Journal article
Impact of Technology Use on Behavior and Sleep Scores in Preschool Children in Saudi Arabia

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Publication Details
Subtitle: Technology Use by Children
Author list: Doaa Almuaigel1, Abrar Alanazi1, Mohammed Almuaigel2, Foziah Alshamrani2,3, Mona AlSheikh4, Nora Almuhana5,6, Mohammad Zeeshan4, Mohammed Alshurem2,3, Alaa Alshammari 2* and Kamel Mansi 7
Publisher: Frontiers
Publication year: 2021
Volume number: 12
Issue number: 649095
ISSN: 1664-1078
Web of Science ID:
PubMed ID:
Scopus ID:
eISSN: 1664-1078

Background: Pre-school children use digital devices both at home and in kindergarten for communication. However, such technologies can also be used for creativity learning and entertainment. Technology usage might exert a negative impact on the psychosocial development of pre-school children, thus necessitating parental monitoring. Previous studies have recommended early intervention for pre-school children by decreasing the duration of digital devices, spending more time with the family, and participation in motor activities to avoid the ill effects of technology.

Aim: To investigate the impact of digital device use on the behavioral and sleep scores of preschool children as perceived by parents in Saudi Arabia (SA).

Method: This cross-sectional study was conducted across two regions in SA. It was ethically approved by the ethical review board of Imam Abdulrahman Bin Faisal University. The participants were randomly selected from well-baby hospital records, surveyed and interviewed to obtain data for the following measures: demographic data, technology usage, sleep disturbance scale, and behavior scale. Children with special needs or comorbidities were excluded from the study. Descriptive and multivariate regression analysis were done.

Results: We recruited 288 children. Most did not attend schools (63.2%), 22.6% were in kindergarten, and 14.2% were in nursery schools. Smart phones were the most commonly used device by the children (42.4%). Most used the technology for 2–3 h/days (34%). Cartoons were the most commonly sought content (42%). The behavior scores for children aged 18–36 months showed a mean value of 5.1, 3.7, and 4.6 for surgency, negative affect, and effortful control, respectively. Children aged 3–5 years showed a mean value of 4.3, 4, and 4.7 for surgency, negative affect, and effortful control, respectively. Sleep disturbance scores for all children showed a mean value of 12.4, 3.5, 3.8, 8, 7.3, and 2.7 on disorders of initiating and maintaining sleep, sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence, and sleep hyperhidrosis, respectively. The mean total sleep score was


Frontiers in Psychiatry |

1 May 2021 | Volume 12 | Article 649095

Almuaigel et al.

Technology Use by Children



In contemporary society, pre-school children use digital devices both at home and in kindergarten. They use technology not only for communication but also for learning and entertainment. The experience with pre-school children using digital devices is relatively new. Therefore, there is little evidence for its impact on children, sleep, behavior, and psychosocial development. Children primarily use technology for entertainment and curiosity satisfaction; caregivers pay scant attention to the influence of this practice (1).

The aforementioned situation is similar in Saudi Arabia (SA), where the use of communication or electronic entertainment devices is particularly common in the pediatric population (2). Technology usage might impose a negative influence on child’s psychosocial development. Therefore, parental awareness and monitoring is necessary (3).

The ill effect of electronic device use on sleep of children can be due to the hormones provoked by excitement, suspense, drama, and conflict that is involved in the media and games that the child is exposed to (4). The secretion of these stress and arousal hormones will result in disruption of sleep quality. The exposure to light emitted from electronic devices can also suppress the secretion of melatonin, a sleep hormone which interferes with the physiologic circadian rhythm (4, 5).

Physical activities will distract the child from screen viewing and is expected to allow restoration of melatonin levels and sleep quality. As afore-mentioned, sleep is very vital for child’s health, immune system, and normal mental, physical, and emotional development. Having a normal family atmosphere encourages communication between the child and his parents or sibs and is expected to have a positive effect on the behavior, sleep, and child’s speech and language development (6).

The ill effect of technology use on sleep and behavior is not new, but quantifying it at different stages of childhood, from

a parental point of view, in the parents’ native language, by interview-reinforced-surveys, is this study’s contribution.

Our aim is to study the association of screen time viewing on behavior and sleep scores of preschool children in SA. Other demographic factors associations were evaluated to control for their confounding effect.


This is a cross-sectional study that was conducted across two regions in SA. It received ethical approval from the ethical review board of Imam Abdulrahman Bin Faisal University.


The study included Saudi children across two regions in SA, namely the Eastern and Central Provinces. We interviewed parents of children aged 1.5–5 years who used technology for any purpose. We excluded children with special needs and comorbidities like chronic illness, congenital syndrome, or disease and parents who could not read or respond to electronic questionnaires.

Study Procedure

The study participants were randomly selected and recruited from well-baby hospital records and by posting fliers on different social media websites. The fliers requested interested parents of pre-school children (kindergarten, nursery schools, and those at home) to fill out their contact details, including their name, mobile number, e-mail address, city, and if their child had any medical condition. We contacted the parents to decide the best time for the interview. Telephonic interviews were conducted in Arabic by trained and qualified graduate students. Consent was taken verbally at the beginning of the interview and electronically at the beginning of the survey.

37. Multivariate regression analysis showed significant positive relationship between surgency and three factors namely family income of 10,000–15,000SR (t = 1.924, p = 0.045), fathers’ bachelor’s degrees (t = 2.416, p = 0.16), and owning a video game device (t = 2.826, p = 0.005<0.05). Negative affect was significantly associated with fathers’ diploma level of education (t = 2.042, p = 0.042). Negative significant relationship between effortful control and fathers’ secondary level of education (t = −2.053, p = 0.041). There was a significant negative relationship between effortful control and owning a TV and video game device (t = −2.35, −2.855, p = 0.043, 0.005<0.05, respectively). A significant positive relationship was found between child’s sleeping score (worse sleep) and watching technology between 3 and 5 h (t = 2.01, p = 0.045), and mothers’ unemployment status (t = 2.468, p = 0.014).

Conclusion: In conclusion, technology use is associated with a negative impact on children sleep and behavior. Owning a digital device, using tablets, screen viewing for more than 3–5 h, and watching movies were significantly associated with negative child’s behavior and sleep.

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Last updated on 2021-19-06 at 05:45