Setting Limits on Screen Time for Children (6-to-12 Years): The Integral Role of Parents and Educators.

Current guidelines on screen time and use of electronic media by children aged 6-to-12 years

The guidelines for screen time have changed over time and have been set largely by the American Academy of Pediatrics (AAP). In 2013, the AAP made the following recommendations on the use of electronic media, as listed in Table 1:

Then in 2016, the AAP released revised guidelines that acknowledged the ‘multifactorial effects of media use’ on children. Recommendations included the need for ‘mindful selection, curation, and co-viewing of content’ by parents, and a ‘personalized media use plan’ that attended to the ‘age, health, temperament, and developmental stage’ of each child. Also acknowledged were the significant challenges faced by parents in setting limits on screen time and in limiting the media consumed by children, especially when children owned their own digital devices (AAP, 2016b, p.1). Even so, parents of school-aged children were advised to ‘carve out’ media limits each day to include 8-10 hours of sleep, 2 hours of screen time, 1 hour of physical activity, and 0 sugary drinks (Swartz, 2016, p.1). Such limits were intended to ‘reduce the risks of obesity, lost sleep, and impaired school performance’, while allowing children to ‘connect online with friends and family and learn about the broader world’. The goal was to keep children off their devices, that is ‘unplugged’, for at least 2 hours per day (Christakis, Medscape Medical News, 2016, p.1).

It was claimed, however, that the AAP (2016b) guidelines, were based on ‘out-of-date research’ conducted before digital devices had become part of everyday life (University of Oxford, 2017, p.1). The time-lapse between the original research and publication made the recommendations ‘difficult to justify and implement’. A re-evaluation of the guidelines was suggested to determine whether they were good for the mental health and wellbeing of young children. Thus, the differing opinions of health and education authorities, as revealed here, created ‘policy and practice dilemmas’ and ‘conflicting guidelines’, on screen time for young children (Straker et al., 2018, p.300).

Importantly, ‘no consistent evidence of health benefits or safe thresholds’ for screen time for children and young people could be identified, with no evidence supporting ‘differential thresholds’ for younger children or adolescents (Stiglic & Viner, 2018, p.14). Very limited evidence was found for a threshold to guide policy on screen time exposure. Nonetheless, evidence of ‘health harms’ across a ‘broad range of domains of physical and mental health, including adiposity, unhealthy diet, depressive symptoms, and quality of life’, broadly supported ‘policy action’ to ‘limit screen use by children and young people’. Suggestions included the setting of limits on screen time for children and young people, and consideration of the impact of the content or contexts of digital screen use, specifically the use of mobile digital devices, on their health and well-being. Organizations such as the AAP were encouraged to consider ‘extending recommendations’ for specific limits on screen time to ‘preteens and teens’ (Twenge & Campbell, 2018, p.280), along with the provision of a diverse menu of online and offline experiences with opportunities for children to let their minds wander and experience boredom, the space in which creativity and imagination happen (Harvard Medical School, 2019, p.1).

A more ‘nuanced’ stance on screen time was proposed in response to the increasingly pervasive and ubiquitous role of media in the lives of children (American Academy of Child & Adolescent Psychiatry, 2020, p.1080). For children aged 6-and-older, the AACAP encouraged the development of ‘healthy’ habits with a ‘consistent’ limit on activities that involved screens, including greater scrutiny of children’s access to screens (especially portable devices), the content accessed, who children are with and how they interact when looking at screens (American Psychological Association, 2020, p.42). Australian parents were advised there was ‘no magic figure’ that could be used to determine how much screen time was safe for young children. The ‘right’ amount of screen time depended on the age and maturity of the child, the kind of content the child was consuming, their learning needs and family routine (Australian Government, Office of the eSafety Commissioner, 2021b, p.1), and the cost of time spent on screen to health, wellbeing and opportunities to live a balanced life (Graham & Sahlberg, 2021, p.5; Longitudinal Study of Australian Children, 2016, p.99). Consequently, no maximum limit on screen time was set for Australian children. However, moderation of screen-use was recommended to promote cognitive development in children (Walsh et al., 2020, p.4), along with the need for the general discussion around screen time to ‘go beyond simply limiting screen time’, to promoting the use of screens in ways that are ‘positive’ for the brain (University of Washington, 2021, p.1).

The effects of screen time on the brain development and cognition of young children

While the current guidelines (AAP, 2016b; ACAP, 2020) provide criteria for the use of media and exposure to screen-based devices, it is necessary to set them against what are known to be the effects of screen time on young children, and the developmental trajectory of children. To that end, the literature from medical science, specifically evidence-based research from Neuroscience, Psychiatry, Psychology and Paediatrics, is investigated.

Screen time and structural changes in the brain

Neuroimaging technologies, specifically ‘Magnetic Resonance Imaging’ (MRI) and ‘functional MRI’ (fMRI), have provided evidence that correlate screen time with ‘structural changes’ in the brains of children aged 0-18 years (Raschle et al., 2012, p.2). ‘Lower microstructural integrity’ of brain white matter tracts were identified in children, aged 3-to-5 years, who used more than the screen time recommended by the AAP (2016b), that is, more than 1 hour per day without parental interaction (Hutton et al., 2019, p.8). Average screen time for these children was slightly more than 2 hours per day but ranged from 1 hour to slightly more than 5 hours per day. Tracts that supported ‘language and emergent literacy skills, cognition, and executive functions’, were ‘more disorganized and underdeveloped’. Screen time, it was concluded, was ‘too passive’ for brain development, and ‘displaced’ other experiences that could have ‘helped children reinforce brain networks more strongly’ (Hutton, LaMotte, CNN News Health, 2019, p.1). Premature ‘thinning’ of the cerebral cortex, that is, cell loss or ‘atrophy’ in the outermost layer of the brain was identified through neuroimaging in children aged 9-to-10 years who used screen-based media for more than 7 hours per day (World Economic Forum, 2018, p.1). Similarly, ‘structural deficits’ in the cortex, identified through neuroimaging, were attributed to excessive online gaming in Chinese adolescents and young adults. ‘Decreased left orbitofrontal grey matter volume’ was found after 6 weeks of daily online gaming in both ‘excessive gamers’ and ‘gaming-naïve' subjects (Zhou et al., 2017, p.100-109;). New rules were announced in China in 2021 to ‘combat gaming addiction’ with online video games limited to 3 hours per week for children under-18 years (Reuters, 2021, p.1; AppInChina, 2007, p.1; China Daily, 2006, p.1).

Correspondingly, ‘reductions in cortical thickness’, across prefrontal, parietal, and temporal regions of the brain that was attributed to ‘social deprivation in early life’, was associated with attention deficit hyperactivity disorder (ADHD) approximately four or five times more often than other children (McLaughlin et al., 2014, p.8). Significant ‘cortical thinning’ was also found in children with ‘Fetal Alcohol Syndrome Disorder’ (FASD) in large areas of the ‘bilateral middle frontal lobe, pre- and post- central areas, lateral and inferior temporal and occipital lobes of the brain’ (Zhou et al., 2011, p.1). Excessive or long-lasting stress, known as ‘toxic stress’, that included ‘physical or sexual abuse, neglect or lack of affection, parental mental illness, family violence, poverty, and lack of adequate housing’, had a negative impact on brain development, especially in the early years (Harvard University, 2021, p.1). While thinning of previously thicker areas of the brain is generally associated with aging, ‘Alzheimer’s disease’ (AD) and ‘progressive brain disorganization’ (Roe et al., 2021, pp.5-6), it is not observed in otherwise healthy children.

Research from animal models (Waxmonsky, 2019, p.1) found frequent exposure to rapidly changing audio and visual bombardment, the hallmarks of many television shows and video games, had prevented brain nerve tracks from developing as intended. These findings, when extrapolated to brain development in children, pointed to ‘what children were not doing’, and ‘what was not happening in their brains’, because they were ‘staring at screens’. It was concluded that there was ‘nothing inherently beneficial about viewing screens’, rather, ‘a matter of how much risk’ screens posed (Waxmonsky, 2019, p.1-2).

In Australian research, the synchronisation of social and emotional networks in the brain was correlated with active human engagement, known as ‘interpersonal neural synchronisation’ or neural coupling (Kerr, 2019, p.14). Physical face-to-face interactions ‘activate different parts of the brain’ that are not activated during virtual meetings (Hasson et al., 2012, pp.6-8). Intensive physical face-to-face interactions, when used within the Auditory-Verbal Therapy (A-VT) approach to teach Australian children (0-18 years) with hearing loss to listen and speak, built and strengthened neural pathways in the auditory area of the brain, in areas where cognitive growth and language development is promoted (Dornan et al., 2011, 2010, 2009, 2009, 2008, 2007).

Notably, changes in the anatomical and physiological development of the brain, particularly the connection between the prefrontal cortex and executive function, were aligned with Piagetian child development theory (Bolton & Hattie, 2017, p.22). It was concluded, therefore, that the first years of life needed to be focused on human interactions, specifically ‘healthy and stimulating experiences’, to ‘build brain architecture’ that can operate at its ‘full genetic potential’ (Harvard University, 2008, p.2).

Screen time and cognition

Higher daily screen time across all screen types was correlated with ‘lower cognition’ in children aged 9-to-10 years, with those in the ‘high’ (7.2 hours per day) and ‘middle’ (2.9 hours per day) screen time groups rated ‘lower in cognition’ when compared to children in the ‘low’ (1.2 hours per day) screen time group (Walsh et al., 2020, p.4). Early data from the NIH 2018 study indicated ‘lower scores in thinking and language tests’ for children whose screen time was ‘more than 2 hours per day’ (CBS News, 2018, p.1). ‘Heavy television use’ by Australian children was predictive of a ‘loss of reading of four months relative to peers two years later’, while ‘heavy computer use’ predicted a similar loss in numeracy two years based on a comparison of academic results from NAPLAN, the National Assessment Program Literacy and Numeracy (Mundy et al., 2020, p.11).

Conversely, ‘superior global cognition’ was identified in Canadian children aged 8-to-11 years who ‘adhered to recommendations of physical activity of 1 hour per day, recreational screen time of 2 hours or less per day, and sleep of 9-11 hours duration per night’, while the ‘limiting of recreational screen time’ and the ‘encouragement of healthy sleep’ was correlated with ‘improved cognition’ (Walsh et al., 2018, p.6; Rodriguez-Ayllon et al., 2020, p.5). Increased screen time, however, was correlated with ‘increased problem behaviours’ in children aged 9-to-10 years, whereas ‘sleep of longer duration’ was associated with ‘reduced problem behaviours’ (Guerrero et al., 2019, pp.3-9; Fakhouri et al., 2013, pp.227-228).

The ‘digital distractions and supernormal capacities for cognitive offloading’ offered during screen time, created a ‘non-ideal environment’ for the ‘refinement of higher cognitive functions during critical periods of brain development’ in children and adolescents (Firth et al., 2019, pp.126-127). ‘Complex and multi-method based visual stimuli’ on screens was associated with ‘overload on working memory’, ‘divided attention’ and ‘impaired recall’. The combination of ‘audio-visual graphics, text, and animations’ impeded the ability to ‘register, process, and remember information with accuracy’. Consequently, cognitive overload impacted the ‘quality of comprehension, prioritization, and deep-level processing of incoming information’. Short-term memory, in turn, could not be consolidated into long-term memory, and resulted in ‘poor processing and understanding of what was taught or said’ (Jha & Arora, 2020, p.1). It was argued ‘the screen should be the tool, not the teacher’ (Roseberry Lytle, University of Washington, 2015, p.1).

Screen time and physiological and psychological effects

Screen time was correlated with ‘adverse physiological and psychological effects’ in children and adolescents, aged 0-to-18 years (Lissak, 2018, p.149). Physiological effects attributed to excessive screen time included ‘poor sleep’ and risk factors for ‘cardiovascular diseases (high blood pressure, low HDL cholesterol, obesity)’, ‘poor stress regulation (high sympathetic arousal and cortisol dysregulation)’, ‘Insulin resistance’, ‘impaired vision’ and ‘reduced bone density’ (Lissak, 2018, pp.149-157; Dahlgren, 2021, pp.2-5). Excessive screen time is defined as ‘sedentary time spent on screen, such as watching television, playing video games, or using the computer for more than 2 hours per day’ (de Lucena et al., 2015, p.407) that ‘comes at the expense of other healthy activities’ (Dahlgren, 2021, p.1). Significantly, in 2018 the World Health Organization (WHO) included gaming disorder in the 11th International Classification of Diseases (WHO, 2018, p.1).

Psychological effects, specifically ‘developmental delay’, were associated with screen time in children aged 11-to-13 years when ‘screen versus non-screen interactions’ during early childhood were compared with behavioural problems in early adolescence (Wong et al., 2021, pp.7-11). The ‘duration’ of exposure to screens by children and the ‘frequency’ of non-screen parent-child activities correlated with ‘externalizing problems’ (rule-breaking behaviours, delinquency and aggression) and ‘internalizing problems’ (emotional symptoms, anxiety and depression) in early adolescence. Fewer externalizing problems were observed when young adolescents spent more time on ‘non-screen parent-child activities’, and less time on ‘child-alone’ video game activities. The overall ‘length’ of screen time, along with ‘violent’, ‘fast-paced’ content and ‘repetitive attentional shifts between multiple tasks’, was found to activate dopamine and reward pathways associated with ‘ADHD-related behaviours’, including ‘inattention’, ‘impulsivity’, ‘sleep problems’, and ‘impaired executive functioning’. Extensive screen time and use of technology were correlated with ‘heightened attention-deficit symptoms’, ‘impaired emotional and social intelligence’, ‘technology addiction’, ‘social isolation’, ‘impaired brain development’, and ‘disrupted sleep’, while ‘background media’ had a negative impact on ‘cognitive load’ and ‘attentional capacity’ (Lissak, 2018, p.149-157).

Constant use of technology offered ‘fewer opportunities to interact offline’ and meant ‘the brain could not reset to its default, or resting, mode’ (Small et al., 2020, p.179-187; Kerr, 2019, p.12). ‘Symptoms of ADHD’ were identified in children and adolescents aged 15-and-16 years after 6 weeks of digital media use, although no symptoms of ADHD were identified in baseline data (Ra et al., 2018, p.258-261). A significant association, therefore, was established between more frequent digital media use and ADHD symptoms. Importantly, it was found that ‘screen time induced ADHD-related behaviour’ could be ‘inaccurately diagnosed’ as ADHD, while reduced screen time was effective in decreasing ADHD-related behaviour (Lissak, 2018, p.149). Additionally, the association between screen time and ADHD, was identified in people at any age, with moderate or severe depression and obesity found in adults who spent more than 4 hours per day watching TV and using computers, outside work or school, with females at higher risk (Madhav et al., 2017, p.67-71; Teychenne et al., 2010, p.246-254).

A summary of the effects of screen time on the brain development and cognition of young children and adolescents, along with associated health consequences, is provided in Table 2:

Conclusions are now presented that are based on a comparison of the science and practice. Expressly, the findings from Neuroscience, Psychiatry, Psychology and Paediatrics on the quantified effects of screen time on the brain development and cognition of children are compared with the current screen time guidelines (AAP, 2016b) for children aged 6-to-12 years.