Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities

Abstract

Research into early screen exposure has raised growing concerns about its impact upon children's neuropsychological well-being. However, possible pathways remain unclear. This study therefore aimed not only to evaluate the association between screen exposure during the ages of 0-3 years and preschoolers' autistic-like behaviors, but also the mediating roles of the frequency of caregiver-child interaction, sleep duration and level of participation in outdoor activities. Based on the 2017 survey of the Longhua Child Cohort Study, data of 29,595 child-caregiver dyads were obtained via a caregiver-reported questionnaire, with the data from 29,461 dyads included in the data analysis. Multiple linear and logistic regression models were employed to estimate the associations between screen exposure, caregiver-child interaction, sleep duration, outdoor activities, and children's autistic-like behaviors. The results indicated that screen exposure during 0-3 years of age was associated with the presence of autistic-like behaviors at preschool age, and the strength of the association was enhanced with the increase of average daily screen time (Odds Ratios (ORs) ranging from 1.358 to 4.026). The frequency of caregiver-child interaction and sleep duration mediated 5.32% and 1.19% of the variance of the association respectively, but outdoor activities did not mediate the association. Our findings indicate that preschoolers who are exposed to screens at aged 0-3 years might have an increased risk of autistic-like behaviors, and that, the frequency of caregiver-child interaction and sleep duration might function as potential mediators of this association.

Keywords: autistic-like behavior; caregiver-child interaction; mediation; outdoor activities; preschool children; screen time; sleep duration.

Figure 1

Multiple mediation model between average daily screen time on autistic-like behaviors through caregiver-child interaction, sleep duration and outdoor activities. Coefficients are shown after adjusting for child’s age, child’s gender, maternal and paternal age at child’s birth, maternal and paternal education level, monthly household income, parental marital status. The letter a₁, a₂ and a₃ represented the coefficient of average daily screen time in the linear regression model to caregiver-child interaction, sleep duration and outdoor activities respectively; The letter b₁, b₂ and b₃ represented the coefficient of caregiver-child interaction, sleep duration and outdoor activities in the logistic model to Autistic-like behaviors respectively; The letter c represented the coefficient of average daily screen time in the logistic model to Autistic-like behaviors without the effect of caregiver-child interaction, sleep duration and outdoor activities; The letter c’ represented the coefficient of average daily screen time in the logistic model to Autistic-like behaviors introducing the effect of caregiver-child interaction, sleep duration and outdoor activities. * p < 0.05; ** p < 0.01; *** p < 0.001.