Karen Heffler, MD, takes viewers on a comprehensive exploration of the relationship between early-life screen time exposure and autism risk. She delves into the intricate interplay of genetics, environmental factors, and development outcomes. The presentation highlights critical findings about screen time, social engagement, and autism symptoms. Heffler considers the potential consequences of screen media on young children’s development and discusses promising new intervention studies.

Printable handouts of the slides (pdf) are online HERE

A list of references from the talk (pdf) are online HERE

In this webinar: 

0:00 – Presenter introduction
3:40 – Background and positive developmental predictors
7:30 – Screen time and social experiences
9:20 – Video and television learning (Video deficit)
11:55 – Developmental outcome associated with early TV/Screen media viewing
13:25 – Brain differences in autism
16:48 – Brain plasticity, social development, and screen time
18:34 – Autism risk factors
21:35 – Study 1 – Association of early-life social and digital media experiences with the development of ASD-like symptoms
26:50 – Study strengths and limitations
28:20 – Literature review on early-life screen time and autism association studies
29:56 – Study 2 – Screen media and social intervention in autism: a 6-month pilot study
36:30 – Study strengths and limitations
37:54 – Literature review on intervention studies
39:12 – Case reports of interest
41:46 – Drivers and mechanisms of association of early-life screen time with autism
43:53 – Summary and next steps
45:45 – Q & A


Autism risk is affected by both genetics and modifiable environmental factors such as verbal stimulation, parental responsiveness, and parental involvement in play (3:42). These factors have been linked to positive developmental and social outcomes, emphasizing the importance of early nurturing experiences (5:25). Conversely, Heffler explains, screen media is related to diminished parental responsiveness, hindered language development, and less toy play, all of which may contribute to adverse developmental outcomes (7:30)

As defined in this presentation, screen time encompasses TV, video, gaming, mobile apps with viewing on tablets or smartphones, and some electronic toys. The presenter highlights that video chatting with family and friends is social and considered differently (20:55). Research indicates that children do not learn well from screens as pre-recorded videos are not socially responsive to the child’s actions. Some developmental outcomes associated with early TV/screen media viewing include language delay, attention problems, executive function difficulties, and disorganization in the white matter of the brain (11:55). Joint attention, or when a child looks back and forth between an adult’s eyes and an object of interest, does predict learning (9:20)

Brain development and plasticity

The presenter discusses differences in autistic brains and underscores the high correlation between superior auditory and visual processing abilities and autism. She notes, however, that this does not necessarily convey good overall brain function (13:20). Some abilities have been linked to autism symptom severity, and other developmental differences predict whole brain overgrowth and/or autism development (15:16). 

Brain plasticity is how the brain responds to one’s experiences, and brain connections are formed based on those experiences and responses. Social factors like eyes, voices, and smiles naturally react to young children and promote the development of social brain pathways. Contrastingly, non-social factors, like screens and electronics, likely promote highly sensory-oriented brain connectivity due to their lack of natural social features (16:48).  

Risk factors and recommendations

Heffler outlines a study that found early-life social experiences and early-life screen time are two important risk factors for autism. The study found that infants with autism traits who were exposed to both screen time and social training from their parents are less likely to develop autism (18:34). She explains that high-screen viewing is concerning in early life because electronic media distracts the child from people and distracts the parents/caregivers from the child, both of which may directly affect brain connectivity and attention mechanisms in autism. Heffler and her colleagues recommend no screen viewing before 18-24 months of age and no more than one hour of screen time per day through age five (20:20).

Drexel Studies

Study 1: Association of early-life social and digital media experiences with the development of ASD-like symptoms 

Using parental report data from the National Children’s Study, researchers investigated the association between TV/DVD exposure and social experiences on autism symptoms. Findings suggested that higher screen time (4 or more hours per day) correlated with an increased risk of autism symptoms at 12 months and two years of age and that autistic children reported more screen time (21:35). Researchers also found that when parents play with the child less than daily at 12 months, there was an 8.9% increase in autism symptoms. Screen exposure at 12 months was also associated with a 4.2% increase (24:15).

Study 2: A literature review on early-life screentime and autism association studies

Heffler defines the parameters of the literature review and discusses critical findings: Greater daily screentime was associated with autism diagnosis (9 studies), autism symptoms (7 studies), and symptom severity (4 studies). Similarly, earlier first screen-viewing was associated with autism diagnosis and symptoms, and less parent-child interaction was also associated with autism risk and severity (28:20)

Study 3 – Screen media and social intervention in autism: a 6-month pilot study

In collaboration with Lori Frome, Dr. Heffler developed a parent training program to reduce screen time and enhance social engagement, particularly for young children with autism and high media exposure (29:56). The program was implemented over six months and included instruction on digital media and child development, parent-child interactions, and poor screen learning. Parents received weekly, 1-hour, in-home support and were encouraged to involve children in family routines like laundry and cleaning to support social and learning development (32:05)

Results showed a significant reduction in screen time, from 5.6 hours per day to five minutes a day, over six months. There was also a 23% reduction in core autism symptoms and a 19% increase in adaptive behavior function (did not quite reach significance) (34:20). Parental stress declined by 37% (large effect size), and positive feedback indicated awareness and improvements in social and developmental outcomes. Heffler notes that changes in child behavior began almost immediately, which made it easier for parents to cut screen time and interact with their children (36:00)

Study 4: A literature review on intervention studies

This review considered six studies, five of which included parent training on social engagement and screen time reduction; these five studies pointed to a correlation between reducing screen time to less than one hour per day and a statistically significant decrease in autism symptoms. Similarly, more than one hour of screen time per day negatively affected therapeutic outcomes. Overall, improvement correlated with screen time reduction, parent stress was significantly improved, and in one study, EEG patterns also improved (37:54). 

The speaker discusses the strengths and limitations of each study.

Case reports and summary

The speaker outlines three case reports that further demonstrate the positive impact of minimizing screentime during early development, including one where autism symptoms entirely resolved in 4 months after eliminating screens (39:12). Heffler reiterates the potential impact of reduced screentime on autism symptom development and lists driving factors and mechanisms of this association (41:46). The speaker highlights the difference between association and causation, noting that all studies presented show associations

She summarizes the presentation by reiterating the main findings and suggestions:

  • More screen time in the first year of life is associated with the development of autism and autism symptoms. 
  • Early-life parent-child social engagement is associated with a decreased risk of autism development.
  • Interventions, including screen time reduction and parental support for social engagement, are associated with a rapid decrease in autism symptoms in children with high screen viewing.

Researchers assert the need for randomized controlled trials, measures of gene-environment interactions, and community-based parent education studies in the future (44:58). Heffler also urges viewers to help raise awareness of these findings among parents of young children and across healthcare providers, government agencies, and everyone in between. She provides thanks before the Q&A (45:45)

The speaker:

Karen F. Heffler, MD is a researcher in the Department of Psychiatry, Drexel University College of Medicine, with primary interest in modifiable risk factors and early childhood development. She completed her medical school and residency training at the University of Pennsylvania, and she began her career as an ophthalmologist. Over a decade ago, she changed focus and began to participate in research involving early childhood development and autism. The rising rates of autism and her own son’s diagnosis of autism spectrum disorder impacted this decision.

Her review of the literature on autism, parent-child interactions, effects of digital media on social interaction, early post-natal brain development, neuroplasticity, and brain development in autism informs her research.  Along with colleagues at Drexel, she researches experiential factors including early digital media use, social experiences, and developmental outcomes. Her group published the first prospective study to show the association between early-life digital media exposure and subsequent autism-like symptoms.

Dr. Heffler and her colleague Lori Frome M.Ed. developed a parent training program on digital media, social interaction, and child development, studying the potential benefit of screen reduction with focus on social engagement in young children with autism and high media exposure. Dr. Heffler speaks at national and international child development and research conferences, and regularly provides talks to pediatricians, psychiatrists, and early-intervention provider groups. Dr. Heffler and her research colleagues have significantly contributed to the early childhood development and autism literature with many publications.

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