Response inhibition in neurodiverse children and the association with excessive screen time use

Abstract

The aim of this study was to examine response inhibition using a gamified version of the Stroop task in a heterogeneous cohort of neurodiverse and neurotypical children, and to identify any key risk factors of screen time associated with performance-based measures of cognition. A total of 229 participants ages 3-16 (89 neurotypical children [54% boys] 90 children with ADHD [51% boys], and 50 children with ASD [72% boys]) were recruited to the study. Using a validated online cognitive battery, participants completed the Stroop task. Parents completed questionnaires regarding children’s screen time use (passive TV watching, social media, video games), sleep, daily/weekly physical activities, socializing, reading, and extracurricular activities. Very few children in the study met national guidelines for screentime, regardless of their neurodiagnostic group (X²=3.71, p=0.16). Based on a multivariate model, performance on congruent and incongruent trials on the Stroop task were comparable between the groups, however autistic children were more likely to make more attempts on the tasks (F(2)=4.35, p=0.014), indicative of reduced impulse control. In a subsequent model examining screen time and other lifestyle factors in relation to performance on the Stroop task, increased video game use was a significant predictor of more attempts. An interaction analysis revealed that only autistic children who spent more time playing video games used more attempts on the Stroop task (B=0.095, p<0.001). Conclusion: Autistic children demonstrated reduced impulse control compared to neurotypical children and children with ADHD. Further, time spent playing video games was associated with decreased response inhibition only in autistic children. Findings indicate that screen time use, particularly video games, may be a modifiable risk factor for response inhibition processes in autistic children. Findings could inform school- or community-based programs focused on screen time awareness and monitoring screen time use in neurodiverse children.