In Singapore, 64.4% of school-age children sleep less than the minimum recommended duration of 9 hours on school nights, thus risking poor mental, cognitive, and brain health. These short-sleeping children, however, spend on average 2.5 hours per school day on non-academic media use, revealing the potential of reducing their screen time for more sleep. Previous interventions targeted at reducing media use and/or improving sleep among school-age children, though effective in increasing sleep, required cooperation from schools, extensive personnel training, and high commitment of participants, rendering them difficult to implement in Singapore. Existing interventions also focused on evening or pre-bedtime screen use, and took a one-size-fits-all approach, ignoring individual differences in the duration, type, and purpose of media use throughout the day. Here, we propose a scalable approach to curtail media use based on individual need throughout the day. We will conduct a randomised controlled trial during term time, recruiting 150 children, aged 6-12 years, who on school days, sleep less than 8 hours and spend more than 2 hours on media use. At baseline, all participants will record their time use patterns. The research staff will then help the intervention group to repurpose at least 60 minutes of media use per school day for sleep. Importantly, participants can decide the type, timing and duration of media use to curtail, thus giving them a sense of agency and mastery, while boosting their self-efficacy, a vital ingredient in behavioural change. The intervention group will follow this personalised schedule for 2 weeks, while the control group will be in a free-living condition. Two weeks after the intervention has ended, the intervention group will undergo follow-up assessments. Throughout the study, sleep, time use, cognitive functions, and psychological well-being will be assessed daily. Other cognitive tasks and questionnaires will be conducted during 2-3 lab/school-classroom visits, with one-third of the participants also undergoing high-density electroencephalography to measure brain activity.
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Change in sustained attention assessed with the Psychomotor Vigilance Task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: PVT will be assessed once daily (up to 3 weeks for the control group and up to 4 weeks for the intervention group) using EMA, and again at the end of the baseline, manipulation and follow-up period through a laptop-based test battery.
Change in sustained attention assessed with the Psychomotor Vigilance Task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: PVT will be assessed once daily (up to 3 weeks for the control group and up to 4 weeks for the intervention group) using EMA, and again at the end of the baseline, manipulation and follow-up period through a laptop-based test battery.
Change in sustained attention assessed with the Psychomotor Vigilance Task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: PVT will be assessed once daily (up to 3 weeks for the control group and up to 4 weeks for the intervention group) using EMA, and again at the end of the baseline, manipulation and follow-up period through a laptop-based test battery.
Change in sustained attention assessed with the Psychomotor Vigilance Task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: PVT will be assessed once daily (up to 3 weeks for the control group and up to 4 weeks for the intervention group) using EMA, and again at the end of the baseline, manipulation and follow-up period through a laptop-based test battery.
Change in sustained attention assessed with the Psychomotor Vigilance Task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: PVT will be assessed once daily (up to 3 weeks for the control group and up to 4 weeks for the intervention group) using EMA, and again at the end of the baseline, manipulation and follow-up period through a laptop-based test battery.
Change in number of correct matches assessed with the 1-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in number of incorrect matches assessed with the 1-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in number of correct mismatches assessed with the 1-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in number of incorrect mismatches assessed with the 1-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in discriminability measure (A') assessed with the 1-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in bias measure (B"D) assessed with the 1-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: On the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in number of correct matches assessed with the 2-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in number of incorrect matches assessed with the 2-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in number of correct mismatches assessed with the 2-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in number of incorrect mismatches assessed with the 2-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in discriminability measure (A') assessed with the 2-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in bias measure (B"D) assessed with the 2-back task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in subjective sleepiness assessed with the Karolinska Sleepiness Scale from baseline to manipulation (for both groups), baseline to follow-up (for intervention group only), and manipulation to follow-up period (for intervention group only)
Timeframe: KSS will be assessed once daily (up to 3 weeks for the control group and up to 4 weeks for the intervention group) using EMA, and again on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery.
Change in positive mood from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: PANAS-C will be assessed once daily (up to 3 weeks for the control group and up to 4 weeks for the intervention group) using EMA, and again on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery.
Change in negative mood from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: PANAS-C will be assessed once daily (up to 3 weeks for the control group and up to 4 weeks for the intervention group) using EMA, and again on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery.
Change in processing speed assessed with the Symbol Digit Modalities Test from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in digital device use assessed by the Digital Addiction Scale for Children from baseline to manipulation (for both groups), baseline to follow-up (for intervention group only), and manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in spatial working memory performance assessed by a Dot Memory Task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Assessed once daily using EMA in both the control (up to 3 weeks) and intervention (up to 4 weeks) groups. The specific time at which the EMA is attempted daily (within a one hour time frame) is decided based on the participant's choice.
Change in speed of processing assessed with a Symbol Search Task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Assessed once daily using EMA in both the control (up to 3 weeks) and intervention (up to 4 weeks) groups. The specific time at which the EMA is attempted daily (within a one hour time frame) is decided based on the participant's choice.
Change in speed of processing assessed with a Symbol Search Task from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Assessed once daily using EMA in both the control (up to 3 weeks) and intervention (up to 4 weeks) groups. The specific time at which the EMA is attempted daily (within a one hour time frame) is decided based on the participant's choice.
Change in daily screen-use time assessed with time-use diary from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Assessed once daily using EMA in both the control (up to 3 weeks) and intervention (up to 4 weeks) groups. The specific time at which the EMA is attempted daily (within a one hour time frame) is decided based on the participant's choice.
Change in sleep duration from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Assessed daily using an actiwatch, fitbit and time-use app/sleep diary. Up to a total of 3 weeks in control participants and up to a total of 4 weeks of daily monitoring in intervention participants.
Change in sleep efficiency from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Assessed daily using an actiwatch. Up to a total of 3 weeks in control participants and up to a total of 4 weeks of daily monitoring in intervention participants.
Change in subjective sleepiness ratings by parents and teachers from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once one the last day of the baseline, manipulation and follow-up period through an online questionnaire sent to parents and teachers. Up to twice in the control group participants and up to thrice in intervention group participants.
Change in subjective sleepiness ratings by parents and teachers from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once one the last day of the baseline, manipulation and follow-up period through an online questionnaire sent to parents and teachers. Up to twice in the control group participants and up to thrice in intervention group participants.
Change in internet addiction symptoms from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in internalising and externalising behaviours from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in parent-reported sleep behaviours and sleep-related factors from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.
Change in EEG power and coherence of the prefrontal cortex from baseline to manipulation (for both groups), from baseline to follow-up (for intervention group only), and from manipulation to follow-up period (for intervention group only)
Timeframe: Once on the last day of the baseline, manipulation and follow-up period through a laptop-based test battery. Up to twice in the control group and up to thrice in intervention group participants.