News Article Details

Screen time linked to ADHD

Capital - 7/29/2018

What with all the swiping, scrolling, Snapchatting, surfing and streaming that consume the adolescent mind, an American parent might well watch his or her teen and wonder whether any sustained thought is even possible.

New research supports that worry, suggesting that teens who spend more time toggling among a growing number of digital media platforms exhibit a mounting array of attention difficulties and impulse-control problems.

In a group of more than 2,500 Los Angeles-area high school students who showed no evidence of attention challenges at the outset, investigators from the University of Southern California, University of California at Los Angeles and UC San Diego found that those who engaged in more digital media activities over a two-year period reported a rising number of symptoms linked to attention deficit hyperactivity disorder.

The association between digital media use and ADHD symptoms in teens was modest. But it was clear enough that it could not be dismissed as a statistical fluke. On average, with each notch a teen climbed up the scale of digital engagement, his or her average level of reported ADHD symptoms rose by about 10 percent.

The results do not show that prolific use of digital media causes ADHD symptoms, much less that it results in a level of impairment that would warrant an ADHD diagnosis or pharmaceutical treatment.

Indeed, it's possible the relationship is reversed - that attention problems drive an adolescent to more intensive online engagement.

But at a time when 95 percent of adolescents own or have access to a smartphone and 45 percent said they are online "almost constantly," the new study raises some stark concerns about the future of paying attention. It was published this month in the Journal of the American Medical Association.

The findings come as mental health professionals are rethinking their understanding of ADHD, a psychiatric condition that was long thought to start in early childhood and last across a lifetime. Marked by impulsivity, hyperactivity and difficulty sustaining attention, ADHD is estimated to affect about 7 percent of children and adolescents.

But the disorder is increasingly being diagnosed in older teens and adults, and in some it waxes and wanes across a life span. Whether its symptoms were missed earlier, developed later or are brought on by changing circumstances is unclear.

The new research, involving 2,587 sophomores and juniors attending public schools in Los Angeles County, raises the possibility that, for some, ADHD symptoms are brought on or exacerbated by the hyperstimulating entreaties of a winking, pinging, vibrating, always-on marketplace of digital offerings that is as close as the wireless device in their pocket.

"We believe we are studying the occurrence of new symptoms that weren't present at the beginning of the study," said USC psychologist Adam M. Leventhal, the study's senior author.

Leventhal and his colleagues assessed the digital engagement of their 15- and 16-year-old subjects five times over a two-year period - when they first entered the study and four more times at six-month intervals. They asked the students to think back over the last week and report whether and how much they had engaged in 14 separate online activities. Those included checking social media sites, browsing the web, posting or commenting on online content, texting, playing games, video chatting, and streaming TV or movies.

Depending on how many of those activities a student reported and how frequently he or she reported engaging in them, the researchers assigned the student a "cumulative media-use index" between 1 and 14.

Four out of 5 students acknowledged "high-frequency use" of at least one activity, including 54 percent who told researchers they checked social media "many times per day." Just over two-thirds engaged in high-frequency use of up to four online activities at some point during the study's course.

Students also were asked whether they had experienced 18 ADHD symptoms, including problems with organization, completing work, staying still or remaining on task. If they acknowledged having any six of them, they were considered to be "ADHD symptom-positive." At various points in the study, anywhere from 4.8 percent to 6.9 percent of the subjects met this criteria.

The additional risk that came with climbing the ladder of "media use intensity" was pretty modest: about 10 percent for each step up.

But compared with the lightest users, the teens who engaged most intensively were more than twice as likely to be symptom-positive. Among the 495 students who reported no high-frequency media use at baseline, 4.6 percent were categorized as symptom-positive at some point. Among the 114 who engaged in seven digital activities many times a day, 9.5 percent were seen to be symptom-positive during the follow-up. And for the 51 students who reported high-frequency use of all 14 digital activities, 10.5 percent met the symptom criteria.

That twofold increase in the odds of being symptom-positive "is not a small effect," said San Diego State University psychologist Jean M. Twenge, who has conducted research on teens and smartphone use but was not involved in the new work. In effect, it suggests that if a teen who is a high-intensity digital user could be weaned from his devices, he might drive down his risk of significant ADHD symptoms by as much as half.

"Most of the time, a lifestyle change that halves the risk of a poor outcome is more than worth undertaking," Twenge said. In the annals of disease prevention research, "the vast majority of interventions are less effective."

In an editorial that accompanies the study, University of Michigan pediatrician Dr. Jenny Radesky wrote that the "always on" quality of digital media may rob the adolescent brain of the ability to rest and refresh in what brain scientists call the "default mode." Teens pining for the next hit of digital affirmation may lose the ability to tolerate boredom, she wrote, and an unending stream of notifications may reduce a child's ability "to stay focused on challenging, nonpreferred tasks."

But that may not fully explain the study's results. If manic digital engagement is displacing sleep and exercise, that would readily explain a child's slipping executive function, wrote Radesky, a behavioral developmental specialist.

Credit: By Melissa Healy - Los Angeles Times

Caption: A study of high school students found a link between digital media use and development of ADHD symptoms. Researchers don't yet know which might be responsible for the other.

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