The COVID-19 pandemic generated unprecedented increases in children and adolescents’ time spent on devices, with some children spending over 6 hours per day on screens (Eyimaya & Irmak, 2021; Nagata et al., 2022; Seguin et al., 2021; Xiang et al., 2020). A parallel epidemic emerged in parents with school-aged children, who reported stress levels in the moderate to high range (Calvano et al., 2021; Li & Zhou, 2021; Seguin et al., 2021). While screen time and parent stress are known to have separate adverse implications on childhood development (Madigan et al 2019l Lissak 2018; Osofsky & Thompson 2000), little is known about the accumulated risks of prolonged screen time exposure on incidences of internalizing and externalizing behaviours in children, and the moderating influence of parent stress and parenting strategies on these relationships.
Screen time is the amount of time spent using a device with a digitized interface, such as computers, television, video games, and smartphones (Tang et al., 2018). Health care professionals caution that excessive screen time may adversely impact childhood development, health, and mental health outcomes with screen time guideline recommending a maximum of 2 hours of screen time per day for children over the age of five (Canadian Paediatric Society, Digital Health Task Force, 2019; World Health Organization, 2020).
The unparalleled impact of COVID-19 engendered nationwide increases in children’s time spent on devices (Eyimaya & Irmak, 2021; Orgilés et al., 2020; Velde et al., 2021; Xiang et al., 2020). Based on early cross-sectional data in Ontario, children’s average screen time increased from 2.6 hours before the pandemic, to 5.9 hours a day during the initial school closures of the pandemic (Seguin et al., 2021). This daily average is more than double the recommended guidelines for Canadian children. Similar increases occurred in the United States, Turkey, China, Italy, and Spain (Eyimaya & Irmak, 2021; Nagata et al., 2022; Xiang et al., 2020), with concurrent decreases in physical activity also found in some of these samples (Orgilés et al., 2020; Xiang et al., 2020). Factors such as socioeconomic status, race/ethnicity, school satisfaction (for both children and parents), and having a child with special needs, contributed to unregulated screen time in children (Assari, 2020; Lee et al., 2022; Nagata et al., 2022; Seguin et al., 2021).
The most prevalent mental health concerns affecting school-aged children prior to the pandemic were anxiety, depression, and conduct problems (Ghandour et al., 2019). Since March 2020, internalizing (i.e., anxiety and depression) and externalizing problems (i.e., aggression) have increased dramatically in school aged children (Khoury et al., 2021), with an estimated 20-25% of children experiencing symptoms of depression and anxiety (Racine et al., 2021). Lockdowns were associated with the most pervasive emotional problems, including anxiety, restlessness, worry, and depression (Orgilés et al., 2020; Racine et al., 2021).
Early evidence indicates that internalizing and externalizing problems may be an enduring issue for children and youth during the pandemic. Increases in internalizing and externalizing symptoms from pre-pandemic to the initial lockdown period were found in Canada and the United Kingdom (Bignardi et al., 2021; Khoury et al., 2021). In a cohort of Norwegian children, an overall increase in mental health issues were reported during the early stages of the pandemic to 9 months after the initial outbreak, with internalizing symptoms accounting for the most increases (Lehmann et al., 2022). Factors such as parent stress, intra-family dysregulation, and screen time contributed to increases in children’s mental health problems (Khoury et al., 2021; Li & Zhou, 2021; Oliveira et al., 2021).
Excessive screen time use appears to have an adverse influence on children’s mental health outcomes (McArthur et al., 2022; Tamana et al., 2019; Tandon et al., 2021). In a large longitudinal study of brain development and child wellbeing in the United States (ABCD study; https://abcdstudy.org) increased screen time was associated with impaired social skills (Jericho & Elliott, 2020; Paulus et al., 2019), depression and anxiety (Fors & Barch, 2019), behavioural and social issues (Guerrero et al., 2019), and reduced sleep duration, fatigue, and insomnia in children (Hisler et al., 2020). Screen time was associated with a dose-dependent increase in depression risk in children (Liu et al., 2016). Youth reporting over 4 hours of passive screen time per day were significantly more likely to meet the criteria for major depressive episode, social phobia, and generalized anxiety disorder (Kim et al., 2020). By contrast, a systematic review (n= 159, 425) on children’s screen time behaviours found that screen time was weakly associated with externalizing and internalizing problems (Eirich et al., 2022). Age-related factors appear to influence the strength and direction of the association (Neville et al., 2021).
Adverse mental health outcomes associated with unregulated screen time is an emergent concern amid the ongoing pandemic. Cross sectional evidence from early stages of the pandemic demonstrates associations between excessive screen time and increased incidence of total mental health difficulties in children and youth, with sleep duration, physical activity and sedentary behaviour mediating these relationships (Olive et al., 2022; Tandon et al., 2021). In a cohort of 2026 Ontario children, more digital media and TV consumption was associated with conduct and hyperactivity/inattention problems in children under the age of 4 and internalizing problems in older children (Li et al., 2021).
Parent mental health, parenting strategies, and involvement with children’s academic and recreational activities may mediate the association between excessive screen time use and mental health problems in children (Arundell et al., 2020; Barroso et al., 2018; Kochanova et al., 2022; Seguin et al., 2021; Tang et al., 2018). For example, in an Israeli cohort of parent-adolescent dyads, negative parenting practices significantly increased the risk of digital media addiction in children, which in turn was associated with behavioural and emotional problems (Scultzman & Gershy, 2023). In a Brazilian cohort, negative parenting strategies were associated with both poorer mental health in children, as well as increased screen time (Oliveira et al 2022).
The pandemic has contributed to heightened perceived stress among parents with school aged children (Adams et al., 2020; Calvano et al., 2021; Orgilés et al., 2020; Seguin et al., 2021), which may put children at risk for greater screen time use and mental health problems in the future (Hartshorne et al., 2020; Li & Zhou, 2021). For example, greater parent anxiety during the initial COVID-19 outbreak was a significant predictor of children’s internalizing and externalizing behaviours (Li & Zhou, 2021). In addition, over-reactive, inconsistent, and authoritarian parenting practices contributed to higher screen time use in children (Eyimaya & Irmak, 2021; Oliveira et al., 2021).
While studies point to the separate negative influences of screen time and parent stress on children’s mental health outcomes, few studies have addressed these concerns longitudinally. The influence of parental stress and parenting strategies has been identified as important mediating factors on both screen use behaviors in children as well as emotional and behavioral outcomes. It is essential to identify the factors that promote or impede childhood development, and to devise early intervention strategies to support parents and children during periods of school closures.
In the current longitudinal study, we examined the association between screen time, parental involvement, and parent stress on the incidences of externalizing, and internalizing behaviours in a cohort of Canadian children from November 2020 to November 2021. These time points encompass different school and public responses to COVID-19. In later 2020 to early 2021, much of Canada was under lockdown measures, resulting in school closures for in-person learning, and the closure of community and recreational centres. In late 2021, all adults were eligible for vaccination, schools across the country were open for in-person learning, and community and recreational centres were resuming activities. Using data gathered from these diverse time points, two research questions were examined: 1) Is screen time associated with internalizing and externalizing behaviours in children over time? 2) Will changes in parent stress and parental involvementaffect the relationship between screen time and children’s mental health outcomes? We hypothesize that protracted screen time exposure will contribute to increased externalizing and internalizing behaviours, and that parent stress and parental involvement will moderate the strength of this association.