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PLOS One logoLink to PLOS One
. 2024 Dec 26;19(12):e0314540. doi: 10.1371/journal.pone.0314540

Examining the relationship between language development, executive function, and screen time: A systematic review

Mazhar Bal 1, Ayşe Gül Kara Aydemir 2,*, Gülüzar Şule Tepetaş Cengiz 3, Ahmet Altındağ 4
Editor: Alexander Röhm5
PMCID: PMC11670964  PMID: 39724067

Abstract

This systematic review study examines the relationship between language development, executive function, and screen time in early childhood. The early childhood period is a crucial phase for the development of the brain, during which fundamental language and executive function skills undergo rapid evolution. This review synthesizes findings from 14 peer-reviewed studies that focused on language development, executive function, and screen time together to provide a comprehensive understanding of their relationship. The findings of current study were categorized under four themes: screen content and adherence to guidelines, parent-child interaction and the family context, passive and active screen time, and attention issues. The findings suggest that interactive and educational screen content may positively influence language development and executive functions when aligned with recommended screen time guidelines. In contrast, excessive passive screen time, such as watching television, has been associated with negative impacts on cognitive and social skills, particularly affecting attention, memory, and emotional regulation. The prevalence of attention problems is found to be higher in individuals who engage in high levels of screen time. This highlights the necessity for balanced consumption of screen media. The review emphasizes the pivotal role of parent-child interaction, where high-quality engagement and verbal scaffolding during screen time can mitigate adverse effects. Furthermore, socioeconomic and cultural factors also play a significant role. Higher socioeconomic status (SES) families are better able to manage screen time and leverage educational content to support development. These findings have the potential to inform the actions of parents, educators, and policymakers. Adherence to recommended screen time guidelines can mitigate the potential negative impact on executive functions and language skills. Furthermore, the importance of limiting passive screen time and ensuring a balance between screen use and real-world interactions and play opportunities is also highlighted.

Introduction

The early childhood period (0–78 months), extending from birth to preschool years, represents a critical phase in language development. During this age range, children rapidly acquire fundamental language skills, beginning with comprehension and expression capabilities, gradually progressing to sentence construction and understanding structural rules of language [1, 2]. This developmental process significantly influences not only linguistic abilities but also social, emotional, and cognitive development [3, 4].

Examining the theoretical foundations of language development, Piaget’s cognitive development theory and Vygotsky’s sociocultural approach are closely associated with the developmental characteristics of children aged 0–78 months. While Piaget emphasized the critical role of language skills in developing thinking, problem-solving, and analytical abilities during this age range [5, 6], Vygotsky highlighted the importance of language in social interaction, emphasizing its role in developing communication and emotional bonds [7, 8]. Furthermore, language functions as a crucial tool in children’s cultural identity formation and environmental interpretation during this early period [9, 10].

Contemporary neurobiological research reveals a strong connection between language processing and executive functions (EF) during early childhood (0–78 months) [11, 12]. Language development plays a crucial role in shaping children’s cognitive processes and expressing thoughts [13, 14]. Executive functions are critical in developing language abilities and interpreting complex linguistic structures [15–20]. During this critical developmental period, executive functions encompass higher-order cognitive abilities such as planning, goal setting, problem-solving, and memory, essential for regulating thought processes [21, 22]. Studies indicate that executive functions and language development mutually reinforce each other during this age range [23, 24].

Screen time can both positively and negatively impact language and cognitive development in children aged 0–78 months [25, 26]. While excessive screen time may delay language acquisition [27], moderate screen use with educational content and parental guidance can support language development and certain executive functions [28, 29]. There are varying interpretations regarding the definition and effects of screen time [30]. Given these mixed results, understanding this relationship is crucial for maximizing benefits while minimizing risks [31–33]. According to the World Health Organization, screen time refers to passive exposure to screen-based entertainment [34]. It is commonly defined as time spent accessing media through various devices, including television, mobile phones, DVDs, computers, and video games [35]. Research indicates that screen media has become a regular part of daily routines, particularly for children under 36 months [36, 37], with screen use frequency increasing for children aged 18–36 months [38]. Findings regarding screen use effects in this age group are contradictory. While some studies demonstrate potential benefits from educational content and moderate use [39–42], others reveal negative impacts on attention, working memory, and problem-solving skills, particularly with prolonged use [43–46]. Bukhalenkova and Almazova [46] conducted a study involving 772 mothers of children aged 5–6 and examined the relationship between active screen time factors such as time spent playing computer games and parental involvement in children’s computer games, concluded that long-term screen use limits children’s creativity and problem-solving skills. Involving 106 parents (aged 18 years or older) of children between 0 and 4 years residing in Australia, Halpin and their colleagues [47] argued that long-term screen use weakens children’s time management skills. Furthermore, prolonged screen exposure has been demonstrated to negatively affect children’s ability to focus and plan tasks [48], as well as their capacity to recognize and regulate their emotions [49]. McArthur, Tough & Madigan [50] involved 1994 mothers and their children in Calgary, Canada, they evaluated children’s screen time, behavior problems, developmental milestones, and vocabulary acquisition at 36 months based on maternal reports.

Systematic reviews and meta-analyses have extensively examined the impact of screen time on child development in the 0–78-month age range. While Jing et al. [51] focused on screen media exposure and vocabulary development, McHarg et al. [52] and Likhitweerawong et al. [29] investigated the relationship between screen time and executive functions. Bustamante et al. [53] conducted a meta-analysis examining the impact of screen time on executive functions in children under 6 years, revealing the complex nature of this relationship. Li et al. [54] provided a broader perspective through their meta-analysis of early childhood screen use and health indicators. Shokrkon and Nicoladis [17], in their literature review examining the directionality between executive functions and language skills, emphasized the complexity of this bidirectional relationship, though they did not address the role of screen time in this interaction. Building on these foundations, several recent studies have further investigated specific aspects of screen time’s impact. Ponti [55], in a comprehensive review for the Canadian Pediatric Society, examined how digital media affects child development, emphasizing the need for age-appropriate content and guided interaction. Jannesar et al. [56], in their scoping review of screen time’s effects on children’s brain development, highlighted the importance of neurological impacts but did not specifically examine the interaction between language development and executive functions. Panjeti-Madan and Ranganathan [57] provided a detailed analysis of screen time’s impact on multiple developmental domains, including cognitive, language, physical, and social-emotional areas, but did not specifically examine the interrelationship between these domains. Regarding language development specifically, Bhutani et al. [58] conducted a scoping study examining how screen time affects children’s language development. Oktarina et al. [59] systematically reviewed the relationship between screen time and children’s language development, demonstrating how this relationship varies by age, content, and parental involvement. Their findings indicate a complex relationship mediated by multiple factors, though they did not investigate the role of executive functions in this relationship. Gowenlock et al. [60] further contributed to this understanding through their comprehensive review of video exposure’s impact on language development in children aged 3–11 years, emphasizing the importance of content quality and interaction patterns. Additionally, Aziz et al. [61] provided valuable insights in their study examining screen exposure’s impact on language development among toddlers and preschoolers, emphasizing the need for controlled screen time and quality content.

Understanding the complex interaction between screen time, language development, and executive functions is critically important, particularly for children aged 0–78 months. While existing literature has typically examined these three factors in the context of binary relationships, their trilateral interaction remains insufficiently addressed, representing a significant research gap. This systematic review aims to fill this gap by synthesizing current evidence regarding the relationship between screen time and language development and executive functions in early childhood (0–78 months). The study’s findings will provide evidence-based guidance to parents and educators regarding optimal screen time use while contributing to the development of scientifically based guidelines for technology integration in preschool educational institutions. Another significant aspect of the study is providing evidence-based data needed for developing educational policies regarding technology use in early childhood. This data will enable the development of strategies that maximize positive effects while minimizing negative impacts of screen use.

Purpose of the study and the research questions

Although technology has many benefits and risks that can negatively affect children, completely excluding today’s children from the use of technology is like neglecting to teach an island child how to swim. It is of critical importance to understand the complex relationship between screen time, language development, and executive functions in early childhood in the context of the digital age. Given the virtual possibility of children interacting with technology, it is imperative for parents, caregivers, and teachers to be aware of potential consequences of technology on children’s development, and to act responsibly. Mantilla and Edwards [62] noted that digital technology has now become and is accepted as an integral part of young children’s daily life; setting from this point the way it is utilized by and with young children play a pivotal role in their well-being, safety, communication, and learning. This study is significant in terms of addressing the gap between cognitive psychology and the impact of technology on child development. The early childhood period is a critical period for brain development, during which basic language and executive function skills rapidly develop. Excessive screen time, which often replaces interactive and stimulating activities, has been shown to negatively affect these developmental processes [36, 53, 63, 64]. In contrast, purposeful and controlled screen time could support cognitive growth if appropriately integrated into educational frameworks [65, 66]. Given the pervasiveness of digital technology in the lives of young children, this research attempts to address the relationship between language development, executive function, and screen time by synthesizing existing findings from the literature to provide a comprehensive understanding of how these interactions influence developmental outcomes. The objective of this study is to present implications for parents, educators, and policy makers regarding the potential risks and benefits associated with the use of digital media. The findings can inform the development of balanced media consumption guidelines and interventions designed to support healthy development. The findings of this study are expected to contribute to the formulation of strategies that leverage the educational potential of technology while mitigating its adverse effects on the cognitive and language development of young children. The study’s focused examination of the relationship between language development, executive functions, and screen time renders it both timely and important. Consequently, the interplay among these three elements has been subjected to a comprehensive analysis. Accordingly, the overarching research question guiding the current study is formulated as below:

What is the relationship between screen time, language development, and executive functions in children aged 0–78 months as reported in the present research literature?

Materials and methods

This study applied the principles of the PRISMA statement [67]. Additionally, the researchers used the CONSORT checklist adapted by Angosto, García-Fernández, Valantine, and Grimaldi-Puyana [68] to assess the reporting quality of the selected studies. The dataset used in this study is provided as S1 File. It is an Excel file containing all the necessary data to replicate the analyses and findings presented in this manuscript. The PRISMA checklist used in this study is provided as S2 File and outlines compliance with PRISMA guidelines. Both files have been deposited in the Open Science Framework (OSF) as supporting information. They can be accessed via the following link: https://osf.io/n7uc6/?view_only=8987e34f20da40ddba6c6c7c7009e84d.

Search strategy

There were no restrictions on the search timeframe. A comprehensive search was conducted until October 1, 2023, for studies completed up to that date. To locate articles for systematic review, the researchers concentrated on studies published in English language, in journals indexed in a variety of databases, including Web of Science, Scopus, Education Resources Information Center (ERIC), EBSCO, and PubMed. In the preliminary search, experts employed specific keywords. The keywords used in the systematic search included "Language Development," "Language Skill," "Language Teaching," "Language Education," "Executive Function," "Screen Time," "Children," "Pre-school Children," and "Early Childhood." These terms were combined using "AND" and "OR" conjunctions, and the population of interest was limited to preschool-aged children. The term “screen time” is used since it encapsulates a broad spectrum of devices (e.g., computers, televisions, phones) and their diverse uses (e.g., gaming, social communication) [69]. Our search strategy was designed to capture studies that fall within this expansive scope, assessing the impact of “screen time” on children’s language development and executive functions. We used the term “screen time” to focus on the duration of engagement with electronic devices. This term is expected to encompass much of the extensive literature in this domain due to its representation of the time spent using electronic devices.

Eligibility criteria

This systematic review examines all peer-reviewed empirical studies that specifically investigate the relationship between executive function, language development, and screen time during early childhood. Inclusion and exclusion criteria were established for the selection of studies to ensure that the identified articles were relevant to the purpose of the study. Duplicate studies were excluded. Table 1 presents the criteria in detail.

Table 1. Inclusion and exclusion criteria.

Category Inclusion criteria Exclusion criteria
Participants Studies included children ranging in age from 0 to 78 months. The studies included participants who were not in the early childhood age range.
Context Studies focused on research on early childhood. Studies that examine the relationship between language development, screen time, and executive function. Studies not addressing the relationship between language development, screen time and executive function in early childhood.
Study design Original articles, qualitative studies, quantitative studies, mixed methods studies. Book chapters, systematic reviews, scoping reviews, meta-analysis.
Language English Languages other than English
Keyword combinations "Language Development” OR "Language Skill" OR "Language Teaching" OR "Language Education" AND "Screen Time" AND "Executive Function" "Children" OR "Pre-school Children" OR "Early Childhood" Studies not containing the specified keyword combinations.

The article selection process took place in two stages. The first stage involved screening studies based on titles, abstracts, and full texts. Two experts (MB and AGKA) independently conducted the selection and screening process, being unaware of each other’s decisions. The second stage involved a thorough review of the selected articles to ensure compliance with the inclusion criteria. Disagreements between the two reviewers were resolved by a third expert (GŞTC) acting as a reviewer. Studies that did not address the relationship between language development, executive function and screen time in early childhood were excluded because they did not meet the eligibility criteria.

Search and selection process

For this systematic analysis, a total of 310 studies were initially identified. Of these, only 191 English articles were included in the study. Among these, 83 duplicate articles were identified and excluded. After reviewing the titles, 54 articles were excluded as they were irrelevant. Similarly, abstracts were analyzed, and 27 articles were excluded. The full texts of the remaining 23 articles were analyzed. Of the 9 studies, 5 were excluded as reviews and 2 were excluded because they did not meet the relevant criteria. After applying the exclusion criteria, a total of 14 articles [19, 66, 70–81] met all the specified criteria.

To ensure transparency and reproducibility, a detailed table documenting the evaluation process has been prepared and uploaded to the OSF for public access as supporting information. The table, entitled "S1 Table" presents a complete list of the studies reviewed during the screening stages, their classification as either "included" or "excluded," and providing rationale for their exclusion at various stages of the evaluation process. Furthermore, the table provides essential details such as the titles of the studies, digital object identifiers (DOIs) or uniform resource locators (URLs), the stages of the evaluation process, and the final inclusion or exclusion status of the studies. The aforementioned table can be accessed via the OSF at the following link: https://osf.io/n7uc6/?view_only=8987e34f20da40ddba6c6c7c7009e84d.

Data extraction processes for analysis

In the final review, 14 articles were included, and a table was created to facilitate understanding of the information for the articles (see Table 2). The data presented in the table details the following: (a) authors; (b) year; (c) main focus of the study; (d) research questions; (e) measured variables, (f) methodology, and (g) participant characteristics covered in the studies.

Table 2. Descriptive register of articles.

Authors Year Main Focus Research Questions Measured Variables Methodology Participant Characteristics
Zhang et al. [66] 2022 Screen time, language development, executive function Examine the associations between different types of screen time and indicators of cognitive development of preschoolers in Canada Screen time, adherence, vocabulary, memory, age, sex, ethnicity, parental education, childcare group A 6-month quasi-experimental pre–post-design study 97 preschoolers aged 36–60 months from Alberta and Ontario, Canada.
Hutton et al. [75] 2020 Screen time, language development, executive function What are the associations between screen-based media use and the integrity of brain white matter tracts supporting language and literacy skills in preschool-aged children? Measured variables include ScreenQ, CTOPP-2, EVT-2, GRTR scores, FA, and RD in white matter tracts. A cross-sectional study of healthy children conducted from August 2017 to November 2018. 47 healthy children aged 3–5 years (57% girls), mean age 54.3 months (SD 7.5), recruited from a US children’s hospital and primary care clinics.
Oflu et al. [78] 2021 Screen time, language development, executive function Is excessive screen time associated with emotional lability in preschool children aged 2 to 5 years? Screen time (low vs. high), sociodemographic (age, gender, parental age, education, mother’s work, family structure, number of children, family type, caregiver, income), screen exposure (age at first exposure, co-viewing, reaction to limits, delaying needs), and emotion regulation (ERC: lability/negativity, regulation). Cross-sectional study (Jan 1—Mar 1, 2018) at a university hospital. Excluded: prematurity, low birth weight, no breastfeeding, language delays, chronic illness. 240 healthy children aged 2–5 with screen time <1 hour or >4 hours.
Excluded: prematurity, low birth weight, no breastfeeding, language delay, chronic illness.
Sociodemographic: age, gender, parental age, education, mother’s work, family structure, number of children, family type, caregiver, income.
Zhang et al. [81] 2022 Screen time, language development, executive function What are the longitudinal associations of subjectively measured physical activity and screen time with multiple domains of cognitive development in young children? Physical activity (organized, non-organized), screen time (TV, video games), total physical activity and screen time, screen time adherence, working memory, inhibitory control, intellectual ability (language, reasoning, speed). Cross-sectional design was employed. 96 children aged 2.5–5 years, English-speaking parents, excluding conditions limiting physical activity or cognitive performance, conducted in Edmonton, Canada.
Hendry et al. [73] 2022 Screen time, language development, executive function How does the variation in the home environment, influenced by factors such as socioeconomic status, parental attitudes, and activities during the 2020 COVID-19 pandemic, relate to infants’ emerging executive functions? Parental attitudes towards learning, affection, attachment, engagement in activities, and screen use. Recruited participants online, used linear regression and path analyses to study SES, parental attitudes, activities, and infant EFs during COVID-19. 575 UK infants aged 8–36 months, from diverse SES.
Dolgikh et al. [72] 2023 Screen time, language development, executive function What is the impact of attending extra classes on the development of executive functions in preschool children? NEPSY-II subtests: Inhibition, Statue, Memory for Designs, Sentences Repetition, and Dimensional Change Card Sort to measure executive functions in preschoolers. Compared executive functions in children attending vs. not attending extra classes using subtests and Mann-Whitney U-test. 124 Russian children (mean age 78 months), 17% boys, 80% medium-income, 1,000–1,300 minutes weekly screen time, differing maternal education.
Hu et al. [74] 2020 Screen time, language development, executive function (1) Is there a difference in Chinese children’s screen time in terms of their gender (male or female), community (urban or rural), and sibling status (one child or multiple children)?
(2) Is there a relationship between Chinese children’s social and cognitive development and their active or passive screen time?
Receptive vocabulary, math achievement, science knowledge, executive function, and social skills. Quantitative study using stratified random sampling and hierarchical multiple regression. 579 five-year-old children from rural Guangdong, China, including boys and single-child households, with potentially high screen time.
Veraksa et al. [19] 2021 Screen time, language development, executive function (1) Is there a difference between developmental outcome for active and passive screen time in preschool children? (2) Is watching television (passive screen time) a negative predictor for the development of phonological memory in children? (3) Is the interaction of children with smart electronic devices an auxiliary factor for the development of phonological memory in children? (4) Is there an influence of family factors on the development of phonological memory in preschoolers? Daily passive and active screen time, phonological memory, age, Raven CPM score, mother’s education, family income. The study was conducted in two stages: at Time 1, the association between children’s phonological memory, passive and active screen time, and family factors was examined. At Time 2, one year later, the impact of passive and active screen time on individual progress in phonological memory development was evaluated. The following test were administered: Understanding of Similar Sounding Words (USSW)
Raven’s Colored Progressive Matrices (CMP)
122 preschool children (mean age 5.72, SD 0.33), 54.9% boys. Mothers’ education: 79.51% higher, 2.46% academic, 4.92% incomplete higher, 11.48% secondary specialized, 1.63% secondary general.
Family income: 4.96% insufficient, 13.22% low, 78.51% average, 3.31% high.
Cliff et al. [71] 2017 Screen time, language development, executive function What are the associations between physical activity, screen-based entertainment, and various developmental and health outcomes in preschool-aged children? Physical activity, screen time, executive function, language, self-regulation, social and emotional development, empathy, cardiac outflow, anthropometrics, retinal microvasculature, blood pressure. Prospective cohort study of 430 children (ages 3–5) assessing physical activity, cognitive and language development, psychosocial development, adiposity, and cardiovascular health, with input from educators and parents. 430 healthy, typically developing children (ages 3–5) in ECEC centers. Data collected on caregiver demographics, household characteristics, media device ownership, and parental health history.
Kim & Chung [76] 2021 Screen time, language development, executive function What is the association between exposure to television or video (TV time) and children’s language development and school achievement in childhood? TV time, parental education, household income, early development (Denver II, K-ASQ), language development (REVT), school achievement (parent/teacher evaluation). Annual assessments from birth to 87.9 months using parental questionnaires for TV time, group-based trajectory analysis, and various tools for language development and school achievement. Data from the Panel Study on Korean Children, following ethical standards. 1087 participants (birth to 87.9 months) sampled via stratified multi-stage sampling. TV time reported from ages 2.2 to 7.3, categorized into four groups with differing socioeconomic variables.
Note: This article is included to the study since it shows the progression from early childhood (starting at 5.5 months) to later stages (up to 87.9 months) allows for a comprehensive understanding of how screen exposure impacts cognitive and language development over time.
Medawar, et al. [77] 2023 Screen time, language development, executive function How do mothers’ home literacy beliefs and practices, along with screen media exposure, influence language outcomes in Argentinean toddlers? Measured variables: exposure time to devices (TV, cell phone, computer, tablet), activity types, content exposure frequency, and shared device and reading material use. Selected 465 mothers via social networks, used hierarchical linear regressions, checked model assumptions, added child demographics, HLE variables, and screen media measures, examined mediation and moderation effects. 465 Argentinean mothers of Spanish-speaking children (18–36 months, 49.2% girls, mean age 26.35 months, SD 5.04). Most parents had tertiary or university education (mothers 93.54%, fathers 80%).
Supanitayanon, et al. [80] 2020 Screen time, language development, executive function What are the associations between screen media exposure variables in the first 2 years of life and cognitive development at 4 years of age, considering positive parenting behaviors? Measured variables: age of screen media onset, cumulative screen exposure, caregiver-child verbal interaction during screen time, and types of devices used (TV, handheld, computers). A longitudinal cohort study to investigate the relationship between screen media exposure, parenting behaviors, and cognitive development in young children. 274 healthy infants with typical development, full-term births (≥2500 g), no complications or medical illnesses, normal growth verified by CAT/CLAMS, middle to high SES in Thai context.
Carson & Kuzik [70] 2021 Screen time, language development, executive function What is the association between parent-child technology interference and cognitive and social-emotional development in preschool-aged children? Parent-child technology interference (six devices), cognitive development (memory, inhibition, vocabulary), social-emotional development (sociability, externalizing/internalizing behaviors, prosocial behavior, self-regulation). Assessing parent-child tech interference, measuring cognitive development with iPad tasks, evaluating social-emotional development via questionnaire, and using multiple linear regression analyses with adjustments. 100 preschool children (3–5 years) and parents from Edmonton, Canada.
Average child age: 4.5 years (29% female).
Average parent age: 37.5 years (80% mothers).
Ribner et al. [79] 2021 Screen time, language development, executive function Investigate whether the content and context of media use—educational, entertainment, and background television—is related to children’s language and literacy skills. Foreground TV (educational and entertainment), background TV, self-regulation issues, language skills, literacy skills. Path models were used to estimate the direct and indirect associations between context and content of media use with language and literacy skills. English-speaking families with 922 children (8 months to 8 years), including 461 girls, mean age 66.19 months (3–7 years).

Source: Own elaboration.

To further ensure transparency and reproducibility, an additional table titled "S2 Table" has been prepared and uploaded to the OSF as supporting information. Table 2 provides detailed insights into the studies included in the review, whereas S2 Table is concerned with documenting the process of data extraction. The table includes the following: (a) the names of the data extractors; (b) the dates of data extraction; (c) confirmation of eligibility for inclusion; and (d) the extracted data variables necessary to replicate the analyses. This S2 Table is accessible on OSF at https://osf.io/n7uc6/?view_only=8987e34f20da40ddba6c6c7c7009e84d.

Additionally, the methodological quality and evidence strength of the included studies were evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system, which assesses study limitations, inconsistency, indirectness, imprecision, and publication bias. Detailed GRADE ratings are provided in "S3 Table" as supporting information. S3 Table is available on the OSF at https://osf.io/n7uc6/?view_only=8987e34f20da40ddba6c6c7c7009e84d.

Review of the quality of reporting

The articles included in this study were all quantitative in nature. The selected studies were initially reviewed using an adapted version of the Consolidated Standards of Reporting Trials (CONSORT) checklist by Angosto, García-Fernández, Valantine, & Grimaldi-Puyana [68], originally designed by Schultz et al. [82]. The original CONSORT statement [82] consists of 25 items and provides a general standard for reporting randomized controlled trials (RCTs). The adapted version incorporates methodological enhancements and expansions. Furthermore, the range and reliability of the data collection tools have been subjected to additional scrutiny. It provides a more suitable framework for evaluating different data collection tools and enhancing the reliability of the results. Additionally, the adapted version has been tailored to specific contexts and topics, making it more appropriate for the objectives of this study. The study aims to analyze the complex relationship between screen time, language development, and executive functions. The adapted version has allowed for a review of the reporting quality in the analyzed studies, with the goal of increasing the validity and reliability of the study findings. The tool includes a total of 20 items in the categories of "title and summary", "introduction", "methods", "results", "discussion", and "other information”. The interrater agreement for the CONSORT protocol ratings in our systematic review study was high across the various items assessed. Each study was independently scored by two researchers who evaluated the sections they reviewed and rated each item with a score of 1, indicating whether the study satisfied the criterion or whether the item was applicable to the study. There was disagreement between the researchers in the evaluation of three studies. Disagreements were resolved by checking and discussing the original study until consensus was reached between the researchers. The first researcher is an expert in the field of language development in the preschool period, and the second researcher is an experienced researcher in the field of instructional technology.

The agreement rates, as reported in the last row of Table 3, indicate a range from 85% to 100% among the different studies evaluated. Specifically, seven studies achieved an agreement rate of 90%, three studies achieved a rate of 95%, two studies reached 85%, and two studies attained a perfect agreement rate of 100%. This high level of agreement demonstrates the consistency and reliability of the ratings provided by the reviewers.

Table 3. Reporting quality of the articles.

No Ítem SECTION, TOPIC, ITEM LIST Zhang et al. (2022a) Hutton et al. (2020) Ribner et al. (2021) Oflu et al. (2021) Zhang et al. (2022b) Hendry et al. (2022) Dolgikh et al. (2023) Hu et al. (2020) Veraksa et al. (2021) Cliff et al. (2017) Kim & Chung (2021) Medawar et al. (2023) Supanitayanon et al. (2020) Carson & Kuzik (2021)
Title and Abstract
1a Identification of the type of study in the title 0 0 0 0 1 0 1 0 0 1 1 0 1 0
1b Structured summary of objective, methods, results, and conclusions 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Introduction
Background and Objectives
2a Scientific background and explanation of rationale 1 1 1 1 1 1 1 1 1 1 1 1 1 1
2b Specific objectives or hypotheses 0 1 1 0 1 1 1 1 1 1 0 1 1 1
Methods
Participants
3a Eligibility criteria for participants 1 1 1 1 1 1 1 1 1 1 1 1 1 0
3b Settings and locations where the data were collected 1 0 0 0 0 1 1 0 1 1 0 1 0 0
3c A table showing baseline demographic characteristics for each group 0 1 1 1 1 1 1 1 1 1 1 1 1 1
Sample Size
4a The sample size has been determined 1 1 1 1 1 1 1 1 1 1 1 1 1 1
4b When applicable, explanation of how sample size was determined 1 0 1 1 1 1 1 1 0 1 1 1 1 1
Procedure
5a The procedure has sufficient details to allow replication, including how and when they were actually administered 1 1 1 1 1 0 1 1 0 1 1 1 1 0
Instrument or Tools
6a Completely defined pre-specified primary and secondary outcome measures, including how and when they were assessed 1 1 1 1 1 1 1 1 1 1 1 1 1 1
6b Use of validity and reliability tools. 1 1 1 1 1 1 0 1 1 1 1 1 1 1
Implementation
7a Who made each part of study 0 1 0 0 0 0 1 0 1 1 1 1 1 1
Statistical Methods
8a Statistical methods used to analyze the results 1 1 1 1 1 1 1 1 1 1 1 1 1 1
8b Use of methods for additional analyses to objective of study 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Results
Outcomes and Estimation
9a A table or figure showing outputs of analysis more relevant of study 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Discussion
Interpretation
10a Interpretation consistent with results, balancing benefits and harms, and considering other relevant evidence 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Limitations
11a Study limitations, addressing sources of potential bias, imprecisions, etc. 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Practical Implication
12a Main applicability to results of study 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Other Information
Funding
13a Sources of funding and other support, role of funders 1 1 0 0 1 0 1 1 1 1 0 0 1 1
Total 16 17 16 15 18 16 19 17 17 20 17 18 19 16
Rater
agreement (%)
90% 85% 95% 90% 90% 85% 90% 90% 100% 100% 90% 95% 95% 90%

To check the quality of reporting of the studies, the quality of reporting of the 14 quantitative studies evaluated in the research was evaluated out of 20 points, presented in Table 3:

As shown in Table 3, 1 article received 20 points [71], 2 articles received 19 points [72, 80], 2 articles received 18 points [66, 77], 4 articles received 17 points [19, 74–76], 4 articles received 16 points [70, 73, 79, 81], 1 article received 15 points [78]. Based on these data, all the articles have a value equal to or greater than 15 points. The average score of the articles was 17.21. In the majority of cases, the studies were in accordance with the standards for acceptable reporting, in terms of the design, methodology and implementation. Data collection tools also provide information about the quality of reporting of the studies. The studies employed varying numbers of data collection tools as follows: 1 [73, 77], 2 [19, 66, 72, 78, 81], 3 [70, 75, 76, 80], 4 [71], and 6 [74]. Most of the studies utilized multiple data collection tools, indicating potentially higher reliability of the articles.

Results

Study flow

Fig 1 shows the flowchart of the current review, illustrating the process from 310 studies to the inclusion of 14 articles in the analysis.

Fig 1.

Fig 1

Thematic analysis

Selected studies on the relationship between language development, executive function, and screen time are synthesized to explain this complex relationship. Before presenting the identified themes, it is important to define key concepts that recur throughout our analysis.

Educational media. It is defined as content specifically designed with learning objectives in mind, including formats such as educational TV, apps, and games. While educational TV typically involves passive viewing, educational apps and games require active engagement from the user, such as completing tasks or interacting with the content to facilitate cognitive development (e.g., Zhang et al. [66]; Hutton et al. [75]).

Interactive media. It is noteworthy to distinguish between two types of interactivities; physical and social. Physical interactivity involves the user’s direct engagement with the media, such as tapping or swiping, whereas social interactivity entails contingent social responses, either with another person through the media or in reaction to prompts within the media itself (Hutton et al. [75]; Ribner et al. [79]; Zhang et al. [66]).

Following these definitions, the analysis identified the following key themes: (1) screen content and adherence to guidelines, (2) parent-child interaction and family context, (3) passive and active screen time, and (4) attention issues. These themes reflect specific areas where the relationship between screen time and developmental outcomes is most evident and were extracted from the analyses of the reviewed studies. The subsequent section presents each thematic area in detail.

Screen content and adherence to guidelines

The nature of screen media and the way children interact with it are of critical importance when considering the effects of children’s screen time. Interactive and educational media content has been found to have positive effects on children’s language development and executive functions. Dolgikh et al. [72] investigated the impact of attending extra classes on the development of language development and executive functions with 124 children, with 60 attending extra classes (e.g., music, art, language) twice a week for 4 hours, and 64 not attending any extra classes. In this study, screen time was assessed through a questionnaire administered to the mothers of the participating children. The questionnaire specifically asked about the average amount of screen time the children engaged in per week. The study compared screen time between two groups: children attending extra classes and those who did not. Although the difference in screen time between the groups was not statistically significant, it was noted that children in the extra classes group had slightly lower screen time (approximately 1016 minutes per week) compared to the no extra classes group (approximately 1299 minutes per week).

This screen time data was considered in the analysis of the children’s executive functions, ensuring that its potential impact on cognitive development was accounted for in the study’s findings.

They observed the positive effects of extra preschool lessons on verbal working memory, highlighting how educational content can support language development. The results indicated that children who participated in extra classes exhibited significantly higher development in verbal working memory over a year compared to those who did not while they report the absence of statistically significant differences between groups who attend extra classes and who do not in terms of executive function development. The difference in the development rate of verbal working memory seems to be directly associated with participation in extra classes. It has been observed that there is a significant positive correlation between active screen time and cognitive development as well as social development. In this study, no specific data was collected regarding the use of screen time for educational purposes during the extra classes. In other words, the relationship between extra classes and screen use was not directly examined. The study concluded that participation in extra classes had a positive impact on the development of children’s executive functions. Therefore, the study does not provide definitive conclusions on whether the supplementary classes balance out the negative effects of high screen time. On the other hand, the article did examine screen time as a factor related to the development of children’s executive functions, emphasizing that excessive screen time could have negative effects on the development of executive functions. Additionally, the study noted that children not attending extra classes had higher screen time and lower maternal education levels, both of which are known to negatively impact executive function development. These findings suggest that structured extra classes can mitigate some of the negative effects of high screen time, enhancing language development and executive functions in preschool children. These findings indicate that interactive and educational screen content supports children’s language development and cognitive skills. Parents’ adherence to screen time recommendations also enables beneficial characteristics of screen media which refers to the positive attributes of screen media when used in a controlled and appropriate manner, particularly in alignment with established screen time guidelines, it was linked to better working memory [66]. The "beneficial characteristics" of screen media include educational content and structured use, which support cognitive development when screen time is kept within recommended limits, unlike excessive use that may harm cognitive functions like working memory as stated in the study [66]. The authors investigated the impact of screen time on cognitive development of preschoolers aged 36 to 60 months in Canada by means of a parental questionnaire assessing screen time and cognitive development via Early Years Toolbox. They observed positive effects of screen time in compliance with the recommended guidelines on cognitive skills and language development, particularly noting that educational content and interactive applications support these positive effects. However, they did not find a significant relationship between screen time and expressive vocabulary in preschool children. The findings suggest that screen time, regardless of its type, may not be related with expressive vocabulary. This implies that children’s verbal expression abilities may not be directly affected by screen time. In addition, the relationship between screen time and executive functions, excluding verbal working memory, indicates that both screen time and maternal education level are associated with all executive functions. Controlling screen time and ensuring access to quality content can encourage active participation in learning processes, thus enhancing critical thinking and problem-solving skills. Zhang et al. [66] also emphasize that not only the amount but also the quality of screen time is important. The significance of adhering to screen time guidelines was underscored by Hutton et al. [75] as well. The authors examined the associations between screen media use and the integrity of brain white matter tracts supporting language and literacy skills in preschooler healthy children aged 3 to 5 years in US. They identified a relationship between excessive screen-based media use beyond the guidelines and reduced microstructural integrity of brain white matter tracts that support language and emergent literacy skills in preschool-aged children. Higher screen time scores are associated with higher resistance to diffusion (RD) in white matter bundles related to language, executive function and developing literacy abilities. The findings indicate that higher ScreenQ scores, 15-item measure of screen-based media use, are significantly associated with lower fractional anisotropy (FA) and higher radial diffusivity (RD) in various white matter tracts across the whole brain. These correlations were observed after controlling for child age and household income, and the results remained statistically significant. This was evidenced by lower scores on related cognitive assessments. White matter tracts are known to facilitate communication between nerve cells and form the basis of cognitive functions. Preserving the integrity of these tracts is critical for cognitive development, especially during early childhood. Hutton et al.’s [75] study shows that screen-based media use can positively impact these tracts as long as screen time guidelines are followed and supporting the development of language and literacy skills despite many of the relationships between screen time and children’s cognitive development being deemed insignificant.

Screen time’s impact manifests simultaneously on both language development and executive functions, with the nature of content playing a crucial role. Dolgikh et al. [72]’s study demonstrated this interconnected relationship: children attending extra classes showed enhanced verbal working memory (a component of both language development and executive functions) despite similar screen time exposure. This finding suggests that structured educational content can support both developmental domains concurrently. Zhang et al. [66] further reinforced this dual impact, showing that adherence to screen time guidelines was associated with improvements in both working memory and language skills, highlighting how appropriate screen use can simultaneously benefit both areas. Hutton et al. [75]’s neuroimaging findings provided biological evidence for this interconnection, showing how excessive screen time affects white matter tracts that support both language processing and executive function development.

Parent-child interaction and the family context

Among the examined studies six of them explored the relationship between language development, executive function, and screen time in terms of parent-child interaction from various aspects. Exposure to screen media has been associated with a reduction in the quality of parent-child interactions, particularly when parents do not engage in sufficient conversation with their children. Supanitayanon et al. [80] conducted research to investigate the associations between the age of onset of screen media exposure, cumulative high media exposure, and verbal interaction during the screen time in the first two years of life, and the cognitive development of 4-year-old children with 274 healthy participants by collecting screen media data at specific ages, evaluating cognition at ages 2, 3, and 4 years, while considering parenting behaviors. Findings of this study indicated that children with earlier screen exposure, more screen time and less verbal interaction during screen time in the first two years of life had lower cognitive and language development in preschool. Furthermore, it is found out that excessive screen media exposure and lack of verbal interaction were associated with lower fine motor skills and lower visual reception. As children need continuous verbal stimulation to develop their language skills and cognitive abilities, increased verbal interactions between parents and children can support these developmental processes. In a similar vein, Carson and Kuzik [70] examined the association between parent-child interference across various devices and measured cognitive development and social-emotional development in preschool-aged children with 100 participants in Canada. They emphasized potential risks and negative impact of electronic devices on early childhood development, parent-child technology interference could interrupt parent-child interactions during the day. Higher parent-child interference was associated with lower response inhibition and emotional self-regulation. To illustrate, when children seek emotional support and guidance, they may be unable to meet these needs due to parental distractions. These findings indicate that parents should regulate their technology use besides from children’s screen time and make it interactive.

Cultural and socioeconomic factors have been found to be critical factors that affect parent-child interaction. Three studies measured how those factors could influence parent-child interaction when they examine the relationship between language development, executive functions, and screen time. Studying the role of cultural and socioeconomic factors on the relationship between language development, executive functions and screen time, Zhang et al. [81] stated that the effects of screen time are largely shaped by several factors, including the life conditions of children and the educational levels of their parents. For instance, in families with higher socioeconomic status, children often have access to more educational resources and parents are better able to manage their children’s screen time. This can mitigate the adverse effects of screen time and facilitate children’s cognitive and language development. The authors found out that children who adhered to the screen time guidelines showed greater improvement in intellectual skills over time, especially in language development and vocabulary knowledge, compared to those who did not follow the screen time recommendations. Medawar et al. [77] also reached comparable conclusions in their study, which examined the effect of mothers’ home literacy beliefs and practices and the quantity and quality of screen media exposure to Argentinian children aged 18 months to 36 months. Their findings pointed out that higher parental education levels were associated with better language development in children, literacy beliefs and practices, particularly those of mothers, were significantly associated with better language outcomes in children. The findings of the study suggest that the quality of parent-child verbal interactions during shared media use contributes significantly to language development by creating an opportunity for dialog and vocabulary learning. The type and quality of screen media exposure were found to have different impacts on language development. Higher SES families often had better access to high-quality educational content and engaged more in joint media engagement, which positively influenced language outcomes. Conversely, passive screen exposure (e.g., TV) was more prevalent in lower SES families and was negatively associated with language development. Lastly, they noted that higher SES parents were more likely to engage in verbal scaffolding and joint media engagement with their children, which further supported language development. Besides, Hu et al. [74] also emphasized that parent-child interaction plays a pivotal role in enhancing language development through shared media usage, as suggested by their findings. In families with a lower socioeconomic status, parents may frequently be required to work longer hours, which may result in a reduction in the quality of time they are able to spend with their children. This can have a negative impact on children’s language development. Furthermore, these families may be constrained in their ability and opportunity to access educational content, which can impede children’s learning opportunities. It is possible that families with low socioeconomic status may utilize screen time as a form of childcare, which could result in increased screen time and negative effects. In parallel with these two studies, Hendry et al. [73] observed a consistent negative association between low socioeconomic status and screen time. Furthermore, the authors proposed that these families may be more vulnerable to the adverse effects of prolonged screen exposure.

The relationship between screen time, language development, and executive functions is significantly mediated through parent-child interactions. Supanitayanon et al. [80] demonstrated how early screen exposure combined with reduced verbal interaction impacts both cognitive domains: children with earlier screen exposure and less verbal interaction showed lower performance in both language skills and cognitive functions. Carson and Kuzik [70] extended this understanding by showing how parent-child technology interference simultaneously affects response inhibition (an executive function) and emotional self-regulation, which in turn influences language learning opportunities. The socioeconomic context further shapes this three-way relationship. Zhang et al. [81] found that higher socioeconomic status families could better manage screen time while providing educational resources that support both language and cognitive development. Medawar et al. [77]’s findings reinforced this, showing how maternal literacy beliefs and practices influence both language outcomes and executive functioning through quality screen time management. Hu et al. [74] and Hendry et al. [73] further demonstrated how socioeconomic status affects both developmental domains through screen time exposure patterns and parent-child interaction quality.

Passive and active screen time

In examining the relationship between language development, executive functions, and screen time, it is essential to consider the way children are exposed to screens. Four of the studies focused on how children were exposed to screen media. Medawar et al. [77] figured out that passive screen exposure (TV viewing) has a detrimental impact on language and literacy abilities, and that these effects are linked to self-regulation challenges in their study, which involved 465 mothers of Argentinian children aged 18–36 months. They reported that the continuous presence of television in the background can act as a distraction, impeding the development of language and literacy skills in children. A constant stream of auditory or visual stimuli in the background can impede children’s ability to maintain attention and concentration, thereby negatively affecting their learning process. Self-regulation difficulties can impede children’s capacity to focus their attention, regulate their emotions, and control their behavior, which can negatively impact their academic and social achievement. Another study conducted by Hu et al. [74] investigates the role of active and passive screen time on Chinese children’s social and cognitive development with 579 children aged 5. They found that passive screen time (TV viewing) is significantly and negatively associated with children’s executive functioning and social skills while there exists a meaningful and positive correlation between children’s active screen time and receptive language skills. Executive functions encompass a range of higher-order cognitive abilities, including planning, problem solving, attention control, and flexibility. The development of these critical skills may be inhibited by passive screen time. Furthermore, television viewing may impede children’s opportunities for social interaction, thereby hindering their capacity to develop social skills. It is evident that children require face-to-face interactions to develop their social skills. Therefore, based on the findings of study, it could be concluded that television viewing cannot replace these interactions and may prevent children from developing skills such as empathy, emotional expression, and understanding social cues.

Veraksa et al. [19] demonstrated that passive screen time, particularly television viewing, is negatively associated with children’s ability to process verbal information effectively, development of executive functions, and social skills in their study conducted with 122 preschool children aged 5–6 in Russia whereas they noted. They found that passive screen time has negative effect on preschoolers’ phonological memory development, especially for those who engage in longer daily periods of television viewing. The capacity to process verbal information is of critical importance for children’s ability to learn and comprehend language; therefore, it could be argued that television viewing or passive engagement with digital devices may prevent children from using and developing these skills based these findings. Another study that showed the negative effects of passive screen time was conducted by Kim and Chung [76]. To investigate the association between exposure to TV or video and children’s language development and school achievement in childhood, Kim and Chung [76] conducted annual assessments from birth to 87.9 months, providing a comprehensive analysis of the longitudinal impact of screen time on child development. They have emphasized the negative effects of early screen exposure on language development. Their research shows that prolonged television exposure at age two negatively impacts children’s language development and school achievement. At this age, children lay the foundations of their language skills and are greatly influenced by the speech and interactions in their environment. Excessive television use can reduce these critical interactions, adversely affecting children’s language acquisition processes, and passive screen time can limit children’s active participation and interaction, restricting the natural learning opportunities that support language development.

Furthermore, passive screen time can impede the interactions that facilitate children’s vocabulary and language comprehension development. Constant background television can weaken children’s ability to focus, negatively impacting their capacity for deep thinking and complex problem-solving. In line with these studies, Ribner et al. [79] conducted a nationally representative study with children ages from 3 to 7 in USA which aims to investigate the effect of the foreground TV exposure (educational, entertainment television), and background TV on self-regulation problems, language, and literacy skills. They observed that background and entertainment TV were negatively associated with language and literacy skills while educational TV was not. Furthermore, self-regulation problems might serve as a mechanism linking TV exposure to language and literacy skills. Likewise self-regulation problems, emotional lability is one aspect that has been found to have a negative relationship between screen time. Oflu et al. [78] observed that prolonged screen time can lead to emotional lability and attention problems in children in their study which examines excessive screen time associated with emotional lability in preschool children aged 2 to 5 years in Türkiye. As screen time increases, children’s ability to control and regulate their emotional responses may weaken. This can lead to negative outcomes in children’s social relationships and school performance. To illustrate, children with poor emotional regulation skills may struggle to concentrate in the classroom and complete academic tasks. In addition, Kim and Chung [76] highlighted the negative effects of screen time on self-regulation skills in early childhood. Self-regulation skills encompass the ability to control one’s thoughts, emotions, and behaviors. The development of these skills in early childhood is critical for academic and social success later in life. Prolonged screen time can hinder children’s development of these skills and weaken their ability to control themselves. These findings indicate that screen time can have negative effects on children’s emotional regulation skills, which can indirectly impact language development and other cognitive functions. It is important to carefully manage screen time and support children’s self-regulation skills. The use of passive screen time can impede the development of critical cognitive and language skills in children, including attention, executive functioning, and social skills. Nevertheless, the promotion of active and interactive screen content may serve to mitigate these negative effects.

The distinction between passive and active screen time reveals crucial differences in their impact on both language development and executive functions. Medawar et al. [77] found that passive screen exposure negatively affects both language acquisition and self-regulation abilities. This finding was corroborated by Hu et al. [74], who showed that while passive screen time negatively impacted executive functioning and social skills, active screen time positively correlated with receptive language skills, demonstrating the differential effects of screen engagement types on both developmental domains. Veraksa et al. [19] provided further evidence of this interconnection, showing how passive screen time simultaneously affects verbal information processing and executive functions. Kim and Chung [76]’s longitudinal study demonstrated how early screen exposure impacts both language development and academic achievement through shared cognitive mechanisms. Ribner et al. [79] extended this understanding by showing how background and entertainment TV affect both language and literacy skills through self-regulation pathways. Oflu et al. [78] and Kim and Chung [76] highlighted how emotional regulation, influenced by screen time, acts as a bridge between language development and executive functioning.

Attention issues

Excessive screen time can negatively impact children’s working memory, executive functions, and language development. Therefore, it emphasizes the importance of high-quality content and adherence to recommended guidelines. Zhang et al. [81] and Hendry et al. [73] emphasize the negative effects of total screen time, particularly television watching, on children’s working memory and executive functions. Working memory is defined as the capacity to store and process information in the short term, playing a critical role in children’s learning and problem-solving abilities. Zhang et al. [81] investigated longitudinal associations of subjectively measured physical activity and screen time with multiple domains of cognitive development in children aged 2.5 to 5 years old and excluded the ones who have conditions limiting physical activity or affecting cognitive performance. They figured out that using screen media in accordance with guidelines is associated with better intellectual ability and language development. Besides, Hendry et al. [71] investigated how variability in the home environment before and during the 2020 pandemic in the United Kingdom, involving 575 children aged 8 to 36 months in a parent-reported study. The authors noted that not only the amount but also the content of screen time has a significant impact on children’s attention and focus skills. This study found that higher screen time in early childhood was associated with lower cognitive outcomes, specifically in executive function and regulation skills. The findings of this theme showed that screen use, particularly in infants, negatively affected cognitive executive function (CEF) and regulation, and it mediated the relationship between socioeconomic status (SES) and these cognitive outcomes. Specifically, fast-paced and distracting content can shorten children’s attention spans and weaken their ability to concentrate. The findings suggest that exposure to such content may lead children to seek similar levels of constant stimulation in real life, making it difficult for them to maintain focus in classroom settings and other learning environments. It is shown that with increased screen time, a significant decline in children’s working memory capacity has been observed. This decline can lead to increased forgetfulness in daily life, difficulties in learning new information, and challenges in completing complex tasks.

The impact of screen time on attention serves as a crucial link between language development and executive functions. Zhang et al. [81] and Hendry et al. [73] demonstrated how screen time affects working memory and executive functions, which in turn influence language processing and acquisition. Their research showed that adherence to screen time guidelines benefits both intellectual ability and language development through shared attention and cognitive control mechanisms. Specifically, Hendry et al. [74] found that excessive screen time negatively impacts cognitive executive function (CEF) and regulation, which serve as foundational skills for both language processing and executive control. The research highlighted how attention capacity, affected by screen exposure, serves as a common pathway influencing both language acquisition and executive function development.

Discussion

The purpose of this study was to investigate the interconnected relationship between language development, executive function, and screen time in children aged 0–78 months through a systematic review. This relationship is particularly complex during this developmental period, as executive functions and language development are mutually influential- executive functions support language acquisition while language skills facilitate executive control development. Given the pervasiveness of digital tools in contemporary society, understanding how screen time affects both these developmental domains simultaneously is crucial for this age group. Chan & Rao [83] and Cumming et al. [84] emphasize this interconnection, noting how executive functions and language development co-develop and mutually influence each other during early childhood (0–78 months). This relationship has been extensively studied in both typically developing children [85] and those with developmental challenges [86–89], revealing how executive functions support various language skills including vocabulary acquisition [90], new word learning [91], and reading comprehension [92–96] while language skills in turn scaffold executive control development.

The gaps identified by Filipe et al. [97] and Hartanto et al. [98] regarding specific cognitive-language relationships and executive function-screen time connections in children aged 0–78 months underscore the importance of examining these domains together. Previous reviews like Karani et al. [49] and Bustamante et al. [53] have examined these relationships separately, finding negative impacts of prolonged screen time on language development but inconclusive results for executive functions in this age group. Our study uniquely contributes to literature by examining how screen time simultaneously affects both domains during this critical period (0–78 months), building on Streegan et al.’s [99] work with older children.

Our thematic analysis revealed four interconnected themes that demonstrate how screen time influences both language development and executive functions in children aged 0–78 months. Regarding screen content and adherence to guidelines, we found that educational content can simultaneously support both domains during this developmental period- enhancing language skills while developing executive control through structured learning experiences. The quality of interaction during screen time emerged as crucial for this age group, as parental involvement creates opportunities for both language learning and executive function development through guided engagement.

The role of parent-child interaction and family context revealed how screen time’s impact on both developmental domains is mediated through social interaction in children aged 0–78 months. Two critical findings emerged: First, insufficient parent-child interaction during screen time impairs both language development and executive control processes that rely on social scaffolding at this age. The literature emphasizes parents’ crucial role in mitigating negative effects of screen exposure on both domains [100–102]. Wong et al. [103] extended this understanding by showing how parents’ own device use can disrupt parent-child interaction during these crucial early years, negatively affecting both language learning opportunities and executive function development. This finding particularly matters since quality interaction supports both domains simultaneously during this period. Second, socioeconomic factors influence access to educational resources and parents’ ability to manage screen time, affecting both domains simultaneously in children aged 0–78 months. Studies like Slobodin et al. [104] and Hoffman et al. [105] support these findings, showing how socioeconomic status moderates screen time’s impact on both language and cognitive development during early childhood.

The distinction between passive and active screen time provided crucial insights into how different types of engagement affect both developmental domains in children aged 0–78 months. Passive screen exposure negatively impacts both language processing and executive functions, particularly attention and social skills [106–108] during this period. Conversely, active screen time with educational and interactive content can positively influence both domains [109–112], as demonstrated by studies showing improvements in both vocabulary and executive function skills [51, 52, 113] in this age group.

The attention issues theme highlighted how screen time affects cognitive processes fundamental to both language development and executive functions during this critical period (0–78 months). Excessive screen time impairs attention control in young children, which simultaneously affects language learning processes and broadens executive functions. This creates a cascade effect where attention deficits disrupt both vocabulary acquisition and cognitive control development during these formative years. Studies by Kebir and Özkaya [114] and Schwarzer et al. This interconnected impact was supported by [115], showing how excessive screen time simultaneously affects cognitive, language, and socio-emotional skills in children aged 0–78 months.

The diversity in findings across studies reflects the complex nature of how screen time influences both developmental domains during early childhood (0–78 months). Factors such as content interactivity, parental involvement, and developmental timing all contribute to whether screen time supports or hinders the co-development of language and executive functions at this age. This complexity is further illustrated by contrasting findings from studies such as Taylor et al. [116] and Dore et al. [117], who found no significant relationships in this age group, with other studies showing clear impacts on both domains.

Our findings emphasize the need to consider language development and executive functions as interrelated processes when studying screen time’s impact on children aged 0–78 months. Future research should focus on understanding how different types of screen engagement can be optimized to support both domains simultaneously during this crucial developmental period. Additionally, more attention should be paid to how socioeconomic and cultural factors moderate screen time’s impact on these interconnected developmental processes in early childhood.

Limitation

Several limitations were considered when interpreting the findings of this study. The systematic review was limited to the Web of Science, Scopus, ERIC, EBSCO, and Pub-Med databases and selected keywords in the search process. While these databases were chosen in line with the research’s purpose, this limitation may have affected the comprehensiveness of the study. In addition, the analysis was conducted with the articles written in English-language only, which represents another limitation to be considered. Excluding various scientific documents may lead to an incomplete interpretation of the literature. It is important to recognize that the assessments of the quality of reporting of studies based on the findings of this systematic analysis may be constrained by the limitations identified within the analysis itself. The sample size was limited to 14 articles, which may limit the generalizability of the results and may not fully encompass the entire body of literature in this field.

Conclusion

Our study’s findings provide valuable insights into the complex relationships between children’s language development, executive functions, and screen time. It emphasizes the importance of considering these three variables together, particularly in the preschool period. The results of this study are consistent with previous research indicating that educational and interactive screen content has a positive impact on children’s cognitive and language development. Excessive and passive screen use has been shown to have a negative effect. Additionally, the study demonstrates that parent-child interaction and socioeconomic factors play a significant role in this relationship. These findings are expected to inform important strategies for parents, educators, and policymakers in managing and guiding children’s screen use. In conclusion, the quality of time children spends in front of screens and the way parents manage this process have a significant impact on language development and executive functions.

Implications

The implications of these findings are significant for parents, educators, and policymakers. For parents, it is crucial to carefully select interactive and educational screen content to support children’s language and cognitive development. Adherence to recommended screen time guidelines can minimize potential negative effects on executive functions and language skills. Engaging in screen media activities with children enhances interaction and supports developmental processes. Limiting passive screen time and ensuring that screen use is balanced with real-world interactions and play opportunities are also essential. For educators, integrating educational and interactive screen content into the curriculum can support language and cognitive skills development. Educating parents on the importance of managing screen time and selecting high-quality content is also crucial. Additionally, promoting activities that reduce passive screen time and encourage active learning and interaction among children is beneficial. For policymakers, it is important to develop and promote guidelines for screen time that emphasize the importance of content quality and interactive use. Supporting initiatives that provide access to high-quality educational media for families from all socioeconomic backgrounds and implementing programs that educate parents about the impact of screen time on child development and strategies for managing screen media use effectively are also key steps. By addressing these areas, it is possible to harness the potential benefits of screen media while mitigating its negative impacts on children’s development. Carefully managing screen time not only supports children’s language and cognitive development but also helps them develop healthy digital habits. Parents can teach their children how to use digital media safely and effectively, improving their digital literacy skills, which is a critical skill for future success in the digital world. In an era where digital technology is becoming increasingly prevalent, it is of paramount importance to gain a deeper understanding of the relationship between screen time, language development, and executive function. Consequently, it is recommended that future systematic reviews expand their research scope to include methodological quality.

Supporting information

S1 File. Dataset.

This Excel file contains the data used in this study, including all variables and analyses reported in the manuscript. It is publicly available and can be accessed directly from the OSF repository.

(XLSX)

pone.0314540.s001.xlsx (85.4KB, xlsx)
S2 File. PRISMA checklist.

The PRISMA checklist outlines the systematic review process and compliance with reporting standards.

(PDF)

pone.0314540.s002.pdf (85.7KB, pdf)
S3 File. Handling missing data.

This document outlines the methodological approach used to handle missing data in the systematic review, ensuring rigor and comprehensiveness at every stage of the analysis.

(DOCX)

pone.0314540.s003.docx (15.4KB, docx)
S1 Table. Evaluation process of studies identified in systematic review.

This table summarizes the evaluation process of studies identified in the systematic review.

(DOCX)

pone.0314540.s004.docx (46.6KB, docx)
S2 Table. Data extraction summary.

This table provides details on the data extracted from the included studies.

(DOCX)

pone.0314540.s005.docx (16.4KB, docx)
S3 Table. Risk of bias and quality/certainty assessments.

This table presents the GRADE assessment of included studies.

(DOCX)

pone.0314540.s006.docx (21.9KB, docx)

Data Availability

https://osf.io/n7uc6/?view_only=8987e34f20da40ddba6c6c7c7009e84d

Funding Statement

The author(s) received no specific funding for this work.

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Decision Letter 0

Alexander Röhm

17 May 2024

PONE-D-24-04813Examining the Relationship Between Language Development, Executive Function, and Screen Time: A Systematic ReviewPLOS ONE

Dear Dr. Kara Aydemir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please pay especially close attention to the issues raised by Reviewer 1 regarding the overall quality of your study and manuscript to adhere to scientific standards and quality criteria for systematic reviews. There are major concerns addressed by both reviewers regarding the general methodological quality and rigor that will be crucial concerning the further development of your manuscript and its potential for acceptance for publication. You will find the reviewers' comments in the body of this email and as detailed remarks from reviewer 1 attached below.

Please submit your revised manuscript by Jul 01 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Alexander Röhm

Guest Editor

PLOS ONE

Journal Requirements:

1. When submitting your revision, we need you to address these additional requirements.

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We will update your Data Availability statement on your behalf to reflect the information you provide.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The recommendation of a major revision has been given due to major corrections that have to be done. Besides plenty errors and inaccuracies in the methodology, that make the review unreproducible and intransparent, these mainly concern the wording and the text structure. Especially the sections results, discussion, and implications have to be revisioned regarding the wording. Writing a systematic review requires a range of skills. It involves thorough literature searching, critical evaluation, and clear presentation of the results. The writer's effort is commendable for attempting this complex task. Nevertheless, the text still needs some polishing (a few rounds of feedback and proofreading) to make it publishable. Otherwise it does not meet the criteria of good scientific practice

Reviewer #2: Thank you for the opportunity to review this article, Examining the relationship between language development executive function and screen time – a systematic review. This is a growing area of importance for policy makers, practitioners and families and so it is very valuable to have systematic reviews to consolidate the research.

While I applaud the authors for this comprehensive review, there are some key methodological concerns that should be addressed prior to publication.

Critique of previous systematic reviews:

There are several recent systematic reviews that have been published in this area (or very closely aligned areas). It would be useful to see a description of these reviews, what their limitations or gaps are and how this current review addresses them. This can then be reflected on in the discussion in the ways previous research has been limited or inconclusive and what the current findings have added. Some examples of the reviews include:

o Madigan, McArthur, Anhorn et al (2020) Associations between screen use and child language skills: a systematic review and meta-analysis

o Streegan, Lugue & Morato-Espino (2022) Effects of screen time on the development of children under 9 years old: a systematic review

o Santos, Mendes, Miranda & Romano-Silva (2022) The association between screen time and attention in children: a systematic review

Description of age ranges:

The authors should provided a clearer description within both the methods and results of what they mean by “preschool children” and “early childhood”. This can mean different things in different contexts and so it is important to be clear on the age range. Of the included studies the age ranges should also be included for all studies listed in Table 1. Within the results section I noted, two studies appear to fall outside the typical early childhood age range and so the authors should make clearer the justification of their inclusion. Specifically:

- Vohr et al focused on “children born preterm” however the study was conducted when the child was 6-7 years old.

- Horowitz-Kraus & Hutton focused on children 8-12 years old.

Methodological quality review:

The authors have used the CONSORT guidelines to support a review of methodological quality. However, I would argue this focuses on more on the quality of reporting the studies and not necessarily the methodological quality. Typically some form of “Risk of Bias” assessment would be used to examine methodological quality there are several tools available depending on the study design. An article by Ma, Wang, Yang et al (2020) “Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better” has a useful summary of the available tools.

Furthermore, on the use of CONSORT there are different guidelines depending on study design but it is unclear if the authors have used these variations depending on the study design on their 16 articles included in the review. I would have also hoped to see an integration of the thematic review and the methodological quality to inform conclusions regarding the relationship between screen time, language development and executive functioning. For example, the authors ultimately conclude (pg 17) that “there is no relationship between executive function and language development, regardless of the type of screen time”. However, this does not seem to be based on an assessment of the quality of these studies that reported no association (or at least this is not detailed in the paper).

Screen time x Language Development x Executive Functioning:

After reading the paper it is not clear to me if studies in the review had to include data on all three constructs or if eligible papers may have included data only on ‘screen time and language development’ and ‘screen time and executive functioning’. Providing this detail would be useful, including detailing outcome measures in Table 1 and providing a more nuanced discussion of differences in findings between language development and executive function.

Within the discussion, the authors also state “Despite advances in understanding the link between language and executive function, the current understating of the relationship between specific cognitive function components and language skills is still limited”. However, it does not appear this was a question the authors were trying to understand in their review – given all the papers were in the context of screen time.

Multiple data collections tools:

It is not clear what the authors are referring to when using this term. Is it related to studies using self-reported vs objective measures of the constructs or that the measure of screen time includes multiple types of devices? If it is the latter, this is an interesting point however, it is not clear in the results as to whether this has made a difference in the conclusions. This may also be a result of authors not restricting date ranges in their review and so many older studies may be focused entirely on TV viewing as mobile technology was not commonly available in studies published more than a decade ago.

Minor formatting recommendations:

Including the definition of different executive functioning process in a Table might be useful to a reader. You could also include an overall definition for executive function, and any key language development measures you are using so that readers can easily refer back to them if need be.

In the section ‘Thematic analysis’ the authors have not included the details of the ‘non-association’ theme.

This sentence in the discussion may need to be reworked: “The study suggests that early childhood teachers are not sufficiently aware of the importance of executive functions in preschool language education [88]. may lack knowledge.”

There are several hyphens used throughout the manuscript that should be removed. Some examples include: “de-velopmental” and “emo-tional” in first paragraph of introduction.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Dr Mary Brushe

**********

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Attachment

Submitted filename: Plos_ONe Review - 1.docx

pone.0314540.s007.docx (18.5KB, docx)
Attachment

Submitted filename: PONE-D-24-04813.pdf

pone.0314540.s008.pdf (1.1MB, pdf)
PLoS One. 2024 Dec 26;19(12):e0314540. doi: 10.1371/journal.pone.0314540.r002

Author response to Decision Letter 0


28 May 2024

Sayın Dr. Alexander Röhm,

Mazhar Bal, Ayşe Gül Kara Aydemir, Gülizar Şule Tepetaş Cengiz ve Ahmet Altındağ tarafından hazırlanan “Dil Gelişimi, Yürütücü İşlev ve Ekran Süresi Arasındaki İlişkinin İncelenmesi: Sistematik Bir İnceleme” başlıklı makalemizin gözden geçirilmiş halini PLOS ONE'da yayınlanmak üzere yeniden değerlendirmeye sunmak için yazıyorum. Hakemlerin yorum ve önerilerini dikkatle değerlendirdik ve revizyonların makalemizi önemli ölçüde güçlendirdiğine inanıyoruz. Hakemlerin ve yayın kurulunun makalemizi değerlendirmek için harcadıkları zaman ve çabaya derinden minnettarız.

Makaleyi açıklık ve tutarlılık açısından gözden geçirdik, net olmayan cümleleri yeniden ifade ettik ve belgenin genel okunabilirliğini sağladık. Giriş bölümünde, araştırma boşluklarını vurgulayarak inceleme için ayrıntılı bir gerekçe ekledik. Uyarlanmış CONSORT protokollerinin kullanımına açıklık getirdiğimiz ve dahil etme kriterlerini belirttiğimiz yöntemler bölümünde önemli revizyonlar yapıldı. Veriler yeniden analiz edildi ve tematik kümeler tutarlılığı ve derinliği artırmak için yeniden yapılandırıldı. Sonuç olarak, tartışma bölümü yeniden yazılarak ilgili literatürden ek bilgiler eklenmiş ve bulguların daha yapılandırılmış bir sunumu sağlanmıştır. Tablolar, katılımcı özellikleri ve yaş aralıkları hakkında ayrıntılı bilgi içerecek şekilde güncellenmiştir. Sonuç ve çıkarımlar bölümleri revize edilen içerikle uyumlu olacak şekilde yeniden yazılmıştır. Her bir hakemin yorumlarına verilen ayrıntılı yanıtlar yanıt belgesinde yer almaktadır.

Gözden geçirilmiş makalenin PLOS ONE standartlarını artık daha iyi karşıladığına ve hakemlerin tüm endişelerini kapsamlı bir şekilde ele aldığına inanıyoruz. Gözden geçirilmiş başvurumuzu olumlu değerlendirmenizi bekliyoruz.

Zaman ayırdığınız ve yeniden değerlendirdiğiniz için teşekkür ediyor ve çalışmamızın PLOS ONE'da yayınlanmak üzere yeniden değerlendirilme fırsatını dört gözle bekliyorum. Ayşe Gül Kara Aydemir bu çalışmanın sorumlu yazarıdır. Herhangi bir sorunuz olması veya daha fazla bilgiye ihtiyaç duymanız halinde, lütfen benimle agkara@gmail.com adresinden e-posta yoluyla iletişime geçin.

Attachment

Submitted filename: PONE-D-24-04813_ResponseToReviewer1.pdf

pone.0314540.s009.pdf (1.1MB, pdf)

Decision Letter 1

Alexander Röhm

27 Aug 2024

PONE-D-24-04813R1Examining the Relationship Between Language Development, Executive Function, and Screen Time: A Systematic ReviewPLOS ONE

Dear Dr. Kara Aydemir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================Please see the Editor's and the Reviewers' Comments below.

==============================

Please submit your revised manuscript by Oct 11 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Alexander Röhm

Guest Editor

PLOS ONE

Additional Editor Comments:

Dear Authors,

thank you for your thourough revision of your manuscript. The reviewers very much appreciate the efforts you put into your review and acknowledge the improvements it made since its original submission. However, there are still some minor, but also major issues that deserve your full attention. In line with both reviews I recommend to especially pay close attention to the following points (as well as the reviewers detailed comments):

- Reference and discussion of other recent SR/MA in the field (see Reviewer 3) to highlight the relevance of your specific SR.

- While you elaborate in detail on various aspects surounding language development like executive functions, working memoriy, problem solving, processing etc. the link between these and "screen time" needs to be pointed out more clearly. At the moment, everything is listed rather additive but not put together into a strong line of argumentation and research rationale. Also, please try to avoid redudant argumentation in the regard, for instance, concerning the relation between language development, EF, and WM. What exactly is the important point here for your review?

- The overall aim of the SR is well described. Yet, the research questions do not seem to fully address what is (a) plannend to do and is (b) actually done by the SR. RQ1 could be omitted, since it appears to aim for a assesment of potential biases, which should be added to every SR following the PRISMA guidelines. RQ2 should be formulated as closely as possible to cover the scope of the SR, e.g.: "What is the relationship between children's screen time, language development, and executive functions reported in the present research literature?"

I hope these comments along with the reviewers' comments help to further improve your manuscript.

Best regards.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: (No Response)

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Partly

Reviewer #3: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: No

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Thank you to the authors for their thorough review of the manuscript. I was pleased to see considerable improvements in this version and acknowledge the time and effort that would have gone into the updates to the results and discussion section.

However, these changes have raised some additional concerns that I believe need to be addressed before publication.

Some are minor formatting/grammatical issues and others have larger implications for the overall review findings and methodology. I have attempted to summarise this based on each section of the manuscript:

Abstract:

- “The study categorizes the impact into four key themes…” – it is not clear what ‘impact’ is referring to. I’m assuming this refers to the impact of screen time on language development and executive functioning, but this should be specified.

- The sentence ‘The prevalence of attention problems is found to be higher in individuals who engage in high levels of screen time’ appears out of place and could be removed from the abstract or included earlier on before discussing socioeconomic and cultural factors.

Introduction:

- Overall, the introduction has been significantly improved and the authors should be commended on their excellent summary of the literature. The summary makes a clear case for RQ2 however, the authors have not really identified why RQ1 is needed as a separate aim. Is there previous evidence to say that quality of reporting in this field is poor and so that’s why we need it to be reviewed, or should this be a sub-aim that can be commented on within findings from RQ2? I would recommend listing RQ2 as the primary question and provide greater rationale on why RQ1 is needed.

Some minor edits to this section also include:

o The summary of the link between language development and executive function on page 5 could be shortened to streamline this section.

o Pg 8: “Mantilla and Edwards [51] noted that digital technology is now become and accepted an integral part…” should read “Mantilla and Edwards [51] noted that digital technology has now become and is accepted as an integral part…”

o Noting the authors advised the incorrect placement of hyphens seems to be an issue due to the submission system, however I note one is still present on page 9, end of first paragraph ‘for-mulated’.

Methods

- The inclusion of Table 2 is very helpful and provides a good overview of the included studies. It does say in text that ‘author and year’ is described, however, currently the table only has the authors listed. Including details of the year of publication would be important especially given there was no restriction on publication date.

Results

- Please check the formatting of Table 3: (1) some of the study details in the first row are cut off; (2) the columns have not always been merged correctly for rows where headings are listed; (3) spelling error for 12a heading ‘Practisal’; (4) Rater agreement (%) should have the percentage sign after the number eg., 90%.

- Second sentence in the first paragraph on pg 22, should be reframed to state “Based on these data, all the articles have a value equal to or greater than 15 points.

- Can the authors please clarify how screen time was incorporated into the Dolgikh et al [62] study? Did the extra classes that were attended in the study use educational screen time? The interpretation of this study may also need clarification, as the authors state ‘These findings suggest that structured extra classes can mitigate some of the negative effects of high screen time, enhancing language development and executive functions in preschool children’. However, it is not clear if that was actually tested in this research and is contradictory to the authors earlier statement that attending extra classes had no relationship to executive functioning?

- “Parents adherence to screen time recommendations also enables beneficial characteristics of screen media, it was linked to better working memory” – what do the authors mean by ‘beneficial characteristics’?

- I would recommend the authors rethink the wording of the theme ‘interactive and educational screen content’ to incorporate something about adherence to guidelines as some of the studies (e.g., Hutton et al) does not appear to investigate interactive or educational content specifically. Similarly, I would recommend reframing the theme ‘Parent and child interaction’ to ‘Parent-child interaction and the family context’ given much of the research summarised is focusing on socioeconomic status of the family.

- First paragraph of pg 25 should be included in the Discussion section of the paper, rather than the results and it should also include references to some of the claims made (e.g., interactions can support children’s social and emotional development).

- As described on pg 29, the study by Kim and Chung [66] appear to include children outside the age range of the eligibility criteria (87.9months). Similarly for the study by Ribner et al [69] is outside the age range (7 years).

- Several statements in the second half of pg31 require associated references to support these claims.

- Final paragraph of the results section (pg 31-32) belongs within the discussion section.

Discussion

- The statement on pg 34 “… the results regarding the quality of reporting can inform researchers about the effective methods for data collection and analysis.” I don’t believe is correct. The review of adherence to reporting guidelines makes no comment on the effectiveness of methodology or data analysis. I would further argue that RQ1 does not make a substantial contribution to the existing body of literature and as a reader it is not clear what can be taken from the findings, other than research in this space seems to be generally applying the CONSORT checklist.

- It would be helpful if the authors could make some comment on why there might be diversity in findings across studies within specific themes. For example, they describe that some studies find negative relationships and others found no relationship – but it is unclear why this may be the case. Are there differences in how they defined screentime or the age of the children they assessed?

- I would recommend reframing the sentence “The literature also emphasizes that one of the significant variables affecting the negative impact of screen exposure is parents.” There is considerable context and factors outside of many parents control that may or may not influence their ability to support healthy screen time, however this sentence appears to place a considerable amount of blame on them.

- Overall, the results and discussion section should be thoroughly reviewed for sentence structure, clarity and flow.

Reviewer #3: PONE-D-24-04813R1

Thank for the opportunity to review the manuscript entitled “Examining the Relationship Between Language Development, Executive Function, and Screen Time: A Systematic Review” submitted to PLOS ONE.

This manuscript describes findings of a systematic review on the relation between Language Development, Executive Function, and Screen Time in children under six. These findings underscore the nuanced impact of screen time on language development and executive function, emphasizing the potential benefits of interactive and educational content when coupled with active parental engagement, while highlighting the risks associated with excessive passive screen time, particularly in lower SES contexts. While the paper addresses an important and relevant topic that is likely to interest many PLOS ONE readers, several issues need to be addressed, which are listed below:

1. I wanted to bring the authors’ attention to two recent meta-analyses on the very similar topic, which may enrich the discussion of the findings.

- Jing, M., Ye, T., Kirkorian, H. L., & Mares, M. L. (2023). Screen media exposure and young children's vocabulary learning and development: A meta‐analysis. Child Development, 94(5), 1398-1418.

- McHarg, G., Ribner, A. D., Devine, R. T., & Hughes, C. (2020). Screen time and executive function in toddlerhood: A longitudinal study. Frontiers in Psychology, 11, 570392.

2. The relation between the two research questions and the four key themes doesn’t appear straightforward to me. Is each research question examined under every theme? If so, why attention issue is an theme while executive function, which involves attention issues, is also part of the research question?

3. It is great that information about the studies’ methodology was included. However, from Table 2, it is unclear, at least for some studies, what exact research design is used. For example, are the first two studies (e.g., Zhang et al. and Hutton et al.) cross-sectional or longitudinal? This is critical information to be taken into account, because 1) previous meta-analyses show reliable difference between the effects of screen media exposure that are derived from different study designs (Jing, Ye, Kirkorian & Mares, 2023), and 2) it influences the coding of child age (e.g., in longitudinal research, the age when children are exposed to screen might be different from the age when the children are assessed on those outcome measures).

4. I would suggest the authors to add definitions for key concepts in the four themes. For example, what is exactly educational and what exactly interactive refers to? The meaning could vary by media format; educational TV is quite different from educational apps and games. And interactive media, which could either focus on physical interactivity or social contingency, is also too general to foster a meaningful discussion.

5. For the Methods, I have some qualm about the search strategy. Both language development and screen time are very board keywords, and I’m afraid this has missed eligible studies that use more specific narrow keywords, such as word learning, vocabulary learning or development, phonetic learning and TV viewing, video game playing, etc.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #2: No

Reviewer #3: No

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PLoS One. 2024 Dec 26;19(12):e0314540. doi: 10.1371/journal.pone.0314540.r004

Author response to Decision Letter 1


1 Sep 2024

We would like to express our sincere gratitude to the reviewers for their continued valuable feedback and constructive criticism on our manuscript submitted to PLOS ONE. We have carefully considered each comment and recommendation provided during this second round of review and have made further revisions to our manuscript in response.

To ensure clarity and transparency in how we have addressed the reviewers' suggestions, we have prepared a detailed table that outlines each comment along with the corresponding revisions made in the manuscript.

We appreciate the opportunity to improve our manuscript, and we believe these revisions have further strengthened our work. We look forward to your further evaluation and hope our manuscript meets the journal's standards for publication.

Reviewer 2: “The study categorizes the impact into four key themes…” – it is not clear what ‘impact’ is referring to. I’m assuming this refers to the impact of screen time on language development and executive functioning, but this should be specified.

Authors’ Response: Based on your suggestion, we have revised the sentence to clearly state that the findings of the current study were categorized under four themes. The sentence now reads: "The findings of the current study were categorized under four themes." We believe this change addresses your concern and makes the intended meaning clearer (page 3).

Reviewer 2: The sentence ‘The prevalence of attention problems is found to be higher in individuals who engage in high levels of screen time’ appears out of place and could be removed from the abstract or included earlier on before discussing socioeconomic and cultural factors.

Authors’ Response: We have removed this sentence from its previous position and integrated the information earlier in the abstract, prior to the discussion of socioeconomic and cultural factors (page 3).

Reviewer 2: Overall, the introduction has been significantly improved and the authors should be commended on their excellent summary of the literature. The summary makes a clear case for RQ2 however, the authors have not really identified why RQ1 is needed as a separate aim. Is there previous evidence to say that quality of reporting in this field is poor and so that’s why we need it to be reviewed, or should this be a sub-aim that can be commented on within findings from RQ2? I would recommend listing RQ2 as the primary question and provide greater rationale on why RQ1 is needed.

Authors’ Response: In response to your suggestion, we have restructured our research questions to emphasize the primary focus of our study. As a result, we have integrated the original RQ1 ("What is the quality of reporting of studies on the relationship between screen time, language development, and executive function?") into the materials and methods section. We believe his revision allows us to maintain the focus on the primary research question while still acknowledging the significance of reporting quality as a critical aspect of our review. We hope this addresses your concerns and provides a clearer rationale for the structure of our study (pages 19-22).

Reviewer 2:

1. Some minor edits to this section also include:

The summary of the link between language development and executive function on page 5 could be shortened to streamline this section.

2. Pg 8: “Mantilla and Edwards [51] noted that digital technology is now become and accepted an integral part…” should read “Mantilla and Edwards [51] noted that digital technology has now become and is accepted as an integral part…”

3. Noting the authors advised the incorrect placement of hyphens seems to be an issue due to the submission system, however I note one is still present on page 9, end of first paragraph ‘formulated’.

Authors’ Response:

Reviewer 2:

Authors’ Response:

1. We have revised whole introduction section, and shortened our literature based on the feedback (pages 4-6).

2. We have revised the sentence as suggested, so it now reads: "Mantilla and Edwards [51] noted that digital technology has now become and is accepted as an integral part..." (page 8).

3. We have corrected the hyphen in the word "formulated" as noted on page 9, at the end of the first paragraph.

Reviewer 2: The inclusion of Table 2 is very helpful and provides a good overview of the included studies. It does say in text that ‘author and year’ is described, however, currently the table only has the authors listed. Including details of the year of publication would be important especially given there was no restriction on publication date.

Authors’ Response: Thank you for your observation. We have updated Table 2 to include the year of publication along with the authors' names, as suggested (pages 12-17).

Reviewer 2: Please check the formatting of Table 3: (1) some of the study details in the first row are cut off; (2) the columns have not always been merged correctly for rows where headings are listed; (3) spelling error for 12a heading ‘Practisal’; (4) Rater agreement (%) should have the percentage sign after the number eg., 90%.

Authors’ Response:

1. Adjusted the first row so that all study details are fully visible (page 20).

2. Corrected the merging of columns where headings are listed (pages 20-21).

3. Fixed the spelling error for the "12a" heading from "Practisal" to "Practical." (page 21).

4. Updated "Rater agreement" to include the percentage sign after the numbers (e.g., 90%) (page 21).

Reviewer 2: Second sentence in the first paragraph on pg 22, should be reframed to state “Based on these data, all the articles have a value equal to or greater than 15 points.

Authors’ Response: We have revised the second sentence in the first paragraph on page 22 based on the reviewer's suggestion. The sentence now reads: “Based on these data, all the articles have a value equal to or greater than 15 points.”

Reviewer 2:

1. Can the authors please clarify how screen time was incorporated into the Dolgikh et al [62] study?

2. Did the extra classes that were attended in the study use educational screen time? The interpretation of this study may also need clarification, as the authors state ‘These findings suggest that structured extra classes can mitigate some of the negative effects of high screen time, enhancing language development and executive functions in preschool children’. However, it is not clear if that was actually tested in this research and is contradictory to the authors earlier statement that attending extra classes had no relationship to executive functioning?

Authors’ Response:

1. We have clarified this in the manuscript as below (page 24):

In this study, screen time was assessed through a questionnaire administered to the mothers of the participating children. The questionnaire specifically asked about the average amount of screen time the children engaged in per week. The study compared screen time between two groups: children attending extra classes and those who did not. Although the difference in screen time between the groups was not statistically significant, it was noted that children in the extra classes group had slightly lower screen time (approximately 1016 minutes per week) compared to the no extra classes group (approximately 1299 minutes per week).

This screen time data was considered in the analysis of the children’s executive functions, ensuring that its potential impact on cognitive development was accounted for in the study’s findings. (page 23).

2. We added further explanation regarding this feedback as below:

“In this study, no specific data was collected regarding the use of screen time for educational purposes during the extra classes. In other words, the relationship between extra classes and screen usa was not directly examined. The study concluded that participation in extra classes had a positive impact on the development of children’s executive functions. Therefore, the study does not provide definitive conclusions on whether the supplementary classes balance out the negative effects of high screen time. On the other hand, the article did examine screen time as a factor related to the development of children’s executive functions, emphasizing that excessive screen time could have negative effects on the development of executive functions (pages 24-25).

Reviewer 2: “Parents adherence to screen time recommendations also enables beneficial characteristics of screen media, it was linked to better working memory” – what do the authors mean by ‘beneficial characteristics?

Authors’ Response: We have revised the manuscript to more clearly reflect this explanation and to ensure that the term "beneficial characteristics" accurately conveys the intended meaning on page 25.

Reviewer 2: I would recommend the authors rethink the wording of the theme ‘interactive and educational screen content’ to incorporate something about adherence to guidelines as some of the studies (e.g., Hutton et al) does not appear to investigate interactive or educational content specifically. Similarly, I would recommend reframing the theme ‘Parent and child interaction’ to ‘Parent-child interaction and the family context’ given much of the research summarised is focusing on socioeconomic status of the family.

Authors’ Response: Thank you for your valuable suggestions. We have revised the theme “Interactive and Educational Screen Content” to “Screen Content and Adherence to Guidelines” better reflect adherence to guidelines (page 23), and we have also rephrased the theme “Parent and Child Interaction” to “Parent-child Interaction and the Family Context” to align with the research focus on socioeconomic status (page 27).

Reviewer 2: First paragraph of pg 25 should be included in the Discussion section of the paper, rather than the results and it should also include references to some of the claims made (e.g., interactions can support children’s social and emotional development).

Authors’ Response: Following the reviewer’s suggestion, this section has been removed from the results section. The reviewer’s recommendation highlighted that this content was redundant. A similar discussion, already supported by relevant literature, is presented in the discussion section (pages 37-38).

Reviewer 2: As described on pg 29, the study by Kim and Chung [66] appear to include children outside the age range of the eligibility criteria (87.9months). Similarly for the study by Ribner et al [69] is outside the age range (7 years).

Authors’ Response: Although the study extends up to 87.9 months, we included the entire dataset in our analysis because it provides valuable insights into the longitudinal effects of screen time on child development. We added the following note to Table 2 (page 16): The progression from early childhood (starting at 5.5 months) to later stages (up to 87.9 months) allows for a comprehensive understanding of how screen exposure impacts cognitive and language development over time. Accordingly, we have revised the sentence on page 31 in the manuscript to clarify that Kim and Chung [66] conducted annual assessments from birth to 87.9 months, capturing the comprehensive longitudinal impact of screen time on child development as well.

Reviewer 2: Several statements in the second half of pg31 require associated references to support these claims.

Authors’ Response: The statements on page 33 are located in the results section and are intended to summarize the findings of the studies included in the theme. These findings were discussed based on the data from the studies themselves, which is why no additional literature references were included in this part of the text. To clarify the relationship between the results and the overarching theme, we have added transition phrases that link these findings to the data presented. Any discussion of these results in the context of existing literature has been deliberately reserved for the discussion section, where appropriate references have been included.

Reviewer 2: Final paragraph of the results section (pg 31-32) belongs within the discussion section.

Authors’ Response: In response, we have removed the final paragraph from the results section and integrated it into the appropriate theme within the discussion section (page 39).

Reviewer 2: The statement on pg 34 “… the results regarding the quality of reporting can inform researchers about the effective methods for data collection and analysis.” I don’t believe is correct.

The review of adherence to reporting guidelines makes no comment on the effectiveness of methodology or data analysis. I would further argue that RQ1 does not make a substantial contribution to the existing body of literature and as a reader it is not clear what can be taken from the findings, other than research in this space seems to be generally applying the CONSORT checklist.

Authors’ Response: In response to your suggestion, we have restructured our research questions to better align with the primary focus of our study as we stated earlier.

Consequently, we have integrated the original RQ1 (What is the quality of reporting of studies on the relationship between screen time, language development, and executive function?) into the materials and methods section (pages 19-21).

This revision allowed us to maintain our focus on the primary research question and eliminate the discussed statement from the discussion section.

Reviewer 2: It would be helpful if the authors could make some comment on why there might be diversity in findings across studies within specific themes. For example, they describe that some studies find negative relationships and others found no relationship – but it is unclear why this may be the case. Are there differences in how they defined screentime or the age of the children they assessed?

Authors’ Response: We agree that explaining the diversity in findings across studies is important. In response, we added a discussion in the manuscript that considers variations in screen time definitions, the age of children, and the context and duration of screen exposure, which may account for the differing results (page 36).

Reviewer 2: I would recommend reframing the sentence “The literature also emphasizes that one of the significant variables affecting the negative impact of screen exposure is parents.” There is considerable context and factors outside of many parents control that may or may not influence their ability to support healthy screen time, however this sentence appears to place a considerable amount of blame on them.

Authors’ Response: We have revised the sentence to read: "The literature highlights the important role of parents in mitigating the negative effects of screen exposure, though this role can be influenced by various external factors (page 37).

Reviewer 2: Overall, the results and discussion section should be thoroughly reviewed for sentence structure, clarity and flow.

Authors’ Response: Discussion section has been revised (pages 33-40).

Reviewer 3: I wanted to bring the authors’ attention to two recent meta-analyses on the very similar topic, which may enrich the discussion of the findings.

- Jing, M., Ye, T., Kirkorian, H. L., & Mares, M. L. (2023). Screen media exposure and young children's vocabulary learning and development: A meta‐analysis. Child Development, 94(5), 1398-1418.

- McHarg, G., Ribner, A. D., Devine, R. T., & Hughes, C. (2020). Screen time and executive function in toddlerhood: A longitudinal study. Frontiers in Psychology, 11, 570392.

Authors’ Response: Thank you for bringing these recent meta-analyses to our attention. We have reviewed the studies by Jing et al. (2023) and McHarg et al. (2020) and have incorporated relevant insights from these works into the discussion of our findings (page 38).

Reviewer 3: The relation between the two research questions and the four key themes doesn’t appear straightforward to me. Is each research question examined under every theme? If so, why attention issue is an theme while executive function, which involves attention issues, is also part of the research question?

Authors’ Response: We have clarified the relationship between the research questions and the identified themes in our manuscript. Specifically, we have added an explanation to the discussion section that outlines why "Attent

Attachment

Submitted filename: ResponseToReviewers2ndRevision.docx

pone.0314540.s010.docx (31.7KB, docx)

Decision Letter 2

Alexander Röhm

16 Oct 2024

PONE-D-24-04813R2Examining the Relationship Between Language Development, Executive Function, and Screen Time: A Systematic ReviewPLOS ONE

Dear Dr. Kara Aydemir,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Since this is another revision round in which some issues that have already been addressed by the reviewers and me, please pay close attention to all comments and try to answer them as unambigous as possible. I have noticed that you did not respond to my specific comments during your last revision. Therefore, I include them again here as well as below:

In line with the present reviews I recommend to especially pay close attention to the following points (as well as the reviewers detailed comments):

- Reference and discussion of other recent SR/MA in the field to highlight the relevance of your specific SR.

- While you elaborate in detail on various aspects surounding language development like executive functions, working memoriy, problem solving, processing etc. the link between these and "screen time" needs to be pointed out more clearly. At the moment, everything is listed rather additive but not put together into a strong line of argumentation and research rationale. Also, please try to avoid redudant argumentation in the regard, for instance, concerning the relation between language development, EF, and WM. What exactly is the important point here for your review?

- The overall aim of the SR is well described. Yet, the research questions do not seem to fully address what is (a) plannend to do and is (b) actually done by the SR. RQ1 could be omitted, since it appears to aim for a assesment of potential biases, which should be added to every SR following the PRISMA guidelines. RQ2 should be formulated as closely as possible to cover the scope of the SR, e.g.: "What is the relationship between children's screen time, language development, and executive functions reported in the present research literature?"

I hope these comments along with the reviewers' comments help to further improve your manuscript.

Please submit your revised manuscript by Nov 30 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Alexander Röhm

Guest Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear Authors,

thank you again for your thourough revision of your manuscript. The remaining reviewer very much appreciates the efforts you put into your review and acknowledge the improvements it made since last revision. However, there are still some minor, but also major issues that deserve your full attention. In line with the present reviews I recommend to especially pay close attention to the following points (as well as the reviewers detailed comments):

- Reference and discussion of other recent SR/MA in the field to highlight the relevance of your specific SR.

- While you elaborate in detail on various aspects surounding language development like executive functions, working memoriy, problem solving, processing etc. the link between these and "screen time" needs to be pointed out more clearly. At the moment, everything is listed rather additive but not put together into a strong line of argumentation and research rationale. Also, please try to avoid redudant argumentation in the regard, for instance, concerning the relation between language development, EF, and WM. What exactly is the important point here for your review?

- The overall aim of the SR is well described. Yet, the research questions do not seem to fully address what is (a) plannend to do and is (b) actually done by the SR. RQ1 could be omitted, since it appears to aim for a assesment of potential biases, which should be added to every SR following the PRISMA guidelines. RQ2 should be formulated as closely as possible to cover the scope of the SR, e.g.: "What is the relationship between children's screen time, language development, and executive functions reported in the present research literature?"

I hope these comments along with the reviewers' comments help to further improve your manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: PONE-D-24-04813R2

I believe that the authors have made great effort improving the manuscript and addressing my major concerns. The flow of the introduction is stronger now, the method is more solid, and the discussion gets richer. However, there are still some remaining issues which are listed below:

I think the authors need to make an even stronger case for studying both language development and executive function in the context of screen time. The Introduction reviews the meaningful relationships between them, but it is not clear to me how this is reflected in the findings and discussion, which appears to address screen time’s relation with language development and executive function respectively.

Additionally, in addressing my previous concern about using broad keywords for study search, the authors stated that using very specific keywords could potentially result in inclusion of irrelevant studies, making the filtering process more problematic. I don't necessarily see that’s problematic, despite the fact that it will surely needs more work to screen relevant studies. At least, the method section needs to give clear definition and operational criteria for language development so that readers know what you mean by language development and how language development is examined in selected studies. And the same for screen time which is studied and measured in all different ways. I wound suggest to consider expanding Table 1 include that information and, if applicable, also for executive function as well.

Lastly, I think it would be beneficial for the study to be more mindful and clearer about the age range it focuses on when defining the research question, reviewing relevant literature in the introduction, and discussing and situating the findings. Given the remarkable developmental variability in children interacting with screen media, specifying the developmental stage could make the paper more informative and better connected to the larger literature.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

**********

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PLoS One. 2024 Dec 26;19(12):e0314540. doi: 10.1371/journal.pone.0314540.r006

Author response to Decision Letter 2


21 Oct 2024

Dear Dr. Alexander Röhm,

I am writing to submit the revised version of our manuscript titled “Examining the Relationship Between Language Development, Executive Function, and Screen Time: A Systematic Review” by Mazhar Bal, Ayşe Gül Kara Aydemir, Gülüzar Şule Tepetaş Cengiz, and Ahmet Altındağ for reconsideration for publication in PLOS ONE. We have carefully considered the editor’s and reviewer’s comments and suggestions, and we believe the revisions have significantly strengthened our manuscript. We deeply appreciate the time and effort dedicated by the reviewer and editorial board in evaluating our manuscript.

In response to both editorial and reviewer feedback, we have implemented comprehensive revisions throughout the manuscript. Following the editor's recommendations, we thoroughly restructured the introduction section to establish more explicit connections between screen time and language development, while incorporating a new section reviewing contemporary systematic reviews and meta-analyses to contextualize our study's contribution. We refined our research question to specifically address the relationship between screen time, language development, and executive functions in children aged 0-78 months. Addressing the reviewer's concerns, we enhanced Table 1 with detailed operational definitions and measurement criteria, systematically integrated age-range specifications throughout the manuscript, and strengthened the coherence between theoretical frameworks and empirical findings through enhanced analytical commentary in both the findings and discussion sections. These revisions collectively strengthen the manuscript's theoretical foundation, methodological clarity, and analytical depth while ensuring consistent developmental context throughout.

We believe that the revised manuscript now better meets the standards of PLOS ONE and addresses editor’s and reviewer’s concerns comprehensively. I appreciate your time and reconsideration and look forward to the opportunity of having our work reconsidered for publication in PLOS ONE. Ayşe Gül Kara Aydemir is the corresponding author of this study. Should you have any questions or require further information, please contact me via email at agkara@gmail.com

Decision Letter 3

Alexander Röhm

13 Nov 2024

Examining the Relationship Between Language Development, Executive Function, and Screen Time: A Systematic Review

PONE-D-24-04813R3

Dear Dr. Kara Aydemir,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Alexander Röhm

Guest Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Authors,

thank you for this final revision of your manuscript, which now is strongly improved concerning the line of argumentation, scientific rigor, and presentation of the findings. I also very much appreciate the effort and work you put into this paper. There are only some last suggestions that you should consider to change before finalizing the manuscript:

1. I believe in Table 1 (p. 10) an AND/OR operand is missing between "Executive Function" "Children".

2. Would it be possible also to estimate the degree of interrater agreement for the quality codings (pp. 18ff) with a more than just percentages? I think, Krippendorff's Alpha should be the methodological standard here, which could be easily calculated with RECAL (https://dfreelon.org/utils/recalfront/).

3. I would suggest to conclude the article either with the Conclusion or Implications section, but not with the Limitations.

4. For full and transparent open science practice, please also add your search strategie, search terms/combination, and criteria to the OSF project.

5. Please, also consinder to publish your adapted CONSORT checklist.

I am very much looking forward to the published article, which, in my opinion, has considerable value for the further discussion of the important topic.

Best regards,

Alexander Röhm

Reviewers' comments:

Acceptance letter

Alexander Röhm

25 Nov 2024

PONE-D-24-04813R3

PLOS ONE

Dear Dr. Kara Aydemir,

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Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 File. Dataset.

    This Excel file contains the data used in this study, including all variables and analyses reported in the manuscript. It is publicly available and can be accessed directly from the OSF repository.

    (XLSX)

    pone.0314540.s001.xlsx (85.4KB, xlsx)
    S2 File. PRISMA checklist.

    The PRISMA checklist outlines the systematic review process and compliance with reporting standards.

    (PDF)

    pone.0314540.s002.pdf (85.7KB, pdf)
    S3 File. Handling missing data.

    This document outlines the methodological approach used to handle missing data in the systematic review, ensuring rigor and comprehensiveness at every stage of the analysis.

    (DOCX)

    pone.0314540.s003.docx (15.4KB, docx)
    S1 Table. Evaluation process of studies identified in systematic review.

    This table summarizes the evaluation process of studies identified in the systematic review.

    (DOCX)

    pone.0314540.s004.docx (46.6KB, docx)
    S2 Table. Data extraction summary.

    This table provides details on the data extracted from the included studies.

    (DOCX)

    pone.0314540.s005.docx (16.4KB, docx)
    S3 Table. Risk of bias and quality/certainty assessments.

    This table presents the GRADE assessment of included studies.

    (DOCX)

    pone.0314540.s006.docx (21.9KB, docx)
    Attachment

    Submitted filename: Plos_ONe Review - 1.docx

    pone.0314540.s007.docx (18.5KB, docx)
    Attachment

    Submitted filename: PONE-D-24-04813.pdf

    pone.0314540.s008.pdf (1.1MB, pdf)
    Attachment

    Submitted filename: PONE-D-24-04813_ResponseToReviewer1.pdf

    pone.0314540.s009.pdf (1.1MB, pdf)
    Attachment

    Submitted filename: ResponseToReviewers2ndRevision.docx

    pone.0314540.s010.docx (31.7KB, docx)

    Data Availability Statement

    https://osf.io/n7uc6/?view_only=8987e34f20da40ddba6c6c7c7009e84d


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