In Reply In response to our article “Association of Early-Life Social and Digital Media Experiences With Development of Autism Spectrum Disorder–Like Symptoms,”1 we greatly appreciate the comments of Alper and encourage further discussion regarding the need to improve research on screen media and autism. In our study, we analyzed existing data from the National Children’s Study, finding a significant association between screen viewing at age 12 months and later autism spectrum disorder (ASD)–like symptoms. In addition, the 18 months’ screen viewing outcome of 4 hours a day or more vs 3 hours a day or less, while not statistically significant (P = .054), showed a point estimate of 10% higher ASD-like symptoms. We noted several limitations of our study based on the available data set and urged the need for further research that includes an ASD diagnosis and data on types and timing of screen exposure starting from birth. In addition, we provided E-values (eTable 3 in the Supplement) to estimate the minimum strength of association that an unmeasured confounder would need to have with each significant predictor to nullify its observed association with the ASD-related outcome.
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Heffler KF, Bennett DS, Subedi K. Improving Research on Screen Media, Autism, and Families of Young Children—Reply. JAMA Pediatr. 2020;174(12):1223–1224. doi:10.1001/jamapediatrics.2020.3022
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