Speaker
Description
Background/Aim
Digital screen use has become routine in early childhood, raising concerns during a critical period of rapid brain development. Excessive screen exposure has been associated with difficulties in attention, language acquisition, and social interaction, and emerging evidence links prolonged exposure to autism-like behaviours in children without autism spectrum disorder, often termed pseudo-autism. However, evidence from low- and middle-income countries remains limited. This study aimed to determine the relationship between digital screen time exposure and autism-like symptoms among children aged 4–6 years in Nairobi County.
Methods
An analytical cross-sectional study was conducted between March and May 2026 among caregivers of children aged 4–6 years without prior neurodevelopmental diagnoses. Participants were recruited using stratified sampling from community and online platforms across Nairobi County. Data were collected using a sociodemographic questionnaire, a screen-time and caregiver awareness questionnaire, and the Social Communication Questionnaire (SCQ). Ethical approval was obtained from the Kenyatta National Hospital–University of Nairobi Ethics and Research Committee (KNH-UoN ERC), and a research permit was obtained from the National Commission for Science, Technology and Innovation (NACOSTI).
Results
A total of 219 children participated (mean age 5.0 years; 50.7% male). Mean daily screen exposure was 4.24 hours, and 81.7% exceeded the World Health Organization recommendation of one hour per day. The mean SCQ score was 9.44 (SD 5.39), while 35 children (16.0%) scored ≥15, indicating probable pseudo-autistic behaviours. In multivariable negative binomial regression, higher SCQ scores were independently associated with male sex (IRR 1.17, p=0.016), rare or absent supervision during screen use (IRR 1.29, p=0.003), and lower household income (IRR 0.77, p=0.004). Older age was protective (IRR 0.90, p=0.006). Each additional hour of daily screen time was associated with a 1.8% increase in SCQ score (IRR 1.018, p=0.035). Awareness of WHO screen-time guidelines was low, with only 34.2% of caregivers reporting awareness.
Conclusions
Autism-like symptoms were common among preschool children in Nairobi County, where screen exposure was high and often inadequately supervised. Although screen-time quantity demonstrated a statistically significant association with autism-like symptoms, the effect size was modest. In contrast, inadequate supervision during screen use emerged as a stronger predictor of elevated symptom scores. These findings suggest that the context and quality of screen use may be as important as the duration of exposure. Interventions promoting supervised, interactive screen use and improving caregiver awareness of screen-time guidelines may help support healthy social-communication development in early childhood.
Ethics Approval
KNH-UoN Ethics and Research Committee approval obtained; NACOSTI research permit granted.
Conflict of Interest
The author declares no commercial or financial conflicts of interest.
Funding No commercial funding was received for this study.