Sitting a baby in front of a tablet or television, as well as less parent-child play time, are associated with developing greater autism spectrum disorder (ASD)-like symptoms later in childhood. These findings, from the first prospective study on the subject, are published today in JAMA Pediatrics from researchers at Drexel University’s College of Medicine and Dornsife School of Public Health.



The authors suggest that these findings come at a critical time during this coronavirus pandemic with many children at home all day and parents juggling working from home or other new responsibilities while watching their children.



“The literature is rich with studies showing the benefits of parent-infant interaction on later child development, as well as the association of greater screen viewing with developmental delays,” said lead author Karen F. Heffler, MD, a researcher in the College of Medicine. Our study expands on this previous research by associating early social and screen media experiences with later ASD-like symptoms.”

During babies’ 12- and 18-months well visits, their caregivers were asked about how often their baby is exposed to screens or books, and how often they play with their child. Following this group of 2,152 children from the National Children’s Study the team examined how watching television or videos, as well as social play time and reading together, were associated with ASD risk and ASD-like symptoms at two years of age as measured by the Modified Checklist for Autism in Toddlers (M-CHAT). While toddlers generally are interested in interacting with others, those with ASD-like symptoms are less likely to show these social behaviors.

Controlling for gender, race, maternal age, and prematurity, the team found that viewing screens at 12 months of age was associated with four percent greater ASD-like symptoms, and daily play time with a parent compared to less than daily play time was associated with nine percent less ASD-like symptoms. The findings back recommendations from the American Academy of Pediatrics which discourages screen time in children younger that 18 months, unless it is used for video chatting.

One in 54 children has ASD, a condition four times more prevalent in boys than in girls, according to the Centers for Disease Control and Prevention. Previous studies report that about 50 to 80 percent of overall autism risk is genetic, yet non-genetic contributors are poorly understood.

“These findings strengthen our understanding of the importance of play time between parents and children relative to screen time,” said senior author David S. Bennett, PhD, a professor of Psychiatry in the College of Medicine. “There is a great opportunity for public health campaigns and pediatricians to educate and empower parents to possibly minimize their child’s risk of ASD symptoms, which may include increasing social interaction and limiting screens at an early age.”

The authors note that their study did not find an association with ASD risk, but rather with ASD-like symptoms. Future studies should explore whether this relationship is determined by children predisposed to ASD being drawn to the screens or screens contributing to ASD-like symptoms, and potentially the audio-visually oriented brain connectivity seen in toddlers with ASD. In the meantime, the authors suggest that parents adhere to the American Academy of Pediatrics recommendation to avoid screen time in children younger than 18 months and limit screens to one hour daily through age 5 years, co-viewed to help children understand what they are seeing.

The paper also provides additional evidence associating prematurity, minority race or ethnicity, as well as lower income with higher risk of ASD and ASD-like symptoms.



In addition to Heffler and Bennett, additional authors on this paper include Danielle M. Sienko, MS, who completed the work while at Drexel’s Dornsife School of Public Health, Keshab Subedi, MS, MSc, of ChristianaCare Health System, and Kathleen A. McCann, M Phil, of Social & Scientific Systems, Inc.

The paper, “Association of Early-Life Social and Digital Media Experiences With Development of Autism Spectrum Disorder–Like Symptoms,” was published online in JAMA Pediatrics and is available at this link.