Psychiatry · Medical Literature
Reducing Screen Time in Children With Borderline IQ: A Randomized Controlled Trial of a Parent-Mediated Screen Time Usage Module.
Abstract
Objective: The rapid expansion of mobile technology has significantly altered children's screen time behaviors, contributing to concerns about excessive usage. These changes are particularly relevant for children with borderline intellectual functioning, in whom unmanaged screen time may exacerbate developmental challenges. This study aimed to evaluate the effectiveness of a parent-mediated screen time usage module (PM-STUM) in reducing screen time and improving physical activity levels, sleep quality, and behavioral outcomes in children aged 4-12 years with borderline IQ. Methods: A randomized controlled trial was conducted with 60 children diagnosed with borderline IQ, recruited from a child and adolescent psychiatry outpatient department at a tertiary care hospital in North India. Participants were randomly allocated to intervention and control groups. The PM-STUM was delivered online to parents through 3 interactive sessions, each lasting 50-60 minutes, addressing the adverse effects of excessive screen time, general guidelines for regulation, technological management, and behavioral strategies for moderating screen time. Screen time was assessed using a 24-hour screen time diary, sleep quality was measured via the Children's Sleep Habits Questionnaire, behavioral outcomes were evaluated using the Strengths and Difficulties Questionnaire, and physical activity was assessed using a standardized physical activity questionnaire. Data were collected between July 15 and September 15, 2023, with outcome assessment conducted 6 weeks postintervention. Results: Repeated-measures analysis of variance indicated significant reductions in children's screen time (P <.05, η2P=0.4), improvements in physical activity (P <.05, η2P=0.2), enhancements in sleep quality (P <.05, η2P=0.3), and reductions in behavioral difficulties (P <.05, η2P=0.2) in the intervention group compared to controls. Conclusion: The PM-STUM demonstrated significant efficacy in reducing screen time and improving associated behavioral and health outcomes among children with borderline IQ. These findings underscore the importance of parent-mediated interventions in managing screen time and fostering healthier behavioral patterns in vulnerable pediatric populations. Trial Registry: Clinical Trials Registry, India: CTRI/2023/08/056180. Prim Care Companion CNS Disord 2026;28(4):25m04135. Author affiliations are listed at the end of this article.
Clinical relevance
Children with borderline intellectual functioning (IQ 70–85) represent a vulnerable and often underserved pediatric population in whom excessive screen time may compound existing developmental, behavioral, and sleep-related challenges. Despite growing clinical concern over screen time in pediatric populations broadly, there is a paucity of RCT-level evidence for targeted interventions in children with borderline IQ specifically. This trial addresses that gap by evaluating a scalable, parent-mediated, online-delivered intervention—highly relevant in the current era of ubiquitous mobile technology access.
Key findings
1. Significant reduction in screen time was observed in the intervention group versus controls at 6-week post-intervention follow-up (P < .05; partial eta-squared [ηp²] = 0.40), indicating a large effect size accounting for approximately 40% of variance in screen time outcomes. 2. Significant improvement in physical activity levels was demonstrated in the intervention group compared to controls (P < .05; ηp² = 0.20), representing a medium-to-large effect size. 3. Significant enhancement in sleep quality, as measured by the Children's Sleep Habits Questionnaire, was noted in the intervention group versus controls (P < .05; ηp² = 0.30), a medium-to-large effect size. 4. Significant reductions in behavioral difficulties, as assessed by the Strengths and Difficulties Questionnaire, were observed in the intervention group compared to controls (P < .05; ηp² = 0.20), again a medium-to-large effect size. 5. The PM-STUM was delivered via 3 online interactive sessions of 50–60 minutes each across a sample of 60 children aged 4–12 years with borderline IQ (n = 30 per arm), with outcome assessment conducted at 6 weeks post-intervention. 6. Note: Specific mean differences, confidence intervals, NNT, and NNH were not reported in the available abstract; effect size estimates (ηp²) are the primary quantitative metrics provided.
Practice implications
Child and adolescent psychiatrists and primary care clinicians managing children aged 4–12 years with borderline intellectual functioning should consider incorporating structured, parent-mediated screen time counseling—such as the PM-STUM model—into routine outpatient care, given its demonstrated large-to-medium effect sizes across screen time, sleep, behavior, and physical activity domains. The intervention's online delivery format (3 sessions of 50–60 minutes) makes it feasible for integration into telehealth workflows, lowering barriers to access for families of children with borderline IQ who may face logistical challenges attending in-person programs. Clinicians should prioritize parent psychoeducation covering adverse effects of excessive screen time, evidence-based regulatory guidelines, and behavioral strategies as a first-line, non-pharmacological approach before considering other management options for screen-time-related behavioral and sleep difficulties in this population.