We have discussed in the previous chapters the importance of the home and neighborhood environment for thriving development. In this section, we will discuss many health and wellness topics for the first time, such as autism and ADHD. We will also continue our conversation about other topics, such as sleep quality and nutrition access, that impact cognitive development in the preschool years. Let’s start our conversation with factors found within the home environment and proceed to those that are influenced at both home and neighborhood environments.

Screen Time

Our world is surrounded by screens. Some children have an extensive exposure to screens at home, school, and many other places. Screens are easy to access, and parents are using them more and more for both activities and entertainment. But are screens good or bad for children? Research thus far shows that the use of screens can be beneficial to children in some instances, such as using them for educational purposes (Radeskey et al., 2015). However, the prolonged use of screens has also been linked to many negative developmental health outcomes, including behavior problems (Tamana et al., 2019), speech delays (van den Heuvel et al., 2019), lower executive functioning (Kostyrka-Allchorne et al., 2017), and academic problems (Adelantado-Renau et al., 2019).

It seems that both the negative and positive effects of screen use depend on the age of exposure, the purpose of usage, and the duration of use (Kerai et al., 2022). Evidence-based guidelines recommend limiting the use of screen time to 1 or 2 hours daily for children under 5 years of age. Screen time includes the use of television, smart phones, tablets, computers, and video game consoles. Kerai and colleagues (2022) found that children that used screen time for more than 1 hour daily were more likely to be at risk in all five developmental domains, including language and cognitive development and communication skills.

Sleep

Adequate sleep is crucial for thriving development as it is a building block of multiple developmental domains. Sleep has a direct impact on alertness and attention, cognitive performance, vocabulary development, and learning and memory, especially in early childhood (Zhou et al., 2015). The American Academy of Pediatrics estimates that about 25 percent of children are impacted by sleep problems (Mindell & Owens, 2015). So, what happens when a child does not get enough sleep? If you ask a parent, they will tell you that if their child does not get adequate sleep, they might be grumpy, unfocused, or hyperactive. Evidence-based recommendations by the American Academy of Pediatrics include 11 to 14 hours for 1- to 2-year-olds, and 10 to 13 hours for 3- to 5-year-olds.

As we just learned, both sleep and screen time impact cognitive and language development in early childhood. Screen time, especially right before bedtime, affects sleep quality and quantity. The use of screens before bedtime can impact alertness, therefore preventing children from being able to relax during bedtime. Additionally, nighttime screen use impacts children’s ability to fall asleep, increases wakings and nightmares during the night, and causes sleepiness during the day. Garrison et al. (2010) found that children between ages 3 and 5 had trouble sleeping when they had screen time after 7 p.m. Furthermore, the results showed that the amount of violent content in the program or game also appeared to be a contributing factor.

Nutrition

We discussed previously the importance of adequate nutrition for thriving cognitive and language development. Healthy brain development requires a well-balanced diet including proteins, fats, carbohydrates, vitamins, minerals, and water to maintain proper functioning. Many micronutrients, including iron, zinc, choline, iodine, folate, and B12, have been identified to play a special role in cognitive development (Bourre, 2006). Unfortunately, it is estimated that almost 11 percent of children age 5 and under experience food insecurity (Ullman et al., 2022). Lack of access to foods, especially healthy ones, can have a profound impact on cognitive, language, and physical development. Interventions targeting food insecurity are fundamental to the developing child.

Mental Health

In this section, we will discuss several common mental health issues that may emerge in the preschool period. All these conditions can have an effect on cognitive and/or language development. For example, attention-deficit/hyperactivity disorder (ADHD) is linked to impaired cognitive development in early childhood (Coghill et al., 2014), and autism spectrum disorder (ASD) is associated with difficulty developing language skills (NIH, 2020).

Attention-Deficit/Hyperactivity Disorder

According to the Centers for Disease Control and Prevention (CDC), ADHD is one of the most common neurodevelopmental disorders in early childhood. However, thriving preschoolers are full of energy and can appear rumbustious, inattentive, and hyperactive at times. Therefore, the line between typical developmental changes and symptoms of ADHD is blurry. This makes ADHD difficult to diagnose. Nonetheless, children with ADHD might experience trouble paying attention and with impulsivity (acting without thinking of consequences), and they might be overly active (CDC, 2022). Let’s discuss common signs and symptoms of ADHD.

First, keep in mind that it is typical of thriving preschoolers to have trouble focusing and behaving at times. Children are constantly learning, evolving, and developing. However, children with ADHD do not grow out of these behaviors. Instead, the symptoms continue and can cause difficulties at home, school, and with relationships. A child with ADHD might daydream a lot, forget or lose things often, squirm or fidget, have difficulty getting along with others, and have trouble resisting temptation (CDC, 2022).

There are three different types of ADHD. However, symptoms and the presentation may change over time. The following is a brief discussion of each type of ADHD:

• Predominantly inattentive presentation: Children with this type of ADHD have difficulty organizing and finishing tasks, paying attention to details, or following instructions and conversations. They may also have difficulty following daily routines and remembering details.
• Predominantly hyperactive-impulsive presentation: Children with this type of ADHD fidget and talk a lot. It is difficult for them to sit still for long, and younger children may jump, run, climb, and move their extremities constantly. Restlessness and impulsivity may be common, and a child with impulsivity might get injured or have more accidents than others (CDC, 2022).
• Combined presentation: Children with this type of ADHD exhibit symptoms of the other two types equally.

Although scientists are actively researching the cause(s), risk factors, and better ways to treat, manage, and prevent ADHD, the cause(s) and risk factors are still unknown. Current research shows that genetics may play a role (Faraone et al., 2021). However, researchers are also studying the potential effects of brain injury, environmental exposure during pregnancy or at a young age, substance use during pregnancy, premature delivery, and low birthweight, among other possible causes (CDC, 2022).

Research does not support popular and somewhat controversial views that ADHD is caused by high sugar consumption, too much screen time, parenting, or certain social and environmental factors, such as poverty or family dynamics (CDC, 2022). Many factors, like the ones already mentioned, can worsen symptoms, especially in certain children. However, the evidence is not strong enough to determine that these are the main causes of ADHD (CDC, 2022).

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a developmental disability caused by brain differences that can cause major social, communication, and behavioral challenges (NIH, 2020). Children with autism present a wide range of symptoms, skills, and level of impairments. The use of the term “spectrum” refers to this wide range among people with autism.

Children with ASD may experience various levels of difficulty with language development and comprehension. Additionally, they may experience difficulty with nonverbal communication, such as body language, eye contact, and facial expressions (NIH, 2020). Some examples of signs and symptoms related to ASD include avoiding and/or not maintaining eye contact; not displaying emotions, such as happy, sad, angry, or surprise, in their facial expressions; ignoring other children; and not singing, dancing, or acting out scenarios (CDC, 2022).

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“Health and Wellness” by Esmeralda Janeth-Julyan is licensed under CC BY 4.0.