107 - Association between Television Viewing Time and ADHD Risk in Children: Effect Modification by Type of Daytime Caregiver-A National Longitudinal Cohort Study in Taiwan

Publication Number: 1099.107

YenTing Chen, National Taiwan University Children's Hospital, Taipei, Taipei, Taiwan (Republic of China); Chi-Nien Chen, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Hsinchu, Taiwan (Republic of China)

Background: Evidence linking screen time to attention-deficit/hyperactivity disorder (ADHD) has been inconsistent, reflecting its multifaceted nature. As screen exposure has become nearly unavoidable, and parenting guidelines largely focus on monitoring duration and content, clarifying these relationships remains an important public-health concern. The caregiving environment-a key determinant of media use and child neurodevelopment-may influence the association between television viewing and ADHD risk.

Objective: To examine the longitudinal association between television viewing duration at age 3 and ADHD risk at age 12, and whether this association varies by caregiving environment.

Design/Methods: We analyzed data from the Taiwan Birth Cohort Study, which was linked to the National Health Insurance Research Database (NHIRD), and included children born in 2005 and followed up to 2017 (age 12). ADHD was defined in the NHIRD as ≥3 outpatient visits or ≥1 hospitalization with an ADHD diagnosis. TV viewing was grouped into 0-1, 1-2, 2-3, and ≥3 hours per day, with 0-1 hours as the reference group, and daytime caregivers categorized as babysitter, parent, grandparent, or kindergarten. Confounding factors, including prenatal and socioeconomic variables, were selected a priori from established risk factors, and participants with missing data were excluded. Multivariable logistic regression was used to estimate the risk of ADHD.

Results: A total of 17,283 children were included in the analysis; 1,274 (7.4%) had a diagnosis of ADHD at 12 years of age (Figure 1, Table 1). Overall, longer television viewing duration (more than 3 hrs) alone was not significantly associated with ADHD risk (aOR, 0.94; 95% CI, 0.77-1.14) compared with TV viewing duration for 0-1 hrs (Table 2). In stratified analyses by daytime caregiver, children attending kindergarten who watched more than 3 hours of television daily had a higher risk of ADHD (aOR, 1.73; 95% CI, 1.43-2.43), whereas those cared for by parents who watched 2-3 hours daily had a lower risk (aOR, 0.64; 95% CI, 0.44-0.92). This association remained significant after adjustment for confounding factors.

Conclusion(s): Television viewing duration alone was not associated with ADHD risk, but caregiving context may modify this relationship. These findings suggest refinement of current duration-based paradigms by highlighting the contextual nature of early screen exposure in ADHD. Guidance on screen use may benefit from incorporating caregiving quality and supervision, and further analyses were conducted to explore pathways linking caregiving context, screen exposure, and subsequent ADHD risk.

Figure 1. Flow chart of study participants
1. TBCS, Taiwan Birth Cohort Study; a nationwide, population-based cohort study.
2. NHIRD, National Health Insurance Research Database, which covers over 99% of Taiwan's 23-million population.

Table 1. Demographic characteristics of participants according to TV watching hours.
* p < 0.05; ** p < 0.01; *** p < 0.001 (by chi-square test).

Table 2. Association between daily television viewing time and risk of ADHD, including subgroup analysis by daytime caregiver.
*Adjusted by gender, delivery mode, maternal childbearing age more than 34 years, preterm, maternal educational level, maternal gestational diabetes, maternal hypertensive disorder during pregnancy, maternal nationality, maternal pre-pregnancy BMI status, family income, maternal smoking during pregnancy, daily home smoking exposure after birth, living area urbanicity, breast feeding duration, accompanying while watching TV, and primary caregiver at daytime.

#Adjusted by gender, delivery mode, maternal childbearing age more than 34 years, preterm, maternal educational level, maternal gestational diabetes, maternal hypertensive disorder during pregnancy, maternal nationality, maternal pre-pregnancy BMI status, family income, maternal smoking during pregnancy, daily home smoking exposure after birth, living area urbanicity, breast feeding duration, and accompanying while watching TV.