Toddler tablet use may hinder attentive, behavioral development

There may be clinical evidence supporting the “tablet kids” trope.

A new cohort study published this week showed that toddlers who engaged with a touch-screen tablet game were less likely to show attention and respond to behavioral requests. Additionally, the study investigators observed an age-association with this trend; the older children were, the more negatively tablet games impacted their behavioral and attentive traits.¹

Recent observational research has observed that excessive media use can associate with risk of childhood attention, linguistic and social-emotional challenges. A team of investigators led by Sara Jane Webb, PhD, and Dimitri A. Christakis, MD, MPH, of the Center on Child Health, Behavior and Development at Seattle Children’s Research Institute, conducted a proof-of-concept study on the hypothesis that the mechanism that dictates the link between tablet media use and worsened language skills is the disruption of joint attention—a toddler-age learning mechanism that is critical to one’s linguistic development.

Webb, Christakis and colleagues wrote that tablets may reduce shared engagement between children and adults, due to the engagement with the screen often being invisible to the latter.

“Shared awareness supports language development, and joint attention is associated with language 1.5 to 6 years later,” the team wrote. “Specifically, we propose that highly engaging touch-screen commercial apps compared with other content types inhibits responding to joint attention and behavioral requests, and reduced joint attention during tablet use will be associated with lower language ability.”

Investigators conducted their cohort study with 63 toddlers aged 18 – 32 months old at a single time point from their behavioral research laboratory. The recruited, volunteer children came from a community sample of neurotypical toddlers.

Toddlers were prompted to engage with either a real toy (serving as control) or 4 different types of iPad tablet content:

• Viewing video of toy play
• Playing with a digital toy
• Playing with a commercial game
• A favorite app identified by the caregiver, or the popular app Fruit Ninja

After children had begun playing with 1 of the 5 assigned toys for 1 minute, an investigator delivered them joint attention prompts every 30 seconds, including asking them to point or look at objects in the laboratory. Afterward, the child’s caregiver was asked to naturally engage with the child for 2 minutes while the investigator did not speak. Then, the investigator concluded the assessment by asking the toddler to return the toy to them with verbal and physical gestures. The toddler was then switched to the next assessed toy.

The team sought primary outcomes including child response to joint attention (measured as the number of prompts with joint attention response per number of prompts delivered) and the child’s response to behavioral requests,

Of the assessed toddlers, 31 (49.2%) were female, and mean age was 26.1 months. Parent-identified race was predominately White (90.4%); a majority of the caregivers were college-educated (81.0%) and worked full- or part-time (71.4%).

Investigators found that when toddlers were playing with a commercial game on the tablet, they responded to fewer prompts for joint attention from the investigators and caregivers (-0.15 prompts; 95% CI, -0.24 to -0.06). The team further found that male toddlers took longer on average to acknowledge a behavioral request, with an interaction of content and sex of -0.75 (95% CI, -1.36 to -0.17).

Additionally, the team observed that the negative impacts of interacting with tablet games increased with the age of toddlers (-2.30; 95% CI, -0.05 to 0.0; P = .03), and that toddlers who reported greater media use at home were linked to decreased joint attention prompt responses while playing with the tablet game (P <.001 wp_automatic_readability="19">

Positively, better baseline language skills per Ages and Stages Questionnaire-3 (ASQ) scores were associated with toddlers showing better joint attention during play with a real toy instead of a tablet (P = .20).

The findings from the trial broadly correlate with prior research suggesting a link between early-age screen exposure and the development of symptoms that imply developmental delays in toddlers.² Webb, Christakis and colleagues concluded their cohort analysis showed that a highly engaging commercial tablet game marketed for toddlers may decrease responses to joint attention prompts, and as such, decrease their behavioral responses.¹

“This suggests that even in a laboratory setting, toddlers are less likely to engage with proximal attentive adults when using a tablet media device,” they wrote. “This may diminish important opportunities for learning and social emotional development.”

References

1. ^{Webb SJ, Howard W, Garrison M, et al. Mobile Media Content Exposure and Toddlers’ Responses to Attention Prompts and Behavioral Requests. JAMA Netw Open. 2024;7(7):e2418492. doi:10.1001/jamanetworkopen.2024.18492}
2. ^{Hester M. Early screen time could lead to ASD-like symptoms. Contemporary Pediatrics. Published April 24, 2020. https://www.contemporarypediatrics.com/view/early-screen-time-could-lead-asd-symptoms}