A Link Between Screen Exposure and Autism-Like Symptoms

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Compelling theoretical reasons suggest the possibility of a causal link between excessive screen exposure in early life and the development of autistic-like symptoms later on.

A large 2020 cohort study in JAMA Pediatrics examined some of these. The prospective study found that watching television and/or videos, and less frequent play interaction between child and caregiver at 12 months of age, was associated with a modestly greater incidence of autistic-like symptoms (but not a greater risk of autism spectrum disorder) at age 2.

I want to make absolutely clear the difference between developmental autism, typically called Autism Spectrum Disorder (ASD), and autistic-like behavior observed by parents and pediatricians while acknowledging the possibility that the two may be intertwined. This is why the issue can be confusing.

Over 40 percent of first-graders now have their own smartphone. iPads hanging over bassinets or mounted in front of bouncy seats, potty trainers, and car seats block out a child’s developing central vision. The more they look at screens, the less they interact socially with actual human beings. Poor socialization remains the main challenge in true autism and those showing autistic-like behavior.

Cause of virtual autism? A chicken-or-egg question

Some critics raise the possibility of reverse causality—i.e., that autism itself is the cause of social disengagement and heavy screen use rather than the other way around. As the authors of the JAMA Pediatrics study note, "Children predisposed to ASD may have a preference for screens, or parents of children already displaying ASD symptoms may be more reliant on screens to soothe a child with self-regulation issues."

Weighing against this, if screen engagement were the result rather than the cause of autistic-like behavior, it would not reverse once screens were taken away. A well-known study by the UCLA Children’s Digital Media Center compared two groups of sixth-graders at an outdoor camp. Control and study groups came from the same public school and shared similar demographic backgrounds, and both showed autistic-like symptoms beforehand.

The study group had no access to phones, TVs, computers, or screens of any kind whereas the control group was allowed its usual amount. After only five days spent interacting with peers and camp staff, the study group started to improve their emotional and social engagement significantly (e.g., tested by having to infer emotional states from photographs of facial expressions and videotaped scenes with the sound turned off).

The precautionary principle or free rein?

The outcome is noteworthy given that social aptitude depends on an ability to read facial expressions, tone of voice, gesture, body language, and gaze. Does the children’s rapid reversal imply there are no long-term consequences of screen engagement to developing minds? Though we don’t yet know conclusively, it is no reason to abandon the precautionary principle.

Might heavy screen exposure early on boost incipient autism? Simon Baron-Cohen, perhaps the world's expert, first noted "systemizing" as part of the cognitive style that defined autistic kids as well as their parents. He noted their heightened attention to detail, expertise in recognizing patterns, and drive to invent systems of organization. Children diagnosed with autism are already strongly attracted to electronic devices, and affected children and their parents are both more likely to be technologically proficient compared to age-matched peers who are not autistic. However, one pediatric center suggests that mirror learning may explain this inasmuch as kids imitate their parents who are fixated on their own screens.

Brains at every age, but especially developing ones, adapt to whatever environment they find themselves in. What worries increasing numbers of parents are the potentially negative adaptations that heavy screen exposure may instill. At first glance, digital devices seem beneficial, even an unalloyed good. To some harried parents, an iPad may be a much-welcomed babysitter or “the only thing that works” to quiet a rambunctious child. Now, however, the ubiquitous number of screens in modern life raises many obstacles to a developing brain and mind.

Does screen time undermine social learning?

One thing screens do is cause displacement. This is why turning to digital devices to “occupy and pacify” kids may be ultimately shortsighted. There are only so many hours in a day, with children awake for only 10 to 12 of them. Although screen viewing may appear innocuous or even educational, digital media crowds out, or displaces, activities that traditionally shape cognitive, social, and emotional development.

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A University of Cambridge study found that the brainwaves of adults and babies synchronize when they hold eye contact. Signaling the availability and intention to communicate might synchronize when it is time to speak and when to listen, which would make learning more effective.

Moments of connection such as this help form a baby’s sense of self in relation to the rest of the world, and particularly to the people in it. To what extent do screens compete with that?

There is a lack of demonstrable benefits to early screen exposure, whereas there are reasons why it may negatively affect growing brains. It might be that diminished face-to-face time with caregivers factors into a causal pathway. Logistical and ethical constraints render it impossible to conduct randomized studies in growing children while having to wait 5 to 7 years for a study’s conclusions before taking action is likewise unworkable. Observational studies, then, are the best way to shed light on possible links between excessive screen viewing and the development of either frank autism or autistic-like symptoms, which is why the JAMA Pediatrics studies are welcome.

A warning from Romania

An early inkling of a possible causal link between heavy screen exposure and autistic behavior came from a Romanian children’s hospital psychiatrist, who said he noticed a rise in autistic behavior over a period of six years. (Another doctor in France reported "autistic symptoms in toddlers exposed to screens.")

The cause of their behavior was inexplicable at first, so the Romanian doctor dug into the activity logs the hospital had collected on all its patients. In these logs, he found that children 3 years and under who were diagnosed as autistic were spending four or more hours a day watching television, a computer, a tablet, or a phone screen. Once affected children were separated from their screens and again encouraged to socialize, symptoms reportedly abated.

Today in Romania, the treatment of autistic behavior by taking screens away has garnered public support. But strong claims about causal links need verification, and rigorous prospective studies in mainstream journals, such as the one mentioned above, are underway.

The spectrum of autism

Autism Spectrum Disorder includes a range—or spectrum—of developmental behaviors. Almost all affected individuals have difficulty communicating and interacting socially. They may have extremely narrow interests and obsess for hours over the same thing such as spinning, counting, or watching a YouTube video over and over. Parents are understandably concerned because the behaviors associated with ASD pose barriers that can make it more difficult to succeed socially, academically, and professionally later in life. Some children never overcome them, which is why the specter of autism can fill a parent with dread.

The Romanian doctor asked parents to take away their child’s screens temporarily, accompany them outside, read books together, talk face-to-face, and simply play with objects at hand. He wanted affected children to engage more often in day-to-day social interactions given that socialization is the primary challenge for anyone on the autism spectrum. Could pulling them away from the solitude of their screens relieve some of the symptoms?

Symptoms did appear to resolve, leading the doctor to propose the existence of “virtual autism,” or autistic-like behavior that seems to be induced by screens. The youngest children aged 18 months, with their more malleable brains, reportedly resolved within a few months while the hospital’s oldest patient, an 8-year-old, took two years to recover fully from his autistic-like symptoms.

Controlled studies beg to be conducted given the findings that seem to support what some pediatric experts have previously warned about: that too much screen can negatively affect developing brains. Accumulated evidence already exists that heavy screen exposure may impede mental health in the young. More than 200 papers at last count tie increased screen exposure to overt addiction, attention deficit-hyperactivity, aggression, and anxiety.

Matt Miles and Joe Clement, two experienced teachers in Fairfax, Virginia, and authors of Screen Schooled: Two Veteran Teachers Expose How Technology Overuse Is Making Our Kids Dumber say, “The one thing parents are most concerned about today is autism. But you can’t mention autism and technology in the same sentence without being immediately dismissed as a fearmonger.”

Parents may not know of the association between autistic-like symptoms and screen exposure of various kinds. Perhaps the prudent position if such behavior appears is, “Unplug, don’t drug.” Limit your child’s screen time. Take them outside and explore. Talk to them in full sentences. Make art together. Introduce them to the games you played as a child. Doing so may protect their minds and teach them more than any brain-training app ever could.