January 8, 2024

expert reaction to study of early life digital media use and atypical sensory processing

A study published in JAMA Paediatrics looks at digital media use during early life and atypical sensory processing. 

Dr Marina Bazhydai, Lecturer in Developmental Psychology, Lancaster University, said:

“This is a relatively large cohort study based on the data from caregivers of children under 3 years of age collected in the USA. Caregivers filled out questionnaires when their children were 12, 18, 24 and 33 months. The study was pre-registered and the reported analyses also transparently specify the minor deviations from the pre-registered protocol, which are not of concern to the study’s integrity. I found the theoretical basis, methodology and analyses of good quality, the authors’ explanations of the study’s strengths and limitations diligent, and the interpretation of results sufficiently cautious, with no evidence of overspeculation and conclusions stemming from the data analyses.

“The study focused on typically developing children, and we have no data as to whether or not they were later diagnosed with any of the conditions of concern related to the main outcome of interest, such as ASD or ADHD. This is important to note when interpreting the results as the study is not aiming to establish any causal links; the sensory profiles were captured at approximately 33 months of age – but we have no data on what they were when children were younger, or when children got older. Thus, as the authors duly acknowledge, the clinical relevance of the atypical sensory processing and behaviour remains unclear.

“Atypical sensory processing is just one of the characteristics of concern here, and if, as the study shows, it is impacted by excessive screen exposure, when looked at in isolation it is not particularly informative for directly impacting caregiving practices.

“In my view, the main limitation of this report is the use of the ad-hoc measures of screen exposure, with the single binary (yes/no) question at 1 months, and a retrospective parent-report question asking caregivers to look back at the past 30 days and indicate how many hours, on average, their child was exposed to screens. Such an estimate is a hard task and subject to biases. Even if we accept this limitation, overall, descriptively, most children were reported to watch 1-2 hours of screens a day at 18 and 24 months. What kind of digital exposure was it? Were toddlers watching cartoons independently, without any social interaction or jointly with someone else? Was digital content child appropriate, engaging, stimulating? Was it interactive in any sense? The authors dutifully acknowledge this crucial limitation that the measure was not fine-grained enough to allow for richer interpretations of the link between screen exposure and sensory processing. From other research, we know that the role of the caregiver, or any social partner, during digital exposure is important. For example, a parent watching age-appropriate content together with the baby while interacting with the baby, smiling, naming objects, using gestures, providing tactile stimulation would be very different from a baby being seated in front of the news channel without anyone else around. Among the included covariates are two that are of interest in this regard (whether the caregiver plays with toys and takes walks with children), but a more sensitive measure of screen exposure would be necessary to draw more direct conclusions.

“Furthermore, the children in the study were born between 2011-2014, and are therefore now about 10-13 years old. Though we can’t check what their sensory processing and behaviour looks like a decade later (such data have not been collected, unfortunately), it is worth acknowledging that screen exposure and even the sorts of screens that were prevalent and possible a decade ago might be substantially different from what children born in 2022-2023 are exposed to. Completely speculatively as the data are not part of this work, if children nowadays are exposed to screens as much as children in the study, but the quality of the exposure is very different (e.g., playing interactive games on the smart phone vs passive watching news channel), the results of such study might look very different.

“Finally, as a further speculation, sensory processing, in particular sensation seeking, have been linked to curiosity. Children who are more curious might be more likely to seek sensory stimulation in various contexts, and their atypical sensory processing profile might not be of concern in the same way as it would be for children at risk of ASD or ADHD, quite the contrary. Thus, I concur with the authors, that this line of research is an exciting avenue for future developments.

“Thus, the implications for the real world that can be extracted from this research are a very limited and cautious possibility that greater screen exposure might be a contributing factor for atypical sensory functioning in toddlers. From this, the results are indeed supportive of the current recommendations to eliminate or limit screen time for very young children.”

Prof Alastair Sutcliffe, Professor of General Paediatrics, UCL, said:

“This study has the strength of not being biased as the cohort were impressively large and all-inclusive with a balance of male to female being 50:50 and there being 5000 children involved monitored periodically.

“The study shows a weak association (factor of 2) with screen time and atypical sensory processing. The authours did not account for confounders so there may be reverse causation at play. Screentime can be different from usual social interactions, and it could be that children who have atypical sensory processing are more attracted to this kind of ‘entertainment’, and therefore further study is needed.”

Prof Dorothy Bishop, Emeritus Professor of Developmental Neuropsychology, University of Oxford, said:

“This is an observational study and cannot establish that there is any causal link between screen exposure and children’s outcomes. As the authors note, without a randomised trial, these results are ambiguous.  Such associations as were found could arise if children with sensory challenges were more likely to seek out screens, and/or some other uncontrolled variable (e.g. noise in the home) led both to more screen exposure and sensory challenges. They also point out other limitations: both sensory difficulties and screen time were based on parental report, which is not objective, and the screen time measure provided no information about the type of screen time. I was surprised to see that the authors state “we also note that this observational study did not correct for multiple comparisons”. I don’t understand why they did not do this, and why the editor did not require it, because without such corrections, false positive findings are likely.”

‘Early-Life Digital Media Experiences and Development of Atypical Sensory Processing’ by Karen Frankel Heffler et al. was published in JAMA Pediatrics at 16:00 UK time on Monday 8^th January.

DOI:10.1001/jamapediatrics.2023.5923

Declared interests

Dr Marina Bazhydai: I declare no conflict of interest

Prof Dorothy Bishop: I have no conflict of interest