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International Journal of Developmental Disabilities logoLink to International Journal of Developmental Disabilities
. 2022 Nov 7;70(4):730–737. doi: 10.1080/20473869.2022.2141878

Correlations between the screen time of children with special needs and their parent-child relationships, home participation, and occupational performance

Gokcen Akyurek 1,✉, Selen Aydoner 2, Ezginur Gundogmus 1, Rumeysa Gunal 1, Aysenur Demir Ozan 1
PMCID: PMC11229744  PMID: 38983485

Abstract

This study aimed to examine the relationships between the screen time of children with special needs and of their parents with their home participation, occupational performance, and parent-child relationships according to sex and diagnosis. Parents of 150 children with special needs (age range, 4 to 6 years) such as autism spectrum disorder, cerebral palsy, and attention deficit hyperactivity disorder, as well as undiagnosed and developmentally risky children, were included. The Demographic Information Form, Screen Time Usage Form, Parent-Child Relationship Scale, Participation and Environment Measure for Children and Youth, and Short Child Occupational Profile were used for the data collection. There was a significant relationship between the screen time of girls and their parent-child relationships, home participation, and occupational performance. Moreover, we detected a relationship between the screen time of children with autism spectrum disorder and positive parent-child relationships, home participation, and occupational performance. Therapists should account for screen time in their interventions associated with parent-child relationships, home participation, and occupational performance.

Keywords: Screen time, home participation, occupational performance, parent-child relationship, children with special needs

Introduction

A child with special needs is defined as an individual who experiences limitations in participation and occupational performance due to physical, cognitive, or psychosocial problems in their body structure and function (WHO 2001). Therefore, the disabilities of children with special needs cause them to spend more time in the home environment (Bedell and Dumas 2004, Galvin et al. 2010). Engel-Yeger et al. (2009) reported that young people with cerebral palsy (CP) had lower participation levels than their typically developing peers; however, compared to their peers, these subjects had higher levels of participation during leisure time activities at home. Nevertheless, these children’s participation levels in the home environment, as well as their occupational performance, are often not sufficient (Law et al. 2013). In this context, the most supportive factor related to these children’s home participation was found to be a positive relationship with their parents (Peterson et al. 2007).

Parents’ relationships with their children are critically important in the early developmental stages, as parents play an important role in developing their children’s abilities by encouraging their children to increase their independence and providing the necessary physical and mental environments for each child’s development (Çıkılı and Karaca 2017, Van Bakel and Hall 2018). It is also known that parents’ responsibilities increase when their child has special needs (Özşenol et al. 2003, Sakız 2011). Another study evaluating the effect of play-based interventions on peer relations in children with attention deficit hyperactivity disorder (ADHD) reported that positive parental relations and social participation by the child could improve their social functioning and peer relations (Barnes et al. 2017). An (2017) revealed that education regarding the parent-child relationship in children with autism spectrum disorder (ASD) provides new experiences in the relationship between parents and their children, which positively affects children’s occupational performance.

There is a relationship between children’s home participation and their parent-child relationships. However, for children with special needs who spend longer durations at home, other things, apart from the parents, that the child can communicate and interact with at home are also important (Bouck et al. 2007). With the development of new technologies, there is now at least one smart device in every home, and its effects on children’s development are being examined by researchers (Gottschalk 2019, Zahra and Alanazi 2019). Concerns regarding the adverse effects of the increasing use of technology on the parent-child relationship have increased recently (Kildare and Middlemiss 2017).

Parents play an essential role in shaping children’s screen time (Plowman et al. 2008). It has been determined that ‘shaping’ screen times involve the actual screen time, type of interaction, and content that the parent allows the child to consume or interact with (Hwang et al. 2017). It has been established that parents must protect their children from the negative effects of screens (Lissak 2018). Akçay and Emiroğlu (2020) reported that motivational interviews with mothers reduce screen time and aggression in typically developing children because parents are role models for children in terms of screen use. In addition, Garrison et al. (2011) found that increased screen use was associated with sleep problems.

In their study, Gwynette et al. (2018) indicated that young people with ASD use screens differently from their typically developing peers; in particular, differences in screen time cause physiological, cognitive, and social-emotional problems. Mazurek and Engelhardt (2013) reported that boys with ASD aged 8–18 years spend more time playing games on screens than their typically developing counterparts. Chonchaiya et al. (2011) reported that children with ASD in early childhood begin screen use at an earlier age than typically developing children, have a higher frequency of screen use, and watch television more often with their parents. The literature generally reports the impact of screen use on typically developing children and their parents (Akçay and Emiroğlu 2020, Garrison et al. 2011). In addition, few studies have suggested that children with special needs use more screens than their typically developing peers (Chonchaiya et al. 2011, Gwynette et al. 2018, Mazurek and Engelhardt 2013).

In the literature, studies have focused on children’s screen time, social participation, and activities away from home (Bedell and Dumas 2004, Galvin et al. 2010, Law et al. 1999), with these studies typically only including children with typical development. Thus, we still do not have sufficient information regarding the effects of screen time in children with special needs (Izadi-Najafabadi et al. 2019, Simpson et al. 2019). This study aimed to examine the relationship between the screen time of children with special needs and of their parents with their parent-child relationships, home participation, and occupational performance according to sex and diagnosis.

Methods

Study design

This cross-sectional, descriptive study was approved by the Hacettepe University Senate Ethics Committee (number 16969557-599). Participants were selected from among the parents of children with special needs who were referred to the Occupational Therapy Department of Hacettepe University. The inclusion criteria for the study were children aged 4–6 years with developmental risk (RG), ASD, CP, or ADHD. Parents with two or more children with special needs were excluded. According to the power analysis, the sample size was calculated to be 160 using a statistical power of 85% and an α error of 0.05. The participants were contacted via social media (n = 170) for the study. Parents filled out all forms by accessing assessment tools from the links sent by the researchers. Twenty parents of the initially contacted 170 were excluded due to incomplete data, lack of desire to participate, or desire to withdraw from the study during data collection. Finally, 150 participants were included in this study.

Data collection tools

Participants were evaluated using the Demographic Information Form to gather information on the child’s sex, age, diagnosis, family income, and parents’ age. The Screen Usage Time Information Form, which was prepared by the authors (Appendix 1), was used to collect data on screen time use on weekdays and weekends. This form consisted of eight questions: four for children and four for parents. The questions [such as, ‘How many hours on average do you spend in front of a screen during compulsory situations, such as during work or school, on a weekday (i.e. TV, phone, tablet, or computer)?’] pertained to screen time at work/school or during leisure activities.

The Parent-Child Relationship Scale (PCRS) was developed to measure the relationships between parents and children aged 4–13 years (Hetherington et al. 1992). The scale consists of 15 items and has two subscales: positive (α = 0.71) and negative (α = 0.74) parent-child relationships. The scale utilizes a 5-point Likert type scale (1 = not at all, 5 = extremely). As the scores increase, the quality of the positive relationship in the parent-child relationship increases, and as the scores decrease, the quality of the negative relationship in the parent-child relationship increases (Aytaç et al. 2018).

The Participation and Environment Measure for Children and Youth (PEM-CY) was developed to measure the participation levels of children aged 5–17 years in three basic living areas: the home, school, and community (Coster et al. 2011). The scale assesses the level, frequency, and change requests for participation along with parents’ perceived environmental support and obstacles at home, school, and in the community. The Cronbach’s α scores for at home, school, and in the community were 0.76, 0.85, and 0.81, respectively (Kaya Kara et al. 2020).

The Short Child Occupational Profile (SCOPE) was developed to evaluate the activity participation of children aged 2–21 years and determine the environmental components that affect their occupational performance (Bowyer et al. 2007). The profile consisted of 25 items. A four-point rating scale (facilitates: 4, allows: 3, inhibits: 2, restricts: 1) was used to describe how each child’s will, habits, and skills affect their activity participation. The sub-parameters of SCOPE are volition, habituation, communication, process skills, motor skills, and the environment. Kashefimehr et al. (2018) examined the validity and reliability of the Turkish version of the profile, which was created by preserving its intended meaning, in children aged 3-8 years (a = 0.94).

Participants

The mean ages were 33.07 ± 4.91 years for the mothers (n = 122), 35.93 ± 5.77 years for the fathers (n = 28), and 4.95 ± 0.80 for the children. The other demographic information of the children and their parents is presented in Table 1.

Table 1.

The demographic information of the children and parents.

  N %
Sex    
Girl 53 35.3
Boy 97 64.7
Age    
4 years old 52 34.6
5 years old 53 35.3
6 years old 45 30
Diagnosis    
ASD* 70 46.7
ADHD* 36 24.0
CP* 26 17.3
The group at developmental risk 18 12.0
IEP* training    
Yes 123 82.0
No 27 18.0
Doctor control    
There is 71 47.3
There is not/ No 79 52.7
Attending school    
Yes 95 63.3
No 55 36.7
Parent    
Mother 122 81.3
Father 28 18.7
Mother’s education status    
Primary School 20 13.3
High School 54 36.0
University 64 42.7
Master 12 8.0
Father’s education status    
Primary school 2 1.3
Middle school 10 6.7
High school 59 39.3
University 67 44.7
Master 12 8.0
Marital status    
Married 140 93.3
Single 10 6.7
Income status    
Low 24 16.0
Middle 107 71.3
High 19 12.7
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* ASD: Autism Spectrum Disorder; ADHD: Attention Deficit Hyperactivity Disorder; CP: Cerebral Palsy IEP: Individualized Education Program.

Statistical analysis

IBM SPSS Statistics for Windows (Version 23.0. Armonk, NY: IBM Corp.) was used for all analyses. Continuous variables were summarized as means and standard deviations, whereas categorical variables were summarized as percentages. The Shapiro–Wilk test was used to examine whether the distribution of the numerical variables was normal. As the parameters demonstrated a normal distribution within the scope of the study, they were analyzed using Spearman’s correlation analysis. Spearman’s correlation analysis was used to examine the correlation between the screen time of children with special needs and their parent-child relationship, home participation, and occupational performance. Statistical significance was set at p < 0.05, and p < 0.001 was considered highly significant. To enhance the clarity of the results, we rounded values to two effective digits (Ehrenberg 1981).

Results

The results of this study, which aimed to examine the relationship between the screen time of children with special needs and of their parents with their parent-child relationships, home participation, and occupational performance, are summarized below.

The mean values of the weekday, weekend, and total screen times (hours) of the child and parent participants are presented in Table 2.

Table 2.

Descriptive statistics of screen time.

  X ± SD (hours) Range (hours)
WDST (hours) Parent 4.6 ± 2.4 1–16
  Child 5.5 ± 2.5 0–13
WEST (hours) Parent 4.1 ± 2.3 1–16
  Child 4.4 ± 2.3 0–20
TST (hours) Parent 30.6 ± 15.3 9–112
  Child 36.2 ± 15.7 0–105
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Note: WDST: Weekday screen time, WEST: Weekend screen time, TST: Total screen time.

The children’s screen times (hours) are summarized according to their diagnosis and sex in Table 3.

Table 3.

Descriptive statistics of screen time by diagnosis and sex.

    WDST (hours)
X ± SD (range)		 WEST (hours)
X ± SD (range)		 TST (hours)
X ± SD (range)
ASD n = 70 5.6 ± 2.5 (0.5–10) 4.3 ± 2.0 (0–12) 36.7 ± 15.2 (2.5–69)
CP n = 26 4.7 ± 2.9 (0–13) 4.5 ± 3.9 (0–20) 32.3 ± 20.6 (0–105)
ADHD n = 36 5.6 ± 2.5 (0.5–11) 4.5 ± 1.9 (5–8) 37.0 ± 14.6 (3.5–63)
RG n = 18 5.7 ± 2.0 (2–9) 4.6 ± 1.4 (2–7) 37.7 ± 11.4 (16–59)
Girl n = 53 5.0 ± 2.6 (0.5–10) 4.1 ± 1.9 (0–20) 33.5 ± 15.2 (2.5–62)
Boy n = 97 5.7 ± 2.5 (0–13) 4.6 ± 2.5 (0–20) 37.6 ± 15.8 (0–105)
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ASD: Autism Spectrum Disorder; ADHD: Attention Deficit Hyperactivity Disorder; CP: Cerebral Palsy, RG: Risky Group, WDST: Weekday screen time, WEST: Weekend screen time, TST: Total screen time.

There was a significant relationship between children’s screen time and positive parent-child relationships (p < 0.005) between both sex. However, in girls, children’s screen time was significantly associated with the PEM-CY’s ‘frequency’ sub-parameter and with all parameters of the SCOPE (p < 0.005), whereas only the ‘volition’ sub-parameter of the SCOPE was significant in boys (p > 0.05) (Table 4).

Table 4.

Correlation between children’s screen time and the parent-child relationship scale, child screen use, PEMCY, and SCOPE.

  Parent Positive Relationship Parent Negative Relationship PEMCY Frequency PEMCY Involvement PEMCY Desire for Change SCOPE Volition SCOPE Habituation SCOPE Communication SCOPE Process Skills SCOPE Motor Skills SCOPE Environment
Girl                      
Child WDST -0.533** 0.158 -0.561** −0.257 0.201 -0.413* -0.394* -0.539** −0.337* -0.414* -0.488**
Child WEST -0.460** 0.296* -0.412* −0.344* 0.344* -0.377* -0.388* −0.350* −0.302* −0.269 -0.485**
Child TST -0.567* 0.199 -0.581** −0.281* 0.251 -0.441** -0.460** -0.571** -0.374* -0.439** -0.538**
Boy                      
Child WDST -0.427** 0.190 −0.245* −0.014 0.184 -0.351** −0.237* −0.264* −0.174 −0.224* −0.245*
Child TST -0.398** 0.182 −0.231* −0.065 0.187 -0.383** −0.234* -0.275* −0.169 −0.208* −0.237*
ASD                      
Child WDST -0.484** 0.147 -0.579** −0.240* 0.273* -0.528** −0.259* -0.374** −0.239* −0.330** -0.490**
Child WEST −0.203 0.163 −0.291* -0.328** 0.369** -0.484** −0.342** -0.360** −0.342** −0.238* -0.402**
Child TST -0.442** 0.149 -0.550** −0.293* 0.329** -0.564** −0.318** -0.407** −0.293* −0.339** -0.512**
CP                      
Parent WDST 0.267 0.213 0.394* 0.058 −0.281 0.293 0.311 0.118 −0.084 −0.140 0.260
Parent WEST˕ 0.353 −0.163 0.335 −0.110 −0.438* 0.351 0.306 0.190 −0.108 −0.027 0.251
Parent TST˕ 0.308 0.124 0.402* 0.018 −0.342 0.329 0.329 0.146 −0.100 −0.120 0.273
Child WDST -0.611** 0.411* 0.001 −0.020 0.423* −0.169 −0.262 −0.304 −0.060 −0.011 0.129
Child TST -0.550** 0.417* 0.043 −0.045 0.370 −0.099 −0.178 −0.201 0.088 0.077 0.188
ADHD                      
Parent WDST 0.391* −0.223 0.011 0.252 0.051 0.324 −0.027 0.095 −0.058 0.142 0.193
Parent WEST˕ 0.263 −0.058 0.268 0.078 −0.331* 0.264 0.342* 0.384* 0.390* 0.515** 0.396*
Parent TST ˕ 0.441** −0.224 0.104 0.230 −0.109 0.367* 0.129 0.214 0.077 0.279 0.296
Child WDST -0.372* 0.036 −0.251 −0.069 0.465** -0.359* -0.546** -0.477** −0.289 -0.388* -0.432**
Child WEST −0.417* 0.200 -0.514** -0.485** 0.404* −0.146 −0.311 -0.383* −0.175 −0.209 -0.396*
Child TST -0.428** 0.083 −0.349* −0.185 0.505** −0.347* -0.550** -0.510** −0.294 -0.388* -0.474**
RG                      
Child WDST −0.328 0.224 −0.064 0.014 −0.256 −0.054 0.304 −0.149 -0.513* -0.540* −0.279
Child TST −0.318 0.247 −0.062 −0.032 −0.237 −0.106 0.313 −0.149 -0.556* -0.555* −0.315
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*p < 0.05; **p < 0.001; ASD: Autism Spectrum Disorder; ADHD: Attention Deficit Hyperactivity Disorder; CP: Cerebral Palsy, RG: Risky Group, WDST: Weekday screen time, WEST: Weekend screen time, TST: Total screen time.

When the results were analyzed according to the diagnostic groups, it was found that in children with CP, children’s screen time was significantly related to positive and negative parent-child relationships (p < 0.005) and the PEM-CY’s ‘desire for change’ sub-parameter (p < 0.005), while it was related to positive parent-child relationships (p < 0.005) and all sub-parameters of the PEM-CY (p < 0.005) in children with ASD and ADHD. Additionally, children’s screen time was significantly related to some parameters of the SCOPE in children with ASD, ADHD, and RG (p < 0.005), while it was not related to any of the parameters of the SCOPE in children with CP (p > 0.05) (Table 4).

Parents’ screen time was significantly related to positive parent-child relationships and the SCOPE’s sub-parameters in children with ADHD, whereas it was significantly related to the PEM-CY’s sub-parameters in children with CP (p < 0.005).

Discussion

This study examined the relationship between the screen time of children with special needs and of their parents. When analyzing the children’s parent-child relationships, home participation, and occupational performance by sex and diagnosis, it was shown that there were differences in the detected relationships between the sex and diagnostic groups. This study is the first to examine the relationship between screen time and parent-child relationship, home participation, and occupational performance of children with special needs according to sex. The results demonstrate that it is crucial for therapists to monitor screen time to improve children’s’ participation and occupational performance, especially in girls with ASD.

The negative correlation between children’s screen time and positive parent-child relationships, which was one of the critical results of the study, revealed that an increase in children’s screen time negatively affected their positive relationships with their parents. In parallel, Lauricella et al. (2015), in their study related to children’s screen time in typically developing children aged 0–8 years, demonstrated that children’s screen time was negatively correlated with a positive parent-child relationship. Similarly, Zhao et al. (2018) reported that in typically developing children aged 3–4 years, it was reported that increased screen use harmed parent-child interactions, which in turn was a risk factor for children’s psychosocial skills. In contrast, Nikken and Schols (2015), in children aged 0–7 years with typical development, reported that the correlation between children’s screen time and positive parent-child relationships was positive. In parallel, Rhodes (2017), in their study with typically developing children, stated that the reason for the increase in children’s screen time was that parents rewarded them with screens following good behaviors, and thus a positive parent-child relationship developed.

According to the literature, there is no consensus on the relationship between children’s screen time and positive parent-child relationships. The first reason may be that the participants in some studies were typically developing children. Another reason may be that the participants’ mean screen time in this study was longer than that in others. This may cause different dynamics between the family and typically developing children (Kelly and Barnard 2000). Accordingly, reducing children’s screen time and increasing the amount of quality time spent with their parents can improve the positive parent-child relationship. Furthermore, this study examined parental screen time, unlike other studies in the literature. Accordingly, there was no relationship between the screen time of parents of children with ASD, CP, and RG and the parent-child relationship. There was only a positive correlation between the screen times of the parents of children with ADHD and positive parent-child relationships. This difference in children with ADHD was reasoned to be that parents of children with other special needs have more responsibilities than parents of children with ADHD (Hallberg et al. 2010).

The second result was the relationship between children’s screen time and home participation according to sex. Accordingly, while there was a negative correlation between girls’ screen time and home participation, no such relationship was detected in boys. Sirard et al. (2010) compared the relationship between the home environment and screen time in typically developing adolescents according to sex, revealing that there was a correlation between girls’ screen time and their home environment. Although this result supports the current study, more studies should be performed in children with special needs according to sex.

Another finding of this study was that children’s screen time was negatively correlated with home participation according to different diagnoses. Bjelland et al. (2015) reported that as the screen time of typically developing children aged 10–12 years increased, children participated less in non-screen activities at home with their parents. Bjelland et al. (2015) argued the introduction of rules and regulations by parents would reduce their children’s screen time and thus increase their participation in screen-free home activities. Roth and Saykin (2004) conducted a study related to the screen time and home participation of children with special needs in children with ADHD. They emphasized that increased screen time negatively affects children’s participation in play-based activities in the home environment. Hochhauser and Engel-Yeger (2010) evaluated home participation in children with high-functioning autism who were aged between 6 to 11 years, and it was predicted that the reason for these children’s higher levels of home participation compared to their typically developing peers was that the home environment is safe and controlled. In addition, it was stated that the external environment contains more movement stimuli, and screen use requires less effort from the parents. In Milicevic and Nedović’s study (2018), in which children aged 5–18 years with CP were compared to their typically developing peers in terms of their home participation, the rate of participation of children with CP in activities involving screens such as watching TV, videos, and DVDs was found to be higher than that of other home-based activities. In addition, it was stated that this may affect the home participation of children with CP negatively compared to their typically developing peers.

There are limited studies in the literature demonstrating the relationship between screen time and home participation in children with special needs. However, the existing findings support those of this study. In this study, the relationship between screen time and home participation was examined, and it was found that the screen time of children with ADHD and ASD and their home participation was negatively related. In this study, the screen time of children with CP was similar to that of children with other diagnoses. The fact that this relationship was positive in only one area among children with CP is the first evidence in the literature on screen time in this population. It is essential to increase this evidence by conducting more studies in the future. Notably, there was no relationship between home participation and screen time in children with RG, and no study was found in the literature for this population.

This study used the SCOPE to examine the relationship between children’s screen use and their occupational performance. When investigating screen time according to sex, there was a negative relationship between the screen time of girls and the SCOPE's volition, habituation, communication, motor skills, and environmental parameters. There was also a negative relationship between the screen time of boys and the SCOPE’s volition parameter. Accordingly, while the screen time of children with ASD and ADHD and their parents was negatively correlated with occupational performance, the screen time of children with RG was found to be negatively correlated only with the motor and processing parameters. However, no significant relationship was detected between the screen time of children with CP and the SCOPE’s subparameters. This result may be because the SCOPE includes questions concerning children with neurodevelopmental disorders, especially ASD and ADHD (Bowyer et al. 2007, Kashefimehr et al. 2018). However, there are not enough studies in the literature on occupational performance according to sex or diagnosis, and more studies are needed on this subject.

This study has several strengths and limitations. The strengths of this study include the ability to obtain and compare data from different diagnoses. In addition, considering that the parents in this study were asked separately about their children’s screen time on weekdays and weekends in different contexts (work, school, and leisure time), differences in screen use were considered. This is a critical strength of this study, as it demonstrates a profile that is not yet available in the literature. The limitations of this study are that the populations with different diagnoses did not have similar sample sizes, the parents provided subjective answers regarding screen time, and the study did not have a control group with typically developed children. In future studies, it will be important to investigate and compare the screen times of children with different diagnoses in addition to typically developing children.

Conclusion

This study provides new evidence that the screen time of 4–6-year-old children with special needs is related to their home participation and parent-child relationships. Knowledge concerning the complex relationships between the screen time of children with special needs and of their parents with their parent-child relationships, home participation, and occupational performance is vital in understanding the importance of including screen time as an intervention parameter in future studies and clinical applications. This study suggests that occupational therapists should include screen time in their interventions relating to parent-child relationships, home participation, and occupational performance. In addition, it should be included as a parameter in their evaluations to support families holistically. Socially, strategies that would support families and children to reduce increased screen time durations should be developed, and awareness should be raised at the social level regarding what to do during screen-free times.

Acknowledgements

All authors thanks to the participants of this study.

Appendix 1. Screen usage time information form

For parent

  1. -How many hours on average do you spend in front of the screen for compulsory situations such as work or school on a weekday? (i.e. TV, phone, tablet, computer)

    … hours … minutes

  2. -How many hours on average do you spend in front of the screen on a weekday for fun or spending time? (i.e. TV, phone, tablet, computer)

    … hours … minutes

  3. -How many hours on average do you spend in front of the screen for compulsory situations such as work or school on a weekend? (i.e. TV, phone, tablet, computer)

    … hour … minute

  4. -How many hours on average do you spend in front of the screen on a weekend for fun or spending time? (i.e. TV, phone, tablet, computer)

    … hours … minutes

For children

  1. -How many hours on average does your child spend in front of the screen on a weekday for compulsory situations such as school or homework? (i.e. TV, phone, tablet, computer)

    … hours … minutes

  2. -How many hours on average does your child spend in front of the screen on a weekday for fun or spending time? (i.e. TV, phone, tablet, computer)

    … hours … minutes

  3. -How many hours on average does your child spend in front of the screen on a weekend for compulsory situations such as school or homework? (i.e. TV, phone, tablet, computer)

    … hours … minutes

  4. -How many hours on average does your child spend in front of the screen on a weekend for fun or spending time? (i.e. TV, phone, tablet, computer)

    … hours … minutes

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [G. A.], upon reasonable request.

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Associated Data

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

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, [G. A.], upon reasonable request.

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