The proliferation of digital technology in modern society has led to a significant increase in screen-based activities among children. Devices such as smartphones, tablets, televisions, and computers have become integral parts of daily life, even for young children, contributing to what many now term as "screen time addiction" (1). While the educational and entertainment value of these devices is widely acknowledged, their excessive use has raised serious concerns about the mental, emotional, and behavioral health of children.

Current evidence suggests that prolonged screen exposure can interfere with developmental processes, particularly in children aged 6 to 12 years, a critical period for cognitive and social maturation (2). The World Health Organization recommends that children in this age group should limit recreational screen time to less than two hours per day; however, many exceed this threshold, especially in urban settings (3). With the recent surge in online learning and digital dependence during and post-COVID-19 pandemic, this trend has intensified further (4).

Screen time addiction, often characterized by compulsive usage and withdrawal symptoms, has been linked with several behavioral problems including hyperactivity, emotional dysregulation, inattention, and peer relationship difficulties (5,6). These symptoms can impair academic performance, reduce physical activity, and increase the risk of psychosocial maladjustments (7). Furthermore, studies have shown a dose-response relationship, with behavioral issues increasing in severity with higher daily screen exposure (8,9).

Despite the growing body of literature on this topic, data specific to Indian populations, especially from urban school settings, remain limited. Understanding the local patterns of screen use and their behavioral consequences is vital for developing culturally appropriate guidelines and interventions. Therefore, this study was designed to evaluate the association between screen time addiction and behavioral problems among school-aged children in an urban area Surat - India.

Study Population

The target population included school-going children aged between 6 and 12 years. Inclusion criteria involved children regularly attending school and whose parents were willing to participate. Children with previously diagnosed neurodevelopmental or psychiatric disorders, or those on long-term medications known to affect behavior, were excluded.

Sample Size and Sampling Technique

Using a prevalence estimate of behavioral problems in children exposed to high screen time at 50% for maximum sample size with a 95% confidence interval and 5% margin of error, the required sample size was calculated to be 384. Accounting for a 5% non-response rate, the final sample size was set at 400. Participants were selected through stratified random sampling across different school types (private vs. public) and classes.

Data Collection Tools

Data were collected using a pretested, structured questionnaire completed by parents or primary caregivers. The questionnaire was divided into three parts:

1. Demographic information – including age, gender, parental education, type of family, and household income.
2. Screen Time Addiction Scale (STAS) – a validated tool to assess screen dependency behavior in children, consisting of 15 items scored on a 5-point Likert scale.
3. Strengths and Difficulties Questionnaire (SDQ) – a widely used behavioral screening tool for children, covering five domains: emotional symptoms, conduct problems, hyperactivity/inattention, peer problems, and prosocial behavior.

Data Collection Procedure

Teachers distributed the questionnaires to the parents during regular parent-teacher meetings. Completed forms were collected after 3–5 days. Field investigators cross-verified the data for completeness and accuracy.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 26.0. Descriptive statistics were computed for demographic variables and scores from STAS and SDQ. Pearson’s correlation was used to evaluate associations between screen addiction scores and behavioral domains. Independent t-tests and ANOVA were employed to compare behavioral scores across screen time categories. A p-value <0.05 was considered statistically significant.

A total of 400 school-aged children were included in the study, with a response rate of 95%. Of the participants, 218 (54.5%) were male and 182 (45.5%) were female. The mean age of the children was 9.1 ± 1.8 years. Most children (72%) belonged to nuclear families, and 60% of parents had completed secondary education or above.

The distribution of average daily screen time revealed that 36.5% of children used screens for less than 2 hours/day, 41.2% for 2–4 hours/day, and 22.3% for more than 4 hours/day. The prevalence of moderate-to-high screen time addiction (STAS score ≥25) was 61% (n = 244). The mean STAS score was 26.4 ± 5.7 (Table 1).

Table 1. Demographic Profile and Screen Usage Patterns (n = 400)

The mean total SDQ score was 17.6 ± 4.3. Children with screen time exceeding 4 hours/day had significantly higher scores in hyperactivity (mean = 6.7 ± 1.3), conduct problems (mean = 4.9 ± 1.1), and peer relationship issues (mean = 5.6 ± 1.4) compared to those with lower screen time (p < 0.01). A positive and moderate correlation was observed between STAS and total SDQ score (r = 0.52, p < 0.001) (Table 2).

Table 2. Comparison of Behavioral Domain Scores by Screen Time Category

As shown in Table 2, behavioral issues such as hyperactivity, conduct problems, and peer difficulties increased progressively with greater screen time. Notably, prosocial behavior declined with increased screen exposure (p < 0.05).

This study aimed to assess the relationship between screen time addiction and behavioral problems among school-aged children. The findings reveal a clear and statistically significant association between increased screen exposure and a variety of behavioral issues, particularly hyperactivity, conduct disturbances, and peer relationship difficulties. These results align with existing literature highlighting the psychosocial risks associated with excessive screen usage in the pediatric population (1,2).

The mean screen time in our sample (4.1 ± 1.3 hours/day) exceeded the daily screen use recommended by the World Health Organization, which advises limiting recreational screen time to less than two hours for children aged 5–12 years (3). Similar findings have been reported in both developed and developing countries, indicating a global trend of escalating screen dependency among children (4,5).

The observed high prevalence of moderate-to-severe screen addiction (61%) is concerning and is consistent with previous Indian and Southeast Asian studies that reported similar figures, particularly in urban settings with greater access to smartphones and internet connectivity (6,7). The psychological mechanisms underlying this addiction are believed to involve the reward pathways of the brain, where screen use leads to dopamine release, fostering compulsive use and decreased self-regulation (8).

Our data show that children with higher screen time (>4 hours/day) had significantly elevated scores for hyperactivity and conduct problems. This corroborates findings by Twenge and Campbell, who demonstrated a dose-dependent relationship between screen exposure and behavioral dysregulation (9). Hyperactivity and impulsivity may stem from overstimulation of the nervous system and reduced time for unstructured physical activity, which is critical for behavioral regulation (10,11). Moreover, the displacement hypothesis suggests that screen time replaces essential activities like sleep, peer interaction, and academic engagement, thereby worsening behavioral outcomes (12).

Peer problems were also prominent among children with high screen use. Digital engagement may offer fewer opportunities for face-to-face social interaction, contributing to poor development of interpersonal skills and empathy (13). Additionally, excessive screen use has been linked with increased irritability, emotional dysregulation, and even symptoms resembling attention-deficit/hyperactivity disorder (ADHD) (14).

An inverse relationship was observed between screen time and prosocial behavior. Children with greater screen addiction displayed reduced empathy and helpfulness, consistent with studies showing that excessive screen media exposure—especially violent or fast-paced content—can blunt prosocial responses (15). This aligns with the theory that content type, in addition to duration, plays a critical role in influencing child behavior (7).

Importantly, a moderate positive correlation was found between the STAS and total SDQ scores (r = 0.52), reinforcing the association between screen dependency and behavioral disturbances. These findings highlight the urgent need for parental guidance, regulated digital exposure, and awareness campaigns to promote healthy screen habits. Interventions should also incorporate behavioral counseling for at-risk children to mitigate long-term consequences (8,9).

Strengths of this study include the use of validated screening tools (STAS and SDQ), a representative sample size, and stratified sampling to ensure diversity. However, limitations include the cross-sectional design, which restricts causal inference, and reliance on parent-reported measures, which may introduce bias. Longitudinal studies are needed to establish temporality and explore the impact of specific screen content types.

This study underscores a significant association between excessive screen time and behavioral problems among school-aged children. Elevated screen exposure was linked to increased hyperactivity, conduct issues, and peer difficulties. These findings highlight the urgent need for parental monitoring, educational interventions, and policy guidelines to promote healthy screen habits and support children's mental well-being.

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