Prevalence of excessive screen time and its association with developmental delay in children aged <5 years: A population-based cross-sectional study in India

Screen Use Time and Its Association With Mental Health Issues in Young Adults in India: Protocol for a Cross-Sectional Study

BACKGROUND

Screen use time has increased in the past decade owing to the increased availability and accessibility of digital devices and the internet. Several studies have shown an association between increased screen use time and mental health issues such as anxiety and depression. However, studies in the young adult population-a demographic with high screen use-and in low- and middle-income country settings are limited.

OBJECTIVE

This protocol describes a study that aims to measure self-reported screen use times and patterns in young adults (18-24 y) in India and assess if increased screen use time is associated with poorer mental well-being.

METHODS

This protocol describes a cross-sectional study of a pan-India, web-based convenience sample of young adults (18-24 y) with access to digital devices with a screen and a minimum of secondary school education. Participants will be recruited through people in the professional networks of the investigators, which includes pediatricians. The survey will also be distributed via the social media pages of our organization (X [X Corp], Instagram [Meta], Facebook [Meta], etc). Sociodemographic details will be collected through a questionnaire designed by the authors; screen use time and patterns will be assessed using an adaptation of the Screen Time Questionnaire to include data on different apps and websites used on digital devices; and mental health parameters will be gauged using the Warwick-Edinburgh Mental Well-Being Scale, Generalized Anxiety Disorder Scale, Perceived Stress Scale, and Patient Health Questionnaire. For statistical analysis, we will consider the following variables: (1) the primary independent variable is screen use time; (2) other independent variables include age, gender, residence: rural or urban, educational qualifications, employment status, stress associated with familial financial status, average sleep time, number of people living in a house or rooms in that house, BMI, substance use, and past psychiatric history; and (3) dependent variables include mental well-being, depression, anxiety, and perceived stress. To quantify the association between screen use time and mental health, we will perform a Bayesian multivariate multiple regression analysis that models the possibility of multiple alternative hypotheses while accounting for relevant sociodemographic covariables.

RESULTS

The survey instrument has been designed, and feedback has been obtained from the domain experts and members of our organization whose profile is similar to the potential study participants. The final data received after this study has been conducted will be analyzed and shared. As of January 2023, we have not yet initiated the data collection.

CONCLUSIONS

Based on the findings of this study, we will be able to establish a correlation between device- and use-specific screen use time and various mental health parameters. This will provide a direction to develop screen use time and mental health guidelines among young adults.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/39707.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Exploring the Effect of Trataka (A Yogic Cleansing Technique) and Cold Eye Pack on Eye Strain During COVID-19 Pandemic: A Randomized Three-Arm Trial

Objective: Computer vision syndrome is a major global public health concern affecting >60 million individuals globally. Yoga and naturopathy practices can reduce visual fatigue and strain. The present study attempted to explore the effect of trataka that is, a yogic cleansing technique and cold eye pack on visual strain and fatigue. Subjects: Three hundred volunteers from an IT company were recruited following inclusion and exclusion criteria. Intervention: The subjects were randomly distributed in three groups, that is, trataka, cold eye pack, and waitlist control group with an allocation ratio of 1:1:1. Outcome measure: Visual Fatigue Scale and Visual symptoms checklist (VSC) was administered at baseline and end of 2 weeks. Repeated measures analysis of variance (RM-ANOVA) with Bonferroni corrections was used to test the difference across the groups. Results: All the variables were similar at the baseline among the groups. Significant changes in the within-group analysis occurred in both the trataka and cold eye pack groups. The RM-ANOVA revealed significant differences in the VAS and VSC (p = 0.001) and the post hoc analysis suggested that there were significant differences in both the trataka and cold eye pack group when compared with the control group (p = 0.001); however, there was no differences between the trataka and cold eye pack group in both the scales (p = 1). Conclusions: The results of the present study suggest that a trataka and cold eye pack for 14 days improves self-rated visual strain and fatigue among IT professionals with computer vision syndrome. Clinical Trial registration number: CTRI/2020/11/029003.

Association between excessive screen time and school-level proportion of no family rules among elementary school children in Japan: a multilevel analysis

BACKGROUND

Excessive screen time (ST) in children is a global concern. We assessed the association between individual- and school-level factors and excessive ST in Japanese children using a multilevel analysis.

METHODS

A school-based cross-sectional study was conducted in Toyama, Japan in 2018. From 110 elementary schools in Toyama Prefecture, 13,413 children in the 4th-6th grades (boys, 50.9%; mean, 10.5 years old) participated. We assessed lifestyle, recreational ST (not for study use), psychological status, and school and family environment including family rules. We defined ≥3 hours ST as excessive. We calculated the school-level proportions of no family rules and divided them into four categories (<20%, 20% to <30%, 30% to <40%, and ≥40%). A modified multilevel Poisson regression analysis was performed.

RESULTS

In total, 12,611 children were included in the analysis (94.0%). The average school-level proportion of those with no family rules was 32.1% (SD = 9.6). The prevalence of excessive ST was 29.9% (34.9% in boys; 24.8% in girls). The regression analysis showed that excessive ST was significantly associated with both individual-level factors, such as boys (adjusted prevalence ratio (aPR); 1.39), older grades (aPR; 1.18 for 5th grades and 1.28 for 6th grades), late wakeup (aPR; 1.13), physical inactivity (aPR; 1.18 for not so much and 1.31 for rarely), late bedtime (aPR; 1.43 for 10 to 11 p.m. and 1.76 for ≥11 p.m.), frequent irritability (aPR; 1.24 for sometimes and 1.46 for often), feelings of school avoidance (aPR; 1.17 for sometimes and 1.22 for often), infrequent child-parental interaction (aPR; 1.16 for rare and 1.21 for none), no family rules (aPR; 1.56), smartphone ownership (aPR; 1.18), and the school-level proportion of no family rules (aPR; 1.20 for 20% to <30%, 1.29 for 30% to <40%, and 1.43 for ≥40%, setting <20% as reference).

CONCLUSION

Besides individual factors, a higher school-level proportion of no family rules seemed influential on excessive ST. Increasing the number of households with family rules and addressing individual factors, could be deterrents against excessive ST in children.

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

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

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

PURPOSE

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

DESIGN AND METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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

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

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

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.

Association between screen time and developmental and behavioral problems among children in the United States: evidence from 2018 to 2020 NSCH

Excessive digital media use has become the common phenomenon among children's lifestyle, and its influences on the plausible accompanying psychological and behavioral problems are gradually investigated. This study aimed to examine the association between screen time and developmental and behavioral problems of children in the United States (US). A secondary analysis based on the data from the 2018 to 2020 National Survey of Children's Health (NSCH) was conducted. Seven types of developmental and behavioral problems and screen time on weekdays of children were collected through parents/caregivers' recall. Logistic regression models were constructed to determine the associations. Overall, 101,350 children aged between 0 and 17 years old were included in this study and 70.3% of preschoolers aged 0-5 years old and 80.2% of children and adolescents aged 6-17 years old had excessive screen time. Excessive screen time was positively associated with behavioral and conduct problem, developmental delay, speech disorder, learning disability, autism spectrum disorders (ASD), and attention deficit hyperactivity disorder (ADHD) and there were significant dose-response relationships. The association between excessive screen time and developmental and behavioral problems was stronger among preschoolers than among children and adolescents. Boys with excessive screen time showed high odds of most types of developmental and behavioral problems. It can be concluded that children with excessive screen time are at high odds of developmental and behavioral problems, especially for preschoolers and boys. Early intervention of digital media use is urgent and essential for children in the US.

Prevalence and Determinants of Excessive Screen Viewing Time in Children Aged 3-15 Years and Its Effects on Physical Activity, Sleep, Eye Symptoms and Headache

Screen viewing time is the total time spent by a child on any digital/electronic device. The objective of the present study was to determine the prevalence and predictors of excessive screen viewing time in children in Ujjain, India. This cross-sectional, community-based study was conducted through a house-to-house survey using the three-stage cluster sampling method in 36 urban wards and 36 villages of Ujjain District, India. Excessive screen viewing time was defined as screen viewing for >2 h/day. The prevalence of excessive screen viewing time was 18%. Risk factors identified using the multivariate logistic regression model were age (OR: 1.63, p < 0.001); mobile phone use before bedtime (OR: 3.35, p = 0.004); parents' perception about the child's habituation to screen time (OR: 8.46, p < 0.001); television in the bedroom (OR: 35.91, p < 0.001); morning mobile screen viewing time (OR: 6.40, p < 0.001); not reading books other than textbooks (OR: 6.45, p < 0.001); and lack of outdoor play for >2 h (OR: 5.17, p < 0.001). The presence of eye pain was a protective factor for excessive screen viewing time (OR: 0.13, p = 0.012). This study identified multiple modifiable risk factors for excessive screen viewing time.

Musical preferences of Indian children with autism spectrum disorder and acceptability of music therapy by their families: An exploratory study

Background

Music therapy has been in use for children with autism spectrum disorder (ASD) since the 1940s. However, there is limited scientific evidence on its use in the Indian context.

Aim

The present study aims to explore musical preferences of children with ASD and their caregivers' acceptability of music as a form of intervention.

Materials and Methods

It is a cross-sectional study of 120 subjects diagnosed with ASD as per the Diagnostic and Statistical Manual of Mental Disorders-5 identified by convenience sampling. A semi-structured interview schedule consisting of 25 objective response questions with multiple choices and 11 open-ended questions (pertaining to music and the use of music) was used to explore caregivers'/parents' thoughts and beliefs. The responses to open-ended questions were collected in narrative mode. A descriptive approach of content analysis was adopted to analyse the data. The data are presented using descriptive statistics. Institutional Ethics Committee's approval was obtained for conducting the study.

Results

Most of the children liked (89.2%, n = 107) music and responded (88.3%, n = 106) actively (listen intently/hum or sing or dance along) to music. Most subjects preferred rhythm (65%, n = 78) over melody (15%, n = 18). While 98.3% (n = 118) of the parents were willing to try music therapy for their child, 61% of them (n = 72) asked follow-up questions like - "Is there available data on it?" (n = 12; 10.2%) and "Will it be worth investing our time and efforts on it?" (n = 60; 50.8%).

Conclusion

Most of the children including those with auditory sensitivity like music and prefer rhythm over melody. Caregivers possess a positive attitude toward the use of music therapy. However, most of them wish to clarify the scientific basis of the same.

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.

Differential diagnosis between autism spectrum disorder and other developmental disorders with emphasis on the preschool period

BACKGROUND

Neurodevelopmental disorders are a heterogeneous group of conditions that manifest as delays or deviations in the acquisition of expected developmental milestones and behavioral changes. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in communication and social interaction and by repetitive and restricted patterns of behavior, interests and activities. The aim of this review is to discuss the clinical features of the differential diagnoses of ASD that are prevalent among preschoolers, focusing on their similarities and disparities.

DATA SOURCES

The international medical literature search was conducted using PubMed and was revised regarding the subject using single and/or combined keywords as follows: differential diagnosis, preschoolers, diagnostic challenge, attention deficit hyperactivity disorder, intellectual disability, high abilities/giftedness, childhood apraxia of speech, social communication disorder, Landau-Kleffner syndrome, stereotyped movement disorder and excessive screen time.

RESULTS

We describe conditions commonly found in clinical practice, taking ASD as a reference. We addressed converging and divergent aspects of behavior, cognition, communication, language, speech, socialization, and stereotypes for the diagnosis of ASD and other disorders identified as potential differential or comorbid diagnoses.

CONCLUSIONS

The ranking and characterization of symptoms appear to be essential for better understanding the underlying common ground between children with developmental disorders and children with ASD, thus properly diagnosing and directing social, professional, or medication interventions. This detailed discussion adds to the literature since, although ASD differential diagnoses are frequently mentioned and discussed in textbooks and journal articles, they rarely occupy a prominent place as we aimed herein.

Determinants of Excessive Screen Time among Children under Five Years Old in Selangor, Malaysia: A Cross-Sectional Study

Excessive screen time interferes with the health and development of children. However, the screen time situation among Malaysian children remains poorly understood. This study aims to identify the prevalence and determinants of excessive screen time among children under five years in Selangor, Malaysia, using the latest World Health Organization guidelines. In this cross-sectional study, 489 parent−child dyads were randomly selected from nine government health clinics in Petaling district, Selangor. Total screen time and factors were assessed using validated self-administered questionnaires and analysed using multiple logistic regression. The overall prevalence of excessive screen time was 91.4% with a median of 3.00 h. The majority of children utilized television (66%), followed by handheld devices (30%) and computers (4%). Determinants of screen time identified were Malay ethnicity, (aOR 3.56, 95% CI 1.65−7.68), parental age of ≥30 years (aOR 3.12, 95% CI 1.58−6.16), parental screen time >2 h a day (aOR 2.42, 95% CI 1.24−4.73), moderate self-efficacy to influence a child’s physical activity (aOR 2.29, 95% CI 1.01−5.20) and the positive perception on the influence of screen time on a child’s cognitive wellbeing (aOR 1.15, 95% CI 1.01−1.32). Parents play an important role in determining their child’s screen time. Future interventions should focus on addressing parental determinants to ensure age-appropriate screen time.

Technological Devices and Their Effect on Preschool Children's Eating Habits in Communities of Mixed Socioeconomic Status in Istanbul; a Pilot Cross-Sectional Study

The use of technological devices is increasing in all age groups, especially in preschool-aged children. However, there is a limiting number of studies investigating the relationship between the use of technological devices, eating behavior, and weight status in preschool children. The aim of this study was (1) to describe total usage of technological devices, (2) to evaluate level of exclusive use of such devices by children, (3) to investigate children’s eating behaviors and diet in relation to screen time and type. A cross-sectional study was conducted with 104 children aged 2–5 years in Küçükçekmece and Bakırköy, Istanbul. Data collection consisted of a validated parental questionnaire on demographics and the child’s use of technology and eating behavior, while associations in children were examined using logistic regression analysis. The analysis of the obtained data uncovered a strong association between children’s TV and tablet/smart phone use and the foods consumed by children when using these devices (p = 0.0001; p = 0.012). Also, there was a significant association between children’s eating habits and TV, and tablet/smart phone durations of use (p = 0.015; p = 0.025), but not with computer duration of use (p > 0.05). Obesity and associated health problems can arise as results of suboptimal eating behavior, such as the ones observed in our study, which are also intensified with an increased duration of use of technological devices. The attitude of families towards prudent use of technological equipment is of great importance in impacting present and future health.

Do Young Children of the "Selfie Generation" Understand Digital Photos as Representations?

In research from the 1990s, very young children failed to use pictures as representations of real events. Today, many children in the "selfie generation" are constantly photographed by their families using smartphones. While family photos are created, children are exposed to live video on the phone screen that, with a screen touch, becomes an instant photo. Children also revisit these family photos in the phone's photo library. This study explored whether toddlers growing up around smartphone photography are more successful in applying information from a photo to a real event, compared to children in the earlier research. Sixty 2-year-old children (23.0 to 26.2 months; M = 24.5 months) were asked to use pictures of a toy's hiding place (printed photographs or digital photos on an iPhone) to search for the hidden toy in 5 conditions. Toddlers were not successful with printed or digital images, whether the digital photos were accessed from the phone photo library or the researcher took the photos during the study. However, after children collaborated with the researcher to create digital photos to help an adult confederate, they were significantly more likely to use photos themselves to solve the search task. Children who experienced this scaffolding with printed photos were somewhat more successful than those without training. As with traditional symbolic media, young children's learning from emerging technologies needs the support of an adult who co-views the medium and helps clarify the symbolic relation between screen and world.