Advertisement
Browse Subject Areas
?

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here.

  • Loading metrics

Cross sectional associations of screen time and outdoor play with social skills in preschool children

  • Trina Hinkley ,

    Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing – original draft

    think.research@outlook.com

    Affiliation Deakin University, Institute for Physical Activity and Nutrition, Burwood, Victoria, Australia

  • Helen Brown ,

    Contributed equally to this work with: Helen Brown, Megan Teychenne

    Roles Conceptualization, Funding acquisition, Investigation, Methodology, Supervision, Writing – review & editing

    Affiliation Deakin University, Institute for Physical Activity and Nutrition, Burwood, Victoria, Australia

  • Valerie Carson,

    Roles Conceptualization, Formal analysis, Methodology, Writing – review & editing

    Affiliation Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada

  • Megan Teychenne

    Contributed equally to this work with: Helen Brown, Megan Teychenne

    Roles Conceptualization, Funding acquisition, Methodology, Writing – review & editing

    Affiliation Deakin University, Institute for Physical Activity and Nutrition, Burwood, Victoria, Australia

Cross sectional associations of screen time and outdoor play with social skills in preschool children

  • Trina Hinkley, 
  • Helen Brown, 
  • Valerie Carson, 
  • Megan Teychenne
PLOS
x

Abstract

Screen time and physical activity behaviours develop during the crucial early childhood period (0–5 years) and impact multiple health and developmental outcomes, including psychosocial wellbeing. Social skills, one component of psychosocial wellbeing, are vital for children’s school readiness and future mental health. This study investigates potential associations of screen time and outdoor play (as a proxy for physical activity) with social skills. Cross sectional data were available for 575 mothers with a child (54% boys) aged 2–5 years. Mothers reported their child’s screen time, outdoor play time and social skills (Adaptive Social Behavior Inventory; ASBI). Multiple linear regression analyses assessed associations of screen and outdoor play time (Model 1) and compliance with screen time and physical activity recommendations (Model 2) with three ASBI subscales. Boys and girls spent a mean of 2.0 and 2.2 hours per day in screen time, and 3.3 and 2.9 hours per day in outdoor play, respectively. Girls scores for express and comply skills were significantly higher than boys (p<0.005). After applying the Benjamini-Hochberg Procedure to adjust for multiple associations, children’s television/DVD/video viewing was inversely associated with their compliant scores (B = -0.35 95% CI -0.26, -0.14; p = 0.001) and outdoor play time was positively associated with both expressive (B = 0.20 95% CI 0.07, 0.34; p = 0.004) and compliant (B = 0.22 95% CI 0.08, 0.36; p = 0.002) scores. Findings indicate that television/DVD/video viewing may be adversely, and outdoor play favourably, associated with preschool children’s social skills. Future research is required to identify the direction of causation and explore potential mechanisms of association.

Introduction

Screen time (i.e. time spent viewing or use of a device with a screen, including, but not limited to television, DVDs, electronic games and computers [1]) and physical activity are two health-related risk behaviours, which typically develop during the crucial early childhood period [2, 3]. Once established, these behaviours tend to track, or remain stable, into middle childhood [4]. These behaviours are also associated with important health and developmental outcomes, such as weight, bone health, cardiovascular disease risk factors [5, 6], cognitive development, academic achievement [79], and psychosocial well-being [1012] from early childhood through to adolescence. That is, higher levels of physical activity and lower levels of screen time are supportive of more favourable outcomes.

Positive indicators of children’s psychosocial well-being during early and middle childhood have been shown to be inversely associated with later depression, hostile behaviour and aggressive interpersonal behaviour [1315]. Social skills (e.g. openness of expression, cooperation) are intrinsic [16, 17] to children’s psychosocial well-being. These skills may also support children’s positive behavioural, social and academic outcomes during later childhood [18, 19]. Specifically, young children’s social skills are an important precursor in their development of school readiness [20] and peer acceptance [21]. Therefore, ensuring preschoolers have sufficient opportunities to develop and practice their social skills may establish a foundation for their long-term health and well-being.

Previous studies have suggested that participation in play and physical activity may provide one way of supporting the development of children’s social skills [22, 23] as these behaviours offer opportunities for interaction [24] where children may observe and practice such skills. Outdoor playtime has previously been shown to be consistently associated with physical activity, and inversely associated with sedentary time, across studies in preschoolers such that children who spend more time outside are more active and less sedentary than children who spend less time outside [2528]. Outdoor playtime has been validated [29] and is often used as a proxy measure [3033] of physical activity in this population, including as a means of assessing children’s compliance with physical activity recommendations [33]. Further, outdoor play has been shown to facilitate interaction with peers, thereby providing more opportunities to support socialisation and the development of social skills [3436] and children’s overall social health [37, 38]. Therefore, outdoor play provides opportunities for children to be both physically active and socially engaged.

Conversely, participation in screen based behaviours, which are largely solitary, sedentary pursuits, may reduce opportunities for interaction with peers and thereby be detrimental to children’s opportunities for socialisation and to development of healthy social skills [39, 40]. Concern has also been raised about the impact of screen time given its potential to reduce time in which children may engage in developmentally appropriate activities [41] and it has recently been reported as parents’ number one concern for their children [42]. Additionally, television viewing has been shown to be associated with delays in cognitive, language and motor development in young children [43]. These skills are necessary to support children’s social interactions with peers and adults and, if compromised, may subsequently affect children’s opportunities for positive social interactions. Therefore, it is imperative to explore potential associations between these behaviours and preschoolers’ social skills.

No previous studies have investigated associations of physical activity with social skills [17] during the preschool period (roughly two to six years of age [44, 45]) and only three studies have investigated associations of television viewing and social skills [17] in that age group. However, findings from those studies are conflicting, with positive, inverse and null associations between television viewing and social skills reported across studies [4648]. No studies have investigated associations of other types of screen time with social skills in preschool children. As such, there is a need to further explore the potential association of television viewing, other types of screen time, and outdoor play with preschoolers’ social skills. Given reported differences in boys’ and girls’ physical activity [49] and social skills [50], and differences in children’s socialisation by sex [51, 52], it may be that children’s physical activity and screen time behaviours, social skills and the associations between those variables also vary by sex. However, no previous research has investigated such a possibility. This study therefore sought to investigate associations of multiple indicators of screen time and outdoor playtime with social skills in preschool children (defined herein as 2–5 years of age) and to determine if differences varied by child sex. Hypothesised findings were that screen time would be adversely, and outdoor play time favourably, associated with preschool children’s social skills.

Methods

Study sample

The ‘Mums, Dads and Kids activity and screen time study’ (MDK) was a cross-sectional, online study where parents of a child aged two to five years (who were not yet in formal schooling) were recruited between September 2013 and March 2014 (early spring to early autumn). MDK obtained ethical approval from Deakin University, Faculty of Health, Human Ethics Advisory Group (HEAG-H 138_2012) and the Department of Education, Employment and Childhood Development. Reporting follows the STROBE recommendations [53, 54].

Participants were recruited through preschools, childcare centres and early childhood activity groups (e.g. music or gym groups) in six randomly selected, socioeconomically diverse [55] local government areas (LGA’s) within metropolitan Melbourne and through online advertising via blogs and Facebook pages related to parenting, child education and family-lifestyle. In total, 191 LGA-based facilities were contacted. Fifty-nine preschools/childcare centres (30.9%) and 81 early childhood activity groups (42.4%) agreed to distribute information regarding the study to parents. A total of 30 Facebook profile administrators and 36 online blog authors were contacted: 15 Facebook profile administrators (50%) and 10 online blog administrators (27.8%) agreed to post study information. Participants were directed to a website where they were screened to ensure eligibility for participation (inclusion: at least one child aged 2–5 years who had not yet started school) and provided informed consent prior to completing an online survey.

A total of 1238 parents were screened; of those, 958 were eligible and were provided with personalized links to complete a mother’s or a father’s survey: the respondent parent was asked to complete the survey relevant to them (either the mother’s or the father’s survey) and to forward the link for the other survey to their partner/spouse. Due to the overall objectives of the project, only the mother’s survey assessed children’s social skills. A total of 679 participants commenced the mother’s survey. From that dataset, eight participants were excluded due to duplicate identification numbers where one version was only partially completed; 13 participants were excluded due to the child age being outside the age range and researchers being unable to obtain clarification; one participant was excluded due to the respondent being male; and two participants were excluded where maternal date of birth was invalid (year of reporting rather than birth year) and respondents were unable to be contacted. In total, 655 (96.5%) cases were available. However, 80 cases had missing data and full data were available for 575 (84.7%) families: 311 boys (54%) and 264 girls. All analyses included the full sample of 575 participants with complete data.

Measures and data management

Dependent variables.

Each mother reported on their child’s social skills using the Adaptive Social Behaviour Inventory (ASBI) [56, 57]. The ASBI is a reliable [56, 57], 30 item inventory which assesses children’s social skills across three subscales: Express (e.g. joins play, is open and direct; 13 items), Comply (e.g. cooperates, is calm and easy going; 10 items) and Disrupt (e.g. teases, bullies; 7 items). These subscales were identified in a previous study through factor analysis from an original pool of 83 items [57] and have been shown to have high levels of internal reliability (α = 0.71–0.87) and generally moderate reliability against the Child Behavior Checklist (r = 0.24–0.63)[56, 57]. Mothers rated their child for each item on a three point Likert scale: rarely/never, sometimes or always. Items were summed for each of the sub-scales. All dependent variables were normally distributed.

Independent variables.

Mothers reported their child’s time (in hours and minutes) in each of the following behaviors separately for week and weekend days (total of 6 items):

  1. television/DVD/video viewing;
  2. computer/electronic game/hand held device use; and
  3. outdoor play time as a proxy for physical activity.

Mothers were directed to consider only that time when the behaviour in the question was the main activity their child was doing. All screen time items had established test-retest reliability (ICC = 0.68–0.69) [58]; outdoor play items had been previously validated against accelerometry (r = 0.2, p = 0.003) [29]. Data were transformed to average hours per day in each behaviour as follows: [(weekday hours * 5) + (weekend hours * 2)]/7. Average hours per day in total screen time (television/DVD/video viewing and computer/electronic game/hand held device use combined) and outdoor play were dichotomised to determine children’s compliance with Australian recommendations [59] for total screen time of less than one hour per day and physical activity of three or more hours per day. Thus, children were determined to be compliant with the screen time guideline if they spent less than one hour per day in screen time, and were determined to be compliant with the physical activity guideline if they spent three or more hours per day in outdoor play.

Covariates.

Mothers reported on a variety of their family’s demographic characteristics. For the purposes of this study, mothers reported their own highest level of education used as a proxy indicator of family socioeconomic position (SEP; low SEP: year 10 or less education; mid-SEP: year 12, diploma, trade; high SEP: university or higher qualification), their child’s sex and date of birth (from which child age at the time of survey completion was determined), and whether or not their child had a disability. These variables were chosen as covariates based on previous studies showing that child social skills differ between the sexes (girls tend to perform more strongly), improve with age [6062], and are poorer in children with a disability [6365]. Maternal education has also been shown to be a predictor of preschool children’s social skills, including in studies using the ASBI [6668].

Statistical analyses

Descriptive statistics were used to describe the sample. T-tests were used to assess differences in independent and dependent variables between boys and girls where data were continuous and Chi square tests were used to assess sex differences for the dichotomous variables, which report compliance with recommendations. Correlations between all the independent variables, and between all the dependent variables, were assessed. Two multiple linear regression models were run for each of the outcome variables:

  1. Model 1 included continuous variables for each of the 3 independent variables—television/DVD/video viewing, computer/electronic game/hand held device use and outdoor play time.
  2. Model 2 included 2 dichotomised variables for compliance with the screen time and physical activity recommendations as the independent variables.

Both models controlled for the covariates identified above. All models were assessed for an interaction between sex and the independent variables; as there were no significant interactions in any of the models, the interaction term was removed and all analyses were undertaken for the whole sample controlling for sex as a covariate. All analyses were undertaken in Stata SE 13.1 (Statacorp, College Station, Texas). Data were analysed in 2015–2017. Statistical significance was set at p<0.05. All significance values for coefficients of independent variables were assessed against the Benjamini-Hochberg Procedure [69] for controlling for false discovery rates. For the 15 coefficients of independent variables tested, the adjusted p-value was determined to be 0.01; therefore, coefficients of independent variables had to be significant at p<0.01 after adjustment to maintain significance.

Results

Boys and girls had a mean age of 3.8 (1.0) and 3.7 (0.9) years, respectively, and 8.5% of the sample (11.1% of boys and 5.4% of girls, p = 0.012) had a parent-reported disability. Three percent of the sample were classified as low SEP based on maternal education; 22% were mid-SEP and 75% were high SEP.

Table 1 reports scores for each of the ASBI subscales and overall social skills for boys, girls and the whole sample. Girls’ scores for the expressive (mean = 35.8, 95%CI 35.4, 36.1) and comply (mean = 25.5, 95%CI 25.2, 25.9) subscales, and for overall social skills (mean = 77.2, 95%CI76.6, 77.9), were significantly higher than boys’ scores (35.0, 95%CI 34.6, 35.4; 24.8, 95%CI 24.4, 25.2; 75.8, 95%CI 75.0, 76.6, respectively). No difference was seen between girls’ and boys’ scores on the disrupt subscale.

thumbnail
Table 1. Screen time, outdoor play and social skills characteristics for boys, girls and the whole sample from the 2013/2014 MDK participants.

https://doi.org/10.1371/journal.pone.0193700.t001

Table 1 shows the mean daily hours in the screen time variables and outdoor play for boys, girls and the whole sample. Nearly 20% more boys met the physical activity recommendations than girls (45.3% vs. 35.8%). There were no other significant between-sex differences in any of the screen time variables or outdoor play.

Correlations between all dependent variables are shown in Table 2 and those for independent variables are shown in Table 3. Express and comply social skills scores were moderately positively and significantly correlated while disrupt was weakly and inversely significantly correlated with both express and comply scores. Independent variables were all weakly, significantly and positively correlated.

Table 4 reports the results of the regression models where television/DVD/video viewing, computer/e-game/hand held game use and outdoor play time (Model 1), or meeting screen time and physical activity recommendations (Model 2), were entered simultaneously as independent variables. Following adjustment using the Benjamini-Hochberg procedure, two significant associations were evident. These included:

  1. children’s television/DVD/video viewing was inversely associated with their compliant scores (B = -0.35 95% CI -0.26, -0.14; p = 0.001) and
  2. outdoor play time was positively associated with both expressive (B = 0.20 95% CI 0.07, 0.34; p = 0.004) and compliant (B = 0.22 95% CI 0.08, 0.36; p = 0.002) scores.
thumbnail
Table 4. Associations from multiple linear regression models of ASBI sub scales with screen time and outdoor play (hours/day) entered simultaneously for 2013/2014 MDK participants (coefficients, 95%CI; p values).

https://doi.org/10.1371/journal.pone.0193700.t004

Discussion

This paper sought to investigate associations of multiple indicators of screen time and outdoor play with social skills in preschool children. These findings suggest that children’s higher levels of screen time, and lower levels of outdoor play, are associated with poorer social skills, particularly children’s compliant skills. Overall, coefficients of association were small; however, consistency between independent variables for children’s compliant skills, and across dependent variables for children’s outdoor play, suggests that these associations may have practical significance.

This study found differences in associations between television/DVD/video viewing and computer/e-game/hand held game use with children’s social skills. Television/DVD/video viewing was inversely associated with compliant skills while computer/e-game/hand held game use showed no association with any of the social skills scales. This finding is consistent with previous studies which similarly report inverse associations between TV viewing and prosocial behaviour [70], cooperation, assertion, self-control and overall social skills [47]. Although few studies have investigated associations between various types of screen devices and indicators of children’s psychosocial well-being such as social skills, those that have done so show different associations between screen time devices and well-being indicators. For instance, television/video viewing has been shown to be associated with emotional well-being, while computer use was associated with emotional problems in the same sample [10]. This is not surprising given the type of content, interaction, behaviour and engagement differs between devices. For instance, during television/DVD/video viewing, children are more likely to be passive consumers of content, while computer, electronic game and smart phone/digital tablet use may elicit more interactive behaviours and engagement [41] between child and content engaged with as well as between children and parents during device use. Such differences may be due to differences in content (e.g. television cartoons or drama programs vs. games which require children to respond or video chatting) or opportunities for interaction with others during use (e.g. video chatting, multi-player games). Further, game playing of all types, including outdoor and sedentary games, is a normal part of childhood and moderate levels of computer game playing have been shown to be associated with favourable outcomes (e.g. activity involvement, positive school engagement, positive mental health, self-concept, friendship network, and low levels of disobedience to parents) in adolescents [71]. No such associations were found in this study, possibly due to the small amount of time (approx. 30 mins/day) children spend in combined computer use and game playing compared to the amount of time (2 h 44 min) adolescents spend in such pastimes [72]. Given such differences, it is essential that future research studies ensure they collect data on a range of screen devices, such as television, computer, and digital tablets, as well as type of content and interaction during use, to more comprehensively examine the components of screen time, which may support or constrain favourable outcomes for children.

This study found that girls had significantly higher scores on the expressive and compliant subscales than boys. Girls have previously been reported to have higher levels of interpersonal and intrapersonal skills [50], which may be similar to the social skills constructs captured in this study. It is possible that characteristics of the socialisation process may account for these differences [51, 52, 73]. Mothers are reported to be more consistently emotionally expressive than fathers [74, 75], and express more positive emotions with their daughters than their sons [76], thereby modelling such behaviours to their children. Parents also reportedly desire differences in emotional development in their sons compared with their daughters. For instance, parents desire more anger suppression in their sons than their daughters [77]. Given that experience and expression of emotion have been shown to be socially constructed rather than innate [78, 79], it is possible that differences in girls’ and boys’ social skills scores in this study are a result of socialisation. However, it is beyond the scope of this study to test this assumption in the current sample.

Evidence is not clear on the association of sedentary behaviors, such as screen time, or physical activity, in children with health or developmental outcomes independently of each other [80]. However, evidence in adults suggests that these behaviors may be independently associated with mental health outcomes [8183].The results of Model 1, which includes individual screen and outdoor play time variables, are consistent with those findings in the adult literature such that associations of television viewing and outdoor playtime with children’s social skills may be independent of each other. That is, even children who spend a large amount of time playing outdoors may suffer adverse effects of higher volumes of television viewing, and vice versa. Given the relatively low prevalence of compliance with recommendations, and the potential associations with health and psychosocial well-being, it is essential that future research further investigates, and implements programs to support healthy levels of these behaviors during early childhood.

There is currently no evidence to identify what possible causal mechanisms may exist between preschool children’s screen time, outdoor play (as a proxy for physical activity) and their social skills. However, some hypotheses may be useful. As play and physical activity provide opportunities for interaction [24], specifically conversation, cooperation and management of conflict, children may learn important social skills through their everyday play and activities. Conversely, participation in screen time, especially passive forms, may limit children’s opportunities to interact with others. Indeed, parent-child interaction has been shown to decrease in the presence of background television [84]. The social withdrawal hypothesis, suggested as a possible causal mechanism between increased television viewing and depression in adults [39, 40], may have some applicability in explaining the associations identified in this study also. That hypothesis suggests that as individual engage in solitary behaviours, such as television viewing, they are withdrawn from social behaviours which may support aspects of wellbeing and mental health. Alternatively, television viewing has been found to be inversely associated with sleep in children, both cross-sectionally during the preschool period and longitudinally from early childhood into middle childhood [8588]. Therefore, children who watch more television, may sleep less, or have poorer quality sleep, which may subsequently reduce their ability to be calm, disrupting their capacity to be compliant and behave appropriately in social situations. Nonetheless, it remains for future research to investigate such potential causal mechanisms.

Strengths and limitations

Strengths and limitations of the study must be acknowledged. The cross-sectional design precludes identification of causality: indeed, it may be that social skills predict screen time and physical activity. The sample was highly educated with 75% of mothers having completed a university degree or higher. Therefore, it is possible that these findings may not be generalizable to families where mothers are less educated. Nonetheless, statistical models included maternal education as an indicator of SEP to control for the potential confounding influence of this characteristic. The findings also may not be generalizable to families of different combinations, such as single-father or grandparent-headed families. Nonetheless, 81% of families in Australia with a child aged 0–4 years are two parent families, and 16% of families are lone mother families; thus these findings are likely to be characteristic of the majority of children [89].

Although this study assessed a range of child screen time behaviours, capturing participation in more recent screen devices such as hand held devices, this time was reported across multiple, rather than individual, devices and therefore associations between use of individual devices and social skills were not able to be ascertained. Further, although it is likely that mothers would have included their child’s use of smart phones and digital tablets in their response to this item, the survey item did not specifically prompt for inclusion of use of those devices. As levels and types of engagement and participation vary between devices [41], it is possible that associations do also. Nonetheless, this is one of the first studies to include investigation of the association of such modern devices with children’s social skills, where most previous studies have primarily captured only television/DVD/video viewing.

The study used only proxy-report of the child’s time in each of the independent variables: with the exception of behavioural observation which is highly resource-intensive, no objective measures of screen time are currently available and it was not feasible to use accelerometry in this study. Children’s outdoor play has been weakly correlated with accelerometry [29], is consistently associated with children’s levels of physical activity across studies [49], and has previously been used as an indicator of children’s compliance with guidelines [33]. However, this measure does not capture all of the children’s physical activity behaviours and neither is all outdoor play time physically active. Further, objective measures may result in different levels of compliance with physical activity recommendations and associations with outcomes being identified.

Children in this study spent a mean of 16.4 (SD = 11.9; median 15) hours per week in childcare/preschool and 77.6% of mothers reported that they are the primary carer for their child, providing 75% or more of the child’s care outside of formal care hours. Therefore, the children in this study spent the majority of their time outside of care with their mothers. It is reasonable that mothers are therefore reporting the majority of children’s outdoor play throughout the week. Proxy-report measures are also subject to biases which, for this study, may include over-reporting of girls’ social skills and boys’ outdoor play.

Data were collected from only one respondent which may add additional bias and precludes triangulation. Nonetheless, evidence from previous studies included above suggests that these perceptions are consistent with previous research and objective physical activity monitoring. As these items were parent-reported, reported time is unlikely to include any time in these behaviours while children were not in the mothers’ care. Therefore, time children participate in screen time while in formal or informal care was not specifically included. However, models were tested with time in childcare as a covariate; only minimal differences in associations (at the second decimal place in the coefficient and p values) were observed and therefore time in childcare was not included in the models. Finally, there may be other factors more strongly associated with children’s social skills than those captured in this study, such as maternal anxiety or depression, which may be worth exploring.

Conclusion

In summary, this study has shown that television/DVD/video viewing, total screen time and outdoor play are associated with preschool children’s social skills. Future longitudinal studies are required to assess the temporal associations between children’s behaviours and indicators of their well-being to determine causality and use of national datasets, where available, would add substantially to this body of literature. Nonetheless, such findings may aid in the development of interventions to support healthy outcomes in preschool children. Additionally, these findings may suggest a possible stealth approach to interventions is feasible [90]. Research has shown that parents are largely unconcerned about their children’s physical activity and screen time behaviours and report multiple reasons to maintain current behaviours [91]. A stealth intervention, targeting outcomes of value and saliency to parents such as children’s well-being, may be successful in engaging and motivating parents to participate and support healthful behaviour change for their children.

Acknowledgments

The authors would like to acknowledge Jennifer McCann who efficiently and effectively managed recruitment and data collection.

References

  1. 1. Sweetser P, Johnson D, Ozdowska A, Wyeth P. Active versus passive screen time for young children. Australasian Journal of Early Childhood. 2012;37(4):94–8.
  2. 2. Certain LK, Kahn RS. Prevalence, correlates, and trajectory of television viewing among infants and toddlers. Pediatr. 2002;109:634–42.
  3. 3. Birch LL, Fisher JO. Development of eating behaviors among children and adolescents. Pediatr. 1998;101(3):539.
  4. 4. Jones RA, Hinkley T, Okely AD, Salmon J. Tracking physical activity and sedentary behavior in childhood: A systematic review. Am J Prev Med. 2013;44(6):651–8. pmid:23683983
  5. 5. Leblanc AG, Spence JC, Carson V, Connor Gorber S, Dillman C, Janssen I, et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37(4):753–72. Epub 2012/07/07. pmid:22765839.
  6. 6. Timmons BW, Leblanc AG, Carson V, Connor Gorber S, Dillman C, Janssen I, et al. Systematic review of physical activity and health in the early years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37(4):773–92. Epub 2012/07/07. pmid:22765840.
  7. 7. Singh A, Uijtdewilligen L, Twisk JW, van Mechelen W, Chinapaw MJ. Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch Pediatr Adolesc Med. 2012;166(1):49–55. Epub 2012/01/04. pmid:22213750.
  8. 8. Tomporowski PD, Davis CL, Miller PH, Naglieri JA. Exercise and children’s intelligence, cognition, and academic achievement. Educ Psychol Rev. 2008;20(2):111–31. pmid:19777141.
  9. 9. Tomporowski PD, Lambourne K, Okumura MS. Physical activity interventions and children’s mental function: an introduction and overview. Prev Med. 2011;52 Suppl 1:S3–9. pmid:21420981.
  10. 10. Hinkley T, Verbestel V, Ahrens W, Lissner L, Molnár D, Moreno LA, et al. Early Childhood Electronic Media Use as a Predictor of Poorer Well-being: A Prospective Cohort Study. JAMA Pediatr. 2014;168(5):485–92. pmid:24639016. Corporate Author: IDEFICS Consortium. Language: English. Entry Date: 20140704. Revision Date: 20140704. Publication Type: journal article.
  11. 11. Lotan M, Merrick J, Carmeli E. A review of physical activity and well-being. Int J Adoles Med Health. 2005;17(1):23–31. pmid:15900809.
  12. 12. Lubans DR, Plotnikoff RC, Lubans NJ. Review: A systematic review of the impact of physical activity programmes on social and emotional well-being in at-risk youth. Child Adoles Mental Health. 2012;17(1):2–13. Language: English. Entry Date: 20120511. Revision Date: 20130208. Publication Type: journal article.
  13. 13. Jones SM, Brown JL, Aber JL. Two-year impacts of a universal school based social emotional and literacy intervention: An experiment in translational developmental research. Child Dev. 2011;82(2):533–54. pmid:21410922. First Author & Affiliation: Jones, Stephanie M.
  14. 14. Meagher SM, Arnold DH, Doctoroff GL, Dobbs J, Fisher PH. Social–emotional problems in early childhood and the development of depressive symptoms in school–age children. Early Educ Dev. 2009;20(1):1–24. First Author & Affiliation: Meagher, Susan M.
  15. 15. Toumbourou JW, Williams I, Letcher P, Sanson A, Smart D. Developmental trajectories of internalising behaviour in the prediction of adolescent depressive symptoms. Aust J Psych. 2011;63(4):214–23.
  16. 16. Demir M, Jaafar J, Bilyk N, Mohd Ariff MR. Social Skills, Friendship and Happiness: A Cross-Cultural Investigation. The Journal of Social Psychology. 2012;152(3):379–85. pmid:22558831
  17. 17. Hinkley T, Teychenne M, Downing KL, Ball K, Salmon J, Hesketh KD. Early childhood physical activity, sedentary behaviors and psychosocial well-being: a systematic review. Prev Med. 2014;62:182–92. pmid:24534461. Language: English. Entry Date: In Process. Revision Date: 20140530. Publication Type: journal article. Journal Subset: Biomedical.
  18. 18. Sanson A, Letcher P, Smart D, Prior M, Toumbourou JW, Oberklaid F. Associations between Early Childhood Temperament Clusters and Later Psychosocial Adjustment. Merrill Palmer Q. 2009;55(1):26–54.
  19. 19. McCabe PC, Altamura M. Empirically valid strategies to improve social and emotional competence of preschool children. Psychol Schools. 2011;48(5):513–40.
  20. 20. Denham SA. Social-Emotional Competence as Support for School Readiness: What Is It and How Do We Assess It? Early Educ Dev. 2006;17(1):57–89.
  21. 21. Lindsey EW. Preschool children’s friendships and peer acceptance: Links to social competence. Child Study J. 2002;32(3):145.
  22. 22. Bailey R, Armour K, Kirk D, Jess M, Pickup I, Sandford R. The Educational Benefits Claimed for Physical Education and School Sport: An Academic Review. Res Papers Educ. 2009;24(1):1–27.
  23. 23. Barbour AC. The impact of playground design on the play behaviors of children with differing levels of physical competence. Early Child Res Q. 1999;14(1):75–98.
  24. 24. Telama R. Moral development. In: Durand M, Bakker F, Vanden Auweele Y, editors. Psychology for physical educators. Champaign, IL: Human Kinetics; 1999. p. 321–42.
  25. 25. Hinkley T, Crawford D, Salmon J, Okely AD, Hesketh K. Preschool children and physical activity: a review of correlates. Am J Prev Med. 2008;34(5):435–41. pmid:18407012
  26. 26. Stone MR, Faulkner GE. Outdoor play in children: associations with objectively-measured physical activity, sedentary behavior and weight status. Prev Med. 2014;65:122–7. pmid:24836417.
  27. 27. Gray C, Gibbons R, Larouche R, Sandseter EB, Bienenstock A, Brussoni M, et al. What Is the Relationship between Outdoor Time and Physical Activity, Sedentary Behaviour, and Physical Fitness in Children? A Systematic Review. Int J Environ Res Public Health. 2015;12(6):6455–74. pmid:26062039.
  28. 28. Vanderloo LM, Tucker P, Johnson AM, Holmes JD. Physical activity among preschoolers during indoor and outdoor childcare play periods. Applied Physiology, Nutrition, and Metabolism. 2013;38(11):1173–5. pmid:24053528
  29. 29. Burdette HL, Whitaker RC, Daniels S. Parental report of outdoor playtime as a measure of physical activity in preschool-aged children. Arch Pediatr Adolesc Med. 2004;158(4):353–7. pmid:15066875
  30. 30. Kuepper-Nybelen J, Lamerz A, Bruning N, Hebebrand J, Herpertz-Dahlmann B, Brenner H. Major differences in prevalence of overweight according to nationality in preschool children living in Germany: determinants and public health implications. Arch Dis Child. 2005;90(4 (Electronic)):359–63. pmid:15781922
  31. 31. Sallis JF, Nader PR, Broyles SL, Berry CC, Elder JP, McKenzie TL, et al. Correlates of physical activity at home in Mexican-American and Anglo-American preschool children. Health Psychol. 1993;12(5):390–8. pmid:8223363
  32. 32. Sääkslahti A, Numminen P, Niinikoski H, Rask-Nissilä L, Viikari J, Tuominen J, et al. Is physical activity related to body size, fundamental motor skills, and CHD risk factors in early childhood? Pediatr Exerc Sci. 1999;11(4):327–40.
  33. 33. Okely AD, Trost SG, Steele JR, Cliff DP, Mickle K. Adherence to physical activity and electronic media guidelines in Australian pre-school children. J Paediatr Child Health. 2009;45(1–2):5–8. Epub 2009/02/12. pmid:19208059.
  34. 34. Dowdell K, Gray T, Malone K. Nature and its influence on children’s outdoor play. Australian Journal of Outdoor Education. 2011;15(2):24.
  35. 35. Aasen W, Grindheim LT, Waters J. The outdoor environment as a site for children’s participation, meaning-making and democratic learning: examples from Norwegian kindergartens. Education 3–13. 2009;37(1):5–13.
  36. 36. Tremblay MS, Gray C, Babcock S, Barnes J, Bradstreet CC, Carr D, et al. Position Statement on Active Outdoor Play. Int J Environ Res Public Health. 2015;12(6):6475–505. pmid:26062040.
  37. 37. Brussoni M, Gibbons R, Gray C, Ishikawa T, Sandseter EB, Bienenstock A, et al. What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review. Int J Environ Res Public Health. 2015;12(6):6423–54. pmid:26062038.
  38. 38. Waite S, Rogers S, Evans J. Freedom, flow and fairness: exploring how children develop socially at school through outdoor play. Journal of Adventure Education and Outdoor Learning. 2013;13(3):255–76.
  39. 39. Varni JW, Magnus B, Stucky BD, Liu Y, Quinn H, Thissen D, et al. Psychometric properties of the PROMIS pediatric scales: precision, stability, and comparison of different scoring and administration options. Qual Life Res. 2013. pmid:24085345.
  40. 40. Lewinsohn PM. A behavioral approach to depression. In: Friedman RJ, Katz MM, Friedman RJ, Katz MM, editors. The psychology of depression: Contemporary theory and research. Oxford, England: John Wiley & Sons; 1974.
  41. 41. Christakis DA. Interactive media use at younger than the age of 2 years: Time to rethink the american academy of pediatrics guideline? JAMA Pediatr. 2014;168(5):399–400. pmid:24615347
  42. 42. The Royal Children’s Hospital Melbourne. Top ten child health problems: What the public thinks Melbourne, Australia: The Royal Children’s Hospital Melbourne; 2015 [cited 2016 2 December]. https://www.childhealthpoll.org.au/polls/top-10-child-health-problems/.
  43. 43. Lin LY, Cherng RJ, Chen YJ, Chen YJ, Yang HM. Effects of television exposure on developmental skills among young children. Infant Behav Dev. 2015;38:20–6. pmid:25544743
  44. 44. Vanderloo LM, Tucker P, Johnson AM, Burke SM, Irwin JD. Environmental Influences on Preschoolers’ Physical Activity Levels in Various Early-Learning Facilities. Res Q Exerc Sport. 2015:1–11. pmid:26288191
  45. 45. Wu CS, Fowler C, Lam WY, Wong HT, Wong CH, Yuen Loke A. Parenting approaches and digital technology use of preschool age children in a Chinese community. Ital J Pediatr. 2014;40:44. pmid:24887105.
  46. 46. Conners-Burrow NA, McKelvey LM, Fussell JJ. Social outcomes associated with media viewing habits of low-income preschool children. Early Educ Dev. 2011;22(2):256–73. First Author & Affiliation: Conners-Burrow, Nicola A.
  47. 47. Mistry KB, Minkovitz CS, Strobino DM, Borzekowski DLG. Children’s television exposure and behavioral and social outcomes at 5.5 years: Does timing of exposure matter? Pediatr. 2007;120(4):762–9. pmid:17908763. First Author & Affiliation: Mistry, Kamila B.
  48. 48. Intusoma U, Mo-Suwan L, Ruangdaraganon N, Panyayong B, Chongsuvivatwong V. Effect of television viewing on social-emotional competence of young Thai children. Infant Behav Dev. 2013;36(4):679–85. pmid:23948636.
  49. 49. Bingham DD, Costa S, Hinkley T, Shire KA, Clemes SA, Barber SE. Physical Activity During the Early Years: A Systematic Review of Correlates and Determinants. Am J Prev Med. 2016;51(3):384–402. pmid:27378255
  50. 50. Keefer KV, Holden RR, Parker JDA. Longitudinal assessment of trait emotional intelligence: Measurement invariance and construct continuity from late childhood to adolescence. Psychol Assess. 2013;25(4):1255–72. PsycARTICLES Identifier: pas-25-4-1255. pmid:23914954. First Author & Affiliation: Keefer, Kateryna V.
  51. 51. Brown GL, Craig AB, Halberstadt AG. Parent gender differences in emotion socialization behaviors vary by ethnicity and child gender. Parenting: Sci Practice. 2015;15(3):135–57.
  52. 52. Morrongiello BA, Dawber T. Parental influences on toddlers’ injury-risk behaviors: Are sons and daughters socialized differently? J Applied Dev Psych. 1999;20(2):227–51.
  53. 53. Sanderson S, Tatt ID, Higgins JPT. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007;36(3):666–76. pmid:17470488
  54. 54. Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med. 2007;4(10):e297–1654. pmid:17941715
  55. 55. Australian Bureau of Statistics. 2033.0.55.001—Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011 2013. http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001.
  56. 56. Greenfield DB, Wasserstein SB, Gold S, Jorden B. The Adaptive Social Behavior Inventory (ASBI): Evaluation with high-risk preschoolers. J Psychoeduc Assess. 1997;15(4):322–33. First Author & Affiliation: Greenfield, Daryl B.
  57. 57. Hogan A, Scott K, Bauer C. The Adaptive Social Behavior Inventory (ASBI): A New Assessment of Social Competence in High-Risk Three-Year-Olds. J Psychoeduc Assess. 1992;10(3):230–9.
  58. 58. Hinkley T, Salmon J, Okely AD, Crawford D, Hesketh K. The HAPPY Study: Development and reliability of a parent survey to assess correlates of preschool children’s physical activity. J Sci Med Sport. 2012;15(5):407–17. pmid:22480665
  59. 59. Department of Health. National physical activity recommendations for children 0–5 years 2014; 2014(7 February). http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-physical-activity-0-5-pdf-cnt.htm.
  60. 60. Gomes RMS, Pereira AS. Influence of age and gender in acquiring social skills in Portuguese preschool education. Psychology. 2014;5(2):99–103.
  61. 61. Takahashi Y, Okada K, Hoshino T, Anme T. Developmental Trajectories of Social Skills during Early Childhood and Links to Parenting Practices in a Japanese Sample. PLoS ONE. 2015;10(8):1–14.
  62. 62. Stefan CA, Miclea M. Effectiveness of the Social-Emotional Prevention Program as a Function of Children’s Baseline Risk Status. Euro Early Childhood Educ Res J. 2014;22(1):14–44.
  63. 63. Baker J, Fenning R, Crnic K, Baker B, Blacher J. Prediction of social skills in 6-year-old children with and without developmental delays: contributions of early regulation and maternal scaffolding. Am J Ment Retard. 2007;112:375–91.pmid:17676961
  64. 64. Green S, Caplan B, Baker B. Maternal supportive and interfering control as predictors of adaptive and social development in children with and without developmental delays. J Intellect Disabil Res. 2014;58(8):691–703 13p. pmid:23865770. Language: English. Entry Date: 20140804. Revision Date: 20150803. Publication Type: Journal Article.
  65. 65. Griswold LA, Townsend S. Assessing the Sensitivity of the Evaluation of Social Interaction: Comparing Social Skills in Children With and Without Disabilities. Am J Occup Ther. 2012;66(6):709–17 9p. pmid:23106991. Language: English. Entry Date: 20121105. Revision Date: 20150819. Publication Type: Journal Article.
  66. 66. McWayne CM, Cheung K, Wright LEG, Hahs-Vaughn DL. Patterns of school readiness among head start children: Meaningful within-group variability during the transition to kindergarten. J Educ Psychol. 2012;104(3):862–78. (Supplemental).
  67. 67. Perry MA, Fantuzzo JW. A multivariate investigation of maternal risks and their relationship to low-income, preschool children’s competencies. Applied Dev Sci. 2010;14(1):1–17.
  68. 68. Brody GH, Flor DL. Maternal resources, parenting practices, and child competence in rural, single-parent African American families. Child Dev. 1998;69(3):803–16. pmid:9680686
  69. 69. Benjamini Y, Hochberg Y. Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. Journal of the Royal Statistical Society Series B (Methodological). 1995;57(1):289–300.
  70. 70. Cheng S, Maeda T, Yoichi S, Yamagata Z, Tomiwa K. Early television exposure and children’s behavioral and social outcomes at age 30 months. J Epidemiol. 2010;20 Suppl 2:S482–9. Epub 2010/02/25. pmid:20179364.
  71. 71. Durkin K, Barber B. Not so doomed: Computer game play and positive adolescent development. J Applied Dev Psych. 2002;23(4):373–92.
  72. 72. Smith LJ, Gradisar M, King DL, Short M. Intrinsic and extrinsic predictors of video-gaming behaviour and adolescent bedtimes: the relationship between flow states, self-perceived risk-taking, device accessibility, parental regulation of media and bedtime. Sleep Medicine. 2017;30:64–70. https://doi.org/10.1016/j.sleep.2016.01.009. pmid:28215265
  73. 73. Langlois JH, Downs AC. Mothers, fathers, and peers as socialization agents of sex-typed play behaviors in young children. Child Dev. 1980;51:1237–47.
  74. 74. Brody LR. The socialization of gender differences in emotional expression: Display rules, infant termperament, and differentiation. In: Fischer AH, Fischer AH, editors. Gender and emotion: Social psychological perspectives. Studies in emotion and social interaction. Second series. New York, NY, US: Cambridge University Press; 2000. p. 24–47.
  75. 75. Wong MS, McElwain NL, Halberstadt AG. Parent, family, and child characteristics: Associations with mother- and father-reported emotion socialization practices. J Family Psychol. 2009;23(4):452–63. pmid:19685981
  76. 76. Fivush R, Brotman MA, Buckner JP, Goodman SH. Gender differences in parent–child emotion narratives. Sex Roles. 2000;42(3–4):233–53.
  77. 77. Diener ML, Lucas RE. Adults’ Desires for Children’s Emotions Across 48 Countries: Associations with Individual and National Characteristics. J Cross-Cultural Psychol. 2004;35(5):525–47.
  78. 78. Brody LR. Gender and emotion: Beyond stereotypes. J Soc Iss. 1997;53(2):369–93.
  79. 79. Matsumoto D, Hwang HS. Culture and emotion: The integration of biological and cultural contributions. J Cross-Cultural Psychol. 2012;43(1):91–118.
  80. 80. Cliff DP, Ridgers ND, Tsiros MD, Hinkley T, Vella S, Lubans DR, et al. Associations between objectively measured sedentary behaviour and adiposity in children and adolescents: Systematic review and meta-analysis. J Sci Med Sport. 2014;18:e154–e.
  81. 81. Teychenne M, Hinkley T. Associations between Screen-Based Sedentary Behaviour and Anxiety Symptoms in Mothers with Young Children. PLoS One. 2016;11(5):e0155696. pmid:27191953.
  82. 82. Zhai L, Zhang Y, Zhang D. Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med. 2015;49(11):705–9. pmid:25183627.
  83. 83. Sanchez-Villegas A, Ara I, Guillen-Grima F, Bes-Rastrollo M, Varo-Cenarruzabeitia JJ, Martinez-Gonzalez MA. Physical activity, sedentary index, and mental disorders in the SUN cohort study. Med Sci Sports Exerc. 2008;40(5):827–34. pmid:18408617.
  84. 84. Kirkorian HL, Pempek TA, Murphy LA, Schmidt ME, Anderson DR. The impact of background television on parent-child interaction. Child Dev. 2009;80(5):1350–9. pmid:19765004.
  85. 85. Cespedes EM, Gillman MW, Kleinman K, Rifas-Shiman SL, Redline S, Taveras EM. Television viewing, bedroom television, and sleep duration from infancy to mid-childhood. Pediatr. 2014;133(5):e1163–e71. 2014-19250-002. pmid:24733878
  86. 86. Magee CA, Lee JK, Vella SA. Bidirectional relationships between sleep duration and screen time in early childhood. JAMA Pediatr. 2014;168(5):465–70 6p. pmid:24589672. Language: English. Entry Date: 20140704. Revision Date: 20150710. Publication Type: Journal Article.
  87. 87. Marinelli M, Sunyer J, Alvarez-Pedrerol M, Iñiguez C, Torrent M, Vioque J, et al. Hours of television viewing and sleep duration in children: a multicenter birth cohort study. JAMA Pediatr. 2014;168(5):458–64 7p. pmid:24615283. Language: English. Entry Date: 20140704. Revision Date: 20150710. Publication Type: Journal Article.
  88. 88. Dworak M, Schierl T, Bruns T, Struder HK. Impact of singular excessive computer game and television exposure on sleep patterns and memory performance of school-aged children. Pediatr. 2007;120(5):978–85. pmid:17974734.
  89. 89. Australian Bureau of Statistics. 4442.0—Family Characteristics and Transitions, Australia, 2012–13. Canberra, Australia: Australian Bureau of Statistics, 2015 June 2015. Report No.
  90. 90. Robinson TN. Stealth interventions for obesity prevention and control: motivating behavior change. In: Dubé L, Bechara A, Dagher A, Drewnowski A, Lebel J, James P, et al., editors. Obesity Prevention: The Role of Brain and Society on Individual Behavior. New York: Elsevier; 2010.
  91. 91. Evans CA, Jordan AB, Horner J. Only two hours?: A qualitative study of the challenges parents perceive in restricting child television time. J Fam Issues. 2011;32(9):1223.