Internet Addiction in Adolescents: A Review

Studies on internet addiction in adolescents published during the years 2014-2017 were found on PubMed and PsycInfo. Predictive factors for internet addiction included parent variables (internet use, depression, heritability), personality traits (self-esteem, self-regulation, perfectionism, empathy, conscientiousness), and psychological problems (attention deficit neuroticism, anxiety, depression). Internet addiction effects included physiological responses (blood pressure, evoked potentials, fMRIs, sleep problems and overweight), psychological problems (depression and suicidal ideation), inferior academic performance, difficult relationships (family and peers), and co-morbid addictions (smoking, alcohol, drug use, cell phone addiction, internet gaming and cyberbullying). The intervention studies found in this recent literature included restricted internet use, internet monitoring by parents and group therapy. Methodological limitations include the lack of a standard internet addiction classification and the reliance on self-report questionnaires that often do not include time spent online and online and offline behaviors as well as potential underlying mechanisms such as social anxiety. Further, most of the studies are cross-sectional, not longitudinal, so that the direction of effects cannot be determined. Field TM. J Addict Ther: JATP-120 DOI: 10.29011/2577-1507/100020 Internet Addiction in Adolescents: A Review One of the first papers on the negative effects of excessive internet use on adolescents’ relationships with their parents and peers was published 18 years ago [1]. At that time, the term internet addiction was rarely used and very few papers on that topic appeared in the literature. Since then, hundreds of studies, mostly survey studies, have been conducted around the world. For this review, a literature search was conducted on PubMed and PsycInfo for the years 2014-2017. Exclusion criteria included non-English papers, case studies, under-powered samples and non-juried papers. Although most of the adolescent internet addiction papers during the last few years have focused on risk factors and negative effects of excessive Internet use by adolescents, this review also includes brief summaries on the measures, prevalence and types of internet use as well as the very few studies on interventions. The signs and symptoms of Internet addiction include compulsive use, withdrawal, tolerance, and adverse consequences [2]. Of the papers reviewed here, approximately a third have used the term Internet addiction, another third have referred to it as problematic Internet use and the final third is distributed across a variety of terms including pathological internet use, excessive internet use, intensive internet use, compulsive internet use, internet dependence, internet addiction disorder, heavy Internet use, high-risk users and internet abuse. This variety of terms reflects the diversity of studies across multiple countries and the relative lack of consensus about how to define internet use. Although some investigators have simply used “greater than two hours per day of internet use for activities other than work or homework” to define internet addiction, most have used a variety of scales, i.e. some 21 instruments that have been developed or adapted as abbreviated scales or as culturally relevant measures. Measures, Prevalence and Types of Internet Use The Internet Addiction Test (IAT) developed by Young in 1995 is among the most popularly used measures of internet addiction in adolescents. This 20-item scale includes questions like “How often do you try to hide how long you’ve been on-line? ”,” How often do you choose to spend more time on-line over going out with others? ” and “How often do you feel depressed, moody or nervous when you are off-line, which goes away once you are back on-line? “ Shorter scales including the abbreviated version of the Problematic Internet Use Questionnaire (PIUQ) (6 items) [3] and the Problematic and Risky Internet Use Screening Scale (PRIUSS) (3 items) [4] have also been used in the recent literature on the prevalence of Internet addiction in adolescents. The 3-item scale Citation: Field TM (2018) Internet Addiction in Adolescents: A Review. J Addict Ther: JATP-120. DOI: 10.29011/2577-1507/100020 2 Volume 2018; Issue 01 J Addict Ther, an open access journal ISSN: 2577-1507 is comprised of items on anxiety when away from the internet, loss of motivation when on the internet and feelings of withdrawal away from the internet. However, the authors suggest that positive screens on the 3-item version should then be followed by the use of the 18-item PRUISS. The prevalence of internet addiction in adolescents has varied significantly depending on the measure used and the country of the research group. For example, the prevalence in a sample of 720 Turkish students on the internet Addiction Scale was 7% (71% men and 29% women) [5]. In another Turkish sample on 271 students using the same scale, the prevalence was 3 times that rate (20%) [6], highlighting the variability of prevalence data. In a sample of 5,005 European adolescents 14% were above the cut off for problematic internet use based on the short (6-item) PIUQ [3]. In a larger sample of 7,351 European adolescents a similar percentage (13%) of adolescents spent more than 20 hours per week on the internet and had high scores on the PIU. A comparison between two different time periods in 5 European countries (Estonia, Germany, Italy, Romania and Spain) showed a 4-7% increase over a two-year period in pathological internet use [7]. Some have argued that heavy use over time should be used as the criterion for internet addiction instead of the self-report scales, but a French survey on 22,945 French and Swiss adolescents suggested that use over time was moderately correlated with scores on internet addiction scales [8]. Culturally appropriate adaptations of the IAT have yielded higher percentages of use. For example, a screening on a sample of 5,366 adolescents from six Asian countries (China, Hong Kong, Japan, South Korea, Malaysia and the Philippines) revealed the highest rate of addiction in the Philippines but only a 5% rate when using the IAT and 4 times that rate when using the Chen Internet Addiction Scale-Revised [9]. The greatest prevalence noted in this literature search was in a sample of 408 Iranian students in which as many as 41% of students had internet addiction based on the IAT [10]. This far exceeds the international average of 15% [11]. Reputedly, pathological internet use occurs more frequently in adolescents than adults and is on the increase in several industrial countries, especially in Asia, North America and Europe [12]. The types of Internet use have varied as a function of demographic variables, for example, gender of user. In a sample of 967 Spanish adolescents, the most frequently used apps included WhatsApp (77%), social networks (70%) and music apps (67%) [13]. The most common use for girls was social networks, WhatsApp, Instagram and listening to music. In contrast, the teenage boys most frequently used the internet to browse the web, Skype, play and watch movies or tv shows. Similar gender differences were noted by another group of researchers including boys spending more time gaming and girls spending more time chatting on the social network [14]. Different motives for internet use have also been studied in a sample of 101 German adolescents [11]. Based on the Internet Motive Questionnaire for Adolescents (IMQ-A) that assesses social, enhancement, coping and conformity motives, half of the students were high-risk internet users. Although this sample of adolescents primarily used the internet for social motives followed by enhancement and coping motives, the high-risk users accessed the internet more often for coping and enhancement and the low-risk users for social reasons.