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The Relationship Among Screen Use, Sleep, and Emotional/Behavioral Difficulties in Preschool Children with Neurodevelopmental Disorders

Lin, Jiayong*; Magiati, Iliana*; Chiong, Shi Hui Rachel*; Singhal, Swati; Riard, Natasha; Ng, Isabel Hui-Xuan; Muller-Riemenschneider, Falk§; Wong, Chui Mae

Journal of Developmental & Behavioral Pediatrics: May 16, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/DBP.0000000000000683
Original Article: PDF Only

Objective: Despite evidence that excessive screen use may contribute to negative health, developmental, emotional, and behavioral outcomes, more children are engaging in increasing amounts of screen-related activities. For children with neurodevelopmental conditions, increased screen use could exacerbate emotional/behavioral difficulties (EBDs) by interfering with sleep quantity and quality.

Aims: This study examined the possible mediating role of sleep in the relationship between screen use and EBDs in preschool children with neurodevelopmental disorders (NDDs) clinically referred to a child development center in Singapore.

Methods: A screen use questionnaire developed for the purposes of the present study, the Children's Sleep Habits Questionnaire, and the Strengths and Difficulties Questionnaire were completed by 367 caregivers of 2- to 5-year-old children with NDDs (39.5% autism spectrum disorder; 36.8% speech-language disorders; 23.7% others).

Results: Average daily screen use duration was 3.98 hours, with 93.9% exceeding 1 hour of screen time daily. 57.7% of children had screen devices in their bedrooms, while 52% commenced screen use at the age of 18 months or earlier. Sleep problems fully mediated the relationship between the number of bedroom screen devices and children's EBDs, as well as between the age of first screen use and EBDs, but not between hours of screen use and EBDs. Controlling for age, developmental level, and family income, children who started using screens earlier than 18 months and who had screen devices in their bedrooms had significantly more sleep problems and EBDs than those without.

Conclusion: Children with neurodevelopmental conditions may have more difficulties disengaging from screen devices in their bedrooms, and an earlier age of screen exposure may contribute to more chronic disruption of sleep.

*Department of Psychology, National University of Singapore, Singapore;

Department of Child Development, KK Women's and Children's Hospital, Singapore;

Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom;

§Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Address for reprints: Jiayong Lin; e-mail:

Disclosure: The authors declare no conflict of interest.

This seeks to inform that the appended paper represents an original contribution. It has not been previously published and is currently not being considered for publication elsewhere.

Received December 17, 2017

Accepted March 22, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.