When it comes to screen time and the effect on kids’ mental health, there’s quantity — how much they’re watching. There’s quality — the substance of what they’re watching.
Then, there’s the realization that neither of those exist in a vacuum, which is the multipronged focus of a first-of-its-kind study published Monday in the Journal of the American Medical Association.
Looking at nearly 16,000 children at ages 3, 5 and 6, the study asked parents to report the amount of screen time their children consume on all screen types — phones, tablets, computers and television.
Researchers also asked parents to categorize the media their children consumed: educational (such as “Sesame Street”), entertainment (“Thomas & Friends”), non-child-directed (meaning anything other than a kids’ show), electronic games and social media.
Caregivers were then asked to complete a Strengths and Difficulties questionnaire at each data point, an internationally recognized behavioral screening tool.
And the results were clear cut.
More screen time was associated with a higher risk of mental health issues, regardless of what was watched. But for the many families who do engage with screens, there are better ways to spend that time, the study suggests.
Higher amounts of screen time spent on educational programming were associated with a lower risk of mental health problems, meaning there’s nothing wrong with a little Abby Cadabby or Big Bird. Conversely, higher amounts of non-child-directed programming — adult shows — were associated with a higher risk of mental health problems.
“I find this study to be really encouraging partially because it’s really actionable and an easy thing to communicate to parents of young children,” said Andrew Ribner, a postdoctoral developmental psychologist at the University of Pittsburgh whose research includes screen time in children. “If your child wants to engage with some kind of electronic screen-based media, just make sure it’s child appropriate. Don’t sit down and watch ‘Law & Order’ or ‘The Crown’ with your young children. Save that for your own time.”
Previous research largely examines only the amount of screen time or only the type of programming and, of the few that examine both, the assessments weren’t repeated, as they were in this study. These results lend credence to recommendations issued by the American Academy of Pediatrics, which ask caregivers to limit non-educational screen time for children ages 2 through 5 to one hour per day on weekdays, and three hours per day on weekends.
As with any study, however, a few questions loom.
This study was performed in Shanghai, China, on Chinese children, which calls “generalizability” into question.
“Whether observations from one culture can apply to others, especially on a topic that is a cultural phenomenon, is an important question to ask, but there are a number of similarities, like the shows they list. ‘Sesame Street,’ for instance,” said Rachel “Maggie” Whelan, assistant professor of psychiatry at Pitt Medical School, a pediatrician and an epidemiologist.
Another similarity between Chinese and American culture is the tendency for children to watch more on-screen programming than recommended. At the study’s three data points, children watched more than one hour per day of non-educational programming (1.72, 2.4 and 2.48 hours per day on average), compared to the 2 1/2 average daily hours consumed by American children ages 2 through 4, according to The Common Sense Census performed in 2020.
“I’m sure the cultural difference weighs in, but one of the great things about a study of this size is you can get rid of some of those biases just by sheer numbers,” Whelan said. “And if we’re looking at these big, compelling results from China, all the more reason we need to be doing a study like this here.”
Another set of issues applies to “background media” and what really counts as “watching.”
In this study, the most negative associations between screen time and mental health occurred around non-child-directed programming, which is everything from ‘Law & Order,’ as Ribner ribs, to the evening news, TikTok videos to a televised hockey game.
If a child is simply in the same room as this programming, even if it’s secondary to their impressive tower of blocks or Calico Critters, it counts as screen time, though parents — maybe even those who participated in this study — often ignore these passive varieties of consumption.
“The news is potentially really scary. It depends on what’s happening in the hockey game, what kind of impact it might have,” Whelan said. “Parents of preschool-age children need to be really cognizant of which media their child is consuming, whether that’s consuming it on purpose — like if they’re given an iPad to watch something — or if they just happen to wander in while the parent is watching.”
While the study results do not suggest that educational programming is beneficial for children’s mental health — versus being non-detrimental, as was shown in the study — previous research points to potential positives.
“There have been consistent findings over the years that educational screen media can have positive effects on aspects of child development, like word learning and prosocial behavior,” Ribner said. “The bigger benefits might come from what it offers parents, whether that’s the ability to put a nutritious meal on the table or the ability to interact more warmly and responsively to the child after they’re done viewing.”
And that’s good news, since even the most ordinary school days now include time in front of screens. Parents don’t get a say there. But at home, they do, and emerging research of this type can inform their quest to grow happy, healthy humans.
“At these ages, they’re little sponges. They suck up everything, and they have way more awareness of what’s going on around them than what people expect or suspect,” Whelan said. “But this study came out with some very clear outcomes. And I think it’s the type of study that could actually inform clinical practice, something that could really change my day-to-day advice to parents.”
