Short-Form Video Media Use Is Associated With Greater Inattentive Symptoms in Thai School-Age Children: Insights From a Cross-Sectional Survey

The study addresses how short-form video media use relates to inattentive behaviors in school-age children (ages 6–12), a developmental window when prefrontal cortex maturation and attentional capacity are actively progressing. Attention problems exist on a continuum from minimal to clinically significant, and subthreshold inattentive symptoms are common and associated with adverse outcomes. Given the rapid rise of short-form video platforms (e.g., TikTok, YouTube Shorts, Instagram Reels) that deliver high-arousal, brief content via continuous scrolling and algorithmic curation, the research examines whether this specific media format is associated with increased inattentive symptoms beyond overall screen time. The primary objective is to test the association between daily short-form video duration and parent-rated inattentive behaviors; secondary objectives assess associations with hyperactive-impulsive and oppositional-defiant behaviors.

The background situates attention as a key neurocognitive function influenced by genetic, neurodevelopmental, and environmental factors, with symptoms distributed dimensionally across populations. Subthreshold inattentive symptoms are prevalent and linked to negative academic, occupational, and mental health outcomes, aligning with dimensional frameworks (DSM-5-TR, HiTOP, RDoC-informed perspectives). Prior literature suggests bidirectional relationships between screen media use and attention disturbances, including ADHD-related traits increasing susceptibility to problematic media use. Short-form videos are distinct due to their brevity, high arousal, continuous scroll-based navigation, and algorithmic personalization, potentially reinforcing immediate gratification and narrowed, high-stimulation content streams. Emerging studies have linked short-form video addiction tendencies with neural correlates (e.g., reduced prefrontal theta power) and mediating relations between ADHD symptoms and problematic short-form video use. Media with similar properties (rapid pacing, fantasy elements, multitasking) can acutely disrupt attention and executive function, with possible cumulative, long-term impacts via mechanisms such as cognitive overload, executive depletion, arousal/reward dysregulation, conditioning to quick rewards, and sleep disruption. Opportunity costs (reduced outdoor play and social interaction) and cultural/emotional regulation factors may further interact with attention difficulties. These lines of evidence motivate focused examination of short-form video use in relation to inattentive and related behaviors.

Design and setting: Cross-sectional survey conducted in a suburban tertiary hospital in Thailand between November 2023 and March 2024. Two recruitment settings were used to capture a broad spectrum of attention-related behaviors: outpatient pediatric vaccination clinics (general population) and child psychiatric clinics (clinical population). Participants: Literate guardians (aged 19–60) of children aged 6–12. Extended family members serving as de facto guardians were permitted due to prevalent skip-generation parenting. Exclusion criteria: guardian-reported global developmental delay, intellectual disability, or autism spectrum disorder. Initially 537 guardians participated; 9 were excluded due to extreme outlier screen time data, yielding N=528 for analyses. Source distribution: psychiatric clinic N=73 (13.8%), vaccination clinic N=455 (86.2%). ADHD diagnoses (DSM-5) were present in 61 children (11.6%). Sample size: Determined via G*Power (v3.1.9.7). For power=0.9, alpha=0.05, and small effect size f=0.04 (converted from observed effect of overall screen media use), required N=485 for linear regression. Measures: - Outcomes: Parent-rated Thai SNAP-IV short form assessing inattentive, hyperactive-impulsive, and oppositional-defiant behaviors (summed domain scores as continuous variables). Internal consistency: α=0.92 (inattentive), α=0.91 (hyperactive-impulsive), α=0.92 (oppositional-defiant). For medicated ADHD children (commonly immediate-release methylphenidate), guardians rated baseline behaviors during medication off periods/drug holidays. - Exposure: Guardian-reported average daily hours of short-form video use and total screen time, estimated separately for weekdays and weekends; averages computed. Reported daily means: total screen time 3.6 h (SD 2.2), short-form video 1.9 h (SD 1.4), comprising ~56.8% (SD 30.6%) of total screen time. - Covariates: Demographics (guardian relationship, gender, religion, age, employment, education, financial status), child factors (age, gender, prenatal/perinatal complications, sleep disturbances, psychiatric and medical comorbidities), parenting practices, and guardian mental wellbeing. - Parenting practices: Thai Alabama Parenting Questionnaire (APQ) subdomains scored so higher scores reflect more optimal practices; α=0.91. - Guardian wellbeing: PERMA profiler total score; α=0.90. Statistical analysis: SPSS v27. Generalized linear models (GLMs) with gamma distribution and canonical log link were used to model the right-skewed continuous SNAP-IV subscale scores. Robust estimator applied. Separate models for each dependent variable (inattentive, hyperactive-impulsive, oppositional-defiant). Variables entered with stepwise backward elimination. Interaction terms between short-form video use and covariates were added exploratorily. Coefficients expressed as B and Exp(B) for multiplicative interpretation. Model fit reported via McFadden's pseudo R². Missing data (0–2.1% due to non-response; highest in one hyperactivity item) handled via multiple imputation. Key descriptive characteristics (Table 1): Guardians: parents 77.7%, extended family 22.3%; female 74.8%; mean age 38.9 y (SD 8.4). Child: mean age 9.2 y (SD 2.1); male 57.4%. Financial status: secure with savings 28.2%, borderline 44.7%, indebted 27.1%. SNAP-IV means: inattentive 9.0 (SD 5.7), hyperactive-impulsive 6.6 (SD 5.4), oppositional-defiant 6.2 (SD 5.1).

- Sample: N=528; 11.6% diagnosed ADHD; recruitment from psychiatric clinic (13.8%) and vaccination clinic (86.2%). - Media use: Mean total daily screen time 3.6 h (SD 2.2); short-form video viewing 1.9 h (SD 1.4), comprising ~56.8% (SD 30.6%) of total screen time. - Primary outcome (inattentive behaviors): Short-form video use significantly associated with higher inattentive behaviors. • Simple regression: B=0.08, Exp(B)=1.08, p<0.01. • Covariate-adjusted model (controlling for guardian education, financial status, mental wellbeing, parenting practices; child age, gender, comorbidities; total screen time): B=0.04, Exp(B)=1.04, p<0.01. Interpretation: Each additional hour of short-form video viewing associated with a 4% multiplicative increase in inattentive behavior score. • Interaction: Short-form video use × child age: B=−0.01, Exp(B)=0.99, p=0.02 (negative moderation; stronger association in younger children). • Model fit: McFadden's pseudo R²=0.08. - Secondary outcomes: • Hyperactive-impulsive behaviors: Simple regression showed association (B=0.06, Exp(B)=1.05, p<0.01), but covariate-adjusted model not significant (B=0.00, Exp(B)=1.00, p=0.82). Model pseudo R²=0.09. • Oppositional-defiant behaviors: Simple regression showed association (B=0.08, Exp(B)=1.08, p<0.01), but covariate-adjusted model not significant (B=0.02, Exp(B)=1.02, p=0.16). Model pseudo R²=0.12. - Total screen time remained significantly positively associated with inattentive, hyperactive-impulsive, and oppositional-defiant behaviors in adjusted models. - Distributional checks supported dimensional interpretation: SNAP-IV subscales were right-skewed, approximating gamma distributions without extreme outliers.

Findings directly address the primary research question by demonstrating that short-form video media use is independently associated with greater inattentive behaviors in Thai school-age children, even after accounting for total screen time and multiple demographic, familial, and psychosocial covariates. The negative interaction with age suggests younger children are more vulnerable, aligning with neurodevelopmental sensitivity during earlier childhood and existing recommendations to limit media exposure in younger age groups. The relatively modest pseudo R² values are consistent with the multifactorial nature of attention development and the small effect size of short-form video use, underscoring the need for comprehensive models that incorporate additional variables and interactions. Mechanistically, the discussion posits that short-form video characteristics—rapid pacing, continuous gesture-based browsing, algorithmic delivery of brief high-arousal content, and multitasking—may acutely and cumulatively tax attention and executive systems, condition preferences for quick rewards, dysregulate arousal/reward pathways, and disrupt sleep, potentially strengthening bottom-up, stimulus-driven circuitry while weakening prefrontal networks. Vulnerabilities in children with attention difficulties (e.g., boredom proneness, reliance on external stimulation, self-regulation deficits) may drive overuse and reinforce self-perpetuating cycles. Opportunity costs (reduced outdoor play and social interaction) and cultural factors related to emotion regulation could compound these effects. Domain-specific analysis showed no adjusted association between short-form video use and hyperactive-impulsive or oppositional-defiant behaviors, whereas total screen time remained a significant predictor, suggesting that unique features of short-form videos may be more relevant to inattention than to hyperactivity or oppositionality. Future work should continue to differentiate effects across symptom domains and investigate bidirectional pathways and long-term impacts to inform clinical practice and public health guidance.

Short-form video media use is associated with increased inattentive behaviors among Thai school-age children, with stronger associations observed in younger children. These findings contribute to evidence on the neuropsychiatric impacts of evolving media formats and support consideration of age-specific guidance for short-form video exposure if future studies corroborate robust, independent associations and elucidate mechanisms and long-term consequences. No significant adjusted associations were found with hyperactive-impulsive or oppositional-defiant behaviors, although total screen time remained a significant predictor for these domains. Future research should explore causal pathways, mechanisms, domain-specific impacts, and refine guidelines to address short-form video consumption in children.

- Outcome measurement: Parent-rated Thai SNAP-IV short form may not fully capture variance in inattentive behaviors, especially milder/subthreshold symptoms; recall bias possible; subtle school-observed behaviors may be missed without teacher input. - Sample heterogeneity: Inclusion of clinical and nonclinical populations aligned with dimensional aims but introduced variability; medicated ADHD children rated during off periods may still have residual therapeutic effects and other interventions influencing ratings. - Diagnostic screening: Limited mental health service availability may have led to undiagnosed neurodevelopmental disorders in the community; full screening was not feasible, potentially affecting variance. - Unmeasured covariates: Media genre, household media rules, sleep quality, and undiagnosed mental health conditions were not assessed and could account for unexplained variance. - Design constraints: Cross-sectional, questionnaire-based design precludes causal inference and limits exploration of underlying mechanisms. - Data handling: Minor missingness (0–2.1%) addressed via multiple imputation; highest in one hyperactivity item, with no systematic pattern identified.