By Gloria Arminio Berlinski, MS
Reviewed by Nicole Foubister, MD, Assistant Clinical Professor of Child & Adolescent Psychiatry and Psychiatry, New York University School of Medicine
- According to newly or soon-to-be published studies in adults, ADHD symptoms are associated with electronic screen time exposure, internet gaming disorder, and addictive use of social media.
- The researchers note that the cross-sectional design used in their studies prevents conclusions of causality and directionality.
- They stress, however, the need for research on intervention measures designed to prevent addictive use of technology in vulnerable individuals.
Strong links exist between addictive use of digital technology and underlying psychiatric disorders, and mounting evidence indicates that attention deficit hyperactivity disorder (ADHD) occurs concurrently with excessive video gaming as well as Internet addiction.1 Newly published studies have specifically explored the association of ADHD symptoms with electronic screen time exposure, internet gaming disorder, and addictive use of social media among university students and older adults.1-3
Higher education students are daily users of electronic devices for both academic activities and recreational time. A researcher at the University of Bordeaux in France, Ilaria Montagni PhD, was the lead author of a 2016 article that described the potential link between high levels of screen time and self-perceived inattention and hyperactivity in graduate students. According to Dr. Montagni, these young adults “spend an average of three hours per day on at least one digital device and they’re frequently exposed to 2 screens, such as laptops and smartphones, at the same time.”
In their cross-sectional study, Dr. Montagni and fellow researchers asked approximately 4,800 French graduate students to self-report their time spent using a smartphone and computer or tablet for working, studying, searching the Internet, social networking, playing video games, or watching television programs or movies. Global information on inattention and hyperactivity over the previous six month period was ascertained through a questionnaire based on the Adult ADHD Self-Report Scale (ASRS-Version 1.1).2
Multivariable ordinal logistic regression analysis<sup2< sup=””> showed that increasing screen time exposure was significantly associated with higher levels of self-perceived attention problems and hyperactivity. The authors noted that the correlation seemed to be stronger for the attention deficit domain versus the hyperactivity domain.2 The risk of self-reported ADHD features “steadily increased with increasing levels of screen time exposure categories,” says Dr. Montagni. “As our study was cross-sectional, we cannot rule out that inattention/hyperactivity leads to increased screen time use, but it appears less likely,” she notes.</sup2<>
As to the next steps in research, Dr. Montagni states that “to better understand whether reduction of screen time use would positively affect attention problems and hyperactivity in students.” This is especially important considering the increased diagnosis of previously unrecognized ADHD among college students, she and fellow researchers point out in their report.2 Dr. Montagni and colleagues also call attention to the need for effective interventions and guidelines to promote the healthy use of digital technology among university students.
An article in press by Yen and fellow researchers presents cross-sectional findings on the relationships among ADHD, Internet gaming disorder (IGD), and their common symptoms of impulsivity and hostility.3 After fulfilling recruitment criteria, students from university campuses in Taiwan underwent diagnostic interviews conducted by a psychiatrist based on the DSM-5 IGD criteria and DSM-IV-TR ADHD criteria, and completed the Dickman’s Impulsivity Inventory and Buss-Durkee Hostility Inventory. Study participants included 87 individuals with IGD and 87 controls with no history of IGD, who were matched for gender, educational level, and age.3
Adult ADHD was identified in 34 (39%) IGD-diagnosed participants versus four (5%) individuals in the control group.3 ADHD was found to be associated with IGD, and symptoms of impulsivity and hostility were observed to mediate this association. Yen and fellow authors noted that because young adults with ADHD may use gaming for a sense of achievement and pleasure to escape from their psychosocial difficulties, they may be more susceptible to IGD. Furthermore, they point out that “young adults with both ADHD and IGD had higher IGD severity than those with only IGD did, suggesting that the comorbid IGD and ADHD among young adults result in a vicious cycle.”
Another newly published cross-sectional study, conducted by Schou Andreassen and colleagues, examined whether symptoms of comorbid psychiatric disorders, including ADHD, affect the variance in addictive use of modern online technologies, namely video games and social media. The authors indicate that their investigation is the first to evaluate the relationship between addictive online social networking and ADHD.
Approximately 23,500 adults from the Norwegian population who completed an online cross-sectional survey that focused on several addictive behaviors subsequently responded to questionnaires of the Bergen Social Media Addiction Scale and the Game Addiction Scale to evaluate symptoms of digital technology addiction. The ASRS-Version 1.1 was used to assess underlying symptoms of ADHD. Participants ranged in age from 16 to 88 years, with the majority between the ages of 16 and 30 years (41%) and 31 and 45 years (35%).1
Overall, findings suggested that symptoms of psychiatric disorders in adults were correlated with an individual’s addictive social networking and video gaming, after controlling for age, sex, and educational and marital status.1 Results for ADHD, in particular, showed that this disorder explained more of the variance in addictive use of social media than in video games. The authors speculate that features (e.g. beeping, constant updates) of mobile phones, which are typically used for social networking, make individuals who are easily distracted or impulsive more susceptible to excessive or compulsive use of social media.1
Researchers from all three studies described here addressed the limitation of a cross-sectional study design, which prevents any definitive interpretation of causality and directionality of statistically significant relationships.1-2 Schou Andreassen and colleagues make the point that “the identified relationships may very well be the other way around or go in both directions. This should be further investigated using longitudinal study designs.” Investigators emphasize that intervention measures are needed to address the addictive use of technology in adults.1-3
- Schou Andreassen C, Griffiths MD, Kuss DJ, et al. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychol Addict Behav. 2016;30:252-262.
- Montagni I, Guichard E, Kurth T. Association of screen time with self-perceived attention problems and hyperactivity levels in French students: a cross-sectional study. BMJ Open. 2016;6:e009089.
- Yen J-Y, Liu T-L, Wang P-W, et al. Association between Internet gaming disorder and adult attention deficit and hyperactivity disorder and their correlates: Impulsivity and hostility. Addict Behav. In press.
- Nugent K, Smart W. Attention-deficit/hyperactivity disorder in postsecondary students. Neuropsychiatr Dis Treat. 2014:10:1781-1791.