The research drew on data from the Study of Estonian Children’s Mental Health, a project commissioned by the Estonian Ministry of Social Affairs to map the psychological wellbeing of the country’s youth. The analytical sample comprised 681 school children, spanning late childhood and adolescence. Each participant reported their daily screen time and completed the Psychological Wellbeing subscale of the Kidscreen-52, a widely used instrument for assessing self-perceived wellbeing in young people. Adolescents aged eleven and older also filled out the youth version of the Pediatric Symptoms Checklist, a brief screening tool for emotional and behavioral difficulties, and the Revised Child Anxiety and Depression Scale, which captures symptoms of anxiety and depression. Parents completed their own version of the Pediatric Symptoms Checklist and a questionnaire about how often the family engaged in joint activities and conversations.

The methodological heart of the study is Latent Class Analysis, a statistical technique that identifies hidden subgroups within a population based on patterns of responses. Rather than treating screen time as a simple continuum and correlating it with mental health scores, the researchers allowed distinct time-use profiles to emerge from the data itself. The model combined children’s self-reported screen time and attendance at training activities with parents’ reports of how frequently the family shared activities and conversations. Age and self-perceived problematic screen use were included as covariates that could predict which class a child belonged to, allowing the researchers to separate the effect of chronological development from the effect of a child’s own sense that their screen habits had gotten out of control.

Three distinct patterns emerged. The largest group, accounting for 48.5 percent of the sample, was labeled Balanced: these children combined moderate screen use with regular participation in training and frequent family time. A second group, 31.4 percent, was labeled Off-Screen Active, characterized by heavy involvement in sports, clubs, and family life. The third and smallest group, 20.1 percent, was labeled Screen-Dominant. These children reported intensive screen use, spent less time in joint family activities and conversations, and attended training less frequently than their peers. In other words, one in five children in the sample lived a daily routine in which screens had effectively crowded out the activities that developmental psychologists traditionally consider protective.

When the researchers compared the three groups on mental health outcomes, the Screen-Dominant class stood out for all the wrong reasons. Its members showed poorer psychological wellbeing on the Kidscreen-52 measure and worse scores across the mental health indicators than children in either of the other two classes. The differences held even after accounting for age and self-perceived problematic screen use, suggesting that the pattern of time use itself, not merely how old a child is or how worried they feel about their own habits, is tied to mental health outcomes. For the Screen-Dominant group, the combination of heavy screen use and displaced family and training time appeared to carry a compound risk.

One of the study’s most striking findings concerns attention. Self-reported attentional problems were lowest not in the Off-Screen Active group, as one might expect, but in the Balanced class. Children whose routines mixed screen time with other activities reported fewer attention difficulties than either the heavy screen users or the highly active off-screen group. This nonlinear pattern hints that the relationship between time use and cognition may not be a simple dose-response curve, and that a moderate, varied routine may support attention better than either extreme.

Equally unexpected was the performance of the Off-Screen Active class. Despite their heavy involvement in training, family activities, and conversations, these children did not differ from the Balanced class on any mental health indicator. Being exceptionally active off-screen, in other words, conferred no additional psychological benefit beyond that enjoyed by children with a balanced routine. The authors interpret this as evidence that what matters most is avoiding the displacement of beneficial activities by screens, rather than maximizing off-screen engagement. The findings thus provide empirical support for the displacement hypothesis, the long-standing theoretical claim that excessive screen use harms development primarily when it replaces developmentally valuable experiences such as face-to-face family interaction, physical activity, and structured skill-building.

The study’s design has notable strengths. By using Latent Class Analysis, the researchers avoided the statistical pitfalls of treating screen time as an isolated variable, instead capturing the way screens, sports, and family life interlock in real daily routines. The inclusion of both child self-reports and parent reports reduces the risk that a single informant’s bias drives the results, and the use of validated instruments such as the PSC-17 and RCADS-25 grounds the mental health comparisons in established clinical screening measures. The work was approved by the Research Ethics Committee of the Estonian National Institute for Health Development, with informed parental consent and child agreement obtained before participation.

Nevertheless, the study’s cross-sectional nature means the arrow of causation remains unresolved. Children with emerging anxiety or depression may retreat into screens and withdraw from family and training, rather than the reverse. Longitudinal follow-up would be needed to determine whether Screen-Dominant routines precede mental health difficulties or develop in response to them. The sample, while substantial, comes from a single national context, and cultural norms around family time and organized activities may shape how these patterns generalize elsewhere. Self-reported screen time is also known to be imperfect, particularly among younger children.

Even with those caveats, the practical implications are clear. The authors argue that preventive efforts to support youth mental health should address both screen use and off-screen activities together, rather than focusing on screen minutes in isolation. Displacement, they conclude, emerges primarily among subgroups whose daily routines are characterized by intensive screen use, which means the children most at risk are those whose screens have crowded out family meals, conversations, clubs, and sports. For parents, educators, and policymakers, the message is less about banning devices and more about protecting the developmental spaces that screens so easily consume. In a world where one in five children in this sample already lives a screen-dominant life, that distinction may shape the next generation of digital wellbeing guidance.

Subject of Research: Associations between screen use patterns, off-screen activities, and mental health in children and adolescents

Article Title: Patterns of screen use and off-screen activities among children and adolescents and their associations with mental health

Article References: Tulviste, T., Tulviste, J., Tuvi, I., Sultson, H., Murd, C., Havik, M., Eensoo, D., Laidra, K., Siilbek, E., & Konstabel, K. (2026). Patterns of screen use and off-screen activities among children and adolescents and their associations with mental health. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07739-w

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07739-w

Keywords: screen time, children, adolescents, mental health, displacement hypothesis, latent class analysis, wellbeing, anxiety, depression, family activities, BMC Pediatrics, Estonia