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SINGAPORE: Early exposure to digital devices such as tablets, smartphones and video consoles could worsen emotional and behavioral difficulties among preschool children with neurodevelopmental disorders (NDDs) such as autism, a new study showed.

It does so by interfering with the amount and quality of their sleep, said the study conducted by researchers from the KK Women’s and Children’s Hospital (KKH) and the National University of Singapore (NUS).



Exposure to an electronic screen before the child turns 18 months of age and the presence of multiple screen devices in the bedroom led to greater sleep disruption.

In the long term, these sleep disturbances could contribute to difficulties such as hyperactivity, low mood and inattention, said Dr Wong Chui Mae, a senior consultant at KKH’s department of child development and the study’s principal investigator.

The report was published in Journal of Developmental & Behavioural Pediatrics earlier this year.



Dr Wong Chui Mae is the principal investigator of the study. (Photo: Rachel Phua)

IMPACT OF SCREEN USE

Between 2015 and 2017, the study’s authors collected self-reported data from 367 caregivers of children between the ages of two and five.



Through the responses, the authors found that 57.7 per cent of children had at least one screen device in their bedrooms, while 52 per cent were exposed to electronic screens at the age of 18 months or earlier.



Sleep problems, which range from having difficulty falling asleep to daytime sleepiness, arose in 72.3 per cent of the children and 59.9 per cent of the children evaluated had emotional and behavioural difficulties, according to the response from their parents.



WHAT SHOULD PARENTS DO?

In light of these results, the authors recommended that parents and caregivers should keep their children’s bedrooms free from screen devices and disallow screen use before 18 months of age. Caregivers who share the same room as the children are encouraged to reduce and avoid screen use while their children are sleeping.



For children between 18 months old and two years old, Dr Wong said that some screen use can be introduced, but it must always be co-viewed with a caregiver “so there is still some interaction”. As for children between the ages of two and six, they should be permitted no more than one hour of screen use a day.



Addressing the common routine where parents use screen devices as a substitute to keep their children engaged, Dr Wong added that this habit is unhelpful.

“We always teach parents that if you give a child something to stop their tantrum, they will always tantrum to get that same thing from you.



“The general advice to parents is if your child is doing an unwanted behaviour like a tantrum, we would advise parents to ignore the unwanted behaviour, tell their child firmly that this is not right, to calm down, and to take their attention off the child.”



The child should also be praised or rewarded for behaving well, she added.

Other recommendations include stopping all screen use among children one hour before bedtime, and encouraging and setting house rules that limit their daily exposure to devices.



Dr Wong added that the study is applicable to children without NDDs as well given the available evidence on this topic.

“Our study actually serves to cement the current information that we know already,” she said.



Mr Chan Fook Chin is a parent who started introducing house rules about two to three years ago after seeking Dr Wong’s advice.

Mr Chan Fook Chin is a father of two daughters with autism who have benefited from less screen time. (Photo: Rachel Phua)

The self-employed 44-year-old, who has two daughters with autism, said that before having any sort of house rules, his children would “jump and sing” in the bedroom before bedtime. It would take about an hour before they settled down.

They were using digital devices for about four hours each day, Mr Chan estimated, and had trouble finishing their homework.



But after talking to Dr Wong, he came up with a schedule that both of them had to follow, and one he got his helper to enforce. They were only allowed 10 minutes of screen time at lunch, and another 15 minutes or so after finishing their homework.



It took about six months to get his children to comply, but sleep comes easily to his daughters now.

They are able to automatically follow the schedule and they focus better at school, with his younger daughter exhibiting less of the stimming or self-stimulating behaviour in children with autism. Interactions within the family have also increased.