Screen-time is associated with inattention problems in preschoolers: Results from the CHILD birth cohort study

Background
Pre-school children spend an average of two-hours daily using screens. We examined associations between screen-time on pre-school behavior using data from the Canadian Healthy Infant Longitudinal Development (CHILD) study.
Methods
CHILD participant parents completed the Child Behavior Checklist (CBCL) at five-years of age. Parents reported their child’s total screen-time including gaming and mobile devices. Screen-time was categorized using the recommended threshold of two-hours/day for five-years or one-hour/day for three-years. Multiple linear regression examined associations between screen-time and externalizing behavior (e.g. inattention and aggression). Multiple logistic regression identified characteristics of children at risk for clinically significant externalizing problems (CBCL T-score≥65).
Results
Screen-time was available for over 95% of children (2,322/2,427) with CBCL data. Mean screen-time was 1·4 hours/day (95%CI 1·4, 1·5) at five-years and 1·5 hours/day (95%CI: 1·5, 1·6) at three-years. Compared to children with less than 30-minutes/day screen-time, those watching more than two-hours/day (13·7%) had a 2·2-point increase in externalizing T-score (95%CI: 0·9, 3·5, p≤0·001); a five-fold increased odd for reporting clinically significant externalizing problems (95%CI: 1·0, 25·0, p = 0·05); and were 5·9 times more likely to report clinically significant inattention problems (95%CI: 1·6, 21·5, p = 0·01). Children with a DSM-5 ADHD T-score above the 65 clinical cut-off were considered to have significant ADHD type symptoms (n = 24). Children with more than 2-hours of screen-time/day had a 7·7-fold increased risk of meeting criteria for ADHD (95%CI: 1·6, 38·1, p = 0·01). There was no significant association between screen-time and aggressive behaviors (p>0.05).
Conclusion
Increased screen-time in pre-school is associated with worse inattention problems.

背景
学龄前儿童日均屏幕使用时长平均为2小时。本研究依托加拿大健康婴儿纵向发展研究（Canadian Healthy Infant Longitudinal Development, CHILD）的数据，探究学龄前儿童屏幕使用时间与学龄前行为之间的关联。
方法
CHILD队列的参与者家长在儿童5岁时填写了儿童行为量表（Child Behavior Checklist, CBCL）。家长报告了孩子的总屏幕使用时长，涵盖游戏与移动设备使用时长。屏幕使用时长按照推荐阈值进行分组：5岁儿童采用每日2小时的阈值，3岁儿童采用每日1小时的阈值。本研究采用多重线性回归分析屏幕使用时间与外化行为（如注意力不集中与攻击行为）的关联；采用多重逻辑回归识别存在临床意义外化问题（CBCL T分≥65）的儿童特征。
结果
共有超过95%的儿童（2322/2427）提供了有效屏幕使用时长数据且完成CBCL测评。5岁儿童的平均屏幕使用时长为1.4小时/日（95%置信区间：1.4, 1.5），3岁儿童为1.5小时/日（95%置信区间：1.5, 1.6）。与日均屏幕使用时长不足30分钟的儿童相比，日均屏幕使用时长超过2小时的儿童（占比13.7%）的外化行为T分升高2.2分（95%置信区间：0.9, 3.5, p≤0.001）；出现临床意义外化问题的比值比升高5倍（95%置信区间：1.0, 25.0, p=0.05）；出现临床意义注意力不集中问题的风险升高5.9倍（95%置信区间：1.6, 21.5, p=0.01）。T分高于临床截断值65的DSM-5注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder, ADHD）患儿被判定存在显著的ADHD型症状（n=24）。日均屏幕使用时长超过2小时的儿童符合ADHD诊断标准的风险升高7.7倍（95%置信区间：1.6, 38.1, p=0.01）。未发现屏幕使用时间与攻击行为存在显著关联（p>0.05）。
结论
学龄前儿童屏幕使用时长增加与更严重的注意力不集中问题显著相关。