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  • Clinical Research Article
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Screen time is a predictor of cognitive function in children with attention deficit hyperactivity disorder

Pediatric Research (2025)Cite this article

Abstract

Background

Screen exposure may affect cognitive function in children with attention deficit hyperactivity disorder (ADHD). We aimed to investigate the relationship between screen time and cognitive function in children with ADHD and explore other risk factors for cognitive function.

Methods

The study included 184 patients with ADHD (aged 6–16 years). Socioeconomic and demographic information was collected. We assessed the core symptoms of ADHD, intelligence quotient (IQ), cognitive function (using the Das-Naglieri cognitive assessment system [DN:CAS] Chinese version), and screen time per day. Multiple linear regression was used to evaluate the factors associated with DN:CAS subscales.

Results

A higher full IQ (p < 0.001), shorter screen time per day (p < 0.001), and higher maternal education level (p = 0.029) were predictors of better scores on the DN:CAS full scale.

Conclusion

IQ, screen time, and maternal education are predictors of cognitive function in children and adolescents with ADHD. Hence, parents should understand the importance of controlling their children’s screen time to enhance their cognitive function.

Impact

  • IQ, screen time, and maternal education are predictors of cognitive function in children and adolescents with ADHD. Thus, parents should understand the importance of controlling their children’s screen time to enhance their cognitive function.

  • Our application of DN:CAS as a cognitive assessment tool is advantageous compared to the Wechsler intelligence test. The DN:CAS Chinese version is a theory-driven assessment kit, developed based on the PASS (planning, attention, simultaneous, and successive) theory assessing cognitive function. The PASS theory is an example of a terminal cognitive processing theory based on the view of functional regions of brain operation and cognitive psychology.

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Data availability

Deidentified individual participant data (including data dictionaries) will be made available, in addition to study protocols, the statistical analysis plan, and the informed consent form. The data will be made available upon publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. Proposals should be submitted to donghanyu@jlu.edu.cn or yuexj@jlu.edu.cn.

References

  1. Baggio, S. et al. Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-Analysis. Front. Psychiatry 9, 331 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Raggi, V. L. & Chronis, A. M. Interventions to Address the Academic Impairment of Children and Adolescents with Adhd. Clin. Child Fam. Psychol. Rev. 9, 85–111 (2006).

    Article  PubMed  Google Scholar 

  3. Loe, I. M. & Feldman, H. M. Academic and Educational Outcomes of Children with Adhd. Ambul. Pediatrics 7, 82–90 (2007).

    Article  Google Scholar 

  4. Langley, K. et al. Adolescent Clinical Outcomes for Young People with Attention-Deficit Hyperactivity Disorder. Br. J. Psychiatry 196, 235–240 (2010).

    Article  PubMed  Google Scholar 

  5. Dalsgaard, S., Østergaard, S. D., Leckman, J. F., Mortensen, P. B. & Pedersen, M. G. Mortality in Children, Adolescents, and Adults with Attention Deficit Hyperactivity Disorder: A Nationwide Cohort Study. Lancet 385, 2190–2196 (2015).

    Article  PubMed  Google Scholar 

  6. Posner, J., Polanczyk, G. V. & Sonuga-Barke, E. Attention-Deficit Hyperactivity Disorder. Lancet 395, 450–462 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Thapar, A. & Cooper, M. Attention Deficit Hyperactivity Disorder. Lancet 387, 1240–1250 (2016).

    Article  PubMed  Google Scholar 

  8. Posner, J. et al. Dissociable Attentional and Affective Circuits in Medication-Naïve Children with Attention-Deficit/Hyperactivity Disorder. Psychiatry Res. 213, 24–30 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brown, T. E. Add/Adhd and Impaired Executive Function in Clinical Practice. Curr. Psychiatry Rep. 10, 407–411 (2008).

    Article  PubMed  Google Scholar 

  10. Barkley, R. A. Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing a Unifying Theory of Adhd. Psychol. Bull. 121, 65–94 (1997).

    Article  PubMed  Google Scholar 

  11. Coghill, D., Hayward, D., Rhodes, S., Grimmer, C. & Matthews, K. A Longitudinal Examination of Neuropsychological and Clinical Functioning in Boys with Attention Deficit Hyperactivity Disorder (Adhd): Improvements in Executive Functioning Do Not Explain Clinical Improvement. Psychological Med. 44, 1087–1099 (2014).

    Article  CAS  Google Scholar 

  12. Cortese, S. et al. Comparative Efficacy and Tolerability of Medications for Attention-Deficit Hyperactivity Disorder in Children, Adolescents, and Adults: A Systematic Review and Network Meta-Analysis. Lancet Psychiatry 5, 727–738 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Johnson, M. et al. Long-Term Medication for Adhd and Development of Cognitive Functions in Children and Adolescents. J. Psychiatr. Res. 142, 204–209 (2021).

    Article  PubMed  Google Scholar 

  14. Kim, S., Nordling, J. K., Yoon, J. E., Boldt, L. J. & Kochanska, G. Effortful Control in “Hot” and “Cool” Tasks Differentially Predicts Children’s Behavior Problems and Academic Performance. J. Abnorm. Child Psychol. 41, 43–56 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zhang, Z. et al. Associations between Screen Time and Cognitive Development in Preschoolers. Paediatr. Child Health 27, 105–110 (2022).

    Article  CAS  PubMed  Google Scholar 

  16. Vohr, B. R. et al. Association of High Screen-Time Use with School-Age Cognitive, Executive Function, and Behavior Outcomes in Extremely Preterm Children. JAMA Pediatrics 175, 1025–1034 (2021).

    Article  PubMed  Google Scholar 

  17. Lillard, A. S., Drell, M. B., Richey, E. M., Boguszewski, K. & Smith, E. D. Further Examination of the Immediate Impact of Television on Children’s Executive Function. Dev. Psychol. 51, 792–805 (2015).

    Article  PubMed  Google Scholar 

  18. Linebarger, D. L. & Walker, D. Infants’ and Toddlers’ Television Viewing and Language Outcomes. Am. Behav. Scientist 48, 624–645 (2005).

    Article  Google Scholar 

  19. Shaw, P. et al. Attention-Deficit/Hyperactivity Disorder Is Characterized by a Delay in Cortical Maturation. Proc. Natl. Acad. Sci. USA 104, 19649–19654 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Gallo, E. F. & Posner, J. Moving Towards Causality in Attention-Deficit Hyperactivity Disorder: Overview of Neural and Genetic Mechanisms. lancet Psychiatry 3, 555–567 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Dun, Y. et al. Reliability and Validity of the Chinese Version of the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version Dsm-5 (K-Sads-Pl-C Dsm-5). J. Affect. Disord. 317, 72–78 (2022).

    Article  PubMed  Google Scholar 

  22. Wolraich, M. L., Bard, D. E., Neas, B., Doffing, M. & Beck, L. The Psychometric Properties of the Vanderbilt Attention-Deficit Hyperactivity Disorder Diagnostic Teacher Rating Scale in a Community Population. J. Dev. Behav. Pediatrics 34, 83–93 (2013).

    Article  Google Scholar 

  23. Chambers, W. J. et al. The Assessment of Affective Disorders in Children and Adolescents by Semistructured Interview: Test-Retest Reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Episode Version. Arch. Gen. Psychiatry 42, 696–702 (1985).

    Article  CAS  PubMed  Google Scholar 

  24. Wolraich, M. L. et al. Psychometric Properties of the Vanderbilt Adhd Diagnostic Parent Rating Scale in a Referred Population. J. Pediatr. Psychol. 28, 559–567 (2003).

    Article  PubMed  Google Scholar 

  25. Wolraich, M. L. et al. Assessing the Impact of Parent and Teacher Agreement on Diagnosing Attention-Deficit Hyperactivity Disorder. J. Dev. Behav. Pediatrics 25, 41–47 (2004).

    Article  Google Scholar 

  26. Xiao, Z. H., Wang, Q. H., Luo, T. T. & Zhong, L. Diagnostic Value of Vanderbilt Adhd Parent Rating Scale in Attention Deficit Hyperactivity Disorder]. Zhongguo dang dai er ke za zhi Chin. J. Contemp. Pediatrics 15, 348–352 (2013).

    Google Scholar 

  27. Li, D., Jin, Y., Vandenberg, S. G., Zhu, Y. M. & Tang, C. H. Report on Shanghai Norms for the Chinese Translation of the Wechsler Intelligence Scale for Children-Revised. Psychological Rep. 67, 531–541 (1990).

    CAS  Google Scholar 

  28. Naglieri, J. A. & Das, J. J. Planning, Attention, Simultaneous, and Successive (Pass) Cognitive Processes as a Model for Intelligence. J. Psychoeducational Assess. 8, 303–337 (1990).

  29. Naglieri, J. A. & Das, J. P. J. J. O. S. P. Planning-Arousal-Simultaneous-Successive (Pass): A Model for. Assessment 26, 35–48 (1988).

    Google Scholar 

  30. Deng, C. P., Liu, M., Wei, W., Chan, R. C. & Das, J. P. Latent Factor Structure of the Das-Naglieri Cognitive Assessment System: A Confirmatory Factor Analysis in a Chinese Setting. Res Dev. Disabil. 32, 1988–1997 (2011).

    Article  PubMed  Google Scholar 

  31. Qin, L., Liu, H., Zhang, H., Fu, Y. & Li, D. Evaluation of the Diagnostic Implications of Das-Naglieri Cognitive Assessment System in Children with Attention Deficit Hyperactivity Disorder. BMC Psychiatry 18, 386 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dong, H. Y. et al. The Challenges of Screen Time in Children with Typical Development and Children with Developmental Disorders During Covid-19 Pandemic. Transl. Pediatrics 12, 977–990 (2023).

    Article  Google Scholar 

  33. McNeill, J., Howard, S. J., Vella, S. A. & Cliff, D. P. Longitudinal Associations of Electronic Application Use and Media Program Viewing with Cognitive and Psychosocial Development in Preschoolers. Acad. Pediatr. 19, 520–528 (2019).

    Article  PubMed  Google Scholar 

  34. Moshel, M. L., Warburton, W. A., Batchelor, J., Bennett, J. M. & Ko, K. Y. Neuropsychological Deficits in Disordered Screen Use Behaviours: A Systematic Review and Meta-Analysis. Neuropsychol. Rev. 34, 791–822 (2024).

    Article  PubMed  Google Scholar 

  35. Weinstein, A. M. Problematic Social Networking Site Use-Effects on Mental Health and the Brain. Front. Psychiatry 13, 1106004 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Likhitweerawong, N. et al. Executive Dysfunction as a Possible Mediator for the Association between Excessive Screen Time and Problematic Behaviors in Preschoolers. Plos One 19, e0298189 (2024).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Cliff, D. P., Howard, S. J., Radesky, J. S., McNeill, J. & Vella, S. A. Early Childhood Media Exposure and Self-Regulation: Bidirectional Longitudinal Associations. Acad. Pediatrics 18, 813–819 (2018).

    Article  Google Scholar 

  38. McHarg, G., Ribner, A. D., Devine, R. T. & Hughes, C. Screen Time and Executive Function in Toddlerhood: A Longitudinal Study. Front. Psychol. 11, 570392 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Carson, V., Rahman, A. A. & Wiebe, S. A. Associations of Subjectively and Objectively Measured Sedentary Behavior and Physical Activity with Cognitive Development in the Early Years. Ment. Health Phys. Act. 13, 1–8 (2017).

    Article  Google Scholar 

  40. Hutton, J. S., Dudley, J., Horowitz-Kraus, T., DeWitt, T. & Holland, S. K. Associations between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children. JAMA Pediatr. 174, e193869 (2020).

    Article  PubMed  Google Scholar 

  41. Murray, J. P. et al. Children’s Brain Activations While Viewing Televised Violence Revealed by Fmri. Media Psychol. 8, 25–37 (2006).

    Article  Google Scholar 

  42. Yang, A. et al. Longer Screen Time Utilization Is Associated with the Polygenic Risk for Attention-Deficit/Hyperactivity Disorder with Mediation by Brain White Matter Microstructure. EBioMedicine 80, 104039 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Clark, L. et al. Association between Response Inhibition and Working Memory in Adult Adhd: A Link to Right Frontal Cortex Pathology?. Biol. Psychiatry 61, 1395–1401 (2007).

    Article  PubMed  Google Scholar 

  44. Montagni, I., Guichard, E. & Kurth, T. Association of Screen Time with Self-Perceived Attention Problems and Hyperactivity Levels in French Students: A Cross-Sectional Study. BMJ Open 6, e009089 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  45. Das, J. P., Naglieri, J. A. & Kirby, J. R. Assessment of Cognitive Processes: The Pass Theory of Intelligence (Allyn & Bacon, 1994).

  46. Naglieri, J. A., De Lauder, B. Y., Goldstein, S. & Schwebech, A. Wisc-Iii and Cas: Which Correlates Higher with Achievement for a Clinical Sample?. Sch. Psychol. Q. 21, 62 (2006).

    Article  Google Scholar 

  47. Ceci, S. J. So near and yet So Far: Lingering Questions About the Use of Measures of General Intelligence for College Admission and Employment Screening. Psychol. Public Policy Law 6, 233 (2000).

    Article  Google Scholar 

  48. Susan, E., Reza, R. & Vahid, S. The Relationships between Wechsler Intelligence Scale for Children (Wisc-R) with the Cognitive Assessment System (Cas). Proc. Soc. Behav. Sci. 5, 1726–1730 (2010).

    Article  Google Scholar 

  49. Yunita, W. & Ramadhani, Y. Nutritional Status on the Cognitive Development of Early Childhood (5-6 Years) at Tkq/Tpq Al Hafiz Medan. Int. J. Public Health Excell. 3, 487–495 (2024).

    Google Scholar 

  50. Bartels, M., van Beijsterveldt, C. E. & Boomsma, D. I. Breastfeeding, Maternal Education and Cognitive Function: A Prospective Study in Twins. Behav. Genet. 39, 616–622 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Green, C. M. et al. Maternal Literacy and Associations between Education and the Cognitive Home Environment in Low-Income Families. Arch. Pediatrics Adolesc. Med. 163, 832–837 (2009).

    Article  Google Scholar 

  52. Wu, V. et al. Associations among Mothers’ Depression, Emotional and Learning-Material Support to Their Child, and Children’s Cognitive Functioning: A 16-Year Longitudinal Study. Child Dev. 90, 1952–1968 (2019).

    Article  PubMed  Google Scholar 

  53. Karonen, A. et al. Maternal Executive Functioning Is Associated with Infant Sustained Attention, but Not Executive Functioning, in a Sex-Specific Manner. Nord. Psychol. 76, 148–162 (2024).

    Article  Google Scholar 

  54. Jones, A. et al. Identifying Effective Intervention Strategies to Reduce Children’s Screen Time: A Systematic Review and Meta-Analysis. Int. J. Behav. Nutr. Phys. Act. 18, 1–20 (2021).

    Article  Google Scholar 

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Acknowledgements

The authors are deeply thankful to all the families who contributed their time to this study to better understand ADHD.

Funding

This work was supported by Youth Development Fund of the First Hospital of Jilin University (Grant No. JDYY14202328, 2023) and The Health Science and Technology ability improvement Project of Jilin Province (Grant number: 2023LC005).

Author information

Authors and Affiliations

  1. Department of Developmental and Behavioral Pediatrics, Children’s Medical Center, The First Hospital of Jilin University, Changchun, China

    Han-Yu Dong, Li-Li Wang, Miao-shui Bai, Lin Du & Xiao-Jing Yue

  2. The Child Health Clinical Research Center of Jilin Province, Changchun, China

    Han-Yu Dong, Li-Li Wang, Miao-shui Bai, Lin Du & Xiao-Jing Yue

Authors
  1. Han-Yu Dong
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  2. Li-Li Wang
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  3. Miao-shui Bai
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  4. Lin Du
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  5. Xiao-Jing Yue
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Contributions

H.D.: Conceptualization; Data curation; Formal analysis; Writing – original draft. L.W.: Investigation; Writing – original draft. L.D. and M.B.: Methodology; Project administration; Resources; Software; Supervision. X.Y.: Supervision; Validation; Visualization; Writing – review & editing. All authors critically reviewed and approved the final manuscript.

Corresponding author

Correspondence to Xiao-Jing Yue.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the first hospital of Jilin University.

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Informed consent was obtained from all subjects involved in the study.

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Dong, HY., Wang, LL., Bai, Ms. et al. Screen time is a predictor of cognitive function in children with attention deficit hyperactivity disorder. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04026-9

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  • DOI: https://doi.org/10.1038/s41390-025-04026-9

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