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Removal of Electronic Screen Media Viewing in Young Children with ASD: Case Reports
Objectives: To describe the developmental trajectory of three young children with ASD with a history of high amounts of electronic screen media (ESM) viewing, who underwent an ESM fast based on the recommendation of a community provider.
Methods: Review of health and early intervention records of three boys with ASD who decreased ESM viewing beginning at ages 20 to 42 months of age.
Results: Child #1 viewed an average of 4 hours of TV daily, received early intervention at 15 months for language delay, but progressed poorly. Diagnosed with ASD as a 43-month-old, he demonstrated poor eye contact, repetitive spinning and solitary play. After screen removal, eye contact improved, followed by increased social interaction and diminished spinning. He no longer met ASD criteria 9 months after screen reduction with language delay resolving 9 months later. Child #2 viewed 11 hours of children's TV daily since birth. In early intervention since a 17-month-old, he was diagnosed with ASD at 21 months with poor eye contact, no awareness of others, no response to name, sensory avoidance and spun wheels on cars rather than engaging in functional play. Batelle Developmental Inventory (BDI) documented > 2 SD delays in cognitive, communication, and social/emotional development. Two months post screen removal, he acknowledged people, had good eye contact, and used gestures. Two months later, goals of sharing joint attention and following 1-step directions were mastered and he added vocabulary words daily. Child #3 was exposed to TV/video 3½ hours daily from age 2 months, increasing to 7 hours daily as a 6-month-old. Early intervention began at 20 months of age for “red flags” of autism with ASD diagnosed at 29 months, with ADOS-2 score of 12. He used few words, avoided eye contact, threw toys instead of functional play, viewed objects of interest in an unusual way, inconsistently responded to name and pulled on parents without eye contact for his needs. Worsening global developmental delay was documented by BDI at age 31 months and goal progress was poor. Over a 4-month period post screen removal, beginning at 36 months of age, he consistently improved his expression of needs and wants from 1.4 to 3.5 out of 4 (rating of 0 to 4 with 0 full prompt and 4 fully initiates). Six months after screen reduction, he has excellent eye contact, fully expresses himself in phrases and and engages in functional and imaginative play with peers. His support services have been reduced.
Conclusions: These cases suggest positive developmental changes related to reduction of ESM exposure in three young children with ASD. Reduction or removal of ESM is unlikely to provide significant risk to a young child. Further research is needed to clarify the relationship between ESM viewing and developmental trajectory in young children with ASD.