“I’ve been hearing about these YouTube videos that can teach my toddler to talk?”

“Kids these days. They spend all their time on tablets instead of playing outside.”

“I read about this study that says too much screen time at a young age causes a language delay.”

“I try to set limits around screen time but my kid has such a meltdown when I take it away, and I just don’t have the energy (or time) to deal with it.”

“All this worry and drama about screen time is blown way out of proportion. The research is all flawed, anyway.”

“I know he’s already had an hour of tablet time today, but I just really need to shower.”

Debates about screen time and its effects on kids are far-reaching, and everyone comes to them with their own experiences, perspectives, levels of worry or shame, and biases. Because of this, it’s (perhaps ironically) really difficult to discuss screen time and its related issues online via social media with people we don’t know personally. 

Thankfully, when working with families directly, we have the unique opportunity to listen to where caregivers are coming from, hear what anxiety or experiences they are bringing with them, and then speak to what they specifically may need to hear. In light of that, let’s go over the current recommendations, what we know (and don’t know!) about screen time and language development, a framework for evaluating children’s media, and some ways we can approach this loaded topic with families.

Screen time recommendations

The American Academy of Pediatrics published its most recent policy statement about early childhood and digital media in 2016, and by now we’re all familiar with the guidelines: 

• < 18 months: no digital media apart from video chatting
• 18-24 months: for those wishing to introduce media, choose high-quality content and engage alongside the child
• 2+ years: limit to one hour per day, choosing high-quality content and co-viewing when possible
• No screens during meals or one hour before bedtime

While these recommendations are valuable at a policy level, they aren’t definitive rules to live by. For example, Dynia et al. found that the “one hour a day” guideline was not significantly associated with children’s language abilities in low-resourced homes. Additionally, enforcing this somewhat arbitrary rule contributed to parents’ stress and reduced their self-efficacy, possibly doing more harm than good. When working with families, we need a more personalized approach—which we’ll get to!—but first, let’s look at what the research has to say. 

Screen time and language development

The relationship between early language development and screen time is certainly complex. We’ve covered studies that have found a relationship, and ones that haven’t. This is one of those cases where, for any question, “it depends” is the most common answer. It depends on the child’s age and developmental profile; it depends on context and co-viewing; it depends on the type of screen time—and on and on. Let’s look at some examples.

Is screen time associated with poorer language outcomes? It depends. 

Karani et al. reviewed studies on how screen time and language development are related and found both positive and negative effects, depending on a number of factors, including parental involvement, co-viewing, the child’s age, and characteristics of the media being watched.

Can young children learn words from digital media? It depends. 

Linebarger & Vaala argue that it depends on various factors like characteristics of the child and their environment, plus—again—the actual content being viewed. Digital media is more likely to support learning if it: 

• closely resembles infants’ and toddlers’ daily lives (real pictures, familiar routines),
• is viewed repetitively, and
• is viewed with another person who can make connections to the real world. 

Additionally, Strouse et al. showed that an adult modeling participation with a video (e.g., doing motions, singing along) could support kids’ ability to learn new words from the video. 

The state of the research

While describing the nuances of studies’ findings is important, we also need to consider the more foundational issues with screen time research. Here’s the overarching reality: our current body of research is riddled with issues. Let’s explore three issues that limit how useful screen time research really is:

1. The issue of measurement

Research is only useful in so far as it accurately measures what we are trying to understand. And yet, per a recent review by Browne et al., we don’t yet have tools to measure digital technology use in accurate and meaningful ways. We actually don’t even have clear definitions of what all “screen time” entails. How are we supposed to draw meaningful conclusions if we can’t accurately measure what we’re studying? 

It’s clear that “screen time” is not one thing. It can include video-chatting with relatives, playing games on a phone, watching a movie with the family, doing homework, reading e-books, scrolling TikTok, and the list goes on. Collapsing all of the ways that we and our children interact with technology in our daily lives into “screen time” reduces something that is highly complex, dynamic, and evolving, into a category that holds little practical meaning. Browne et al. recommend that it may be time to move beyond the term “screen time” in favor of more descriptive and specific terms.

2. The issue of drawing clinical implications from population research

Beyond measurement, there’s also how we analyze and make sense of what we see in the data. It’s tempting to look at a huge population data set and draw the conclusion that because the sample size is so big the results must be really powerful and have important clinical implications. But what can get clouded here is that results can be statistically significant on a large scale while having little practical meaning on the individual level. 

To illustrate, Orben & Przybylski compared the relationship between adolescent well-being and technology use to other factors. They found that the association between technology and poorer well-being was essentially on par with the negative “effects” of—get this—wearing glasses or eating potatoes regularly. So maybe there are worse things than being a TV “spec”-“tater”? Sorry, we couldn’t resist. Conversely, the positive associations of getting enough sleep and eating breakfast daily far outweighed the negative associations of digital technology use. All that to say, the actual clinical implications from large population studies are limited and often falsely inflated.

3. The issue of correlation vs causation

A third issue with the interpretation of research studies lies in the reliance on correlational data to make causal inferences. Ah yes, correlation vs causation, our old nemesis. We often rely on correlational data when we can’t feasibly (or ethically) conduct a randomized controlled trial. This is definitely the case with screen time since we can’t randomly assign one group of children to “receive” screen time, and another to not get any. 

To get around this, researchers will try to account for as many confounding variables as possible in their analysis. So for screen time, they’ll control for income, maternal education, age, gender, etc., and then say, “OK, now we’re sure that we’re comparing apples with apples.” But humans, I think we can agree, are not reducible to demographic data points, which makes interpreting that type of data somewhat fraught. 

For an excellent discussion on the nuances and limits of correlational research, check out parenting economist Emily Oster’s recent post on the topic.

Does that mean screen time is no big deal and we shouldn’t worry about it?

Definitely not, but to grapple with it we may need to widen our lens. While it’s clear that research on screen time is flawed and dominates the conversation in misleading ways, another thing is also clear: caregivers and children face myriad challenges, especially in the wake of the pandemic, and “screen time” is part of that bigger picture. It’s impossible to tease apart screens from other concerns such as lack of affordable childcare or paid parental leave, financial insecurity, distracted and stressed caregivers, and widespread spikes in mental health challenges. The question then becomes, what do we do about all these things?

That is a question that’s not easily answered with a bulleted list. But remember how we started off by saying that we’d end up with more questions than answers? We would argue this is a good thing. It’s critical that we engage our curiosity and direct our attention and questions to the broader issues our communities face. Instead of focusing all our attention on individuals’ behaviors, we need to zoom out in order to see the systemic issues at play.  

Let’s ask questions about the companies that profit off of our children’s attention, and why apps and media for children are designed to be addictive. Let’s ask why the ability to disengage from technology is ever-increasingly becoming a matter of resources. Let’s ask why we heap so much shame and pressure on parents (and on ourselves) to make all of the “right” parenting choices rather than putting our focus and energy into creating a society that prioritizes the well-being of children and caregivers at a systemic level. And finally, let’s ask questions together about what we truly hope for ourselves, our communities, and our children. And then from there, let’s consider how technology can support or hinder that vision. What we pay attention to and the questions we ask matter. Let’s invest our attention and energy wisely.  

*deep breath*  So, how do we talk about all of this with families?

Navigating “educational apps and videos” 

Perhaps the most common way that the topic of screen time shows up in our work as SLPs is related to educational or “therapeutic” media and apps. There are some points worth emphasizing here. 

• Videos and apps aren’t equivalent to real-life experiences and interactions, which are rich, socially contingent, relational, and three-dimensional.
• Videos and apps shouldn’t be primary resources for families who are concerned about their child’s language development, despite savvy marketers profiting off of convincing them otherwise. Apps aren’t substitutes for skilled, individualized assessment and therapy services, though they may be used as part of a therapeutic plan (e.g., AAC apps).
• Marketers can exploit parents’ anxiety by claiming to “cure” children with developmental delays. Seeing this type of language should activate our skepticism and make us take a closer look.
• Marketers often distort developmental and academic expectations so that parents will sit their child in front of their app or show in order to help them “catch up” or “get ahead.” This stems from and perpetuates a culture of trying to “optimize” children’s development and employs the capitalistic tactic of creating a problem in order to sell a solution.
• E-books share some of the benefits of non-digital book reading, depending on the app and the context. Reading books (whether digital or paper) with adults provides the most benefit. When there isn’t an adult present, audio narration is better than nothing for kids who are preliterate. For older children, some amount of interactive elements can be supportive for learning (e.g., a built-in dictionary), but too many distracting bells and whistles probably negate that benefit.

Evaluating the benefits and risks of screen time for young children

In today’s rapidly evolving digital landscape, we need to move beyond absolutes and hard-and-fast rules like “screen time is bad” or “only one hour per day.” These rules aren’t practical for most families, and can further a shame-based “abstinence” mindset. Rather, we need a compassionate, realistic framework that considers a scale of relative risks and benefits. This includes taking the context, the content, the child, and the caregivers into consideration.

(Note that here we are talking about digital media such as games, videos, and children’s apps. Video-chatting and AAC apps are important exceptions.)

The context matters. Look at everything surrounding how the child engages with digital media.

• In what situations is the child engaging with the media? Are there boundaries around when and where the child has access to the device?
• Who is the child with? Is it a solo activity or are they watching with peers or another adult? Are they supervised?
• What activities is screen time taking the place of? Are there other activities that would provide more diverse learning opportunities that the child could be doing instead?
• How long is the child spending on screens? Limiting screen time when you can won't have downsides, and it could potentially have benefits. Less is more.

The content matters. Not all children’s content is created equal. Here are some things to keep in mind.

• What is the pace? Notice the slow pace of old Sesame Street and Mr. Rogers shows (and even Ms. Rachel). Pay attention to the “average shot length,” or how often the camera angle shifts. Also, notice the pace of communication. Are there moments of quiet in between talking or is it constant fast-paced movement? Does it resemble the pace of real-life interactions?
• How “busy” is it? Consider how chaotic both the visual and auditory environments are. Simpler and more repetitive may be better.
• Who is profiting and how are they marketing and monetizing it? Some detective work is warranted before downloading or purchasing an app. High prices or “free with lots of ads” are both important considerations. Head to their website and look through their “about” page to see who is funding it and who is on their advisory board if there is one. Common Sense Media is a well-regarded website that provides age-based recommendations and reviews of children’s media.
• Is any of the content violent? Research suggests that viewing violent content at a young age poses unique risks for psychosocial development.
• Does it model strategies for caregivers? This is one underrated possible benefit of some children’s media. Caregivers may be able to learn language facilitation or parenting strategies from the media if they are co-viewing with the child.
• To what extent is it addictive? Apps use persuasive design to keep children engaged longer. Once you know the features, you’ll see them everywhere.
  • Motivation to engage. Immediate rewards, bright colors and vibrant visuals, and engaging characters all motivate children (whose systems of delayed gratification are still developing) to keep coming back for more.
  • Repetition and easy learning. If a child gets frustrated with a game, they may lose interest. Apps use repetitive tasks to tap into children’s growing sense of autonomy and desire for mastery.
  • Pop-ups and novelty. Pop-ups and ads are how many free apps make money and they create novel stimulation for children.

The child matters. Children vary in how they respond to and engage with digital media. Encourage caregivers to consider their specific child.

• How does the child engage with it? Do they zone out in front of it? Are they actively responding to the content and showing it to you? Dancing around the living room to a favorite music video?
• How disruptive are transitions off of the device? This can be a major stressor for caregivers, and some children may find this transition particularly difficult.
• What is the child learning? Children pick up on all sorts of things from videos. This can range from new words and songs (yay!) to other behaviors that we may not want to encourage.

The caregivers matter. Parents’ purposes and attitudes about screen time vary widely. Chong et al. found that caregivers’ reasons for allowing screen time ranged from using it as a distraction (or “babysitter”) to using it for educational purposes or as a reward. Some caregivers viewed screen time as a necessity and encouraged it, while others were concerned about the negative impact of screen time on their child’s development.

Because there is such a range of perspectives, a parent’s values and priorities are important to consider rather than “one-size-fits-all” messaging. Reducing screen time may not be a priority for all families. In fact, screens may be an important coping tool for a family for any number of reasons and provide them with real benefits. If caregivers ask questions or would like assistance in thinking through their child’s media habits, here are some things to keep in mind:

• Lead with compassion and empathy. Media habits are often laden with shame. We can all recognize how challenging it is to navigate these waters.
• Respect caregivers’ decisions. If a family is choosing to not allow any screen time and prefers not to use screens during therapy, we should respect this.
• Affirm and elaborate on caregivers’ experiences and observations. Don’t discount caregivers’ experiences of their child learning from digital media. Affirm parents’ role as important teachers. Use the old “yes, and!” strategy. For example, a parent says, “Wow! My child is learning so many new words from his Youtube videos!” and you can reply, “Yes, he is so engaged with those videos and learning new words, and you’ve likely played a big role in this too by showing your excitement, singing those same songs throughout the day, and joining in with him. How cool!”
• Communicate the importance of “real world” learning and live social interactions. It’s important for children to connect what they may have learned in a shallow way through media to the richness and complexities of real-world contexts. Help the child make connections between what they see on their tablet or TV and their other lived experiences.
• Help parents consider the role that they’d like technology and media to play in their daily lives. How does it fit in with other daily life and recreational activities? Help them explore what is feasible for them and in alignment with their values.
• Consider the impact of “technoference.” Caregivers’ use of smartphones can impact their interactions with their children as well. Navigating the nuances of these conversations is complex, but our free caregiver handout can help.
• Finally, educate carefully, honestly, and empathetically, acknowledging that there are true knowledge gaps. Be clear about what we do and don’t know from the research. Work to understand and respect families’ current beliefs and understanding about screen time and digital media before jumping in with your own.
   

More screen time resources for parents

• Reconsidering Screen Time: Research, Reason, & Real Life. This blog post is a well-researched, nuanced, and parent-friendly read.
• Children and Media: Tips for Parents. This blog post includes suggestions for parents surrounding media habits.
• Shifting off screens. This parent handout describes strategies for transitioning off of screens–an especially challenging transition for many kids.

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