Violeta R. Manolova and Stoyan R. Vezenkov
Center for applied neuroscience Vezenkov, BG-1582 Sofia, e-mail: info@vezenkov.com
For citation: Manolova V.R. and Vezenkov S.R. (2025) Are Screen-Induced Synesthesia and Screen-induced Cue-Dependent Behavior Contributing Factors in the Misdiagnosis of ASD Among Children with Screen Addiction? Nootism 1(3), 11-16, ISSN 3033-1765 (print), ISSN 3033-1986 (on-line)
Abstract
This study explores the potential relationship between early screen addiction, induced synesthetic experiences, and cue-dependent behavioral structures in children diagnosed with Autism Spectrum Disorder (ASD). Through analysis of three case studies and comparative review of developmental neuroscience literature, the report identifies phenomena such as visual-motor synesthesia, color–person associations, ordinal–spatial sequencing, and sensory-contingent behavior as interconnected outcomes rooted in neural mechanisms shaped by excessive and homogeneous audiovisual stimulation in early childhood.
Particularly concerning is the role of media products—animations and video games—which are often intentionally designed to induce multisensory integration resembling synesthesia. These digital environments rely on tightly coupled audiovisual markers, emotional symbolism, and repetitive structures to produce immersive effects that may anchor perception and behavior in vulnerable developmental stages. This mirrors phenomena observed in Game Transfer Phenomena (GTP), where game-related stimuli persist beyond gameplay, altering perception and reaction patterns.
From a neurodevelopmental perspective, early exposure to such media disrupts the normal course of synaptic pruning—especially in the visual and associative cortices—leading to structural dominance of sensory pathways and weakening of cognitive flexibility. As a result, synesthetic couplings may emerge as persistent cross-modal links, while cue-dependent behavior manifests as a rigidity wherein basic physiological functions (eating, sleeping, elimination) become contingent on specific sensory cues. These effects are often misinterpreted as symptoms of core ASD.
A key contribution of the study lies in the quasi-experimental evidence: during targeted interventions aimed at reducing screen exposure, both synesthetic reactions and cue-dependent behaviors diminished or disappeared. This suggests these patterns are not immutable traits but rather plastic, reversible adaptations to environmental overstimulation.
The findings call for a paradigm shift in the interpretation of ASD-like symptoms in early childhood, emphasizing the need for refined diagnostics and targeted therapies. They underscore how digital environments can profoundly alter neural development through synthetic synesthetic conditioning, reinforcing the urgency of re-evaluating screen use in critical developmental periods.
Keywords: screen-induced synesthesia, screen-induced cue-dependent behavior, misdiagnosis of ASD, early screen addiction
Introduction
Early screen addiction is a widespread issue that remains poorly understood both scientifically and clinically, with limited in-depth research. Children are most often diagnosed with Autism Spectrum Disorder (ASD), and this fundamental misdiagnosis places families and therapists in an unequal battle against a condition for which no strict definitions exist, and whose mechanisms of onset and treatment remain unexplained. Screen addiction is a demonstrably reversible condition, and children can achieve full recovery regardless of whether they have been diagnosed with ASD or not (Vezenkov et al., 2024 (1); (2); 2025 (1); (2)). Our aim is not to initiate a debate over misdiagnosis, but to demonstrate that a functional characteristic typically associated with ASD in children is, in fact, induced by screen addiction and lies at the core of what is perceived as autistic behavior. (Vezenkov et al., 2025 (3)) The phenomenon reflects an atypical pattern of neurological development, marked by synesthetic experiences and cue-dependent behavioral responses.
The early years of human life represent a critical period for brain development, characterized by high synaptic density followed by a process of reduction known as pruning (de Silva 2018; Eltokhi et al., 2020) Within this dynamic process, one of the primary functions of pruning is to ensure the specialization of neural pathways by eliminating weakly used connections, thereby optimizing the brain's efficiency and reducing “neural noise.” In early childhood, the highest levels of activity are observed in the visual, auditory, and somatosensory cortices, while in middle childhood, the associative regions—responsible for language, social interaction, and cognition—undergo significant changes. During adolescence, the prefrontal cortex enters a prolonged process of structural reorganization, which often continues into early adulthood. (Petanjek et al., 2011; Tang et al., 2014; Thomas et al., 2016; Kim et al., 2017; Neniskyte et al., 2017; Sellgren et al., 2019)
In the context of modern society, the impact of screen devices on brain development has gained particular relevance. In young children, especially during the critical period up to the age of three, excessive screen use induces chronic audiovisual stimulation that can disrupt normal synaptic pruning mechanisms. MRI studies have shown that children with high screen exposure exhibit reduced cortical thickness in the occipital lobe, decreased sulcal depth, as well as weakened white matter integrity and impaired functional connectivity between visual and associative brain regions. (Hubbard et al., 2011; Harvard Medical School, 2019) These findings point to a structural and functional asymmetry primarily oriented toward the visual and auditory networks, leaving other sensory and motor areas under-stimulated. As a result, a brain architecture emerges that is audiovisually dominated, with deficits in cognitive flexibility and integrative connectivity.
Findings in the neurodevelopmental literature indicate that such structural changes are characteristic of various neurodevelopmental profiles. Children on the autism spectrum, including individuals with Asperger-like traits, often exhibit increased synaptic density and deficits in pruning, particularly in visual-cortical and prefrontal regions. This leads to sensory overload, overly detailed perception, limited global integration, and rigid behavior (Tang et al., 2014; Thomas et al., 2016; Fernández de Cossío et al., 2017) The resulting forms of synesthesia - including visual-gustatory associations, where a specific color or sound evokes a taste sensation - reflect the physiological preservation of non-functional cross-modal pathways that would typically be eliminated during typical development (Hubbard, 2007; Hubbard et al., 2011; Neufeld et al., 2013; Ortiz de Gortari et al., 2014; 2016; 2021; 2022). The transition into adolescence entails a period of intensive reorganization within neural networks, particularly in the prefrontal and associative cortices. This phase is sometimes marked by excessive pruning, which may liberate neural circuits; however, in certain cases, its dysregulated progression can lead to fragmentation of cognitive trajectories, impaired coordination between cortical regions, and the emergence of psychotic symptoms – such as hallucinations, disorganized thinking, and schizoid features (Stein et al, 1993; Sellgren et al., 2019; Riedel et al., 2020; Robertson et al., 2017). The occipital cortex, as the primary region for visual processing, is particularly vulnerable to such changes. Initial stimulation establishes its structural dominance, but when excessive pruning occurs, the connections between visual and cognitive-associative regions are disrupted, creating a neural backdrop conducive to psychotic manifestations.
In the context of childhood neurodivergence, cue-dependent behavior refers to a phenomenon in which a specific action, reaction, or physiological response occurs only in the presence of a particular external stimulus or “cue.” Among children with Autism Spectrum Disorders (ASD), this dependency is especially pronounced, with behaviors often appearing unstable or absent outside the specific context that originally elicited them. The mechanisms underlying this phenomenon include rigidity in cognitive flexibility, deficits in behavioral generalization, and sensory hypersensitivity. Bouwman (2020) point out that children with autism process sensory and social information in a detailed and localized manner, which leads to the binding of behavior to specific environmental cues, without the automatic transfer of learned responses to new situations. For example, a child with ASD may only urinate upon seeing a blue light in the bathroom, eat only in the presence of a specific toy, or participate in an educational activity only when seated in a particular spot. In behavioral therapy (Applied Behavior Analysis – ABA), this is described as prompt dependency, where the behavior is maintained solely by the presence of an external cue rather than by internal motivation or a generalized behavioral pattern. (van Leeuwen et al., 2020; 2021; Waterhouse et al. 1996; Wilsson et al., 2023)
Research shows that children with autism often exhibit synesthetic or quasi-synesthetic responses—for example, a sound triggering a motor reaction or a color being associated with a bodily sensation. In this context, a cue may function not only as an external stimulus but also as a multisensory link that activates or inhibits behavior (Laeng et al., 2021). This suggests that some cue dependencies are not merely behavioral but are deeply rooted in neuro-sensory mechanisms. Cue-dependent behavior in children with ASD represents a key phenomenon linked both to their sensory architecture and to limitations in cognitive flexibility. Understanding this phenomenon provides not only a foundation for more accurate diagnosis but also practical guidelines for more effective intervention.
An additional challenge in studying synesthesia in children with Autism Spectrum Disorders (ASD) arises from the fact that a significant proportion of these children are nonverbal or have limited language abilities. As a result, internal sensory experiences—including potential synesthetic responses—cannot be directly verbalized or described. This presents a serious methodological limitation in the diagnosis and investigation of synesthesia within this population. Consequently, the relationship between synesthesia and cue-dependent behavior remains insufficiently explored, despite multiple observations suggesting overlap between sensory hypersensitivity, fixation on specific stimuli, and distinct behavioral blockages.
Methods
This report examines three case studies of children with early-onset screen addiction and a formal ASD diagnosis, all of whom exhibit both cue-dependent behavior and synesthetic responses. The relationship between screen addiction and the emergence of synesthesia and cue-dependent behavior was explored through parental reports and direct input from one of the children.
Therapy for Early Screen Addiction
The conceptual framework of the early screen addiction therapy has been described in detail elsewhere (Vezenkov et al., 2025 (2); (3); Manolova et al., (1)). It involves a complete screen detox, a sensorimotor reset, the processing of screen-induced pathological reflexes, restoration of sleep quality, neutralization of power-and-control behavioral programs, cortical activation, replacement of addicted functioning with exploratory and orienting behaviors, and the gradual reintroduction of activities rooted in real-life experiences.
Results
Case 1
Age: 4 years
Diagnosis: Autism Spectrum Disorder (ASD)
Language Profile: Nonverbal
Screen Exposure: Strong addiction to tablet - used during car rides, to fall asleep, and immediately upon waking.
Findings:
- SIPVR test (Screen-Induced Pathological Vestibular Reflex) was positive (Vezenkov et al., 2025 (1);(3)).
- A color cloth covering test revealed pronounced aversion to the color red Synesthetic Responses:
- Visual–tactile synesthesia: Upon seeing a dog, the child scratches the left palm intensely.
- Visual–auditory-emotional response: When exposed to purple light, the child begins to whimper.
Ordinal–spatial synesthesia:
- Assembles puzzles with remarkable speed and precision. Displays aggressive behavior (shouting, hitting) if someone attempts to participate in the activity, indicating disrupted cognitive flow or spatial mapping.
- Navigates complex routes with ease but insists on repeating only familiar routes.
Cue-dependent behavior with avoidance:
- Refuses to eat red-colored foods.
- Refuses to wear red clothing.
Cue-dependent inhibitory behavior:
- Able to urinate only in the presence of a yellow image.
Case 2
Age: 6 years
Diagnosis: Autism Spectrum Disorder (ASD)
Language Profile: Automatic speech; absence of functional communication
Screen Exposure: Introduced around age 2; severe screen addiction
Findings:
- SIPVR test (Screen-Induced Pathological Vestibular Reflex) was positive.
- The colored cloth test revealed strong aversion to individual colors.
Synesthetic Responses:
- Person–motor synesthesia: Upon seeing one of her uncles, the child lies on her back and makes buzzing sounds with her mouth, sometimes for over an hour, uninterrupted by parental attempts to intervene.
- Visual–motor synesthesia: When shown a particular cartoon character (on paper, not a screen), she begins flapping her right hand.
Ordinal–spatial synesthesia:
- Draws identical anime-style girl characters in strict height order. If the sequence in the drawing is disrupted, she enters a state of acute distress.
Cue-dependent behavior with avoidance:
- Insists on wearing the same shirt featuring a specific image for weeks. Parents buy multiple identical copies to rotate them unnoticed.
Cue-dependent inhibitory behavior:
- Defecates only once a week, and only while seated on a potty placed in the center of the bathroom, while singing a specific animated theme song.
- Falls asleep only with the light left on.
Case 3
Age: 7 years
Diagnosis: Autism Spectrum Disorder (ASD)
Language Profile: Verbal
Screen Exposure: Introduced at 2 years and 9 months—after the child had begun speaking; developed severe screen addiction
Clinical Features: Severe automatisms and self-injurious behavior
Findings:
- SIPVR test (Screen-Induced Pathological Vestibular Reflex) was positive
- The colored cloth test revealed strong aversion to green, blue, and purple
Synesthetic Responses (reported by both child and mother):
- Person–color synesthesia: Perceives his mother as blue and his father as green; “all green people are bad”
- Grapheme–color synesthesia: Each letter and number appears in a different color
- Visual–emotional–physiological synesthesia: Sweats profusely when seeing a dog
- Reading patterns: Reads backwards and fails to grasp the meaning of the text
Ordinal–spatial synesthesia:
- Rapidly sequences five different alphabets
- Navigates complex routes with ease
- Arranges all toys in precise color-coded matrices; exhibits self-injurious behavior if the arrangement is disturbed
Cue-dependent behavior with avoidance:
- Refuses to eat green-colored foods
- Avoids all interaction with his father and others perceived as "green"
Cue-dependent inhibitory behavior:
- Eats only when he can see a real traffic light or an image of one
- Falls asleep only in his swing
A quasi-experimental approach demonstrated recovery in the children, evidenced by the disappearance of synesthetic experiences and cue-dependent behaviors during the course of screen addiction therapy, as detailed in other reports (Vezenkov et al., 2025 (1); (2); (3); Manolova et al. 2025). All cue-dependent behavioral features - both avoidance-based and inhibitory - were resolved within the five-month course of comprehensive therapy.
Discussion
All three cases clearly demonstrate structured multisensory and conceptual associations characteristic of various types of synesthesia, combined with cue-dependent behavior, including inhibitory responses. The children's behavior and perception are consistently shaped by specific sensory stimuli—such as colors, visual symbols, musical motifs, objects, or even faces. Synesthesia, as a perceptual foundation for behavior, is observed in several distinct forms:
Visual–somatic synesthesia: In Cases 1 and 3, automatic bodily responses (e.g., scratching, excessive sweating) are observed in response to a visual stimulus (a dog), consistent with sensorimotor synesthesia.
Color–identity synesthesia: In Case 3, the colors blue and green are associated with representations of the mother and father, respectively, while "green people" are perceived as threatening—likely manifestations of affective synesthesia.
Ordinal–spatial synesthesia: All three children arrange symbols, puzzles, or characters according to a strict sequential and color-based logic—indicating a deeply integrated form of perceptual cartography.
Stimulus-induced motor response: Case 2 exhibits automatic behaviors (buzzing, hand-flapping) in response to social or visual cues—indicative of sensory–motor quasi-synesthesia.
Alongside the synesthetic experiences, cue-dependent behavior is observed as a functional outcome of synesthetic associations. Each child's behavior is stimulus-bound: in the absence of a specific cue (visual, auditory, or spatial), reflexive or basic functions such as eating, urinating, or sleeping are inhibited. The examples illustrate an inhibitory dependency - children do not perform certain actions unless a precise visual or audio-sensory configuration is present. This represents cue-dependent inhibition, a phenomenon rarely described in the literature but critically important for understanding adaptive behavior in ASD. (Park, 2023)
Contemporary animations and video games are increasingly designed with targeted sensory effects that simulate synesthetic experiences. The classic film Fantasia (1940) was one of the first experiments in visual-musical symbiosis, where music was transformed into moving colors and shapes - an experience reminiscent of innate synesthesia. Modern productions such as Inside Out and World of Tomorrow employ complex visual-emotional associations, while researchers like Robby Gilbert describe children’s animation as a multisensory synthesis in which music, color, movement, and emotion are inseparably intertwined. Research on the phenomenon known as Game Transfer Phenomena (GTP) shows that such sensory patterns not only create immersion during gameplay but also continue to influence perception and behavior after the game ends. This is due to the deep embedding of audiovisual patterns that are automatically triggered in real-life contexts - a process akin to perceptual synaptic anchoring. (Laeng et al., 2021; Ortiz de Gortari et al., 2014; 2016; 2021; 2022)
When such an environment is introduced during the critical period of neurodevelopment - particularly before the age of three - the result can be severe screen addiction that restructures the very architecture of the brain. MRI studies in children with high screen exposure reveal reduced cortical thickness, disrupted connectivity between visual and associative regions, and a loss of flexibility in the prefrontal cortex - the area responsible for control, planning, and social interaction. Instead of a brain that integrates sensory, social, and cognitive channels, an architecture emerges that is dominated by visual and auditory pathways, lacking coordination with higher-order cognitive networks. It is within this neurobiological framework that induced synesthetic experiences arise - for example, when a color triggers a bodily reaction, or a musical motif becomes a prerequisite for a physiological function. In this context, screen addiction does not merely lead to behavioral deviations - it actively reshapes neural networks by distorting the process of synaptic pruning. During the early years of life, pruning plays a critical role by eliminating weak connections and optimizing frequently used ones. When the brain is exposed to excessive and monotonous sensory stimulation, it retains the pathways that are most frequently activated - such as those involved in color recognition, visual rhythms, and audiovisual cycles - while simultaneously eliminating connections that would normally support language, social coordination, and abstract thinking.
Particularly concerning is the role of pruning during adolescence—a second critical period when the prefrontal cortex must complete its structural organization. It is well established that addictions—including screen addiction—can interrupt or distort this process, resulting in immature executive control, impulsivity, and increased vulnerability to chronic addictive behaviors. This creates a vicious cycle: early screen addiction disrupts pruning, and the resulting disorganized neural architecture further reinforces addiction and increases the risk of neurodevelopmental disorders (Paulus et al., 2019; Vezenkov et al., 2025 (1); (4)).
Another crucial aspect of this process is the role of microglia - the cells responsible for synaptic pruning. Under conditions of chronic stimulation and inflammatory stress, microglia can induce abnormal pruning, leading to the loss of connections in brain regions responsible for self-regulation, reward processing, and social functioning. This constitutes a biological basis for the emergence of autism-like manifestations, including cue-dependent behavior, in which a given function (e.g., eating or sleeping) occurs only in the presence of a specific stimulus - such as a sound, image, or object. In this way, children become “anchored” to external sensory markers, and their behavior becomes fixed and inflexible - a symptom profile often misinterpreted as autism.
Screen addiction in young children is not merely a behavioral issue, but a deeply neuro-sensory and neuroplastic disorder in which induced synesthesia and cue-dependent behaviors arise against a background of disrupted synaptic pruning. This lays the foundation for autistic-like functioning that, however, may be potentially reversible if the vicious cycle is interrupted through reduced screen exposure and the restoration of sensory and social experiences in the real world. Our approach opens the possibility to investigate both the emergence and the resolution of synesthetic phenomena during child development - and, most importantly, to gather further data on the neurophysiological mechanisms through which our therapy facilitates recovery in children with early screen addiction and an ASD diagnosis.
Conclusion
Particularly alarming is the role of media products in this process. Animated films and video games do not merely provide sensory-rich content but are often deliberately designed to induce synesthetic-like experiences. The classic film Fantasia (1940) was an early experiment in tightly synchronized music and animation, creating experiences akin to sound–color synesthesia. Contemporary productions like Inside Out and various Japanese anime series rely heavily on color–emotion codes, rapid visual transitions, and symbolic repetition. In the gaming industry, as seen in the phenomenon of Game Transfer Phenomena (GTP), intentionally repetitive audiovisual markers, sounds, and rhythms are used to “anchor” the user’s attention, memory, and emotion through multisensory integration. Thus, animations and games do not merely produce aesthetic effects; they shape persistent perceptual patterns which, when internalized at an early age, may become automated neurosensory associations. It becomes inevitable to ask: from which point in human history do screen-induced synesthesia and autism originate?
It is within this context that the cue-dependent behaviors observed in the children studied emerge. In the absence of a specific audiovisual stimulus - such as colored light, a musical motif, or a particular visual symbol - the children are unable to initiate basic physiological and behavioral functions such as eating, urinating, or sleeping. The synesthetic experiences serve as activating or inhibiting “keys” for action, resulting in behavior that is fixed and maladaptive. In this way, induced synesthesia becomes the foundation for neurofunctional rigidity, which is often misinterpreted as characteristic of ASD.
The most significant finding of this report is demonstrated through a quasi-experimental approach: during the course of screen addiction therapy, both synesthetic and cue-dependent behaviors were observed to disappear. This strongly suggests that the phenomena in question are reversible and do not stem from permanent organic pathology, but rather from functional neuroplasticity shaped by environmental exposure. In conclusion, the report reveals a profound neuro-sensory interaction between screen exposure, synaptic pruning, and synesthesia, in which digitally induced experiences give rise to persistent - yet potentially reversible - behavioral and cognitive patterns. This not only highlights the urgent need for a critical reassessment of early screen exposure, but also calls for the implementation of appropriate interventions that address induced neuro-sensory dependencies and help restore the flexibility of the developing brain.
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