Too much screen time for infants connected with higher risks for autism spectrum disorders | Expert Opinion

As a pediatrician for over 25 years, I’ve seen a lot of health trends. And two of the most concerning trends may not seem related: how much more time even infants are spending in front of TVs and other screens, and the increase in the prevalence of autism spectrum disorders (ASD).

In the past decade, not a week has gone by that I haven’t seen a child with autism. Nor is there a week that goes by that I am not in awe of families’ commitment, love, and acceptance.

Autism diagnosis varies by state. Connecticut has the highest rates (one in 23) and Washington, D.C., the lowest (one in 83). Nationally, one in 44 children has a diagnosis of ASD. Twenty years ago the prevalence was one in 150.

Twenty years ago, there was no iPhone (introduced in 2007), iPad (2010), or YouTube (2005). Baby Einstein was just hitting the market, and Daniel Tiger’s Neighborhood was launched to the squeals of infants in 2012. Twenty years ago the average screen time for children under 2 was about one hour a day. As of a few years ago, that number had almost tripled, and during the pandemic, these rates most likely have soared even more.

The American Academy of Pediatrics (AAP) recommends no screen time for children under 18 months of age, a tough standard for many busy families, but the science behind the recommendation is very strong.

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In the first year of life, an infant’s brain is making 700 new neuronal connections every second, more than any other time in their lives. For healthy brain development, infants need human interaction, touch, human sounds, and strong attachments with their community. What does this rapid shift from human connection to digital connection do to this vulnerable organ?

Besides ASD, excessive early life screen time is also associated with language delay, attention deficit disorder, lower cognitive outcomes, early childhood obesity, behavioral problems, emotional dysregulation, and sleep problems. Alternatives to screen time are more available to those with more means — such as books and parents with the time to read to children, as well as quality early child care.

Earlier this month a large prospective cohort study published in JAMA Pediatrics showed that screen time over two hours a day at 1 year of age was associated with over a three-times-increased risk of ASD by age 3. This study corrected for early autism symptoms, which seems to counter the idea of autism driving the screen time rather than screen time driving the development of autism.

The mechanism of audiovisual screen exposure as a risk factor for ASD is consistent with extensive findings in child development, how screens impact parent-child social interactions, the brain findings in autism, and even the fact that boys have four times the autism risk of girls. In this study, when boys were considered separately from girls, boys who watched screens two hours or more per day at age 1 had over three times greater odds of developing an autism diagnosis by age 3 than children who had no screen time at age 1.

The authors of this study adjusted for factors such as parents’ age, anxiety and depression, child development at age 1, and household income, as these factors may also be associated with screen time, yet the findings were consistent.

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Autism is an extremely complex diagnosis with genetics, environmental, and other yet-unknown variables that may play into a child developing this disorder. There are many children who have autism who didn’t get a lot of screen time in infancy, and many infants who had excessive screen time yet did not develop autism. But this study adds to our understanding of a potential preventable risk factor.

This study also builds on a previous study from Drexel’s School of Psychiatry published in 2020 that showed excessive screen time at 1 year of age was associated with autism-like symptoms at 2 years of age.

Other researchers have reported rapid improvement in autism symptoms when screen time is replaced with socially-oriented activities in autistic children 4 and younger who had a history of high screen exposure since the first year of life.

So what do we do as a society, as parents all trying to do our best, under the extreme pressures of COVID-19, escalating income inequities, and competition for our attention from TV and social media?

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At the core of public health is harm reduction, with the realization that completely eliminating screen time is unrealistic for most, but reducing screen time could be within reach.

As a city, Philadelphia could be investing more in proven programs like Reach Out and Read that put books into the hands of our most vulnerable children, as well as home-visiting programs like Philly Families Can, so families can bond more with their infants. We can invest in families now, or we can pay later as the costs of autism explode.

My last patient one recent day was a 6-month-old, perfectly developing little boy. As I walked into the exam room, I smiled to see the mother, her baby snuggled in her lap, pointing out the various animals in the book that I had given her to take home, something we do for all our young patients.

Daniel R. Taylor is the medical director of the outpatient center at St. Christopher’s Hospital for Children.