Tracking children from early childhood into adolescence revealed a far more complex picture of how different types and levels of screen use relate to psychosocial development.
Study: Screen Use and Emotional, Behavioral, and Social Development in Children. Image Credit: PeopleImages / Shutterstock
A recent study from Scotland, published in the journal JAMA Network Open, found that screen use was not consistently associated with poorer emotional, behavioral, or social development after accounting for family functioning and other factors.
Background
Digital and screen-based devices such as televisions and cell phones have become an integral part of children’s lives over the past 20 years.
In the UK, 85% of children aged 3-5 years go online, rising to 100% by age 10. And despite the minimum age of 13 for using social media and messaging apps, 81% of children aged 10-12 use these platforms.
The effects of such long-term and extensive exposure to screens remain unclear, with conflicting reports from previous reviews. According to the authors of the current study, this could be due in part to small sample sizes, variation in methodologies, and a lack of adjustment for confounding factors, as well as differences in how screen use may affect children at different developmental stages.
Moreover, most such studies were cross-sectional and therefore unable to provide evidence about changes in these effects over time. Available longitudinal studies reported no major long-term detrimental effects on psychosocial development arising from screen use in early life. However, they did not include adolescents, nor did they evaluate parent-child relationships.
The current study sought to fill this gap by examining cross-sectional associations between screen use and psychosocial development at three time points, 5, 10, and 15 years, as well as screen use across these ages. The authors also examined whether screen use at 5 years was linked to psychosocial outcomes at 10 and 15 years of age.
Study characteristics
The researchers conducted a secondary analysis of a large Scottish birth cohort, using data from the Growing Up in Scotland (GUS) study collected in 2009-2010, 2014-2015, and 2019-2020. The analysis included 3,786 children at age 5, 3,126 at age 10, and 2,598 at age 15.
Children who were unavailable for follow-up had several differences from those who remained available for follow-up, including having single parents, being more deprived, having lower household income, having younger mothers, and having higher TDS at baseline.
Importantly, some of the apps most popular among children (such as TikTok) were launched relatively late in the study period.
Screen use during non-school hours was reported by parents or by the children themselves at 15 years. At 5 years and 10 years, total screen use was converted to a daily average. At age 15, the researchers examined different forms of screen use.
Psychosocial development was assessed using the parent-completed Strengths and Difficulties Questionnaire (SDQ). The questionnaire measures emotional difficulties, conduct difficulties, hyperactivity, peer difficulties, and the prosocial score (PS).
The researchers combined scores from the first 4 domains to obtain a total difficulties score (TDS). A score of 14 or higher was classified as above average, indicating a higher risk of psychosocial difficulties. A PS of 7 or lower was classified as below average, indicating a risk of prosocial adjustment problems.
The analyses accounted for family functioning and other potential confounding factors.
Screen use increased with age
The authors found that median daily non-school screen use increased from 2 hours at 5 years to 3 hours at 10 years of age.
The proportion of children spending 3 or more hours per day on screens was 25% at 5 years, increasing to 52.4% at 10 years. Among those who played games for 3 or more hours per day, a similar pattern was observed, with 1.7% at 5 years increasing to 21.1% at 15 years of age. And at 15 years, 28.4% of adolescents spent 3 or more hours per day on social media and messaging apps.
Categorical analyses found no higher TDS at ages 5 or 10
At ages 5 and 10, the researchers found no associations between screen use and an above-average total difficulties score (reflecting greater emotional or behavioral difficulties) after adjustment for confounding factors.
High gaming stood out among mixed TDS findings
After adjusting for confounding factors and correcting for multiple testing, very high gaming was the only screen-use category associated with higher odds of an above-average TDS. Gaming for 5 or more hours per day was linked to 2.6-fold higher odds of having a TDS score of 14 or higher. Conversely, using social media or messaging apps for 1-2 hours per day was associated with 43% lower odds of an above-average TDS, although the authors cautioned against interpreting this as a protective effect.
When TDS was analyzed as a continuous measure, 3-4 hours of total screen time per day at 5 years was associated with higher TDS, whereas this was not observed in the earlier categorical analysis. Moreover, at 15 years, 5 or more hours per day of television, films, or videos, and 3 or more hours per day of gaming, were associated with higher TDS.
Prosocial findings were limited and inconsistent
After adjusting for confounding, the authors found that the odds of a below-average PS, indicating poor adaptation, were 32% higher with 3-4 hours of screen time per day at 5 years.
When PS was analyzed as a continuous measure, PS decreased at the highest levels (5 or more hours per day) of watching television, films, or videos, or using social media/messaging apps. Notably, this did not always drop below the preset threshold for below-average scores. Categorical associations at age 15 were no longer significant after multiple-testing correction.
Early screen use and later psychosocial development
While screen use of 5 or more hours per day at age 5 was associated with 2.7-fold higher odds of a TDS of 14 or higher at age 10, this association disappeared by age 15. A different pattern was observed for PS: reduced odds of a below-average PS at age 10 did not persist at age 15.
However, sensitivity analyses using stricter score thresholds, screen-time quartiles, and alternative weighting approaches did not consistently reproduce these associations.
Limitations
The study has several limitations. Screen use was reported by parents or children, while psychosocial development was assessed using a parent-completed questionnaire, potentially introducing measurement and reporting bias.
There was no clear dose-response relationship, which might reflect inadequate sample size at higher levels of screen use, residual confounding, or analytical limitations. The type of content and context of engagement were not assessed, and unmeasured factors such as peer networks, platform-specific behavior, and content type may have influenced the associations.
The cohort was predominantly White, with low representation from disadvantaged groups, single-parent households, and younger mothers, limiting the generalizability. Screen-use measures also differed between childhood and adolescence, limiting direct comparisons across ages, and the data may already be partly outdated given the rapidly changing digital landscape.
Conclusions
The findings indicate that the relationship between screen use and psychosocial development is not straightforward. High screen use in early childhood was associated with greater difficulties at 10 years but not in adolescence, and was not consistently reproduced in sensitivity analyses. At age 15, in the main categorical analysis, only those with high gaming use showed an association with greater psychosocial difficulties, rather than other forms of screen use.
The authors point out that screen use is clearly linked to some harms, including online bullying, sedentary behavior, and exposure to dangerous content. It also has potential benefits, such as providing information, facilitating social connections, and offering more educational opportunities.
Overall, the findings suggest that more evidence is needed to define healthy screen use and develop guidance that goes beyond simply limiting screen time in childhood.
Future studies should provide data on screen use that describes the type of content, the age of exposure, the setting and timing, the device used, and the involvement of parents and caregivers. This could help inform more useful guidelines on screen use among children.
