The Negative Impact of Excessive Screen Time on Language Development in Children Under 6-Years-Old: An Integrative Review with Screen Time Reduction Toolkit and Presentation for Outpatient Pediatric and Family Health Providers
University of Massachusetts – Dr Christina Kuta Kuhl (2004) reported that in studies examining speech-perception learning and speech-production learning, human-human interactions had a strong influence on a child’s language development. She also reported that infants learned best from live sessions versus televised ones, and social feedback was an important predictor for the quantity and quality of infant vocalizations. Therefore, heavy television use or excessive screen time can interfere with a child’s language development because parents spend less
Introduction and Background
Language development and vocabulary growth in young children are directly related to the amount of time parents spend speaking to them & interacting with and talking to their child. Furthermore, receptive language delays by age 5 are a significant risk factor for social and emotional problems in adulthood (Schoon, Parsons, Rush, & Law, 2010).
Results from several studies support this association between excessive screen time in children under 6-years-old and language delays (Chonchaiya & Pruksananonda, 2008; Duch et al., 2013; Lin et al., 2015). Lin, Cherng, Chen, Chen, and Yang (2015) conducted a quasi- experimental study and determined that exposure to television was correlated with an increased risk for language developmental delays in young children ages 15- to 35-months-old. The exposure group consisted of 75 children who watched an average of 137.2 min/day. The 75 children in the control group watched an average of 16.3 min/day. The exposure group’s risk of delayed language development was 3.3 times higher than that of the control group. Duch et al. (2013) found that Hispanic infants and toddlers who watched excessive television, defined as
2 hr/day or more, had 5.5 times the risk of having lower scores on the Communication section of the Ages and Stages Questionnaire (ASQ-3) after 1 year compared to those children who watched less than 2 hr/day. Chonchaiya and Pruksananonda (2008) also conducted a study with a sample of 56 children with language delays and 110 children with normal language development, ages 15- to 48-months-old. They asserted that children who started watching television before 12 months of age and watched more than 2 hr/day were six times more likely to develop a language delay. Although studies on the relationship between screen time and language development are few and mostly limited to observational or quasi-experimental methods, findings have remained consistent that increased screen time is associated with an increased risk for language developmental delays.
Researchers have also investigated how screen time interferes with language development by examining the interactions between young children and their caregivers (Chonchaiya & Pruksananonda, 2008; Christakis et al., 2009; Tanimura, Okuma, & Kyoshima, 2007). Christakis et al. (2009) explored verbal exchanges between a parent and child while watching television. They conducted an observational study to determine the relationship between the amount of time watching television and the number of parent-child interactions in a group of 326 children ages 2 to 36 months. For every 1 hr of television watched, the children were exposed to 500 to 1000 fewer words. The authors also ascertained that significant reductions for child vocalizations, vocalization duration, and conversational turns were associated with more time spent watching television. These decreased experiences for parent- child interactive language learning may impact normal language development. Chonchaiya and Pruksananonda (2008) established an association between the amounts of time caregivers interacted and conversed with their children in a day and risk for developing language delays.
The children with language delays spent an average of 7 hr/day with their caregivers in which
- of those hours, on average, were spent in conversation. The children in the control group with normal language development spent an average of 9.3 hr/day with their caregivers in which 5.8 of those hours, on average, were spent in conversation. Furthermore, Chonchaiya and Pruksananonda (2008) determined that children who watched television alone were 8.5 times more likely to develop a language delay. Similarly, Tanimura, Okuma, and Kyoshima (2007) observed that when the television is on, parents converse and interact less with their children. In an observational study performed in Japan, parents frequently spoke in shorter, one-word sentences and spoke less words overall to their children when the television was on. Taken together, results from these studies support the premise that television viewing disrupts
caregiver-child verbal interactions, which results in less words being spoken to the child and less opportunities for modeling two-way conversation and conveying thoughts in sentences rather than single words.
The American Academy of Pediatrics (AAP) advisory board recognizes the health implications of too much screen time. In addition to language delays, children are at increased risk for obesity, violence and aggression, loss of social skills, attention problems, anxiety and depression, sleep deprivation, vision problems, migraine headaches, repetitive motion syndrome and arthritis (American Academy of Pediatrics [AAP], 2016). In January 2017, the AAP advisory board ratified an online Media and Children Communication Toolkit, which encourages families to create a media use plan to gain awareness of media use habits and adopt methods to decrease use. In their most recent 2016 policy statement, the AAP advisory board advocated for no screen time in children under the age of 18-24 months other than video-chatting and to limit screen time to less than 1 hr/day of high-quality programming and apps for children ages 2-5
because of the harmful impact it might have on the developing brain. They also recommended caregivers co-view and co-use media, not allow screen time during meals or for 1 hour before bedtime, and remove televisions and other media devices from children’s bedrooms. Still, according to parent surveys, 90% of children younger than 2-years-old are exposed to 1 to 2 hr/day of television with 14% of them watching greater than 2 hr/day of television (AAP, 2011). Thirty-eight percent of infants use mobile devices like smartphones (Rideout, 2013). The typical American child before age 5 watches 4.5 hr/day of television (Christakis, 2011).
Many caregivers believe that screen media can have a positive impact on their child’s cognitive development because many programs and products advertise this as a benefit (AAP, 2011; Beck et al., 2015; Vandewater et al., 2005). Caregivers who believe a television program or video is educational and important to healthy development are twice as likely to have the television on for extended periods of time (Vandewater et al., 2005). An interview with a group of Hispanic families found limited knowledge among caregivers about the potential risks of too much screen time, but the caregivers also reported they would reduce their children’s screen time if they were better educated about this issue (Beck et al., 2015). Improved education and awareness about the potential for language delays in young children due to excessive screen time can empower families to reduce screen time in their homes.
The primary care setting offers excellent opportunities to promote screen reduction education to young children and their families. From birth to age 5, children will see their provider a minimum of 12 times for routine wellness visits. Despite this opportunity only 16% of pediatricians in the United States ask patients and their families about their media use, and this statistic has not changed in the last 20 years despite the production of new devices providing
more opportunities for screen time, including tablets, portable DVD players, and smartphones (Shifrin et al., 2015).
Increased amounts of recreational screen time, defined as time watching television and DVDs, playing videogames, and using computers, tablets, and cellular phones without academic purpose, and the lack of effective media use assessment and patient education being done by primary care providers is associated with increased risk of language developmental delays for young children under 6-years-old. This is a significant issue because language development is biologically correlated to age, and these early years are crucial for language acquisition, especially phonetics and syntax.
Integrative Review of the Literature
Search strategy. A three-step search strategy was utilized in this review to find published studies. An initial limited search of Medical Literature Anayslis and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across CINAHL, PubMed/MEDLINE, and PubMed Central.
The following keywords and combinations were searched in CINAHL: young children, television, television viewing, television viewing reduction, decreasing television viewing, media use, media use reduction, decreasing media use, screen time, screen time reduction, decreasing screen time, language, language development, and language delays. The following Medical Subject Headings (MeSH) and combinations were searched in PubMed/MEDLINE and PubMed
Central: television, language development disorders, child—preschool, and infant. Thirdly, the reference list of all identified reports and articles were searched for additional studies. Studies published in English between 2004 and 2016 were considered for inclusion in this review.