Screen Media Overuse and Associated Physical, Cognitive, and Emotional/Behavioral Outcomes in Children and Adolescents: An Integrative Review

In that study, each hour of screen media use was linked to nearly 16 minutes less total sleep per day.

“A cross-sectional study of 715 infants and toddlers from the United Kingdom reported that increased frequency of portable touchscreen device use was associated with reduced sleep duration, longer sleep onset, and increased daytime sleepiness; with every hour of screen media use, nearly 16 min of total sleep was lost per day (Cheung, Bedford, Saez De Urabain, Karmiloff-Smith, & Smith, 2017).”

• cites Cheung, Bedford, Saez De Urabain, Karmiloff-Smith, & Smith, 2017 sourceSupported

In that study, more frequent use of portable touchscreen devices was linked to increased daytime sleepiness.

“A cross-sectional study of 715 infants and toddlers from the United Kingdom reported that increased frequency of portable touchscreen device use was associated with reduced sleep duration, longer sleep onset, and increased daytime sleepiness; with every hour of screen media use, nearly 16 min of total sleep was lost per day (Cheung, Bedford, Saez De Urabain, Karmiloff-Smith, & Smith, 2017).”

• cites Cheung, Bedford, Saez De Urabain, Karmiloff-Smith, & Smith, 2017 sourcePartly supported

  The Discussion reports that more touchscreen use was associated with increased daytime sleep duration in infants and toddlers. It does not report increased daytime sleepiness, which is a different outcome. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

In US infants, higher screen media exposure predicted 7 fewer minutes of total sleep per day.

“Longitudinal analyses of United States (Cespedes et al., 2014) and Thai (Vijakkhana, Wilaisakditipakorn, Ruedeekhajorn, Pruksananonda, & Chonchaiya, 2015) infants demonstrated similar results, with greater screen media exposure predictive of 7 and 28 min fewer total sleep per day, respectively.”

• cites Cespedes et al., 2014 sourcePartly supported

  The Cross-Sectional and Longitudinal Associations section reports 7 fewer minutes of sleep per day for each additional hour per day of lifetime-average TV viewing. That estimate covers children followed from infancy through mid-childhood, not infants alone, and measures TV viewing rather than screen media exposure generally. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

In that study, more frequent use of portable touchscreen devices was linked to longer sleep onset.

“A cross-sectional study of 715 infants and toddlers from the United Kingdom reported that increased frequency of portable touchscreen device use was associated with reduced sleep duration, longer sleep onset, and increased daytime sleepiness; with every hour of screen media use, nearly 16 min of total sleep was lost per day (Cheung, Bedford, Saez De Urabain, Karmiloff-Smith, & Smith, 2017).”

• cites Cheung, Bedford, Saez De Urabain, Karmiloff-Smith, & Smith, 2017 sourceSupported

A UK cross-sectional study of 715 infants and toddlers found that more frequent use of portable touchscreen devices was linked to shorter sleep duration.

“A cross-sectional study of 715 infants and toddlers from the United Kingdom reported that increased frequency of portable touchscreen device use was associated with reduced sleep duration, longer sleep onset, and increased daytime sleepiness; with every hour of screen media use, nearly 16 min of total sleep was lost per day (Cheung, Bedford, Saez De Urabain, Karmiloff-Smith, & Smith, 2017).”

• cites Cheung, Bedford, Saez De Urabain, Karmiloff-Smith, & Smith, 2017 sourcePartly supported

  The Discussion reports that, among 715 UK infants and toddlers, more frequent touchscreen use was associated with shorter total sleep and longer sleep onset; each additional hour of tablet use was associated with 15.6 minutes less total sleep. The citing sentence also attributes increased daytime sleepiness to the study, but our copy reports increased daytime sleep duration, not daytime sleepiness. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Screen media use near bedtime may suppress melatonin production by blue light emission from electronic devices, leading to subsequent circadian rhythm delay.

“suppress melatonin production by blue light emission from electronic devices that leads to subsequent circadian rhythm delay (Hersh, Sisti, Richiutti, & Schernhammer, 2015).”

• cites Hersh, Sisti, Richiutti, & Schernhammer, 2015 sourcePartly supported

  The Discussion (page not provided) says blue-light wavelengths suppress melatonin, electronic devices emit light in that range, and LED displays may suppress melatonin with sufficiently long exposure. It does not establish that bedtime screen use causes a subsequent circadian delay; in this adolescent sample, electronic use after lights out was not a significant predictor of urinary melatonin levels. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

In Taiwanese adolescents, mobile phone use is associated with low self-esteem.

“A large cross-sectional study conducted on Taiwanese adolescents revealed a relationship between mobile phone use and low self-esteem (Yang, Yen, Ko, Cheng, & Yen, 2010).”

• cites Yang, Yen, Ko, Cheng, & Yen, 2010 sourcePartly supported

  The “Problematic CPU and low self-esteem” section reports a positive association in the adolescent groups studied and notes that the cross-sectional design cannot establish causation. The citing sentence omits the key qualifier: the study examined problematic cellular phone use, not mobile phone use generally. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

More media multitasking was linked to significantly worse standardized test scores in math and English.

“and a U.S. study similarly found greater media multitasking was linked to statistically significant poorer performance on standardized test scores measuring academic performance in math and English (Cain, Leonard, Gabrieli, & Finn, 2016).”

• cites Cain, Leonard, Gabrieli, & Finn, 2016 sourceSupported

Of screen media types, TV viewing shows the most consistent link to higher BMI.

“Interestingly, TV viewing is most consistently associated with increased BMI (Bickham, Blood, Walls, Shrier, & Rich, 2013; Falbe et al., 2013), possibly because of the influence of TV commercials that advertise energy-dense, micronutrient-poor foods, and excessive snacking while watching TV.”

• cites Bickham, Blood, Walls, Shrier, & Rich, 2013 sourceNot checked — no full text of the source
• cites Falbe et al., 2013 sourceSupported

Several studies of young adults found a negative link between screen media use and college students' test performance and GPA.

“During young adulthood, several studies have found a negative relationship between screen media use and college students’ test performance and grade point average (Jacobsen & Forste, 2011; Walsh, Fielder, Carey, & Carey, 2013)”

• cites Jacobsen & Forste, 2011 sourceNot checked — no full text of the source
• cites Walsh, Fielder, Carey, & Carey, 2013 sourceSupported

Students with low self-esteem are more likely than those with high self-esteem to spend time using mobile phones and become addicted.

“Conversely, students reporting low self-esteem were more likely to spend time using mobile phones and become addicted than those reporting high self-esteem (Ehrenberg, Juckes, White, & Walsh, 2008).”

• cites Ehrenberg, Juckes, White, & Walsh, 2008 sourcePartly supported

  The Introduction reports that lower self-esteem had been associated with higher and problematic mobile-phone use in earlier research. But this paper’s Results and Discussion associate lower self-esteem with greater instant-messaging use and addictive tendencies, not mobile-phone use or mobile-phone addictive tendencies; neuroticism was the only significant predictor of the latter. The study measured addictive tendencies, not whether students became addicted. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Screen media use near bedtime may act as a direct displacement of sleep.

“screen media use near bedtime may act as a direct displacement of sleep”

• cites Hersh, Sisti, Richiutti, & Schernhammer, 2015 sourcePartly supported

  The Sleep habits section reports that some adolescents used electronics for more than an hour after turning off the lights and before falling asleep. That supports screen use near bedtime, but the paper does not establish that this use displaced sleep; its Discussion focuses on melatonin rather than that proposed mechanism. No page number is available in our copy. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Violent content may mediate the adverse relationship between screen media use and externalizing behavior.

“the results of this study indicate that violent content may mediate the adverse relationship between screen media use and externalizing behavior”

• cites Christakis et al., 2013 sourceSupported

Several studies of high school students found positive links between depression/anxiety symptoms and greater mobile phone use.

“Multiple studies with high school students have shown positive associations between depression and anxiety symptoms and increased use of both mobile phones (Demirci, Akgönül, & Akpinar, 2015) and the Internet (Jenaro, Flores, Gómez-Vela, González-Gil, & Caballo, 2007).”

• cites Demirci, Akgönül, & Akpinar, 2015 sourcePartly supported

  The Discussion reports positive associations between smartphone use severity and depression and anxiety, supporting the mobile-phone association. But the Introduction and Discussion identify this study's participants as university students, not high school students; this source therefore does not establish that association in the population the citing sentence names. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

A recent UK cross-sectional study of 4,495 children found strong, graded links between screen time and adiposity.

“a recent United Kingdom cross-sectional study (N = 4,495) using child self-report measures and objective measures of physical activity, fasting cardiometabolic risk marker assessments, and anthropometry measurements found strong, graded associations between screen time and adiposity (Nightingale et al., 2017).”

• cites Nightingale et al., 2017 sourceSupported

A Spanish study found that adolescents' academic performance was inversely related to their screen media use.

“In adolescence, a Spanish study found academic performance to be inversely related to screen media use (Peiró-Velert et al., 2014)”

• cites Peiró-Velert et al., 2014 sourceSupported

Some digital tools, such as educational games, learn-to-read apps, and e-books, might improve early literacy in children.

“For example, promising research has indicated that digital educational games, learn-to-read apps, and electronic books may enhance children’s early literacy skills (Kucirkova, 2014; Neumann, 2014; M. Neumann & D. Neumann, 2014) and creative thinking abilities (Doron, 2017).”

• cites Kucirkova, 2014 sourcePartly supported

  In “The First Wave of iPad Research” (page unavailable), Kucirkova reports a study in which 4-year-old boys’ reading ability increased after exposure to a digital picture book, while cautioning that the study could not separate the effects of format from method. The “Second Wave” section discusses literacy apps used by 5-year-olds but does not report that apps or digital educational games improved literacy skills. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites Neumann, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites M. Neumann & D. Neumann, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Screen media use near bedtime may cause physiological arousals that make it more difficult for children and adolescents to relax.

“cause physiological arousals that make it more difficult for children and adolescents to relax”

• cites Hersh, Sisti, Richiutti, & Schernhammer, 2015 sourceCould not verify

  The Discussion addresses screen light, melatonin suppression, and electronic-device use after lights out, but not physiological arousal or difficulty relaxing. Searches for those effects found no passage in our copy that addresses the claim. (LLM, conf=0.75)

  Experimental — accuracy not yet measured

Emerging research has demonstrated bidirectional associations between screen media overuse and several variables including sleep, obesity, executive functioning, and internalizing/externalizing behaviors.

“Emerging research has demonstrated bidirectional associations between several variables, including sleep, obesity (Hashem et al., 2019), executive functioning, internalizing/externalizing behaviors, and screen media overuse.”

• cites Hashem et al., 2019 sourcePartly supported

  The Associations between sedentary behaviours and BMI section reports an inverse association between videogame time and BMI in Kuwaiti adolescents, but no association for total screen time, TV viewing, or computer use. The Data handling and statistical analysis section describes regressions of sedentary behaviours against BMI; it does not establish bidirectional associations or assess screen media overuse. The citation is attached to obesity, not to the other variables in the citing sentence. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Content type (prosocial/educational vs. violent) may contribute to the development of emotional/behavioral problems.

“the type of content (prosocial/educational content vs. violent content) may also contribute to the development of emotional/behavioral problems (Christakis et al., 2013).”

• cites Christakis et al., 2013 sourceSupported

Screen media activities like video gaming may generate physiological arousal that alters the processing and shaping of child and adolescent neural networks.

“screen media activities like video gaming may generate physiological arousal that produces alterations in the processing and shaping of child and adolescent neural networks (Green, Li, & Bavelier, 2010).”

• cites Green, Li, & Bavelier, 2010 sourcePartly supported

  The Mechanisms section (p. 9) says video games are physiologically arousing and that arousal can modulate learning and task performance. It also proposes neural-network changes during game-related perceptual learning (pp. 11–12), but does not establish that arousal causes those changes or specifically describe the shaping of child and adolescent neural networks. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Increased caloric intake via cravings for unhealthy snack foods and sweetened drinks during TV watching and video game playing is a suggested mechanism for obesity.

“increased caloric intake via cravings for unhealthy snack foods and sweetened drinks during TV watching and video game playing (Borgogna et al., 2015)”

• cites Borgogna et al., 2015 sourceSupported

Displacement of physical activity by increased screen-based sedentary lifestyle is a suggested mechanism for obesity.

“the displacement of physical activity by increased screen-based sedentary lifestyle (LeBlanc et al., 2015)”

• cites LeBlanc et al., 2015 sourcePartly supported

  The Multivariable Analyses section reports that children with more screen time were less active and had greater waist circumference, which supports the associations behind the proposed mechanism. It does not establish or explicitly propose that screen time displaces physical activity, or that such displacement causes obesity. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

In children and adolescents, overuse of screen media is linked to poor sleep quality.

“Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems.”

• Also stated in: § Physical Health Outcomes · boosted

  “Among children and adolescents, a strong and consistently reported association exists between screen media use and sleep problems, with even higher usage times and prevalences (Calamaro, Mason, & Ratcliffe, 2009).”

• cites Calamaro, Mason, & Ratcliffe, 2009 sourceNot checked — no full text of the source

In children and adolescents, overuse of screen media is linked to increased externalizing problems.

“Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems.”

In children and adolescents, overuse of screen media is linked to lower executive functioning.

“Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems.”

• Also stated in: § Adverse Cognitive Outcomes · plain

  “In contrast, studies have also supported adverse consequences of screen media use on several cognitive domains, including sensorimotor development, executive functioning, and academic outcomes (Suggate & Martzog, 2021; Liu et al., 2020).”

• cites Suggate & Martzog, 2021 sourceNot checked — no full text of the source
• cites Liu et al., 2020 sourceNot checked — no full text of the source

In children and adolescents, overuse of screen media is linked to poorer academic performance.

“Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems.”

• Also stated in: § Adverse Cognitive Outcomes · boosted

  “Addressing academic outcomes, studies across several age groups have demonstrated negative effects of screen media use.”

In children and adolescents, overuse of screen media is linked to a greater likelihood of overweight or obesity.

“Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems.”

In children and adolescents, overuse of screen media is linked to increased internalizing problems.

“Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems.”

• Also stated in: § Emotional/Behavioral Problems · boosted

  “A growing body of research has demonstrated the relationship between screen use and internalizing behavior problems, including depression, anxiety, suicidal thoughts and behaviors, feelings of loneliness, and low self-esteem.”

In children and adolescents, overuse of screen media is linked to shorter sleep duration.

“Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems.”

In Thai infants, higher screen media exposure predicted 28 fewer minutes of total sleep per day.

“Longitudinal analyses of United States (Cespedes et al., 2014) and Thai (Vijakkhana, Wilaisakditipakorn, Ruedeekhajorn, Pruksananonda, & Chonchaiya, 2015) infants demonstrated similar results, with greater screen media exposure predictive of 7 and 28 min fewer total sleep per day, respectively.”

• cites Vijakkhana, Wilaisakditipakorn, Ruedeekhajorn, Pruksananonda, & Chonchaiya, 2015 sourceNot checked — no full text of the source

Bidirectional associations may exist between screen media overuse and outcomes.

“Bidirectional associations may exist.”

• Also stated in: § Physical Health Outcomes · hedged

  “Although most research has focused on the potential negative impact of screen media use on sleep, the relationship may be bidirectional.”

In that study, less sleep was linked to more screen time later, particularly TV viewing.

“In a longitudinal study of Australian children, Magee, Lee, & Vella (2014) found that not only does increased screen media use predict shorter sleep duration, but also shorter sleep duration was associated with increased subsequent screen time, especially for television (TV) viewing.”

• cites Magee, Lee, & Vella (2014) sourceNot checked — no full text of the source

Several studies of high school students found positive links between depression/anxiety symptoms and greater Internet use.

“Multiple studies with high school students have shown positive associations between depression and anxiety symptoms and increased use of both mobile phones (Demirci, Akgönül, & Akpinar, 2015) and the Internet (Jenaro, Flores, Gómez-Vela, González-Gil, & Caballo, 2007).”

• cites Jenaro, Flores, Gómez-Vela, González-Gil, & Caballo, 2007 sourceNot checked — no full text of the source

Those same digital tools might also improve children's creative thinking.

“For example, promising research has indicated that digital educational games, learn-to-read apps, and electronic books may enhance children’s early literacy skills (Kucirkova, 2014; Neumann, 2014; M. Neumann & D. Neumann, 2014) and creative thinking abilities (Doron, 2017).”

• cites Doron, 2017 sourceNot checked — no full text of the source

Extensive screen media use may negatively impact self-esteem.

“self-esteem may be negatively impacted by extensive screen media use (Ha, Chin, Park, Ryu, & Yu, 2008).”

• cites Ha, Chin, Park, Ryu, & Yu, 2008 sourceNot checked — no full text of the source

The relationship between screen media use and loneliness is likely bidirectional.

“Thus, the relationship between screen media use and loneliness is likely bidirectional.”

These changes were mediated by reductions in dietary energy intake.

“These changes persisted for 2 years and were mediated by reductions in dietary energy intake.”

Two nationally representative surveys of U.S. adolescents since the 1990s showed a sharp rise in depressive symptoms and suicide-related outcomes.

“Data from two nationally representative surveys on U.S. adolescents since the 1990s revealed a stark increase in depressive symptoms and suicide-related outcomes (Twenge, Joiner, Rogers and Martin, 2018) because of the rise in media use and the subsequent decline in engagement in nonmedia-related activities.”

• cites Twenge, Joiner, Rogers and Martin, 2018 sourceNot checked — no full text of the source

Poor academic outcomes might be confounded by reduced attention and focus from multitasking, not only by screen media overuse.

“however, adverse academic outcomes may be confounded by the poorer attention and focus from multitasking behaviors rather than solely from screen media overuse, and more research is necessary to tease out this relationship.”

There are inconsistent results between screen media use and externalizing behavior.

“Nevertheless, other researchers have found inconsistent results between screen media use and externalizing behavior.”

• Also stated in: § IMPLICATIONS · plain

  “there continues to be conflicting data with regard to externalizing behavior”

An expanding body of research links screen use to internalizing problems such as depression, anxiety, suicidal thoughts and behaviors, loneliness, and low self-esteem.

“A growing body of research has demonstrated the relationship between screen use and internalizing behavior problems, including depression, anxiety, suicidal thoughts and behaviors, feelings of loneliness, and low self-esteem.”

Research also supports harmful effects of screen media use on cognitive domains such as sensorimotor development, executive functioning, and academic performance.

“In contrast, studies have also supported adverse consequences of screen media use on several cognitive domains, including sensorimotor development, executive functioning, and academic outcomes (Suggate & Martzog, 2021; Liu et al., 2020).”

• cites Suggate & Martzog, 2021 sourceNot checked — no full text of the source
• cites Liu et al., 2020 sourceNot checked — no full text of the source

That rise in depressive symptoms and suicide-related outcomes was attributed to increased media use and decreased participation in nonmedia activities.

“Data from two nationally representative surveys on U.S. adolescents since the 1990s revealed a stark increase in depressive symptoms and suicide-related outcomes (Twenge, Joiner, Rogers and Martin, 2018) because of the rise in media use and the subsequent decline in engagement in nonmedia-related activities.”

• cites Twenge, Joiner, Rogers and Martin, 2018 sourceNot checked — no full text of the source

In Latino toddlers, screen media use at 21 months is significantly associated with aggressive behavior and overall externalizing problems at 33 months.

“A longitudinal cohort study of Latino toddlers yielded similar results, with screen media use at 21 months significantly associated with aggressive behavior and overall externalizing problems at 33 months (Tomopoulos et al., 2007).”

• cites Tomopoulos et al., 2007 sourceNot checked — no full text of the source

It is possible that the content being viewed, rather than overuse itself, is associated with externalizing symptomology in children.

“making it possible that it is the content being viewed, rather than overuse itself, that is associated with externalizing symptomology in children.”

Screen media use appears to have significant but indirect effects on academic outcomes.

“Thus, there are significant, albeit indirect, effects of screen media use on academic outcomes.”

Young children who viewed fast-paced, fantastical educational programs showed lower executive functioning than controls who played or watched a slow, realistic show.

“A study found that young children who watched fast-paced, fantastical shows intended to be educational had lower executive functioning than children in a control group who either played or watched a slow, realistic show (Lillard, Drell, Richey, Boguszewski, & Smith, 2015).”

• cites Lillard, Drell, Richey, Boguszewski, & Smith, 2015 sourceNot checked — no full text of the source

Longitudinal cohort studies showed a strong dose-response link between daily TV viewing time and overweight prevalence in children aged 10 to 15.

“Longitudinal cohort studies revealed similar results, indicating a strong, dose−response relationship between television viewing time per day and the prevalence of overweight in children aged 10−15 years (Robinson et al., 2017).”

• cites Robinson et al., 2017 sourceNot checked — no full text of the source

Compared with controls, children and families who received screen time reduction interventions showed significant decreases in TV/computer use and BMI.

“A later study found that children and families receiving screen time reduction interventions demonstrated significant decreases in television viewing/computer use and BMI compared with controls.”

In a school-based randomized trial with elementary students, the intervention group had statistically significant reductions in TV viewing.

“Although body mass index (BMI) increases were observed in both groups over the school year, there were statistically significant decreases in TV viewing and significantly slower relative increases in BMI in the intervention group (Robinson, 1999).”

• cites Robinson, 1999 sourceNot checked — no full text of the source

Among Chinese students, higher loneliness scores on the UCLA Loneliness Scale are associated with greater likelihood of addictive smartphone use.

“A study conducted on Chinese students demonstrated that those who scored higher in loneliness on the UCLA Loneliness Scale were more likely to demonstrate addictive use of their smartphones (Bian & Leung, 2015).”

• cites Bian & Leung, 2015 sourceNot checked — no full text of the source

A considerable number of studies have not adjusted for violent content as a potential confounder.

“a considerable number have not adjusted for violent content as a potential confounder”

Screen media use is positively associated with loneliness.

“recent research has demonstrated the positive association between the use of screen media and loneliness (Caplan, 2007; Kim, LaRose, & Peng, 2009).”

• cites Caplan, 2007 sourceNot checked — no full text of the source
• cites Kim, LaRose, & Peng, 2009 sourceNot checked — no full text of the source

The directionality of the association between self-esteem and screen media use is unclear.

“Therefore, the directionality of the association between self-esteem and screen media use is unclear”

Short sleep duration and insomnia partially mediated the link between mobile phone use and depressive symptoms.

“However, these associations were partially mediated by short sleep duration and insomnia, suggesting that the effects of mobile screen media use on mental health may result, at least in part, from the direct effect of sleep disturbances.”

Among adolescents, frequent media multitasking was linked to worse executive functioning, particularly working memory, inhibition, and task switching.

“In adolescents, frequent media multitasking was found to be negatively associated with executive functioning, specifically working memory, inhibition, and the ability to shift between tasks (Baumgartner, Weeda, van der Heijden, & Huizinga, 2014).”

• cites Baumgartner, Weeda, van der Heijden, & Huizinga, 2014 sourceNot checked — no full text of the source

These changes persisted for 2 years.

“These changes persisted for 2 years and were mediated by reductions in dietary energy intake.”

A longitudinal study of Australian children found that more screen media use predicted shorter sleep duration.

“In a longitudinal study of Australian children, Magee, Lee, & Vella (2014) found that not only does increased screen media use predict shorter sleep duration, but also shorter sleep duration was associated with increased subsequent screen time, especially for television (TV) viewing.”

• cites Magee, Lee, & Vella (2014) sourceNot checked — no full text of the source

The specific mechanisms of action through which screen media overuse acts on physical, cognitive, and behavioral consequences in children and adolescents are not well understood.

“To date, the specific mechanisms of action through which screen media overuse acts on physical, cognitive, and behavioral consequences in children and adolescents are not well understood”

Mobile screen media use may affect mental health partly through sleep disturbances.

“However, these associations were partially mediated by short sleep duration and insomnia, suggesting that the effects of mobile screen media use on mental health may result, at least in part, from the direct effect of sleep disturbances.”

The relationship between screen media use and sleep duration may be bidirectional.

“Although most research has focused on the potential negative impact of screen media use on sleep, the relationship may be bidirectional.”

• Also stated in: § Results: · hedged

  “Bidirectional associations may exist.”

In that trial, the intervention group had significantly slower relative increases in BMI.

“Although body mass index (BMI) increases were observed in both groups over the school year, there were statistically significant decreases in TV viewing and significantly slower relative increases in BMI in the intervention group (Robinson, 1999).”

• cites Robinson, 1999 sourceNot checked — no full text of the source

In 11,831 adolescents from the Shandong Adolescent Behavioral and Health Cohort, using a mobile phone more than 2 hours daily on weekdays and 5 hours on weekends was linked to depressive symptoms.

“More recently, a sample of 11,831 adolescents from the Shandong Adolescent Behavioral and Health Cohort (Liu et al. 2019) found that mobile phone use of over 2 hr/day on weekdays and 5 hr/day on weekends were associated with depressive symptoms.”

• cites Liu et al. 2019 sourceNot checked — no full text of the source

A small number of randomized controlled trials have shown that reducing screen time in community settings directly reduces weight gain in children.

“A few randomized controlled trials have found direct causal effects of reducing screen time in community settings on reducing weight gain in children.”

The two-way link between screen use and sleep might arise because less sleep causes tiredness and lower energy, which encourages sedentary activities such as screen media use.

“This reciprocal relationship may be due to shorter sleep, leading to tiredness, fatigue, and reduced energy, and promoting engagement in sedentary behaviors, including screen media use.”

Screen media use might affect cognitive outcomes in children and adolescents both positively and negatively.

“For children’s and adolescents’ cognitive outcomes, screen media use may have both positive and negative consequences.”

Epidemiological research has consistently found significant positive links between screen media use and obesity.

“In addition, epidemiological studies have consistently demonstrated significant positive associations between screen media use and obesity.”

Sleep is a significant mediator of the relationship between internalizing and externalizing behavior and screen media use.

“Increasingly, literature has found sleep to be a significant mediator of the relationship between internalizing and externalizing behavior and screen media use.”

• cites Palmer & Alfano, 2017 sourceNot checked — no full text of the source

Screen media overuse has repeatedly been shown to negatively impact health outcomes, especially among children and adolescents.

“screen media overuse has repeatedly been shown to negatively impact health outcomes, especially among children and adolescents.”

Considerable screen media research relies on parental or youth self-report, seldom both parents and youth or other sources such as teachers, making data susceptible to substantial inaccuracies and biases.

“considerable research currently relies on parental or youth self-report, but seldom by both parents and youth, or by other sources such as teachers, rendering the data susceptible to substantial inaccuracies and biases (Marshall, Gorely, & Biddle, 2006).”

• cites Marshall, Gorely, & Biddle, 2006 sourceNot checked — no full text of the source

There are potential bidirectional relationships between screen media overuse and the adverse outcomes discussed in this review.

“potential bidirectional relationships shared with the adverse outcomes discussed in this review”

Exposure to advertisements of calorie-dense foods with low nutritional value is a suggested mechanism for obesity.

“exposure to advertisements of calorie-dense foods with low nutritional value (Robinson et al., 2017)”

• cites Robinson et al., 2017 sourceNot checked — no full text of the source

Current guidelines for screen media use conflict.

“Currently, the guidelines for screen media use conflict.”

• Also stated in: § IMPLICATIONS · plain

  “the AAP states that parents should place limits on time spent on-screen media use to ensure it does not displace time for adequate sleep and physical activity for children aged > 6 years (Pediatrics); the Australian 24-hr Movement Guidelines, meanwhile, state screen time should be limited to no more than 2 hr/day.”

• cites PediatricsNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Australian 24-hr Movement GuidelinesNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

There are wide array of methodological limitations in screen media research to date.

“Given the wide array of methodological limitations that exist in screen media research to date”

Because sleep is significantly related to mood regulation, children and adolescents with sleep disruptions due to screen media use may be more likely to have anxious, depressive, withdrawn, aggressive, and oppositional behavior.

“Because sleep is significantly related to mood regulation, children and adolescents with sleep disruptions because of screen media use may face a greater likelihood of anxious, depressive, withdrawn, aggressive, and oppositional behavior (Palmer & Alfano, 2017).”

• cites Palmer & Alfano, 2017 sourceNot checked — no full text of the source

Growing evidence suggests that screen media overuse has adverse effects on a wide range of physical, cognitive, and emotional/behavioral problems.

“growing evidence also suggests that overuse has adverse effects on a wide range of physical, cognitive, and emotional/behavioral problems.”