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Original Investigation
November 4, 2019

Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children

Author Affiliations
  • 1Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 2Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 3Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 4Educational Neuroimaging Center, Biomedical Engineering, Technion, Israel
  • 5Medpace Inc, Cincinnati, Ohio
JAMA Pediatr. Published online November 4, 2019. doi:https://doi.org/10.1001/jamapediatrics.2019.3869
Key Points

Question  Is screen-based media use associated with differences in the structural integrity of brain white matter tracts that support language and literacy skills in preschool-aged children?

Findings  In this cross-sectional study of 47 healthy prekindergarten children, screen use greater than that recommended by the American Academy of Pediatrics guidelines was associated with (1) lower measures of microstructural organization and myelination of brain white matter tracts that support language and emergent literacy skills and (2) corresponding cognitive assessments.

Meaning  These findings suggest a need for further study into the association between screen-based media use and the developing brain, particularly during early childhood.

Abstract

Importance  The American Academy of Pediatrics (AAP) recommends limits on screen-based media use, citing its cognitive-behavioral risks. Screen use by young children is prevalent and increasing, although its implications for brain development are unknown.

Objective  To explore the associations between screen-based media use and integrity of brain white matter tracts supporting language and literacy skills in preschool-aged children.

Design, Setting, and Participants  This cross-sectional study of healthy children aged 3 to 5 years (n = 47) was conducted from August 2017 to November 2018. Participants were recruited at a US children’s hospital and community primary care clinics.

Exposures  Children completed cognitive testing followed by diffusion tensor imaging (DTI), and their parent completed a ScreenQ survey.

Main Outcomes and Measures  ScreenQ is a 15-item measure of screen-based media use reflecting the domains in the AAP recommendations: access to screens, frequency of use, content viewed, and coviewing. Higher scores reflect greater use. ScreenQ scores were applied as the independent variable in 3 multiple linear regression models, with scores in 3 standardized assessments as the dependent variable, controlling for child age and household income: Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2; Rapid Object Naming subtest); Expressive Vocabulary Test, Second Edition (EVT-2; expressive language); and Get Ready to Read! (GRTR; emergent literacy skills). The DTI measures included fractional anisotropy (FA) and radial diffusivity (RD), which estimated microstructural organization and myelination of white matter tracts. ScreenQ was applied as a factor associated with FA and RD in whole-brain regression analyses, which were then narrowed to 3 left-sided tracts supporting language and emergent literacy abilities.

Results  Of the 69 children recruited, 47 (among whom 27 [57%] were girls, and the mean [SD] age was 54.3 [7.5] months) completed DTI. Mean (SD; range) ScreenQ score was 8.6 (4.8; 1-19) points. Mean (SD; range) CTOPP-2 score was 9.4 (3.3; 2-15) points, EVT-2 score was 113.1 (16.6; 88-144) points, and GRTR score was 19.0 (5.9; 5-25) points. ScreenQ scores were negatively correlated with EVT-2 (F2,43 = 5.14; R2 = 0.19; P < .01), CTOPP-2 (F2,35 = 6.64; R2 = 0.28; P < .01), and GRTR (F2,44 = 17.08; R2 = 0.44; P < .01) scores, controlling for child age. Higher ScreenQ scores were correlated with lower FA and higher RD in tracts involved with language, executive function, and emergent literacy abilities (P < .05, familywise error–corrected), controlling for child age and household income.

Conclusions and Relevance  This study found an association between increased screen-based media use, compared with the AAP guidelines, and lower microstructural integrity of brain white matter tracts supporting language and emergent literacy skills in prekindergarten children. The findings suggest further study is needed, particularly during the rapid early stages of brain development.

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    6 Comments for this article
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    Was prenatal alcohol exposure excluded in these healthy children?
    barry stanley, MBChB, FRCS(C) | N/A
    There is nothing to indicate that pae was excluded, or accounted for, in the above Abstract. Could the authors say how such an omission might impact their conclusions and recommendations?
    Barry Stanley
    CONFLICT OF INTEREST: None Reported
    ScreenQ details
    Eric Osika, MD | Pediatric Department, Hopital Saint Camille, Bry Sur Marne France
    ScreenQ is a screen-based media use assessment that could be useful for the studies of other colleagues. Where could we find the details of that score? For example, how to reach a score of 26 with 15 items?
    CONFLICT OF INTEREST: None Reported
    What type of screens were the kids exposed too?
    Amir Borenstein, Electronic Practical Eng | www.norad4u.com
    Hello and congratulate on the study.
    I would like to ask if you have some data on the type of screens the kids were exposed to?
    Were they smart phones, wireless tablets, wireless laptops, wired computers, wireless smart TV or other?
    The reason I am asking is that there might be a link to the exposure of these kids to Radio Frequency radiation from the screens (if wireless). Past studies showed that RF radiation can cause changes and damage to the myelin layer over the nerves.
    https://www.ncbi.nlm.nih.gov/pubmed/25205214
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247706/
    Thanks in advance.
    Amirb
    CONFLICT OF INTEREST: I develop and sell EMF measurement and protection products.
    Control
    Sarah Wheeler |
    What was controlled for here other than SES and she? Couldn't this association be more about the third factors that would exist in a home where a child was in front of a TV all day? Poverty? Parental neglect? Trauma?
    CONFLICT OF INTEREST: None Reported
    Technology Safety Training for Clinicians and Patients
    Cecelia Doucette, Master Tech Writing | The international non-profit Wireless Education; Understanding EMFs; EMF Conference
    After spending years doing fundraising to bring technology into our public schools in Ashland, MA for what we were hearing was needed for the 21st Century Classroom, I discovered all wireless technology came to market with no safety testing, and transmits our data via two-way microwave radiation signals.

    The peer-reviewed, published scientific literature indicates this non-ionizing, low-level, non-thermal radiation is very toxic at levels well below what the FCC continues to allow.

    Thousands of studies link today's wireless radiation exposures to our skyrocketing rates of infertility, Alzheimer's, autism, genotoxicity, neurotoxicity, child and adult cancers, insomnia, headaches,
    nausea, nosebleeds, irregular heartbeats, skin abnormalities, behavior issues, cognitive impairment, memory deficits, learning disabilities, pain, anger, anxiety, depression, suicidal ideation and more.

    After investigating, I helped our school district become the first in the nation to begin taking precautionary measures until public policy catches up to the science.

    I have also educated legislators, and helped Massachusetts lead the nation with 20 bills to address man-made radiation. NH and OR have just passed laws to investigate health and environmental impacts, especially in light of 5G which puts cell antennas outside our homes.

    I was honored to be asked to help plan the recent EMF Conference to train health care providers to recognize, diagnose, treat and prevent illnesses from wireless technology. The impact on brain development was widely discussed.

    Dr. Victoria Dunkley, author of Reset Your Child's Brain, lectured on Excessive Screen Syndrome (ESS) and the four-week protocol she has developed for digital detox.

    Other experts from around the world and U.S. flew in to educate on other detrimental impacts wireless technology is having on our health.

    The EMF Conference (electromagnetic fields of radiation) offered 16 CMEs and the conference videos are expected to be available this fall. Please see https://emfconference.com/.

    To quickly understand the scope of this issue, please consider taking a course from the non-profit Wireless Education. The Schools & Families Course and the Corporate Induction Safety Awareness Course can each be completed in about a half hour on-line. There is a nominal fee to help keep the non-profit afloat.

    You will learn the science, risks, what other countries are already doing to protect their public, and medically recommended best practices for safe technology use. A printable tip sheet is available at the end with handy reminders. https://www.wirelesseducation.org/store/l2/

    You may also wish to consider watching the award-winning film Generation Zapped. You will hear directly from leading scientists and doctors, several of whom presented at the EMF Conference in September. https://generationzapped.com/#gen-trailer.

    Dr. Delaney Ruston has also produced two documentaries being shown in middle and high schools today. She investigates the social, emotional and addiction impact of today's technology on teenagers and offers stress resilience strategies. Please see https://www.screenagersmovie.com/.

    Please share these resources widely with loved ones, colleagues, patients, schools and your own public servants as this information is not typically covered in mainstream media and most are in the dark. Fox25 in Boston did a JAMA follow-on story last night: https://www.boston25news.com/news/plugged-in-too-much-screen-time-could-be-harming-children-s-brains/1005520155.

    Thank you for your time and consideration.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Blue light or RF? Flicker or Magnetic Field?
    Samantha Vilppu, BS ARCE (engineering) | EMF Consultant and Course Creator
    As a couple of the other comments on this page have pointed out, the current technology that was used in this study needs to be clearly described, since the factors within the construction of such devices has been changing quite rapidly over the past several years. Television screens from 20 years ago are not the same as TV screens that are currently available, and so it helps to zero in on the actual factors of causality by being more specific. The factors that current technology has can include RF (radio frequency/microwave) wireless radiation, as well as excessive blue frequencies from the visible spectrum, and also flicker. There is also the electric and magnetic field that one is exposed to when in close proximity to the device which can also affect our biology negatively. If these factors are not controlled for, then it becomes impossible to separate out which of (or if all) these factors are actually causing these developmental defects to occur. I believe all of these to be an issue, but rather than blanketing them all together in the study, it is important to differentiate.
    CONFLICT OF INTEREST: None Reported
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