Attention-deficit/hyperactivity disorder (ADHD) in Adolescents and the Risk of Internet Addiction

With more people online, there have been increasing incidences of internet addiction, especially among younger generations (the youth). ^[2] The American Society of Addiction Medicine (ASAM) defines addiction as a psychiatric disorder where an individual displays problematic patterns in both behaviors and with substances. There is also a growing understanding of the importance of prevention in addiction and recovery. ^[3]

Attention-deficit/hyperactivity disorder (ADHD) and Addiction: What’s the Link?

There has been substantial research conducted on attention-deficit/hyperactivity disorder (ADHD) and addiction disorders, with researchers finding that those with ADHD have an increased risk for addiction disorders. ^[4]

One of the main characteristics of ADHD is impulsivity, which significantly increases the chances of engaging in addictive behaviors. When someone (especially a young person) has ADHD, it is difficult to think through the consequences of actions. Difficulty considering consequences can lead to impulsive decision-making, such as engaging in risky activities like excessive or complusive internet usage, without fully considering the long-term impact. ^[5]

For most people diagnosed with ADHD, the symptoms decrease as they age, although some adults may still have significant psychological symptoms that interfere with their daily functioning. ^[6] Because symptoms decline in adulthood, youth are most often affected by addiction as a result of ADHD.

How Does Attention-deficit/hyperactivity disorder (ADHD) Impact Behavior?

According to DSM-5, Attention-Deficit/Hyperactivity Disorder (ADHD) is defined as having severe symptoms of inattentiveness and/or hyperactivity-impulsivity, which has lasted more than six months. ^[7]

Attention-deficit/hyperactivity disorder (ADHD) Symptoms in Children and Teenagers

ADHD symptoms are grouped into two main types of behavior problems, namely inattentiveness and hyperactivity/impulsiveness, with many people diagnosed with ADHD having symptoms that fall into both categories. ^[8]

Subject matter expert

Holly Schiff Psy.D.

Children, adolescents, and families

View experience

Inattentiveness Symptoms

• Short attention span
• Easily distractible
• Careless mistake-making
• Forgetfulness or losing things
• Inability to complete time-consuming tasks
• Inability to listen or follow instructions
• Constant changing of activities or tasks
• Difficulty organizing tasks

Hyperactivity and Impulsiveness

• Inability to sit still
• Fidgeting
• Inability to concentrate on tasks
• Excessive movement
• Excessive talking
• Inability to wait
• Impulsive actions
• Interrupting conversations
• Little or no sense of danger

The Link Between Attention-deficit/hyperactivity disorder (ADHD) Symptoms and Internet Use

One study of 100 children (50 with ADHD and 50 without) found that 54% of the children with ADHD had a “probable Internet addiction,” and 2% of the children with ADHD had a “definite Internet addiction.” In comparison, only 12% of the children without ADHD had Internet addiction (all 12% had “probable Internet addiction”). The same study also found that children with ADHD were 9.3 times more likely to develop Internet addiction disorder as compared to children without ADHD. ^[9] A commonly overlooked symptom of ADHD is hyperfocus, which is defined as an intense concentration on a particular object. Hyperfocus is known to disrupt attention control, resulting in a focus on inappropriate behaviors such as problematic internet usage. ^[10]

Attention-deficit/hyperactivity disorder (ADHD) and Screen Addiction

Screen addiction is defined as excessive use of technology, such as a smartphone, tablet, laptop, or television, that causes dependency. Screen addiction includes video game addiction, social media addiction, internet addiction, and pornography addiction. ^[7]

Each of these addictions has unique features but has excessive screen time in common. Screen addiction is on the rise across all age groups. In children and teenagers, excessive screen time has been shown to have a significant impact on their physical health, including issues such as sleep disturbance, eye strain, low physical activity, poor mental health, or attention deficits. ^[8]

Children with ADHD are more prone to excessive screen time use because people with ADHD don’t have challenges concentrating; they have difficulty maintaining concentration on things that do not stimulate the ADHD brain. Video games and the internet provide stimulating visual graphics, sound effects, action, constant change, immediate feedback, and incentive to get to the next level. ^[6]

Attention-deficit/hyperactivity disorder (ADHD) and Social Media Addiction

The use of social media websites, such as Facebook, X (previously Twitter), and Instagram are prevalent among Internet users. Surveys suggest that over 93% of teens use social media (approximately 37 million teenagers in the USA alone). ^[12][13] Research has found that ADHD-related symptoms and time perspective (which relates to whether we focus on our past, present, or future when a person makes decisions) ^[14] are factors that may worsen the addictive use of social media among adolescents. Addictive use of social media can cause issues in many areas of a person's personal life, including negatively affecting academics and mental health. ^[12]

Attention-deficit/hyperactivity disorder (ADHD) and Technology Addiction

Technology addiction is defined as excessive use of technology that leads to problems and distress. A person who is addicted to technology could engage in excessive technology use to alleviate feelings of anxiety or irritability rather than for fun. Technology addiction causes psychiatric symptoms of tolerance, dependency, and withdrawal similar to those who have substance use disorders. ^[15] One specific facet of technology addiction is gaming disorder (GD), also known as internet gaming disorder (IGD). Adolescents with ADHD and GD are more dysfunctional video gamers. Adolescents with ADHD and GD also display dysfunctional sleeping patterns, such as going to sleep between 2 and 4 a.m., compared to those without ADHD, who went to sleep between 8:30 and 10:30 p.m. ^[16]

Attention-deficit/hyperactivity disorder (ADHD) and Pornography Addiction

In recent years, there has been much research on behavioral addictions, with some focus on online pornography addiction. However, researchers still cannot agree on when engaging in online pornography becomes an addiction^[17]. While excessive pornography usage displays similar characteristics to other behavioral addictions, such as compulsive behavior with negative consequences, it is not classified as an addiction. The World Health Organization's ICD-11 (2022) has recognized compulsive sexual behavior disorder (CSBD) as an "impulsive control disorder," and this may extend to pornography. ^[18] The reason why excessive pornography use can be treated as an addiction and is an issue faced by adolescents diagnosed with ADHD is because it provides a quick, intense stimulus. These intense stimuli work with the ADHD brain's craving for instant gratification and stimulation. ^[19]

Identifying Signs of Internet Addiction in Adolescents with Attention-deficit/hyperactivity disorder (ADHD)

While the risk of internet addiction is higher in adolescents with ADHD, the signs of internet addiction are the same in those with or without ADHD and include:

1. Preoccupation with the Internet

The first and most apparent sign of internet addiction in adolescents is a preoccupation with the internet. Those who have an internet addiction may constantly think about being online. These cravings may lead to excessive Internet usage and neglecting other responsibilities. ^[20]

2. Withdrawal Symptoms

Withdrawal symptoms, such as anxiety and moodiness, are indicators of Internet addiction. When an adolescent is addicted to the internet and is unable to engage in online activities, they may experience symptoms similar to those seen in substance withdrawal. The intensity of withdrawal symptoms differs depending on the level of addiction. ^[21]

3. Loss of Interest in Other Activities

A noticeable loss of interest in activities previously enjoyed is a common symptom of addiction. When people become addicted to the internet, they may prioritize online activities over other important ones. Loss of interest in other activities can impact overall well-being and may lead to a decline in academic performance and a reduced quality of life. ^[22]

4. Declining Academic Performance

Research has shown a negative association between internet addiction and academic performance among teenagers. One study in Australia found that non-academic internet use of more than four hours during weekdays negatively affects academic performance. Students with higher levels of internet addiction also tend to have lower academic achievements. ^[23]

Strategies for Managing Screen Time

There are several strategies that parents can put into place to manage screen time and reduce the risk of internet addiction in adolescents; these include:

1. Mindful Screen Time

Parents should ensure that the screen time they allow their children is of good quality. Apps and videos should be previewed before children watch them. Parents should also seek out engaging apps or games rather than those that require pushing and swiping. Parents may also consider parental control apps to control their children's screen time. ^[24]

2. Set Screen Time Limits

Screen time for adolescents should be limited to a maximum of two hours per day, and parents must enforce this rule. ^[24]

3. Create Screen-Free Zones

Parents can create areas in the home where screens are not allowed. Examples of these areas could be the dining room and bedroom. When screen-free zones are created, parents minimize the impulsive use of the internet and encourage adolescents to engage in other activities. ^[25]

4. Lead By Example

Older adults and parents should teach children to safely use screens by practicing good screen habits. Adolescents are keen observers (they model behavior) and often copy the behaviors of adults around them. ^[26]

Treatment Approaches for Co-occurring Attention-deficit/hyperactivity disorder (ADHD) and Internet Addiction

Adolescents with co-occurring ADHD and addiction disorders will often require a combination of treatments, including medications and therapy, to achieve improvement. ^[27]

Medication Therapy

There are five medicines licensed for the treatment of ADHD:

1. Methylphenidate
2. Atomoxetine
3. Lisdexamfetamine
4. Dexamfetamine
5. Guanfacine

While these medicines may help to improve the symptoms of ADHD, they are not a cure. Some must be taken daily, while others may be taken as needed, such as on days when the person is attending school. Sometimes, a psychiatrist may recommend a treatment break to assess whether the medicine is still needed. ^[9] Of the five licensed drugs, methylphenidate (Ritalin, Ritalin LA, Concerta, Metadate CD, Methylin, Methylin ER, Daytrana, Quillivant XR, Quillichew ER, Aptensio XR, Cotempla XR-ODT, Jornay PM, and Adhansia XR^[28]) is the most commonly used for ADHD. It belongs to a group of medicines called stimulants, which increase activity in brain areas that control attention and behavior. ^[29]

Psychotherapy

Therapy in adolescents with ADHD is a helpful resource. If the adolescent has a co-occurring mental disorder, such as addiction, it can become even more necessary. A few different types of therapy have been found to help parents and adolescents manage symptoms and improve functioning.

1. Behavioral therapy may help an adolescent with ADHD and addiction to change their behavior. Behavioral therapy may involve practical assistance, such as teaching parents and adolescents how to organize tasks or complete schoolwork and learning social skills, such as controlling behavior.
2. Cognitive behavioral therapy can help adolescents with ADHD become aware of their concentration challenges and help them develop strategies to improve focus and complete daily tasks.
3. Family and marital therapy may be important for family members of ADHD adolescents to help them learn to manage disruptive behaviors.

Each or a combination of these therapies can teach adolescents with ADHD or their family members skills to improve daily functioning. ^[30]

Conclusion

Screens and the internet are so ingrained in the lives of children, whether for academic or entertainment purposes, and their use is nearly inescapable. Because adolescents with ADHD often have impulse control issues and the internet is designed to engage and draw users in, these adolescents have an increased risk of becoming addicted.

Parents have the responsibility to ensure that routine use of the internet and technology does not become an addiction, especially in at-risk adolescents like those with ADHD.

Treatment options are vast and very effective, including medication treatment and psychotherapy.