Problematic use of digital media in children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder compared to controls. A meta-analysis

Toward the classification of social media use disorder: Clinical characterization and proposed diagnostic criteria

Empirical studies and theoretical models highlight that problematic use of social media can lead to significant functional impairments in several domains, such as social, relational, occupational, and psychological functioning, as well as physical health. However, social media use disorder is not currently recognized as an official disorder in major diagnostic systems, limiting comparability among studies, precise prevalence estimation, and ad-hoc preventive and treatment program development. The present work aims to classify social media use disorder as a pathological condition sharing main mechanisms and maladaptive patterns with addictive behaviors. We discuss diagnostic criteria for social media use disorder by integrating peculiar features of this maladaptive behavior with criteria for substance use disorders and behavioral addictions from major diagnostic systems (i.e., DSM-5 and ICD-11). Moreover, we address some controversies related to the classification of social media use disorder as a behavioral addiction and highlight literature findings indicating social media use disorder shares main alterations in mechanisms and processes characterizing addiction (i.e., maladaptive activation of reward systems and impairment of inhibitory control mechanisms). Despite the lack of studies including clinical populations and the need for future research to validate the proposed criteria and refine knowledge of the mechanisms underlying this condition, our work provides a structured framework for classifying and identifying social media use disorder.

Caught in the Web of the Net? Part I: Meta-analyses of Problematic Internet Use and Social Media Use in (Young) People with Autism Spectrum Disorder

This article examined the internet and social media usage among (young) individuals with autism spectrum disorder (ASD). Two meta-analyses were conducted to quantify (1) the relation between ASD/autistic traits and problematic internet use (PIU, which included generalized PIU, problematic gaming, excessive smartphone use), and (2) the relation between ASD/autistic traits and social media use. The results of our first meta-analysis-comprising 46 studies and 42,274 participants-revealed that people with ASD or higher levels of autistic traits showed higher levels of PIU, with an average effect size of r = 0.26 (95% CI [0.21, 0.31]). The second meta-analysis-consisting of 15 studies and 7036 participants-indicated that people with ASD or higher levels of autistic traits were less involved on social media platforms as compared to their typically developing counterparts, with the average effect size being r = - 0.28 (95% CI [- 0.38, - 0.18]). The quality of the research on PIU and social media in persons with ASD was critically evaluated and possible directions for future research on this topic are discussed.

The effect of digital parental awareness and somatic symptoms on problematic media use in children with attention-deficit/hyperactivity disorder

BACKGROUND

Children diagnosed with Attention-deficit/hyperactivity disorder (ADHD) have greater difficulty in regulating their own media usage and are inclined to spend more time engaging in video games compared to neurotypical children. This study aimed to investigate the effects of ADHD severity, digital parenting awareness, and accompanying psychiatric symptoms on children's problematic media (PMU) use in children with ADHD.

METHODS

The study included 95 ADHD patients aged between 6 and 11 years and 90 age-and gender-matched healthy controls. The Problematic Media Use Measure-Short form (PMUM-SF), Child Behavior Checklist (6-18 years) (CBCL-6/18), Conners Parent Rating Scale-Revised Short (CPRS-RS), and Digital Parental Awareness Scale (DPAS) were administered to all parents.

RESULTS

Daily screen time was 183.56 ± 84.77 min in the ADHD group and 117.47 ± 49.08 min in the control group (p < 0.001), and PMUM-SF scores were higher in children with ADHD (p < 0.001). Comorbid internalizing and externalizing problems were positively associated with PMU. The results of the hierarchical regression analysis showed that ADHD severity, somatic complaints in children, negative media role modeling by mothers, and neglect of children's media use were associated with increased PMU in children (p < 0.001, Adjusted R2 = 0.520).

CONCLUSION

PMU in children with ADHD can be better managed by raising parents' awareness of the adverse effects of digital media within prevention and treatment interventions. Moreover, since comorbid ADHD and somatic symptoms may affect PMU, the severity of somatic complaints should be evaluated within the scope of treatment programs.

Long-term changes on behavioral addictions symptoms among adults with attention deficit hyperactivity disorder treated with methylphenidate

Background

Attention deficit hyperactivity disorder (ADHD) and behavioral addictions (BAs) are highly comorbid but little is known about the effect of anti-ADHD medications on behavioral addiction symptoms. Thus, the aim of this naturalistic prospective study was to investigate the long-term changes on BAs symptoms among methylphenidate-treated adults with a primary diagnosis of ADHD.

Methods

37 consecutive adult ADHD outpatients completed a baseline and follow-up assessment of ADHD, mood and BAs symptoms (internet, shopping, food, sex addictions and gambling disorder) after one year of methylphenidate (flexible dose) treatment.

Results

Internet addiction test scores pre-treatment were significantly higher than post-treatment scores (p < 0.001). The same trend was seen for the shopping addiction (p = 0.022), food addiction scores (p = 0.039) and sex addiction scores (p = 0.047). Gambling disorder scores did not differ pre and post treatment since none of the included patients reported significant gambling symptoms at baseline. The rate of ADHD patients with at least one comorbid BA was reduced after methylphenidate treatment (51.4% vs 35.1%). The correlation analyses showed a moderate positive correlation between the changes in sluggish cognitive tempo symptoms, cognitive impulsivity, mood and anxiety symptoms and changes in internet addiction symptoms.

Conclusions

This is the first study showing that after one-year of treatment with methylphenidate, adult ADHD patients show a significant reduction on internet, food, shopping and sex addiction symptoms. Further controlled studies with larger samples should replicate these preliminary results and elucidate the role of methylphenidate and other moderator factors (such as concomitant psychological treatments or lifestyle habits changes) on BAs improvements.

A case-control study for psychiatric comorbidity and associative factors of gaming disorder and hazardous gaming based on ICD-11 criteria: Cognitive control, emotion regulation, and reinforcement sensitivity

Background and aims

The authors of the present study wanted to know whether the previously reported psychiatric comorbidities of internet gaming disorder (IGD) based on DSM-5 criteria were also more prevalent among gaming disorder (GD) or hazardous gaming (HG) based on ICD-11 criteria. Therefore, the present case-control study evaluated the psychiatric comorbidities and associative factors of GD and HG based on ICD-11 criteria.

Methods

A sample of 60 individuals with GD, 45 with HG, and 120 controls were assessed with an ICD-11 criteria-based diagnostic interview along with attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder (GAD), depressive disorder, and social anxiety disorder (SAD). Participants also completed Conners' Continuous Performance Test (CCPT), Dickman's Impulsivity Inventory, the Emotion Regulation Questionnaire, and the Behavior Inhibition System and Behavior Approach System Scales.

Results

GD was associated with ADHD, depressive disorder, and GAD. ADHD was the most associative comorbidity of HG. Depressive disorder was associated with GD relative to HG. Moreover, individuals with lower reappraisal, higher aversion sensitivity, and impulsivity were more likely to be diagnosed with GD. Those with higher fun-seeking were more likely to be diagnosed with HG.

Conclusion

In the present study, ADHD was the psychiatric comorbidity most significantly associated with GD, followed by depressive disorder and GAD, as previously reported for IGD. ADHD was also associated with HG. Depressive disorder was more associated with GD compared to HG. Intervention for HG and GD should be tailored by the consideration of the clients' psychiatric comorbidity as well as their reappraisal skills, impulsivity, aversion sensitivity, and fun-seeking.

Gender-specific motivational pathways in ADHD-related inattention and gaming disorder symptoms

Comorbidity between attention-deficit/hyperactivity disorder (ADHD) and gaming disorder (GD) is widely recognized in the literature. Previous research has indicated gender-dependent underlying mechanisms in the development and maintenance of problematic gaming. Motivational research presents an opportunity to provide further insight regarding the nature of this association. Self-report data were collected from videogame players (N = 14,740) using an online survey in collaboration with a popular gaming magazine. The survey included items concerning symptoms of ADHD and GD, motives for gaming, and time spent playing videogames. Structural equation modeling was used to create two parallel mediation models (one for males, one for females), including motives to play games as mediators. This was done to potentially explain psychological drivers of the association between ADHD and GD. Results demonstrated a common pathway from inattention to GD symptom severity through the immersion/escapism motivation for both males (β = 0.068; p < 0.001) and females (β = 0.081; p < 0.05), while the paths from inattention to GD symptom severity through the habit/boredom motive (β = 0.094; p < 0.001) and competition motive (β = 0.021; p < 0.001) were only significant for males. Gamers experiencing symptoms of ADHD, especially inattentive symptoms, are at risk of the occurrence of GD symptoms through videogames becoming a source of maladaptive coping with daily psychological disturbances. Males experiencing inattentive symptoms tend to additionally develop problematic patterns of use through videogame playing, becoming a subjectively meaningless and boredom-reduction-oriented habitual activity or a platform of virtual competition. Unique differences suggest the necessity of different treatment approaches for males and females.

The impacts associated with having ADHD: an umbrella review

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD.

Methods

An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications.

Results

Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality.

Discussion

This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning.

Registration

International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).

The longitudinal associations between internet addiction and ADHD symptoms among adolescents

Background and aims

Internet addiction has been linked to ADHD-related symptoms. However, the direction of the relationship and its potential for reciprocal relations is not well understood. This study examined the potential reciprocal relations between the three components of ADHD and Internet addiction, as well as the moderating effects of gender on these relations.

Methods

Using a longitudinal design, we collected data of 865 Chinese adolescents across three waves (Mage = 13.78, SD = 1.56 in wave 1), with a time interval of 6 months.

Results

Cross-lagged analyses revealed bidirectional associations between hyperactivity, inattention, impulsivity, and Internet addiction over time. Multi-group analyses did not yield any significant gender differences in these relationships.

Discussion and conclusions

These findings enhance our understanding of the complex link between ADHD components and Internet addiction and have implications for interventions aimed at reducing the prevalence of Internet addiction and ADHD.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

The emerging evidence on the association between symptoms of ADHD and gaming disorder: A systematic review and meta-analysis

The co-existence of gaming disorder (GD) with other mental health problems has been widely reported. Despite the growing research interest in the comorbidity of GD with attention-deficit/hyperactivity disorder (ADHD), to date, no quantitative synthesis has been performed. The present study comprised a systematic literature search using Scopus, Science Direct, Web of Science, and PubMed databases. Three types of studies were included in the analyses: studies reporting (i) correlation coefficients between the symptoms of GD and ADHD, (ii) means, and standard deviations for comparison of GD severity between ADHD/non-ADHD individuals, and (iii) comparison of ADHD severity between GD/non-GD individuals. The results indicated a moderate relationship between GD and ADHD symptom severity when both subdomains of ADHD were combined (r = 0.296), and also when only inattention (r = 0.306) or hyperactivity (r = 0.266) symptoms were analyzed, which was also confirmed in a structural equation model meta-analysis. Studies showed a large average difference comparing the GD symptom severity of ADHD and non-ADHD individuals (g = 0.693), or ADHD symptom severity of GD and non-GD individuals (g = 0.854). In some cases, higher estimates of association were reported among studies that (i) had a higher proportion of males, (ii) assessed problematic internet use among predominantly videogame player samples rather than assessing only GD, and (iii) had been more recently published. The present review shows that this is an emerging field demonstrating significant results in cross-sectional correlational studies. However, future research should apply more rigorous methodologies to investigate the relationship further (e.g., longitudinal studies and studies using professional/clinical ratings and diagnosis). These results suggest that screening and treatment for ADHD among individuals with gaming disorder is necessary, and individuals with ADHD should be made aware of their higher susceptibility to gaming disorder.

Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause

The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.

Children's excessive digital media use, mental health problems and the protective role of parenting during COVID-19

COVID-19's outbreak in March 2020 and the social distancing measures that followed it changed the lives of children worldwide. Studies assessing the pandemic's implications for children have reported an alarming increase in the use of digital media (DM) and warned of its adverse impacts on children's functioning and development. The current study aimed to assess the relationship between excessive and problematic DM use and emotional, behavioral, and academic functioning among Israeli adolescents during COVID-19 and to identify adolescents at elevated risk of developing problematic DM use. Three hundred forty-seven Israeli parent-child dyads (M age = 11.81, SD = 1.41) separately completed measures assessing children's DM use (time and addiction), functioning (academic, social, emotional, and behavioral), behavioral dysregulation, and the parents' parenting practices. The results showed that DM addiction, but not DM use, was related to children's emotional, behavioral, and academic difficulties. Moreover, the results indicated that negative parenting and behavioral dysregulation increased the risk of DM addiction, which in turn increased emotional, behavioral, and academic difficulties. The results underscored parents' role in preventing problematic DM use and highlighted the need to treat DM use and problematic DM use as distinct constructs.