OT Research Spotlight

What is the impact of screen time on children’s fine motor and visual perceptual skills? This research study compares the visual perceptual and fine motor skills between children that use electronic tablets and those that do not use tablets. The results are interesting, pointing to areas for further exploration by occupational therapy students and intervention options for occupational therapy practitioners.

Article

Differences between preschool children using tablets and non-tablets in visual perception and fine motor skills.

Author

Lin, Ling-Yi

Research Design

Cross-sectional

Objectives

(1) Investigate differences in visual perceptual and fine motor skills between children that use tablets and children that do not use tablets and (2) examines the association between visual perception ability and fine motor skills in both groups.

Participants

72 preschool children (mean age 61.9 +/-7.3 months; 46 males). Tablet and non-tablet group each had 36 participants.

Recruitment questions:

(1) Does your child use a tablet to play any game or educational purposes more than 6 months?

(2) How many times does your child use a tablet per week?

(3) How much time does your child play per time?

Inclusion criteria:

(1) Typically developing children ages four to six years.

(2) A score on the Peabody Picture Vocabulary Test-Revised that was above 85.

(3) No visual or hearing impairment.

Participant Group Assignment:

(1) Children who used tablets to play any game or for educational purposes more than once a week, for at least 20 minutes per time, for more than 6 months were assigned to the tablet group.

(2) Children who never used tablets were assigned to the non-tablet group.

Measures

Researchers examined the relationship between visual perceptual skills and fine motor skills of typically developing preschool-aged children and tablet use or non-use. Researchers also examined the association between visual perception ability and fine motor skills.

Cognition was measured with the Chinese version of the Peabody Picture Vocabulary Test-Revised (PPVT-R).

Visual perception was measured with The Test of Visual Perceptual Skills, Third Edition

Fine motor skills were measured with The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition.

Procedures

A registered occupational therapist administered the PPVT-R, TVPS-3, and the three fine motor subtests of the BOT-2. The occupational therapist was blinded to the which students were in the tablet group or non-tablet group when completing the assessments.

Statistical Analysis

(1) Independent sample t-test to analyze data.

(2) One-way analysis of covariance (ANCOVA) to determine impact of demographic characteristics between the two groups on differences seen in visual perceptual and fine motor skills.

(3) Bivariate correlations to determine correlation between fine motor and visual perceptual skills.  

Results

t-test results

Visual Perceptual Skills using TVPS-3Tablet Group mean scoreNon-tablet group mean score
Visual Discrimination *11.0312.67
Visual Memory *12.0814.83
Spatial Relations *13.5816.03
Form Constancy *9.8312.58
Sequential Memory10.9712.36
Figure Ground *11.6713.83
Visual Closure9.3610.64
   
Fine motor Skills using BOT-2  
Fine motor precision*18.6721.78
Fine motor integration*18.4220.75
Manual Dexterity*17.2218.92

*=Statistically significant difference between tablet group and non-tablet
group, with non-tablet group scoring higher in all measures.

ANCOVA results

Researcher provided outcome of one demographic variable, being an only child, using an ANCOVA and noted that results were the same as t-test results comparing the two groups.

Bivariate correlation results

Results showed the following correlations were significant in the tablet-group:

(1) Fine motor precision and fine motor integration with visual discrimination, spatial relationships, and sequential memory.

(2) Manual dexterity with visual memory and form constancy.

Results showed the following correlations were significant in the non-tablet group:

(1) Fine motor precision with visual discrimination and spatial relationships.

(2) Fine motor integration with visual discrimination, spatial relationships, and visual closure.

Conclusion

The objective of this study was (1) Investigate differences in visual perceptual and fine motor skills of children that use tablets and children that do not use tablets and (2) examine the association between visual perception ability and fine motor skills in both groups. The outcomes indicate:

(1) Children in the non-tablet group scored significantly higher in a majority of visual perceptual skills and all fine motor measures.

(2) There are significant correlations between visual perception skills and fine motor skills with both tablet and non-tablet groups.

Limitations of Study

(1) Small sample size.

(2) Study design. This is a cross-sectional design which is lower on the research hierarchy. There is also no information provided on why the six schools were chosen, which provides less of a clear picture of the randomness of the schools selected.

(3) Construct definition. Using tablet-use as the construct to define technology use is limited. The children in the non-tablet group could use smartphones, which would affect the validity of the results.

(4) ANCOVA results in this study are limited to one demographic.

(5) Correlation does not indicate causation with the relationship between visual perception skills and fine motor skills. Few of the correlations are moderate correlations, most are small correlations.

Takeaway for OT Students

This research provides OT students with ideas of the gaps that are in research studying this important area:

(1) Determining the relationship between fine motor skills and visual perceptual skills.

(2) The impact of different types of technology on the visual perceptual skills and fine motor skills of children.

(3) The relationship of demographical factors such as parent education and income with technology use in children.

Takeaway for Clinicians  

(1) Having research data such as the results of this study when working with other professionals to make the point of the importance of focusing on fine motor and visual perceptual skills with hands-on activities rather than only technological tools.

(2) Recognizing the different types of visual perceptual skills that are impacted by technology use to guide intervention.

(3) Recognizing the impact of screen use on children, it is important to provide supports to parents for alternatives to screen use such as games and physical activity that can be easily incorporated into the family’s day. This can include a calendar with daily activities that work on fine motor and visual perceptual skills such as here: Summer Activities Calendar  or creating one of your own knowing what is available to your client.

(4) With the provision of intervention using telehealth or using apps, provide children with screen breaks to perform exercises that use visual perceptual and fine motor skills such as yoga: Pediatric Yoga This can be done at the beginning or at the end of a session, depending on what time in the session works best for your client.

(5) Complete a toy box tour with families to determine what tools are available in the home that the child can use to work on fine motor and visual perceptual skills.

Article Information

The full article can be accessed here in the Hong Kong Journal of Occupational Therapy: https://journals.sagepub.com/doi/10.1177/1569186119888698 This is an open-access journal and the entire article can be downloaded for free. Access to the article would allow for a deeper review of the statistical analysis, such as the p-values that were used to determine significance with t-tests and correlations and the standard deviations (SD) of the means comparing the results with tablet and non-tablet groups on visual perceptual and fine motor skills. Information can also be reviewed on group demographics to determine possible impacts of demographic variables on outcomes.

Citation: Lin, L. (2019). Differences between preschool children using tablets and non-tablets in visual perception and fine motor skills. Hong Kong Journal of Occupational Therapy, 32, (2)118-126. https://doi.org/10.1177/1569186119888698   

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