22 Digital citizenship among children and youth with autism: Developing guidelines for promoting healthy screen time use
Authors: Cohen-Eilig Mor , Mayer Yael , Jarus Tal , Glodjo Armansa , Kuzyk Natasha , Chan Janice , Lei Emma , Nguyen Kimberly , Goldberger Tessa , Dispirito Nicole 
Published: October 2024

Abstract

Background
In response to the rising prevalence of screen-based usage among children, particularly those with autism, this study addresses the urgent need for tailored guidelines and strategies to support the digital citizenship and healthy screen time management of children and youth with autism. The currently available screen time guidelines do not adequately account for the specific requirements of autistic children, prompting an exploratory investigation into the information needs of clinicians and families in this domain.

Objectives
To develop clear and specific guidelines for caregivers and clinicians to facilitate the digital citizenship of children with autism.

Design/Methods
This multi-phase study was guided by the Knowledge to Action framework for knowledge development (figure 1). First, we identified the existing knowledge gaps regarding screen time use by conducting semi-structured interviews with 15 clinicians. Next, a Delphi method was employed, involving 30 experts in autism, comprising 20 clinicians and 10 caregivers. These experts participated in a series of three surveys, wherein they rated their agreement with a set of statements, encompassing potential guidelines and strategies. Statements that garnered agreement from over 75% of the panel were included in the final guidelines, which were categorized into six sections. In the last phase, evaluation and implementation of the guidelines were studied by asking parents and clinicians for their opinion on key criteria, including accessibility, relevance, clarity, usability, knowledge, and delivery.

Results
The 1st phase highlighted the need to create uniform recommendations for screen time management. The 2nd phase finalized a set of guidelines comprises six key sections, each playing a pivotal role in promoting healthy screen time use among children with autism: General principles; considerations related to the timing and content of leisure screen time; strategies for caregivers and clinicians to oversee and regulate screen time usage; behavioral indicators of screen time overuse; additional guidelines tailored for clinicians; and a section on resources. In the evaluation phase, participants responded positively and reported that disseminating the guidelines online is feasible and useful. Participant were satisfied with the key criteria with responses scoring between “Somewhat agree” and “Agree” across all domains. Please visit https://asdtechnology.osot.ubc.ca/screen-time-use-guidelines/

Conclusion
The guidelines established through this collaborative effort between stakeholders in the autism community provide valuable insights and a tangible framework to address screen time overuse in children with autism. By identifying and addressing the unique needs of this population, these guidelines aim to assist clinicians and caregivers in nurturing healthy digital citizenship among autistic children.