Enhancing Communication in Screen-Exposed Children: Role of Behavioral Intervention: A Preliminary Study Conducted in a Hospital Setting in India.

Enhancing Communication in Screen-Exposed Children: Role of Behavioral Intervention: A Preliminary Study Conducted in a Hospital Setting in India. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Communication in Screen-Exposed Children: Role of Behavioral Intervention: A Preliminary Study Conducted in a Hospital Setting in India. Nicola Judith Flynn, Arunima datta This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7674524/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives This study assessed the effectiveness of behavioural interventions in reducing screen time and enhancing parent-child interaction to improve communication in children aged 18 to 60 months. Methods observational and crosse-sectional was designed in this study. 114 parents of children ages 18 to 60 months with delayed communication skills were among the participants in the pediatric department at tertiary hospital, Kolkata, India. Participants were were randomly assigned to either receive BI (group-A) or not (group-B). Participants underwent assessment of primary outcomes at baseline and every two weeks for three consecutive months. To define the impact of BI, appropriate statistics were applied to calculate the Mean ± SD of the primary outcomes’ score. Result Findings revealed, In Group A, 69.80% of children utilize screens for less than three hours, while in Group B, only 38.20% of children engage with these devices for the same duration. Sstatistical report compliance after completing sessions communication was developed, in Group A versus Group B (19.06 ± 3.65 vs11.4 ± 1.93). Conclusion Following the evidence, children receiving BI in regular manner exhibited a greater reduction in duration of screen time compared with children who did not receive. Social communication Behavioural intervention and Smartphone use Figures Figure 1 Key findings Reducing the use of mobile phones and other electronic devices, especially during early childhood and infancy, can improve mental health and communication development. For healthy development, it is essential to encourage alternate activities like reading, interactive play, and in-person interactions. (Muppalla, Vuppalapati, Pulliahgaru, & Sreenivasulu, 2023) (Goswami & Parekh, 2023). Furthermore, it was highlighted how parent-child interactions can support development, which is consistent with mental health strategies meant to encourage sound social-emotional development during crucial developmental stages.(Frosch, Schoppe-Sullivan, & O’Banion, 2019). Background Nowadays, electronic gadgets and mobile phones have become the preferred toys and ‘tantrum pacifiers’ for toddlers and pre-school children especially from Covid-19 taking place in India. However, this virtual world involving smartphones., tabs and other screen devices, opened up a Pandora’s box for the time to follow (Serra, Lo Scalzo, Giuffrè, Ferrara, & Corsello, 2021 ). Screen addiction and online friendships has replaced normal interaction especially since the covid quarantine phase. According to studies, the median age of a child's first exposure to smartphones/other electronic devices was approximately 10 months, with exposure occurring as early as 2 months. Most children have been exposed to screen-based media by the time they are 18 months old. It's interesting to note that among these young children, smartphone usage (96%) is more common than television viewing (89%). Previous studies had already establish a positive correlation between increased screen time and a higher risk of communication developmental delays (Varadarajan et al., 2021 ). While there some evidence from high-income Western nations regarding the impact of screen time on development, there is not much from low- and middle-income nations (Hill et al., 2016 ). As research stated, parent's expression, reflection, and discussion of their emotions with their child impacts on a child’s development of social communication. But most of the parents, become engrossed in their own smartphones/ other devices, which may limit their ability to interact with their child. Several observational studies have focused that the unsettling impact of smartphones/ other devices use extends beyond parent-child interactions. Previous studies which have already discussed about the impact of parent-child interaction therapy on child’s behaviour. For e.g.- improved parenting style (Vess & Campbell, 2022 ), reduced child behavioural problems (Bjørseth & Wichstrøm, 2016 ), improved relationship with siblings (Vess & Campbell, n.d.), reduced parental stress, improve parent-child bond, improved child’s understanding of feelings and increased self-confidence (Lieneman, Brabson, Highlander, Wallace, & McNeil, 2017 ) Based on previous research, we developed a behavioural intervention (BI) for this study involving active participation from both the child and their primary caregiver (parent, nanny, or extended family member). The primary aim was to evaluate the impact of caregiver-delivered BI on reducing screen time in children aged 18 to 60 months. Additionally, the study examined its effects on enhancing social communication skills by promoting extended parent-child interaction. Methods Participants and Procedure This observational, cross-sectional study was conducted in the outpatient (OPD) and inpatient (IPD) departments of Paediatrics at a co-operate hospital in West Bengal, India. In the Indian context, children are often introduced to mobile phones or other electronic devices—such as tablets, laptops, or televisions—as early as 12 months of age, typically by parents or extended family members. During routine pediatric practice, doctors observed that many parents expressed concerns about their children's difficulties in social interaction. As a result, these children were referred to a clinical psychologist for developmental milestone assessments. Using the Bayley Scales of Infant and Toddler Development, 176 out of 259 assessed children were found to have delayed communication skills. Following the study protocol, children aged 18 to 60 months whose parents consented to participate were considered eligible. This specific age range was chosen because key communication milestones—such as social smiling and the use of meaningful single words—typically develop during this period. Ultimately, 114 children were enrolled in the study after obtaining written informed consent from their caregivers. Purposefully divided all the children into two groups, Group A (N = 63) and Group B (N = 51). We also noted the cause for refusal to participate in the study. This information helped to determine the acceptability of the psychological support as well as document the major barriers to participation. (Fig: -1). Group-A: (N = 63) The participants of this group underwent a series of five behavioral intervention sessions aimed at reducing their children’s screen time and enhancing social communication skills. The intervention took place biweekly over a period of three months. The Bayley scale was used by psychologists to assess social communication skills prior to each session, and the amount of time spent on smartphones or other electronic devices was also recorded. Group-B: (N = 51) The participants of this group only underwent reassessment of their children’s level of social communication development using the Bayley scale biweekly over a period of three months. Additionally, the amount of time spent on smartphones or other electronic devices was also recorded. Inclusion and Exclusion Criteria for the participants The inclusion criteria consisted of those children who use smart phones or other electronic device for > 3 hours (complained by parents) and as parent’s complaint, the signs of delay in social communication- unable to describe basic needs (hunger, thirst), no toilet training, social smile, deficit in social understanding and interaction. In part of exclusion criteria consisted of children with a known diagnosis of autism spectrum disorder or severe developmental delay, known genetic causes, hearing problems, cerebral palsy, neurological disorders was excluded (Schwarzer, Grafe, Hiemisch, Kiess, & Poulain, 2022 ). Behavioural Intervention Direct, in-person interaction remains the most effective method for fostering communication skills in young children. Through face-to-face engagement, children acquire fundamental social behaviours, such as eye contact, non-verbal communication, turn-taking, and reciprocation. These interactions form the basis of social communication development. Prior research has consistently highlighted the detrimental effects of excessive screen time on early childhood development. Children exposed to prolonged use of smartphones or other electronic devices demonstrate poorer vocabulary acquisition and delays in social communication skills when compared to peers engaged in more interactive, real-world activities (Wörle & Paulus, 2019a ) Informed by these findings, the present study implemented a structured behavioural intervention comprising five sessions. The programme required equal involvement from both the child and their primary caregiver, based on the principle that parents or primary caregivers serve as the child’s primary social learning context. Each session was designed to target a specific domain of social communication development: Reciprocation: (Individual Play) - It is a core social norm, promotes positive response behaviors and mutual engagement during interactions. Individual play activities were used to help children develop the ability to respond appropriately and sustain interaction (Wörle & Paulus, 2019b ) Interaction: (Associative play)- A ssociative play enhances a child's capacity to engage with others, fostering a sense of being heard and understood. It reinforces skills such as active listening, shared attention, and verbal responsiveness (Schuchert et al., 2023 ) Social adjustment: (cooperative Play) - Early structured environments, such as preschools, allow children to practice essential social skills—sharing, turn-taking, and cooperation—through guided group activities. These experiences contribute to smoother peer interactions and better school readiness (Hirsch, 2016 ) Adjustment with extended family members: (Family indoor games) - Involving children in culturally rooted family games helps them adapt to their familial and cultural contexts. These interactions promote bonding and social comfort within extended family systems (Carneiro, Carvalho, Frota, & Filipe, 2024 ) Responsibility: (family domestic activities) - Assigning children simple household responsibilities supports the development of clear and respectful communication. It fosters accountability in interactions and ensures that messages are effectively conveyed and understood. (Bucăţa & Rizescu, 2017 ) Overall, the intervention sought to reduce screen dependency while strengthening naturalistic, meaningful communication opportunities within the child’s everyday environment. It was held in a controlled room in the Clinical Psychology Unit of the hospital, was coordinated by the coordinator. It comprised of five face-to-face sessions (one time in 1 month for three months) delivered by a trained and experienced psychologist. Each session was 40–45 minutes in duration; a presentation of interactive content followed by questions and discussion. Before starting the psychological session, at first the clinical psychologist assessed the intensity of smart phone use and parent-child interaction at baseline (Table-1) Measures Sociodemographic Details Consists of 7 items related to their details, such as age, gender, and going to school or not, parents both working or not, family type (nuclear or joint), duration of parent-child interaction, number of caregiver and number of caregivers. Kuppuswamy's SES scale Socioeconomic status (SES) is one of the most important social determinants of health and disease, thus, widely studied constructs in the social sciences. Kuppuswamy SES scale was developed by Kuppuswamy in the year 1976 with education, occupation and total income as the parameters, which was modified in later years to include the educational, occupational status of the head of the family and overall aggregate income of the whole family. (East, 2023) Primary Outcomes Mobile Phone use details To define impact BI on delay social and communication development with limiting smartphones or other electronic device use. We have included information about smartphone or other electronic devices. For example: - Use of smartphone or other electronic devices Use - Yes = 1, No = 2 and duration of - Use of smartphone or other electronic devices Use- 3hours = 2. Duration of Parent -child interaction Questionnaire The researchers developed this questionnaire influenced by Parent Child Interaction Questionnaire-R and parent child relationship. This questionnaire was developed to assess how parents view relationships with their children. The items in this question refer to parents’ interpersonal behaviour and feelings. Questions based on learning theory and structural system theory. The scale has three response options against each question. For example- Parent plays with child- 1–2 hours, > 2–4 hours and > 4 hours. Against each response the score should be 0, 1, 2 respectively. Secondary Outcome Bayley scale The Bayley-III is an individually administered assessment tool of global developmental status for children aged 1–58 months. The test consists of three domains: - Cognitive, Language (receptive and expressive communication), and Motor (fine and gross moto) domain (Ranjitkar et al., 2018 ). For the present study we will use only language domain. The test will take 10–15 mints. Data Analysis Statistics were analyzed using version 22.0 of SPSS software. Descriptive statistics were calculated as the Mean ± Standard deviation of age and frequency of demographic factors was tabulated according to gender, residential areas, family structure, parents working status, number of caregivers, relationship with caregiver, socioeconomic status, age of going to school according to two groups. Distribution of smart phones or other electronic device use or parent-child interaction questionnaire were also tabulated in the form of frequency. The BAYLEY Scale performance score was used to calculate the degree of social communication development skill, and the results were converted to Mean ± SD. Chi square was applied to observe comparability according to two groups. Bar graph was used to present the overall mean values of Bayley's scale were calculated at baseline/day 0, day 14, 28, 42, 56, 70, and on days 14, 28, and 84 of the BI in order to assess the impact of BI. Graph was used to present decreasing smart phone or other electronic device use and increasing parent child interaction over the course of BI. Repeated measure anova was used to define significance of behavioural intervention among children through BAYLEY Scale’s score before, during and after participation of the intervention. Results Demographic Information From Table 2, all the two groups match in terms of sociodemographic variables and distribution of smartphone use and duration of parent child interaction. In Group-A, the mean age of children was 3.41 ± 1.23 years. 51% were boys, 54% were residing in community area, 73% were living in nuclear family. 61% children used smart phones more than > 3hours. 54.3% of children had the opportunity to engage with their parents for less than 8 hours. In Group-B, the mean age of children was 3.67 ± 1.5 years. 56% were boys, 49% were residing in community area, 69% were living in nuclear family. 62% children used smart phones more than > 3hours. 34.2% of children had the opportunity to engage with their parents for less than 8 hours. Both the groups were comparable with each other in part of demographic factors and distribution of smartphone use. Table 3 , graph presented repeated analysis of changes in the level of social communication skills across the period of sessions. There it had been found that, those participants assigned BI had significantly increased in number of percentages for the positive social response eg. social smile, able to speak in 2–3 sentences, social response, able to ask simple questions, able to express basic needs compare with those who did don’t assigned. Following those responses had reflected in number of percentages for high score in BAYLEY scale among participants. In Group A, 69.80% of children utilize smartphones or other electronic devices for less than three hours, while in Group B, only 38.20% of children engage with these devices for the same duration. As a result of this intervention, 68.80% of children in Group A had the opportunity to engage with their parents for over 8 hours, in contrast to Group B, where only 30.20% of children experienced the same level of interaction. Table- 4 presented a change of social communication skills and smartphones or other electronic devices among participants across the research duration among children. The Bayley scale score exhibited a significant interaction between Group A and Group B over a period of time, and this interaction was found to be statistically significant (p = < 0.001). Discussion To the best of our knowledge, this is the first study to use behavioural intervention (BI) to reduce screen time among children aged 18–60 months in a routine care setting. The intervention group included children receiving regular care, compared with those who did not. Parents were followed up every two weeks over a period of three months. As noted in the results section, five of the interventions showed a promising reduction in screen time. Over the full course of intervention, children in Group-A exhibited a daily reduction in screen time of nearly three hours compared to Group B. These findings are consistent with previous research, supporting the effectiveness of BI in reducing screen time among young children. (Lewis et al., 2021 )and (Mendoza et al., 2016 ). A critical insight from previous research is that BI tend to be the most effective under "ideal" conditions, where consistent parental involvement is ensured (Mendoza et al., 2016 ). Additionally, meta-analyses have also demonstrated that shorter-duration interventions are more successful in reducing screen time than longer-duration ones. Notably, early reviews often included physical activity as a primary outcome and focused on children up to age six—highlighting a key distinction from the present study, which focused exclusively on screen time reduction and social communication outcomes. The intervention was designed for equal participation of both parents and children which not only increased the quality of time spent together but also reduce screen time. These outcomes were supported by improvements observed in the Bayley Scales of Infant and Toddler Development. Children in Group A demonstrated enhanced reciprocal attention, mimicked simple words, and showed improved eye contact during interactions. Parents were trained in specific techniques to foster a secure and nurturing relationship, while also addressing the child’s social adjustment capabilities. As a result, children in the intervention group developed improved verbal expression and non-verbal gestures following screen time reduction. They also exhibited increased social vocalization and laughter, and responded appropriately when called by name. In contrast, children in Group B showed less interest in social interactions. These findings of the present study evidenced that this BI not only reduced screen time but also influenced the parents' responsiveness to their children's communication cues. Techniques includes responding verbally to children's vocalizations and expanding on them (Edmunds, Kover, & Stone, 2019 )(Grumi et al., 2021 ) BI should be considered as a valuable strategy for supporting socio-communicational development in children aged 18–60 months those were using excessive smart phones/other electronic devices. Future studies should investigate the long-term application of BI, exploring age-specific factors across broader populations. Our findings suggest that BI holds significant potential as an alternative therapeutic approach, especially in contexts where group-based interactions are limited, by enhancing both social communication and parent-child bonding. Conclusion This study investigated the efficacy of BI among children aged 18–60 months those were using excessive mobile phone. It was observed that BI was an effective for developing social emotional skill. Because BI has been tested and found effective in treating young children aged 18–60 months, it is recommended that the use of BI be encouraged to combat young children. A larger sample size is also recommended to further establish the findings of this research. The concept of behavioural intervention to develop social communication skill in the field of paediatric is still new in West Bengal, therefore, there is not much research to reference. This was the primary study following the present concerning factors such as excessive smart phones/other electronic devices. Declarations Ethical Declaration Ethical approval to report this case series was obtained from Clinical Research Ethics Committee- CRE/2024/MAR/1(i) to the institute, East India, prior to conducting the study, in accordance with ICMR guidelines. Funding Declaration This is a tertiary hospital. We have done our research work based on our own fund Consent to Participate “All participants provided informed consent prior to participation in the study. The purpose, procedures, potential risks, and benefits of the study were explained, and participants were informed that they could withdraw at any time without any effect on the care received.” Consent to Publish “All participants (or their legal guardians/primary caregivers, where applicable) provided consent for anonymized data from the study to be published in scientific journals. Any potentially identifiable information has been removed to ensure confidentiality and privacy.” Author Contribution Nicola Judith: Conceptualization, Supervision, Methodology, Formal Analysis, Final Approval of the Manuscript.Arunima Datta: Data Collection, Critical Review, Editing, Interpretation of Findings, Drafting of the Manuscript. References Bjørseth Å, Wichstrøm L. Effectiveness of Parent-Child Interaction Therapy (PCIT) in the Treatment of Young Children’s Behavior Problems. A Randomized Controlled Study. PLoS ONE. 2016;11(9). https://doi.org/10.1371/JOURNAL.PONE.0159845 . Bucăţa G, Rizescu AM. The Role of Communication in Enhancing Work Effectiveness of an Organization. Land Forces Acad Rev. 2017;22(1):49–57. https://doi.org/10.1515/raft-2017-0008 . Carneiro T, Carvalho A, Frota S, Filipe MG. Serious Games for Developing Social Skills in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review. Healthc (Basel Switzerland). 2024;12(5). https://doi.org/10.3390/HEALTHCARE12050508 . East QS, Patenaude IPOS. Scholarship Submission Form International Psycho-Oncology Society, 2023. Edmunds SR, Kover ST, Stone WL. The Relation between Parent Verbal Responsiveness and Child Communication in Young Children with or at Risk for Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Autism Research: Official J Int Soc Autism Res. 2019;12(5):715. https://doi.org/10.1002/AUR.2100 . Frosch CA, Schoppe-Sullivan SJ, O’Banion DD. Parenting and Child Development: A Relational Health Perspective. Am J Lifestyle Med. 2019;15(1):45. https://doi.org/10.1177/1559827619849028 . Goswami P, Parekh V. The impact of screen time on child and adolescent development: a review. Int J Contemp Pediatr. 2023;10(7):1161–5. https://doi.org/10.18203/2349-3291.ijcp20231865 . Grumi S, Cappagli G, Aprile G, Mascherpa E, Gori M, Provenzi L, Signorini S. (2021). Togetherness, beyond the eyes: A systematic review on the interaction between visually impaired children and their parents. Infant Behavior & Development , 64 . https://doi.org/10.1016/J.INFBEH.2021.101590 Hill D, Ameenuddin N, Chassiakos YR, Cross C, Radesky J, Hutchinson J, Swanson WS. Media and young minds. Pediatrics. 2016;138(5). https://doi.org/10.1542/peds.2016-2591 . Hirsch B. (2016). Cooperative group play social skills training for children with socimotional, and behavior challenges: Impact on self-esteem and social skills, 108. Retrieved from http://digitalcommons.pcom.edu/psychology_dissertations Lewis L, Povey R, Rose S, Cowap L, Semper H, Carey A, Clark-Carter D. (2021). What behavior change techniques are associated with effective interventions to reduce screen time in 0–5 year olds? A narrative systematic review. Preventive Medicine Reports , 23 . https://doi.org/10.1016/J.PMEDR.2021.101429 Lieneman CC, Brabson LA, Highlander A, Wallace NM, McNeil CB. Parent–Child Interaction Therapy: current perspectives. Psychol Res Behav Manage. 2017;10:239. https://doi.org/10.2147/PRBM.S91200 . Mendoza JA, Baranowski T, Jaramillo S, Fesinmeyer MD, Haaland W, Thompson D, Nicklas TA. Fit 5 Kids TV Reduction Program for Latino Preschoolers: A Cluster Randomized Controlled Trial. Am J Prev Med. 2016;50(5):584–92. https://doi.org/10.1016/J.AMEPRE.2015.09.017 . Muppalla SK, Vuppalapati S, Pulliahgaru AR, Sreenivasulu H. Effects of Excessive Screen Time on Child Development: An Updated Review and Strategies for Management. Cureus. 2023;15(6):e40608. https://doi.org/10.7759/CUREUS.40608 . Ranjitkar S, Kvestad I, Strand TA, Ulak M, Shrestha M, Chandyo RK, Hysing M. Acceptability and reliability of the Bayley Scales of infant and Toddler Development-III Among Children in Bhaktapur, Nepal. Front Psychol. 2018;9(JUL):1265. https://doi.org/10.3389/FPSYG.2018.01265/BIBTEX . Schuchert SA, Khattar S, Tekkar P, Rathour A, Dawar S, Gupta P. Exploring social stages of play through eye to I© intervention model. Clin Child Psychol Psychiatry. 2023;29(3):928. https://doi.org/10.1177/13591045231177477 . Schwarzer C, Grafe N, Hiemisch A, Kiess W, Poulain T. Associations of media use and early childhood development: cross-sectional findings from the LIFE Child study. Pediatr Res. 2022;91(1):247–53. https://doi.org/10.1038/S41390-021-01433-6 . Serra G, Lo Scalzo L, Giuffrè M, Ferrara P, Corsello G. Smartphone use and addiction during the coronavirus disease 2019 (COVID-19) pandemic: cohort study on 184 Italian children and adolescents. Ital J Pediatr. 2021;47(1):1–10. https://doi.org/10.1186/s13052-021-01102-8 . Varadarajan S, Venguidesvarane AG, Ramaswamy KN, Rajamohan M, Krupa M, Christadoss SBW. Prevalence of excessive screen time and its association with developmental delay in children aged < 5 years: A population-based cross-sectional study in India. PLoS ONE. 2021;16(7 July):1–13. https://doi.org/10.1371/journal.pone.0254102 . Vess SF, Campbell JM (n.d.), editors. Parent-child interaction therapy (PCIT) with families of children with autism spectrum disorder. https://doi.org/10.1177/23969415221140707 Vess SF, Campbell JM. (2022). Parent–child interaction therapy (PCIT) with families of children with autism spectrum disorder. Autism and Developmental Language Impairments , 7 . https://doi.org/10.1177/23969415221140707/ASSET/IMAGES/LARGE/10.1177_23969415221140707-FIG3.JPEG Wörle M, Paulus M. (2019a). Normative foundations of reciprocity in preschoolers. Journal of Experimental Child Psychology , 188 . https://doi.org/10.1016/J.JECP.2019.104693 Wörle M, Paulus M. (2019b). Normative foundations of reciprocity in preschoolers. Journal of Experimental Child Psychology , 188 . https://doi.org/10.1016/J.JECP.2019.104693 Tables Tables 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7674524","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":543872822,"identity":"e19b682c-81c8-49b9-8134-59591454cd84","order_by":0,"name":"Nicola Judith Flynn","email":"","orcid":"","institution":"Medica Superspecialty Hopital","correspondingAuthor":false,"prefix":"","firstName":"Nicola","middleName":"Judith","lastName":"Flynn","suffix":""},{"id":543872823,"identity":"28d4242b-2795-444f-8bd6-c97d976fb061","order_by":1,"name":"Arunima datta","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYLCCBBBxAERU2AAJxsYDRGphZmxgOJMG0tJAWAsDTAtj22EGuI24AP/sM2YPHubYMfAdP3/8wY8z5+3Wth8G2lJjE41Li8S5HHODxG3JDJJnkhkbeypuJ287kwjUciwttwGXnjM8ZhKJ25gZDA4kMzbwnLmdbHYAqIWx4TBOLfIQLfUMBucfMzb+bTuXbHb+IX4tBhAthxkMbiQzNvO2HbAzu0HAFsMzbGVALcd5JG88NpwtcyY5wewG0JYEPH6RO8O8TfLntmo5vvOJDz6+qbCzNzuf/vDBhxob3N6HAh4YIxGsMoGAchRgT4riUTAKRsEoGBkAALPbZvD2S/ewAAAAAElFTkSuQmCC","orcid":"","institution":"Medica Superspecialty Hopital","correspondingAuthor":true,"prefix":"","firstName":"Arunima","middleName":"","lastName":"datta","suffix":""}],"badges":[],"createdAt":"2025-09-22 12:09:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7674524/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7674524/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96049371,"identity":"d3891616-af19-4d01-9955-5b105d4c7e2b","added_by":"auto","created_at":"2025-11-17 06:32:07","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1022159,"visible":true,"origin":"","legend":"","description":"","filename":"MainDocument2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/2f73ef348a4d3fadc12a7716.docx"},{"id":96049368,"identity":"69aefb34-bd58-4b56-b1f4-16a287ff0223","added_by":"auto","created_at":"2025-11-17 06:32:07","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4035,"visible":true,"origin":"","legend":"","description":"","filename":"d4c5dfd2cf8f4b0492becf4fb9f5488b.json","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/122230a4c7ddb30af123b40f.json"},{"id":96049373,"identity":"66b6d6ab-09e1-499f-b2a8-5f4f952e7d4e","added_by":"auto","created_at":"2025-11-17 06:32:07","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84455,"visible":true,"origin":"","legend":"","description":"","filename":"d4c5dfd2cf8f4b0492becf4fb9f5488b1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/3df0d976bf6a5f232a56d8f2.xml"},{"id":96246003,"identity":"7782ca80-d8e0-4905-8735-cae4f27364bb","added_by":"auto","created_at":"2025-11-19 07:24:07","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":428016,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/4347d9e836b7f378b1085f11.png"},{"id":96049372,"identity":"524b9342-8478-44f7-bb81-d00f01c11b62","added_by":"auto","created_at":"2025-11-17 06:32:07","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85466,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/192a78f06cb53ce461ea92c5.png"},{"id":96049381,"identity":"46552f2e-a59e-4227-967b-8c3946aade82","added_by":"auto","created_at":"2025-11-17 06:32:08","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87666,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/9e147004336fba9514086f93.png"},{"id":96049377,"identity":"af9a750b-cd1c-4c54-a4ef-60ff3cd71813","added_by":"auto","created_at":"2025-11-17 06:32:07","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":841496,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/be24901772e57ac9c5e3ca39.jpeg"},{"id":96049378,"identity":"68d6847d-5c1f-4f41-9151-3b5ba561d23f","added_by":"auto","created_at":"2025-11-17 06:32:08","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":82420,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/e0e0106e7a647c969f6528fb.png"},{"id":96049376,"identity":"3c2af195-3592-4572-a797-bb7868a29333","added_by":"auto","created_at":"2025-11-17 06:32:07","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":31930,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/3b31d9898cee0d6f5f93b0b8.png"},{"id":96049375,"identity":"bb1870b9-5c6b-4a66-9e22-57b09a34ed54","added_by":"auto","created_at":"2025-11-17 06:32:07","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":33006,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/8668fa18fb4ad3e3a67b57da.png"},{"id":96246169,"identity":"e431f6bd-3fe3-4aed-8193-779277921747","added_by":"auto","created_at":"2025-11-19 07:24:56","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":255896,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/ca276bc1faecf3cb9136e0fd.png"},{"id":96049382,"identity":"911ec8ea-cb0f-45f2-93e0-a2863f8f1450","added_by":"auto","created_at":"2025-11-17 06:32:08","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":82571,"visible":true,"origin":"","legend":"","description":"","filename":"d4c5dfd2cf8f4b0492becf4fb9f5488b1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/7389304292494adbda05f32a.xml"},{"id":96049380,"identity":"7137b2e2-27ff-4536-8d01-3d2866681bd9","added_by":"auto","created_at":"2025-11-17 06:32:08","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92035,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/8e5dee6f43f406f296824dc7.html"},{"id":96247108,"identity":"b1328b3d-50b0-4f79-9f4d-84b38e9570e4","added_by":"auto","created_at":"2025-11-19 07:27:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":201382,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Design\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/5f560e2de325b780ec07145d.png"},{"id":99788759,"identity":"1116f745-d225-4609-a690-bf179c9a21ea","added_by":"auto","created_at":"2026-01-08 12:47:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":680825,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/94d5f258-fea7-4988-9cbb-e0a54b8254e0.pdf"},{"id":96049370,"identity":"50947c20-72a0-416e-afa2-6f8446d73253","added_by":"auto","created_at":"2025-11-17 06:32:07","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":474099,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7674524/v1/7790831b766fc8f4745749a1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhancing Communication in Screen-Exposed Children: Role of Behavioral Intervention: A Preliminary Study Conducted in a Hospital Setting in India.","fulltext":[{"header":"Key findings","content":"\u003cp\u003eReducing the use of mobile phones and other electronic devices, especially during early childhood and infancy, can improve mental health and communication development. For healthy development, it is essential to encourage alternate activities like reading, interactive play, and in-person interactions. (Muppalla, Vuppalapati, Pulliahgaru, \u0026amp; Sreenivasulu, 2023) (Goswami \u0026amp; Parekh, 2023). Furthermore, it was highlighted how parent-child interactions can support development, which is consistent with mental health strategies meant to encourage sound social-emotional development during crucial developmental stages.(Frosch, Schoppe-Sullivan, \u0026amp; O\u0026rsquo;Banion, 2019).\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eNowadays, electronic gadgets and mobile phones have become the preferred toys and \u0026lsquo;tantrum pacifiers\u0026rsquo; for toddlers and pre-school children especially from Covid-19 taking place in India. However, this virtual world involving smartphones., tabs and other screen devices, opened up a Pandora\u0026rsquo;s box for the time to follow (Serra, Lo Scalzo, Giuffr\u0026egrave;, Ferrara, \u0026amp; Corsello, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Screen addiction and online friendships has replaced normal interaction especially since the covid quarantine phase. According to studies, the median age of a child's first exposure to smartphones/other electronic devices was approximately 10 months, with exposure occurring as early as 2 months. Most children have been exposed to screen-based media by the time they are 18 months old. It's interesting to note that among these young children, smartphone usage (96%) is more common than television viewing (89%). Previous studies had already establish a positive correlation between increased screen time and a higher risk of communication developmental delays (Varadarajan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). While there some evidence from high-income Western nations regarding the impact of screen time on development, there is not much from low- and middle-income nations (Hill et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). As research stated, parent's expression, reflection, and discussion of their emotions with their child impacts on a child\u0026rsquo;s development of social communication. But most of the parents, become engrossed in their own smartphones/ other devices, which may limit their ability to interact with their child. Several observational studies have focused that the unsettling impact of smartphones/ other devices use extends beyond parent-child interactions. Previous studies which have already discussed about the impact of parent-child interaction therapy on child\u0026rsquo;s behaviour. For e.g.- improved parenting style (Vess \u0026amp; Campbell, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), reduced child behavioural problems (Bj\u0026oslash;rseth \u0026amp; Wichstr\u0026oslash;m, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), improved relationship with siblings (Vess \u0026amp; Campbell, n.d.), reduced parental stress, improve parent-child bond, improved child\u0026rsquo;s understanding of feelings and increased self-confidence (Lieneman, Brabson, Highlander, Wallace, \u0026amp; McNeil, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e Based on previous research, we developed a behavioural intervention (BI) for this study involving active participation from both the child and their primary caregiver (parent, nanny, or extended family member). The primary aim was to evaluate the impact of caregiver-delivered BI on reducing screen time in children aged 18 to 60 months. Additionally, the study examined its effects on enhancing social communication skills by promoting extended parent-child interaction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants and Procedure\u003c/h2\u003e\u003cp\u003eThis observational, cross-sectional study was conducted in the outpatient (OPD) and inpatient (IPD) departments of Paediatrics at a co-operate hospital in West Bengal, India. In the Indian context, children are often introduced to mobile phones or other electronic devices\u0026mdash;such as tablets, laptops, or televisions\u0026mdash;as early as 12 months of age, typically by parents or extended family members. During routine pediatric practice, doctors observed that many parents expressed concerns about their children's difficulties in social interaction. As a result, these children were referred to a clinical psychologist for developmental milestone assessments. Using the Bayley Scales of Infant and Toddler Development, 176 out of 259 assessed children were found to have delayed communication skills.\u003c/p\u003e\u003cp\u003e Following the study protocol, children aged 18 to 60 months whose parents consented to participate were considered eligible. This specific age range was chosen because key communication milestones\u0026mdash;such as social smiling and the use of meaningful single words\u0026mdash;typically develop during this period. Ultimately, 114 children were enrolled in the study after obtaining written informed consent from their caregivers.\u003c/p\u003e\u003cp\u003ePurposefully divided all the children into two groups, Group A (N\u0026thinsp;=\u0026thinsp;63) and Group B (N\u0026thinsp;=\u0026thinsp;51). We also noted the cause for refusal to participate in the study. This information helped to determine the acceptability of the psychological support as well as document the major barriers to participation. (Fig: -1).\u003c/p\u003e\u003cp\u003eGroup-A: (N\u0026thinsp;=\u0026thinsp;63)\u003c/p\u003e\u003cp\u003e The participants of this group underwent a series of five behavioral intervention sessions aimed at reducing their children\u0026rsquo;s screen time and enhancing social communication skills. The intervention took place biweekly over a period of three months. The Bayley scale was used by psychologists to assess social communication skills prior to each session, and the amount of time spent on smartphones or other electronic devices was also recorded.\u003c/p\u003e\u003cp\u003eGroup-B: (N\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e\u003cp\u003eThe participants of this group only underwent reassessment of their children\u0026rsquo;s level of social communication development using the Bayley scale biweekly over a period of three months. Additionally, the amount of time spent on smartphones or other electronic devices was also recorded.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria for the participants\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria consisted of those children who use smart phones or other electronic device for \u0026gt;\u0026thinsp;3 hours (complained by parents) and as parent\u0026rsquo;s complaint, the signs of delay in social communication- unable to describe basic needs (hunger, thirst), no toilet training, social smile, deficit in social understanding and interaction. In part of exclusion criteria consisted of children with a known diagnosis of autism spectrum disorder or severe developmental delay, known genetic causes, hearing problems, cerebral palsy, neurological disorders was excluded (Schwarzer, Grafe, Hiemisch, Kiess, \u0026amp; Poulain, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eBehavioural Intervention\u003c/h3\u003e\n\u003cp\u003eDirect, in-person interaction remains the most effective method for fostering communication skills in young children. Through face-to-face engagement, children acquire fundamental social behaviours, such as eye contact, non-verbal communication, turn-taking, and reciprocation. These interactions form the basis of social communication development.\u003c/p\u003e\u003cp\u003ePrior research has consistently highlighted the detrimental effects of excessive screen time on early childhood development. Children exposed to prolonged use of smartphones or other electronic devices demonstrate poorer vocabulary acquisition and delays in social communication skills when compared to peers engaged in more interactive, real-world activities (W\u0026ouml;rle \u0026amp; Paulus, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019a\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eInformed by these findings, the present study implemented a structured behavioural intervention comprising five sessions. The programme required equal involvement from both the child and their primary caregiver, based on the principle that parents or primary caregivers serve as the child\u0026rsquo;s primary social learning context.\u003c/p\u003e\u003cp\u003eEach session was designed to target a specific domain of social communication development:\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eReciprocation: (Individual Play)\u003c/span\u003e\u003cb\u003e-\u003c/b\u003e It is a core social norm, promotes positive response behaviors and mutual engagement during interactions. Individual play activities were used to help children develop the ability to respond appropriately and sustain interaction (W\u0026ouml;rle \u0026amp; Paulus, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019b\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eInteraction: (Associative play)-\u003c/span\u003e\u003cb\u003eA\u003c/b\u003essociative play enhances a child's capacity to engage with others, fostering a sense of being heard and understood. It reinforces skills such as active listening, shared attention, and verbal responsiveness (Schuchert et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSocial adjustment: (cooperative Play)\u003c/span\u003e\u003cb\u003e-\u003c/b\u003e Early structured environments, such as preschools, allow children to practice essential social skills\u0026mdash;sharing, turn-taking, and cooperation\u0026mdash;through guided group activities. These experiences contribute to smoother peer interactions and better school readiness (Hirsch, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eAdjustment with extended family members: (Family indoor games)\u003c/span\u003e\u003cb\u003e-\u003c/b\u003e Involving children in culturally rooted family games helps them adapt to their familial and cultural contexts. These interactions promote bonding and social comfort within extended family systems (Carneiro, Carvalho, Frota, \u0026amp; Filipe, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eResponsibility: (family domestic activities)\u003c/span\u003e- Assigning children simple household responsibilities supports the development of clear and respectful communication. It fosters accountability in interactions and ensures that messages are effectively conveyed and understood. (Bucăţa \u0026amp; Rizescu, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eOverall, the intervention sought to reduce screen dependency while strengthening naturalistic, meaningful communication opportunities within the child\u0026rsquo;s everyday environment.\u003c/p\u003e\u003cp\u003eIt was held in a controlled room in the Clinical Psychology Unit of the hospital, was coordinated by the coordinator. It comprised of five face-to-face sessions (one time in 1 month for three months) delivered by a trained and experienced psychologist. Each session was 40\u0026ndash;45 minutes in duration; a presentation of interactive content followed by questions and discussion. Before starting the psychological session, at first the clinical psychologist assessed the intensity of smart phone use and parent-child interaction at baseline (Table-1)\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographic Details\u003c/h2\u003e\u003cp\u003eConsists of 7 items related to their details, such as age, gender, and going to school or not, parents both working or not, family type (nuclear or joint), duration of parent-child interaction, number of caregiver and number of caregivers.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eKuppuswamy's SES scale\u003c/h2\u003e\u003cp\u003eSocioeconomic status (SES) is one of the most important social determinants of health and disease, thus, widely studied constructs in the social sciences. Kuppuswamy SES scale was developed by Kuppuswamy in the year 1976 with education, occupation and total income as the parameters, which was modified in later years to include the educational, occupational status of the head of the family and overall aggregate income of the whole family. (East, 2023)\u003c/p\u003e\u003cp\u003ePrimary Outcomes\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMobile Phone use details\u003c/h3\u003e\n\u003cp\u003eTo define impact BI on delay social and communication development with limiting smartphones or other electronic device use. We have included information about smartphone or other electronic devices. For example: - Use of smartphone or other electronic devices Use - Yes\u0026thinsp;=\u0026thinsp;1, No\u0026thinsp;=\u0026thinsp;2 and duration of - Use of smartphone or other electronic devices Use- \u0026lt;3 hours\u0026thinsp;=\u0026thinsp;1, \u0026gt;3hours\u0026thinsp;=\u0026thinsp;2.\u003c/p\u003e\n\u003ch3\u003eDuration of Parent -child interaction Questionnaire\u003c/h3\u003e\n\u003cp\u003eThe researchers developed this questionnaire influenced by Parent Child Interaction Questionnaire-R and parent child relationship. This questionnaire was developed to assess how parents view relationships with their children. The items in this question refer to parents\u0026rsquo; interpersonal behaviour and feelings. Questions based on learning theory and structural system theory. The scale has three response options against each question. For example- Parent plays with child- 1\u0026ndash;2 hours, \u0026gt;\u0026thinsp;2\u0026ndash;4 hours and \u0026gt;\u0026thinsp;4 hours. Against each response the score should be 0, 1, 2 respectively.\u003c/p\u003e\u003cp\u003eSecondary Outcome\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eBayley scale\u003c/h2\u003e\u003cp\u003eThe Bayley-III is an individually administered assessment tool of global developmental status for children aged 1\u0026ndash;58 months. The test consists of three domains: - Cognitive, Language (receptive and expressive communication), and Motor (fine and gross moto) domain (Ranjitkar et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). For the present study we will use only language domain. The test will take 10\u0026ndash;15 mints.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eStatistics were analyzed using version 22.0 of SPSS software. Descriptive statistics were calculated as the Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard deviation of age and frequency of demographic factors was tabulated according to gender, residential areas, family structure, parents working status, number of caregivers, relationship with caregiver, socioeconomic status, age of going to school according to two groups. Distribution of smart phones or other electronic device use or parent-child interaction questionnaire were also tabulated in the form of frequency. The BAYLEY Scale performance score was used to calculate the degree of social communication development skill, and the results were converted to Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Chi square was applied to observe comparability according to two groups. Bar graph was used to present the overall mean values of Bayley's scale were calculated at baseline/day 0, day 14, 28, 42, 56, 70, and on days 14, 28, and 84 of the BI in order to assess the impact of BI. Graph was used to present decreasing smart phone or other electronic device use and increasing parent child interaction over the course of BI. Repeated measure anova was used to define significance of behavioural intervention among children through BAYLEY Scale\u0026rsquo;s score before, during and after participation of the intervention.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eDemographic Information\u003c/h2\u003e\n \u003cp\u003eFrom Table\u0026nbsp;2, all the two groups match in terms of sociodemographic variables and distribution of smartphone use and duration of parent child interaction.\u003c/p\u003e\n \u003cp\u003eIn Group-A, the mean age of children was 3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23 years. 51% were boys, 54% were residing in community area, 73% were living in nuclear family. 61% children used smart phones more than \u0026gt;\u0026thinsp;3hours. 54.3% of children had the opportunity to engage with their parents for less than 8 hours.\u003c/p\u003e\n \u003cp\u003eIn Group-B, the mean age of children was 3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 years. 56% were boys, 49% were residing in community area, 69% were living in nuclear family. 62% children used smart phones more than \u0026gt;\u0026thinsp;3hours. 34.2% of children had the opportunity to engage with their parents for less than 8 hours.\u003c/p\u003e\n \u003cp\u003eBoth the groups were comparable with each other in part of demographic factors and distribution of smartphone use.\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, graph presented repeated analysis of changes in the level of social communication skills across the period of sessions. There it had been found that, those participants assigned BI had significantly increased in number of percentages for the positive social response eg. social smile, able to speak in 2\u0026ndash;3 sentences, social response, able to ask simple questions, able to express basic needs compare with those who did don\u0026rsquo;t assigned. Following those responses had reflected in number of percentages for high score in BAYLEY scale among participants. In Group A, 69.80% of children utilize smartphones or other electronic devices for less than three hours, while in Group B, only 38.20% of children engage with these devices for the same duration. As a result of this intervention, 68.80% of children in Group A had the opportunity to engage with their parents for over 8 hours, in contrast to Group B, where only 30.20% of children experienced the same level of interaction.\u003c/p\u003e\n \u003cp\u003eTable- 4 presented a change of social communication skills and smartphones or other electronic devices among participants across the research duration among children. The Bayley scale score exhibited a significant interaction between Group A and Group B over a period of time, and this interaction was found to be statistically significant (p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first study to use behavioural intervention (BI) to reduce screen time among children aged 18\u0026ndash;60 months in a routine care setting. The intervention group included children receiving regular care, compared with those who did not. Parents were followed up every two weeks over a period of three months.\u003c/p\u003e\u003cp\u003eAs noted in the results section, five of the interventions showed a promising reduction in screen time. Over the full course of intervention, children in Group-A exhibited a daily reduction in screen time of nearly three hours compared to Group B. These findings are consistent with previous research, supporting the effectiveness of BI in reducing screen time among young children. (Lewis et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)and (Mendoza et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). A critical insight from previous research is that BI tend to be the most effective under \"ideal\" conditions, where consistent parental involvement is ensured (Mendoza et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Additionally, meta-analyses have also demonstrated that shorter-duration interventions are more successful in reducing screen time than longer-duration ones. Notably, early reviews often included physical activity as a primary outcome and focused on children up to age six\u0026mdash;highlighting a key distinction from the present study, which focused exclusively on screen time reduction and social communication outcomes.\u003c/p\u003e\u003cp\u003eThe intervention was designed for equal participation of both parents and children which not only increased the quality of time spent together but also reduce screen time. These outcomes were supported by improvements observed in the Bayley Scales of Infant and Toddler Development. Children in Group A demonstrated enhanced reciprocal attention, mimicked simple words, and showed improved eye contact during interactions. Parents were trained in specific techniques to foster a secure and nurturing relationship, while also addressing the child\u0026rsquo;s social adjustment capabilities. As a result, children in the intervention group developed improved verbal expression and non-verbal gestures following screen time reduction. They also exhibited increased social vocalization and laughter, and responded appropriately when called by name. In contrast, children in Group B showed less interest in social interactions. These findings of the present study evidenced that this BI not only reduced screen time but also influenced the parents' responsiveness to their children's communication cues. Techniques includes responding verbally to children's vocalizations and expanding on them (Edmunds, Kover, \u0026amp; Stone, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)(Grumi et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eBI should be considered as a valuable strategy for supporting socio-communicational development in children aged 18\u0026ndash;60 months those were using excessive smart phones/other electronic devices. Future studies should investigate the long-term application of BI, exploring age-specific factors across broader populations. Our findings suggest that BI holds significant potential as an alternative therapeutic approach, especially in contexts where group-based interactions are limited, by enhancing both social communication and parent-child bonding.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study investigated the efficacy of BI among children aged 18\u0026ndash;60 months those were using excessive mobile phone. It was observed that BI was an effective for developing social emotional skill. Because BI has been tested and found effective in treating young children aged 18\u0026ndash;60 months, it is recommended that the use of BI be encouraged to combat young children. A larger sample size is also recommended to further establish the findings of this research.\u003c/p\u003e\u003cp\u003eThe concept of behavioural intervention to develop social communication skill in the field of paediatric is still new in West Bengal, therefore, there is not much research to reference. This was the primary study following the present concerning factors such as excessive smart phones/other electronic devices.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Declaration \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval to report this case series was obtained from Clinical Research Ethics Committee- CRE/2024/MAR/1(i) to the institute, East India, prior to conducting the study, in accordance with ICMR guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a tertiary hospital. We have done our research work based on our own fund\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;All participants provided informed consent prior to participation in the study. The purpose, procedures, potential risks, and benefits of the study were explained, and participants were informed that they could withdraw at any time without any effect on the care received.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;All participants (or their legal guardians/primary caregivers, where applicable) provided consent for anonymized data from the study to be published in scientific journals. Any potentially identifiable information has been removed to ensure confidentiality and privacy.\u0026rdquo;\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNicola Judith: Conceptualization, Supervision, Methodology, Formal Analysis, Final Approval of the Manuscript.Arunima Datta: Data Collection, Critical Review, Editing, Interpretation of Findings, Drafting of the Manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBj\u0026oslash;rseth \u0026Aring;, Wichstr\u0026oslash;m L. Effectiveness of Parent-Child Interaction Therapy (PCIT) in the Treatment of Young Children\u0026rsquo;s Behavior Problems. A Randomized Controlled Study. PLoS ONE. 2016;11(9). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/JOURNAL.PONE.0159845\u003c/span\u003e\u003cspan address=\"10.1371/JOURNAL.PONE.0159845\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBucăţa G, Rizescu AM. The Role of Communication in Enhancing Work Effectiveness of an Organization. Land Forces Acad Rev. 2017;22(1):49\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1515/raft-2017-0008\u003c/span\u003e\u003cspan address=\"10.1515/raft-2017-0008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarneiro T, Carvalho A, Frota S, Filipe MG. Serious Games for Developing Social Skills in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review. Healthc (Basel Switzerland). 2024;12(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/HEALTHCARE12050508\u003c/span\u003e\u003cspan address=\"10.3390/HEALTHCARE12050508\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEast QS, Patenaude IPOS. Scholarship Submission Form International Psycho-Oncology Society, 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEdmunds SR, Kover ST, Stone WL. The Relation between Parent Verbal Responsiveness and Child Communication in Young Children with or at Risk for Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Autism Research: Official J Int Soc Autism Res. 2019;12(5):715. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/AUR.2100\u003c/span\u003e\u003cspan address=\"10.1002/AUR.2100\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrosch CA, Schoppe-Sullivan SJ, O\u0026rsquo;Banion DD. Parenting and Child Development: A Relational Health Perspective. Am J Lifestyle Med. 2019;15(1):45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1559827619849028\u003c/span\u003e\u003cspan address=\"10.1177/1559827619849028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoswami P, Parekh V. The impact of screen time on child and adolescent development: a review. Int J Contemp Pediatr. 2023;10(7):1161\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18203/2349-3291.ijcp20231865\u003c/span\u003e\u003cspan address=\"10.18203/2349-3291.ijcp20231865\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrumi S, Cappagli G, Aprile G, Mascherpa E, Gori M, Provenzi L, Signorini S. (2021). Togetherness, beyond the eyes: A systematic review on the interaction between visually impaired children and their parents. \u003cem\u003eInfant Behavior \u0026amp; Development\u003c/em\u003e, \u003cem\u003e64\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/J.INFBEH.2021.101590\u003c/span\u003e\u003cspan address=\"10.1016/J.INFBEH.2021.101590\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHill D, Ameenuddin N, Chassiakos YR, Cross C, Radesky J, Hutchinson J, Swanson WS. Media and young minds. Pediatrics. 2016;138(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2016-2591\u003c/span\u003e\u003cspan address=\"10.1542/peds.2016-2591\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHirsch B. (2016). Cooperative group play social skills training for children with socimotional, and behavior challenges: Impact on self-esteem and social skills, 108. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://digitalcommons.pcom.edu/psychology_dissertations\u003c/span\u003e\u003cspan address=\"http://digitalcommons.pcom.edu/psychology_dissertations\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLewis L, Povey R, Rose S, Cowap L, Semper H, Carey A, Clark-Carter D. (2021). What behavior change techniques are associated with effective interventions to reduce screen time in 0\u0026ndash;5 year olds? A narrative systematic review. \u003cem\u003ePreventive Medicine Reports\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/J.PMEDR.2021.101429\u003c/span\u003e\u003cspan address=\"10.1016/J.PMEDR.2021.101429\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLieneman CC, Brabson LA, Highlander A, Wallace NM, McNeil CB. Parent\u0026ndash;Child Interaction Therapy: current perspectives. Psychol Res Behav Manage. 2017;10:239. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/PRBM.S91200\u003c/span\u003e\u003cspan address=\"10.2147/PRBM.S91200\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMendoza JA, Baranowski T, Jaramillo S, Fesinmeyer MD, Haaland W, Thompson D, Nicklas TA. Fit 5 Kids TV Reduction Program for Latino Preschoolers: A Cluster Randomized Controlled Trial. Am J Prev Med. 2016;50(5):584\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/J.AMEPRE.2015.09.017\u003c/span\u003e\u003cspan address=\"10.1016/J.AMEPRE.2015.09.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuppalla SK, Vuppalapati S, Pulliahgaru AR, Sreenivasulu H. Effects of Excessive Screen Time on Child Development: An Updated Review and Strategies for Management. Cureus. 2023;15(6):e40608. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/CUREUS.40608\u003c/span\u003e\u003cspan address=\"10.7759/CUREUS.40608\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRanjitkar S, Kvestad I, Strand TA, Ulak M, Shrestha M, Chandyo RK, Hysing M. Acceptability and reliability of the Bayley Scales of infant and Toddler Development-III Among Children in Bhaktapur, Nepal. Front Psychol. 2018;9(JUL):1265. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/FPSYG.2018.01265/BIBTEX\u003c/span\u003e\u003cspan address=\"10.3389/FPSYG.2018.01265/BIBTEX\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchuchert SA, Khattar S, Tekkar P, Rathour A, Dawar S, Gupta P. Exploring social stages of play through eye to I\u0026copy; intervention model. Clin Child Psychol Psychiatry. 2023;29(3):928. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/13591045231177477\u003c/span\u003e\u003cspan address=\"10.1177/13591045231177477\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchwarzer C, Grafe N, Hiemisch A, Kiess W, Poulain T. Associations of media use and early childhood development: cross-sectional findings from the LIFE Child study. Pediatr Res. 2022;91(1):247\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/S41390-021-01433-6\u003c/span\u003e\u003cspan address=\"10.1038/S41390-021-01433-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSerra G, Lo Scalzo L, Giuffr\u0026egrave; M, Ferrara P, Corsello G. Smartphone use and addiction during the coronavirus disease 2019 (COVID-19) pandemic: cohort study on 184 Italian children and adolescents. Ital J Pediatr. 2021;47(1):1\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13052-021-01102-8\u003c/span\u003e\u003cspan address=\"10.1186/s13052-021-01102-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVaradarajan S, Venguidesvarane AG, Ramaswamy KN, Rajamohan M, Krupa M, Christadoss SBW. Prevalence of excessive screen time and its association with developmental delay in children aged\u0026thinsp;\u0026lt;\u0026thinsp;5 years: A population-based cross-sectional study in India. PLoS ONE. 2021;16(7 July):1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0254102\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0254102\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVess SF, Campbell JM (n.d.), editors. Parent-child interaction therapy (PCIT) with families of children with autism spectrum disorder. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/23969415221140707\u003c/span\u003e\u003cspan address=\"10.1177/23969415221140707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVess SF, Campbell JM. (2022). Parent\u0026ndash;child interaction therapy (PCIT) with families of children with autism spectrum disorder. \u003cem\u003eAutism and Developmental Language Impairments\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/23969415221140707/ASSET/IMAGES/LARGE/10.1177_23969415221140707-FIG3.JPEG\u003c/span\u003e\u003cspan address=\"10.1177/23969415221140707/ASSET/IMAGES/LARGE/10.1177_23969415221140707-FIG3.JPEG\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eW\u0026ouml;rle M, Paulus M. (2019a). Normative foundations of reciprocity in preschoolers. \u003cem\u003eJournal of Experimental Child Psychology\u003c/em\u003e, \u003cem\u003e188\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/J.JECP.2019.104693\u003c/span\u003e\u003cspan address=\"10.1016/J.JECP.2019.104693\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eW\u0026ouml;rle M, Paulus M. (2019b). Normative foundations of reciprocity in preschoolers. \u003cem\u003eJournal of Experimental Child Psychology\u003c/em\u003e, \u003cem\u003e188\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/J.JECP.2019.104693\u003c/span\u003e\u003cspan address=\"10.1016/J.JECP.2019.104693\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Social communication, Behavioural intervention, and Smartphone use","lastPublishedDoi":"10.21203/rs.3.rs-7674524/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7674524/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study assessed the effectiveness of behavioural interventions in reducing screen time and enhancing parent-child interaction to improve communication in children aged 18 to 60 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eobservational and crosse-sectional was designed in this study. 114 parents of children ages 18 to 60 months with delayed communication skills were among the participants in the pediatric department at tertiary hospital, Kolkata, India. Participants were were randomly assigned to either receive BI (group-A) or not (group-B). Participants underwent assessment of primary outcomes at baseline and every two weeks for three consecutive months. To define the impact of BI, appropriate statistics were applied to calculate the Mean ± SD of the primary outcomes’ score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings revealed, In Group A, 69.80% of children utilize screens for less than three hours, while in Group B, only 38.20% of children engage with these devices for the same duration. Sstatistical report compliance after completing sessions communication was developed, in Group A versus Group B (19.06 ± 3.65 vs11.4 ± 1.93).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the evidence, children receiving BI in regular manner exhibited a greater reduction in duration of screen time compared with children who did not receive.\u003c/p\u003e","manuscriptTitle":"Enhancing Communication in Screen-Exposed Children: Role of Behavioral Intervention: A Preliminary Study Conducted in a Hospital Setting in India.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-17 06:32:03","doi":"10.21203/rs.3.rs-7674524/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ea3aea1-97a8-4387-8906-d0503cb484b6","owner":[],"postedDate":"November 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-02T06:24:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-17 06:32:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7674524","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7674524","identity":"rs-7674524","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}