Screen Time Before Bed and Sleep Patterns in AdolescentsKatherine Harp – Lead InvestigatorAngela Lee – Faculty Supervisor

Introduction:

Screen time amongst adolescent children has proven to yield various different effects; effects

ranging from violence to obesity. In response to this, many different pediatric organizations,

such as the American Academy of Pediatric or AAP (Jago), have established digital time limits

for children above the age of five. Despite these recommendations, American children are using

technological devices at all times of the day; from the moment they wake up to the second they

go to bed. Jago et. al discusses how the number of devices within a household can contribute to

increased media usage time. If tablets, televisions, and phones constantly surround children,

their eyes will absorb more light and their minds, more information. This round-the-clock media

usage at home and at school can cause developmental problems as the children grow older,

starting with something as simple as their sleep. I was interested in this topic because, as an aunt

and a childcare giver, I see children that are completely absorbed into their iPad’s or phones. It

is not uncommon to see children that will throw tantrums when the devices are turned off or

taken away. I wanted to look at how this addiction to media devices at startling young ages

affects children's development and sleep. If children growing up in the 21st century are

consuming large amounts of white light from devices immediately before they go to bed, how

does that affect their quality of sleep? Perhaps even further, does this cause them to not sleep at

night? My research survey was set out to answer the question: does screen time before bed

affect children’s sleep?

Literature Review:

In the 21st century, technological advancements have enabled nearly every single American to

have access to the digital world no matter where they are or what time of day it may be. These

technological advancements have rubbed off onto younger generations who are consuming

massive amounts of media each day without acknowledging the effects this media usage has on

them both socially and developmentally. It is well known that children are having much more

difficult time falling asleep each night because, growing up in the technology age, they have

created poor bedtime habits that hinder their melatonin development and keeps them from

naturally falling asleep.

Jago et. al set out to see if parental screen-time and electronic media usage was associated with

how much time their children spent using screen-time. Data collected between March 2009 and

January 2010 showed that televisions in the bedroom was associated with the child watching

more television in a day (especially on the weekends); additionally, that the number of electronic

game devices was a good indicator of whether or not the child would spend more time using

other mediums. Having a multitude of devices that are easy and readily available for children to

use is leading to increasing times that they are using these devices. Jago et. al was able to find

this correlation between not just televisions and gaming devices, but with laptops/ PC’s as well.

Especially when it came to having these devices within the walls of their own bedrooms, where

they spend majority of their time away from their parents’ supervision. Ownership of these

devices within the bedroom generally correlated to the children using >1 hour per day using

combined media that was different from the one that they had the ownership of (Jago).

Additionally, parents who modeled habits that included consuming large amounts of media had

an effect on how much media their child consumed (Jago). This is vitally important for parents

to understand that they are modeling what habits their children will soon exhibit. Jago et. al

found that if parents watched more than two hours of television a day, their children were

between 1.5-8 times more likely to do the same. Overall, parents need to become more aware of

how available devices are to their children, as well as aware of what they are modeling for their

children to absorb as habits. Children of parents who allow them to use a multitude of devices at

younger ages will only lead to an increase in the time they spend on devices, which ultimately

has an effect on their social, cognitive, and developmental processes.

Atkin et. al is a cross-sectional study that looked to see if ownership, bedroom media, and

sedentary behaviors were all linked together in school aged children. This cross-sectional self-

reported study looked at the children at a baseline in 2007, then a follow up in 2008 (1 year

later), and the last survey was conducted in 2011 (4 years later). When it came to the media

devices in the bedroom, researchers focused on televisions and computers as well as the

ownership of those devices (Atkin). Over the four year period, Atkin et. al found that the

participants that had televisions in their bedrooms decreased from 70.9% at year one to 42.5% at

year four. The families that more often had televisions in their bedrooms came from low SES

and children with laptops/computers in their bedrooms came from urban areas. The most

important finding from this research was that the number of children that had absolutely no

electronic devices in their bedroom went up from 25.2% to 48.9% within that four-year period

(Atkin). Taken into account that Atkin et. al also found that there is that positive association

between media in children's bedrooms and the overall amount of screen time the child then

received. The findings in Atkins et. al are very interesting in that they show perhaps parents,

who see how often their children are using media, will do anything they can to monitor and cut

down that media time within the walls of their bedroom. Taken into a larger scale, poor media

habits can be broken down and meditated in as little as four years.

Adolescent media effects studies has shown that home setting is an incredibly important factor

on how often and how much media a child consumes. Carson and Janssen set out to see what

effects the attitudes on screen time at home amongst preschool aged children had on the amount

of media they consumed. The study took into account interpersonal factors, intrapersonal, and

physical factors that could lead to either more or less screen time for each child. Parental

attitudes, viewing rules and regulations, and barriers were some of the topical questions

(Carson). The study found that “age, parental attitudes, parental barriers, parental descriptive

norms, parental screen time, having a television in the bedroom, and having video games in the

bedroom were positive correlates of screen time (Carson).” This shows that parents are the ones

that hold the key to their child’s media usage and the pattern that are then created from their

media usage. Carson’s findings did show that a television and video games in the bedroom were

associated with higher doses of screen time. Constant access to televisions, computers, tablets,

etc. are enabling children to consume massive amounts of media. The home setting is the most

important factor for all of a child’s development, from healthy eating habits to fostering a sense

of self; parents need to create barriers for their children so that they are not tempted to develop

bad media habits that will hinder them socially and developmentally.

Popular press articles have also taken data collected from research and have expanded on how to

better aid those in breaking bad digital habits. “Junk sleep” from CNN discusses how the

National Sleep Foundation found in 2013 that approximately 75% of children have at least one

electronic device in their bedroom. These electronic devices are hindering the beneficial

development of melatonin (hormones enabling our bodies to fall asleep) and keep them from

establishing sleep patterns that both children and adults need (Breus). Not only does the white

lights emitted from devices keep our bodies from naturally producing melatonin, but every single

electronic device emits low levels of radiation which keeps the human body from reaching deep

sleep (Breus). Having these devices in our bedrooms are not only keeping us from falling asleep

because they keep buzzing, but they are actually harming our health and putting us at risk to low

levels of radiation. Effects are still unknown as to what a large amount of radiation can do to a

young child, perhaps disrupting their sleep on a nightly basis could be just the tipping point of

the media effects.

All of the aforementioned studies and articles show how parents are the key factors in

monitoring and limiting their child’s media usage, both at home and while they are away.

Creating barriers and healthy routines are what children developmentally need, their media usage

should be just the same. Establishing beneficial screen time and device usage for children will

help mediate the negative effects that devices can have more than just their sleep patterns.

Method and Participants:

The study collected data between October 21, 2015 and November 25, 2015 on children 2-13

years old in the Dallas, TX area. Parents of children between the ages of 2-13 were recruited via

social media sites and word of mouth. From there, the parents were able to participate in one of

two surveys: one that served as a daily log for one week that looked into media usage before bed

and the sleep patterns of their child each night or a survey that looked specifically at the media

usage and sleep patterns of their child the night before. The weeklong survey was to be

completed by one parent for one child each week; if the parent had more than one child they

were instructed to wait until the following week to fill out the survey for any additional children

in the household. Out of approximately 15 participants that were recruited for the surveys, three

responses were fully recorded from the weeklong survey. On November 4, 2015 the survey was

modified to record only information from the night before. This shorter survey allowed for

participants to fully finish the survey in one setting, allowing for 6 complete responses.

Measures that were found to have results are found in the appendix. Consent was obtained from

each parent in written form.

Data Collection Procedure:

Parents who consented to participate in the survey were sent, via email, the link and password to

their corresponding survey. All responses were kept anonymous; the only identifying data

collected were cookies placed on the Internet browser to allow for the ‘save and continue’ option

on the weeklong survey. Data was then collected and analyzed for patterns between the two

surveys. Questions were modeled after the Jago et. al “Parent and Child Screen-Viewing Time

and Home Media Environment” data collection. In both surveys, parents were asked to record

the number of televisions, laptops, cell phones, and tablets in the household. They were then

asked if the child was able to use those devices in their room at night, as well as the ownership of

those devices (i.e.: do the devices belong to a parent or to the child).

Data Analysis:

To examine the results of the two surveys, the shorter one-day survey was analyzed to find

patterns in the responses via cross tabulations. From there, the weeklong survey responses were

added to those results to show further and lasting correlation. Given the small number of

participants, few assumptions were generalized between media usage before bed and the amount

of sleep resulting that night.

Results:

Participant results are displayed in the appendix. The sample was composed of nine children

ages 2-13 years old with 88% of the participants identified as female.

Devices in the bedroom:

Responses gathered from both the weeklong and the shorter survey showed that children do not

have televisions, laptops, phones, or tablets in their bedrooms at night. The shorter survey did

show that children do not have technological devices in their rooms at night; but respondents

answered that 33% of the children did fall asleep with their device(s) on in their bedroom, while

the other 33% turned off devices more than two hours before bedtime. A variance in responses

from the same individuals is interesting and may show that parents have attitudes that do not

align with what they allow. When it came to the number of hours slept each night, data collected

showed that children of parents who are very unfavorable to kids' having devices in their

bedroom at night sleep more than kids of parents who are favorable; 10+ hours for those that are

unfavorable versus 9 hours to those that are favorable. Additionally, children of parents who are

unfavorable to device usage before bed did not wake up last night. However, the only child

whose parents are favorable did not know if their kid woke up or not. The variations in responses

shows that more research with a larger and more diverse number of participants will yield better

results that can be applied out further.

Ownership of devices:

When it comes to the ownership of the device, both surveys showed that children are more likely

to be the owner of either a cell phone or a tablet device. Upon discussion with parents, it was

discovered that affluent school districts are supplying children with their own tablet device to

complete homework on. This could give children access and ownership that they would initially

not have supplied from the parents, regardless of attitudes on devices. This ownership from

school can also influence children to stay on these devices for longer periods of time, whether or

not they are completing homework assignments. Research that follows children that have

ownership of their devices from ages 10-18 could see if the children use devices their own in

their rooms at night without their parents knowledge. This research could understand if

unsupervised usage of devices leads to hard to break media habits that, ultimately, disrupt sleep

at night.

Bedtime routines/Sleep patterns:

Both surveys showed that every single child has a bedtime routine that was consistent each night.

The weeklong survey showed that majority of children were able to maintain a fairly consistent

number of hours of sleep each night. One exception was found in the weeklong survey, one

specific child that tended to use devices closer to their bedtime reported experiencing less

beneficial sleep (i.e. waking up during the night or sleeping for less hours) for the week versus

the other children taking the weeklong survey. These consistent bedtime routines that keep

technological devices out of the bedrooms enable the child to have beneficial and consistent

sleep patterns each night. For example, one parent from the shorter survey responded that their

child is not allowed to have any screen time at night after dinner that only print books are

allowed. Overall, data collected from both surveys show that adolescents generally do not have

access to technological devices in their bedrooms at night and do have consistent bedtime

routines. These consistent routines are possibly what keep the children from engaging with the

bright lights emitted from devices in dark rooms, enabling for more beneficial sleep on average.

Co-watching of television:

When it came to co-watching television with their child, 33% of parents indicated that they

discuss the television show with the child in order to answer questions or discuss topics with the

child. This is an incredible finding that shows that parents are engaged in what their children are

watching and able to discuss the information with them. Data collected found that parents who

frequently or occasionally co-watch with kids report that they kids rarely have nightmares,

ultimately easing their minds and making it easier for them to understand tough topics that may

be discussed in adolescent televisions shows.

Strengths and Limitations:

There were many limitations to this survey process. Most importantly, the number of

participants (n=9) makes the findings very limited and difficult to relate on a larger scale.

Additionally, the survey sample was taken from a limited source, possibly skewing the

responses. Another limitation that was found out through the survey was that, with the

advancements in technologies, more schools are giving out and endorsing the usage of tablets to

complete homework assignments. This could cause children to use devices closer to their

bedtime, thus disrupting their sleep. Overall, more research on the same topic with a larger

sample would improve the applicability of results.

Unanticipated challenges:

There were many unanticipated challenges while conducting this survey. The initial creation of

the survey and IRB approval process took much longer than anticipated. This set back my

ability to send out the survey approximately three weeks, making it difficult to adjust the survey

in a timely manner. If I were to replicate the study, I would have initially ask parents I know if

they have approximately five minutes each morning to record how much their child slept and

what devices they used at night. This would have shown me that parents do not have this time

each morning and show me that my initial survey would fail in number of participants that were

able to complete the survey. Had I known that, I would have been able to jump straight to the

shorter survey that only took approximately 10 minutes one time to take. Looking at other survey

options, it would have been beneficial to know that I did not need to have written consent for

participation in my survey. I could have displayed consent before the survey with an accept

button within Qualtrics that could have been accepted as consent. This would have made it

much easier for people to complete the survey without the back and forth between the lead

investigator that resulted because of the need of a formal signature required with my consenting

process. Lastly, the recruitment process was much more difficult than I had initially thought it

would have been. If I were to replicate this survey, I would have asked for the university’s help

in recruiting participants via the SONA system. This would have increased the number of

participants tenfold and would have lead for a better variation of participants. Overall, I have

learned a lot from working hands on with this survey and have set a foundation for future and

more in depth research on children's media.

Conclusion:

This survey set out to see what happened to children’s sleep if they choose to fall asleep or use

media devices before bed. One major finding from this survey was that children generally do

have set bedtimes established by their parents. This finding show that it is incredibly beneficial

for the children to have an idea of what an established bedtime routines are so that they can

model the same thing as they get older. Slight patterns were found between media usage closer to

bed and less sleep time in one child. However, with just one child having these results, it is

difficult to see if these suggest anything more. Overall, more research with a larger sample

would prove beneficial in establishing a solid correlation between media usage before bed and

sleep disruption in adolescent children.

References:

Atkin, A., Corder, K., & Van Sluijs, E. (2013). Bedroom media, sedentary time and screen-time in children: A longitudinal analysis. doi:10.1186/1479-5868-10-137Breus, M. (2014, June 12). Junk sleep: When sleep and technology don't mix - CNN.com. Retrieved December 9, 2015, from http://www.cnn.com/2014/06/12/health/junk-sleep-live-longer/Carson, V., & Janssen, I. (2012). Associations between factors within the home setting and

screen time among children aged 0–5 years: A cross-sectional study. BMC Public Health, 539-539. doi:10.1186/1471-2458-12-539Jago, R., Stamatsakis, E., Gama, A., Carvalhal, I., Nogueira, H., Rosado, V., & Padez, C. (n.d.). Parent and Child Screen-Viewing Time and Home Media Environment. American Journal of Preventive Medicine, 43(2), 150-158. doi:10.1016

Appendix:How favorable are you to your child having devices in their bedroom at night? (i.e. televisions, phones, tablets, computers)

Very favorable 0

Favorable 1

Neutral 2

Unfavorable 3

Very unfavorable 3

Does your child have a consistent bedtime routine? (i.e. dinner at 7, bath at 8, books and bedtime at 8:30)

Yes 9

No 0

What is the number of televisions available for child to watch on a daily basis?

None 1

1 2

2 4

3 1

4 or more 1

How often do you co-watch television with your child? (i.e. you and your child actively watch television together)

Frequently 3

Occasionally 5

Rarely 1

Never 0

Does your child have a laptop/computer access in their bedroom?

Yes 0

No 9

Does your child have his/her own tablet?

Yes 2

No 7

Is your child allowed to use a/their tablet device in their bedroom?

Yes 3

No 6

Does your child fall asleep using this tablet? (i.e. screen is illuminated as they fall asleep)

Yes 0

No 3

Does your child have his/her own cell phone?

Yes 4

No 5

Does your child use a/their cell phone in their bedroom at night?

Yes 0

No 5

If your child has no devices in their bedroom, how long before bedtime are all devices turned off for the night?

15-29 minutes 0

30-59 minutes 1

60-89 minutes 1

90-120 minutes 0

more than 120 minutes 0

Does your child multitask between multiple devices at night (i.e. handling more than one device at the same time such as watching television and texting at the same time)

Yes 3

No 6

What is the gender of your child?

Male 1

Female 8

Does your child share a bedroom with any additional children in the household?

Yes 2

No 7

What is the approximate household income?

Less than $25,000 0

$25,000 to $34,999 1

$35,000 to $49,999 1

$50,000 to $74,999 1

$75,000 to $99,999 3

$100,000 to $149,999 1

$150,000 or more 2