Psychology

Running head: SUMMARY 1

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SUMMARY 2

Summary

Student Name

Institution Affiliation

Date

Summary

Introduction

This study aims to shed light on the difficulties faced by Scottish Muslims while interacting with law enforcement, with a particular focus on airports. The project’s scope includes an investigation into the experiences of 38 Muslim Scots who have interacted with airport authorities through individual and focus group interviews and examining common themes that surfaced in those discussions. The paper’s central claim or argument is that, despite the seeming insignificance of interactions with airport authorities, such encounters can give rise to severe problems for British Muslims who may feel their identities are denied, misrecognized, and their agency is limited.

Study aim

The purpose of this article by Blackwood et al., (2013) was to investigate the interactions of Scottish Muslims with law enforcement, namely at airports. The study’s overarching goal was to investigate how British Muslims’ interactions with others influenced their sense of self and prompted concerns about how they were perceived and where they stood in the eyes of others.

Methods

The research was conducted using a qualitative methodology. Data from a sample of individuals in three Scottish cities were gathered via semi-structured interviews and focus groups. The researchers used semi-structured interview questions to learn about participants’ encounters and perceptions of those encounters. The narratives and anecdotes shared by the respondents during the semi-structured interviews served as the primary evidence for the study.

Observations

From the results, most Muslim participants agreed that airports posed a significant problem and that they had experienced discrimination and humiliation due to their religion. The research employed semi-structured interviews and focused groups as its experimental manipulation strategy. Other than asserting a specific frequency of occurrence, the study sought to understand better the variety of interactions with authoritative figures and the many possible ways in which they might be perceived and understood.

Conclusion

Most respondents agree that airports present difficulties and that being stopped at an airport is an unjust and humiliating experience, especially for Muslims. The study shows a pattern of observations that fits with this larger hypothesis. For example, all but two of the 38 interviewees said that airports were the wrong place to have bad experiences with authorities, and a “prototypical Muslim airport story” was seen that helps people understand their own experiences with authorities.

Broader implications of work

This research contributes to our understanding of the topic by delving into the unique perspectives of Muslim passengers in airports. This work also highlights how such encounters might threaten not just one’s professional, corporate, and communal elder identities but also the dynamics of gender practices (Blackwood et al., 2013). This study’s findings have real-world applications for airport security measures since they emphasize the negative impact on individuals who have been stopped simply because of their Muslim identity.

References

Blackwood, L., Hopkins, N. and Reicher, S. (2013) “I know who I am, but who do they think I am? Muslim perspectives on encounters with airport authorities,” Ethnic and Racial Studies, 36(6), pp. 1090–1108. Available at: https://doi.org/10.1080/01419870.2011.645845.

Instructions

·
A 1500-word critical comparison of two research

· An even-handed critical analysis (
Compare and contrast) of two studies based on the strengths and weaknesses of qualitative and quantitative approaches (this requires extra reading)

·
Critically evaluate the ideas and methods portrayed.

· Concentrate on the scholarly content of the presentations

· Intro (250 words)

· Summary 1(300 words)

· Summary 2(300 words)

· Analysis and integration (400)

· Conclusion (250 words)

· Files for the two studies are attached in different document

· (Summary one and summary two are already done so you only have to do the introduction, the analysis and integration and the conclusion

· Please include everything in text citation in everything and put the link of the website down below without referencing it.

· Please do not write over 900 words as the 2 summaries are already 600 words

image1

1Scientific RepoRts | 7:46104 | DOI: 10.1038/srep46104

www.nature.com/scientificreports

Daily touchscreen use in infants and
toddlers is associated with reduced
sleep and delayed sleep onset
Celeste H. M. Cheung1, Rachael Bedford2, Irati R. Saez De Urabain1, Annette Karmiloff-Smith1
& Tim J. Smith3

Traditional screen time (e.g. TV and videogaming) has been linked to sleep problems and poorer
developmental outcomes in children. With the advent of portable touchscreen devices, this association
may be extending down in age to disrupt the sleep of infants and toddlers, an age when sleep is
essential for cognitive development. However, this association has not been demonstrated empirically.
This study aims to examine whether frequency of touchscreen use is associated with sleep in infants
and toddlers between 6 and 36 months of age. An online survey was administered to 715 parents
reporting on child media use (daily exposure to TV and use of touchscreens), sleep patterns (night-time
and daytime sleep duration, sleep onset – time to fall asleep, and frequencies of night awakenings).
Structural equation models controlling for age, sex, TV exposure and maternal education indicated
a significant association between touchscreen use and night-time sleep, daytime sleep and sleep
onset. No significant effect was observed for the number of night awakenings. To our knowledge, this
is the first report linking the use of touchscreen with sleep problems in infants and toddlers. Future
longitudinal studies are needed to clarify the direction of effects and the mechanisms underlying these
associations using detailed sleep tracking.

Sleep is the dominant activity of an infant and plays an important role in neurodevelopment and synaptic plas-
ticity1–3. Both the brain and sleep patterns undergo parallel and substantial developmental change during the first
few years of life. Given that neural plasticity is at its greatest during infancy and toddlerhood4, sleep is likely to
have the most impact on the brain and on cognition during this critical period of early development. Yet, around
20–30% of young children experience problems with sleep5. One known environmental contributor to poor sleep
is the heavy use of screen media, such as TV and videogaming (see review 6,7). In recent years, family ownership
of touch screen devices has risen rapidly (from 7% in 2011 to 71% in 2014)8. Reports from 2016 indicated that
86% of UK family homes have access to the Internet, with access mainly via portable media devices9. For infants
and toddlers, touchscreen devices offer an intuitive and attractive source of stimulation10, and their portability
allows for a wide range of use across multiple settings11. Yet, the widespread use in this age group has raised
serious concerns for parents, educators and policy makers, as the potential impact of touchscreen use on toddler
development, such as sleep, remains unknown. In this study, we use data from a large UK survey (see ref. 12 for
details) to investigate the relationship between touchscreen use and sleep in infants and toddlers between 6 and
36 months of age.

Problematic sleep in children is not uncommon. A recent longitudinal study mapped the sleep trajectories in
around 3000 children from birth to 7 years and found that 60% of the children have atypical sleeping patterns:
the majority of whom were initially short sleepers (45%), others were either persistent short sleepers (12%) or
poor sleepers (3%). Compared to the typical sleepers, all three groups showed some degree of impaired physical,
emotional and social functioning13. The results suggest that, even though some infants with atypical sleep patterns
early on eventually develop typical patterns of sleep by 6 or 7 years of age, reduced sleep duration in the first two
years of life may have long-term consequences on later developmental outcomes. These findings are mirrored by
several follow-up studies in children and adolescents, showing significant associations between sleep difficul-
ties or irregular bedtime and later problems with mental and physical health and lower cognitive and academic

1Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK. 2Biostatistics
Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK. 3Psychological
Sciences, Birkbeck, University of London, London, UK. Correspondence and requests for materials should be
addressed to T.J.S. (email: tj.smith@bbk.ac.uk)

received: 10 November 2016

accepted: 08 March 2017

Published: 13 April 2017

OPEN

mailto:tj.smith@bbk.ac.uk

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2Scientific RepoRts | 7:46104 | DOI: 10.1038/srep46104

performance13–17. As such, specific guidelines have recommended screens to be kept out of a child’s bedroom spe-
cifically because of the potential impact they may have on sleep9,18. To date, research into the long-term impact of
poor sleep during early development remains limited. Yet, findings so far converge, linking shorter sleep duration
to negative developmental outcomes.

Media use has frequently been linked with inadequate sleep in children and adolescents (see 6,7 for review).
The majority of studies (~90%) show a consistent pattern linking increased screen time with shorter total sleep
time and delayed bedtime. This association was observed across various types of media including TV, computer
and mobile phone devices. Research on touchscreen media and sleep in children is by comparison, more lim-
ited. A recent meta-analytic review identified 20 studies in children and adolescents aged between 6 and 19, and
found strong and consistent evidence for detrimental effects of portable touchscreen devices on sleep quality
and quantity19. Specifically, individuals who are exposed to or have access to a portable media device at bedtime
have significantly reduced night-time sleep and increased poor quality of sleep (defined as difficulties in sleep
initiation and maintenance). To date, only a handful of studies have explored the impact of screen media on sleep
in preschool infants and toddlers – all of which included only TV as media type20–24. All studies used parent
questionnaires, and have reported a significant effect of screen time on sleep: increased amount of TV viewing
was associated with parent-reported sleep problems24, shorter night-time sleep duration20,22, reduced quality of
sleep23, and irregular naptime and bedtime schedules21, adjusting for known confounds including socioeconomic
status (SES). Other maternal or child characteristics were also included in some studies, including maternal age,
education, pregnancy BMI; child’s ethnicity and gender20,22. Portable touchscreen devices may exacerbate the
problem by allowing small children to increase screen time throughout the day and carry the screen into their
sleeping space. Yet, so far no studies have examined the impact of touchscreen use on infant and toddler sleep.

In our UK-based survey on 715 families, we reported that 75% of toddlers between 6 months and 3 years of
age use a touchscreen on a daily basis12. This figure is similar to another study from the UK25 and to reports from
other countries in both high10 and low SES communities26. In our sample12 we found that the prevalence of daily
use increases substantially with age, from 51% in 6- to 11-month-old infants to 92.05% by 25–36 months. Even
among the 25% of children who did not use a touchscreen daily, only 42% reported no prior use. Among users,
daily usage increased with age from 8.53 minutes a day (6–11 months) to 45 minutes a day (26–36 months). Given
the evidence that 1) media use is linked to poor sleep in older children and adults, 2) touchscreen use in infants/
toddlers is highly prevalent, and 3) sleep plays a prominent role in early cognitive and brain development, it is
critical to investigate whether touchscreen use is associated with sleep problems early in development.

Using a large online survey, this study aims to investigate whether the frequency of daily touchscreen use is
associated with sleep in infants and toddlers between 6 and 36 months. Parents were asked to report on the aver-
age duration of their child’s daytime and night-time sleep, the time taken for their child to fall asleep, as well as the
frequency of night awakenings, to obtain a comprehensive account of infant/toddler sleep patterns.

Results
As we have reported in our previous study12, the average touchscreen usage in this sample is 24.44 minutes
(Table 1). Descriptive statistics for the sleep variables split by age quartiles are also presented in Table 1. Modest

Age quartiles Total

6–11 m 12–18 m 19–25 m 26–36 m 6–36 m

Age (months)
M

(SD)

N

8.99
(1.82)

134

14.40
(2.19)

215

21.94
(2.07)

179

30.64
(3.07)

187

19.52
(8.26)

715

Male %
N

51.49
134

53.02
215

55.87
179

51.34
187

53.01
715

Background TV (minutes)
M

(SD)
N

209.72
(186.08)

123

189.62
(172.70)

194

187.00
(162.99)

145

219.01
(183.24)

151

200.27
(175.99)

613

Touchscreen use (minutes)
M

(SD)
N

8.53
(15.54)

123

18.80
(36.83)

194

25.18
(37.46)

145

44.11
(47.75)

150

24.45
(38.98)

612

Night-time sleep duration
(minutes)

M
(SD)

N

637.24
(64.81)

116

647.24
(50.13)

176

651.25
(60.12)

132

643.21
(61.81)

130

645.16
58.66
554

Daytime sleep duration
(minutes)

M
(SD)

N

139.05
(47.27)

116

122.47
(38.40)

176

100.57
(40.28)

132

68.25
(53.20)

126

108.29
(51.15)

552

Total sleep (sum of night-time
& daytime sleep)

M
(SD)

N

776.29
(64.94)

116

769.31
(51.84)

175

751.82
(71.09)

132

711.63
(68.23)

126

753.34
(67.84)

549

Average number of night
awakenings

M
(SD)

N

2.00
(1.73)

116

1.29
(1.33)

177

0.91
(1.01)

133

0.58
(0.81)

130

1.17
(1.35)

556

Sleep onset
M

(SD)
N

22.80
(23.69)

116

21.54
(16.53)

177

22.22
(16.97)

131

29.34
(27.86)

130

23.79
(21.49)

551

Table 1. Descriptive statistics: Parent reported touchscreen use and sleep patterns in 6- to 36-month-olds.

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3Scientific RepoRts | 7:46104 | DOI: 10.1038/srep46104

but significant correlations are observed amongst the sleep variables, with the exception of daytime sleep and
sleep onset, which were not significantly correlated (Table 2).

To examine the relationship between touchscreen use and sleep, a saturated path analysis model was run
(see Fig. 1), with the sleep variables (duration of sleep at night, duration of sleep during the day, sleep onset, and
frequency of night awakenings) as correlated dependent outcomes, and tablet use, as well as several covariates
(average duration of daily TV exposure, age, mother’s education, and sex) as predictors. There was a signifi-
cant association between touchscreen use and duration of sleep at night (beta = − 0.291, SE = 0.062, p < 0.001), duration of sleep during the day (beta = 0.139, SE = 0.068, p = 0.042), and sleep onset (beta = 0.213, SE = 0.051, p < 0.001), with increased touchscreen use associated with decreased night-time sleep, increased daytime sleep and a longer sleep onset. There was no significant association between touchscreen usage and frequency of night awakenings (beta = 0.068, SE = 0.044, p = 0.122).

Results also showed a significant association between average duration of daily TV exposure and duration of
daytime sleep, independent of frequency of tablet use (beta = − 0.093, SE = 0.040, p = 0.020), with increased TV
exposure associated with less sleep in the day. No other associations between TV exposure and the sleep variables
were found (p values > 0.134). Sex was also only associated with sleep during the day (beta = − 0.103, SE = 0.036,
p = 0.004) with boys sleeping more than girls. The effect of age was significant across all sleep variables (except
time to put to sleep; p = 0.228), with older children showing increased duration of sleep at night (beta = 0.099,
SE = 0.045, p = 0.028), decreased duration of sleep during the day (beta = − 0.574, SE = 0.031, p < 0.001), and less night awakenings (beta = − 0.349, SE = 0.038, p < 0.001). No significant effects of maternal education were found (p values > 0.107).

To test whether touchscreen use was significantly associated with the total amount of sleep (i.e., day
time + night time sleep) we re-ran the model replacing the outcome variables sleep at night and sleep during the

Night-time sleep
duration

Daytime sleep
duration

Sleep
onset

Daytime sleep duration − 0.24^ — —

Sleep onset − 0.32* − 0.02 —

Average number of awakenings − 0.31* 0.11* 0.19*

Table 2. Correlations of the sleep variables. Pearson’s correlations were conducted for the correlation
between night-time and daytime duration as these two variables were normally distributed. Spearman’s rho
correlations were conducted for all remaining comparisons as sleep onset and average number of awakenings
were not normally distributed. ^Pearson’s r correlations, p < 0.01. *Spearman’s rho correlations, p < 0.01.

Figure 1. Path diagram showing the association between tablet use and sleep, controlling for TV exposure, age,
maternal education and sex (0 = male, 1 = female). Solid black arrows with standardized coefficients represent
significant pathways, grey arrows show non-significant pathways. Correlations between the predictor variables
and between the outcome variables were included in the model but are not shown in the figure for simplicity.

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4Scientific RepoRts | 7:46104 | DOI: 10.1038/srep46104

day with their sum ‘total sleep’. The other associations specified in the model remained the same. Results showed
that increased touchscreen use was associated with decreased overall amount of sleep (beta = − 0.146, SE = 0.049,
p = 0.003). The unstandardized beta value (− 0.26) means that every additional hour of touchscreen use is associ-
ated with an overall reduction in sleep of 15.6 minutes.

Discussion
Data from 715 UK infants and toddlers aged 6–36 months indicated a significant association between the fre-
quency of touchscreen use and sleep quantity (reduced total duration, with reduced duration of night-time and
increased daytime sleep), and longer sleep onset (time taken to fall asleep). Every additional hour of tablet use was
associated with 15.6 minutes less total sleep (on average, 26.4 minutes less of night-time sleep and 10.8 minutes
more of daytime sleep). However, we found no association between touchscreen use and the number of night
awakenings. To our knowledge, this is the first study to investigate the association between touchscreen use and
infant/toddler sleep. Our results are consistent with a recent meta-review in older children and adolescents illus-
trating the negative effects of touchscreen use on sleep quality and quantity27, extending the findings to younger
children under the age of 3. Our results also extend existing reports on the negative effects of TV exposure on
sleep in this age group20–24. We show that, independent of other known factors related to sleep and touchscreen
use (age, sex, maternal education and TV exposure), touchscreen use was robustly associated with many sleep
attributes.

Studies that have examined media use and sleep have hypothesized four potential mechanisms by which
screen time can affect sleep in older children and adolescents. Firstly, electronic media may directly displace
the time that children have available for sleep, leading to later bedtime and shorter night-time sleep duration6,7.
Secondly, the content of the media may elevate psychological and physiological arousal, making it more diffi-
cult for children to fall asleep and reducing the quality of sleep28. Third, the bright blue light from screens can
affect the circadian timing through melatonin suppression29,30, indirectly affecting arousal levels. Fourth, certain
heritable traits in a child such as sensation seeking or hyperactivity, which correlate highly with his/her family
environment, may also lead to both irregular sleep patterns and increased tablet use. As infants and toddlers have
less control over their bedtime schedule, the displacement account is less likely to explain shorter sleep duration
than in older children or adolescents, unless parents are, themselves inconsistent and irregular in their night-time
routine. However, the portability of touchscreens does allow more flexibility in terms of where such devices are
used. As such, some young children who have a touchscreen device in their bedroom may delay falling asleep in
favor of playing on a touchscreen or even seek the device when restless in the night. Our finding of increased sleep
latency could be due to increased physiological arousal from the media content or from the bright light. However,
in the current study we are unable to confirm these hypotheses, as information on the time or nature of exposure
is not available. Future research is needed to clarify this relationship by carefully documenting the time and con-
tent of use, and, if possible, also measure melatonin levels, physiological arousal and specific temperament traits.

In addition to shorter night-time sleep, increased touchscreen use was also associated with increased daytime
sleep. Similarly, increased background TV exposure (not necessarily TV that the child is watching) was also inde-
pendently associated with reduced daytime sleep. Recent studies in toddlers suggest that daytime nap duration is
negatively correlated with night-time sleep duration and sleep onset31. As such, touchscreen use may indirectly
influence daytime sleep duration by reducing night-time sleep quality, or vice versa. This hypothesis would also
be consistent with studies in older children, which found increased media use affecting daytime functioning due
to indirect effects of poor quality and quantity of night-time sleep32. However, unlike school children, infants
and toddlers regularly nap in the day. Thus, the indirect impact of media use on emotional and cognitive func-
tioning through sleep might be lessened in this younger age group, as they are able to ‘catch up’ with their sleep
during the day. Our findings indicate that this may not be the case, as despite on average sleeping more during
the day, infants and toddlers who spend more time on a touchscreen still spend less overall time sleeping. Future
studies that examine the impact of media use on developmental outcomes in this younger age group should take
into account both daytime and night-time sleep duration. In addition to the quantity of sleep, Nakagawa and
colleagues also reported an association between day time naps that occurred during late afternoon and shorter
night-time sleep duration and late sleep onset time31. The extent to which increased touchscreen use affects tim-
ing of daytime naps cannot be determined in the present study, but warrants further investigation.

Sleep fragmentation, as measured by the number of night awakenings, was not associated with touchscreen
use in the current study, when controlling for the known confounds. Previous studies in older children and
adolescents that included this variable have reported mixed results: while one study found a positive association
between media use and self-report night-time awakenings in adolescents33, another study in younger children
aged between 4 and 10 years did not34. However, sleep fragmentation in the previous and current study was based
on self or parent-report, which may not be reliable. A recent study in infants using both parent-report and an
objective actigraphy measure of sleep revealed a weak association between the two measures for the frequency of
night awakening (r = 0.10), but a strong correlation for nocturnal sleep duration (r = 0.43)35. Furthermore, the
objective measure of sleep fragmentation was also found to have the strongest impact on infant cognitive devel-
opment35. Although we did not find an association between touchscreen use and sleep quality, this could be due
to an underestimation of night awakenings by parent report. It is important that future studies also include an
objective measure of sleep fragmentation, either using actigraphy or EEG measures.

In this study, we included a range of specific sleep outcomes encompassing quality, quantity and onset of
sleep. Our findings extend the limited knowledge at present on media use and sleep in toddlers beyond TV
exposure. Yet, a few limitations should be noted. Firstly, our findings are based on cross-sectional data, therefore
a directional relationship between touchscreen use and sleep cannot be established. It is possible that infants and
toddlers who use touchscreen devices more frequently also require less sleep. Future longitudinal or intervention
studies will be needed to examine the direction of causality. Secondly, as mentioned above, we did not include

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5Scientific RepoRts | 7:46104 | DOI: 10.1038/srep46104

specific records of the timing, content and location of use. Such information would be crucial in future studies to
elucidate the mechanisms by which touchscreen usage impacts sleep patterns. Previous studies in older children
do suggest, however, that it is not the exposure to a media device per se that impacts sleep, but the modifiable
aspects of media such as content, timing and environment that may have a damaging effect on sleep24. Third, the
current study only investigated the association between touchscreen use and sleep, it will be important for future
studies to establish whether this reduced sleep indirectly impacts cognitive functioning. It is worth noting that
touchscreen use may also have positive effect on some aspects of development. In our recent study of the same
sample of infants and toddlers, increased active touchscreen use was associated with earlier achievement in fine
motor milestones12. Thus, total restriction of touchscreen use may limit young children in terms of the potential
benefits of these devices. Together, our findings emphasize the need for a more in-depth understanding of how to
maximize benefits and minimize negative consequences of this modern technology.

Methods
Participants. In total, 715 UK-based parents of 6- to 36-month-old children completed an online question-
naire asking questions about demographic information, their child’s media usage and retrospectively reported
developmental milestones. The questionnaire was administered between June 2015 and March 2016. Parents
were informed about the broad aim of our online survey: to examine how use of touchscreen devices such as
smart phones or tablets might influence infants’ development. Specifically, we were interested in the impact on
developmental milestones, sleep and temperament. We encouraged all kinds of users, including babies that had
never used a touchscreen. Parents completed the questionnaires, on a voluntary basis, which took on average
15 minutes. The final sample size for each variable varied due to missing data for certain questionnaire elements
(see Table 1). An online survey was chosen in order to allow maximum response from a range of socioeconomic
groups, varying degrees of touchscreen use and to reach families across the UK. Parents were recruited via the
Birkbeck Babylab database, Goldsmiths’ Babylab database and study advertisements from various news agencies,
magazines and agencies including National Childbirth Trust (NCT). All methods in the study were carried out
in accordance with the latest version of the Declaration of Helsinki, and all experimental protocol were approved
by the Birkbeck Psychological Sciences’ ethics board (approval number 141570). Informed consent of the partic-
ipants was obtained after the nature of the procedures had been fully explained.

Information was collected about the child’s age (mean age = 19.52 months, SD = 8.26 months) and sex (336
females), as well as mother’s educational level (a proxy for family socioeconomic status, SES; “What is the highest
degree or level of education the mother of the child has completed?” Responses were “Not applicable”, N = 3;
“School leaving qualification”, N = 20; “College”, N = 79; “University”, N = 294; and “Post-graduate”, N = 319).
Parents were also asked about child illnesses, but no sleep-related disorders were reported.

Measures. Touchscreen usage and TV exposure. Media questions were derived from existing questionnaires
investigating touchscreen usage8,36,37. Parents reported on the frequency of child’s daily touchscreen use: ‘On a
typical day, how long does your child spend using a touchscreen device?’. For TV exposure, parents were asked
‘On a typical day, how long is a TV switched on in your home?’.

Sleep variables. The Brief Screening Questionnaire for Infant Sleep Problems (BISQ38) was used to assess
infant sleep. This measure has been validated against actigraphy and daily logs, and is sensitive to developmental
changes in infant and toddler sleep in the first 3 years38. Five sleep variables were obtained by asking parents
to report on their child’s (1) night-time sleep duration: ‘How much their child spent sleeping during the night
(between 7 pm and 7 am)’; (2) daytime sleep duration: ‘How much does your child spend sleeping during the day
(between 7 am and 7 pm)’; 3) number of night awakenings: ‘What is the average number of times your child wakes
up per night’; and 4) sleep onset: ‘How long does it take to put your child to sleep in the evening?’.

Statistical Analysis. Data were initially cleaned using scripts in SPSS39 to remove any impossible values
due to entry errors. One child’s reported daily touchscreen usage time was removed (recoded as missing) from
the current analyses (a clear outlier of 1200 minutes per day which was > 19 SDs above the mean). For nocturnal
sleep duration, one outlier was removed (18 hours, 6.5 SD above the mean). In addition, scores were capped at
12 hours in line with the questionnaire (duration of sleep at night ‘between 7 pm and 7 am’) with all values above
this trimmed back to 12 hours (n = 12). For daytime sleep duration, three responses were removed as they were
clear outliers (10–14 hours, 6.5 SDs above the mean). For sleep onset, four responses were > 8 SDs above the mean
(10–20 hours), and were removed. No exclusions were made for the average number of night awakenings. Sleep
onset and average number of night awakenings were positively skewed and contained zero values. An integer of
one was added to all values in these variables, which were then transformed to normal using the Zero-skewness
Box-Cox transformation (bcskew0 command in Stata40). Duration of night-time sleep was slightly skewed (skew-
ness of − 1.25), but rather than transform this variable, we accounted for this slight non-normality by applying
an estimator with robust standard errors in the analysis. To test the relationship between touchscreen usage and
sleep, a saturated path analysis model was estimated in Mplus41, using maximum likelihood with robust standard
errors (MLR), covarying for age, sex, maternal education and background TV exposure. The MLR estimator
assumes data are missing at random42, where missingness relates only to observed variables. Standardized model
results (STDYX) are presented.

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Acknowledgements
We are very grateful to all the parents who took part in this online questionnaire and to the Centre for Brain and
Cognitive Development, Goldsmiths Babylab, the NCT and Fundamentally Children for help with recruitment.

https://www.ofcom.org.uk/__data/assets/pdf_file/0027/76266/childrens_2014_report

https://www.ofcom.org.uk/__data/assets/pdf_file/0027/76266/childrens_2014_report

https://www.ofcom.org.uk/__data/assets/pdf_file/0024/26826/cmr_uk_2016

https://www.ofcom.org.uk/__data/assets/pdf_file/0024/26826/cmr_uk_2016

http://www.techandplay.org/reports/TAP_Final_Report

http://www.techandplay.org/reports/TAP_Final_Report

https://www.ibm.com/analytics/us/en/technology/spss/

https://www.ibm.com/analytics/us/en/technology/spss/

http://www.stata.com

https://www.statmodel.com

www.nature.com/scientificreports/

7Scientific RepoRts | 7:46104 | DOI: 10.1038/srep46104

We also thank Shaili Shah for help with data cleaning. The Tablet Project was funded by a Philip Leverhulme Prize
(PLP-2013–028) to TS. RB was supported by a Sir Henry Wellcome Postdoctoral Fellowship.

Author Contributions
C.C.: coordinated questionnaire recruitment, processed and analysed the data, and wrote the paper; R.B.:
conceptualized and designed the study, analyzed the data and wrote the paper; I.S.U.: designed and implemented
the questionnaire, processed the data, and contributed to drafts of the paper; A.K.-S.: conceptualized and designed
the study and contributed to drafts of the paper; T.S.: conceptualized and designed the study and contributed to
drafts of the paper.

Additional Information
Competing Interests: The authors declare no competing financial interests.
How to cite this article: Cheung, C. H. M. et al. Daily touchscreen use in infants and toddlers is associated with
reduced sleep and delayed sleep onset. Sci. Rep. 7, 46104; doi: 10.1038/srep46104 (2017).
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and
institutional affiliations.

This work is licensed under a Creative Commons Attribution 4.0 International License. The images
or other third party material in this article are included in the article’s Creative Commons license,

unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license,
users will need to obtain permission from the license holder to reproduce the material. To view a copy of this
license, visit http://creativecommons.org/licenses/by/4.0/

© The Author(s) 2017

http://creativecommons.org/licenses/by/4.0/

  • Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset
  • Results

    Discussion

    Methods

    Participants.

    Measures.

    Touchscreen usage and TV exposure.

    Sleep variables.

    Statistical Analysis.

    Acknowledgements

    Author Contributions

    Figure 1.  Path diagram showing the association between tablet use and sleep, controlling for TV exposure, age, maternal education and sex (0 = male, 1 = female).

    Table 1.  Descriptive statistics: Parent reported touchscreen use and sleep patterns in 6- to 36-month-olds.

    Table 2.  Correlations of the sleep variables.

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Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset

srep , (2017). doi:10.1038/srep46104

Celeste H. M. Cheung
Rachael Bedford
Irati R. Saez De Urabain
Annette Karmiloff-Smith
Tim J. Smith

doi:10.1038/srep46104

Nature Publishing Group

© 2017 Nature Publishing Group

© 2017 The Author(s)
10.1038/srep46104
2045-2322

Nature Publishing Group

permissions@nature.com

http://dx.doi.org/10.1038/srep46104

doi:10.1038/srep46104

srep , (2017). doi:10.1038/srep46104

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