Television, Computer, Tablet, and Smartphone Use and Risk of Autism Spectrum Disorder in Early Childhood: A Nationally Representative Study | BMC Public Health


In a nationally representative study of 2-year-old children, the majority were exposed to screens daily. In IPW-controlled analyses, screen media use, primarily television, was associated with an increased likelihood of mid-level risk of neurodevelopmental difficulties, but a reduced likelihood of high risk. Our study adds to a growing literature showing high levels of screen-based media use in young children and possible associations with development. However, several studies have shown high levels of screen use in children at risk for autism spectrum disorders [6, 8] and our data temper the results of previous surveys. Our data suggest a complex relationship between screen-based activities and the risk of neurodevelopmental difficulties, including the risk of autism.

We must recognize several limitations. First, ELFE is based on the voluntary participation of parents and may have left out children vulnerable to neurodevelopmental difficulties. [9]. Nevertheless, the sample is heterogeneous enough to study environmental risk factors for neurodevelopment. [12, 15] and our data has been weighted to be nationally representative. Second, ELFE is a longitudinal cohort study, but the data we used is cross-sectional and we cannot rule out that children’s neurodevelopmental difficulties may influence their use of screens. This may partly explain the lower exposure levels in children at high risk for neurodevelopmental difficulties. To address this issue, our statistical analyzes controlled for a range of covariates that precede and predict children’s screen use and ASD symptoms, which is one way to account for common sources of variation. Future studies with prospective designs are warranted to assess the role of early use of screening on the risk of neurodevelopmental difficulties in children, particularly those in the ASD range. Third, we used a single M-CHAT measure, which is likely less specific than repeated assessments and it is unlikely that all children identified as having intermediate or high risk will actually be diagnosed with ASD. [10]. This leads to the possibility of misclassification, particularly in the intermediate risk group, and necessitates close monitoring of children’s later neurodevelopmental outcomes. [11]. Fourth, participants in the ELFE study were born in 2011 and levels of screen use by children have since increased, particularly during the COVID-19 pandemic. [1]. This implies that 2-year prevalence levels of screen exposure are likely currently higher than what we report. However, the associations we observe between children’s media screen use and the risk of neurodevelopmental difficulties are likely to be valid under current circumstances or may have increased.

Our study also has strengths that we would like to highlight. First, ours is one of the few studies to examine the early risk of neurodevelopmental difficulties in a nationally representative community sample of young children. Second, to our knowledge, this is the first study in a general population setting to include a measure of computer/tablet and smartphone use in early childhood and to investigate the relationship with neurodevelopment. One of the hypotheses explaining this association is the effect of exposure to electromagnetic fields on brain development in children. [6]. Third, we used propensity scores and inverse probability weights to control for selection biases and a large number of child and family characteristics prior to measures of screen media use that might confound the study. association of interest, excluding a number of alternative explanations.

Overall, young children exposed to multimedia screens may experience neurodevelopmental delays, captured by the intermediate risk category on the M-CHAT. Our data suggest that television use appears to be more strongly associated with ASD risk in children than other types of screen-based media. This may reflect children’s greater passivity in front of a television screen, which should be confirmed by further research, using both quantitative and qualitative models. This association may reflect reduced playtime and physical activity, as well as more limited interactions with other children and adults. [5]. Low levels of screen use among children at high risk of neurodevelopmental difficulties suggest limited interest or specific parenting behaviors in some – rather highly educated – families that limit children’s exposure [16]. It is suggested that early environmental exposures such as screen time may increase the experience of symptoms suggestive of ASD risk, but this should be further investigated in studies that longitudinally follow large samples of potentially at-risk children. ASD risk.

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