Saliency-Driven Visual Search Performance in Toddlers With Low– vs High–Touch Screen Use

Ana Maria Portugal, PhD1Rachael Bedford, PhD2Celeste H. M. Cheung, PhD1et alTeodora Gliga, PhD3Tim J. Smith, PhD1Author AffiliationsArticle InformationJAMA Pediatr. Published online August 10, 2020. doi:10.1001/jamapediatrics.2020.2344

During toddlerhood, a peak period of neurocognitive development, increased exposure to sensory stimulation through touch screen use, may influence developing attentional control.1 While TV’s rapidly changing, noncontingent flow of sensory information has been hypothesized to lead to difficulties voluntarily focusing attention,2 video gaming’s contingent and cognitively demanding sensory environments may improve visual processing and attention.3 Toddler touch screen use involves both exogenous attention, driven by salient audio-visual features, and endogenous/voluntary control, eg, video selection and app use.4,5

The current study compared high– and low–touch screen users on a gaze-contingent visual search paradigm,6 assessing exogenous, saliency-based attention (single-feature trials), and endogenous attention control (conjunction trials).


Individuals aged 12 months were recruited from October 2015 to March 2016 (as part of the TABLET project5) and followed up longitudinally at 18 months and 3.5 years. Parents gave informed written consent, and the Birkbeck, University of London institutional review board approved this study. Before each visit, parents were asked, “On a typical day, how long does your child spend using a touchscreen device (tablet, smartphone or touchscreen laptop)?” Participants were recruited as high users and low users based on median use of 10 minutes per day reported in a previous survey sample.5 At 18 months and 3.5 years, user groups were reassigned using the within-sample median (15 minutes per day). At recruitment, groups were matched on developmental level (Mullen Scales of Early Learning), age, sex, background TV (parent-reported minutes per day), and mother’s education.

The visual search task was administered at 18 months and 3.5 years (Tobii TX300 eye tracker with 120-Hz tracking, 60-cm distance, 5-point calibration). Arrays were presented (single feature [target red apple among blue apples; set sizes 5 and 9] or conjunction [target red apple among blue apples and slices of red apples; set sizes 5, 9, and 13; only set sizes matched across conditions were analyzed, ie, 5 and 9) for 4 seconds or until the target was fixated. Trials were presented continuously, grouped into blocks: (1) 3 single feature, fixed order; (2) 1 single feature, 9 conjunction, randomized; and (3) 4 single feature, 9 conjunction, randomized. values were 2-sided and were significant at less than .05. SPSS version (SPSS Inc) was used. Analysis began November 2018 and ended in November 2019.


Of 56 infants recruited, 49 were followed up longitudinally at 18 months and 46 were followed up at 3.5 years. Data quality and accuracy did not differ significantly across groups. Linear generalized estimating equations for saccadic reaction time (SRT) (Figure) were run with an unstructured correlation matrix (deviation from preregistered 3.5-year analysis of variance; to include missing data and treat group as a time-varying predictor (some children changed user groups over time; usage correlations: 12 to 18 months, Spearman rs = 0.78; 18 months to 3.5 years, Spearman rs = 0.33; 12 months to 3.5 years, Spearman rs = 0.31).

Direct link to the research

About S. R. Zelenz 119 Articles
S.R. Zelenz has worked in education for 20 years. Working with students from all walks of life, cultures, races, and social diversity, Zelenz’s research in Educational Leadership led to finding a better way to approach learning for students with trauma histories. Many were juvenile offenders, gang members, diagnosed with varying behavioral disorders, or had family histories of violence, murder, or narcissistic parenting. This research could not be effectively accomplished without further understanding: how epigenetic trauma inheritance may be impacting these students; how brain development from trauma may be impacting their behavioral and emotional development; as well as deep understanding of psychology and its varying classifications for behavioral and personality disorders. The goal is to find solutions for changing the conversation and making a real difference for these students. She has also worked with nonprofits of varying focus areas for the last 25 years. Her undergraduate degree in Arts Administration and Music prepared her for managing nonprofits of any size as well as procuring funding so that they can achieve their goals. Pairing her nonprofit background with her education background, she has been able to make a difference for over 200 nonprofits worldwide, written curriculum for schools across the globe, and assisted many arts organizations through performance and management.