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What is the association between screen use and children’s language skills across the extant literature?
In this systematic review and meta-analysis of data from 42 studies, greater quantity of screen use (ie, hours per day/week) was negatively associated with child language, while better quality of screen use (ie, educational programs and co-viewing with caregivers) were positively associated with child language skills.
Findings support pediatric recommendations to limit screen exposure, to provide high-quality programming, and to co-view when possible.
There is considerable public and scientific debate as to whether screen use helps or hinders early child development, particularly the development of language skills.
To examine via meta-analyses the associations between quantity (duration of screen time and background television), quality (educational programming and co-viewing), and onset of screen use and children’s language skills.
Searches were conducted in MEDLINE, Embase, and PsycINFO in March 2019. The search strategy included a publication date limit from 1960 through March 2019.
Inclusion criteria were a measure of screen use; a measure of language skills; and statistical data that could be transformed into an effect size. Exclusion criteria were qualitative studies; child age older than 12 years; and language assessment preverbal.
Data Extraction and Synthesis
The following variables were extracted: effect size, child age and sex, screen measure type, study publication year, and study design. All studies were independently coded by 2 coders and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Main Outcomes and Measures
Based on a priori study criteria, quantity of screen use included duration of screen time and background television, quality of screen use included co-viewing and exposure to educational programs, and onset of screen use was defined as the age children first began viewing screens. The child language outcome included assessments of receptive and/or expressive language.
Participants totaled 18 905 from 42 studies included. Effect sizes were measured as correlations (r). Greater quantity of screen use (hours per use) was associated with lower language skills (screen time [n = 38; r = −0.14; 95% CI, −0.18 to −0.10]; background television [n = 5; r = −0.19; 95% CI, −0.33 to −0.05]), while better-quality screen use (educational programs [n = 13; r = 0.13; 95% CI, 0.02-0.24]; co-viewing [n = 12; r = 0.16; 95% CI, 0.07-.24]) were associated with stronger child language skills. Later age at screen use onset was also associated with stronger child language skills [n = 4; r = 0.17; 95% CI, 0.07-0.27].
Conclusions and Relevance
The findings of this meta-analysis support pediatric recommendations to limit children’s duration of screen exposure, to select high-quality programming, and to co-view when possible.
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Corresponding Author: Sheri Madigan, PhD, Department of Psychology, University of Calgary, 2500 University Ave, Calgary, AB T2N 1N4, Canada (firstname.lastname@example.org).
Accepted for Publication: January 22, 2020.
Published Online: March 23, 2020. doi:10.1001/jamapediatrics.2020.0327
Author Contributions: Dr Madigan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Madigan, Anhorn, Christakis.
Acquisition, analysis, or interpretation of data: Madigan, McArthur, Anhorn, Eirich.
Drafting of the manuscript: Madigan, McArthur, Eirich, Christakis.
Critical revision of the manuscript for important intellectual content: Anhorn, Eirich.
Statistical analysis: Madigan, McArthur, Anhorn.
Administrative, technical, or material support: Madigan, Eirich, Christakis.
Supervision: Madigan, Christakis.
Conflict of Interest Disclosures: None reported.
Disclaimer: Dr Christakis is Editor of JAMA Pediatrics, but he was not involved in any of the decisions regarding review of the manuscript or its acceptance.
Additional Contributions: Cheri Nickel, MLIS, conducted the literature search. Claire McGuinness, BSc, assisted in the abstract review and data extraction, and David Sidhu, PhD, assisted with figure preparations. All are affiliated with the University of Calgary. All received compensation for their work.
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