The effect of technology on different levels of physical activity in young children has been studied previously in the typically developed child (25), autism disorder (14), and developmental delay disorders (16), however, no study has been reported in the DS population of Saudi Arabia. The current study's major objective was to examine the relationship between technology usage and levels of physical activity in C-DS in Riyadh, Saudi Arabia. The study enrolled 49 moms of C-DS who were between the ages of 6 and 12 years and had mild to moderate intellectual disability.
Mothers over the age of 45 responded at a higher rate than other age groups. According to some reports, older mothers (≥ 45 years) are more likely to have a child with DS than younger mothers (26). Although there is lack of knowledge regarding the incidence of DS according to mother's age in Saudi Arabia, the outcomes of this study may provide us with indirect evidence about DS occurrence, nonetheless, additional research is necessary to validate it. This study found that mothers of female C-DS responded more positively. To our knowledge, no study has been reported so far in Saudi Arabia to determine the incidence of DS by gender, but another study indicated that DS is more prevalent in female than male children (27–29). Additionally, the findings indicated that the majority of DS children began using electronic devices at the age of four, and the majority of them already owned one. Numerous research has been conducted to determine the association between device ownership and screen time usage among youngsters (30–32). These research' conclusions corroborate our findings, which indicate that youngsters who own their gadgets are more likely to spend time with electronic gadgets. This finding asserts that device ownership facilitates access to entertainment with different games, podcasts, programs, and similar other applications (30). Despite the short sample size, the presented study found a positive association between the mother's education level and the child holding a gadget. The better educated the mother of a kid with DS is, the more likely the youngster will use technology. In contrast to the findings, Carson et al. (2012) stated a negative correlation between use of technology among normally developing children and parents' educational level (21, 33).
This study found that majority of C-DS (81.6%) spent between 1–10 hours/week watching TV. Previously it has been reported that normally developing children who watch TV excessively are more likely to develop health and developmental problems, such as obesity, delayed development of cognition and language (25, 34, 35), as well as motor developmental skills (16). Such developmental complications may be exacerbated in children with neurological disabilities. The American Academy of Pediatrics recommends that children ≥ 2 years should not watch TV for more than two hours per day (36–38); hence, C-DS should spend less time over TV. In this study, 46.9% C-DS spent between 1–5 hours/week using portable electronic gadgets. Additionally, the results show that 87.8% of all the C-DS in this study were not using social media, which could be due to the cognitive requirement for such task. Many studies indicate that C-DS have varying degrees of cognitive damage, with most of them classed as mild (IQ: 50-55-69) or moderate (30–35 to 50–55), while a minority (10%) are classified as severe (IQ: 20–25 to 30–35) (39, 40). A prior study of adolescents with attention deficit disorder (ADD) found that those with ADD watched more television and used social media less than those with other disabilities such as intellectual disabilities, speech or language impairments and learning disabilities (41). Similarly, it was found that children with ADD spend more time over television and video games than their typically developing siblings and less time using interactive video games or social media (42). It is assumed that television entertainment and electronic virtual game is appealing to individuals who have difficulty, due to the nature of challenges faced by them, in engaging in activities requiring cognitive and socializing abilities (41).
There was no significant correlation between technology usage and physical activity levels in our study. In addition, most of children's physical activities were classified as low-level physical activities. Also, there was no significant association between the child's gender and his or her level of physical activity. The outcomes are coherent with the former reports that incorporated objective and subjective measures (43, 44). Although numerous studies (1, 6, 45) have revealed limitations in physical activity in C-DS, the limitations could be ascribed to a variety of different reasons. For instance, limitation may be related to co-occurring medical issues, as 50% of them have congenital heart disease and 10–30% have atlanto-axial/atlanto-occipital instability (46, 47). Additionally, they have a poor cardiovascular fitness, limited muscle strength, and a predisposition to obesity/overweight. The reason of the high rate of overweight/obesity in C-DS is multifaceted, since it may be a result of physiological, sociological, environmental, or psychological factors (48). Physical activity restrictions, particularly in Saudi Arabia, could be attributed to the country's environment. Saudi Arabia's climate is defined by northward-moving winds that generate sand and dust storms. Numerous research has found that C-DS are more prone to infection of ear, sinuses and respiratory tract including throat, as well as consequences from these illnesses (49). Additionally, few reports have linked health problems in general and respiratory problems to climate change, particularly for those who face everyday challenges with medications and mobility (50). Another limiting factor that could explain the low level of physical activity in C-DS and their increased reliance on technology use is the scarcity of physical activity facilities designed for children with special needs (51).