 36.9%, respectively. For TV screen time, a high wealth index (aPR 1.13; 95%CI: 1.03-1.23) and children's age (aPR 1.18; 95%CI: 1.08-1.29 for 4 years, PR = 1.17; 95%CI: 1.07-1.28 for 5 years) were significant. For electronic devices, significant associations included mothers with more than 3 children (aPR 0.77; 95%CI: 0.62-0.96), being single (aPR 1.27; 95%CI: 1.01-1.58) and a high wealth index (aPR 1.38; 95%CI: 1.13-1.68). Furthermore, significant associations were found between excessive electronic device screen time and consumption of candies and chocolates (aPR 1.38; 95%CI: 1.08-1.77).

CONCLUSIONS

Seven out of 10 preschool children exceeded the recommended television screen time. Certain characteristics of the children, their mothers and the family's socio-economic situation are related to excessive television screen time and excessive electronic device screen time.

Electronic device usage among preschool children and its association with mental health status in Saudi Arabian kindergartens

OBJECTIVES

To estimate the prevalence of electronic device usage and its association with mental health status among preschool children aged 3-6 years.

METHODS

A cross-sectional study was conducted among preschool children aged 3-6 years in kindergartens in Makkah city in 2023-2024, using an electronic questionnaire. An Arabic version of the Strengths and Difficulties Questionnaire was used to assess mental health.

RESULTS

We recruited a total of 399 children. The prevalence of electronic device usage was 91.5%. The number of hours spent using electronic devices ranged from 0 to 12 hour (h)/day, with a mean of 3.1 h/day. We found a significant positive correlation between the number of hours spent using electronic devices and emotional problems (r=0.200, p<0.001), conduct problems (r=0.149, p=0.003), hyperactivity (r=0.279, p<0.001), peer problems (r=0.104, p=0.038), and total difficulty scores (r=0.263, p<0.001). We also found a significant negative correlation between the number of hours spent using electronic devices and the prosocial score (r= -0.128, p=0.011), and most of the included children had scores within the "close to average" category across all scales of mental health status.

CONCLUSION

There was a high prevalence of electronic device usage among preschool children, which exceeded the recommended time limit. A significant correlation was observed between electronic device use and mental health scores. Further longitudinal studies are required to understand the nature of this association and its implications for child development.

From "online brains" to "online lives": understanding the individualized impacts of Internet use across psychological, cognitive and social dimensions

In response to the mass adoption and extensive usage of Internet-enabled devices across the world, a major review published in this journal in 2019 examined the impact of Internet on human cognition, discussing the concepts and ideas behind the "online brain". Since then, the online world has become further entwined with the fabric of society, and the extent to which we use such technologies has continued to grow. Furthermore, the research evidence on the ways in which Internet usage affects the human mind has advanced considerably. In this paper, we sought to draw upon the latest data from large-scale epidemiological studies and systematic reviews, along with randomized controlled trials and qualitative research recently emerging on this topic, in order to now provide a multi-dimensional overview of the impacts of Internet usage across psychological, cognitive and societal outcomes. Within this, we detail the empirical evidence on how effects differ according to various factors such as age, gender, and usage types. We also draw from new research examining more experiential aspects of individuals' online lives, to understand how the specifics of their interactions with the Internet, and the impact on their lifestyle, determine the benefits or drawbacks of online time. Additionally, we explore how the nascent but intriguing areas of culturomics, artificial intelligence, virtual reality, and augmented reality are changing our understanding of how the Internet can interact with brain and behavior. Overall, the importance of taking an individualized and multi-dimensional approach to how the Internet affects mental health, cognition and social functioning is clear. Furthermore, we emphasize the need for guidelines, policies and initiatives around Internet usage to make full use of the evidence available from neuroscientific, behavioral and societal levels of research presented herein.

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.

Enhancing computational thinking in early childhood education through ScratchJr integration

A plethora of programming platforms purports to teach preschool-aged children computational thinking (CT) and coding skills. However, the empirical evidence to support their effectiveness is still in its early stages. A three-week didactic intervention using ScratchJr was conducted to investigate its effectiveness in fostering CT and rudimentary coding skills in a cohort of preschool children (N = 34, aged 4-6 years). While the initial performance mean of the control group (M = 7.07, SD = 2.58) exhibits a statistically significant elevation t (22.64 = 2.23, p = 0.036) vis-à-vis the experimental group (M = 5.35, SD = 1.58), t (22.64) = 2.23, p = 0.0 the terminal performance means of both groups converge closely. However, meticulous data analysis unveils a statistically notable enhancement among preschool participants exposed to the educational intervention involving ScratchJr. Notably, both instructional modalities appear commensurate in nurturing elementary computational tenets, namely modularity and control structures. The experimental cohort outperforms the control group with statistical significance in comprehending potent ideational constructs encompassing representation, algorithms, and hardware/software interplay. Conversely, the control group performs better in grasping the debugging concept than their experimental counterparts. The outcomes lend substantive credence to the efficacy of the distinct programming milieu offered by ScratchJr, underscoring its effectiveness in cultivating CT and coding proficiencies within the preschool demographic.

Assessment of Executive Functions in Children with Sensorineural Hearing Loss and in Children with Specific Language Impairment: Preliminary Reports

Executive functions (EFs) are related abilities, associated with the frontal lobes functions, that allow individuals to modify behavioral patterns when they become unsatisfactory. The aim of this study was to assess EFs in children with sensorineural hearing loss (SNHL) and in children with "specific language impairment" (SLI), compared with a control group of children with normal development, to identify specific skill deficits. Three groups of preschool children aged between 2 and 6 years were assessed: 19 children with normal hearing, cognitive, and language development, 10 children with SNHL, and 20 children with SLI. The FE-PS 2-6 Battery was used for the assessment of preschool EFs, supplemented with the Modified Bell Test for the analysis of selective attention. Statistically significant differences were found between the two experimental groups and the control one, regarding the investigated skills. Children with SNHL showed a clear deficit in flexibility, whereas children with SLI had greater problems in self-regulation and management of waiting for gratification. Selective attention was found to be deficient in all three groups, with no statistically significant differences. This study shows that the skills investigated were found to be deficient in both SNHL and SLI patients. It is essential to start targeted exercises based on specific deficient skills as part of the rehabilitation program. It is of great importance to understand the consequences of EF deficit in preschool children to achieve an accurate diagnosis and carry out customized rehabilitation programs.

Maternal asthma symptoms during pregnancy on child behaviour and executive function: A Bayesian phenomics approach

OBJECTIVE

Maternal history of inflammatory conditions has been linked to offspring developmental and behavioural outcomes. This phenomenon may be explained by the maternal immune activation (MIA) hypothesis, which posits that dysregulation of the gestational immune environment affects foetal neurodevelopment. The timing of inflammation is critical. We aimed to understand maternal asthma symptoms during pregnancy, in contrast with paternal asthma symptoms during the same period, on child behaviour problems and executive function in a population-based cohort.

METHODS

Data were obtained from 844 families from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort. Parent asthma symptoms during the prenatal period were reported. Asthma symptoms in children were reported longitudinally from two to five years old, while behavioural problems and executive functioning were obtained at seven years old. Parent and child measures were compared between mothers with and without prenatal asthma symptoms. Generalized linear and Bayesian phenomics models were used to determine the relation between parent or child asthma symptoms and child outcomes.

RESULTS

Children of mothers with prenatal asthma symptoms had greater behavioural and executive problems than controls (Cohen's d: 0.43-0.75; all p < 0.05). This association remained after adjustments for emerging asthma symptoms during the preschool years and fathers' asthma symptoms during the prenatal period. After adjusting for dependence between child outcomes, the Bayesian phenomics model showed that maternal prenatal asthma symptoms were associated with child internalising symptoms and higher-order executive function, while child asthma symptoms were associated with executive function skills. Paternal asthma symptoms during the prenatal period were not associated with child outcomes.

CONCLUSIONS

Associations between child outcomes and maternal but not paternal asthma symptoms during the prenatal period suggests a role for MIA. These findings need to be validated in larger samples, and further research may identify behavioural and cognitive profiles of children with exposure to MIA.

The relationship between screen time and gross motor movement: A cross-sectional study of pre-school aged left-behind children in China

OBJECTIVE

To investigate the level of screen time and gross motor movement level and the correlation between them in left-behind children aged 3 to 6 years old in China.

METHODS

A randomized whole-group sampling method was used to study 817 left-behind children aged 3-6 years in 15 kindergartens in Xiangcheng city, Henan province. The third version of the Test of Gross Motor Development (TGMD-3) was used to test the children's gross motor movement level, and the screen time questionnaire was used to test the children's screen time level. The relationship between the two and the indicators was explored using Pearson's two-sided correlation and multilevel regression.

RESULTS

The average daily screen time of left-behind children aged 3-6 years old increased with age, and the reporting rate of >2 h/d ranged from 22.43% to 33.73%; gross motor movement of left-behind children aged 3-6 years old increased with age, with significant differences between age (p<0.05). There was a low to moderate negative correlation (r = -0.133 to -0.354, p<0.05) between screen time and gross motor movement in children aged 3-6 years, and multiple regression analysis showed that screen time was predictive of gross motor movement in children (p<0.05), with an explanation rate of 21.4%.

CONCLUSION

There is a correlation between screen time and gross motor movement development in children aged 3-6 years old left behind, and the gross motor movement ability of children aged 3-6 years old can be developed by reducing screen time and increasing physical activity.

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.

Green Space and Internalizing or Externalizing Symptoms Among Children

Importance

Evidence suggests that living near green space supports mental health, but studies examining the association of green space with early mental health symptoms among children are rare.

Objective

To evaluate the association between residential green space and early internalizing (eg, anxiety and depression) and externalizing (eg, aggression and rule-breaking) symptoms.

Design, Setting, and Participants

Data for this cohort study were drawn from the Environmental Influences on Child Health Outcomes cohort; analysis was conducted from July to October 2023. Children born between 2007 and 2013 with outcome data in early (aged 2-5 years) and/or middle (aged 6-11 years) childhood who resided in 41 states across the US, drawing from clinic, hospital, and community-based cohorts, were included. Cohort sites were eligible if they recruited general population participants and if at least 30 children had outcome and residential address data to measure green space exposure. Nine cohorts with 13 sites met these criteria. Children diagnosed with autism or developmental delay were excluded, and 1 child per family was included.

Exposures

Green space exposure was measured using a biannual (ie, summer and winter) Normalized Difference Vegetation Index, a satellite image-based indicator of vegetation density assigned to monthly residential history from birth to outcome assessment.

Main Outcome and Measures

Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist for Ages 1½ to 5 or 6 to 18. The association between green space and internalizing and externalizing symptoms was modeled with multivariable linear regression using generalized estimating equations, adjusting for birthing parent educational level, age at delivery, child sex, prematurity, and neighborhood socioeconomic vulnerability. Models were estimated separately for early and middle childhood samples.

Results

Among 2103 children included, 1061 (50.5%) were male; 606 (29.1%) identified as Black, 1094 (52.5%) as White, 248 (11.9%) as multiple races, and 137 (6.6%) as other races. Outcomes were assessed at mean (SD) ages of 4.2 (0.6) years in 1469 children aged 2 to 5 years and 7.8 (1.6) years in 1173 children aged 6 to 11 years. Greater green space exposure was associated with fewer early childhood internalizing symptoms in fully adjusted models (b = -1.29; 95% CI, -1.62 to -0.97). No associations were observed between residential green space and internalizing or externalizing symptoms in middle childhood.

Conclusions and Relevance

In this study of residential green space and children's mental health, the association of green space with fewer internalizing symptoms was observed only in early childhood, suggesting a sensitive period for nature exposure. Policies protecting and promoting access to green space may help alleviate early mental health risk.

Adherence to the Singapore Integrated 24-Hour Activity Guidelines by Infants and Toddlers and Its Association With Well-Being

BACKGROUND

This study estimated the prevalence of Singapore infants and toddlers who met the new Singapore Integrated 24-Hour Activity Guidelines for Early Childhood and examined its association with well-being.

METHODS

A total of 267 parents of children aged between 0 and 2 years completed an online questionnaire that consists of the Singaporean Children Lifestyle Questionnaire and either the Pediatric Quality of Life (PedsQL) Inventory Infant Scale or the Strength and Difficulties Questionnaire. Well-being of infants was measured through parent responses to PedsQL and that of toddlers was measured through Strength and Difficulties Questionnaire. Data were benchmarked against age-specific guidelines for physical activity, screen time, and sleep in the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood.

RESULTS

A higher percentage of infants (37.3%) than toddlers (20.6%) had met 3 guidelines. In contrast, a lower percentage of infants than toddlers met at least one or did not meet any guidelines (3.8% and 0% for infants vs 22.4% and 1.8% for toddlers, respectively). Infants who met more guidelines had significantly higher parent-reported PedsQL total scale score than infants who met fewer guidelines (P < .05). However, the present study found that the number of guidelines met was not associated to infants' PedsQL scale score and toddlers' total difficulty score (P > .05).

CONCLUSION

Adherence to this set of local guidelines should be widely publicized, so parents will have greater awareness and knowledge on cultivating good physical activity, screen time, and sleep habits for their child from a young age.

Stress and Infant Media Exposure During COVID-19: A Study Among Latino Families

OBJECTIVE

The COVID-19 pandemic disproportionately harmed Latino families; however, its effects on their stress and media routines remain understudied. We examined economic and parenting stress patterns during the COVID-19 pandemic and estimated associations between these forms of stress and nonadherence to American Academy of Pediatrics (AAP) infant media exposure recommendations among Latino families. We also explored how nonadherence with AAP recommendations varied with COVID-19 cases.

METHODS

We analyzed baseline data from an ongoing clinical trial recruiting low-income Latino parent-infant dyads. Nonadherence with AAP media exposure recommendations (ScreenQ) and economic and parent stress were measured using parent reports. Additional variables included epidemiological data on COVID-19 cases. Linear models examined associations between the pandemic and both stress variables as well as between stress and ScreenQ. Using locally weighted scatterplot smoothing curve fitting, the rise and fall of NJ COVID-19 cases were overlayed with ScreenQ scores over time to visualize and explore trends.

RESULTS

All parents identified as Latino (62.6% unemployed, 91.5% limited English proficiency). Mean infant age was 8.2 months. Parent stress increased over time during the COVID-19 pandemic (r = 0.13, p = 0.0369). After covariate adjustment, economic and parent stress were associated with increased nonadherence with AAP recommendations (standardized beta = 0.16, 95% confidence interval [CI], 0.03-0.29; standardized beta = 0.18, 95% CI, 0.04-0.31, respectively). Nonadherence to media exposure recommendations seemed to track with rises in the number of COVID-19 cases with a lag of 7 days.

CONCLUSION

Parent and economic stress were associated with nonadherence to infant media exposure recommendations among Latino families. These findings highlight the need for practitioners to support families from under-resourced communities and to promote healthy media routines.

Impact of lockdown due to COVID-19 pandemic on neurobehavioral profile of children aged 6-12 years (NeuBeC study)

BACKGROUND

The lockdown due to the COVID-19 pandemic has affected the lives of children and resulted in behavioral and emotional disturbances in children. This study was planned to identify the prevalence of these problems in Indian children. The aim of the study was to estimate the effect of lockdown on the neurobehavioral profile of children 6-12 years of age by using the Child Behavior Checklist (CBCL) scale. CBCL is the most widely used validated scientific tool to detect behavioral and emotional problems in children.

MATERIALS AND METHODS

All children 6-12 years of age who were fulfilling the inclusion criteria of the study were included from all over India through an online Google form link. The children attending the outpatient department (OPD) at our tertiary-level care medical college were also included in offline mode. Data were collected and entered in an Excel sheet and analyzed statistically.

RESULTS

A total of 173 children in the age group 6-12 years were enrolled. The mean standard deviation (SD) age of all children was 8.88 (1.84) years, out of which males were of a mean age of 9.2 (1.84) years and females were 8.44 (1.74) years. Total CBCL T-scores (mean (SD)) for internalizing, externalizing, and total scores were 63.07 (7.98), 63.95 (6.51), and 62.39 (4.9), respectively.

CONCLUSION

Lockdown has resulted in neurobehavioral changes in normal children. The independent predictors found were the increase in screen-based media use, sleep issues, or behavioral changes like aggression due to restriction of their mobility or confinement. Females exhibited more internalizing problems, and males exhibited more externalizing problems.

Relationship between mental health, sleep status and screen time among university students during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

On 20 July 2021, after the outbreak of COVID-19 at Nanjing Lukou International Airport, several universities started closed management and online teaching. This had a large impact on students' daily life and study, which may lead to mental health problems. The purpose of this study is to study the effect of screen time on mental health status of university students and the possible mediating effect of sleep status.

METHODS

This was a cross-sectional study. A web-based questionnaire survey was employed that included demographic characteristics, sleep status and mental health status (depression, anxiety and loneliness). The Pittsburgh Sleep Quality Index scale was used to assess sleep status, while the Centre for Epidemiologic Studies Depression (CES-D) scale, Generalised Anxiety Disorder-7 (GAD-7) scale and Emotional versus Social Loneliness Scale (ESLS) were used to assess depression, anxiety and loneliness, respectively. Linear and logistic regression models were developed and adjusted for confounding factors, and finally the mediating effects were tested using the Karlson-Holm-Breen method.

RESULTS

Finally, 1070 valid questionnaires were included. Among these, 604 (56.45%) indicated depressive symptoms (CES-D score ≥16) and 902 (84.30%) indicated anxiety symptoms (GAD-7 score ≥10). The mean ESLS score (for loneliness) was 26.51±6.64. The relationship between screen time and depressive symptoms (OR 1.118, 95% CI 1.072 to 1.166) and anxiety symptoms (OR 1.079, 95% CI 1.023 to 1.138) remained significant after adjusting for confounding factors. Meanwhile, sleep status plays an intermediary role in screen time and mental health status (depression and anxiety) and accounts for 13.73% and 19.68% of the total effects, respectively. We did not find a significant association between screen time and loneliness.

CONCLUSION

During the outbreak of COVID-19, screen time is inevitably prolonged among university students. There is a relationship between mental health and screen time, and sleep status plays a mediating role.

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.

Meeting preschool screen time recommendations: which parental strategies matter?

Background

High levels of screen use by preschoolers may contribute to adverse health and developmental outcomes. Little is known about which parental strategies may be protective against intensive screen use by children. Our aim is to estimate whether parent strategies for mediating child screen time including restrictive and instructive mediation and social coviewing, predict preschooler adherence to the screen time recommendation of ≤1 h/day during the COVID-19 pandemic. We also examine if parent restrictive mediation interacts with child temperament characteristics.

Methods

Our sample is composed of 315 Canadian parents of preschoolers surveyed during the COVID-19 pandemic. Parents provided measures of child adherence to screen time guidelines at ages 3.5 (baseline) and 4.5 years. Parents also reported how often they used restrictive and instructional mediation, and social coviewing to manage their child's screen use. Control variables include child sex and temperament (effortful control, negative affectivity, extraversion), educational attainment, and parenting stress at age 3.5.

Results

A logistic regression revealed that parental restrictiveness was associated with a 4 time increase in the odds of adherence to screen time guidelines, OR = 4.07 (95% CI [1.70-13.03]). Parental social coviewing decreased the chances of adherence by 80% (OR = 0.20, 95% CI [0.09-0.48]). Furthermore, children not meeting recommendation at 3.5 were 98% less likely to respect the recommendation 1 year later (OR = 0.02, 95% CI [0.01-0.07]). Results were adjusted for child sex, temperament, baseline screen time, and parent education and stress The interaction between the restriction mediation and child temperament on later screen time was not significant.

Conclusion

Our results indicate that some parental strategies may be more effective than others for managing preschooler screen time. Parent use of restrictive mediation was most likely to forecast child adherence to later screen time recommendations. The present results may contribute to the development of targeted family-based interventions designed to promote healthy development from a young age.

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.

Shared Genetic Risk in the Association of Screen Time With Psychiatric Problems in Children

Importance

Children's exposure to screen time has been associated with poor mental health outcomes, yet the role of genetic factors remains largely unknown.

Objective

To assess the extent of genetic confounding in the associations between screen time and attention problems or internalizing problems in preadolescent children.

Design, Setting, and Participants

This cohort study analyzed data obtained between 2016 and 2019 from the Adolescent Brain Cognitive Development Study at 21 sites in the US. The sample included children aged 9 to 11 years of genetically assigned European ancestry with self-reported screen time. Data were analyzed between November 2021 and September 2023.

Exposure

Child-reported daily screen time (in hours) was ascertained from questionnaires completed by the children at baseline.

Main Outcomes and Measures

Child psychiatric problems, specifically attention and internalizing problems, were measured with the parent-completed Achenbach Child Behavior Checklist at the 1-year follow-up. Genetic sensitivity analyses model (Gsens) was used, which incorporated polygenic risk scores (PRSs) of both exposure and outcomes as well as either single-nucleotide variant (SNV; formerly single-nucleotide polymorphism)-based heritability or twin-based heritability to estimate genetic confounding.

Results

The 4262 children in the sample included 2269 males (53.2%) with a mean (SD) age of 9.9 (0.6) years. Child screen time was associated with attention problems (β = 0.10 SD; 95% CI, 0.07-0.13 SD) and internalizing problems (β = 0.03 SD; 95% CI, 0.003-0.06 SD). The television time PRS was associated with child screen time (β = 0.18 SD; 95% CI, 0.14-0.23 SD), the attention-deficit/hyperactivity disorder PRS was associated with attention problems (β = 0.13 SD; 95% CI, 0.10-0.16 SD), and the depression PRS was associated with internalizing problems (β = 0.10 SD; 95% CI, 0.07-0.13 SD). These PRSs were associated with cross-traits, suggesting genetic confounding. Estimates using PRSs and SNV-based heritability showed that genetic confounding accounted for most of the association between child screen time and attention problems and for 42.7% of the association between child screen time and internalizing problems. When PRSs and twin-based heritability estimates were used, genetic confounding fully explained both associations.

Conclusions and Relevance

Results of this study suggest that genetic confounding may explain a substantial part of the associations between child screen time and psychiatric problems. Genetic confounding should be considered in sociobehavioral studies of modifiable factors for youth mental health.

Screen time of toddlers in Paris suburbs: Quantitative and qualitative analysis

BACKGROUND

Our aim was to describe the exposure of French children aged 12-36 months to screens (time, content, age of first exposure) and to analyze different moderating factors: sociodemographic data, parents' screen time, and other factors (childcare arrangements, language spoken at home, book reading).

POPULATION AND METHODS

We conducted an observational, cross-sectional, descriptive and analytical study based on 171 questionnaires from parents of children aged 12-36 months who consulted different hospitals in the Paris region during the summer of 2020.

RESULTS

The median screen time was 1 h per day and was essentially television time. The median age of first exposure for children was 12 months. Among the most-watched sites, YouTube was in first place. One third of the children chose the content they watched alone, and the majority did so without any parental guidance (66%). Children watched a screen during mealtime every day in 25% of cases, before bedtime in 12.3% of cases, and 8.8% had a screen in their bedroom. More than one third of families left the television on in the background most of the time. In the multivariate analysis, a high level of screen time was notably linked to the child's age, the parents' screen time, and background television. However, the parental reason for exposure "to calm the child" was the most strongly correlated factor with significant child screen time. Reading books appeared to be a determining factor for less screen exposure.

CONCLUSION

These results emphasize the importance of raising parents' awareness about the potential negative effects of screen exposure (particularly on children's cognitive and emotional development) as early as possible during the maternity period. Implementing this prevention in the maternity wards could be an effective way of informing and educating parents about the potential negative effects of screen time on their child's development.

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.

Emotional and Behavioral Correlates of Exposure to Electronic Media in School-Aged Children: A Prospective Study

BACKGROUND

Exposure to electronic media is increasing from early childhood. This study aimed to examine the association between screen time and behavioral outcomes in school-aged children with a prospective birth-cohort.

METHODS

We examined the association between screen time and behavioral outcomes in school-aged children with a Korean birth-cohort study. Participants were 2,150 children, recruited during their fetal period, assessed annually for developmental outcomes. Media exposure was assessed at T4 (3.2 y/o), T8 (7.3 y/o), and T10 (9.4 y/o). After exclusions for missing data, 1,368 children were categorized into four groups (Low-Low, Low-High, High-Low, and High-High) based on average daily media time in early childhood and during schooldays, respectively. Children's temperament was assessed from T1 (0.5 y/o) to T4. Emotional and behavioral outcomes were assessed using the Child Behavior Checklist (DSM-oriented subscales) at T8 and T10.

RESULTS

We found that early-years temperament was generally similar between the media-time groups: they only differed significantly on Activity at T1 and Emotionality at T2 (1.2 y/o). However, compared to the Low-Low group, the Low-High group had significantly higher odds of high-risk scores for Conduct Problems (increased odds ratios [ORs] of 1.82 at T8 and 1.83 at T10) and Anxiety Problems (increased ORs of 1.60 at T8 and 1.82 at T10). Self-rated self-esteem and overall happiness at T10 also significantly differed among the four groups.

CONCLUSION

Our findings suggest the negative impacts of media exposure on the emotional and behavioral development of school-aged children, which substantiates the guidelines that restrict media exposure during childhood.

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.

Exploring the perception of parents on children's screentime: a systematic review and meta-synthesis of qualitative studies

BACKGROUND

Screentime (ST) has been increasingly pervasive in young children. Evidence suggests positive and negative effects of ST on children's development. Parents play a crucial role in influencing their children's ST. There is limited research consolidating the parental perceptions related to children's ST. This review consolidates the evidence on the perception of parents on their children's ST.

METHODS

Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, and ProQuest) were searched from their inception to September 2022. Critical appraisal was conducted using the Critical Appraisal Skills Program (CASP) checklist. Data synthesis was performed using Sandelowski and Barroso's approach.

RESULTS

Twenty studies were included in this review, encapsulating the experiences of 1,311 parents. Three main themes with corresponding subthemes were identified: (1) Varied reasons behind ST; (2) Attitudes toward ST; and (3) Strategies and approaches to managing ST.

CONCLUSION

The findings highlighted the varied reasons parents promote ST. Parents reported their concerns and confusion about ST and shared some strategies and approaches for better ST. Future research is needed to develop and evaluate educational programs to ensure that parents understand the risks and benefits of ST and in turn, ensure the appropriate adoption of ST for their children.

IMPACT

In the digital era, parents' attitudes towards screentime (ST) for their children are mixed. This review presents the dilemma parents face and their struggles with using optimal screen time for their children. This review provides up-to-date evidence on the parents' confusion and concerns about ST as well as strategies and approaches used by the parents for better ST. There is an urgent need for evidence-based educational programs to enhance parental knowledge about ST so that they can ensure appropriate ST among children.

CLINICAL TRIAL REGISTRATION

PROSPERO Registration No. CRD42022356083.

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

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

The relationship between screen time and attention deficit/hyperactivity disorder in Chinese preschool children under the multichild policy: a cross-sectional survey

BACKGROUND

Long screen time has become a public health problem that cannot be ignored. The association between screen time and attention-deficit/hyperactivity disorder (ADHD) in preschool children has received widespread attention.

METHODS

A questionnaire was used to survey 2452 people. ADHD symptoms were assessed by the Conners Child Behavior Scale. Considering that the ADHD symptoms of boys and girls might be different, we stratified the data by gender. Logistic regression model was used for regression analysis. To exclude the influence of multichild family and obesity level, we also conducted a sensitivity analysis. P values were two-tailed with a significance level at 0.05.

RESULTS

The results showed that the association between screen time and ADHD symptoms in preschool children was significant (OR = 1.826, 95%CI: 1.032, 3.232). After grouping the genders, the correlation was not significant. There was an association between screen time and ADHD symptoms in children from families with multiple children. However, after excluding overweight and obese children from the overall population, the association between screen time and ADHD symptoms did not have statistical significance.

CONCLUSIONS

The issue of screen time for preschoolers needs to be taken seriously. Although the results indicate a significant correlation between screen time and ADHD symptoms, clearer evidence is needed to provide recommendations to policy makers.

Media screen time use and mental health in school aged children during the pandemic

BACKGROUND

Children's screen time activity has increased significantly during the pandemic. Extended school closures and heightened parent stress are associated with children's behavioural difficulties and time spent watching screens. The primary aim of this study was to determine which school and household factors were associated with challenging behaviours in Canadian schoolchildren during the COVID-19 pandemic.

METHODS

This longitudinal survey study examined the association amongst screen time, internalizing and externalizing behaviours in school-aged children at two time points over the 2020-2021 academic school year. Parents completed survey measures on their parental involvement, stress levels, and their child's screen time use as well as their emotional and behavioural difficulties.

RESULTS

Children's average daily screen time was 4.40 h (SE = 18.45) at baseline and 3.89 h (SE = 16.70) at 1-year follow up, with no significant change across the school year (p = .316). Increased screen time use was associated with a greater incidence of internalizing behaviours in children (p = .03). Children who spent more time on screens and who were in households with parents reporting higher stress levels had increased internalizing behaviours (p < .001). No association between screen time use and externalizing behaviours was evident; however, parent stress was positively associated with children's externalizing behaviours (p < .001).

CONCLUSIONS

Children's screen time use has remained high during the pandemic and is associated with anxious and depressive symptoms. Children who spent more time on screens and who were in households with parents reporting higher stress levels had increased internalizing behaviours. Parent stress was positively associated with children's externalizing behaviours. Targeted family intervention plans focused on reducing parent stress and screen time use may aid in improving children's mental health during the ongoing pandemic.

Measuring effects of screen time on the development of children in the Philippines: a cross-sectional study

BACKGROUND

Screen time in young children is discouraged because of its negative effects on their development. However, excessive screen media use has been rising, particularly during the global pandemic when stay-at-home mandates were placed on young children in several countries. This study documents potential developmental effects of excessive screen media use.

METHOD

This is a cross-sectional study. Participants were 24 to 36 month old Filipino children recruited through non-probable convenience sampling from August to October 2021. Regression analyses were performed to test the association between screen time and changes in scaled scores for skills and behaviors determined from the Adaptive Behavior Scale and to identify factors associated with increased screen media use.

RESULTS

Increased odds of excessive use of screen media of children by 4.19 when parents watch excessively and 8.56 times greater odds when children are alone compared to watching with a parent or other children. When adjusted for co-viewing, more than 2 h of screen time is significantly associated with decrease in receptive and expressive language scores. The effects on personal skills, interpersonal relationships and play and leisure skills were only statistically significant at 4 to 5 or more hours of screen time use.

CONCLUSION

The study found that spending no more than 2 h screen time had minimal negative effects on development and that use beyond 2 h was associated with poorer language development among 2 year olds. There is less excessive screen media use when a child co-views with an adult, sibling or other child and when parents likewise have less screen time themselves.

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.

Prospective associations between child screen time and parenting stress and later inattention symptoms in preschoolers during the COVID-19 pandemic

Introduction

Child attention skills are critical for supporting self-regulation abilities, especially during the first years of life. On the other hand, inattention symptoms in preschoolers have been associated with poor school readiness, literacy skills and academic achievement. Previous research has linked excessive screen time with increased inattention symptoms in early childhood. However, most research has only focused on TV exposure and did not investigate this association during the COVID-19 pandemic. This atypical context has increased screen time in children worldwide, including preschoolers. We hypothesize that higher levels of child screen media and parenting stress at age 3.5 will be associated with higher child inattention symptoms at age 4.5.

Method

This study draws on participants followed longitudinally over the span of 2-years for an investigation of Canadian preschoolers' screen media use during the pandemic (N = 315, 2020). A follow-up with this sample was completed in 2021 (N = 264).

Results

Analyses using multiple linear regression, revealed a positive association between child screen time at age 3.5 and inattention symptoms at 4.5 years. Parental stress was also positively associated with child inattention symptoms. Associations were observed above individual (child age, inhibitory control, and sex) and family (parent education and family income) characteristics.

Discussion

These results confirmed our hypothesis and highlight that preschooler screen use and parenting stress may undermine attentional skills. Since attention is a crucial component for children development, behavior and academic outcomes, our study reinforces the importance for parents of adopting healthy media habits.

Prevalence, determinants and consequences of problematic smartphone use among preschoolers (3-5 years) from Dhaka, Bangladesh: A cross-sectional investigation

The problematic smartphone use (PSU) has been becoming a challenging health issue for preschoolers aged 3-5 years as it has severe adverse effect on their psychological, physical, and cognitive development. The scarcity of scientific research on this issue in the context of Bangladesh motivated the authors for conducting this cross-sectional study to explore the prevalence of PSU with its influential factors and adverse effects on preschooler's psychological and physical development based on primary data collected from 400 mothers. The multivariable ordinal logistic regression (OLR) was used to compute the adjusted likelihoods. The estimated prevalence of PSU was approximately 86 %, where about 29 % were severely problematic user. The likelihood of preschoolers' PSU was observed to increase with >1 h/day usage of smartphone by children (Adjusted Odds Ratio (AOR): 3.92). Other important factors were parental smartphone use, education, profession, family income, and mother's age. Both of moderate and severe PSU had adverse effect on preschoolers' health- severe PSU was found to increase the likelihood of psychological and physical problems by 6.03 and 3.29 times, respectively. The preschoolers with PSU reported to suffer from many physical and mental health problems such as attention deficit and hyperactivity disorder (ADHD), emotional instability, aggressiveness, depression, lack of control, impaired vision and hearing, obesity, body imbalance, and lack of brain development. It is now prime time to undertake strategic policies considering the findings for limiting the preschoolers' usage of smartphone, which will make Bangladesh susceptible to protect its future generation from harmful effects of PSU.

Supporting Preschoolers' Motor Development in Virtual Environments: Listening to Teachers' Voices

Going down a slide, dancing to music, and pushing someone on a tire swing are more than simply "play activities" or a means to staying physically fit. Engagement in motor play provides important opportunities for preschoolers to develop a variety of skills, including gross motor, social, communication, and cognitive skills. However, during the past several years, since the identification of the COVID-19 virus, no guidelines have been available to ensure that gross motor content is addressed while simultaneously meeting the educational needs of preschoolers with and without disabilities during virtual learning. The purpose of this study was to understand the benefits and challenges that 26 preschool teachers faced as they attempted to embed motor play into their curriculum during virtual learning. All teachers worked in inclusive preschool settings and interviews were conducted between March-June 2021. Constant comparative analysis and emergent coding were used to interpret the data. Findings revealed that school readiness skills were the primary focus of virtual learning. Teachers indicated that motor play can help expand students' pre-academic skills, be fun and motivating for children, and help students be more focused and attentive. Some logistical barriers (e.g., technology, limited physical spaces, limited resources) need to be addressed in order to successfully teach motor play in a virtual format. Study findings suggest policies and guidelines need to be established to provide young children with high quality and accessible virtual instruction. Implications for research and practice are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10643-023-01492-w.

Correlation between screen time and psychosomatic symptoms in children during COVID-19 pandemic-related lockdown

Background

This study was planned to estimate the effect of lockdown on psychosomatic problems and sleep of children and their association with screen the time during the lockdown.

Methods

A cross-sectional study was conducted among 1-12-year-old children at a tertiary care hospital in South India. A pre-validated questionnaire with 20 related questions was disseminated through pediatric OPD, telemedicine service, and social media to eligible parents.

Results

A total of 278 children aged 1-12 years with a mean (SD) age of 6.92 (3.01) years were studied. Most under 5-year-oldchildren had screen time of ≤2 hours/day, whereas 58.16% of children between 5 and 12 years spent >4 hours/day (P < 0.000). A significant proportion of participants aged 5-12 years had vision problems (P = 0.019), whereas under 5-year-old children had significant associated behavioral changes (P = 0.016) and sleep problems (P = 0.043).

Conclusion

Behavioral and sleep problems were significantly high and correlated with an increase in screen time among under 5-year-old children. Vision problems were more in 5-12-year-old children.

Promotive and risk factors for children's mental health-Finnish municipal policymakers' and leading officeholders' views

Findings on children's mental health promotion at the policy level are scarce, and the perceptions of the municipal administration on factors affecting children's mental health have not been reported. This study describes the perspectives of policymakers and leading officeholders on promotive and risk factors for children's mental health in a socioecological context. The perspectives of Finnish policymakers (n = 15) and officeholders (n = 10) in municipalities were examined using semi-structured interviews. The data were analyzed using inductive content analysis and were categorized according to the five levels of a socioecological model of health promotion: public policy, community, organizational, interpersonal and individual levels. The public policy level emerged strongly in the findings, specifically strategic planning and implementation challenges related to the promotion of children's mental health in the municipality and state administration. At the community level, environmental factors promoting children's mental health as well as risk factors were described. The organizational level consisted of support, requirements and development needs in children's services. The importance of family and close networks at the interpersonal level, as well as the individual basis of mental health, were also evident. The integration and better collaboration of child and family services, the use of child rights impact assessment in political decision-making, and financial support from the state could contribute to improving strategic planning to support children's mental health at the municipal level.

Association between screen time and suspected developmental coordination disorder in preschoolers: A national population-based study in China

Introduction

Excessive screen exposure (ESE) is a growing global public health concern. This study aims to investigate the potential association between ESE and suspected developmental coordination disorder (DCD) in Chinese pre-schoolers, with or without siblings.

Method

A retrospective cohort study was conducted, involving 126,433 children from 551 cities in China. The Little Developmental Coordination Disorder Questionnaire (LDCDQ) was employed to evaluate motor impairment in children, while parents provided information on their children’s screen time in the past year. A mixed and multi-level logistic regression model was used to analyze the associations of all screen exposure measurements from the past year with LDCDQ scores and the risk of suspected DCD.

Results

The prevalence of excessive screen exposure was 67.6% (&gt;1 h per day) and 28.9% (&gt;2 h per day) in Chinese pre-schoolers. One hour’s increase in weekday daily screen time, weekend daily screen time, and screen time before sleep in the past year was associated with a decreased total score of the LDCDQ (β were −0.690, −0.398, and −1.587, p &lt; 0.001) and an increased risk of suspected DCD by 15.3%, 9.1%, and 46.8% when adjusting for the child, family and maternal health characteristics. Excessive screen exposure decreased the total LDCDQ scores by 1.335 (&gt;1 vs. ≤1 h) and 1.162 (&gt;2 vs. ≤2 h) and increased risks of suspected DCD by 44.0% (&gt;1 vs. ≤1 h) and 31.1% (&gt;2 vs. ≤2 h) with statistical significance (each p &lt; 0.05). The stratified analysis showed that the association between screen time and LDCDQ score was stronger in children without siblings than in those with siblings.

Conclusion

The risk of suspected DCD was highest for screen time exposure before bed compared with average weekday and weekend exposures. Parents should be advised to prevent their children from using electronic screens unsupervised, especially in one-child families.