Longitudinal Associations Between Use of Mobile Devices for Calming and Emotional Reactivity and Executive Functioning in Children Aged 3 to 5 Years.

Importance: Mobile devices are often used to keep young children occupied or calm, but it is not known whether this practice influences child development. Objective: To examine the longitudinal, bidirectional associations between the parent-reported frequency of using mobile devices to calm young children and children's executive functioning (EF) and emotional reactivity, testing moderation by child sex and temperament. Design, Setting, and Participants: This prospective cohort study included a community-based convenience sample of English-speaking parents of typically developing children aged 3 to 5 years. The study duration was from August 2018 to January 2020, with baseline (T1), 3-month follow-up (T2), and 6-month follow-up (T3) waves. Exposures: Parent-reported frequency of use of mobile devices to calm children when upset (5-point Likert scale). Main Outcomes and Measures: At each wave, the child's EF was assessed with the Behavior Rating Inventory of Executive Function-Preschool Version Global Executive Composite and emotional reactivity with the Child Behavior Checklist Emotional Reactivity subscale. Structural equation models were built to examine cross-lagged associations of the use of devices for calming, EF, and emotional reactivity, testing for moderation by child sex or temperament (Child Behavior Questionnaire-Very Short Form surgency score, median split). Results: Of 422 eligible parents with data at T1, 375 (88.9%) provided data at T2 and 366 (86.7%) at T3. At baseline, the mean (SD) age of the 422 children was 3.8 (0.5) years, the number of boys in the sample was 224 (53.1%), the number of individuals of non-Hispanic White race and ethnicity was 313 (74.2%), and among the parents, 254 (60.2%) had a college degree or higher. Among the boys, the use of devices to calm at T2 was associated with higher emotional reactivity at T3 (r [standardized regression coefficient] = 0.20; 95% CI, 0.10-0.30), while higher emotional reactivity at T2 had a nonsignificant association with increased device use for calming at T3 (r = 0.10; 95% CI, -0.01 to 0.21). Among children with high temperamental surgency, the use of devices to calm at T2 was associated with increased emotional reactivity at T3 (r = 0.11; 95% CI, 0.01-0.22), while higher emotional reactivity at T2 was associated with increased device use for calming at T3 (r = 0.13; 95% CI, 0.02-0.24). Conclusions and Relevance: The findings of this study suggest that the frequent use of mobile devices for calming young children may displace their opportunities for learning emotion-regulation strategies over time; therefore, pediatric health care professionals may wish to encourage alternate calming approaches.

Primary Care Pediatricians' Perspectives on Autism Care.

OBJECTIVES: We aimed to explore pediatric primary care provider (PCP) experiences and needs around identification and management of autism spectrum disorder (ASD) in toddlers for the purpose of planning improved supports and services for ASD in the medical home. METHODS: We recruited 28 PCPs to participate in semistructured interviews via Zoom. Probe questions elicited opinions about current screening and referral procedures, experiences obtaining services for patients, effective communication with parents, physician emotional experience when introducing ASD concerns, practice-based sources of disparities, and larger needs for ASD management in the primary care setting. Interview transcripts were analyzed qualitatively by a multispecialty research team for recurrent themes using grounded theory analysis. RESULTS: Participants were 89% women, ranging in clinical experience from <1 year to >27 years, representing 8 diverse pediatric primary care clinic sites at a Midwest academic medical center. Dominant themes relating to PCPs' cognitive, emotional, and environmental experience of caring for patients with ASD were identified, which reflected the trajectory of ASD identification (the parent lens; the "A" word), referral (the autism labyrinth; provider disempowerment; parent activation as a source of inequities), and long-term management (the "black box"; provider emotional investment). CONCLUSIONS: Existing literature and results from this study suggest a need for targeted improvements in primary care to: (1) increase PCP capacity and confidence in communicating concerns of ASD with families; (2) refer for timely diagnostic evaluations in trusted and easy-to-navigate care systems; and (3) increase family activation and capacity to follow up on ASD evaluation and treatment services.

Child Media Use During COVID-19: Associations with Contextual and Social-Emotional Factors.

OBJECTIVE: The aim of this study was to test associations between (1) contextual factors and types of digital media use and (2) types of digital media use and children's social-emotional and sleep outcomes during COVID-19. METHODS: In February to March 2021, 303 parents of elementary schoolers participated in this cross-sectional survey gathering information on demographics, child school format, contextual factors, duration of types of digital media use, social-emotional outcomes, and sleep. Multivariable regressions examined associations outlined in the objective, adjusting for school format, only child, race/ethnicity, and parental stress, depressive symptoms, education, and material hardship. RESULTS: Children were aged 5 years to younger than 11 years and spent approximately 4 hours on screen media daily. In multivariable analyses, remote school format; greater material hardship; Black, Indigenous, and people of color child race/ethnicity; lower parenting stress; and parent depressive symptoms were associated with longer duration of various digital media. Longer daily duration of streaming video and video chat were associated with higher prosocial scores, while console games, mobile apps/games, and video-sharing platforms were associated with greater problematic media use (PMU) (defined as interfering with adaptive functioning). More time on mobile apps/games, video-sharing platforms, and video streaming was linked with shorter sleep. CONCLUSION: Lower parenting stress predicted greater digital media use. Greater digital media use during the pandemic may have enabled parents to focus on other needs. Use of media for social connection predicted greater prosocial behaviors. Engagement-prolonging digital media predicted PMU. Pediatric providers may wish to consider family context when addressing digital media use and encourage socially oriented digital media.

Remote and Hybrid Schooling During COVID-19: Associations with Child Behavior and Sleep.

OBJECTIVE: The purpose of this study was to assess the prevalence of child behavior, academic and sleep concerns, and parent stress and depression symptoms during COVID-19; to test associations of parent-child well-being with child school format; and to examine effect moderation by child race/ethnicity and material hardship. METHODS: A total of 305 English-speaking parents of elementary school-age children completed online surveys regarding demographics, child school format, behavior, learning-related experiences, sleep, and parent stress and depression symptoms. Multivariable linear and logistic regression analyses examined associations of school format with child and parent outcomes. RESULTS: Children were aged 5.00 to 10.99 years, with 27.8% underrepresented minority race/ethnicity. Per parental report, 27.7% attended school in-person, 12.8% hybrid, and 59.5% remote. In multivariable models, compared with children receiving in-person instruction, children receiving remote instruction exhibited more hyperactivity (ß 0.94 [95% confidence interval, 0.18-1.70]), peer problems (ß 0.71 [0.17-1.25]), and total behavioral difficulties (ß 2.82 [1.11-4.53]); were less likely to show academic motivation (odds ratio [OR] 0.47 [0.26-0.85]) and social engagement (OR 0.13 [0.06-0.25]); were more likely to show schoolwork defiance (OR 2.91 [1.56-5.40]); and had a later sleep midpoint (ß 0.37 [0.18-0.56]) and higher odds of cosleeping (OR 1.89 [1.06-3.37]). Associations of remote learning with behavior difficulties were stronger for children without material hardships. CONCLUSION: Children receiving remote and hybrid instruction were reported to have more difficulties compared with children receiving in-person instruction. Children with material hardships showed more behavior challenges overall but less associated with school format. Therefore, planning for a return to in-person learning should also include consideration of family supports.

Video-Sharing Platform Viewing Among Preschool-Aged Children: Differences by Child Characteristics and Contextual Factors.

Free video-sharing platforms such as YouTube are highly popular among young children but may contain low-quality and highly commercialized content. This study aimed to describe the prevalence, duration, and timing of objectively measured mobile YouTube viewing in preschool-aged children and test hypotheses about associations with child individual differences and contextual factors. We analyzed mobile sampling data from 349 English-speaking children aged 3-4.99 years whose parents completed surveys about child, parent, and household characteristics. We assessed whether the child ever viewed YouTube during the sampling week and calculated average daily duration in a subsample of 121 participants with their own mobile devices. We built multivariable logistic regression models to test correlates of mobile YouTube viewership and duration. Children were 3.82 years (SD 0.53), 74.6 percent white non-Hispanic; parents were mostly mothers (93.7 percent), 34.0 (SD 4.6) years, and 37.9 percent had less than a college degree. Mobile YouTube viewing (37.0 percent of children) was more likely in children who used Android devices, shared mobile devices with family members, were older, attended home-based childcare, or had parents with lower educational attainment. Median YouTube duration was 61.2 min/day, with longer durations in children whose parents had lower educational attainment. These results demonstrate that many young children use free video-sharing platforms on mobile devices for long durations, and this practice may be disproportionately higher in children from lower socioeconomic status. Longitudinal research is needed on video-sharing platform viewing and child outcomes.

Children aged 3-4 years were more likely to be given mobile devices for calming purposes if they had weaker overall executive functioning.

AIM: Young children with weaker self-regulation use more digital media, but studies have been limited by parent-reported screen time measures. We examine associations between early childhood executive functioning and objective mobile device usage. METHODS: The parents of 368 American children (51.6% male) aged 3-4 years of age completed standardised measures of executive functioning, parenting stress and household chaos. They provided mobile sampling data for 1 week in 2018-2019 and reported how often the children used mobile devices to calm themselves. RESULTS: The children's mean age was about 3.8 years. A third of the children who were given devices to calm them down had weaker executive functioning in the overall and multivariable models, including working memory, planning and organisation. So did 39.7% of the children who used educational apps. Streaming videos, using age-inappropriate apps and using the mobile device for more than1 h per day were not associated with executive functioning levels. Parenting stress and household chaos did not moderate the associations. CONCLUSION: This study confirms previous studies that suggesting that children with weaker overall executive functioning used devices more for calming purposes. It also raises questions about whether children with weaker executive functioning should use educational apps.

Data Collection Practices of Mobile Applications Played by Preschool-Aged Children.

Importance: Child-directed mobile applications (apps) have been found to collect digital identifiers and transmit them to third-party companies, a potential violation of federal privacy rules. This study seeks to examine the differences in app data collection and sharing practices by evaluating the sociodemographic characteristics of the children who play them. Objective: To examine data collection and sharing practices of 451 apps played by young children and to test associations with child sociodemographic characteristics. Design, Setting, and Participants: This study used data from the baseline phase of the Preschooler Tablet Study, a prospective cohort study conducted from August 2018 to January 2020. This study used a population-based sample. A convenience sample of the parents of preschool-aged children was recruited from pediatric offices, childcare centers, social media posts, and an online participant registry. Eligibility criteria included (1) parent or guardian of a child aged 3 to 5 years, (2) parent or guardian who lived with the child at least 5 days per week, (3) participants who spoke English, and (4) a child who used an Android (Google LLC) device. All interactions with participants were through email, online surveys, and mobile device sampling. Exposures: Sociodemographic characteristics were assessed by parental report. Main Outcomes and Measures: This study tested the hypothesis that data transmissions to third-party domains are more common in apps played by children from low-socioeconomic-status homes. Child app usage was assessed via a mobile sampling app for an average of 9 days. Persistent identifier data transmissions to third-party domains were quantified for each app using an instrumented Android environment with monitoring of network traffic; for each child, the counts of total data transmissions were calculated, and the total third-party domains were detected for the apps they played. Results: Our sample comprised 124 children who used Android devices (35 tablets, 89 smartphones; 65 girls [52%]; mean [SD] age, 3.85 [0.57] years; 87 non-Hispanic White [71%]). One hundred twenty of participating parents (97%) were women. Of 451 apps tested, 303 (67%) transmitted persistent identifiers to 1 to 33 third-party domains. Child data transmission counts ranged from 0 to 614 (median [interquartile range], 5.0 [1-17.5]) and third-party domain counts from 0 to 399 (4.0 [1-12.5]). In multivariable negative binomial regression models, higher transmission and third-party domain rates per app were positively associated with older age (rate ratio, 1.67 [95% CI, 1.20-2.33]; P = .002 and 1.69 [95% CI, 1.26-2.27]; P < .001, respectively) and lower parent educational attainment (eg, high school or General Educational Development or less rate ratio, 2.29 [95% CI, 1.20-4.39]; P = .003 and 2.05 [95% CI, 1.13-3.70]; P < .02, respectively), but not with household income. Conclusions and Relevance: This study found that apps used by young children had a high frequency of persistent identifier transmissions to third-party companies, suggesting that federal privacy rules are not being enforced. Older children, those with their own devices, or those from lower-education households may be at higher risk of potential privacy violations.

Young Children's Use of Smartphones and Tablets.

BACKGROUND AND OBJECTIVES: Child mobile device use is increasingly prevalent, but research is limited by parent-report survey methods that may not capture the complex ways devices are used. We aimed to implement mobile device sampling, a set of novel methods for objectively measuring child mobile device use. METHODS: We recruited 346 English-speaking parents and guardians of children aged 3 to 5 years to take part in a prospective cohort study of child media use. All interactions with participants were through e-mail, online surveys, and mobile device sampling; we used a passive-sensing application (Chronicle) in Android devices and screenshots of the battery feature in iOS devices. Baseline data were analyzed to describe usage behaviors and compare sampling output with parent-reported duration of use. RESULTS: The sample comprised 126 Android users (35 tablets, 91 smartphones) and 220 iOS users (143 tablets, 77 smartphones); 35.0% of children had their own device. The most commonly used applications were YouTube, YouTube Kids, Internet browser, quick search or Siri, and streaming video services. Average daily usage among the 121 children with their own device was 115.3 minutes/day (SD 115.1; range 0.20-632.5) and was similar between Android and iOS devices. Compared with mobile device sampling output, most parents underestimated (35.7%) or overestimated (34.8%) their child's use. CONCLUSIONS: Mobile device sampling is an unobtrusive and accurate method for assessing mobile device use. Parent-reported duration of mobile device use in young children has low accuracy, and use of objective measures is needed in future research.

Longitudinal Associations Between Early Childhood Externalizing Behavior, Parenting Stress, and Child Media Use.

Limited research has examined bidirectional associations between modern media (e.g., smartphone, tablet) use and behavior in early childhood. This study aimed to test the hypotheses that, over 6 months, (H1) child externalizing behavior would predict later media use, mediated by parenting stress, and (H2) media use would predict later externalizing behavior. Participants included mothers and fathers from 183 heterosexual couples with a child 1-5 years old, followed for 6 months-assessed at baseline, 1, and 6 months. Frequency of child media use was assessed at baseline and 6 months through parent report across eight items (e.g., television [TV], smartphone, tablet use). Child externalizing behavior was assessed through the Child Behavioral Checklist, and parent stress through the Parenting Stress Index. Hypotheses were tested using structural equation modeling. Mothers were 31.8 (standard deviation [SD] = 4.2), fathers 33.3 (SD = 4.9), and children 3.0 years old (SD = 1.2). Structural equation models showed good overall fit. As hypothesized, we found that (H1) greater child externalizing behavior predicted greater parenting stress (ß = 0.48, p < 0.001), which predicted increases in child media use (ß = 0.15, p < 0.05); however, (H2) child media use did not predict later externalizing behavior (ß = 0.06, p = 0.23). In post hoc analyses, results differed slightly by specific type of media; for example, externalizing behavior was associated with later tablet and game use, whereas TV use predicted increases in externalizing behavior. Our results suggest that child behavior problems associate with later media use habits, possibly as a parent coping strategy, which should be considered when providing clinical guidance.

Interactional theory of childhood problematic media use.

The growth of mobile device access and ownership has yielded many opportunities and challenges for raising healthy digital media consumers. As adoption of mobile and internet-connected devices has increased among children, concerns for healthy child development have been expressed regarding excessive or problematic use. Although much theoretical and empirical work has been conducted evaluating adolescents' and adults' risks for dependence on various screen media (e.g., Gaming Disorder, Internet Addiction), little theoretical consideration has been expounded regarding the etiology and maintenance of problematic media use earlier in childhood (i.e., under age 12 years). The purpose of this paper is to propose a theoretical framework through which to investigate problematic media use in early childhood. Our theory, the Interactional Theory of Childhood Problematic Media Use (IT-CPU) merges developmental and clinical psychology theories, with communication and human-computer interaction perspectives. We outline distal and proximal factors that we hypothesize contribute to the development of problematic media use in childhood, and emphasize maintaining factors that could be targets for intervention. Finally, we provide recommendations for an interdisciplinary research agenda to test our proposed theory and inform experimental trials to prevent and treat childhood problematic media use.

A Naturalistic Study of Child and Family Screen Media and Mobile Device Use.

Parental mediation of screen media (e.g., television, video games) is associated with better outcomes for children. Although much research has examined parental mediation of television (TV), there is a dearth of research examining communication about mobile media (e.g., Smartphones, tablets) in the digital age. This study seeks to identify themes of family communication around media and mobile devices using naturalistic observational methodology. The sample consisted of 21 toddlers (ages 12-24-months old), 31 preschool-age children (3-5 years old), and 23 school-age (10-13 years old) children and their families. Children wore Language ENvironment Analysis (LENA) audio recording devices, which recorded vocalizations and other sounds proximal to the child wearing the device in the home environment, as well as audible screen media use. ATLAS.ti was used to transcribe dialogue from the audio recordings that pertained to screen media. Experts from the fields of communication, clinical child psychology, and developmental-behavioral pediatrics independently analyzed the transcripts to identify common themes. Five main themes emerged. First, parental mediation of screen media was primarily restrictive, reactive, and focused on technology functionality. Second, active mediation was child-driven. Third, siblings played a more dominant role in mediation than parents. Fourth, parents and children negotiated screen time limits. Finally, parallel family media use was common. Multiple family members engaged with their own mobile devices while simultaneously being exposed to background screen media (i.e., media multitasking). Assessing media use in the naturalistic home environment elucidated current patterns of family media use and communication about media in the digital age.

Technoference: longitudinal associations between parent technology use, parenting stress, and child behavior problems.

BACKGROUND AND OBJECTIVES: Heavy parent digital technology use has been associated with suboptimal parent-child interactions and internalizing/externalizing child behavior, but directionality of associations is unclear. This study aims to investigate longitudinal bidirectional associations between parent technology use and child behavior, and understand whether this is mediated by parenting stress. METHODS: Participants included 183 couples with a young child (age 0-5 years, mean = 3.0 years) who completed surveys at baseline, 1, 3 and 6 months. Cross-lagged structural equation models of parent technology interference during parent-child activities, parenting stress, and child externalizing and internalizing behavior were tested. RESULTS: Controlling for potential confounders, we found that across all time points (1) greater child externalizing behavior predicted greater technology interference, via greater parenting stress; and (2) technology interference often predicted greater externalizing behavior. Although associations between child internalizing behavior and technology interference were relatively weaker, bidirectional associations were more consistent for child withdrawal behaviors. CONCLUSIONS: Our results suggest bidirectional dynamics in which (a) parents, stressed by their child's difficult behavior, may then withdraw from parent-child interactions with technology and (b) this higher technology use during parent-child interactions may influence externalizing and withdrawal behaviors over time.

Early Childhood Media Exposure and Self-Regulation: Bidirectional Longitudinal Associations.

OBJECTIVE: To investigate: 1) prospective associations between media exposure (television viewing, computers, and electronic games) at 2 years and self-regulation at 4 and 6 years, and 2) bidirectional associations between media exposure and self-regulation at 4 and 6 years. We hypothesized that media exposure and self-regulation would show a negative prospective association and subsequent bidirectional inverse associations. METHODS: Data from the nationally-representative Longitudinal Study of Australian Children when children were aged 2 years (n = 2786) and 4/6 years (n = 3527) were used. Primary caregivers reported children's weekly electronic media exposure. A composite measure of self-regulation was computed from caregiver-, teacher-, and observer-report data. Associations were examined using linear regression and cross-lagged panel models, accounting for covariates. RESULTS: Lower television viewing and total media exposure at 2 years were associated with higher self-regulation at 4 years (both ß = -0.02; 95% confidence interval [CI], -0.03 to -0.01). Lower self-regulation at 4 years was also significantly associated with higher television viewing (ß = -0.15; 95% CI, -0.21 to -0.08), electronic game use (ß = -0.05; 95% CI, -0.09 to -0.01), and total media exposure (ß = -0.19; 95% CI, -0.29 to -0.09) at 6 years. However, media exposure at 4 years was not associated with self-regulation at 6 years. CONCLUSIONS: Although media exposure duration at 2 years was associated with later self-regulation, and self-regulation at 4 years was associated with later media exposure, associations were of small magnitude. More research is needed to examine content quality, social context, and mobile media use and child self-regulation.