Summary:
Screen use among infants and young children has increased substantially in recent years, often exceeding recommended limits. Given that the first years of life are a critical period for brain maturation, there is growing concern about how early exposure to screens may influence neurodevelopment and mental health outcomes. There is emerging evidence linking screen use to behavioural outcomes such as poor attention and emotional regulation. However, evidence examining how early screen exposure shapes brain development trajectories and mental health outcomes remains limited. To address this gap, this longitudinal cohort study used data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort to examine whether infant screen time is associated with adolescent anxiety through intermediate effects on brain network development and decision-making behaviour. The study included 168 children using repeated measures of brain imaging, behavioural assessment, and mental health outcomes across childhood and adolescence. Infant screen time was assessed at ages 1 and 2 years using parent-reported questionnaires. Brain network development was measured using MRIs at 4.5, 6.0, and 7.5 years of age. Decision-making performance was assessed at 8.5 years of age and anxiety symptoms were measured at 13 years of age. Higher infant screen time was associated with a decline in visual and cognitive neural networks across childhood. These altered developmental milestones were associated with slower decision-making at 8.5 years, which in turn was linked to higher anxiety symptoms in adolescence. This significant indirect pathway that was observed suggests that early screen exposure may influence anxiety through its impact on brain maturation and subsequent decision-making processes. Overall, this study suggests that infant screen exposure may be associated with altered development of neural networks involved in sensory and cognitive control processes, with secondary effects on decision-making and adolescent anxiety.
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Abstract:
Background: Infant screen time is linked to many negative outcomes, including anxiety, but the underlying neural correlates and pathways remains understudied. We aimed to assess the directional association between infant screen time, development of brain network topology, decision-making behaviour and anxiety symptoms in adolescence. Methods: Using data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study, we examined the effects of total daily screen time for infants on developmental outcomes using structural equation modelling. Specifically, we looked at the developmental slopes of network integration for the seven major brain cortical networks between ages 4.5, 6.0, and 7.5, decision-making behaviour assessed using the Cambridge Gambling Task (CGT) and anxiety symptoms assessed using the Multidimensional Anxiety Scale for Children, 2nd Edition (MASC). This study included 168 children from the GUSTO cohort with data on infant screen time (ages 1–2), diffusion MRI (ages 4.5–7.5), data on decision-making performance (CGT at age 8.5), and anxiety symptoms (MASC at age 13). Brain network integration was derived from diffusion MRI and each participant’s developmental slopes were modelled using latent growth models. Structural equation modelling assessed pathways linking early screen time to adolescent anxiety, mediated by brain network development and decision-making. Findings: Higher infant screen time was associated with a steeper decline in visual-cognitive control network integration from ages 4.5–7.5 years (β = −1.03 (−1.61, −0.46)), which mediated increased CGT deliberation time at age 8.5. Deliberation time, in turn, was associated with greater anxiety symptoms at age 13. A full serial mediation pathway was significant, linking infant screen time to later anxiety via accelerated brain network maturation and decision-making behaviour (β = 0.033 (0.002, 0.160)). Interpretation: Higher infant screen time is linked to accelerated topological maturation of the visual and cognitive control networks, leading to prolonged decision latency and increased adolescent anxiety. Sensory processing impairment may underlie this novel neurodevelopmental pathway, highlighting a potential target for early intervention.
Article Publication Date: 29/12/2025
DOI: 10.1016/j.ebiom.2025.106093
