Tots and Technology: Taming the Monster Judith L. Page, Ph.D., CCC-SLP Jane O. Kleinert, Ph.D., CCC-SLP Annual Convention of the American Speech-Language-Hearing Association Philadelphia, PA 11/18/16

Disclosure Financial: Non-financial: Judith L. Page: Employed by the University of Kentucky and TAALC/ SPDG grant from the Kentucky Department of Education Jane O. Kleinert: Employed by the University of Kentucky and TAALC/ SPDG grant from the Kentucky Department of Education Non-financial: Both authors have developed trainings, online modules and materials during grant activities

Screen Use Data 40% of infants watch some type of video by age 5 months By age 2, 90% watch some sort of electronic media Higher media use by children from homes with lower SES, single mothers or mothers with less than HS education Technology: Interactive digital and electronic devices, software, multi-touch tablets, technology-based toys, apps, video games and interactive (nonlinear) screen-based media Screen Time: Screen time can be described as the time spent viewing of TV/video, computer, electronic games, hand-held devices or other visual devices.

ASHA 2015 Survey: Tech Use 24 percent of 2-year-olds use technology at the dinner table. By age 8, that percentage nearly doubles to 45 percent. More than half of parents say they use technology to keep kids ages 0 to 3 entertained; nearly 50 percent of parents of children age 8 report they often rely on technology to prevent behavior problems and tantrums. By age 6, 44 percent of kids would rather play a game on a technology device than read a book or be read to. By age 8, a majority would prefer that technology be present when spending time with a family member or friend. http://www.asha.org/uploadedFiles/BHSM-Parent-Poll.pdf

Technology at the Table

ASHA 2015 Survey: Parent Concerns 55 percent of parents have some degree of concern that misuse of technology may be harming their children’s hearing, and 52 percent have concerns about speech and language skills. 2 percent say they are concerned that technology negatively affects the quality of their conversations with their children; 54 percent say they are concerned that they have fewer conversations with their children than they would like to because of technology. Parents recognize the potential hearing hazards of personal audio devices: 72 percent agree that loud noise from technology may lead to hearing loss in their children. Majority report setting limits, but do not enforce them.

Mobile Technology & Early Childhood Access & Usage Increased Rapidly 2011: 10% under 2, 38% under 8 2013: 38% under 2, 72% under 8 2015: 97% under 4 Parents: 84% own smartphone use mobile technology about 3 hrs/day Wartella. E. Parenting in the age of digital technology. http://static1.1.sqspcdn.com/static/f/1083077/22839022/1370380073813/PARENTING_IN_THE_AGE_OF_DIGITAL_TECHNOLOGY.pdf?token=iO5vMItReCqjiGoPeIDR9eNAmOs%3D

Today’s ‘Connected’ Family

Why Is Screen Time a Problem? Infants may stare at the bright colors and motion on a screen, but their brains are incapable of making sense or meaning out of all those bizarre pictures. It takes 2 full years for a baby’s brain to develop to the point where the symbols on a screen come to represent their equivalents in the real world. American Academy of Pediatrics (AAP)

Arguments Against Screen Time Children learn better from real-life experiences than from screen time – especially moving and doing activities (but average 12 month old exposed to 2 hours screen time/day) Active exploration develops eye-hand coordination, visual perception, and fine motor skills that can’t be developed on a 2D screen

Critical to learn new concepts while interacting with actual people and objects Building, climbing, pretending, banging, stacking, and manipulating are all 3D motor sensory experiences that the screen can’t replicate (yet)

Specifically, children are programmed to learn from interacting with other people. The dance of facial expressions, tone of voice, and body language between a toddler and parent is not only beautiful, it’s also complex... Whenever one party in this dance, child or parent, is watching TV, the exchange comes to a halt. American Academy of Pediatrics

Effects of Too Much Screen Time Physical Effects Irregular sleep schedules Lower physical activity Increased risk of obesity Hearing loss

Cognitive Effects Language learning delays – at least short term Delayed reading skills Lower math skills Lower psychological ability Poorer short-term memory Less time in creative play

Emotional/Social Effects Increased risk of attention problems, anxiety and depression Higher likelihood of psychological distress (emotional, conduct, peer relationships) AAP Less time in social interaction Social isolation Increased victimization

Effects of Background Screen Infant vocabulary growth is directly related to the amount of time parents spend speaking with their infant BUT Technology use may decrease parent-child language: Normally parents speak about 940 words/hour when a toddler is present With background TV, that number falls to 170 words/hour!

Background TV and Parent-Child Interaction When TV is on, adults and children have: Fewer verbal exchanges (Christakis, Arch Pediatric & Adolescent Medicine, 2009) Fewer initiated interactions, less sustained/complex play interactions(Kirkorian, Child Dev, 2009) Background TV use during mother-infant toy play associated with smaller child vocabulary at 17 mo, mediated by lower maternal speech quantity and quality (Masur, First Language, 2016)

Digital Play Less parent verbal exchange during electronic toy play compared to traditional play or book Less parent dialogic reading during eBooks with lots of enhancements Low-income parents report they more frequently use media to keep children quiet or calm Radestky, J.S. et al. (2016). Toddler social-emotional difficulties and use of mobile technology for calming purposes. JAMA Pediatrics.

Arguments for Screen Time Educational Benefits Most effective when interacting with others Communication Benefits Easy and fun ways to communicate (e.g. Skype) Blog/scrapbook for photos (memory, interpretation, problem solving) Creative Benefits Physical Benefits Fine motor skills and coordination Physical activity

Evidence for Screen Time The content children view is the best predictor of cognitive effects Flewitt (Inst of Education, London): iPads make kids more cooperative and help quiet kids speak up Immediate feedback Multimedia Survey of 1000 parents and teachers of 3-5 year olds kids enjoy reading more with books + touch screen Performance of low SES children better when use both at home New Scientist (26 March 2014): https://www.newscientist.com/article/dn25297-children-benefit-from-the-right-sort-of-screen-time/

More Arguments Careful choice of screen and content can be a facilitator Interactive e-books stimulate reading habits Innovative apps like “Google Goggles” or “Hidden Park”, or “Pokemon Go” can add adventure to indoor or outdoor play Smart parents use these as supplements, not replacements, for books, neighborhood exploration or free play

May be true for children older than 2 - Children older than 2 who use high quality media may have improved social skills, language skills, and school readiness But may or may not be true for children younger than 2 – Little evidence of cognitive benefit of screen use for children 0 – 2.

American Academy of Pediatrics-1999 Discouraged screen time (primarily TV) for children under 2

In 2011 the collective pediatric wisdom of the American Academy of Pediatrics, lifted earlier bans and opened the door to a little computer use

AAP’s Revised Screen Time Guidelines Media is just another environment – with positive and negative effects Parenting has not changed Role modeling is critical We learn from each other “talk time” is critical for language development Passive video presentations do not lead to language learning in infants and young toddlers Optimal media educational opportunities begin after age 2 http://www.forbes.com/sites/jordanshapiro/2015/09/30/the-american-academy-of-pediatrics-just-changed-their-guidelines-on-kids-and-screen-time/

Content matters – quality is more important than time Curation helps Co-engagement counts – essential for infants and toddlers Playtime is important – unstructured, unplugged, especially for very young Set limits - reasonable

It’s OK for teens to be online Create tech-free zones – mealtime bedroom Kids will be kids

The Bottom Line Discourages media use by children younger than 2 years Encourages provision of unstructured, unplugged play – both independent and cooperative Encourages parents to read to child Encourages parents to realize that their media use can have a negative effect on children American Academy of Pediatrics (November 2011), Pediatrics, 128:5

HOWEVER… “There are some preliminary studies — and I emphasize preliminary — that babies as young as six months can learn from prosocial media, but they learn 20 times better from parents. I think very judicious use of technology for under-2s may be okay, but personally I don’t see the hurry.” In Klass, P. (2016, March). A reconsideration of children and screen time. New York Times. Retrieved August 12, 2016 from http://well.blogs.nytimes.com/2016/03/21/a-reconsideration-of-children-and-screen-time/?_r=0

AND… New Research Babies as young as 6 months can differentiate between a video broadcast and a video-chat Use of video-chat 85% of families with babies under 2; 40% used once a week 40% used once a week 4 month old upset by out of sync video, but cope better with guidance from a trusted caregiver Toddlers more comforted by mother via video chat than through audio alone Phone-only causes problems through age 7 Ages 2-5: have the ability to transfer knowledge from screens to the real world, including early literacy and math, and positive social and emotional skills and behaviors The Atlantic. (2013, April).The Touch Screen Generation. http://www.theatlantic.com/magazine/archive/2013/04/the-touch-screen-generation/309250/ The Atlantic (2013, September) Discovering that your 18-month-old is using an iPad in Preschool. http://www.theatlantic.com/education/archive/2013/09/discovering-that-your-18-month-old-is-using-an-ipad-in-pre-school/279438/

Skype /Video-Chat Toddlers 24 months old can learn novel words from contingent interactions over Skype Joint attention over video-chat emerges at about 16 months Video-chat facilitates connection with distant family members Roseberry, S., Hirsch-Pasek, K. & Golinkoff, R.M. (2013, September).Skype Me! Socially contingent interactions help toddlers learn language. Child Development. DOI: 10-111/cdev.12166

So … AAP’s 2016 Guidelines Lifted “No screens Under 2’ rule Shift focus from WHAT is on the screen to WHO is in the room Under 18 months: no screens best, except for video-chat 15 months – 2 years: avoid solo media use 2-5 years: no more than 1 hours/day with caregiver participation (co-viewing) American Academy of Pediatrics ifts ‘No Screens Under 2 Rule’. NPR Morning Edition. http://www.npr.org/sections/ed/2016/10/21/498550475/american-academy-of-pediatrics-lifts-no-screens-under-2-rule

https://www. healthychildren https://www.healthychildren.org/English/family-life/Media/Pages/Healthy-Digital-Media-Use-Habits-for-Babies-Toddlers-Preschoolers.aspx

Tips for Managing Tech Time to Prioritize Communication … Creating a “Digital Diet”

Create Tech-Free Times 1-2 opportunities/day Mealtime is a prime opportunity Check devices at the kitchen door

Resist overreliance on technology to pacify boredom Half of parents of 0-3 year olds use technology to entertain their children

Don’t overestimate the value of educational apps Children learn best by talking, conversing & reading Technology is best used for reinforcement and practice, not teaching Choose quality apps

The C’s of Choosing Child Media Content Context Child

Make tech use a group activity Play/interact jointly Talk about what you are doing

Consider whether young children really need their own devices Many designed & marketed for kids May lead to more solitary tech time BUT, may have limited child-appropriate content and extra security

Set daily time limits Program devices to shut off Keep track yourself

Be consistent in enforcing parameters you set for tech use Majority do this, but don’t stick to it Adherence seems to break down around ages 7 or 8

Always practice safe listening, especially when using ear buds or headphones Misuse can lead to noise-induced hearing loss Even minor loss impacts academics, social, vocational and other areas Keep volume down (good guide is half volume) Take frequent listening breaks

Model the tech habits you want your kids to adopt Practice what you preach in Tech time Safe-listening

Learn the signs of communication disorders Regardless of technology use Early treatment can prevent or reverse Don’t wait for child to ‘outgrow’ problem Seek help from a speech-language pathologist or audiologist

Additional Suggestions for Managing Screen Time Remove TV or computer from bedroom DO NOT allow TV during meals or homework DO NOT let child eat while watching TV or using the computer DO NOT use the TV for background noise. Use radio or no noise. Decide which TV programs to watch ahead of time. Turn the TV off when the programs are over. Medline https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000355.htm

Additional Suggestions (cont.) Suggest other activities: board games, puzzles, walk, outdoor activities Record how much time is spent in front of a screen – spend an equal amount of time being active Try using a sleep function so TV turns off automatically Challenge family to go 1 week without TV or other screen activities Avoid exposure to devices or screens 1 hour before bedtime Avoid using media as the only way to calm your children Develop a Family Media Use Plan for you and your family

Family Media Use Plan https://www.healthychildren.org/English/media/Pages/default.aspx

Implementing the new Guidelines: Effective Use of Technology

Technology for Children Should… “Be designed to meet the developmental age and needs of the young child” (p. 1) Have content that supports development of cognition, physical motor, social/emotional and academic areas “Have digital interactions engage children in activities that foster optimal developmental assets” (p. 1) Positive Technological Development for Young Children in the Context of Children’s Mobile Apps (Chau, C., 2014)

Infants and Toddlers Technology tools that infants and toddlers might use must be safe, sturdy, and not easily damaged. Allow children to explore digital materials in the context of human interactions, with an adult as mediator and co-player. Avoid passive screen time. Provide children with toy representations of digital objects to encourage toddlers to begin pretending about the ways in which others use technology (National Association for the Education of Young Children - NAEYC)

Preschool and Kindergarten Provide an outlet for creativity Freely explore touch screens loaded with a wide variety of developmentally appropriate interactive media experiences Begin to explore and feel comfortable using “traditional” mouse and keyboard computers. Capture and replay photos or videos of block buildings, art work or dramatic play that children have created. (NAEYC Documents)

Celebrate children’s accomplishments with digital displays. Record children’s stories about their drawings or their play. Explore digital storytelling with children. Share e-books. Use video conferencing software to communicate with families and children in other places. Set up play experiences for children to construct and explore their ideas about how technology works. (NAEYC Documents)

Selecting Technology for Children with Disabilities What skills/needs can the technology assist– ENDLESS!!! SO BEWARE !!!!!!! What is the purpose of the technology Communication Language development Literacy Academics

Mills, 2016

One More Word: Rules for Using Technology The device is not a toy Teach respect for the device If your child already has a device, you might change the color of the cover when it is to be used for communication or language LIMIT the time with a device Ensure that TECH time does not replace TALK time

Questions??

References Duch, H., Fisher, E., Ensari, I., & Harrington, A. (2013) Screen time use in children under 3 years old: A systematic review of the correlates. International Journal of Behavioral Nutrition and Physical Activity. DOI: 10.1186/1479-5868-10-102 Kourlaba, G., Kondaki, K., Liarigkovinos, T., & Manios, Y. (2009). Factors associated with television viewing time in toddlers and preschoolers in Greece: The GENESIS study. Journal of Public Health. DOI: 10.1093/pubmed/fdp011 Mills, C.B. (2016). The Effect of Digital Media on Emergent Literacy Skills: A Systematic Review. (Unpublished thesis). University of Kentucky, Lexington. Page, J.L. (2015, May 8). Babies Don’t Need Smart Phones. USA Today. Page, J.L. (2015, May 8). ASHA President Judith Page: Healthy Use of Technology for Children. Public Health Newswire, American Public Health Association. Page, J.L. (2015, May). Keeping Tech Time in Check During the Critical Developmental Years for Children. Speak Now for Kids, Children’s Hospital Association. Schmidt, M., Haines, J., O’Brien, A., McDonald, J., Price, S., Sherry, B., & Taveras, E. (2012). Systematic review of effective strategies for reducing screen time among young children. Obesity: A Research Journal. DOI: 10.1038/oby.2011.348 Shapiro, J. (2015). The American Academy of Pediatrics just changed their guidelines on kids and screen time. Forbes. Retrieved August 16, 2016 from http://www.forbes.com/sites/jordanshapiro/2015/09/30/the-american-academy-of-pediatrics-just-changed-their-guidelines-on-kids-and-screen-time/#105f655a137c Sweetser, Penelope; Johnson, Daniel; Ozdowska, Anne and Wyeth, Peta. Active versus passive screen time for young children [online]. Australasian Journal of Early Childhood, Vol. 37, No. 4, Dec 2012: 94-98. Availability: < http://search.informit.com.au/documentSummary;dn=062087616247198;res=IELAPA> ISSN: 1836-9391. [cited 13 Aug 16 Vandewater, E., Rideouit, E., Wartella, E.., Huang, X, Lee, J., & Shim, M. (2006). Digital childhood: Electronic media and technology use among infants, toddlers, and preschoolers. DOI: 10.1542/peds.2006-1804