Link to full text: https://www.nature.com/articles/s41390-020-0765-1
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Download the full text: Hutton_2020_A novel, composite measure of screen-based media use in young children (ScreenQ) and associations with parenting practices and cognitive abilities
study descriptionPsychometric assessment.
core topic(s)Early Literacy
Exposures, Outcomes, OtherChild Behaviors and Skills , Home Language/Literacy/Learning Environment , Implementation and Evaluation , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs , Screening and Tools , Technology and Digital/Screen-Based Media , Validity, Reliability, Feasibility, and Acceptability
metric(s)Expressive Vocabulary Test (EVT)
Comprehensive Test of Phonological Processing (CTOPP)
Get Ready to Read! (GRTR)
StimQ Cognitive Home Environment Questionnaire (StimQ)
objectivesThe aim of this study was to test the ScreenQ, a composite measure of screen-based media use.
outcomes evaluatedScreen based media use and psychometric properties of the ScreenQ.
settingA large children’s medical center and local pediatric primary care clinics.
methodsScreenQ is a 15-item parent report measure reflecting AAP recommendations. Range is 0–26, higher scores reflecting greater non-adherence. With no “gold standard” available, four validated measures of skills and parenting practices cited as influenced by overuse were applied as the external criteria, including expressive language, speed of processing, emergent literacy, and cognitive stimulation at home. Psychometric analyses involved Rasch methods and Spearman’s ρ correlations.
sample sizen=69 (families)
ScreenQ Measure: derived from aspects of media use cited in current AAP recommendations:
- access to screens
- frequency of use
- media content
- caregiver–child coviewing
Reference Measures: Four criterion-referenced standards of child cognitive abilities and parenting practices were utilized, which were selected on the basis of cited associations with screen-based media use in children:
- EVT-2 (Pearson) is a norm-referenced assessment of expressive vocabulary for children of age 2.5 years and older.
- CTOPP-2 (Pearson; Rapid Object Naming subtest) is a comprehensive, norm-referenced instrument designed to assess phonological processing abilities as prerequisites to reading fluency in children.
- GRTR is a norm-referenced assessment of core emergent literacy skills for children 3–6 years of age, predictive of reading outcomes.
- StimQ-P is a validated measure of cognitive stimulation in the home for children 3 to 6 years old, and consists of four subscales involving mostly “yes/no” questions: (1) availability of learning materials, (2) reading, (3) parental involvement in developmental advance, and (4) parental verbal responsivity.
resultsSixty-nine families were administered ScreenQ. Child age ranged from 36 to 63 months old (52 ± 8; 35 girls). Mean ScreenQ score was 9.6 (±5.0; 1–22). Psychometric properties were strong (rCo-α = 0.74). ScreenQ scores were negatively correlated with CTOPP-2 (Comprehensive Test of Phonological Processing, Second Edition) (rρ = −0.57), EVT-2 (Expressive Vocabulary Test, Second Edition) (rρ = −0.45), GRTR (Get Ready to Read!) (rρ = −0.30) and StimQ-P (rρ = −0.42) scores (all p ≤ 0.01).
conclusionsScreenQ shows potential as a composite measure of screen-based media use in young children in the context of AAP recommendations. ScreenQ scores were correlated with lower executive, language and literacy skills, and less stimulating home cognitive environment.
limitationsWhile reasonably diverse, our sample size was relatively small, and our results may not be generalizable to larger populations or groups, such as other ethnicities or fathers. Our study involved a relatively narrow age range (3–5 years old); yet, this span is formative in terms of child development and viewing habits, and media use tends to increase with age, particularly for entertainment.1,30 Further study involving wider age ranges would also be worthwhile. All children scored average or better on the EVT-2, and it is unclear if a negative correlation with ScreenQ scores would apply in children with lower language abilities, although we believe that they could be even stronger. External standards were chosen in the context of cited negative effects of screen-based media, and may not adequately identify potential benefits. Like all parent report measures, ScreenQ is subject to social desirability bias, and comparison with direct observation would be useful to quantify such bias and provide an objective external criterion, although this was not feasible within the confines of this study and is planned as an important next step. ScreenQ development did not involve rigorous qualitative methods such as focus groups, although items were pilot tested for clarity with families in clinical settings across versions and no parental concerns during this study were noted. While most items performed well, one (educational content) was removed due to negative correlation with total ScreenQ score and concerns that this was attributable to unclear wording. As educational content is stressed in AAP recommendations3 and germane to our conceptual model (although “educational” claims can be misleading9,37), this item will be revised for a future version. ScreenQ was administered by research coordinators and feasibility for clinical use is uncertain, although with simple reading level and brief administration time, we believe that it could be adapted for parents to complete during a well visit. Most importantly, while this study offers a respectable first step towards validation in the preschool-age range, more extensive, longitudinal studies including an objective screen time criterion are needed.