|Year : 2021 | Volume
| Issue : 2 | Page : 79-86
Newer addictions in children and adolescents
Rama Subba Reddy
Department of Child Psychiatry, Niloufer Hospital, Telangana, India
|Date of Submission||06-Dec-2021|
|Date of Acceptance||07-Dec-2021|
|Date of Web Publication||12-Jan-2022|
Dr. Rama Subba Reddy
Department of Child Psychiatry, Niloufer Hospital, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
New forms of digital/social media include Applications (Apps), Multiplayer Video Games, YouTube Videos, Or Video Blogs (Vlogs), WhatsApp, Twitter, Snapchat, Instagram, Telegram. Research evidence suggests that these newer media offer both benefits and risks to the health of children and teenagers. In a survey done on parents by family foundation in 2011, 52% of children 0–8 years of age had access to a mobile device (although only 38% had ever used once). By 2013, this access had increased to 75% between 0 and 8-year olds. In addiction cycle, there are three stages: Binge/intoxication, Withdrawal/negative affect, Preoccupation/anticipation. Majority of us spend much of our time online, especially now during the era of COVID-19 to stay connected to others and keep ourselves entertained during social distancing. As with most disorders, there is not always a clear cause of Internet addiction. However, there are likely multiple factors that contribute to the development of this disorder, some of which are rooted in nature and others that are rooted in nurture. Other newer addictions are pathological gambling, internet gaming disorder, online porn addiction, online shopping addiction, social networking addiction causes biological as well as psychological problems. Manage screen use, Meaningful screen use, Model healthy screen use, Monitor for problematic screen use at any age. To promote health and wellness in children and adolescents maintain adequate physical activity, healthy nutrition, good sleep hygiene, and a nurturing social environment.
Keywords: Internet gaming disorder, pathological gambling, social media
|How to cite this article:|
Reddy RS. Newer addictions in children and adolescents. Telangana J Psychiatry 2021;7:79-86
| Introduction|| |
The initial concept of addiction was based on a medical model and is properly reserved for bodily and psychological dependence on a physical substance and not a behavioral pattern. However, it is Widened and a broader coverage of behaviors in addiction lead to a subset of behavioral addiction proposed by Griffith, which is a technological addiction, human machine interaction.
The reasons why children and adolescents move toward online world are they feel safer, to gain personal identity, to maintain companionship and it is more confident socializing online, and to escape from negative feelings.
The newer addictions are:
- Internet addiction disorder
- Online gambling disorder
- Online gaming disorder
- Online porn addiction
- Social networking addiction
- Online shopping disorder (compulsive buying).
| Digital/Social Media|| |
Social media is a group of Internet-based applications that build on the technological foundations of Web 2.0 which allows the creation and exchange of user-generated content. Web-based and mobile technologies include Internet forums, E-mail, instant messaging (IM), social network services (Twitter, Instagram, Snapchat) blogs, and microblogs, etc.
There is a shift from traditional to digital media, that is A NEW PARADIGM. Traditional media/broadcast media includes Television, radio, periodicals. New forms of digital/social media include Applications (Apps), Multiplayer Video Games, YouTube Videos, Or Video Blogs (Vlogs), WhatsApp, Twitter, Snapchat, Instagram, Telegram.
Through the traditional media, the health concerns and negative outcomes correlate with the duration and content of viewing. Research evidence suggests that these newer media offer both benefits and risks to the health of children and teenagers.
As per Goodman, excessive behaviors that serve to produce pleasure, provide escape from emotional and physiological discomfort, and are characterized by powerlessness and unmanageability.
This has three components:
- Medium (through which one engages in a behavior that is the Internet itself)
- Behavior (which is the observable action component leading to the problems such as gaming, gambling, and shopping)
- Addiction component.
Griffith proposed 6 core components of addiction:
- Salience (preoccupation with the behavior)
- Mood modification (behavior used to modify their mood-to escape from negative emotional state or for euphoria)
- Withdrawal symptoms (there are no physical symptoms unlike substance addiction. The person feels anxious depressed and irritable when unable to engage in the behavior)
- Conflict (conflict occurring due to online behavior)
- Relapse (inability to continuously abstain) (Mark Griffith 2005).
The gratifications sought on Internet are entertainment gratification, status gaining, expressing opinions and engaging in intellectual dialogue, impress people, try out new identity, avoid responsibilities forget their problems, identity experimentation.
| Epidemeology Prevalence|| |
- Prevalence is highest in Hong Kong (26.7%) and least in Iran (0%)
- Most evidences are from China and Korea
- Precedence is more in boys compared to girls (except online shopping more in girls) and is common in younger age.
In a survey done on parents by family foundation in 2011, 52% of children 0–8 years of age had access to a mobile device (although only 38% had ever used once). By 2013, this access had increased to 75% between 0 and 8-year olds.
Three-quarters of teenagers own a smartphone, 24% of adolescents describe themselves as “constantly connected” to the Internet and 50% report feeling “addicted” to their phones.
Teenagers maintain a “social media portfolio” of several selected sites including, as indicated by rates of use in the pew survey, Instagram (52%), Snapchat (41%), Twitter (33%), Google+ (33%), and other social media (11%).
Pew data from 2012 suggest that teenagers between 14 and 17 years of age sent a median of 100 texts a day.
| Risk Factors for Addictions|| |
- Biological factors
Vulnerability to addictions, deficits in neurotransmitters, psychiatric comorbidity: depression, anxiety, ADHD, ASD, etc.
- Personality and psychological vulnerability factors
Immaturity, emotional instability, unconsolidated identity, low self-esteem and indecision, lack of self-control, frustration, low resilience, high sensation search, deficit of social skills, inhibition, and extreme shyness.
- Environmental factors
Family environment: Conflictive, poor communication and affection, lack of supervision and family cohesion, etc., School environment with low performance, demotivation, etc., poor social environment.
- Stress factors
Grief, major crises, drastic life changes.
- Structural factors.
| Neuroanatomy|| |
Brief overview of anatomical structures involved nucleus accumbens (NAc), ventral tegmental area and medial forebrain bundle areas for reward and pleasure Prefrontal cortex controls decision making, planning, and judgment hippocampus, amygdala (AMG), limbic system – memory, learning and emotions orbitofrontal cortex-gateway for sensory perception Ventral striatum–seeking excitement
| Neurobiology|| |
In addiction cycle, there are three stages [Figure 1] and [Figure 2]:
- Withdrawal/negative affect
The neurocircuits involved:
- The basal ganglia, including the NAc, dorsal striatum (DS), globus pallidus (GP), and thalamus (Thal) as key elements of the binge/intoxication stage The extended AMG, including the central nucleus of the AMG, bed nucleus of the stria terminals (BNST), and a transition area in the shell of the NAc as key elements of the withdrawal/negative affect stage
- The frontal cortex and allocortex, including the prefrontal cortex (PFC), orbitofrontal cortex (OFC), hippocampus (Hippo), and insula (Insula) as key elements of the preoccupation/anticipation stage.
Molecular, synaptic, and neurocircuitry neuroadaptations combine to render the four key elements of the transition to addiction:
- Increased incentive salience
- Decreased reward
- Increased stress
- Decreased executive function.
| Explanatory Models|| |
- Biopsychosocial Model
Cognitive-behavioral model explains maladaptive cognitions social emotional model reveals social anxiety.
- Pace model - Interaction of person affect cognition and execution
Predisposing variables, affective and cognitive responses to internal and external stimuli, executive and inhibitory control, decision-making behavior/consequences.
| Internet Addiction Disorder|| |
Majority of us spend much of our time online, especially now during the era of COVID-19 to stay connected to others and keep ourselves entertained during social distancing. However, we do not all suffer as a result of our Internet use and time online - at least not to the degree of those with an addiction.
Internet addiction - sometimes called compulsive computer use, pathological Internet use, and Internet dependence - is yet to be listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, when engagement in a certain activity negatively impacts one's well-being and takes priority over important areas of life - such as work, school, and the individual's relationships - this activity can be classified as an addiction.
In simple terms, Internet addiction is compulsive or frequent activity on the Internet despite harmful consequences. They are missing school or work, neglecting their relationships, and disregarding other responsibilities. As mentioned above, Internet addiction is not yet classified as a disorder in the DSM. However, that does not mean other professionals do not recognize Internet addiction. Those that do acknowledge Internet addiction classify it as an obsessive-compulsive disorder or impulse control disorder. Moreover, they use corresponding treatment methods to help the affected individual(s).
- There are more than 4.33 billion active Internet users (Datareportal, 2019)
- There are 3.9 billion unique mobile Internet users (Statistica, 2019)
- On average, Internet users spend 6 h and 30 min online every day (Bond Cap, 2019)
- 91% visit online stores
- 2 + h a day on social media; highest among Millennials and Generation X.
- China has the highest amount of Internet users, with over 854 million (Internetworldstats, 2019)
- In the US, 81% of adults go online every single day (Pew Research, 2019)
- There are over 1.7 billion websites (Internet Live Stats, 2019).
| Ko et al.'s (2005) Proposed Diagnostic Criteria for Internet Addiction|| |
- Six or more of: (1) Preoccupation with Internet activities. (2) Recurrent failure to resist the impulse to use the Internet. (3) Tolerance: A marked increase in Internet use needed to achieve satisfaction. (4) Withdrawal, as manifested by either of the following: (a) dysphoric mood, anxiety, irritability, and boredom after several days without Internet activity; (b) use of the Internet to relieve or avoid withdrawal symptoms. (5) Use of the Internet for a period of time longer than intended. (6) Persistent desire and/or unsuccessful attempts to cut down or reduce Internet use. (7) Excessive time spent on Internet activities. (8) Excessive effort spent on activities necessary to obtain access to the Internet. (9) Continued heavy Internet use despite knowledge of physical or psychological problem caused or exacerbated by Internet use
- Functional impairment. One or more of: (1) Recurrent Internet use resulting in a failure to fulfill major obligations. (2) Impairments in social relationships. (3) Behavior violating school rules or laws due to Internet use
- The Internet addictive behavior is not better accounted for by another disorder.
| Causes of Internet Addiction|| |
As with most disorders, there is not always a clear cause of Internet addiction. However, there are likely multiple factors that contribute to the development of this disorder, some of which are rooted in nature and others that are rooted in nurture. The potential factors are,
Many addictive drugs, like alcohol and cocaine, are linked to this elusive “dopamine chase,” when an individual uses their drug of choice, they experience pleasure and release dopamine, which causes them to experience euphoria. The drug user starts to chase this euphoric feeling, which reinforces their behavior. And over time, more of the drug is needed for the individual to achieve the feelings they seek. A similar cycle is seen in Internet addiction: If we like to play video games or shop online, and we struggle with an Internet addiction or obsession, we'll have to spend more and more time engaging in the behavior to achieve the same level of pleasure.
Multiple layers of rewards
Another theory, the variable ratio reinforcement schedule theory, says that Internet addiction can stem from multiple levels of rewards. Scrolling through media might reward many times, as we receive likes and comments on the photo. Posted, accept a friend request and read exciting updates. Every time when individual sign on to Facebook, Instagram, or another social platform, the person never knows what he is going to get - but there is always potential for multiple levels of rewards, which keeps coming back for more.
Chemical makeup and structural brain changes
In addition, research suggests that those with Internet addiction have brain makeup similar to individuals with drug or alcohol dependence Internet addiction physically changes the structure of the brain, in that it affects gray and white matter in the prefrontal regions, which help with remembering details, planning, prioritizing, and paying attention. Therefore, when this area of the brain is altered, we are not able to prioritize the right tasks - we prioritize the Internet, instead.
Genetics might also play a role in the development of Internet addiction. If Individual struggle with this form of addiction (or another type of addiction), dopamine or serotonin levels might be lower than most, requiring to engage in more similar behaviors to achieve the same level of pleasure. This biological predisposition can increase the risk for addiction.
Depression and anxiety
Finally, if Individual has depression or anxiety, he is more likely to turn to the Internet for relief. If the person suffers from social anxiety, it is much easier to meet people in a virtual world than it is to meet people face to face. These individuals find pleasure in these interactions and relationships, only they must engage in them online. This can put someone on the fast road to Internet addiction.
Emotional Internet addiction symptoms
Euphoria when using the Internet on one's phone or computer, inability to prioritize schedules or Unable to manage time, feeling Boredom or lack of interest in routine tasks, they do not have sense of time, mood swings or irritability are common findings in Internet addiction. Depression, anxiety, avoidance of work, defensiveness are some of the other emotional symptoms
Regarding physical Internet addiction symptoms
Carpal tunnel syndrome, headaches, insomnia, or other sleep disturbances are common poor nutrition and/or personal hygiene, Significant changes in weight, Neck and back pain, Dry eyes, or other vision issues are also reported.
There is not a specific set of criteria one must meet to be diagnosed with Internet addiction (because Internet addiction is not technically classified as a disorder in the DSM, as we have mentioned), but if the person is experiencing the above symptoms with excessive Internet use, one might have a problem. The following diagnostic criteria, proposed by KW Beard in the journal Cyberpsychology and Behavior and they are well-received in the community:
- The individual is preoccupied with the Internet, in that they are constantly thinking about using it or their past use of it
- The individual must increase the amount of time they spend on the Internet to continue gaining satisfaction
- They have tried and failed to control, cut back on, or stop their Internet use
- They become depressed, restless, moody, or irritable as a result of trying to manage their Internet use
- The individual stays online longer than they originally intended. In addition, at least one of the following must be present:
- The individual has jeopardized their job, relationships, schooling, or opportunities due to their Internet use
- They have lied to family members, friends, and others about their Internet use
- The individual uses the Internet to escape or avoid their problems, or to cope with difficult emotions.
When it comes to Internet addiction (and other types of addiction), there are both short-term and long-term effects, of which can prove harmful to the individual. Short-term effects include incomplete tasks, neglected responsibilities, weight loss or gain, backache, neck pain.
An individual with Internet addiction might experience the above symptoms after only several sessions on the Internet.
When one is farther into their addiction, they are more likely to experience the following long-term side effects. As they spend more and more time on the Internet, they are at a greater risk of experiencing carpal tunnel syndrome, hurting their vision, damaging their relationships, losing their job, and entering financial distress as a result of their job loss or spending money on shopping, gambling, or gambling online.
According to ICD-10, pathological gambling comes under F63 Habit and impulse disorders; there is no specific description between online and offline.
In ICD, 11 Pathological Gambling classified under:
- Disorders due to addictive behaviors (BlockL2-6C5) separately
- 6C50 Gambling disorder (offline and online)
- 6C51 Gaming disorder (offline and online)
- 6C5Y Other specified disorders due to addictive behaviors
- 6C5Z Disorders due to addictive behaviors, unspecified.
In DSM-IV TR:
312.31 - Pathological gambling was classified under impulse control disorders not elsewhere classified
In DSM-V, Pathological Gambling brought under substance-related and addictive disorders/Nonsubstance related Disorders with specifier
312.31 - Gambling disorder
Specify current severity mild/moderate/severe
Conditions for further study.
Online gambling disorder
Online gambling causes more problem than offline gambling. Children and adolescents are more addictive reasons are easy availability and, Accessibility online gambling is more affordable and convenient Moreover it maintains, Anonymity.
| Pathological Gambling|| |
A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: (a) Needs to gamble with increasing amounts of money in order to achieve the desired excitement. (b) Is restless or irritable when attempting to cut down or stop gambling. (c) Has made repeated unsuccessful efforts to control, cut back, or stop gambling. (d) Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). (e) Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). (f). After losing money in gambling, often returns another day to get even (”chasing” one's losses). (g) Lies to conceal the extent of involvement with gambling. (h) Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. (i) Relies on others to provide money to relieve desperate financial situations caused by gambling.
B. The gambling behavior is not better explained by a manic episode. There are two types of specifiers in pathological gambling disorders: Episodic and persistent Meeting diagnostic criteria at more than one time point, with symptoms subsiding between periods of gambling disorder for at least several months that is Episodic IN Persistent: Experiencing continuous symptoms, to meet diagnostic criteria for multiple years.
In early remission, after full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met for at least 3 months but for less than 12 months. In sustained remission, after full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met during a period of 12 months or longer.
Severity is based on number of criteria – mild: 4–5 criteria met. Moderate: 6–7 criteria met. Severe: 8–9 criteria met. From the DSM, 5th Edition (section 312.31).
| Internet Gaming Disorder|| |
- Preoccupation with gaming
- Withdrawal symptoms when gaming is taken away or not possible (sadness, anxiety, irritability)
- Tolerance, the need to spend more time gaming to satisfy the urge
- Inability to reduce playing, unsuccessful attempts to quit gaming
- Giving up other activities, loss of interest in previously enjoyed activities due to gaming
- Continuing to game despite problems
- Deceiving family members or others about the amount of time spent on gaming
- The use of gaming to relieve negative moods, such as guilt or hopelessness
- Risk, having jeopardized or lost a job or relationship due to gaming.
Under the above-proposed criteria, a diagnosis of Internet gaming disorder would require experiencing five or more of these symptoms within a year. The condition can include gaming on the Internet, or on any electronic device, although most people who develop clinically significant gaming problems play primarily on the Internet.
| Online Porn Addiction|| |
Online pornography use, also known as Internet pornography use or cybersex, may be one of those Internet-specific behaviors with a risk for addiction. It corresponds to the use of Internet to engage in various gratifying sexual activities. Hypersexual disorder is sometimes considered one of those behavioral addictions. It is used as an umbrella construct that encompasses various problematic behaviors (excessive masturbation, cybersex, pornography use, telephone sex, sexual behavior with consenting adults, strip club visitations, etc. Behavioral addictions study among substance users found that only 9.80% out of 51 participants considered they had an addiction to sex or pornography.
Study with a sample of 1913 participants through a web questionnaire, 7.6% reported some Internet sexual problem and 4.5% indicated feeling “addicted” to Internet for love and sexual purposes, and that this is a “big problem” Swedish study.
Study with a sample of 1557 college students found that 8.6% was in a potential risk of developing a pathological usage of online pornography, but that the actual pathological user prevalence was 0.7% only Spanish study.
While the possibility to diagnose hypersexual behavior was always available with “sexual disorder not otherwise specified” in the DSM. Kafka tried to propose it as a diagnostic entity for the DSM-5. He presented a set of criteria for it, as part of the sexual disorders chapter. These proposed models included hypersexual behavior as (1) sexually motivated, (2) a behavioral addiction, (3) part of the obsessive-compulsive spectrum disorder, (4) part of the impulsivity-spectrum disorders, and (5) an “out of control” excessive sexual behavior. This proposal was ultimately rejected due to several reasons; the main was said to be absence of consolidated epidemiological and neuroimaging data regarding this behavior, but also its potential for forensic abuse, a not specific enough set of diagnostic criteria, and potential political and social ramifications of pathologizing an integral area of behavior to human life.
DSM-5 and ICD-11 approaches to classifying hypersexual behavior.
Sexual Addiction Screening Test (SAST) proposed by Carnes, and it is later revised SAST-R, the Compulsive Sexual Behavior Inventory and the Hypersexual Disorder Screening Inventory. Internet Sex-screening test. It assesses five distinct dimensions (online sexual compulsivity, online sexual behavior-social domain, online sexual behavior-isolated, online sexual spending, and interest in online sexual behavior) through 25 dichotomic (yes/no) questions.
| Social Networking Addiction Epidemeology Prevalence|| |
Pew data from 2012 suggest that teenagers between 14 and 17 years of age sent a median of 100 texts a day social networking sites (SNSs) are virtual communities where users can create individual public profiles, interact with real-life friends, and meet other people based on shared interests. (i) Social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using SNSs; (v) Facebook addiction is only one example of SNsite addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNsite addiction; and (x) there are methodological problems with research to date.
Facebook addiction was assessed using a self-devised 11-item scale on 380 Malaysian female university students. The higher the overall score, the more addicted the person is deemed to be. No cut-off scores were provided by the authors to determine classification as a Facebook addict. The results of the 11 statements in terms of those who answered Strongly Agree (followed by the mean score of the sample out of 7, and standard deviation) are presented here:
- ”Facebook has become part of individuals' daily routine.” In (19%; 5.5; 1.0)
- ”Individual staying on Facebook longer than intended.” In (16%; 5.2; 1.2)
- ”The person feels out of touch when he was not logged onto Facebook for a while. “Is (13%; 5.0; 1.4)
- ”14% individuals said life without Facebook would be boring.”
There are some corrective strategies in relation to SNS addiction, corrective strategies include (1) content-control software, (2) counseling, and (3) cognitive-behavioral therapy.
| Online Shopping Addiction|| |
Shopping addiction is a behavioral addiction that involves compulsive buying as a way to feel good and avoid negative feelings, such as anxiety and depression. Like other behavioral addictions, shopping addiction can take over as a preoccupation that leads to problems in other areas of life.
Usually beginning in one's late teens and early adulthood, shopping addiction often co-occurs with other disorders, including mood and anxiety disorders, substance use disorders, eating disorders, other impulse control disorders, and personality disorders. Some people develop shopping addiction as a way to try and boost their self-esteem, although it does not tend to be very effective for this.
Compulsive shoppers use shopping as a way of escaping negative feelings, such as depression, anxiety, boredom, and anger, as well as self-critical thoughts. Unfortunately, the escape is short-lived.
Items purchased during a compulsive shopping spree are often simply hoarded unused, compulsive shoppers then begin to plan the next spending spree. Most shop alone, although some shop with others who enjoy it. In general, it will lead to embarrassment to shop with people who do not share this type of enthusiasm for shopping.
There is also some disagreement among professionals about whether compulsive shopping should be considered an obsessive-compulsive disorder, impulse control disorder (like kleptomania or compulsive stealing), mood disorder (like depression), or behavioral addiction (like gambling disorder).
CBD compulsive buying disorder is defined by the presence of repetitive, impulsive, and excessive buying (Lejoyeux, Mathieu, Embouazza, Huet and Lequen (2007) and is characterized by excessive shopping cognitions and buying behaviors that lead to distress or impairment (Black, 2007). The best term to describe CB behaviors is “addiction” (Clark and Calleja, 2008). Due to its similarities with pathological gambling, it is deemed more appropriate to describe CB as an addiction (Lawrence et al., 2014).
Scales to assess shopping addiction are hedonic shopping scale. Bergen shopping addiction scale (Andreasen et al., 2016) which was designed to measure the core criterion and components of shopping addiction.
| Consequences of Online Addictions|| |
- Unfavorable body composition and lower fitness due to less physical activity, weight gain and obesity, disordered eating, disrupting sleep rhythms, inhibiting melatonin release, delayed bedtime, shorter sleep duration, back pain, eye strain, and carpal tunnel syndrome.
- Increased conduct problems, hyperactivity, peer problems, emotional problems such as depression, anxiety, aggression are common self-injury, increased risk of violence are reported
- Social deterioration offline social relations, self-disclose - target for harassment, exposing privacy, cyberbullying, identity theft, cyber aggression, cyberstalking, sex solicitation.
| Pharmacological Management|| |
Gambling - opioid antagonist-serotonin reuptake inhibitors and mood stabilizers Internet gaming disorder – Bupropion > Escitalopram > atomoxetine > Methylphenidate Neuromodulation techniques - Transcranial direct current stimulation.
| Nonpharmacological|| |
Harm reduction approach, limit setting techniques, psychoeducation, intrapersonal and interpersonal therapy, family intervention, wilderness therapy, applied mindfulness/motivational enhancement.
Benefits of digital media, finally, there are considerable benefits with digital media. It helps in maintaining positive relationships with teachers and peers. Digital media encourages automotive and collaborative learning and it also stimulates inquiry. It also promotes prosocial behavior and increases sense of wellbeing. Recreational screentime 1 h per day lowers depression. Digital media helps in developing diverse and gender inclusive relationships. Two to four hours per day is associated with cognitive and psychosocial benefits Informative screen experiences, It improves children's academic performance/positive relationships with teachers and peers, Autonomous and collaborative learning and stimulate enquiry, Prosocial behavior/increased sense of well-being, Recreational screen time (1 h per day) associated with lower depression, Diverse and gender inclusive relationships, 2–4 h per day associated with cognitive and psychosocial benefits.
| 4 M's|| |
Manage screen use, Meaningful screen use, Model healthy screen use, Monitor for problematic screen use at any age.
To promote health and wellness in children and adolescents maintain adequate physical activity, healthy nutrition, good sleep hygiene, and a nurturing social environment. A healthy Family Media Use plan that is individualized for a specific child, teenager, or family can identify an appropriate balance between screen time/online time and other activities, set boundaries for accessing content, guide displays of personal information, encourage age-appropriate critical thinking, and digital literacy, and support open family communication and implementation of consistent rules about media use.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]