Problematic use of electronic devices and screen addiction in preschool children: a parent coaching program for prevention and treatment

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Preventive interventions involving parents are crucial, as screen habits in preschoolers are established by parents, tend to persist over time, and yield long-term negative consequences. This study evaluates the effectiveness of a parent coaching intervention in reducing children’s daily exposure to electronic devices and screen addiction. One or both parents of 192 children (mean age: 3.1 years, range: 0.3–6.0) attended a 90-minute session, describing the consequences of excessive screen time in children, the behavioral hallmarks and neurobiological mechanisms of screen addiction, and practical strategies to overcome dependence, if present. The parents of 75 (39.1%) children also attended a second session one month later, to share their experience. The ScreenQ questionnaire was filled by parents before both sessions. At baseline, 148 (77.1%) preschoolers had already been exposed to portable electronic devices, with 71 (37.0%) starting before 18 months of age. Notably, 30/75 (40.0%) exhibited at least one indicator of problematic screen use, specifically irritability upon device withdrawal, and 7/75 (9.3%) met all criteria for screen addiction. After the intervention, ScreenQ total scores significantly decreased in the Access and Interactivity domains, reflecting reduced daily screen time and unsupervised use, with increased parental engagement during media exposure. Our findings highlight the need to address emerging digital dependence early in preschoolers and support the efficacy of parent-directed interventions to contrast excessive screen exposure in young children. internet addiction parent coaching preschoolers screen time smartphone addiction Figures Figure 1 Introduction Screen devices, including televisions, computers, and mobile devices like smartphones and tablets, have become ubiquitous in modern households, and children are being increasingly exposed to these devices at an early age. In recognition of this trend, the American Academy of Pediatrics (AAP) released a Policy Statement with recommendations on the use of digital devices in young children [ 1 ]. The AAP discourages the exposure to digital media of children younger than 18–24 months, while recommends limiting it to 1 hour per day between the ages of 18–24 months and 5 years. On 2019, the World Health Organization (WHO) released similar guidelines [ 2 ]. Despite these warnings, evidence indicates that to date only about one third of children under 5 years of age meets screen time guidelines [ 3 ]. According to a recent survey [ 4 ], in the U.S. children under 2-year of age spend approximately 1 hour on screen media, children 2–4-year-old approximately 2 hours, and children 5–8-year-old up to 3 hours daily. Furthermore, about half of the children aged 0–8 years possess their own device, especially tablets [ 4 ]. A growing body of evidence indicates that excessive daily screen exposure is linked to several developmental and health risks, including language and cognitive delays [ 5 – 11 ], behavioral problems [ 5 , 12 , 13 ], attention deficit [ 14 – 16 ], executive dysfunction [ 17 , 18 ], sleep disorders [ 19 , 20 ], hypertension and obesity [ 21 ]. Excessive screen time may also hinder psychosocial development, as children tend to engage with digital devices at the expense of more age-appropriate activities, including peer play [ 22 ]. Converging evidence supports the negative impact of excessive screen time on the development of the neural circuits underlying language processing. Hutton and Colleagues [ 10 ] showed that excessive screen time in children aged 0–3 years interferes with the development of verbal language and emergent literacy skills, delaying the myelination of neural circuits underlying linguistic abilities. Language acquisition is fostered primarily through adult-child interactions, which are absent when children passively consume video content. Nevertheless, several studies highlight that certain factors, such as high-quality media content and parental co-viewing, may mitigate this negative association [ 23 , 24 ]. Co-viewing, in particular, can provide caregivers with opportunities to promote learning through joint engagement with the child [ 23 – 25 ]. At the same time, excessive screen use by both children and parents can interfere with adult-child interactions: this phenomenon, referred to as “technoference”[ 26 ], negatively impacts the quality of parent-child relationship and, consequently, child development [ 26 – 30 ]. Caregivers, particularly those with over-reactive or over-permissive parenting styles, may resort to portable screen devices as a soothing tool, for example during mealtime, at bedtime, to fill in empty hours, or to calm children when upset, especially in those who display higher negative emotionality or limited self-regulation [ 31 – 33 ]. However, this practice may hinder the development of children’s self-regulatory skills, reinforcing a vicious cycle that ultimately makes problematic behaviors more difficult to manage over time [ 34 ]. These negative outcomes have been documented in all age groups, but effects appear to be particularly detrimental and long-lasting when excessive screen exposure occurs during preschool years, a critical period for the development of many neural circuits [ 13 ]. Furthermore, longitudinal studies suggest that the association between negative effects and screen exposure is not bidirectional, i.e. excessive screen exposure leads to adverse outcomes rather than the opposite [ 8 , 11 , 31 ]. Excessive screen exposure may actually represent the expression of an addictive behavior. Digital products are specifically designed with appealing features to capture and retain users’ attention, relying on behavioral reinforcement mechanisms that make disengagement difficult, especially for young children whose impulse control is still underdeveloped [ 34 ]. Children 6–11 years old engaging with electronic devices for more than 2 hours daily show increased internet addiction behaviors, compared with peers engaged for a shorter time [ 35 ]. Also in preschoolers, smartphone use, when exceeding 2 hours per day, easily becomes “problematic smartphone use” (PSU) [ 36 ]. Interestingly, children with PSU used smartphones more frequently but for shorter periods compared to those without PSU, suggesting a heightened compulsive urge to engage with the device, that is rapidly yet temporarily satisfied [ 36 ]. These results are consistent with several imaging studies demonstrating that screen devices, and especially smartphones, foster addictive behaviors, triggering and promoting their own compulsive use. In particular, certain forms of screen-related addiction, especially gaming and internet addiction, are associated with increased dopamine release in the ventral striatum, a key structure within the brain’s reward circuitry [ 37 , 38 ]. A systematic review of neuroimaging studies provided compelling evidence for shared neural mechanisms between substance-related addictions and internet and gaming addiction, particularly within brain regions involved in reward processing, craving and emotional regulation [ 39 ]. Young individuals with smartphone addiction exhibit brain activation patterns during cue-reactivity tasks involving smartphone-related versus neutral stimuli that closely resemble those observed in other addictive disorders [ 40 ]. Similarly, another study [ 41 ] reported alterations in the microstructural properties of white matter in brain regions implicated in cognitive functioning and emotion regulation among young adults with smartphone addiction—changes that parallel those found in individuals with substance-related addictions. Consistent with these neurobiological findings, a systematic review and meta-analysis found that approximately one in four children and adolescents present PSU, and that this is significantly associated with several mental health issues, such as depression, anxiety, insomnia, heightened stress, and poor academic performance [ 42 ]. Several intervention studies aimed at reducing screen time exposure in children and adolescents have been published to date, with some reporting positive outcomes [ 43 – 45 ]. However, very few intervention/prevention programs have specifically targeted preschool-age children. In two studies conducted in pediatric clinic settings [ 46 , 47 ], parents received brief 10-minute counselling sessions on the adverse effects of screen exposure (a single session in [ 47 ], and three sessions in [ 46 ]) with only the latter study reporting a significant reduction in children screen time [ 46 ]. Another study [ 48 ] implemented a preschool-based intervention as part of a health promotion program, where children were encouraged to turn off the television and were actively involved in identifying alternative activities. This approach also proved effective in reducing television viewing. Given the evidence that screen time habits established in early childhood tend to persist later in life and to exert long-term detrimental effects on neurodevelopment, preventive interventions during the preschool years may offer the greatest benefits [ 31 ]. Moreover, access of preschool-age children to electronic devices and daily screen time exposure are decided by their parents. As parenting styles influence caregivers’ decisions regarding children’s screen exposure, the implementation of effective parent-coaching programs to guide healthy media use is essential. Aims of the study The aims of this study were: (1) to collect information on electronic device exposure and screen addiction from parents of children aged 0–6 years; (2) to assess the effectiveness of a parent-directed intervention in reducing the indiscriminate exposure of preschoolers to electronic devices, especially smartphones, by (a) increasing parental awareness of their potential negative effects on child neurodevelopment and behavior; (b) providing simple criteria to recognize whether their child was at risk or had already developed an addiction to an electronic device; and (c) offering simple, straightforward and practical strategies to appropriately manage screen addiction in the child. In addition, parental compliance and satisfaction with the program were measured by (a) the proportion of parents attending the second session one month after the first session, and (b) parental perceived benefit of the intervention, measured through an ad hoc questionnaire. Methods Participants This study presents the first set of results obtained by the “Smartkids project”, a collaboration between the Modena Public Education Service 0–6 and MeMo Center, Fondazione Cresci@Mo, and the University of Modena and Reggio Emilia. All parents of children aged 0–6 years enrolled in public nursery schools, kindergartens, or preschools in the city of Modena (Italy) were eligible to freely participate in this study. No exclusion criteria were applied, other than the child’s age and enrollment in the pre-school public education system. The study was approved on December 14, 2023 by the Ethical Committee of Area Vasta Emilia Nord (prot. n. 36275/23). All parents provided written informed consent for themselves and for their child. The data reported in this study refer to 192 children, whose parents were enrolled between January 2024 and March 2025. Intervention Parents were asked to participate to two meetings of 90 minutes each, conducted one month apart. The first meeting consisted in a parent-coaching session held by one pf the authors (A.M.P., L.A.), addressing: a) a review of recent evidence on the negative effects of prolonged screen time during early childhood on neuropsychological development; b) causes and manifestations of addiction induced in young children by electronic devices, especially smartphones and tablets. Drawing on DSM-5 criteria for Substance-Related and Addictive Disorders [ 49 ], screen addiction in this age range was defined by the presence of the three following features: 1) compulsivity: the child compulsively seeks electronic devices, even when engaged in other enjoyable activities; 2) loss of control: the child does not stop using the electronic device, unless interrupted; 3) irritability or dysphoric mood upon withdrawal: the child becomes highly irritable when interrupted while using the electronic device or when access to it is denied, with emotional intensity and anger far beyond typical complains. c) a set of simple, practical strategies to help parents prevent screen addiction or remove it, if already present. Specifically, caregivers and other family members living in the household were encouraged to completely abstain from using digital devices in their child’s presence for a period of two weeks, explaining to the child that the devices were unavailable because broken and temporarily under repair. Parents were informed that this approach might initially elicit increased irritability and oppositional behaviors lasting a few days. To minimize this inconvenience, they were advised to consistently provide alternative, funny, highly personalized and non-screen-based activities that could capture the child’s interest and sustain neural activity in the reward circuits during the withdrawal period. This approach was conceived by one of the Authors (A.M.P.) with expertise in addictions and in child psychiatry, and were found clinically effective on smartphone addiction within approximately 7–12 days, even in preschoolers with severe neurodevelopmental disorders. Parents were asked not to intervene immediately, but rather to spend at least one week observing their child’s behaviors and reactions when engaged with electronic devices, paying particular attention to the three potential signs of internet addiction described above. Parents were also asked to self-monitor their own use of smartphones, especially during daily family life. After this initial observation, parents could decide whether and to what extent it may be necessary for them to promote changes in their management of electronic devices with their child by applying the strategies presented during the first session, and then to share their experience during the second session, held approximately one month later. This second session took the form of a circle-time group meeting, coordinated by the same expert leading the first session (A.M.P., L.A.). Procedure Prior to the start of each session, parents were asked to complete the ScreenQ questionnaire [ 50 ], a standardized and easy-to-administer tool that provides a quantitative score of children’s overall exposure to video devices. The ScreenQ consists of 15 items and gathers information across four domains derived from the AAP recommendations: access to screens, frequency of use, media content, and co-viewing with an adult. For this study, an Italian translation of the original ScreenQ questionnaire was used, specifically explaining that the term “screen media” or “video devices” encompasses smartphone, tablet, computer, playstation and television, and containing four additional specifiers not present in the original version of ScreenQ, added to items 2 and 8 to collect more information specifically on which device was used by the child, and to items 3 and 7 to collect more details about the frequency of use. Finally, the ScreenQ questionnaire administered before the second session contained one additional item, asking parents whether during the month between the two sessions they had observed compulsivity, loss of control, and/or irritability upon withdrawal in their children (i.e. the three behavioral signs of internet dependence described above). The Italian translation has not been formally validated, but was prepared by one of the Authors (A.M.P.) and approved by a bilingual native English speaker working as a professional translator. The original English version and the Italian translation of the ScreenQ questionnaire are provided as Supplementary Files 1 and 2, respectively. Finally, at the end of the second session parents were asked to answer five questions on a 5-point Likert scale to assess how useful they found their participation in this project (Supplementary File 3). This participant satisfaction questionnaire was introduced starting with the second year of the “Smartkids Project”, and data have been thus collected from the parents of 49 children (Suppl. Table S1 ). Statistical analyses Numerical variables are presented as mean ± standard deviation (S.D.). Categorical variables are presented as frequencies and percentages. Shapiro-Wilk test showed that data were not normally distributed, thus paired-sample Wilcoxon Test was performed to assess differences in ScreenQ scores before and after intervention. Data from the original ScreenQ questionnaire are always reported; whenever results obtained from the additional specifiers and item present in our Italian translation are presented, this is explicitly stated. Analyses were performed using R, version 4.5.0 (R Core Team, 2025). Results Participants The parents of 192 children (mean age = 3.1 years, range = 0.3–6.0; 108 M: 84 F) were enrolled in the study after written parental informed consent was obtained and the ScreenQ was completed before the first session. In the majority of cases, the parent attending the first session was the mother (n = 151, 78.7%), followed by the father (n = 31, 16.1%), while both parents attended in 10 cases (5.2%). The second session was attended by parents of 75 (39.1%) children. Screen time habits At baseline, parents reported that the majority of children in our sample (n = 148; 77.1%) had already been exposed to portable digital devices, most frequently smartphones (n = 135; 70.3%). Early exposure was common: 71 children (37.0%) were introduced to screen devices before 18 months of age, including 21 (10.9%) who were exposed before their first year of age. Importantly, parents of 73 children (38.0%) reported daily screen time exceeding one hour; however, only 3 (1.5%) were reported to use smartphones for more than one hour per day. Caregivers reported interacting with their children during and after video viewing in 173 (90.1%) and 165 (85.9%) cases, respectively, although parental engagement was short-lasting and inconsistent in the majority of cases. Notably, 32 (16.7%) children watched videos and 12 (6.3%) used applications on smartphones or tablets without any adult supervision. Parents of 45 (23.4%) children affirmed using electronic devices to calm down their child when upset, 44 (22.9%) during meals and in 32 (16.7%) cases electronic devices, especially television, were employed at bedtime to facilitate sleep. ScreenQ scores Table 1 and Fig. 1 summarize ScreenQ domains scores before and after the intervention, respectively, as reported by the parents of 75 children who participated in both sessions. Highly significant improvement was found in the domains of Access and Interactivity, as well as in the Total Score, indicating reduced access to electronic devices and increased interactions with the caregivers during vision. Table 2 details differences at single ScreenQ items. After the intervention, children were significantly less exposed both to smartphones (item 2, p = 0.003) and to screens altogether (item 7a, p = 0.002), especially when outside of the house (item 5, p = 0.04). Children were also less frequently allowed to independently select videos or download apps (item 11, p = 0.04), and parents more likely to discuss with their children about the content of the video or game previously played (item 15, p = 0.025). A reduction in unsupervised app use was also observed at item 13b, although it did not reach significance (p = 0.07) (Table 2 ). Finally, an important change was picked by our specifier at item n. 3 and missed by the original item n.3. In fact, the number of children exposed during meals (original item 3: yes = 1, no = 0) was not significantly reduced (p = 0.145), but the frequency of smartphone exposure during mealtime (item 3 specifier: rarely = 0, often = 1, always = 2) indeed showed a significant decrease in frequency (p = 0.049) (Table 2 ). Table 1 ScreenQ domains before and after the intervention (T1 = before the first session and T2 = at the second session). N , mean score and paired sample Wilcoxon test statistics are reported. Statistically significant results are highlighted in bold. T1 T2 ScreenQ domain N Mean N Mean Paired Wilcoxon Test Statistics Access 75 2.69 75 0.79 V = 2048.5, p = 4.855e-12 Frequency 75 1.35 75 1.25 V = 464, p = 0.4359 Content 74 0.49 74 0.45 V = 143, p = 0.5731 Interactivity 75 1.51 75 1.12 V = 541.5; p = 0.003179 Total 75 5.95 75 3.6 V = 1943.5, p = 1.233e-10 Table 2 ScreenQ item scores before and after the intervention (T1 = questionnaire filled before the first session, T2 = questionnaire filled during the second session). N , mean score and paired sample Wilcoxon test statistics are reported. Nominally significant results are highlighted in bold. T1 T2 N Mean N Mean Paired Wilcoxon Test Statistics Item_1 74 0.189 75 0.187 V = 1, p = 1 Item_2 75 1.60 75 1.351 V = 140, p = 0.04117 Item_3_original 75 0.173 75 0.108 V = 48, p = 0.145 Item_3_specifier 75 0.227 75 0.107 V = 71.5, p = 0.04982 Item_4 75 0.493 75 0.467 V = 76.5, p = 0.6379 Item_5 75 0.240 74 0.137 V = 31.5, p = 0.04108 Item_6 66 0.530 70 0.614 V = 37.5, p = 0.3014 Item_7_original 72 0.472 74 0.338 V = 55, p = 0.001904 Item_7_specifier 68 0.015 66 0.015 V = 1.5, p = 1 Item_8 74 0.230 75 0.187 V = 28.5, p = 0.4922 Item_9 74 0.203 75 0.160 V = 80, p = 0.5095 Item_10 73 0.096 74 0.081 V = 22.5, p = 0.5297 Item_11 73 0.315 75 0.227 V = 32, p = 0.04183 Item_12 69 0.087 72 0.153 V = 8, p = 0.2986 Item_13a 71 0.183 74 0.176 V = 36, p = 0.8016 Item_13b 58 0.12 57 0.035 V = 10, p = 0.07186 Item_14 71 0.606 72 0.500 V = 123.5, p = 0.06277 Item_15 71 0.620 72 0.444 V = 189.5, p = 0.02545 Screen addiction Parents attending the second session reported observing unusually intense irritability when use of the electronic device was interrupted or access was denied in more than one third of the children (30/75, 40.0%) (Table 3 A). Notably, irritability was present in all children who exhibited at least one sign of screen addiction and was always perceived by parents as different in intensity, duration, and emotional quality from the typical tantrums of their child. The electronic device responsible for precipitating intense irritability upon withdrawal was television in 21 children, smartphone in 18 cases and tablet in 4 children. Compulsive seeking of screen devices was observed in 13 children (17.3%), while loss of control during use was reported in 10 (13.3%) (Table 3 A). Overall, 30 children (40.0%) displayed at least one indicator of screen addiction, with 9 (12.0%) children displaying two indicators and 7 (9.3%) meeting all three criteria (Table 3 B). Interestingly, 6 of these 7 preschoolers were reported to be dependent on both smartphone and television, with YouTube videos on smartphones and handling of the remote control of televisions particularly attractive. Table 3 Number and percentages of children showing compulsive use of electronic devices, loss of control and irritability when using screens. A Signs of screen addiction N % Irritability following interruption of device use or access denial 30 40.0% Compulsive seeking of the electronic device 13 17.3% Loss of control while using the electronic device 10 13.3% B Number of screen addiction N % 0/3 45 60.0% 1/3 - irritability only 14 18.7% 2/3 - irritability + compulsive seeking or loss of control 9 12.0% 3/3 - irritability + compulsive seeking + loss of control 7 9.3% Discussion The present study explored screen use habits in preschoolers and evaluated the short-term efficacy of a parent coaching intervention aimed at: (a) preventing problematic use of electronic devices by raising parental awareness about the risks of excessive screen use, including its neurodevelopmental consequences and potential for addiction; (b) providing parents with simple and easy-to-apply criteria to define whether and to what extent exposure to electronic devices had produced dependence in their child; and (c) supporting parents in managing problematic use and screen dependence, when already established. More than one third of children in our sample had been introduced to digital media before 18 months of age, and a substantial proportion exceeded the one-hour daily limit recommended by pediatric guidelines. These findings align with prior research documenting widespread and early screen exposure among preschoolers. Although we did not systematically collect information on the type of activities performed with digital devices or on the nature of the content accessed, these topics were extensively discussed during the second meeting. Parents reported that the most frequent activity was watching short cartoons considered age-appropriate and educational, both on smartphones and on TV. Most caregivers reported interacting with their children during (173/192, 90.1%) and after (165/192, 85.9%) media use. However, co-viewing was neither long-lasting nor consistent, and a considerable proportion of children were often left unsupervised while using electronic devices. In these instances, young children were often found compulsively scrolling the smartphone for images and videos typically on YouTube. These findings underscore the need for interventions aimed not only at reducing daily total screen time, but also at strengthening parental awareness of the protective role of active co-viewing, which has been shown to mitigate the negative consequences of early screen exposure [ 23 ]. In this regard, our intervention proved effective: following the first informative session, parents engaged more frequently with their child after video viewing, while children were less frequently allowed to use applications without adult supervision. The use of electronic devices as a soothing tool against tantrums, at bedtime, or during meals, was initially reported by parents of 45 (23.4%), 44 (22.9%), and 32 (16.7%) children, respectively. Given the documented association with emotional dysregulation [ 12 , 51 ] and sleep disturbances [ 52 ], this finding raises concern. Our intervention produced a significant reduction in smartphone exposure during meals (Table 2 , item 3-specifier), whereas use to calm the child or at bedtime did not decrease significantly (Table 2 , items 8 and 9 respectively). Furthermore, during the discussion held in the second meeting, parents often claimed resorting to screen media to keep children occupied, for example at home when cooking dinner or when dealing with younger siblings. It is important to support parents in finding enjoyable alternatives to electronic devices, when they need to keep their child engaged without direct supervision. Overall, the “Smartkids program” effectively reduced children’s overall screen exposure, at least short-term. The observed reduction in ScreenQ total scores was primarily driven by significant changes in the Access and Interactivity domains (Table 1 , Fig. 1), suggesting that the intervention successfully decreased total daily screen exposure, limited use outside the home, and promoted greater caregiver-child engagement during media use. Non-significant reductions were instead observed in the Frequency and Content domains (Table 1 and Fig. 1). The Frequency domain includes items related to the age of first screen exposure and the use of screens for soothing or at bedtime, while the Content domain assessed exposure to violent or fast-paced media and children’s autonomy in selecting programs or apps. Given the very young age of our sample, it is not surprising that parents were already avoiding inappropriate content. Stronger effects on these domains may be expected in older children, although parents of preschoolers are not always aware of what their children view, since parental supervision is not constant and 12 (6.3%) children were admittedly on electronic devices entirely unsupervised. Full screen addiction was identified in 7 (9.3%) children, a remarkable proportion given the young age of participants (Table 3 A). However, 30/75 (40.0%) children exhibited one sign of screen addiction always in the form of withdrawal dysphoria, i.e. acute irritability when use of the electronic device is interrupted or access denied (Table 3 A). The negative affect of these emotional tantrums, likely produced by a sustained and prolonged activation of the extended amygdala [ 40 ], was defined by parents as “more profound” (i.e., of greater intensity and duration) compared to the typical outbursts of their child. Importantly, compulsive seeking and loss of control over device use were always observed in children who also displayed irritability when device use was interrupted or access denied (Table 3 B), suggesting that the onset of withdrawal irritability alone may represent an early marker of emerging dependence on screen devices. In line with the neurobiology of addictive stimuli, parents reported that this irritability emerged already after few exposures to the device, especially with smartphones. We anticipated greater addictive potential for smartphones over other electronic devices, due to their portability, interactivity, and faster response. However, signs of full-blown screen addiction were observed most frequently in children misusing both to smartphone and television. This may reflect the young age of our cohort, in which independent access to the smartphone is typically mediated by parents, whereas television remains more easily available. Nonetheless, it is important to consider that television remains a salient medium for young children. Limitations This study has several limitations. No demographic information was collected except for age and sex, limiting our ability to account for sociodemographic confounds. We did not collect information on indirect screen exposure, such as background television, which has been shown to exert detrimental effects on child development. The activity or content most frequently consumed by children was discussed with parents during the second meeting, but not systematically assessed. The ScreenQ is a parent-reported measure which may suffer from response distortion due to social desirability and underestimate children’s actual screen exposure. The substantial participation rate at the first “educational” session reflects parental concern about managing screen use in their children, but only the parents of 75/192 (39.1%) children also attended the second “discussion” session. This substantial decrease may not necessarily reflect lack of interest or impact. Indeed, feedback obtained from a subgroup of 49/75 (65.3%) parents who completed both sessions was largely positive (see Suppl. Table S1 ). Furthermore, anecdotal reports by some teachers suggest that many families, especially those with very young children, may have found the information provided in the first session already sufficient to address their needs. Nonetheless, future editions of this program will implement the satisfaction questionnaire also after the first session, to better capture parental perceptions. Conclusions Overall, our current findings are consistent with the emerging literature reporting frequent problematic media use in children and emphasizing the importance of early prevention, identification, and management strategies. A brief and structured educational intervention based on parent coaching here improved parental practices related to media use, likely translating into a healthier life style within the family. Importantly, our intervention provided not only information on the negative consequences of excessive screen exposure in young children, but also simple and effective empowerment strategies to promote addiction recognition and management by parents. Furthermore, the possibility to attend the second session after one month, made parents in need of additional help feel accompanied in their efforts. This study should be viewed as “work-in-progress”, since our “Smartkids project” in the Modena school system will continue in the years to come. The collection of larger samples of preschoolers, assessments of long-term outcome, and the design of programs tailored for older children and adolescents represent promising avenues of future investigation. Declarations Ethics approval. The study was approved by the Ethics Committee of Area Vasta Emilia Nord (protocol no. 36275/23, 14/12/2023). Consent to participate. All participants in this study provided written informed consent in accordance with the procedures approved by the ethics committee. Competing interests. The authors declare no competing interests. Funding. This study was funded the University of Modena and Reggio Emilia under grant scheme for the promotion of Public Engagement activities (“Bando per l’agevolazione di attività di Public Engagement”), for the years 2022, 2023, and 2025. Author Contribution L.A. was involved in participant recruitment, data collection, database preparation, data analysis, results tabulation, and drafting of the manuscript. L.S. was involved in database preparation and reviewing of the manuscript. A.M.P. was involved in the conceptualization of the study, study design, participant recruitment, data interpretation, and reviewing of the manuscript. All authors read and approved the final version of this manuscript. Acknowledgement The authors gratefully acknowledge Silvia Cestarollo, Simona Cristoni, Giuliano Boni, Paola Francia, Patrizia Guerra (Modena Public Education Service 0-6 and MeMo Center), and Emanuela Ricci (Fondazione Cresci@Mo) for their collaboration, and Modena City Councelors Grazia Baracchi and Federica Venturelli for their continued support to the “Smartkids” project. Data Availability Data are available from the authors upon reasonable request - subject to ethical permissions and participant consent. References COUNCIL ON COMMUNICATIONS AND MEDIA, Hill D, Ameenuddin N et al (2016) Media and Young Minds. Pediatrics 138(5):e20162591. 10.1542/peds.2016-2591 To grow up healthy, children need to sit less and play more. 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Pediatr Res 93(5):1425–1431. 10.1038/s41390-022-02261-y Rasmussen EE, Shafer A, Colwell MJ et al (2016) Relation between active mediation, exposure to Daniel Tiger’s Neighborhood , and US preschoolers’ social and emotional development. J Child Media 10(4):443–461. 10.1080/17482798.2016.1203806 Madigan S, McArthur BA, Anhorn C, Eirich R, Christakis DA (2020) Associations Between Screen Use and Child Language Skills: A Systematic Review and Meta-analysis. JAMA Pediatr 174(7):665. 10.1001/jamapediatrics.2020.0327 Radesky JS, 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. 10.1542/peds.2014-2251 McDaniel BT (2019) Parent distraction with phones, reasons for use, and impacts on parenting and child outcomes: A review of the emerging research. Hum Behav Emerg Technol 1(2):72–80. 10.1002/hbe2.139 Brushe ME, Haag DG, Melhuish EC, Reilly S, Gregory T (2024) Screen Time and Parent-Child Talk When Children Are Aged 12 to 36 Months. JAMA Pediatr 178(4):369. 10.1001/jamapediatrics.2023.6790 Christakis DA, Gilkerson J, Richards JA et al (2009) Audible Television and Decreased Adult Words, Infant Vocalizations, and Conversational Turns: A Population-Based Study. Arch Pediatr Adolesc Med 163(6):554. 10.1001/archpediatrics.2009.61 Knitter B, Zemp M (2020) Digital Family Life: A Systematic Review of the Impact of Parental Smartphone Use on Parent-Child Interactions. Digit Psychol 1(1):29–43. 10.24989/dp.v1i1.1809 Li H, Luo W, He H (2022) Association of Parental Screen Addiction with Young Children’s Screen Addiction: A Chain-Mediating Model. Int J Environ Res Public Health 19(19):12788. 10.3390/ijerph191912788 Fitzpatrick C, Harvey E, Cristini E, Laurent A, Lemelin JP, Garon-Carrier G (2022) Is the Association Between Early Childhood Screen Media Use and Effortful Control Bidirectional? A Prospective Study During the COVID-19 Pandemic. Front Psychol 13:918834. 10.3389/fpsyg.2022.918834 Domoff SE, Lumeng JC, Kaciroti N, Miller AL (2017) Early Childhood Risk Factors for Mealtime TV Exposure and Engagement in Low-Income Families. Acad Pediatr 17(4):411–415. 10.1016/j.acap.2016.12.003 Radesky JS, Silverstein M, Zuckerman B, Christakis DA (2014) Infant Self-Regulation and Early Childhood Media Exposure. Pediatrics 133(5):e1172–e1178. 10.1542/peds.2013-2367 Domoff SE, Borgen AL, Radesky JS (2020) Interactional theory of childhood problematic media use. Hum Behav Emerg Technol 2(4):343–353. 10.1002/hbe2.217 Tekeci Y, Torpil B, Altuntaş O (2024) The Impact of Screen Exposure on Screen Addiction and Sensory Processing in Typically Developing Children Aged 6–10 Years. Children 11(4):464. 10.3390/children11040464 Park JH, Park M (2021) Smartphone use patterns and problematic smartphone use among preschool children. Horowitz-Kraus T, ed. PLOS ONE . ;16(3):e0244276. 10.1371/journal.pone.0244276 Lorenz RC, Gleich T, Gallinat J, Kühn S (2015) Video game training and the reward system. Front Hum Neurosci 9. 10.3389/fnhum.2015.00040 Sigman A (2017) Screen Dependency Disorders: a new challenge for child neurology. J Int Child Neurol Assoc Published online April 19. 10.17724/jicna.2017.119 Kuss DJ, Griffiths MD (2012) Internet and Gaming Addiction: A Systematic Literature Review of Neuroimaging Studies. Brain Sci 2(3):347–374. 10.3390/brainsci2030347 Schmitgen MM, Horvath J, Mundinger C et al (2020) Neural correlates of cue reactivity in individuals with smartphone addiction. Addict Behav 108:106422. 10.1016/j.addbeh.2020.106422 Hu Y, Long X, Lyu H, Zhou Y, Chen J (2017) Alterations in White Matter Integrity in Young Adults with Smartphone Dependence. Front Hum Neurosci 11:532. 10.3389/fnhum.2017.00532 Sohn SY, Rees P, Wildridge B, Kalk NJ, Carter B (2019) Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: a systematic review, meta-analysis and GRADE of the evidence. BMC Psychiatry 19(1):356. 10.1186/s12888-019-2350-x Ding K, Li H (2023) Digital Addiction Intervention for Children and Adolescents: A Scoping Review. Int J Environ Res Public Health 20(6):4777. 10.3390/ijerph20064777 Maniccia DM, Davison KK, Marshall SJ, Manganello JA, Dennison BA (2011) A Meta-analysis of Interventions That Target Children’s Screen Time for Reduction. Pediatrics 128(1):e193–e210. 10.1542/peds.2010-2353 Wu L, Sun S, He Y, Jiang B (2016) The effect of interventions targeting screen time reduction: A systematic review and meta-analysis. Med (Baltim) 95(27):e4029. 10.1097/MD.0000000000004029 Bahadur Eİ, Akkuş PZ, Yoldaş TÇ, Özmert EN (2021) How effective is family counselling on screen exposure of pre-school children? Turk J Pediatr 63(2):282–290. 10.24953/turkjped.2021.02.012 Birken CS, Maguire J, Mekky M et al (2012) Office-Based Randomized Controlled Trial to Reduce Screen Time in Preschool Children. Pediatrics 130(6):1110–1115. 10.1542/peds.2011-3088 Dennison BA, Russo TJ, Burdick PA, Jenkins PL (2004) An Intervention to Reduce Television Viewing by Preschool Children. Arch Pediatr Adolesc Med 158(2):170. 10.1001/archpedi.158.2.170 American Psychiatric Association (2022) Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR . DSM-5-TR. American Psychiatric Association Publishing. 10.1176/appi.books.9780890425787 Hutton JS, Huang G, Sahay RD, DeWitt T, Ittenbach RF (2020) A novel, composite measure of screen-based media use in young children (ScreenQ) and associations with parenting practices and cognitive abilities. Pediatr Res 87(7):1211–1218. 10.1038/s41390-020-0765-1 Cliff DP, Howard SJ, Radesky JS, McNeill J, Vella SA (2018) Early Childhood Media Exposure and Self-Regulation: Bidirectional Longitudinal Associations. Acad Pediatr 18(7):813–819. 10.1016/j.acap.2018.04.012 Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS (2016) Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatr 170(12):1202. 10.1001/jamapediatrics.2016.2341 Additional Declarations No competing interests reported. Supplementary Files 2aSmartkidsSupplFile1ScreenQEnglishoriginal130126.pdf 2cSmartkidsSupplfile3Satisfactionquestionnaire130126.pdf 2SmartkidsSupplMatsubmitted130126.pdf 2bSmartkidsSupplfile2ScreenQItaliantranslation130126.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 06 Feb, 2026 Reviewers agreed at journal 02 Feb, 2026 Reviewers invited by journal 02 Feb, 2026 Editor assigned by journal 01 Feb, 2026 Submission checks completed at journal 26 Jan, 2026 First submitted to journal 25 Jan, 2026 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. 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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-8693325","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":584627184,"identity":"b9c4c215-88ff-4a5d-8ec4-acc4ceaa4552","order_by":0,"name":"Lisa Asta","email":"","orcid":"","institution":"University of Modena and Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Asta","suffix":""},{"id":584627185,"identity":"b0d6024d-f286-434d-a22d-32ee9fe4d6e0","order_by":1,"name":"Laura Sandoni","email":"","orcid":"","institution":"University of Modena and Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Sandoni","suffix":""},{"id":584627186,"identity":"b3da7ba6-23fd-4291-a060-7a8f54135165","order_by":2,"name":"Antonio Persico","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYNACAyidwMAgx8DA2ADmsOFUzoyqxRihBaceZlRuYgOciUML/+z+g48LCmwYzNl7H394UGOTvuF2c+uGj3tsGPjkG7BqkbhzmNl4hkEag2XPcTOJhGNpuRvuHGy7OeNZGm6H3Uhmk+YxOMxgcCONDeiqw7kbbiS23eY5cBinFnm4lvvPmD8AtaQbQLT8x6nFAGELG4MEUEsCVMsBnFoMbyQbG/MYpPFY9qSxgfxiOBOo5eaMA8k8bGwJWLXI3Uh8+Jjnj42cOfsx5o8/amzk+W6kP7vx4YCdnHzzARz+hwAeAwwRvOrBniKoYhSMglEwCkYsAAB0zVl1qxsJ3gAAAABJRU5ErkJggg==","orcid":"","institution":"University of Modena and Reggio Emilia","correspondingAuthor":true,"prefix":"","firstName":"Antonio","middleName":"","lastName":"Persico","suffix":""}],"badges":[],"createdAt":"2026-01-25 15:09:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8693325/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8693325/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101935785,"identity":"7e9fbd0b-0ae7-4036-bc16-385e067e9aae","added_by":"auto","created_at":"2026-02-05 08:28:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":15411,"visible":true,"origin":"","legend":"\u003cp\u003eMean ScreenQ domain scores before and after the intervention (T1= questionnaire filled before the first session, T2=questionnaire filled during the second session). \u003cbr\u003e\n \u003cem\u003e**p\u003c/em\u003e \u0026lt; 0.01; *** \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8693325/v1/09a9fba759c9836f62fbb534.png"},{"id":101935864,"identity":"6f87caf2-7d74-4e9e-8a92-6fa0323acbc2","added_by":"auto","created_at":"2026-02-05 08:28:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":942210,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8693325/v1/7e50c18a-df28-4970-b110-dd885ec7a142.pdf"},{"id":101935794,"identity":"3e0ec455-e2fe-4e0d-8094-35a97adbf658","added_by":"auto","created_at":"2026-02-05 08:28:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":112311,"visible":true,"origin":"","legend":"","description":"","filename":"2aSmartkidsSupplFile1ScreenQEnglishoriginal130126.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8693325/v1/7bf5fda906a0b660e85d8f97.pdf"},{"id":101935788,"identity":"df0be9b2-502b-4409-b191-ca6c9e91aa93","added_by":"auto","created_at":"2026-02-05 08:28:34","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":113005,"visible":true,"origin":"","legend":"","description":"","filename":"2cSmartkidsSupplfile3Satisfactionquestionnaire130126.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8693325/v1/dc232d7a74c482f893601097.pdf"},{"id":101935840,"identity":"ce1dd0f2-2b5a-4006-a7b1-3d241f8ce263","added_by":"auto","created_at":"2026-02-05 08:28:48","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":225528,"visible":true,"origin":"","legend":"","description":"","filename":"2SmartkidsSupplMatsubmitted130126.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8693325/v1/21fd12d13b9340f39831c735.pdf"},{"id":101935800,"identity":"5c11c36e-c5fc-4236-ade7-45aa76e47906","added_by":"auto","created_at":"2026-02-05 08:28:38","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":126224,"visible":true,"origin":"","legend":"","description":"","filename":"2bSmartkidsSupplfile2ScreenQItaliantranslation130126.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8693325/v1/592d411e84838301afc16171.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Problematic use of electronic devices and screen addiction in preschool children: a parent coaching program for prevention and treatment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eScreen devices, including televisions, computers, and mobile devices like smartphones and tablets, have become ubiquitous in modern households, and children are being increasingly exposed to these devices at an early age. In recognition of this trend, the American Academy of Pediatrics (AAP) released a Policy Statement with recommendations on the use of digital devices in young children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The AAP discourages the exposure to digital media of children younger than 18\u0026ndash;24 months, while recommends limiting it to 1 hour per day between the ages of 18\u0026ndash;24 months and 5 years. On 2019, the World Health Organization (WHO) released similar guidelines [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite these warnings, evidence indicates that to date only about one third of children under 5 years of age meets screen time guidelines [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to a recent survey [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], in the U.S. children under 2-year of age spend approximately 1 hour on screen media, children 2\u0026ndash;4-year-old approximately 2 hours, and children 5\u0026ndash;8-year-old up to 3 hours daily. Furthermore, about half of the children aged 0\u0026ndash;8 years possess their own device, especially tablets [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA growing body of evidence indicates that excessive daily screen exposure is linked to several developmental and health risks, including language and cognitive delays [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], behavioral problems [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], attention deficit [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], executive dysfunction [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], sleep disorders [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], hypertension and obesity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Excessive screen time may also hinder psychosocial development, as children tend to engage with digital devices at the expense of more age-appropriate activities, including peer play [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Converging evidence supports the negative impact of excessive screen time on the development of the neural circuits underlying language processing. Hutton and Colleagues [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] showed that excessive screen time in children aged 0\u0026ndash;3 years interferes with the development of verbal language and emergent literacy skills, delaying the myelination of neural circuits underlying linguistic abilities. Language acquisition is fostered primarily through adult-child interactions, which are absent when children passively consume video content. Nevertheless, several studies highlight that certain factors, such as high-quality media content and parental co-viewing, may mitigate this negative association [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Co-viewing, in particular, can provide caregivers with opportunities to promote learning through joint engagement with the child [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. At the same time, excessive screen use by both children and parents can interfere with adult-child interactions: this phenomenon, referred to as \u0026ldquo;technoference\u0026rdquo;[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], negatively impacts the quality of parent-child relationship and, consequently, child development [\u003cspan additionalcitationids=\"CR27 CR28 CR29\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Caregivers, particularly those with over-reactive or over-permissive parenting styles, may resort to portable screen devices as a soothing tool, for example during mealtime, at bedtime, to fill in empty hours, or to calm children when upset, especially in those who display higher negative emotionality or limited self-regulation [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, this practice may hinder the development of children\u0026rsquo;s self-regulatory skills, reinforcing a vicious cycle that ultimately makes problematic behaviors more difficult to manage over time [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. These negative outcomes have been documented in all age groups, but effects appear to be particularly detrimental and long-lasting when excessive screen exposure occurs during preschool years, a critical period for the development of many neural circuits [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, longitudinal studies suggest that the association between negative effects and screen exposure is not bidirectional, i.e. excessive screen exposure leads to adverse outcomes rather than the opposite [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExcessive screen exposure may actually represent the expression of an addictive behavior. Digital products are specifically designed with appealing features to capture and retain users\u0026rsquo; attention, relying on behavioral reinforcement mechanisms that make disengagement difficult, especially for young children whose impulse control is still underdeveloped [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Children 6\u0026ndash;11 years old engaging with electronic devices for more than 2 hours daily show increased internet addiction behaviors, compared with peers engaged for a shorter time [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Also in preschoolers, smartphone use, when exceeding 2 hours per day, easily becomes \u0026ldquo;problematic smartphone use\u0026rdquo; (PSU) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Interestingly, children with PSU used smartphones more frequently but for shorter periods compared to those without PSU, suggesting a heightened compulsive urge to engage with the device, that is rapidly yet temporarily satisfied [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. These results are consistent with several imaging studies demonstrating that screen devices, and especially smartphones, foster addictive behaviors, triggering and promoting their own compulsive use. In particular, certain forms of screen-related addiction, especially gaming and internet addiction, are associated with increased dopamine release in the ventral striatum, a key structure within the brain\u0026rsquo;s reward circuitry [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A systematic review of neuroimaging studies provided compelling evidence for shared neural mechanisms between substance-related addictions and internet and gaming addiction, particularly within brain regions involved in reward processing, craving and emotional regulation [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Young individuals with smartphone addiction exhibit brain activation patterns during cue-reactivity tasks involving smartphone-related versus neutral stimuli that closely resemble those observed in other addictive disorders [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Similarly, another study [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] reported alterations in the microstructural properties of white matter in brain regions implicated in cognitive functioning and emotion regulation among young adults with smartphone addiction\u0026mdash;changes that parallel those found in individuals with substance-related addictions. Consistent with these neurobiological findings, a systematic review and meta-analysis found that approximately one in four children and adolescents present PSU, and that this is significantly associated with several mental health issues, such as depression, anxiety, insomnia, heightened stress, and poor academic performance [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral intervention studies aimed at reducing screen time exposure in children and adolescents have been published to date, with some reporting positive outcomes [\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. However, very few intervention/prevention programs have specifically targeted preschool-age children. In two studies conducted in pediatric clinic settings [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], parents received brief 10-minute counselling sessions on the adverse effects of screen exposure (a single session in [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], and three sessions in [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]) with only the latter study reporting a significant reduction in children screen time [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Another study [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] implemented a preschool-based intervention as part of a health promotion program, where children were encouraged to turn off the television and were actively involved in identifying alternative activities. This approach also proved effective in reducing television viewing.\u003c/p\u003e \u003cp\u003eGiven the evidence that screen time habits established in early childhood tend to persist later in life and to exert long-term detrimental effects on neurodevelopment, preventive interventions during the preschool years may offer the greatest benefits [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Moreover, access of preschool-age children to electronic devices and daily screen time exposure are decided by their parents. As parenting styles influence caregivers\u0026rsquo; decisions regarding children\u0026rsquo;s screen exposure, the implementation of effective parent-coaching programs to guide healthy media use is essential.\u003c/p\u003e\n\u003ch3\u003eAims of the study\u003c/h3\u003e\n\u003cp\u003eThe aims of this study were:\u003c/p\u003e \u003cp\u003e(1) to collect information on electronic device exposure and screen addiction from parents of children aged 0–6 years;\u003c/p\u003e \u003cp\u003e(2) to assess the effectiveness of a parent-directed intervention in reducing the indiscriminate exposure of preschoolers to electronic devices, especially smartphones, by\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e(a) increasing parental awareness of their potential negative effects on child neurodevelopment and behavior;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e(b) providing simple criteria to recognize whether their child was at risk or had already developed an addiction to an electronic device; and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e(c) offering simple, straightforward and practical strategies to appropriately manage screen addiction in the child.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eIn addition, parental compliance and satisfaction with the program were measured by (a) the proportion of parents attending the second session one month after the first session, and (b) parental perceived benefit of the intervention, measured through an \u003cem\u003ead hoc\u003c/em\u003e questionnaire.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003e This study presents the first set of results obtained by the “Smartkids project”, a collaboration between the Modena Public Education Service 0–6 and MeMo Center, Fondazione Cresci@Mo, and the University of Modena and Reggio Emilia. All parents of children aged 0–6 years enrolled in public nursery schools, kindergartens, or preschools in the city of Modena (Italy) were eligible to freely participate in this study. No exclusion criteria were applied, other than the child’s age and enrollment in the pre-school public education system. The study was approved on December 14, 2023 by the Ethical Committee of Area Vasta Emilia Nord (prot. n. 36275/23). All parents provided written informed consent for themselves and for their child. The data reported in this study refer to 192 children, whose parents were enrolled between January 2024 and March 2025.\u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eParents were asked to participate to two meetings of 90 minutes each, conducted one month apart. The first meeting consisted in a parent-coaching session held by one pf the authors (A.M.P., L.A.), addressing:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ea) a review of recent evidence on the negative effects of prolonged screen time during early childhood on neuropsychological development;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eb) causes and manifestations of addiction induced in young children by electronic devices, especially smartphones and tablets. Drawing on DSM-5 criteria for Substance-Related and Addictive Disorders [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], screen addiction in this age range was defined by the presence of the three following features:\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e1) compulsivity: the child compulsively seeks electronic devices, even when engaged in other enjoyable activities;\u003c/p\u003e \u003cp\u003e2) loss of control: the child does not stop using the electronic device, unless interrupted;\u003c/p\u003e \u003cp\u003e3) irritability or dysphoric mood upon withdrawal: the child becomes highly irritable when interrupted while using the electronic device or when access to it is denied, with emotional intensity and anger far beyond typical complains.\u003c/p\u003e \u003cp\u003ec) a set of simple, practical strategies to help parents prevent screen addiction or remove it, if already present.\u003c/p\u003e \u003cp\u003e Specifically, caregivers and other family members living in the household were encouraged to completely abstain from using digital devices in their child\u0026rsquo;s presence for a period of two weeks, explaining to the child that the devices were unavailable because broken and temporarily under repair. Parents were informed that this approach might initially elicit increased irritability and oppositional behaviors lasting a few days. To minimize this inconvenience, they were advised to consistently provide alternative, funny, highly personalized and non-screen-based activities that could capture the child\u0026rsquo;s interest and sustain neural activity in the reward circuits during the withdrawal period. This approach was conceived by one of the Authors (A.M.P.) with expertise in addictions and in child psychiatry, and were found clinically effective on smartphone addiction within approximately 7\u0026ndash;12 days, even in preschoolers with severe neurodevelopmental disorders.\u003c/p\u003e \u003cp\u003eParents were asked not to intervene immediately, but rather to spend at least one week observing their child\u0026rsquo;s behaviors and reactions when engaged with electronic devices, paying particular attention to the three potential signs of internet addiction described above. Parents were also asked to self-monitor their own use of smartphones, especially during daily family life. After this initial observation, parents could decide whether and to what extent it may be necessary for them to promote changes in their management of electronic devices with their child by applying the strategies presented during the first session, and then to share their experience during the second session, held approximately one month later. This second session took the form of a circle-time group meeting, coordinated by the same expert leading the first session (A.M.P., L.A.).\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003ePrior to the start of each session, parents were asked to complete the ScreenQ questionnaire [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], a standardized and easy-to-administer tool that provides a quantitative score of children\u0026rsquo;s overall exposure to video devices. The ScreenQ consists of 15 items and gathers information across four domains derived from the AAP recommendations: access to screens, frequency of use, media content, and co-viewing with an adult. For this study, an Italian translation of the original ScreenQ questionnaire was used, specifically explaining that the term \u0026ldquo;screen media\u0026rdquo; or \u0026ldquo;video devices\u0026rdquo; encompasses smartphone, tablet, computer, playstation and television, and containing four additional specifiers not present in the original version of ScreenQ, added to items 2 and 8 to collect more information specifically on which device was used by the child, and to items 3 and 7 to collect more details about the frequency of use. Finally, the ScreenQ questionnaire administered before the second session contained one additional item, asking parents whether during the month between the two sessions they had observed compulsivity, loss of control, and/or irritability upon withdrawal in their children (i.e. the three behavioral signs of internet dependence described above). The Italian translation has not been formally validated, but was prepared by one of the Authors (A.M.P.) and approved by a bilingual native English speaker working as a professional translator. The original English version and the Italian translation of the ScreenQ questionnaire are provided as Supplementary Files 1 and 2, respectively. Finally, at the end of the second session parents were asked to answer five questions on a 5-point Likert scale to assess how useful they found their participation in this project (Supplementary File 3). This participant satisfaction questionnaire was introduced starting with the second year of the \u0026ldquo;Smartkids Project\u0026rdquo;, and data have been thus collected from the parents of 49 children (Suppl. Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eNumerical variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (S.D.). Categorical variables are presented as frequencies and percentages. Shapiro-Wilk test showed that data were not normally distributed, thus paired-sample Wilcoxon Test was performed to assess differences in ScreenQ scores before and after intervention. Data from the original ScreenQ questionnaire are always reported; whenever results obtained from the additional specifiers and item present in our Italian translation are presented, this is explicitly stated. Analyses were performed using R, version 4.5.0 (R Core Team, 2025).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eParticipants\u003c/h2\u003e\n\u003cp\u003eThe parents of 192 children (mean age\u0026thinsp;=\u0026thinsp;3.1 years, range\u0026thinsp;=\u0026thinsp;0.3\u0026ndash;6.0; 108 M: 84 F) were enrolled in the study after written parental informed consent was obtained and the ScreenQ was completed before the first session. In the majority of cases, the parent attending the first session was the mother (n\u0026thinsp;=\u0026thinsp;151, 78.7%), followed by the father (n\u0026thinsp;=\u0026thinsp;31, 16.1%), while both parents attended in 10 cases (5.2%). The second session was attended by parents of 75 (39.1%) children.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eScreen time habits\u003c/h3\u003e\n\u003cp\u003eAt baseline, parents reported that the majority of children in our sample (n\u0026thinsp;=\u0026thinsp;148; 77.1%) had already been exposed to portable digital devices, most frequently smartphones (n\u0026thinsp;=\u0026thinsp;135; 70.3%). Early exposure was common: 71 children (37.0%) were introduced to screen devices before 18 months of age, including 21 (10.9%) who were exposed before their first year of age. Importantly, parents of 73 children (38.0%) reported daily screen time exceeding one hour; however, only 3 (1.5%) were reported to use smartphones for more than one hour per day. Caregivers reported interacting with their children during and after video viewing in 173 (90.1%) and 165 (85.9%) cases, respectively, although parental engagement was short-lasting and inconsistent in the majority of cases. Notably, 32 (16.7%) children watched videos and 12 (6.3%) used applications on smartphones or tablets without any adult supervision. Parents of 45 (23.4%) children affirmed using electronic devices to calm down their child when upset, 44 (22.9%) during meals and in 32 (16.7%) cases electronic devices, especially television, were employed at bedtime to facilitate sleep.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eScreenQ scores\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;1 summarize ScreenQ domains scores before and after the intervention, respectively, as reported by the parents of 75 children who participated in both sessions. Highly significant improvement was found in the domains of Access and Interactivity, as well as in the Total Score, indicating reduced access to electronic devices and increased interactions with the caregivers during vision. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e details differences at single ScreenQ items. After the intervention, children were significantly less exposed both to smartphones (item 2, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) and to screens altogether (item 7a, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), especially when outside of the house (item 5, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04). Children were also less frequently allowed to independently select videos or download apps (item 11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04), and parents more likely to discuss with their children about the content of the video or game previously played (item 15, p\u0026thinsp;=\u0026thinsp;0.025). A reduction in unsupervised app use was also observed at item 13b, although it did not reach significance (p\u0026thinsp;=\u0026thinsp;0.07) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Finally, an important change was picked by our specifier at item n. 3 and missed by the original item n.3. In fact, the number of children exposed during meals (original item 3: yes\u0026thinsp;=\u0026thinsp;1, no\u0026thinsp;=\u0026thinsp;0) was not significantly reduced (p\u0026thinsp;=\u0026thinsp;0.145), but the frequency of smartphone exposure during mealtime (item 3 specifier: rarely\u0026thinsp;=\u0026thinsp;0, often\u0026thinsp;=\u0026thinsp;1, always\u0026thinsp;=\u0026thinsp;2) indeed showed a significant decrease in frequency (p\u0026thinsp;=\u0026thinsp;0.049) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eScreenQ domains before and after the intervention (T1\u0026thinsp;=\u0026thinsp;before the first session and T2\u0026thinsp;=\u0026thinsp;at the second session). \u003cem\u003eN\u003c/em\u003e, mean score and paired sample Wilcoxon test statistics are reported. Statistically significant results are highlighted in bold.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"1\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eScreenQ domain\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePaired Wilcoxon Test Statistics\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAccess\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;2048.5, \u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;4.855e-12\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;464, p\u0026thinsp;=\u0026thinsp;0.4359\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eContent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;143, p\u0026thinsp;=\u0026thinsp;0.5731\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInteractivity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;541.5; \u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.003179\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;1943.5, \u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;1.233e-10\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eScreenQ item scores before and after the intervention (T1\u0026thinsp;=\u0026thinsp;questionnaire filled before the first session, T2\u0026thinsp;=\u0026thinsp;questionnaire filled during the second session). \u003cem\u003eN\u003c/em\u003e, mean score and paired sample Wilcoxon test statistics are reported. Nominally significant results are highlighted in bold.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePaired Wilcoxon Test Statistics\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.189\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.187\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.351\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eV\u0026thinsp;=\u0026thinsp;140, p\u0026thinsp;=\u0026thinsp;0.04117\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_3_original\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.173\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;48, p\u0026thinsp;=\u0026thinsp;0.145\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_3_specifier\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.227\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.107\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eV\u0026thinsp;=\u0026thinsp;71.5, p\u0026thinsp;=\u0026thinsp;0.04982\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.493\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.467\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;76.5, p\u0026thinsp;=\u0026thinsp;0.6379\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.240\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.137\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eV\u0026thinsp;=\u0026thinsp;31.5, p\u0026thinsp;=\u0026thinsp;0.04108\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.530\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.614\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;37.5, p\u0026thinsp;=\u0026thinsp;0.3014\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_7_original\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.472\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.338\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eV\u0026thinsp;=\u0026thinsp;55, p\u0026thinsp;=\u0026thinsp;0.001904\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_7_specifier\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;1.5, p\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.230\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.187\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;28.5, p\u0026thinsp;=\u0026thinsp;0.4922\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.203\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.160\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;80, p\u0026thinsp;=\u0026thinsp;0.5095\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_10\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.096\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.081\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;22.5, p\u0026thinsp;=\u0026thinsp;0.5297\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_11\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.315\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.227\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eV\u0026thinsp;=\u0026thinsp;32, p\u0026thinsp;=\u0026thinsp;0.04183\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_12\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.087\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.153\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;8, p\u0026thinsp;=\u0026thinsp;0.2986\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_13a\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.183\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.176\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;36, p\u0026thinsp;=\u0026thinsp;0.8016\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_13b\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.035\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;10, p\u0026thinsp;=\u0026thinsp;0.07186\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_14\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.606\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eV\u0026thinsp;=\u0026thinsp;123.5, p\u0026thinsp;=\u0026thinsp;0.06277\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eItem_15\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.620\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.444\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eV\u0026thinsp;=\u0026thinsp;189.5, p\u0026thinsp;=\u0026thinsp;0.02545\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eScreen addiction\u003c/h2\u003e\n\u003cp\u003eParents attending the second session reported observing unusually intense irritability when use of the electronic device was interrupted or access was denied in more than one third of the children (30/75, 40.0%) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eA). Notably, irritability was present in all children who exhibited at least one sign of screen addiction and was always perceived by parents as different in intensity, duration, and emotional quality from the typical tantrums of their child. The electronic device responsible for precipitating intense irritability upon withdrawal was television in 21 children, smartphone in 18 cases and tablet in 4 children. Compulsive seeking of screen devices was observed in 13 children (17.3%), while loss of control during use was reported in 10 (13.3%) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eA). Overall, 30 children (40.0%) displayed at least one indicator of screen addiction, with 9 (12.0%) children displaying two indicators and 7 (9.3%) meeting all three criteria (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eB). Interestingly, 6 of these 7 preschoolers were reported to be dependent on both smartphone and television, with YouTube videos on smartphones and handling of the remote control of televisions particularly attractive.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eNumber and percentages of children showing compulsive use of electronic devices, loss of control and irritability when using screens.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSigns of screen addiction\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIrritability following interruption of device use or access denial\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCompulsive seeking of the electronic device\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLoss of control while using the electronic device\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of screen addiction\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0/3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1/3 - irritability only\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2/3 - irritability\u0026thinsp;+\u0026thinsp;compulsive seeking or loss of control\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3/3 - irritability\u0026thinsp;+\u0026thinsp;compulsive seeking\u0026thinsp;+\u0026thinsp;loss of control\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study explored screen use habits in preschoolers and evaluated the short-term efficacy of a parent coaching intervention aimed at: (a) preventing problematic use of electronic devices by raising parental awareness about the risks of excessive screen use, including its neurodevelopmental consequences and potential for addiction; (b) providing parents with simple and easy-to-apply criteria to define whether and to what extent exposure to electronic devices had produced dependence in their child; and (c) supporting parents in managing problematic use and screen dependence, when already established.\u003c/p\u003e \u003cp\u003e More than one third of children in our sample had been introduced to digital media before 18 months of age, and a substantial proportion exceeded the one-hour daily limit recommended by pediatric guidelines. These findings align with prior research documenting widespread and early screen exposure among preschoolers. Although we did not systematically collect information on the type of activities performed with digital devices or on the nature of the content accessed, these topics were extensively discussed during the second meeting. Parents reported that the most frequent activity was watching short cartoons considered age-appropriate and educational, both on smartphones and on TV. Most caregivers reported interacting with their children during (173/192, 90.1%) and after (165/192, 85.9%) media use. However, co-viewing was neither long-lasting nor consistent, and a considerable proportion of children were often left unsupervised while using electronic devices. In these instances, young children were often found compulsively scrolling the smartphone for images and videos typically on YouTube. These findings underscore the need for interventions aimed not only at reducing daily total screen time, but also at strengthening parental awareness of the protective role of active co-viewing, which has been shown to mitigate the negative consequences of early screen exposure [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this regard, our intervention proved effective: following the first informative session, parents engaged more frequently with their child after video viewing, while children were less frequently allowed to use applications without adult supervision.\u003c/p\u003e \u003cp\u003eThe use of electronic devices as a soothing tool against tantrums, at bedtime, or during meals, was initially reported by parents of 45 (23.4%), 44 (22.9%), and 32 (16.7%) children, respectively. Given the documented association with emotional dysregulation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] and sleep disturbances [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], this finding raises concern. Our intervention produced a significant reduction in smartphone exposure during meals (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, item 3-specifier), whereas use to calm the child or at bedtime did not decrease significantly (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, items 8 and 9 respectively). Furthermore, during the discussion held in the second meeting, parents often claimed resorting to screen media to keep children occupied, for example at home when cooking dinner or when dealing with younger siblings. It is important to support parents in finding enjoyable alternatives to electronic devices, when they need to keep their child engaged without direct supervision.\u003c/p\u003e \u003cp\u003eOverall, the \u0026ldquo;Smartkids program\u0026rdquo; effectively reduced children\u0026rsquo;s overall screen exposure, at least short-term. The observed reduction in ScreenQ total scores was primarily driven by significant changes in the Access and Interactivity domains (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;1), suggesting that the intervention successfully decreased total daily screen exposure, limited use outside the home, and promoted greater caregiver-child engagement during media use. Non-significant reductions were instead observed in the Frequency and Content domains (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;1). The Frequency domain includes items related to the age of first screen exposure and the use of screens for soothing or at bedtime, while the Content domain assessed exposure to violent or fast-paced media and children\u0026rsquo;s autonomy in selecting programs or apps. Given the very young age of our sample, it is not surprising that parents were already avoiding inappropriate content. Stronger effects on these domains may be expected in older children, although parents of preschoolers are not always aware of what their children view, since parental supervision is not constant and 12 (6.3%) children were admittedly on electronic devices entirely unsupervised.\u003c/p\u003e \u003cp\u003eFull screen addiction was identified in 7 (9.3%) children, a remarkable proportion given the young age of participants (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). However, 30/75 (40.0%) children exhibited one sign of screen addiction always in the form of withdrawal dysphoria, i.e. acute irritability when use of the electronic device is interrupted or access denied (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). The negative affect of these emotional tantrums, likely produced by a sustained and prolonged activation of the extended amygdala [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], was defined by parents as \u0026ldquo;more profound\u0026rdquo; (i.e., of greater intensity and duration) compared to the typical outbursts of their child. Importantly, compulsive seeking and loss of control over device use were always observed in children who also displayed irritability when device use was interrupted or access denied (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB), suggesting that the onset of withdrawal irritability alone may represent an early marker of emerging dependence on screen devices. In line with the neurobiology of addictive stimuli, parents reported that this irritability emerged already after few exposures to the device, especially with smartphones.\u003c/p\u003e \u003cp\u003eWe anticipated greater addictive potential for smartphones over other electronic devices, due to their portability, interactivity, and faster response. However, signs of full-blown screen addiction were observed most frequently in children misusing \u003cem\u003eboth\u003c/em\u003e to smartphone and television. This may reflect the young age of our cohort, in which independent access to the smartphone is typically mediated by parents, whereas television remains more easily available. Nonetheless, it is important to consider that television remains a salient medium for young children.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. No demographic information was collected except for age and sex, limiting our ability to account for sociodemographic confounds. We did not collect information on indirect screen exposure, such as background television, which has been shown to exert detrimental effects on child development. The activity or content most frequently consumed by children was discussed with parents during the second meeting, but not systematically assessed. The ScreenQ is a parent-reported measure which may suffer from response distortion due to social desirability and underestimate children\u0026rsquo;s actual screen exposure.\u003c/p\u003e \u003cp\u003eThe substantial participation rate at the first \u0026ldquo;educational\u0026rdquo; session reflects parental concern about managing screen use in their children, but only the parents of 75/192 (39.1%) children also attended the second \u0026ldquo;discussion\u0026rdquo; session. This substantial decrease may not necessarily reflect lack of interest or impact. Indeed, feedback obtained from a subgroup of 49/75 (65.3%) parents who completed both sessions was largely positive (see Suppl. Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). Furthermore, anecdotal reports by some teachers suggest that many families, especially those with very young children, may have found the information provided in the first session already sufficient to address their needs. Nonetheless, future editions of this program will implement the satisfaction questionnaire also after the first session, to better capture parental perceptions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOverall, our current findings are consistent with the emerging literature reporting frequent problematic media use in children and emphasizing the importance of early prevention, identification, and management strategies. A brief and structured educational intervention based on parent coaching here improved parental practices related to media use, likely translating into a healthier life style within the family. Importantly, our intervention provided not only information on the negative consequences of excessive screen exposure in young children, but also simple and effective empowerment strategies to promote addiction recognition and management by parents. Furthermore, the possibility to attend the second session after one month, made parents in need of additional help feel accompanied in their efforts.\u003c/p\u003e \u003cp\u003eThis study should be viewed as \u0026ldquo;work-in-progress\u0026rdquo;, since our \u0026ldquo;Smartkids project\u0026rdquo; in the Modena school system will continue in the years to come. The collection of larger samples of preschoolers, assessments of long-term outcome, and the design of programs tailored for older children and adolescents represent promising avenues of future investigation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval.\u003c/h2\u003e \u003cp\u003eThe study was approved by the Ethics Committee of Area Vasta Emilia Nord (protocol no. 36275/23, 14/12/2023).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate.\u003c/strong\u003e \u003cp\u003e All participants in this study provided written informed consent in accordance with the procedures approved by the ethics committee.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests.\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding.\u003c/h2\u003e \u003cp\u003eThis study was funded the University of Modena and Reggio Emilia under grant scheme for the promotion of Public Engagement activities (\u0026ldquo;Bando per l\u0026rsquo;agevolazione di attivit\u0026agrave; di Public Engagement\u0026rdquo;), for the years 2022, 2023, and 2025.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eL.A. was involved in participant recruitment, data collection, database preparation, data analysis, results tabulation, and drafting of the manuscript. L.S. was involved in database preparation and reviewing of the manuscript. A.M.P. was involved in the conceptualization of the study, study design, participant recruitment, data interpretation, and reviewing of the manuscript. All authors read and approved the final version of this manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors gratefully acknowledge Silvia Cestarollo, Simona Cristoni, Giuliano Boni, Paola Francia, Patrizia Guerra (Modena Public Education Service 0-6 and MeMo Center), and Emanuela Ricci (Fondazione Cresci@Mo) for their collaboration, and Modena City Councelors Grazia Baracchi and Federica Venturelli for their continued support to the \u0026ldquo;Smartkids\u0026rdquo; project.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData are available from the authors upon reasonable request - subject to ethical permissions and participant consent.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCOUNCIL ON COMMUNICATIONS AND MEDIA, Hill D, Ameenuddin N et al (2016) Media and Young Minds. Pediatrics 138(5):e20162591. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/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\u003eTo grow up healthy, children need to sit less and play more. 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JAMA Pediatr 170(12):1202. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamapediatrics.2016.2341\u003c/span\u003e\u003cspan address=\"10.1001/jamapediatrics.2016.2341\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"child-psychiatry-and-human-development","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"chud","sideBox":"Learn more about [Child Psychiatry \u0026 Human Development](http://link.springer.com/journal/10578)","snPcode":"10578","submissionUrl":"https://submission.nature.com/new-submission/10578/3","title":"Child Psychiatry \u0026 Human Development","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"internet addiction, parent coaching, preschoolers, screen time, smartphone addiction","lastPublishedDoi":"10.21203/rs.3.rs-8693325/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8693325/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eExcessive and early exposure to electronic screen devices has been consistently associated with developmental, behavioral, and emotional problems in children, including the emergence of screen addiction. Preventive interventions involving parents are crucial, as screen habits in preschoolers are established by parents, tend to persist over time, and yield long-term negative consequences. This study evaluates the effectiveness of a parent coaching intervention in reducing children\u0026rsquo;s daily exposure to electronic devices and screen addiction. One or both parents of 192 children (mean age: 3.1 years, range: 0.3\u0026ndash;6.0) attended a 90-minute session, describing the consequences of excessive screen time in children, the behavioral hallmarks and neurobiological mechanisms of screen addiction, and practical strategies to overcome dependence, if present. The parents of 75 (39.1%) children also attended a second session one month later, to share their experience. The ScreenQ questionnaire was filled by parents before both sessions. At baseline, 148 (77.1%) preschoolers had already been exposed to portable electronic devices, with 71 (37.0%) starting before 18 months of age. Notably, 30/75 (40.0%) exhibited at least one indicator of problematic screen use, specifically irritability upon device withdrawal, and 7/75 (9.3%) met all criteria for screen addiction. After the intervention, ScreenQ total scores significantly decreased in the Access and Interactivity domains, reflecting reduced daily screen time and unsupervised use, with increased parental engagement during media exposure. Our findings highlight the need to address emerging digital dependence early in preschoolers and support the efficacy of parent-directed interventions to contrast excessive screen exposure in young children.\u003c/p\u003e","manuscriptTitle":"Problematic use of electronic devices and screen addiction in preschool children: a parent coaching program for prevention and treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-05 08:26:59","doi":"10.21203/rs.3.rs-8693325/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-06T20:17:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3112565735867887700053552867277780118","date":"2026-02-02T22:07:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-02T15:30:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-02T01:16:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-27T01:56:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Child Psychiatry \u0026 Human Development","date":"2026-01-25T15:02:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"child-psychiatry-and-human-development","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"chud","sideBox":"Learn more about [Child Psychiatry \u0026 Human Development](http://link.springer.com/journal/10578)","snPcode":"10578","submissionUrl":"https://submission.nature.com/new-submission/10578/3","title":"Child Psychiatry \u0026 Human Development","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"801279e2-b0d7-4b92-9a86-c9f00341788b","owner":[],"postedDate":"February 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-05T08:27:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-05 08:26:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8693325","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8693325","identity":"rs-8693325","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}