Is there an association between screen time and autism spectrum disorder?

In a recent study published in JAMA Network Open, researchers conducted a meta-analysis to investigate the potential relationship between screen usage and autism spectrum disorders (ASD).

Background

The growth in autism spectrum disorder (ASD) rates is a pediatric concern, especially the impact of excess screen usage on disease development, increased by the rise in the use of screen-based gadgets such as smartphones and tablets. There is limited recent scientific evidence on the effects of screen use on ASD risk, with contradictory findings.

The coronavirus disease 2019 (COVID-19) has increased screen time; however, no quantitative study of the relationship between screen time and ASD has been reported. Studies indicate that excess screen time may cause younger children to be less active, talkative, and outgoing, increasing their risk of developmental delays, behavioral issues, and ASD symptoms. The empirical basis for this worry is uncertain, with few long-term research and the current picture requiring additional investigation.

About the study

In the present study, researchers performed a meta-analysis of the existing literature on the bi-directional relationship between screen usage and autism spectrum disorders. They also performed a meta-regression analysis to identify moderating factors for the association.

The team searched the PsycNET, ProQuest Dissertation & Theses Global, and PubMed databases for peer-reviewed, empirical articles and dissertations written in English and published through 1 May 2023. They excluded literature reviews and studies without comparator groups or statistical information on effect sizes [such as Pearson r, Cohen’s d, odds ratio (OR), or log odds ratio values].

Two researchers independently screened data and resolved disparities by consensus. They converted effect sizes into log OR values to perform random-effects-type meta-analytical research as well as mixed-effects-type meta-regressions. They used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) checklist to assess the quality of the included studies and the Egger Z statistic to assess publication bias and funnel plot symmetry.

The data were analyzed in June of 2023. Screen time and autism spectrum disorders were the interest variables. The researchers described screen time as the number of hours spent using screens daily or weekly and ASD based on clinical symptoms and diagnosis. They considered the type of screen usage (such as video games, television, smartphones, social media, and computers), ASD measure type (ASD symptoms vs. clinical diagnosis), and age (children versus adults and other age groups) for the meta-regression analysis.

Results

After removing duplicate studies, the data search yielded 4,677 records examining the relationship between autism spectrum disorders and use of screen types such as computers (n=2,884), media (n=922), mobile media (n=7), mobile phones (n=17), phones (n=121), smartphones (n=60), social media (n=309), television (n=105), and video games (n=88) or the duration of screen usage (n=164).

The complementary ProQuest search yielded five additional records of the doctoral dissertation type, thus identifying 4,682 records in total. Of 4,682 initially identified studies, 46 were published from 2011 to 2023, including 562,131 individuals eligible for analysis, of which 41 and 5 were of the cross-sectional-type and longitudinal type, respectively, including 66 values of effect sizes.

Thirty-seven effect sizes were observed among pediatric individuals aged below 12 years (266,474 individuals) and 29 effect sizes among adult individuals of different age groups (346,646). The included studies were of relatively low quality. The effect size was notably decreased and non-significant after trim-and-fill-type corrections for the considerable publication-type bias in the included studies (Egger Z statistic, 2.2).

Meta-regression findings indicated statistically significant positive summary impact sizes only for records targeting the general use of screens. The impact size was predominant among studies including pediatric individuals (log odds ratio, 1.0). Of interest, the researchers observed a negative summary impact size in records investigating the relationships between ASD and social media (log odds ratio, −1.2).

Conclusions

Overall, the study findings showed that there is limited scientific evidence to substantiate the link between screen use and autistic spectrum diseases. The team found a significant relationship between screen usage and ASD, particularly in research assessing general screen usage among pediatric individuals. However, the study findings were inconsequential, considering publication bias.

Excessive use of screens may lead to unfavorable developmental outcomes; nevertheless, the inconsistent results, observational study design, and modest effect sizes (particularly given the publication bias) leave the conclusions equivocal, warranting further research. Furthermore, the study findings do not eliminate the possibility that ASD children prefer screen-based activities to evade social obstacles.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.