Abstract
Electronic screens are everywhere and are easily accessible to children. Parents report fears that screens cause socioemotional problems. But most research has been cross-sectional, making it difficult to establish causality. We reviewed the longitudinal evidence to answer two fundamental questions: Does screen use lead to socioemotional problems, and do socioemotional problems lead children to use screens more often? A total of 132 longitudinal studies met the inclusion criteria and were included in the systematic review. From these, 117 studies (292,739 children; 2,284 effects) were meta-analyzed. Small significant associations were found in both directions: Screen use led to socioemotional problems, b = 0.06, 95% confidence interval (CI) [0.02, 0.11], p ≤ 0.05, n = 200,018, K = 117, and socioemotional problems led to greater screen use (b = 0.06, 95% CI [0.01, 0.12], p = .01, n = 200,018, K = 117). Moderation analyses showed stronger effects in both directions when screens were used for gaming than for other purposes: Socioemotional problems led to more gaming behavior (b = 0.44, 95% CI [0.29, 0.60], n = 80,809, K = 31), and playing games led to later socioemotional problems (b = 0.32, 95% CI [0.23, 0.42], n = 80,809, K = 31). The reciprocal relationship between socioemotional problems and screen use was moderated by children's age, total screen time at baseline, and type of socioemotional problem (i.e., externalizing and internalizing behavior). Compared with prior cross-sectional studies, our temporal evidence reinforces the benefits of screen time guidelines but suggests a change in focus. Instead of merely emphasizing the reduction of screen time, guidelines should prioritize improving the quality of screen content and enhancing social interactions during screen use. Additionally, screen time guidelines should discourage high levels of the most high-risk behaviors like gaming.