Association of Screen Time With Internalizing and Externalizing Behavior Problems in Children 12 Years or Younger

Abstract

IMPORTANCE Currently, there is a lack of consensus in the literature on the association between screen time (eg, television, video games) and children's behavior problems.OBJECTIVE To assess the association between the duration of screen time and externalizing and internalizing behavior problems among children 12 years or younger.DATA SOURCES For this systematic review and meta-analysis, MEDLINE, Embase, and PsycINFO databases were searched for articles published from January 1960 to May 2021. Reference lists were manually searched for additional studies.STUDY SELECTION Included studies measured screen time (ie, duration) and externalizing or internalizing behavior problems in children 12 years or younger, were observational or experimental (with baseline data), were available in English, and had data that could be transformed into an effect size. Studies conducted during the COVID-19 pandemic were excluded. Of 25 196 nonduplicate articles identified and screened for inclusion, 595 met the selection criteria.DATA EXTRACTION AND SYNTHESIS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Extracted variables were child age, sex, and socioeconomic status; informants and measurement type for screen time and behavior problems; study publication year; and study design and quality. Data were extracted by 2 independent coders and were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe primary outcome was the association of screen time duration with externalizing (eg, aggression, attention deficit/hyperactivity disorder symptoms) and internalizing (eg, depression, anxiety) behaviors or diagnoses. RESULTSOf the 595 full-text articles assessed for eligibility, 87 studies met all inclusion criteria, comprising 98 independent samples and 159 425 participants (mean [SD] age, 6.07 [2.89] years; 83 246 [51.30%] male). Increased duration of screen time had a small but significant correlation with more externalizing problems (90 samples; r, 0.11; 95% CI, 0.10-0.12) and internalizing problems (43 samples; r, 0.07; 95% CI, 0.05-0.08) in children. Several methodological moderators explained between-study heterogeneity. There was evidence of significant between study heterogeneity (I 2 = 87.80). CONCLUSIONS AND RELEVANCEThis systematic review and meta-analysis found small but significant correlations between screen time and children's behavior problems. Methodological differences across studies likely contributed to the mixed findings in the literature.

Impact of mobile phones and wireless devices use on children and adolescents’ mental health: a systematic review

“…The results of the current review largely align with recent systematic reviews on aggregated electronic screen time in children and young people, which have concluded that there are positive small but significant correlations between screen time and young children's internalizing and externalizing behaviours [63,64], and that longitudinal associations between screen time and depressive symptoms varied between different devices and uses [64].…”

“…We encourage future reviews to conduct meta-analyses of specific MP/WD types of activity and their effects on mental health, as Sohn et al have conducted with PSU [18]. A further consequence of not conducting a meta-analysis is that we were not able to estimate publication bias, evidence of which has been reported in a recent systematic review into child screen time and behaviour problems [63].…”

Cross-sectional associations between screen time and the selected lifestyle behaviors in adolescents

“…Across the previous studies, most of them focused on overall ST or television watching time instead of distinguishing different types of ST when examining the associations between ST and lifestyle behaviors ( 11 , 35 ). While television viewing remains the most common type of screen-based activities among adolescents, video and computer games have also become part of everyday life for adolescents, television and video/computer games are also the most commonly studied types in screen research ( 36 ). Therefore, more research is needed to explore the associations between different types of ST and lifestyle behaviors, in order to understand how to promote healthy lifestyles from the perspective of limiting specifically diverse ST.…”

Contemporary screen time modalities and disruptive behavior disorders in children: a prospective cohort study

“…Therefore, it is important to understand the modifiable risk factors associated with the development of disruptive behavior disorders. Previous studies have described associations between higher screen time and more externalizing behaviors, such as violence and rule-breaking in children, though findings have been mixed, mostly limited to television and video games, and effect sizes were generally small (Carson et al, 2016;Christakis & Zimmerman, 2007;Eirich et al, 2022;Pagani, L evesque-Seck, & Fitzpatrick, 2016;Willoughby, Adachi, & Good, 2012). Exposure to aggressive, inappropriate, or violent content online may lead to similar behaviors offline or further reinforce externalizing behaviors (Bandura, 1977;Ellis, Dumas, & Forbes, 2020).…”