University of Groningen
Uso de mídia interativa e desenvolvimento infantil precoce
Hadders-Algra, Mijna
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Jornal de pediatria
DOI:
10.1016/j.jped.2019.05.001
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Hadders-Algra, M. (2020). Uso de mídia interativa e desenvolvimento infantil precoce. Jornal de pediatria,
96(3), 273-275. https://doi.org/10.1016/j.jped.2019.05.001
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JPediatr(RioJ).2020;96(3):273---275
www.jped.com.br
EDITORIAL
Interactive
media
use
and
early
childhood
development
夽,夽夽
Uso
de
mídia
interativa
e
desenvolvimento
infantil
precoce
Mijna
Hadders-Algra
UniversityofGroningen,UniversityMedicalCenterGroningen,DepartmentofPediatrics,SectionofDevelopmentalNeurology, Groningen,TheNetherlands
ThestudybyJulianaNobreetal.inthisissueintroducesa novelinstrumenttoassessinteractivemediauseinchildren youngerthan4years.1Thedevelopmentofthisinstrumentis
well-timed.Societyisconfrontedwithanexplosiveincrease intheuseofinteractivemedia.RecentdatafromtheUnited States illustrate the changes in media use.2 In 2011, 41%
ofAmerican0---8yearoldshadasmartphoneinthehome, whereasin2017thisnumberhadincreasedto95%.Despite the increase in mobile devices, children’s overall screen time did not increase. Children continued to use screen mediaonaveragewellovertwohoursperday.Yet,the rela-tivetimespentwithmobiledevicesincreasedfrom4%to35% oftotalscreentime.Also,themajorityoftheyoungest chil-dren nowadaysuse mobiledevices:in 2013---2014,30---44% ofchildrenyoungerthan1yearusedamobiledevice,and 77---90% of 2-year-olds (studies in the United States3 and
France).4Unlikethe computer’skeyboard andmousethat
require considerable fine motor coordination, the touch
DOIoforiginalarticle:
https://doi.org/10.1016/j.jped.2018.11.015
夽 Please cite this article as: Hadders-Algra M. Interactive
media use and early childhood development. J Pediatr (Rio J). 2020;96:273---5.
夽夽SeepaperbyNobreetal.inpages310---7.
E-mail:m.hadders-algra@umcg.nl
screensofmobiledevicesarecompatiblewiththefinemotor skillsofyoungchildren.Ataround1yearofagemost chil-drenareabletotap,touch,swipe,andpinchonthescreen.5
Duetotheubiquityoftheaccessiblemobiledevices, inter-active media currently form an integral part of young children’sdailylife.Nevertheless,theeffectofthesemedia onchildhealthanddevelopmentisnotwellunderstood.
Thelargemajorityofstudiesonscreenmediausein chil-dren addressed passive forms of screen media use, such aswatching television programs,prerecorded videos,and DVDs. These studies reported that increased screen time isassociatedwithahigherrisk ofobesity.6 Thisincreased
riskhasbeen attributedespeciallytothe effectof snack-ingwhile watching TV andtothe exposure toadvertising forhigh-caloriefoodsandsnacks.7,8Increasedscreen time
alsohasbeen associated withanegativeeffect onsleep, most likely caused by the screen’s arousing content and itsbluelight suppressing melatoninandtherewith affect-ing circadian rhythm.8 Many studies showed associations
betweenexcessivetelevisionviewingduringchildhoodand cognitive, language, and socio-emotional delay. Yet, it is importanttorealizethatassociationsdonotautomatically implycausations,asitiswellknownthatfamiliesthat func-tionless well,e.g.,familieswithalow householdincome or a single parent, areprone tohigh media use.8
Never-theless,thelongitudinalstudybyMadiganetal.9indicated
thatgreater screen timewhenthe childwas2 or 3years
https://doi.org/10.1016/j.jped.2019.05.001
0021-7557/©2019SociedadeBrasileiradePediatria.PublishedbyElsevierEditoraLtda.ThisisanopenaccessarticleundertheCCBY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).
274 Hadders-AlgraM oldwasassociatedwithworsedevelopmentalscoresatthe
ageof5years.Thestudysuggestedthatscreentime func-tionedasaninitialfactor.However,thequestionremained whetherincreasedscreentimehadinducedworse develop-mentorwhetherchildrenwithlessoptimaldevelopmenthad receivedmorescreentime.Thelattermechanismisknown toplay aroleintheassociation betweenscreen timeand behavioralproblems.Radeskyetal.10showedthatchildren
withpoor self-regulation during infancy were more likely toconsumemediaattheageof2yearsthanchildrenwith typicalself-regulation.Thestudysuggestedthatpartofthe associationcouldbeattributedtothecaregiver’sstrategy tocopewiththeyounginfant’simpairedself-regulationby placingthe infantin frontof screen media.Yet,a recent studysuggestedthatmoderatelyhighlevelsofscreentime arenotassociatedwithbehavioralproblems inyoung chil-drenoryouth.11
Theavailablestudiesregardingtheeffectofinteractive mediauseonthedevelopmentofinfantsandpreschoolage childrenhavefocusedonlanguagelearning.Someofthese studiesusedvideoswithandwithoutinteractioninsteadof interactivemedia.Thestudiesindicatedthatinfantsof15 monthsofagearenotabletolearnnewwordsfrom watch-ingvideo, evenwhenthepersononthevideoistalkingto the watching infant,and even when the parentnaturally interactswiththechild duringvideowatching.12,13 In
con-trast,15-months-old childrenareabletolearnnewwords whenparentsteachthewordsinausualwayduringevery dayactivities.13 Toddlersagedatleast19monthsareable
tolearnnewwordsbysimplyvideowatching,butonlywhen thepersononthevideoistalkingtotheobservingand listen-ingchild.13Toddlersdonotlearnnewwordswhentheactor
onthevideoisaddressinganotherchild.14Nevertheless,the
learningofnewwordsintoddlersismoreefficientwhenthe videorequiresthemtotouchthescreeninacontingentway than when theywatch a non-interactive video.15 In
addi-tion,thestudybyRusso-Johnsonetal.16suggestedthatword
learningimprovedmorewhenthetoddlershadtodragthe objectlabeledwiththenewwordthanwhentheyhadtotap onthescreenorsimplywerewatchingtheactionsbeing per-formedonthescreen---aneffectthatwasespeciallyfound in girlsand in children fromlower classfamilies.Four of thefivedescribed studies thatassessedthe child’sability to learn new words12---14,16 evaluated the child’s
achieve-mentbymeansofpresentingthenewlylabeledobject(the newword)onascreen.Thismeansthattheevaluationsdid notmeasure whetherthe child hadbeen abletotransfer theknowledge obtainedduringscreen learningtothereal world.Itshouldbenoted,however,thatyoungchildrenare hamperedbyaso-calledtransferdeficit.17Thismeansthat
thechildrenhavemoredifficultiestorecognizewordsthat havebeendemonstratedtotheminapicturebook,on tele-vision,orontouchscreens(intheabsenceofaninteracting caregiver)thanwordsthathavebeenpresentedduring face-to-face interactions. In infants the transfer deficit most likelycanbeattributedtoperceptualdifficulties(e.g.,3D imagesona2Dscreen)orcontextualmismatch(e.g., inabil-ityto distinguishbetween the frame andthe contents of thescreen).From2yearsonwards,thetransferdeficitmay mostlybe attributed to a lack of symbolic understanding ---ittakesdevelopmentaltimebeforechildrenunderstand
that a symbolis not only an object in itselfbut also is a representationofsomethingelse.17
Thestudiesonscreen-basedlanguagelearningillustrate that childrenlearnmore frommediainthe followingtwo conditions: (1) when caregivers join the activity and are activelyengagedand(2)whenitinvolvesspecificcontingent interactions.5 This means that learning is most effective
when it mimics the real life situation of interactionwith acaringadult.PatriciaKuhlsuggestedthattheefficacyof this learning condition is not only mediated by its ability to enhance the child’sattention and arousal, but also by the provision of multifaceted information, as theuttered wordsareaccompaniedbysocialcues,suchaseyegazeand pointinggestures.18
Thestudiesdescribedaboveindicatethattheeffectof interactivemediauseonchilddevelopmentlargelydepends on the social context of its use and the type of activi-tiesperformed.Thenoveltyofthequestionnairedeveloped by Nobreetal.1is thatit paysexplicit attentiontothese
latter two aspects of interactive media use. The ques-tionnaire results in a multicriteria index, in which higher scoresreflect,forinstance,theabsenceofexcessivescreen time,the use of atablet(instead of asmartphone), per-forming activities requiring manual actions or consisting ofeducationalapplications,andcaregiverattendanceand monitoring.Theauthorsdemonstratedthatahigherscoreon themulticriteriaindex--- reflectingahigherqualityof inter-activemediause---inBrazilianchildrenaged23---42months wasassociatedwithhigherscoresonthelanguage, cogni-tive,andfinemotorscalesoftheBayleyScalesofInfantand Toddler Development.1 The positive association between
goodqualityinteractivemedia useandlanguage develop-ment corresponds to the above described literature. The positiveassociationbetweengoodqualityinteractivemedia useandfinemotordevelopmentagreeswiththefindingsofa recentstudyreportingthattabletuseatpreschoolagewas associated withbetterfine motor skills.19 The association
betweengoodqualityinteractivemediauseandbetter cog-nitivedevelopmentisnew.ThefindingsofNobreetal.imply thatthemulticriteriaindexoffersnewopportunitiesto eval-uatetheeffectsofinteractivemediauseonearlychildhood development.Yet,Isuggestthattheauthorsmayimprove thesensitivityoftheindexbyaddingtwoitems:oneonthe wayinwhichthecaregivers interactwiththechild during jointmediaactivityandanotheronthechild’spredominant typesofmanualactionsduringinteractivemediause. Appli-cationofthemulticriteriaindexwillpavethewaytoabetter understandingoftheeffectsofinteractivemediause.This knowledgeisrequiredforadequateguidanceandadvicefor caregiversoninteractivemediauseininfancyandpreschool age. Conceivably, interactive media when properly used,
i.e.,withparentalguidanceandinteraction,andnotlonger than2hoursperdayandnotshortlybeforebedtime,maybe oneofthetoolstopromoteearlychildhooddevelopment. Recallthatexplorativeself-practicedactivitiesarepivotal driversofdevelopment!20
Conflicts
of
interest
Interactivemediauseandearlychildhooddevelopment 275
Acknowledgements
Igratefullyacknowledgethecriticalandconstructive com-ments of Ying-Chin Wu, PT, PhD and Jaqueline da Silva Frônio,PT,PhDonapreviousdraftofthemanuscript.
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