4.1. Exploring the Functionality of Screen Media in the Lives of Children and Youths with ASD
In general, screen media was mostly used for wellbeing, with playing computer or video games being used particularly often for this purpose among children with ASD. Almost all interviewees mentioned this topic and it was by far the most frequent statement within the online survey. Screen media usage for wellbeing purposes among children without ASD has been reported before [32
]. However, especially for children with ASD this wellbeing is of extensive significance: Regarding the sensory overload in pupils with ASD [46
], it can be speculated that focusing on one stimulus (screen) might help fading out other stimuli for a certain time, and thus relaxes other senses. Several studies have shown a preference for visual stimuli, especially via media, in children with autism [8
]. Other studies reported that while playing video games [34
] or watching TV [8
] children with ASD fade out sensory challenges or environmental distractors.
Based on these findings, it may be suggested that screen media might have the potential to positively influence children with ASD through rebalancing their personal overstrain caused by the great amount of environmental stimuli they encounter. This might be of further relevance considering that four children in the interview study used screen media as a background noise, for example as a sleeping aid. As highlighted by other studies, the background noise of screen media is also commonly used among children without ASD [30
]. It can be suggested that permanent background noise (e.g., white noise through television) may particularly help children with ASD to fade out other stimuli as mentioned above—in the auditory instead of the visual sense. Future research is needed regarding the wellbeing effect of screen-based media in children and youths with ASD.
The present study demonstrates that screen media are used to support the development of certain skills (e.g., language, social competence). Seven interviewed parents reported that their children are imitating voices or noises of the screen media as well as watching social stories from which they can learn. In the online survey this point seems to be less crucial. The functional “learning aspect” in using screen media might become more obvious while having a free conversation about one’s own child (interview) compared to a situation in which one is asked to complete a questionnaire (online survey). However, some studies examined the development or optimization of supportive strategies which use media and particularly videos as a model learning component. Ref. [53
] described different computerized programs, which focus on social communication skills (e.g., language, emotion recognition) and highlight the positive effects computer technology can have in this context. In Interview 7 of this study, for example, the child benefited from bedtime stories. Bedtime stories are usually characterized by their simplification of otherwise complicated social interactions, problems or other phenomena. It can be suggested that the reduction of complexity helps children to understand the point of the story and to learn from the presented role-model and its behaviour. Due to their obvious messages, bedtime stories are easy to understand and may work even better for children with ASD. In this context, other studies have reported the positive influence that electronic media can have on social or communicative skills [8
Another important finding of the present study is that almost all interviewees mentioned that screen media time is often perceived as family time (it was also one of the most frequent statements in the online-survey), for instance when the whole family is attending television events together, enjoying television evenings or when screen media content becomes a shared topic of conversation (e.g., at dinner). This is also reported in other studies on children with [36
] and without ASD [28
]. The participants in the present online survey stated that watching TV/DVD is especially used as shared time with the family. Spending quality time together with a child with ASD is not always easy to achieve. Studies indicate that parents of children with ASD feel more stressed than parents of children without ASD [54
] or compared to parents of children affected by chronic illness (e.g., cancer, diabetes), or at-risk (e.g., low income, subclinical behavioral problems) for behavioral and/or mood disorders [55
]. Thus, spending time together in a relaxed (screen) atmosphere may offer parents an opportunity to brighten everyday life and increase the quality of family life. This becomes particularly relevant when taking into account that media can offer a common topic of conversation. However, almost half of the interviewees mentioned that it is important to attend to the child during screen media use in order to answer any questions from the child (educational support) or to control the media consumption of the child (monitoring). This may be of particular relevance for children affected by ASD. Drawing for example on the report of Interviewee 7 or 13 highlights the need of an accompanying person to help put things into perspective. Thus, it can be important for children with ASD to have the opportunity to address questions that might come up during their media consumption.
This point is even more important considering that children with special needs are more likely to become victims of cyberbullying than children without special needs [56
]. In this context, [59
] found that parental mediation had a buffering effect on the relationship between cyber victimization and depression in children with ASD. It may be favourable for parents to be aware of the content of their child’s media use as well as related problems in order to be able to consider it in the assessment of their child’s behaviour, and thus react to it in an adequate way.
In the present study, screen media was also reported as being used for communication and social exchange, for instance while doing homework, by four interviewees and some participants of the online survey. Particularly smartphones are used for this purpose. In the interviews, parents appeared pleased by their child’s interaction with other children via chats or social apps, even though this was mostly limited to communication in a restricted scope and rarely lead to face-to-face-encounters with friends. However, messaging features seem to play a vital role for children without ASD [60
], but possible also for children with ASD. In this context, some parents highlight what they consider a positive side effect. According to them, the respective communication that comes with it helps their children to overcome social isolation.
Other children of the present study are using screen media in order to improve their sense of safeness, on the one hand as a means to contact others and for communication, e.g., by calling their parents. The participants of the online survey ascribed particular importance to smartphones as being a safety device; also because they provide the opportunity to make emergency calls. One interviewed mother of the present study mentioned that her son would not independently approach a stranger to call home, but he would call home with his own phone.
In the present study, screen media was also used as a source of information by some children described in the interviews and in the online survey (the second most frequent statement), e.g., watching TV to get factual information or using the internet to look for information. In times of proceeding digitalization this is what one would expect, especially since available evidence suggests that children without ASD use screen media for educational purposes or homework assignments [32
Furthermore, the present study indicates that some parents at times use screen media to gain some free time, or to take care of the needs of their other children. This “babysitter” function of screen media has also been observed in studies with parents of children without ASD [28
]. However, screen-based media becomes problematic if parents use screen-based media as a digital babysitter [20
]. This becomes particularly relevant when the above-mentioned suggested need for educational support and monitoring during screen use is taken into account. It was also observed in the present study that screen media were occasionally applied as an instrument to reinforce desired behavior by some interviewees. According to studies with parents of children without ASD, this seems to be common as results show that screen media, especially television, are used as a reward or punishment tool [31
]. However, using screen-based media as a reward, or its withdrawal, as a sanction could entail a problematic screen-based media use [20
], whereas the other dimensions (time, content) must be considered as well.
Some parents of children of the present study reported that screen media helps them to gain a certain status, especially to become part of a group (social acceptance). Interviewee 10, for instance, expressed her belief that providing high-end devices to her child will help him maintain his social inclusion. It therefore seems possible that screen media devices support children with ASD not only in interacting with peers [26
], but also in retaining the social status within their peer group, which may be associated with children’s desire for affiliation. For example, in their study [64
] observed that children with ASD generally want to have friendships. However, older children rather avoid social interaction due to their negative experiences [64
]. In their experimental study, [28
] concluded that children with ASD do have a wish for social interaction, though it might not be at an explicit (measured by the Social Interaction Scale) but instead at a rather implicit (measured by the Face Turn AAT) level. That is, although there is a (implicit) desire for social interaction, interacting in a direct way might be too complex for many of children with ASD [28
]. In general, the desire for affiliation is a natural part of children’s development and a core source of motivation in humans of all ages [65
]. Even if children with ASD are less socially motivated [50
], there is evidence that some children with ASD feel lonely [72
], and are objectively more excluded than children without ASD [74
]. Furthermore, if their problems in social interaction [75
] are taken into account, affiliation is more difficult to achieve for children with ASD. Thus, media use might potentially provide easier access to social experiences and it may consequently increase the sense of safeness in social interactions. In the cross-sectional study the authors observed a positive association between social media use and quality in friendships in adolescents with ASD [80
]. Contrary to the desire for social affiliation, some studies found that children with ASD use screen media in order to avoid social interaction or to compensate for a lack of friends [26
]. This was not be confirmed in the current study. Though one needs to consider that parents had been asked directly to report about their child’s functionality of screen media. It seems likely that the compensation for a lack of friends therefore is not among the first functions that comes to parents’ minds.
For some children in the present study, screen media plays a major role in daily life. This also bears the risk that the child is preoccupied with thoughts about using screen media, which might result in problems (e.g., excessive use, addiction). In this context it is important to consider the risks and chances involved in screen media use including the additional dimensions time and content. That is, the trade-off between risks and chances might not always be easy to determine. Particularly online multiplayer video games encourage an excessive gaming behaviour due to specific computer game characteristics (e.g., social integration, intermittent reinforcement) [25
]. However, the majority of youths with ASD are more likely to never engage in playing multiplayer video games in contrast to their typically developed control group [2
]. Despite this and disregarding the suggested positive attitudes towards screen media as a tool to overcome social isolation as reported in the study, the risk of negative outcomes [12
] must be taken into account.
4.2. Practical Implications, Limitations and Future Prospects
Screen media use involves risks and chances for children with and without ASD. According to the findings of the present study, it is suggested that children with ASD can benefit from screen media by using it for wellbeing purposes and for the improvement of language skills and other social competencies. Thus, it seems beneficial to include screen media in (selected) therapeutic approaches when working with children with ASD. Further research is needed in order to help identify best practice strategies.
The present study also suggested that screen media may help children with ASD to feel safe (e.g., calling) or socially accepted (fulfilling the desire for affiliation). The (resulting) feeling of safety may be seen as a chance for children with ASD to compensate a possible lack of confidence. However, it is important to note that screen media must not be the only strategy to achieve affiliation but that a child with ASD should also be strengthened in other areas; keeping in mind that studies have shown lower self-esteem [81
] and low social competence [82
] in persons without ASD who are addicted to video games. Furthermore, two longitudinal studies with youths without ASD observed that youths with higher levels of loneliness [83
] and a lack of success experienced in real life [84
] are particularly at risk of developing an excessive and problematic usage of video or computer games. However, monitoring and supporting their children in their screen media use regarding time, content and functionality seems to be more realistic when parents of children with ASD have time for themselves in other situations. If there are few alternatives to have time for themselves, parents of children with ASD use the time their child sits in front of the screen for themselves as well. This is understandable when considering that parents of children with ASD experience more stress than other parents [54
Thus, regarding leisure activities, there is a need for alternatives to screen media use for children with ASD. [85
] reviewed eight studies that addressed the level of quality of life in adults with ASD and associated factors. They summarized that the more participation in leisure time activities, the higher the reported quality of life in adults with ASD. To the best of our knowledge, there is no study that examined the relationship between leisure time activities and quality of life in children or youths with ASD. However, studies indicated that through watching television/movies other leisure activities (e.g., outdoor play, music) are neglected [2
]. Future research is needed regarding the leisure time activities of children with ASD and their impact on the quality of life.
Any conclusions drawn from this study must be interpreted in the context of several methodological considerations. The present study is based on parental (mostly maternal) information about their child (external assessment); the children were not interviewed themselves. Though a participatory approach would be more appropriate, there is no tradition in Germany of involving (handicapped) children in research yet. Considering related ethical issues and methodological challenges, it was decided to collect parental information for this exploration first. However, parent surveys are a reliable source of information about the living environment of children, in particular children with special needs. There are a lot of studies that generate their data on children with ASD through parent surveys [1
]. Nonetheless, future studies would benefit from involving the children’s perspective. Data might be collected through (participatory) observation, interviews or surveys in diary format. Furthermore, the recruitment of the participants was realized through public announcements, flyer distribution, and word-of-mouth recommendation (interview study) as well as through cooperating with regional associations, autism therapy centres, and through placing the link for the online survey on the homepage of Autism Germany e.V. (online survey). The majority of children reported on in the online survey were diagnosed with Asperger syndrome; infantile autism or atypical autism were underrepresented. In the interview study there were no children with atypical autism, but the other two diagnoses were in balance. Almost all of the children had verbal communication skills. Readers should be cautious when generalizing the results presented here to other populations of children with ASD. Finally it must be highlighted that despite the fact that it is generally well known that using patterns differ between age groups [5
], the quantitative data in the present study does not facilitate a comparison of developmental trends. However, the qualitative data indicates that there are some differences between younger children and adolescent, but some subcodes were also mentioned independent of children’s age. Nonetheless, the number of interviews was limited to 13. Future research with a larger sample would benefit from analysing developmental patterns in order to generate a more differentiated picture (e.g., regarding the age or the severity of symptoms). In this context, a control group would be a good opportunity to compare the patterns of children with ASD with children without ASD.