Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities.

Jing-Yi Chen,Ying-Jie Chen,Esben Strodl,Li-Hua Huang,Gui-You Yang,Wei-Qing Chen

doi:10.3390/children7110200

Abstract

Research into early screen exposure has raised growing concerns about its impact upon children’s neuropsychological well-being. However, possible pathways remain unclear. This study therefore aimed not only to evaluate the association between screen exposure during the ages of 0–3 years and preschoolers’ autistic-like behaviors, but also the mediating roles of the frequency of caregiver-child interaction, sleep duration and level of participation in outdoor activities. Based on the 2017 survey of the Longhua Child Cohort Study, data of 29,595 child-caregiver dyads were obtained via a caregiver-reported questionnaire, with the data from 29,461 dyads included in the data analysis. Multiple linear and logistic regression models were employed to estimate the associations between screen exposure, caregiver-child interaction, sleep duration, outdoor activities, and children’s autistic-like behaviors. The results indicated that screen exposure during 0–3 years of age was associated with the presence of autistic-like behaviors at preschool age, and the strength of the association was enhanced with the increase of average daily screen time (Odds Ratios (ORs) ranging from 1.358 to 4.026). The frequency of caregiver-child interaction and sleep duration mediated 5.32% and 1.19% of the variance of the association respectively, but outdoor activities did not mediate the association. Our findings indicate that preschoolers who are exposed to screens at aged 0–3 years might have an increased risk of autistic-like behaviors, and that, the frequency of caregiver-child interaction and sleep duration might function as potential mediators of this association.

Highlights

1 in 160 children worldwide meet the criteria for autism spectrum disorder (ASD) [1], which is characterized by impairments in social interactions and communication, and restrictive and repetitive behavioral patterns [2]
A genetic overlap has been confirmed between individuals with ASD and with autistic-like behaviors [9], and delayed or atypical behaviors are associated with later ASD diagnosis [10,11]
Based on the cross-sectional survey data from the Longhua Child Cohort Study (LCCS) in 2017, we explored the associations between screen exposure, the frequency of caregiver-child interaction, sleep duration, level of participation in outdoor activities in early life and autistic-like behaviors at preschool age

Summary

Introduction

1 in 160 children worldwide meet the criteria for autism spectrum disorder (ASD) [1], which is characterized by impairments in social interactions and communication, and restrictive and repetitive behavioral patterns [2]. ASD goes undiagnosed until four years of age [5], while early emerging autistic-like behaviors such as eye fixations decline and avoidant responses to touch can be observed as early as 18–24 months [6,7,8]. A genetic overlap has been confirmed between individuals with ASD and with autistic-like behaviors [9], and delayed or atypical behaviors are associated with later ASD diagnosis [10,11]. As growing evidence supports that early behavioral intervention can improve core manifestations of ASD [12,13], the identification and the exploration of risk factors for the onset of autistic-like behaviors becomes increasingly consequential [14]. Three reviews have respectively summarized the findings on screen-time-related adverse psychological outcomes among children and adolescents, such as depressive symptoms, attention problems, and poor cognitive development [18,19,20]

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