Does early screentime exposure or duration affect M-CHAT-R autism screening tool score?

The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) is commonly used by pediatricians to detect early signs of ASD and guide further diagnostic evaluation, and we hypothesize that increased or early screen time exposure is associated with higher M-CHAT-R scores. Therefore, the study aims to clarify the relationship between early exposure and duration of active screen time with M-CHAT-R scores. An observational cohort study was conducted, enrolling 646 children (male – 377, female − 269) aged 16 to 30 months. Data collection was conducted over an 8-month period (January–August 2024) at three large pediatric clinics in Tbilisi, Georgia, ensuring a diverse and representative sample. Data included M-CHAT-R/F screening scores (official Georgian translation), daily screen time exposure (minutes per day), and age of initial screen exposure, including background use. The analysis revealed a weak positive correlation between M-CHAT-R scores and average active daily screen time (r(644) = 0.15, p < 0.001), although only 2.3% of the variance in M-CHAT-R scores was explained by screen time. A modest association was also observed between higher M-CHAT-R scores and an earlier age of screen exposure (η² = 0.05, p = 0.03), 5% of the variance in M-CHAT-R score explained by the age of screen time exposure. Chi-square analysis indicated a statistically significant association between screen exposure before 6 months of age and M-CHAT-R risk categories (χ²(2) = 12.64, p = 0.002). Notably, the prevalence of high-risk M-CHAT-R scores (8 points or above) was nearly tripled in children exposed to screen time before 6 months (12.24% vs. 4.33%), a difference that reached statistical significance. These findings indicate that early screen time exposure is associated with an increased likelihood of high-risk M-CHAT-R outcomes (scores of 8 or above). In contrast, although there is a statistically significant weak positive correlation between average active daily screen time and M-CHAT-R scores, this variable accounted for only 2.3% of the variance. Future prospective research that incorporates potential confounding factors is necessary to further clarify these relationships. Meanwhile, adherence to the current guidelines from the World Health Organization and the American Academy of Pediatrics is advised.