Bidirectional associations between screen time and children's externalizing and internalizing behaviors

Influence of lifestyle and family environment factors on mental health problems in Hong Kong preschoolers

BACKGROUND AND AIMS

Existing studies that simultaneously consider the effects of lifestyle and family environment factors on mental health problems (MHPs), particularly in preschoolers, are limited. This study aims to explore lifestyle and family environment factors associated with MHPs, externalising problems (EPs) and internalising problems (IPs) in preschoolers.

METHODS

This territory-wide, school-based study conducted from 2020 to 2022 involved 1926 preschoolers. MHPs, EPs, and IPs and factors such as sleep duration, sleep latency, entertainment screen time, educational screen time, parent-child recreation and learning activities were assessed. Linear and logistic regression analyses were used to explore the relationships between these factors and MHPs, EPs, and IPs.

RESULTS

The average sleep duration was 9.94 h per day, average screen time of 2.53 h per day, and 42.6 % experienced sleep latency exceeding 20 min per day among preschoolers (mean age: 4.39 years, 49.1 % female). Adjusted analyses showed that decreased parent-child recreation activities, prolonged sleep latency and excessive entertainment screen time were associated with increased MHPs, EPs, and IPs (β: 0.05 to 0.20, all p < 0.05). Weekend sleep duration of <10 h per day, sleep latency of >20 min per day, and educational screen time of >30 min per day were identified as risk factors for MHPs, EPs, and IPs, with an adjusted odds ratio ranging from 1.32 to 2.32 (all p < 0.05).

CONCLUSIONS

Preschoolers' lifestyle and family environment factors are associated with MHPs, EPs, and IPs respectively. Ensuring adequate sleep duration, avoiding sleep latency exceeding 20 min per day, reducing entertainment screen time, limiting educational screen time to 30 min per day, and increasing parent-child interactions may help to minimise mental health problems.

The Prevalences of Behavioral Problems in Children and adolescents in Chengdu, Sichuan, China and Associated Risk Factors: A Multi-Center Cross-Sectional Study

This study aimed to investigate the prevalence of behavioral problems in children and adolescents in Chengdu, Sichuan, China and the associated risk factors. A questionnaire survey was conducted with the students and their parents or caregivers from five primary and middle schools to investigate the parent-child relationship, family financial situations, health risk behaviors, and behavioral problems. A total of 8157 questionnaires were distributed, and 7928 (97.19%) valid questionnaires were returned. Among the 7928 valid questionnaires, 3846 were completed by female students and their parents or caregivers, and 4082 were completed by male students and their parents or caregivers. The average age of the surveyed students was 10.62 years. The prevalence rate of behavioral problems in children and adolescents was 13.79%, and the prevalence rate of behavioral problems significantly varied by gender and age. The female students had a higher prevalence rate of behavioral problems than male students (14.6% versus 13.0%). The students aged 12-16 years had a higher prevalence rate of behavioral problems than those aged 6-11 years (16.4% versus 12.2%). A correlation between behavioral problems and weekly pocket money was detected in the children and adolescents. Poor parent-child relationships, excessive screen time for both parents and children, short duration of sleep, and excessive intake of sugar-sweetened beverages could lead to a significant increase to the risk of developing behavioral problems in children and adolescents. Health-risky behaviors in children and adolescents were closely correlated to their behavioral problems. More attention should be paid to encouraging children and adolescents to live healthy lifestyles and tackling their behavioral problems.

The association between screen time trajectories and the comorbidity of depression and anxiety

Depression and anxiety are often comorbid among adolescents. Adolescent screen time changes over time. This study investigates the association between screen time trajectories and the comorbidity of depression and anxiety from a longitudinal perspective. The data were collected from an ongoing prospective puberty cohort which was established in 2014 from Chongqing, China. 838 participants (52.03 % female; wave 1 mean age = 8.62, SD = 1.15) were followed up from 2014 to 2020. Questions about screen time were administered every six months. Trajectories of screen time were identified using latent class growth analysis. Children's Depression Inventory (CDI) and Screen for Child Anxiety Related Disorders (SCARED) were used to measure depression and anxiety. Latent profile analysis was used to identify the subtypes of comorbidity of depression and anxiety. Logistic regression was used to explore the association between screen time trajectory and the comorbidity of depression and anxiety. Three distinct trajectories of screen time were identified: Group Low (68.26 %) had consistently low screen time, Group High (26.37 %) had high screen time and Group Increasing (5.37 %) was characterized by an increasing screen time. Four subtypes of the comorbidity of depression and anxiety were fitted ("High comorbidity", "Low comorbidity", "Low depression symptoms" and "No symptoms"). Group Increasing and Group High were associated with "Low comorbidity" and "Low depression symptoms". Group Increasing was more likely to be the "high comorbidity" both boys and girls. However, Group High was associated with "high comorbidity" only in girls. The results of this study may inform future research and provide possible intervention targets.

Anxiety in the family: A five-wave random-intercept cross-lagged panel analysis of dynamic reciprocal associations between father, mother, and child anxiety

This five-wave longitudinal study examined the between- and within-family dynamic associations between father, mother, and child anxiety and the moderating effects of child gender in Chinese culture. Five hundred and twenty-two father-mother dyads of children (59% boys; M age T1 = 8.34 years) completed measures of father, mother, and child anxiety at five time points, 6 months apart. Between-family associations suggested that children whose parents had more anxiety symptoms showed higher anxiety levels, and mothers or fathers whose partners had more anxiety symptoms showed higher anxiety levels. At the within-family level, after periods with higher child anxiety symptoms, mothers reported higher anxiety symptoms and vice versa. However, no reciprocal associations were found between father and child anxiety and between father and mother anxiety. Finally, the associations between father, mother, and child anxiety did not differ across boys and girls. Our findings highlight the importance of distinguishing among between-family and within-family associations and help to develop effective programs to prevent anxiety disorders in families.

Emotional Reactivity and Behavioral Problems in Preschoolers: The Interplay of Parental Stress, Media-Related Coping, and Child Screen Time

Background/Objectives: Excessive screen time has been linked to poorer developmental outcomes in preschool years, with the impact depending on context. Parents of emotionally reactive children, in particular, may use screens to manage their child's emotions, especially when experiencing distress themselves. This reliance on screens can hinder the development of self-regulation, leading to behavioral difficulties. Our study aimed to explore how emotional reactivity, parental distress, screen time, and media-related coping interact while contributing to externalizing (behavioral) problems in preschool-aged children. Methods: The study included 754 children (49.1% girls), aged 2-5 years (M = 44.6 months, SD = 13.7). Parents reported children's emotional reactivity and externalizing problems using the Child Behavior Checklist and provided data on daily screen time and media-related coping behaviors. Bivariate correlations, group comparisons, and structural equation modeling were employed to analyze the data. Results: Children averaged 111.86 min of daily screen time (SD = 83.94), with 35.2% of parents using screens as a coping strategy. Emotional reactivity was the strongest predictor of externalizing problems, while the role of screen time was weak, yet significant. Parental distress was positively associated with child emotional reactivity and screen time. Structural equation modeling showed that child emotional reactivity related to behavioral problems both directly and indirectly via parental distress, media-related coping, and increased screen time. Conclusions: The findings highlight emotional reactivity as a key factor in child behavioral problems, emphasizing the cumulative risks posed by parental distress and screen use. The results suggest interventions promoting healthier screen habits and supporting parental well-being.

Psychosocial Problems at Preschool Age and Cardiometabolic Health Profile at Preadolescence

OBJECTIVE

Evidence suggests that children with psychosocial problems face a higher risk of cardiometabolic diseases in adulthood. However, this may already be evident prior to adulthood. In this study, the associations between psychosocial problems at preschool age and cardiometabolic outcomes 6 years later were investigated.

METHODS

Data from 936 participants from the Amsterdam Born Children and their Development (ABCD) study was used. Psychosocial problems were assessed using the Strengths & Difficulties Questionnaire (SDQ) when the children were 5-6 years old, reported by both mothers and teachers. Cardiometabolic parameters, including body mass index, waist circumference, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol, fasting glucose, systolic and diastolic blood pressure, and carotid intima-media thickness were subsequently measured at ages 11-12 years. The associations between psychosocial problems and cardiometabolic outcomes were assessed using multivariable linear and logistic regression models.

RESULTS

In model 1, adjusted for age, sex, and puberty status, and in model 2, for sociodemographic and biological predisposition factors, the combined mother-teacher score yielded a positive association with clustered cardiometabolic score (b = 0.05, 95% confidence interval = 0.03-0.10) 6 years later. Adjusting for lifestyle factors rendered this association nonsignificant. Significant associations between mother-reported SDQ scores and most cardiometabolic parameters, except for triglycerides, diminished after controlling for confounders. Children with higher total SDQ score (by mother) had 1.31 times higher odds of developing metabolic syndrome (95% confidence interval = 1.05-1.62).

CONCLUSION

This study established a small inverse association between mother-reported psychosocial problems at ages 5-6 years and cardiometabolic health profile at ages 11-12 years.

Is the association between infant regulatory problems and trajectories of childhood co-developing internalizing and externalizing symptoms moderated by early screen media exposure?

Regulatory problems in infancy are associated with internalizing and externalizing symptom trajectories across childhood, however, it is unknown whether early screen media exposure exacerbates this association. We studied 10,170 individuals from the Growing Up in Ireland '08 cohort. Parents reported on their children's regulatory problems at 9 months, screen media exposure at 3 years, and internalizing and externalizing symptoms at 3, 5, 7, and 9 years. Children were categorized based on their patterns of co-developing internalizing and externalizing symptoms. Subsequently, multinominal logistic regression analyses were conducted to estimate whether screen media exposure (> 1 h or > 2 h) moderated the association between regulatory problems in infancy and co-developing internalizing and externalizing symptom classes across childhood. There were four groups of children with distinct patterns of co-developing internalizing and externalizing symptoms. Presence of regulatory problems at 9 months and excessive screen media exposure at 3 years (particularly > 2 h) were independently associated with increased likelihood of all classes. Excessive screen media exposure at 3 years did not significantly moderate the association between regulatory problems at 9 months and internalizing and externalizing symptom trajectories.

Analysing Digital Engagement Patterns: A Machine Learning Investigation into Social Anxiety Among Adolescents with ADHD

Background: The relationship between screen time and mental health among adolescents, particularly those identified as "digital natives", has become increasingly pertinent, especially in the context of heightened digital engagement during the COVID-19 pandemic. This study aims to examine the associations between digital engagement patterns, ADHD severity, and anxiety symptoms in adolescents aged 11-18. Methods: A cross-sectional observational study was conducted with a sample of 97 adolescents diagnosed with ADHD. Participants completed validated questionnaires assessing daily digital activities and anxiety symptoms while caregivers provided additional contextual information. Data were analyzed using Random Forest regression to identify relationships between screen time, ADHD severity, and anxiety symptoms. Results: The findings indicate an average screen time of 6.6 h on weekdays and 8.1 h on weekends, with social media emerging as the primary activity, particularly among female participants. Notable gender differences were identified, with family dynamics influencing digital engagement; family disputes had a more significant impact on girls than boys. Furthermore, specific anxiety traits, i.e., physical symptoms and harm avoidance, significantly predicted time spent on social media across all genders considered in the study, while others, namely social anxiety and separation anxiety, were less valuable. Conclusions: This study highlights the complex interplay between screen time, ADHD, and anxiety symptoms in adolescents. These findings underscore the importance of tailored interventions that address the nuanced relationships between digital engagement and mental health in this population, warranting further research to develop effective management strategies.

Association between excessive screen time and falls, with additional risk from insufficient sleep duration in children and adolescents, a large cross-sectional study in China

Objective

Falls is a major global public health issue that occur in all age groups. However, the association between screen time, sleep duration and falls in children and adolescents remains unclear.

Methods

This study included children and adolescents who participated in the 2017 Nutrition and Health Surveillance of Children and Lactating Mothers in China. Screen time, sleep duration and falls in the past 12 months were assessed using baseline questionnaires completed by the participants. We utilized a multivariate logistic regression model to estimate the association between screen time, sleep duration, and falls in children and adolescents. Stratified analyses and sensitivity analyses were performed using the same modelling strategies.

Results

A total of 564 participants (5.7%) self-reported falls in the past 12 months. Multivariate logistic regression analysis revealed that high screen time (> 2 h per day) was associated with a higher incidence of falls (cOR:1.46, 95% CI: 1.22-1.74, p < 0.001). The combination of high screen time and low sleep duration was associated with an increased risk of falls compared to the recommended low screen time and high sleep duration group (cOR: 1.62, 95% CI: 1.25-2.09, p < 0.001). After adjusting for relevant covariates, the associations remained significant (aOR: 1.30, 95% CI: 1.08-1.56, p = 0.006; aOR: 1.43, 95% CI: 1.10-1.87, p = 0.008).

Conclusion

Our study demonstrates that both high screen time and the combination of high screen time and low sleep duration were associated with an increased risk of falls. Interventions to promote healthy physical development should commence in early childhood to decrease the incidence of fall injuries in children and adolescents.

Prospective associations of screen time at age 2 with specific behavioral subscales at age 3: a cohort study

BACKGROUND

We aim to discover which, if any, of the subscales of internalizing and externalizing behavioral problems at age 3 are still associated with screen time (ST) at age 2 after adjusting for behavioral problems scores at age 2.

METHODS

This study was conducted under the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Information was gathered prospectively, with 7207 mother-child pairs included in the analysis. Children's ST was categorized in hours a day at age 2 (<1, 1-<2, 2-<4, ≥4). We assessed children's behavioral problems using the Child Behavior Checklist for Ages 1½-5 (CBCL) at ages 2 and 3. 'Having behavioral problems' was defined by them being within a clinical range for internalizing behaviors (withdrawn, somatic complaints, anxious/depressed and emotionally reactive) and externalizing behaviors (attention problems and aggressive behaviors) at age 3. Continuous scores on each of the behavioral problem scales at age 2 were used as covariates.

RESULTS

Greater ST for children at age 2 was associated with specific subscales for emotionally reactive and aggressive behaviors at age 3.

CONCLUSIONS

This study found that ST is prospectively associated with some behavioral scales but not others.

How Parental Mediation and Parental Phubbing Affect Preschool Children's Screen Media Use: A Response Surface Analysis

Parental mediation (PM) and parental phubbing (PP) are two pivotal factors that influence children's screen media use. This study used response surface analysis to examine the combined effect of PM and PP on screen time among preschool children. A total of 3,445 parents with preschool-aged children participated in this study, providing self-reported data on PM, PP, and their children's screen time (CST). The results revealed that CST decreased when parents enhanced their mediation behaviors and reduced phubbing behaviors in the cases of congruence between PM and PP. In instances of incongruence, reduced screen time was observed when parents exhibited lower frequency in mediating their CST and displayed fewer phubbing behaviors compared with situations where parents mediated their children more frequently but engaged in higher levels of phubbing behaviors. The findings suggest that PM play a significant role in mitigating preschool-aged children's excessive screen time. Moreover, it is critical to establish positive role modeling by reducing PP behaviors.

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.

The importance of mother-child interaction on smart device usage and behavior outcomes among toddlers: a longitudinal study

BACKGROUND

In recent years, smart devices have become an integral part of daily life. However, longitudinal studies, particularly those regarding the relationship between toddlers' smart device usage and behavioral outcomes, are limited. Understanding the impact of parent-child interactions on this relationship is crucial for enhancing toddlers' developmental outcomes. Accordingly, this study examined the influence of early screen time and media content exposure on toddlers' behaviors, as well as the positive effects of mother-child interactions on this influence.

METHODS

We used relevant data related to 277 children born between November 2016 and July 2020 and who were part of an ongoing prospective follow-up study conducted across five hospitals in Taipei City, Taiwan. We analyzed (1) data from maternal reports regarding children's behavior by using the Child Behavior Checklist (for ages 11/2-5 years), (2) assessments of mother-child interactions by using the Brigance Parent-Child Interactions Scale, and (3) self-reported parental data covering the first 3 postpartum years. Statistical analyses involved group-based trajectory modeling and multiple linear regression.

RESULTS

A considerable increase in screen time between the ages of 1 and 3 years was associated with less favorable behavioral outcomes at age 3. These outcomes included somatic complaints [adjusted beta coefficient (aβ) = 2.17, 95% confidence interval (CI) = 0.39-3.95, p-value = 0.01], withdrawal (aβ = 2.42, 95% CI = 0.15-4.69, p-value = 0.04), and aggressive behavior (aβ = 6.53, 95% CI = 0.25-12.81, p-value = 0.04). This association was particularly evident among children with lower levels of mother-child interaction. Nevertheless, positive mother-child interactions mitigated most of the adverse effects. Additionally, increased exposure to games and cartoons was associated with poorer behavioral outcomes in all children except for those experiencing positive mother-child interactions.

CONCLUSION

Early mother-child interactions play a crucial role in mitigating the risk of behavioral problems in toddlers who spend prolonged periods looking at screens and who are frequently exposed to game and cartoon content.

When and what: A longitudinal study on the role of screen time and activities in adolescent sleep

OBJECTIVES

Previous research has highlighted a link between electronic media use and sleep outcomes, but the nuanced impacts of screen use at different time of day and activities on adolescent sleep are underexplored.

METHODS

831 participants underwent online assessment three times with interval of three months regarding their screen time and activities at specific times of the day, daytime sleepiness was assessed with the Epworth Sleepiness Scale, and sleep outcomes were assessed with the Pittsburgh Sleep Quality Index and Insomnia Severity Index. The associations between time spent on various screen activities, and sleep outcomes were examined respectively after controlling for inter-individual differences using the Random Intercept Cross-Lagged Panel Model models and LMMs.

RESULTS

The RI_CLPM model revealed that both electronic screen time during daytime and after lights off in the evening in Wave1 negatively predicted the sleep quality in Wave2; the nighttime screen time before lights off in Wave1 significantly negatively predicted the seventy of insomnia in Wave2. Whereas no cross-lag and predictive effects of sleep outcomes on screen time were revealed. Moreover, daytime screen exposure, including T.V. watching and social media use, and nighttime music listening were negatively associated with sleep quality. Conversely, nighttime screen time of shopping and working/studying positively influenced sleep quality. Additionally, daytime screen time of T.V. viewing was positively associated with increased insomnia severity, whereas nighttime work/study-related screen time negatively affected insomnia severity. Nighttime screen time of music listening negatively predicted daytime sleepiness.

CONCLUSIONS

The current findings contributed to the existing literature suggesting that the effects of electronic screen time on sleep depended on both the time of day and type of screen activities.

Sibling effects on problem and prosocial behavior in childhood: Patterns of intrafamilial "contagion" by birth order

We investigated longitudinal relations between siblings' problem and prosocial behavior, measured by the Strengths and Difficulties Questionnaire, among different sibship sizes in the UK's Millennium Cohort Study. We identified 3436 families with two children and 1188 families with three children. All children (cohort members and their older sibling [OS]) had valid data on behavior at two time points (in 2004 and 2006). Using structural equation model, we found that for internalizing and externalizing problems, OSs (MOS1 = 6.3 years, MOS2 = 9.1 years at T1) exerted a dominant effect on younger siblings (Mage = 3.12 years at T1; 49.7% boys) across sibship sizes. For prosocial behavior, there was OS dominance in two-child families and youngest sibling dominance in three-child families.

Screen Time and Socioemotional and Behavioural Difficulties Among Indigenous Children in Canada: Temps d'écran et difficultés socio-émotionnelles et comportementales chez les enfants autochtones du Canada

OBJECTIVES

To describe screen time levels and determine their association with socioemotional and behavioural difficulties among preschool-aged First Nations, Métis, and Inuit children.

METHOD

Data were taken from the Aboriginal Children's Survey, a nationally representative survey of 2-5-year-old Indigenous children in Canada. Socioemotional and behavioural difficulties were defined using parent/guardian reports on the Strengths and Difficulties Questionnaire. Multiple linear regression analyses were conducted separately for First Nations, Métis, and Inuit participants, and statistically adjusted for child age, child sex, and parent/guardian education. Statistical significance was set at P < 0.002 to adjust for multiple comparisons.

RESULTS

Of these 2-5-year-old children (mean [M] = 3.57 years) 3,085 were First Nations (53.5%), 2,430 Métis (39.2%), and 990 Inuit (7.3%). Screen time exposure was high among First Nations (M = 2 h and 58 min/day, standard deviation [SD] = 1.89), Métis (M = 2 h and 50 min [SD = 1.83]), and Inuit children (M = 3 h and 25 min [SD = 2.20]), with 79.7% exceeding recommended guidelines (>1 h/day). After adjusting for confounders, screen time was associated with more socioemotional and behavioural difficulties among First Nations (total difficulties β = 0.15 [95% CI, 0.12 to 0.19]) and Métis (β = 0.16 [95% CI, 0.12 to 0.20]) but not Inuit children (β = 0.12 [95% CI, 0.01 to 0.23]).

CONCLUSIONS

Screen time exposure is high among Indigenous children in Canada, and is associated with more socioemotional and behavioural difficulties among First Nations and Métis children. Contributing factors could include enduring colonialism that resulted in family dissolution, lack of positive parental role models, and disproportionate socioeconomic disadvantage. Predictors of poor well-being should continue to be identified to develop targets for intervention to optimize the health and development of Indigenous children.

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.

High screen time and internalizing and externalizing behaviours among children aged 3 to 14 years during the COVID-19 pandemic in France

Children's screen time increased as a result of the COVID-19 pandemic. In the summer of 2021, we explored the association between high screen time over a period of one year since May 2020 and behavioural problems among children and adolescents. The data were derived from the French EpiCov cohort study, collected in spring 2020, autumn 2020, and spring 2021. Participants (N = 1089) responded to online or telephone interviews about one of their children aged 3 to 14 years. Screen time was categorized as high if the daily mean screen time exceeded recommendations at each collection time. The Strengths and Difficulties Questionnaire (SDQ) was completed by parents to identify internalizing (emotional or peer problems) and externalizing (conduct problems or hyperactivity/inattention) behaviours in their children. Among the 1,089 children, 561 (51.5%) were girls, the average age was 8.6 years (SD 3.7). Internalizing behaviours: High screen time was not associated with internalizing behaviours (OR [95% CI] 1.20 [0.90-1.59]) or emotional symptoms (1.00 [0.71-1.41]) while it was associated with peer problems (1.42 [1.04-1.95]). Externalizing behaviours: High screen time was associated with externalizing problems (1.63 [1.01-2.63]) and conduct problems (1.91 [1.15-3.22]) only among older children aged 11 to 14 years. No association with hyperactivity/inattention was found. In a French cohort, exploration of persistent high screen time in the first year of the pandemic and behaviour difficulties in Summer 2021 resulted in mixed findings according to behaviour's type and children's age. These mixed findings warrant further investigation into screen type and leisure/school screen use to enhance future pandemic responses appropriate for children.

Isotemporal substitution effect of 24-hour movement behavior on the mental health of Chinese preschool children

The 24-h movement behavior of preschoolers comprises a spectrum of activities, including moderate-to-vigorous intensity physical activity (MVPA), light-intensity physical activity (LPA), screen-based sedentary behavior (SCSB), non-screen-based sedentary behavior (NSCSB), and sleep. While previous research has shed light on the link between movement behaviors and children's mental health, the specific impacts on the unique demographic of Chinese preschoolers remain underexplored. This study significantly contributes to the literature by exploring how 24-h movement behavior affects the mental health of preschoolers in a Chinese context. The study involved205 Chinese preschool children (117 boys and 88 girls) between the ages of 3 and 6 years wore accelerometers to measure their LPA, MVPA, and sedentary behavior (SB), while their parents reported the time spent on sleep and SCSB. The parents also completed the Strength and Difficulties Questionnaire to assess their children's mental health. The study used compositional regression and isotemporal substitution models to examine the relationship between the various components of 24-h movement behavior and mental health. The results showed that greater NCSSB compared to MVPA, LPA, sleep, and SCSB was associated with good prosocial behavior and lower scores on externalizing problems. This highlights the potential of NSCSB as a beneficial component in the daily routine of preschoolers for fostering mental well-being. Replacing 15 min of sleep and SCSB with 15 min of NSCSB was associated with a decrease of 0.24 and 0.15 units, respectively, in externalizing problems. Reallocating 15 min of sleep to NSCSB was linked to an increase of 0.11 units in prosocial behavior. There were no significant substitution effects between LPA and MVPA time with any other movement behavior on prosocial behavior and externalizing problems. Given the positive associations observed, further longitudinal studies are necessary to explore the link between 24-h movement behavior and mental health in preschool children.

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.

Screen media activity in youth: A critical review of mental health and neuroscience findings

This review has two primary objectives: (1) to offer a balanced examination of recent findings on the relationship between screen media activity (SMA) in young individuals and outcomes such as sleep patterns, mood disturbances, anxiety-related concerns, and cognitive processes; and (2) to introduce a novel multi-level system model that integrates these findings, resolves contradictions in the literature, and guides future studies in examining key covariates affecting the SMA-mental health relationship. Key findings include: (1) Several meta-analyses reveal a significant association between SMA and mental health issues, particularly anxiety and depression, including specific negative effects linked to prolonged screen time; (2) substantial evidence indicates that SMA has both immediate and long-term impacts on sleep duration and quality; (3) the relationship between SMA and cognitive functioning is complex, with mixed findings showing both positive and negative associations; and (4) the multifaceted relationship between SMA and various aspects of adolescent life is influenced by a wide range of environmental and contextual factors. SMA in youth is best understood within a complex system encompassing individual, caregiver, school, peer, and environmental factors, as framed by Bronfenbrenner's ecological systems theory, which identifies five interrelated systems (microsystem, mesosystem, exosystem, macrosystem, and chronosystem) that influence development across both proximal and distal levels of the environment. This model provides a framework for future research to examine these interactions, considering moderating factors, and to develop targeted interventions that can mitigate potential adverse effects of SMA on mental well-being.

Exploring the longitudinal association between body dissatisfaction and body appreciation in Chinese adolescents: A four-wave, random intercept cross-lagged panel model

Although ample research evidence exists regarding the negative association between body dissatisfaction and body appreciation, the longitudinal association between these two constructs remains unclear, especially for adolescents. Thus, this study investigated the longitudinal association between body dissatisfaction and body appreciation and potential gender differences in this relationship in Chinese adolescents using four-wave longitudinal data. A sample of 2566 adolescents (54.10% girls) were included. A Random Intercept Cross-Lagged Panel Model (RI-CLPM) was conducted separately for boys and girls after controlling for baseline age and BMI z-scores. Results at the within-person level showed that for boys, body dissatisfaction at each wave negatively predicted body appreciation at the following wave, and body appreciation at Wave 2 and Wave 3 negatively predicted body dissatisfaction at Wave 3 and Wave 4. For girls, at the within-person level, body dissatisfaction at Wave 1 and Wave 2 negatively predicted body appreciation at Wave 2 and Wave 3, and body appreciation at Wave 3 negatively predicted body dissatisfaction at Wave 4. However, no gender differences in the RI-CLPM were found. The current findings enrich positive and negative body image research by providing evidence for the reciprocal relationships between body dissatisfaction and body appreciation in Chinese adolescents.

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.

Maternal COVID-19 Distress and Chinese Preschool Children's Problematic Media Use: A Moderated Serial Mediation Model

Introduction

Maternal distress increased during the COVID-19 pandemic, significantly impacting children's media use. The purpose of this study was to explore the influence mechanism of maternal COVID-19 distress on preschoolers' problematic media us through a moderated mediation model; specifically, we examined the possible mediating roles of parenting stress and negative instrumental use of media in parenting and the moderating role of supportive co-parenting.

Methods

An online survey was conducted in a sample of 1357 children (M_age = 4.01, SD = 1.06; 47.4% boys) and their parents from six public kindergartens in Shanghai, China. The mothers provided information by completing measures on their levels of distress related to COVID-19, parenting stress levels, digital parenting practices, and perception of supportive co-parenting from their partners. Additionally, both parents rated their children's problematic media use.

Results

(1) maternal COVID-19 distress was significantly and positively related to children's problematic media use; (2) this relationship was sequentially mediated by parenting stress and parents' negative instrumental use of media in parenting; and (3) supportive co-parenting moderated the serial mediation path by reducing the effect of maternal COVID-19 distress on parenting stress.

Conclusion

The findings provide some support and guidance for preventing children's problematic media use and enhancing parental adaptation during the COVID-19 pandemic or in potentially adverse situations.

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.

Associations of active and passive smartphone use with measures of youth mental health during the COVID-19 pandemic

Smartphone use provides a significant amount of screen-time for youth, and there have been growing concerns regarding its impact on their mental health. While time spent in a passive manner on the device is frequently considered deleterious, more active engagement with the phone might be protective for mental health. Recent developments in mobile sensing technology provide a unique opportunity to examine behaviour in a naturalistic manner. The present study sought to investigate, in a sample of 451 individuals (mean age 20.97 years old, 83% female), whether the amount of time spent on the device, an indicator of passive smartphone use, would be associated with worse mental health in youth and whether an active form of smartphone use, namely frequent checking of the device, would be associated with better outcomes. The findings highlight that overall time spent on the smartphone was associated with more pronounced internalizing and externalizing symptoms in youth, while the number of unlocks was associated with fewer internalizing symptoms. For externalizing symptoms, there was also a significant interaction between the two types of smartphone use observed. Using objective measures, our results suggest interventions targeting passive smartphone use may contribute to improving the mental health of youth.

Screen time and preschool children: Promoting health and development in a digital world

COVID-19 transformed the family media environment and spurred research on the effects of screen media exposure and use on young children. This update of a 2017 CPS statement re-examines the potential benefits and risks of screen media in children younger than 5 years, with focus on developmental, psychosocial, and physical health. Four evidence-based principles-minimizing, mitigating, mindfully using, and modelling healthy use of screens-continue to guide children's early experience with a rapidly changing media landscape. Knowing how young children learn and develop informs best practice for health care providers and early years professionals (e.g., early childhood educators, child care providers). Anticipatory guidance should now include child and family screen use in (and beyond) pandemic conditions.

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.

Screen media exposure and behavioral adjustment in early childhood during and after COVID-19 home lockdown periods

There is ample evidence that young children's screen media use has sharply increased since the outbreak of the novel 2019 coronavirus disease (COVID-19). However, the long-term impact of these changes on children's adjustment is currently unclear. The goals of the current study were to assess longitudinal trajectories of young children's screen media exposure through a series of national COVID-19 home lockdowns and to examine the predictive associations between different aspects of media exposure and post-lockdown behavioral adjustment. Data were collected at four timepoints during and after home lockdown periods in Israel. Longitudinal data measuring various aspects of media use, behavioral conduct and emotional problems were gathered from a sample of 313 Israeli children (54% females) between the ages two to five years (Mage at T1 = 3.6), by surveying their mothers at 5 points in time. Child overall screen time use, exposure to background television, use of media to regulate child distress and maternal mobile device use all changed throughout the lockdown periods. Moreover, during lockdowns children's behavior problems were concurrently and positively correlated with screen time, use of media to regulate child distress, and exposure to background television. However, these were not longitudinally related to child behavior problems in the post-lockdown period. Possible implications for family media use during a public health crisis are discussed.

Preschooler screen time and temperamental anger/frustration during the COVID-19 pandemic

BACKGROUND

In the context of increased media use and family distress during the pandemic, we examine whether preschooler screen time at age 3.5 contributes to later expressions of anger/frustration at 4.5, while also considering the inverse association.

METHODS

Data are from a cohort of 315 Canadian preschool-aged children during the COVID-19 pandemic. Parent-reported measures included child h/day of screen time and child temperamental anger/frustration, both measured at 3.5 and 4.5 years of age. Indicators of family distress include use of childcare and child sleep, family income, parenting stress, and parent education, marital and employment status. We also consider child sex as a control variable.

RESULTS

A crossed-lagged panel model revealed continuity in screen time between the ages of 3.5 and 4.5 (ß = 0.68) and temperamental anger/frustration from 3.5 to 4.5 (ß = 0.60). Child screen time at age 3.5 predicted increased proneness to anger/frustration at age 4.5 (ß = 0.14). Anger/frustration at age 3.5 did not predict screen time at age 4.5.

CONCLUSION

Our results suggest that preschooler screen time during the pandemic may have undermined the ability to regulate negative emotions, a key component of social and academic competence. Supporting parents in implementing healthy media habits post pandemic may benefit young children's development.

IMPACT

Key message: this study observes prospective bidirectional associations between preschoolers screen time and temperamental displays of anger or frustration during the COVID-19 pandemic. What does it add: we provide evidence that preschool screen time at age 3.5 prospectively contributes to the tendency to react in anger/frustration at age 4.5. In contrast, greater proneness to anger/frustration did not predict later exposure to screen time. What is the impact: health practitioners should enquire about media use habits during well-child visits to foster children's healthy development during the preschool years.

The influence of sedentary behaviour on mental health among children and adolescents: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Systematic reviews that have examined associations between sedentary behaviour (SB) and mental health among children and adolescents are mainly based on cross-sectional investigations. There is a lack of evidence for a prospective relationship between SB and mental health in children and adolescents. This systematic review synthesized longitudinal studies that examined prospective associations between SB and mental health among children and adolescents.

METHODS

We conducted computer searches for English language literature from electronic databases of PubMed, Embase, PsycInfo and Google scholar, and manually screened the references of existing relevant studies to select studies for the synthesis. We included observational longitudinal studies that assessed the association between SB and mental health among children and adolescents. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

In total, 58 longitudinal studies met the inclusion criteria and were synthesized in the review. We found that higher SB among children and adolescents was associated with increased depression, anxiety and other mental health problems later in life. A dose-response association between SB and mental health was observed, suggesting that children and adolescents who spend more time on SB may have a higher risk of developing poorer mental health later.

CONCLUSIONS

The findings in the present study suggest that intervention programs targeting reducing SB may benefit to the prevention of poor mental health among children and adolescents. Future intervention studies especially randomized controlled trials are needed to elucidate a causal relationship between SB and mental health among children and adolescents.

Parental psychological problems were associated with higher screen time and the use of mature-rated media in children

Aim

Parents’ psychological problems may affect children's screen time, but research has been scarce. We examined the association between parental psychological problems and children's screen media behaviours in a nationally representative sample.

Methods

The participants were from the Adolescent Brain Cognitive Development study, recruited by probability sampling from the USA population. Children reported their use of TV, videos, video games, social media and mature‐rated media. The parents (85% mothers) reported psychological problems using the Adult Self‐Report questionnaire.

Results

In 10,650 children (5112 girls, 5538 boys) aged 9.9 ± 0.6 years, the presence of parental psychological problems was associated with children spending more daily time on screen media and with meeting the recommendation of ≤2 daily hours less often than children whose parents did not have psychological problems. Parental psychological problems were associated with children's TV watching, video watching and gaming but not with using social media. Parental internalising problems were associated with children watching mature‐rated movies (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.00, 1.30) and playing mature‐rated games (OR = 1.27, 95% CI = 1.11, 1.45).

Conclusion

Presence of parental psychological problems is associated with higher screen time and use of mature‐rated media in children. This cross‐sectional study was not able to examine causal associations.

The clustering of physical activity and screen time behaviours in early childhood and impact on future health-related behaviours: a longitudinal analysis of children aged 3 to 8 years

BACKGROUND

Meeting physical activity and screen time guidelines has been associated with improved health in children. Research has shown that lifestyle behaviours happen in combination and can be tracked into later life. Thus, a complex approach is needed to identify the effects of physical activity and screen time altogether. This study aims to identify clusters of both behaviours in a cohort of Irish 3-year-old children (n = 8833) and determine the association with sociodemographic characteristics and behaviours at age 5 and 7-8.

METHODS

Data from the "Growing Up in Ireland" study collected between 2010 and 2016 was used in this study. Two-step cluster analysis was used to understand how physical activity and recreational screen time behaviours group together among 3-year-old children. Binary logistic regressions were conducted to examine if cluster placement at age 3 determined physical activity and recreational screen time behaviours at age 5 and 7-8 years, while controlling for gender of child, gender, age and employment status of the primary caregiver.

RESULTS

Six clusters were identified in 9771 (49.3% female) 3-year-old children with the majority falling into a "High Active & Mixed Screen Time" (23.2%). Those in the "High Active & Mixed Screen Time" cluster at age 3 were more likely to engage in all physical activities reported at age 5 (p < 0.01) and age 7-8 (p < 0.01) when compared to a "Low Active & Screen Time Exceed" cluster. Children categorised in a "Moderate Active & Screen Time Below" and "Moderate Active & Screen Time Exceed" were more likely to engage in the same physical activities at age 5 and 7-8 (p < 0.05 - p < 0.01). However, children in the latter cluster were also more likely (p < 0.05) to play on a computer or tablet device.

CONCLUSIONS

This paper highlights the importance of establishing positive health-related behaviours during early childhood, as this predicts future engagement in health-promoting activities. Regardless of screen time level, being part of a cluster with moderate or high levels of physical activity positively influences a child's future physical activity at age 5 and again at age 7 -8 years. The multiple layers of influence on a child's development should be leveraged to support the adoption of health-enhancing behaviours.

Screen Time as a Mechanism Through Which Cumulative Risk is Related to Child Socioemotional and Developmental Outcomes in Early Childhood

Socio-demographic risks are associated with higher child screen time and higher screen time is associated with poor socioemotional and developmental health. Existing studies have not examined children's screen time as a mechanism through which distal risks may be associated with child outcomes. In the current study, we examined whether two proximal factors, screen time and parenting quality, mediate the relation between distal cumulative risk and child outcomes. Participants (N = 1992) were drawn from a birth cohort of mothers and their children (81% white; 46% female). Mothers reported on cumulative risk factors (maternal income, education, depression, stress, marital status, housing instability, unemployment, and maternal history of childhood adversity) during the prenatal period. Parenting quality (ineffective/hostile, positive interactions) and children's screen time (hours/week) were assessed when children were three years of age. Child socioemotional (internalizing and externalizing problems) and developmental (achievement of developmental milestones) outcomes were measured at five years of age. Path analysis revealed indirect effects from cumulative risk to internalizing symptoms and achievement of developmental milestones via screen time. Indirect effects were observed from cumulative risk to internalizing and externalizing behavior via hostile parenting behavior. Over and above the effects of parenting, screen time may be a factor that links structural forms of social disadvantage during the prenatal period to child socioemotional and developmental outcomes. Due to modest effect sizes of screen time, it remains the case that child socioemotional and developmental health should be conceptualized within the context of distal cumulative risk factors such as caregiver psychological and material resources.