Early Literacy Research Library (ELRL) - Article

Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children

Hutton, J.S., Dudley, J., Horowitz-Kraus, T., DeWitt, T., Holland, S.K. (2020) Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children. JAMA Pediatrics, 174(1), e193869.,

Access: FREE/Open Access

Publication year


study description

Cross-sectional study.

core topic(s)

Early Literacy

Population Characteristics


Exposures, Outcomes, Other

Brain/Neurocognitive , Child Development (general) , Language and Literacy Development , Technology and Digital/Screen-Based Media


To explore the associations between screen-based media use and integrity of brain white matter tracts supporting language and literacy skills in preschool-aged children.


Screen based media use.

outcomes evaluated

Brain tracts supporting language and emergent literacy skills.


Healthy children aged 3 to 5 years (n = 47) from August 2017 to November 2018 recruited at a US children's hospital and community primary care clinics.


Children completed cognitive testing followed by diffusion tensor imaging (DTI), and their parent completed a ScreenQ survey.

sample size

n=47 (children)


Measure of Screen Based Media Use: ScreenQ, is a 15-item measure of screen-based media use reflecting the domains in the AAP recommendations (access to screens, frequency of use, content viewed, and coviewing). Higher scores reflect greater use).


Measure of Controls (for child age and household income): Comprehensive Test of Phonological Processing, Second Edition (CTOPP-2; Rapid Object Naming subtest); Expressive Vocabulary Test, Second Edition (EVT-2; expressive language); and Get Ready to Read! (GRTR; emergent literacy skills).


Measure of Neural Networks: DTI (Diffusion Tensor Imaging) including fractional anisotropy (FA) and radial diffusivity (RD), which estimated microstructural organization and myelination of white matter tracts supporting language and emergent literacy abilities.


Of the 69 children recruited, 47 (among whom 27 [57%] were girls, and the mean [SD] age was 54.3 [7.5] months) completed DTI. Mean (SD; range) ScreenQ score was 8.6 (4.8; 1-19) points. Mean (SD; range) CTOPP-2 score was 9.4 (3.3; 2-15) points, EVT-2 score was 113.1 (16.6; 88-144) points, and GRTR score was 19.0 (5.9; 5-25) points. ScreenQ scores were negatively correlated with EVT-2 (F2,43 = 5.14; R2 = 0.19; P < .01), CTOPP-2 (F2,35 = 6.64; R2 = 0.28; P < .01), and GRTR (F2,44 = 17.08; R2 = 0.44; P < .01) scores, controlling for child age. Higher ScreenQ scores were correlated with lower FA and higher RD in tracts involved with language, executive function, and emergent literacy abilities (P < .05, familywise error-corrected), controlling for child age and household income.


This study found an association between increased screen-based media use, compared with the AAP guidelines, and lower microstructural integrity of brain white matter tracts supporting language and emergent literacy skills in prekindergarten children. The findings suggest further study is needed, particularly during the rapid early stages of brain development.


The sample largely comprised families with high socioeconomic status, yet household income was accounted for in the DTI analyses. Associations between ScreenQ survey and cognitive testing scores did not meet the threshold for statistical significance when income was included in the model, which may be associated with the moderate collinearity between income level and ScreenQ scores that negatively affected statistical power, particularly given the small sample size. Both behavioral and DTI findings may have been even more robust in families with higher socioeconomic status compared with families with lower socioeconomic status, for whom language, literacy, and other cognitive disparities are well documented.