New Delhi: In this wide-ranging and urgent conversation with ETHealthworld’s Rashmi Mabiyan Kaur, Dr. Samir Dalwai, Developmental Behavioural Paediatrician and Spokesperson for the Indian Academy of Paediatrics, raises a red flag on the escalating neurodevelopmental challenges facing children in urban India, including autism, ADHD, anxiety, and a growing spectrum of subclinical behavioural issues.
Drawing on over two decades of clinical experience, Dr. Dalwai underscores the profound impact of excessive screen exposure, the critical shortfall in early diagnosis and intervention, and the disconnect between clinical care and school systems.
He calls for a nationwide shift toward human-centric parenting, timely detection, and coordinated, outcome-driven support—before irreversible damage is done.
You’ve worked with thousands of children over the past two decades. What trends have you observed in the incidence of autism, ADHD, and learning disorders among children in urban India?
The trends indicate an alarmingly increasing number of children with not just autism, ADHD, and other diagnosable conditions, but also those that present as subclinical.
This means their behaviour may not fit into a definitive diagnosis, but they exhibit multiple concerning indicators such as aggression, poor attention span, hyperactivity, impulsivity, poor sitting tolerance, anxiety, anger issues, poor self-esteem, self-harm, and poor emotional resilience, among others.
Why is early diagnosis and intervention crucial in neurodevelopmental disorders—and where does India currently fall short?
Early diagnosis and interventions are crucial to improving the child’s quality of life. The brain is also very adaptable during early childhood, and early interventions can go a long way in maximising developmental potential.
At the same time, equipping families with the support and resources they need can help them better understand and meet their child’s needs. At present, India falls woefully short in terms of awareness, both within and external to the medical fraternity. The numbers of trained doctors and support staff are also lacking.
How can we bridge the gap between clinical detection and support systems in schools and public health programs?
The biggest challenge in the Indian ecosystem is that there are multiple stakeholders involved in the child’s care who are not on the same page. For instance, while schools are focused on academic performance, therapy focuses on clinical improvements.
The goals of Individualised Education Programmes (IEPs) and therapy are not aligned. This gap can be bridged by making the child’s improvement the focus and mandating the monitoring of outcomes as per standardised guidelines or by an independent body.
You’ve been vocal about the dangers of excessive screen time for children. What are the most serious cognitive and behavioural issues you’re seeing as a result?
Pervasive human interaction and nurturing care in the first few years of a child’s life are essential for normal development. With screens and digital gadgets replacing these within a very short span of time, the development of children has been impacted in several ways, including delays in the development of crucial cognitive, social, and emotional skills.
How do screen habits in early childhood impact brain development, emotional regulation, and attention span?
Human interaction and nurturing care in the first few years of a child’s life help the child’s brain to develop innumerable networks. These networks are crucial for behavioural and communication skills, as well as emotional and cognitive development.
Early childhood learning must comprise diverse engagements and exposure in familiar, nurturing environments, where adults help children to learn and cope with different social situations over a substantial period of time. When these interactions occur within a non-judgemental environment and with a non-intimidating approach, a child can develop social cognition.
Screens replace this gradual pace of learning with intense, enrapturing, and provocative exposures that target ‘fight or flight’ responses. They encourage the child to seek instant gratification, develop binary thinking, and engage in impulsive actions. At the same time, increased screen time decreases the opportunities available to a child to learn and develop rational thought, tolerance, social diversity, and empathy.
Children end up living in a false world, driven by instant gratification and violence, and triggered by the need to always be in their comfort zone. We are seeing increasing cases of anxiety, inattention, and the inability to communicate or get along with peers. The heightened reliance on screens means that the basic framework for normal human social existence is not being laid down.
Many parents struggle with setting digital boundaries. What are the key principles of a healthy digital diet for children under 10?
It is essential to focus on restricting or limiting screen time rather than aiming to eliminate it altogether, which may be a utopian and hence unattainable goal. The key principle of a healthy digital diet involves helping the child to learn the boundaries that govern their entire day—including mealtimes, playtime, study time, outdoor time, visiting/spending time with family and neighbours, etc.
Setting up daily timetables that include all of these, sticking to them, and role-modelling time discipline as adults is important. Rewarding overall observance of schedules motivates the child to stick to the entire day’s timetable (and unconsciously develop healthy boundaries) as a part of his/her lifestyle.
Children learn that following boundaries is beneficial as it helps them do everything they like – but within reason. A common mistake that parents make is to only focus on disciplining the child with regard to his/her digital time, without placing this in the context of the child’s daily routine.
What are some early warning signs of digital addiction in children that parents often miss?
Every child is attracted to gadgets, especially digital gadgets. As a common rule of thumb, digital gadgets should only be introduced to them after three years of age. A child can be considered addicted when (s)he cannot limit or restrict their use of screens. The earliest sign in a child is the inability to adhere to the schedule that has been established for him/her.
Choosing screen time over human engagement, which can involve meeting relatives and friends, and physical playtime or outdoor time with digital time is another serious red flag.
Disordered sleep is another significant indicator. Refusal to give up the device and getting into conflict with caregivers over the use of the device is a clear sign of impending addiction.
Do you believe India is ready for a national policy that limits or regulates social media access for minors?
It is imperative since the challenges to voluntarily regulating the use of social media are enormous. Most children today are already fairly addicted, as are their parents. Most importantly, the lack of social engagements and the gradual change in lifestyles with a growing focus on individual and solitary pursuits make such monitoring very difficult.
Many businesses have a vested interest in the use of digital media by consumers. They will, thus, resist any change to the status quo. In many ways, I believe that it is already too late since many parents sincerely believe that introducing their children to digital platforms is for their own good and that becoming familiar with AI is best for their future.
What reforms would you prioritize to address adolescent mental health issues, including rising cases of self-harm, depression, and aggression?
All reform must be focused on reestablishing the role of human engagement in an adolescent’s life. During adolescence, children deprioritise parents and stop viewing them as role models. Instead, they become more concerned with their peers.
Developing an environment that drives the child towards sports, music, games, and other forms of recreation that necessitate human engagement must be considered. The only antidote for screen time is human time. Secondly, increased self-awareness and easy access to quality counselling and help for adolescents is a must.
