Could Reducing Screen Time Among Young Autism Patients Reduce Symptoms?

Father playing with kid

One of the lesser-known downstream consequences of the COVID-19 pandemic is an increase in screen time among Americans in every age category. Although lots of television watching, social media scrolling, and playing video games may be detrimental to the brains of children and adults, some of the strongest effects of screen time may be found in infants. Several studies linked screen use in infants to a diagnosis of autism, including a study from Japan published earlier this year in which longer screen time at 1 year of age was significantly associated with an autism diagnosis at 3 years of age among boys (but not girls).

Now, a pilot study from researchers at Drexel College of Medicine suggests that cutting back on screen time and increasing focus on social engagement may decrease symptoms among kids with autism. The parents of nine children (18 to 40 months) with autism received a training on screen time and child development and were asked to reduce screen viewing by their children to no more than 1 hour per week.  The screen time of the children was reduced from an average of 5.6 hours of media on screens each day to about 5 minutes per day.

The research team also incorporated weekly one-hour in-home support visits to replace screen time with engagement with an adult over the six-month study.  After six-months of less television time and more social time incorporating strategies to gain eye contact and attention of the children, authors saw significant reductions in children’s autism symptoms and parent stress. Researchers at the AJ Drexel Autism Institute used the Brief Observation of Social Communication Change to assess social communication and restricted or repetitive behaviors, and evaluated fine motor skills and language development using the Mullen Scales of Early Learning. The findings of the pilot study were recently published in the journal Pediatrics International.

“Though more work is needed, including a randomized controlled trial of the intervention, this is the first prospective study of its kind involving screen reduction in children with an autism diagnosis and high screen viewing,” said lead author Karen Heffler, MD, a researcher in the College of Medicine. “These findings support retrospective studies and case reports that suggest rapid improvements in autism symptoms with screen reduction in addition to usual therapies.”

One such case report comes out in the December 2022 issue of Psychiatry Research Case Reports, in which Heffler and colleagues show developmental improvements in children when screen time is replaced with social time, and an increase in symptoms when screen time was increased.  

The study comes at a crucial time, as new data suggests babies born during the pandemic are experiencing higher rates of developmental delays and behavior issues, and participate in verbal interaction less often, compared to previous generations. Researchers speculate that this may be caused by family health issues, less access to medical care, economic challenges, taking on stress from parents, or other issues.

Those infant and toddler years are so crucial for development, as more than a million new neural connections are formed every second and as much as 90 percent of a child’s brain develops before age 5.

Therefore, it’s not surprising that the American Academy of Pediatrics advises no screen time – other than video chats — for children under 18 months.

The latest study from Heffler and colleagues builds on their 2020 study in JAMA Pediatrics that found a link between screen time in babies and autism symptoms later in childhood, while greater play time with babies was associated with less subsequent autism-like symptoms.

Data from 2017 on media use suggests that kids under two are watching 42 minutes of screentime daily and those two to four years old are watching much more than the AAP’s maximum of up to one hour advised – watching an average of 2 hours and 39 minutes each day (and that was before the pandemic when experts suggest has caused media watching to increase—although data is limited).

When a child is old enough to be in front of a screen, some supervised viewing of interactive, age-appropriate shows, watched with an adult, may actuallyhelp brain development, suggest researchers at the University of Portsmouth. The authors say that caregivers of children under three years of age should be warned about the risks of long-term exposure to screens in the wrong context.

“Since screens generally impair parent-child interactions and there are less vocalizations from both the parent and the child as well as less parent involvement in play and less child play when screens are on, it is hard to know the full impact on the youngest minds, even with parent engagement,” said Heffler.

The American Academy of Pediatrics, which sets milestones for child development, recommends checking at nine, 18 and 30 months for progress or at any time. If a delay is caught early, it’s easier to use therapy and correct it. The CDC has more information on milestone checklists and developmental screenings here.

“There is consistent evidence that prolonged viewing of screens in the youngest children is associated with negative developmental outcomes,” Heffler says. “There is no evidence that prolonged viewing of screens in the early years has a positive impact on development.”

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