See discussions, stats, and author profiles for this publication at: [Link]

net/publication/384569527

"Virtual autism" or Autism? How can we prevent misdiagnosis?

Thesis · October 2024

DOI: 10.13140/RG.2.2.24090.86728

CITATIONS READS

0 281

1 author:

Walaa Musawi
Birkbeck, University of London
3 PUBLICATIONS 0 CITATIONS

SEE PROFILE

All content following this page was uploaded by Walaa Musawi on 02 October 2024.

The user has requested enhancement of the downloaded file.

“Virtual autism” or Autism? How can we prevent misdiagnosis?

MA Brain and Cognitive Development of Birkbeck University of London

Walaa Almusawi

Supervised by: Professor Denis Mareschal

Submitted on: August / 2024

0
 “Virtual autism” or Autism? How can we prevent misdiagnosis?

Walaa Almusawi

Supervised by: Professor Denis Mareschal

Abstract

Extensive research indicates a potential link between early exposure to digital media and children's
behavioral, developmental, and cognitive issues. Some experts have proposed the idea of "virtual
autism," suggesting that the widespread presence of autism spectrum disorder could result in
misdiagnoses, as many children may exhibit autism-like symptoms when exposed to digital media. This
study seeks to examine existing research on digital addiction and its potential connection to autism-like
symptoms to provide a comprehensive overview and propose a strategy to prevent misdiagnoses. The
findings indicate that prolonged and early exposure to various screens can impact cognitive and
language development and result in like-autism symptoms. Furthermore, interventions involving the
removal of screens and digital content have been shown to mitigate autism-like symptoms and enhance
overall mental well-being, as well as address sleep and nutritional issues. Finally, a proposed plan aims
to implement interventions with minimal risk and maximum benefits, such as electronic fasting or
digital detoxification.

Key words: virtual autism, screen exposure, autism-like symptoms, misdiagnose

1
Contents
Abstract ................................................................................................................................ 1
Introduction .......................................................................................................................... 3
Research question ............................................................................................................... 4
Search strategy and Eligibility criteria .................................................................................. 5
What is the media? ................................................................................................................ 6
Foreground media and background media ............................................................................ 6
Leisure noise and white noise (noise pollution) as a background media ................................... 7
Electronic toys .................................................................................................................... 9
Educational programs ......................................................................................................... 9
Disorders related to screen exposure ..................................................................................... 11
Impaired self-regulation ................................................................................................... 11
Impaired cognitive development ....................................................................................... 12
Language delay ................................................................................................................ 12
Obesity and Sleep disorder ............................................................................................... 14
Electronic Screen Syndrome (ESS) ....................................................................................... 15
Intensive early screen exposure and autism ........................................................................... 17
Virtual autism as an emerging clinical phenomenon .............................................................. 18
Electronic detoxification....................................................................................................... 20
How can we stop misdiagnosing? .......................................................................................... 20
Conclusion........................................................................................................................... 21
Intervention proposal: Digital Detoxification Protocol ........................................................... 22
Abstract .............................................................................................................................. 22
Introduction ........................................................................................................................ 23
Implications and benefits of digital detoxification protocol .................................................... 24
Digital detoxification protocol .............................................................................................. 25
Participants: .................................................................................................................... 25
Study Design: ................................................................................................................... 25
Intervention: .................................................................................................................... 26
Control Group: ................................................................................................................ 26
Data Collection: ............................................................................................................... 26
Follow-Up Assessments: ................................................................................................... 27
Data Analysis: .................................................................................................................. 27
Ethical Considerations: .................................................................................................... 27
Significance and possible outcomes ....................................................................................... 27
Limitations .......................................................................................................................... 28
References ........................................................................................................................... 29

2
Introduction

Autism is a widespread global concern impacting individuals across various countries, cultures, and
socioeconomic contexts (de Leeuw, Happé, & Hoekstra, 2020). This significant prevalence serves as a
clear indication to experts that a common environmental factor may have been disregarded or that
autism may not be the core disorder at play. The Diagnostic and Statistical Manual of Mental Disorders
(5th ed.; DSM-5) classifies autism as an "Autism Spectrum Disorder (American Psychiatric
Association, 2013)." It encompasses a range of symptoms, including deficits in social communication
and interaction and repetitive and unusual behaviours. These characteristics typically manifest in the
early stages of a child's development, making autism one of several complex disorders categorized
under neurodevelopmental disorders (Venkatesan & Gopalkrishnan, 2022). Consequently, conducting
a timeline analysis for autism is intended to outline its progression while addressing the contentious
themes and issues associated with this disorder (Venkatesan & Gopalkrishnan, 2022).

Concurrently with the extensive prevalence of autism, the rapid advancement of technology in recent
decades has created a new experience in the digital era: screen exposure (Korres, et al., 2024). Despite
consistent warnings from reputable institutions regarding the immediate and prolonged consequences
of excessive screen time exposure, these advisories still need to be adequately heeded (Harlé, 2019;
Dunckley, 2015; Heffler & Oestreicher, 2016; Zamfir, 2018). The yearly surge in media consumption
among toddlers and children reflects a troubling trend (Harlé, 2019). Regrettably, over the past few
decades, the age at which individuals are exposed to media has significantly decreased, with babies
under six months now being classified as media users (Eric, 2021). An investigation in Singapore
revealed that 28% of children under six months were regularly exposed to daily media (Chen, et al.,
2019). As children are increasingly exposed to digital environments from a young age, there is a rising
concern regarding the potential effects of screen time on their developmental progress. Given the
significance of early and rapid brain development, it is crucial to comprehend the developmental
consequences of screen time during early childhood comprehensively. The American Academy of
Paediatrics (AAP) issued a policy statement in 1999 on media use in children (Brown & Council on
Communications and Media, 2011). The statement recommended avoiding television viewing for
children under two years due to potential adverse effects. It also emphasised the lack of evidence for
educational or developmental benefits from media use for this age group. The American Academy of
Paediatrics cautions parents that excessive media use should not substitute for children's engagement in
activities and social interactions and should not be relied upon as a method for soothing the child (Hill,
et al., 2016).

It is crucial to consider the age of the group being studied in order to comprehend any environmental
impact on that specific group of infants over time (Heffler & Oestreicher, 2016). Stockdale et al.
explored the impact of media exposure on infant development. This study investigated the association

3
between infants' early media exposure and subsequent media exposure patterns. The findings indicated
that infants exposed to high levels of media in their early months and years tended to maintain high
levels of exposure in the following years, albeit with a reduced inclination compared to those with
minimal early exposure. Furthermore, infants with high early exposure exhibited poorer performance
in language development, executive functions, and cognitive development in later years. During
preschool years, children with early and prolonged exposure demonstrated inferior cognitive
performance across all areas compared to their peers (Stockdale, Holmgren, Porter, Clifford, & Coyne,
2022).

Children under two must engage in hands-on exploration and meaningful social interaction with reliable
caregivers for optimal cognitive, language, motor, and social-emotional development (Hill, et al., 2016).
Exposure to screens at an early age can have adverse effects on various aspects, such as attention,
language development, emotional regulation and social skills, which are essential for the diagnosis of
certain neurodevelopmental conditions like ADHD and learning disabilities (Harlé, 2019). With the
unprecedented rise in autism rates and developmental disorders, some researchers have proposed the
concept of virtual autism (Harlé, 2019; Zamfir, 2018; Wedge, 2017). They believe that excessive media
exposure can lead to symptoms resembling those of autism, potentially leading to misdiagnosis. The
potential link between screen time and autism-like symptoms is a new area of research seeking to
understand the impact of this environmental factor. Understanding the specific complications associated
with screen exposure could help experts make more accurate diagnoses and prevent misdiagnosis.

There is an increasing amount of clinical and empirical proof that suggests a possible connection
between intensive screen exposure during early childhood (more than four hours a day) and the
development of autism spectrum disorders symptoms in some vulnerable children who are younger than
six years old (Harlé, 2019). Currently, an array of digital technologies is readily accessible to all,
allowing these tools to assume the responsibilities of parental figures, caregivers, and child-minders
without considering the potential long-term implications of such exposure (Zamfir, 2018). In recent
years, multiple studies have highlighted the potential risks of exposing children aged 0-5 to virtual
environments, citing concerns about their physical and cognitive developmental processes (Brown &
Council on Communications and Media, 2011). As recent studies have demonstrated that interventions
aimed at decreasing screen time can lead to significant reductions in autism-like symptoms among
children. Increased parent-child interaction is expected to enhance the child's future social relationships
while also significantly reducing parental stress (Heffler, Frome, Garvin, Bungert, & Bennett, 2022).

Research question
In light of recent studies suggesting a potential link between screen exposure and the development of
autism-like symptoms, it raises the question of whether the high incidence of autism may be attributed
to misdiagnosis and whether the term 'virtual autism' could apply to some individuals? The key focus

4
of this research is to determine whether the practical application of the digital detox protocol can
validate the hypothesis of existing virtual autism disorder or electronic screen syndrome.

Search strategy and Eligibility criteria

This review thoroughly examined five categories of research conducted between 2000 and 2024 and
written in English. The complete list of all the research used is provided at the end of this dissertation.
1. Studies describing various media types, including the terminology used in different studies to refer
to media (e.g., screen, media, computer games, music).

2. Research investigating the effects of media exposure on children, focusing on disorders or issues
raised in different studies related to the media, using correlation and association as key investigation
terms.

3. Research exploring the relationship between media exposure and autism-like symptoms.

4. Research examining the virtual autism phenomenon.

5. Research examining studies evaluating programs or interventions for treating issues and disorders
stemming from digital exposure.

While numerous studies have highlighted the detrimental effects of screen exposure on children, it is
important to acknowledge that there is also scientific evidence delineating the positive effects. For
example, research indicates that certain computer games have the potential to enhance the executive
functions and social skills of children diagnosed with ADHD (Alabdulakareem & Jamjoom, 2020).
However, the current research will primarily focus on reviewing studies that have reported negative
effects of screen exposure on children.

5
What is the media?
The term "media" encompasses television shows, pre-recorded videos, online content, and DVDs
watched on traditional or modern screen technologies. In today's digital landscape, ubiquitous screens
have become a norm. Online videos are readily accessible anytime, and the widespread use of tablets
and smartphones allows for viewing even in transient environments such as cars, restaurants, and
paediatrician waiting rooms (Eric, 2021).

The new media category, driven by the increasing internet connectivity through mobile devices, consists
of new video-on-demand platforms, such as free options like YouTube or subscription-based ones like
Netflix. Most of the time, there is a version specifically designed for children. Interactive tablets, e-
books, and mobile phones with increasing internet connectivity make up mobile screens, playing a
crucial role in shaping the digital landscape of children's development (Eric, 2021).

As Dunkley (2017) points out in her book, "screen time" encompasses any duration spent in front of a
digital device, such as computers, televisions, video games, smartphones, iPads, tablets, laptops, digital
cameras, e-readers, and more. It encompasses all screen-related activities for work, education, or
leisure, including texting, video chatting, web browsing, gaming, emailing, social media engagement,
app usage, online shopping, word processing, reading from a device, and browsing through phone
photos. This includes playing electronic games, using "educational" electronic apps, and reading from
a Kindle.

Foreground media and background media

When considering children's media exposure, we encounter the concepts of foreground and background
as two defining terms. The research indicates that interpersonal communication is significantly reduced
when television is watched at home, even if a child is not actively involved. This phenomenon has been
extensively researched over the past two decades, particularly its effects on young children (Eric, 2021).
Typically, children encounter media through two primary avenues. Background TV refers to scenarios
where an older family member selects a program or the TV is left on with only a toddler present
(Pempek, Kirkorian, & Anderson, 2014); On the other hand, foreground television is content
specifically designed for very young children, who are likely to engage actively (Pempek, Kirkorian, &
Anderson, 2014). A research indicates that interpersonal communication is significantly reduced when
television is watched at home, even if a child is not actively involved.

Parents report that most of the content viewed is suitable for children. Still, infants and toddlers are also
subjected to an extra 5.5 hours of "background" TV each day, which is not meant for them specifically
but is generally watched by older children and adults (Lapierre, Piotrowski, & Linebarger, 2012).
Research indicates that having the TV on in the background can have negative effects on the parent-
child relationship, as well as disrupt the child's ability to focus and concentrate (Dunckley, 2015).

6
Many parents justify using various television programs for their children by pointing to the diverse
range of products offered by different manufacturing companies. These companies employ targeted
marketing strategies to promote their products to this demographic. Some digital content companies
assert that their programs are designed for families, aiming to enhance social interactions and foster an
improved learning experience (Garrison & Christakis, 2005). However, studies have shown that having
a television at home can reduce the amount of quality time parents spend interacting with their children.
In households with a television, parents often prioritise other activities over spending time with their
kids, even when the TV is on (Christakis, et al., 2009).

One form of electronic screen exposure for children and infants is through parental video calls, which
can be present in the background and foreground. The increasing prevalence of video conversations
between parents and relatives has led to greater exposure of babies and toddlers to digital media
(McClure, Chentsova-Dutton, Barr, Holochwost, & Parrott, 2016). This heightened exposure
necessitates careful parental monitoring and control over the content that young children are exposed
to. Electronic books represent another avenue for exposing children to media or screens. Electronic
books, or e-books, are a form of media that have the potential to cause distraction and diminish a child's
attention and concentration, thereby impacting the child-parent relationship (Bus, Takacs, & Kegel,
2015). To mitigate this, parents should minimise the visual distractions of e-books to maintain
interaction with their children (Hill, et al., 2016). As mentioned above, some studies on children's
exposure to media suggest that whether children are exposed to digital media intentionally or
unintentionally, it can impact various aspects of their development.

Leisure noise and white noise (noise pollution) as a background media

Finding unbiased research on-screen use by children and teenagers can be challenging. As a result,
parents often need more specific recommendations. Additionally, many parents may need to fully
understand the potential harm associated with background screen exposure, mistakenly believing that
screen damage only occurs when a child is directly engaged with the screen or playing games
(Dunckley, 2015). Various studies have focused significantly on the impact of background screen
damage and audio-visual stimulation. However, parents have given relatively little attention to the
discussion of auditory stimulation. Today, it is common to encounter the use of music in various
settings, including at home, work, and public places such as stores, restaurants, and cafes. Whereas,
some studies have indicated that noise pollution can impact children's and adults' cognitive abilities
(Thompson, et al., 2022). In addition, some studies show that noise exposure treatments may provide
temporary relief, but they can ultimately harm the central auditory system and the brain's overall
structure and function (Attarha, Bigelow, & Merzenich, 2018).

In the discussion of children's exposure to digital media, it has become evident that this exposure occurs
both in the background and foreground. This is particularly significant for infants who cannot interact
with screens purposefully. For these young children, background exposure to digital sounds is more

7
impactful than other forms of exposure. These babies and children are exposed to the sounds emanating
from various devices as digital content. This raises the issue of noise pollution and its detrimental
effects, highlighting its importance in our considerations. According to the World Health Organization
(World Health Organization, 2024), in 2011, only one million healthy life years were lost due to traffic-
related noise in Western Europe. Roads, railways, air traffic, and construction sites are primary sources
of environmental noise exposure. Additionally, noise exposure can stem from other sources such as
wind turbines, leisure activities like listening to loud music or engaging in e-sports, which includes
video and computer game competitions. Excessive noise can be annoying, and research suggests that it
increases the risk of ischemic heart disease and hypertension, disrupts sleep, impairs hearing, and causes
tinnitus and cognitive impairment. Furthermore, there is mounting evidence of other health impacts,
such as adverse birth outcomes and mental health problems (World Health Organization, 2024).

White noise, a standard method many parents use to help babies and children fall asleep and relax (De
Jong, et al., 2024), represents another form of digital sound exposure in this digital age. Recently, there
has been a growing trend among parents to utilize white noise to calm their infants and facilitate sleep.
Some professionals in the health industry have also begun advocating for the use of white noise or quiet
music to aid in this process. At present, researchers continue to investigate the potential beneficial or
adverse impacts of white noise (De Jong, et al., 2024). Also, the emerging field of brain plasticity over
the last 50 years has shown that the brain can undergo significant anatomical, neurochemical, and
functional changes throughout life, either in a positive or negative direction (Merzenich, Nahum, & van
Vleet, 2013).

In their study concerning the impact of white noise on tinnitus treatment, Attarha et al. reference the
“Cobra effect”. This effect highlights how the well-intentioned use of white noise to alleviate a disease
such as tinnitus can worsen the symptoms (Attarha, Bigelow, & Merzenich, 2018). This research
focused on highlighting the brain's neuroplasticity and illustrating the detrimental effects of frequent
white noise exposure on the auditory nerve system. Researchers conducted this study to test the theory
that white noise could be used as a treatment for tinnitus. Surprisingly, they discovered that, similar to
tinnitus, white noise could harm central auditory function and may contribute to accelerating brain
ageing. The study focused on adults, whose brain development is naturally more advanced than that of
infants. It has sparked concerns about the potential negative impact of white noise on brain development
and other neurological functions in infants with more adaptable brains. This raises questions about the
possible effects on infant brain development. Research demonstrates that environmental stimuli can
profoundly impact the neurological architecture of the brain due to its neuroplasticity (Markham &
Greenough, 2004).

A significant and increasing amount of literature indicates that disorganized, unpredictable sound input
can lead to detrimental changes in the central auditory system, which can ultimately compromise its

8
structural and functional integrity (Attarha, Bigelow, & Merzenich, 2018). Recent research, primarily
in animal models over the past decade, has shown that prolonged exposure to nontraumatic noise, which
does not affect peripheral hearing thresholds, can lead to maladaptive changes in the central auditory
nervous system (Eggermont, 2017). Recognizing the potential adverse effects of environmental sounds
is crucial, as they can have both therapeutic and undesirable aspects. It is also essential to consider the
impact of exposing children and infants to background media.

Electronic toys
Another electronic device readily available to children today, which forms part of their media exposure,
is battery or electricity-operated electronic toys or electronic books. According to Wooldridge's
research, the use of these games significantly impacts mother-child interaction, leading to lower quality
compared to traditional toys. Additionally, the study suggests that the use of such toys may hinder a
child's expressive language development, as the various sounds from the toys reduce the child's
inclination to communicate verbally. Furthermore, parents no longer need to engage directly with their
children (Wooldridge & Shapka, 2012). The most striking instances occurred in this study when using
the electronic book, which prompted the child to locate an item on its pages by touching the "bee" to a
specific object. None of the children directly followed the toy's instructions. On a few occasions, a child
did echo the word(s) prompted by the toy, but only after the mother had first repeated the toy's words,
effectively facilitating the interaction. In a couple of instances, a child did point to a picture in the
electronic book, but only in response to the mother asking a "where is…" question (Wooldridge &
Shapka, 2012). Considering that children with autism-like symptoms often face challenges in social
interaction, it's crucial to conduct more research into the potential connection between the use of digital
toys and these symptoms. Analyzing the frequency of digital toy usage in various children is critical to
understanding its impact better.

Educational programs
The educational implications of screen use continue to be a significant concern for parents, mainly when
screens are used as educational tools. As digital usage becomes increasingly prevalent daily, some
advocates highlight its positive aspects and utilise it for beneficial purposes, especially for children.
However, it is essential to acknowledge that the potential adverse effects of screen exposure outweigh
the positive ones (Korres, et al., 2024). Therefore, researchers recommend providing children with
supervised screen time at the very least. Several studies indicate that television programs can positively
impact children over the age of two (Anand & Krosnick, 2005). However, insufficient evidence
supports the same claim for children under two. Some justifications exist for parents providing screens
to their children, one being the educational content available. Companies that produce educational
content often advertise to encourage parents to invest in their products. Additionally, some research
studies highlight the benefits of educational content. However, recent studies indicate that exposure to

9
screen time, regardless of the content, can lead to abnormal brain stimulation and result in various
physical and psychological issues (Dunckley, 2015).

The learning process is contingent upon attention, concentration, and comprehension of the material
being presented, and the viewer must have reached a particular cognitive developmental stage to grasp
this fully. It is essential to consider that children under two may have yet to reach the necessary cognitive
development to comprehend broadcasted programs effectively (Piaget & Cook, 1952). In today's digital
era, parents are confronted with a challenging paradox. Although there is abundant rapid information
exchange and digital tools, these technologies can disrupt a child's ability to focus and pay attention. It
is worrisome that many educational programs today lack scientific evidence to support their claims, and
experts have yet to establish clear guidelines for creating such programs (Guernsey & Levine, 2015).
This serves as a warning for parents relying heavily on digital programs for their children's education.
It is widely recognized that numerous educational programs prioritize marketing over scientific validity.

Superior performance in executive functions may indicate an individual's academic and occupational
achievements, as early childhood experiences and the quality of parent-child relationships largely
influence this proficiency. One result of the underdeveloped executive functioning in young children is
their high level of distractibility (Courage, 2017). Some experts and digital game developers advocate
for parents to engage with their children through digital games, citing potential benefits for relationships
and education. However, research indicates that children's cognitive performance, executive function,
and educational outcomes are associated more with social games and irregular social communication
rather than digital games (Shaheen, 2014).

10
Disorders related to screen exposure
Given the global concern over the early and extensive exposure of children to media, researchers from
various disciplines are investigating the impact of media on different age groups. They are focusing on
psychological and physical factors in their studies of children. The detrimental effects of screen
exposure have been a research subject for decades. Since the early 2000s, Dunckley has been studying
children with severe mental health issues and noticed common symptoms among them (Dunckley,
2015). This led the researcher to believe that a shared environmental factor may influence various social,
cultural, and economic contexts. Through regular observations, Dunckley found that even a limited
amount of computer games can elicit similar responses in all children, triggering the fight or flight
response that professionals attempted to address through psychotherapy or medication. Despite strong
resistance from parents and caregivers, when the researcher’s suggestion of a complete ban on playing
computer games was followed, many children experienced rapid relief from some severe symptoms.
Most studies have consistently demonstrated that prolonged television viewing is associated with a
decline in cognitive performance, particularly concerning language skills, concentration, and overall
developmental milestones, irrespective of the specific viewing context or content (Kostyrka-Allchorne,
Cooper, & Simpson, 2017). Other research studies indicate that television exposure is linked with
poorer cognitive abilities, irrespective of the material being watched (Eric, 2021).

In a comprehensive systematic review encompassing 91 studies, findings indicated a significant recent

increase in the prevalence of depression in children by 31%, anxiety by 31%, and sleep disorders by
42%. An essential factor to consider is the pervasive nature of excessive media use among these
patients, warranting further investigation (Deng, et al., 2022). The prevalence of psychiatric disorders
among Danish youth has seen a significant uptick in recent years; most affected individuals have not
presented symptoms or sought treatment in the past five years, prompting consideration of underlying
factors (Bliddal, et al., 2023). Based on the data gathered from multiple research studies, it can be
posited that screen exposure is a fundamental environmental factor that may be correlated with
numerous psychological disorders and issues experienced during childhood. In the upcoming section,
we will explore certain disorders or symptoms that may be associated with digital exposure and have
attracted considerable interest from researchers.

Impaired self-regulation
Self-regulation plays a crucial role in children's developmental trajectory, influencing their current well-
being and future outcomes. Individual differences and environmental factors can significantly impact
an individual's capacity to regulate emotions effectively. Research indicates that effective self-
regulation during childhood is a strong predictor of future academic achievement, occupational
advancement, and decreased likelihood of criminal behaviour in adulthood (Moffitt, et al., 2011).
Screen exposure is identified as an environmental factor that may contribute to impaired self-regulation.
The time young children spend engaging with electronic media, such as watching television and playing

11
electronic games, may impact their early childhood self-regulation abilities (Cliff, Howard, Radesky,
McNeill, & Vella, 2018). Research indicates that kids who spent more time watching TV at a young
age had more difficulties with self-regulation in subsequent years compared to those with less exposure,
who showed better self-regulation skills (Cliff, Howard, Radesky, McNeill, & Vella, 2018). We are
observing an increasing trend where parents use screens to regulate their children's emotions and
behaviours. However, there is increasing concern that relying on electronic devices to manage children's
feelings and behaviours may impede their development of internal self-regulation skills (Radesky, et
al., 2015). There is evidence suggesting that children with autism struggle with self-regulation
(Charitaki, Soulis, & Tyropoli, 2021). This raises questions about the potential impact of screen
exposure on the development of autism-like symptoms and self-regulation difficulties. Further
investigation is necessary to understand these issues' connection and provide a more comprehensive
interpretation.

Impaired cognitive development

Prolonged screen exposure can significantly impact a child's cognitive processes, including attention,
concentration, memory, and executive functions. This excessive exposure can disrupt a child's
concentration, potentially affecting academic performance. In 2019, McNeil and his colleagues
conducted a longitudinal study in Australia to explore the impact of traditional and contemporary media
usage on preschool children's cognitive functions and psychosocial development. The study involved
185 children aged 4 to 6 whose parents reported their media usage. The results indicated a significant
association between high media usage at the baseline and increased externalizing problems in children.
Additionally, the study highlighted the disruptive impact of media exposure on children's executive
functions. The researchers suggested reducing children's screen time could enhance their cognitive and
psychosocial well-being (McNeill, Howard, Vella, & Cliff, 2019). The potential effects of television on
the development of attention networks were initially brought up in the 1970s, coinciding with the
introduction of fast-paced children's TV shows like Sesame Street (Geist & Gibson, 2000). This was
also linked to a rise in reported attention issues in school, such as distractibility and hyperactivity.

Language delay
Extensive and early screen exposure has been extensively researched for its potential association with
speech delay in children. Studies have demonstrated that prolonged screen time can delay speech in
young children. A comprehensive study in Canada encompassed 2441 children and revealed a
correlation between increased media exposure at 24 and 36 months and decreased cognitive
development in subsequent assessments. The researchers posit a causal relationship between media
consumption and impaired cognitive functions in children, urging parents and experts to prioritize
careful monitoring of children's media exposure (Madigan, Browne, Racine, Mori, & Tough, 2019).

Exposure to media can significantly impact language development, affecting both the quantity and
quality of words used by a child. Research indicates that background television exposure can impact a

12
child's language development by introducing words into their cognitive processes, potentially hindering
their language acquisition (Pempek, Kirkorian, & Anderson, 2014). The background presence of media
disrupts the child's word and sentence production and the acquisition of new words (Pempek, Kirkorian,
& Anderson, 2014). The excessive presence of media in the background and parental distraction from
direct conversation with their child has been shown to impact the child's quantitative and qualitative
language development negatively. Research indicates that mothers who use mobile phones extensively
daily have reduced verbal and non-verbal interaction with their children (Radesky, et al., 2015). This
lack of communication can lead to internalizing and externalizing issues in the child, impacting their
language development. This suggests that reducing media consumption and increasing direct interaction
with the child can effectively support language development. The presence of background television
can lead to parental neglect, resulting in various psychological consequences for the child. A study
published in 2019 revealed that cell phone use can negatively impact the interactive skills of 18-month-
old toddlers. The cross-sectional study conducted between 2011 and 2015 by Heuvel and colleagues
involved 893 children whose parents provided information about their cell phone usage. The findings
indicated a correlation between higher mobile phone use and reported delays in developing expressive
communication and other communication skills in the following months (Heuvel, et al., 2019).
Inadequate interaction with the primary caregiver, especially the mother, is the primary determinant
affecting a child's predisposition to speech development, and the presence of media can be disruptive
in this regard. A study indicated that ambient television noise diminishes both the richness and amount
of interaction in parent-child communication, resulting in an approximate thousand-word deficit
compared to other communication settings (Masur, Flynn, & Olson, 2016).

Hence, it is imperative to raise parental awareness regarding background media's potential hazards and
emphasize the benefits of engaging in direct communication with their children. Currently, a limited
body of research focuses on the impact of background media on children, with most studies centred on
the direct effects of media exposure. Based on the existing literature, it is apparent that the indirect
impact of background media presence includes decreased attention and concentration in children,
particularly affecting speech development. At the same time, its direct effect leads to a decline in parent-
child relationships. It can be inferred that the absence of parental connection may impact a child's
inclination to communicate and talking. Common issues observed in autistic children include deficient
connections and speech delays. Individuals with Autism Spectrum Disorder (ASD) often experience
language delay (Weismer, Lord, & Esler , 2010). Given the high incidence of verbal delay in children
with autism and their challenges in communication, combined with research indicating the impact of
screen exposure on these issues, it may be reasonable to consider that screen exposure could contribute
to the symptoms observed in children displaying autism-like traits.

13
Obesity and Sleep disorder
Although obesity and sleep disorder are not primary symptoms of autism, they are frequently comorbid
with autism spectrum disorder. Therefore, a brief review of these conditions is warranted due to their
high coexistence with autism spectrum disorder. Childhood obesity is now a significant issue for public
health worldwide (Köse, et al., 2021). Extended periods spent using electronic screens have been linked
to an increase in children's body mass index (BMI), raising concerns about the growing prevalence of
elevated BMI levels among children (Bellissimo, Pencharz, Thomas, & Anderson, 2007). Studies have
suggested that prolonged exposure to digital devices could potentially contribute to future obesity risks
for children (Wen, Baur, Rissel, Xu, & Simpson, 2014). Frequent exposure to screens while
experiencing anxiety can lead to a disconnection from bodily sensations, potentially causing overeating
or eating without feeling hungry. For some individuals, excessive eating may serve as a coping
mechanism, ultimately contributing to weight gain and posing a threat to their well-being. It is crucial
to consider the impact of obesity, especially in light of studies that have explored the connection
between autism spectrum disorder and obesity. A systematic review revealed that children and
adolescents with autism are at a higher risk of obesity compared to their peers (Sammels, Karjalainen,
Dahlgren, & Wentz, 2022). When we juxtapose obesity with other symptoms associated with autism, it
underscores the significance of precise diagnosis.

Prolonged exposure to media and the availability of electronic devices such as televisions, computers,
or mobile phones in the bedroom during early childhood has been linked to a reduction in nightly sleep
duration. Research has shown that children from racial/ethnic minority groups who have increased
television watching and a TV in the bedroom tend to have reduced sleep duration from infancy to mid-
childhood (Cespedes, Gillman, Kleinman, Rifas-Shiman, & Redline, 2014). Moreover, allowing infants
to watch media in the evening can lead to reduced sleep duration for 12-month-old babies over the
following year. To promote healthy sleep habits, it is recommended to refrain from exposing infants to
media after 7 p.m. (Vijakkhana, Wilaisakditipakorn, Ruedeekhajorn, Pruksananonda, & Chonchaiya,
2015). Studies indicate that prolonged media exposure can decrease melatonin levels over time,
disrupting the natural rhythm of melatonin secretion. This disruption is particularly prevalent among
children who have had extensive media exposure, especially during critical developmental stages like
puberty (Salti, et al., 2006).

In recent years, the emergence of COVID-19 has resulted in significant and atypical disruptions to the
daily lives of children and adolescents. During the quarantine period related to COVID-19, a study was
conducted to investigate the prevalence of sleep disorders. The results indicated that sleep disorders
were widespread in European, Asian, and American countries during this period (Cai, et al., 2024).
However, the underlying cause of this phenomenon remained unclear.

14
Electronic Screen Syndrome (ESS)
Dunkley conceptualised a newly identified disorder that impacts various facets of mood, cognition, and
behavior, labelling it the "electronic screen syndrome" (ESS). ESS may manifest on its own, mirror
another psychiatric disorder, or even intensify the symptoms of an existing disorder. She has outlined
seven distinct features of this syndrome (Dunckley, 2015).

1. An overactive nervous system can cause a child to exhibit symptoms such as mood
disturbances, anxiety, cognitive issues, or behavioral challenges. These can affect the child's
performance at school, at home, or in interactions with peers. Signs may manifest as irritability,
fluctuations in mood, outbursts, difficulty in self-regulation, learning challenges, and other
related issues.
2. The signs of ESS might manifest with or without other mental health, neurological, behavioral,
or learning conditions, and they have the potential to imitate or worsen almost any mental
health-related issue.
3. Parents and educators frequently characterise children with Emotional Self-Regulation (ESS)
challenges as "stressed," "overexcited," "agitated," or "disengaged." Family members often
express the need to be cautious and delicate in their interactions with the child.
4. The symptoms demonstrate significant improvement or resolution following an electronic fast,
which involves eliminating interactive electronic screen media for several weeks. A fasting
period of three weeks is generally required to achieve a lasting effect, although it may not be
adequate in certain instances.
5. Symptoms frequently resurface when electronic media is reintroduced after a period of fasting,
especially if screen-time exposure returns to previous levels. Post-fast, some children can
tolerate limited screen time with strict moderation, while others appear to experience a
recurrence of symptoms upon re-exposure immediately.
6. Often, children experience a strong attraction to screen devices and struggle to disengage from
them.
7. Certain factors can increase the risk of developing ESS, including being male, younger, having
preexisting psychiatric disorders, experiencing psychosocial stressors, having tendencies
toward addiction, exposure to screen time at a younger age, and higher levels of lifetime screen
exposure. Possible risk factors may include environmentally sensitive medical conditions such
as asthma, food or chemical sensitivities, and sensory dysfunction. Boys with ADHD and
autism spectrum disorders are at exceptionally high risk.

Dunkley (2015) draws parallels between addiction to electronic screens and addiction to stimulant
drugs, pointing out the potential long-term effects of excessive screen exposure. While the immediate
impacts of digital addiction may not be readily apparent, it can lead to severe issues in the years to
come. Dunkley suggests that short-term positive effects of screen exposure may give way to changes in

15
brain function, leading to heightened arousal and similarities to the effects of cocaine and
methamphetamines. These changes can result in severe mood swings, attention and concentration
disturbances, and limitations on a person's interests and choices.

ESS is a disorder characterised by dysregulation. Due to its stimulating nature, interactive screen time
can shift the nervous system into fight-or-flight mode, leading to dysregulation and disorganisation of
various biological systems. The stress response can be immediate and evident, such as when playing a
video game, or subtler, gradually developing from repetitive screen interaction like frequent texting or
social media use. The stress response may sometimes be delayed, accumulating over years of screen
time before manifesting. Nevertheless, repeated overstimulation of the nervous system from electronics
will often eventually result in a dysregulated child (Dunckley, 2015). Although electronic screen
syndrome (ESS) is still in the research stages and has not been recognised as a separate disorder, current
studies provide valuable insights, particularly in the field of autism. Many of the symptoms associated
with ESS, such as sleep disorders, restlessness, self-regulation problems, cognitive issues, and
developmental delays, are also observed in autistic children. It can be inferred that ESS may present
challenges to existing diagnoses and raise questions about their validity.

16
Intensive early screen exposure and autism
Based on the information available to parents and the publicly accessible articles, a set of core beliefs
has been established regarding the etiology of autism. Parents’ beliefs in what causes ASD are primarily
based on genetics, brain structure, the will of God, toxins in vaccines, and environmental pollution
(Heffler & Oestreicher, 2016). It seems that parents may not be informed about research connecting
media exposure to autism-like symptoms. It was commonly thought that genetic factors played a
significant role and that autism was established before birth.

Considerable articles have explored the link between screen exposure and the prevalence of autism. The
field of autism research recently has emphasized genetic factors, but it has also delved into the impact
of environmental factors, such as environmental toxins. To date, no substantial evidence has been found
to establish a significant link between these toxins and autism (Nevison, 2014). In recent decades,
despite the increased prevalence of autism since the late 1980s, children's exposure to the ten major
environmental toxic compounds previously identified has either remained stable or decreased over these
decades (Nevison, 2014). Based on epidemiological data and experimental studies, it has been
hypothesized that Intensive Early Screen Exposure (IESE) may increase the likelihood of developing
ADHD, learning disorders, and autism spectrum disorders (Harlé, 2019). While biological factors play
a significant role in these neurodevelopmental disorders, it is essential to consider that gene-
environment interactions may provide the best explanation for their manifestation (Harlé, 2019). We
are aware that exposure to TV screens during infancy is linked to autism-like symptoms, but we do not
have a complete understanding of the extent to which this exposure may impact the development of
those symptoms (Heffler & Oestreicher, 2016).

As no specific gene directly linked to autism has been identified, researchers have shifted their focus to
exploring other contributing factors. Some studies examining the causes of autism have placed
particular emphasis on environmental factors and the interaction between genes and the environment
(Kim & Leventhal, 2015). However, the specific environmental factor that has a more significant impact
on the development of autism cannot be definitively determined (Stamou, Streifel, Goines, & Lein,
2013). When examining a potential environmental factor linked to ASD that infants encounter, we
anticipate observing a more significant impact with higher levels of exposure. Additionally, we would
expect autism rates to level off once the community has reached saturation of that particular factor
(Heffler & Oestreicher, 2016). One emerging environmental variable that has garnered increased
interest among researchers is early and excessive exposure to media. Numerous studies have noted the
propensity of children with autism to engage with audio-visual content. However, this significant
environmental factor has been neglected, and there has been a reluctance to explore causality in this
context (Heffler & Oestreicher, 2016). Heffler (2016) proposed that for an environmental factor to be
considered in autism, it should likely possess specific characteristics: (1) Demonstrate an increased
chance of exposure in infants, which typically aligns with the rise in the prevalence of ASD over time.

17
(2) Show a connection with atypical brain development and support theories of disruption to typical
social brain development. (3) Disrupt opportunities for social learning. (4) Respond to early
intervention. (5) Have a link to autism and hindered language development. (6) Receive insufficient
attention in extensive ASD sibling and environmental studies (Heffler & Oestreicher, 2016). Heffler
(2016) presents a causal model to explain the significant rise in autism cases over the past 25 years.
According to this model, early exposure of infants to non-social audio-visual content leads to excessive
brain stimulation, resulting in abnormal connections. This overstimulation and atypical neural
connections have been suggested to impact social behaviors and overall neurological development in
infants, potentially contributing to various aspects of the autism spectrum. These aspects include
excessive neural connections, exceptional abilities in specific areas, manifestation across different
spectrums, increasing prevalence, and the potential for positive responses to early interventions.

It is commonly believed that children with autism lack the desire to form social relationships, with some
researchers attributing this to inherent factors. However, Heffler proposes a different perspective,
suggesting that early screen exposure may precede children's disinterest in social interactions.
According to Heffler's model, frequent exposure to media during early development may prioritize
audio-visual stimuli over human relationships in the brain's neural circuits. Consequently, this
heightened stimulation of the non-social aspects of the brain could diminish the child's motivation for
interpersonal communication (Heffler & Oestreicher, 2016). The most critical symptom of autistic
children is their difficulty with social communication. When children rely on audiovisual materials
instead of fundamental social interactions, they miss the opportunity to grasp the nuances of real-world
social dynamics (Heffler & Oestreicher, 2016). As a result, they may struggle to communicate with
others in the future because these interactions are unfamiliar to them.

Virtual autism as an emerging clinical phenomenon

While we may not want to link autism with media exposure definitively, there are evidence to suggest
that digital exposure is associated with the emergence of autism-like symptoms. With the growing
prevalence of autism, researchers have been investigating environmental factors that may contribute to
the substantial and unexplained rise in autism rates. A study conducted in 2006 revealed a higher
prevalence of autism among families with cable television subscriptions in the United States compared
to those without (Waldman, Nicholson, & Adilov, 2006). In recent years, the rapidly increasing
prevalence of autism has sparked significant interest among experts in medicine and psychiatry
regarding the possible causes and contributing factors to the development of this disorder. Despite
numerous studies and research, a specific reason for autism has yet to be identified, and the existing
literature only presents potential explanations and speculations, which are widely covered in the media
(Zhai, Sun, Wang, & Ding, 2017).

18
In contemporary society, the pervasive use of mobile phones at home, akin to television consumption,
has established itself as a customary practice. Consequently, children need a more crucial foundation
and environment for comprehending various emotional and behavioral intricacies in their daily lives
(Radesky, et al., 2015). This section will specifically examine studies that demonstrate the relationship
between media exposure and autism symptoms after considering other disorders and issues associated
with early and excessive media exposure. Numerous studies indicate that children diagnosed with
autism are more prone to digital addiction. In 2018, Zamfir coined the term "virtual autism" and
conducted a study suggesting a correlation between high digital content consumption and autism
diagnosis in children (Zamfir, 2018). Premature and excessive exposure of infants and young children
to digital devices, such as phones, tablets, and laptops, has been linked to the onset of symptoms
commonly associated with autism in children, according to recent research. Researchers have raised the
concept of "virtual autism" after observing that completely removing digital content from children led
to the complete disappearance of autism symptoms in those children. This suggests that the symptoms
being observed may not be classic autism but rather a disorder that mimics the symptoms of autism
(Harlé, 2019).

In a recently published case report, Heffler and colleagues (2022) conducted a study on two children
diagnosed with autism who had been extensively exposed to media from a very young age. The
researchers hypothesized that substituting social interaction with media could alleviate the symptoms
of autism. Decreasing the screen time resulted in a significant decrease in symptoms and marked
improvement in the children's development. Conversely, increased screen time led to worsening
symptoms, which once again improved when media exposure was minimized. The correlation between
fluctuating symptoms and varying levels of media exposure suggests that media has a substantial impact
on the symptoms of children with autism. The researchers concluded that fostering social interactions
should take precedence over screen time for children diagnosed with autism (Heffler, Frome, & Gullo,
2022). In a study conducted by Dong, it was found that increased screen time was associated with more
severe autism symptoms in children diagnosed with autism. Conversely, children with less screen time
exhibited less severe symptoms (Dong, Wang, Li, Yue, & Jia, 2021).

Children diagnosed with autism who have also been exposed to extensive screen time often experience
sensory issues. It has been suggested that frequent exposure to media and abnormal audio-visual
stimulations can disrupt the neural connections in these children, leading to reduced attention and
disproportionate sensory reactions (Heffler & Oestreicher, 2016). The impact of early and high screen
exposure on brain development in young children remains uncertain. It is not clear whether it aligns
with the displacement hypothesis or has a direct negative effect (Heffler, Frome, & Gullo, 2022). The
displacement hypothesis posits that the increased use of media among children and adolescents reduces
the time allocated for social and physical activities (Lizandra, Devís-Devís, Valencia-Peris, Tomás, &
Peiró-Velert, 2019).

19
A study conducted on approximately 30,000 Chinese children has established a correlation between
early and prolonged exposure to electronic screens and the development of autism-like symptoms,
particularly in preschool-aged children (Chen, et al., 2021). The study highlights that the first three
years of life are a critical period, and long-term daily exposure to electronic screens increases the
likelihood of exhibiting symptoms of autism. Thus, early intervention in regulating children's use of
electronic devices is recommended.

Electronic detoxification
Based on extensive research into the adverse effects of excessive screen exposure, some experts
recommend intervention and treatment programs centered around digital detoxification as the initial
approach (Dunckley, 2015; Harlé, 2019; Heffler, Frome, Garvin, Bungert, & Bennett, 2022; Zamfir,
2018). Although empirical findings on the effects of digital detox are still emerging, positive reports
should be considered. The current practice in Romania involves the widespread use of media removal
as a part of the overall treatment for children diagnosed with autism. This approach has gained
significant support from the public (Wedge, 2017). Researchers in France found that eliminating
exposure to electronic screens was highly beneficial for children between the ages of 0 and 4 with
autism. They observed a complete disappearance of symptoms in the children just one month after
eliminating screen exposure (Wedge, 2017).

How can we stop misdiagnosing?

Lack of awareness about the syndromes and issues triggered by screen exposure can lead even
experienced professionals to make incorrect diagnoses. This can result in ineffective treatment and
hinder a child's access to appropriate care. Each year, there is a notable rise in psychiatric disorders and
neurodevelopmental issues, coinciding with the undeniable and significant increase in screen exposure
(Dunckley, 2015). The critical distinction between autism and other psychiatric disorders in children is
how parents respond to the diagnosis by a specialist. Receiving an autism diagnosis often leaves parents
feeling hopeless and inclined to experience guilt. Conversely, if a child is diagnosed with ADHD,
parents tend to approach treatment more calmly. This underscores the significance of early diagnosis,
and the use of digital addiction questionnaires can enhance screening accuracy, leading to fewer
misdiagnoses.

Identical symptoms and comorbidities of psychological disorders in various individuals serve as a

serious red flag for professionals to consider the ramifications of prolonged screen time exposure
closely. For example, in tic disorder, there is frequently a high prevalence of comorbid conditions,
including ADHD, OCD, and impulse control disorders (Cohen, Leckman, & Bloch, 2013). Also current
research on the influence of digital media on infants and children has highlighted the necessity for
greater consensus regarding the impact of screen time addiction. Consequently, there is no specific age
at which children should completely abstain from digital devices. Diverse studies have presented

20
varying detrimental or advantageous effects across different age groups, posing a challenge in
establishing a universal guideline. Furthermore, it is difficult to pinpoint a specific threshold for harm
in digital exposure, as some children encounter issues even with minimal screen time exposure.

Conclusion
Recent studies have indicated a growing link between media exposure and the development of various
disorders, and including autism-like symptoms. This connection has become more apparent, especially
following the COVID-19 pandemic, which saw a sharp and sudden increase in autism diagnoses. As a
result, researchers have become increasingly vigilant, and studies have revealed that early exposure to
screens from birth can lead to symptoms resembling autism. The concept of "virtual autism" has been
proposed to guide specialists in preventing misdiagnoses and selecting more suitable treatments. Given
that a majority of children diagnosed with autism also exhibit digital addiction, distinguishing between
virtual autism and classical autism can pose a significant challenge.

It is essential to acknowledge the global prevalence of autism spectrum disorders (ASD) and investigate
potential environmental factors contributing to its increase. Recent research has brought attention to the
potential link between early and excessive screen exposure and the emergence of autism-like symptoms,
suggesting that some cases labelled as autism could be attributed to what researchers call "virtual
autism." This theory underscores the significance of understanding the impact of screen exposure on
early childhood development, particularly in areas such as social communication, language
development, and cognitive functions.

As digital media consumption becomes more pervasive, especially among young children, it is crucial
to consider its developmental impacts comprehensively. Studies have shown that excessive screen time
can lead to adverse effects, including impaired self-regulation, delays in cognitive development, sleep
disorders, obesity, and language delays. Furthermore, the concept of virtual autism, supported by cases
demonstrating symptom reduction after reducing screen time, provides a strong rationale for re-
evaluating the criteria and methods used in diagnosing autism. Addressing these issues requires
educating parents and caregivers about the potential risks associated with early and excessive screen
exposure, promoting activities that encourage direct social interaction and cognitive engagement, and
considering digital detox protocols as a potential intervention for children displaying autism-like
symptoms. By increasing awareness and adjusting diagnostic approaches, healthcare professionals can
more effectively distinguish between actual autism spectrum disorders and conditions exacerbated by
digital media exposure, ensuring that children receive the most appropriate and effective care for their
developmental needs.

21
Intervention proposal: Digital Detoxification Protocol

Abstract

Despite some experts warning about the risks of early and extensive digital exposure for children,
parents still expose their children to digital media from a very young age. On the other hand, some
experts highlight the positive outcomes of media exposure, leading to confusion among parents. With
the rise in children's exposure to various types of media, researchers have introduced the concept of
"virtual autism," where children exhibit autism-like symptoms. This phenomenon may contribute to the
increased diagnosis of autism spectrum disorder by experts. However, only a few studies have explored
the impact of programs or interventions focused on reducing digital exposure in children. Early
interventions to limit the use of digital devices for children exhibiting autism-like symptoms could
provide parents and professionals with better treatment options and prevent potential misdiagnoses.
Nevertheless, the challenge remains due to the striking similarity between the symptoms of classic
autism and virtual autism and the lack of accurate diagnostic tests such as blood or genetic tests for
autism. Furthermore, some research indicates that even children diagnosed with autism spectrum
disorder can benefit from programs that entail reducing or eliminating digital media use.

22
Introduction
The extensive use of electronic screens by children has reached concerning levels. Although various
countries are conducting assessments, there needs to be more widespread reporting and attention from
authorities and professionals, raising apprehension about the situation. Between 2005 and 2009, the
percentage of children who owned mobile phones doubled compared to the preceding years (Dunckley,
2015). In 2020, a nationwide study in the United States found that 48% of children between 0 and 8
have a mobile media device (Korres, et al., 2024). Many parents often argue that they cannot resist their
children's insistence on having multiple screens. However, the truth is that the parents or caregivers
initially introduce these devices to children, and the allure of these tools naturally leads children to use
them. Surprisingly, when a digital detox is implemented, children naturally shift to healthier activities
and decrease their demands for screen time and video games (Dunckley, 2015). Despite claims from
television program producers about the educational value of their content and its positive influence on
parent-child communication and improvement in learning processing, these assertions lack supporting
evidence. Due to the lack of fully developed cognitive abilities in babies and young children, their
capacity to process information from media sources is limited, making relying on media for their
learning impractical. Additionally, their inability to connect digital information with real-life
experiences further hinders their capacity for learning from digital media (Anderson & Pempek, 2005).

Over the past 30 years, extensive research has been conducted on the impact of media on the
development of psychological issues in children, confirming its association with various psychological
disorders. However, a significant number of children worldwide are misdiagnosed annually, leading to
prolonged stigmatization. Experts using Diagnostic references, particularly the Diagnostic and
Statistical Manual of Mental Disorders (DSM), strongly assert the accuracy of their diagnoses, leaving
little room for doubt. Numerous studies have indicated a causal link between screen exposure and
various issues and disorders. These issues can manifest as symptoms similar to those seen in individuals
diagnosed with autism. Instead of discussing the co-occurrence of other disorders with autism, perhaps
we should consider referring to the phenomenon as "electronic screen syndrome" or "virtual autism,"
with the more severe form being labelled as autism.

When analyzing an environmental factor, it's essential to consider its history thoroughly. There has been
a notable surge in the use of audio-visual content since the 1980s, reaching its peak in 2000. It's worth
noting that this surge coincides with a significant increase in autism rates (Heffler & Oestreicher, 2016).
For instance, amid the COVID-19 pandemic, there was a notable rise in psychological disorders as
families turned to the digital realm for solace. With the closure of schools, parents relied on a variety
of media programs to both educate and entertain their children, seeking to navigate the challenges
presented by the outbreak.

23
Studies indicate that despite professional recommendations against exposing children under two to
digital content, many infants have been regularly exposed to digital media from birth, as families often
leave the TV on even when not actively watching (Heffler & Oestreicher, 2016). This common practice
in many households increases young children's exposure to audiovisual materials. The effectiveness of
early interventions in reducing the severity of autism symptoms implies that there may be an
unrecognized environmental factor that contributes to the worsening or appearance of these symptoms
(Heffler & Oestreicher, Causation model of autism: Audiovisual brain specialization in infancy
competes with social brain networks, 2016).

There is a lack of research on interventions aimed at reducing or eliminating media exposure in children
with autism despite increasing concerns about their early and frequent exposure to screens. However, a
recent study demonstrated that reducing screen time from 5-6 hours per day to just 5 minutes led to
significant improvements in the core symptoms of autism or virtual autism and ESS. Those study
focused on reducing screen time and emphasized fostering social relationships and teaching parents
how to replace screen-based activities with other beneficial pursuits (Heffler, Frome, Garvin, Bungert,
& Bennett, 2022; Harlé, 2019; Wedge, 2017; Zamfir, 2018). Such researches show promise for
developing early and effective interventions, especially for children exposed to screen at a young age,
with the potential for rapid results.

With the increasing exposure of infants and young children to media and the simultaneous rise in autism
diagnoses, is it possible to consider this rising of autism as a phenomenon like virtual autism that is
primarily influenced by media exposure? Can early interventions to reduce media exposure effectively
alleviate symptoms and reduce misdiagnoses? Given the established possible link between media
consumption and various physical and mental health issues in children, should a standardised protocol
addressing media management be considered for other childhood disorders? Furthermore, given the
pervasive influence of media, is it conceivable to develop a two-pronged intervention involving
concurrent electronic fasting for both parents and children to enhance interactions and alleviate
psychological symptoms associated with different disorders? The main objective of the proposed design
is to create an early intervention protocol for children displaying autism-like symptoms after being
significantly exposed to a wide range of digital content from a young age. Additionally, within the
framework of this intervention, we can investigate the possible link between screen exposure and the
manifestation of autism-like symptoms.

Implications and benefits of digital detoxification protocol

It is essential to consider the potential benefits of implementing programs aimed at reducing digital
exposure in children's lives. One key advantage of such programs is the prevention of misdiagnoses that
may result in unnecessary medication prescriptions or other interventions. Accurate diagnoses can help
mitigate additional costs and ensure appropriate treatment. The author suggests researching siblings of

24
individuals with ASD, including documenting infant audiovisual viewing data by parents and
conducting a prospective multi-center study. The study would involve families willing to limit or
eliminate audiovisual exposure in children who are diagnosed with ASD under seven years old.
According to this protocol, if it's proven that exposure to audiovisual media (AV) has a causal effect on
child development, parents will have the necessary information to make informed decisions about their
child's exposure.

Raising awareness about this treatment protocol will drive further research to address these questions.
This will enable parents to make well-informed decisions based on scientific evidence. Currently,
autism is often perceived as mysterious, leaving parents feeling confused and helpless when faced with
questions about the condition. Additionally, implementing this treatment protocol may lead parents and
professionals to question the accuracy of an autism diagnosis for children who respond positively to
intervention.

Digital detoxification protocol

Multiple studies have reviewed the digital devices commonly used by children. As part of the digital
detox protocol, removing all digital tools available to the child, including television, phones, tablets,
digital toys, gaming consoles, audiobooks, white noise devices, and so on, is crucial. It is recommended
that the digital detox program be maintained for a minimum of six months. The objective of this protocol
is to determine the effectiveness of a digital detox intervention in reducing autism-like symptoms in
young children who have been exposed to excessive screen time.

Participants:
 Inclusion Criteria:

o The study includes participants in the age range of two to six years’ old who were
referred to health centers in London and have received a diagnosis of autism or are
being assessed for a potential autism diagnosis by specialists at these centers.
Diagnosed with autism spectrum disorder (ASD) or displaying autism-like symptoms

o Daily screen time exceeding 4 hours

 Exclusion Criteria:

o Children with significant medical or neurological conditions unrelated to screen

exposure

o Children undergoing other intensive behavioral therapies during the study period

Study Design:
The research design involves a quasi-experimental design between groups with repeated measurements
of multiple variables. The study includes three groups of participants with autism-like symptoms. The

25
first group undergoes digital detoxification treatment, the second group receives standard interventions,
and the third group receives no intervention. All three groups will be compared at baseline.

The effect size will be 0.25, with a 5% error margin, and four measurements will be taken from the pre-
test to the second follow-up stage. The power level of 95% indicates that each group should consist of
approximately 52 participants, resulting in a total of 156 participants across three groups. Furthermore,
efforts will be made to align the participants in each group based on gender and age.

Intervention:
 Digital Detox Protocol:

o Complete elimination of non-essential screen time, including television,

tablets, smartphones, and computers, for the intervention group.

o Essential screen time (e.g., for educational purposes) limited to a maximum of

30 minutes per day under parental supervision.

o Replacement activities include interactive play, reading, outdoor activities,

and social interactions with caregivers and peers.

o Parents receive weekly guidance and support from a trained therapist to

manage the transition and to implement alternative activities effectively.

Control Group:
 Continue with their usual screen exposure without any imposed restrictions.

 Parents will receive general health and wellness tips unrelated to screen time.

Data Collection:
 Baseline Assessment:

o Comprehensive evaluation of autism-like symptoms using standardized tools

such as the Autism Diagnostic Observation Schedule (ADOS) and the
Childhood Autism Rating Scale (CARS).

o Assessment of cognitive development, language skills, social interactions,

sleep patterns, and behavior using validated questionnaires and observational
checklists.

o Parental reports on screen time habits, types of content consumed, and overall
media usage.

26
Follow-Up Assessments:
o They are conducted at one month, three months, and six months.

o Re-assessment of autism-like symptoms, cognitive development, language

skills, social interactions, sleep patterns, and behavior.

o Parental feedback on adherence to the digital detox protocol, challenges faced,

and perceived changes in their child's behavior and symptoms.

Data Analysis:
 Statistical analysis will be conducted to compare the intervention and control groups.

 Multivariate Repeated Measures Analysis

 Considering the potential confounding variables and making the necessary adjustments.
This can include factors such as the family's economic status, the parents' level of
education, their age, and their history of severe psychiatric disorders.

Ethical Considerations:
 Informed consent obtained from parents or guardians before participation.

 Assurance of confidentiality and the right to withdraw from the study at any time
without any consequences.

 The researcher must carry out the suggested intervention for the control groups upon
completion of the study.

Significance and possible outcomes

It would be beneficial to prioritize organizing an intervention to prevent children from being exposed
to various forms of electronic content. This is due to the similarities between the symptoms of virtual
autism and classical autism found in different diagnostic sources, making it challenging to distinguish
between these two disorders. Research literature on the effects of children's exposure to electronic
content and the prevalence of virtual autism has been overlooked and under-tested by health researchers
and policymakers. Studies have focused on biological variables in recent decades, such as specific
autism-related genes. At the same time, environmental factors, particularly the potential causal
relationship between early and excessive media exposure, have been neglected. Encouraging health
policymakers to take decisive action against the prevalence of autism, akin to the global response to the
spread of the Coronavirus, could be a vital step forward. Given the growing evidence, the significant
impact of ASD diagnosis on children and parents, as well as its social costs, it is unscientific to refrain
from further testing the hypothesis of a link between frequent exposure to media and the emergence of
like-autism symptoms (Harlé, 2019).

27
Limitations
It is essential to consider the potential interference between interventions aimed at improving like-
autism symptoms and early interventions that advocate for completely removing digital content. Some
therapies, such as Applied Behavior Analysis (ABA), occupational therapy, and speech therapy, heavily
rely on electronic tools, which may conflict with minimizing sensory stimulation for individuals with
like-autism symptoms. Additionally, experts may face challenges in distinguishing between classical
autism and virtual autism, leading to uncertainty in diagnosis and treatment effectiveness for parents.
Furthermore, parents' eagerness to understand the optimal time for intervention, coupled with the
pervasive digital environment, may disrupt the progress of interventions that require abstaining from
media. Studies suggest that reintroducing media to children who have limited their exposure may
exacerbate their symptoms, posing a significant hurdle for intervention facilitators.

Also It is essential to consider the impact of caregiver digital addiction, mainly if the primary caregiver
is the mother, on the child's treatment process. When children's exposure to media is reduced, they must
engage in meaningful communication with those around them instead of merely consuming media. If
the mother is digitally addicted, it may lead to the child feeling neglected and frustrated, undermining
the effectiveness of efforts to limit media exposure. Frequent exposure to screens can lead to changes
in brain function and hormone secretion. Consequently, specialists often recommend medications to
address these functional changes. Another challenge we may encounter during intervention is the
concurrent use of psychiatric medications by children for various reasons. These medications may
hinder normal brain function, making it challenging to observe genuine changes in brain function.

28
References
Alabdulakareem, E., & Jamjoom, M. (2020). Computer-assisted learning for improving ADHD
individuals’ executive functions through gamified interventions: A review.
Entertainment Computing, 33, 100341.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc..
American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of
mental disorders: DSM-5™ (5th ed.). (2013). American Psychiatric Publishing, Inc..
Anand, A., & Krosnick, J. (2005). Demographic predictors of media use among infants,
toddlers, and preschoolers. American Behavioral Scientist, 48(5), 539-561.
Anderson, D., & Pempek, T. (2005). Television and very young children. American behavioral
scientist, 48(5), 505-522.
Attarha, M., Bigelow, J., & Merzenich, M. (2018). Unintended consequences of white noise
therapy for tinnitus—otolaryngology's cobra effect: a review. JAMA Otolaryngology–
Head & Neck Surgery, 144(10), 938-943.
Bellissimo, N., Pencharz, P., Thomas, S., & Anderson, G. (2007). Effect of television viewing
at mealtime on food intake after a glucose preload in boys. Pediatric research, 61(6),
745-749.
Bliddal, M., Rasmussen, L., Andersen, J., Jensen, P., Pottegård, A., Munk-Olsen, T., . . .
Wesselhoeft, R. (2023). Psychotropic medication use and psychiatric disorders during
the COVID-19 pandemic among Danish children, adolescents, and young adults.
JAMA psychiatry, 80(2), 176-180.
Brown, A., & Council on Communications and Media. (2011). Media use by children younger
than 2 years. Pediatrics, 128(5), 1040-1045.
Bus, A., Takacs, Z., & Kegel, C. (2015). Affordances and limitations of electronic storybooks
for young children's emergent literacy. Developmental review, 35, 79-97.
Cai, H., Chen, P., Jin, Y., Zhang, Q., Cheung, T., Ng, C., . . . Feng, Y. (2024). Prevalence of
sleep disturbances in children and adolescents during COVID-19 pandemic: a meta-
analysis and systematic review of epidemiological surveys. Translational Psychiatry,
14(1), 12.
Cespedes, E., Gillman, M., Kleinman, K., Rifas-Shiman, S., & Redline, S. (2014). Television
Viewing, Bedroom Television, and Sleep Duration From Infancy to Mid-Childhood.
Pediatrics, 133(5), e1163-e1171.
Charitaki, G., Soulis, S.-G., & Tyropoli, R. (2021). Academic self-regulation in autism spectrum
disorder: A principal components analysis. International Journal of Disability,
Development and Education, 68(1), 26-45.
Chen, B., Van Dam, R., Seng Tan, C., Chua, H., Wong, P., Bernard, J., & Müller-
Riemenschneider, F. (2019). Screen viewing behavior and sleep duration among
children aged 2 and below. BMC Public Health, 19, 1-10.
Chen, J.-Y., Strodl, E., Wu, C.-a., Huang, L.-H., Yin, X.-N., Wen, G.-M., . . . Chen, W.-Q.
(2021). Screen time and autistic-like behaviors among preschool children in China.
Psychology, health & medicine, 26(5), 607-620.

29
Christakis, D., Gilkerson, J., Richards, J., Zimmerman, F., Garrison, M., Xu, D., . . . Yapanel,
U. (2009). Audible television and decreased adult words, infant vocalizations, and
conversational turns: a population-based study. Archives of pediatrics & adolescent
medicine, 163(6), 554-558.
Cliff, D., Howard, S., Radesky, J., McNeill, J., & Vella, S. (2018). Early childhood media
exposure and self-regulation: Bidirectional longitudinal associations. Academic
pediatrics, 18(7), 813-819.
Cohen, S., Leckman, J., & Bloch, M. (2013). Clinical assessment of Tourette syndrome and
tic disorders. Neuroscience & Biobehavioral Reviews, 37(6), 997-1007.
Courage, M. (2017). Screen media and the youngest viewers: Implications for attention and
learning. In F. Blumberg, & P. Brooks, Cognitive development in digital contexts (pp.
(pp. 3-28)). Academic Press.
De Jong, R., Davis, G., Chelf, C., Marinelli, J., Erbele, I., & Bowe, S. (2024). Continuous White
Noise Exposure During Sleep and Childhood Development. A Scoping Review. Sleep
Medicine.
de Leeuw, A., Happé, F., & Hoekstra, R. (2020). A conceptual framework for understanding
the cultural and contextual factors on autism across the globe. Autism Research, 13(7),
1029-1050.
Deng, J., Zhou, F., Hou, W., Heybati, K., Lohit, S., Abbas, U., . . . Heybati, S. (2022).
Prevalence of mental health symptoms in children and adolescents during the COVID‐
19 pandemic: A meta‐analysis. Annals of the New York Academy of Sciences, 1520(1),
53-73.
Dong, H.-Y., Wang, B., Li, H.-H., Yue, X.-J., & Jia, F.-Y. (2021). Correlation between screen
time and autistic symptoms as well as development quotients in children with autism
spectrum disorder. Frontiers in Psychiatry, 12, 619994.
Dunckley, V. (2015). Reset your child's brain: A four-week plan to end meltdowns, raise
grades, and boost social skills by reversing the effects of electronic screen-time. New
world library.
Eggermont, J. (2017). Effects of long-term non-traumatic noise exposure on the adult central
auditory system. Hearing problems without hearing loss. Hearing research, 352, 12-
22.
Eric, O. (2021). The negative effects of new screens on the cognitive functions of young
children require new recommendations. Italian Journal of Pediatrics, 47(1), 223.
Garrison, M., & Christakis, D. (2005). A teacher in the living room?: Educational media for
babies, toddlers and preschoolers: A background report prepared for Kaiser Family
Foundation. Henry J. Kaiser Family Foundation.
Geist, E., & Gibson, M. (2000). The effect of network and public television programs on four
and five year olds ability to attend to educational tasks. Journal of Instructional
Psychology, 27(4), 250.
Guernsey, L., & Levine, M. (2015). Tap, click, read: Growing readers in a world of screens.
John Wiley & Sons.

30
Harlé, B. (2019). Intensive early screen exposure as a causal factor for symptoms of autistic
spectrum disorder: The case for «Virtual autism». Trends in neuroscience and
education, 17, 100119.
Heffler, K., & Oestreicher, L. (2016). Medical hypotheses, 91, 114-122.
Heffler, K., & Oestreicher, L. (2016). Causation model of autism: Audiovisual brain
specialization in infancy competes with social brain networks. Medical hypotheses, 91,
114-122.
Heffler, K., Frome, L., & Gullo, D. (2022). Psychiatry Research Case Reports, 1(2), 100059.
Heffler, K., Frome, L., Garvin, B., Bungert, L., & Bennett, D. (2022). Screen time reduction and
focus on social engagement in autism spectrum disorder: A pilot study. Pediatrics
International, 64(1), e15343.
Heuvel, M., Ma, J., Borkhoff, C., Koroshegyi, C., Dai, D., Parkin, P., . . . on behalf of the
TARGet Kids! Collaboration. (2019). Mobile media device use is associated with
expressive language delay in 18-month-old children. Journal of Developmental &
Behavioral Pediatrics, 40(2), 99-104.
Hill, D., Ameenuddin, N., Chassiakos, Y., Cross, C., Hutchinson, J., Levine, A., . . . Swanson,
W. (2016). Media and Young Minds. Pediatrics, 138 (5): e20162591.
Kim, Y., & Leventhal, B. (2015). Genetic epidemiology and insights into interactive genetic and
environmental effects in autism spectrum disorders. Biological psychiatry, 77(1), 66-
74.
Korres, G., Kourklidou, M., Sideris, G., Bastaki, D., Demagkou, A., Riga, M., . . . Delides, A.
(2024). Unsupervised Screen Exposure and Poor Language Development: A Scoping
Review to Assess Current Evidence and Suggest Priorities for Research. Cureus,
16(3).
Köse, S., Kafalı, H., Erkan İdris, Z., Pilan, B., Özbaran, B., & Erermiş, S. (2021). The
prevalence and risk factors for overweight/obesity among Turkish children with
neurodevelopmental disorders. Research in Developmental Disabilities, 114, 103992.
Kostyrka-Allchorne, K., Cooper, N., & Simpson, A. (2017). The relationship between television
exposure and children’s cognition and behaviour: A systematic review. Developmental
review, 44, 19-58.
Lapierre, M., Piotrowski, J., & Linebarger, D. (2012). Background television in the homes of
US children. Pediatrics, 130(5), 839-846.
Lizandra, J., Devís-Devís, J., Valencia-Peris, A., Tomás, J., & Peiró-Velert, C. (2019). Screen
time and moderate-to-vigorous physical activity changes and displacement in
adolescence: A prospective cohort study. European journal of sport science, 19(5),
686-695.
Madigan, S., Browne, D., Racine, N., Mori, C., & Tough, S. (2019). Association between
screen time and children’s performance on a developmental screening test. JAMA
pediatrics, 173(3), 244-250.
Markham, J., & Greenough, W. (2004). Experience-driven brain plasticity: beyond the
synapse. Neuron glia biology, 1(4), 351-363.

31
Masur, E., Flynn, V., & Olson, J. (2016). Infants’ background television exposure during play:
Negative relations to the quantity and quality of mothers’ speech and infants’
vocabulary acquisition. First Language, 36(2), 109-123.
McClure, E., Chentsova-Dutton, Y., Barr, R., Holochwost, S., & Parrott, W. (2016). “Facetime
doesn’t count”: Video chat as an exception to media restrictions for infants and
toddlers. International Journal of Child-Computer Interaction, 6, 1-6.
McNeill, J., Howard, S., Vella, S., & Cliff, D. (2019). Longitudinal associations of electronic
application use and media program viewing with cognitive and psychosocial
development in preschoolers. Academic pediatrics, 19(5), 520-528.
Merzenich, M., Nahum, M., & van Vleet, T. (2013). Changing brains: applying brain plasticity
to advance and recover human ability. Vol. 207). Elsevier.
Moffitt, T., Arseneault, L., Belsky, D., Dickson, N., Hancox, R., Harrington, H., . . . Caspi, A.
(2011). A gradient of childhood self-control predicts health, wealth, and public safety.
Proceedings of the national Academy of Sciences, 108(7), 2693-2698.
Nevison, C. (2014). A comparison of temporal trends in United States autism prevalence to
trends in suspected environmental factors. Environmental Health, 13, 1-16.
Pempek, T., Kirkorian, H., & Anderson, D. (2014). The Effects of Background Television on
the Quantity and Quality of Child-Directed Speech by Parents. Journal of Children and
Media, 8(3), 211-222.
Piaget, J., & Cook, M. (1952). The origins of intelligence in children. In When Thinking Begins
(p. 18). New York: International Universities Press.
Radesky, J., Miller, A., Rosenblum, K., Appugliese, D., Kaciroti, N., & Lumeng, J. (2015).
Maternal mobile device use during a structured parent–child interaction task.
Academic pediatrics, 15(2), 238-244.
Radesky, J., Schumacher, J., & Zuckerman, B. (2015). Mobile and interactive media use by
young children: the good, the bad, and the unknown. Pediatrics, 135(1), 1-3.
Salti, R., Tarquini, R., Stagi, S., Perfetto, F., Cornelissen, G., Laffi, G., . . . Halberg, F. (2006).
Age-dependent association of exposure to television screen with children’s urinary
melatonin excretion? Neuroendocrinology Letters, 27(1-2), 73-80.
Sammels, O., Karjalainen, L., Dahlgren, J., & Wentz, E. (2022). Autism spectrum disorder and
obesity in children: a systematic review and meta-analysis. Obesity facts, 15(3), 305-
320.
Shaheen, S. (2014). How Child's Play Impacts Executive Function–Related Behaviors.
Applied Neuropsychology: Child, 3(3), 182-187.
Stamou, M., Streifel, K., Goines, P., & Lein, P. (2013). Neuronal connectivity as a convergent
target of gene× environment interactions that confer risk for Autism Spectrum
Disorders. Neurotoxicology and teratology, 36, 3-16. Neurotoxicology and teratology,
36, 3-16.
Stockdale, L., Holmgren, H., Porter, C., Clifford, B., & Coyne, S. (2022). Varying trajectories
of infant television viewing over the first four years of life: Relations to language
development and executive functions. Varying trajectories of infant television viewing
over the first four years of Journal of Applied Developmental Psychology, 80, 101418.

32
 Thompson, R., Smith, R., Bou Karim, Y., Shen, C., Drummond, K., Teng, C., & Toledano, M.
(2022). "Noise pollution and human cognition: An updated systematic review and
meta-analysis of recent evidence. Environment international, 158: 106905.
Venkatesan, S., & Gopalkrishnan, I. (2022). Controversial themes and issues surrounding
Autism: A chronological timeline analysis. Indian Journal of Mental Health, 9(3).
Vijakkhana, N., Wilaisakditipakorn, T., Ruedeekhajorn, K., Pruksananonda, C., & Chonchaiya,
W. (2015). Evening media exposure reduces night-time sleep. Acta Paediatrica,
104(3), 306-312.
Waldman, M., Nicholson, S., & Adilov, N. (2006). Does television cause autism?. Working
Paper, 12632.
Wedge, M. (2017, 8 15). “Virtual Autism” May Explain Explosive Rise in ASD Diagnoses.
Retrieved from Mad in America, SCIENCE, PSYCHIATRY AND SOCIAL JUSTICE:
[Link]
Weismer, S., Lord, C., & Esler , A. (2010). Early language patterns of toddlers on the autism
spectrum compared to toddlers with developmental delay. Journal of autism and
developmental disorders, 40, 1259-1273.
Wen, L., Baur, L., Rissel, C., Xu, H., & Simpson, J. (2014). Correlates of Body Mass Index
and Overweight and Obesity of Children Aged 2 Years: Findings from the Healthy
Beginnings Trial. Obesity, 22(7), 1723-1730.
Wooldridge, M., & Shapka, J. (2012). Playing with technology: Mother–toddler interaction
scores lower during play with electronic toys. Journal of Applied Developmental
Psychology, 33(5), 211-218.
World Health Organization. (2024). Compendium of WHO and other UN guidance on health
and environment: version with International Classification of Health Intervention (ICHI)
codes. World Health Organization.
Zamfir, M. (2018). The consumption of virtual environment more than 4 hours/day, in the
children between 0-3 years old, can cause a syndrome similar with the autism
spectrum disorder. Journal of Romanian literary studies, (13), 953-968.
Zhai, Y., Sun, S., Wang, F., & Ding, Y. (2017). Multiplicity and uncertainty: Media coverage of
autism causation. Journal of Informetrics, 11(3), 873-887.

33

View publication stats