A New Millennium: A New Age of Behavioral Disorders?

University of Kentucky UKnowledge Pediatrics Faculty Publications Pediatrics 2013 A New Millennium: A New Age of Behavioral Disorders? Artemis Tsitsika National and Kapodistrian University of Athens, Greece Mari Janikian National and Kapodistrian University of Athens, Greece Donald E. Greydanus Western Michigan University Hatim A. Omar University of Kentucky, [email protected] Joav Merrick University of Kentucky Right click to open a feedback form in a new tab to let us know how this document benefits you. Follow this and additional works at: https://uknowledge.uky.edu/pediatrics_facpub Part of the Pediatrics Commons Repository Citation Tsitsika, Artemis; Janikian, Mari; Greydanus, Donald E.; Omar, Hatim A.; and Merrick, Joav, "A New Millennium: A New Age of Behavioral Disorders?" (2013). Pediatrics Faculty Publications. 127. https://uknowledge.uky.edu/pediatrics_facpub/127 This Article is brought to you for free and open access by the Pediatrics at UKnowledge. It has been accepted for inclusion in Pediatrics Faculty Publications by an authorized administrator of UKnowledge. For more information, please contact [email protected]. A New Millennium: A New Age of Behavioral Disorders? Notes/Citation Information Published in International Journal of Child and Adolescent Health, v. 6, no. 4, p. 363-366. © Nova Science Publishers, Inc. The copyright holder has granted permission for posting the chapter here. This article is available at UKnowledge: https://uknowledge.uky.edu/pediatrics_facpub/127 ISSN: l9.39-.S930 ©Nova Science Publisher~, Inc. Int J Child Adolesc Health 2013;6(4):363-366 1 Artemis T:dts~kl, 1\-lD~ .PhD , ~1,·- l an. J. an1.t;:1an, ~-· pit., n;H.2 . ~I u , , Donald E GreydamJ.s, lV!D~ Dr. .HC (ATHENS)\ Hatim A Oma.r~ lHD, FAA!-'>'\ and Joav Merrick, MD~ MMcdSe, DMScfl,S,iS,i i AdolescentHealth Unit, 2nd Department of Pediatrics "P & A Kyriakou'' Chilqren's HospiU:t!, Nation<>i and Kapodi.stri::\.n University of Athens School of Medic.Lne, 1\thens., (ire.c-'~ ;;Gtaduate Progtarn u1 Applied Psychology, 'Ibe of Crec:ce, Deree College, Athens, American Coileg~: (irGCCC. 3 Depmtrr:ent of Pediatric and Adolescent i\tiedicine, We:>tem M:chigan University School of Medicine, Kalatnazoo, ?vfichig;m, United States of America ~Divson of Adolescent Medicine and Young Parents Program (J422), Kentucky Children's HospitaL UK Heaithcare, Department ofPediatncs, tJniversity of l{cntucky College of Medicine, L<:x.ington, Kcntacky, United S::ates of America 5 Nati.onal institute of Child Health and Human Development, Jenisa.lern, israel 6 0fficc vfthe Medical Director, Health Services, Division for lntelkctua1 anJ fk>>eloprnental Disabi.\itjcs, lvii.nistry of Social Affairs and SociaL Services, Jerusalem, Jsrad :rbiv1sion ofPedialxics, H:::.dassah Hebrew University Medical Center, 1'Vt Scorms C;mlpl:ts, .lcrusalctn, !srad -~ Cor.c~!l<mdte : Mari Jm1iki.un. PhD, P~;cho!gist, Assisunt Prolesi;or cf l'S_Fho!ogy, The Amerka,'") Colkg;~ of (lre:ece, Dcrcc Colleg<;, C1mdnate !-'rograrn in Applid Psychology6 Gre.via<: Street_, Aghia I'<tm~kevi 1534-2 i\thens, (Jreccc. E...ma~l: r:Jjan.ik~81(0c·gedu Introdudim.1 The internet has become one of the nwst widely accessible media and is a significant part of everyday in adole.;cence, offering opportunities for social hte netv·{o~kig and c. omtnu1cai~ education and entenaimnent. However, over the past dc<!~e a specific behavioral pu11ern h<Js been rescan:hcd ln respect to Tnterttet use, leading to isolation and negleci of everyday activities, social Life -even personal health in generaL The phenomenon has receiv;;d increasing attention from the scientific community·, describing it in various terms such as "excessive", "problematic", "pathological", "addictivG" use among others. European research on Internet addictive behavior have been conducted in the past years giving various results, however tools that have be{cn used are not validated, ages that have been st1.di{~ vary a lot and Clt)tural factors have not he{~n taken under full cons1deration, The ElJ Kids Online project ( 1) notes several key gaps in the (:vidence base of research on hlten!et safety issues for chi1dren and young people. Internet addictive behavior is one of tlw risks id~mtflc as little researched in. Europe. According to (l), t1mher re~>ach the latest EU Kids Ontine r<~pot on teem_tgers is needed as they continue to take the lead in the depth and breadth of lnternet use Spcif!~.ly, additional 1ndicatoro; are needed by which to identifv particularly ''vulner:.tble" or "at ri.;;k" children. Minors and especially ado1escents in the mlddlc chronological period (H to 17 years) appear espt~ci . aliy vulnerable to such a behavior due to the developmental characteristics of this phase. In detail, K::::::::::::::::::::: '::::::::::::::::::::::::::::::::::::::::::::::'::::::::::::::::::::::: Artemis Tsitsika, lVIa.ri Janikian, Donald E Greydanus et al. young people do nut ycl have the abiiily to 11lter and ~v alu ate given information and their c.ritkal thinking a.od sense of boundaries are still unclear (2). 'vVhen it comes to acquiring knowledge, apart from theoretical $ducation, 1rial aml error seems tt"> b.e the most 1 ear~' h-cq··"Ilt p"'OC"'SS .-,f ari.-l rl" ..-r.uu-~, :.~ "' .:...e.v ~' . , #. ~ ·. L . ,d. , , ,· Ho· b ~ \..i ..... "i<.F"u v l~> . t:· A adolescents ate more exposed to variom inf1ucnce3 while they undergo an era of experimentation. tn addition, f.hey art by nature enthusia.~l ic ~nd unabk to control activities that s1imulatc th~rl , sud1 as Internet games. Continuously e:;caping fro:n rca! lite to cyberspace has been associated with serious problem:; ·\G adok sc~nt' daily liDe. On the other hand, you.ng pe("Jple <•re Qur hope tor the f!Jture and the\r healthy psycht:social development is the key to producing happy, well-functioning and hcah.hy aduits. Focusing on youth n:ic.nral health will lead to pers0nal. snciai and economic proti.t for all societies and it is of major ptlblic concern to rcsea.r:.;h <md fi:1ally give potential solutions to any problem they face, in order to mrmmi'Ze any negative outcome. Esped41lly a~ ir:temct use h; a major pa:rt of th~_ir life and it offers them great opportunities and possibi1itie:t, it 1:; very crud<tl to get infonnation on potentiaJ hazards that this <K-tivhy may lead to, in order to create a safe l n . h~md cnv.tronnwnl. Particularly among a.doks•~em, the Internet is ob~ervcd w be increasingly adopted as a readily acce5sib1e l'neans for information n:trieval, entertainment? and s;.wiali7n::ttimJ (3 ..4). Excessive Internet use may instigate potential .:idvers(O effects upon the psychosod{d de·vei0pment ():f adolescents (5). \VbX!.e both the adoptlc-t:. of excessive lntemct us.e, as \Ve1i as the adverse p s yt ~ hosu<;ial ef f ects~ rnay be attrUJuted to the ;;ompromised p ~ychosz:ia l wdlbeing prior to the initiation of Internet use (6), the hkdihood of developing addictive patterns of behavior during adclesccn;;c is observed ta be eminent (7 .. 8). Consequerttly, as adolescents al1ocate ev:r·in~. . asi ng ti.rne p~ri ods f(Jr Internet use~ the risk f()r developing Intcmet addictive behavior is inherent. th.rvughou:. the scierttitk literatu re (9), Several re[X-;rt.-s state that concq1tuaUy rhe diagnosis f~ils under the {-'Dmpulsiv0-lm,pulsive .~pedrum disorder (OCD) involving online /or online comp:utcr usage (10) and consisting of z.t least three subtypes: <~x.cs>iv gaming, sexna1 preoccupations, and e-mail text messaging. These subtypes .share the f0!1owing t~c t o r s: (a) excessive use, wh ich is assudated with a loss of sense of time or <t negiect of basic d rives, (b) tension, withdrawal, )ncluding feelings of c.ng~r, when computer is inaccessible, (c) and/or d~presion tok:rance, inc1ud1ng the need fer better computet equipment, .rnme soft v.-~r ; or incrensed honrs of use, and (d) negath'e repercussions, indudi:ng arguments, lyh<g, poor achieve:nerrt, ~oci a1 isolation, and fatigue (11 ). Research also ,sugges1s that excessive Internet u:;c resembles addictive behaviors sud: a~ gambling m1d drug use {12 ). Problematic .lntemet use is deflrted by the following characteristics: Internet use, (b) (a) uncontrollabie use that is. ma.rkdiy distressing; time-consuming or results in social, occupational or financial dlffku.hies end (c) Intem.et present during hypomc1nic or manic u;;e not ~oley dinical episodes ( l 0). Accordir:g to a most recent deGnit.l::>n for <!ddicti\>e Jntcrnct us.e, a person must presc:1t at lea.st r;,,e of the s ix following criteria: (a) spending increasing amount of time online; (b) fail ure w reduce use with conw m~tan feeiings of restlessness artd depr~sun; (c) staying online longer than originally intended; (o) running tho risk of losing a rc!<:.Lenshlp or oth.:r opportunities due to Internet US(~; (e) lyirlg to conceal the extent ofJ ntemet use; and (f) usi.ng the Internet in order (o es ~-:ape negative ., ;_ .,)_:~ ~ ......;.,t~· - ne ( I ~' htem~ ) . ' ) •• •~piMmol g cai i evaluation in Greece A n~cm, demonstrated tb3J 1~ - { and l Y>S of adolescents 1i ving )n Athens (mcF:.o age: 14-.5 years) presented wlth ln1e:met addictive behavior and borderline scores t ~x Internet misuse rcspectivj!iy (14). A. c~or<ling sdemitk litentun;, the prevalence to .Lhc of Internet varies amnng adolescents ir, c1ther ·European couritries. The preva:lence of Internet addictive behavior in N<:)rway is 1.98%. (12), in Great Britain 18.3%. (ll), irJ. the Netherlands 4% (15), .in Rmmmia 1.4% {16), in Haty 5 .4~1) (17), in C.lcnnany 5.1% (18). and in Atlstria 2.7% ( i 9). ad \-Vhile Intern.et addictive behavior has received everincreasing research attemion, a con.siste:nt definition of this construct ha" not been c.urrently ap-plied ~nd !c hv(~ beh~v io r 365 Editori.al ·:·:·.·· ··.:::::· .. Internet addictive behavior rates arnong ado1escents secrn to difier from country to cotmtry and depend1ng on the age group, cultural dtf<~re:ncs, 1edmological tol~ used. However, the phenomenon is considerd to be a serious globa1 p\2b1ic health issue (20). h a Norwegian study ml:ch concern is raised on the increasing number of individuals abandoning ~·.chol Qr 'NQrk in order to spend more time on comput~rs ( 12). from diverse hackgreund5 will also find the various <>pproachcs in screening and treating client!:> who exhibit these behaviors helpful. Finally, this special issue could also be a useful resmm:e fOi' scholar~' ccnducting ongoing research in the a:rc:a of Internet addictive behaviors. [!J Livi,1gstzme S, I-hddon L, Gcrzig />., Olaf.,;;on K. EU f:r~1.l rept.)rt ·Lqnd(.)"n; E:t.: 'Kl.O.s {)nl_1:c~ LSE~ 2011. Liu T, Pnn:::-;za i\·1;-..i_ hohlcmati<: Internet use: Clit:ical ja:ptlcations. C':N·s Spcctr 2:007;!2(6):45.3-.66. Kidb online The phenomenon of Internet addictive beha.vior is relatively nevv and aithi;ugh studies have documented vthat has hecome an increasing health care isslw, scientific conccptualiz&tion of the problem 1s progressing. In this special issue we have compiled an up-1o-date culkct!on of papers V·lith the current literature addressing this growing topic. You will find the ~main clinical features of addic11ve behaviors in general and intrvducing \:.rays to comh;ct dl ffercntia] diagnosis and assess comorhidity; <>n overview of the main areas of inquiry· into the etiology of Tnternet adictve~ behaviors; review cf the curre11t hteraturc n~g<!tdi lntemet addictive behavior and psychiatrjc comotbidities; the main assessrnent tno!s that have been us<:d to measure hlternei addictive behavior; different applications that may potentrdly lead to Internet addictive behavior; social networking use in particular al\d focus on the psydwlogica1 underpirming of use (motivations or needs) and on associations •vilh lntcrr.ct addictive behaviors. You will also find a focus on the p:>ychoiogical. sodological and neurohie!bgical factors r<:'lev:::mt to rhe development cf excessiv;; and addicted cQmputer garnkg, higlt~ of the impmtance of designing for prevention and intmvention progtP~mn1_e.s adokscent lnt<:n:ct addictive beluvior specialized interv~o tedmiques, inducting c:eg:nitjvebehavieral therapy and motlvatiorJ.al intervie\'>'ing to addn::s:; Internet a.ddicti ve bd1avlors and last relevant ;' '•.) J' \:1add D, Mu.nccr S. B(:ck fwm the beach bu; hr:ng!ng rt l~ • ,' dialogue between pmctitioners and for academics interested in n;vie:...v of lnternet addictive behavior::> and relevant issues in the tidd, this special issue will be valuable. Practitioners or Tkr Dmsch 1007 ;6·'1(2): l 03-18Tahirog!Ol!. AT, Cdik GG. Uzel M, Ozcan N, Avcci A.. internet use among Ti~rksh ado{csrcrrts. Cybi:r[Jsychol f3.ehav2nO&; l \f5):537-43. [6) [7l Caplan S. R~1ations among. loneliness, sncia1 anxiety, 8l1d problemilllc f;;temet usc. Cybe:·psychol Bchav 2007:10{2):23 11-42. Leuf!g L. Stre3sfrd IitC events! motives fOr luiemel use. r:.nd social suppo-11 an1ong digital ki·:JS. Cyb~tpsi,;ho.l lkha.v 2007;1D(2):204--214. [S] Palian.ti 8, Bernardi. S, Querdi>li L Th~ Shorter PROMIS cju~sli-:;mare ~md the [nternet addiction scale in the a~se!>in:t of multiple addictions in il highPrc·va!cncc and :r~1ated tLi.sab;~ly . CNS Spcctr 20:}6;1 i(12):966-74. Dm;gla~ A, MiHs J, Nia:ng M.. l1y,Jr: S, LeeS.. Le,·: J, et d. Internet ;;ddiction: ~v1eta-symhci of qualitative res~:ch fi)t the decade 1996-2.006. Compu; Hmoan Behav 2001-\;24(6) 3027..44. Shapira NA, Goldsmith TD, Kt:<:k PE .rr, Khosla UM, Md:Jroy SL Psydliatric fe<ltures of individuals with v;·ubkmatic bkm::;t :Jsc. J Affect Di;;ed 20()0;57(1· ~chno1 [9] r111 policy issues. We hope Ihat this special iss;;e contributes to the ()ngoing res•~ach. en the t;d~phom:? English adolescents' attitudes ;md cxp<:riences oJ mobile phones and the Intemct. Cyberpsyd;nl lkhav 2004;7(3):359--67. Suss D IJmpacts compukr awi m(;-d1a usage on the perso;1ality dcvdopmcnl of childrr:rr <::nd yo::r.g pNp!eJ. ru1 rop~latf·n: ' 3 )~267Ymmg KS. fnternet addkti<x,: A new cEdcal phenn:11encm a.nd it~ C<)nseq;Jcnces. Am Ikhav .Sci 204;S:~ l 5. Jol"..aEssojJ. ./\., .{}etcstan1 (}_ ·tn:ten·:.et adchctlon: (:harteis~c> of 8, qur...:;bOtln•:drc and pr(!V<~lenc in Nor~veg:m; youth (]1-lg ye~:ts). Sca~:d J Fsychol 2004,45:123-9. Sadock BJ. S<ldo<.'k "I,'A. Kaplan and Sadock's {.;Ompreh:;;[;5ivc textbook of psychiatry, Voll and 2, 8th ed. Philadelphir<, PA: Lippincott Williams \Viikins. 20~H·. .·.·.·.·.·.·.·.·.·.·.·. ":":". ":":":". ·.·.· Artern1s Tsitsika, Mari Janik) an. Donald E 366 r l4} Tsitsika. A , Critseiis E, Kz)rm>.:s G, !'i!ipf:-OfX!'JlOIJ A, Tcmnl.3;;idor: D, Freskou A. et <iL nt~rc! usc and - m~ s:.J~e .'\ rnu~t:i.v1bc r~-gesio anatysis of the [actors of Internet t:se among Greek adniesc~:lt. EEr J Ped;w 2008;168{6):655-65. Van ]<:(:.nij AJ, Sd:oenma.k<:rs TM, Meedn::rk GJ, Van de Mheen D, Mor;itGr Internet en Jongeren 2006·2009. pr<::dictivc [l5j [17] 2tl1'J:){45~ Comwmr 1998; 13(2) ·J8l-2G{) [20J et a1 Ferra!\) G. Casi B, D'Amico A, B!a5t M. Internet udditrion Ciis\)rdct: An Itali::n s:;tdy. Cybctpsytlwl Bt:hav 2007;1 0(2): 170-5. t-.'fUller K\V_, \Vo]f!ing K. Pat!J>:.>h)gische ~;ompr:tc-sid· nad \Vat dr~c:n _jongcr~! !}Aenh·.)f stlid~.· j H!} or::: ln:ternet en ho~·vers:tacnd ~s dit? l::w-:rnet w:;J Y0~1tr. 2006--2010. Vilhat l'XC n.doksct~ doing c:n tbe In.te:·!let nnd ho~.,adit:.\-~c is it?} R''Ht:;·dam: IVO, 2009. [Du~chj Ro<: K, Mt:i].> D Chi!drer: ~nd comput<::r gam(:s. I:Hr J !181 Gn~ydaus Intemetrmtzt!ng. S\JChtmd .Forsd,ung Praxi~ [Germ~nj Batthyany D, Mu!let K W, Bcnk.;;r F, \~·ijlf>g K. Cornpu;er game playing: Clinical characteristics ot' depe-ndence il.l'Hi -abus~ mitOr1g ~dot.;iGen:s . ~V-jcn KJin \Voc.bensc_hr 2DD9; f2:i :502 ..9. Bbck JJ. Js~.:c f<lr D SM ~V: bkmd <tddidior:. An'). .l Psydnalry 2008;165:306-?.