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Sleep, screen time and behaviour problems in preschool children: an actigraphy study

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Abstract

Inadequate sleep and excessive exposure to media screens have both been linked to poorer mental health in youth. However, the ways in which these interact to predict behaviour problems have yet to be examined using objective sleep measurement. The lack of objective evidence for these relationships in young children has recently been defined by the World Health Organization (2019) as a gap in the field. We thus aimed to test the interacting effects of screen exposure and objectively measured sleep on behaviour problems in the preschool age. A total of 145 children aged 3-to-6-years participated in this cross-sectional study. Sleep was assessed objectively using actigraphy for 1-week, and subjectively using parent-reported daily sleep diaries. Parents reported the child’s daily duration of screen exposure, and completed the Strengths and Difficulties Questionnaire. Results showed that actigraphic sleep duration, timing and efficiency were associated with screen exposure. The link between screen time and behaviour problems was moderated by sleep duration, as it was significant only for children with sleep duration of 9.88 h or less per night. Sleep duration also moderated the relation between screen time and externalizing—but not internalizing—problems. Hence, the combination of increased screen exposure and decreased sleep duration may be particularly adverse for child mental health. While these key relationships should be further examined in longitudinal and experimental investigations, our findings shed light on their complexity, underscoring the importance of the moderating role of sleep.

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Acknowledgements

Research reported in this manuscript was supported by the Israeli Science Foundation Grant, 689/12. The authors are grateful to the participating families, and to our team of research assistants. We also thank Pawel Skuza for his feedback on data analyses. We dedicate this paper to our beloved colleague, Prof. Avi Sadeh, who brought this study to life, and dedicated his career to improving the sleep and well-being of young children.

Funding

Research reported in this manuscript was supported by the Israel Science Foundation grant, 689/12.

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Authors and Affiliations

  1. School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel

    Michal Kahn, Ortal Schnabel, Michelle Slone & Avi Sadeh

  2. College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia

    Michal Kahn & Michael Gradisar

  3. Clinical Nutrition Department, Rambam Medical Center, Haifa, Israel

    Geila S. Rozen

  4. Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Naama Atzaba-Poria & Liat Tikotzky

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  1. Michal Kahn
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  2. Ortal Schnabel
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  3. Michael Gradisar
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  4. Geila S. Rozen
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  5. Michelle Slone
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  7. Liat Tikotzky
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  8. Avi Sadeh
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Contributions

MK co-conceptualized and designed the study, collected data, conducted data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. OS provided co-conception and design of the study, collected data, carried out the initial analyses, and reviewed and revised the manuscript. MG, MS and NA provided critical evaluation of manuscript drafts. GSR and LT co-conceptualized and designed the study and provided critical evaluation of manuscript drafts. AS conceptualized and designed the study, supervised data collection, and carried out and interpreted initial analyses. Due to his unfortunate passing in September 2016, AS did not have a chance to review the manuscript, but we believe that his vast contribution to this study makes him worthy of senior authorship.

Corresponding author

Correspondence to Michal Kahn.

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The authors declare that they have no competing or potential conflicts of interest.

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All procedures were approved by the Institutional Review Board, and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Prior to their inclusion in the study, participating parents provided signed informed consent and children provided voiced assent.

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Kahn, M., Schnabel, O., Gradisar, M. et al. Sleep, screen time and behaviour problems in preschool children: an actigraphy study. Eur Child Adolesc Psychiatry 30, 1793–1802 (2021). https://doi.org/10.1007/s00787-020-01654-w

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