家庭养育环境在早期屏幕暴露与高危幼儿ASD样行为间的中介效应

Mediating effect of family nurturing environment on the association between early screen exposure and autism spectrum disorder-like behavior in high-risk children

摘要

目的 探究屏幕暴露对幼儿孤独症谱系障碍(ASD)样行为的影响,了解家庭养育环境在其中的中介作用,为幼儿ASD样行为的干预提供参考。方法 2024年1—12月,以在合肥市妇女儿童保健中心儿童心理保健科接受复筛的377名18～35月龄幼儿为研究对象,采用问卷调查收集幼儿基本信息及屏幕暴露情况,采用婴幼儿孤独症行为量表(ABC)评估ASD样行为,使用1～3岁儿童家庭养育环境问卷(城市版)评估儿童家庭养育环境。采用logistic回归分析屏幕暴露与幼儿ASD样行为的关联。此外,应用结构方程模型检验家庭养育环境在屏幕暴露与幼儿ASD样行为之间的中介效应。结果 377名高危幼儿中有96名(25.5%)被评估为ASD样行为;182名(48.3%)存在早期高屏幕暴露;家庭养育环境量表总分平均为(131±19.63)分。与无ASD样行为幼儿相比较,ASD样行为幼儿高屏幕暴露比例更高、家庭养育环境中的社会适应/自理维度得分更低(P均<0.05)。logistic回归分析表明高屏幕暴露是幼儿ASD样行为的危险因素(OR=1.710,95%CI:1.055～2.771,P=0.029)。家庭养育环境中社会适应/自理维度在屏幕暴露与幼儿ASD样行为的关联中发挥完全中介效应(间接效应显著,95%CI:0.001~0.042)。结论 家庭养育环境中的社会适应/自理维度在屏幕暴露与高危幼儿ASD样行为之间起完全中介作用。优化家庭养育环境,特别是提升社会适应/自理维度的养育质量,有助于缓解屏幕暴露对幼儿ASD样行为的不良影响。

Abstract

Objective To explore the association between early screen exposure and autism spectrum disorder (ASD)-like behavior in high-risk toddlers, and to examine the mediating role of the family nurturing environment, so as to provide evidence for early intervention of ASD-like behavior. Methods A total of 377 high-risk toddlers aged 18 to 35 months, who underwent re-screening at the Hefei Women and Children′s Health Center from January to December 2024, were enrolled.Data on basic information and screen exposure were collected via questionnaires.ASD-like behavior was assessed using the Autism Behavior Checklist (ABC), and the family nurturing environment was evaluated using the 1-3 Year Old Children′s Family Nurturing Environment Questionnaire (Urban Version).Logistic regression was used to analyze the association between screen exposure and ASD-like behavior.The mediating effect of the family nurturing environment was tested using Structural Equation Modeling (SEM). Results Among the 377 high-risk toddlers, 96 (25.5%) exhibited ASD-like behavior, and 182 (48.3%) had high screen exposure.The average total score of the Family Nurturing Environment Scale is (131±19.63).Compared with children without ASD-like behavior, those with ASD-like behavior had a significantly higher rate of high screen exposure and lower scores in the social adaptation/self-care dimension of the family nurturing environment (both P<0.05).Logistic regression analysis showed that high screen exposure was a risk factor for ASD-like behavior (OR=1.710, 95%CI: 1.055 - 2.771, P=0.029).Mediation analysis revealed that the social adaptation/self-care dimension of the family nurturing environment played a full mediating role between screen exposure and ASD-like behavior (significant indirect effect, 95%CI: 0.001 - 0.042). Conclusions The social adaptation/self-care dimension of the family nurturing environment fully mediates the relationship between early screen exposure and ASD-like behavior in high-risk toddlers.Optimizing the family nurturing environment, particularly enhancing the quality of parenting in the social adaptation/self-care dimension, may help alleviate the adverse effects of screen exposure on ASD-like behavior in young children.

关键词

屏幕暴露 / 家庭养育环境 / ASD样行为 / 中介效应 / 幼儿

Key words

screen exposure / family nurturing environment / autism spectrum disorder like behavior / mediation effect / infant

[1] Genovese A, Butler MG.Clinical assessment, genetics, and treatment approaches in autism spectrum disorder (ASD)[J].Int J Mol Sci, 2020, 21(13):4726.
[2] Shaw KA, Williams S, Patrick ME, et al.Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years - Autism and developmental disabilities monitoring network, 16 sites, united states, 2022[J].MMWR Surveill Summ, 2025, 74(2):1-22.
[3] 赵亚楠,李智文,李琳,等.中国0～6岁儿童孤独症谱系障碍筛查患病现状[J].中国生育健康杂志,2023,34(5):423-428.
Zhao YN, Li ZW, Li L, et al. The prevalence of ASD screening in children aged 0 - 6 years old in China[J]. Chinese Journal of Reproductive Health, 2023, 34(5):423-428.(in Chinese)
[4] Chen JY, Strodl E, Wu CA, et al.Screen time and autistic-like behaviors among preschool children in China[J].Psychol Health Med, 2020, 26(5):11-14.
[5] Kushima M, Kojima R, Shinohara R, et al.Association between screen time exposure in children at 1 year of age and autism spectrum disorder at 3 years of age: The Japan environment and children′s study[J].JAMA Pediatr, 2022,176(4):384-191.
[6] Vanderloo LM.Screen-viewing among preschoolers in childcare: A systematic review[J].BMC Pediatr, 2014, 14:205.
[7] Massaroni V, Donne DV, Marra C, et al.The relationship between language and technology: How screen time affects language development in early life - A systematic review[J].Brain Sci, 2023, 14(1):27.
[8] Law EC, Han MX, Lai Z, et al.Associations between infant screen use, electroencephalography markers, and cognitive outcomes[J].JAMA Pediatr, 2023, 177(3):311-318.
[9] Hutton JS, Dudley J, Horowitz-Kraus T, et al.Differences in functional brain network connectivity during stories pre-sented in audio, illustrated, and animated format in preschool-age children[J].Brain Imaging Behav, 2020, 14(1):130-141.
[10] Brushe ME, Haag DG, Melhuish EC, et al.Screen time and parent-child talk when children are aged 12 to 36 months[J].JAMA Pediatr, 2024, 178(4):369-375.
[11] Kuenzel E, Seguin D, Nicolson R, et al.Early adversity and positive parenting: Association with cognitive outcomes in children with autism spectrum disorder[J].Autism Res, 2021, 14(12):2654-2662.
[12] 钱晟,徐勇,颜博秋,等.家庭养育环境与儿童孤独症特质的关系[J].中国儿童保健杂志,2020,28(1):82-85.
Qian S, Xu Y, Yan BQ, et al. Association between child rearing environment and autistic traits[J]. Chin J Child Health Care, 2020, 28(1):82-85.(in Chinese)
[13] 杨帆,李庆红,李翌鸣,等.孤独症谱系障碍儿童屏幕使用现状及其与核心症状的相关性[J].中国儿童保健杂志,2024,32(10):1080-1084,1110.
Yang F, Li QH, LiYM, et al. Status of screen use and its association with core symptoms in children with autism spectrum disorder[J]. Chin J Child Health Care, 2024, 32(10):1080-1084,1110.(in Chinese)
[14] Guidelines onphysical activity, sedentary behaviour and sleep for children under 5 years of age[M].Geneva: World Health Organization, 2019.
[15] 赵文华,李可基.中国人群身体活动指南(2021)[J].中国慢性病预防与控制,2022,30(1):1-2.
Zhao WH, Li KJ.Physical activity guidelines for Chinese(2021)[J].Chin J Prev Contr Chron Dis, 2022, 30(1):1-2.(in Chinese)
[16] 杨玉凤.儿童发育行为心理评定量表[M].2版.北京:人民卫生出版社, 2023:423-424.
[17] 何守森,汪翼,关春荣,等.城市1～3岁儿童家庭养育环境量表的编制及其信度效度研究[J].中国儿童保健杂志,2008,16(6):650-652.
He SS, Wang Y, Guan CR, et al. 1～3 years Child Home Environment Scales: Development, reliability and validity[J]. Chin J Child Health Care, 2008, 16 (6):650-652.(in Chinese)
[18] Chen L, Wang Y, Wu Z, et al.Four-dimensional mapping of dynamic longitudinal brain subcortical development and early learning functions in infants[J].Nat Commun, 2023, 14(1):3727.
[19] Hutton JS, Dudley J, Horowitz-Kraus T, et al.Associations between screen-based media use and brain white matter integrity in preschool-aged children[J].JAMA Pediatr, 2019, 174(1):e193869.
[20] Qu G, Hu W, Meng J, et al.Association between screen time and developmental and behavioral problems among children in the United States: Evidence from 2018 to 2020 NSCH[J].J Psychiatr Res, 2023, 161:140-149.
[21] Ni′matuzahroh, Suen MW, Ningrum V, et al.The Association betweenparenting stress, positive reappraisal coping, and quality of life in parents with autism spectrum disorder (ASD) children: A systematic review[J].Healthcare (Basel).2021,10(1):52.
[22] Khalsa AS, Andridge R, Keim SA, et al.Screen time, outdoor play, and sleep routines in early childhood: Longitudinal associations with parenting stress during toddler to preschool years[J].J Pediatr Health Care.2024, 38(6):794-803.
[23] Heffler KF, Sienko DM, Subedi K, et al.Association of early-life social and digital media experiences with development of autism spectrum disorder-like symptoms[J].JAMA Pediatr, 2020, 174(7):690-696.
[24] Edmunds SR, Kover ST, Stone WL.The relation between parent verbal responsiveness and child communication in young children with or at risk for autism spectrum disorder: A systematic review and meta-analysis[J].Autism Res, 2019, 12(5):715-731.
[25] Vess SF, Campbell JM.Parent-child interaction therapy (PCIT) with families of children with autism spectrum disorder[J].Autism Dev Lang Impair, 2022, 7:2396941522 1140707.
[26] 刘桂华,欧萍,黄龙生,等.亲子绘画和创意手工疗法对学龄前期孤独症谱系障碍儿童及其母亲效果评价的前瞻性随机对照研究[J].中国当代儿科杂志,2021,23(8):779-785.
Liu GH, Ou P, Huang LS, et al. Effects of parent-child painting and creative crafting therapy on preschool children with autism spectrum disorder and their mothers: A prospective randomized controlled trial[J]. Chin J Contemp Pediatr, 2021, 23(8):779-785.(in Chinese)
[27] Chi IJ, Lin LY.Relationship between the performance of self-care and visual perception among young children with autism spectrum disorder and typical developing children[J].Autism Res.2021, 14(2):315-323.
[28] Bradshaw J, McCracken C, Pileggi M, et al.Early social communication development in infants with autism spectrum disorder[J].Child Dev,2021,92(6):2224-2234.
[29] Bal VH, Kim SH, Cheong D, et al.Daily living skills in individuals with autism spectrum disorder from 2 to 21 years of age[J].Autism, 2015, 19(7):774-784.
[30] Dong HY, Feng JY, Wang B, et al.Screen time and autism: Current situation and risk factors for screen time among pre-school children with ASD[J].Front Psychiatry, 2021, 12:675902.
[31] Méndez Leal AS, Silvers JA.Neurobiological markers of resilience to early life adversity during adolescence[J].Biol Psychiatry Cogn Neurosci Neuroimaging, 2021, 6(2):238-247.
[32] Tu K, Shen C, Luo Y, et al.The relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants: The mediating role of shared viewing and parent-child conversation[J].PLoS One, 2024, 19(1):e0296356.
[33] Yuan JJ, Zhao YN, Lan XY, et al.Prenatal, perinatal and parental risk factors for autism spectrum disorder in China: A case-control study[J].BMC Psychiatry, 2024, 24(1):219.

基金资助

合肥市卫生健康委员会2022年度应用医学重点项目(Hwk2022zd019)