School of Education, University of Wollongong, Wollongong, New South Wales, Australia.
Australian Research Council Centre of Excellence for the Digital Child, Brisbane, Queensland, Australia.
JAMA Pediatr. 2024 Oct 1;178(10):1017-1026. doi: 10.1001/jamapediatrics.2024.2620.
The multifaceted nature of screen use has been largely overlooked in favor of a simplistic unidimensional measure of overall screen time when evaluating the benefits and risks of screen use to early childhood development.
To conduct a systematic review and meta-analysis to examine associations of screen use contexts in early childhood with cognitive and psychosocial outcomes.
PsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science, and Scopus were searched from inception to December 31, 2023.
A total of 7441 studies were initially identified. 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 clinical 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 3-level meta-analyses. The remaining study designs were narratively synthesized.
Screen use contexts included content (child directed and age inappropriate), type (program viewing and game or app use), co-use (or solo use), background television, caregiver screen use during child routines, and purpose. Outcomes were cognitive (executive functioning, language, and academic skills) or psychosocial (internalizing and externalizing behavior problems and socioemotional competence).
Overall, 100 studies (176 742 participants) were included, and of these, 64 observational studies (pooled sample sizes ranging from 711 to 69 232) were included in meta-analyses. Program viewing (n = 14; k = 48; r, -0.16; 95% CI, -0.24 to -0.08) and background television (n = 8; k = 18; r, -0.10; 95% CI, -0.18 to -0.02) were negatively associated with cognitive outcomes, while program viewing (n = 6; k = 31; r, -0.04; 95% CI, -0.07 to -0.01), age-inappropriate content (n = 9; k = 36; r, -0.11; 95% CI, -0.17 to -0.04), and caregiver screen use during routines (n = 6; k = 14; r, -0.11; 95% CI, -0.20 to -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 to 0.25).
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 screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.
在评估屏幕使用对儿童早期发展的益处和风险时，屏幕使用的多方面性质在很大程度上被忽视了，而倾向于采用一种简单的、单一维度的整体屏幕时间衡量方法。
进行系统回顾和荟萃分析，以研究儿童早期屏幕使用的各种情境因素与认知和社会心理结果之间的关联。
从开始到 2023 年 12 月 31 日，在 PsycINFO、Embase、MEDLINE Ovid、ProQuest、CINAHL、Web of Science 和 Scopus 中进行了搜索。
最初共确定了 7441 项研究。如果研究考察了 0 至 5.99 岁儿童屏幕使用的情境因素与认知或社会心理发展之间的关联，则纳入研究。纳入了观察性、实验性和随机临床试验研究设计。
所有研究均按照 PRISMA 指南独立进行了重复筛选。使用随机效应 3 水平荟萃分析汇总了来自观察性研究的关联效应大小(r)。其余研究设计进行了叙述性综合。
屏幕使用情境包括内容（儿童导向和年龄不适当）、类型（节目观看和游戏或应用程序使用）、共同使用（或单独使用）、背景电视、照顾者在儿童日常生活中使用屏幕以及目的。结果是认知（执行功能、语言和学业技能）或社会心理（内化和外化行为问题和社会情感能力）。
总体而言，纳入了 100 项研究（176742 名参与者），其中 64 项观察性研究（汇总样本量从 711 到 69232 不等）纳入荟萃分析。节目观看（n=14；k=48；r，-0.16；95%CI，-0.24 至-0.08）和背景电视（n=8；k=18；r，-0.10；95%CI，-0.18 至-0.02）与认知结果呈负相关，而节目观看（n=6；k=31；r，-0.04；95%CI，-0.07 至-0.01）、年龄不适当的内容（n=9；k=36；r，-0.11；95%CI，-0.17 至-0.04）和照顾者在日常生活中使用屏幕（n=6；k=14；r，-0.11；95%CI，-0.20 至-0.03）与社会心理结果呈负相关。共同使用（n=8；k=28；r，0.14；95%CI，0.03 至 0.25）与认知结果呈正相关。
研究结果表明，大小适中的效应量突出表明，除了屏幕时间限制外，在为家庭、临床医生和教育工作者提供建议时，有必要考虑屏幕使用情境，包括鼓励有意和富有成效的屏幕使用、适合年龄的内容以及与照顾者共同使用。
