Screen exposure and cognitive outcomes in school-aged children and adolescents: a narrative review through the lens of Cognitive Load Theory

Introduction

In recent years, the accelerated growth of digital technology has transformed the learning, recreational, and social environments of children and adolescents. School-aged children and adolescents aged 6–18 years are regularly exposed to digital screens through smartphones, tablets, computers, televisions, and other digital devices. This widespread—and often unmonitored—exposure has raised concerns among educators, health-care professionals, and parents about the potential cognitive correlates of prolonged screen time (ST) during critical periods of neurodevelopment.

In this review, “screen exposure” refers to engagement with screen-based devices and digital media, including televisions, computers, tablets, smartphones, video games, and related digital platforms. Screen exposure is multidimensional and may vary according to duration, device, content, purpose, timing, context, level of interactivity, and caregiver mediation. Because the included studies used heterogeneous thresholds and measurement approaches, this review did not apply a single operational definition of “excessive” screen use. Study-specific definitions and thresholds are reported where available (Stiglic and Viner, 2019). As digital technology becomes more available, accessible, and portable, screen engagement has become nearly ubiquitous in both home and school settings. While digital tools offer notable educational benefits, the rising duration and intensity of screen use, especially when passive or cognitively overstimulating, have sparked ongoing debates about their long-term effects on children's cognitive abilities.

Cognitive functions such as attention, memory, and executive function are essential for learning, problem-solving, and academic achievement (Anderson and Subrahmanyam, 2017). Emerging evidence suggests that excessive or extended ST exposure has been associated with differences in these domains. For example, studies have linked high screen exposure to reduced attention spans, weakened working memory, and diminished executive functioning (Twenge and Campbell, 2018). Although some research reports cognitive benefits when children engage with high-quality, educational media (Huber et al., 2018), the overall literature presents mixed findings, and concerns continue to grow regarding the adverse effects of prolonged screen exposure on neurocognitive development.

Pediatric recommendations increasingly recognize that healthy digital-media use cannot be determined solely by a universal daily time threshold. The American Academy of Pediatrics recommends that families establish consistent, developmentally appropriate limits and ensure that screen use does not displace adequate sleep, physical activity, family interaction, and other health-promoting behaviors (American Academy of Pediatrics [AAP], 2016). Similarly, the Canadian Pediatric Society emphasizes healthy management, meaningful screen use, positive parental modeling, and balanced monitoring among school-aged children and adolescents (Ponti and Canadian Paediatric Society, 2019). Italian pediatric guidance recommends age-appropriate limits, caregiver supervision, high-quality content, avoiding screens during meals and before bedtime, and preserving sleep, physical activity, reading, and face-to-face interaction (Bozzola et al., 2018, 2019). More recent recommendations from the Italian Society of Pediatrics advise delaying personal smartphone ownership until at least 13 years of age and avoiding unsupervised Internet access before that age (Bozzola et al., 2026). Collectively, these recommendations indicate that pediatric assessment should consider the child's age and developmental stage, the type and content of digital media, the timing and purpose of use, the degree of caregiver mediation, and whether screen use displaces developmentally important activities, rather than focusing exclusively on total screen duration.

Despite growing interest in this area, a significant gap remains in the literature: few narrative reviews have systematically examined the associations between screen exposure and cognitive outcomes on children's cognitive abilities through the lens of Cognitive Load Theory (CLT). CLT offers a compelling framework for understanding how overstimulation and excessive cognitive input from digital media may overload working memory and impair information processing. However, this theoretical perspective has not been sufficiently explored in existing reviews of the ST literature. A focused synthesis that applies CLT to prolonged screen exposure can offer valuable insights into the underlying cognitive mechanisms and guide educational and clinical interventions.

Purpose and contribution

This narrative review aims to explore and synthesize the existing literature on the associations between patterns of screen exposure and cognitive outcomes on the cognitive abilities of school-aged children aged 6–18, with a specific focus on the domains of attention, memory, and executive function from the perspective of CLT. While numerous studies have investigated the cognitive effects of screen exposure, few have contextualized these findings within a robust theoretical framework. Therefore, this review specifically addresses a gap in the literature by examining these effects through the lens of CLT. By applying CLT, the review aims to clarify how prolonged screen use may overload children's working memory, disrupt cognitive processes, and negatively impact learning outcomes. In doing so, the review aims to provide a deeper theoretical understanding of the pathways that may help explain observed associations between screen exposure and cognitive development.

Attention, memory, and executive function were selected a priori because they are central to the review's research question and closely related to the limited-capacity information-processing mechanisms described by Cognitive Load Theory. These domains are particularly relevant during the school-age years because they support attentional control, learning, academic performance, and the management of competing information. Language development is also an important outcome associated with digital-media exposure, and its exclusion does not suggest that it is less important or supported by weaker evidence. However, language-related outcomes are especially prominent during infancy and early childhood and may involve distinct mechanisms, including caregiver–child interaction, co-viewing, exposure to language-rich content, and the displacement of verbal and social experiences. Including language would therefore have substantially broadened the developmental and theoretical scope of the review and reduced the depth of its analysis of the cognitive domains most directly aligned with Cognitive Load Theory. Language outcomes were consequently considered outside the predefined scope of this review and warrant a separate, developmentally focused synthesis.

Background

Over the past decade, ST has emerged as a central component of children's daily routines, driven by rapid advancements in digital technology and the widespread integration of screen-based tools into educational and recreational environments. School-aged children increasingly use screens for a wide range of purposes, from online learning and entertainment to gaming and social interaction, resulting in prolonged and frequently excessive daily exposure.

This shift has generated widespread concern regarding how prolonged ST may influence cognitive development during a critical window of brain maturation. A growing body of research has explored the relationship between ST and core cognitive functions, particularly attention, memory, and executive function. While some studies suggest that structured, educational screen engagement may support certain cognitive skills (Huber et al., 2018), the majority point to potential risks associated with unregulated and passive screen consumption. These risks include reduced attentional control, impaired memory consolidation, and diminished executive functioning, all of which are vital for academic success and adaptive behavior (Twenge and Campbell, 2018; Radesky et al., 2015).

Despite growing empirical interest, a notable gap remains in the literature; existing reviews rarely apply CLT to interpret the cognitive effects of prolonged screen exposure. CLT, originally developed by Sweller (1988), offers a valuable lens for understanding how excessive digital stimuli can overwhelm working memory, thereby hindering learning and mental performance. When children are exposed to fast-paced, non-instructional, or multitasked digital content, their cognitive systems may be overloaded by extraneous cognitive demands, reducing their ability to process and retain meaningful information.

This theoretical perspective provides an important explanatory framework for synthesizing findings that might otherwise appear inconsistent or fragmented across studies. This review responds to this gap by applying CLT to examine how prolonged ST may interfere with core cognitive functions in children aged 6–18. By integrating theory with empirical findings, the review aims to advance understanding of the cognitive mechanisms at play and inform evidence-based recommendations for educators, parents, and policymakers.

Theoretical framework

Several theoretical frameworks provide insight into how prolonged ST may affect the cognitive development of school-aged children. Among the most relevant are CLT, Neuroplasticity Theory, and Developmental Psychology frameworks.

CLT, developed by Sweller (1988), posits that working memory has a limited capacity for processing information. When this capacity is overloaded, such as through exposure to fast-paced, complex, or distracting digital content, learning efficiency declines (Sweller, 1994). In the context of prolonged ST, children often experience high levels of extraneous cognitive load, particularly when multitasking across various applications or engaging with non-educational media. This can reduce their ability to focus, process, and retain new information, which may be associated with poorer cognitive performance such as attention and memory (Paas and van Merriënboer, 1994).

Neuroplasticity Theory emphasizes the brain's capacity to reorganize and form new neural pathways in response to experience, particularly during childhood and adolescence, a critical window for cognitive development (Kolb and Gibb, 2011). Prolonged ST, especially involving passive or overstimulating content, may reinforce neural circuits associated with instant gratification and rapid visual stimulation. This may reduce children's engagement in activities that support sustained attention, self-regulation, and problem-solving (Christakis, 2019).

Developmental psychology frameworks also emphasize the importance of balanced cognitive, emotional, and social experiences during the school-age years. Piaget highlighted children's active construction of knowledge through interactions with their environment. Vygotsky emphasized that higher psychological processes develop through socially mediated activities and that culturally developed signs, particularly language, are subsequently internalized as tools for regulating attention, memory, thinking, and voluntary behavior (Piaget, 1972; Vygotsky, 1978). From a Vygotskian perspective, development involves qualitative changes in psychological functions and the reorganization of the relationships among these functions. Excessive screen exposure, particularly when it displaces guided social interaction and real-world experiences, may reduce children's opportunities to develop these interconnected psychological processes, as well as emotional regulation and interpersonal skills (Radesky et al., 2015).

Additional perspectives summarized by Sticca et al. (2025) help explain why screen exposure may not have uniform developmental consequences. The learning hypothesis and information-processing theory recognize that children may learn behaviors, knowledge, and skills from well designed digital content. In contrast, the video-deficit hypothesis suggests that children, particularly at earlier developmental stages, may learn less effectively from two-dimensional media than from direct, socially responsive experiences. The displacement hypothesis proposes that screen use may be associated with poorer developmental outcomes when it replaces sleep, physical activity, reading, imaginative play, caregiver interaction, or face-to-face communication. The mental-effort and passivity hypotheses further suggest that passive or fast-paced media may require less sustained cognitive engagement than active activities such as reading, problem-solving, or socially guided learning. Although Sticca et al. focused primarily on children younger than 3 years, these perspectives remain conceptually relevant to school-aged children and adolescents because they emphasize that developmental outcomes depend not only on screen duration but also on content, context, interactivity, developmental stage, and the activities displaced by screen use. These perspectives complement Cognitive Load Theory by explaining both the potential benefits of purposeful digital learning and the risks associated with passive, cognitively fragmented, or developmentally inappropriate media use.

Cognitive Load Theory, the neuroplasticity perspective, and developmental psychology should not be viewed as competing or mutually exclusive explanations. Rather, they address different levels and timescales of the relationship between screen exposure and cognitive development. Cognitive Load Theory provides a proximal cognitive explanation: rapid transitions, irrelevant audiovisual stimuli, notifications, and media multitasking may impose extraneous cognitive load and compete for limited working-memory resources required for attention, information processing, and learning (Sweller, 1994; Paas and van Merriënboer, 1994). The neuroplasticity perspective operates at the neural level by explaining how repeated patterns of stimulation and behavior may be associated with longer-term differences in brain structure, function, and connectivity. Developmental psychology provides a broader contextual explanation by emphasizing children's changing cognitive capacities, social interaction, culturally mediated learning, developmental tasks, and the activities that screen use may displace (Piaget, 1972; Vygotsky, 1978; Sticca et al., 2025). Cognitive Load Theory was retained as the primary organizing framework because the outcomes examined in this review, attention, memory, executive function, and learning, are closely related to limited-capacity information processing. However, the other two perspectives provide important neural and developmental context for understanding how immediate cognitive demands may accumulate over time and vary according to children's developmental stages and social environments.

Together, these theories suggest that the negative associations between screen exposure and children's cognitive outcomes are not merely due to screen exposure itself, but to how it disrupts the brain's natural learning processes and developmental trajectories. They also highlight the importance of screen content, context of use, and the child's age when evaluating cognitive outcomes.

This review follows integrative research principles (Kirkevold, 1997) and draws on systematic evidence synthesis practices (Mays et al., 2005). Cognitive Load Theory was selected as the primary interpretive framework, while Neuroplasticity Theory and developmental psychology were considered complementary perspectives.

Cognitive load theory

CLT suggests that prolonged screen use, especially when involving fast-paced, visually complex, or irrelevant content, can increase extraneous cognitive load, reducing the brain's ability to efficiently process, store, and retrieve meaningful information. In children, excessive screen exposure often involves multitasking and sensory overstimulation, which hinders deep cognitive engagement and learning (Sweller, 1994; Paas and van Merriënboer, 1994).

Attention

Attention is a core cognitive function that has been closely linked to screen media exposure. Prolonged ST, particularly when involving fast-paced or overstimulating content, has been associated with attention difficulties in children (Lillard and Peterson, 2011). Children exposed to high levels of screen media may develop shortened attention spans and heightened distractibility, which negatively affect classroom performance and task completion (Radesky et al., 2015). Moreover, media multitasking, frequent switching between tasks while using screens, has been shown to impair sustained attention and elevate cognitive load (Cain and Mitroff, 2011).

Memory

Memory, particularly working memory, is vulnerable to overload when children are exposed to prolonged screen-based media. Research suggests that fast-moving visual stimulation may interfere with the brain's ability to encode and retain information due to continuous distraction and divided attention (Bavelier et al., 2010). While some digital tools support memory development through interactive and educational content, passive ST, such as binge-watching shows, may hinder memory formation. Studies have found that children who spend extensive time on screens may struggle with recalling, processing, and integrating information, particularly if screen use displaces more cognitively enriching experiences (Moser et al., 2011; Huber et al., 2018).

Executive function

Higher screen exposure and frequent media multitasking have been associated with executive-function difficulties in school-aged children and early adolescents, although findings differ across populations and measurement approaches (Baumgartner et al., 2014; Vohr et al., 2021). Lillard and Peterson (2011) found that children exposed to just 9 min of fast-paced cartoons performed worse on executive function tasks compared to those who engaged in drawing. Frequent screen use may reduce opportunities for imaginative play and real-world, hands-on problem-solving, both of which are vital for executive function development.

Academic performance

Cognitive functions such as attention, memory, and executive functioning are foundational to academic achievement. Research has demonstrated a negative association between prolonged ST and academic performance (Gentile et al., 2014). This association is thought to be mediated by screen-induced sleep disruption, reduced study time, and compromised cognitive functioning. While some ST may support learning through educational content, the overall trend suggests that excessive screen exposure, particularly during study periods, can diminish academic outcomes (Radesky et al., 2015).

The age range of 6–18 years was selected to provide a coherent focus on school-age childhood and adolescence. During this period, children encounter increasingly complex academic demands and use digital devices with growing independence. Attention, working memory, executive control, and self-regulation also continue to develop and are fundamental to learning and academic performance. Cognitive Load Theory is therefore particularly relevant for examining how distracting, rapidly changing, or simultaneous digital stimuli may compete for the limited cognitive resources required for formal learning (Sweller, 1994; Paas and van Merriënboer, 1994). This age boundary does not imply that Cognitive Load Theory is inapplicable to younger children. However, children younger than six differ from school-aged children in their cognitive capacities, patterns and contexts of screen use, dependence on caregiver mediation, and predominant developmental outcomes, particularly language and social communication (Sticca et al., 2025). Combining early childhood with school-age populations could therefore obscure developmentally specific mechanisms and patterns of association. Early childhood warrants a separate synthesis that applies Cognitive Load Theory while accounting for its distinct developmental characteristics and screen-use contexts.

Methods

A structured narrative review was selected because the objective was to develop a theory-informed interpretation of a heterogeneous body of evidence rather than to estimate a pooled effect. The included literature encompassed neuroimaging, behavioral, cognitive, academic, cross-sectional, and longitudinal research that varied substantially in its definitions of screen exposure, outcome measures, participant characteristics, and study designs. Although this heterogeneity does not preclude a systematic review, a structured narrative approach was considered appropriate because the primary purpose was conceptual interpretation and theoretical integration rather than exhaustive effect estimation or meta-analysis.

The review was informed by Mays, Pope and Popay's (2005) discussion of methodologically explicit narrative approaches for synthesizing diverse forms of evidence. Kirkevold's (1997) integrative research perspective also informed the synthesis of theoretical concepts and empirical findings. Cognitive Load Theory served as the primary interpretive framework, allowing the findings to be examined in relation to limited working-memory capacity, extraneous cognitive load, attentional demands, and the processing of digital information. Neuroplasticity and developmental psychology perspectives were retained as complementary frameworks operating at neural and developmental levels.

To enhance transparency and reproducibility, the review employed predefined eligibility criteria, a documented search and screening process, and standardized data extraction. The complete database-specific search strategies, including keywords, subject headings, Boolean operators, and applied limits, are presented in Table 1.

Table 1. Characteristics, findings, and Cognitive Load Theory interpretation of the included studies.

School-aged children were defined as participants aged 6–11 years, and adolescents were defined as participants aged 12–18 years. Studies spanning both categories were classified as mixed developmental samples. Cognitive Load Theory was applied as an interpretive framework; the included studies did not directly measure intrinsic, extraneous, or germane cognitive load. Sample sizes represent the analytic samples reported for the relevant analyses where available. ABCD, Adolescent Brain Cognitive Development; ADHD, attention-deficit/hyperactivity disorder; BRIEF-2, Behavior Rating Inventory of Executive Function, Second Edition; CLT, Cognitive Load Theory; fMRI, functional magnetic resonance imaging; GWAS, genome-wide association study; MRI, magnetic resonance imaging.

Eligibility criteria

Studies were eligible if they were published between 2014 and 2025 in English or Arabic and examined children or adolescents aged 6–18 years. Studies involving broader age ranges were considered only when findings for participants aged 6–18 years were reported separately or when the sample predominantly represented this developmental period. Eligible studies examined screen exposure in relation to at least one of the review's primary cognitive domains: attention, memory, or executive function. We included empirical studies using cross-sectional, longitudinal, experimental, neuroimaging, or mixed-methods designs.

Reviews, editorials, commentaries, case reports, studies focused exclusively on children younger than 6 years, and studies that did not assess a relevant cognitive outcome were excluded.

Information sources, eligibility, and selection

We conducted a structured literature search in PubMed/MEDLINE, PsycINFO, and Google Scholar for peer-reviewed studies published from January 2014 through June 10, 2025. The initial search was conducted on May 15, 2025, and updated on June 10, 2025. Search terms addressed three principal concepts: screen exposure, children and adolescents, and cognitive outcomes.

The PubMed/MEDLINE search strategy was:

(“Screen Time”[MeSH] OR “screen time” OR “screen exposure” OR “digital media” OR smartphone^* OR television OR “video game^*” OR computer^*) AND (“Child”[MeSH] OR “Adolescent”[MeSH] OR child^* OR adolescen^* OR youth OR “school-aged”) AND (“Cognition”[MeSH] OR cognit^* OR attention OR “working memory” OR “executive function^*” OR “inhibitory control” OR learning).

Eligibility criteria

Studies were eligible if they: (1) were published in English or Arabic between 2014 and 2025; (2) included children or adolescents aged 6–18 years; (3) examined exposure to screen-based digital media, including television, computers, tablets, smartphones, video games, or media multitasking; (4) assessed attention, memory, executive function, or a closely related cognitive or academic outcome; and (5) reported original empirical findings using a cross-sectional, longitudinal, experimental, neuroimaging, genetically informed, or mixed-methods design. Studies with broader age ranges were included only when findings for participants aged 6–18 years were reported separately or when the sample predominantly represented this developmental period.

Reviews, editorials, commentaries, case reports, and studies that did not assess a relevant cognitive outcome were excluded. Studies focused exclusively on screen-time reduction without evaluating cognitive outcomes were also excluded. Studies involving only children younger than 6 years were excluded from the narrative synthesis. Selected early-childhood studies were cited only in the Introduction, theoretical framework, or Discussion to provide developmental context.

Study selection and data extraction

One author conducted the database searches and screened the titles, abstracts, and full texts. The second author reviewed the eligibility criteria and independently verified the final set of included studies. Uncertainties concerning study eligibility or interpretation were resolved through discussion and consensus. Because this was a structured narrative review, the search was designed to identify evidence relevant to the review objectives and theoretical synthesis rather than to claim the exhaustive coverage expected of a registered systematic review.

Data were extracted into a standardized table containing the author, publication year, country, study design, sample size, participant age, screen-exposure definition and measurement, cognitive outcome measures, principal findings, study limitations, and relevance to Cognitive Load Theory. Findings were then organized thematically across neural, cognitive, and psychosocial domains and interpreted primarily through Cognitive Load Theory, with neuroplasticity and developmental perspectives used as complementary frameworks.

Results

Study selection and characteristics

Thirteen empirical studies published between 2014 and 2025 met the eligibility criteria and were included in the narrative synthesis (Figure 1). All included studies used quantitative methods and examined children or adolescents within the target age range of 6–18 years. The studies were conducted in several national settings, including the United States, Japan, the Netherlands, and India.

The evidence included cross-sectional, longitudinal, neuroimaging, population-based, cohort, and genetically informed designs. Sample sizes ranged from 19 participants in the neuroimaging study by Horowitz-Kraus and Hutton (2017) to 17,076 participants in the population-based study by Onyeaka et al. (2022). Other large studies included approximately 11,875 participants in Paulich et al. (2021), while Meng et al. (2024) used genome-wide association summary data in a Mendelian randomization analysis.

Screen exposure was measured using child or parent reports, media-use questionnaires, time-use estimates, and device- or activity-specific indicators. The assessed outcomes included attention, working memory, executive function, academic performance, intelligence, behavioral regulation, psychological wellbeing, and measures of brain structure and connectivity. Differences in study design, exposure measurement, participant characteristics, and outcome assessment limited direct quantitative comparison across studies.

The findings were organized into three overarching themes: (1) neural and structural brain differences; (2) cognitive outcomes related to attention, memory, and executive function; and (3) mental health and wellbeing relevant to cognition. Detailed characteristics, findings, limitations, and Cognitive Load Theory interpretations of the 13 included studies are presented in Table 1.

Neural and structural brain differences

Recent neuroimaging studies have shown associations between screen exposure and brain structure and function. Horowitz-Kraus and Hutton (2017), in a U.S.-based functional magnetic resonance imaging (fMRI) study, found that reading was linked to increased functional connectivity in cognitive control areas (frontal and temporal lobes), while screen exposure was associated with decreased connectivity in these regions. Takeuchi et al. (2015) similarly reported reduced gray matter volume in the frontal cortex associated with higher media use in adolescents, a region critical for executive function and attention regulation.

Paulus et al. (2019), using data from the U.S.-based ABCD study (n = 4,277), identified structural brain networks linked to screen media activity. Some networks were associated with lower fluid and crystallized intelligence and increased externalizing behavior, suggesting that habitual screen use was associated with differences in brain measures, particularly in areas supporting cognitive and behavioral control.

Cognitive Load Theory interpretation

From a CLT perspective, these associations may be interpreted as consistent with the possibility that distracting, rapidly changing, or multitasked content imposes extraneous cognitive demands. However, the included neuroimaging studies did not directly measure cognitive load; therefore, this interpretation remains theoretical. In CLT, extraneous cognitive load refers to the mental effort imposed by irrelevant or overstimulating information that does not contribute to the learning objective (Sweller, 1988; Sweller et al., 2011). Features common to digital environments, such as rapid scene transitions, pop-up notifications, or multitasking, can overwhelm the working memory by imposing excessive demands that are unrelated to learning objectives (Mayer and Moreno, 2003). When extraneous load consumes most of the available working memory capacity, it impairs the learner's ability to manage intrinsic load (the complexity inherent in the task) and reduces engagement in germane load (the mental effort invested in constructing and automating schemas) (Paas et al., 2003). Over time, continuous exposure to fragmented digital input may limit deep cognitive processing and hinder the development of organized neural pathways. These theoretical insights are supported by neuroimaging evidence demonstrating reduced connectivity and gray matter volume in brain regions responsible for executive function and attention (Horowitz-Kraus and Hutton, 2017; Takeuchi et al., 2015; Paulus et al., 2019), suggesting that excessive screen exposure during critical developmental periods may disrupt the brain's capacity for efficient cognitive functioning.

Attention, memory, and executive function

Numerous studies indicate that excessive ST has been associated with poorer outcomes attention, memory and executive function. In a large U.S cohort, Paulich et al. (2021) found that increased screen use was linked to attention problems, behavioral issues, and weaker EF. Baumgartner et al. (2014) reported that individuals who frequently multitasked with media exhibited reduced working memory. Jain et al. (2025), studying Indian tweens, identified a non-linear dose-response relationship: moderate users outperformed both low and high users on auditory memory tasks, suggesting that optimal levels of screen engagement may support cognitive performance.

Onyeaka et al. (2022), analyzing national U.S. survey data, found that each additional hour of ST was associated with a 5% increase in the likelihood of cognitive impairment. Chaarani et al. (2022) offered a more nuanced view, finding that video game players performed better on EF and memory tasks, suggesting that interactive screen use may have cognitive benefits.

In the UK, Meng et al. (2024) employed Mendelian randomization analysis to investigate the causal relationship between screen time and childhood ADHD. Their findings indicated that longer durations of mobile phone use (OR = 1.85) and television viewing (OR = 2.10) were associated with an increased genetically predicted risk of developing attention-deficit/hyperactivity disorder (ADHD) in children. Notably, the analysis did not support the tested reverse pathway, suggesting that pre-existing ADHD symptoms did not lead to increased screen time. Yang et al. (2022) extended this by showing that reduction in white matter volume mediated the relationship between genetic ADHD risk and screen use, reinforcing the idea that brain structure and genetic vulnerability jointly influence screen habits and cognitive outcomes.

Cognitive Load Theory interpretation

This theme directly reflects the impact of imbalanced cognitive load distribution. Excessive screen use, especially involving multitasking or passive scrolling, raises extraneous cognitive load, as users constantly shift attention among tasks, visuals, and stimuli (Kalyuga, 2007; Mayer, 2011). This reduces the brain's ability to effectively process intrinsic load, particularly for tasks requiring concentration and working memory. In contrast, moderate or intentional screen use (e.g., educational games or structured learning platforms) may optimize germane load by supporting active engagement and schema construction (Sweller et al., 2011). The variation in findings suggests that the cognitive impact of ST depends not just on quantity but also on content design and the learner's ability to manage cognitive resources effectively (Paas et al., 2003).

Mental health and wellbeing relevant to cognition

The academic and behavioral consequences of excessive screen use are well documented in the literature. Sidiq et al. (2025), in a cross-sectional study conducted in India, found that students with higher daily ST demonstrated lower academic performance and greater behavioral challenges. Using behavioral rating scales and academic records, the study illustrated how prolonged screen exposure may displace time from educational or cognitively enriching activities, thereby weakening school readiness and emotional self-regulation. These findings align with broader evidence suggesting that screen use may displace opportunities for face-to-face interaction, physical activity, and adequate sleep—all of which are essential to academic success and psychosocial development. Moreover, the type of screen content (e.g., passive vs. interactive, educational vs. entertainment) and the time of use (e.g., particularly before bedtime) are likely moderating variables influencing these outcomes.

Moreover, Nagata et al. (2024), utilizing data from the ABCD study involving over 9,500 children aged 9–10 years, conducted a 2-year longitudinal analysis to examine the relationship between ST and mental health outcomes. Their findings revealed that higher total ST was significantly associated with increased symptoms of depression, conduct problems, somatic complaints, and attention-deficit/hyperactivity disorder (ADHD). Notably, the strongest associations were observed for depressive symptoms, particularly with screen types such as video chatting, texting, video streaming, and gaming. The study also highlighted that these effects were more pronounced among White adolescents compared to their Black or Asian peers, suggesting a potential interaction between screen exposure and sociocultural factors.

These results support broader evidence indicating that excessive screen use was associated with emotional-regulation difficulties and compromised psychological wellbeing. This likely occurs through multiple pathways, including cognitive overload, sleep disruption, and reduced interpersonal engagement. The findings further reinforce the American Academy of Pediatrics' (American Academy of Pediatrics [AAP], 2016) recommendations, which emphasize limiting ST duration, prioritizing high-quality content, and co-viewing as key strategies for safeguarding children's mental and cognitive health.

Cognitive Load Theory interpretation

Within this theme, CLT offers a valuable explanation for how ST may indirectly impair learning and emotional functioning by increasing extraneous cognitive load, especially when screen use is unregulated, passive, or accompanied by multitasking (Leahy and Sweller, 2011). Fatigue and sleep disruption, often associated with evening or nighttime screen use, further impair the brain's ability to process intrinsic load (i.e., task-relevant mental effort), such as during academic activities (Kalyuga, 2007). Consequently, children may be less capable of engaging in germane load, which is the deep cognitive processing required for schema formation, reasoning, and problem-solving (Sweller et al., 2011). Learning efficiency thus declines not merely because of ST duration but due to a mismatch between the cognitive demands of digital content and the child's developmental capacity.

Synthesizing the evidence across neural, cognitive, and behavioral domains, it becomes clear that the associations between screen exposure and cognitive outcomes in school-aged children are multifaceted and closely aligned with the principles of CLT. The reviewed studies reveal that excessive and unregulated screen exposure imposes a high extraneous load (Sweller, 1988; Mayer, 2011), which may affect learning processes and impair the development of attention, memory, and executive function. Neuroimaging data further indicate that chronic overstimulation may be associated with structural differences in brain areas responsible for cognitive control. Meanwhile, behavioral and academic research shows that when extraneous load overwhelms working memory due to multitasking, passive consumption, or fragmented digital input, there is limited capacity left to manage intrinsic load or invest in germane processing (Paas et al., 2003; Leahy and Sweller, 2011).

However, not all ST is inherently harmful. Moderate, intentional, and developmentally appropriate engagement with interactive digital media may foster germane load and enhance learning. This nuanced perspective highlights that the cognitive effects of screen use depend not only on duration but also on content quality, context of use, and alignment with the learner's cognitive abilities. Accordingly, educators, parents, and policymakers should move beyond general ST limits and focus on curating screen experiences that minimize cognitive overload and promote active, meaningful engagement, particularly during critical stages of cognitive development.

Discussion

The growing ubiquity of digital screens in the lives of school-aged children has sparked widespread concern about their cognitive development. This review integrates findings from neuroimaging, behavioral, and longitudinal research to explore how screen time (ST) influences brain maturation, executive functioning, academic performance, and long-term cognitive outcomes. Interpreted through the lens of CLT, the findings illustrate that excessive or unstructured screen use may be associated with poorer cognitive performance by overburdening children's limited cognitive resources.

At the neurobiological level, studies (Horowitz-Kraus and Hutton, 2017; Takeuchi et al., 2015). Although preschool-aged children were outside the eligibility criteria for the narrative synthesis, contextual evidence from Hutton et al. (2020) similarly identified associations between screen-based media use and measures of white-matter integrity in preschool children. This evidence is presented only to provide developmental context and was not included in the synthesis of the 13 eligible studies.

CLT posits that cognitive architecture has a limited capacity for processing new information. Continuous stimulation from digital media, especially when lacking cognitive structure, increases extraneous load, diverting mental resources away from meaningful learning, and schema construction. As a result, higher exposure may be associated with differences in relevant cognitive processes to regulate attention, plan behavior, and manage distractions, fundamental processes for effective learning.

Behavioral research reinforces this neurostructural evidence. Across studies included in the review, higher screen exposure is frequently associated with lower executive functioning, reduced attention span, and memory difficulties (Paulich et al., 2021; Fitzpatrick et al., 2025; Zhang et al., 2023). Notably, the nature of screen engagement matters. Passive activities such as binge-watching or aimless scrolling introduce high levels of irrelevant stimuli, which heighten extraneous load and reduce the mental bandwidth available for schema automation. By contrast, active, goal-oriented screen use, such as educational games or structured digital learning, can enhance germane load by supporting attentional focus and instructional alignment. This distinction highlights the need for nuance in policy and parental guidance; ST is not uniformly harmful, but its cognitive impact is heavily dependent on the quality, structure, and developmental appropriateness of the content.

Academic performance is another domain associated with screen exposure. Children who engage in high screen use tend to perform more poorly in literacy, math, and school readiness assessments (Kostyrka-Allchorne et al., 2020; Sidiq et al., 2025). According to CLT, academic learning imposes a significant intrinsic load, particularly in literacy and numeracy. When this intrinsic load is compounded by digital distractions, children may fail to engage deeply or automate essential foundational skills, leading to weaker long-term academic outcomes. The rapid, fragmented nature of digital content may also weaken sustained attention and the ability to engage in effortful processing, both of which are essential for academic success.

Further, sleep disruption has been identified as a critical indirect pathway mediating the relationship between ST and cognitive impairment. Evidence from Carter et al. (2016) and Paulich et al. (2021) shows that screen use, particularly before bedtime, is associated with shorter or poorer-quality sleep, leading to fatigue and poor attention regulation during the day. From a CLT perspective, sleep deprivation impairs working memory and hinders schema consolidation, magnifying the negative cognitive consequences of screen exposure. Similarly, emotional dysregulation associated with screen overuse may further impair attention and motivation, reducing learners' ability to manage both intrinsic and germane loads effectively.

A more concerning, yet emerging area of inquiry involves the potential long-term consequences of early screen exposure on cognitive reserve and age-related cognitive decline. Theoretical models (Manwell et al., 2022) suggest that chronic cognitive overstimulation without meaningful mental engagement may lead to underdeveloped executive skills and weaker cognitive scaffolding in later life, increasing the risk of dementia and cognitive decline. CLT would argue that early failures to automate cognitive processes and build strong mental schemas result in lower cognitive efficiency and flexibility across the lifespan.

Despite the largely negative trends, several studies offer a more balanced perspective. For example, Chaarani et al. (2022) and Hu et al. (2020) highlight that interactive, cognitively demanding screen activities (e.g., certain video games or educational tools) can stimulate pre-frontal networks and enhance selective attention and task-switching, suggesting that under the right conditions, screen-based activities can enhance rather than hinder cognitive development. These findings support CLT's premise that well designed instruction, even if screen-based, can enhance germane load by guiding attention, reducing irrelevant information, and scaffolding learning.

Overall, this synthesis reveals a dynamic interaction between screen use and cognitive development, shaped by factors such as age, type of screen content, context of use, and biological vulnerability. The integration of CLT provides a valuable theoretical framework for interpreting these effects, emphasizing that cognitive harm is not caused by screen use alone, but by how screen exposure interacts with mental processing limits, task complexity, and the learning environment.

The cognitive mechanisms identified in this review provide several directions for educational and clinical interventions. Specifically, attention fragmentation associated with media multitasking, working-memory overload resulting from rapidly changing digital content, and reduced opportunities for schema construction provide plausible mechanisms through which excessive or poorly structure screen exposure may affect learning and cognitive performance. From a CLT perspective, educational interventions should aim to reduce unnecessary extraneous load by minimizing irrelevant audiovisual stimuli, notifications, rapid content switching, and media multitasking during learning. Digital instruction can be divided into manageable segments, emphasize essential information, and incorporate guided, interactive activities that support active processing and schema construction. Educators may also establish periods of focused, screen-free work when students are completing tasks that require sustained attention or working memory. In clinical practice, assessment should extend beyond total screen duration to include the content and purpose of use, multitasking, bedtime use, sleep disruption, emotional regulation, and interference with academic or social functioning. Clinicians can then provide individualized guidance, such as reducing stimulating content before bedtime, managing notifications, encouraging developmentally appropriate media, and protecting time for sleep, physical activity, reading, and face-to-face interaction. These recommendations should be interpreted cautiously because the reviewed evidence primarily identifies associations and does not establish that screen exposure directly causes the reported outcomes.

The three themes identified in this review- neural and structural brain differences, cognitive outcomes, and mental health and wellbeing- should be understood as interconnected developmental domains rather than independent consequences of screen exposure. At the neural level, the reviewed neuroimaging studies reported associations between screen exposure and differences in brain regions and networks involved in cognitive and behavioral control (Horowitz-Kraus and Hutton, 2017; Takeuchi et al., 2015; Paulus et al., 2019). These neural systems support attention, working memory, goal-directed behavior, and distraction regulation, providing a potential link to the cognitive outcomes identified in the second theme. Cognitive Load Theory provides a useful framework for linking these domains because attention, working memory, and self-regulatory capacities are central to managing cognitive load. When digital environments impose excessive extraneous load through rapid scene changes, multitasking, or competing stimuli, fewer cognitive resources remain available for learning and self-regulation. Over time, this may contribute not only to poorer cognitive performance but also to downstream academic, emotional, and behavioral difficulties. Difficulties in these cognitive processes may, in turn, affect academic performance, emotional self-regulation, and adaptive functioning. At the psychosocial level, sleep disruption, emotional dysregulation, depressive symptoms, and reduced interpersonal engagement may further diminish the cognitive resources available for sustained attention, memory consolidation, motivation, and learning (Paulich et al., 2021; Nagata et al., 2024).

Viewed together, the three theoretical perspectives provide a multilevel interpretation of these interconnected findings. Cognitive Load Theory explains how fragmented, rapidly changing, or multitasked screen engagement may impose immediate demands on attention and working memory, leaving fewer cognitive resources available for managing task demands and constructing durable schemas. The neuroplasticity perspective suggests that repeated patterns of digital stimulation may be associated with longer-term differences in neural systems involved in attention, memory, and cognitive and behavioral control. Developmental psychology explains why these associations may vary according to children's developmental capacities, social contexts, caregiver involvement, and whether screen use displaces sleep, physical activity, reading, imaginative play, or face-to-face interaction. These processes may interact: repeated exposure to cognitively fragmented media may increase short-term cognitive demands while also shaping patterns of engagement and displacing experiences that support cognitive and psychosocial development. Nevertheless, because most included studies were observational, these connections represent theoretically plausible interpretations rather than established causal pathways.

Implications for pediatric practice

Pediatric assessment should move beyond asking only how many hours a child spends using screens. Clinicians should assess the child's developmental stage; device and content type; educational, recreational, or social purpose; timing of use; media multitasking; caregiver involvement; and whether screen use displaces sleep, physical activity, reading, homework, family interaction, or face-to-face social activities. Clinicians can recommend developmentally appropriate content, screen-free meals, reduced exposure before bedtime, notification management during schoolwork, shared media use when appropriate, and regular opportunities for offline activities. Recent Italian guidance further recommends delaying personal smartphone ownership until at least age 13. These recommendations should be individualized and presented cautiously because the available evidence primarily demonstrates associations rather than causal effects.

Conclusion

This narrative review synthesized evidence from 13 empirical studies examining the cognitive and psychological outcomes associated with screen exposure in school-aged children and adolescents, interpreted through the lens of CLT. The literature reported associations between excessive or unstructured screen exposure and adverse outcomes, which were categorized into three central themes: neurobiological changes, cognitive performance (i.e., attention, memory, and executive function), and mental health and wellbeing. Neuroimaging studies reported altered connectivity and reduced gray matter volume in regions critical for cognitive control, while behavioral evidence revealed deficits in working memory, reduced attentional capacity, and elevated symptoms of anxiety and ADHD among children with high levels of screen use. Interpreting these findings through CLT suggests that prolonged screen use may increase extraneous cognitive load, disrupt the processing of intrinsic task demands, and limit opportunities for germane load necessary for deep learning and schema construction.

However, this review has limitations. First, variability across study methodologies, including differences in screen time assessment tools, study designs, and cognitive outcome measures, made direct comparisons challenging. Many studies relied on self- or parent-reported screen use, which may be prone to recall bias and misclassification. Moreover, although some studies utilized neuroimaging or longitudinal methods to capture developmental change over time, many were cross-sectional, limiting the ability to infer causality. Data from low- and middle-income countries are also limited, which constrains the generalizability of these findings to diverse socioeconomic and cultural populations.

The findings have meaningful implications for education, health-care, and parenting practices. For educators and health-care professionals, a better understanding of how various types and patterns of screen use influence cognitive load can inform curriculum development, instructional technology use, and the early identification of at-risk students. Parents need guidance on balancing beneficial screen use (e.g., educational or interactive content) with limits on passive or overstimulating media, particularly before bedtime or during homework hours. School counselors and clinicians should also consider children's digital media habits when assessing issues related to attention, learning, or emotional regulation. Future research should prioritize longitudinal and experimental designs that can more accurately identify causal pathways and developmental trajectories. Developing standardized, validated tools for measuring screen time, accounting for duration, content type, user engagement, and context, is essential. Future research should also examine parental mediation and individual differences in susceptibility to cognitive overload. Furthermore, integrating neurocognitive and physiological biomarkers could enhance our understanding of the mechanisms through which screen exposure may relate to cognitive load and brain development. In summary, while digital media has become an integral part of modern childhood, this review highlights the importance of critically evaluating how screen exposure interacts with cognitive development. CLT offers a robust framework for interpreting these dynamics, highlighting both potential risks and instructional opportunities. Its application can guide evidence-based strategies for families, educators, and policymakers to support healthier and more cognitively constructive screen use among youth.

Limitations

This review has limitations beyond those of the included studies. Because it was conducted as a structured narrative review rather than a registered systematic review, the search and selection procedures may not have identified every relevant study. No validated risk-of-bias instrument was applied; therefore, the descriptive strength-of-evidence labels presented in Table 1 should not be interpreted as formal certainty ratings. The synthesis also combines heterogeneous types of screen exposure, including television viewing, gaming, mobile-phone use, and media multitasking, as well as heterogeneous cognitive and psychosocial outcomes. These methodological differences limit direct quantitative comparisons across studies.

The target population encompassed school-aged children aged 6–11 years and adolescents aged 12–18 years, who differ substantially in cognitive maturation, educational demands, autonomy, and patterns of digital-media use. Findings were presented by developmental stage when the included studies provided sufficient information. However, several studies included overlapping age ranges or did not report age-stratified findings, preventing consistent developmental subgroup comparisons.

Because the review was restricted to participants aged 6–18 years, its conclusions should not be generalized to preschool-aged children; future reviews should examine how Cognitive Load Theory operates in early childhood while accounting for developmental capacity, caregiver mediation, content characteristics, and language and social-communication outcomes.

Most included studies were observational; therefore, interpret their findings as associations rather than causal effects. Reverse causation remains possible because children and adolescents with pre-existing attention, executive-function, or behavioral difficulties may engage with digital media differently. Residual confounding by sleep, physical activity, family environment, socioeconomic circumstances, parental practices, and baseline neurodevelopment may also contribute to the observed associations. Cognitive Load Theory provides a plausible framework for interpreting these findings but does not establish a causal mechanism.

The review was intentionally limited to attention, memory, and executive function; consequently, its conclusions should not be generalized to other important developmental domains, including language, which warrants a separate synthesis incorporating language-specific mechanisms and younger developmental populations.

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Footnotes

Edited by: Marco Lunghi, University of Padova, Italy

Reviewed by: Elena Bozzola, Bambino Gesù Children's Hospital (IRCCS), Italy

Claudia Ximena González-Moreno, Pontifical Javeriana University, Colombia