Television viewing and externalizing problems in preschool children: the Generation R Study.

Objective: To determine whether the amount, type, and patterns of television viewing predict the onset or the persistence of externalizing problems in preschool children.

Design: Longitudinal study of a prospective population-based cohort in the Netherlands.

Setting: Parents reported time of television exposure and type of programs watched by children. Externalizing problems were assessed using the Child Behavior Checklist at 18 and 36 months.

Participants: A population-based sample of 3913 children.

Main exposure: Television viewing time, content, and patterns of exposure (at 24 and 36 months) in children with and without preexisting problems to assess the incidence and persistence of externalizing problems.

Main outcome measures: Externalizing problems at 36 months.

Results: Program content and time of television exposure assessed at 24 months did not predict the incidence of externalizing problems at 36 months (odds ratio, 2.24; 95% CI, 0.97-5.18). However, the patterns of exposure over time reflecting high levels of television viewing were associated with the incidence of externalizing problems (odds ratio, 2.00; 95% CI, 1.07-3.75) and the persistence of the preexisting externalizing problems (2.59; 1.03-6.55).

Conclusions: Our study showed that high television exposure increases the risk of the incidence and the persistence of externalizing problems in preschool children.