Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Measurement of Autistic-Like Behaviors
2.4. Measurement of Electronic Screen Exposure
2.5. Measurement of Caregiver-Child Interaction
2.6. Measurement of Sleep Duration
2.7. Measurement of Outdoor Activities
2.8. Covariates
2.9. Statistical Analysis
3. Results
3.1. Social-Demographic Characteristics of Participants by Status of Autistic-Like Behaviors
3.2. Associations between Electronic Screen Exposure at Age 0 to 3 Years and Autistic-Like Behaviors in Preschoolers
3.3. Associations between Average Daily Screen Time, Caregiver-Child Interaction, Sleep Duration, Outdoor Activities and Autistic-Like Behaviors
3.4. Mediation Effect of Average Daily Screen Time on Autistic-Like Behaviors through Caregiver-Child Interaction, Sleep Duration and Outdoor Activities
4. Discussion
4.1. Association between Early Electronic Screen Exposure and Autistic-Like Behaviors in Preschoolers
4.2. Association between Early Electronic Screen Exposure and Caregiver-Child Interaction, Sleep Duration, and Outdoor Activities
4.3. Associations of Caregiver-Child Interaction, Sleep Duration, and Outdoor Activities with Autistic-Like Behaviors in Preschoolers
4.4. Potential Pathways for Early Electronic Screen Exposure Causing Autistic-Like Behaviors in Preschoolers
4.5. Strength and Limitation
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Elsabbagh, M.; Divan, G.; Koh, Y.J.; Kim, Y.S.; Kauchali, S.; Marcin, C.; Montiel-Nava, C.; Patel, V.; Paula, C.S.; Wang, C.; et al. Global prevalence of autism and other pervasive developmental disorders. Autism Res. 2012, 5, 160–179. [Google Scholar] [CrossRef] [Green Version]
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; Psychiatric Publishing: Washington, DC, USA, 2013. [Google Scholar]
- Lord, C.; Elsabbagh, M.; Baird, G.; Veenstra-Vanderweele, J. Autism spectrum disorder. Lancet 2018, 392, 508–520. [Google Scholar] [CrossRef]
- Buescher, A.V.; Cidav, Z.; Knapp, M.; Mandell, D.S. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatr. 2014, 168, 721–728. [Google Scholar] [CrossRef] [PubMed]
- Zwaigenbaum, L.; Penner, M. Autism spectrum disorder: Advances in diagnosis and evaluation. BMJ 2018, 361, k1674. [Google Scholar] [CrossRef] [PubMed]
- Yoon, J.M.; Vouloumanos, A. When and how does autism begin? Trends Cogn. Sci. 2014, 18, 272–273. [Google Scholar] [CrossRef] [PubMed]
- Mammen, M.A.; Moore, G.A.; Scaramella, L.V.; Reiss, D.; Ganiban, J.M.; Shaw, D.S.; Leve, L.D.; Neiderhiser, J.M. Infant Avoidance during a Tactile Task Predicts Autism Spectrum Behaviors in Toddlerhood. Infant Ment Health J 2015, 36, 575–587. [Google Scholar] [CrossRef]
- Elsabbagh, M. Linking risk factors and outcomes in autism spectrum disorder: Is there evidence for resilience? BMJ 2020, 368, l6880. [Google Scholar] [CrossRef] [Green Version]
- Bralten, J.; van Hulzen, K.J.; Martens, M.B.; Galesloot, T.E.; Arias Vasquez, A.; Kiemeney, L.A.; Buitelaar, J.K.; Muntjewerff, J.W.; Franke, B.; Poelmans, G. Autism spectrum disorders and autistic traits share genetics and biology. Mol. Psychiatry 2018, 23, 1205–1212. [Google Scholar] [CrossRef] [Green Version]
- Karp, E.A.; Ibanez, L.V.; Warren, Z.; Stone, W.L. Brief Report: What Drives Parental Concerns About Their 18-Month-Olds at Familial Risk for Autism Spectrum Disorder? J. Autism Dev. Disord. 2017, 47, 1535–1541. [Google Scholar] [CrossRef]
- Pijl, M.K.J.; Bussu, G.; Charman, T.; Johnson, M.H.; Jones, E.J.H.; Pasco, G.; Oosterling, I.J.; Rommelse, N.N.J.; Buitelaar, J.K.; Team, B. Temperament as an Early Risk Marker for Autism Spectrum Disorders? A Longitudinal Study of High-Risk and Low-Risk Infants. J. Autism Dev. Disord. 2019, 49, 1825–1836. [Google Scholar] [CrossRef] [Green Version]
- Reichow, B.; Hume, K.; Barton, E.E.; Boyd, B.A. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst. Rev. 2018, 5, CD009260. [Google Scholar] [CrossRef] [PubMed]
- Dawson, G.; Rogers, S.; Munson, J.; Smith, M.; Winter, J.; Greenson, J.; Donaldson, A.; Varley, J. Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics 2010, 125, e17–e23. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sacrey, L.R.; Zwaigenbaum, L.; Bryson, S.; Brian, J.; Smith, I.M.; Roberts, W.; Szatmari, P.; Vaillancourt, T.; Roncadin, C.; Garon, N. Parent and clinician agreement regarding early behavioral signs in 12- and 18-month-old infants at-risk of autism spectrum disorder. Autism Res. 2018, 11, 539–547. [Google Scholar] [CrossRef] [PubMed]
- Lai, M.-C.; Lombardo, M.V.; Baron-Cohen, S. Autism. Lancet 2014, 383, 896–910. [Google Scholar] [CrossRef]
- Bolte, S.; Girdler, S.; Marschik, P.B. The contribution of environmental exposure to the etiology of autism spectrum disorder. Cell. Mol. Life Sci. 2019, 76, 1275–1297. [Google Scholar] [CrossRef] [Green Version]
- Przybylski, A.K.; Weinstein, N. Digital Screen Time Limits and Young Children’s Psychological Well-Being: Evidence From a Population-Based Study. Child Dev. 2019, 90, e56. [Google Scholar] [CrossRef] [Green Version]
- Lissak, G. Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environ. Res. 2018, 164, 149–157. [Google Scholar] [CrossRef]
- Stiglic, N.; Viner, R.M. Effects of screentime on the health and well-being of children and adolescents: A systematic review of reviews. BMJ Open 2019, 9, e023191. [Google Scholar] [CrossRef] [Green Version]
- Carson, V.; Kuzik, N.; Hunter, S.; Wiebe, S.A.; Spence, J.C.; Friedman, A.; Tremblay, M.S.; Slater, L.G.; Hinkley, T. Systematic review of sedentary behavior and cognitive development in early childhood. Prev. Med. 2015, 78, 115–122. [Google Scholar] [CrossRef]
- Wu, X.; Tao, S.; Rutayisire, E.; Chen, Y.; Huang, K.; Tao, F. The relationship between screen time, nighttime sleep duration, and behavioural problems in preschool children in China. Eur. Child Adolesc. Psychiatry 2017, 26, 541–548. [Google Scholar] [CrossRef]
- Must, A.; Phillips, S.M.; Curtin, C.; Anderson, S.E.; Maslin, M.; Lividini, K.; Bandini, L.G. Comparison of sedentary behaviors between children with autism spectrum disorders and typically developing children. Autism 2014, 18, 376–384. [Google Scholar] [CrossRef] [Green Version]
- Chonchaiya, W.; Nuntnarumit, P.; Pruksananonda, C. Comparison of television viewing between children with autism spectrum disorder and controls. Acta Paediatr. 2011, 100, 1033–1037. [Google Scholar] [CrossRef] [PubMed]
- Harle, B. Intensive early screen exposure as a causal factor for symptoms of autistic spectrum disorder: The case for <<Virtual autism>>. Trends Neurosci. Educ. 2019, 17, 100119. [Google Scholar] [CrossRef]
- Numata-Uematsu, Y.; Yokoyama, H.; Sato, H.; Endo, W.; Uematsu, M.; Nara, C.; Kure, S. Attachment Disorder and Early Media Exposure: Neurobehavioral symptoms mimicking autism spectrum disorder. J. Med. Investig. 2018, 65, 280–282. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lane, R.; Radesky, J. Digital Media and Autism Spectrum Disorders: Review of Evidence, Theoretical Concerns, and Opportunities for Intervention. J. Dev. Behav. Pediatr. 2019, 40, 364–368. [Google Scholar] [CrossRef] [PubMed]
- Wen, X.; Zhang, H.; Li, G.; Liu, M.; Yin, W.; Lin, W.; Zhang, J.; Shen, D. First-year development of modules and hubs in infant brain functional networks. Neuroimage 2019, 185, 222–235. [Google Scholar] [CrossRef] [PubMed]
- Jones, R.A.; Hinkley, T.; Okely, A.D.; Salmon, J. Tracking physical activity and sedentary behavior in childhood: A systematic review. Am. J. Prev. Med. 2013, 44, 651–658. [Google Scholar] [CrossRef]
- Zhao, J.; Zhang, Y.; Jiang, F.; Ip, P.; Ho, F.K.W.; Zhang, Y.; Huang, H. Excessive Screen Time and Psychosocial Well-Being: The Mediating Role of Body Mass Index, Sleep Duration, and Parent-Child Interaction. J. Pediatr. 2018, 202, 157–162.e1. [Google Scholar] [CrossRef]
- Van Hoorn, J.; Van Dijk, E.; Crone, E.; Stockmann, L.; Rieffe, C. Peers Influence Prosocial Behavior in Adolescent Males with Autism Spectrum Disorders. J. Autism Dev. Disord. 2017, 47, 2225–2237. [Google Scholar] [CrossRef]
- Teng, B.; Nonneman, R.; Agster, K.; Nikolova, V.; Davis, T.; Riddick, N.; Baker, L.; Pedersen, C.; Jarstfer, M.; Moy, S. Prosocial effects of oxytocin in two mouse models of autism spectrum disorders. Neuropharmacology 2013, 72, 187–196. [Google Scholar] [CrossRef] [Green Version]
- Wan, M.; Green, J.; Elsabbagh, M.; Johnson, M.; Charman, T.; Plummer, F. Parent-infant interaction in infant siblings at risk of autism. Res. Dev. Disabil. 2012, 33, 924–932. [Google Scholar] [CrossRef]
- Wan, M.; Green, J.; Scott, J. A systematic review of parent-infant interaction in infants at risk of autism. Autism: Int. J. Res. Pract. 2019, 23, 811–820. [Google Scholar] [CrossRef] [PubMed]
- Courage, M.; Murphy, A.; Goulding, S.; Setliff, A. When the television is on: The impact of infant-directed video on 6- and 18-month-olds’ attention during toy play and on parent-infant interaction. Infant Behav. Dev. 2010, 33, 176–188. [Google Scholar] [CrossRef] [PubMed]
- Kirkorian, H.L.; Pempek, T.A.; Murphy, L.A.; Schmidt, M.E.; Anderson, D.R. The impact of background television on parent-child interaction. Child Dev. 2009, 80, 1350–1359. [Google Scholar] [CrossRef] [Green Version]
- Vandendriessche, A.; Ghekiere, A.; Van Cauwenberg, J.; De Clercq, B.; Dhondt, K.; DeSmet, A.; Tynjala, J.; Verloigne, M.; Deforche, B. Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? A 12-Country Study. Int. J. Environ. Res. Public Health 2019, 16, 1072. [Google Scholar] [CrossRef] [Green Version]
- Thompson, D.A.; Christakis, D.A. The association between television viewing and irregular sleep schedules among children less than 3 years of age. Pediatrics 2005, 116, 851–856. [Google Scholar] [CrossRef] [PubMed]
- Chang, A.M.; Aeschbach, D.; Duffy, J.F.; Czeisler, C.A. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc. Natl. Acad. Sci. USA 2015, 112, 1232–1237. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Magee, C.A.; Lee, J.K.; Vella, S.A. Bidirectional relationships between sleep duration and screen time in early childhood. JAMA Pediatr 2014, 168, 465–470. [Google Scholar] [CrossRef] [Green Version]
- Chindamo, S.; Buja, A.; DeBattisti, E.; Terraneo, A.; Marini, E.; Gomez Perez, L.J.; Marconi, L.; Baldo, V.; Chiamenti, G.; Doria, M.; et al. Sleep and new media usage in toddlers. Eur. J. Pediatr. 2019, 178, 483–490. [Google Scholar] [CrossRef] [PubMed]
- Paavonen, E.J.; Raikkonen, K.; Lahti, J.; Komsi, N.; Heinonen, K.; Pesonen, A.K.; Jarvenpaa, A.L.; Strandberg, T.; Kajantie, E.; Porkka-Heiskanen, T. Short sleep duration and behavioral symptoms of attention-deficit/hyperactivity disorder in healthy 7- to 8-year-old children. Pediatrics 2009, 123, e857–e864. [Google Scholar] [CrossRef] [Green Version]
- Cheng, W.; Rolls, E.; Gong, W.; Du, J.; Zhang, J.; Zhang, X.Y.; Li, F.; Feng, J. Sleep duration, brain structure, and psychiatric and cognitive problems in children. Mol. Psychiatry 2020. [Google Scholar] [CrossRef] [PubMed]
- Vriend, J.L.; Davidson, F.D.; Corkum, P.V.; Rusak, B.; Chambers, C.T.; McLaughlin, E.N. Manipulating sleep duration alters emotional functioning and cognitive performance in children. J. Pediatr. Psychol. 2013, 38, 1058–1069. [Google Scholar] [CrossRef]
- Venetsanou, F.; Kambas, A.; Gourgoulis, V.; Yannakoulia, M. Physical activity in pre-school children: Trends over time and associations with body mass index and screen time. Ann. Hum. Biol. 2019, 46, 393–399. [Google Scholar] [CrossRef] [PubMed]
- Hinkley, T.; Brown, H.; Carson, V.; Teychenne, M. Cross sectional associations of screen time and outdoor play with social skills in preschool children. PLoS ONE 2018, 13, e0193700. [Google Scholar] [CrossRef] [PubMed]
- Suchert, V.; Hanewinkel, R.; Isensee, B. Sedentary behavior and indicators of mental health in school-aged children and adolescents: A systematic review. Prev. Med. 2015, 76, 48–57. [Google Scholar] [CrossRef]
- Yang, G.Y.; Huang, L.H.; Schmid, K.L.; Li, C.G.; Chen, J.Y.; He, G.H.; Liu, L.; Ruan, Z.L.; Chen, W.Q. Associations Between Screen Exposure in Early Life and Myopia amongst Chinese Preschoolers. Int. J. Environ. Res. Public Health 2020, 17, 1056. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- He, G.H.; Strodl, E.; Liu, L.; Ruan, Z.L.; Yin, X.N.; Wen, G.M.; Sun, D.L.; Xian, D.X.; Jiang, H.; Jing, J.; et al. Teacher’s Type D Personality and Chinese Children’s Hyperactive Behaviors: Moderation Effect of Parental Type D Personality and Mediation Effect of Teacher-Student Relationship. Front. Psychol. 2019, 10, 2517. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- He, G.H.; Liu, L.; Strodl, E.; Ruan, Z.L.; Jiang, H.; Jing, J.; Jin, Y.; Chen, W.Q. Parental Type D Personality and Children’s Hyperactive Behaviors: The Mediating Role of Parent(-)Child Interactive Activities. Int. J. Environ. Res. Public Health 2019, 16, 1116. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Liu, L.; Fan, L.; Hou, X.Y.; Wu, C.A.; Yin, X.N.; Wen, G.M.; Sun, D.; Xian, D.X.; Jiang, H.; Jing, J.; et al. Family Childcare Types and Conduct Problem Behaviors in Young Children: The Mediation Role of Caregiver-Child Interaction. Front Pediatr 2018, 6, 217. [Google Scholar] [CrossRef]
- Krug, D.A.; Arick, J.; Almond, P. Behavior checklist for identifying severely handicapped individuals with high levels of autistic behavior. J. Child Psychol. Psychiatry 1980, 21, 221–229. [Google Scholar] [CrossRef]
- Bravo Oro, A.; Navarro-Calvillo, M.E.; Esmer, C. Autistic Behavior Checklist (ABC) and Its Applications. In Comprehensive Guide to Autism; Springer Science+Business Media New York: New York, NY, USA, 2014; pp. 2787–2798. [Google Scholar] [CrossRef]
- Yang, X.; Huang, Y.; Jia, M. Test report of autism behavior checklist in China. Chin. Ment. Health J. 1993, 7, 275–280. [Google Scholar]
- Huang, L.; Yang, G.Y.; Schmid, K.L.; Chen, J.Y.; Li, C.G.; He, G.H.; Ruan, Z.L.; Chen, W.Q. Screen Exposure during Early Life and the Increased Risk of Astigmatism among Preschool Children: Findings from Longhua Child Cohort Study. Int. J. Environ. Res. Public Health 2020, 17, 2216. [Google Scholar] [CrossRef] [Green Version]
- Hayes, A.F.; Aut, V.X.X. Introduction to Mediation, Moderation, and Conditional Process Analysis a Regression-Based Approach Andrew f. Hayes; Series Editor’s Note by Todd d. Little; The Guilford Press: York, NY, USA, 2018. [Google Scholar]
- Preacher, K.J.; Hayes, A.F. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav. Res. Methods 2008, 40, 879–891. [Google Scholar] [CrossRef] [PubMed]
- Council on Communications and Media. Media and Young Minds. Pediatrics 2016, 138, e20162591. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children under 5 Years of Age; World Health Organization (c) World Health Organization: Geneva, Switzerland, 2019.
- Canadian Paediatric Society, Digital Health Task Force, Ottawa, Ontario. Screen time and young children: Promoting health and development in a digital world. Paediatr. Child Health 2017, 22, 461–477. [Google Scholar] [CrossRef] [Green Version]
- LeBourgeois, M.K.; Hale, L.; Chang, A.M.; Akacem, L.D.; Montgomery-Downs, H.E.; Buxton, O.M. Digital Media and Sleep in Childhood and Adolescence. Pediatrics 2017, 140, S92–S96. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Guerrero, M.D.; Barnes, J.D.; Chaput, J.P.; Tremblay, M.S. Screen time and problem behaviors in children: Exploring the mediating role of sleep duration. Int. J. Behav. Nutr. Phys. Act. 2019, 16, 105. [Google Scholar] [CrossRef]
- Krupa, M.; Boominathan, P.; Ramanan, P.V.; Sebastian, S. Relationship Between Screen Time and Mother-Child Reciprocal Interaction in Typically Developing Children and Children with Autism Spectrum Disorders. Indian J. Pediatr. 2019, 86, 394. [Google Scholar] [CrossRef] [Green Version]
- Mendelsohn, A.L.; Berkule, S.B.; Tomopoulos, S.; Tamis-LeMonda, C.S.; Huberman, H.S.; Alvir, J.; Dreyer, B.P. Infant television and video exposure associated with limited parent-child verbal interactions in low socioeconomic status households. Arch. Pediatr. Adolesc. Med. 2008, 162, 411–417. [Google Scholar] [CrossRef] [Green Version]
- Detnakarintra, K.; Trairatvorakul, P.; Pruksananonda, C.; Chonchaiya, W. Positive mother-child interactions and parenting styles were associated with lower screen time in early childhood. Acta Paediatr. 2020, 109, 817–826. [Google Scholar] [CrossRef]
- Twenge, J.M.; Hisler, G.C.; Krizan, Z. Associations between screen time and sleep duration are primarily driven by portable electronic devices: Evidence from a population-based study of U.S. children ages 0-17. Sleep Med. 2019, 56, 211–218. [Google Scholar] [CrossRef]
- Xu, H.; Wen, L.M.; Hardy, L.L.; Rissel, C. Associations of outdoor play and screen time with nocturnal sleep duration and pattern among young children. Acta Paediatr. 2016, 105, 297–303. [Google Scholar] [CrossRef] [PubMed]
- Healy, S.; Garcia, J.; Haegele, J. Environmental Factors Associated with Physical Activity and Screen Time Among Children with and Without Autism Spectrum Disorder. J. Autism Dev. Disord. 2020, 50, 1572–1579. [Google Scholar] [CrossRef]
- Garcia, J.; Healy, S.; Rice, D. The Individual, Social, and Environmental Correlates of Physical Activity and Screen Time in Irish Children: Growing Up in Ireland Study. J. Phys. Act. Health 2016, 13, 1285–1293. [Google Scholar] [CrossRef]
- Xu, H.; Wen, L.M.; Hardy, L.L.; Rissel, C. A 5-year longitudinal analysis of modifiable predictors for outdoor play and screen-time of 2- to 5-year-olds. Int. J. Behav. Nutr. Phys. Act. 2016, 13, 96. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Anderson, D.R.; Subrahmanyam, K.; Cognitive Impacts of Digital Media Workgroup. Digital Screen Media and Cognitive Development. Pediatrics 2017, 140, S57–S61. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Council on Communications and Media; Brown, A. Media use by children younger than 2 years. Pediatrics 2011, 128, 1040–1045. [Google Scholar] [CrossRef] [Green Version]
- Kuhl, P.K. Is speech learning ‘gated’ by the social brain? Dev. Sci 2007, 10, 110–120. [Google Scholar] [CrossRef] [PubMed]
- Kuhl, P.K.; Williams, K.A.; Meltzoff, A.N. Cross-modal speech perception in adults and infants using nonspeech auditory stimuli. J. Exp. Psychol. Hum. Percept. Perform. 1991, 17, 829–840. [Google Scholar] [CrossRef]
- Zlomke, K.R.; Jeter, K. Comparative Effectiveness of Parent-Child Interaction Therapy for Children with and Without Autism Spectrum Disorder. J. Autism Dev. Disord. 2020, 50, 2041–2052. [Google Scholar] [CrossRef]
- Parlade, M.V.; Weinstein, A.; Garcia, D.; Rowley, A.M.; Ginn, N.C.; Jent, J.F. Parent-Child Interaction Therapy for children with autism spectrum disorder and a matched case-control sample. Autism 2020, 24, 160–176. [Google Scholar] [CrossRef] [PubMed]
- Sivertsen, B.; Harvey, A.G.; Reichborn-Kjennerud, T.; Torgersen, L.; Ystrom, E.; Hysing, M. Later emotional and behavioral problems associated with sleep problems in toddlers: A longitudinal study. JAMA Pediatr 2015, 169, 575–582. [Google Scholar] [CrossRef] [Green Version]
- Zachor, D.A.; Vardi, S.; Baron-Eitan, S.; Brodai-Meir, I.; Ginossar, N.; Ben-Itzchak, E. The effectiveness of an outdoor adventure programme for young children with autism spectrum disorder: A controlled study. Dev. Med. Child Neurol. 2017, 59, 550–556. [Google Scholar] [CrossRef]
- Li, X.; Buxton, O.M.; Lee, S.; Chang, A.M.; Berger, L.M.; Hale, L. Sleep mediates the association between adolescent screen time and depressive symptoms. Sleep Med. 2019, 57, 51–60. [Google Scholar] [CrossRef] [PubMed]
- Exelmans, L.; Van den Bulck, J. Bedtime mobile phone use and sleep in adults. Soc. Sci. Med. 2016, 148, 93–101. [Google Scholar] [CrossRef]
- Luo, D.; Zhao, X.; Qu, S.; Zhang, T.; Guan, H.; Guo, J. Development of exercise guidelines for preschool children in China. In Proceedings of the Abstracts of the 11th National Sports Science Conference, Nanjing, China, 2 November 2019. [Google Scholar]
- Li, S.; Jin, X.; Wu, S.; Jiang, F.; Yan, C.; Shen, X. The impact of media use on sleep patterns and sleep disorders among school-aged children in China. Sleep 2007, 30, 361–367. [Google Scholar] [CrossRef]
- Liu, J.; Ge, Y. Psychometric Analysis on Neurotransmitter Deficiency of Internet Addicted Urban Left-behind Children. J. Alcohol. Drug Depend. 2015, 3. [Google Scholar] [CrossRef]
- Hutton, J.S.; Dudley, J.; Horowitz-Kraus, T.; DeWitt, T.; Holland, S.K. Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children. JAMA Pediatr. 2019, 174, e193869. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Heffler, K.F.; Oestreicher, L.M. Causation model of autism: Audiovisual brain specialization in infancy competes with social brain networks. Med. Hypotheses 2016, 91, 114–122. [Google Scholar] [CrossRef]
- Yang, W.; Xia, H.; Wen, G.; Liu, L.; Fu, X.; Lu, J.; Li, H. Epidemiological investigation of suspected autism in children and implications for healthcare system: A mainstream kindergarten-based population study in Longhua District, Shenzhen. BMC Pediatr. 2015, 15, 207. [Google Scholar] [CrossRef] [Green Version]
- Wang, F.; Lu, L.; Wang, S.B.; Zhang, L.; Ng, C.H.; Ungvari, G.S.; Cao, X.L.; Lu, J.P.; Hou, C.L.; Jia, F.J.; et al. The prevalence of autism spectrum disorders in China: A comprehensive meta-analysis. Int. J. Biol. Sci. 2018, 14, 717–725. [Google Scholar] [CrossRef] [PubMed]
- Christakis, D.A. The effects of infant media usage: What do we know and what should we learn? Acta Paediatr. 2009, 98, 8–16. [Google Scholar] [CrossRef] [PubMed]
Characteristics | Total (N = 29,461) | Autistic-Like Behaviors | χ2/t | p-Value | |
---|---|---|---|---|---|
No (N = 28,586) | Yes (N = 875) | ||||
Child’s age [mean ± SD (years)] | 29,461 | 4.60 ± 0.88 | 4.33 ± 0.89 | 8.98 | <0.001 |
Maternal age at child’s birth [mean ± SD (years)] | 29,461 | 27.17 ± 4.22 | 26.01 ± 4.52 | 7.46 | <0.001 |
Paternal age at child’s birth [mean ± SD (years)] | 29,461 | 29.73 ± 4.81 | 28.80 ± 5.07 | 5.36 | <0.001 |
Child’s gender [n (%)] | 22.46 | <0.001 | |||
Male | 16,000 | 15,456 (54.1) | 544 (62.2) | ||
Female | 13,461 | 13,130 (45.9) | 331 (37.8) | ||
Maternal education level [n (%)] | 95.78 | <0.001 | |||
Junior high school or lower | 7367 | 7041 (24.6) | 326 (37.3) | ||
High school | 8604 | 8333 (29.2) | 271 (31.0) | ||
College | 7236 | 7073 (24.7) | 163 (18.6) | ||
Undergraduate or above | 6254 | 6139 (21.5) | 115 (13.1) | ||
Paternal education level [n (%)] | 114.61 | <0.001 | |||
Junior high school or lower | 6076 | 5787 (20.2) | 289 (33.0) | ||
High school | 7954 | 7689 (26.9) | 265 (30.3) | ||
College | 6777 | 6624 (23.2) | 153 (17.5) | ||
Undergraduate or above | 8654 | 8486 (29.7) | 168 (19.2) | ||
Monthly household income [n (%)] | 91.15 | <0.001 | |||
≤¥5000 Yuan | 4341 | 4150 (14.5) | 191 (21.8) | ||
¥5000–10,000 Yuan | 7779 | 7487 (26.2) | 292 (33.4) | ||
¥10,001–15,000 Yuan | 5645 | 5479 (19.2) | 166 (19.0) | ||
¥15,001–20,000 Yuan | 4083 | 4006 (14.0) | 77 (8.8) | ||
>¥20,000 Yuan | 7613 | 7476 (26.1) | 149 (17.0) | ||
Parental marital status [n (%)] | 16.67 | <0.001 | |||
Married | 28,417 | 27,595 (96.5) | 822 (93.9) | ||
Unmarried/Divorced/ Widowed/Remarried | 1044 | 991 (3.5) | 53 (6.1) |
Screen Exposure at Age 0 to 3 Years | Autistic-Like Behaviors (N = 29,461) | ||
---|---|---|---|
Number of Children | Cases (N%) | AOR (95% CI) | |
Exposure to electronic screens | |||
No | 7097 | 112 (1.6) | Ref |
Yes | 22,364 | 763 (3.4) | 1.900 (1.551, 2.327) *** |
Average daily screen time (minutes) | |||
Never | 7097 | 112 (1.6) | Ref |
<30 | 8271 | 190 (2.3) | 1.358 (1.071, 1.722) * |
30–60 | 6857 | 223 (3.3) | 1.802 (1.429, 2.273) *** |
60–90 | 3723 | 137 (3.7) | 1.967 (1.521, 2.543) *** |
90–120 | 2303 | 125 (5.4) | 2.982 (2.291, 3.882) *** |
>120 | 1210 | 88 (7.3) | 4.026 (3.009, 5.387) *** |
Average Daily Screen Time at Age 0 to 3 Years (Minutes) | Autistic-Like Behaviors | |
---|---|---|
β, 95%CI | AOR, 95%CI | |
Caregiver-child interaction | −0.031 (−0.037, −0.026) *** | 0.621 (0.567, 0.679) *** |
Sleep duration | −0.058 (−0.075, −0.040) *** | 0.928 (0.899, 0.958) *** |
Outdoor activities | −0.253 (−0.469, −0.037) * | 0.995 (0.992, 0.998) *** |
Effect Size (SE) | Bootstrapping BC 95% CI | Proportion of Indirect Effect | ||
---|---|---|---|---|
Lower | Upper | |||
Direct effects | ||||
0.249 (0.023) | 0.203 | 0.295 | ||
Indirect effects | ||||
Caregiver-child interaction | 0.014 (0.002) | 0.010 | 0.018 | 5.32% |
Sleep duration | 0.003 (0.001) | 0.001 | 0.005 | 1.19% |
Outdoor activities | 0.000 (0.000) | 0.000 | 0.002 | NS |
Total | 0.017 (0.002) | 0.013 | 0.021 | 6.39% |
Contrasts | ||||
Caregiver-child interaction vs. sleep duration | 0.011 (0.002) | 0.006 | 0.015 | |
Caregiver-child interaction vs. outdoor activities | 0.013 (0.002) | 0.009 | 0.018 | |
Sleep duration vs. outdoor activities | 0.003 (0.001) | 0.001 | 0.005 |
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Chen, J.-Y.; Strodl, E.; Huang, L.-H.; Chen, Y.-J.; Yang, G.-Y.; Chen, W.-Q. Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities. Children 2020, 7, 200. https://doi.org/10.3390/children7110200
Chen J-Y, Strodl E, Huang L-H, Chen Y-J, Yang G-Y, Chen W-Q. Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities. Children. 2020; 7(11):200. https://doi.org/10.3390/children7110200
Chicago/Turabian StyleChen, Jing-Yi, Esben Strodl, Li-Hua Huang, Ying-Jie Chen, Gui-You Yang, and Wei-Qing Chen. 2020. "Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities" Children 7, no. 11: 200. https://doi.org/10.3390/children7110200