Early Screen Exposure and Its Association with Communication and Cognitive Outcomes in Children Aged 6-24 Months: A Cross-Sectional Study Using the CSBS-DP

Background: Early exposure to screens during infancy and toddlerhood has become a significant public health issue as studies have found a possible impact on communication, cognition and social-emotional development. The first two years of life bring about rapid maturation of the neurodevelopmental system through symbolic exchange, reciprocal social interaction and through caregiver-mediated learning. Too much and/or unsupervised use of screens can disrupt these developmental processes. The aim and objective is to examine communication and cognition skills in children 6-24 months of age on the Communication and Symbolic Behaviour Scales Developmental Profile (CSBS-DP); identify and quantify children with abnormal scores; and identify factors associated with early screen exposure. Material and Methods: A cross sectional observational study was conducted in a hospital with respect to children aged 6-24 months attending Immunization Centre and Paediatric Out Patient Department of MGM Medical College and M.Y. Hospital, Indore. A structured questionnaire was used to collect data on the demographic characteristics and screen exposure patterns. The assessment tools for communication and cognitive development were CSBS-DP scale. Data analysis was carried out with SPSS 25.0 program, and p<0.05 was accepted as statistically significant. Results: A total of 500 children aged 6-24 months with screen exposure were included in the study. Smartphones were the most commonly used devices (72%), and 23.0% of children had screen exposure exceeding 2 hours/day. Developmental concern on the CSBS-DP total composite score was identified in 54.0% of children, predominantly affecting speech (59.0%) and social communication (57.0%) domains. Mean CSBS-DP scores declined significantly with increasing screen exposure duration across all domains (p<0.001), with prolonged screen time showing a significant dose-dependent association with adverse developmental outcomes. Conclusion: Early screen exposure during infancy and toddlerhood may be associated with adverse communication and symbolic behavioural outcomes, particularly when exposure is prolonged, unsupervised, and associated with reduced caregiver interaction. Early developmental surveillance and parental counselling regarding responsive caregiving and age-appropriate media practices are essential.

Keywords: Early childhood development, Screen exposure, Communication, Cognition, CSBS-DP.