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

Dear Dr. Kara Aydemir,

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

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

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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Alexander Röhm

Guest Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: No

Reviewer #2: Partly

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

Reviewer #1: No

Reviewer #2: No

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

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

Reviewer #1: No

Reviewer #2: No

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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

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5. Review Comments to the Author

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

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

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

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

Critique of previous systematic reviews:

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

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

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

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

Description of age ranges:

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

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

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

Methodological quality review:

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

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

Screen time x Language Development x Executive Functioning:

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

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

Multiple data collections tools:

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

Minor formatting recommendations:

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

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

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

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

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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.

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

Reviewer #1: No

Reviewer #2: Yes: Dr Mary Brushe

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

Dear Dr. Kara Aydemir,

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

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

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

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

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

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

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

We look forward to receiving your revised manuscript.

Kind regards,

Alexander Röhm

Guest Editor

PLOS ONE

Additional Editor Comments:

Dear Authors,

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

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

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

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

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

Best regards.

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

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

Reviewer #2: (No Response)

Reviewer #3: (No Response)

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

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

Reviewer #2: Partly

Reviewer #3: Partly

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

Reviewer #2: Yes

Reviewer #3: N/A

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

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

Reviewer #2: Yes

Reviewer #3: Yes

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

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

Reviewer #2: No

Reviewer #3: Yes

**********

6. Review Comments to the Author

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

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

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

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

Abstract:

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

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

Introduction:

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

Some minor edits to this section also include:

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

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

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

Methods

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

Results

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

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

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

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

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

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

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

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

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

Discussion

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

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

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

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

Reviewer #3: PONE-D-24-04813R1

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

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

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

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

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

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

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

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

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

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

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 #2: No

Reviewer #3: No

**********

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

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

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

Dear Dr. Kara Aydemir,

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

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

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

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

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

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

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

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

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

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

We look forward to receiving your revised manuscript.

Kind regards,

Alexander Röhm

Guest Editor

PLOS ONE

Journal Requirements:

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

Additional Editor Comments:

Dear Authors,

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

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

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

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

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

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

Reviewer #3: (No Response)

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

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

Reviewer #3: Partly

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

Reviewer #3: N/A

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

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

Reviewer #3: Yes

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

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

Reviewer #3: Yes

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6. Review Comments to the Author

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

Reviewer #3: PONE-D-24-04813R2

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

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

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

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

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Reviewer #3: No

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

PONE-D-24-04813R3

Dear Dr. Kara Aydemir,

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

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

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Kind regards,

Alexander Röhm

Guest Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Authors,

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

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

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

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

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

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

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

Best regards,

Alexander Röhm

Reviewers' comments: