Frontiers in pediatrics · 2026
Screen time and attention-deficit/hyperactivity disorder in children: a systematic review and meta-analysis.
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Zhao Caihong, Xu Jing, Wu Xirui, Li Yufen
Аннотация
BACKGROUND: Children's exposure to electronic screens has risen sharply. This study quantitatively evaluated the association between excessive screen time and childhood attention-deficit/hyperactivity disorder (ADHD) risk through a systematic review and meta-analysis, exploring the moderating roles of age and media type.
METHODS: Following PRISMA guidelines, we systematically searched observational studies assessing children's screen time and ADHD, and finally included 10 observational studies with overall low-to-moderate risk of bias. Risk of bias was evaluated using the ROBINS-I tool. Continuous data were unified using the Chinn conversion rule. A DerSimonian-Laird random-effects model calculated pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses, leave-one-out sensitivity analyses, and Begg's and Egger's tests were also conducted.
RESULTS: Excessive screen time was significantly associated with elevated childhood ADHD risk (pooled OR = 1.56, 95% CI: 1.31-1.87, P < 0.001). Substantial between-study heterogeneity was observed (Q = 344.51, I2 = 97.4%, P < 0.001). Subgroup analyses revealed significant age-related heterogeneity: preschoolers (0-6 years) showed a larger magnitude of association (OR = 2.40, 95% CI: 1.44-3.98), whereas the association in school-age children and adolescents (>6 years) was of smaller magnitude (OR = 1.16, 95% CI: 1.05-1.29). Passive TV/video viewing showed a higher point estimate of ADHD risk (OR = 2.20) than interactive digital media (OR = 1.10), but the between-group difference did not reach statistical significance. Sensitivity analyses confirmed the robustness of these findings.
CONCLUSIONS: Excessive screen exposure is significantly associated with elevated ADHD risk in children, with distinct age-specific and media type-specific patterns. The preschool period appears to be a high-risk window for screen-related neurodevelopmental effects, with a trend toward stronger association for passive screen exposure. Public health and clinical interventions should prioritize restricting early screen exposure, particularly passive, fast-paced videos without substantial interaction.
METHODS: Following PRISMA guidelines, we systematically searched observational studies assessing children's screen time and ADHD, and finally included 10 observational studies with overall low-to-moderate risk of bias. Risk of bias was evaluated using the ROBINS-I tool. Continuous data were unified using the Chinn conversion rule. A DerSimonian-Laird random-effects model calculated pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses, leave-one-out sensitivity analyses, and Begg's and Egger's tests were also conducted.
RESULTS: Excessive screen time was significantly associated with elevated childhood ADHD risk (pooled OR = 1.56, 95% CI: 1.31-1.87, P < 0.001). Substantial between-study heterogeneity was observed (Q = 344.51, I2 = 97.4%, P < 0.001). Subgroup analyses revealed significant age-related heterogeneity: preschoolers (0-6 years) showed a larger magnitude of association (OR = 2.40, 95% CI: 1.44-3.98), whereas the association in school-age children and adolescents (>6 years) was of smaller magnitude (OR = 1.16, 95% CI: 1.05-1.29). Passive TV/video viewing showed a higher point estimate of ADHD risk (OR = 2.20) than interactive digital media (OR = 1.10), but the between-group difference did not reach statistical significance. Sensitivity analyses confirmed the robustness of these findings.
CONCLUSIONS: Excessive screen exposure is significantly associated with elevated ADHD risk in children, with distinct age-specific and media type-specific patterns. The preschool period appears to be a high-risk window for screen-related neurodevelopmental effects, with a trend toward stronger association for passive screen exposure. Public health and clinical interventions should prioritize restricting early screen exposure, particularly passive, fast-paced videos without substantial interaction.