Screen media use, and particularly mobile device use, is frequent among preschool-age children. Studies support that problematic media use (PMU) symptoms are present among older children (4–11-year-olds) and toddlers, and PMU correlates with child temperament and parenting around child media use. We examined the performance of a widely used PMU measure among a sample of 85 3–5-year-old children to document whether variation in PMU exists in this age group and whether this PMU measure specifically has face validity relative to expected correlates of PMU. To address our study goals, we completed a confirmatory factor analysis of the PMU scale and compared PMU scores with child externalizing behaviors when parents set limits on the child’s media use and three measures of child self-regulation (emotional self-regulation, attentional focusing, and inhibitory control). Results supported a one-factor construct of PMU, and PMU was positively related to greater screen time among children. Results further documented strong associations between PMU and more extreme child behaviors when limits were set on media (e.g., more bothersome pestering, crying, whining, and physical gestures). Additionally, PMU related to less emotional self-regulation among children. Overall, findings support the validity of the PMU measure in preschool-age children and confirm associations around child media use behaviors and temperament. The implications related to media parenting are discussed.
Keywords: problematic media use, digital media, screen time, children, pestering
Acknowledgments: The authors thank the children and parents who participated in this research.
Funding: This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases under Grant K01DK117971 (Jennifer A. Emond). The funding agency had no involvement in the study other than financial support.
Disclosures: None of the authors have a real or potential conflict of interest related to this research.
Author Contributions: Jennifer A. Emond formalized hypotheses, designed the study, completed the data analyses, and drafted the article. Delaina Carlson and Grace Ballarino enrolled and consented participants, collected data, and provided critical intellectual and procedural feedback on the article. Sarah E. Domoff advised on the data analysis plan and provided critical intellectual feedback on the article.
Data Availability: Data are not freely shared because participants are children. The corresponding author will provide access to the data after reasonable request and upon approval of the analysis protocol by the study principal investigator (Jennifer A. Emond) and the Dartmouth College Institutional Review Board.
Open Access License: This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY- NC-ND). This license permits copying and redistributing the work in any medium or format for noncommercial use provided the original authors and source are credited and a link to the license is included in attribution. No derivative works are permitted under this license.
Correspondence concerning this article should be addressed to Jennifer A. Emond, Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, One Rope Ferry Road, Hanover, NH 03755, United States. Email: Jennifer.A.Emond@Dartmouth.edu
Video Abstract
Preschool-age children in the United States are heavily engaged with screen media. In 2020, 2–4-year-olds in the United States averaged 2½ hours per day engaged with screen media (Rideout & Azman, 2020), inclusive of 1 hr per day on touchscreen mobile devices (tablet or smartphone; Rideout & Azman, 2020). Watching shows, movies, and/or videos; playing video games; and using apps are the most common screen media activities for this age group (Rideout & Azman, 2020). In contrast, the American Academy of Pediatrics recommends that preschool-age children spend no more than 1 hr per day using screen media, with a focus on quality media (Hill et al., 2016). Importantly, the COVID-19 pandemic greatly impacted children’s screen media use, with relaxed parenting around screen use (e.g., screens allowed in the child’s bedroom or during mealtime) more common during, versus before, the pandemic among 6–17-year-old children (Kroshus et al., 2022). It is unclear if those patterns persisted as the pandemic has eased. Screen media use at a young age is concerning for a multitude of reasons; high levels of screen use are related to vision problems, language delays, disrupted sleep, physical inactivity, obesity, and development delays, including impaired executive functioning (Dresp-Langley, 2020; Hill et al., 2016).
Importantly, screen media can be highly engaging for children, and it is possible that some children may exhibit symptoms of problematic media use (PMU) or dysregulated screen media use that has a negative impact on daily life (Domoff et al., 2019). Based on the Interactional Theory of Childhood Problematic Media Use (Domoff et al., 2020), multiple factors may contribute to greater PMU, including child, family, and social factors. Those factors may further interact with each other to maintain dysregulated media use. For example, parenting around media use may contribute to symptoms of PMU in children when parents use screen media as a way to pacify or manage challenging behavior in young children (Coyne et al., 2021; Radesky et al., 2023). Thus, children with greater problems self-regulating their emotions may be at risk of more dysregulated media use.
The media content and design itself can further maintain dysregulated media use among children. Children’s TV shows are largely colorful, fantastical, and fun, and children can form positive parasocial relationships with media characters (Brunick et al., 2016). Contemporary media, such as online videos and apps, may be especially rewarding for young children because they are persuasively designed to prolong engagement (Vox, 2022). Touchscreen mobile devices likely increase the rewarding effects of screen media because young children can easily navigate within and across media on these devices and gain autonomy in their own media use. It is possible that such characteristics of media activate reward systems of the brain, stimulating the release of dopamine and elevating mood (Brand et al., 2016; Dresp-Langley, 2020). Additionally, the rapid pace and fantastical content of children’s media (Jiang et al., 2019; Li et al., 2020; Lillard et al., 2015; Lillard & Peterson, 2011; Rhodes et al., 2020) and the multitude of media options that children can navigate on a touchscreen device can deplete children’s “top–down” executive functioning, leaving children in a depleted state when they transition away from screen media (Rhodes et al., 2020) that can make children vulnerable to emotional outbursts when media is removed or limited. It is thus not surprising that limiting children’s screen time can be quite difficult for parents; it limits anger in children and creates conflict in the home (Evans et al., 2011; Hiniker et al., 2016; Jago et al., 2016).
Identifying PMU among young children is important to intervene and reduce the potential negative effects of such screen use. Several studies (Harris et al., 2020; Marengo et al., 2021; Rozgonjuk et al., 2021; Sahu et al., 2019; Sohn et al., 2019) document that addiction-like or dysregulated media use is evident among school-age children and adolescents. Measures of PMU vary across specific measurement scales; however, symptoms are largely reflective of use disorders and addiction (Brand et al., 2016) and include preoccupation with media use, use of media to regulate mood, interference with family relationships, and irritability when media is not available (Domoff et al., 2019). In 2019, Domoff and colleagues developed and validated the PMU measure, a parent-reported scale to measure PMU among 4–11-year-olds (Domoff et al., 2019). However, research on PMU among younger children is only recently emerging. In a study among 269 2–3-year-old children (Coyne et al., 2021), children with a temperament marked by more negative affect (e.g., getting easily irritated) had higher scores on the PMU measure, and parents’ use of media to manage children’s negative emotions partially mediated that effect. Additional studies on the same cohort of toddlers demonstrated that parents with greater efficacy around managing their child’s media use (Coyne et al., 2023) related to less PMU, and greater viewing of educational TV programming among children related to less PMU 1 year later (Coyne et al., 2022). However, a comprehensive assessment of the proposed factor structure and validity of the PMU measure among that sample of toddlers was not provided.
The goals of this study are to confirm the validity of the PMU measure among a sample of preschool-age children and to understand the correlates of PMU among this sample, including children’s screen media use and externalizing behaviors reflective of behavioral problems when parents set limits on screen media use. We predicted that PMU would be related to measures of children’s trait-level emotional and behavioral (i.e., attention and inhibition) self-regulation. That later hypothesis is grounded in our framework (as summarized above) that children with self-regulatory problems may use, or be provided with, media for mood regulation and that the use of persuasive screen media may impact children’s self-regulation directly by depleting children’s executive functioning.
This study is a cross-sectional, secondary analysis of data collected from the baseline visit of a study examining screen media use and obesity risk among preschool-age children. Parents of preschool-age children, aged 3–5-years-old, were recruited from the community during July 2019 and October 2022; all parents resided in two states in Northern New England (93.8% and 92.6% White, non-Hispanic; 41.7% and 39.0% of adults with a bachelor’s degree or higher per 2022 U.S. Census estimates) and had to live with the child at least half of the week. Children were ineligible if they had any significant developmental or language delays, sleep disorders, food allergies or dietary restrictions, appetite- or attention-altering disorders or medications, or if they were not fluent in English. Participants were excluded if they had an immediate family member who had previously participated in the study or if the family was planning to relocate within 6 months. Parents provided written informed consent, and children provided verbal assent. Up to $60 compensation was provided for the baseline visit. Dartmouth College’s Committee for the Protection of Human Subjects approved all study protocols (CPHS No. 31097).