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Is there a link between autism and handheld electronic devices in Cambodia?

Dr. J.Bhoomikumar / Share:

Many studies report ‘autism like symptoms’ in toddlers when exposed to electronic devices over significant amount of time during the day. All over the world use of smartphones, tablets, electronic games and other handheld screens have increased significantly and some children are introduced to these devices even before they begin to talk. Developmental pediatricians, neurologists, physicians and mental health professionals are concerned about the exposure of young brains to handheld and other electronic devises. Does exposure to electronic devises cause autism? The jury is not out yet on this very important concern, but exposure to electronic devises may trigger symptoms akin to autism spectrum disorder (ASD) in genetically vulnerable individuals.  A study from US cautions that though children with ASD did not differ in their screen time habits compared to other children, better to follow the screen time recommendations of American Academy of Pediatrics.

Most children are exposed to TV or mobile apps/ games even before 18 months. In a survey among parents in a high-income country, 92% of one-year old children have already used a mobile device, some of them starting as early as 4 months. A recent research indicates the children who are exposed to electronic-screens early in life are at higher risk for speech delays.  This is of concern, particularly in low and middle income countries (LMICs) such as Cambodia, where parents are unware of the negative impact of early exposure to hand held electronic devises (HHEDs). A study from Indonesia revealed that those children who were exposure to electronic gadgets more than 3 hours per day had language delay, short attention span, and hyperactivity, all of which are also common in children with ASD. The authors found that these children had no parents-child interaction during the exposure to screen time, -meaning children were left with the devices (baby-sitter?!) alone .


Electronic- screen-time use is associated with language delay in young children

In a study conducted among 894 children (6 months to 2 years) in Canada, the parents reported, 20% of the children at 18 months of age had used the handheld devices for an average of 28 minutes. The researchers found more screen time the child was exposed to, more likely for the child to suffer from expressive speech delay. There is a dose-response relationship, -meaning each 30-minute exposure to handheld screen time, increased the risk of expressive speech delay by 49% . Interestingly, many caregivers, particularly grandparents who accompany children to our center , had observed giving HHEDs early on (less than 4 months of age) delays development of language and after stopping or reducing the screen time, the language abilities improved.


Electronic- screen-time interferes with the development of relational-neuronal-network

Many parents say that their baby likes and even enjoys the bright colors and motion on the screen. But their young brains are incapable of making sense or meaning out of all those bizarre pictures. It takes around 18 months for the baby’s brain to understand the symbols on a screen. What infants and toddlers need most to learn a language is interaction with the people around them, particularly the emotional expressions of their immediate care giver. Children learn a lot more from banging pans on the floor while mother is cooking than he/she does from watching a screen for the same amount of time, because every now and then the two (mother and child) look at each other. Normally a parent speaks about 940 words per hour when a toddler is around, but when the television is on, the number of spoken words falls to 770! Fewer words means less learning. Toddlers exposed to prolonged TV-time are more likely to have problems paying attention at age 7. Video programs constantly change and are fast, therefore the young growing brain is easily conditioned to not paying attention to human expressions that are slower than the commercials/ advertisements on TV.

The problem lies not only with what toddlers are experience while they watch TV, but also what they miss because of over exposure to hand-held-electronic and other screen-devices. Children’s brain is biologically programmed to learn from interacting with other people. The dance of facial expressions, tone of voice, and body language between a toddler and parent is not only beautiful, but it’s stimulating and promotes development of new neural networks. Whenever a child or parent is watching TV, this unique interactional-exchange comes to a halt, thereby depriving the child the opportunity to develop its ‘relational-neuronal-network’. Screen viewing before age 18 months not only has lasting negative effects on children’s language development, reading skills, and short-term memory but also contributes to problems with sleep and attention.

The American Academy of Pediatrics has the following recommendations (4 Ms) with regard to screen time and children.

Minimize screen time:

  • Screen time for children younger than 2 years is not recommended.
  • For children 2 to 5 years, limit routine or regular screen time to less than 1 hour per day.
  • Ensure that sedentary screen time is not a routine of children below 5 years.
  • Maintain daily ‘screen-free’ times, especially during family meal time
  • Avoid screens 1 hour before bedtime

Mitigate the risks associated with screen time:

  • Be present and engaged when screens are used, and co-view with children.
  • Be aware of content and prioritize educational, age-appropriate and interactive programs.
  • Use parenting strategies that teach self-regulation, calming and limit-setting.

Mindful about the use of screen time, as a family:

  • Develop a ‘family-screen-time-routine’ , -when, how and where screens may (and may not) be used.
  • Help children recognize and question advertising messages, and other problematic content.
  • Remember: too much screen time means lost opportunities for teaching and learning.


Modeling healthy screen use by adults:

  • Choose healthy alternatives, such as reading, outdoor play and creative, hands-on activities.
  • Turn off the electronic devices at home during family time.
  • Turn off screens when not in use and avoid background TV.

2nd April has been declared by the United Nations as Autism Awareness Day. To highlight the issues related to ASD and other risk factors including the use of hand-held electronic devices, the Center for Child and Adolescent Mental Health (CCAMH), located within the campus of Chey Chumneas Hospital, Takhmau, Kandal province organizes the ‘World Autism Awareness Week’ every year in the month of April.


Dr. J.Bhoomikumar

MBBS;DPM;DCH; DPH (India); DCAP (UK); MPH; PhD (Sweden)

Director and Consultant Child Psychiatrist

Center for Child and Adolescent Mental Health (Caritas-CCAMH)

Chey Chumneas Referral Hospital

National Road No. 2, Takhmau, Kandal Province

Office Phone: (+855) 23 983 348, HP: (+855) 12 482 854

E-mail: [email protected]


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