Videogame exposure positively associates with selective attention in a cross-sectional sample of young children

Alexandria D Samson; Christiane S Rohr; Suhyeon Park; Anish Arora; Amanda Ip; Ryann Tansey; Tiana Comessotti; Sheri Madigan; Deborah Dewey; Signe Bray

doi:10.1371/journal.pone.0257877

. 2021 Sep 27;16(9):e0257877. doi: 10.1371/journal.pone.0257877

Videogame exposure positively associates with selective attention in a cross-sectional sample of young children

Alexandria D Samson ^1,^2,³, Christiane S Rohr ^1,^4,^5,⁶, Suhyeon Park ^1,^4,⁷, Anish Arora ^1,^4,⁷, Amanda Ip ^1,^4,^5,⁶, Ryann Tansey ^1,^4,^5,⁶, Tiana Comessotti ⁴, Sheri Madigan ^1,⁸, Deborah Dewey ^1,⁹, Signe Bray ^1,^4,^5,^6,^*

Editor: Trinidad Garcia¹⁰

¹Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

²Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada

³Department of Psychology, University of Toronto, Toronto, Ontario, Canada

⁴Child and Adolescent Imaging Research (CAIR) Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

⁵Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

⁶Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

⁷Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

⁸Department of Psychology, University of Calgary, Calgary, Alberta, Canada

⁹Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

¹⁰University of Oviedo, SPAIN

Competing Interests: The authors have declared that no competing interests exist.

^✉

* E-mail: slbray@ucalgary.ca

Roles

Alexandria D Samson: Data curation, Formal analysis, Writing – original draft, Writing – review & editing

Christiane S Rohr: Data curation, Methodology, Supervision, Writing – original draft, Writing – review & editing

Suhyeon Park: Data curation, Formal analysis, Writing – review & editing

Anish Arora: Data curation, Formal analysis, Writing – review & editing

Amanda Ip: Data curation, Formal analysis, Investigation, Project administration, Supervision, Writing – review & editing

Ryann Tansey: Investigation, Writing – review & editing

Tiana Comessotti: Formal analysis, Investigation, Writing – review & editing

Sheri Madigan: Formal analysis, Supervision, Writing – original draft, Writing – review & editing

Deborah Dewey: Conceptualization, Supervision, Writing – review & editing

Signe Bray: Conceptualization, Formal analysis, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

Trinidad Garcia: Editor

PMCID: PMC8476027 PMID: 34570826

Abstract

There is growing interest in how exposure to videogames is associated with young children’s development. While videogames may displace time from developmentally important activities and have been related to lower reading skills, work in older children and adolescents has suggested that experience with attention-demanding/fast-reaction games positively associates with attention and visuomotor skills. In the current study, we assessed 154 children aged 4–7 years (77 male; mean age 5.38) whose parents reported average daily weekday recreational videogame time, including information about which videogames were played. We investigated associations between videogame exposure and children’s sustained, selective, and executive attention skills. We found that videogame time was significantly positively associated only with selective attention. Longitudinal studies are needed to elucidate the directional association between time spent playing recreational videogames and attention skills.

Introduction

There is growing concern about young children’s exposure to screen-media activities (SMA) [1, 2], such as television or videogames, as excessive exposure may displace time from other developmentally important activities and could impact brain, behaviour, and cognitive development [3–6]. In particular, use of videogames in young children may be increasing with the proliferation and accessibility of gaming devices [7, 8]. A 2015 study in a large UK cohort showed that ~70% of 5-year old children play video/electronic games regularly [9]. Early childhood is a particularly interesting and important period in which to examine associations between videogame use and cognition, due to rapid brain, cognitive, and behavioural development [10–13], which may confer greater susceptibility to experience-dependent plasticity.

While much screen-media literature has focused on potential negative impacts and associations (such as with attention deficit hyperactivity disorder behaviours [5, 14–16]), interactive screen-media also has the potential to support learning (e.g., language learning, history, and physical education; [17]), and in some contexts, has shown positive associations with attention and other cognitive skills [18–22]. Videogames give users practice with maintaining vigilance over long periods, ignoring distractions, and making fast motor responses. Literature in older children and adults suggests that playing videogames with an ‘action’ component, i.e., placing specific demands on visual-spatial attention [21], associates with enhanced perceptual skills [19, 20], visual selective attention [23] and, visuomotor skills [24].

Attention is a multi-faceted cognitive domain that has been conceptualized in a tripartite model including sustained, selective, and executive components [25–27]. All three types of attention are maturing in young children [25]. This may perhaps confer an opportunity for experience-dependent developmental plasticity such that spending time playing videogames that engage attention may associate with greater skills. Further, with a growing interest in the use of ‘serious-games’ (e.g., educational videogames used to enhance working memory) for cognitive therapeutic purposes [28], it is valuable to determine whether videogames that place demands on vigilance and fast-reaction played recreationally associate with cognitive benefits in young children.

The goal of the present study is to assess whether there are associations between videogame exposure and attention skills in young children. Specifically, this study examined cross-sectional associations between parent-reported weekday recreational videogame use and children’s selective, sustained, and executive attention skills. Based on prior literature in young adults [23, 29], we hypothesized that time spent playing videogames would be associated with better selective attention.

Materials and methods

Participants

Data was collected at the Alberta Children’s Hospital from 180 typically developing children between the ages of 4-7-years. Participants were recruited through community advertisements, the Healthy Infants and Children’s Clinical Research Program (HICCUP) at the University of Calgary, and by reaching out to families who gave consent to be contacted during enrollment in other University of Calgary research studies. Parents provided informed written consent and children provided written assent. Study procedures were approved by the Conjoint Health Research Ethics Board of the University of Calgary. Exclusion criteria were: history of a neurodevelopmental disorder, psychiatric and/or neurological diagnosis, contraindications to magnetic resonance imaging (study participation involved neuroimaging session, not reported here), or chronic medical condition. Fourteen children withdrew from the study. Twelve sibling pairs participated; one child per family was chosen at random to be included in analyses. Data was analyzed for 154 children (77 female) who had complete videogame data; however, not all 154 participants had complete data on maternal education (n = 2) and cognition outcomes (selective attention, n = 4; visual sustain attention, n = 8; auditory sustained attention, n = 5; executive attention, n = 7; IQ, n = 2). Participants were excluded from any analyses for which they had missing data.

Procedure

Study participation involved three separate 1.5- to 2-hour visits to the Alberta Children’s Hospital that typically took place within two weeks of each other. During these sessions, parents completed questionnaires (10% were fathers) and children participated in cognitive assessments. The IQ assessments were conducted by a trained psychometrist and other assessments were conducted by a research assistant.

Demographic questionnaire

Parents reported on maternal and paternal education and occupation. For analyses presented here, maternal education (highest degree completed) was used as an indicator of family socioeconomic status (SES) and was grouped into five categories: high school diploma, technical/trade school degree, college diploma, bachelor’s degree, or graduate/professional school.

Videogame assessment

Parents completed a questionnaire [9] that asked them to estimate their child’s typical weekday time spent playing videogames at home over the past two weeks. Videogames included games that were played on the internet, television, or handheld device. Daily weekday time was measured because children’s weekday schedules are more consistent than weekends [30]. For each game, parents were asked to record their child’s daily participation time using the following time intervals: 0 min, <30min, 30min-1hr, 1hr-3hr, and >3hr, which were later converted to a score from 0 (0 min) to 4 (>3hr). Parents were asked to report the name of each game, and the device it was played on. To estimate total videogame time, time spent playing each game reported was summed.

General cognition

To characterize the sample, intelligence was assessed using the Wechsler Preschool and Primary Scale of Intelligence– 4^th Edition CDN (WPPSI-IV; [31]). Full Scale IQ (mean = 108, standard deviation = 13) was estimated from the scores on the following sub-tests of the WPPSI-IV: Block Design, Information, Matrix Reasoning, Bug Search, Picture Memory, and Similarities. These sub-tests were chosen as representative measures for each of the five WPPSI-IV sub-domains (visual spatial, fluid reasoning, working memory, processing speed, verbal comprehension). A test in each sub-domain is needed to calculate a Full Scale IQ for children 4 to 7 years of age.

Attention assessments

The Early Childhood Attention Battery (ECAB; [25]) was used to assess attention. In previous work, split-half reliability was found to be good (r = 0.75) as was validity relative to the Test of Everyday Attention for Children [26] (Pearson r = 0.765; [25]). Children completed eight sub-tests of the ECAB, four of which were included in this study to assess three components of attention: selective attention, sustained attention (visual sustained attention and auditory sustained attention), and executive attention. All of the sub-tests, except the selective attention task, were administered via a Dell laptop computer (screen size 31 cm by 17.5 cm), at a 35–50 cm viewing distance. The auditory components of the tasks were played through a set of external speakers. All computerized tasks included a practice trial, which was repeated if the child demonstrated they did not understand the instructions.

i. Selective attention

Selective attention was measured using the ECAB visual search task. Children were given one 60 s trial to point to targets (18 red apples, each 1.5 x 1.5 cm) among distractors (162 white apples and red strawberries, each 1.5 x 1.5 cm) on a laminated letter-sized search sheet. The experimenter marked items with an erasable marker as children pointed to them. This test was scored by summing correctly identified targets.

ii. Visual sustained attention

For the ECAB visual sustained attention measure, a series of pictures was presented on a computer screen (200 ms presentations with an inter-stimulus interval [ISI] of 1800 ms). The child was asked to verbally say “yes”, “animal”, or the name of the animal when a picture of an animal appeared on the screen. Thirty targets and 120 non-targets (familiar everyday items, e.g., car or bike) were presented over a 5-minute session. All pictures depicted animals or objects with monosyllabic names. Children were prompted to pay attention if they missed four consecutive targets. The score was the sum of the correct animal responses minus any errors (responses to non-targets) and prompts.

iii. Auditory sustained attention

Children also completed a similar auditory sustained attention task from the ECAB in which a continuous stream of words (monosyllabic animal target words and familiar item non-target words) were presented (average duration 650 ms, ISI 1,350 ms) over 5-minute task duration. The child was again asked to say “yes”, “animal”, or the name of the animal when they heard an animal name. The measure was scored as the number of correct responses minus any errors and prompts.

iv. Executive attention

Executive attention was assessed using the ECAB’s child-appropriate adaptation of a Wisconsin Card Sorting Test [32]. Children had to deduce which kind of balloon a teddy bear preferred. Each trial showed two balloons that varied in colour and shape. In stage one, the teddy bear liked one colour of balloon; in stage two, the preferred colour changed; and in stage three, the bear preferred balloons of a particular shape. Children received visual feedback on whether their choice was correct, but no other information was given. A total of 20 possible trials could be given for each stage, with six consecutive correct trials required for a pass to the next stage. If a child failed a stage, the test was discontinued. The task was scored as the total number of stages (three total) that were successfully completed.

Data analysis

All analyses were completed in R version 3.6.2. Mann-Whitney Wilcoxon tests were used to assess sex differences in age. Fisher’s exact test was used to assess sex differences in maternal education, videogame time, and videogame use. We examined whether demographic data (age, sex, and maternal education) were associated with the predictor (time spent playing videogames) or the outcome (attention measures) variables. Sex and age were correlated with many of the predictors and outcome measures; therefore, they were used as covariates in all models. Maternal education, as a marker of SES, was controlled for in follow-up analyses. As the videogame time measure was non-linear, we used partial Spearman correlations to assess relationships between outcomes and videogame time. Inferences were drawn at p < 0.05 Bonferroni corrected for multiple comparisons across attention measures; specifically, p-values were divided by four.

Exploratory analysis based on videogame content

Some literature on videogames has distinguished ‘action’ from ‘non-action’ games with action games being games that involve rapid pacing, switching attention between vigilance across the visual field to monitor for potential threats, and focusing in to accomplish a specific task and often include the control of an avatar (e.g. first-person shooter; [18]). While first-person shooter videogames are not commonly used by young children, we conducted an exploratory analysis modeled on the action/non-action distinction stratifying games based on a rough estimation of the cognitive demand, into ‘fast-reaction games’ or ‘slow-reaction games’. Fast-reaction games were those that included challenges such as hand-eye coordination and time pressure to make a response, while the latter mainly involved games with an educational component such as learning math, the alphabet, or social skills. Games were classified by two independent raters using http://igdb.com and other online sources including videos about the games on youtube.com. There was high inter-rater reliability between videogame classifications with 97% agreement but, in the case of a disagreement, a third rater acted as a tiebreaker. For categorical analyses, children were grouped as ‘non-gamers’ who did not play any videogames, ‘slow-reaction gamers’ who played only slow-reaction games, and ‘fast-reaction gamers’ who played fast-reaction games (with or without also playing slow-reaction games). Follow-up exploratory analyses used analysis of covariance (ANCOVA) models to examine associations between attention measures and gamer-type (non-gamer, slow-reaction gamer, fast-reaction gamer).

Results

Sample demographics

Participant demographics are shown in Table 1. We note that the distribution of maternal education in our sample was skewed towards the upper end of our scale. As seen in Table 1, boys and girls did not differ in terms of age or maternal education. In our sample, boys scored lower than girls on IQ (Table 1). We did not find significant sex differences on attention measures (Table 2).

Table 1. Demographics, general cognition, time spent playing videogames, and videogame use.

	All	Female	Male	p
N	154	77	77
Age (median [IQR])	5.43 [4.52, 6.13]	5.36 [4.46, 5.98]	5.61 [4.60, 6.17]	0.26
IQ (mean (SD))	108.72 (12.57)	111.29 (10.87)	106.09 (13.68)	0.01
Maternal Education (%)				0.99
High school	7 (4.6)	3 (3.9)	4 (5.3)
Trade/technical	5 (3.9)	2 (2.6)	3 (4.0)
College diploma	31 (20.3)	16 (20.8)	15 (20.0)
Bachelor’s degree	69 (45.1)	35 (45.4)	34 (45.4)
Graduate/professional	40 (26.1)	21 (27.3)	19 (25.3)
Videogame Time (%)				0.23
0min	68 (44.1)	36 (46.8)	32 (41.5)
< 30min	26 (16.9)	10 (13.0)	16 (20.8)
30min - 1h	22 (14.3)	14 (18.2)	8 (10.4)
1- 3h	16 (10.4)	5 (6.5)	11 (14.3)
> 3h	22 (14.3)	12 (15.6)	10 (13.0)
Videogame Use				0.63
None (%)	68 (44.1)	36 (46.8)	32 (41.6)
Some (%)	86 (55.8)	41 (53.2)	45 (58.4)

Open in a new tab

Scores are presented for the entire sample and for male and female participants separately. For non-normally distributed scores, median and interquartile ranges are given. Wilcoxon test was used for age. A two-sample t-test was used for IQ. Fisher’s exact tests were used for maternal education, videogame time, and videogame use.

Table 2. Attention measures.

	All	n	Female	Male	p
Executive attention (median [IQR])	34.70 (12.88)	147	32 [26, 41]	32 [26, 37]	0.462
Selective attention (median [IQR])	13.57 (3.22)	150	14 [12, 16]	14 [11, 16]	0.813
Visual sustained (median [IQR])	23.44 (6.30)	146	26 [21, 28]	25 [21, 28]	0.979
Auditory sustained (median [IQR])	20.81 (7.27)	150	22 [19, 27]	22 [17, 26]	0.207

Open in a new tab

Scores are presented for the entire sample and for male and female participants separately. For non-normally distributed scores, median and interquartile ranges are given. A two-sample t-test was used for IQ, other scores were compared using Kruskal-Wallis test.

Videogame use and associations with demographics

Videogame play was common in this sample but not ubiquitous, with more than half of children spending some time playing videogames (Table 1). The median of videogame time was 0–30min per weekday; among children who played games, the median was 30min -1h. Time spent playing videogames did not differ by sex (Table 1). Age was significantly positively correlated with time spent playing videogames (r_s (152) = 0.20, p < 0.05). General cognition, measured by Full Scale IQ, was associated at trend-level with time spent-playing videogames when controlling for age and sex (r_s (150) = -0.14, p = 0.08). Maternal education was significantly associated with time spent on videogames (r_s (150) = -0.16, p < 0.05).

Associations between videogame use and attention skills

Time spent playing videogames was positively associated with selective attention (r_s (148) = 0.20, p < 0.05) when controlling for age and sex (Fig 1). This association survived Bonferroni correction and remained significant when additionally controlling for maternal education (r_s (146) = 0.22, p < 0.01). Additionally, when an outlier was removed from the selective attention scores the association remained, again controlling for age, sex, and maternal education (r_s (145) = 0.24, p < 0.01). Spearman correlations revealed no significant association with the other attention measures when controlling for age and sex (visual sustained: r_s (144) = 0.046, p > 0.05; auditory sustained: r_s (147) = 0.00076, p > 0.05; executive: r_s (145) = -0.023, p > 0.05).

Exploratory analyses based on videogame content

There were 226 different videogames reported that were classified as fast-reaction (n = 72) or slow-reaction games (n = 154). For example, Subway Surfers [33] was considered a fast-reaction game while My Little Pony: Friendship Gardens [34] was considered a slow-reaction game.

Fast-reaction, slow-reaction, and non-gamer type did not differ by sex (Table 3). Age was significantly associated with gamer type (F (1,152) = 8.7, p < 0.01, np² = 0.054), with fast-reaction gamers (t (100.6) = 2.9, p < 0.01; mean = 5.60) older than non-gamers (mean = 5.16). However, fast-reaction and slow-reaction gamers (mean = 5.48) did not significantly differ in age (t (77.3) = 0.64, p > 0.05) nor did slow-reaction and non-gamers (t (68.8) = 1.93, p > 0.05). Maternal education showed a trend level association with gamer type (F (1, 150) = 3.09, p = 0.08).

Table 3. Gamer type in this sample.

	All	Female	Male	p
Gamer Type (%)				0.20
Non-gamer	68 (44.2)	36 (46.7)	32 (41.5)
Slow-reaction gamer	36 (23.3)	21 (27.3)	15 (19.5)
Fast-reaction gamer	50 (32.5)	20 (26.0)	30 (39.0)

Open in a new tab

Scores are presented for the entire sample and for male and female participants separately. Fisher’s exact test was used.

Gamer type was associated with selective attention scores in an ANCOVA model that controlled for age and sex (F (1, 146) = 6.34, p < 0.05, np² = 0.042); however this association did not survive Bonferroni correction. There was no association between gamer type and other attention measures when controlling for age and sex (visual sustained: F (1, 142) = 2.06, p > 0.05, np² = 0.014; auditory sustained: F (1, 145) = 0.24, p > 0.05, np² = 0.0095; executive: F (1, 143) = 0.027, p > 0.05, np² = 0.00019).

Discussion

This study investigated whether time spent playing recreational videogames was associated with children’s attention skills. We found that more than half of the children in our sample regularly played videogames and that use was more frequent in older children. We found a positive association between time spent playing videogames and selective attention skills but not visual sustained, auditory sustained, or executive attention skills. Importantly, longitudinal studies are needed to determine whether children with greater selective attention skills play videogames more frequently because they are more predisposed to be good at them, or whether there is a practice-dependent effect.

Our findings suggest that there is a potential ‘advantage’ in terms of selective attention skills in children who spend more time playing videogames. These findings are consistent with previous literature in adults. For example, action videogame experts (≥7 hours of videogame play per week) compared to non-gamers (≤1 hour of videogame play per week) showed enhanced task-switching abilities, a selective attention skill, [35] and comparable results have been demonstrated elsewhere [36, 37]. Furthermore, the ability to filter irrelevant information, another selective attention skill, was shown to be enhanced in action gamers (≥ 5 hours of videogame play per week) compared to non-gamers (≤1 hour of videogame play per week) in conjunction with gamers displaying different neural activity, suggested to be associated with greater attentional control [29]. However, dissimilar to these adult studies, we note that our effect of selective attention was associated with videogame duration rather than with a particular type of videogame.

We note that this potential ‘advantage’ of recreational videogame duration did not generalize to other attention skills assessed here. Studies in adults have shown associations between playing action videogames and executive attention skills, such as enhanced executive functioning [38] and executive control [39]. Studies in young children, on the other hand, have shown mixed results with regards to time spent on videogames and executive functioning skills. In line with our finding of no association between videogame use and executive attention, Jusienė et al. [40] found that SMA exposure, including TV, computer, smartphone, and tablet use, in preschool-aged children did not associate with executive function. However, a screen intervention study that assessed young children’s (2 and 3 years old) executive functioning before and after a screen activity, demonstrated that playing an educational app (similar to slow-reaction games here) had no significant adverse effects on children’s executive functioning and even improved scores on one executive function task compared to children who passively watched an educational television show or cartoon [41].

We found no association with sustained attention here. Previous work investigating sustained attention and videogaming in adolescents found that across a sustained attention task, action gamers (≥7 hours of videogame play per week) showed a greater performance decline relative to non-action gamers (≤1 hour of videogame play per week) [42]. These authors speculate that because of the fast-paced environment that action gamers are used to, this may cause them more difficulty when trying to complete relatively mundane sustained attention tasks. No studies to our knowledge have shown positive associations.

In terms of associations between time spent playing recreational videogames and demographic variables, we found a positive association with age, a negative association with maternal education, and no association with sex. Similarly, fast-reaction gamers were significantly older than non-gamers (p < 0.05) and mothers of fast-reaction gamers on average had lower educational attainment relative to non-gamers (p = 0.05). Although we expected to find that boys spent more time playing videogames than girls, we did not see this or a sex-specific effect for gamer-type. It is possible that a distinction between sexes in videogame use may emerge later in development [43] as games developed for young children tend to focus on appealing to both sexes (e.g., see S1 Table). On the other hand, it could be that sex differences in children’s videogame use is diminishing as the use of handheld games becomes more common.

One of the motivations for examining recreational videogame use in relation to attention skills is motivated by the use of ‘serious-games’ for cognitive rehabilitation. This is an active, though sometimes controversial [44], area of research, and recent preliminary work has shown positive effects of cognitive videogame training on visual working memory and selective attention in young children (6–12 years) with Autism Spectrum Disorder [45]. Furthermore, various studies [46] have illustrated the benefits in using videogames to improve symptoms in children with attention deficit hyperactivity disorder [46, 47] and to improve reading abilities and attentional skills in children with dyslexia [48]. Thus, videogame play has the potential to be a therapeutic tool in clinical settings. Our study suggests that the use of recreational videogames should be considered in the context of cognitive rehabilitation, as a potential confound and, given the positive association with selective attention found here, support integrating features of recreational games into therapeutic games.

Strengths of the present study include the use of direct assessment of children’s attention skills in an early childhood sample and analyses based on videogame duration and characteristics. However, several study limitations should also be noted. Maternal education, used here as a proxy for SES, was skewed toward the upper end of our scale, limiting the generalizability of our findings. The relatively small sample size may have limited our power to detect small effects as significant. Our data are cross-sectional and therefore cannot be used to assess the causal effects of videogames on cognition or attention. We did not collect information about the social context of videogames or parenting style [43]. As noted above, our criteria for ‘fast-reaction’ games differed from that used to classify videogames played by older children and adults (i.e., ‘action’ games [18]). Finally, parent- reports likely underestimate actual use of videogames and mobile devices in young children [49] as well, only recreational games were included in this study therefore games played in school, at a friend’s house, or elsewhere were not taken into account. Future work should incorporate objective measurements for more accurate videogame usage including time-use diaries and passive sensing [50]

Conclusions

Videogaming is increasingly common in young children and to support recommendations on SMA use for families it is important to understand whether videogaming associates with children’s attention skills and whether associations are positive or negative. Focusing on a tripartite model of attention, we found a significant positive association between time spent playing recreational videogames and selective attention. Importantly, our cross-sectional findings cannot be used to infer causality or directionality of these associations, and future longitudinal or interventional studies are needed to determine whether playing videogames in early childhood influences attention development.

Supporting information

S1 Table. List of videogames played by participants.

(DOCX)

Click here for additional data file.^{(16.3KB, docx)}

S1 Dataset. Raw data.

(XLSX)

Click here for additional data file.^{(21.5KB, xlsx)}

Acknowledgments

The authors gratefully acknowledge study support from Sarah Vinette, Ivy Cho, Amy Webber, and Kari Parsons. We also thank all of the families who took the time to participate in this research.

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

Funding Statement

This work was supported by: Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant (DG 435787) to SB [www.nserc-crsng.gc.ca]. Natural Sciences and Engineering Research Council of Canada (NSERC) Undergraduate Student Research Award (USRA) award to AS [www.nserc-crsng.gc.ca]. Canadian Institutes of Health Research (CIHR) Project Scheme award (Project 156415) to SB [cihr-irsc.gc.ca]. Alberta Innovates Health Solutions (AIHS) Postdoctoral Award to CR [albertainnovates.ca]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

1.Christakis DA. The effects of infant media usage: what do we know and what should we learn? Acta Paediatrica. 2009Jan;98(1):8–16. doi: 10.1111/j.1651-2227.2008.01027.x [DOI] [PubMed] [Google Scholar]
2.Canadian Paediatric Society, Digital Health Task Force, Ottawa Ontario, Ponti M, Bélanger S, Grimes R, Heard J, Johnson M, et al. Screen time and young children: Promoting health and development in a digital world. Paediatrics & Child Health. 2017Nov27;22(8):461–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Hutton JS, Dudley J, Horowitz-Kraus T, DeWitt T, Holland SK. Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children. JAMA Pediatr. 2019Nov04:174(1):e193869. [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Takeuchi H, Taki Y, Hashizume H, Asano K, Asano M, Sassa Y, et al. Impact of videogame play on the brain’s microstructural properties: cross-sectional and longitudinal analyses. Mol Psychiatry. 2016Jan05;21:1781–1789. doi: 10.1038/mp.2015.193 [DOI] [PMC free article] [PubMed] [Google Scholar]
5.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. 2016Feb26;6(2):e009089. doi: 10.1136/bmjopen-2015-009089 [DOI] [PMC free article] [PubMed] [Google Scholar]
6.McArthur BA, Eirich R, McDonald S, Tough S, Madigan S. Screen use relates to decreased offline enrichment activities. Acta Paediatr. 2021Mar;110(3):896–8. doi: 10.1111/apa.15601 [DOI] [PubMed] [Google Scholar]
7.Kabali HK, Irigoyen MM, Nunez-Davis R, Budacki JG, Mohanty SH, Leister KP, et al. Exposure and Use of Mobile Media Devices by Young Children. PEDIATRICS. 2015Dec1;136(6):1044–50. doi: 10.1542/peds.2015-2151 [DOI] [PubMed] [Google Scholar]
8.Paudel S, Jancey J, Subedi N, Leavy J. Correlates of mobile screen media use among children aged 0–8: a systematic review. BMJ Open. 2017Oct;7(10):e014585. doi: 10.1136/bmjopen-2016-014585 [DOI] [PMC free article] [PubMed] [Google Scholar]
9.Parkes A, Sweeting H, Wight D, Henderson M. Do television and electronic games predict children’s psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study. Arch Dis Child. 2013;98: 341–348. doi: 10.1136/archdischild-2011-301508 [DOI] [PMC free article] [PubMed] [Google Scholar]
10.Rohr CS, Arora A, Cho IYK, Katlariwala P, Dimond D, Dewey D, et al. Functional network integration and attention skills in young children. Dev Cogn Neurosci. 2018Apr;30:200–11. doi: 10.1016/j.dcn.2018.03.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
11.Reynolds JE, Grohs MN, Dewey D, Lebel C. Global and regional white matter development in early childhood. Neuroimage. 2019Aug1;196:49–58. doi: 10.1016/j.neuroimage.2019.04.004 [DOI] [PubMed] [Google Scholar]
12.Haynes L, Ip A, Cho IYK, Dimond D, Rohr CS, Bagshawe M, et al. Grey and white matter volumes in early childhood: A comparison of voxel-based morphometry pipelines. Dev Cogn Neurosci. 2020Dec;46:100875. doi: 10.1016/j.dcn.2020.100875 [DOI] [PMC free article] [PubMed] [Google Scholar]
13.Dimond D, Rohr CS, Smith RE, Dhollander T, Cho I, Lebel C, et al. Early childhood development of white matter fiber density and morphology. Neuroimage. 2020;210: 116552. doi: 10.1016/j.neuroimage.2020.116552 [DOI] [PubMed] [Google Scholar]
14.Tamana SK, Ezeugwu V, Chikuma J, Lefebvre DL, Azad MB, Moraes TJ, et al. Screen-time is associated with inattention problems in preschoolers: Results from the CHILD birth cohort study. PLoS One. 2019;14: e0213995. doi: 10.1371/journal.pone.0213995 [DOI] [PMC free article] [PubMed] [Google Scholar]
15.Miller CJ, Marks DJ, Miller SR, Berwid OG, Kera EC, Santra A, et al. Brief Report: Television Viewing and Risk for Attention Problems in Preschool Children. Journal of Pediatric Psychology. 2006Oct3;32(4):448–52. doi: 10.1093/jpepsy/jsl035 [DOI] [PubMed] [Google Scholar]
16.Swing EL, Gentile DA, Anderson CA, Walsh DA. Television and video game exposure and the development of attention problems. Pediatrics. 2010Jul05;126: 214–221. doi: 10.1542/peds.2009-1508 [DOI] [PubMed] [Google Scholar]
17.Young MF, Slota S, Cutter AB, Jalette G, Mullin G, Lai B, et al. Our Princess Is in Another Castle: A Review of Trends in Serious Gaming for Education. Review of Educational Research. 2012Mar;82(1):61–89. [Google Scholar]
18.Dale G, Joessel A, Bavelier D, Green CS. A new look at the cognitive neuroscience of video game play. Ann N Y Acad Sci. 2020Jan13;1464: 192–203. doi: 10.1111/nyas.14295 [DOI] [PubMed] [Google Scholar]
19.Chopin A, Bediou B, Bavelier D. Altering perception: the case of action video gaming. Curr Opin Psychol. 2019Mar13;29: 168–173. doi: 10.1016/j.copsyc.2019.03.004 [DOI] [PubMed] [Google Scholar]
20.Eichenbaum A, Bavelier D, Green C. Video Games—Play That Can Do Serious Good. Am J Play. 2014;7: 50–72. [Google Scholar]
21.Bediou B, Adams DM, Mayer RE, Tipton E, Green CS, Bavelier D. Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills. Psychol Bull. 2018;144: 77–110. doi: 10.1037/bul0000130 [DOI] [PubMed] [Google Scholar]
22.Polinsky N, Flynn R, Wartella EA, Uttal DH. The role of spatial abilities in young children’s spatially-focused touchscreen game play. Cognitive Development. 2021Jan;57:100970. [Google Scholar]
23.Green CS, Bavelier D. Action video game modifies visual selective attention. Nature. 2003;423: 534–537. doi: 10.1038/nature01647 [DOI] [PubMed] [Google Scholar]
24.Li L, Chen R, Chen J. Playing Action Video Games Improves Visuomotor Control. Psychol Sci. 2016Aug;27(8):1092–108. doi: 10.1177/0956797616650300 [DOI] [PubMed] [Google Scholar]
25.Breckenridge K, Braddick O, Atkinson J. The organization of attention in typical development: a new preschool attention test battery. Br J Dev Psychol. 2013;31: 271–288. doi: 10.1111/bjdp.12004 [DOI] [PubMed] [Google Scholar]
26.Manly TI, Robertson IH, Anderson V, Nimmo-Smith I. The test of everyday attention for children (TEA-Ch). Bury St Edmunds, UK: Thames Valley Test Company. 1999. [Google Scholar]
27.Manly T, Anderson V, Nimmo-Smith I, Turner A, Watson P, Robertson IH. The differential assessment of children’s attention: the Test of Everyday Attention for Children (TEA-Ch), normative sample and ADHD performance. J Child Psychol Psychiatry. 2001Nov;42(8):1065–81. doi: 10.1111/1469-7610.00806 [DOI] [PubMed] [Google Scholar]
28.Kerns KA, Macoun S, MacSween J, Pei J, Hutchison M. Attention and working memory training: A feasibility study in children with neurodevelopmental disorders. Appl Neuropsychol Child. 2016Apr06;6: 120–137. doi: 10.1080/21622965.2015.1109513 [DOI] [PubMed] [Google Scholar]
29.Bavelier D, Achtman RL, Mani M, Föcker J. Neural bases of selective attention in action video game players. Vis Res. 2012Aug16;61: 132–143. doi: 10.1016/j.visres.2011.08.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
30.Lubans DR, Hesketh K, Cliff DP, Barnett LM, Salmon J, Dollman J, et al. A systematic review of the validity and reliability of sedentary behaviour measures used with children and adolescents. Obes Rev. 2011Jun16;12: 781–799. doi: 10.1111/j.1467-789X.2011.00896.x [DOI] [PubMed] [Google Scholar]
31.Wechsler D. Wechsler Preschool and Primary Scale of Intelligence. 4th ed. Toronto ON: Pearson Canada Assessment; 2012. [Google Scholar]
32.Robinson AL, Heaton RK, Lehman RA, Stilson DW. The utility of the Wisconsin Card Sorting Test in detecting and localizing frontal lobe lesions. J Consult Clin Psychol. 1980;48: 605–614. doi: 10.1037//0022-006x.48.5.605 [DOI] [PubMed] [Google Scholar]
33.Subway Surfer [Video game]. Aarhus, Denmark: Kiloo, SYBO Games. 2012.
34.My Little Pony: Friendship Gardens [Video game]. Pawtucket, USA: Hasbro, Inc. 1998.
35.Boot WR, Kramer AF, Simons DJ, Fabiani M, Gratton G. The effects of video game playing on attention, memory, and executive control. Acta Psychologica. 2008Nov;129(3):387–98. doi: 10.1016/j.actpsy.2008.09.005 [DOI] [PubMed] [Google Scholar]
36.Andrews G, Murphy K. Does video-game play improve executive function? In M.A. Vachevsky (Ed.), Front. Psychol. Hauppage (NY): Nova Science Publishers Inc; 2006. 145–161 p. [Google Scholar]
37.Karle JW, Watter S, Shedden JM. Task switching in video game players: Benefits of selective attention but not resistance to proactive interference. Acta Psychologica. 2010May;134(1):70–8. doi: 10.1016/j.actpsy.2009.12.007 [DOI] [PubMed] [Google Scholar]
38.Cain MS, Landau AN, Shimamura AP. Action video game experience reduces the cost of switching tasks. Atten Percept Psychophys. 2012May;74(4):641–7. doi: 10.3758/s13414-012-0284-1 [DOI] [PubMed] [Google Scholar]
39.Strobach T, Frensch PA, Schubert T. Video game practice optimizes executive control skills in dual-task and task switching situations. Acta Psychol (Amst). 2012May;140(1):13–24. doi: 10.1016/j.actpsy.2012.02.001 [DOI] [PubMed] [Google Scholar]
40.Jusienė R, Rakickienė L, Breidokienė R, Laurinaitytė I. Executive function and screen‐based media use in preschool children. Inf Child Dev. 2020Jan;29(1). [Google Scholar]
41.Huber B, Yeates M, Meyer D, Fleckhammer L, Kaufman J. The effects of screen media content on young children’s executive functioning. Journal of Experimental Child Psychology. 2018Jun;170:72–85. doi: 10.1016/j.jecp.2018.01.006 [DOI] [PubMed] [Google Scholar]
42.Trisolini DC, Petilli MA, Daini R. Is action video gaming related to sustained attention of adolescents? Quarterly Journal of Experimental Psychology. 2018May;71(5):1033–9. doi: 10.1080/17470218.2017.1310912 [DOI] [PubMed] [Google Scholar]
43.Linebarger DL. Contextualizing video game play: The moderating effects of cumulative risk and parenting styles on the relations among video game exposure and problem behaviors. Psychol Pop Media Cult. 2015;4: 375–396. [Google Scholar]
44.Stojanoski B, Wild CJ, Battista ME, Nichols ES, Owen AM. Brain training habits are not associated with generalized benefits to cognition: An online study of over 1000 “brain trainers”. Journal of Experimental Psychology: General. 2021Apr;150(4):729–38. [DOI] [PubMed] [Google Scholar]
45.Macoun SJ, Schneider I, Bedir B, Sheehan J, Sung A. Pilot Study of an Attention and Executive Function Cognitive Intervention in Children with Autism Spectrum Disorders. J Autism Dev Disord. 2021Aug;51(8):2600–10. doi: 10.1007/s10803-020-04723-w [DOI] [PubMed] [Google Scholar]
46.Lim CG, Lee TS, Guan C, Fung DSS, Zhao Y, Teng SSW, et al. A Brain-Computer Interface Based Attention Training Program for Treating Attention Deficit Hyperactivity Disorder. Zang Y-F, editor. PLoS ONE. 2012Oct24;7(10):e46692. doi: 10.1371/journal.pone.0046692 [DOI] [PMC free article] [PubMed] [Google Scholar]
47.van der Oord S, Ponsioen AJGB, Geurts HM, Brink ELT, Prins PJM. A Pilot Study of the Efficacy of a Computerized Executive Functioning Remediation Training With Game Elements for Children With ADHD in an Outpatient Setting: Outcome on Parent- and Teacher-Rated Executive Functioning and ADHD Behavior. J Atten Disord. 2014Nov;18(8):699–712. doi: 10.1177/1087054712453167 [DOI] [PubMed] [Google Scholar]
48.Franceschini S, Gori S, Ruffino M, Viola S, Molteni M, Facoetti A. Action Video Games Make Dyslexic Children Read Better. Current Biology. 2013Mar;23(6):462–6. doi: 10.1016/j.cub.2013.01.044 [DOI] [PubMed] [Google Scholar]
49.Radesky JS, Weeks HM, Ball R, Schaller A, Yeo S, Durnez J, et al. Young Children’s Use of Smartphones and Tablets. Pediatrics. 2020Jul;146(1):e20193518. doi: 10.1542/peds.2019-3518 [DOI] [PMC free article] [PubMed] [Google Scholar]
50.Barr R, Kirkorian H, Radesky J, Coyne S, Nichols D, Blanchfield O, et al. Beyond Screen Time: A Synergistic Approach to a More Comprehensive Assessment of Family Media Exposure During Early Childhood. Front Psychol. 2020Jul10;11:1283. doi: 10.3389/fpsyg.2020.01283 [DOI] [PMC free article] [PubMed] [Google Scholar]

PLoS One. 2021 Sep 27;16(9):e0257877. doi: 10.1371/journal.pone.0257877.r001

Author response to previous submission

28 Sep 2020

Attachment

Submitted filename: Response to Reviewers 1.docx

Click here for additional data file.^{(363.3KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0257877.r002

Decision Letter 0

Trinidad Garcia

12 Feb 2021

PONE-D-20-30582

Screen-games and their association with cognition and behaviour in young children

PLOS ONE

Dear Dr. Bray,

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.

Firt of all, we would like to apologize for the delay in sending the reviewers´s comments to the authors. This time was specially hard for finding available reviewers, as the COVID-19 is still dramatically affecting our lifes in different senses.

Based on the comments of the reviewers and my own opinion, I recommend a major revision of your manuscript, paying special attention at the reviewers´ comments concerning background, methods and results. Also, a revision and editing of the english language is required.

Please submit your revised manuscript by Mar 29 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.

We look forward to receiving your revised manuscript.

Kind regards,

Trinidad Garcia, PhD

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. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

3.We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match.

When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.

[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: Partly

Reviewer #2: Partly

**********

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

Reviewer #1: No

Reviewer #2: Yes

**********

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: Yes

Reviewer #2: 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: No

Reviewer #2: Yes

**********

5. Review Comments to the Author

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

Reviewer #1: The authors examine the linkage between young children's time spent playing digital games, diverse indices of their attentional abilities including sustained and selective attention, and ADHD and ASD symptoms.

The reasons for studying these linkages is not well-justified. In fact, the authors' claims about the relative dearth of information about young children's digital game exposure as linked to cognitive skills reflect limited consultation of developmental research that would show otherwise. Specifically, the authors are urged to consult the work emanating from the labs of, for example, Heather Kirkorian and Ellen Wartella. Consideration of the characteristics of the games and apps that young children use and the cognitive and academic skills that may be promoted through their play also is available in research done by those within the developmental psychology and educational technology communities. Reasons for linking game play to ASD symptoms is not well grounded in the literature aside from these symptoms being shown more frequently among males than girls; the latter of whom are presumed to spend more time playing digital games than girls. This presumption alone, particularly among young children, warrants greater substantiation than the authors provide.

The methods section was far too limited in the information provided. For example, which parent completed the surveys? Did parents have full knowledge of children's game activities outside the home, given that many preschools may not include digital game play as part of the academic curriculum. Similarly, were games included if they were presented as part of a website that included activities for children? Distinctions between what qualified as action v. non-action game were fuzzy. What exactly would qualify as a non-action game? In looking at Table 2, it seems as if those games that were more educational in nature were more inclined to be labeled as non-action games. What was the inter-rater reliability for making distinctions between the two types of games as none is reported. What was the reason for including particular subtests of the WPPSI-IV? What exactly did the attention assessments as modeled on ECAB entail? The authors should be willing to provide at least a brief description. How many trials in the selective attention task? What was the basis for the sustained attention task used in the study and who developed it? What were the criteria that needed to be met for successful completion of forms in the VMI task? For the behavioral assessments, were the parents the reporters or were independent assessments made as the authors make mention on page 4 of using a multi-informant approach. In fact, the authors later note in their discussion section that a strength of the study was this approach. Thus, specific mention of these informants is warranted.

The results section was somewhat baffling to me as I failed to understand why participants with missing or outlier data were still included in the analyses. How were the missing data points handled within the data set? Similarly, why were those participants who exceeded clinical cut-offs on the AQC still included in the study?

Overall, I am not sure what story is told by the minimal significant findings or why the study was done. The distinction between action and non-action games seems particularly blunt and the multi-informant approach is not at all obvious.

Reviewer #2: This paper investigates the association between video-games and cognitive measurements and hyperactivity and autistic traits measured by questionnaires filled by parents in preschool children. This is a very well-written and sounded paper that I recommand for publication with minor revisions that I detail here below:

-The title is not very accurate : there is no association between screen-games and cognition and the association with behavior is in fact an association with parents' perception of their children's behavior. I would suggest to put the result : video-games were not associated with cognitive abilities but with behavior reported by parents.

- Define what is screen-media activities and what is screen-games. Why the authors do not use the term video-games?

-The introduction can be better structured. Here is my suggestion : begin with defintiions, then prevalence and then the effects of games on cognition. Then you can develop in a separate section the effect on hyperactivity and autistic traits. This would help formalize better hypotheses about the association between hyperactivty and autistic symptoms. In fact, I did not fully understand the association between video-games and autistic symptoms.

-In your hypothesis "We hypothesized that time spent playing screen-games would be positively associated with ADHD and ASD symptoms and that playing attentionally demanding games would be associated with better selective attention and visuomotor integration", how can you reconcile a positive effect on cognition and a negative effect on behavior?

-Hyperactivity and autistic traits were studied through questionnaires by parents and these were the only significant correlations with screen-games. This was not discussed in the discussion. How much reliable are parents' answers ? This study shows a correlation between games and parents' perception of the level of activity of their children and some of their personaity traits. This hihglight should have implications on the title, the abstract and the discussion.

-The table with demographics is good and could contain the percentages so the authors do not repeat the figures in the paragraph below.

-The table with the distinction between action games and non action games is not very interesting. You may give an example.

-There is a sentence in the discussion saying that this study is correlational and other studies need to study the causal effects. I agree and in my view this is not sufficiantly developped in the discussion especially when showing the positive correlations between games and hyperactivity and autistic traits. My concern is that this may mislead some readers or can be misinterpreted by journalists and parents.

**********

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

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

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

Reviewer #1: No

Reviewer #2: Yes: Rana Esseily

[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.

PLoS One. 2021 Sep 27;16(9):e0257877. doi: 10.1371/journal.pone.0257877.r003

Author response to Decision Letter 0

30 Apr 2021

Reviewer #1

The authors examine the linkage between young children's time spent playing digital games, diverse indices of their attentional abilities including sustained and selective attention, and ADHD and ASD symptoms.

1. The reasons for studying these linkages is not well-justified. In fact, the authors' claims about the relative dearth of information about young children's digital game exposure as linked to cognitive skills reflect limited consultation of developmental research that would show otherwise. Specifically, the authors are urged to consult the work emanating from the labs of, for example, Heather Kirkorian and Ellen Wartella. Consideration of the characteristics of the games and apps that young children use and the cognitive and academic skills that may be promoted through their play also is available in research done by those within the developmental psychology and educational technology communities.

We agree that the Introduction and justification for the study could benefit from a more in-depth description of the prior literature. We have now substantially revised the Introduction to focus more directly on the main novel contribution of our work, which is direct assessment of attention skills in young children, and also referenced the important work by Wartella and colleagues [14, 19] and other development psychology research on related topics (i.e., Dale, Bavelier & Green (2020) [10]; McNeill et al., (2019) [18]; Jusiene et al. (2020) [21]). Please see the Introduction section for all of the changes made (Pages 3 – 5, Lines 26 -81).

Further, work by Kirkorian and colleagues [46] was added to the Discussion (Lines 434 – 435)

2. Reasons for linking game play to ASD symptoms is not well grounded in the literature aside from these symptoms being shown more frequently among males than girls; the latter of whom are presumed to spend more time playing digital games than girls. This presumption alone, particularly among young children, warrants greater substantiation than the authors provide.

We agree that the rationale for examining ASD symptoms was under-developed and have decided to remove measures of ASD symptoms and behaviours from the manuscript.

3. The methods section was far too limited in the information provided. For example, which parent completed the surveys? Did parents have full knowledge of children's game activities outside the home, given that many preschools may not include digital game play as part of the academic curriculum. Similarly, were games included if they were presented as part of a website that included activities for children?

We thank the reviewer for noting details that should be added to the Methods section. These questions helped us to improve the clarity of this section.

- Which parent completed the surveys?

We have added this to the Procedure of the Methods section: “During these sessions, parents completed questionnaires (10% were fathers) and children participated in cognitive assessments.” (Lines 108 –110)

- Did parents have full knowledge of children's game activities outside the home, given that many preschools may not include digital game play as part of the academic curriculum?

Great question, “Parents completed a questionnaire [17] that asked them to estimate their child’s typical weekday time spent playing videogames at home over the past two weeks.” (Lines 122-123)

- Similarly, were games included if they were presented as part of a website that included activities for children?

Parents provided information about devices used to play videogames and names of the videogames played. Based on Google searches of the games that were named by the parents, some were internet games. This has now been added to the manuscript for clarification: “Videogames included games that were played on the internet, television, or handheld device.”(Line 123 - 124)

4. Distinctions between what qualified as action v. non-action game were fuzzy. What exactly would qualify as a non-action game? In looking at Table 2, it seems as if those games that were more educational in nature were more inclined to be labeled as non-action games. What was the inter-rater reliability for making distinctions between the two types of games as none is reported.

We agree that the distinction between action and non-action games was not clear therefore we now classify the games as attention-demanding and non-attention-demanding games. We believe this classification better captures the way in which we rated the games. For example, as the reviewer mentions the non-attention-demanding games are typically educational in nature thus require less demand of attention.

“The cognitive psychology literature typically distinguishes ‘action’ from ‘non-action games with action games being games that involve rapid pacing, switching attention between vigilance across the visual field to monitor for potential threats, and focusing in to accomplish a specific task and often include the control of an avatar (e.g. first-person shooter; [10]). However, these types of games are not commonly used by young children therefore we decided to categorize the games as ‘attention-demanding’ and ‘non-attention-demanding’ games. The former involved games with challenges such as fast reaction time, hand-eye coordination, and time pressure to make a response while the latter, involved games with an educational component such as learning math, the alphabet, or social skills.” (Lines 139 – 143).

Inter-rater reliability was reported: “There was high inter-rater reliability between videogame classifications with 97% agreement but, in the case of a disagreement, a third rater acted as a tiebreaker.” (Lines 145 – 147)

5. What was the reason for including particular subtests of the WPPSI-IV?

Great question. We added an explanation to the methods section: “These sub-tests were chosen as representative measures for each of the five WPPSI-IV sub-domains (visual spatial, fluid reasoning, working memory, processing speed, verbal comprehension).” (Lines 160 – 162)

6. What exactly did the attention assessments as modeled on ECAB entail? The authors should be willing to provide at least a brief description. How many trials in the selective attention task? What was the basis for the sustained attention task used in the study and who developed it?

Thank you for the questions, we have elaborated on the ECAB in the Methods section. Specifically, we have clarified how all four of the cognitive attention measures were derived from the ECAB. The ECAB measurement is broadly discussed followed by detailed explanations of the four sub-tests that were used in the study (Lines 166 – 211).

7. What were the criteria that needed to be met for successful completion of forms in the VMI task?

We decided to streamline our paper to focus on attention and VMI was removed from the analysis. We also note that because this measure was added after data collection began and therefore was only available for a smaller sample (n = 129), making comparisons to other outcomes reported more complicated.

8. For the behavioral assessments, were the parents the reporters or were independent assessments made as the authors make mention on page 4 of using a multi-informant approach. In fact, the authors later note in their discussion section that a strength of the study was this approach. Thus, specific mention of these informants is warranted.

We have decided to use the term multi-method instead of multi-informant to clarify that different types of methods were used to collect the data for this study; parent-reports of ADHD behaviour traits and videogame data in addition to direct assessments of children’s attention and general cognition. We have made this more explicit within the Methods section as well as in the Introduction (e.g. Introduction section: “As a step towards understanding the potential impact of videogames on attention and cognition in early childhood, we describe a cross-sectional study examining associations between parent-reported videogame use and assessments of children’s attention skills.” (Lines 68 – 70).

9. The results section was somewhat baffling to me as I failed to understand why participants with missing or outlier data were still included in the analyses. How were the missing data points handled within the data set? Similarly, why were those participants who exceeded clinical cut-offs on the AQC still included in the study?

We have now clarified that participants with missing data on a particular assessment were not included in the analyses that included that measure as a predictor or outcome.

For example, if a participant did not have a selective attention score, they were not included in analyses when selective attention was being assessed. Additionally, the one selective attention outlier was removed from the model of videogame play and selective attention scores in order to test whether the effect remained significant (Line 285-287).

We have now added a clarification to the Participants section: “Data was analyzed for 154 children (77 female) who had complete videogame data; however, not all 154 participants had complete data on maternal education (n = 2), cognitive outcomes (selective attention, n = 4; visual sustain attention, n = 8; auditory sustained attention, n = 5; executive attention, n = 7; IQ, n = 2), and behavioural traits (SNAPI, n = 2; SNAPH, n = 3; SNAPC, n = 3). Participants were excluded from any analyses for which they had missing data.”(Lines 98 – 103)

Analyses involving the AQC have now been removed from the manuscript.

10. Overall, I am not sure what story is told by the minimal significant findings or why the study was done. The distinction between action and non-action games seems particularly blunt and the multi-informant approach is not at all obvious.

As the reviewer suggested and as mentioned above, we added rationale to the Introduction including emphasis on literature of videogames in older children as well as videogames in younger children (see response to #1) to highlight the rationale for conducting this study. We have also clarified the distinction between game characteristics (see response to #4) and clarified what we meant by multi-informant approach (see response to #8).

Reviewer #2

This paper investigates the association between video-games and cognitive measurements and hyperactivity and autistic traits measured by questionnaires filled by parents in preschool children. This is a very well-written and sounded paper that I recommend for publication with minor revisions that I detail here below:

1. The title is not very accurate: there is no association between screen-games and cognition and the association with behavior is in fact an association with parents' perception of their children's behavior. I would suggest to put the result: video-games were not associated with cognitive abilities but with behavior reported by parents.

The reviewer raises an important consideration therefore we decided to change the title of the manuscript to: Videogame play associates with selective attention skills and hyperactivity in early childhood

Additionally, we took the reviewers suggestion to clarify the results of the study (i.e., Conclusion section: “We found a significant positive association between time spent playing recreational videogames and selective attention as well as a significant positive association between time spent playing recreational videogames and parent-rated hyperactivity behaviours. Importantly, our cross-sectional findings cannot be used to infer causality or directionality of these associations and future longitudinal or interventional studies are needed to determine whether playing videogames in early childhood influences cognitive or behavioral development.” (Lines 442 - 448).

2. Define what screen-media activities is and what is screen-games. Why the authors do not use the term video-games?

We appreciate the suggestion and we decided to use videogames, instead of screen-games, throughout the manuscript.

Additionally, examples of screen-media activities were provided: “There is growing concern about young children’s exposure to screen-media activities (SMAs) [1] such as television or videogames,…” (Lines 27 – 28).

3. The introduction can be better structured. Here is my suggestion: begin with definitions, then prevalence and then the effects of games on cognition. Then you can develop in a separate section the effect on hyperactivity and autistic traits. This would help formalize better hypotheses about the association between hyperactivity and autistic symptoms. In fact, I did not fully understand the association between video-games and autistic symptoms.

As mentioned in the response to Reviewer 1 (response #1), the Introduction was thoroughly revised to more clearly justify the study rationale in light of existing literature. Further, as noted above, analyses of ASD traits have been removed from the manuscript.

4. In your hypothesis "We hypothesized that time spent playing screen-games would be positively associated with ADHD and ASD symptoms and that playing attentionally demanding games would be associated with better selective attention and visuomotor integration", how can you reconcile a positive effect on cognition and a negative effect on behavior?

We agree that these hypotheses may sound counterintuitive; however, directly assessed cognitive skills and parent-reported behaviour traits do not always correlate. In the ADHD literature, there is variation in the extent and nature of cognitive challenges reported. In context of our study hypotheses, we considered that there could be a possibility that a child who scores high on parent-rated hyperactive traits and frequent videogame usage, could also demonstrate high selective attention abilities through extensive practice from frequent videogaming.

We have now added a sentence to justify the reason for our hypothesis as well as cited other resources that have found similar results: “It may be counterintuitive to hypothesize different direction of effects when considering cognitive or behavioural measures, but these hypotheses are supported by previous literature [8, 24]. Further, children in our sample did not have a diagnosis of ADHD and the literature on cognitive differences in ADHD is mixed, with few studies examining cognitive differences specific to inattentive or hyperactive ADHD traits [25].” (Lines 76 – 81)

5. Hyperactivity and autistic traits were studied through questionnaires by parents and these were the only significant correlations with screen-games. This was not discussed in the discussion. How reliable are parents' answers? This study shows a correlation between games and parents' perception of the level of activity of their children and some of their personality traits. This highlight should have implications on the title, the abstract and the discussion.

Many great points are made here. We have made sure to be more explicit in mentioning that the behaviour outcomes are based on parent reports in the Title, Abstract, and Discussion (e.g., Abstract section: “We found that videogame time was significantly positively associated with directly assessed selective attention and parent-rated hyperactivity scores, but not parent-rated inattention or other directly assessed attention skills.” (Lines 11 – 13).

Also, we have added the parent-reports as a limitation to the study in the Discussion of the manuscript: “Finally, parent- reports likely underestimate actual use of videogames and mobile devices in young children [45]. Future work should incorporate objective measurements for more accurate videogame usage including time-use diaries and passive sensing [46] in addition to, teacher reports of children’s ADHD behaviours to corroborate the parent reports [47].” (Lines 432– 436)

6. The table with demographics is good and could contain the percentages so the authors do not repeat the figures in the paragraph below.

Following this suggestion we eliminated the percentages in the text. Now all percentages can be found in Table 1 (Line 250)

7. The table with the distinction between action games and non action games is not very interesting. You may give an example.

The Table with the list of action and non-action games was removed. As per the response to Reviewer 1 (response #4), the games are now classified as attention-demanding and non-attention-demanding. An example of an attention-demanding game and a non-attention-demanding game were provided in the text instead: “There were 226 different videogames reported that were classified as attention-demanding (n = 72) or non-attention-demanding (n = 154). For example, Subway Surfers [31] was considered an attention-demanding game while My Little Pony: Friendship Gardens [32] was considered a non-attention-demanding game.” (Lines 262 – 265)

8. There is a sentence in the discussion saying that this study is correlational and other studies need to study the causal effects. I agree and in my view this is not sufficiently developed in the discussion especially when showing the positive correlations between games and hyperactivity and autistic traits. My concern is that this may mislead some readers or can be misinterpreted by journalists and parents.

We understand the concern, and have made sure to be clear when explaining that this study is correlational not causal whenever necessary through out the manuscript. For example, we acknowledge the correlational nature of this work in the new Title, Introduction, Results, and Discussion sections to more accurately reflect the results of the study.

Attachment

Submitted filename: Reviewer Response.docx

Click here for additional data file.^{(24.3KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0257877.r004

Decision Letter 1

Trinidad Garcia

5 Jul 2021

PONE-D-20-30582R1

Videogame play cross-sectionally associates with selective attention skills and hyperactivity traits in young children

PLOS ONE

Dear Dr. Bray,

After deeply considering the comments and suggestions made by the reviewers (which are very divergent), we consider that a new revision on the manuscript should be made before it can be considered for publication. Specially relevant are the comments from Reviewer 1, who still expressess important concerns regarding the current study. Please try to address these comments in a new version of your manuscript.

Please submit your revised manuscript by Aug 19 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 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,

Trinidad Garcia, PhD

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 #2: All comments have been addressed

**********

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

Reviewer #1: No

Reviewer #2: Yes

**********

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

Reviewer #1: N/A

Reviewer #2: Yes

**********

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

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Reviewer #1: I remain unconvinced that the changes here help to better substantiate the need for the study. For example, I fail to understand how the study shared here provides nuanced information to address mixed findings in the data concerning the benefits or liabilities of SMAs which sometimes seem to refer to videogames and sometimes to a larger category of screen devices. I am no clearer on what constitutes attention-demanding v. non-attention demanding which is likely the eyes of the player rather than the investigators. Without far greater substantiation, I do not buy into the assumption that action games are attentionally demanding and educational games not, especially for younger children.

I do not understand why the examination of ADHD "traits" and why the display of those traits at a non-clinical level is necessarily bad. Again, why only parent informants here warrants explanation. I remain unclear about what is meant by attention skills, which is not a monolithic construct or why selective attention in particular is targeted within the hypothesis. The methods section does make it clearer that different forms of attention are examined. However, reasons for their investigation remain unspecified in the study rationale.

I was further confused as to why maternal education was examined and how game play was assessed. For example, if children are enrolled in day care or some preschool program, might it be the case that children play digital games in those settings? For that matter, might they play games on apps with their friends or a sibling? I ask as I find it unusual that so many children would be characterized as "no-gamers."

Regardless, the distinction between types of games children play is no clearer to me than in the earlier version of the study. I can appreciate the authors' goals to analyze data that they have about children's game play and individual differences but a better reason for doing so needs to be apparent as do far clearer measures and characterizations of the games played for readers to identify the story being shared by the findings.

Reviewer #2: The authors have now answered all of my questions and the article has been revised accordingly. I believe that the paper can be published now.

**********

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 #2: Yes: Rana Esseily

PLoS One. 2021 Sep 27;16(9):e0257877. doi: 10.1371/journal.pone.0257877.r005

Author response to Decision Letter 1

27 Aug 2021

Response to Reviewers

We thank the reviewers again for their valuable feedback on our manuscript, which we have integrated into this revised submission. We have incorporated most of the suggestions made by Reviewer #1. The reviewers questions are bolded, text from the manuscript are “italicized and in quotations”, with new additions/revisions to the manuscript in blue and the corresponding lines are highlighted in yellow. Please see below for a point-by-point response.

Altogether, we feel this new revision of the manuscript encompasses the key contributions of our study and is therefore more focused and concise. Again, we would like express our gratitude towards the reviewers for their positive contribution to this manuscript.

Reviewer #1:

1. I remain unconvinced that the changes here help to better substantiate the need for the study. For example, I fail to understand how the study shared here provides nuanced information to address mixed findings in the data concerning the benefits or liabilities of SMAs which sometimes seem to refer to videogames and sometimes to a larger category of screen devices.

In light of this and comment #3, we have substantially revised the manuscript beginning with the Introduction, to focus on the main contributions of our study, which is associating recreational videogame exposure with attention skills in an early childhood sample. We acknowledge the confusion and inconsistency in using both screen-media activities (SMA) and videogames therefore, we now mention SMA once in the Introduction to illustrate that videogaming is a type of SMA: “There is growing concern about young children’s exposure to screen-media activities (SMA) [1,2], such as television or videogames, as excessive exposure may displace time from other developmentally important activities and could impact brain, behaviour, and cognitive development [3–6].” (Lines 23 – 26) and once in the Conclusion to suggest that our findings can support videogaming guidelines for young children thus, help guide children SMA guidelines as a whole: “Videogaming is increasingly common in young children and to support recommendations on SMA use for families it is important to understand whether videogaming associates with children’s attention skills and whether associations are positive or negative.” (Lines 357 - 359).

2. I am no clearer on what constitutes attention-demanding v. non-attention demanding which is likely the eyes of the player rather than the investigators. Without far greater substantiation, I do not buy into the assumption that action games are attentionally demanding and educational games not, especially for younger children.

Our goal was to draw parallels to literature in older children and adults suggesting that there is a specific benefit of action games in terms of attention skills. However, we acknowledge that we used internet descriptions of games for classification and did not do a detailed content analysis of each game, nor have our definitions of different types of games been validated. However, we felt that the detail we collected in terms of games children play was valuable and worth exploring. We have now therefore moved the analysis based on game content to sections that are explicitly labeled ‘exploratory’ on page 10 in the Methods section (Lines 174 – 193) and pages 13 and 14 in the Results section (Lines 254 – 271).

Moreover, to better reflect the videogames that were played by the children the games are now referred to as ‘fast-reaction games’ and ‘slow-reaction games’ rather than ‘attention demanding’ and ‘non-attention demanding’ (Lines 182 – 185).

3. I do not understand why the examination of ADHD "traits" and why the display of those traits at a non-clinical level is necessarily bad. Again, why only parent informants here warrants explanation.

This part of the study was a replication of prior work with less informative data. Given the limited information collected here on parenting and family environment, we have now removed analyses related to attention-deficit hyperactivity disorder (ADHD) traits from the manuscript to focus our study on attention skills more specifically.

4. I remain unclear about what is meant by attention skills, which is not a monolithic construct or why selective attention in particular is targeted within the hypothesis. The methods section does make it clearer that different forms of attention are examined. However, reasons for their investigation remain unspecified in the study rationale.

In terms of study rationale, we have now clarified through the Introduction that because children spend a lot of time playing videogames, which place demands on attention skills, there is an opportunity for experience-dependent plasticity and the potential for games to associate with attention skills as a result. Specifically, we hypothesize that selective attention, the ability to focus and ignore distractions, may be enhanced in children who spend more time playing videogames.

We now more clearly articulate in the Introduction that this study used a tripartite model of attention and the rationale for looking at attention in relation to videogames: “Attention is a multi-faceted construct that has been conceptualized in a tripartite model including sustained, selective, and executive components [25-27]. All three components are maturing in young children [25], perhaps conferring an opportunity for experience-dependent developmental plasticity with videogame use. Spending time playing videogames that engage attention may therefore associate with greater skills in these areas. Further, with a growing interest in the use of ‘serious-games’ (e.g., educational videogames used to enhance working memory) for cognitive therapeutic purposes [28], it is valuable to determine whether videogames that place demands on vigilance and fast-reaction played recreationally are associated with cognitive benefits in young children.” (Lines 41 – 49).

We now more clearly articulate our reasoning for this hypothesis in the Introduction: “Based on prior literature in young adults [23,29], we hypothesized that time spent playing videogames would be associated with better selective attention.” (Lines 53 – 55).

Additionally, in the Methods section we specified that the Early Childhood Attention Battery (ECAB) was used to assess three components of attention in line with the tripartite model. “Children completed eight sub-tests of the ECAB, four of which were included in this study to assess the three components of attention: selective attention, sustained attention (visual sustained attention and auditory sustained attention), and executive attention.” (Lines 115 – 118).

5. I was further confused as to why maternal education was examined and how game play was assessed. For example, if children are enrolled in day care or some preschool program, might it be the case that children play digital games in those settings? For that matter, might they play games on apps with their friends or a sibling? I ask as I find it unusual that so many children would be characterized as "no-gamers." Regardless, the distinction between types of games children play is no clearer to me than in the earlier version of the study.

As noted in the manuscript (Lines 85- 89) maternal education was used as proxy for socioeconomic status: “For analyses presented here, maternal education (highest degree completed) was used as an indicator of family socioeconomic status (SES) and was grouped into five categories: high school diploma, technical/trade school degree, college diploma, bachelor’s degree, or graduate/professional school.”

We are now clearer that we assess only recreational game play in the home. For example, in the Introduction: “The goal of the present study is to assess whether there are associations between videogame exposure and attention skills in young children. Specifically, this study examined associations between parent-reported weekday recreational videogame use and direct assessments of children’s selective, sustained, and executive attention skills.” (Lines 50 – 53). As well as in the Conclusion: “Finally, parent- reports likely underestimate actual use of videogames and mobile devices in young children [35] as well as, only recreational games were included in this study therefore games played in school, at a friend’s house, or elsewhere were not taken into account.” (Lines 349 – 352).

As noted above, we have removed the attention-demanding game distinction from the main analyses to an exploratory analysis as well as renamed the games to better characterize the games played by the children (please see response to comment #2).

6. I can appreciate the authors' goals to analyze data that they have about children's game play and individual differences but a better reason for doing so needs to be apparent as do far clearer measures and characterizations of the games played for readers to identify the story being shared by the findings.

We have taken this feedback to heart and as noted above have further streamlined the paper to focus on the key contributions: weekday time spent playing recreational videogames and selective attention skills in typically developing young children. As mentioned above in comment #5, we have attempted to be more clear in introducing the three measures of attention that are being assessed according to the tripartite model of attention. Additionally, as mentioned in the manuscript, a validated battery of attention was used to measure the three types of attention which is more than what other studies have done. Furthermore, as there are no standardized and validated parent reports or other measures for videogame use in young children we would have used them but as this is a rapidly evolving field validated measures have yet to be established. For these reasons, we made the analyses regarding videogame content and their characterization exploratory given the lack of prior literature guiding the distinction between types of games. Overall, our approach mirrors and extends on previously published research and provides insights into a very timely topic, at a crucial time in children’s cognitive development.

Reviewer #2:

The authors have now answered all of my questions and the article has been revised accordingly. I believe that the paper can be published now.

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(25KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0257877.r006

Decision Letter 2

Trinidad Garcia

14 Sep 2021

Videogame exposure positively associates with selective attention in a cross-sectional sample of young children

PONE-D-20-30582R2

Dear Dr. Bray,

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,

Trinidad Garcia, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Many thanks for sending a revised version of the manuscript. Based on its current state, the Editor considers it can be published.

Reviewers' comments:

PLoS One. doi: 10.1371/journal.pone.0257877.r007

Acceptance letter

Trinidad Garcia

17 Sep 2021

PONE-D-20-30582R2

Videogame exposure positively associates with selective attention in a cross-sectional sample of young children

Dear Dr. Bray:

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. Trinidad Garcia

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. List of videogames played by participants.

(DOCX)

Click here for additional data file.^{(16.3KB, docx)}

S1 Dataset. Raw data.

(XLSX)

Click here for additional data file.^{(21.5KB, xlsx)}

Attachment

Submitted filename: Response to Reviewers 1.docx

Click here for additional data file.^{(363.3KB, docx)}

Attachment

Submitted filename: Reviewer Response.docx

Click here for additional data file.^{(24.3KB, docx)}

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(25KB, docx)}

Data Availability Statement

All relevant data are within the manuscript and its Supporting Information files.

[pone.0257877.ref001] 1.Christakis DA. The effects of infant media usage: what do we know and what should we learn? Acta Paediatrica. 2009Jan;98(1):8–16. doi: 10.1111/j.1651-2227.2008.01027.x [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref002] 2.Canadian Paediatric Society, Digital Health Task Force, Ottawa Ontario, Ponti M, Bélanger S, Grimes R, Heard J, Johnson M, et al. Screen time and young children: Promoting health and development in a digital world. Paediatrics & Child Health. 2017Nov27;22(8):461–8. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref003] 3.Hutton JS, Dudley J, Horowitz-Kraus T, DeWitt T, Holland SK. Associations Between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children. JAMA Pediatr. 2019Nov04:174(1):e193869. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref004] 4.Takeuchi H, Taki Y, Hashizume H, Asano K, Asano M, Sassa Y, et al. Impact of videogame play on the brain’s microstructural properties: cross-sectional and longitudinal analyses. Mol Psychiatry. 2016Jan05;21:1781–1789. doi: 10.1038/mp.2015.193 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref005] 5.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. 2016Feb26;6(2):e009089. doi: 10.1136/bmjopen-2015-009089 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref006] 6.McArthur BA, Eirich R, McDonald S, Tough S, Madigan S. Screen use relates to decreased offline enrichment activities. Acta Paediatr. 2021Mar;110(3):896–8. doi: 10.1111/apa.15601 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref007] 7.Kabali HK, Irigoyen MM, Nunez-Davis R, Budacki JG, Mohanty SH, Leister KP, et al. Exposure and Use of Mobile Media Devices by Young Children. PEDIATRICS. 2015Dec1;136(6):1044–50. doi: 10.1542/peds.2015-2151 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref008] 8.Paudel S, Jancey J, Subedi N, Leavy J. Correlates of mobile screen media use among children aged 0–8: a systematic review. BMJ Open. 2017Oct;7(10):e014585. doi: 10.1136/bmjopen-2016-014585 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref009] 9.Parkes A, Sweeting H, Wight D, Henderson M. Do television and electronic games predict children’s psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study. Arch Dis Child. 2013;98: 341–348. doi: 10.1136/archdischild-2011-301508 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref010] 10.Rohr CS, Arora A, Cho IYK, Katlariwala P, Dimond D, Dewey D, et al. Functional network integration and attention skills in young children. Dev Cogn Neurosci. 2018Apr;30:200–11. doi: 10.1016/j.dcn.2018.03.007 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref011] 11.Reynolds JE, Grohs MN, Dewey D, Lebel C. Global and regional white matter development in early childhood. Neuroimage. 2019Aug1;196:49–58. doi: 10.1016/j.neuroimage.2019.04.004 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref012] 12.Haynes L, Ip A, Cho IYK, Dimond D, Rohr CS, Bagshawe M, et al. Grey and white matter volumes in early childhood: A comparison of voxel-based morphometry pipelines. Dev Cogn Neurosci. 2020Dec;46:100875. doi: 10.1016/j.dcn.2020.100875 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref013] 13.Dimond D, Rohr CS, Smith RE, Dhollander T, Cho I, Lebel C, et al. Early childhood development of white matter fiber density and morphology. Neuroimage. 2020;210: 116552. doi: 10.1016/j.neuroimage.2020.116552 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref014] 14.Tamana SK, Ezeugwu V, Chikuma J, Lefebvre DL, Azad MB, Moraes TJ, et al. Screen-time is associated with inattention problems in preschoolers: Results from the CHILD birth cohort study. PLoS One. 2019;14: e0213995. doi: 10.1371/journal.pone.0213995 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref015] 15.Miller CJ, Marks DJ, Miller SR, Berwid OG, Kera EC, Santra A, et al. Brief Report: Television Viewing and Risk for Attention Problems in Preschool Children. Journal of Pediatric Psychology. 2006Oct3;32(4):448–52. doi: 10.1093/jpepsy/jsl035 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref016] 16.Swing EL, Gentile DA, Anderson CA, Walsh DA. Television and video game exposure and the development of attention problems. Pediatrics. 2010Jul05;126: 214–221. doi: 10.1542/peds.2009-1508 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref017] 17.Young MF, Slota S, Cutter AB, Jalette G, Mullin G, Lai B, et al. Our Princess Is in Another Castle: A Review of Trends in Serious Gaming for Education. Review of Educational Research. 2012Mar;82(1):61–89. [Google Scholar]

[pone.0257877.ref018] 18.Dale G, Joessel A, Bavelier D, Green CS. A new look at the cognitive neuroscience of video game play. Ann N Y Acad Sci. 2020Jan13;1464: 192–203. doi: 10.1111/nyas.14295 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref019] 19.Chopin A, Bediou B, Bavelier D. Altering perception: the case of action video gaming. Curr Opin Psychol. 2019Mar13;29: 168–173. doi: 10.1016/j.copsyc.2019.03.004 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref020] 20.Eichenbaum A, Bavelier D, Green C. Video Games—Play That Can Do Serious Good. Am J Play. 2014;7: 50–72. [Google Scholar]

[pone.0257877.ref021] 21.Bediou B, Adams DM, Mayer RE, Tipton E, Green CS, Bavelier D. Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills. Psychol Bull. 2018;144: 77–110. doi: 10.1037/bul0000130 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref022] 22.Polinsky N, Flynn R, Wartella EA, Uttal DH. The role of spatial abilities in young children’s spatially-focused touchscreen game play. Cognitive Development. 2021Jan;57:100970. [Google Scholar]

[pone.0257877.ref023] 23.Green CS, Bavelier D. Action video game modifies visual selective attention. Nature. 2003;423: 534–537. doi: 10.1038/nature01647 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref024] 24.Li L, Chen R, Chen J. Playing Action Video Games Improves Visuomotor Control. Psychol Sci. 2016Aug;27(8):1092–108. doi: 10.1177/0956797616650300 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref025] 25.Breckenridge K, Braddick O, Atkinson J. The organization of attention in typical development: a new preschool attention test battery. Br J Dev Psychol. 2013;31: 271–288. doi: 10.1111/bjdp.12004 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref026] 26.Manly TI, Robertson IH, Anderson V, Nimmo-Smith I. The test of everyday attention for children (TEA-Ch). Bury St Edmunds, UK: Thames Valley Test Company. 1999. [Google Scholar]

[pone.0257877.ref027] 27.Manly T, Anderson V, Nimmo-Smith I, Turner A, Watson P, Robertson IH. The differential assessment of children’s attention: the Test of Everyday Attention for Children (TEA-Ch), normative sample and ADHD performance. J Child Psychol Psychiatry. 2001Nov;42(8):1065–81. doi: 10.1111/1469-7610.00806 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref028] 28.Kerns KA, Macoun S, MacSween J, Pei J, Hutchison M. Attention and working memory training: A feasibility study in children with neurodevelopmental disorders. Appl Neuropsychol Child. 2016Apr06;6: 120–137. doi: 10.1080/21622965.2015.1109513 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref029] 29.Bavelier D, Achtman RL, Mani M, Föcker J. Neural bases of selective attention in action video game players. Vis Res. 2012Aug16;61: 132–143. doi: 10.1016/j.visres.2011.08.007 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref030] 30.Lubans DR, Hesketh K, Cliff DP, Barnett LM, Salmon J, Dollman J, et al. A systematic review of the validity and reliability of sedentary behaviour measures used with children and adolescents. Obes Rev. 2011Jun16;12: 781–799. doi: 10.1111/j.1467-789X.2011.00896.x [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref031] 31.Wechsler D. Wechsler Preschool and Primary Scale of Intelligence. 4th ed. Toronto ON: Pearson Canada Assessment; 2012. [Google Scholar]

[pone.0257877.ref032] 32.Robinson AL, Heaton RK, Lehman RA, Stilson DW. The utility of the Wisconsin Card Sorting Test in detecting and localizing frontal lobe lesions. J Consult Clin Psychol. 1980;48: 605–614. doi: 10.1037//0022-006x.48.5.605 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref033] 33.Subway Surfer [Video game]. Aarhus, Denmark: Kiloo, SYBO Games. 2012.

[pone.0257877.ref034] 34.My Little Pony: Friendship Gardens [Video game]. Pawtucket, USA: Hasbro, Inc. 1998.

[pone.0257877.ref035] 35.Boot WR, Kramer AF, Simons DJ, Fabiani M, Gratton G. The effects of video game playing on attention, memory, and executive control. Acta Psychologica. 2008Nov;129(3):387–98. doi: 10.1016/j.actpsy.2008.09.005 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref036] 36.Andrews G, Murphy K. Does video-game play improve executive function? In M.A. Vachevsky (Ed.), Front. Psychol. Hauppage (NY): Nova Science Publishers Inc; 2006. 145–161 p. [Google Scholar]

[pone.0257877.ref037] 37.Karle JW, Watter S, Shedden JM. Task switching in video game players: Benefits of selective attention but not resistance to proactive interference. Acta Psychologica. 2010May;134(1):70–8. doi: 10.1016/j.actpsy.2009.12.007 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref038] 38.Cain MS, Landau AN, Shimamura AP. Action video game experience reduces the cost of switching tasks. Atten Percept Psychophys. 2012May;74(4):641–7. doi: 10.3758/s13414-012-0284-1 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref039] 39.Strobach T, Frensch PA, Schubert T. Video game practice optimizes executive control skills in dual-task and task switching situations. Acta Psychol (Amst). 2012May;140(1):13–24. doi: 10.1016/j.actpsy.2012.02.001 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref040] 40.Jusienė R, Rakickienė L, Breidokienė R, Laurinaitytė I. Executive function and screen‐based media use in preschool children. Inf Child Dev. 2020Jan;29(1). [Google Scholar]

[pone.0257877.ref041] 41.Huber B, Yeates M, Meyer D, Fleckhammer L, Kaufman J. The effects of screen media content on young children’s executive functioning. Journal of Experimental Child Psychology. 2018Jun;170:72–85. doi: 10.1016/j.jecp.2018.01.006 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref042] 42.Trisolini DC, Petilli MA, Daini R. Is action video gaming related to sustained attention of adolescents? Quarterly Journal of Experimental Psychology. 2018May;71(5):1033–9. doi: 10.1080/17470218.2017.1310912 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref043] 43.Linebarger DL. Contextualizing video game play: The moderating effects of cumulative risk and parenting styles on the relations among video game exposure and problem behaviors. Psychol Pop Media Cult. 2015;4: 375–396. [Google Scholar]

[pone.0257877.ref044] 44.Stojanoski B, Wild CJ, Battista ME, Nichols ES, Owen AM. Brain training habits are not associated with generalized benefits to cognition: An online study of over 1000 “brain trainers”. Journal of Experimental Psychology: General. 2021Apr;150(4):729–38. [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref045] 45.Macoun SJ, Schneider I, Bedir B, Sheehan J, Sung A. Pilot Study of an Attention and Executive Function Cognitive Intervention in Children with Autism Spectrum Disorders. J Autism Dev Disord. 2021Aug;51(8):2600–10. doi: 10.1007/s10803-020-04723-w [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref046] 46.Lim CG, Lee TS, Guan C, Fung DSS, Zhao Y, Teng SSW, et al. A Brain-Computer Interface Based Attention Training Program for Treating Attention Deficit Hyperactivity Disorder. Zang Y-F, editor. PLoS ONE. 2012Oct24;7(10):e46692. doi: 10.1371/journal.pone.0046692 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref047] 47.van der Oord S, Ponsioen AJGB, Geurts HM, Brink ELT, Prins PJM. A Pilot Study of the Efficacy of a Computerized Executive Functioning Remediation Training With Game Elements for Children With ADHD in an Outpatient Setting: Outcome on Parent- and Teacher-Rated Executive Functioning and ADHD Behavior. J Atten Disord. 2014Nov;18(8):699–712. doi: 10.1177/1087054712453167 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref048] 48.Franceschini S, Gori S, Ruffino M, Viola S, Molteni M, Facoetti A. Action Video Games Make Dyslexic Children Read Better. Current Biology. 2013Mar;23(6):462–6. doi: 10.1016/j.cub.2013.01.044 [DOI] [PubMed] [Google Scholar]

[pone.0257877.ref049] 49.Radesky JS, Weeks HM, Ball R, Schaller A, Yeo S, Durnez J, et al. Young Children’s Use of Smartphones and Tablets. Pediatrics. 2020Jul;146(1):e20193518. doi: 10.1542/peds.2019-3518 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0257877.ref050] 50.Barr R, Kirkorian H, Radesky J, Coyne S, Nichols D, Blanchfield O, et al. Beyond Screen Time: A Synergistic Approach to a More Comprehensive Assessment of Family Media Exposure During Early Childhood. Front Psychol. 2020Jul10;11:1283. doi: 10.3389/fpsyg.2020.01283 [DOI] [PMC free article] [PubMed] [Google Scholar]

PERMALINK

Videogame exposure positively associates with selective attention in a cross-sectional sample of young children

Alexandria D Samson

Christiane S Rohr

Suhyeon Park

Anish Arora

Amanda Ip

Ryann Tansey

Tiana Comessotti

Sheri Madigan

Deborah Dewey

Signe Bray

Roles

Abstract

Introduction

Materials and methods

Participants

Procedure

Demographic questionnaire

Videogame assessment

General cognition

Attention assessments

i. Selective attention

ii. Visual sustained attention

iii. Auditory sustained attention

iv. Executive attention

Data analysis

Exploratory analysis based on videogame content

Results

Sample demographics

Table 1. Demographics, general cognition, time spent playing videogames, and videogame use.

Table 2. Attention measures.

Videogame use and associations with demographics

Associations between videogame use and attention skills

Fig 1. Association between time spent playing videogames and selective attention scores.

Exploratory analyses based on videogame content

Table 3. Gamer type in this sample.

Discussion

Conclusions

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Author response to previous submission

Decision Letter 0

Trinidad Garcia

Roles

Author response to Decision Letter 0

Decision Letter 1

Trinidad Garcia

Roles

Author response to Decision Letter 1

Decision Letter 2

Trinidad Garcia

Roles

Acceptance letter

Trinidad Garcia

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases