How screen time may impact expressive speech development
When I went back into practice as a Pediatric Nurse Practitioner after a 2-year hiatus, I started noticing an alarming amount of patients aged 18 months to 2 years old exhibiting expressive speech delay. They couldn’t express themselves verbally. The weird thing was that they could work a tablet like a computer programmer! I thought this was strange, but their parents saw it as ‘normal.’
I would then turn to the parents and ask them about their child’s speech. What’s their vocabulary like? Are they putting 2 words together? The parents would look at me with confusion on their face and say “no!” I then would ask them about screen time, and I was met with a blank stare.
A recent New York Times article published in October 2018 states that parents in Silicon Valley are not allowing their children to use ‘screens.’ They are even having their nannies sign no tech contracts! Even tech gurus like Bill Gates and Mark Cuban have been rumored to placed restrictions on their kids’ technology use. Do they perhaps know something that the general population does not?
A 2017 study by Dr. Catherine Birkin found that by an 18-month checkup, 20% of the children had daily average handheld device use of 28 minutes, according to their parents. Based on a screening tool for language delay, researchers found that the more handheld screen time a child’s parent reported, the more likely the child was to have delays in expressive speech. For each 30-minute increase in handheld screen time, researchers found a 49% increased risk of expressive speech delay. There was no apparent link between handheld device screen time and other communications delays, such as social interactions, body language or gestures. This is the first study to report a link between handheld devices and expressive language delay.
By one measure, kids spend an average of 4 and a half hours a day gazing at their phones. Increasingly toddlers are also given smartphones and tablet devices. Dr. Dimitri Christakis, who is the lead author of the recent screen time guidelines for children by the American Academy Pediatrics, stated “Pediatric patients are given a smartphone by their parents after getting a vaccine so that they can soothe themselves. They are losing the ability to self soothe when they are given a smartphone. They need laps more than apps!” He further states, “A toddler who is left with an app isn’t really learning anything and is missing out on critical human interactions.”
According to an observational study of more than 4,500 US children aged 8-11 years old published in The Lancet Child & Adolescent Health journal, limiting recreational screen time to less than two hours a day, combined with sufficient sleep and physical activity is associated with improved cognition, compared with not meeting any of those recommendations.
The American Academy Of Pediatrics Guidelines For Screen Time Include:
- For children younger than 18 months, avoid the use of screen media other than video chatting. Parents of children 18 to 24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they’re seeing.
- For children ages, 2 to 5 years, limit screen use to 1 hour per day of high-quality programs. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
- For children ages 6 and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviors essential to health.
- Designate media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms.
- Have ongoing communication about online citizenship and safety, including treating others with respect online and offline.
National Institutes of Health is conducting a $300-million study using MRI scans to examine changes in brain structure among children who use smartphones and other screen devices. The first batch of results from the study shows that kids who spent more than two hours per day on screens scored lower on language and thinking tests. Kids who spent more than seven hours per day on electronic devices showed premature thinning of the cortex, which Dr. Gaya Dowling of the National Institutes of Health described as a “maturational process” that typically happens later in development.
“We don’t know if it’s being caused by the screen time,” said Dowling. “We don’t know yet if it’s a bad thing. It won’t be until we follow them over time that we will see if there are outcomes that are associated with the differences that we’re seeing in this single snapshot.” She states. It will take a few years to get answers to some of the questions raised by the study.
In my personal practice, when I diagnose a child with an expressive speech delay that may have been caused by screens, I educate the parent to decrease screen time and use the AAP guidelines. Sometimes I am met with great hesitation. Many parents believe that screens are ‘educating’ their children. I then give them a copy of the study from Dr. Catherine Birkin, a referral to speech therapy, along with educating them to speak and interact with their child. I’m happy to say that I’ve personally seen many of my patients regain their speech after decreasing and or eliminating screen time.