Advancing the understanding of children's digital engagement: responsive methodologies and ethical considerations in psychological research.

Children's perspectives and experiences with digital media (digital engagement for short) are becoming difficult to observe and measure in today's highly multi-faceted, personalized and dynamic media ecosystem. In response, psychologists are developing a host of innovative methods. These may be broadly divided into those which prioritize children's active participation in research and those which develop techniques for passive observation. This article presents a state-of-the-art review of emerging methodologies to highlight the ethical issues that arise, by drawing on the Belmont principles for ethical research. We identify strengths and weaknesses of both participatory and non-participatory methods and recommend ways for future research to harness the potential of child-centered, responsive, and ethical methods.

Algorithmic Content Recommendations on a Video-Sharing Platform Used by Children.

Importance: Free video-sharing platforms (VSPs) make up a high proportion of children's daily screen use. Many VSPs make algorithmic recommendations, appearing as thumbnail images from the video, which content creators use to advertise their video content. Objective: To explore how VSP thumbnails use attention-capture designs to encourage engagement with content and to test whether VSP algorithmic recommendations offer more problematic thumbnail features over time. Design, Setting, and Participants: In this cross-sectional study conducted in January 2022, researchers mimicked the search behavior of children on a popular VSP by randomly clicking on recommended videos in order to test whether thumbnail designs changed over 20 sequential video engagements. A digital, footprint-free data collection setting was created by using a new computer and wireless internet router. Data were collected from YouTube via an internet browser not logged into a user account. Data analysis occurred from April to December 2022. Exposures: Manual searches using 12 top-searched terms popular with school-aged children were conducted. Researchers captured the video thumbnails recommended at the end of each video and randomly clicked subsequent videos for 20 sequential engagements. Main Outcomes and Measures: Thumbnail content codes were developed through iterative review of screenshots by a multidisciplinary research team and applied by trained coders (reliability, κ >.70). The prevalence of problematic thumbnail content and change in prevalence over 20 engagements was calculated using the Cochran-Armitage trend test. Results: A total of 2880 video thumbnails were analyzed and 6 features were coded, including visual loudness; drama and intrigue; lavish excess and wish fulfillment; creepy, bizarre, and disturbing; violence, peril, and pranks; and gender stereotypes. A high proportion contained problematic features including the creepy, bizarre, and disturbing feature (1283 thumbnails [44.6%]), violence, peril, and pranks feature (1170 thumbnails [40.6%]), and gender stereotypes feature (525 thumbnails [18.2%]). Other features included attention-capture designs such as the visual loudness feature (2278 thumbnails [79.1%]), drama and intrigue feature (2636 thumbnails [91.5%]) and lavish excess and wish fulfillment feature (1286 thumbnails [44.7%]). Contrary to the hypotheses, problematic feature prevalence did not increase over time, but the gender stereotypes feature increased with more engagement in the recommendations feed (P for trend < .001). Conclusions and Relevance: In this study of video recommendations for search terms popular with children, thumbnails contained problematic and attention-capturing designs including violent, stereotyped, and frightening themes. Research is needed to understand how children respond to thumbnail designs and whether such designs influence the quality of content children consume.

Greater mobile device-prompted phone pickups are associated with daily parent stress.

AIM: No studies have examined notifications as they relate to parent stress. We aimed to examine associations between objective daily mobile device notifications and pickups with daily parenting stress. METHODS: This was a within- and between-subjects, cross-sectional study that took place from 2020 to 2021. The study occurred during the coronavirus disease of 2019 pandemic. Data were collected in a low-contact home visit. This study included 62 parents of 62 children aged 48-71 months. Parents downloaded a passive sensing app on their Android mobile devices collecting data on duration, device notifications and device pickups. Parents completed an end-of-day stress survey for 4 days. We used random effects models to examine the variation of daily stress with smartphone duration, notification frequency, pickup frequency and device-initiated pickups, adjusting for covariates. RESULTS: Parents were on average 37.3 years old (SD ± 5.7) and were predominantly mothers (82.3%). On average, parents received 293 daily notifications and picked up their phones 93 times. Duration of smartphone use and notification frequency were not associated with daily stress. Device-initiated pickups were associated with daily parent stress. CONCLUSION: When notifications prompted parents to pick up their phones more often, parents experienced greater stress.

Parents' Desire to Change Phone Use: Associations with Objective Smartphone Use and Feelings About Problematic Use and Distraction.

We examined objective smartphone use (via a mobile sensing application) and self-reported desire to change phone use among a sample of 268 U.S. parents of infants. Using the Transtheoretical Stages of Change model as a conceptual foundation, we contextualized their attitudes and behaviors and explored how phone use and desire to change relate to perceptions of distraction and problematic phone use around their child. Latent profile analysis of parents' precontemplation, contemplation, and action scores revealed two classes-precontemplators (15%) and contemplators (85%). Contemplators-those considering or desiring change-showed more bedtime phone use and general social networking than precontemplors; however, there were no significant differences between groups on other objective use measures (e.g., total daily duration of phone use, phone use around child, etc.). Contemplators also showed greater perceptions of problematic use around their child and parenting distraction. Moreover, parents' problematic use and distraction were predictive of higher contemplation scores, even after controlling for demographic and objective phone use variables. Taken together, these results suggest that perceptions of phone use as problematic may be more important than actual phone habits, especially total phone use duration, for desire to change. Suggestions for future research and intervention are provided.

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.

Prevalence and Characteristics of Manipulative Design in Mobile Applications Used by Children.

Importance: Manipulative design features (known as dark patterns) are common in video games and adult-directed technologies, but their prevalence in children's interactive media has not been described. Objectives: To develop a reliable coding scheme for gathering data on manipulative digital designs, describe their prevalence within apps used by a community-based sample of young children, and test hypotheses about associations of manipulative design features with socioeconomic status (SES). Design, Setting, and Participants: This cross-sectional study of a convenience sample of parents of children aged 3 to 5 years was conducted online. Eligible parents were legal guardians of a 3-to-5-year-old child, lived with their child at least 5 days per week, understood English, and were part of a family that owned at least 1 Android or iOS tablet or smartphone. For each participant, the 3 apps used for the longest duration by children with their own mobile devices were downloaded, played, and coded. Data were analyzed between April and August 2021. Exposures: Child SES, operationalized as parent educational attainment and household income-to-needs ratio. Main Outcomes and Measures: Researchers assigned each child a prevalence score for manipulative design features (overall, gameplay pressure, purchase pressure, and advertisement viewing pressure) within the apps children played. Results: Of 160 children in the sample, mean (SD) age was 4.0 (0.6) years; 120 children (75.0%) were non-Hispanic White, and 96 (60.0%) had a parent with a college degree or more. Manipulative designs promoted prolonged gameplay or purchases through 4 user experience typologies: parasocial relationship pressure occurred in 33 (24.8%) and 25 (18.8%) apps with characters; time pressure in 23 (17.3%) and 14 (10.5%) apps; navigation constraints in 61 (45.9%) and 49 (36.8%) apps; and attractive lures in 60 (45.1%) and 61 (45.9%) apps, respectively. Children from households whose parents had lower education levels had higher manipulative design prevalence scores than children whose parents had graduated from college (median [IQR] 3.7 [2.5-5.0] vs 3.0 [2.0-4.0]; P = .02), gameplay-prolonging design (2.3 [1.6-3.0] vs 2.0 [1.5-2.8]; P = .047), and purchase pressure (1.0 [0.5-1.5] vs 0.6 [0-1.3]; P = .02). Purchase pressure prevalence scores were higher for children from households with lower income (R = -0.18; P = .02). Conclusions and Relevance: Design features that encourage monetization of children's digital experiences were common in this sample and disproportionately occurred in apps used by children with lower SES.

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.

From Moral Panic to Systemic Change: Making Child-Centered Design the Default.

Academic scholarship and public discourse about children's digital media use often invokes concepts such as 'screen time' that place the locus of responsibility on individual users and families rather than on designers creating digital environments. In this vision article, we argue that research, design, and policy frameworks that assume individual responsibility contribute to intensive parenting messaging about children's media use, are less likely than systemic approaches to achieve population-level change, and produce inequities in children's access to positive, child-centered media. Platforms (e.g., app marketplaces, video streaming services) act as entry points for children's use of digital spaces, and thus are strong determinants of children's experiences. As such, platforms are an ideal point of intervention for systemic change and have the potential to create equitable and child-centered digital environments at an ecosystem level. We contend that policies that encourage platforms to establish child-centered design as the default user interface will both create better experiences for children and relieve pressure on parents as gatekeepers. Finally, we review the types of research questions that could examine how to measure and optimize platforms for their impact on child wellbeing and outline steps researchers can take to provide evidence-based guidance to industry about designing ecosystems for children's best interests.

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.

Parent Verbalizations and Toddler Responses With Touchscreen Tablet Nursery Rhyme Apps.

OBJECTIVES: In some studies, parents and toddlers verbalize less when engaging with a tablet versus a print book. More needs to be known regarding child contributions to specific parent verbalizations. We examined parent-toddler contingent interactions with tablet applications versus print books, as well as moderators of these associations. METHODS: We conducted a laboratory-based, within-subjects counterbalanced study of 72 parent-toddler dyads engaging with a nursery rhyme application (with enhanced + autonarration [E+A] and enhanced formats) and print book. We coded parent verbalizations (eg, dialogic, nondialogic) and proportions of child responses to these in 5-second epochs. Poisson regressions were used to analyze within-subjects variance by tablet or print format. We tested effect modification by child emotion regulation and home media practices. RESULTS: Children responded more to parent overall (print 0.38; E+A 0.31, P = .04; enhanced 0.11, P = .01), dialogic (print 0.21; E+A 0.13, P = .04; enhanced 0.1, P = .02), and nondialogic (print 0.45; E+A 0.27, P < .001; enhanced 0.32, P < .001) verbalizations during print book versus tablet. Stronger child emotion regulation, greater frequency of co-viewing, and instructive practices moderated associations such that differences between conditions were no longer significant for some parent verbalizations and child responses. CONCLUSIONS: Parent-toddler reciprocal verbal interactions occurred less frequently with tablet versus print book use. Child emotion regulation and parent home media practices moderated some of these associations. Pediatricians may wish to promote co-viewing and instructive media practices but may also consider that child emotion regulation may determine response to interactive tablet design.

How educational are 'educational' apps for young children? App store content analysis using the Four Pillars of Learning framework.

Experts have expressed concerns about the lack of evidence demonstrating that children's "educational" applications (apps) have educational value. This study aimed to operationalize Hirsh-Pasek, Zosh, et al.'s (2015) Four Pillars of Learning into a reliable coding scheme (Pillar 1: Active Learning, Pillar 2: Engagement in the Learning Process, Pillar 3: Meaningful Learning, Pillar 4: Social Interaction), describe the educational quality of commercially-available apps, and examine differences in educational quality between free and paid apps. We analyzed 100 children's educational apps with the highest downloads from Google Play and Apple app stores, as well as 24 apps most frequently played by preschool-age children in a longitudinal cohort study. We developed a coding scheme in which each app earned a value of 0-3 for each Pillar, defining lower-quality apps as those scoring ≤ 4, summed across the Four Pillars. Overall scores were low across all Pillars. Free apps had significantly lower Pillar 2 (Engagement in Learning Process) scores (t-test, p < .0001) and overall scores (t-test, p < .0047) when compared to paid apps, due to the presence of distracting enhancements. These results highlight the need for improved design of educational apps guided by developmental science.