Screen use and children and adolescents’ emotional, cognitive and motor development: an umbrella review
Systematic review
|Published
We performed an umbrella review where we conducted a systematic literature search in five databases. We included systematic reviews on screen use and children and adolescents' emotional, cognitive and motor development.
Key message
Children and young people use digital screens in most arenas. Screen use can have both positive and negative consequences for health and development, but the results from studies are not clear-cut. We performed an umbrella review where we conducted a systematic literature search in five databases. We included systematic reviews on screen use and children and adolescents' emotional, cognitive and motor development.
The title and abstracts, and then the full text of references included on title and abstract level, were screened according to our predefined inclusion criteria. We assessed the methodological quality of the relevant reviews using AMSTAR-2. We included 19 systematic reviews.
Our main conclusion is that there is a considerable lack of good quality research on the effect of screen use on the emotional, cognitive, and motor development of children and adolescents (0-19 years). We found that:
- 5-year-olds who have their screen time significantly reduced probably engage in less aggressive and abusive behaviour.
- it is possible that increased smartphone/tablet use has little or no correlation with aggressive behaviour scores in 1-5 year old children.
- it is possible that increased TV time is correlated with increased aggressive behaviour scores in 1-5 year old children.
- it is possible that increased TV time has little or no correlation with executive functions in 6- and 7-year-old children after 7-8 years of follow-up.
We cannot conclude that there is an association or not between screen use and children and adolescents' emotional, cognitive or motor development.
Summary
Introduction
Children and adolescents use digital screens in most arenas. Screen use can have both positive and negative consequences for health and development, but the results of studies are not clear-cut. We have therefore summarised the most recent systematic reviews that seek to answer and clarify these questions.
Objective
The aim was to prepare an umbrella review (systematic review of systematic reviews) to investigate the effects and consequences of digital screen use in children and adolescents on their emotional, cognitive, and motor development.
Methods
We conducted a systematic literature search in Medline, PsycINFO, Embase and Epistemonikos, in December 2023. Two project members independently assessed the titles and abstracts of 62 % of the references, and the remaining references were single screened. Two project members then assessed relevant full-text systematic reviews against the inclusion criteria. We included systematic reviews that examined screen use and the emotional, cognitive, and motor development of children and adolescents (0-19 years). Two project members conducted independent quality assessments of the relevant systematic reviews (most recent search date) using the AMSTAR-2 checklist. One project member extracted results and another project member checked the extracted data. For emotional development, we retrieved results on emotion understanding, emotion regulation, aggression and behavioural difficulties, attention, self-image, and attachment. For cognitive development, we extracted results on general cognitive development, memory, executive functions, and language. For motor development, we extracted results on fine motor skills, gross motor skills, balance, and coordination (measured as motor development milestones: sitting, crawling, standing, walking, running, and limping). Confidence in the results was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
Results
We included 19 systematic reviews. Several of them had examined multiple aspects of development: There were 13 that had reported on emotional development, 10 that had reported on cognitive development and four that had reported on motor development.
Emotional development:
It is likely that when screen use time is reduced to approximately 21 min/day compared to continued levels of screen use time of approximately 94 min/day among children aged 3.5 years, it probably leads to less aggressive and abusive behaviour (moderate confidence in the estimate).
It is possible that increased smartphone/tablet use has little or no correlation with scores for aggressive behaviour in children aged 1-5 years, but increased TV time may be correlated with higher scores for aggressive behaviour in children aged 1-5 years (low confidence).
There is a lack of good documentation on the impact of screen use on the emotional development of children and adolescents. We therefore do not know whether screen use has an impact (very low confidence or lack of documentation) on:
- emotion understanding in children and adolescents aged 0-19 years
- emotion regulation in children and adolescents aged 0-19 years
- aggression, attention, and behavioural problems in infants (0-1 years) or in children and adolescents aged 6-19 years
- focused attention in children 17 to 19 months old
- attention problems in children aged 6-12 years
- self-image in children and adolescents aged 0-19 years
- family attachment in children and adolescents aged 0-19 years
Cognitive development:
It is possible that increased TV time has little or no correlation with executive functions in children aged 6-7 years (low confidence).
There is a lack of good documentation on the impact of screen use on children and adolescents' cognitive development. We therefore do not know whether screen use has an impact (very low confidence or lack of documentation) on:
- general cognitive development in children and young people aged 0-19 years
- memory in children and adolescents aged 0-19 years
- executive functions in children aged 0-6 years, 8-12 years, and adolescents aged 13-19 years
- language in children and adolescents aged 0-19 years
Motor development: There are many gaps in our knowledge about the impact of screen use on children and adolescents' motor development. We therefore do not know whether screen use has an impact (very low confidence or lack of documentation) on:
- fine motor development in children and adolescents aged 0-19 years
- gross motor development in children and adolescents aged 0-19 years
- balance in children and adolescents aged 0-19 years
- coordination in children and young people aged 0-19 years
There is a lack of good documentation on whether screen use affects subgroups of children and adolescents, or whether the setting around screen use affects children and adolescents' emotional, cognitive, and motor development (very low confidence or lack of documentation).
Discussion
We have summarised systematic reviews that examine screen use and children and adolescents' emotional, cognitive, and motor development. We included 19 systematic reviews in this umbrella review. We emphasised the dissemination of the most recent reviews of the highest methodological quality. We acknowledge that even the best systematic review cannot be more conclusive than what the available and included studies allow. A systematic review of high methodological quality may contain poorly conducted primary studies and a review of critically low methodological quality may contain the best studies.
We first assessed the methodological quality of the systematic reviews (using the AMSTAR-2 checklist) and excluded those of critically low quality. All systematic reviews must have assessed the risk of bias for their included studies. We used these assessments in our GRADE assessment, where we downgrade studies with a high risk of bias.
Most of the primary studies included in the systematic reviews were cross-sectional studies, a study design that is not suitable for investigating causality. There were very few studies with designs that can provide information about causality, such as controlled prospective studies and randomised controlled trials. We have therefore reported information from the cross-sectional studies, as they can provide information about possible correlations and thus perhaps indicate where it is most urgent to conduct new studies with designs adapted to questions about causal relationships.
Conclusion
Our main conclusion is that there is a significant lack of good quality research on the effect of screen use on the emotional, cognitive, and motor development of children and adolescents (0-19 years). We therefore cannot draw firm conclusions, but the results show that it is likely that reduced screen time is correlated with less aggressive and abusive behaviour in 3.5-year-olds. It is also possible that excessive TV time is correlated with higher scores for aggressive behaviour in children aged 1-5 years. It does not appear that high smartphone/tablet use is correlated with aggressive behaviour scores in children aged 1-5 years, or that high TV time is correlated with executive functions in children aged 6-7 years.
