1. 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

2. 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

3. 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.

4. 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.

5. Technology at the Table

6. 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.

7. 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.

8. Today’s ‘Connected’ Family

9. 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)

10. 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

11. 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)

12. 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

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

14. 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

15. 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

16. 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!

17. 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)

18. 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.

19. 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

20. 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):

21. 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

22. 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.

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

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

25. 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

26. 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

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

28. 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

29. 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

30. 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.
The Atlantic (2013, September) Discovering that your 18-month-old is using an iPad in Preschool.

31. 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: /cdev.12166

32. 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.

33. https://www. healthychildren

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

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

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

37. 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

39. The C’s of Choosing Child Media
Content
Context
Child

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

41. 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

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

43. 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

44. 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

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

46. 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

47. 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

48. 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

49. Family Media Use Plan

50. Implementing the new Guidelines: Effective Use of Technology

51. 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)

52. 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)

53. 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)

54. 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)

55. 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

56. Mills, 2016

57. 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

58. Questions??

59. 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: / 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: /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: /oby Shapiro, J. (2015). The American Academy of Pediatrics just changed their guidelines on kids and screen time. Forbes. Retrieved August 16, 2016 from 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: Availability: < ISSN: [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: /peds