Tablet vs book learning: Impact on memory, attention and learning skills

Tablet vs book learning: Impact on memory, attention and learning skills | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Tablet vs book learning: Impact on memory, attention and learning skills Jessika Tawil, Chadia Haddad, Youssef Farchakh, Hala Sacre, Rita Nabout, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-15843/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives : Textbooks are the major source of instruction, yet many Lebanese schools have partially introduced electronic devices, and have discreetly started to rely on them. Given the reported discrepancies between textbooks and tablets learning in international literature, it is essential to conduct a Lebanese study that compares both entities. Therefore, the objective of this paper was to assess the impact of tablet use at school on memory, attention and learning abilities among Lebanese children. Methods: This cross-sectional study, conducted between January and May 2019, enrolled 566 students aged of 11-13 years. Three schools were chosen conveniently for this study, one of them uses the Tablet and text books for students’ learning whereas the second one uses text books exclusively. Students were randomly chosen from the list given by the school administration. Results : Textbook learning was significantly associated with lower episodic memory score (better episodic memory) and lower visual memory score (better visual memory), lower attention score (better attention), lower processing speed score (better processing speed), lower mathematic skills score (better mathematic skills) compared to tablets and textbook learning. Conclusion : Learning is evolving to another level and forever changing. Many studies should be conducted in order to understand the importance of merging new and old techniques to ensure that the next generations are receiving what can positively affect their cognitive skills and their performance. Psychiatry memory attention learning tablet book education adolescents. Introduction Education is must. It is a fundamental human virtue, an essentiality for society, and a firm basis for a healthy life 1 . Although education is not limited to schools, the intrinsic important aim of the expansion of human mental capacities starts in schools 2 . As a matter of fact, it is known that education improves the cognitive abilities in children: a meta-analysis done by Jennifer L. Carter et al. in 2019 points out a positive correlation between cognitive skills and education 9 . The cognitive skills of the human brain are very intriguing, yet essential in a healthy human brain to be able to manage his own decisions 3 . The main cognitive skills include memory, attention, and learning capacities, among others. It is mandatory to mention that the thread of the mental development of children depends upon the quality of education that is being transmitted, as well as the process in which the information is received. In this context, many schools have tried to shift from printed texts to electronic ones, while others held on textbooks only. Moreover, the debate whether electronic devices are more effective than textbooks in education or not is still ongoing 4 . Electronic devices are hypothesized to affect several aspects of education, such as memory, attention, learning capacities and academic performance (mathematical, reading and expression skills). Memory can be divided into short term and long term memory. The short term is responsible of maintaining essential information for immediate purposes, accordingly, this data will be selectively relocated to long term memory 5 . Many types of memory could be highlighted such as the working memory which preserves recent acquired information and is helpful to recall data from the long term memory needed at a specific moment, the episodic memory which is essential to recall specific events, and the semantic memory which elicits objects, facts and concepts 6 . Many previous studies have explored the effect of tablets use on children’s memory in comparison to textbooks use and found contradictory results. Wagner and Sternberg determined that students reading texts on tablets were not capable of remembering the details of the text 7 , while Belmore concluded that students who used electronic devices have increased reading speed and comprehension, thus a higher capacity to recall details 8 . Attention is defined as “a psychological phenomenon that interacts with all other cognitive processes, such as perception, memory, behavioral planning or actions, linguistic production, and spatial orientation” 9 . It implicates several systems of the human brain to be able first, to process all the input acquired, second, to avoid distraction and focus on the selected resources and finally, to switch the attention from one stimulus to the other successfully 10 . According to a study conducted by Kropman et al., tablets use is tiresome compared to textbooks which decreases the attention span in children trying to focus for long periods every day 11 . In addition to that, a study found that 87% of teachers believe that nowadays electronic and digital technologies are generating an easily distracted generation with short duration of attention maintenance, and that tablets in classrooms could conceivably do more harm than good. Learning capacities largely depend on the way information is received. Many studies evaluated the impact of the electronic use on learning capacities and academic performances. Some studies revealed student’s positive learning attitude towards the use of tablets and electronic devices in schooling 4 . The characteristics of tablets, such as unlimited internet access and being easy to carry were helpful 12 and made students more implicated in their learning. A study further showed that tablets’ users tended to take notes directly, three times more than students using textbooks 13 . Other papers demonstrated that logical thinking and critical criticism were improved in children using tablets by enhancing their problem solving ability 14 . On the opposite side, some studies showed that tablets negatively affected academic performance and learning skills due to the eyestrain that occurs with excessive use 15 . Originally, textbooks were the main tool for acquiring information 12 . With time, as technology was implicated in various fields, and access to the internet or to an electronic device was easier and cheaper 16 , it started to replace textbooks. In fact, the methods of instruction employed in Lebanese classrooms are mostly classic. Teachers spend a great deal of time giving lessons and homework to students, as well as reading assignments and correcting exercises finished in class. Students usually play a passive role in the education process. They listen calmly, occasionally question what is presented, and copy texts and information dictated by the teacher. Textbooks are the major source of instruction, yet many Lebanese schools have partially introduced electronic devices, and have discreetly started to rely on them 17 . Given the reported discrepancies between textbooks and tablets learning, it is essential to conduct a Lebanese study that compares both entities. In order to assess the influence of textbooks and tablets on cognition and attention, it is also essential to take the schooling age into consideration. The latter is critical to understand the human brain and cognition as one of the major skills of the mind. Therefore, the objective of this paper was to assess the impact of tablet use at school on memory, attention and learning abilities among Lebanese children. Methods Participants This study was a cross-sectional, conducted between January and May 2019. Three schools were chosen conveniently for this study, one of them uses the Tablet and text books for students’ learning whereas the second one uses text books exclusively. Students were randomly chosen from the list given by the school administration. Prior to participation, parents were briefed on the study objectives and methodology, and were assured of the anonymity of their participation. Individual participants had the right to accept or refuse participation in the study, with no financial compensation provided in exchange for individual participation. All participants were parents of children aged between the age of 11 and 13 years of age were eligible to participate. Procedure The questionnaire was distributed to each student in the classroom to be taken home. Parents filled it within 25 minutes approximately. The completed questionnaires were collected back and sent for data entry. During the data collection process, the anonymity of the participants was guaranteed. Questionnaire The questionnaire used was in Arabic, the native language of Lebanon. The first part assessed the sociodemographic details of the participant’s child (i.e. age, gender, grade, and father and mother education level). Questions were also asked about number of hours using the tablet for learning at home and at school, number of hours using screens for electronic use (IPad/cellphone for playing electronic games…), number of hours watching TV programs and number of hours reading books. The second part of the questionnaire included the following scales: The Children’s Memory Questionnaire (CMQ) The CMQ is a 36-item questionnaire designed to assess parents’ perceptions of their children’s memory. The CMQ requires parents to assess their child’s memory based on five possible options: 1 = never or almost never happens; 2 = happens less than once a week; 3 = happens once or twice in a week; 4 = happens about once a day; and 5 = happens more than once a day 1 . Three subscales derived from the total scale representing the episodic memory, visual memory and working memory and attention. The higher the scores, the greater the impairment in the cognition domain 18 . In this study, the Cronbach alpha values for the episodic memory subscale was 0.888, for the visual memory was 0.770 and for the working memory was 0.845. The Clinical Attention Problems Scale The scale measures the frequency of activity and attention by asking the parent and teacher to respond to a series of 12 statements and their applicability to their child in the morning and afternoon. Response options range from "not true"(0), "somewhat or sometimes true" (1), "very often" or often true (2). The higher the scores, the greater the attention problems exist 19 . In this study, the Cronbach alpha values for the clinical attention problem in the morning and in the afternoon were 0.844 and 0.839 respectively. Learning, Executive and Attention Functioning (LEAF) Scale The LEAF is a 55-item self-report questionnaire that assesses executive functions, related neurocognitive functions, and academic skills in children and adults. The LEAF evaluates a broad set of core cognitive abilities as well as related cognitive learning and academic abilities. Cognitive areas assessed by the LEAF include attention, processing speed (including visual-spatial organization skills), and sustained sequential processing to achieve goals (e.g., planning and executing goal-directed behavior), working memory, and novel problem-solving. Also, LEAF includes comprehension and concept formation, declarative/factual memory, and academic functioning. The LEAF contains Academic subscales assessing reading, writing, and math fluency and abilities. LEAF items are grouped by subscale, and all subscales have the same number of items. The subscales of the LEAF are: 1. Comprehension and Conceptual Learning (tracking and understanding information); 2. Factual Memory (memorization and retention of facts); 3. Attention (sustained focus); 4. Processing Speed (speed of completing cognitive and behavioral tasks that involve a component of focus and concentration); 5. Visual-Spatial Organization (organization and visual-constructive skills); 6. Sustained Sequential Processing (planning and sustaining effort in order to follow and complete multistep directions and sequences); 7. Working Memory (remembering and processing multiple things at the same time); and 8. Novel Problem Solving (initiating effort toward processing new or unfamiliar information); 9. Mathematics Skills (math calculation difficulty); 10. Basic Reading Skills (reading/phonics difficulty); and 11. Written Expression Skills (limited/impoverished or slow/effortful written expression). Individual items are rated on a 0–3 scale, and a raw subscale score for each of the 11 content areas is created by summing the 5 constituent items, such that higher scores indicate more cognitive problems 20 . In this study, the Cronbach alpha values for the subscales was: comprehension and conceptual learning = 0.961; factual memory = 0.792; attention = 0.901; processing speed = 0.866; visual-spatial organization = 0.729; sustained sequential processing = 0.768; working memory = 0.816; novel problem solving = 0.811; mathematics skills = 0.871; basic reading skills = 0.923 and written expression skills = 0.905. Translation procedure The forward and backward translation method was conducted on all the scales. The forward translation was done by one translator, whereas the backward translation was performed by a second healthcare professional. The two English versions were compared afterwards; discrepancies were resolved by consensus. Statistical analysis SPSS software version 23 was used to conduct data analysis. Cronbach’s alpha values were recorded for reliability analysis for all the scales. A descriptive analysis was done using the counts and percentages for categorical variables and mean and standard deviation for continuous measures. A bivariate analysis using Pearson correlation coefficient served to assess the relationship between recreational use of electronic devices, TV watching and book reading. A multivariate analysis of covariance (MANCOVA) was carried out to compare multiple measures (each scale was taken as a dependent variable) between the groups of school type (book vs. Tablet learning), taking into account potential confounding variables: age, gender, family monthly income, mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books. A p < 0.05 was considered significant. Results Sample characteristics description Out of 700 questionnaires distributed, 566 (80.86%) were completed and collected back. The sociodemographic characteristics of the participants are summarized in Table 1. The mean age was 10.77 ± 1.38 years, with 55.2% males and 48.8% females. More than half of the selected school were using book and Tablet (61.1%). Also, higher education level in parents was found in 58.9% among mothers and 39.4% among fathers. The mean number of hours per day learning on tablet at school was 0.91 ± 0.78, the mean number of hours per day spending using tablet to do homework was 0.44 ± 1.09, the mean number of hours per day using tablet or cellphone playing electronic games was 1.70 ± 2.06, the mean number of hours spending per day watching TV programs for children was 1.42 ± 1.23 and the mean number of hours spent per day reading books was 0.79 ± 1.09 (table 1). Table 1: Sociodemographic characteristics of the study sample Frequency Percentage Gender Male 286 55.2% Female 232 44.8% School Type Mixed (Book and Tablet learning) 346 61.1% Book learning 220 38.9% Education level father Illiterate 14 2.9% Primary 34 7.0% Complementary 111 22.9% Secondary 135 27.8% University 191 39.4% Education level mother Illiterate 14 2.9% Primary 11 2.2% Complementary 58 11.9% Secondary 118 24.1% University 288 58.9% Mean SD Age 10.77 1.38 Number of hours per day learning on tablet at school 0.91 0.78 Number hours per day spending using tablet to do homework 0.44 1.09 Hours per day using tablet or cellphone playing electronic games 1.70 2.06 Hours spending per day watching TV programs for children 1.42 1.23 Hours spent per day reading books .79 1.09 Bivariate analysis of electronic devices’ recreational use, TV watching and books’ reading with children educational aspects Higher hours spent per day using iPad and cellphones was significantly associated with higher episodic and visual memory scores. A higher number of hours spent per day watching TV programs was significantly associated with higher working and visual memory scores, as well as higher mathematics skills scores. A higher number of hours spent per day reading books was significantly associated with higher visual memory and novel problem solving scores. A higher number of hours spent per day learning on tablet at school was significantly associated with higher episodic memory, working memory, visual memory, comprehension conceptual learning, factual memory, LEAF attention, processing speed, mathematic skills and basic reading skills scores. Finally, a higher number of hours spent per day using tablet to do homework was significantly associated with higher visual memory (Table 2). Table 2. Bivariate analysis of factors (hours spent per day using iPad/cellphone, hours spent per day watching TV programs for children, hours spent per day reading books) associated with the memory, learning and attention scores. Hours spent per day using iPad/cellphone Hours spent per day watching TV programs for children Hours spent per day reading books Hours spent per day learning on tablet at school Hours spent per day spending using tablet to do homework Episodic memory 0.104 c 0.087 -0.011 0.101 c 0.021 Working memory 0.059 0.099 c 0.066 0.143 b 0.031 Visual memory 0.116 c 0.170 a 0.200 a 0.239 a 0.130 b Clinical attention (morning) 0.014 0.012 0.008 -0.067 0.006 Clinical attention (afternoon) 0.008 0.035 0.021 -0.053 -0.029 Comprehension conceptual learning -0.014 0.055 0.01 0.149 b 0.024 Factual memory 0.028 0.059 0.064 0.135 b 0.028 LEAF attention 0.009 0.065 0.012 0.145 b -0.005 Processing speed 0.012 0.092 0.018 0.166 a 0.034 Visual spatial organization 0.014 0.051 -0.031 -0.082 -0.021 Sustained sequential processing 0.001 0.051 -0.027 -0.083 -0.059 LEAF working memory -0.036 -0.034 0.03 -0.072 -0.058 Novel problem solving 0.028 -0.012 0.115 c -0.080 0.002 Mathematics skills -0.015 0.098 b 0.089 0.155 b 0.037 Basic reading skills 0.013 0.092 0.056 0.109 c -0.063 Written expression skills -0.017 0.008 0.016 -0.060 -0.041 a p<0.001; b p<0.01; c p<0.05 Multivariate analysis: Educational aspects comparison between textbook and electronics use The MANCOVA analysis was performed taking the scales as the dependent variables and the school type (Textbook vs tablets and textbook learning) as the independent variable, adjusting for the covariates (age, gender, family monthly income mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books). The means of the memory, attention and LEAF subscales between school type learning systems (tablets and textbook vs. textbook), adjusted for age, gender, family income, mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books, are shown in Fig. 1 . After adjusting for all covariates, a significant difference was found for episodic memory, visual memory, LEAF-attention, LEAF- processing speed and LEAF mathematics skills. The use of electronic devices was associated with worse results: a significantly higher mean of episodic memory (8.08), visual memory (4.71), LEAF attention (3.27), LEAF processing speed (3.75) and LEAF mathematics skills (2.95) scores were found in those using tablets and textbook as compared to those using textbook exclusively. Note *p 0.05 A MANCOVA models were performed taking the scales as the dependent variables and the school type (Textbook vs tablets and textbook learning) as the independent variable adjusted for age, gender, family monthly income mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books. The MANCOVA derived models showed worse results for students of schools using electronic devices for teaching: Textbook learning was significantly associated with lower episodic memory score (better episodic memory) (B=-2.62) and lower visual memory score (better visual memory) (B=-1.75), lower attention score (better attention) (B=-1.06), lower processing speed score (better processing speed) (B=-1.41), lower mathematic skills score (better mathematic skills) (B=-1.08) compared to tablets and textbook learning (Table 3). Table 3: Multivariate analysis of covariance (MANCOVA) models taking the scales as the dependent variables and the school type (Textbook vs tablets and textbook learning) as the independent variable, adjusting for the covariates ( age, gender, family monthly income mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books) Beta p-value 95% Confidence Interval Lower Bound Upper Bound Episodic memory School type (Textbook vs tablets and textbook* learning) -2.62 0.013 -4.69 -0.55 Working memory School type (Textbook vs tablets and textbook* learning) -1.34 0.078 -2.84 0.15 Visual memory School type (Textbook vs tablets and textbook* learning) -1.75 < 0.001 -2.59 -0.91 Mother secondary compared to illiteracy/primary level* -2.26 0.009 -3.97 -0.56 Clinical attention in the morning School type (Textbook vs tablets and textbook* learning) -0.55 0.431 -1.94 0.82 Clinical attention in the afternoon School type (Textbook vs tablets and textbook* learning) -0.64 0.393 -2.12 0.83 Gender (females vs males*) -1.59 0.006 -2.74 -0.45 LEAF comprehension and conceptual learning School type (Textbook vs tablets and textbook* learning) -0.38 0.336 -1.17 0.40 Father university compared to illiteracy/primary level* -1.16 0.042 -2.28 -0.04 LEAF factual memory Mother secondary compared to illiteracy/primary level* -1.59 0.024 -2.98 -0.21 Mother university compared to illiteracy/primary level* -1.58 0.020 -2.90 -0.25 School type (Textbook vs tablets and textbook* learning) -0.58 0.094 -1.25 0.100 LEAF attention School type (Textbook vs tablets and textbook* learning) -1.06 0.034 -2.04 -0.07 Father university compared to illiteracy/primary level* -1.62 0.023 -3.02 -0.22 LEAF processing speed School type (Textbook vs tablets and textbook* learning) -1.41 0.005 -2.40 -0.42 LEAF visual spatial organization School type (Textbook vs tablets and textbook* learning) -0.70 0.09 -1.53 0.11 Gender (females vs males*) -0.70 0.029 -1.34 -0.07 LEAF sustained sequential processing School type (Textbook vs tablets and textbook* learning) -0.37 0.385 -1.22 0.47 LEAF working memory School type (Textbook vs tablets and textbook* learning) -0.70 0.097 -1.54 0.12 LEAF novel problem solving School type (Textbook vs tablets and textbook* learning) -0.36 0.364 -1.15 0.42 LEAF academic: mathematic skills School type (Textbook vs tablets and textbook* learning) -1.08 0.018 -1.97 -0.18 Father university level of education compared to illiteracy/primary level* -1.37 0.035 -2.64 -0.09 LEAF Basic reading skills School type (Textbook vs tablets and textbook* learning) -0.85 0.091 -1.83 0.13 Father university level of education compared to illiteracy/primary level* -1.76 0.014 -3.17 -0.35 LEAF written expression skills School type (Textbook vs tablets and textbook* learning) -0.91 0.104 -2.02 0.18 Father university level of education compared to illiteracy/primary level* -1.77 0.028 -3.35 -0.19 *Reference group Discussion This pilot study is the first of its kind in Lebanon that aims to evaluate the association between tablet vs book learning on memory, attention and learning. Overall, the major finding from the study is that the use of textbooks was associated with better results in many aspects that can influence the learning process. The findings elicit that the students that used textbooks had better memory function, which contradicts the study that showed improvement in cognitive learning in people using tablets 13 . Another study concluded that learning from a tablet made the person involved in the process of learning. Many e-texts provide the option to highlight text, present with high resolution graphics and not to forget that many e-texts can be saved on the same tablet 12 . Despite these advantages, tablets can cause eyestrain and are a major source of distraction to the learner. Thus, a person reading a book will be focused on the material presented in front of him. On the other hand, a tablet especially connected to the internet can provide endless information that can affect the ability of the learner to retrieve the needed information 12 . A positive correlation is found between the use of textbooks and the episodic, working, visual and factual memory, which is confirmed in the literature 21 . To be able to understand a textbook or an e-book, the long term and short term memory need to be involved 21 . A previous study conducted in 2012, implied that it is easier to recall information read in books than in tablets due to many factors 22 . For example, tablets present fewer spatial landmarks, smaller screens that can cause eyestrain. In addition to that, scrolling along text can cause distraction 21 . All of that can negatively influence the memory and eventually affect the comprehension. Another study done in 2012 found a better reading comprehension in books compared to e-books 23 , and people noted that e-books were not clear enough because of the screen and text size, which affects their ability to comprehend the text and the way they perceived the e-book 23 . As for attention, the results were inconclusive in accordance to other studies that could not find a difference between tablets and books regarding many aspects such as comprehension 12 , and reading skills 4,24 . Books learning was correlated with better cognitive skills especially in memory but did not seem to directly affect the attention: attention was found to be similar in books and in tablets learning. Meaning that people were able to focus on the text and the data regardless of the way it was presented to them. The media used to read and to learn did not seem to affect attention. A study done in 2019 that compared comprehension in reading text in printed books and on a tablet showed that there is no difference in the attention paid in both cases 21 . Moreover, learning in books was associated with an improved processing speed compared to tablets learning. In a study done by A. Lynne Beal et al in 2016 showed that processing speed is correlated with the improvement of reading and mathematical skills 25 . This paper also showed a positive impact for learning in books on mathematical skills and reading abilities that is in favor of the positive impact on the processing speed in learning: children learning in books will depend more on their basic skills and knowledge to be able to develop their mathematical, reading and writing abilities. They have to memorize the multiplication table to be able to do calculation. In addition to that, they need to be creative in order to write a good sentence. Oppositely, tablets have a “built-in calculator” which is able to do all the complex calculation in a fraction of second. At the same time, there is a reading option dedicated to read a whole text so the child is only passively receiving information, without him trying to improve his reading skills. Furthermore, tablets also provide “predictions” when writing which can negatively affect the creativity of the child compared to books. Additionally, the level of education of the parents, especially the father influenced on the results. Children with educated fathers showed better scores in reading and written expression skills, mathematic subscale and comprehension and conceptual learning which is a finding not discussed in other studies. According to these findings, we hypothesize that educated parents will be more involved in helping their children learn and be more involved in education 26 . Limitations There are some limitations in our study. Since this is a one-time measurement of exposure, it is difficult to derive causal relationships from a cross-sectional analysis. This study type is also prone to certain biases. An under or over estimation of a question could be experienced by the parent, leading to a non-differential information bias; this is expected to drive the results towards the null hypothesis. Selection bias and misclassification due to recall bias could may have also occurred. More than that, attrition bias could have happened when participants don’t respond to certain questions. Furthermore, although the multivariate analysis took into account several potential confounding factors, a residual confounding is still possible. Nevertheless, the overall results are consistent with the study hypothesis and the majority of literature findings, which can be considered as a strength of this study. Conclusion The results suggest that tablet learning was significantly associated with worse memory, attention, processing speed, mathematic skills, as well as, worse writing skills, compared to book learning. Education and technology are merging in societies. Learning is evolving to another level and forever changing. Many studies should be conducted in order to understand the importance of merging new and old techniques to ensure that the next generations are receiving what can positively affect their cognitive skills and their performance. Declarations Ethics Approval and Consent to Participate The Psychiatric Hospital of the Cross Ethics and Research Committee approved this study protocol (HPC-012-2018). A written consent was obtained from the students’ parents prior to starting the data collection. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are not publicly available to maintain the privacy of the individuals’ identities. The dataset supporting the conclusions is available upon request to the corresponding author. Competing interests The authors have nothing to disclose. Funding None. Author contributions DM, GAK and NK were responsible for the data collection and entry. SH and PS designed the study and drafted the manuscript; SH, CH and PS carried out the analysis and interpreted the results; HS, RH and AH assisted in drafting and reviewing the manuscript; All authors reviewed the final manuscript and gave their consent; PS and RH were the project supervisors. Acknowledgements The authors would like to thank Mr Jihad Gerges, Mr Joseph Chahine and the following persons of College Central des Moines Libanais Maronites- Jounieh: Father Superior Antoine Salame, General Director Father Dr. Wadih Al Skayem, Mrs Hélène Chbeir- Director of the kindergarten, Mr Joseph Rassi- Director of the primary cycle as well as the teachers of the primary cycle for their help in the data collection. Special thanks to the parents who participated in this study and for Ms Marine Arisdakessian for her help in the data entry. References Bhardwaj A . Importance of Education in human life: A holistic Approach. International Journal of Science and Consciousness. 2016;2(2):23-28. World E . The importance of school education in child development. Available at: https://www.educationworld.in/the-importance-of-school-education-in-child-development/ . . 2019. Posner MI, DiGirolamo GJ, Fernandez-Duque D . Brain mechanisms of cognitive skills. Conscious Cogn. 1997;6(2-3):267-290. Dündar H, Akçayır M . Tablet vs. paper: The effect on learners' reading performance. International Electronic Journal of Elementary Education. 2017;4(3):441-450. Kandel ER, Schwartz JH, Jessell TM, et al. Principles of neural science. Vol 4: McGraw-hill New York; 2000. Loewenstein RJ . Dissociative amnesia: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. Wagner RK, Sternberg RJ . Executive control in reading comprehension. Executive control processes in reading. 1987:1-21. Belmore SM . Reading computer-presented text. Bulletin of the Psychonomic Society. 1985;23(1):12-14. Zimmermann P, Gondan M, Fimm B . KiTAP: Test for Attentional Performance in Children. Herzogenrath, Germany: Psytest. 2002. Beauvais J, Martino S, Walker JS, Roback HB, Welch L. Psychological Assessment. In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis & Treatment: Psychiatry, 3e New York, NY: McGraw-Hill. Available from: http://neurology.mhmedical.com.ezproxy.usek.edu.lb/content.aspx?bookid=2509§ionid=200979810 . [Accessed October 05, 2019]. Kropman M, Schoch HP, Teoh HY. An experience in e-learning: Using an electronic textbook. Paper presented at: Beyond the comfort zone: Proceedings of the 21st ASCILITE Conference2004. Folkers S . Students’ Attitudes on Electronic Versus Traditional Print Textbooks: Is Cognitive Performance Affected? Rockinson-Szapkiw AJ, Courduff J, Carter K, Bennett D . Electronic versus traditional print textbooks: A comparison study on the influence of university students' learning. Computers & Education. 2013;63:259-266. Mei-Ju C . How are our prince and princess satisfying with iPad learning. Procedia-Social and Behavioral Sciences. 2014;116:2857-2865. Montrieux H, Vanderlinde R, Schellens T, De Marez L . Teaching and learning with mobile technology: A qualitative explorative study about the introduction of tablet devices in secondary education. PloS one. 2015;10(12):e0144008. Wario RD, Ireri BN, De Wet L . An Evaluation of iPad as a Learning Tool in Higher Education within a Rural Catchment: A Case Study at a South African University. International Association for Development of the Information Society. 2016. System—overview L-E . Lebanon. Available at: https://education.stateuniversity.com/pages/827/Lebanon-EDUCATIONAL-SYSTEM-OVERVIEW.html . 2019. Drysdale K, Shores A, Levick W . Use of the everyday memory questionnaire with children. Child Neuropsychology. 2004;10(2):67-75. Edelbrock C, Rancurello MD . Childhood hyperactivity: An overview of rating scales and their applications. Clinical Psychology Review. 1985;5(5):429-445. Castellanos I, Kronenberger WG, Pisoni DB . Questionnaire-based assessment of executive functioning: Psychometrics. Applied Neuropsychology: Child. 2018;7(2):93-109. Mangen A, Olivier G, Velay J-L . Comparing comprehension of a long text read in print book and on Kindle: Where in the text and when in the story? Frontiers in psychology. 2019;10. Szalavitz M . Do e-books make it harder to remember what you just read? online], Time, http://healthland . time. com/2012/03/14/do-e-books-impair-memory. 2012. Jeong H . A comparison of the influence of electronic books and paper books on reading comprehension, eye fatigue, and perception. The Electronic Library. 2012;30(3):390-408. Sackstein S, Spark L, Jenkins A . Are e-books effective tools for learning? Reading speed and comprehension: iPad® i vs. paper. South African Journal of Education. 2015;35(4). Holdnack JA, Prifitera A, Weiss LG, Saklofske DH . WISC-V and the Personalized Assessment Approach. WISC-V Assessment and Interpretation: Scientist-Practitioner Perspectives. 2015:373. Stevenson DL, Baker DP . The family-school relation and the child's school performance. Child development. 1987:1348-1357. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-15843","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":380736,"identity":"e4c027ad-51c3-4f53-aa06-29f530329b25","order_by":1,"name":"Jessika Tawil","email":"","orcid":"","institution":"Universite Saint-Esprit de Kaslik Faculte de Medicine et des Sciences Medicales","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jessika","middleName":"","lastName":"Tawil","suffix":""},{"id":380737,"identity":"6d8d66da-a674-4636-a4a5-7fac530d2a74","order_by":2,"name":"Chadia Haddad","email":"","orcid":"","institution":"Hopital Psychiatrique de la Croix","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chadia","middleName":"","lastName":"Haddad","suffix":""},{"id":380738,"identity":"ae811ee4-b0c1-4421-b80b-c0802cac937c","order_by":3,"name":"Youssef Farchakh","email":"","orcid":"","institution":"Universite Saint-Esprit de Kaslik Faculte de Medicine et des Sciences Medicales","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Youssef","middleName":"","lastName":"Farchakh","suffix":""},{"id":380739,"identity":"016bdfa1-d99a-4aa0-ba54-790323332918","order_by":4,"name":"Hala Sacre","email":"","orcid":"","institution":"Ordre des Pharmaciens du Liban","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hala","middleName":"","lastName":"Sacre","suffix":""},{"id":380740,"identity":"569b50c2-ac6d-4018-8397-182deca101d7","order_by":5,"name":"Rita Nabout","email":"","orcid":"","institution":"Universite Libanaise","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rita","middleName":"","lastName":"Nabout","suffix":""},{"id":380741,"identity":"6ad96859-57e5-44c8-aa90-d13ff7a695e9","order_by":6,"name":"Sahar Obeid","email":"","orcid":"","institution":"Universite Saint-Esprit de Kaslik","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sahar","middleName":"","lastName":"Obeid","suffix":""},{"id":380742,"identity":"58c2fd68-3fe1-49be-821e-507070859cfa","order_by":7,"name":"Pascale Salameh","email":"","orcid":"","institution":"Universite Libanaise","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pascale","middleName":"","lastName":"Salameh","suffix":""},{"id":380743,"identity":"d5187569-ca1a-4d52-9f3d-db58b26bb226","order_by":8,"name":"Souheil Hallit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYHACNgYGA4sEBnbmhgMMFQfAQgceENYikcDAzNhw4MCZAww8IC0JBLUwQLQwHGyDaGHAp0W+vcfswYcCiTz+ZsbGwx/n3ZGzFzv8EGiLnZxuA3YtBmfOmBvOMJAoljgMdNjBbc+MeaTTDIBako3NDuDQIpFjJs1jIJHYANFyOLFHOgGk5UDiNhxa5GcAtfwBapkP1jIHpCX9A14tDDeAWoB2JW4Aa2kAacnBb4vBmWNlkj1ALRtBWs4cO2zMczun4ECCAW6/yLc3b5P48ccmcd7x5sMfKmoOy7HPTt/84UOFnRwuLbiAAWnKR8EoGAWjYBSgAgC4x2kS03JWmAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-6918-5689","institution":"Universite Saint-Esprit de Kaslik Faculte de Medicine et des Sciences Medicales","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Souheil","middleName":"","lastName":"Hallit","suffix":""}],"badges":[],"createdAt":"2020-02-28 12:31:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-15843/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-15843/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13492690,"identity":"20c85627-497b-4ccf-93e1-efe61b1bd5e9","added_by":"auto","created_at":"2021-09-16 22:32:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":632956,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-15843/v1/bdff509f-de8d-418e-9044-0c109bb2b414.pdf"}],"financialInterests":"","formattedTitle":"Tablet vs book learning: Impact on memory, attention and learning skills","fulltext":[{"header":"Introduction","content":" \u003cp\u003eEducation is must. It is a fundamental human virtue, an essentiality for society, and a firm basis for a healthy life \u003csup\u003e1\u003c/sup\u003e. Although education is not limited to schools, the intrinsic important aim of the expansion of human mental capacities starts in schools \u003csup\u003e2\u003c/sup\u003e. As a matter of fact, it is known that education improves the cognitive abilities in children: a meta-analysis done by Jennifer L. Carter et al. in 2019 points out a positive correlation between cognitive skills and education\u003csup\u003e9\u003c/sup\u003e. The cognitive skills of the human brain are very intriguing, yet essential in a healthy human brain to be able to manage his own decisions \u003csup\u003e3\u003c/sup\u003e. The main cognitive skills include memory, attention, and learning capacities, among others. It is mandatory to mention that the thread of the mental development of children depends upon the quality of education that is being transmitted, as well as the process in which the information is received. In this context, many schools have tried to shift from printed texts to electronic ones, while others held on textbooks only. Moreover, the debate whether electronic devices are more effective than textbooks in education or not is still ongoing \u003csup\u003e4\u003c/sup\u003e. Electronic devices are hypothesized to affect several aspects of education, such as memory, attention, learning capacities and academic performance (mathematical, reading and expression skills).\u003c/p\u003e \u003cp\u003eMemory can be divided into short term and long term memory. The short term is responsible of maintaining essential information for immediate purposes, accordingly, this data will be selectively relocated to long term memory \u003csup\u003e5\u003c/sup\u003e. Many types of memory could be highlighted such as the working memory which preserves recent acquired information and is helpful to recall data from the long term memory needed at a specific moment, the episodic memory which is essential to recall specific events, and the semantic memory which elicits objects, facts and concepts \u003csup\u003e6\u003c/sup\u003e. Many previous studies have explored the effect of tablets use on children\u0026rsquo;s memory in comparison to textbooks use and found contradictory results. Wagner and Sternberg determined that students reading texts on tablets were not capable of remembering the details of the text \u003csup\u003e7\u003c/sup\u003e, while Belmore concluded that students who used electronic devices have increased reading speed and comprehension, thus a higher capacity to recall details \u003csup\u003e8\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAttention is defined as \u0026ldquo;a psychological phenomenon that interacts with all other cognitive processes, such as perception, memory, behavioral planning or actions, linguistic production, and spatial orientation\u0026rdquo; \u003csup\u003e9\u003c/sup\u003e. It implicates several systems of the human brain to be able first, to process all the input acquired, second, to avoid distraction and focus on the selected resources and finally, to switch the attention from one stimulus to the other successfully \u003csup\u003e10\u003c/sup\u003e. According to a study conducted by Kropman et al., tablets use is tiresome compared to textbooks which decreases the attention span in children trying to focus for long periods every day \u003csup\u003e11\u003c/sup\u003e. In addition to that, a study found that 87% of teachers believe that nowadays electronic and digital technologies are generating an easily distracted generation with short duration of attention maintenance, and that tablets in classrooms could conceivably do more harm than good.\u003c/p\u003e \u003cp\u003eLearning capacities largely depend on the way information is received. Many studies evaluated the impact of the electronic use on learning capacities and academic performances. Some studies revealed student\u0026rsquo;s positive learning attitude towards the use of tablets and electronic devices in schooling \u003csup\u003e4\u003c/sup\u003e. The characteristics of tablets, such as unlimited internet access and being easy to carry were helpful \u003csup\u003e12\u003c/sup\u003e and made students more implicated in their learning. A study further showed that tablets\u0026rsquo; users tended to take notes directly, three times more than students using textbooks \u003csup\u003e13\u003c/sup\u003e. Other papers demonstrated that logical thinking and critical criticism were improved in children using tablets by enhancing their problem solving ability \u003csup\u003e14\u003c/sup\u003e. On the opposite side, some studies showed that tablets negatively affected academic performance and learning skills due to the eyestrain that occurs with excessive use \u003csup\u003e15\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOriginally, textbooks were the main tool for acquiring information \u003csup\u003e12\u003c/sup\u003e. With time, as technology was implicated in various fields, and access to the internet or to an electronic device was easier and cheaper \u003csup\u003e16\u003c/sup\u003e, it started to replace textbooks. In fact, the methods of instruction employed in Lebanese classrooms are mostly classic. Teachers spend a great deal of time giving lessons and homework to students, as well as reading assignments and correcting exercises finished in class. Students usually play a passive role in the education process. They listen calmly, occasionally question what is presented, and copy texts and information dictated by the teacher. Textbooks are the major source of instruction, yet many Lebanese schools have partially introduced electronic devices, and have discreetly started to rely on them \u003csup\u003e17\u003c/sup\u003e. Given the reported discrepancies between textbooks and tablets learning, it is essential to conduct a Lebanese study that compares both entities. In order to assess the influence of textbooks and tablets on cognition and attention, it is also essential to take the schooling age into consideration. The latter is critical to understand the human brain and cognition as one of the major skills of the mind. Therefore, the objective of this paper was to assess the impact of tablet use at school on memory, attention and learning abilities among Lebanese children.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eParticipants\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThis study was a cross-sectional, conducted between January and May 2019. Three schools were chosen conveniently for this study, one of them uses the Tablet and text books for students\u0026rsquo; learning whereas the second one uses text books exclusively. Students were randomly chosen from the list given by the school administration. Prior to participation, parents were briefed on the study objectives and methodology, and were assured of the anonymity of their participation. Individual participants had the right to accept or refuse participation in the study, with no financial compensation provided in exchange for individual participation. All participants were parents of children aged between the age of 11 and 13\u0026nbsp;years of age were eligible to participate.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eProcedure\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThe questionnaire was distributed to each student in the classroom to be taken home. Parents filled it within 25 minutes approximately. The completed questionnaires were collected back and sent for data entry. During the data collection process, the anonymity of the participants was guaranteed.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eQuestionnaire\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThe questionnaire used was in Arabic, the native language of Lebanon. The first part assessed the sociodemographic details of the participant\u0026rsquo;s child (i.e. age, gender, grade, and father and mother education level). Questions were also asked about number of hours using the tablet for learning at home and at school, number of hours using screens for electronic use (IPad/cellphone for playing electronic games\u0026hellip;), number of hours watching TV programs and number of hours reading books. The second part of the questionnaire included the following scales:\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eThe Children\u0026rsquo;s Memory Questionnaire (CMQ)\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThe CMQ is a 36-item questionnaire designed to assess parents\u0026rsquo; perceptions of their children\u0026rsquo;s memory. The CMQ requires parents to assess their child\u0026rsquo;s memory based on five possible options: 1\u0026thinsp;=\u0026thinsp;never or almost never happens; 2\u0026thinsp;=\u0026thinsp;happens less than once a week; 3\u0026thinsp;=\u0026thinsp;happens once or twice in a week; 4\u0026thinsp;=\u0026thinsp;happens about once a day; and 5\u0026thinsp;=\u0026thinsp;happens more than once a day\u003csup\u003e1\u003c/sup\u003e. Three subscales derived from the total scale representing the episodic memory, visual memory and working memory and attention. The higher the scores, the greater the impairment in the cognition domain \u003csup\u003e18\u003c/sup\u003e. In this study, the Cronbach alpha values for the episodic memory subscale was 0.888, for the visual memory was 0.770 and for the working memory was 0.845.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eThe Clinical Attention Problems Scale\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThe scale measures the frequency of activity and attention by asking the parent and teacher to respond to a series of 12 statements and their applicability to their child in the morning and afternoon. Response options range from \"not true\"(0), \"somewhat or sometimes true\" (1), \"very often\" or often true (2). The higher the scores, the greater the attention problems exist \u003csup\u003e19\u003c/sup\u003e. In this study, the Cronbach alpha values for the clinical attention problem in the morning and in the afternoon were 0.844 and 0.839 respectively.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLearning, Executive and Attention Functioning (LEAF) Scale\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThe LEAF is a 55-item self-report questionnaire that assesses executive functions, related neurocognitive functions, and academic skills in children and adults. The LEAF evaluates a broad set of core cognitive abilities as well as related cognitive learning and academic abilities. Cognitive areas assessed by the LEAF include attention, processing speed (including visual-spatial organization skills), and sustained sequential processing to achieve goals (e.g., planning and executing goal-directed behavior), working memory, and novel problem-solving. Also, LEAF includes comprehension and concept formation, declarative/factual memory, and academic functioning. The LEAF contains Academic subscales assessing reading, writing, and math fluency and abilities. LEAF items are grouped by subscale, and all subscales have the same number of items.\u003c/p\u003e \u003cp\u003eThe subscales of the LEAF are: 1. Comprehension and Conceptual Learning (tracking and understanding information); 2. Factual Memory (memorization and retention of facts); 3. Attention (sustained focus); 4. Processing Speed (speed of completing cognitive and behavioral tasks that involve a component of focus and concentration); 5. Visual-Spatial Organization (organization and visual-constructive skills); 6. Sustained Sequential Processing (planning and sustaining effort in order to follow and complete multistep directions and sequences); 7. Working Memory (remembering and processing multiple things at the same time); and 8. Novel Problem Solving (initiating effort toward processing new or unfamiliar information); 9. Mathematics Skills (math calculation difficulty); 10. Basic Reading Skills (reading/phonics difficulty); and 11. Written Expression Skills (limited/impoverished or slow/effortful written expression). Individual items are rated on a 0\u0026ndash;3 scale, and a raw subscale score for each of the 11 content areas is created by summing the 5 constituent items, such that higher scores indicate more cognitive problems \u003csup\u003e20\u003c/sup\u003e. In this study, the Cronbach alpha values for the subscales was: comprehension and conceptual learning\u0026thinsp;=\u0026thinsp;0.961; factual memory\u0026thinsp;=\u0026thinsp;0.792; attention\u0026thinsp;=\u0026thinsp;0.901; processing speed\u0026thinsp;=\u0026thinsp;0.866; visual-spatial organization\u0026thinsp;=\u0026thinsp;0.729; sustained sequential processing\u0026thinsp;=\u0026thinsp;0.768; working memory\u0026thinsp;=\u0026thinsp;0.816; novel problem solving\u0026thinsp;=\u0026thinsp;0.811; mathematics skills\u0026thinsp;=\u0026thinsp;0.871; basic reading skills\u0026thinsp;=\u0026thinsp;0.923 and written expression skills\u0026thinsp;=\u0026thinsp;0.905.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTranslation procedure\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThe forward and backward translation method was conducted on all the scales. The forward translation was done by one translator, whereas the backward translation was performed by a second healthcare professional. The two English versions were compared afterwards; discrepancies were resolved by consensus.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003eStatistical analysis\u003c/p\u003e \u003cp\u003eSPSS software version 23 was used to conduct data analysis. Cronbach\u0026rsquo;s alpha values were recorded for reliability analysis for all the scales. A descriptive analysis was done using the counts and percentages for categorical variables and mean and standard deviation for continuous measures. A bivariate analysis using Pearson correlation coefficient served to assess the relationship between recreational use of electronic devices, TV watching and book reading.\u003c/p\u003e \u003cp\u003eA multivariate analysis of covariance (MANCOVA) was carried out to compare multiple measures (each scale was taken as a dependent variable) between the groups of school type (book vs. Tablet learning), taking into account potential confounding variables: age, gender, family monthly income, mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books. A p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":" \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSample characteristics description\u003c/span\u003e \u003c/p\u003e \u003cp\u003eOut of 700 questionnaires distributed, 566 (80.86%) were completed and collected back. The sociodemographic characteristics of the participants are summarized in Table\u0026nbsp;1. The mean age was 10.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38 years, with 55.2% males and 48.8% females. More than half of the selected school were using book and Tablet (61.1%). Also, higher education level in parents was found in 58.9% among mothers and 39.4% among fathers. The mean number of hours per day learning on tablet at school was 0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78, the mean number of hours per day spending using tablet to do homework was 0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09, the mean number of hours per day using tablet or cellphone playing electronic games was 1.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06, the mean number of hours spending per day watching TV programs for children was 1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23 and the mean number of hours spent per day reading books was 0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09 (table 1).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTable\u0026nbsp;1: Sociodemographic characteristics of the study sample\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eFrequency\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePercentage\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGender\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e286\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e55.2%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e232\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e44.8%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSchool Type\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMixed (Book and Tablet learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e346\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e61.1%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBook learning\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e220\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e38.9%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEducation level father\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIlliterate\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.9%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrimary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.0%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eComplementary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e111\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e22.9%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSecondary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e135\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e27.8%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUniversity\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e191\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e39.4%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEducation level mother\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIlliterate\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.9%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrimary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.2%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eComplementary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e58\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.9%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSecondary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e118\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e24.1%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUniversity\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e288\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e58.9%\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMean\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSD\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAge\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.77\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.38\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNumber of hours per day learning on tablet at school\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.78\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNumber hours per day spending using tablet to do homework\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.09\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHours per day using tablet or cellphone playing electronic games\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.70\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.06\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHours spending per day watching TV programs for children\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.23\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHours spent per day reading books\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e.79\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.09\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eBivariate analysis of electronic devices\u0026rsquo; recreational use, TV watching and books\u0026rsquo; reading with children educational aspects\u003c/span\u003e \u003c/p\u003e \u003cp\u003eHigher hours spent per day using iPad and cellphones was significantly associated with higher episodic and visual memory scores. A higher number of hours spent per day watching TV programs was significantly associated with higher working and visual memory scores, as well as higher mathematics skills scores. A higher number of hours spent per day reading books was significantly associated with higher visual memory and novel problem solving scores. A higher number of hours spent per day learning on tablet at school was significantly associated with higher episodic memory, working memory, visual memory, comprehension conceptual learning, factual memory, LEAF attention, processing speed, mathematic skills and basic reading skills scores. Finally, a higher number of hours spent per day using tablet to do homework was significantly associated with higher visual memory (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTable\u0026nbsp;2. Bivariate analysis of factors (hours spent per day using iPad/cellphone, hours spent per day watching TV programs for children, hours spent per day reading books) associated with the memory, learning and attention scores.\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHours spent per day using iPad/cellphone\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHours spent per day watching TV programs for children\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHours spent per day reading books\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHours spent per day learning on tablet at school\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHours spent per day spending using tablet to do homework\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEpisodic memory\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.104\u003csup\u003ec\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.087\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.011\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.101\u003csup\u003ec\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.021\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eWorking memory\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.059\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.099\u003csup\u003ec\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.066\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.143\u003csup\u003eb\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.031\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVisual memory\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.116\u003csup\u003ec\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.170\u003csup\u003ea\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.200\u003csup\u003ea\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.239\u003csup\u003ea\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.130\u003csup\u003eb\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eClinical attention (morning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.014\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.012\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.008\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.067\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.006\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eClinical attention (afternoon)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.008\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.035\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.021\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.053\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.029\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eComprehension conceptual learning\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.014\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.055\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.149\u003csup\u003eb\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.024\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFactual memory\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.028\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.059\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.064\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.135\u003csup\u003eb\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.028\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLEAF attention\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.009\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.065\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.012\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.145\u003csup\u003eb\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.005\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eProcessing speed\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.012\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.092\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.018\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.166\u003csup\u003ea\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.034\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVisual spatial organization\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.014\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.051\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.031\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.082\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.021\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSustained sequential processing\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.051\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.027\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.083\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.059\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLEAF working memory\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.036\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.034\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.03\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.072\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.058\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNovel problem solving\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.028\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.012\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.115\u003csup\u003ec\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.080\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.002\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMathematics skills\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.015\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.098\u003csup\u003eb\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.089\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.155\u003csup\u003eb\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.037\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBasic reading skills\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.013\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.092\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.056\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.109\u003csup\u003ec\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.063\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eWritten expression skills\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.017\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.008\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.016\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.060\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.041\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003ep\u0026lt;0.001; \u003csup\u003eb\u003c/sup\u003ep\u0026lt;0.01; \u003csup\u003ec\u003c/sup\u003ep\u0026lt;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMultivariate analysis: Educational aspects comparison between textbook and electronics use\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThe MANCOVA analysis was performed taking the scales as the dependent variables and the school type (Textbook vs tablets and textbook learning) as the independent variable, adjusting for the covariates (age, gender, family monthly income mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books).\u003c/p\u003e \u003cp\u003eThe means of the memory, attention and LEAF subscales between school type learning systems (tablets and textbook vs. textbook), adjusted for age, gender, family income, mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books, are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAfter adjusting for all covariates, a significant difference was found for episodic memory, visual memory, LEAF-attention, LEAF- processing speed and LEAF mathematics skills. The use of electronic devices was associated with worse results: a significantly higher mean of episodic memory (8.08), visual memory (4.71), LEAF attention (3.27), LEAF processing speed (3.75) and LEAF mathematics skills (2.95) scores were found in those using tablets and textbook as compared to those using textbook exclusively.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"FPar1\" renderingstyle=\"Style1\" class=\"FormalPara\"\u003e \u003cdiv class=\"Heading\"\u003eNote\u003c/div\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 **p\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/span\u003e \u003c/p\u003e \u003c/div\u003e \u003cp\u003eA MANCOVA models were performed taking the scales as the dependent variables and the school type (Textbook vs tablets and textbook learning) as the independent variable adjusted for age, gender, family monthly income mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books.\u003c/p\u003e \u003cp\u003eThe MANCOVA derived models showed worse results for students of schools using electronic devices for teaching: Textbook learning was significantly associated with lower episodic memory score (better episodic memory) (B=-2.62) and lower visual memory score (better visual memory) (B=-1.75), lower attention score (better attention) (B=-1.06), lower processing speed score (better processing speed) (B=-1.41), lower mathematic skills score (better mathematic skills) (B=-1.08) compared to tablets and textbook learning (Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTable\u0026nbsp;3: Multivariate analysis of covariance (MANCOVA) models taking the scales as the dependent variables and the school type (Textbook vs tablets and textbook learning) as the independent variable, adjusting for the covariates ( age, gender, family monthly income mother and father education level, number of hours using IPad, cellphone or playing electronic games, number of hours watching TV programs and number of hours reading books)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eBeta\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ep-value\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e95% Confidence Interval\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLower Bound\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUpper Bound\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEpisodic memory\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.62\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.013\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-4.69\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.55\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eWorking memory\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.34\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.078\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.15\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eVisual memory\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.75\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.91\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMother secondary compared to illiteracy/primary level*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.009\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-3.97\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.56\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eClinical attention in the morning\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.55\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.431\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.94\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.82\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eClinical attention in the afternoon\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.393\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.83\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGender (females vs males*)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.006\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.74\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.45\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF comprehension and conceptual learning\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.336\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.40\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFather university compared to illiteracy/primary level*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.16\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.042\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.28\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.04\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF factual memory\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMother secondary compared to illiteracy/primary level*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.024\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.21\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMother university compared to illiteracy/primary level*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.58\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.020\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.25\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.58\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.094\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.100\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF attention\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.06\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.034\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.07\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFather university compared to illiteracy/primary level*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.62\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.023\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-3.02\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.22\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF processing speed\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.005\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.40\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.42\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF visual spatial organization\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.70\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.09\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.53\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.11\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGender (females vs males*)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.70\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.029\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.34\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.07\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF sustained sequential processing\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.385\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.22\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.47\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF working memory\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.70\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.097\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.54\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.12\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF novel problem solving\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.36\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.364\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.42\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF academic: mathematic skills\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.08\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.018\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.97\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.18\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFather university level of education compared to illiteracy/primary level*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.035\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.09\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF Basic reading skills\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.091\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.83\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.13\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFather university level of education compared to illiteracy/primary level*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.76\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.014\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-3.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.35\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLEAF written expression skills\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSchool type (Textbook vs tablets and textbook* learning)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.104\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-2.02\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.18\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFather university level of education compared to illiteracy/primary level*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-1.77\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.028\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-3.35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.19\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e*Reference group\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003eThis pilot study is the first of its kind in Lebanon that aims to evaluate the association between tablet vs book learning on memory, attention and learning. Overall, the major finding from the study is that the use of textbooks was associated with better results in many aspects that can influence the learning process. The findings elicit that the students that used textbooks had better memory function, which contradicts the study that showed improvement in cognitive learning in people using tablets \u003csup\u003e13\u003c/sup\u003e. Another study concluded that learning from a tablet made the person involved in the process of learning. Many e-texts provide the option to highlight text, present with high resolution graphics and not to forget that many e-texts can be saved on the same tablet \u003csup\u003e12\u003c/sup\u003e. Despite these advantages, tablets can cause eyestrain and are a major source of distraction to the learner. Thus, a person reading a book will be focused on the material presented in front of him. On the other hand, a tablet especially connected to the internet can provide endless information that can affect the ability of the learner to retrieve the needed information \u003csup\u003e12\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA positive correlation is found between the use of textbooks and the episodic, working, visual and factual memory, which is confirmed in the literature \u003csup\u003e21\u003c/sup\u003e. To be able to understand a textbook or an e-book, the long term and short term memory need to be involved \u003csup\u003e21\u003c/sup\u003e. A previous study conducted in 2012, implied that it is easier to recall information read in books than in tablets due to many factors \u003csup\u003e22\u003c/sup\u003e. For example, tablets present fewer spatial landmarks, smaller screens that can cause eyestrain. In addition to that, scrolling along text can cause distraction \u003csup\u003e21\u003c/sup\u003e. All of that can negatively influence the memory and eventually affect the comprehension. Another study done in 2012 found a better reading comprehension in books compared to e-books \u003csup\u003e23\u003c/sup\u003e, and people noted that e-books were not clear enough because of the screen and text size, which affects their ability to comprehend the text and the way they perceived the e-book \u003csup\u003e23\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAs for attention, the results were inconclusive in accordance to other studies that could not find a difference between tablets and books regarding many aspects such as comprehension \u003csup\u003e12\u003c/sup\u003e, and reading skills \u003csup\u003e4,24\u003c/sup\u003e. Books learning was correlated with better cognitive skills especially in memory but did not seem to directly affect the attention: attention was found to be similar in books and in tablets learning. Meaning that people were able to focus on the text and the data regardless of the way it was presented to them. The media used to read and to learn did not seem to affect attention. A study done in 2019 that compared comprehension in reading text in printed books and on a tablet showed that there is no difference in the attention paid in both cases \u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMoreover, learning in books was associated with an improved processing speed compared to tablets learning. In a study done by A. Lynne Beal et al in 2016 showed that processing speed is correlated with the improvement of reading and mathematical skills \u003csup\u003e25\u003c/sup\u003e. This paper also showed a positive impact for learning in books on mathematical skills and reading abilities that is in favor of the positive impact on the processing speed in learning: children learning in books will depend more on their basic skills and knowledge to be able to develop their mathematical, reading and writing abilities. They have to memorize the multiplication table to be able to do calculation. In addition to that, they need to be creative in order to write a good sentence. Oppositely, tablets have a \u0026ldquo;built-in calculator\u0026rdquo; which is able to do all the complex calculation in a fraction of second. At the same time, there is a reading option dedicated to read a whole text so the child is only passively receiving information, without him trying to improve his reading skills. Furthermore, tablets also provide \u0026ldquo;predictions\u0026rdquo; when writing which can negatively affect the creativity of the child compared to books.\u003c/p\u003e \u003cp\u003eAdditionally, the level of education of the parents, especially the father influenced on the results. Children with educated fathers showed better scores in reading and written expression skills, mathematic subscale and comprehension and conceptual learning which is a finding not discussed in other studies. According to these findings, we hypothesize that educated parents will be more involved in helping their children learn and be more involved in education \u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLimitations\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThere are some limitations in our study. Since this is a one-time measurement of exposure, it is difficult to derive causal relationships from a cross-sectional analysis. This study type is also prone to certain biases. An under or over estimation of a question could be experienced by the parent, leading to a non-differential information bias; this is expected to drive the results towards the null hypothesis. Selection bias and misclassification due to recall bias could may have also occurred. More than that, attrition bias could have happened when participants don\u0026rsquo;t respond to certain questions. Furthermore, although the multivariate analysis took into account several potential confounding factors, a residual confounding is still possible. Nevertheless, the overall results are consistent with the study hypothesis and the majority of literature findings, which can be considered as a strength of this study.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eThe results suggest that tablet learning was significantly associated with worse memory, attention, processing speed, mathematic skills, as well as, worse writing skills, compared to book learning. Education and technology are merging in societies. Learning is evolving to another level and forever changing. Many studies should be conducted in order to understand the importance of merging new and old techniques to ensure that the next generations are receiving what can positively affect their cognitive skills and their performance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Psychiatric Hospital of the Cross Ethics and Research Committee approved this study protocol (HPC-012-2018). A written consent was obtained from the students\u0026rsquo; parents prior to starting the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are not publicly available to maintain the privacy of the individuals\u0026rsquo; identities. The dataset supporting the conclusions is available upon request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have nothing to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDM, GAK and NK were responsible for the data collection and entry. SH and PS designed the study and drafted the manuscript; SH, CH and PS carried out the analysis and interpreted the results; HS, RH and AH assisted in drafting and reviewing the manuscript; All authors reviewed the final manuscript and gave their consent; PS and RH were the project supervisors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Mr Jihad Gerges, Mr Joseph Chahine and the following persons of College Central des Moines Libanais Maronites- Jounieh: Father Superior Antoine Salame, General Director Father Dr. Wadih Al Skayem, Mrs H\u0026eacute;l\u0026egrave;ne Chbeir- Director of the kindergarten, Mr Joseph Rassi- Director of the primary cycle as well as the teachers of the primary cycle for their help in the data collection. Special thanks to the parents who participated in this study and for Ms Marine Arisdakessian for her help in the data entry.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eBhardwaj A\u003c/strong\u003e. Importance of Education in human life: A holistic Approach. \u003cem\u003eInternational Journal of Science and Consciousness. \u003c/em\u003e2016;2(2):23-28.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWorld E\u003c/strong\u003e. The importance of school education in child development. Available at: \u003ca href=\"https://www.educationworld.in/the-importance-of-school-education-in-child-development/\"\u003ehttps://www.educationworld.in/the-importance-of-school-education-in-child-development/\u003c/a\u003e. . 2019.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePosner MI, DiGirolamo GJ, Fernandez-Duque D\u003c/strong\u003e. Brain mechanisms of cognitive skills. \u003cem\u003eConscious Cogn. \u003c/em\u003e1997;6(2-3):267-290.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eD\u0026uuml;ndar H, Ak\u0026ccedil;ayır M\u003c/strong\u003e. Tablet vs. paper: The effect on learners' reading performance. \u003cem\u003eInternational Electronic Journal of Elementary Education. \u003c/em\u003e2017;4(3):441-450.\u003c/li\u003e\n\u003cli\u003eKandel ER, Schwartz JH, Jessell TM, et al. \u003cem\u003ePrinciples of neural science.\u003c/em\u003e Vol 4: McGraw-hill New York; 2000.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLoewenstein RJ\u003c/strong\u003e. Dissociative amnesia: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWagner RK, Sternberg RJ\u003c/strong\u003e. Executive control in reading comprehension. \u003cem\u003eExecutive control processes in reading. \u003c/em\u003e1987:1-21.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eBelmore SM\u003c/strong\u003e. Reading computer-presented text. \u003cem\u003eBulletin of the Psychonomic Society. \u003c/em\u003e1985;23(1):12-14.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eZimmermann P, Gondan M, Fimm B\u003c/strong\u003e. KiTAP: Test for Attentional Performance in Children. \u003cem\u003eHerzogenrath, Germany: Psytest. \u003c/em\u003e2002.\u003c/li\u003e\n\u003cli\u003eBeauvais J, Martino S, Walker JS, Roback HB, Welch L. Psychological Assessment. In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis \u0026amp; Treatment: Psychiatry, 3e New York, NY: McGraw-Hill. Available from: \u003ca href=\"http://neurology.mhmedical.com.ezproxy.usek.edu.lb/content.aspx?bookid=2509\u0026amp;sectionid=200979810\"\u003ehttp://neurology.mhmedical.com.ezproxy.usek.edu.lb/content.aspx?bookid=2509\u0026amp;sectionid=200979810\u003c/a\u003e. [Accessed October 05, 2019].\u003c/li\u003e\n\u003cli\u003eKropman M, Schoch HP, Teoh HY. An experience in e-learning: Using an electronic textbook. Paper presented at: Beyond the comfort zone: Proceedings of the 21st ASCILITE Conference2004.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFolkers S\u003c/strong\u003e. Students\u0026rsquo; Attitudes on Electronic Versus Traditional Print Textbooks: Is Cognitive Performance Affected?\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eRockinson-Szapkiw AJ, Courduff J, Carter K, Bennett D\u003c/strong\u003e. Electronic versus traditional print textbooks: A comparison study on the influence of university students' learning. \u003cem\u003eComputers \u0026amp; Education. \u003c/em\u003e2013;63:259-266.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMei-Ju C\u003c/strong\u003e. How are our prince and princess satisfying with iPad learning. \u003cem\u003eProcedia-Social and Behavioral Sciences. \u003c/em\u003e2014;116:2857-2865.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMontrieux H, Vanderlinde R, Schellens T, De Marez L\u003c/strong\u003e. Teaching and learning with mobile technology: A qualitative explorative study about the introduction of tablet devices in secondary education. \u003cem\u003ePloS one. \u003c/em\u003e2015;10(12):e0144008.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWario RD, Ireri BN, De Wet L\u003c/strong\u003e. An Evaluation of iPad as a Learning Tool in Higher Education within a Rural Catchment: A Case Study at a South African University. \u003cem\u003eInternational Association for Development of the Information Society. \u003c/em\u003e2016.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSystem\u0026mdash;overview L-E\u003c/strong\u003e. Lebanon. Available at: \u003ca href=\"https://education.stateuniversity.com/pages/827/Lebanon-EDUCATIONAL-SYSTEM-OVERVIEW.html\"\u003ehttps://education.stateuniversity.com/pages/827/Lebanon-EDUCATIONAL-SYSTEM-OVERVIEW.html\u003c/a\u003e. 2019.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDrysdale K, Shores A, Levick W\u003c/strong\u003e. Use of the everyday memory questionnaire with children. \u003cem\u003eChild Neuropsychology. \u003c/em\u003e2004;10(2):67-75.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eEdelbrock C, Rancurello MD\u003c/strong\u003e. Childhood hyperactivity: An overview of rating scales and their applications. \u003cem\u003eClinical Psychology Review. \u003c/em\u003e1985;5(5):429-445.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCastellanos I, Kronenberger WG, Pisoni DB\u003c/strong\u003e. Questionnaire-based assessment of executive functioning: Psychometrics. \u003cem\u003eApplied Neuropsychology: Child. \u003c/em\u003e2018;7(2):93-109.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMangen A, Olivier G, Velay J-L\u003c/strong\u003e. Comparing comprehension of a long text read in print book and on Kindle: Where in the text and when in the story? \u003cem\u003eFrontiers in psychology. \u003c/em\u003e2019;10.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSzalavitz M\u003c/strong\u003e. Do e-books make it harder to remember what you just read? \u003cem\u003eonline], Time, \u003c/em\u003e\u003ca href=\"http://healthland\"\u003e\u003cem\u003ehttp://healthland\u003c/em\u003e\u003c/a\u003e\u003cem\u003e. time. com/2012/03/14/do-e-books-impair-memory. \u003c/em\u003e2012.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eJeong H\u003c/strong\u003e. A comparison of the influence of electronic books and paper books on reading comprehension, eye fatigue, and perception. \u003cem\u003eThe Electronic Library. \u003c/em\u003e2012;30(3):390-408.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSackstein S, Spark L, Jenkins A\u003c/strong\u003e. Are e-books effective tools for learning? Reading speed and comprehension: iPad\u0026reg; i vs. paper. \u003cem\u003eSouth African Journal of Education. \u003c/em\u003e2015;35(4).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHoldnack JA, Prifitera A, Weiss LG, Saklofske DH\u003c/strong\u003e. WISC-V and the Personalized Assessment Approach. \u003cem\u003eWISC-V Assessment and Interpretation: Scientist-Practitioner Perspectives. \u003c/em\u003e2015:373.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eStevenson DL, Baker DP\u003c/strong\u003e. The family-school relation and the child's school performance. \u003cem\u003eChild development. \u003c/em\u003e1987:1348-1357.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"memory; attention; learning; tablet; book; education; adolescents. ","lastPublishedDoi":"10.21203/rs.3.rs-15843/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-15843/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjectives : Textbooks are the major source of instruction, yet many Lebanese schools have partially introduced electronic devices, and have discreetly started to rely on them. Given the reported discrepancies between textbooks and tablets learning in international literature, it is essential to conduct a Lebanese study that compares both entities. Therefore, the objective of this paper was to assess the impact of tablet use at school on memory, attention and learning abilities among Lebanese children. Methods: This cross-sectional study, conducted between January and May 2019, enrolled 566 students aged of 11-13 years. Three schools were chosen conveniently for this study, one of them uses the Tablet and text books for students’ learning whereas the second one uses text books exclusively. Students were randomly chosen from the list given by the school administration. Results : Textbook learning was significantly associated with lower episodic memory score (better episodic memory) and lower visual memory score (better visual memory), lower attention score (better attention), lower processing speed score (better processing speed), lower mathematic skills score (better mathematic skills) compared to tablets and textbook learning. Conclusion : Learning is evolving to another level and forever changing. Many studies should be conducted in order to understand the importance of merging new and old techniques to ensure that the next generations are receiving what can positively affect their cognitive skills and their performance.\u003c/p\u003e","manuscriptTitle":"Tablet vs book learning: Impact on memory, attention and learning skills","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-03-03 15:59:14","doi":"10.21203/rs.3.rs-15843/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b82755a6-768f-460d-a93e-aec485021104","owner":[],"postedDate":"March 3rd, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":65266,"name":"Psychiatry"}],"tags":[],"updatedAt":"2020-04-03T17:47:16+00:00","versionOfRecord":[],"versionCreatedAt":"2020-03-03 15:59:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-15843","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-15843","identity":"rs-15843","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}