Skip to main content
PLOS ONE logoLink to PLOS ONE
. 2021 Sep 8;16(9):e0256591. doi: 10.1371/journal.pone.0256591

Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠ (ABCD) Study

Katie N Paulich 1,2,*, J Megan Ross 1,¤,#, Jeffrey M Lessem 1,#, John K Hewitt 1,2
Editor: Enamul Kabir3
PMCID: PMC8425530  PMID: 34496002

Abstract

In a technology-driven society, screens are being used more than ever. The high rate of electronic media use among children and adolescents begs the question: is screen time harming our youth? The current study draws from a nationwide sample of 11,875 participants in the United States, aged 9 to 10 years, from the Adolescent Brain Cognitive Development Study (ABCD Study®). We investigate relationships between screen time and mental health, behavioral problems, academic performance, sleep habits, and peer relationships by conducting a series of correlation and regression analyses, controlling for SES and race/ethnicity. We find that more screen time is moderately associated with worse mental health, increased behavioral problems, decreased academic performance, and poorer sleep, but heightened quality of peer relationships. However, effect sizes associated with screen time and the various outcomes were modest; SES was more strongly associated with each outcome measure. Our analyses do not establish causality and the small effect sizes observed suggest that increased screen time is unlikely to be directly harmful to 9-and-10-year-old children.

Introduction

Children and adolescents are spending more time on screens and electronic media than ever before, with 95% of teens in the United States having access to a smartphone [1]. While global inequalities in technology use certainly exist—in 71 out of 195 countries globally, less than half the population has access to the internet—it is undeniable that average global technology use is on the rise, especially among youth [2]. With the rise in media use, one might ask whether screen time—the amount of time one spends on electronic media, usually viewing electronic screens—is harming youth. Adolescence is a critical developmental period [3] during which important aspects of health and well-being are easily influenced. As electronic media use among adolescents climbs, screens are increasingly incorporated into adolescents’ development [4] and, therefore, potential relationships between screen time and adolescent well-being are of interest. Among the most important markers of adolescent well-being are internalizing and externalizing disorders [5], academic performance [6], sleep [7], and peer relationships [8].

Previous literature links increased screen time to a number of negative outcomes, including poor mental health and worse behavioral problems [9]; internalizing problems during adolescence have been linked with impaired development of autonomy, identity, morality, and social responsibility [10]. One study thus far has examined the relationship between screen time and mental health in the context of anxiety and depression in 4528 participants from an early data release of the Adolescent Brain Cognitive Development Study (ABCD Study), reporting that, when controlling for participant age, sex, BMI, family income, race, and physical activity, screen time was positively associated with anxiety and depression [11]. The authors found that child report of weekday electronic media use and both child and parent report of weekend electronic media use were significantly associated with anxiety, and both child and parent report of both weekend and weekday electronic media use were significantly associated with depression. The same study also found that different types of screen time (e.g., television, texting) showed differential relationships to anxiety and depression. Another study has linked screen time to increased adolescent depression and anxiety diagnoses, as well as to prevalence of treatment by a mental health professional and subsequent use of medication for psychological or behavioral health concerns [12].

In addition to internalizing problems, screen time has been linked to externalizing behavioral concerns (e.g., aggression). One publication examined technology-related parenting strategies, reporting that strategies with increased child screen time were associated with more externalizing behavioral problems [13]. Nevertheless, externalizing problems are the most common and persistent problem behaviors seen in childhood and adolescence [14], and therefore, should be examined in studies focused on adolescent development. Screen time has also been associated with attention problems; one study utilized a sample of French students to examine the relationship between self-report screen time and self-perceived attention problems, including attention-deficit hyperactivity disorder (ADHD). Researchers found a significant association between screen time and total score of self-perceived attention problems and hyperactivity levels [15].

There has also been a documented decline in academic performance with increased screen time [16], which may have implications for overall grade point average and potential college admission. When clustering screen time and sleep time, researchers saw that participants with higher academic achievement scores tended to spend less time on screens and sleep more than their peers with lower academic achievement scores; previous studies have also demonstrated negative associations between screen time and sleep quantity and quality [17], such that those who spend more time on screens get less sleep overall and more interrupted sleep. Because of the relationship between sleep deficits and mood and cognitive problems [18], sleep has a direct impact on adolescent well-being. Another study used the ABCD Study sample in examining the mediating role of sleep in screen time and problem behaviors in children, and found that sleep duration mediates the association between screen time and problem behaviors [19].

Formation of peer relationships is one of the most important and influential aspects of adolescence [20]. It has been shown that spending more time on screens is positively associated with the quality of peer relationships in school-age children [21]. Researchers reported that TV and computer use—including social media and messaging—were related to more positive peer relationships, with the suggestion that those forms of media use might be culturally linked to socialization.

However, a recent annual research review reported that previous literature examining screen time has produced mixed results, and that screen time itself may not be cause for concern; rather, how electronic media is being consumed by adolescents is the more important consideration [22]. An Australian study also suggests that the type of screen time matters [23], and it has been posited that youth from low SES backgrounds may disproportionally impacted by psychological problems linked to high screen time [24].

Given the mixed results of previous research, and the importance of adolescence as a developmental period, investigation of relationships between screen time and those important aspects of adolescent development could shed new light on cornerstones of adolescent well-being. Additionally, if we were to identify that screen time may be problematic in areas of adolescent development, there could be implications for public health. The current study examines relationships between child and parent reports of screen time use and various important developmental outcome variables in a large and diverse nationwide sample of 9- and 10- year old children collected by the Adolescent Brain Cognitive Development (ABCD) Study [25]. By design, assessing the children for the first time at 9- and 10- years of age allows us to observe adolescent behavioral and psychological relationships at an early stage and prior to the onset of substance experimentation and use, while subsequent waves of assessment will allow us to observe how these relationships change with adolescent development and are modified by experiences including substance experimentation and use. Of additional importance, few studies have examined screen time use at such a young age. The majority of the current literature focuses on mid-to-late adolescence, rather than very early adolescence; the current study’s focus on 9- and 10- year old children fills that gap in the literature.

Specific dependent variables of interest are anxiety and depression symptoms, composite internalizing problems, composite externalizing problems, attention problems, attention-deficit hyperactivity disorder symptoms, academic performance, sleep patterns, and peer relationships. In examining these associations, we control for socio-economic status as well as race/ethnicity, as those factors directly impact access to screens and electronic media. Given the previous findings on screen time associations, we ask: in 9- and 10- year old children, what relationships exist between screen time and mental health, behavioral health, academic success, and peer relationships? We hypothesized that total screen time would be 1) positively associated with depression and anxiety symptoms as well as behavioral problems including ADHD, 2) negatively associated with academic performance and sleep quantity and quality, and 3) positively associated with quantity and quality of peer relationships. Our study is unique in its ability to allow us to determine the magnitude of these associations, their importance, and potential adverse impacts of increased screen time in a novel and very large, diverse national sample of 9- to 10- year old children. Our findings lay groundwork for future analyses on the longitudinal ABCD Study sample.

Materials and methods

Data

All data were from the existing Adolescent Brain Cognitive Development (ABCD) dataset; the ABCD Study is the largest long-term study of brain development and child and adolescent health in the United States [26]. The ABCD dataset was chosen for analysis because it draws from 21 research sites across the country, which in total recruited 11,875 children, ages 9 to 10 years, primarily from local schools, or, in the case of an embedded twin sample at four sites, from birth records. Schools in the study were selected in part based on demographic makeup, ensuring the inclusion of all demographic groups. The baseline data collection was completed in October 2018 and subsequent follow-up assessments will occur annually for 10 years, including brain imaging every two years. This resulted in a quasi-representative, longitudinal dataset consisting of both child self-report and parent reported measures of behavioral and psychological characteristics, physical wellness, cognitive function, and environmental factors, and structural and functional brain imaging; biomarkers including DNA for genetic assays were also collected. For parent-report variables, only one parent completed questionnaires, most often the mother. Of note, the entire ABCD sample consists of more males (52.1%) than females (47.8%).

Participants

Participants were drawn from the 11,875 children enrolled in the Adolescent Brain Cognitive Development (ABCD) Study. We utilized the entire existing dataset because the large sample size, which was determined by the design of the ABCD Study, ensures sufficient power to detect even small associations. Both written and verbal consent were collected from all parents/guardians and from all children. All procedures were approved by a central institutional review board and comply with the World Medical Association Declaration of Helsinki. The University of California San Diego institutional review board has indicated that analyses using the publicly released, anonymized ABCD data are not human subjects research and do not require their own approval. The data used in this study are owned by the National Institute of Mental Health Data Archive; qualified researchers can request access to ABCD shared data at https://nda.nih.gov/abcd/request-access. The ABCD data used in this paper came from NIMH Data Archive Digital Object Identifier 10.15154/1519271.

The sample was 52% White, 20.3% Hispanic, 15% Black, 2.1% Asian, and 10.5% Other or Prefer Not to Respond. The sample tended toward upper-middle SES, with 3.6% reporting annual family income <$5000; 3.6% reporting $5000–$11,999; 2.3% reported $12,000–$15,999; 4.4% reported $16,000–$24,999; 5.5% reporting $25,000–$34,999; 7.9% reporting $35,000–$49,999; 12.6% reporting $50,000–$74,999; 13.2% reporting $75,000–$99,999; 27.9% reporting $100,000–$199,999; 10.5% reporting $200,000+; with 4.3% refuse to answer and 4.2% don’t know.

We divided the current study into two parts to better assess fundamental differences in weekday and weekend screen time use. There exists a significant difference in time spent on screens, t(11,723) = -53.34, p < .001, during a weekday (M = 3.39, SD = 2.94) and time spent on screens during the weekend (M = 4.57, SD = 3.54). There was also a significant difference in parent reports of their child’s screen time, t(11,748) = -61.63, p < .001, between weekdays (M = 2.55, SD = 2.59) and weekends (M = 3.99, SD = 2.66). Additionally, there existed significant differences between weekday and weekend screen usage type (e.g., TV/movies, online videos, gaming, etc.) for every usage type examined (see S1 Table). These significant differences suggest that weekday and weekend screen time and screen time use type differ, and therefore, should be examined separately.

Part 1

Part 1 examines weekday screen time use only, which is defined as media use per individual day of the week (Monday through Friday). Of the original 11,875 participants, 41 were excluded for implausible self-reported weekday screen time use of 18 hours or more, 69 were excluded for implausible parent report of weekday screen time use of 18 hours or more, and 38 were excluded for missing data. Thus, the current analyses were conducted on a sample of 11,727 children ages 9 to 10.92 years (M = 9.91 years, SD = .62 years). The sample remained representative of the ABCD Study, with 6111 males (52.1%), 5613 females (47.9%), and 3 individuals who chose not to disclose their sex.

Part 2

Part 2 examines weekend screen time use only, which is defined as media use per individual day of the weekend (Saturday and Sunday). We returned to the original 11,875 participants and followed similar exclusion principles as in Part 1. First, 115 participants were excluded for self-reported weekend screen time use of 18 hours or more per day. Next, 49 were excluded for parent report of weekend screen time use of 18 hours or more per day, and 37 were excluded for missing data. The current analyses were conducted on a sample of 11,672 children ages 9 to 10.92 years, (M = 9.91 years, SD = 0.62 years). The sample remained representative of the ABCD Study, with 6071 males (52%), 5598 females (48%), and 3 individuals who chose not to disclose their sex.

Measures

Screen time

A 14-question Screen Time Questionnaire (STQ) was completed by the children, providing self-report measures of screen time use, divided by weekdays and weekends. The questionnaire asks how many hours per weekday/weekend day the child uses screens for different types of media, with responses ranging from “0 h” (0) to “4 + h” (4). The STQ divides screen time use among six different forms of recreational (not for schoolwork) media use: television shows and movies, videos, video games, texting, social media, and video chat. The total amount of time spent on screens on an individual weekday or weekend day is a composite across all six forms of media types. The questionnaire also asks children to report the frequency with which they engage in mature video gaming and R-rated movie viewing (0 = never, 3 = all the time). The child’s parent/guardian also completed a shorter STQ, which asked about the child’s total screen time on individual weekdays/weekend days in both hours and minutes (e.g., a parent could report that their child spends 2 hours and 30 minutes on a screen). Screen time in hours was used in this analysis (e.g. 2 hours and 30 minutes = 2.5 hours).

Depression

The parent/guardian of the child participant completed the 112-item Child Behavior Checklist (CBCL), which asks parents about various psychiatric symptoms and behaviors the child shows [27]. Participants’ depression symptoms were evaluated on a subscale containing 13 statements, to which parents of the participant reported on a scale from 0 (not true) to 2 (very true/often true) in response to statements about their child, which included items concerning withdrawal and depressed mood. The resulting CBCL derived T-score for depression was used for analysis; subsequent CBCL measures of interest were also analyzed via T-scores.

Anxiety

Participant anxiety was evaluated by the CBCL on a subscale of 9 statements. Participants’ parents reported on a scale from 0 (not true) to 2 (very true/often true) in response to statements about their child that concerned anxious behavior.

Internalizing problems

Internalizing problems is a composite score on the CBCL, calculated by summing the total depression, anxiety, and somatic scores for the participant.

Externalizing problems

Externalizing behavioral problems is a composite score on the CBCL, calculated by summing the participant’s total rule-breaking behavior and aggressive behavior scores.

Oppositional defiant disorder (ODD)

The ODD subscale is one of six DSM-oriented scales within the CBCL that is consistent with DSM-5 diagnosis. Parents reported on a scale from 0 (not true) to 2 (very true/often true) in response to statements about their child’s behavior in accordance with DSM-5 criterion for oppositional defiant problems.

Conduct disorder

Conduct disorder is another of six DSM-oriented scales within the CBCL that is consistent with DSM-5 diagnosis. Parents reported on a scale from 0 (not true) to 2 (very true/often true) in response to statements about their child’s behavior in accordance with DSM-5 criterion for conduct problems.

Attention problems

Participant attention problems were measured by the CBCL on a subscale, to which parents reported on a scale from 0 (not true) to 2 (very true/often true) in response to statements about their child concerning attentional problems.

Attention-deficit hyperactivity disorder (ADHD)

ADHD is one of six DSM-oriented scales within the CBCL that is consistent with DSM-5 diagnosis. Parents reported on a scale from 0 (not true) to 2 (very true/often true) in response to statements about their child’s attention behavior in accordance with DSM-5 criterion for ADHD.

Academic performance

Academic performance was measured by participants’ grades in school, which were reported by their parents in response to the question, “What kind of grades does your child get on average?” Parents reported if their child earned As, Bs, Cs, Ds, or Fs (1 = As, 5 = Fs) or they selected N/A (-1) if not applicable. To conduct analysis, the variable for grades were re-coded so that higher codes corresponded with better grades (1 = Fs, 5 = As) and N/As were set to missing.

Sleep quantity

Participant sleep habits were partially measured by the quantity of sleep the participant typically gets per night. The average number of hours of sleep per night were reported by participants’ parents in response to the question, “How many hours of sleep does your child get on most nights?” Parents reported if their child typically sleeps 9–11 hours, 8–9 hours, 7–8 hours, 5–7 hours, or less than 5 hours (1 = 9–11 hours, 5 = less than 5 hours). To conduct analysis, the variable for amount of sleep was re-coded so that higher codes corresponded with more sleep (1 = less than 5 hours, 5 = 9–11 hours).

Sleep quality

Participant sleep habits were also measured by the quality of sleep the participant typically has. Participants’ general sleep quality was reported by their parents in response to a series of questions that produced scores indicative of six different sleep disorders: disorders of arousal, disorders of initiating and maintaining sleep, disorders of excessive somnolence, sleep breathing disorders, sleep hyperhidrosis, and sleep-wake transition disorders. Scores across disorders were summed into a total sleep disorder score, with a higher score meaning higher incidents of sleep disorders, and thus, poorer quality sleep.

Number of close friends who are boys

The quantity and quality of peer relationships was measured by the number of close friends a participant has. By specifically examining the number of close friends, rather than merely the total number of friends, we can assume that these friendships are of quality to the participant. The questionnaire divided friendships by sex of the friend; first, participants were asked to report how many close friends who are boys they have.

Number of close friends who are girls

Participants were also asked to report how many close friends who are girls they have. The correlation between the self-report number of close friends who are boys and number of close friends who are girls was weak across both Part 1 and Part 2, so these outcomes were analyzed separately.

Combined family income

Parents/guardians reported the total combined family income before taxes for the previous 12 months. Income responses were coded as 1 = < $5,000; 2 = $5,000 - $11,999; 3 = $12,000 - $15,999; 4 = $16,000 - $24,999; 5 = $25,000 - $34,999; 6 = $35,000 - $49,999; 7 = $50,000 - $74,999; 8 = $75,000 - $99,999; 9 = $100,000 - $199,999; and 10 = $200,000+. Responses “refuse to answer” and “don’t know” were set to missing for analysis.

Race/Ethnicity

Child race/ethnicity was obtained via both parent and self-report. Responses were coded as 1 = White; 2 = Black; 3 = Hispanic; 4 = Asian; 5 = Other. Distributions for each study are reported above.

Statistical analysis

All statistical analyses were conducted with IBM SPSS Statistics Version 26. Bivariate Pearson correlations between each of the variables were computed to evaluate the interrelationships between all variables, including the different measures of screen time. Correlations were calculated separately for each sex. We conducted a combined regression (across sex), coding sex as a dummy variable to investigate—via interaction test—whether the effect of screen time on our outcome variables depended on sex. Sex was dummy coded with females = 0 and males = 1, making “females” the base category for comparison. Multiple linear regressions were then run, separately by sex, with the different measures for screen time as the predictor and each outcome variable as the dependent variable. All regressions controlled for both SES and race/ethnicity. The analyses conducted rely on the normal distribution assumption; the independent variables (screen time) and depended variables are only approximately normally distributed and thus p-values are necessarily subject to some imprecision. Thirteen primary regressions were conducted; to account for multiple testing, the Bonferroni corrected significance level was .004 for our primary test: the interaction test and the investigation of relationships between weekend/weekday screen time total and mental health, behavioral health, academic performance, sleep quality and quantity, and peer relationships. The significance level for all secondary tests was .05. We conducted analyses separately by sex because there existed significant sex differences in total weekday screen time, t(11,831) = 10.22, p < .001, with males (M = 3.74, SD = 3.17) spending more weekday time on screens than females (M = 3.16, SD = 2.99); in total weekend screen time, t(11,829) = 13.54, p < .001, with males (M = 5.05, SD = 3.68) spending more weekend time on screens than females (M = 4.16, SD = 3.53); as well as each outcome measure. The sex differences suggested that males and females differed in both independent and dependent variables, and therefore, should be examined separately. Subsequent analyses were conducted separately by sex. Table 1 provides sex differences, separated by Parts 1 and 2.

Table 1. Participant sex differences on screen time measures and outcome variables for Part 1 and Part 2.

  Males Mean (SD) Females Mean (SD) t statistic p-value
Part 1 (N = 6111) (N = 5613)
Total Screen Time 3.67 (3.01) 3.09 (2.82) 10.72 < .001*
Parent-Report Total 2.56 (2.29) 2.32 (2.06) 5.91 < .001*
TV and Movies 1.12 (1.10) 1.10 (1.09) 1.05 .294
Videos 0.96 (1.18) 0.83 (1.11) 6.50 < .001*
Video Chat 0.15 (0.43) 0.19 (0.46) -4.81 < .001*
Texting 0.17 (0.47) 0.24 (0.55) -7.39 < .001*
Social Media 0.08 (0.35) 0.12 (0.41) -5.21 < .001*
Video Games 1.19 (1.24) 0.62 (0.91) 28.14 < .001*
Mature Games 0.82 (0.98) 0.28 (0.60) 35.72 < .001*
R-rated Movies 0.43 (0.67) 0.32 (0.59) 9.49 < .001*
Depression 54.23 (6.31) 52.72 (5.05) 14.22 < .001*
Anxiety 53.79 (6.15) 53.13 (5.73) 6.01 < .001*
Internalizing 49.35 (10.67) 47.44 (10.50) 9.75 < .001*
Externalizing 46.47 (10.65) 44.86 (9.85) 8.49 < .001*
Oppositional defiance 53.95 (5.81) 52.93 (4.86) 10.24 < .001*
Conduct disorder 53.28 (5.70) 52.71 (5.28) 5.65 < .001*
Attention problems 54.24 (6.49) 53.51 (5.73) 6.42 < .001*
ADHD 53.63 (6.00) 52.75 (5.14) 8.50 < .001*
Academic performance 4.23 (0.84) 4.41 (0.74) -11.42 < .001*
Sleep quantity 4.28 (0.82) 4.30 (0.80) -1.01 .313
Sleep quality 36.78 (8.46) 36.22 (7.92) 3.73 < .001*
Num. of close m. friends 4.45 (6.92) 1.30 (2.49) 33.14 < .001*
Num. of close f. friends 1.69 (4.85) 5.13 (7.37) -30.04 < .001*
Part 2 (N = 6071) (N = 5598)
Total Screen Time 4.88 (3.32) 4.00 (3.16) 14.68 < .001*
Parent-Report Total 4.09 (2.47) 3.70 (2.31) 8.69 .003*
TV and Movies 1.62 (1.27) 1.61 (1.25) 0.45 .084
Videos 1.22 (1.34) 1.01 (1.25) 8.90 < .001*
Video Chat 0.16 (0.48) 0.22 (0.54) -6.44 < .001*
Texting 0.18 (0.48) 0.26 (0.59) -8.40 < .001*
Social Media 0.08 (0.35) 0.14 (0.49) -7.51 < .001*
Video Games 1.62 (1.37) 0.75 (1.03) 38.14 < .001*
Mature Games 0.81 (0.97) 0.28 (0.60) 35.43 < .001*
R-rated Movies 0.43 (0.66) 0.32 (0.59) 9.21 < .001*
Depression 54.22 (6.29) 52.72 (5.03) 14.20 < .001*
Anxiety 53.78 (6.49) 53.12 (5.71) 6.00 < .001*
Internalizing 49.32 (10.66) 47.45 (10.49) 9.54 .008*
Externalizing 46.41 (10.63) 44.84 (9.85) 8.26 < .001*
Oppositional defiance 53.91 (5.77) 52.92 (4.85) 9.95 < .001*
Conduct disorder 53.26 (5.66) 52.70 (5.29) 5.47 < .001*
Attention problems 54.21 (6.49) 53.50 (5.74) 6.23 < .001*
ADHD 53.60 (5.98) 52.75 (5.14) 8.24 < .001*
Academic performance 4.24 (0.83) 4.41 (0.74) -11.18 < .001*
Sleep quantity 4.29 (0.82) 4.30 (0.80) -1.04 .058
Sleep quality 36.73 (8.33) 36.21 (7.91) 3.44 < .001*
Num. of close m. friends 4.52 (6.81) 1.29 (2.46) 33.56 < .001*
Num. of close f. friends 1.67 (4.68) 5.11 (7.44) -30.16 < .001*

Note. Starred significance at .05. Screen time measure means given in hours. ADHD = attention/deficit hyperactivity disorder; Num. of Close M. Friends = number of close friends who are male; Num. of Close F. Friends = number of close friends who are female.

Part 1

Only weekday screen time measures were included. Sex differences between each screen time type and each outcome measure were examined with a two-tailed independent samples t-test, alpha level .05, and are displayed in the top section of Table 1.

Part 2

Only weekend screen time measures were included. Sex differences between each screen time type and each outcome measure were examined as in Part 1 and are displayed in the lower section of Table 1.

Results

Part 1

Correlations between all variables, separately by sex, are shown in S2 Table. While the majority of correlations are significant, most are weak or moderate in strength. Measures that one would expect to be correlated are (e.g., the correlation between attention problems and ADHD is strong for both sexes). The data do not demonstrate multicollinearity, as seen in S3 Table.

Examination of whether the effect of weekday screen time on our outcome variables of interest depended on sex yielded interesting results. The vast majority of interactions were not significant; however, both main effects of weekday screen time and sex were often significant at Bonferroni corrected alpha .004, as seen in Table 2. Our primary interest was examination of the effects of screen time and sex on our dependent variables; however, we also report results for race/ethnicity and SES for the sake of completeness. The main effect of SES was also often significant.

Table 2. Examination of main effects of weekday screen time and sex, as well as the interaction between them, on outcome variables, controlling for SES and race/ethnicity.

  Standardized Beta t statistic p-value Standard Error Partial Correlation
Depression
Main effect of ST 0.018 1.24 .214 .029 .012
Main effect of sex 0.112 7.78 < .001* .166 .075
Main effect of R/E -0.007 -0.72 .472 .042 -.01
Main effect of SES -0.141 -14.01 < .001* .024 -.13
Interaction sex*ST 0.028 1.48 .139 .038 .014
Anxiety
Main effect of ST -0.002 -0.16 .877 .030 -.001
Main effect of sex 0.036 2.42 .016 .176 .023
Main effect of R/E -0.018 -1.86 .063 .044 -.018
Main effect of SES -0.045 -4.36 < .001* .025 -.042
Interaction sex*ST 0.031 1.66 .097 .040 .016
Internalizing
Main effect of ST 0.007 0.45 .655 .054 .004
Main effect of sex 0.065 4.44 < .001* .310 .043
Main effect of R/E -0.011 -1.09 .278 .078 -.010
Main effect of SES -0.077 -7.49 < .001* .045 -.072
Interaction sex*ST 0.036 1.91 .056 .071 .018
Externalizing
Main effect of ST 0.083 5.69 < .001* .051 .055
Main effect of sex 0.069 4.73 < .001* .297 .046
Main effect of R/E -0.014 -1.41 .159 .075 -.014
Main effect of SES -0.142 -14.03 < .001* .043 -.134
Interaction sex*ST 0.001 0.04 .967 .068 .000
Oppositional defiance
Main effect of ST 0.066 4.47 < .001* .027 .043
Main effect of sex 0.077 5.31 < .001* .157 .051
Main effect of R/E -0.021 -2.19 .029 .040 -.021
Main effect of SES -0.090 -8.86 < .001* .023 -.085
Interaction sex*ST 0.014 0.76 .450 .036 .007
Conduct disorder
Main effect of ST 0.096 6.65 < .001* .027 .064
Main effect of sex 0.037 2.60 .009 .157 .025
Main effect of R/E -0.006 -0.62 .539 .040 -.006
Main effect of SES -0.165 -16.43 < .001* .023 -.157
Interaction sex*ST 0.008 0.43 .664 .036 .004
Attention problems
Main effect of ST 0.074 5.07 < .001* .031 .049
Main effect of sex 0.044 3.02 .003* .178 .029
Main effect of R/E 0.011 1.12 .261 .045 .011
Main effect of SES -0.095 -9.36 < .001* .026 -.090
Interaction sex*ST 0.013 0.71 .480 .041 .007
ADHD
Main effect of ST 0.088 6.04 < .001* .028 .058
Main effect of sex 0.056 3.85 < .001* .163 .037
Main effect of R/E 0.010 1.02 .310 .041 .010
Main effect of SES -0.089 -8.80 < .001* .024 -.085
Interaction sex*ST 0.022 1.15 .250 .037 .011
Academic performance
Main effect of ST -0.107 -7.37 < .001* .004 -.074
Main effect of sex -0.083 -5.69 < .001* .023 -.057
Main effect of R/E -0.041 -4.24 < .001* .006 -.043
Main effect of SES 0.253 25.04 < .001* .003 .244
Interaction sex*ST -0.010 -0.54 .593 .005 -.005
Sleep quantity
Main effect of ST -0.149 -10.69 < .001* .004 -.103
Main effect of sex 0.011 0.80 .426 .022 .007
Main effect of R/E -0.065 -7.03 < .001* .006 -.068
Main effect of SES 0.246 25.53 < .001* .003 .239
Interaction sex*ST -0.018 -1.00 .316 .005 -.009
Sleep quality
Main effect of ST 0.054 3.70 < .001* .041 .036
Main effect of sex 0.008 0.58 .565 .236 .006
Main effect of R/E 0.012 1.19 .235 .060 .011
Main effect of SES -0.099 -9.74 < .001* .034 -.094
Interaction sex*ST 0.031 1.66 .096 .054 .016
Num. of close m. friends
Main effect of ST 0.029 2.06 .039 .026 .020
Main effect of sex 0.247 17.60 < .001* .150 .168
Main effect of R/E -0.013 -1.34 .182 .038 -.013
Main effect of SES 0.012 1.26 .209 .022 .012
Interaction sex*ST 0.077 4.26 < .001* .034 .041
Num. of close f. friends
Main effect of ST 0.067 4.67 < .001* .031 .045
Main effect of sex -0.285 -20.15 < .001* .179 -.191
Main effect of R/E -0.017 -1.79 .074 .045 -.017
Main effect of SES -0.014 -1.376 .169 .026 -.013
Interaction sex*ST 0.001 0.08 .934 .041 .001

Note: Starred regressions are significant at Bonferroni corrected alpha .004. ST = weekday screen time in hours. R/E = race/ethnicity.

Because there is a demonstrated significant main effect of sex, it was important to also run Multiple regression separately by sex to more closely examine sex differences. When running Multiple Regression separately by sex, the majority of regressions of outcome variables on total weekday screen time were significant using a Bonferroni corrected p-value of less than .004, and were in line with our hypotheses, controlling for SES and race/ethnicity, as shown in Table 3. Effect sizes for each of these tests are small and also shown in Table 3.

Table 3. Outcome measures regressed on weekday total screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

  Standardized Beta t statistic p-value Standard Error Partial Correlation
Males (N = 6111)          
Depression 0.036 2.58 0.010 .029 .035
Anxiety 0.028 1.97 0.049 .029 .026
Internalizing 0.043 3.06 .002* .050 .041
Externalizing 0.076 5.48 < .001* .049 .073
Oppositional defiance 0.068 4.88 < .001* .027 .065
Conduct disorder 0.093 6.84 < .001* .026 .091
Attention problems 0.079 5.70 < .001* .030 .076
ADHD 0.102 7.34 < .001* .028 .098
Academic performance -0.107 -7.70 < .001* .004 -.107
Sleep quantity -0.171 -12.97 < .001* .004 -.171
Sleep quality 0.081 5.81 < .001* .039 .078
Num. of close m. friends 0.092 6.58 < .001* .031 .088
Num. of close f. friends 0.079 5.69 < .001* .022 .076
Females (N = 5613)          
Depression 0.029 2.03 0.042 .026 .028
Anxiety 0.000 0.002 0.999 .030 .000
Internalizing 0.008 0.56 0.579 .054 .008
Externalizing 0.091 6.35 < .001* .050 .088
Oppositional defiance 0.079 5.51 < .001* .025 .077
Conduct disorder 0.107 7.50 < .001* .027 .104
Attention problems 0.083 5.81 < .001* .029 .081
ADHD 0.097 6.80 < .001* .026 .094
Academic performance -0.118 -8.27 < .001* .004 -.119
Sleep quantity -0.143 -10.56 < .001* .004 -.146
Sleep quality 0.060 4.16 < .001* .041 .058
Num. of close m. friends 0.053 3.66 < .001* .013 .051
Num. of close f. friends 0.065 4.50 < .001* .038 .063

Note. Starred regressions are significant at Bonferroni corrected alpha .004. ADHD = attention/deficit hyperactivity disorder; Num. of close m. friends = number of close friends who are male; Num. of close f. friends = number of close friends who are female.

As seen in Table 3, for males, total weekday screen time is significantly associated with internalizing problems, externalizing problems, ODD, conduct disorder, attention problems, ADHD, academic performance, sleep quantity, sleep quality, the number of close friends who are male, and the number of close friends who are female. However, weekday total screen time is not significantly associated with either depression or anxiety.

Additionally seen in Table 3, for females, total weekday screen time is significantly associated with externalizing problems, ODD, conduct disorder, attention problems, ADHD, academic performance, sleep quantity, sleep quality, the number of close friends who are male, and the number of close friends who are female. Weekday total screen time is not significantly associated with depression, anxiety, or internalizing problems.

We were secondarily interested in the relationships between our outcome measures and differing forms of weekday screen time use (e.g., social media versus video viewing). For males, relationships between differing types of screen time and depression, anxiety, and internalizing problems are not significant at alpha .05. For all other outcome measures, the majority of associations between the various types of screen time and that outcome are significant. Of the types of screen time, video chat and texting have the least reliable predictive power and are only significant for some outcomes. Parent report of total screen time is significant for about half of outcome variables.

Similarly for females, relationships between differing types of screen time and depression, anxiety, and internalizing problems are not significant. For all other outcome measures, the majority of associations between the various types of screen time and that outcome are significant. Of the types of screen time, video chat has the least reliable predictive power, and is significant in about half of outcome measures. Parent report of total screen time significantly predicted the outcome measures for the majority of tests, apart from the number of close friends who are boys and the number of close friends who are girls.

The comprehensive results of our statistical analyses for Part 1, including effect sizes, are displayed in S6S18 Tables.

Part 2

Correlations between all variables, separately by sex, are shown in S4 Table. As in Part 1, the majority of correlations are significant, are weak or moderate in strength, and measures that one would expect to be correlated are. The data do not demonstrate multicollinearity, as seen in S5 Table.

Once again, examination of whether the effect of weekend screen time on our outcome variables of interest depended on sex yielded varied results. The vast majority of interactions were not significant; however, as in Part 1, both main effects of weekday screen time and sex were often significant at Bonferroni corrected alpha .004, as seen in Table 4. As in Part 1, our primary interest was examination of the effects of screen time and sex on our dependent variables; however, we also report results for race/ethnicity and SES for the sake of completeness. The main effect of SES was also often significant.

Table 4. Examination of main effects of weekend screen time and sex, as well as the interaction between them, on outcome variables, controlling for SES and race/ethnicity.

  Standardized Beta t statistic p-value Standard Error Partial Correlation
Depression
Main effect of ST 0.014 0.98 .327 .025 .009
Main effect of sex 0.102 6.35 < .001* .183 .061
Main effect of R/E -0.005 -0.55 .584 .042 -.005
Main effect of SES -0.140 -14.04 < .001* .024 -.135
Interaction sex*ST 0.041 2.02 .043 .034 .020
Anxiety
Main effect of ST -0.001 -0.05 .959 .027 .000
Main effect of sex 0.015 0.92 .358 .194 .009
Main effect of R/E -0.017 -1.75 .080 .044 -.017
Main effect of SES -0.040 -3.98 < .001* .025 -.039
Interaction sex*ST 0.057 2.80 .005 .036 .027
Internalizing
Main effect of ST 0.017 1.14 .253 .047 .011
Main effect of sex 0.054 3.32 .001* .343 .032
Main effect of R/E -0.010 -0.97 .334 .078 -.009
Main effect of SES -0.072 -7.14 < .001* .044 -.069
Interaction sex*ST 0.044 2.18 .030 .063 .021
Externalizing
Main effect of ST 0.096 6.70 < .001* .045 .065
Main effect of sex 0.067 4.18 < .001* .329 .040
Main effect of R/E -0.013 -1.37 .172 .075 -.013
Main effect of SES -0.141 -14.13 < .001* .042 -.136
Interaction sex*ST -0.005 -0.26 .796 .061 -.003
Oppositional defiance
Main effect of ST 0.074 5.10 < .001* .024 .049
Main effect of sex 0.069 4.26 < .001* .173 .041
Main effect of R/E -0.022 -2.24 .025 .040 -.022
Main effect of SES -0.089 -8.83 < .001* .022 -.085
Interaction sex*ST 0.017 0.84 .402 .032 .008
Conduct disorder
Main effect of ST 0.104 7.25 < .001* .024 .070
Main effect of sex 0.038 2.37 .018 .174 .023
Main effect of R/E -0.004 -0.45 .651 .040 -.004
Main effect of SES -0.166 -17.72 < .001* .022 -.160
Interaction sex*ST 0.000 -0.01 .989 .032 .000
Attention problems
Main effect of ST 0.103 7.13 < .001* .027 .069
Main effect of sex 0.035 2.18 .029 .197 .021
Main effect of R/E 0.009 0.89 .376 .045 .009
Main effect of SES -0.092 -9.15 < .001* .025 -.088
Interaction sex*ST 0.015 0.73 .468 .036 .007
ADHD
Main effect of ST 0.121 8.43 < .001* .025 .081
Main effect of sex 0.050 3.09 .002* .180 .030
Main effect of R/E 0.007 0.68 .495 .041 .007
Main effect of SES -0.086 -8.63 < .001* .023 -.083
Interaction sex*ST 0.015 0.77 .444 .033 .007
Academic performance
Main effect of ST -0.076 -5.30 < .001* .003 -.053
Main effect of sex -0.070 -4.33 < .001* .025 -.044
Main effect of R/E -0.043 -4.38 < .001* .006 -.044
Main effect of SES 0.264 26.32 < .001* .003 .256
Interaction sex*ST -0.026 -1.30 .194 .005 -.013
Sleep quantity
Main effect of ST -0.139 -10.08 < .001* .003 -.097
Main effect of sex 0.006 0.40 .693 .025 .004
Main effect of R/E -0.066 -7.08 < .001* .006 -.068
Main effect of SES 0.257 26.82 < .001* .003 .251
Interaction sex*ST -0.006 -0.33 .739 .005 -.003
Sleep quality
Main effect of ST 0.072 4.98 < .001* .036 .048
Main effect of sex 0.001 0.09 .928 .261 .001
Main effect of R/E 0.010 1.04 .300 .059 .010
Main effect of SES -0.095 -9.47 < .001* .034 -.091
Interaction sex*ST 0.031 1.53 .127 .048 .015
Num. of close m. friends
Main effect of ST 0.043 3.06 .002* .022 .030
Main effect of sex 0.249 16.01 < .001* .163 .153
Main effect of R/E -0.014 -1.45 .146 .037 -.014
Main effect of SES 0.010 1.042 .297 .021 .010
Interaction sex*ST 0.070 3.60 < .001* .030 .035
Num. of close f. friends
Main effect of ST 0.067 4.74 < .001* .027 .046
Main effect of sex -0.279 -17.75 < .001* .198 -.170
Main effect of R/E -0.016 -1.64 .101 .045 -.016
Main effect of SES -0.017 -1.73 .083 .026 -.017
Interaction sex*ST -0.014 -0.71 .477 .036 -.007

Note: Starred regressions are significant at Bonferroni corrected alpha .004. ST = weekend screen time in hours. R/E = race/ethnicity.

Because there is a significant main effect of sex, it was important to also run Multiple regression separately by sex to more closely examine sex differences. When running Multiple Regression separately by sex, the majority of regressions of outcome variables on total weekend screen time are significant using a Bonferroni corrected p-value of less than .004 and are in line with our hypotheses, controlling for SES and race/ethnicity, as shown in Table 5. Effect sizes for each of these tests are small and are also shown in Table 5.

Table 5. Outcome measures regressed on weekend total screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

  Standardized Beta t statistic p-value Standard Error Partial Correlation
Males (N = 6071)          
Depression 0.044 3.22 .001* .007 .043
Anxiety 0.052 3.75 < .001* .026 .050
Internalizing 0.058 4.24 < .001* .044 .057
Externalizing 0.084 6.21 < .001* .044 .083
Oppositional defiance 0.079 5.77 < .001* .024 .077
Conduct disorder 0.094 6.96 < .001* .023 .093
Attention problems 0.108 7.88 < .001* .027 .105
ADHD 0.126 9.25 < .001* .025 .123
Academic performance -0.092 -6.70 < .001* .003 -.094
Sleep quantity -0.145 -11.14 < .001* .003 -.148
Sleep quality 0.096 7.03 < .001* .034 .094
Num. of close m. friends 0.091 6.57 < .001* .027 .088
Num. of close f. friends 0.062 4.52 < .001* .018 .061
Females (N = 5598)          
Depression 0.022 1.57 0.117 .007 .022
Anxiety 0.001 0.05 0.958 .026 .001
Internalizing 0.017 1.21 0.227 .047 .017
Externalizing 0.102 7.27 < .001* .044 .101
Oppositional defiance 0.085 6.02 < .001* .022 .084
Conduct disorder 0.112 7.98 < .001* .023 .111
Attention problems 0.111 7.88 < .001* .026 .109
ADHD 0.131 9.32 < .001* .023 .129
Academic performance -0.085 -5.99 < .001* .003 -.086
Sleep quantity -0.136 -10.13 < .001* .003 -.140
Sleep quality 0.076 5.37 < .001* .035 .075
Num. of close m. friends 0.084 5.90 < .001* .011 .082
Num. of close f. friends 0.063 4.39 < .001* .034 .061

Note. Starred regressions are significant at Bonferroni corrected alpha .004. ADHD = attention/deficit hyperactivity disorder; Num. of Close M. Friends = number of close friends who are male; Num. of Close F. Friends = number of close friends who are female.

As seen in Table 5, for males, total weekend screen time is significantly associated with all outcome measures: depression, anxiety, internalizing problems, externalizing problems, ODD, conduct disorder, attention problems, ADHD, academic performance, sleep quantity, sleep quality, the number of close friends who are male, and the number of close friends who are female.

As seen in Table 5, for females, total weekend screen time is significantly associated with externalizing problems, ODD, conduct disorder, attention problems, ADHD, academic performance, sleep quantity, sleep quality, the number of close friends who are male, and the number of close friends who are female. Weekend total screen time is not significantly associated with depression, anxiety, or internalizing problems.

We were secondarily interested in the relationships between our outcome measures and differing types of weekend screen time use. For males, although total weekend screen time demonstrated a significant relationship to every outcome variable at alpha .05, the overall relationships between differing types of screen time and depression, anxiety, and internalizing problems are not significant. For all other outcome measures, the majority of associations between the various types of screen time and that outcome are significant. Of the types of screen time, video chat and texting have the least reliable predictive power and are only significantly associated with some outcomes. Parent report of total weekend screen time is significant for all outcomes apart from the number of close friends who are boys and the number of close friends who are girls.

For females, relationships between differing types of weekend screen time and depression, anxiety, and internalizing problems are not significant. For all other outcome measures, the majority of associations between the various types of screen time and that outcome are significant. Of the types of screen time, both video chat and texting have the least reliable predictive power and are significant in only about half of outcome measures. Parent report of total weekend screen time is significantly related to all outcome variables.

The comprehensive results of our statistical analyses for Part 2, including effect sizes, are displayed in S19S31 Tables.

Discussion

These results have important implications. The lack of consistently significant interactions between screen time and sex—but often significant main effects for both screen time and sex—demonstrate that generally, both screen time and sex predict the outcome variables, but that the effect of screen time on the outcome variables often does not depend on sex, and vice versa. For the outcome measures with non-significant interaction terms but significant main effects of both/either screen time and/or sex, it appears that screen time and sex are independent predictors of the outcome measure. For these outcome measures, the effect of either screen time or sex on the outcome variable did not depend on the other independent variable. A potential reason for that finding could be sex differences in how screens are being used. The only outcome measure demonstrating a significant interaction term, for Part 1 and for Part 2, is number of close friends who are males. It is possible that, because males in this study tend to use screen time for video gaming—which is often a social activity—more than females do (refer to Table 1), screen time and sex interact such that the effect of screen time (e.g., using screens for video gaming) on number of close male friends depends on the sex of the participant, where male participants who spend more time on screens video gaming have more male friends.

Screen time—above and beyond both SES and race/ethnicity—is a significant predictor of some internalizing symptoms, behavioral problems, academic performance, sleep quality and quantity, and the strength of peer relationships for 9- to 10-year-old children, in both boys and girls. However, the effect of screen time was small (<2% of the variance explained) for all outcomes, with SES—which was demonstrated to be a significant predictor for the nearly all outcome variables of interest—accounting for much more of the variance (~5%), perhaps because parent SES contributes to nearly every facet of children’s physical and mental health outcomes [28]. Taken together, our results imply that too much time spent on screens is associated with poorer mental health, behavioral health, and academic outcomes in 9- and 10- year old children, but that negative impact on the subjects is likely not clinically harmful at this age.

The significant association between screen time and externalizing disorder symptoms was in line with previous research [13]. However, this association is not necessarily causal; for example, it has been suggested that parents/guardians of children who display externalizing disorder symptoms, along with oppositional defiance disorder and conduct disorder, are more likely to place their child in front of a screen as a distraction [29], so it is possible that externalizing disorder symptoms feed into additional screen time rather than the reverse.

The negative association between screen time and academic performance may be of some concern to parents; another group of researchers reported a similar trend in a sample of Chinese adolescents [30]. We speculate that more time dedicated to recreational screen use detracts from time spent on schoolwork and studying for exams, though this proposed explanation should be examined further. In data collection for the ABCD Study, academic screen time (e.g., using a computer to complete an academic paper) was not recorded; it is possible that academic screen time could be positively associated with academic performance, suggesting, as previous studies [22, 23] point out, that the type of screen time use is more important to consider than screen time itself.

The negative association between screen time and amount of sleep has been demonstrated previously [17] and, as in the case of academic performance, it is possible that time on screens takes away from time asleep. The positive association between sleep disorder score and screen time is of interest, though how that relationship is mediated is a topic of future research. It could be that when children and adolescents struggle with sleep, they turn to electronic media as a way to distract themselves or in an attempt to lull themselves back to sleep, or that screen use contributes to delayed bedtime, as has been suggested in previous literature [17].

The lack of significant relationships between screen time and internalizing disorder symptoms (i.e., depression and anxiety) was surprising and does not align with prior findings by researchers who also used the ABCD study to examine screen time as a predictor variable. To examine the discrepancy, we conducted a replication of their study [11], using the early release data of 4528 participants, which is less than half the sample size used in the current study. We replicated their findings closely, which suggests that the discrepancy in our results primarily arises from the differences in the sample as it doubled in size. Overall, both the current study and the previous [11] find only weak associations of screen time with internalizing problems in the baseline ABCD sample. It is possible that because internalizing disorders typically develop throughout childhood and adolescence [31, 32], 9- and 10- year old children are simply not displaying immediately noticeable internalizing symptoms.

The finding that more screen time is associated with a greater number of close friends, both male and female, is in line with previous research [21] and suggests that when on screens, adolescents are communicating with their friends via texting, social media, or video chat, and the social nature of such screen time use strengthens relationships between peers and allows them to stay connected even when apart.

The current study is not without limitations. Because participants are 9 and 10, they simply are not using screens as much as their older peers; means for screen time use are low, especially for texting and social media, two aspects of screen time that may have the most impact on peer relationships and mental health outcomes [21]. The frequencies of mature gaming and viewing of R-rated movies are also low. Similarly due to the age of the sample, the majority of participants do not display signs of mental ill health. Follow-up interview studies conducted as the sample ages would likely be more powered as adolescents increase in their screen use and they evidence more mental health issues at older ages. Beneficially, however, the longitudinal nature of the ABCD Study will allow continuation of study of these potential associations over the course of the participants’ adolescence. Next, the measures used by the ABCD Study at baseline have some limitations. By restricting the screen time maximum label to “4+ hours” for all subsets of screen time apart from total screen time, it was not possible to examine extremes in screen time (e.g., the present data do not differentiate between four hours of texting and 15 hours. Additionally, the majority of outcome measures were evaluated through parent report rather than child self-report, and it is possible that parent evaluations are inaccurate, especially for more subtle symptoms such as internalizing problems. However, for the majority of outcome variables, parents responded to the Child Behavior Checklist, which demonstrates strong psychometric validity [33]. Additionally, parent report is preferred for assessing some outcome measures of interest; in externalizing problems and attention problems specifically, the positive illusory bias skews youth self-report to overly positive reports of their performance in comparison to criteria that reflects actual performance [34, 35].

Conclusions

Both weekday and weekend total screen time are moderately associated with greater behavioral problems including ADHD, poor academic performance and poor sleep quantity and quality. Conversely, screen time is positively associated with the quantity and quality of peer relationships. The effect of screen time on those outcome measures typically does not depend on sex. Observed effect sizes are small (<2% variance explained), with SES contributing much more to the variance in outcomes. Though these associations should be monitored and examined further as this study cohort ages in mid- and late- adolescence, our results are in line with a recent review [22]. It seems that screen time itself is not strongly associated with adverse outcomes in 9- and 10- year old children.

Supporting information

S1 Table. Weekday and weekend differences on screen time measures.

Note. Significance at .05. Means and SD for weekday/weekend screen time measures given in hours.

(DOCX)

S2 Table. Correlations by sex between all variables for Part 1, weekday screen time.

Note. Male participant correlations are shown across the top and in upper right triangle, female participant correlations are shown along the left side and in the lower left triangle. Grayed correlations were not significant at alpha .05. Abbreviations: Tot. = total, PR = parent report, TV = television and movies, Vid. = videos, VC = video chat, Text = texting, SM = social media, VG = video games, MG = mature games, RM = R-rated movies, Dep. = depression, Anx. = anxiety, Int. = internalizing problems, Ext. = externalizing problems, ODD = oppositional defiance disorder, CD = conduct disorder, Attn. = attention problems, AD = ADHD, AP = academic performance, ST = sleep quantity, SD = sleep quality, NCB = number of close friends who are boys, NCG = number of close friends who are girls.

(DOCX)

S3 Table. Multicollinearity statistics (VIF and tolerance) for Part 1 variables.

Note. T2 Weekday = multicollinearity statistics corresponding to the interaction analyses conducted in Table 2. T3 Males = multicollinearity statistics corresponding to the regression analyses conducted in Table 3 for males only. T3 Females = multicollinearity statistics corresponding to the regression analyses conducted in Table 3 for females only. ST = screen time. R/E = race/ethnicity. SES = socioeconomic status. VIF = variance inflation factor. Tol = tolerance. Oppos. Def = oppositional defiance disorder. Cond. Dis = conduct disorder. Attn. Prob. = attention problems. Sleep Quant. = sleep quantity in hours. Sleep Qual. = sleep quality. Num. M. Fr. = number of close male friends. Num. F. Fr. = number of close female friends.

(DOCX)

S4 Table. Correlations by sex between all variables for Part 2, weekend screen time.

Note. Male participant correlations are shown across the top and in upper right triangle, female participant correlations are shown along the left side and in the lower left triangle. Grayed correlations were not significant at alpha .05. Abbreviations: Tot. = total, PR = parent report, TV = television and movies, Vid. = videos, VC = video chat, Text = texting, SM = social media, VG = video games, MG = mature games, RM = R-rated movies, Dep. = depression, Anx. = anxiety, Int. = internalizing problems, Ext. = externalizing problems, ODD = oppositional defiance disorder, CD = conduct disorder, Attn. = attention problems, AD = ADHD, AP = academic performance, ST = sleep quantity, SD = sleep quality, NCB = number of close friends who are boys, NCG = number of close friends who are girls.

(DOCX)

S5 Table. Multicollinearity statistics (VIF and tolerance) for Part 2 variables.

Note. T4 Weekend = multicollinearity statistics corresponding to the interaction analyses conducted in Table 4. T5 Males = multicollinearity statistics corresponding to the regression analyses conducted in Table 5 for males only. T5 Females = multicollinearity statistics corresponding to the regression analyses conducted in Table 5 for females only. ST = screen time. R/E = race/ethnicity. SES = socioeconomic status. VIF = variance inflation factor. Tol = tolerance. Oppos. Def = oppositional defiance disorder. Cond. Dis = conduct disorder. Attn. Prob. = attention problems. Sleep Quant. = sleep quantity in hours. Sleep Qual. = sleep quality. Num. M. Fr. = number of close male friends. Num. F. Fr. = number of close female friends.

(DOCX)

S6 Table. Depression regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S7 Table. Anxiety regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S8 Table. Internalizing symptoms regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S9 Table. Externalizing symptoms regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S10 Table. Oppositional defiance disorder regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S11 Table. Conduct disorder regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S12 Table. Attention problems regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S13 Table. ADHD regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S14 Table. Grades regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S15 Table. Average nightly hours of sleep regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S16 Table. Sleep disorder score regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S17 Table. Number of close friends who are boys regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S18 Table. Number of close friends who are girls regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S19 Table. Depression regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S20 Table. Anxiety regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S21 Table. Internalizing symptoms regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S22 Table. Externalizing symptoms regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S23 Table. Oppositional defiance disorder regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S24 Table. Conduct disorder regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S25 Table. Attention problems regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S26 Table. ADHD regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S27 Table. Grades regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S28 Table. Average nightly hours of sleep regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S29 Table. Sleep disorder score regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S30 Table. Number of close friends who are boys regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

S31 Table. Number of close friends who are girls regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

Note. Starred regressions are significant at alpha .05.

(DOCX)

Data Availability

Legal restrictions on sharing the utilized de-identified data set are in place; the data are owned by a third-party organization, the National Institute of Mental Health Data Archive. However, qualified researchers can request access to ABCD shared data at https://nda.nih.gov/abcd/request-access. The datasets used in this study can be found in online repositories; the ABCD data used in this paper came from NIMH Data Archive Digital Object Identifier 10.15154/1519271.

Funding Statement

Data used in the preparation of this paper were obtained from the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org), held in the National institute of Mental Health Data Archive (NDA). This is a multisite, longitudinal study designed to recruit more than 10,000 children age 9-10 and follow them over 10 years into early adulthood. The ABCD Study is supported by the National Institutes of Health (NIH) and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, and U24DA041147. A full list of supporters is available at https://abcdstudy.org/nih-collaborators. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/principal-investigators.html. ABCD consortium investigators designed and implemented the study and/or provided data but did not necessarily participate in analysis or writing of this report. This manuscript reflects the views of the authors and may not reflect the opinions or views of the NIH or ABCD consortium investigators. The ABCD data repository grows and changes over time. The ABCD data used in this paper came from [NIMH Data Archive Digital Object Identifier (10.15154/1519271)].

References

  • 1.Anderson M, Jiang J. Teens, social media & technology 2018. Pew Research Center. 2018;1. Available from://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/
  • 2.Wiggins, B 2020. UNICEF. 2020 June 5;1. Available from: https://www.unicef.org/press-releases/unequal-access-remote-schooling-amid-covid-19-threatens-deepen-global-learning#_ftn1
  • 3.Fuhrmann D, Knoll LJ, Blakemore SJ. Adolescence as a sensitive period of brain development. Trends Cogn Sci. 2015Oct;19(10):558–566. doi: 10.1016/j.tics.2015.07.008 . [DOI] [PubMed] [Google Scholar]
  • 4.Ashton JJ, Beattie RM. Screen time in children and adolescents: Is there evidence to guide parents and policy? Lancet Child Adolesc Health. 2019May;3(5):292–294. doi: 10.1016/S2352-4642(19)30062-8 [DOI] [PubMed] [Google Scholar]
  • 5.Compas BE, Hinden BR, Gerhardt CA. Adolescent development: Pathways and processes of risk and resilience. Annual Review of Psychology. 1995:46:265–293. doi: 10.1146/annurev.ps.46.020195.001405 [DOI] [PubMed] [Google Scholar]
  • 6.O’Connell Schmakel P. Early adolescents’ perspectives on motivation and achievement in academics. Urban Education. 2008:43(6), 723–749. doi: 10.1177/0042085907311831 [DOI] [Google Scholar]
  • 7.Shochat T, Cohen-Zion M, Tzischinsky O. Functional consequences of inadequate sleep in adolescents: a systematic review. Sleep Med Rev. 2014Feb;18(1):75–87. doi: 10.1016/j.smrv.2013.03.005 Epub 2013 Jun 24. . [DOI] [PubMed] [Google Scholar]
  • 8.Burke RJ, Weir T. Helping responses of parents and peers and adolescent well-being. The Journal of Psychology. 2010:102(1), 49–62. doi: 10.1080/00223980.1979.9915094 [DOI] [Google Scholar]
  • 9.Parent J, Sanders W, Forehand R. Youth Screen Time and Behavioral Health Problems: The Role of Sleep Duration and Disturbances. J Dev Behav Pediatr. 2016May;37(4):277–84. doi: 10.1097/DBP.0000000000000272 ; PMCID: PMC4851593. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Collins WA, Gleason T, Sesma A Jr. Internalization, autonomy, and relationships: Development during adolescence. In Grusec J. E. & Kuczynski L., editors. Parenting and children’s internalization of values: A handbook of contemporary theory. John Wiley & Sons Inc.; 1997. [Google Scholar]
  • 11.Fors PQ, Barch DM. Differential relationships of child anxiety and depression to child report and parent report of electronic media use. Child Psychiatry & Human Development. 2019:50(6):907–917. doi: 10.1007/s10578-019-00892-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Twenge JM, Campbell WK. Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Prev Med Rep. 2018Oct18;12:271–283. doi: 10.1016/j.pmedr.2018.10.003 eCollection 2018 Dec. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Sanders W, Parent J, Forehand R, Sullivan AD, Jones DJ. Parental perceptions of technology and technology-focused parenting: Associations with youth screen time. J Appl Dev Psychol. 2016May-Jun;44:28–38. doi: 10.1016/j.appdev.2016.02.005 Epub 2016 Mar 14. ; PMCID: PMC5082753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Campbell SB. Behavior problems in preschool children: A review of recent research. J Child Psychol Psychiatry. 1995Jan;36(1):113–49. doi: 10.1111/j.1469-7610.1995.tb01657.x [DOI] [PubMed] [Google Scholar]
  • 15.Montagni I, Guichard E, Kurth T. Association of screen time with self-perceived attention problems and hyperactivity levels in French students: a cross-sectional study. BMJ Open 2016;6:e009089. doi: 10.1136/bmjopen-2015-009089 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Peiró-Velert C, Valencia-Peris A, González LM, García-Massó X, Serra-Añó P, Devís-Devís J. (2014). Screen media usage, sleep time and academic performance in adolescents: clustering a self-organizing maps analysis. PLOS ONE. 2014 June18:9(6): e99478. doi: 10.1371/journal.pone.0099478 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev. 2015Jun;21:50–8. doi: 10.1016/j.smrv.2014.07.007 Epub 2014 Aug 12. ; PMCID: PMC4437561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Barnett KJ, Cooper NJ. The effects of a poor night sleep on mood, cognitive, autonomic and electrophysiological measures. J Integr Neurosci. 2008Sep;7(3):405–20. doi: 10.1142/s0219635208001903 . [DOI] [PubMed] [Google Scholar]
  • 19.Guerrero MD, Barnes JD, Chaput J, Tremblay MS. Screen time and problem behaviors in children: exploring the mediating role of sleep duration. Int J Behav Nutr Phys Act. 2019:16:105. doi: 10.1186/s12966-019-0862-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Brown BB, Larson J. Peer relationships in adolescence. In Lerner R. M. & Steinberg L., editors. Handbook of adolescent psychology: Contextual influences on adolescent development. John Wiley & Sons Inc.; 2009. [Google Scholar]
  • 21.Iannotti RJ, Kogan MD, Janssen I, Boyce WF. Patterns of adolescent physical activity, screen-based media use, and positive and negative health indicators in the U.S. and Canada. J Adolesc Health. 2009May; 44(5): 493–499. doi: 10.1016/j.jadohealth.2008.10.142 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Odgers CL, Jensen MR. Annual research review: Adolescent mental health in the digital age: facts, fears, and future directions. J of Child Psychology and Psychiatry. 2020Jan17:61(3). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Sanders T, Parker PD, Pozo-Cruz B, Noetel M, Lonsdale C. Type of screen time moderates effects on outcomes in 4013 children: evidence from the Longitudinal Study of Australian Children. Int J Behav Nutr Phys Act. 2019:16:117. doi: 10.1186/s12966-019-0881-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Oswald TK, Rumbold AR, Kedzior SGE, Moore VM. Psychological impacts of “screen time” and “green time” for children and adolescents: A systematic scoping review. PLOS ONE. 2020Sept4;15:9 e0237725. doi: 10.1371/journal.pone.0237725 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Garavan H, Bartsch H, Conway K, Decastro A, Goldstein RZ, Heeringa S, et al. Recruiting the ABCD sample: Design considerations and procedures. Dev Cogn Neurosci. 2018Aug;32:16–22. doi: 10.1016/j.dcn.2018.04.004 Epub 2018 Apr 16. ; PMCID: PMC6314286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Adolescent Brain Cognitive Development (ABCD) Study. About the study. ABCD Study. 2019. Available from: https://abcdstudy.org/about/
  • 27.Achenbach TM. The Child Behavior Checklist and related instruments. In: Maruish ME, editor. The use of psychological testing for treatment planning and outcomes assessment. Lawrence Erlbaum Associates Publishers; 1999. [Google Scholar]
  • 28.Vukojevic M, Zovko A, Talic I, Tanovic M, Resic B, Vrdoljak I, et al. Parental socioeconomic status as a predictor of physical and mental health outcomes in children–literature review. Acta Clin Croat 2017;56:742–748. doi: 10.20471/acc.2017.56.04.23 [DOI] [PubMed] [Google Scholar]
  • 29.Smith BJ, Grunseit A, Hardy LL, King L, Wolfenden L, Milat A. Parental influences on child physical activity and screen viewing time: a population based study. BMC Public Health. 2010:10(593):1–11. doi: 10.1186/1471-2458-10-593 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Yan H, Zhang R, Oniffrey TM, Chen G, Wang Y, Wu Y, et al. Associations among Screen Time and Unhealthy Behaviors, Academic Performance, and Well-Being in Chinese Adolescents. Int J Environ Res Public Health. 2017Jun4;14(6):596. doi: 10.3390/ijerph14060596; PMCID: PMC5486282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Durbeej N, Sorman K, Selinus EN, Lundstrom S, Lichtenstein P, Hellner C, et al. Trends in childhood and adolescent internalizing symptoms: Results from Swedish population based twin cohorts. BMC Psychology. 2019; 7:9. doi: 10.1186/s40359-019-0287-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Shanahan L, Calkins SD, Keane SP, Kelleher R, Suffness R. Trajectories of internalizing symptoms across childhood: The roles of biological self-regulation and maternal psychopathy. Dev Psychopathol. 2014Nov; 26(4 0 2): 1353–1368. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Ebesutani C, Bernstein A, Nakamura BJ, Chorpita BF, Higa-McMillan CK, Weisz JR; The Research Network on Youth Mental Health. Concurrent Validity of the Child Behavior Checklist DSM-Oriented Scales: Correspondence with DSM Diagnoses and Comparison to Syndrome Scales. J Psychopathol Behav Assess. 2010Sep;32(3):373–384. doi: 10.1007/s10862-009-9174-9 Epub 2009 Nov 27. ; PMCID: PMC2914253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Owens JS, Goldfine ME, Evangelista NM, Hoza B, Kaiser NM. A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clin Child Fam Psychol Rev. 2007Dec;10(4):335–51. doi: 10.1007/s10567-007-0027-3 . [DOI] [PubMed] [Google Scholar]
  • 35.Bourchtein E, Langberg JM, Owens JS, Evans SW, Perera RA. Is the positive illusory bias common in young adolescents with ADHD? A fresh look at prevalence and stability using latent profile and transition analyses. J Abnorm Child Psychol. 2017Aug; 45(6): 1063–1075. doi: 10.1007/s10802-016-0248-3 [DOI] [PMC free article] [PubMed] [Google Scholar]

Decision Letter 0

Enamul Kabir

22 Mar 2021

PONE-D-20-40267

Screen time is only modestly associated with mental health, academic outcomes, and peer relationships in the Adolescent Brain Cognitive Development ℠ Study

PLOS ONE

Dear Dr. Paulich,

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. 

There are a number of concerns raised by the reviewers those need to be addressed before taking final decision. 

Please submit your revised manuscript by May 06 2021 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: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Enamul Kabir

Academic Editor

PLOS ONE

Journal Requirements:

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

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

In your revised cover letter, please address the following prompts:

2a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

2b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

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

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

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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: No

Reviewer #2: I Don't Know

Reviewer #3: 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: Yes

Reviewer #3: Yes

**********

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: Yes

Reviewer #2: Yes

Reviewer #3: 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: Comments to Manuscript Number PONE-D-20-40267

Full Title: Screen time is only modestly associated with mental health, academic outcomes, and peer relationships in the Adolescent Brain Cognitive Development ℠ Study

Short Title: Screen time and the ABCD Study

The paper examines an interesting and useful topic related to screen time and mental health, behavioral problems, academic performance, sleep habits, and peer relationships in the USA. It does fit the scope of PLoS ONE. Overall, it contributes to the advancement of knowledge and debate on matters of mental anxiety, depression, and academic results by those who are using more screens in the United States. Though the study finding got a small effect size. But still, the results are significant in line with the expected hypothesis. The findings will help to understand to what extent screen time are creating vulnerability to the child during their early adolescent stage.

However, the fundamental shortcomings of the paper are:

1. Why the study is divided by study 1 and study 2 in the results section. I understand study 1 is for weekday screen time and study 2 for weekend screen time. Changing it to part 1 and part 2 would help. Need a clear justification for dividing these two parts.

2. For logistics regression, the study divides the sample by their sex. The study runs two separate regressions for both males and females. Some further explanation and justification need to be provided regarding the two separate regressions. It would be interesting if the author(s) could add a combined regression (for both male and female) using sex as a dummy explanatory variable and then run two separate regression for male and female to check how does gender play a role in explaining the effect of screen time on mental health, academic performance and peer relationships. The study is restricting the sample for two separate regression by their sex and in fact, sex is a channel to explain the role of screen time on different outcome variables.

3. The study found a very low effect size to explain the linkage between total screen time and the outcome measures. Along with the total screen time, the study can estimate the effect of screen time by creating a dummy for an acceptable level of screen time and beyond that. This will help to show how too much screen time creating an effect on the outcome variables.

4. The descriptive statistics about the outcome and explanatory variables should be provided in the main paper instead of placing them in the appendix. Suggest bringing table S1 and S2 after combining them in a single table up into the main body of the text so the reader has a better sense of their characteristics (if the appendix is published with the paper (and not just online) that may be less of a problem).

5. It would be better to provide the overall descriptive statistics about the SES.

6. Reference to other studies, including Twenge and Campbell, 2018; Oswald et al., 2020.

7. Better to use the clustering by different demographic zone while running a regression. As the study participant covers different demographic zone, therefore, the clustering (clustered standard errors) could provide more robust results.

8. The discussion section is written appropriately. However, the results section is not written consistently. It would be better to make the writing of the result section consistent to make it more reader-friendly.

9. Though the study focused too much on sex and weekday/weekend without proper justification. A clear justification is useful to add.

10. The study considers many outcomes without focusing on them in more detail. It would be better if the study restricts their outcome variable and then cover the heterogeneous channels to find the linkage between the outcome and screen time. For example, sex is a channel where the effect size of screen time on the outcome variables is different depending on the sex of the participants. The study could concentrate on some other channels from the SES to find the effect of screen time on the outcome variables in more detail.

Reviewer #2: I enjoyed reading this article and drawing conclusion from larger sample size is commendable. Also the study pointed out the influence of screen time on academic outcomes and others which is very insightful. However, I have few comments and suggestions for them.

The title “Screen time is only modestly associated with mental health, academic outcomes, and peer relationships in the Adolescent Brain Cognitive Development” should be reshaped. A good title should at least, tell us the dependent and independent variables, study population and the area of study. The title looks a bit confusing.

Abstract section

“We are using screens more than ever” [line 23]. This is not clear. Please the “we” should be clarified. Who are you referring to?

Main Text

Introduction

“with 95% of teens having access to a smartphone”…. [line 45]. The “95%”, is it a global prevalence or what?

The authors did well by stating the expected results/working hypothesis. However, the study lacks theoretical conceptual framework. Therefore, I suggest the authors should add a theory to it.

Also, authors should tell us the prevalence of screen time for us to be clear about proportion of children being exposed to screen, from global to study area perspective, if such data exist. Such trend analysis could enrich the paper.

Statistical analysis

Why should the authors use Multiple linear regressions because such estimating technique may not help to understand differences within groupings? Also, they fail to account or check for multicollinearity that might exist between explanatory variables.

Also, they should simply tell us how the results were interpreted.

Discussion section

The authors did a great job by comparing their results with previous studies. However, their explanations were mostly based on conjecture and speculations without literature. I suggest the authors adopt/adapt a theory and situate their results and discussions in the theory.

Also, at the introductory aspect of the discussion, I suggest the authors should tell us the main/key findings in brief and show us how significant are these results before moving on to discuss them.

References

The authors also used current literature which is commendable.

Overall, the paper could be published if they are able to improve the paper.

Also, they should proof read for few grammatical errors.

Reviewer #3: 1) Title needs to be shortened too long.

2) Introduction and literature should be given under separate titles.

3) The importance of this study should be explained in more detail. Research questions should be specified more clearly.

4) The current study is divided into Study 1 and Study 2. The reason for this was explained as “We divided the current study into two studies to better assess fundamental differences in anticipated weekday and weekend screen time use. On an average weekday, children aged 9 and 10 are likely to be in a structured educational environment and, therefore, limited in their daytime screen use. On weekends, children are likely to be at home or in differently structured environments and may have ready access to screens.”. This explanation is not very satisfactory. A scientific explanation is required. What kind of trouble would it have caused if seven days were taken together and evaluated?

5) “Bivariate Pearson correlations”, “Independent samples t test” and “Multiple linear regressions” analyzes were applied. One of the basic assumptions of these analyzes is the normal distribution assumption. No information was given in the article that the normal distribution assumption was met.

6) There is no need to give confidence intervals in the tables. Constant and non-standardized beta coefficients should also be given in the tables of regression models.

**********

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: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment

Submitted filename: Comments_PONE-D-20-40267.pdf

Attachment

Submitted filename: Review Comments.docx

PLoS One. 2021 Sep 8;16(9):e0256591. doi: 10.1371/journal.pone.0256591.r002

Author response to Decision Letter 0


5 May 2021

Response to Reviewers

We appreciate the opportunity to revise and resubmit our manuscript; incorporating the reviewer suggestions below has improved the quality of our paper, and we thank you for the additional consideration.

*Please note that all references to line number are within the Revised Manuscript with Track Changes.

Journal Requirements:

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

To the best of our knowledge, our manuscript meets PLOS ONE’s style requirements.

2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly.

In your revised cover letter, please address the following prompts:

2a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

The following has been added to the revised cover letter: “Legal restrictions on sharing the utilized de-identified data set are in place; the data are owned by a third-party organization, the National Institute of Mental Health Data Archive. However, qualified researchers can request access to ABCD shared data at https://nda.nih.gov/abcd/request-access. The datasets used in this study can be found in online repositories; the ABCD data used in this paper came from NIMH Data Archive Digital Object Identifier 10.15154/1519271.”

Additionally, the following has been added to the revised manuscript at line 173: “The data used in this study are owned by the National Institute of Mental Health Data Archive; qualified researchers can request access to ABCD shared data at https://nda.nih.gov/abcd/request-access. The ABCD data used in this paper came from NIMH Data Archive Digital Object Identifier 10.15154/1519271.”

Reviewer #1: Comments to Manuscript Number PONE-D-20-40267

The paper examines an interesting and useful topic related to screen time and mental health, behavioral problems, academic performance, sleep habits, and peer relationships in the USA. It does fit the scope of PLoS ONE. Overall, it contributes to the advancement of knowledge and debate on matters of mental anxiety, depression, and academic results by those who are using more screens in the United States. Though the study finding got a small effect size. But still, the results are significant in line with the expected hypothesis. The findings will help to understand to what extent screen time are creating vulnerability to the child during their early adolescent stage.

However, the fundamental shortcomings of the paper are:

1. Why the study is divided by study 1 and study 2 in the results section. I understand study 1 is for weekday screen time and study 2 for weekend screen time. Changing it to part 1 and part 2 would help. Need a clear justification for dividing these two parts.

The following has been added to the end of the Participants section at line 185: “We divided the current study into two parts to better assess fundamental differences in weekday and weekend screen time use. There exists a significant difference in time spent on screens, t(11,832) = -52.31, p<.001, during a weekday (M = 3.46, SD = 3.10) and time spent on screens during the weekend (M = 4.62, SD = 3.63). There was also a significant difference in parent reports of their child’s screen time, t(11,747) = -61.63, p<.001, between weekdays (M = 2.55, SD = 2.59) and weekends (M = 3.99, SD = 2.66). Additionally, there existed significant differences between weekday and weekend screen usage type (e.g., TV/movies, online videos, gaming, etc.) for every usage type examined (see Table S1). These significant differences suggest that weekday and weekend screen time and screen time use type differ, and therefore, should be examined separately.”

We have followed the suggestion to change “Study 1” and “Study 2” to “Part 1” and “Part 2” to make the division more clear.

2. For logistics regression, the study divides the sample by their sex. The study runs two separate regressions for both males and females. Some further explanation and justification need to be provided regarding the two separate regressions. It would be interesting if the author(s) could add a combined regression (for both male and female) using sex as a dummy explanatory variable and then run two separate regression for male and female to check how does gender play a role in explaining the effect of screen time on mental health, academic performance and peer relationships. The study is restricting the sample for two separate regression by their sex and in fact, sex is a channel to explain the role of screen time on different outcome variables.

Regarding justification for two separate regressions, the following has been added to the end of the Statistical Analysis section of the Materials and Method at line 345: “We conducted analyses separately by sex because there existed significant sex differences in total weekday screen time, t(11,831) = 10.22, p<.001, with males (M = 3.74, SD = 3.17) spending more weekday time on screens than females (M = 3.16, SD = 2.99); in total weekend screen time, t(11,829) = 13.54, p<.001, with males (M = 5.05, SD = 3.68) spending more weekend time on screens than females (M = 4.16, SD = 3.53); as well as each outcome measure. The sex differences suggested that males and females differed in both independent and dependent variables, and therefore, should be examined separately. Subsequent analyses were conducted separately by sex. Table 1 provides sex differences separated by Parts 1 and 2.”

Additionally, we followed the suggestion to add a combined regression, using sex as a dummy variable and as an interaction term to investigate whether the effect of screen time depends on sex. The following was inserted into the Statistical Analysis section of the Materials and Methods, at line 333: “We conducted a combined regression (across sex), coding sex as a dummy variable to investigate—via interaction test—whether the effect of screen time on our outcome variables depended on sex.”

Because the study is divided into Part 1 and Part 2, we conducted two additional regressions in this manner (one for Part 1 and one for Part 2), as weekday and weekend screen time use differs. The results of these additional analyses can be found in the new Table 2 and Table 4.

3. The study found a very low effect size to explain the linkage between total screen time and the outcome measures. Along with the total screen time, the study can estimate the effect of screen time by creating a dummy for an acceptable level of screen time and beyond that. This will help to show how too much screen time creating an effect on the outcome variables.

Thank you for this suggestion. Unfortunately, there is not currently an empirically established threshold for an “acceptable level of screen time and beyond,” so to create such a dummy code in the context of this study would be an arbitrary decision based only on speculation and not on previous literature. We understand the reasoning behind this suggestion, and agree that it would be a promising avenue for future research on this topic, once such a threshold has been firmly established in the literature on screen time.

4. The descriptive statistics about the outcome and explanatory variables should be provided in the main paper instead of placing them in the appendix. Suggest bringing table S1 and S2 after combining them in a single table up into the main body of the text so the reader has a better sense of their characteristics (if the appendix is published with the paper (and not just online) that may be less of a problem).

We have added Table 1, which displays descriptive statistics and sex differences, into the main body of the text to address this concern. As the reviewer suggested, this table is a combined Table S1 and S2.

5. It would be better to provide the overall descriptive statistics about the SES.

Overall descriptive statistics about SES have been added to the end of the Participants section of the Materials and Methods, at line 174, and have been removed from the Part 1 and Part 2 sections for the sake of brevity.

6. Reference to other studies, including Twenge and Campbell, 2018; Oswald et al., 2020.

References to both Twenge & Campbell, 2018, and Oswald et al., 2020, have been added to the Introduction, and both studies have been cited in the references. Thank you for bringing these relevant studies to our attention.

7. Better to use the clustering by different demographic zone while running a regression. As the study participant covers different demographic zone, therefore, the clustering (clustered standard errors) could provide more robust results.

The regressions are conducted by sex, clustering the results by that demographic zone. We consider this study to be an initial exploration of the relationships between screen time and those various aspects of well-being and health in 9- and 10- year old children, a population that is seldom examined in studies of screen time on adolescence. As such, we have controlled for SES in every regression, rather than dividing it into different zones as suggested, in order to glean an overview of the findings. Standard errors have been added to the tables, in place of confidence intervals.

8. The discussion section is written appropriately. However, the results section is not written consistently. It would be better to make the writing of the result section consistent to make it more reader-friendly.

Thank you for your comment; the writing of the Results section has been revised accordingly.

9. Though the study focused too much on sex and weekday/weekend without proper justification. A clear justification is useful to add.

The following has been added to the end of the Participants section at line 185: “We divided the current study into two parts to better assess fundamental differences in weekday and weekend screen time use. There exists a significant difference in time spent on screens, t(11,832) = -52.31, p<.001, during a weekday (M = 3.46, SD = 3.10) and time spent on screens during the weekend (M = 4.62, SD = 3.63). There was also a significant difference in parent reports of their child’s screen time, t(11,747) = -61.63, p<.001, between weekdays (M = 2.55, SD = 2.59) and weekends (M = 3.99, SD = 2.66). Additionally, there existed significant differences between weekday and weekend screen usage type (e.g., TV/movies, online videos, gaming, etc.) for every usage type examined (see Table S1). These significant differences suggest that weekday and weekend screen time and screen time use type differ, and therefore, should be examined separately.”

The following has been added to the end of the Statistical Analysis section of the Materials and Method at line 345: “We conducted analyses separately by sex because there existed significant sex differences in total weekday screen time, t(11,831) = 10.22, p<.001, with males (M = 3.74, SD = 3.17) spending more weekday time on screens than females (M = 3.16, SD = 2.99); in total weekend screen time, t(11,829) = 13.54, p<.001, with males (M = 5.05, SD = 3.68) spending more weekend time on screens than females (M = 4.16, SD = 3.53); as well as each outcome measure. The sex differences suggested that males and females differed in both independent and dependent variables, and therefore, should be examined separately. Subsequent analyses were conducted separately by sex. Table 1 provides sex differences separated by Parts 1 and 2.”

10. The study considers many outcomes without focusing on them in more detail. It would be better if the study restricts their outcome variable and then cover the heterogeneous channels to find the linkage between the outcome and screen time. For example, sex is a channel where the effect size of screen time on the outcome variables is different depending on the sex of the participants. The study could concentrate on some other channels from the SES to find the effect of screen time on the outcome variables in more detail.

Thank you for this suggestion; our study considers many outcomes without focusing on specific ones in more detail because we consider this study to be an initial exploration of the relationships between screen time and those various aspects of well-being and health in 9- and 10- year old children, a population that is seldom examined in studies of screen time on adolescence. Follow-up studies should focus on more specific variables of interest and additional channels such as SES, which we have controlled for in this study to examine effects of screen time above and beyond SES.

We did follow suggestion #2, adding an interacting effect of sex, to explore that specific relationship further.

Reviewer #2: I enjoyed reading this article and drawing conclusion from larger sample size is commendable. Also the study pointed out the influence of screen time on academic outcomes and others which is very insightful. However, I have few comments and suggestions for them.

The title “Screen time is only modestly associated with mental health, academic outcomes, and peer relationships in the Adolescent Brain Cognitive Development” should be reshaped. A good title should at least, tell us the dependent and independent variables, study population and the area of study. The title looks a bit confusing.

The title of the manuscript has been revised to: Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠ (ABCD) Study

The title lists the dependent variables: “early adolescent mental health, academic, and social outcomes”

The title names the independent variable: “screen time”

The title names the study population: “the Adolescent Brain Cognitive Development ℠ (ABCD) Study” and “9- and 10- year old children”

The title names the area of study: “early adolescent”, “screen time,” and “9- and 10- year old children”

Abstract section

“We are using screens more than ever” [line 23]. This is not clear. Please the “we” should be clarified. Who are you referring to?

That line (now line 30) has been revised to read, “In a technology-driven society, screens are being used more than ever.”

Main Text

Introduction

“with 95% of teens having access to a smartphone”…. [line 45]. The “95%”, is it a global prevalence or what?

That line (now line 51) has been revised to read: “Children and adolescents are spending more time on screens and electronic media than ever before, with 95% of teens in the United States having access to a smartphone.”

The authors did well by stating the expected results/working hypothesis. However, the study lacks theoretical conceptual framework. Therefore, I suggest the authors should add a theory to it.

The final paragraph of the Introduction at line 135 now reads, “Given the previous findings on screen time associations, we ask: in 9- and 10- year old children, what relationships exist between screen time and mental health, behavioral health, academic success, and peer relationships? We hypothesized that total screen time would be 1) positively associated with increased depression and anxiety symptoms as well as behavioral problems including ADHD, 2) negatively associated with academic performance and sleep quantity and quality, and 3) positively associated with quantity and quality of peer relationships. Our study is unique in its ability to allow us to determine the magnitude of these associations, their importance, and potential adverse impacts of increased screen time in a novel and very large, diverse national sample of 9- to 10- year old children. Our findings lay groundwork for future analyses on the longitudinal ABCD Study sample.”

Also, authors should tell us the prevalence of screen time for us to be clear about proportion of children being exposed to screen, from global to study area perspective, if such data exist. Such trend analysis could enrich the paper.

The beginning of the Introduction now reads: “Children and adolescents are spending more time on screens and electronic media than ever before, with 95% of teens in the United States having access to a smartphone [1]. While global inequalities in technology use certainly exist—in 71 out of 195 countries globally, less than half the population has access to the internet—it is undeniable that average global technology use is on the rise, especially among youth [2].”

Statistical analysis

Why should the authors use Multiple linear regressions because such estimating technique may not help to understand differences within groupings? Also, they fail to account or check for multicollinearity that might exist between explanatory variables.

We utilized Multiple Regression in order to investigate general predictive power of screen time on various adolescent well-being outcomes (e.g., depression, anxiety, conduct disorder, strength of peer relationships, etc.). We grouped the regressions by sex, and also examined sex as an interaction with screen time, to investigate the demonstrated sex differences more clearly. Our data met the assumptions of a Multiple Regression analysis. The data did not demonstrate collinearity or multicollinearity, as shown by the correlation tables S2 and S3, which display correlations between all variables.

To clarify the question of multicollinearity, the following was added to the Results section for each Part (following referral to Tables S2 and S3), at lines 367 and 423. “The data do not demonstrate multicollinearity.”

Also, they should simply tell us how the results were interpreted.

The first paragraph of the discussion, at line 485, has been revised and now reads: “These results have important implications. The lack of consistently significant interactions between sex and screen time—but often significant main effects for both sex and screen time—demonstrate that independently, both screen time and sex predict the outcome variables, but that the effect of screen time on the outcome variables does not depend on sex, and vice versa. Screen time—above and beyond both SES and race/ethnicity—is a significant predictor of internalizing symptoms, behavioral problems, academic performance, sleep quality and quantity, and the strength of peer relationships for 9- to 10-year-old children, in both boys and girls. However, the effect of screen time was small (<2% of the variance explained) for all outcomes, with SES accounting for much more of the variance (~5%). Taken together, our results imply that too much time spent on screens is associated with poorer mental health, behavioral health, and academic outcomes in 9- and 10- year old children, but that negative impact on the subjects is likely not clinically harmful at this age.”

Discussion section

The authors did a great job by comparing their results with previous studies. However, their explanations were mostly based on conjecture and speculations without literature. I suggest the authors adopt/adapt a theory and situate their results and discussions in the theory.

Potential explanations for our findings are supported by the following literature, which are cited in the Discussion:

17. Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev. 2015 Jun;21:50-8. doi: 10.1016/j.smrv.2014.07.007. Epub 2014 Aug 12. PMID: 25193149; PMCID: PMC4437561.

21. Iannotti RJ, Kogan MD, Janssen I, Boyce WF. Patterns of adolescent physical activity, screen-based media use, and positive and negative health indicators in the U.S. and Canada. J Adolesc Health. 2009 May; 44(5): 493–499. doi:10.1016/j.jadohealth.2008.10.142.

22. Odgers CL, Jensen MR. Annual research review: Adolescent mental health in the digital age: facts, fears, and future directions. J of Child Psychology and Psychiatry. 2020 Jan 17:61(3).

23. Sanders T, Parker PD, Pozo-Cruz B, Noetel M, Lonsdale C. Type of screen time moderates effects on outcomes in 4013 children: evidence from the Longitudinal Study of Australian Children. Int J Behav Nutr Phys Act. 2019:16:117. doi:10.1186/s12966-019-0881-7.

28. Smith BJ, Grunseit A, Hardy LL, King L, Wolfenden L, Milat A. Parental influences on child physical activity and screen viewing time: a population based study. BMC Public Health. 2010:10(593):1-11. doi:10.1186/1471-2458-10-593.

30. Durbeej N, Sorman K, Selinus EN, Lundstrom S, Lichtenstein P, Hellner C, Halldner L. Trends in childhood and adolescent internalizing symptoms: Results from Swedish population based twin cohorts. BMC Psychology. 2019; 7:9.

31. Shanahan L, Calkins SD, Keane SP, Kelleher R, Suffness R. Trajectories of internalizing symptoms across childhood: The roles of biological self-regulation and maternal psychopathy. Dev Psychopathol. 2014 Nov; 26(4 0 2): 1353-1368.

We also found additional support for our potential explanations and cited them. Where current literature did not exist to provide potential explanations for the findings, our own possible explanations were presented as avenues for future research.

Also, at the introductory aspect of the discussion, I suggest the authors should tell us the main/key findings in brief and show us how significant are these results before moving on to discuss them.

The first paragraph of the discussion, at line 485, has been revised and now reads: “These results have important implications. The lack of consistently significant interactions between sex and screen time—but often significant main effects for both sex and screen time—demonstrate that independently, both screen time and sex predict the outcome variables, but that the effect of screen time on the outcome variables does not depend on sex, and vice versa. Screen time—above and beyond both SES and race/ethnicity—is a significant predictor of internalizing symptoms, behavioral problems, academic performance, sleep quality and quantity, and the strength of peer relationships for 9- to 10-year-old children, in both boys and girls. However, the effect of screen time was small (<2% of the variance explained) for all outcomes, with SES accounting for much more of the variance (~5%). Taken together, our results imply that too much time spent on screens is associated with poorer mental health, behavioral health, and academic outcomes in 9- and 10- year old children, but that negative impact on the subjects is likely not clinically harmful at this age.”

References

The authors also used current literature which is commendable.

Overall, the paper could be published if they are able to improve the paper.

Also, they should proof read for few grammatical errors.

The paper has been revised and improved, and has been proofread for grammatical concerns.

Reviewer #3:

1) Title needs to be shortened too long.

The title has been revised to: Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠ (ABCD) Study

The title length is under the maximum 250 characters specified by the PLOS ONE Submission Guidelines. https://journals.plos.org/plosone/s/submission-guidelines#loc-title

2) Introduction and literature should be given under separate titles.

According to the PLOS ONE style guide (provided by PLOS ONE editors, https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf) there is not a separate heading for literature.

3) The importance of this study should be explained in more detail. Research questions should be specified more clearly.

The final sentences of the Introduction section, at line 135, have been revised to read: “Given the previous findings on screen time associations, we ask: in 9- and 10- year old children, what relationships exist between screen time and mental health, behavioral health, academic success, and peer relationships? We hypothesized that total screen time would be 1) positively associated with increased depression and anxiety symptoms as well as behavioral problems including ADHD, 2) negatively associated with academic performance and sleep quantity and quality, and 3) positively associated with quantity and quality of peer relationships. Our study is unique in its ability to allow us to determine the magnitude of these associations, their importance, and potential adverse impacts of increased screen time in a novel and very large, diverse national sample of 9- to 10- year old children. Our findings lay groundwork for future analyses on the longitudinal ABCD Study sample.”

4) The current study is divided into Study 1 and Study 2. The reason for this was explained as “We divided the current study into two studies to better assess fundamental differences in anticipated weekday and weekend screen time use. On an average weekday, children aged 9 and 10 are likely to be in a structured educational environment and, therefore, limited in their daytime screen use. On weekends, children are likely to be at home or in differently structured environments and may have ready access to screens.”. This explanation is not very satisfactory. A scientific explanation is required. What kind of trouble would it have caused if seven days were taken together and evaluated?

The following has been added to the end of the Participants section at line 185: “We divided the current study into two parts to better assess fundamental differences in weekday and weekend screen time use. There exists a significant difference in time spent on screens, t(11,832) = -52.31, p<.001, during a weekday (M = 3.46, SD = 3.10) and time spent on screens during the weekend (M = 4.62, SD = 3.63). There was also a significant difference in parent reports of their child’s screen time, t(11,747) = -61.63, p<.001, between weekdays (M = 2.55, SD = 2.59) and weekends (M = 3.99, SD = 2.66). Additionally, there existed significant differences between weekday and weekend screen usage type (e.g., TV/movies, online videos, gaming, etc.) for every usage type examined (see Table S1). These significant differences suggest that weekday and weekend screen time and screen time use type differ, and therefore, should be examined separately.”

Please note that the labels “Study 1” and “Study 2” have been changed to “Part 1” and “Part 2” to reflect the adjustment.

5) “Bivariate Pearson correlations”, “Independent samples t test” and “Multiple linear regressions” analyzes were applied. One of the basic assumptions of these analyzes is the normal distribution assumption. No information was given in the article that the normal distribution assumption was met.

The following has been added to the Statistical analysis section of the Materials and methods at line 338: “The analyses conducted rely on the normal distribution assumption; the independent variables (screen time) and dependent variables are only approximately normally distributed and thus p values are necessarily subject to some imprecision.”

6) There is no need to give confidence intervals in the tables. Constant and non-standardized beta coefficients should also be given in the tables of regression models.

Rather than reporting 95% confidence intervals, the tables have been revised to instead report standard errors, which appears to be more typical.

Multiple sources suggest that providing either standardized or unstandardized Beta coefficients is acceptable.

Attachment

Submitted filename: Response to Reviewers.docx

Decision Letter 1

Enamul Kabir

26 May 2021

PONE-D-20-40267R1

Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠ (ABCD) Study

PLOS ONE

Dear Dr. Paulich,

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.

Some of the important variables (e.g., race/ethnicity, SES)  are missing, these variables need to be added in the analysis. Check multicollinearity as the correlation between the variables are high. Proper interpretations of the interaction terms are also necessary.  

Please submit your revised manuscript by Jul 10 2021 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: http://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,

Enamul Kabir

Academic Editor

PLOS ONE

[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 #1: (No Response)

Reviewer #3: All comments have been addressed

**********

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 #1: (No Response)

Reviewer #3: Yes

**********

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

Reviewer #1: (No Response)

Reviewer #3: Yes

**********

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 #1: (No Response)

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 #1: (No Response)

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 #1: Comments to Manuscript Number PONE-D-20-40267

Full Title: Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠

(ABCD) Study

Short Title: Screen time and the ABCD Study

Thanks to the authors for addressing most of the comments that were made during the first review. Still, I have few comments to fit the paper as a good one to publish in PLoS ONE. Therefore, the paper should address the existing shortcomings:

1. How is the variable sex dummy constructed? Which one is the base category to compare with?

2. The authors have used the interaction of sex and screen time (weekday/weekend) and mostly got insignificant results. But they somehow missed the main interpretation of interaction terms. Why the coefficient of interaction is insignificant while they are highly significant separately? In the discussion section, the authors have written few sentences on this issue. However, it requires more discussion on it as the existing write-up may create confusion.

3. The paper mostly focused on sex as an explanatory variable along with screen time. But this lacks concentration on SES and race/ethnicity in results and discussion. Adding race/ethnicity and SES by creating dummies will increase the scope and contribution of this paper. As they are included in each model but not reported. Therefore, reporting them in main results, particularly, in table 2 and table 4 (of the revised submission) similar to sex would be much appreciated.

4. One of the concerns was multicollinearity. The author says there is no multicollinearity referring to the appendix table 3 where the correlation among the variables are reported including the sets of outcome and explanatory variables without reporting SES and race/ethnicity (these are included in regression table). Better to produce tables with multicollinearity tests for models used in this paper (alternative to correlation table).

Reviewer #3: I reviewed the paper. It was a good paper. The requisite modifications have been done. It can be published as it is.

**********

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 #1: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment

Submitted filename: Re_Comments_PONE-D-20-40267.pdf

PLoS One. 2021 Sep 8;16(9):e0256591. doi: 10.1371/journal.pone.0256591.r004

Author response to Decision Letter 1


6 Jul 2021

We appreciate the opportunity to revise and resubmit our manuscript; incorporating the reviewer suggestions below has improved the quality of our paper, and we thank you for the additional consideration.

*Please note that all references to line number are within the Revised Manuscript with Track Changes.

Reviewer #1: Comments to Manuscript Number PONE-D-20-40267

Full Title: Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠

(ABCD) Study

Short Title: Screen time and the ABCD Study

Thanks to the authors for addressing most of the comments that were made during the first review. Still, I have few comments to fit the paper as a good one to publish in PLoS ONE. Therefore, the paper should address the existing shortcomings:

1. How is the variable sex dummy constructed? Which one is the base category to compare with?

The following has been added to the Statistical Analysis section of the Materials and Methods at line 306: Sex was dummy coded with females = 0 and males = 1, making “females” the base category for comparison.

2. The authors have used the interaction of sex and screen time (weekday/weekend) and mostly got insignificant results. But they somehow missed the main interpretation of interaction terms. Why the coefficient of interaction is insignificant while they are highly significant separately? In the discussion section, the authors have written few sentences on this issue. However, it requires more discussion on it as the existing write-up may create confusion.

Thank you for urging clarification on these interpretations.

The beginning of the Discussion section at line 461 now reads: These results have important implications. The lack of consistently significant interactions between screen time and sex—but often significant main effects for both screen time and sex—demonstrate that generally, both screen time and sex predict the outcome variables, but that the effect of screen time on the outcome variables often does not depend on sex, and vice versa. For the outcome measures with non-significant interaction terms but significant main effects of both/either screen time and/or sex, it appears that screen time and sex are independent predictors of the outcome measure. For these outcome measures, the effect of either screen time or sex on the outcome variable did not depend on the other independent variable. A potential reason for that finding could be sex differences in how screens are being used. The only outcome measure demonstrating a significant interaction term, for Part 1 and for Part 2, is number of close friends who are males. It is possible that, because males in this study tend to use screen time for video gaming—which is often a social activity—more than females do (refer to Table 1), screen time and sex interact such that the effect of screen time (e.g., using screens for video gaming) on number of close male friends depends on the sex of the participant, where male participants who spend more time on screens video gaming have more male friends.

3. The paper mostly focused on sex as an explanatory variable along with screen time. But this lacks concentration on SES and race/ethnicity in results and discussion. Adding race/ethnicity and SES by creating dummies will increase the scope and contribution of this paper. As they are included in each model but not reported. Therefore, reporting them in main results, particularly, in table 2 and table 4 (of the revised submission) similar to sex would be much appreciated.

Thank you for this suggestion. Both race/ethnicity and SES are already dummy coded, as they are categorical variables rather than continuous variables.

For SES, the coding scheme is as follows: 1 = < $5,000; 2 = $5,000 - $11,999; 3 = $12,000 - $15,999; 4 = $16,000 - $24,999; 5 = $25,000 - $34,999; 6 = $35,000 - $49,999; 7 = $50,000 - $74,999; 8 = $75,000 - $99,999; 9 = $100,000 - $199,999; and 10 = $200,000+; with options for “don’t know” and “refuse to answer.” This information has been added to line 291 of the Combined family income explanation of the Measures section of the Materials and Methods.

For race/ethnicity, the coding scheme is as follows: 1 = White; 2 = Black; 3 = Hispanic; 4 = Asian; 5 = Other. This information has been added to line 297 of the Race/Ethnicity explanation of the Measures section of the Materials and Methods.

We have followed the suggestion to report statistics for both race/ethnicity and SES, as we agree that including them will increase the scope and contribution of this paper. Please refer to Table 2 and Table 4 (of the revised/latest submission) to find the reported results.

The following has also been added to lines 349 and 408 just prior to Table 2 and Table 4: Our primary interest was examination of the effects of screen time and sex on our dependent variables; however, we also report results for race/ethnicity and SES for the sake of completeness. The main effect of SES was also often significant.

We discuss the significance of the main effect of SES in the Discussion section at line 480: However, the effect of screen time was small (<2% of the variance explained) for all outcomes, with SES—which was demonstrated to be a significant predictor for the nearly all outcome variables of interest— accounting for much more of the variance (~5%), perhaps because parent SES contributes to nearly every facet of children’s physical and mental health outcomes [28].

4. One of the concerns was multicollinearity. The author says there is no multicollinearity referring to the appendix table 3 where the correlation among the variables are reported including the sets of outcome and explanatory variables without reporting SES and race/ethnicity (these are included in regression table). Better to produce tables with multicollinearity tests for models used in this paper (alternative to correlation table).

Thank you for this suggestion. We have conducted multicollinearity tests via examination of tolerance and variance inflation factor (VIF), and have produced two new tables displaying those results for the Supporting Information, S3 Table and S5 Table. We chose to retain the correlation tables (S2 Table and S4 Table) in order to provide readers with both the multicollinearity test results as well as the correlation matrices, in case both tables are of interest to readers. The results of both the multicollinearity tests and the correlation tables show that our variables do not demonstrate multicollinearity.

The following has also been added to the Part 1 section of the Results at line 345: The data do not demonstrate multicollinearity, as seen in S3 Table.

The following has been added to the Part 2 section of the Results at line 403: The data do not demonstrate multicollinearity, as seen in S5 Table.

Please note that the original S3 table (showing correlations between variables for Part 2) has been renamed to S4 Table, and subsequent Supporting Information Tables have been renamed accordingly and referred to accordingly in the manuscript. The changes allow the Supporting Information Tables to be referred to in numeric order.

Attachment

Submitted filename: Response to Reviewers.docx

Decision Letter 2

Enamul Kabir

11 Aug 2021

Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠ (ABCD) Study

PONE-D-20-40267R2

Dear Dr. Paulich,

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.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

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,

Enamul Kabir

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #1: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

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 #1: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: Yes

**********

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 #1: No

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 #1: Yes

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 #1: Thanks to the authors for their effort to address all the comments and implement the recommendations that were made during the second time review. I appreciate their work to make the manuscript reads better. I think this version now fits as a good one to publish in PLoS ONE. I believe the changes they have made significantly improved the quality of this paper.

Reviewer #3: I reviewed the paper. It was a good paper. The requisite modifications have been done. It can be published as it is.

**********

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 #1: No

Reviewer #3: No

Attachment

Submitted filename: Comments_third time_PONE-D-20-40267.pdf

Acceptance letter

Enamul Kabir

16 Aug 2021

PONE-D-20-40267R2

Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠ (ABCD) Study

Dear Dr. Paulich:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Enamul Kabir

Academic Editor

PLOS ONE

Associated Data

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

    Supplementary Materials

    S1 Table. Weekday and weekend differences on screen time measures.

    Note. Significance at .05. Means and SD for weekday/weekend screen time measures given in hours.

    (DOCX)

    S2 Table. Correlations by sex between all variables for Part 1, weekday screen time.

    Note. Male participant correlations are shown across the top and in upper right triangle, female participant correlations are shown along the left side and in the lower left triangle. Grayed correlations were not significant at alpha .05. Abbreviations: Tot. = total, PR = parent report, TV = television and movies, Vid. = videos, VC = video chat, Text = texting, SM = social media, VG = video games, MG = mature games, RM = R-rated movies, Dep. = depression, Anx. = anxiety, Int. = internalizing problems, Ext. = externalizing problems, ODD = oppositional defiance disorder, CD = conduct disorder, Attn. = attention problems, AD = ADHD, AP = academic performance, ST = sleep quantity, SD = sleep quality, NCB = number of close friends who are boys, NCG = number of close friends who are girls.

    (DOCX)

    S3 Table. Multicollinearity statistics (VIF and tolerance) for Part 1 variables.

    Note. T2 Weekday = multicollinearity statistics corresponding to the interaction analyses conducted in Table 2. T3 Males = multicollinearity statistics corresponding to the regression analyses conducted in Table 3 for males only. T3 Females = multicollinearity statistics corresponding to the regression analyses conducted in Table 3 for females only. ST = screen time. R/E = race/ethnicity. SES = socioeconomic status. VIF = variance inflation factor. Tol = tolerance. Oppos. Def = oppositional defiance disorder. Cond. Dis = conduct disorder. Attn. Prob. = attention problems. Sleep Quant. = sleep quantity in hours. Sleep Qual. = sleep quality. Num. M. Fr. = number of close male friends. Num. F. Fr. = number of close female friends.

    (DOCX)

    S4 Table. Correlations by sex between all variables for Part 2, weekend screen time.

    Note. Male participant correlations are shown across the top and in upper right triangle, female participant correlations are shown along the left side and in the lower left triangle. Grayed correlations were not significant at alpha .05. Abbreviations: Tot. = total, PR = parent report, TV = television and movies, Vid. = videos, VC = video chat, Text = texting, SM = social media, VG = video games, MG = mature games, RM = R-rated movies, Dep. = depression, Anx. = anxiety, Int. = internalizing problems, Ext. = externalizing problems, ODD = oppositional defiance disorder, CD = conduct disorder, Attn. = attention problems, AD = ADHD, AP = academic performance, ST = sleep quantity, SD = sleep quality, NCB = number of close friends who are boys, NCG = number of close friends who are girls.

    (DOCX)

    S5 Table. Multicollinearity statistics (VIF and tolerance) for Part 2 variables.

    Note. T4 Weekend = multicollinearity statistics corresponding to the interaction analyses conducted in Table 4. T5 Males = multicollinearity statistics corresponding to the regression analyses conducted in Table 5 for males only. T5 Females = multicollinearity statistics corresponding to the regression analyses conducted in Table 5 for females only. ST = screen time. R/E = race/ethnicity. SES = socioeconomic status. VIF = variance inflation factor. Tol = tolerance. Oppos. Def = oppositional defiance disorder. Cond. Dis = conduct disorder. Attn. Prob. = attention problems. Sleep Quant. = sleep quantity in hours. Sleep Qual. = sleep quality. Num. M. Fr. = number of close male friends. Num. F. Fr. = number of close female friends.

    (DOCX)

    S6 Table. Depression regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S7 Table. Anxiety regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S8 Table. Internalizing symptoms regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S9 Table. Externalizing symptoms regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S10 Table. Oppositional defiance disorder regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S11 Table. Conduct disorder regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S12 Table. Attention problems regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S13 Table. ADHD regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S14 Table. Grades regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S15 Table. Average nightly hours of sleep regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S16 Table. Sleep disorder score regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S17 Table. Number of close friends who are boys regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S18 Table. Number of close friends who are girls regressed on various types of weekday screen time for Part 1, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S19 Table. Depression regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S20 Table. Anxiety regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S21 Table. Internalizing symptoms regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S22 Table. Externalizing symptoms regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S23 Table. Oppositional defiance disorder regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S24 Table. Conduct disorder regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S25 Table. Attention problems regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S26 Table. ADHD regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S27 Table. Grades regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S28 Table. Average nightly hours of sleep regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S29 Table. Sleep disorder score regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S30 Table. Number of close friends who are boys regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    S31 Table. Number of close friends who are girls regressed on various types of weekend screen time for Part 2, controlling for SES and race/ethnicity, separated by sex.

    Note. Starred regressions are significant at alpha .05.

    (DOCX)

    Attachment

    Submitted filename: Comments_PONE-D-20-40267.pdf

    Attachment

    Submitted filename: Review Comments.docx

    Attachment

    Submitted filename: Response to Reviewers.docx

    Attachment

    Submitted filename: Re_Comments_PONE-D-20-40267.pdf

    Attachment

    Submitted filename: Response to Reviewers.docx

    Attachment

    Submitted filename: Comments_third time_PONE-D-20-40267.pdf

    Data Availability Statement

    Legal restrictions on sharing the utilized de-identified data set are in place; the data are owned by a third-party organization, the National Institute of Mental Health Data Archive. However, qualified researchers can request access to ABCD shared data at https://nda.nih.gov/abcd/request-access. The datasets used in this study can be found in online repositories; the ABCD data used in this paper came from NIMH Data Archive Digital Object Identifier 10.15154/1519271.


    Articles from PLoS ONE are provided here courtesy of PLOS

    RESOURCES