Photo Credit: Maxim Trukhin

 Early childhood tablet use was associated with emotional regulation, including more expressions of anger and frustration, by the age of 4.5 years.

Preschoolers who spend more time on tablets tend to express more outbursts of anger and frustration, according to findings published in JAMA Pediatrics.

“In this study, child tablet use at age 3.5 years was associated with more expressions of anger and frustration by the age of 4.5 years. Child proneness to anger and frustration at age 4.5 years was then associated with more use of tablets by age 5.5 years,” the study authors wrote. “These results suggest that early-childhood tablet use may contribute to a cycle that is deleterious for emotional regulation.”

A Province-Wide Study During the COVID-19 Pandemic

In their prospective, community-based, longitudinal convenience sample of 315 preschool-aged children, Caroline Fitzpatrick, PhD, Gabrielle Garon-Carrier, PhD, and colleagues investigated the relationships between child tablet use and their expressions of anger and frustration over time.

The researchers recruited parents in Nova Scotia through newspaper and radio ads, posters, flyers, sign-up sheets related to preschools and prekindergarten classes, and a Facebook page. Overall, 287 (91%) parents in the study reported being Canadian, and 258 (82%) reported being married. Among the children. 171 (54%) were born male and 144 (46%) were born female

The parents used the Media Assessment Questionnaire to document their children’s tablet use at ages 3.5 years in 2020, 4.5 years in 2021, and 5.5 years in 2022. They reported the average length of time their child used a tablet daily, ranging from (1) never to (7) more than 5 hours. The researchers converted these categorical responses into continuous variables showing hours of tablet use.

Parents also reported child expressions of anger and frustration at the ages of 3.5, 4.5, and 5.5 years using the Children’s Behavior Questionnaire—Short Form with scores based on the mean of 7 items ranging from 0 to 7 (eg, the child gets angry when told has to go to bed), and with higher scores indicating greater anger and frustration intensity and duration.

• At each successive year, the Cronbach α coefficients were 0.79, 0.80, and 0.83, respectively.

Using a random-intercept cross-lagged panel model estimated across the three time points to verify the longitudinal association between average weekly hours of tablet use and anger and frustration expression, the researchers found:

• A 1-standard deviation (SD) increase in tablet use (corresponding to 1.15 hours per day) at age 3.5 was associated with a 22% SD scale increase in anger and frustration at age 4.5 (standardized coefficient = 0.22; 95% CI, 0.01-0.44).
• Conversely, a 1 SD scale increase in anger and frustration at 4.5 years was associated with a 22% SD increase in tablet use (corresponding to 0.28 hours per day) at 5.5 years (standardized coefficient = 0.22; 95% CI, 0.01-0.43)

The researchers acknowledged the study’s strengths, including its longitudinal design with repeated measures over time and its stringent analytical approach. They also acknowledged its limitations, including its use of a convenience sample and the “unique sociohistorical period” in which it took place.

“Importantly, the study was conducted during the pandemic, a highly stressful time for many families during which it was not possible to account for the quality of the content the children viewed on tablets,” notes Dr. Fitzpatrick. “We are in the process of replicating our study post-pandemic with more information on the nature of child tablet use.”

Establishing Healthy Screen Habits is Important

“The preschool period, typically ages 3 to 5, is of particular importance for children’s school readiness. Children must have the ability to manage intense emotions such as anger and frustration if they are to have a successful start in school,” Dr. Garon-Carrier tells Physician’s Weekly.

She cautioned adults to closely monitor young children’s tablet use and avoid using screens to regulate their child’s emotions.

“Younger children are very sensitive to their home environment, which contributes to school readiness. Better understanding of the factors in the home that are associated with anger and frustration regulation, such as tablet use, is one way to help researchers develop recommendations to enable each child to make a healthy transition to formal schooling,” Dr. Garon-Carrier says.

“Tablet use is increasingly popular among young children, and they are first exposed to them at younger and younger ages. During well-child visits, medical practitioners can include questions about child screen use and encourage parents to establish healthy screen use routines early on because habits become more entrenched as children grow older,” Dr. Fitzgerald adds.