Disclosures: The authors report no relevant financial disclosures.
May 14, 2020
2 min read

Early screen exposure associated with increased ASD-like symptoms

Disclosures: The authors report no relevant financial disclosures.
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David S. Bennett

An analysis of 2,152 children showed that screen viewing at age 12 months was associated with a “modest [but] notable” increase in autism spectrum disorder-like symptoms at age 2 years, though not an increase in ASD risk, researchers reported in JAMA Pediatrics.

Additionally, the study showed that daily parent-child play also was modestly associated with fewer ASD-like symptoms at age 2 years compared with less than daily parent-child play, according to David S. Bennett, PhD, a professor of psychiatry at Drexel University College of Medicine, and colleagues.

“Given our findings in combination with extensive research showing an association of early screen time and developmental problems, as well as the benefits of early parent-child play and interaction, it is reasonable to be cautious about screen time for infants in place of social time,” Bennett told Healio.

Researchers measured children for ASD-like symptoms using the Modified Checklist for Autism in Toddlers, or M-CHAT. They assessed children at 12 months of age, and again at 18 months.

At 12 months of age, caregivers were asked to report if their child watched TV or DVDs, how often they read or looked at books with their child and how often the caregiver played with their child. At 18 months of age, caregivers were asked to report how many hours of television their child watched over the course of the last 30 days.

Bennett said the study had several limitations.

“The data set that we analyzed used the M-CHAT, a screening for autism, and not a full diagnostic evaluation of autism symptoms,” Bennett said. “In addition, the measures of screen exposure were based on just one question and included only TV/DVD use — and not tablets or smart phones. The findings are correlational in nature and do not establish a causal link between screen media exposure and autism.”

Overall, 7% of children (n = 150) had positive screens on the M-CHAT. Television viewing at age 12 months compared with no viewing at the same age was significantly associated with greater ASD-like symptoms by M-CHAT total score (change, 4.2%; 95% CI, 0.1%-8.3%). It was not associated with ASD risk (risk prevalence rates, 8.3% vs. 4.4%; adjusted OR = 1.40; 95% CI, 0.86-2.29).

Parental play every day compared with play less than every day was associated with fewer ASD-like symptoms (change, –8.9%; 95% CI, –16.5% to –0.9%). It did not affect ASD risk (risk prevalence rates, 6.4% vs. 14%; aOR = 0.58; 95% CI, 0.31-1.08).


Screen exposure of 4 hours or more per day, compared with 3 hours or less per day at age 18 months, was not significantly associated with ASD-like symptoms (change, 10.7%; 95% CI, –2% to 23%). It also was not significantly associated with ASD risk at age 2 years (aOR = 1.18; 95% CI, 0.56- 2.49).

“Currently, it’s premature to make any clinical recommendations based on these findings,” Bennett said. “We need to first establish that early childhood screen exposure could worsen developmental outcomes for some children with autism in the first years of life. There is some evidence that screen viewing as early as age 6 months in infants is significantly determined by parent screen viewing and parental attitudes toward child screen-viewing, but that does not negate the possibility that children who exhibit developmental differences early on may be already gravitating toward screens.”

Bennett said these findings are consistent with the AAP’s recommendations on screen exposure in infants. – by Ken Downey Jr.

Disclosures: The authors report no relevant financial disclosures.