International Journal of Public Health Research Vol 12 No 2 2022, pp (1625-1636)

ARTICLE REVIEW
Understanding Internet Addiction and its Associated Factors
Among Children and Adolescents: A review of literature
Ayuzeity Bistari Md Bukhori and Mohd. Hasni Ja’afar*

Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Kuala Lumpur,
Malaysia.

*For reprint and all correspondence: Mohd. Hasni Ja’afar, Department of Community Health, Faculty of
Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia.
Email: [email protected]

ABSTRACT

Internet Addiction (IA) is becoming increasingly recognized as a serious public health issue,
particularly for children and adolescents. This review article discussed the complexity of IA
diagnostic criteria and IA-related risk factors from a public health perspective with the intention
of fostering a better understanding of IA in adolescents and children. The entire discussion
pointed out how the epidemiological triad of disease framework helps to explain the IA
associated factors among adolescents. This framework emphasises the agent (Internet
characteristics and its content), host (e.g., self-personality, comorbidity, psychological status,
inter- and intrapersonal relationship), and environment as extrinsic factors (i.e., physical
pollution, socioeconomic status, availability, and accessibility of the Internet) that facilitate
interaction between the agent and the host. Evaluation of all three components and their
association with IA is essential as it allows for a more comprehensive understanding of how the
issues arise, which can be useful in developing future effective public health measures for IA.

Keywords Internet addiction - Adolescents - Diagnostic criteria - Self-personality -

Environmental influences.

Article history:
Received: 14 July 2022
Accepted: 31 August 2022
Published: 1 September 2022

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Internet Addiction in Adolescents

INTRODUCTION researchers and medical professionals to be

Young people born in generations Z and Alpha have concerned.16-17 This is due to the fact that negative
had access to the Internet since childhood. In fact, impact is a prerequisite for the emergence of a
access to the Internet is no longer a luxury, but a disease state.18 When a person is "addicted" to the
basic requirement for children and adolescents Internet, they will spend excessive time on Internet-
seeking general education information. Age- related activities at the expense of other important
appropriate, family-friendly, and purposeful aspects of their lives, such as their basic needs for
viewing of web content with boundaries can result food and water, personal hygiene, adequate sleep,
in immersive, educational screen experiences.1 and intimate relationships, among others.15
Previous research has demonstrated that Internet- Additionally, those who are addicted to the
based learning can improve children and Internet experience detrimental physical and
adolescent’s grades, academic performance and psychosocial effects from a clinical and public
their literacy skills,2 enhance learning motivation,3 health perspective, including an unhealthy diet,
and foster good relationships with teachers and physical inactivity, skeletal muscle issues like back
peers.2,4 When compared to not using a screen at all, pain, poor posture, signs of social withdrawal,
recreational screen usage at modest levels —1 hour family conflict, and poor academic performance,
per day—have been linked to a lower risk of among others.15
depression.5 Essentially, it is believed that an Many personality and psychiatric
individual's quality of life impacted if they lack disorders, including low self-confidence,
Internet access.6 impulsivity, poor sleep quality, mood disorders, and
While Internet use is viewed as a positive suicide, are associated with IA.19 Moreover, IA is
phenomenon, empirical evidence reveals a number associated with numerous neuroanatomical and
of negative effects associated with excessive and neurochemical alterations, such as the thinning of
uncontrolled Internet use, which can lead to Internet the cortex and the modification of the dopaminergic
Addiction (IA). This addiction is characterized as reward circuit.19 In fact, neuroimaging studies
uncontrolled or excessive Internet use conducted on adolescents indicate that Internet
preoccupation, which is associated with the addiction is associated with structural and functional
development of tolerance and withdrawal changes in regions of the brain responsible for
symptoms.7 Despite the lack of standardised attention span, decision-making, emotional
diagnostic criteria for Internet Addiction, a number processing, cognitive control, and behavioural
of studies have measured its prevalence. A disorders.
systematic review and meta-analysis of 113 Besides, excessive Internet use is viewed as
epidemiological studies published between 1996 a form of addiction that is closely associated with
and 2018 involving 693,306 participants indicates substance and behavioural responses.3 In an earlier
that the average prevalence of Internet addiction is report, K.S. Young20 asserted that IA results in the
7%. with a rising rate over time8. According to same academic, social, and employment decline as
another global study, the prevalence rate of Internet drug or alcohol addiction. This assertion is
addiction among European children ranges from 1% supported by the findings of neuroimaging
to 9%,9-10 between 1.0% - 22.0% in the Middle experiments and neurological studies indicating that
East,10,11 and a prevalence in Asia ranging from individuals with IA exhibit biological changes in the
2.0% - 21.0%.9,12 prefrontal cortex and share similar neuronal
Meanwhile, according to the recent biological mechanisms with other addictive
research evidence from Southeast Asia, the syndromes, such as substance addiction and
prevalence of IA among students aged 11 to 26 years behavioural addiction.21,22
ranges between 7.4% and 46.4%.13 Another meta- Adolescents are regarded as a vulnerable
analysis of seven Southeast Asian nations revealed a group that is more susceptible to the risk of Internet
combined IA prevalence rate of 20.0%.14 It should addiction due to early Internet exposure, personality,
be noted that the variety of research findings with and individual risk factors, as well as environmental
varying prevalence rates is due to the use of different factors that heighten their level of vulnerability. This
screening assessment tests, varying criteria for generation has been using digital devices and the
defining Internet addiction, different sample age Internet since they were young due to the
groups, and varying cultural backgrounds for each technological age, they are living in. In fact, it was
studied population. There are at least 21 different discovered in 2015 that a 15-year-old child's
assessment tests used worldwide to determine the propensity to use digital devices and the Internet as
prevalence and severity of Internet addiction, early as 10 years of age and the amount of time spent
including the Young Internet Addiction Test and the surfing the Internet had increased significantly,
Chen Internet Addiction Test.15 particularly in countries belonging to the
IA is increasingly recognised as a serious Organization for Economic Co-operation and
public health issue, especially when it has negative Development.23 This study aims to explain the
effects on children and adolescents, causing

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Internet Addiction among children and adolescent behavioural disorders that result in deterioration and
with their associated factors in this country. cause problems has piqued the interest of numerous
researchers and medical experts working in the field
METHODS of behavioural addiction. This interest is also
In this narrative review, databases like PubMed, influenced by the inclusion of more specific Internet
Web of Science, and Google Scholar were used. Gaming Disorder (IGD) criteria in the DSM-5
Keywords such as (“Internet Addiction” OR appendix. Due to the fact that the diagnostic criteria
“Problematic Internet Use” OR “Internet Addiction for IGD place the behaviour in the category of "non-
Disorder” OR “Pathological Internet Use” OR substance addiction," it is possible that IA is also one
"Problematic Internet Use" OR "Excessive Internet of the candidates for this category, along with
Use" OR "Compulsive Internet Use" OR "Internet "Gambling Disorder".25
Dependence" OR "Virtual Addiction") AND There have been continuous efforts since
(“determinants” OR “risk factors” OR “predictors”) the 1990s to define Internet addiction, leading to
AND (“adolescents” OR “children”) were used. In heated discussion in the process. Finding common
addition to the aforementioned databases, the search ground on terminology to infer the broader meaning
was carried out using the snowballing technique, of Internet addiction is the most challenging task.
which involved looking for references from the first The terms "Internet Addiction Disorder (IAD)",
search. "Pathological Internet Use (PIU)", "Problematic
All study types, including cohort, case- Internet Use", "Excessive Internet Use,"
control, clinical trial, and retrospective record "Compulsive Internet Use," "Internet Dependence,"
review studies, were eligible for inclusion in the and "Virtual Addiction" have been commonly used
selection criteria. The articles cover a wide range of for decades.26
research topics and include reports written in both If a person is said to be addicted to the
Malay and English. The years covered in this Internet, this argument seems equivalent to stating
article's publishing dates range from 2005 to 2022. that an alcoholic is addicted to a store selling
Following evaluation of the entire document, alcohol. Consequently, the term "Internet addiction"
selected papers were imported into Mendeley is imprecise or inappropriate.27 Nevertheless, a
version 1.19.8. similar method is used to study widespread Internet
use around the world, and most authors, including
RESULTS the authors of the reviewed models, continue to use
According to the search strategy, publications on the term "Internet addiction" in general to describe
Internet Addiction and its associated factors among the various behavioural addictions connected to
adolescents and children as well as the IA criteria Internet use.
and terminology produced a total of 68 articles, IA can thus be described as a persistent
including reports and research articles. The pattern of maladaptive behaviour, characterised by
information obtained from the literatures was then preoccupation, insistence, or uncontrolled or
divided into the following headings.: excessive Internet use associated with the
development of tolerance, withdrawal symptoms,
• IA Criteria and Terminology
and unsuccessful attempts to reduce or stop,
• Factors Contributing to Internet Addiction
resulting in clinically significant functional decline
among Adolescents and Children in the
or impairment.15,7,28-29
Context of Public Health (Epidemiology
There are few well-known diagnostic
Triad)
criteria and models for IA that have ever been
created and put forth by prior researchers (Table 1).
DISCUSSION These models were chosen in accordance with
IA Criteria and Terminology previously developed criteria for IA that have been
The American National Psychiatric Association widely or frequently cited by other researchers. The
(APA) has omitted the term "addiction" in the three models of Internet addiction criteria
Diagnostic and Statistical Manual of Mental highlighted by K.S. Young,20 Griffiths,30 and Tao et
Disorders (DSM) for four consecutive editions al31 share similarities in that all sets of criteria
because it is stigmatising, viewed as a general term describe a lack of control over Internet use, which
rather than a scientific one, and is too difficult to leads to psychological, social, or professional
define. A new category of "Substance and Addiction conflict or problems (including excessive use) and
Related Disorders" was created by the term's mental preoccupation.
introduction in the DSM-5. The term was, however, Meanwhile, other related characteristics,
added to the DSM-5 and developed into a new including mood management, tolerance,
category of "Substance and Addiction Related withdrawal, and desire or anticipation, are stated
Disorders".24 inconsistently by all three models.18 Internet activity
The expansion of the definition of is frequently viewed as a single entity by researchers
"addiction" to include non-substance-related of all three models. There is a strong correlation

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Internet Addiction in Adolescents

between Internet addiction and the amount of time be noted that the DSM-5 still does not include
spent engaging in online activities like social media, subcategories for "sex addiction," "exercise
online shopping, and online gaming.32 addiction," or "shopping addiction" because at this
Hence, there are recommendations for time, the reassessment review lacks the necessary
compulsive "processes" or "behaviours" based on a data to establish diagnostic criteria and detailed
variety of themes, including shopping, physical descriptions are required to classify this behaviour
activity, and online video games, social media, and as a mental disorder.35
various sexual behaviours.18,33,34 However, it should

Table 1 Comparison of the descriptive diagnostic criteria for Internet addiction based on assessment instruments

Criteria K.S. Young20 Griffiths30 Tao et al31

Preoccupation Feel absorbed and distracted The Internet dominates Thinking about previous
by the Internet when offline thoughts (complacency, online activity
or fantasise about being cognitive impairment),
online. feelings (addiction,
desire) and behaviour.
Mood Attempting to stop using the Mood alterations Functional deterioration
management Internet causes mood Utilize the Internet to alleviate
(negative) changes. or escape depressive feelings.
Tolerance Utilizing the Internet for It is necessary to increase At least three-month usage
longer than intended. the number of certain period.
activities to achieve the Spend at least six hours on
same effect as before. non-business-related activities.
Significant increase in
satisfaction-related Internet
usage.
Withdrawal Attempts that failed to stop Unpleasant feelings and / Manifested by mood
Internet usage. Feeling or physical effects that dysphoria, anxiety, irritability
anxious or depressed while occur when certain and boredom after a few days
offline, but these feelings activities are stopped or without the Internet
disappear when online. abruptly reduced
External Affect important Conflict between Internet Loss of interest, hobbies, and
consequences relationships, jobs or addicts and those around entertainment is a direct result
/ conflicts opportunities. them (interpersonal of Internet use, with the
Choose to spend more time conflict) or from within exception of fraudulent
online as opposed to (intrapsychic conflict) cost/real-time involvement in
socialising with others, regarding particular the Internet from family
completing homework, and activities. members, therapists, and
getting enough sleep. others.
Others express concern Using the Internet excessively
regarding the amount of time despite being aware of having
spent online. persistent or recurrent physical
Shout, yell, or become or psychological problems
enraged if people interrupt resulting from Internet use.
while online.
Relapse / Failed to decrease online The propensity to Constant desire and/or
control usage. repeatedly regress on an unsuccessful attempts to limit,
initial pattern of a reduce, or halt Internet usage
particular activity.
Addiction / Find yourself anticipating - Anticipate the next online
anticipation when online. session or have an intense
desire to access the Internet
Lying / hiding Be defensive or secretive - -
use when questioned about
online activities
Attempt to hide how long
you've been spent online.
Source 18,26

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Factors Contributing to Internet Addiction among influencing an individual's level of vulnerability,

Adolescents and Children in the Context of Public exposure, or response to a causative agent (Internet
Health (Epidemiology Triad) feature).41,42 Individual intrapersonal and
interpersonal variables, such as personality traits and
Internet characteristics (Agent) psychosocial well-being have received the most
The characteristics of the Internet and its effects on attention in the existing literature on IA among
addictive behaviour serve as ‘agents’ in the causes adolencents.16,43,44
of IA. Several previous works have attempted to
explain IA by examining the Internet-specific a. Intrapersonal
factors responsible for increasing or decreasing It has been demonstrated that the Big Five
consumer overuse patterns on the Internet, such as Personality Traits, which are made up of the five
captivating and satisfying features that appear to be fundamental personality dimensions of openness to
appealing to users.16,36,37 experience, conscientiousness, social nature,
Multiple prior studies have concluded that extraversion, and agreeableness, are either
Internet users are driven by various satisfaction negatively or positively associated with IA.42
factors including information seeking, escapism, Openness, prudence, extraversion, and consent have
relationship building, self-development and been shown to have an inverse or negative
anonymity. Other factors include entertainment, relationship with IA in previous research. Contrary
environmental and social factors.16,36,37 to this, neuroticism is positively correlated with
According to the theory of consumption IA.42,45
and satisfaction, one medium is chosen and utilised Individuals who are open are more
over another because it is believed to be able to independent and less reliant on external factors such
satisfy the desires of users. This gives users as the Internet. Due to their high level of curiosity
perceptions of the Internet's usefulness and ease of and interest, open individuals prefer real -world
use, which in turn influences their media choices and activities over virtual realms.42,45 Individuals with a
Internet usage tendencies37. Therefore, adolescents high level of attention to detail are cautious,
who are more interested in social satisfaction and organised, self-controlled, and goal oriented. Due to
entertainment are more susceptible to IA. On the this trait, individuals of this type are unlikely to
other hand, adolescents who actively seek spend extended periods of time on the Internet.42,45
knowledge and have specific intentions when using The nature of extraversion indicates that a
the Internet, for instance to gather information, have person likes to be actively involved with other
a lower risk of developing IA.37,38 people in order to build friendships, gain admiration,
Internet use is found to be more prevalent and enhance their status; this suggests whether the
among adolescents who view the Internet as a way person is competitive and self-confident. Thus,
to socialize or build interpersonal relationships. This individuals with a greater level of social interaction,
illustrates that the Internet is particularly appealing competitiveness, and self-esteem tend to have a
to some individuals, as noted earlier, individuals lower level of IA.42,46
who have difficulty socializing in other ways. In Individuals who are agreeable, empathetic,
addition, IA is more prevalent among adolescents trustworthy, tolerant, and forgiving dislike using
who believe that the Internet’s ability to act force and avoid placing themselves under pressure.
independently without revealing one's identity is one Moreover, agreeable attitudes are negatively
of its alluring features.16,36 correlated with negative emotions and stress, both of
Perceived pleasure is another major driver which are known predictors of Internet addiction.
for continued Internet usage through various Thus, consenting attitudes have been identified as a
mechanisms. This factor refers to the positive predictor factor of protection against IA.42,47
experience response that occurs when an individual Compared to other traits, neurotics experience
uses the Internet, resulting in the individual's actions negative emotions and profound guilt and often use
to continue their activities becoming stronger, which the Internet to escape negative emotions and stress
ultimately leads to addictive behaviour.39 Similarly, and gaining social support. Therefore, individuals
the Internet has increased user satisfaction with with high levels of neuroticism are more susceptible
technology and fostered the development of stronger and likely to develop an Internet addiction than their
Internet use habits.40 If individuals have a peers.42,48
favourable Internet experience, they are more likely Other intrapersonal risk factors include
to continue spending additional time and effort to psychological factors such as depression, Attention
satisfy cravings. Deficit Hyperactivity Disorder (ADHD), anxiety,
impulsivity, lack of self-confidence, and withdrawal
Individual factors (Host) symptoms, to name a few, which frequently coexist
Regarding ‘host’, the term refers to adolescent who with IA.15,16,44,49 Pre-existing psychosocial problems
is vulnerable to IA. Numerous intrapersonal and are likely to increase an individual's risk of
interpersonal risk factors have been identified as developing maladaptive cognition as a result of

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Internet use. Because they share a common are the third and final component of the
aetiology, there is also a reasonable possibility that epidemiological triad. In contrast to the other
IA and mental disorders co-occur.50 variables mentioned earlier, environmental factors
Moreover, excessive Internet users are received less attention. Environmental factors in the
more likely to have homozygous short alleles in the context of IA may include physical factors such as
serotonin transporter-related promoter region (5- pollution exposure, socioeconomic factors such as
HTTLPR), which is linked to depressive housing condition, Internet accessibility, as well as
disorders.50,51 Despite this, it is difficult to establish exposure to advertising.16, 41
a causal relationship between Internet addiction and
psychological problems due to the lack of a. Environmental pollution
longitudinal data. In addition, there is an ongoing According to the results of a meta-analysis involving
debate as to whether IA should be considered a 31 countries from seven different regions of the
major disease disorder or whether participation in world, the prevalence of IA is higher in countries
Internet activities is merely one way for individuals with higher emotional stress status due to traffic
with gambling issues, compulsive shopping, and congestion and commute times, worries about air
pornography addiction to manifest their disease pollution, lower national income, and general life
problems. Regardless of whether IA is a major dissatisfaction.57
disorder or not, the negative relationship between IA The presence of mentally taxing
and overall psychological well-being has been environmental conditions, such as poor air quality,
clearly demonstrated in previous scientific traffic congestion, and loud noise, can be stressful
literature.50 for those in the area. Due to the unfavourable,
unsuitable environment or the possibility of being
b. Interpersonal exposed to harmful contaminants, people prefer to
Numerous researchers have identified conflict relieve stress by browsing the Internet rather than
between parents and children, the functioning of engaging in outdoor activities.57 As people's stress
family institutions, parental protection, and school levels increase, they are more likely to turn to the
involvement as factors influencing IA in children Internet as a means of escape, which increases their
and adolescents.16,44,52-53 susceptibility to IA due to prolonged Internet use.50
In addition, a study conducted among Moreover, the direct effects of air
adolescents in Hong Kong revealed that adolescents pollutants on humans can manifest in numerous
from parents and divorced families, families ways. The World Health Organization (WHO)
experiencing conflict, and families with severe released a report on six major air pollutants
dysfunction exhibited and positively predicted IA.54 including lead as a neurobehavioral substance
In a large-scale local study, it was also discovered affecting more younger generation. Lead pollution
that adolescents whose parents were married but derived from the use of fuel in transportation and
lived apart were more likely to have IA issues.28 It is engines, paints, electronic waste, incinerators
understood that divorced or cohabiting parents will (burners), water pipes, particularly in developing
have limited time with their children when juggling countries, is a threat to public health due to its
work, family management and maintaining negative neurobehavioral effects on humans, animal
relationships with their children. While it was also life, and the environment.58,59
discovered that children use the Internet to reduce
the psychological insecurity inherent in a single- b. Lead (Plumbum) exposure
parent family environment.54 Furthermore, families Children are particularly susceptible to lead
with emotionally friendly parenting styles can exposure due to its neurotoxic properties, which can
reliably predict adolescent self-regulatory strategies, impair learning, memory, hyperactivity, and, in
an important factor given that Internet use and other extreme cases, result in mental retardation.58 It has
forms of misbehaviour depend on these adolescents' also been found in pre-clinical research that brain
capacity for self-control.53 areas associated with addiction circuits have been
In the meantime, some researchers enhanced as a result of lead-induced modifications
highlight the importance of school involvement in of neurotransmitter receptors, which are known to
IA occurrence, as schools are a crucial environment facilitate the course of illicit substance activity into
for children's development and also promote healthy the brain during adolescence. This period is when
lifestyles.53,55 Due to the negative relationships adolescents are most exposed to addictive behaviors
formed with teachers and peers, adolescents who are such as lead exposure, as well as the appearance of
emotionally affected and poor participation in psychiatric problems in individuals.60
school activities are more likely to develop IA.56 Similarly, the researchers discovered a
similarity between neuro image scanning of
Environmental factors adolescents with IA and substance dependence,
Environmental factors, which are extrinsic factors suggesting that the two share similar
that influence 'agents' and exposure opportunities, neurobiological mechanisms.21 Interestingly, there

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is increasing evidence that early exposure to Pb2+ is time, relieve stress, and have fun on the internet
a risk factor for psychiatric disorders and substance rather than on activities that need financial
abuse. Current evidence also suggests that early resources.64
exposure to Pb2+ during early childhood is It was also found that adolescents from
associated with poor neural development outcomes, low-income households are more likely to receive
with effects varying with exposure magnitude and less information and assistance for their needs,
duration.60 However, assumptions about whether IA making Internet use a cost-effective alternative
shares the same pathway as other addictive activity for them. In addition, low-income families
behaviours must be clarified in future research. tend to have lower educational attainment, which
decreases their likelihood of being aware of the
c. Housing conditions and household count negative effects of Internet addiction and the
The findings of a study conducted in Spain on 1,509 preventative measures available to avoid them, such
individuals between the ages of 18 and 78 seated at as positive parent-child relationships and effective
home (when the movement control phase was communication.54
implemented due to the COVID-19 pandemic)
revealed that those living in smaller houses and with e. Internet availability and Internet advertising
fewer children are more likely to use the Internet When discussing Internet advertising, for instance,
than those living in larger houses with terraces and in the context of alcohol-related research,
more children. It is highly probable that many of availability and exposure to alcohol are well-known
them use the Internet in an unhealthy, excessive, and environmental factors that influence the alcohol
compulsive manner in an attempt to alleviate the consumption of young people.16,65 Given that neural
negative emotions they experience as a result of abnormalities (e.g., atrophy of the dorsolateral
being confined to a small space at home.61 prefrontal cortex) and cognitive dysfunction (e.g.,
This assertion is in line with a study of 220 memory impairment) associated with IA are similar
parents who had children in Japan during the to substance abuse and addictive behaviour
COVID-19 outbreak, which discovered that having problems, it is reasonable to believe that Internet
fewer rooms at home was linked to higher IA availability and accessibility may also influence
scores.62 According to the Ministry of Internal IA.21,57,66
Affairs and Communications of Japan, the number A study conducted in Korea found that
of persons renting housing is highest among those in adolescents who are exposed to more Internet game
their 20s, and the proportion of people living in their advertising and who are more susceptible to being
own properties rises with age. Hence, IA is a severe misled or influenced by advertisements are more
problem among young people if the number of likely to develop a video game addiction.16,67 In
rooms in the house rises with age, money, and other order to prevent problems related to alcohol, the
markers of social standing. Additionally, if there are WHO has emphasised the significance of regulating
many rooms, the lives of the roommates can have the availability and marketing of alcohol.68 The
some influence on how much time is spent online.62 same logic can be applied to the problem of IA. To
date, many countries lack regulations or policies
d. Household income governing advertising content (especially those
Low family income was found to be a predictor of containing violence, adult viewing material or
IA.54,63,64 The low-income group was shown to be pornography). Consequently, adolescents are often
much more addicted to the internet than other exposed to Internet game advertisement with
groups, and this addiction lessened as wealth inappropriate sexual and violent content. Table 2
increased. This may be because those coming from provides a summary of the general overview of
low-income family frequently choose to spend their factors related to IA.

Table 2 Summary of Factors Associated with Internet Addiction

Factors associated with IA Description Author

Agent Internet Internet users are driven by various satisfaction 16,36,37

Characteristics factors including information seeking, escapism,

relationship building, self-development and
anonymity. Other factors include entertainment,
environmental and social factors.

Positive experience response that occurs when an 37,39,40

individual uses the Internet fostered the development

of stronger Internet use habits, which leads to
addictive behaviour

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Internet Addiction in Adolescents

Host Intrapersonal

Personality trait Openness, prudence, extraversion, and consent have 42,45

been shown to have an inverse or negative

relationship with IA.

Neuroticism is positively correlated with IA. 42,45

Depression, Attention Deficit Hyperactivity

Psychological factors Disorder (ADHD), anxiety, impulsivity, lack of self- 15,16,44,49

confidence, and withdrawal symptoms, to name a

few, frequently coexist with IA. Pre-existing
psychosocial problems are likely to increase an
individual's risk of developing maladaptive
cognition as a result of Internet use.
Interpersonal

Adolescent – family Adolescents from parents and divorced families, 54

relationship families experiencing conflict, and families with

severe dysfunction exhibited and positively
predicted IA.

Adolescents whose parents were married but lived 28

apart were more likely to have IA issues.

Adolescents who are emotionally affected and poor 56

Adolescent – teacher participation in school activities are more likely to

& peers’ relationship develop IA due to the negative relationships formed
with teachers and peers.
Environment Environmental Prevalence of IA is higher in countries with higher 57

pollution emotional stress status due to traffic congestion and

commute times, worries about air pollution, lower
national income, and general life dissatisfaction.

People prefer to relieve stress by browsing the

Internet rather than engaging in outdoor activities 57

due to unfavourable, unsuitable environment or the

possibility of being exposed to harmful
contaminants.
Lead exposure Brain areas associated with addiction circuits have 60

been enhanced as a result of lead-induced

modifications of neurotransmitter receptors, which
are known to facilitate the course of illicit substance
activity into the brain during adolescence.

There is similarity between neuro image scanning of 21, 60

adolescents with IA and substance dependence,

suggesting that both share similar neurobiological
mechanisms and there is increasing evidence that
early exposure to Pb2+ is a risk factor for psychiatric
disorders and substance abuse.
Housing conditions Those living in smaller houses and with fewer 61

and household count children are more likely to use the Internet than those
living in larger houses with terraces and more
children.

Having fewer rooms at home was linked to higher IA 62

scores.
Household income Low family income was found to be a predictor of 54,63,64

IA.

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The low-income group was shown to be much more 64

addicted to the internet than other groups, and this

addiction lessened as wealth increased
Internet availability Availability and exposure to alcohol are well-known 16,65,21,57,66

and Internet environmental factors that influence the alcohol

advertising consumption of young people. Given that neural
abnormalities (e.g., atrophy of the dorsolateral
prefrontal cortex) and cognitive dysfunction (e.g.,
memory impairment) associated with IA are similar
to substance abuse and addictive behaviour
problems, it is reasonable to believe that Internet
availability and accessibility may also influence IA.

Adolescents who exposed to more Internet game 16,67

advertising and who are more susceptible to being

misled or influenced by advertisements are more
likely to develop a video game addiction.

CONCLUSION Paediatr Child Heal. 2019;24(6):402–8.

This review article discussed the complexity of IA 3. Mihajlov M, Vejmelka L. Internet
diagnostic criteria, and it is evident that children and addiction: A review of the first twenty years.
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appear enticing to users, individual factors, and Cross C, Radesky J, Hutchinson J, et al.
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significant issues revealed that necessitate the 5. Liu M, Wu L, Yao S. Dose-response
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