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Preschoolers’ integrated technology usage was examined related to cognitive and visual spatial functioning. The participants consisted of 492 typically developing preschool children. Parent/caregiver reports of children’s television viewing and digital technology usage, and WPPSI-IV intelligence scale scores and Visual Spatial Composite scores were examined. Preschoolers’ screen time was also compared to a previous 2010 group to look for changes in television viewing patterns following an increase in digital device usage. The results provide evidence of an interaction between digital media usage and visual spatial abilities. Preschoolers with higher reported digital media usage had lower WPPSIIV Visual Spatial Composite scores and Full Scale IQ scores, on average. Television viewing patterns have remained similar over time, but technological device usage has increased. Lower maternal education, lower SES, and being from a historically disadvantaged background were associated with greater usage time. Practical implications for prevention, early intervention, education and policy are discussed.