Exploring the Association between Screen Time Exposure and Autism Spectrum Disorder in Preschool-aged Children in Sulaymaniyah

1. INTRODUCTION

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction, as well as restricted and repetitive behaviors, interests, or activities. The global prevalence of ASD has risen markedly over the past two decades. According to the World Health Organization (2023), approximately 1 in 100 children worldwide is diagnosed with ASD, compared to 1 in 150 two decades ago. In some high-income countries, recent surveillance reports estimate prevalence rates as high as 1 in 36 children (CDC, 2023). This increasing incidence has prompted researchers to explore both genetic predispositions and environmental influences. Among the environmental determinants, prolonged exposure to electronic screens has emerged as a potential factor influencing neurodevelopmental patterns associated with ASD [1]. Among environmental determinants, prolonged exposure to electronic screens has emerged as a potential factor influencing neurodevelopmental patterns associated with ASD [2].

Excessive screen time has been widely documented as having adverse effects on both typically developing children and those diagnosed with ASD. These detrimental consequences range from reduced academic performance and disrupted sleep cycles to deficits in attention, social behaviors, and language acquisition [3]. Additional concerns include mood disorders and the manifestation of ASD-like symptoms [4]. Given the pervasiveness of digital technology in modern life, young children are increasingly exposed to electronic devices, often exceeding the screen time limits recommended by health organizations such as the World Health Organization (WHO, 2019) and the American Academy of Pediatrics (AAP, 2016). The AAP advises avoiding digital exposure for children under 2 years of age, while recommending a restriction of no more than 1 h daily for those aged 2–5 [4]. Similarly, the WHO suggests a maximum of 1 h/day for children aged 4–6 ([5]. Notably, children diagnosed with ASD exhibit heightened engagement with screens, including television, video games, and mobile devices [6]. A study conducted among preschoolers in China revealed a pronounced risk of ASD-like symptoms among children exposed to more than 2 h of screen time per day [7]. Additional findings reinforce the association between early digital exposure and elevated ASD-related behaviors in preschool-aged children [8].

Recent research has increasingly focused on how excessive screen exposure may contribute to the development or worsening of ASD-related behaviors in early childhood. Prolonged screen use has been associated with reduced social interaction, delayed language acquisition, and limited eye contact, features commonly observed in children with ASD [4], [8]. Moreover, early and unregulated screen exposure during critical developmental periods may interfere with sensory processing and social engagement, potentially influencing the expression of ASD-related symptoms [6]. Moreover, differences in screen content quality and duration can yield varied developmental outcomes. Higher-quality digital content has been linked to improved language skills, whereas excessive screen exposure, especially in early developmental stages, is associated with diminished language proficiency [9].

Diagnostic disparities exist across different populations, with variable prevalence rates influenced by genetic, environmental, and socioeconomic factors. While males are diagnosed more frequently, females with ASD tend to exhibit higher intellectual disabilities [10]–[13].

Piaget’s theory of cognitive development underscores the importance of language acquisition and attentional responsiveness as key milestones in early childhood development [14]. Recent studies highlight the growing phenomenon of language delays and attention deficits among young children, partly attributed to excessive screen exposure. The COVID-19 pandemic further exacerbated this trend, as increased digital engagement displaced traditional parental interactions. Observational reports from childcare centers indicate a marked rise in preschoolers exhibiting language deficits and attention-related concerns post-pandemic [15], [16]

Despite mounting evidence of screen exposure influencing neurodevelopmental trajectories, research on this phenomenon remains limited, particularly within the Kurdistan Region of Iraq. This study seeks to address this gap by examining the correlation between screen time and ASD-related symptoms in children aged 2–6 in Sulaymaniyah. By analyzing screen exposure patterns and their neurodevelopmental consequences, the findings aim to contribute to informed parental strategies for managing digital engagement among young children, particularly those predisposed to ASD.

2. MATERIALS AND METHODS

3. RESULTS

The analysis showed that children aged 2–6 years in Sulaymaniyah spent an average of 257.3 ± 209.0 min/day on screen-based activities (approximately 4.3 h/day). This high SD indicates considerable variation in screen time among participants as illustrated in Figure 1. Overall, the average screen exposure greatly exceeds the World Health Organization’s recommended limit of 1 h/day for preschool-aged children.

Fig. 1. Average daily screen time (min/day)

Categorical variables are represented as frequencies (percentages) as shown in Table 1. The study sample consisted of 73 male participants (65.8%) and 48 female participants (34.2%). The children ranged in age from 2 to 6 years, with a mean age of 4.23 years (SD = 1.21). Regarding parental education, 18 parents (24.7%) had an educational attainment below the high school level, while 55 parents (75.3%) had pursued education beyond high school. In terms of caregivers’ occupations, the majority (47.9%, n = 35) were housewives, followed by 16.4% (n = 12) who worked as teachers and 35.6% (n = 26) engaged in other professions. Household income varied, with 8.2% (n = 6) of families earning below 300,000, 9.6% (n = 7) falling within the 300,000–500,000 income range, and the majority (82.2%, n = 60) reporting an income above 500,000. Regarding screen content preferences, 76.7% (n = 56) of children primarily engaged in entertainment and gaming, while 17.8% (n = 13) consumed educational content. A small proportion (5.5%, n = 4) reported no screen-based content consumption. Language preferences showed variability, with 37% (n = 27) consuming content in Kurdish, Arabic, and English, while 12.3% (n = 9) exclusively used Kurdish. A notable 46.6% (n = 34) preferred English-language content, and 4.1% (n = 3) reported no screen-based content engagement. Screen time regulation varied among households, with 68.5% (n = 50) of parents reporting the absence of predefined screen time rules, whereas 31.5% (n = 23) adhered to structured screen time guidelines. Parent-child interaction patterns indicated that 54.8% (n = 40) of children engaged in recreational play with caregivers, while 24.7% (n = 18) assisted with household chores, and 20.5% (n = 15) participated in other activities. Communication quality assessment revealed 2.7% (n = 2) of children experienced low-quality communication, while 9.6% (n = 7) reported interactions. A larger proportion (35.6%, n = 26) experienced moderate communication quality, 39.7% (n = 29) perceived communication as good, and 12.3% (n = 9) reported excellent communication. Regarding shared screen time activities, 54.8% (n = 40) of children engaged in screen-based interactions with caregivers, while 45.2% (n = 33) did not (Table 1).

TABLE 1: Number and percentage of each category in the variables

To evaluate the strength, direction, and significance of relations between the observed variables, Non-parametric (i.e., Kendall’s tau-b) correlation analysis was used. Among the demographic and contextual factors scrutinized, several revealed noteworthy correlations with screen time. As shown in Table 2, Parental education notably exhibited a moderately negative correlation (τ = −0.264, P = 0.019), implying a robust inverse association with screen time. Higher levels of parenteral education are linked to reduced screen time among children. Moreover, the occupation of the parents exhibited a significant negative correlation (τ = −0.249, P = 0.020), indicating a pronounced inverse association with screen time, suggesting a negative relationship with screen time.

TABLE 2: Observed correlations between observed variables and screen time (n=73)

Further insights into these correlations, as detailed in Table 3, reinforce the importance of demographic and contextual influences in shaping screen time behaviors among young children, particularly in relation to ASD.

TABLE 3: Model fit statistics from logistic regression analysis

Logistic regression analysis was conducted to assess the association between screen time duration and ASD-related symptoms among children aged 2–6 years (Table 4). Screen time emerged as the only statistically significant predictor of ASD-related behaviors (B = 1.851, P = 0.011, Exp[B] = 6.364), indicating that longer daily screen exposure markedly increased the likelihood of exhibiting ASD-related symptoms.

TABLE 4: Results of fitting the logistic regression model to the data

Other demographic and contextual factors, such as child’s age, gender, parental education, and occupation, did not show a significant effect (P > 0.05) and were therefore excluded from further interpretation. These findings emphasize that excessive screen exposure is the main contributing factor linked to ASD-related behaviors in this sample, aligning directly with the study’s objective to examine the correlation between screen time and ASD symptoms (Table 4).

4. DISCUSSION

The findings of this study indicate that children aged 2–6 years engage in screen-based activities significantly beyond the recommended daily limit of <1 h, with an average screen time of 257.27 min (4.28 h) per day. This aligns with previous research that predominantly focuses on older children and adolescents diagnosed with ASD. For instance, a study by Healy et al., in Ireland, reported that 13-year-old children with ASD spend an average of 121–150 min/day watching television [17]. Similarly, another study by MacMullin et al., on electronic media use among youth and young adults with ASD, found that individuals aged 6–21 years dedicate approximately 5.67 h/day to electronic device usage [18]. Despite these insights, studies exploring screen time exposure in younger children with ASD remain scarce, highlighting a critical gap in the literature. Notably, a study conducted in Qatar by Kheir et al., reported that children under the age of 3 with ASD engage in screen activities for an average of 4.7 h daily [19].

Interestingly, parental reports in this study revealed no significant difference in children’s screen time habits between weekdays and weekends. This finding may be attributed to the high proportion of housewives among caregivers, whose daily routines remain relatively unchanged across the week, potentially influencing children’s screen exposure patterns. This null finding necessitates further investigation across larger and more diverse populations to better understand the factors shaping screen time behaviors in young children with ASD.

Existing research presents mixed results regarding weekday-weekend screen time disparities in children with ASD. A study in China suggested that weekdays tend to feature longer screen exposure compared to weekends, possibly due to reduced parent-child interaction during the workweek. In contrast, findings from Must’s study indicated an opposite trend, suggesting children with ASD spend more time on screens during weekends than weekdays [20].

In contrast to this finding, Must’s study (2014) posits an opposing trend, suggesting that children with ASD exhibit increased screen time during weekends relative to weekdays. Furthermore, the research indicates that children who engage in higher levels of screen time are at an elevated risk of being diagnosed with ASD or exhibiting ASD-like symptoms, demonstrating a statistically significant correlation with a P = 0.011. Conversely, the data suggest that children who limit their screen time are associated with a reduced likelihood of receiving a diagnosis of ASD or ASD-like symptoms [21].

Our findings highlight several critical sociodemographic factors associated with both ASD and screen time among children aged 2–6 in Sulaymaniyah. Household income demonstrated a significant inverse relationship with ASD or ASD-like symptoms (P = 0.011), indicating that children from higher-income families were less likely to be diagnosed with ASD. In contrast, those from lower-income households showed a higher prevalence of ASD or related symptoms. Parental education was also significantly correlated with children’s screen time (P = 0.019); specifically, higher parental education levels were associated with reduced screen time for their children, whereas lower educational attainment among parents corresponded to increased screen time. In addition, parental occupation emerged as a significant factor influencing screen time (P = 0.020). The data revealed that 47.9% of parents were housewives, 16.4% were teachers, and 35.6% held various other occupations. This suggests that the diversity in parental occupation is linked to differences in children’s screen exposure. Collectively, these results underscore the complex interplay between socioeconomic status, parental characteristics, and both ASD risk and screen time in early childhood, emphasizing the need for targeted interventions considering these contextual factors.

The findings of this study provide valuable insights into the distribution of parent-child activities and communication quality among participants. Engagement in parent-child activities was categorized into three main domains: Play, Housework, and Other. Notably, most respondents (54.8%) primarily engaged in Play-related activities, suggesting that recreational interactions are the most prevalent form of engagement between parents and children. In contrast, a smaller proportion (24.7%) participated in Housework, indicating a comparatively lower parental involvement in household-related tasks with their children. In addition, 20.5% of respondents reported engagement in other activities, highlighting variability in parent-child interaction patterns. Furthermore, this study examined the perceived communication quality within the parent-child dyad, categorized into five distinct levels: Poor, Fair, Average, Good, and Excellent. The data indicate that most respondents (39.7%) perceived their communication as Good, followed by 35.6% who rated it as Average. Smaller proportions rated communication as Excellent (12.3%), Fair (9.6%), or Poor (2.7%). These results underscore the prevailing perception of adequate parent-child communication, emphasizing the need for further exploration into the factors influencing interpersonal dynamics and parental engagement in early childhood.

In our study, all participants exhibited at least one core symptom of ASD, with language delay and communication problems being the most prevalent. While previous research has consistently identified a correlation between increased screen time and more pronounced ASD symptoms, particularly in communication and language development, our findings did not establish a direct association between screen time and these specific deficits. For example, systematic reviews and cohort studies have shown that prolonged or early screen exposure is linked to a greater risk and severity of ASD symptoms, including delayed language and social difficulties. However, some studies, such as an extensive cohort analysis, found no significant association between screen time at age three and ASD diagnosis, suggesting that the timing and context of screen exposure may influence outcomes. These differences highlight the need for further research to clarify the complex relationship between screen time and ASD symptomatology in diverse populations [22], [23].

5. CONCLUSION

This study examined the correlation between ASD and screen time in children aged 2–6 years in Sulaymaniyah, revealing key insights into screen exposure patterns and their potential implications for ASD diagnosis. The findings indicate that children in this study exhibited significantly high screen time, averaging 257.27 min/day, far exceeding recommended guidelines for early childhood. The logistic regression analysis identified screen time as a significant positive predictor of ASD symptoms (P = 0.011, Exp[B] = 6.364), demonstrating that increased screen exposure is associated with a greater likelihood of ASD-related outcomes. In contrast, household income emerged as a negative predictor (P = 0.011, Exp[B] = 0.132), suggesting that higher income levels may correlate with reduced ASD risk. While other factors – including content type, parent-child interactions, and screen time regulations – did not reach statistical significance, observed trends warrant further exploration. These findings underscore the importance of regulating screen exposure in young children, particularly those at risk for ASD, and call for larger-scale studies to refine the understanding of how socioeconomic and behavioral variables shape neurodevelopmental outcomes.

6. ACKNOWLEDGMENTS

We express our gratitude to all participants of the study.

7. FUNDING

No any specific funding giving to this work, and the authors did not receive any financial support for conducting the research, preparing the article, or publishing this article.

8. DATA AVAILABILITY

The data used to support the findings of this study are available on request from the corresponding authors or can be accessed.