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Association between screen time exposure and autism symptoms scores (M-CHAT-R/F) in children from a multi-ethnic population-based sample in XXX.

Ruth Mingli ZHENG, Erdembileg SUNDARIMAA, Ramkumar AISHWORIYA, Siew Pang CHAN and Shang Chee CHONG

Despite the growing evidence suggesting an association between screen time exposure (STE) in children and autism symptoms, an understanding of this among the general child population is lacking.We aimed to determine the associations between STE and results on the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) questionnaire, in children from a multi-ethnic population-based sample in XXX.This cross-sectional study included children between 17 and 24 months of age, with no known developmental conditions, attending routine visits in primary care. Caregivers reported daily screen time via a questionnaire and completed the M-CHAT-R/F (standard administration protocol followed). Logistic and linear regression analyses and structured equation modelling including covariates were conducted.The sample comprised 5,336 multi-ethnic children (mean age 18.6 ± 0.9 months, 64.2% Chinese ethnicity, 23.9% Malay, 5.8% Indian). Mean STE was 1.31 ± 1.33 h/day. Increased STE was associated with a higher likelihood of a positive M-CHAT-R/F screen (OR = 1.24, 95% CI [1.01, 1.53], p < 0.05). Higher STE was associated with greater odds of having a response of concern for the social-communication questions but not those on motor/sensory aversion. Both the final M-CHAT-R/F score and the screening outcome was directly explained by STE in the structural equation model (β = 0.05, 95% CI [0.03, 0.07], p < 0.001 and OR = 1.24, 95% CI [1.01, 1.53], p < 0.05).Strengths of study include the large, community-based multi-ethnic study sample. Limitations include: cross sectional nature limits ability to infer causality, potential reporting bias of STE. In future studies, factors such as screen time content and co-viewing could be explored.Findings suggest a significant association between higher STE and autism symptoms, especially social communication domain. Evaluation and support of children with a positive M-CHAT-R/F screening result should include addressing STE and mitigating exposure.