In 1999, the American Academy of Paediatricians issued guidelines to limit screen exposure in children less than 2 years of age and caution for under 5s in general. These recommendations were again ratified in 2011, although digital media has dramatically changed since then. However, there is little current research to show any detrimental effects of media use in such populations. In fact, interactive media screens are becoming part of children’s everyday life and they have increased participation in children with special needs and disabilities.

Following a special issue on the Zero to Three Journal published last March 2013, I will attempt to summarise their findings and possible implications for OTs working with younger children.

Traditional video Vs. Interactive screen media

Most studies on very young children have been carried out solely on the effects of ‘passive’ media (i.e. TVs, video and DVD players). The results appear conclusive, over the past ten years of research:

–          Background/foreground TV: Background TV (media directed at adults and older children) seems to affect attention, language development, reduces parent-child interactions and quality/ quantity of language directed to the younger child. In contrast, Foreground programmes directed to younger children does not seem to have such negative consequences, but young children (under 2) seem to learn better from real-life demonstrations or require higher number of repetitions from the same videos (this is called Video deficit).

–          Commercial videos and targeted programmes: it is now proven that some claims from programmes such as Baby Einstein or Brainy baby are not supported by evidence and at times are misleading altogether. Producers do not seem to be able to develop useful learning media programmes for under 2s, but older children seem to benefit from certain programmes. Sesame Street tops the list of favourite programmes for learning new concepts in pre-schoolers, especially from more deprived backgrounds. On the other hand, watching videos together with their parents and interactive questioning from the programmes looks like a promising way to develop new learning in the thinking and language areas.

Although there is quite limited research at the moment, experimental studies have shown that interactive computer games can be as helpful as face-to-face learning, and they are definitely more effective than passive media. Apparently, babies as young as 6 months can recognise familiar pictures on a screen, and there is plenty of anecdotal evidence from parents allowing their babies to use their touch screen devices with simple apps. These findings seem to support the thought that future uses of interactive media are likely to aid young children’s learning and skill development, but it might too early to come to any definite conclusions just yet.



What this means for OTs working with children with special needs:

Most parents continue to disregard the most recent advice from the AAP about ‘screen time’ for younger children, primarily due to positive memories of their childhood educational programmes (i.e. Sesame street) and also due to convenience within their family routines (i.e. keeping children busy while adults get on with chores). As a result, children are increasingly filling large chunks of their day engaged in interactions with screen devices, which are becoming more interactive and providing instant feedback on their actions and efforts.  OTs need to carefully consider how and when to facilitate participation and access to these activities as part of a child’s regular routine.

Advantages of digital media:

–          New technologies such as smart phones, games, tablets, interactive video chats and touch screens are making the child an active participant and increasing opportunities for disability access.

–          They are part of children’s everyday occupations and even younger children are now regular media consumers: OT can increase attention and motivation by using media that children are already familiar with.

–          Immediate feedback: interactivity and contingency are strategies known to promote learning in infants and toddlers.

–          Opportunities for learning: it can be part of our bag of tools to practice a variety of ‘traditional’ OT tasks, from letter formation on a screen to practicing hygiene tasks on a virtual child model.


–          General lack of evidence into the short and long term effects of interactive technologies on the children’s learning.

–          Transfer of learning to the real world: are children able to generalise the skills learned to other contexts? Are they able to use their newly acquired words or concepts in other settings such as the classroom?

–          Potential to limit the child’s natural interaction with people, especially if social communication difficulties are already present. Excessive preoccupation by technology can already be found in certain populations, such as ASD.

–          Consideration needs to be given to fine motor skills and visual/auditory perception in children with special needs. Alterations may be required for those children with physical/coordination difficulties and sensory impairments.

Any opinions / comments are welcomed. Do you regularly use any type of technology as part of your assessments/therapy sessions? What have you found more/less useful?

Watch out for an upcoming post on the use of iPads in education settings for children with special needs. Also, the last edition of our ebook will be available to download, in August 2013: Assistive Technology and AAC in the Classroom. An essential guide for OTs and SLTs working in paediatrics.

Want to find out more? Some sites:

Center for Media and Health:

Common Sense Media:

Joan Ganz Cooney Center at Sesame Street:

Fred Rogers Center for Early Learning and Children’s Media at St. Vincent College:

Book: Screen Time: How Electronic Media – from baby videos to educational software – Affects Your Young Child. L Guernsey (2012). New York, N.Y: Basic Books.

Photo Credit: <a href=””>Alfredi</a&gt; via <a href=””>Compfight</a&gt; <a href=”″>cc</a&gt;


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