Interactive technology use and child development: A systematic review

Background: There is mixed evidence regarding the impact of interactive digital devices on child development. Tentatively some studies suggested that the use of digital devices may correlate negatively with language, executive function, and motor skills. However, attempts to amalgamate this evidence has been limited related to the available number of experimental and cohort studies that have evaluated the impact of digital technology use on child development. We conducted this review to determine the impact of interactive digital devices on child development among children aged 7 years or younger. Interactive technology has been defined as methods, tools, or devices that users interact with in order to achieve specific tasks. Data source: To carry out this systematic review, databases CINAHL, MEDLINE, Embase, PsychINFO, Scopus and Google Scholar were searched for relevant studies. Study selection: We used the Joanna Briggs Institute methodology for systematic reviews. Data extraction: Data extraction and synthesis was carried out by two reviewers and checked by a third reviewer. Studies were stratified into tiers depending on the level of evidence provided and the domain of development assessed. Results: Fifty-three studies were eligible for inclusion in the review, 39 Tier 1 (randomized controlled trials and quasi-experimental

Data source: To carry out this systematic review, databases CINAHL, MEDLINE, Embase, PsychINFO, Scopus and Google Scholar were searched for relevant studies.
Study selection: We used the Joanna Briggs Institute methodology for systematic reviews.
Data extraction: Data extraction and synthesis was carried out by two reviewers and checked by a third reviewer.Studies were stratified into tiers depending on the level of evidence provided and the domain of development assessed.
Results: Fifty-three studies were eligible for inclusion in the review, 39 Tier 1 (randomized controlled trials and quasi-experimental studies) and 16 Tier 2 (descriptive studies).Children's use of interactive digital technology was positively associated with receptive language and executive function and negatively associated or unrelated to motor proficiency.Other critical aspects informing the evidence, such as dose of exposure, intensity, or duration, were inconsistently reported, making estimates of exposure tentative and imprecise.

| INTRODUCTION
The increased time that children engage in online activities has raised concerns about the potential impact of the use of computers, smart phones, tablets and/or electronic games on children's health (Görzig & Holloway, 2020).In response to those concerns, both Canadian and Australian governments have released 24-h movement guidelines for the early years (0-5 years) that recommend no screen time for children younger than 2 years and no more than 1 h per day for children aged 2-5 years (Joshi & Hinkley, 2021;McNeill et al., 2020).Estimates from primary research suggest only 17% of preschoolers in Australia meet screen-time guidelines of no more than 1 h per day (Cliff et al., 2017).Recent evidence suggests that supporting children to meet the 24-h movement guidelines associated with better cognitive development (McNeill et al., 2020) and better social-cognitive development in preschool children (Cliff et al., 2017).However, this evidence was limited for meeting the physical activity guidelines at 3-5 years of age and not evident for screen time (McNeill et al., 2020) or psychosocial outcomes (Hinkley et al., 2020).
An earlier systematic review in this area conducted by Poitras et al. (2017) examined the relationships between sedentary behavior and health indicators in children aged 0 to 4 years highlighted the value of minimizing screen time for health promotion in the early years and the potential cognitive benefits of interactive non-screenbased sedentary behaviors such as storytelling, reading, and puzzles.
Another two systematic reviews in these special issues conducted by Madigan et al. (2020) and Reus and Mosley (2018) of studies examining the association between screen use and child development indicated minimal discussion of interactive digital devices use in young children, or its impact other than on language or cognitive domains.
Interactive digital technology is a broad term that refers to methods, tools or devices that allow individuals, machines, or organization to engage in mediated communication to facilitate the planning and consummation of exchanges between them (Varadarajan et al., 2010, p. 97).Reus and Mosley (2018) suggested a negative relationship between touchscreen use and cognition, language and executive functioning among children less than 5 years.However, their scoping review lacked a systematic approach in the assessment of digital technology use as well as the methods of assessment of child development.The findings were broad and included 24 published studies that correlated screen media use with cognition, language, executive functioning, obesity, and socio-emotional development.
The same finding was detected in the meta-analysis of 42 studies conducted by Madigan et al. (2020), where a greater quantity of screen use, such as duration of use and background television noise, was associated with a reduction in language skill development in children.The authors of this meta-analysis suggested both a negative and positive impact of screen media use on language development and recommended high-quality programming and co-viewing when possible.Overall, evidence from earlier reviews (Madigan et al., 2020;Reus & Mosley, 2018) concluded that what is missed in many, if not most, published studies is a discussion of the differential effects of content available to children and the type of programming watched.
Therefore, conclusions regarding the potential benefits of limited screen time and children development in the early years remain limited, and there is a need to examine the potential benefits or risks for broader outcomes, including motor, language, and cognitive development.

Key messages
• Use of digital technology can lead to no gains or may associate negatively with fine motor development.
• Children's use of interactive digital technology is commonly associate with enhanced receptive language, executive function and memory, but not with comprehension.
• When used in a learning context, digital technology interventions are effective in enhancing literacy and numeracy skills, manual dexterity, and visuo-spatial working memory.
• Better understanding of the dose of exposure to video games or screen devices is important prior to further research in this area.
• More reliable methods of measuring touchscreen usage, such as media diaries or device monitoring, are required.
• The constant advancement of interactive digital technologies means that many of the more recent releases have yet to be evaluated through research.
As Anderson and Subrahmanyam (2017) argue in a discussion paper published on behalf of the Cognitive Impacts of Digital Media Workgroup, recent studies have failed to identify the impact of digital screen device use on young children.Published research on how and how much children younger than 5 years of age learn from digital technology through screen use is limited.Therefore, the knowledge base regarding the impact of digital technology overall on child development and the impact of digital screen devices remains sparse.The field of early child development is often broken down into three basic domains of cognitive, language, and motor development.The combination of linguistic learning (language) and cognitive abilities has been linked to a myriad of factors such as later academic outcomes and abilities to learn (Picard et al., 2014;Riggs et al., 2006).Children's motor skills have been likely to affect motor and cognitive outcomes at school age, but not mental health (Baumann, 2020).This is in addition to being reported as an important precursor of long-term outcomes across multiple psychological domains (Baumann, 2020).A systemic literature review of recent studies examining the impact of interactive digital devices on child development will enable healthcare professionals to provide evidence-based care to families and carers of children.It will help to build new understandings about the influence of digital devices on children's motor, language, and cognitive development to inform recommendations and guidelines.Other social and emotional aspects of child development were not included as their consideration would have involved a greatly expanded scope of work.

| AIM
We conducted a systematic review to determine the impact of interactive digital devices on the development of children aged 7 years or younger.

| Design
This systematic literature review was carried out following the Joanna Briggs Institute (JBI) methodology for systematic reviews and research syntheses (Munn et al., 2019) and in accordance with a protocol that was published in PROSPERO (registration number was deleted to promote anonymous review).

| Data source
We searched seven databases for primary research studies published over the last 11 years, between January 2010 and August 2021.We excluded studies published prior to 2010 as the focus of the review was on contemporary technologies with regards to the definitions and context of interactive digital devices and the impact of use.The databases searched were CINAHL, MEDLINE, PsychINFO, Embase, Scopus, and Google Scholar.Manual or hand searching of reference lists was also conducted.The key search terms were developed in collaboration with a research librarian and included three sets of keywords: (1) 'child' OR 'infant' OR 'toddler' OR 'pre-schooler'; AND (2) 'digital technology' OR 'digital media' OR 'screen time' OR 'computer' OR 'smartphones' OR 'tablets' OR 'videogame'; AND (3) 'impact' OR 'effect' OR 'outcome' (see Appendix A).

| Study inclusion criteria
In agreement with the Joanna Briggs Institute recommendation for systematic review (JBI, 2014;Tufanaru et al., 2015), authors, when feasible, should include RCTs and quasi-experimental and observational studies in their review of impact or effectiveness.Thus, we have included all study designs in this review as it is the most inclusive approach.All studies were assessed against the following general inclusion criteria: Primary research studies related to the usage of technology, published in English language, and studies of children aged 7 years or younger (different from published protocol).Commentary, anecdotal, and review studies were excluded.Studies limited to children with functional disabilities such as autism spectrum disorders (ASD), attention deficient hyperactivity disorders (ADHD), and cerebral palsy (CP) were excluded.Studies that included assessment of literacy and numeracy skills were eligible for inclusion in this review if they were measured as an outcome of cognitive development.In this review, numeracy skills were defined as the child's ability to perform basic arithmetic operations, recognize numbers, and count accurately.
Only screen-based technologies were considered in this review.
Internet-connected toys were not included in this review.This review excluded articles with a limited focus on TV viewing and general screen time as there was no current gap in the literature.
It should be noted that although the inclusion criteria specified developmental outcomes for children aged 7 years or younger, some studies including children older than 5 years were not excluded from the review because they contributed relevant data on the population of interest.This included, for example, studies involving children older than 7 years but with data stratified by age or developmental group.

| Studies selection
We used Rayyan, an online systematic review tool, to assist in the selection process (Ouzzani et al., 2016).After removal of duplicates, two reviewers independently read title and abstracts of articles acquired in the initial search.Both reviewers screened the relevant articles identified by the search strategy on inclusion and exclusion criteria to identify studies that examined the impact of digital technology on child development.A third reviewer adjudicated on any disagreements between the two reviewers and cross-checked data from all eligible studies.

| Process used for data extraction
Data extraction was carried out by two reviewers and checked by a third reviewer.For each study included, information was extracted using a structured data sheet that included information about first author's last name, year of publication, country, study design, aim, sample, type and content of interactive digital technology, methods of measuring developmental outcomes, and main results.

| Definition of outcome and conceptual issues
For the purpose of this review, we defined digital technology as the use of digital devices including computers, tablets, and mobile phones and smart phones, as well as the digitally mediated activities that children engage in via these devices, such as using the Internet, going on social networking sites, chatting, or playing video games (Anderson & Subrahmanyam, 2017).Child development was defined as an orderly progression of gross and fine motor, cognitive and language skills that are formed by an interaction of genetic potential and environmental opportunities (Black et al., 2015, p. 853).
Based on the Black et al. ( 2015) definition, we defined child performance indicators on gross and fine motor, cognition, and language as measures of child development.For the purpose of this review, we considered acquisition of perceptual-motor skills and manual dexterity as indicators of motor development.For example, while writing and drawing are perceived as complex skills that require the combination of motor, perceptual, and cognitive components (Otake et al., 2017), we used writing or drawing as an indicator of fine motor skills.We also did not distinguish between vocabulary acquisition or word learning in categorizing approaches to language development.We defined vocabulary acquisition and word learning as the primary means by which a child learns to communicate and advance language skills.
There is substantive variability in how researchers define and measure cognitive development.Our definition of cognitive development subsumes both learning and executive functioning.For this review, a good understanding of the particular definition of executive function used to guide the selection of cognitive tasks to assess the construct was central because it can influence our ability to interpret the results.McNeill et al. (2019) suggested that executive function is a higher order cognitive processes implicated in the ability to reason, problem solve, and plan through their enabling of manipulating information in the mind (working memory), resisting distractions and impulsive behaviors (inhibition), and flexibly switching between task demands (shifting).It was also conceptualized as the cognitive process that organized simple ideas, behaviors, and affects into complex action (The Diagnostic and Statistical Manual of mental Disorders, 4th edition).

| Selection of outcome data for synthesis
As the definition of 'child development' is broad, the potential range of outcomes of eligible studies is also large.However, not all outcome data were relevant for analysis.In this review, data synthesized included only those studies that specifically addressed how different forms of interactive digital devices impacted on developmental outcomes in children including but not limited to motor, language, and cognition.
We used narrative synthesis (Siddaway et al., 2019) to analyze the included studies and structured the synthesis around a summary table presenting descriptive details of each developmental domain included in the review.Three main questions were used to guide the synthesis of data: What are the developmental outcomes examined in the evidence?What is the evidence on whether different types/ contents of interactive digital devices lead to different developmental outcomes in children?What is the overall evidence on the impact of various types/contents of interactive digital devices for children aged 5 years relative to younger children?
For the narrative synthesis, the studies were grouped into three different categories of development: Motor skills, language acquisition, and learning and cognitive development.In the data synthesis of this review, all findings were discussed with appropriate emphasis given to the studies that were more methodologically robust.The narratives were written by one reviewer, yet all decisions were arrived at through discussion and a consensus process by two reviewers.

| Quality assessment
In this review, we classified experimental and quasi-experimental studies as Tier 1 studies, and the remaining qualitative, descriptive surveys/with or without comparison were classified as Tier 2 studies.
Then, quality assessment of eligible studies was evaluated using the No studies were excluded on the basis of the minimum quality threshold.

| Search outcome
Across the six databases, we initially retrieved 7632 studies, 1757 studies were excluded based on duplicate records and 5705 studies were removed after screening the title and abstract.An additional 117 studies were excluded after reading the full text document.Consequently, 53 studies met the inclusion criteria and were included in the review (Figure 1).

| Characteristics of included reviews
Fifty-three studies were eligible for inclusion in the review, 39 Tier 1 and 14 Tier 2. The studies ranked as Tier 1 were defined as studies used RCT and quasi-experimental designs, where studies ranked as Tier 2 were defined as studies used descriptive designs including cross-sectional, cohorts, case control and qualitative.
Below, we summarize our findings into three main categories: Motor, language, and learning and cognitive development.
Quality assessment of the included studies was conducted using the JBI quality appraisal checklist (Table 2).All of the 53 original studies were considered of high to moderate methodological quality.
As shown in Table 2, many important variables, including dose of exposure, duration, and intensity were inconsistently reported and varied significantly from 3 min in Diehm et al. (2020)  In Bedford et al. (2016), the association between early touchscreen use and age of reaching developmental milestones was limited by the fact the only measure of child's usage of touchscreen was reported at the child's current age without being able to conclude how this relates to child's earlier usage.An evaluation of the doseresponse relationship was not clearly included, although this is an important topic as the magnitude of any change in child's development is critical to the conclusions.
Most studies suggested a negative association between the use of digital technology and fine motor development (Kiefer et al., 2015;Lin, 2019;Lin et al., 2017;Mayer et al., 2020;Picard et al., 2014).
Only two studies found significant benefits for using an iPad (Axford et al., 2018) or a digital notebook application (Bonneton-Botté et al., 2020) as a mean of developing fine motor skills.In contrast, Axford et al. concluded that children's use of iPads negatively associated with fine motor development when used for more than 30 min a day.One study suggested no significant difference in children's motor skills between groups (Spinosa et al., 2020), and another study (Trost & Brookes, 2021) suggested a positive association between digital application use and object control skills.
In Tier 2, data were available from 1 qualitative (Clarke & Abbott, 2016), 1 cohort (Barnett et al., 2012), 4 cross-sectional studies (Bedford et al., 2016;Moon et al., 2019;Souto et al., 2020;Zheng & Sun, 2021).One study (Clarke & Abbott, 2016) used a qualitative approach to explore the impact of iPad technology on learning and revealed a positive association between iPad use and children's writing and drawing skills.One cohort study (Barnett et al., 2012) investigated the use of videogames or computers and gross motor proficiency and reported mixed findings.All four of the cross-sectional studies investigated the use of computers and touch screens at home and found that prior use of interactive digital technology was associated positively with fine motor development (Bedford et al., 2016;Moon et al., 2019;Souto et al., 2020)  Graphic scores were lower in the finger on screen using an iPad when compared to the pen on paper.
Finger on screen drawings were
One study evaluated the use of learning videos and vocabulary acquisition in toddlers and reported lower impact of learning videos on children's productive vocabulary as compared to children learning from live presentations (Zimmermann et al., 2015).All six quasiexperimental studies compared digital technology use to no intervention and reported a positive association between use of interactive technologies and language acquisition when used in educational settings.Data from Tier 1 studies provided plausible evidence that technology that integrate educational content may be effective in promoting both receptive language skills and vocabulary acquisition in children.
In Tier 2, data were available from four cross-sectional studies (Bedford et al., 2016;Hu et al., 2020;Lin et al., 2020;Moon et al., 2019).Two cross-sectional studies explored the relationship between touchscreen use and language development in toddlers and suggested no association between children using touch screen devices and language development (Bedford et al., 2016;Lin et al., 2020).Hu et al. (2020) studied screen time and social development in children and reported mixed findings, but active computer and screen device use was generally associated with higher receptive language skills in children.Moon et al. (2019) presented a contrasting view that a higher level of touch screen device use was associated with poorer language development in children aged 1.5 to 3 years.These findings could suggest a positive association between language development and use digital technology.
All studies in both tiers were exclusively aimed at exploring the association between use of interactive digital devices and cognitive skills and were focused on general use of touchscreen devices This paper reports a systematic review examining the impact of digital technology use on child development.The studies reviewed in this review were predominantly correlational or comparative in nature and focused on cognitive domains of learning rather than a specific developmental outcome.In addition, both RCT and quasiexperimental studies were mainly concerned with investigating whether or not there were differences between children using digital devices (tablets and non-tablets) in cognitive and motor skills.Therefore, it was difficult to conclude cause from effect regarding the relationship or impact of digital technology use on child development.
One prominent explanation for these associations or effects suggests that children's use of interactive digital technology commonly associate with better receptive language and executive function, but not motor proficiency.
In this review, only three studies used longitudinal designs to clarify correlates (Barnett et al., 2012;Fikkers et al., 2019;McNeill et al., 2019), and seven studies (Bonneton-Botté et al., 2020;Clarke & Abbott, 2016;Desoete & Praet, 2013;Di Lieto et al., 2017;Konok et al., 2021;Liu et al., 2021;Trost & Brookes, 2021) reported on the impact on children when using computer applications or other touchscreen devices.In these studies, it was difficult to determine the magnitude of any change in child's development or whether it would be reasonable to expect that the use of certain interactive technology devices would play an important role in enhancing or embedding developmental outcomes.However, placed within the larger context of research on the digital technology's relations with child development, there was some evidence that use of interactive technology, such as computers and screen devices, can poorly associate or impact motor development in young children.
For motor skill development, a large body of Tier 1 studies suggested that the use of digital technology can lead to no gains or associate negatively with fine motor development.While Tier 2 studies hypothesized benefits for touchscreen use, we found no clear evidence that digital technology use was effective in improving gross motor outcomes in children (Barnett et al., 2012;Bedford et al., 2016;Spinosa et al., 2020).
The result of our review would have been much more meaningful if the dose of exposure to games, videos, computers, or mobile phones had been reported in an informative manner.This highlights the gap in defining the type, content, and intensity of digital technology use, rather than a gap in access to digital devices.Our findings showed critical aspects informing the evidence, such as dose of exposure, intensity, or duration were inconsistently reported and varied significantly across studies, making estimates of exposure ten- gested that the relationship between some electronic media use and executive function may actually be curvilinear rather than linear.
Therefore, the effects of some electronic media use could be stronger for some children due to higher dose of exposure (30 min/day threshold), which may reduce other regular developmentally appropriate experiences and practices, potentially harming a child's development.However, this idea remains largely unexamined and open to question.We were unable to locate similar reviews evaluating the digital impact on motor development to which we might compare findings.The impact of digital technology most prevalent in the literature included the developmental correlates of screen media exposure, mainly with relation to the physical activity and/or obesity/ adiposity (Fang et al., 2019;Reus & Mosley, 2018;Stiglic & Viner, 2019).All reviews suggested increasing screen time and screen media exposure in children was predominantly adversely associated with obesity/adiposity and physical activity.The ways that motor proficiency was measured were not comparable, and therefore, these results were not comparable.Likewise, another systematic review by Kuzik et al. (2017) identified favorable associations with at least one motor development indicator in two RCT studies that examined the most ideal combinations of sedentary behavior and physical activity.
In our review, improved comprehension was not consistently associated with digital technology use, although use of digital technology was fairly associated with enhanced receptive language, executive function, and memory.This finding contrasts with a previous scoping review that suggested negative or no association between touchscreen media use and language development (Reus & Mosley, 2018).
However, it should be noted that the positive association found in our review was not supported in other reviews other than in the receptive domain of language (Gremmen et al., 2016;Hu et al., 2020).While we present evidence that supports the receptive language development of specific interactive digital technologies, the level of benefit was reported as dependent on adult company or co-viewing (Walter-Laager et al., 2017), limited screen time (Duch et al., 2013), and being over 3 years of age (Moon et al., 2019).
On the cognitive domain, cited studies with a positive association or impact included enhanced literacy and numeracy skills, manual dexterity, and visuo-spatial working memory when used in a learning context.Use of touchscreen devices in Tier 1 studies were often intended to evaluate executive function and visual-motor integration and were particularly prevalent in studies of literacy learning.
While there were reported benefits in this context, none of the Tier 1 studies reported significant impact of digital technology use in children on comprehension (Parish-Morris et al., 2013;Ross et al., 2016).Part of these findings were consistent with other studies, which reported positive association of specific TV programs or video games and cognitive development of children (Reus & Mosley, 2018).It was suggested that the use of educational computer programs or games can lead to short-term increases in visual processing skills, attention, and executive function skills (Anderson & Subrahmanyam, 2017).What remains unclear is not whether this effect depends on the content-specific or type of games played, but whether such positive cognitive impact can be prolonged and enhanced in those children.
In this review, the included studies were of high quality and the majority were classified as Tier 1.In our conclusion, we argue that an emphasis on rigorous study designs such as RCT and quasiexperimental rather than on cross-sectional and qualitative studies is necessary to provide casual evidence, but that should be countered by the issues of longer term effects and ability to adequately control sufficiently in real-world RCTs.We do not suggest negating the evidence generated by cross-sectional studies, rather that trials are "content-specific" more generally.We argue also that evaluation and understanding of the dose of exposure to video games or screen devices is important prior to any conclusion as dose of exposure may be a confounding factor for any impact on developmental outcomes.
We need to acknowledge that there were several limitations to this review including limitations with the search strategy, inclusion and exclusion criteria, and the search terms used.The search strategy used was comprehensive but did not include searches in grey data sets such as OpenGrey, Health Canda, or TRIp Pro.Our search strategy was designed to ensure quality by limiting studies to those published in peer-reviewed journal and those with good quality appraisal.
In addition, the search used for this review was supplemented using reference lists; so, it is likely that most relevant articles were included.
Another limitation is that our review did not specifically search for smart connected toys or electronic games.For example, articles that evaluated connected toys that are Internet-enabled devices with Wi-Fi, Bluetooth, or other capabilities were not included related to limitations of search strategy.However, evaluation of outcomes specifically related to Internet-connected toys, which are becoming increasingly popular among very young children (<7 years), is also important and should be analyzed in future studies.
Other limitations to be considered in our review is reported data for motor and language domains may suffer from different degrees of inconsistencies or may be incomplete due to the broad definition of child development and assessment methods.For example, in a few studies, assessment of manual dexterity and writing or drawing skills were used as one component of a general assessment of the cognitive and learning domain.This made it difficult to isolate the specific correlates of fine motor development because such skills require the combination of motor, perceptual, and cognitive components (Picard et al., 2014).A number of contextual factors that may moderate the association between digital technology use and child development was not adequately provided in the primary studies.This included stratified data by age group, gender, screen time, and content, in addition to other critical aspects informing the evidence, such as dose of exposure, intensity, or duration.Therefore, our findings suggest only a rudimentary level of understanding of the area.
Finally, while our review offers a thorough examination of the published studies in social and health science, the constant advancement of interactive digital technologies, including video games means that many of the more recent releases have yet to be evaluated through research.The review may not capture all digital technologies, and the question of whether interactive digital technology impacts literacy, vocabulary, and executive function among children will continue to evolve.
to 75 min in DiLieto et al. (2017).Dose of exposure to digital technology was informatively reported only in one study withAxford et al. (2018) showing that regular use of iPad application with over 30 min was negatively associated with fine motor skills.In another study byMcNeill et al. (2019), high dose of exposure (≥30 min) was associated with lower inhibition capabilities 12 months later compared with low dose of exposure.These results underscore the importance of dose-response relationship that is important for understanding the impact of digital technology use.
To determine the impact of pen-onpaper versus finger-on-screen, on drawing quality, in children Standardized graphic scale yielding an overall graphic score tative and imprecise.Bedford et al. (2016) suggested that more reliable methods of tracking current touchscreen usage, such as media diaries or device monitoring, are required along with the detailed analysis of other usage factors, such as co-use, physical context, and type of use.The longitudinal designs of McNeill et al. (2019) sug- Level of evidence for primary outcomes and conclusions of included studies

Table 5
et al., 2021;Liu et al., 2021;Neumann, 2018;O'Toole & Kannass, 2018;Outhwaite et al., 2019;Parish-Morris et al., 2013;Ross et al., 2016; Rogowsky et al., 2018;Schmitt et al., 2018; Summary of studies related to interactive technologies and cognitive development (Chen et al., 2013)2020)limelech & Aram, 2020;Fikkers et al., 2019;Herodotou, 2018;Russo-Johnson et al., 2017;Schmitt et al., 2018;Schroeder & Kirkorian, 2016).The studies included children from 2 to 5 years.Most digital technology content aimed to enhance executive function and literacy and/or numeracy skills, but not comprehension level.includedchildrenwithneedsforauditoryand/or visual supports(Elimelech & Aram, 2020)and children with developmental delay(Chen et al., 2013).Findings from these studies highlight key areas of concern for improving not only access to interactive technologies, but for promoting digital equity as well.T A B L E 4 Summary of studies related to interactive technologies and language acquisition T A B L E 5