Family-based Screen Withdrawal and Changes in Autistic Traits in Toddlers With Heavy Screen Exposure

Objective: The aim of this study was to examine six-month changes in autistic traits measured by the Quantitative Checklist for Autism in Toddlers (Q-CHAT) after a family-based screen withdrawal and shared-activity program in toddlers with developmental concerns and heavy early screen exposure. Methods: This pragmatic single-arm before–after study was conducted in a hospital-based developmental consultation (January 2021–December 2024). Consecutive children younger than 3 years with developmental concerns and heavy or very early screen exposure were included. The intervention combined complete withdrawal of active and passive screen exposure with structured reallocation of time toward shared activities. The primary outcome was change in Q-CHAT score at 6 months. Secondary outcomes included Q-CHAT ≤30 and a ≥10-point reduction from baseline. Analyses included intention-to-treat analyses and comparisons by complete adherence (0 min/d vs > 0 min/d). Results: Sixty-seven children were included; 53 (79%) completed 6-month follow-up. Mean baseline Q-CHAT score was 51.7 ± 10.2. Median change at 6 months was −12 points (mean −16.8 ± 15.2; p < 0.001). Among completers, 18 of 53 (34%) reached Q-CHAT ≤30; in intention-to-treat analysis, 18 of 67 (27%) reached this threshold. Full adherence was associated with a higher adjusted probability of Q-CHAT ≤30 (RR 7.31, 95% CI 2.00–26.70) and a 12.7-point lower 6-month Q-CHAT after baseline adjustment (95% CI, −19.6 to −5.8; p < 0.001). A ≥10-point reduction was observed in 34 of 53 children (64.2%). Conclusion: In this pragmatic clinical cohort, a structured family-based screen withdrawal program was associated with substantial short-term improvement in Q-CHAT scores, with a gradient according to adherence. Controlled comparative studies are warranted.