screen time and autism spectrum disorder (ASD)

Last edited 07/2022 and last reviewed 07/2022

Screen time and Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) has been suggested to be associated with congenital factors, such as genomic mutations and prenatal, perinatal, and neonatal risk factors

ASDs are estimated to affect approximately 1% of children (1,2)

• are significantly skewed towards boys, with a sex ratio of 4:1 (1)
• among siblings of children with an ASD, the prevalence increases to 2-8% (1)
• concordance of autism in monozygotic twins is 36-60%, versus 0% in same sex dizygotic twins (1)
• the heritability of ASDs has been estimated to be about 90%, making ASDs the most heritable of the childhood onset neuropsychiatric disorders(1)

In addition, abnormalities in brain morphology and function have been observed in children with ASD since early childhood (3)

• in studies, it has been reported that as a postnatal environmental factor, duration of screen time may be associated with ASD characteristics (3,4,5)
  • excessive screen time can impinge on children's ability to develop optimally; it is recommended that pediatricians and health care practitioners guide parents on appropriate amounts of screen exposure and discuss potential consequences of excessive screen use (4)
    • cohort study of early childhood development in 2441 mothers and children, higher levels of screen time in children aged 24 and 36 months were associated with poor performance on a screening measure assessing children's achievement of development milestones at 36 and 60 months, respectively
  • less screen exposure and more parent-child play at 12 months of age were associated with fewer ASD-like symptoms at 2 years of age (5)
    • cohort study of 2152 children controlled for perinatal and demographic variables and found that television and/or video exposure and less caregiver-child interactive play at 12 months of age were each significantly associated with greater AS-like symptoms, determined by total revised Modified Checklist for Autism in Toddlers score, but not with the risk of ASD
  • cohort study, even after accounting for predisposition to ASD at 1 year of age and maternal maltreatment factors, longer screen time at 1 year of age was associated with ASD at 3 years of age in boys (3)
    • total of 84030 mother-child dyads were analyzed using data derived from a large birth cohort study conducted in Japan. Among boys, but not girls, longer screen time at 1 year of age was significantly associated with autism spectrum disorder diagnosis at 3 years of age
    • study authors concluded that:
      • with the rapid increase in the use of devices, it is necessary to review its health effects on infants and control excessive screen time

Reference:

• 1) Holt R, Monaco AP.E Links between genetics and pathophysiology in the autism spectrum disorders. MBO Mol Med. 2011 Aug;3(8):438-50.
• 2) NICE (June 2012). Autism: recognition, referral, diagnosis and management of adults on the autism spectrum
• 3) Kushima M, Kojima R, Shinohara R, et al. Association Between Screen Time Exposure in Children at 1 Year of Age and Autism Spectrum Disorder at 3 Years of Age: The Japan Environment and Children’s Study. JAMA Pediatr. 2022;176(4):384-391. doi:10.1001/jamapediatrics.2021.5778
• 4) Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children's Performance on a Developmental Screening Test. JAMA Pediatr. 2019 Mar 1;173(3):244-250. doi: 10.1001/jamapediatrics.2018.5056. Erratum in: JAMA Pediatr. 2019 May 1;173(5):501-502
• 5) Heffle KF et al. Association of early-life social and digital media experiences with development of autism spectrum disorder-like symptoms. JAMA Pediatr. 2020;174(7):690-696. doi:10.1001/jamapediatrics.2020.0230