One the saturation ofour culture and daily life

One of the drastic changes in our social environment in the 21st century has been the saturation ofour culture and daily life with mass media and other similar digital devices.1 It is like a double edgedsword. On one side these digital technologies offer significant development and educational benefitsfor children. They offer new spaces for learning, play, socialization and entertainment. Social mediaand these digital technologies provide incredible opportunities for children?s active participation.2Whereas on other hand studies shows that excessive use of this media like entertainment television isassociated with long term attention problems.3This media not only affect adolescents and adult population but infants and toddlers are not out ofreach. In part, this increasing exposure of infants and toddlers is due to emergence of media contentoriented towards infants and toddlers and marketed as educational.4,5 Correlational analyses suggestthat for every hour children under 2 year of age spend watching TV, they spend about 50 minutesless interacting with their parents and 20 minute less in creative play.6 Children from low socioeconomicstatus are most adversely affected because of greater exposure to media7 and are atincreased risk in general for disparities in early development, school readiness, and educationalachievement.8 Nine-month-olds spend nearly an hour a day watching television or DVDs, 5-yearoldsare begging to play with their parents? smartphone, and 7-year-olds are sitting down in front of acomputer several times a week to play games, do homework, or check out how their avatars aredoing in their favorite virtual worlds.9The use of interactive screen media such as TV, smartphones and tablets by young children isincreasing rapidly like a forest fire. However, research regarding the impact of this portable andinstantly accessible source of screen time on learning, behavior, and family dynamics, childdevelopmental milestones and autistic behavior has lagged considerably behind its rate ofadoption.10There is considerable lack of our knowledge about effects of screen time use ondevelopmental milestones and development of autism in children. In particular, to our knowledgethere is no prior longitudinal study conducted in India concerning the time spend on screen by youngchildren and its effect on developmental milestones and autistic behavior. American academy ofpediatrics (AAP) recommends guidelines for use of media in children, however no such guidelinesexist in India.Objectives: To fill this lacuna in knowledge, the present study has been planned with followingobjectives:1) To know correlation of time spent on screen and its effect on developmental milestones i.e.positive or negative (if any), in children of 6 months to 6 years of age.2) To know effect of screen use on development of autistic behavior in children3) To assess the burden of screen use in 6 month to 6 year of population.Methodology:Type of Study and Study design: The present study is a hospital based cross-sectional study.Duration of Study: The period of data collection will be two month.Study population: The present study would be conducted on children of 6 month to 6 years of age.Exclusion criteria: Those children whose parents are not willing to participate, premature infants,child with obvious delay related to neurological causes, dysmorphism, physical disabilities andchildren with chronic illness.Sample size: According to one study conducted in urbanized village of South Delhi, the prevalenceof developmental delay in under -five children was found to be 10.6%.11The sample size for the following study will be calculated by formula12:N = 4pq/L2N= required sample sizeP (prevalence rate)= 10.6q= 1-pL= least permissible error (absolute precision)L= 5%Desired confidence level= 95%Hence sample size= 4×10.6×89.4 ÷ 52= 151.8 ~ 152Adding a 20% nonresponse sample size will be 152+30.4 ~ 182To simplify data analysis we round off the sample size to 200.Sampling technique: Patients visiting the pediatric OPD would be selected as sample.Tools of Data collection: The assessment of screen time use would be done by using pretestedquestionnaire. First three questions are directed towards parent?s media usage. This questionnaireinclude questions about type of media available at home, numbers of “app” downloaded for child,type of media used by child, frequency of use of different kind of media etc. The questionnaire wouldbe administered by investigator to overcome any bias.Development would be assessed by using pre standardized and pre validated 51-item TrivandrumDevelopment Screening Chart (TDSC). This test is developed for assessment of developmental delayamong children of 0-6 year of age. TDSC is simple, reliable and easy to administer with sensitivity of90.8% and specificity of 84.62%. One item delay in TDSC (0-6 y) is considered as „TDSC delay?(test positive).13 The questionnaire would be administered by the investigator to overcome any bias.Autistic behavior would be assessed by using pre standardized and pre validated Childhood AutismRating Scale (CARS) tested for Indian population. The Childhood Autism Rating Scale (CARS) is a15-item behavior-rating scale designed to detect and quantify symptoms of autism as well as todistinguish them from other developmental disabilities. Each item on the CARS is scored on a Likertscale, from 1 (no signs of autism) to 4 (severe symptoms). The maximum CARS score is 60, and thecut-off for a diagnosis of autism is 30. Children with scores of 30.5 to 37 are rated as mildlymoderatelyautistic, and 37.5 to 60 as severely autistic. The CARS has strong psychometricproperties in a high-risk sample of children for autism. A threshold score of ?33 in the CARS wasconsidered ideal as a diagnostic cut-off score to identify cases of autism in Indian populations withsensitivity and specificity of 81.4% and 78.6% respectively, a positive predictive value of 95.9%, anda negative predictive value of 40.7%; therefore it was ideal as a screening cut-off score to identifypossible cases of autism.14 The scale would be administered by investigator to overcomeinterpersonal bias.The data regarding socio-demographic characteristics & social factors would be collected through apre-designed, pre-tested questionnaire.Statistical analysis: Data will be analyzed using SPSS version 16. Appropriate statistical tests wouldbe applied to analyze data.Ethical consideration: Ethical clearance for the study would be obtained from the Institutionalethical committee of the present Institute.Implications: The study would help us to know the relation of screen time use on various domains ofdevelopment. It would also unravel relationship between excessive media use and development ofautism, if any exist. Study data would help to know prevalence of screen use in 6 month to 6 years ofage. It would also help me in learning about the procedure of conducting a hospital based researchstudy.References:1. Ray M, Jat KR Effect electronic media on children. Indian Pediatr. 2010 Jul;47(7):561-8.2. UNICEF India. First comprehensive report on child online safety in India. Avilablefrom: Accessed on 12th January 20183. Zimmerman FJ, Christakis DA. Associations between content types of early mediaexposure and subsequent attentional problems. Pediatrics. 2007;120(5):986 –992.4. Garrison MM, Christakis DA. A Teacher in the Living Room? Educational Media for Babies,Toddlers and Preschoolers. Menlo Park, CA: Henry J. Kaiser Family Foundation; 2005.5. Christakis DA. The effects of infant media usage: what do we know and what should welearn? Acta Paediatr. 2009;98(1):8-16.6. Vandewater EA, Bickham DS, Lee JH. Time well spent? Relating television use to children?sfree-time activities. Pediatrics. 2006; 117(2):e181–e191.: doi 10.1542/peds.2005-08127. Mendelsohn AL, Berkule SB, Tomopoulos S, et al. Infant television and video exposureassociated with limited parent-child verbal interactions in low socioeconomic statushouseholds. Arch Pediat Adolesc Med. 2008;162(5):411-417.8. Hart B, Risley TR. Meaningful Differences in the Everyday Experience of Young AmericanChildren. Baltimore, MD: Brookes Publishing; 1995.9. Common sense media. Zero to Eight: Children?s Media Use in America. Availablefrom: 11th January 2018.10. Jenny S. Radesky, Schumacher J, Zuckerman B. Mobile and Interactive Media Use byYoung Children: The Good, the Bad, and the Dabar D, Das R, Nagesh S, Yadav V, Mangal A. A community based study on growth anddevelopment of under-five children in an urbanized village of South Delhi. Journal ofTropical Pediatrics, 2016, 62, 446–456.12. Lawanga SK, Lemeshaw S. Sample size determination in health studies: A practicalmanual.Geneva.WHO;199113. Nair, M.K.C., Nair, G.S.H., George, B. et al. Development and validation of Trivandrumdevelopment screening chart for children aged 0-6 yearsTDSC (0-6) .Indian J Pediatr,2013 80(Suppl 2): 248. Russell SSP, Daniel A, Russell S, Mammen P, Abel JS, Raj LE, Shankar SR, Thomas N.Diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale in India.World J Pediatr. 2010 May; 6(2): 141–147. Published online 2010 May21. doi: 10.1007/s12519-010-0029-y