A systematic review and meta-analysis, published in JAMA Psychiatry, identified a relationship between problematic behavior among children and screen time.

Investigators at the University of Calgary in Canada searched publication databases through May 2021 for studies of screen time and behavioral impacts among children. A total of 87 studies comprising 159,425 participants were included.

The studies included children aged mean 6.07 (range, 0.5-11.0) years, 51.25% were boys, and problematic behavior onset at 7.16 (range, 1.3-12.0) years of age. Studies were conducted in North America (44.9%), Europe (24.5%), Asia (14.3%), Australia or New Zealand (7.1%), the Middle East (5.1%), South America (2.0%), and Africa (1.0%).


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Externalizing behaviors were evaluated in 80 publications and internalizing in 40.

Externalizing behavioral problems was correlated with screen time (r, 0.11). Studies with smaller sample size tended to identify more extreme effect sizes, indicating study heterogeneity (I2, 87.80%; P <.001).

In a moderator analysis, the investigators observed that externalizing problems increased with the proportion of boys in the study population (b, 0.007; P =.001). Stratified by specific behaviors, the correlation between screen time and aggression was higher (r, 0.17) than with attention-deficit/hyperactivity disorder (r, 0.09).

In addition, studies that controlled for baseline externalizing behavioral problems observed more weak correlations with screen time (r, 0.06) than studies with cross-sectional designs (r, 0.13) or those without a control group (r, 0.11).

The effect size decreased over time on the basis of publication date (b, -0.003; P <.001) and as the quality of the study increased (b, -0.017; P <.001). Stratified by study location, the studies conducted in the Middle East found the strongest correlation (r, 0.23).

The studies which relied on behavioral reporting from peers found the highest correlation (r, 0.20) compared with studies relying on parent reports (r, 0.10), combined informants (r, 0.09), child reports (r, 0.08), or teacher reports (r, 0.07).

For internalizing behaviors, screen time was also significantly, although weakly correlated (r, 0.07). Study heterogeneity was observed (I2, 85.27%; P <.001), however, smaller sample sizes were not associated with stronger effects.

The moderator analysis identified studies that used different informants found increased effects (r, 0.08) compared with studies that used the same informant (r, 0.01).

The major limitation of these findings is that the level of the overall effect size is indicative of correlation and not causation.

The study authors concluded, “The association between screen time and children’s mental health has garnered marked attention from academic, health, and public sectors. This systematic review and meta-analysis found that screen time was weakly but significantly correlated with children’s internalizing and externalizing behaviors.”

Reference

Eirich R, McArthur BA, Anhorn C, et al. Association of screen time with internalizing and externalizing behavior problems in children 12 years or younger: a systematic review and meta-analysis. JAMA Psychiatry. 2022;e220155. doi:10.1001/jamapsychiatry.2022.0155