Media Consumption by Preschool Children

The risk of autism and developmental disorders

Background: Autism spectrum disorder (ASD) is a persistent neurodevelopmental condition characterized by impaired social communication and the presence of restricted, repetitive patterns of behavior, typically manifesting in early childhood. The rising prevalence of ASD has been discussed in relation to increased media consumption.

Methods: A selective literature search was conducted in the Medline database on the topics of media consumption and mental disorders, particularly autism, in preschool children. Seven systematic reviews and meta-analyses and 36 original studies were included in the analysis.

Results: The findings across studies consistently demonstrated that media consumption in preschool children was associated with deficits in language and cognitive development (adjusted odds ratio [aOR] 1.67–2.28) and was a risk factor for the development of emotional, behavioral, and developmental disorders (aOR: 1.34–3.06). Symptoms consistent with ASD were also found to be associated with increased media consumption (OR 1.97, 95% confidence interval [1.30; 3.00]). However, these observed effects were consistently identified in the context of multiple other risk factors for mental health problems—such as low socioeconomic status, a family history of mental disorders, or parental stress—which mediated these effects, either directly or indirectly. Intervention studies showed that reducing media consumption, combined with an increase in constructive parent–child interactions, led to a reduction in symptom severity.

Conclusion: In the context of additional risk factors, increased media consumption in young children is associated with atypical or delayed development. The extent of developmental disorders can be reduced through targeted support for parents. When risk factors are present, it is therefore essential to educate parents and implement preventive measures to promote the long-term healthy development of children.

Cite this as: Kamp-Becker I, Poustka L: Media consumption by preschool children: The risk of autism and developmental disorders. Dtsch Arztebl Int 2025; 122: 433–8. DOI: 10.3238/arztebl.m2025.0087

Autism spectrum disorder (ASD) is an early-onset, genetically determined developmental disorder. There is ongoing discussion about the role of environmental factors in its origin, such as advanced parental age, medication use during pregnancy, or perinatal oxygen deprivation (e1). The prevalence of ASD is around one percent (e2), but questions arise as to whether the rate will continue to increase (e3) and what are the underlying factors for this. One environmental factor currently under discussion in this context is media consumption in early childhood, with reference to both passive and active use of all types of media.

Media use by preschool children is increasing in Germany (e4) as well as internationally (1). Two meta-analyses (24 and 63 studies, respectively) showed that media consumption in children under the age of two ranges between 36 minutes and more than five hours per day (e5). More than 70% of families do not follow existing recommendations (Table 1) (e6, e7). Objective methods of measurement (e8) arrive at times between 1.2 h/day ± 1.5 h (age: 6 months) and 2.5 h/day, ± 2.0 (age: 24 months). On average, first screen exposure (i.e., first contact with screen-based media) was 12 months (e8). One third of the children used media on their own, most of them without parental guidance. Parents mentioned the desire to calm down their children as the main reason for this (2).

Table 1

Recommendations* by the WHO (e26) and the DGKJ (taken from [40]; slightly abridged)

We are investigating whether excessive screen time is linked with mental health, on the one hand, and with the development of ASD in preschool children on the other. For a better understanding, it is important to note that only correlative associations are reported here and not causal effects. There is a large number of confounding variables which have an impact on this association. These are usually included in the analyses and so allow adjusted odds ratios (AOR) to be determined.

Methods

The present article is a narrative overview based on a literature search of topics relating to screen time and mental disorders, and particularly autism, in preschool children. Details are provided in the eMethods section.

Results

The results of systematic reviews and meta-analyses are summarized in Table 2. More identified studies and study details (for example, adjusted variables) are listed in eTable 1 and eTable 2.

Table 2

Meta-analyses und systematic reviews regarding the associations between screen time and mental health

Media consumption and mental health

A total of 395 studies were found, and a further 95 were screened. These included four systematic reviews and meta-analyses and 26 other studies (eTable 1). The overall results show that both active and passive screen time by preschool children was associated with emotional and behavioral problems (1, e9). Furthermore, there were indications of associations with cognitive impairment and delayed language acquisition. (3, 4). The risk of language developmental disorders had an AOR from 1.67 to 2.28 (3, 5) and between 1.81 and 2.12 for cognitive deficits (6).

With regard to associations with mental health, significant correlations were found with internalizing/emotional problems (anxiety, depressive, and somatization symptoms) as well as externalizing/behavioral problems (hyperactive, oppositional, and aggressive symptoms) (7, 8, 9, 10, 11, e10, 12). Only one study found no associations in either domain (e11), while another showed the associations only for behavioral problems (13).

The risk of emotional and behavioral problems was increased overall (AOR: 1.34–3.06) (14, 15) or was in the clinically abnormal range (AOR: 1.18–1.90) (15). In particular, the consumption of non-child-directed content was associated with an increased risk (AOR: 2.82) (14). The associations were greater for preschool children than for school children (7) and greater for boys than for girls (8, 16, 17, e12). Long-term studies indicate a long-term association linked in particular with behavioral problems and poorer self-regulation skills (6, 7, 9, 14, 17, 18, 19, 20, e13). Overall, excessive screen time by infants is meanwhile regarded as a risk factor for the development of emotional, behavioral, and developmental disorders of various types.

Dose-dependent effect

A dose-dependent effect is illustrated here by taking the risk of emotional problems as an example (6): With a screen time of more than 3 h/day (17% of subjects) the risk (OR: 2.21; 95% confidence interval: [1.67; 2.92] AOR: 1.90 [1.41; 2.55]) was significantly increased in comparison with children with less than 1 h/day. The risk was lower for 2 h/day (36%) than for more than over 3 h/day, yet nevertheless increased (OR: 1.37 [1.09; 1.73]; AOR: 1.36 [1.06; 1.73].

Risk areas and bidirectional effects

A total of five studies showed associations and risks of symptoms of attention deficit hyperactivity disorder (ADHD) (8, 9, 11, 17, 18). The risk of this disorder is increased with an AOR of 1.62 to 1.85 (5, 18, 21). Three studies found associations with peer problems (10, 13, 17). One study (13) in particular showed that the risk remained relatively high even after adjustment for eight variables (OR 2.62 [1.50; 4.59]; AOR: 2.57 [1.25; 5.26]). Other studies found associations with reduced self-regulation (e12, 18, 22) (AOR: 1.14–1.54) (18). Bidirectional, longitudinal effects were evident: Children who were inherently dysregulated or displayed behavioral problems engaged with media more often (7, 17) and, over time, showed less abilities in emotional self-regulation (22). Conversely, the risk of developing problems in emotional regulation in children with an average age of 21 months was increased if these children had a screen time of more than two hours per day (20).

Differentiating and exacerbating effects

Screen exposure to educational programs (as opposed to entertainment programs) was associated with a smaller risk of mental health problems (e10, 14, 23). Furthermore, it was also important whether a caregiver was present during screen time (23). Poor mental wellbeing of the parents, higher parental stress levels, and lower household income were associated with higher risks (11, 20, e14). The intensity of screen time was closely related to the following variables (23):

• unmediated consumption
• exposure to non-educational content
• maternal media consumption
• maternal mental health.

Cumulative risk

The studies reported above were controlled for a wide range of confounding variables, but the identified effects remained within a significant range. Even when confounding variables were incrementally included in the analysis (11, 15), the model that incorporated parental stress showed the greatest effect size. One study (24) included eight risk factors during the prenatal period (= cumulative risk) as predictor variables in the path analysis. This revealed indirect effects from these cumulative risks on later socioemotional and developmental health , applying screen time as a variable. Hostile parenting also conveyed indirect connections between cumulative risk and emotional and behavioral problems.

The effect of age at exposure

The later media exposure starts, the better are language skills (3) and the lower the severity of emotional and behavioral problems (7, 9, e12, e13, 25). For example, a large study (N = 4985, age: three to six years) (8) showed that children with screen use before the age of two years demonstrated a significantly lower emotional developmental age, a higher risk of behavioral, learning, and psychosomatic problems as well as more impulsive-hyperactive behavior than children who only started using media after the age of two years. Furthermore, a large cohort study indicated that exposure to online games during preschool years is associated with an increased risk of developing internet gaming disorder in adolescence (26).

Risk factors for increased media consumption

A systematic review of 29 studies summarized the factors which exacerbated the risk of excessive screen time in children under three years (Table 2) (27, 28). Parental knowledge about the risks associated with screen time as well as media consumption by caregivers are also key factors (23, 29, 30).

Media consumption and autism spectrum disorder

A total of 107 articles were found dealing with the association between screen time and autism, of which 46 were further screened. In addition, there were also two further meta-analyses and four studies which were not included in the meta-analyses (eTable 2).

One meta-analysis (31) (46 studies) showed a significant association between screen time and ASD-like symptoms which was slightly higher for the longitudinal studies. It is interesting to note that the effects mainly involved children under the age of 12 years. Another meta-analysis (32) reached the conclusion that children with the greatest intensity of screen time have a 97% increase in probability of receiving a diagnosis of ASD as compared with children of the lowest exposure category. This means that with a baseline risk for ASD of one percent, around two out of 100 children with excessive screen time (3 hours/day) receive a diagnosis of ASD. The results of a subgroup analysis indicate that there is no significant association between a screen time of less than one hour per day and ASD-like symptoms. If, however, daily screen time rose to 1.5 hours, 2.5 hours, 3 hours, and 6 hours, the likelihood that ASD was diagnosed increased by 51%, 93%, 71%, and 135%, respectively.

Distinction between autism symptoms and diagnosis of autism

Neither of the two meta-analyses made a clear distinction between ASD-like symptoms and the diagnosis of ASD. To clarify this, three studies were examined in more detail (33, 34, 35): In one study (34) involving 2152 children – of which 150 had a positive screening outcome for ASD – the caregivers were asked whether their children had viewed television and/or videos at the age of 12 months (yes/no). Screen time at 12 months of age was significantly associated with more ASD-like symptoms at two years of age (change: 4.2% [0.1; 8.3]), but not with a significant risk of ASD (risk prevalence rates: 8.3% versus 4.4 %; AOR: 1.40 [0,86; 2,29]).

Daily interactive play with parents compared with less than daily play was significantly associated with fewer ASD-like symptoms at two years (change: –8.9 % [−16.5; –0.9]), but not with the risk of being diagnosed with ASD (risk prevalence rates: 6.4 versus 14.0%; AOR 0.58 [0.31; 1.08]. Screen time of 4 h/day and longer in comparison with 3 h/day at 18 months of age, however, was not significantly associated with ASD-like symptoms (change: 10,7 % [−2,0; 23,0] or the risk of developing ASD (AOR: 1,18 [0,56; 2,49]) by the age of two years.

Another study (35) involving 5107 children, of which 145 had received the diagnosis of ASD at the age of 12 years, showed that the risk of this diagnosis was increased in children with more than 14 hours of weekly screen time by the age of two years (A OR: 1.79). Furthermore, the degree of screen time was not significantly associated with the risk of ASD if family income and maternal education were treated as instrumental variables which could only be associated with the risk of ASD via the length of screen time (coefficient = −0.73 [−1.90; 0.45], p = 0.23). This means that the association between ASD and screen time should not be considered causal.

Dose-dependent effect

We shall now take a closer look at one of the largest studies, as an example, which included 84 030 mother-child dyads of which 330 children had the diagnosis of ASD (prevalence = 0.4%) (36) The children were assessed at the ages of one and three years. The cohort was divided into the following subgroups:

• no screen time (10.26%)
• <1 h (33.29%)
• 1 to <2 h (30.07%)
• 2 to <4 h (19.89%)
• ≥ 4 h/day (6.49%).

The risk of being diagnosed with ASD at the age of three years rose continuously in association with a longer screen time at the age of one year, even after controlling for confounding variables (age, sex, and developmental stage of the child, mental illness and age of the mother, household income). A subgroup analysis found that this association applied only to boys.

Bidirectional effects and mediators

A longitudinal study (25) examined the directionality of these relationships: Path models showed that increased screen time exposure at earlier time points is associated with more ASD-like symptoms at later time points. Conversely, ASD-like symptoms at a younger age did not predict later screen time at any point.

The mediating role of the frequency of caregiver-child interaction, child’s sleep duration, and outdoor activities have also been examined (37): Significant effects were ascertained for caregiver-child interaction (5.32% of the variance) and sleep duration (1.19%), i.e., these variables mediated the association between screen time and ASD-like symptoms (34).

Discussion

Overall, it is apparent that: The earlier and more intensely a child is occupied with screen time, the greater is the risk of developing behavioral problems and developmental deficits. The risk of developing behavioral problems, however, is not just restricted to ASD-like symptoms. Numerous studies have also found strong associations and risks for symptoms of ADHD. (8, 9, 11, 17, 18, 21) (Overview: [e15]).

Moderators and mediators

Complex associations involving many additional variables undoubtedly exist which, on the one hand, have an impact on the strength of the association (= moderators) and through which, on the other hand, an association is influenced and mediated (= mediators). This is illustrated by the results of a large study involving 101 350 children (70.3% under the age of five years) (5). The following variables, among others, were controlled for in order to assess the associations between screen time and various developmental and behavioral disorders: age, sex, ethnicity, premature birth, birth weight, physical activity, education level of the caregivers, household income, family structure, number of children, parental stress, parental participation in children’s activities. Significant differences were observed between the crude and adjusted ORs concerning symptoms or the diagnosis of ASD and other disorders. Nevertheless, the adjusted ORs that were found remained within a range that was lower but still significant.

Media consumption takes place within a certain context that influences and mediates media behavior. Understanding these associations is crucial for the development and implementation of preventive and intervention methods. Screen time should not be rejected off hand, but it is important to consider its context, the extent of its use, as well as the stage in the individual’s life. Furthermore, it would appear important to raise awareness about the significance of media behavior within the family as a whole and to consider the extent to which children are exposed to media content in the absence of any parental guidance.

Potential interventions

One positive aspect is that the symptoms associated with media consumption can be reduced. More frequent interactive caregiver-child play per day is already associated with fewer symptoms (36). Parent training programs that explicitly aim to reduce media consumption and promote increased interactive play with the child have been shown to be effective. In this respect, (systematic) reviews (38, e16, e17), one meta-analysis (e18), and four studies involving children with ASD-like symptoms (39, e19, e20, e21) were identified. Overall, moderate reductions in screen time have been reported (ranging from 25 to 39 minutes per day), with substantially greater reductions seen in children with ASD-like symptoms (ranging from 1 to 7 hours per day). Preliminary studies adopting a pre-post design (N = 91) have also demonstrated reductions in ASD-like symptoms, with moderate to large effect sizes.

Conclusions for clinical practice

Excessive screen time is associated with emotional and behavioral problems, particularly in the context of additional factors (Box). Underlying mechanisms and confounding factors have so far not been fully understood. The detailed associations are complex and in part bidirectional, and the associated psychopathology is multifaceted. Nevertheless, targeted and intensified education is necessary, which, in our view, has not yet been sufficiently implemented into routine clinical practice, despite the availability of relevant material (e22, e23, e24).

Box

Protective factors and risk factors concerning media consumption*

Both professionals and parents have limited awareness of the associations presented here. Type and extent of screen time should be specifically asked during the medical history interview in order to take this fully into account for diagnostic assessment and therapy planning. However, there are currently hardly any standardized instruments available to capture this (eTable 3). In the presence of relevant risk factors, preventive measures are necessary, in addition to education, in order to provide long-term support for children and their parents.

eTable 3

Questions relating to media consumption among children

Acknowledgments

We would like to thank Mr. E. Staatz for his support with the literature search.

Conflict of interest statement

IK-B received fees for scientific counseling and lectures from Infectopharm.

LP received fees for scientific counseling and lectures from Infectopharm, Medice, Shire/Takeda.

Both authors received financial support (third party funding) for research projects or for direct financing of co-workers from the EU, the German Research Foundation (DFG), the Austrian Science Fund (FWF), the German Federal Ministry for Education and Research (BMBF), and the Innovation Fund.

Manuscript received on 14 October 2024, revised version accepted on 12 May 2025

Translated from the original German by Dr. Grahame Larkin

Corresponding author:
Prof. Dr. phil. Inge Kamp-Becker

Information about this CME

This article has been certified by the North Rhine Academy for Continuing Medical Education. The questions on this article may be found (in German) at http://daebl.de/RY95 (Deutsches Ärzteblatt’s CME portal). Their English translation may be found in the PDF version of this article. The closing date for entries is August 7, 2026.
Participation is possible at cme.aerztebatt.de

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