Screen patterns and neurodevelopmental delay in preschoolers: an intelligent monitoring study (Preprint)

BACKGROUND Few studies have analyzed preschoolers’ screen exposure patterns, especially combined screen time and content, and their neurodevelopmental impacts. OBJECTIVE This study aims to identify the screen exposure patterns in preschoolers by intelligent technology, and to examine their associations with their neurodevelopment. METHODS This cross-sectional study enrolled preschool children from two kindergartens in Shanghai. Screen time and content types were monitored over 7 consecutive days using a validated intelligent monitoring technology. Neurodevelopmental outcomes were assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3). K-means clustering analysis identified screen exposure patterns, and binary logistic regression was applied to examine associations between screen exposure patterns and neurodevelopmental outcomes. RESULTS Of 355 preschool children included, 204 were boys (57.5%) and 251 (70.7%) were aged between 34.5 months and 50.5 months. K-means cluster analysis yielded 4 screen exposure patterns: restrictive use, moderately educational, noneducational, and educational-dominant pattern. Binary logistic regression showed the moderately educational pattern linked to gross motor abnormalities (OR = 2.530, 95% CI: 1.089 – 5.875, P = 0.031), and non - educational to fine motor abnormalities (OR = 3.172, 95% CI: 1.122 – 8.968, P = 0.029). CONCLUSIONS This monitoring study identified heterogeneous screen exposure patterns in preschool-aged children, revealing that excessive use of moderately educational content and noneducational content was associated with lower gross motor and fine motor skills. When limiting total screen time, parents should focus on content selection for preschool-aged children. Future research should focus on the objective measurement of different types of screen content.