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Early Childhood Screen Use
Contexts and Cognitive and Psychosocial Outcomes:
A Systematic Review and Meta-Analysis
*MALLAWAARACHCHI, SUMUDU2, *BURLEY, JADE1,2, MAVILIDI, MYRTO1,2, HOWARD, STEVEN J.1,2,
STRAKER, LEON2,3, KERVIN, LISA1,2, STATON, SALLY2,4, HAYES, NICOLE2,5, MACHELL, AMANDA2,6,
TORJINSKI, MARINA2,7, BRADY, BRODIE1,2, THOMAS, GEORGE2,8, HORWOOD, SHARON2,7, WHITE,
SONIA L. J.2,5, ZABATIERO, JULIANA2,3, RIVERA, CLARA1,2, CLIFF, DYLAN1,2
BACKGROUND: The multifaceted nature of screen use has been largely overlooked in favour of a simplistic
unidimensional measure of overall screen time when evaluating the benets and risks of screen use to early
childhood development. The current review aimed to synthesise and meta-analyse associations of screen use
contexts in early childhood with cognitive and psychosocial outcomes, and examine potential moderators.
METHODS: PsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science and Scopus
were searched (inception to 31/12/2023). 7441 studies were initially identied. Studies were included if
they examined associations between a contextual factor of screen use among children aged 0 to 5.99 years
and cognitive or psychosocial development. Observational, experimental and randomized control trial
study designs were included. All studies were independently screened in duplicate following PRISMA
guidelines. Effect sizes of associations (r) from observational studies were pooled using random-effects
three-level meta-analyses. The remaining study designs were narratively synthesized. Screen use contexts
included content (child-directed, age-inappropriate), type (program viewing, game or app use), co-use
(or solo use), background television, caregiver screen use during child routines, and purpose of use (for
calming). Outcomes were cognitive (executive functioning, language and academic skills) or psychosocial
(internalizing and externalizing behavior problems, and socio-emotional competence).
RESULTS: Overall, 100 studies (176,742 participants) were included, of which 64 observational studies
(pooled sample sizes ranging from 711 to 69,232) were included in meta-analyses. There were 22 acute
experimental studies, 4 RCTs, 37 cross-sectional studies and 37 longitudinal studies included. Most studies
were rated weak on study quality (n=65) while 27 and 8 studies were rated moderate and strong, respectively.
Program viewing [n=14, k=48, r=-0.16, 95% CI: -0.24, -0.08] and background television [n=8, k=18, r=-0.10,
95% CI: -0.18, -0.02] were negatively associated with cognitive outcomes; while program viewing [n=6,
k=31, r=-0.04, 95% CI: -0.07, -0.01], age-inappropriate content [n=9, k=36, r=-0.11, 95% CI: -0.17, -0.04] and
caregiver screen use during routines [n=6, k=14, r=-0.11, 95% CI: -0.20, -0.03] were negatively associated
with psychosocial outcomes. Co-use was positively associated with cognitive outcomes [n=8, k=28, r =0.14,
95% CI: 0.03, 0.25].
IMPLICATIONS: Findings show small-to-moderate effect sizes that highlight the need to consider screen
use contexts when making recommendations for families, clinicians, and educators beyond total screen
time limits; including encouraging intentional and productive screen use, age-appropriate content and co-
use with caregivers, as well as avoiding background television and caregiver screen use during parent-child
interactions or routines. Future research should further evaluate elements within those contexts that may
be associated with children’s development (e.g., ‘What elements of co-use interactions may be benecial
beyond co-viewing?’). The consideration of a broad scope of screen use contexts and outcomes presents new
opportunities and actionable targets for intervention and public health messaging.
COI DISCLOSURE: Dr. Mallawaarachchi reports grants from ARC Centre of Excellence for the Digital
Child (CE200100022) during the conduct of the research to be presented.