The effect of active versus passive screen time on learning disabilities in preschool Egyptian children: a cross-sectional study

Abstract Background Following the advent of COVID-19, concern has escalated over the developmental consequences of screen time exposure in preschool children; although existing studies report associations between excessive screen use and learning disabilities, they have not rigorously assessed individual cognitive domains or contrasted the effects of active (interactive) versus passive (viewing-only) forms of engagement. Nearly 16.5% of Egyptian preschool children have learning disabilities, which is a major public health concern. The study set out to evaluate how active and passive forms of screen exposure distinctly affect several learning-related cognitive domains in preschoolers aged 4.5–6.5 years. Methods A multicenter cross-sectional study was conducted between May 2024 and April 2025 at three Egyptian institutions. A total of 260 preschoolers with average IQ were subjected to full neuropsychological testing that included auditory and visual processing and memory using the Stanford-Binet-4, working memory and its components using the Arabic Working Memory Tasks Scale. Prereading skills related to the included age group were evaluated using the validated batteries for phonological processing and emergent literacy. The screen exposure was categorized by duration (less than two hours, two to four hours, more than four hours per day) and type (active versus passive).​ Results Effects were greater in passive users than active users and increased with time of exposure, with significant deficits in auditory processing (p < 0.001), auditory memory (p < 0.001), executive function (10 vs 14, p < 0.001), and phonological processing (p = 0.001) in > 4 h group; dose–response analysis revealed steep deterioration in passive users across all levels of exposure, while active users appeared to demonstrate relative cognitive resilience, with visual memory intact across all conditions. Sleep onset screen exposure resulted in significant impairment of auditory processing, auditory memory, and working memory following adjustment for duration.​ Conclusion This differentiation between active versus passive screen effects, indicates that passive exposure is far more risky for developing cognitive systems, particularly auditory-verbal domains critical to academic readiness, and that interactive engagement is associated with measurable protective effects, whereas visual systems may be more resilient. They found that precision-based interventions are required that target at-risk domains, rather than across-the-board restrictions.