Dose-response relationship between screen time and behavioral problems in children with attention-deficit/hyperactivity disorder comorbid with tic disorder

SUN Haiting; WANG Ping; LI Yan; QIAO Hongyu; JIAN Fangfang; SUN Xin

doi:10.11852/zgetbjzz2026-0588

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Chinese Journal of Child Health Care ›› 2026, Vol. 34 ›› Issue (9) : 980-984. DOI: 10.11852/zgetbjzz2026-0588

Child Mental Health and Emotional Problems

Dose-response relationship between screen time and behavioral problems in children with attention-deficit/hyperactivity disorder comorbid with tic disorder

SUN Haiting¹, WANG Ping¹, LI Yan², QIAO Hongyu¹, JIAN Fangfang¹, SUN Xin¹

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Abstract

Objective To investigate screen use characteristics in children with attention-deficit/hyperactivity disorder (ADHD) comorbid with tic disorder (TD) and its association with behavioral problems, and to explore a potential nonlinear association between screen time and behavioral problems, in order to provide reference for clinical interventions. Methods A clinical case-control study was conducted involving 172 children aged 6 to 12 years recruited from outpatient clinics and routine physical examinations between August 2024 and May 2026. Participants were divided into four groups: the comorbid ADHD and TD group (CAT group, n=48), ADHD group (n=46), TD group (n=48), and healthy control group (n=30). Daily screen time and age at first screen exposure were collected using caregiver questionnaires. Symptom severity and behavioral problems were assessed using the 26-item Swanson, Nolan, and Pelham Rating Scale (SNAP-IV-26), the Yale Global Tic Severity Scale (YGTSS), and the parent version of Achenbach Child Behavior Checklist (CBCL). Data were analyzed using one-way analysis of variance (ANOVA), correlation analysis, and linear regression models. Results Theaverage daily screen time of the CAT group was (2.84±1.12) hours, significantly longer than that of the other three groups (P<0.001). Age at first screen exposure did not differ significantly among groups(P＞0.05). After adjusting for confounders, daily screen time was positively associated with the CBCL total score (β=0.442, P<0.001). Segmented regression analysis of the whole sample indicated a critical threshold of approximately 2.5h/d regarding the impact of screen time on behavioral problems. When stratified by diagnosis, disease severity inversely correlated with the tolerance threshold for screen exposure; the CAT group exhibited a threshold of 2.5h/d, where the threshold effect was most evident. Conclusion Daily screen time is an independent influencing factor for behavioral problems in children. Children with ADHD comorbid with TD exhibit higher sensitivity to screen exposure. The 2.5 h/d cutoff may serves as a potential reference for screen time management in this population, providing guidance for targeted clinical interventions.

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attention-deficit/hyperactivity disorder / tic disorder / screen time / behavioral problems / dose-response relationship / child

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SUN Haiting, WANG Ping, LI Yan, QIAO Hongyu, JIAN Fangfang, SUN Xin. Dose-response relationship between screen time and behavioral problems in children with attention-deficit/hyperactivity disorder comorbid with tic disorder[J]. Chinese Journal of Child Health Care. 2026, 34(9): 980-984 https://doi.org/10.11852/zgetbjzz2026-0588

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