TV, computer, tablet and smartphone use and autism spectrum disorder risk in early childhood: a nationally-representative study | BMC Public Health

TV, computer, tablet and smartphone use and autism spectrum disorder risk in early childhood: a nationally-representative study | BMC Public Health
Written by Publishing Team

In a nationally-representative study of 2-year old children, a majority were exposed to screen media daily. In IPW-controlled analyses, screen media use, mainly TV, was associated with an increased likelihood of intermediate level risk of neurodevelopmental difficulties, but a reduced likelihood of a high risk. Our study adds to a growing literature showing elevated levels of screen-based media use among young children and possible associations with development. However, several studies showed elevated levels of screen use among children at risk of autism spectrum disorder [6, 8] and our data temper the results of prior investigations. Our data suggest a complex relationship between screen-based activities and risk of neurodevelopmental difficulties, including autism risk.

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

Our study also has strengths which we would like to highlight. First, ours is one of a few studies to examine the early risk of neurodevelopmental difficulties in a community-based nationally representative 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 study the relationship with neurodevelopment. One of the hypotheses explaining this association is the effect of electromagnetic field exposure on children’s brain development [6]. Third, we used profitability scores and inverse-probability weights to control for selection biases and for a large number of child and family characteristics predating measures of screen media use that could confound the association of interest, ruling out a number of alternative explanations.

Overall, young children exposed to screen media may experience some neurodevelopmental delays, captured by the intermediate risk category on the M-CHAT. Our data suggest that TV use seems more strongly associated with children’s ASD risk than other types of screen media. This may reflect children’s greater passivity in front of a TV screen, which should be confirmed by other research, using quantitative as well as qualitative designs. This association may reflect reduced play time 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 parental behaviors in some – rather than highly educated – families which restrict children’s exposure [16]. There is a suggestion that early environmental exposures such as screen media exposure could increase the experience of evocative symptoms of ASD risk, however this should be further investigated in studies which follow longitudinally large samples of children potentially at risk of ASD.

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