Psychological Medicine (2016), 46, 3329–3337.

© Cambridge University Press 2016 OR I G I N A L A R T I C L E

doi:10.1017/S0033291716001689

Prospective associations between televiewing at

toddlerhood and later self-reported social
impairment at middle school in a Canadian
longitudinal cohort born in 1997/1998

L. S. Pagani1*, F. Lévesque-Seck1 and C. Fitzpatrick2,3

1
School of Psycho-Education and Sainte-Justine’s Hospital Research Center (Brain Diseases Axis), Université de Montréal, Montréal, Québec,
Canada
2
Psychology Department, Université Ste-Anne, Church Point, Nova Scotia, Canada
3
Exercise Science Department, Concordia University, Montréal, Québec, Canada

Background. Using a large Canadian population-based sample, this study aimed to verify whether televiewing in
toddlerhood is prospectively associated with self-reported social impairment in middle school.

Method. Participants are from a prospective–longitudinal birth cohort of 991 girls and 1006 boys from the Quebec
Longitudinal Study of Child Development. Child self-reported ratings of relational difficulties at age 13 years were
linearly regressed on parent-reported televiewing at age 2 years while adjusting for potential confounders.

Results. Every additional 1 h of early childhood television exposure corresponded to an 11% S.D. unit increase in
self-reported peer victimization [unstandardized β = 0.03, 95% confidence interval (CI) 0.02–0.04], a 10% S.D. unit increase
in self-reported social isolation (unstandardized β = 0.04, 95% CI 0.03–0.05), a 9% S.D. unit increase in self-reported
proactive aggression (unstandardized β = 0.02, 95% CI 0.01–0.03) and a 6% S.D. unit increase in self-reported antisocial
behavior (unstandardized β = 0.01, 95% CI 0.01–0.01) at age 13 years. These results are above and beyond pre-existing
individual and family factors.

Conclusions. Televiewing in toddlerhood was prospectively associated with experiencing victimization and social
withdrawal from fellow students and engaging in antisocial behavior and proactive aggression toward fellow students
at age 13 years. Adolescents who experience relational difficulties are at risk of long-term health problems (like depres-
sion and cardiometabolic disease) and socio-economic problems (like underachievement and unemployment). These
relationships, observed more than a decade later, and independent of key potential confounders, suggest a need for
better parental awareness of how young children invest their limited waking hours.

Received 24 November 2015; Revised 16 June 2016; Accepted 21 June 2016; First published online 13 September 2016

Key words: Aggression, antisocial behavior, child televiewing, social impairment, victimization.

Introduction appropriate. Almost half of children exceed those limits,

especially if they attend child care facilities (Tandon et al.
Television viewing is a common pastime in very young
2012). Many parents seem unaware or unconcerned
children (Cespedes et al. 2014). In toddlerhood, its role
about these guidelines (Funk et al. 2009; Cespedes et al.
is more than entertainment as some parents depend
2014). What is more, adults do not always actively
on children’s screen time to keep them safe and busy
supervise the television remote, thus not being able to
while they engage in adult activities (Funk et al.
ensure optimal home viewing content (Funk et al.
2009). Current guidelines recommend that, beyond
2009; Fitzpatrick et al. 2012). As many as a third of chil-
age 2 years, children should minimize their teleview-
dren eat breakfast or supper in front of the television
ing time to no more than 2 h per day (American
and many children have a screen device in their bed-
Academy of Pediatrics, 2013). This is assuming that
room (Sisson et al. 2014). Both characteristics diminish
the content is of quality and developmentally
social exchanges and child monitoring in the home en-
vironment, which is daunting given that family inter-
action remains the primary vehicle of socialization in
* Address for correspondence: L. S. Pagani, Ph.D., École de
psychoéducation, Université de Montréal, C.P. 6128, succursale
childhood (Richert et al. 2011; Gingold et al. 2014).
Centre-ville, Montréal, Québec, H3C 3J7, Canada. From birth through the preschool years, exponential
(Email: Linda.s.pagani@umontreal.ca) brain maturation is characterized by increasingly

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 3330 L. S. Pagani et al.
effective cognitive problem-solving, communication
and interpersonal skills (Kuhl, 2007; Meltzoff et al.
2009). During this developmental period, children
are particularly sensitive to environmental input
through live social interaction and active play with
persons and objects across different social contexts
(Christakis, 2009; Richert et al. 2011). Rapid and exten-
sive brain growth in the first several years of life also
implies considerable vulnerability in less stimulating
or neurotoxic home environments (Cillero & Jago,
2010; Shonkoff, 2011).
Social skills, such as sharing, valuing and being
respected by others, are rooted in early development
and eventually play a key role in personal and eco-
nomic success (Heckman, 2006). Because there are
only so many waking hours in a day, more time
spent televiewing typical content might leave less
time for creative play, interactive endeavors and foun-
dational experiences that hone basic socio-cognitive
skills (Pagani et al. 2010). Televiewing does not require
much cognitive effort, making it a more passive rather
than active cognitive activity in daily preschool life
(Christakis, 2009). Consequently, it might serve as a
means of distraction from endeavors that require
more effortful attention (Barkley, 2012), thus interfer-
ing with the development of the brain’s executive sys-
tem, which is important for emotional regulation and,
ultimately, social interaction (Nathanson et al. 2014).
Although it does sometimes help receptive vocabu-
lary in toddlers (Richert et al. 2011), excessive teleview-
ing could be detrimental to learning skills associated
with social competence and management of interper-
sonal conflict (Mistry et al. 2007; Fitzpatrick et al.
2012). This could place children at later risk of experi-
encing relational difficulties and, ultimately, poor men-
tal health (Arseneault et al. 2010). In one observational
birth cohort study, Canadian toddlers who watched
more television were later rated by kindergarten
teachers as more likely to be victimized than their
counterparts who watched less (Pagani et al. 2013).
Furthermore, higher amounts of televiewing at age
2 years by the same children predicted an increased
risk of being victimized by classmates at age 10 years,
as reported by fourth-grade teachers (Pagani et al.
2010). In both studies, victimization at school was
defined as experiencing repeated negative interactions
with one (or more) classmate(s) who intentionally
aimed to inflict harm, alienate or cause discomfort to
a fellow classmate. Whether direct or indirect, such pro-
active relational aggression is associated with a number
of short- and long-term mental health and academic
consequences for their targets as they grow into adoles-
cence and adulthood, including an increased risk of so-
cial withdrawal and even depression (Arseneault et al.
2010; Rudolph et al. 2014). Solitude, preferred or not,
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is generally associated with peer rejection and victimiza-
tion (Rubin & Barstead, 2014). It also predicts deviant
peer affiliation in adolescence (Rudolph et al. 2014).
Through social learning processes, victims also risk be-
coming reactively antisocial themselves (Arseneault
et al. 2010). Although not based on a birth cohort data,
one previous study on American children from the
National Longitudinal Survey of Youth suggests that
televiewing at age 4 years predicted parent-reported
bullying between the ages of 6 and 11 years
(Zimmerman et al. 2005).
To greater extremes, antisocial behavior violates
major age-appropriate societal norms and the basic
rights of others and is linked with social disruption in
the school, neighborhood and home (Byrd et al. 2014).
It includes behaviors such as vandalism, risk-taking,
stealing, lying and passive aggression. Although any
such behaviors can occur from time to time in typical
elementary school-aged children, their persistence
across development forecasts unhealthy lifestyle, men-
tal health, judiciary and socio-economic risks (Moffitt,
1993). Antisocial behavior is often accompanied by pro-
active aggression, which refers to unprovoked, premedi-
tated and apathetic harmful behavior in order to obtain
or coerce a desired object from or outcome on others
(Hubbard et al. 2010). Longitudinally observing a
Canadian birth cohort, Fitzpatrick et al. (2012) found
that preschool televiewing habits are also associated
with antisocial behavior in later childhood. In children
from the 1972–1973 Dunedin birth cohort (New
Zealand), excessive televiewing from the ages of 5 to
15 years is associated with increased chances of a crim-
inal conviction, a diagnosis of antisocial personality dis-
order, and more aggressive personality traits in
emerging adulthood compared with those who viewed
less television in that age range (Robertson et al. 2013).
How youth relate to each other is of major clinical con-
cern in adolescence, as it is more resistant to treatment
and also charts a psychopathological developmental
course in adulthood (Moffitt, 1993; Arseneault et al.
2010; Byrd et al. 2014).
Very little is known about whether childhood tele-
viewing habits during early exuberant brain develop-
ment in areas that regulate emotional regulation and
intelligence pose any long-term risks for relational im-
pairment. Moreover, the prospective–longitudinal
studies available have been either on externalizing or
internalizing behavioral pathologies, but not both. An
inclusive design with consistent control over potential
confounders would be clearly advantageous for estab-
lishing associations, if any, with subsequent relational
impairment. Thus, in the present study, we use a
population-based birth cohort to verify whether tele-
viewing at age 2 years is prospectively associated
with self-reported difficulties in social relations at age

13 years, which corresponds to the end of the first year
of middle school. Internalizing and externalizing
behavioral outcomes include victimization and social
isolation, and proactive aggression and antisocial be-
havior, respectively. It is expected that children with
higher levels of televiewing during toddlerhood will
be at greater risk of social impairment in adolescence.
Method
Participants
The participants in this institutional review board (IRB)-
approved study were from the Quebec Longitudinal
Study of Child Development (www.jesuisjeserai.stat.
gouv.qc.ca/etude_an.htm) which originates from a ran-
domly selected stratified sample of 2837 newborns
born in 1997 and 1998 in Quebec, Canada. From this
birth registry selection: 93 were deemed ineligible; 172
were untraceable due to incorrect coordinates; 14 were
untraceable; and 438 refused participation. The baseline
sample, representing 82% of the eligible target popula-
tion, comprises 2120 infants followed up annually
from 5 months throughout childhood. Of these, 39%
were firstborn. For each follow-up, informed consent
was obtained from parents, teachers and children
when applicable. Predictor variable data were collected
for 991 girls and 1006 boys at age 2 years (specifically, 29
months), thus creating our subsample for analyses.
Outcome variable data were collected at age 13 years
(158 months).
Predictor variable: daily televiewing (age 2 years)
During the early childhood follow-up, parents answered
the following questions: ‘How much time per day does
your child spend watching TV on a typical weekday?’
and ‘How much time per day does your child spend
watching TV on a typical weekend?’ Scores reflect the
total hours of weekly television exposure (weekday view-
ing multiplied by 5 plus weekend viewing multiplied by
2), which were then divided by 7 to give an estimate of
typical daily viewing. This measure is comparable or
similar to previous population-based assessments of chil-
dren’s screen viewing in the home (Christakis et al. 2004;
Mistry et al. 2007), including our own (Pagani et al. 2010,
2013; Fitzpatrick et al. 2012; Watt et al. 2015).
Outcome variables: indicators of social impairment
(age 13 years)
Participants self-reported on social impairment over
the previous 6 months using four factors from the
Social Behavior Questionnaire (Tremblay et al. 1994;
Dobkin et al. 1995; Pagani et al. 2010, 2013;
Fitzpatrick et al. 2012): (1) victimization (α = 0.81):
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Early television and social difficulties 3331
insulted by peers; actively excluded from being a
part of a group; told mean words; laughed at; robbed;
and pushed, shoved, or hassled; (2) social isolation (α =
0.72): tends to work on his own; low interest in activities
with others; and prefers playing alone; (3) proactive ag-
gression (α = 0.74): threatened to hit others; encouraged
others to pick on someone; sought to dominate others;
and used fear to obtain something; and (4) antisocial be-
havior (α = 0.75): broken his own belongings; broken
belongings of others; stolen from home; stolen outside
of home; lied or cheated; committed vandalism; and
tried to exclude members of a group when angry at
them. Item responses ranged on a Likert scale ranging
from 1 (never) to 3 (often). Factor scores were then
rescaled from 0 to 10, with higher scores corresponding
to a higher level the factor of interest.
Pre-existing and concurrent control variables
These include child and family factors which could
confound the relationship between early televiewing
and later social impairment (Pagani et al. 2010, 2013;
Fitzpatrick et al. 2012; Watt et al. 2015). Individual char-
acteristics include temperament (using the sum of both
parent-reports of difficult and unpredictable tempera-
ment at 17 months), early cognitive skills (measured
using the Imitation Sorting Task which assesses atten-
tion and working memory at 29 months), concurrent
screen time at age 13 years (television, DVD, and
videogame exposure during both week and weekend)
and child gender (boys = 1 and girls = 0). Family char-
acteristics at the 17-month assessment include family
configuration (two-parent = 1 and single-parent = 0),
parental education (mother and father graduated
high school = 2, mother or father graduated = 1, and
neither parent graduated = 0) and parental antisocial
behavior during adolescence and adulthood. This last
measure was assessed using a composite score from
mother and father responses to the National Institute
of Mental Health-Diagnostic Interview Schedule
(Robins et al. 1981). Higher scores correspond to
more parental antisocial behavior.
Data analytic strategy
In this study, we aimed to examine long-term prospect-
ive linear associations using multiple regression, in
which indicators of social impairment (SIi@age13, repre-
sented by victimization, social isolation, proactive ag-
gression and antisocial behavior) at age 13 years are
regressed on televiewing at age 2 years (TVi@age 2) for
each individuali child. To reduce the possibility of omit-
ted variable bias, we estimate this linear relationship
while simultaneously controlling for pre-existing and
concurrent child (CHILDi) and family (FAMILYi) char-
acteristics that statistically or theoretically correlate with
 3332 L. S. Pagani et al.

our predictor and/or outcome variables (Christakis, Table 1. Descriptive statistics of predictor, outcome and control
2009; Arseneault et al. 2010; Byrd et al. 2014). Our results variables
refer to the adjusted model, where ‘a’ and ‘e’ corres-
pondingly represent the intercept and stochastic error: Mean
(standard
SIi@age13 = a1 + β1 TVi@age2 + γ1 CHILDi + γ2 FAMILYi
Independent variables deviation)
+ eit
Early televiewing, age 29 months, h/week 8.82 (6.17)
Concurrent televiewing, age 13 years, h/week 4.33 (1.46)
Statistical analysis
Child gender, boys = 1
This population-based longitudinal study required Boys, % 50
data from several collection waves and sources. Over Temperament, 17 months 0.47 (0.62)
a third of the data were incomplete either for control Cognitive skills, age 29 months 1.15 (0.79)
or outcome variables (37.4%). Consequently, we con- Family configuration, 17 months, %
One parent 24
ducted an attrition analysis to compare the 1314 cases
Two parents 76
with complete televiewing data at age 2 years with
Parental education, 17 months, %
the 823 cases from the original sample (n = 2120) with
Both no high school 11
incomplete control variable data, using independent- One high school 25
sample t tests. Some differences were found. Children Both high school 64
with complete televiewing data were less likely to be Parental antisocial behavior, 17 months 0.09 (0.29)
raised by single parents (mean = 0.80 v. 0.81, t2039 = Proactive aggression, age 13 years 0.61 (1.30)
2.42, p = 0.04). An attrition analysis also compared the Social isolation, age 13 years 2.33 (2.39)
children with complete v. incomplete outcome data at Antisocial behavior, age 13 years 0.63 (0.95)
age 13 years and control variable data. More girls had Victimization, age 13 years 1.41 (1.55)
complete outcome data than boys (mean = 0.45 v.
0.59, t1312 = −4.912, p < 0.001). Between-group differ-
ences for temperament problems at 17 months were
developmentally appropriate. Nevertheless, 11% of
marginally significant (mean = 0.493 v. 0.427, t1312 =
children in our subsample surpassed the AAP tele-
1.883, p = 0.060). The NORM multiple imputation pro-
viewing recommendations at age 2 years.
gram was used to impute missing control and outcome
Bivariate associations between the predictor, out-
data (Schafer, 1999). By drawing values from the con-
comes and confounding variables are detailed in
ditional variable distributions, NORM uses an iterative
Table 2. Televiewing at age 2 years is associated with
method based on the EM algorithm to impute missing
all four outcome variables at age 13 years. Table 3
data, depending on the available and valid observa-
reports standardized regression coefficients reflecting
tions from the original dataset (http://www.stat.psu.
the relationship between televiewing at age 2 years
edu/~jls/misoftwa.html).
and pre-existing individual and family factors, which
were implemented as control variables. As expected
from the bivariate relationships in Table 2, children
Results
with less educated parents watched more television
Table 1 provides descriptive statistics of predictor, out- (11.62 v. 8.65 h/week, t157.136 = 4.196, p < 0.001) and chil-
come and control variables. Boys comprised 50% of the dren from single-parent families watched more televi-
sample and 24% lived in single-parent homes when the sion (9.93 v. 8.65 h/week, t444.71 = −2.83, p < 0.01) at
child was 17 months. In toddlerhood, participants age 2 years, compared with children from more edu-
watched on average 1.26 h/day (S.D. = 0.88 h/day), cated and two-parent families, respectively.
based on 8.82 h for the entire week (S.D. = 6.17 h). Table 4 reports regression coefficients which reflect
These quantities are similar to averages found with the relationship between early televiewing and social
American children at this age (Christakis et al. 2004; impairment in early adolescence. At age 2 years,
Mistry et al. 2007). At age 13 years, participants television habits predicted increases in self-reported
watched on average 4.33 h for the entire week (S.D. = victimization, social isolation, proactive aggression and
1.46 h). Televiewing mostly occurred on the weekend, antisocial behavior at age 13 years. More specifically,
rather than daily, and this is probably due to home- every 1 h increase in daily televiewing was prospective-
work and extracurricular activities. These quantities ly associated with an 11% S.D. unit increase in victimiza-
are within current American Academy of Pediatrics tion [unstandardized β = 0.03, 95% confidence interval
(AAP) (2013) limitations of not more than 2 h/day be- (CI) 0.02–0.04], a 10% S.D. unit increase in social isolation
yond 2 years of age, assuming that the content is (unstandardized β = 0.04, 95% CI 0.03–0.05), a 9% S.D.

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 Early television and social difficulties 3333

12
Table 3. Standardized regression coefficients which reflect the

_
_
_
_
_
_
_
_
_
_
_
1
relationship between child televiewing at toddlerhood and
pre-existing individual and family characteristics

0.09**
11

_
_
_
_
_
_
_
_
_
_
1
Independent variables Early televiewing

−0.37***
0.8***
Child gender 0.04 (0.33)
_
_
_
_
_
_
_
_
_
1
Temperament, 17 months −0.01 (0.27)
10

Cognitive skills, age 29 months −0.01 (0.21)

Family configuration, 17 months 0.03 (0.69)**

0.10**
−0.02

0.00
Parental education, 17 months −0.20 (0.27)***
_
_
_
_
_
_
_
_
1
Parental antisocial behavior, 17 months 0.02 (0.56)
9

Adjusted R2 0.05
0.05
−0.02
0.00
−0.01
_
_
_
_
_
_
_
1

Data are given as standardized regression coefficient

8

(standard error).
* p 4 0.05, ** p < 0.01, *** p < 0.001.
−0.01
−0.04
0.01
−0.01
0.05
_
_
_
_
_
_
1
7

unit increase in proactive aggression (unstandardized

−0.05
−0.02
−0.02
0.00
−0.02
−0.01

β = 0.02, 95% CI 0.01–0.03) and a 6% S.D. unit increase

_
_
_
_
_
1

in antisocial behavior (unstandardized β = 0.01, 95% CI

6

0.01–0.01). Increases in concurrent televiewing were

0.12**

0.10**

associated with additional independent risks of victim-

0.06
0.05
−0.05
0.05
−0.02

ization (unstandardized β = 0.07, 95% CI0.04–0.10),

_
_
_
_
1
5

proactive aggression (unstandardized β = 0.09, 95% CI

0.07–0.11) and antisocial behavior (unstandardized β =
0.14***

0.08*
−0.08*

0.08, 95% CI 0.06–0.10). Coefficients in Tables S1 and

0.02
0.02
0.00
0.03

−0.02

S2 are not corrected for attrition bias.

_
_
_
1
4

0.13***
0.47***
0.10***
0.12***

−0.08**

Discussion
0.07*
0.07*
0.05

0.03
Table 2. Bivariate associations between the predictor, outcomes and confounding variables

_
_
1

Identifying early modifiable factors that foretell later

3

risks for child well-being represents an important

goal for public health and social pediatrics (American
0.35***
0.30***
0.35***

0.13***

−0.13***
0.13***
0.08*

−0.08*
0.08*
−0.01

Academy of Pediatrics, 2013). Developing solid peer

_
1

relationships, getting along with others and establish-

2

ing a positive social identity within a group represent

0.13***

0.11***
−0.21***

essential elements of a successful transition from child-

0.10**
0.10**
0.08*
0.06
0.04
−0.01
−0.04

0.04

hood to adolescence. We sought to examine the pro-

1
1

spective influence of early childhood televiewing on

four key indicators of social impairment in typically
12. Parental antisocial behavior, age 17 months

developing youth at age 13 years. Remarkably, our

self-reported findings revealed long-term risks for
10. Family configuration, age 17 months
6. Concurrent televiewing, age 13 years

developmental psychopathology. Moreover, save for

9. Early cognitive skills, age 29 months

11. Parental education, age 17 months

* p 4 0.05, ** p < 0.01, *** p < 0.001.

3. Proactive aggression, age 13 years

social isolation, televiewing at age 13 years also

1. Early televiewing, age 29 months

5. Antisocial behavior, age 13 years

showed additional concurrent risks for social impair-

8. Temperament, age 17 months
4. Social isolation, age 13 years
2. Victimization, age 13 years

ment. This suggests independent dose–response asso-

ciations operating over the lifetime of the participants.
7. Child gender, boys = 1

Approximately every additional daily hour of tele-

viewing at age 2 years predicted an increased risk of
later victimization and socially isolative behavior.
Victimization represents a traumatic social learning ex-
Variables

perience and its relationship with early televiewing is

detectable around school entry (Pagani et al. 2013).
Adolescent experiences such as being teased, assaulted

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 3334 L. S. Pagani et al.
Table 4. Standardized regression coefficients which reflect the relationship between televiewing at toddlerhood and self-reported victimization,
social withdrawal, proactive aggression and antisocial behavior at age 13 years
Independent variable Victimization
Early televiewing, age 29 months 0.11 (0.01)***
Concurrent televiewing, age 13 years 0.07 (0.03)*
Child gender 0.11 (0.08)***
Temperament, 17 months 0.02 (0.07)
Cognitive skills, age 29 months −0.07 (0.05)*
Family configuration, 17 months 0.07 (0.17)*
Parental education, 17 months −0.09 (0.07)**
Parental antisocial behavior, 17 months 0.07 (0.14)*
Adjusted R2 0.06
Data are given as standardized regression coefficient, corrected for attrition bias (standard error).
* p 4 0.05, ** p < 0.01, *** p < 0.001.
or insulted by other classmates and personal prefer-
ences toward solitude for typical leisure activities
were associated with higher levels of watching televi-
sion in toddlerhood. These social characteristics place
adolescents at risk for long-term negative psychologic-
al and interpersonal sequelae such as underachieve-
ment, loneliness, lower self-esteem and depression
(Gini & Pozzoli, 2009; Schreier et al. 2009; Reijntjes
et al. 2010; Rudolph et al. 2014; Van Geel et al. 2014).
The consequences of childhood victimization show
developmental stability into adulthood (Arseneault
et al. 2010; Brunstein et al. 2010). Victimization experi-
ences often developmentally precede predispositions
toward antisocial behavior, which includes bullying
(Arseneault et al. 2010).
Approximately every additional 1 h of early child-
hood television exposure at age 2 years also forecasted
an increased risk of engaging in deception, theft, van-
dalism, and threatening and instilling fear on others,
and encouraging social exclusion of others as an
aggressive means of social domination. Such proactive
antisocial behaviors were self-reported at age 13 years,
which is disconcerting from a clinical perspective be-
cause externalizing childhood psychopathology pre-
dicts Axis I and II mental health disorders, unhealthy
lifestyle habits, criminality and physical disease in
adulthood (Morcillo et al. 2012; Loth et al. 2014).
There are macroscopic mechanisms that can eluci-
date the link between early childhood televiewing
and subsequent victimization and such extreme disre-
gard for the well-being of others. Excessive televiewing
habits create a time debt for effortful interpersonal
interactions that sharpen the critical foundations of
self-regulation and emotional intelligence. That is,
higher amounts of televiewing indicate a higher
proportion of passive rather than active daily cognitive
activity in toddlerhood, ultimately affecting social
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Social isolation Proactive aggression Antisocial behavior
0.10 (0.01)*** 0.09 (0.01)** 0.06 (0.00)*
0.03 (.05) 0.10 (0.02)*** 0.13 (0.02)***
−0.02 (0.13) 0.11 (0.07)*** 0.01 (0.05)
−0.01 (0.11) 0.06 (0.06)* 0.04 (0.04)
0.04 (0.08) −0.07 (0.05)* −0.08 (0.03)**
0.04 (0.27) 0.04 (0.15) 0.06 (0.07)
−0.02 (0.11) −0.02 (0.06) 0.01 (0.04)
−0.01 (0.23) 0.06 (0.12)* 0.10 (0.09)**
0.01 0.04 0.04
interaction frequency which practises socio-emotional
skills (Pagani et al. 2013). Related to all of this is that
more early televiewing is linked to developmental
deficits in executive functions, which drive interper-
sonal problem solving, emotional regulation, socially
competent peer play and positive social contact
(Nathanson et al. 2014). Like a coordinated orchestra,
the executive functions play a key role in developing
one’s cognitive and emotional processing (Barkley,
2012). Time spent televiewing represents choosing
less effortful endeavors in lieu of partaking in activities
and playing games that require more sustained atten-
tion and working memory (Nathanson et al. 2014).
Habitually elevated televiewing predicts increased ex-
posure to fast-paced cartoon content, which is common
in preschool programming and undermines executive
functioning (Lillard & Peterson, 2011).
As for microscopic mechanisms, eye contact is at the
heart of positive social development (Zeidner et al.
2009). In the first years of life, attention and self-
assertion skills recruit common sensory systems and
cortical structures (Marsh et al. 2008). Throughout de-
velopment, a shared gaze between people functions
beyond mere visual detection, as it remains a vital
cue system for mutual understandings between people
(Beier & Spelke, 2012). Eye contact is a necessary con-
dition for human empathy and appropriate social
exchanges, as it modulates the activation of the social
brain as it processes socially relevant sensory informa-
tion and internal states of partners in social interaction
(Farroni et al. 2002; Senju & Johnson, 2009). Although
wired prenatally, this inherent skill is honed by opportun-
ities for increasingly complex social interactions during
early childhood (Beier & Spelke, 2012). Children who de-
velop asynchronous gaze behavioral patterns, such as
looking down or away from others, tend to evoke more
negative social responses from others throughout

development (Zeidner et al. 2009; Beier & Spelke, 2012)
and risk having callous–unemotional traits (Dadds
et al. 2012). Very few televised programs have scenes
where the central character speaks directly to the view-
er, which both parallels a real-life social interaction and
fosters a virtual social relationship with the character
(Cummins & Cui, 2014). More time televiewing
means less time being spoken to directly, either in
person or from the screen. This adds support to our
speculative hypothesis regarding disrupted gaze de-
velopment. It is plausible that a time debt for complex
social interaction created by excessive televiewing at
age 2 years could interfere with progressive inter-
dependence in overlapping cortical structures which
eventually support higher-order cognitive functions
and cortico-thalamic sensory relay processes involved
in social interaction and emotional intelligence
(Zeidner et al. 2009). Using functional imaging with
116 Japanese children aged 5–18 years, Takeuchi et al.
(2015) remains the only study to our knowledge that
has documented cross-sectional and longitudinal cor-
relations between televiewing time and compromised
regional gray/white matter volume. Taken together,
these neuroscientific explanations could translate into
plausible risks for impaired social and emotional de-
velopment and warrant further direct investigation in
relation to excessive early televiewing.
This study is not without limitations. Foremost is
that epigenetic influences cannot be denied their direct
and even more plausible indirect explanatory role in
how environmental quality either activates or sup-
presses phenotypic expression. Second, our measure
of television exposure did not comprise a finely
tuned, objective scale of quantity and content of televi-
sion exposure. Moreover, parents using child care may
have underestimated the true amount of total screen-
time. Despite such a limited television measure, we
still found robust net effects. This is statistically re-
markable and points to a stronger associations than
suggested by the coefficients. The question remains:
influence of what? We have argued that too much tele-
viewing means less time left for other developmental
enriching activities during waking hours. Framing it
this way suggests that, beyond genetic influence, exces-
sive early childhood screen time represents a marker for
deficient socialization experiences. From this perspec-
tive, campaigns and guidelines that aim to discourage
screen time could instead be reconceptualized to en-
courage the value-added of socialization as an enriching
alternative.
The use of a prospective longitudinal design from
birth onward represents a major strength, as it does
not depend on retrospective recall and monitors
growth and development without researcher bias or
interference. The findings, which capitalize on child
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. https://doi.org/10.1017/S0033291716001689
Early television and social difficulties 3335
self-reports of specific social outcomes within an inclu-
sive study, not only replicate previous singular
findings based on adult observations but also to exam-
ine whether habitual cognitive and physical sedentari-
ness in toddlerhood influences social relationship
patterns in adolescence. This represents an improve-
ment on prior research since adults may not always
be fully aware of the extent to which a child is experi-
encing or causing psychosocial distress. By statistical
standards, the results only show modest associations,
yet small adjusted effect sizes can conservatively trans-
late into important social costs when projected over a
lifespan and across an entire population. Because social
impairment risks can translate into a general propen-
sity for morbidity and mortality in adulthood (Teo
et al. 2013; Non et al. 2014), excessive early childhood
television exposure could pose epigenetic risks to
population health. Our findings thus suggest a need
for better parental awareness of how young children
invest their time in what remains of their 24-h day.
Supplementary material
The supplementary material for this article can be
found at http://dx.doi.org/10.1017/S0033291716001689
Acknowledgements
All authors have had full access to all data in the study
and take responsibility for its integrity and the accur-
acy of its analysis. This IRB-approved study was con-
ducted without specific funding to any of the authors.
Declaration of Interest
None.
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