***Post submitted by Servio Carroll, Awards Chair for WSPA***

This study correlates heavy use of social media and the onset of ADHD symptoms in adolescents not previously diagnosed with ADHD. The results are not diagnostic but outline the presence of “look alike” symptoms, which need to be rule-out in making a diagnosis.

The article can be found at Medscape. It order to access it, you need to complete the free registration process.

National recommendations call for limiting screen time among children and adolescents, in part because of concern regarding the cognitive outcomes of too much time in front of televisions, tablets, or smart phones. Johnson and colleagues performed a prospective epidemiological study to evaluate any relationship between heavy television viewing among adolescents and problems with attention and learning. Their results were published in the May 2007 issue of the Archives of Pediatrics and Adolescent Medicine.[1]

The researchers found that even short durations of television viewing were associated with worse outcomes. Adolescents at age 14 years who watched at least 1 hour of television per day were at higher risk for negative attitudes toward school and poor grades compared with children who watched less television. Results in these domains for children who watched at least 3 hours of television daily were even worse. Children with the highest totals of television viewing not only demonstrated attention problems but also were less likely to attend postsecondary education. Researchers found little evidence of reverse causation; that is, more attention and learning problems leading to more television viewing.

Since the publication of this research, the paradigm of how children find entertainment has changed dramatically. The current study focuses on the potential role of digital media use in contributing to the risk for attention-deficit/hyperactivity disorder (ADHD).

Study Synopsis and Perspective

Heavy use of texting, video chatting, and social media may contribute to the onset of symptoms of ADHD in youth, new research suggests.

Among a large group of adolescents who did not have symptoms of ADHD at baseline, frequent use of digital media was found to be associated with the emergence of new ADHD symptoms.

“We cannot confirm whether there is a causal effect of digital media use on ADHD from our study. However, this study raises new concerns about whether the proliferation of high-performance digital media technologies may be putting a new generation of youth at risk for ADHD,” Adam Leventhal, PhD, director, Health, Emotion, & Addiction Laboratory, University of Southern California, Los Angeles, told Medscape Medical News.

“While digital media use in moderation might provide some benefits, like access to educational information or social support, excessive exposure to digital media entertainment could have adverse mental health consequences,” said Leventhal.

The study was published online July 17 in JAMA.[2]

Modest Association

The investigators tracked 2587 adolescents (mean age, 15.5 years; 54% girls) in 10 high schools in Los Angeles County, California, during a period of 2 years. None of participants had ADHD symptoms at baseline, as determined on the basis of scores on the Current Symptoms Self-Report Form. Participants completed surveys at baseline and at 6, 12, and 24 months.

At the start of the study, the students reported how often they used 14 popular digital media activities, such as checking social media, texting, playing digital games, video chatting, online browsing, or streaming videos, among others. On the basis of their responses, the researchers classified the participants into 3 categories: no use, medium use, and high use. The high-use category was defined as past-week use of all 14 different media activities multiple times a day.

The average number of digital media activities used at a high frequency rate was 3.62. The most common media activity was checking social media, with 54.1% of students in the high-use category on this activity.

According to the researchers, higher-frequency use of digital media was significantly associated with subsequent symptoms of ADHD during the 24-month follow-up period (odds ratio, 1.11; 95% confidence interval [CI], 1.06-1.16 per each additional digital media activity).

On average, ADHD symptoms emerged during follow-up in 9.5% of the students who reported engaging in 7 high-frequency digital media activities and 10.5% of those who reported engaging in all 14 high-frequency digital media activities compared with only 4.6% of students who reported not engaging in any of the digital media activities.

The association between higher-frequency digital media use and subsequent ADHD symptoms was “statistically significant but modest,” the researchers write. Stronger associations between media use and ADHD were found among adolescents who had more mental health symptoms, such as delinquent behavior and depressive symptoms.

Dr Leventhal told Medscape Medical News that parents, educators, and pediatricians “should be aware about the link between media use and mental health and open a dialogue with teens about digital media use. One useful resource are digital applications that can be downloaded directly to a device and track how much time the user is spending on the device using specific apps. Simply having information on the extent of use may be a good starting point for thinking about whether changes in media use might be helpful,” said Leventhal.

Several Potential Mechanisms

In an accompanying editorial, Jenny Radesky, MD, from the University of Michigan School of Medicine, Ann Arbor, says several mechanisms might explain the associations found in this study.[3]

For example, instant access to highly engaging technologies may affect users’ impulse control and expectations for immediate feedback, she explains. It has also been hypothesized that the ubiquitous, “always-on” nature of mobile media displaces opportunities for the brain to rest in its default mode, tolerate boredom, or practice mindfulness.

“Attentional shifts triggered by notifications may reduce a child’s ability to stay focused on challenging, nonpreferred tasks that require top-down executive control. Displacement of sleep and exercise, both important to executive functioning, are also possible mechanisms that would explain the findings in this study,” writes Dr Radesky.

Interpret With Caution

That stronger associations between media use and ADHD were found among adolescents who had more mental health symptoms “suggests that emotional dysregulation may be an important mechanism in some adolescents,” Dr Radesky points out.

But Gabrielle Carlson, MD, professor, Department of Psychiatry at Stony Brook University, New York, urges against jumping to the conclusion that high use of social media is contributing to ADHD.

“Although I am not a fan of social media, I don’t think the data can say that social media is giving [teenagers] ADHD,” she noted in an interview with Medscape Medical News.

It is also noteworthy, Dr Carlson said, that the “biggest bumps in ADHD symptoms were in the first 6 months, and with successive follow-up, symptoms came down a bit, so it’s hard for me to believe that that’s really ADHD. If this is really a media impact, you’d expect to see symptoms increasing over time, not decreasing,” she noted.

The study was supported by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

JAMA. Published online July 17, 2018.

Study Highlights

  • Researchers examined data from the Happiness & Health Study, which focused on adolescents attending public schools in Los Angeles, California. The current study assesses data collected in the 10th grade, and evaluations continued semiannually for up to 24 months thereafter.
  • Adolescents with a previous diagnosis of ADHD were excluded from analysis. ADHD was measured via the Current Symptoms Self-Report Form score. ADHD was diagnosed among participants with at least 6 symptoms of inattention or hyperactivity/impulsivity for at least 6 months.
  • Participants were asked to describe the use of 14 media activities during the 24-month follow-up period.
  • The main study result was the relationship, if any, between media use among adolescents and the risk for ADHD symptoms. This result was adjusted to account for demographic and socioeconomic variables.
  • 2587 adolescents provided data for study analysis: 54.4% of participants were female, and the cohort was diverse in terms of race/ethnicity. The mean age of participants at baseline was 15.5 years. Nearly half the study cohort was receiving subsidized lunch.
  • 80.9% of participants reported high-frequency use of at least 1 media activity. The mean number of high-frequency media activities per adolescent was 3.62. Frequent checking of social media sites was the most common activity.
  • Between 4.8% and 6.9% of the study population was diagnosed with ADHD at each of the follow-up visits.
  • The adjusted odds ratio for ADHD associated with high-frequency engagement with each additional media activity was 1.10 (95% CI, 1.05-1.15). The rate of ADHD was 4.6% across follow-up among adolescents who had no high-frequency media contact compared with a respective rate of 9.5% among adolescents who reported frequent participation in 7 media activities.
  • High-frequency use of 10 different media activities was associated with a higher risk for ADHD. Media activities not significantly associated with the risk for ADHD included texting, chatting online, playing games with friends, and posting one’s own photographs or images.
  • The authors describe that reverse causation or parenting styles may help explain some of the effect of media on the risk for ADHD among adolescents.

Clinical Implications

  • A previous study found that even 1 hour of television viewing daily among 14-year-old adolescents was associated with negative attitudes toward school and poor grades compared with those of children who watched less television. Results in these domains for children who watched at least 3 hours of television daily were even worse. Children with the highest totals of television viewing not only demonstrated attention problems but also were less likely to attend postsecondary education. Researchers found little evidence of reverse causation; that is, more attention and learning problems leading to more television viewing.
  • The current study demonstrates a positive relationship between most high-frequency media activities and the risk for ADHD among adolescents. A higher amount of time spent in media activities was associated with a progressively higher risk for ADHD. Texting and chatting online were not individual activities significantly associated with the risk for ADHD.
  • Implications for the Healthcare Team: The healthcare team should advocate for a healthy balance of cognitive activities, physical activity, and social activity among adolescents, and the results of the current study may help to make this recommendation resonate with teenagers and parents.