Device addiction in children and adolescents

Dr Darshani Hettiarachchi
Consultant Child and Adolescent psychiatrists
TH Karapitiya
Not to avoid……
But to handle it with care…
 Content

• The place of technological devices in

modern world

• What is device addiction?

• Adverse consequences

• Management
 The place of technological devices in modern world

• Digital technology has already changed the world

– and as more and more children go online around
the world , it is increasingly changing childhood.

• Youth (ages 15–24) is the most connected age

group

• Worldwide, 71 per cent are online compared with

48 per cent of the total population.

• under 18 account for an estimated one in three

internet users around the world

UNICEF report 2017

 Global advantages

• Connectivity
Can be a game changer for some of the world’s most
marginalized children, helping them fulfill their
potential and break intergenerational cycles of
poverty.

• More opportunities for learning and education

• More access to economic opportunity

Providing young people with training opportunities
and job-matching services, and by creating new kinds
of work.

• More access to information

 Global disadvantages
• Digital access is becoming the new dividing line (millions
of the children do not have access )

About 29 per cent of youth worldwide – around 346 million

individuals – are not online.
African youth are the least connected. Around 60 per cent are
not online, compared with just 4 percent in Europe.

• Children who rely on mobile phones rather than computers

may get only a second-best online experience

• Those who lack digital skills or speak minority languages

often can’t find relevant content online.

• Digital divices also mirror prevailing economic gaps,

amplifying the advantages of children from wealthier
backgrounds and failing to deliver opportunities to the
poorest and most disadvantaged children.

• Digital gender gap .

Globally, 12 per cent more men than women used the internet in
2017. In India, less than one third of internet users are female.

• Challenges in proper verification of sources

 Defining Internet Addiction

• Internet addiction is a complex and an emerging issue, thus is difficult to find a single and
widely accepted definition.

• Internet addiction disorder (IAD) was first reported by Ivan Goldberg, psychiatrist in New
York, in 1996.
 Internet Gaming Disorder (DSM 5) (Diagnostic and statistical
manual of mental disorders 5th edition by American psychiatric association )

Persistent and recurrent use of the internet to engage in games ,often with other players leading to
significant impairment or distress as indicated by five or more of the following in a 12 months period

1. Preoccupation with internet games

2. Withdrawal symptoms when internet gaming is taken away ( anxiety , irritability , sadness )

3. Tolerance

4. Unsuccessful attempt to control the behvaiour

5. Loss of interest in previous hobbies and entertainments as a result of internet games

6. Continued excessive use of internet games despite knowledge of psychosocial problems

7. Has deceived family members ,therapists or others regarding the amount of internet gaming

8. Use of internet to escape or relieve a negative mood

9. Has jeopardized or lost a significant relationship, job or educational or career opportunity because of
participation in internet games
(IGD appears to be most common in male adolescents, aged 12–20 years)
 Different clinical presentations and terminologies

• Pathological Internet use

• Cyberspace addiction

• Cyber-Affair / Relational Addiction

• Information Overload: a compulsive behavior associated with excessive "surfing" on the Internet and
database searches

• Mobile phone dependence

• Social network site addiction

• Facebook addiction

• Internet pornography addiction

• Many more…….
(need further evaluation and research on diagnostic criteria, assessment tools and conceptual formulation)
 Problematic internet use

• In 1996, the psychologist K. Young became the first to publish a detailed case report of
problematic Internet use

• PIU is characterized by overuse of the internet with associated impairment(s) across various
domains of functioning (physical , educational, relationship, financial , legal, psycological etc..)

Anita et al 2020
 Problematic internet use ctd

Limited data on prevalence. There is lack of consensus regarding the definition of PIU, and the
term has been used in different studies with different connotations.
• Prevalence 1-10% ( Global)
• Asia- up to 25%
(Durkee T etal 2012, Park SK 2008)

• Adolescents- 0.8% in Italy , 26.7% in Hong Kong

(Kuss D.J., Griffiths M.D 2014)
 Why do adolescents use internet?

• Learning new things

Education • Seeking knowledge on technology and sciences
• Doing research

• Watching movies
Entertainment • Playing games
• Shopping

• Killing out of boredom

Psychological needs • Forgetting problems
• Relaxing, get rid of stress

• Talking to friends
Socialization • Searching new friends
• Sharing ideas
Mental health issues –
Adolescent age-
• Attention Deficit Hyperactivity disorder

• Social anxiety, Generalized anxiety

• Developmentally vulnerable period for risk taking behaviours
• Obsessive compulsive disorder and novelty seeking

• Depression

• Aggression

• Impulsivity

Risk factors for problematic internet use in

adolescents

Personality related- Social and environmental

• Family related -Parental conflicts , Family dysfunction, poor

• Low self esteem
supervision
• Interpersonal difficulties • School related problems – high demands for achievements ,peer
influence

• Free availability and accessibility

• Influence from advertisements

( Zulki Chung 2019 )

 Psychological
Physical
• Loneliness, withdrawal from family and poor self
• Headaches esteem
• Problems with vision
• Spinal deformity • Increased aggression and violence, anti-social
• Problems with your wrist ( carpal tunnel syndrome) behaviour, social difficulties, reduced prosocial
• weight gain , obesity, increase metabolic risk, behaviour and lack of empathy
• Sleep problems
• Increase mental health issues (anxiety , depression ,
suicidal ideas and self harming behvaiours )

Adverse consequences of problematic internet

use

Cognitive Social

• Lower quality of life

• Negative impact on
• Worse scholastic outcomes
-Memory
-Attention span
• Occupational difficulties
-Abilities for critical reasoning
-Language acquisition,
• Loneliness
-Reading
-Learning
• Relationship problems
• Management
 Prevention

• Prevention and health promotion as a

method of positively impacting youth
engagement with the online
environment

• Multi-system approaches, involving

parents, schools, the community and
other relevant stakeholders in guiding
prevention efforts
 Prevention

• Address risky adolescent lifestyles

Primary prevention

• Screening for potential problems

Secondary prevention

• Treatment for problematic behavior

Tertiary prevention
 Primary prevention

School based prevention Enhance personal protective factors

• Teacher and parent training • Increase the knowledge of PIU risks and impacts
• Promotion of psychosocial competencies:
• Student education
-Critical evaluation skills
• Awareness raising -Social skills
-Problem solving skills
-Emotion regulation and self-control skills
• Enhance protective factors
-Cognitive restructuring skills
-Reduction of impulsiveness
• Reinforce positive behaviours -Self-concept
-Self-management
• Environment al modifications that reduce the -Promotion of healthy social relationships
likelihood of negative occurrences -Promotion of awareness of subjective
relationship (personal relevance) with
technologies

(Melina A. Throuvala Mark D, 2019)

 Treatment objectives

• The focus of treatment should be to assist the patient in developing effective coping strategies in order to
change the addictive behavior through personal empowerment and proper support systems
• Desired improvements in

• Physical
Sym • Psychological
pto
ms

• Physical activity, activities of daily living, academic performance

• Maintaining intimate and peer relationships, involvement in community activities
Func
tioni
ng

• Spirituality, life satisfaction

• Quality of life, and the promotion of recovery
Well
bein
g
 Treatment ctd

The psychotherapeutic intervention can be done under two contexts –

• Total abstinence – (Given the internet's numerous advantages and positive uses in day-to-day
life, it is impractical to try the total abstinence model )

• Controlled Use -
The guiding principle should primarily be ‘moderate and controlled use’.
Most frequently investigated psychotherapeutic approaches

• Cognitive behavioural therapy (CBT)- ( ptns with maladoptive cognitions to change their
cognitive errors (Wieland DM 2005)

• Motivational enhancement therapy- collaborative, non-confrontational effort by the person

with internet addiction and the therapist to create an individualized treatment plan and
attainable goals (Chou C, Condron L, Belland JC 2005)
 Treatment strategies
• Practice the opposite time in Internet use- disrupt their normal routine and re-adapt new time
patterns of use in an effort to break the on-line habit

• Use external stoppers - things that the patient needs to do or places to go as prompters to help log
off

• Set goals- will give the patient a sense of being in control, rather than allowing the Internet to take
control.

• Abstain from a particular application (most problematic ones )

• Use reminder cards ( eg: (a) five major problems caused by addiction to the Internet, and (b) five
major benefits for cutting down Internet )

• Develop a personal inventory (what he or she has cut down on, or cut out, because of the time spent
on the Internet

• Enter a support group- improving the patient’s real life social support network

• Family therapy (educate the family, avoid blame, open communication, support )
( KS Young 1999)
 Place of pharmacological management

Very limited evidence ( only few case studies )

• SSRIs- resisting the urge and compulsion,

associated depression

• Opioid receptor antagonists such as naltrexone

(dopamine dysfunction of the neural reward
system )- one case report

• Mood stabilizers – lithium carbonate

• Antipsychotics-

• Methylphenidate – if associated with ADHD

 Prognosis/ outcome

• Limited and inconsistent

data
Questions.?
Thank you….