Teens plus heavy screen time equals ADHD?

Andrew Adesman, MD

Digital media can connect adolescents to new people and experiences, but there is another side to the coin, and researchers warn that digital media use has the potential to increase symptoms of attention-deficit/hyperactivity disorder (ADHD).

The report, published in JAMA, studied teenagers aged 15 and 16 years at a baseline without symptoms of ADHD and found a “significant association” between high-frequency digital media use-“several times per day”-and the presence of ADHD symptoms after a 2-year follow-up.¹

“With more and more teens being connected to their digital devices around-the-clock, it is concerning that this well-designed longitudinal study found that teens who use 1 or more media devices many times daily were more likely to report difficulties with sustained attention over time,” says Andrew Adesman, MD, chief of Developmental and Behavioral Pediatrics at Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, New York. Adesman was not involved in the study but offered insight on the report’s findings to Contemporary Pediatrics.

Adesman adds that because the investigators relied on the teenagers for self-report of digital media use and of ADHD symptoms, it is possible that some response bias may have influenced these findings.

“Likewise, it is possible that some of the observed differences in digital media activities were due to-not a consequence of-differences in attention span,” Adesman says. “The findings from this study cannot be ignored. On the one hand, parents and clinicians should be aware that very frequent digital media activity may-with time-have an adverse effect on attention span; on the other hand, this effect is not very large and further studies are needed for us to verify that this is indeed the case.”

The longitudinal study investigated a group of students across 10 Los Angeles, California, high schools, reviewing their digital media use and display of ADHD symptoms at 6-, 12-, 18-, and 24 months. Students were asked to self-report on 14 different digital media activities, providing information on daily and weekly frequency of use.

The research team found that of the more than 2500 students without ADHD symptoms at baseline at the start of the study, nearly 81% reported high-frequency use of digital media after 24 months, and 5.9% of these teenagers experienced self-reported ADHD symptoms during the study period. Some of the most common high-frequency digital media use reported in the study was checking social media sites, with 54.1% of teenagers reporting this as a high-frequency activity.

Previous studies have addressed the use of traditional media exposure in relation to ADHD symptoms, but new digital media use is a different kind of exposure because of its speed, level of stimulation, and potential for high-frequency exposure, according to the report. The lure of digital media in mid-adolescence is high, the report notes, because teenagers are trying to develop their social identify and build relationships.

“Modern media platforms provide unprecedented opportunities for social connection. Teens can converse with dozens of peers simultaneously via group text messages. Social media permits instantaneous communication with thousands. Video chatting enables immediate face-to-face interactions,” the research team writes, adding a bit of caution. “Mid-adolescence is also a period of high neural plasticity during which brain circuitry underlying attention and behavioral control mature rapidly and may be vulnerable to exposures that disrupt neurodevelopment.”

Whereas digital media use may not be causative to ADHD symptoms, the study notes, ADHD is associated with “sensation seeking,” and digital media may satisfy a drive for stimulation in some individuals.

“Although alternative explanations remain possible, modern digital media use could play a role in the development of ADHD symptoms. The primary symptoms of ADHD are inattention-distractibility, trouble with organization-and hyperactivity-impulsivity-difficulty waiting, interrupting others, restlessness,” the report notes. “Modern media devices immediately notify users when new text messages, social media postings, or videogame play invitations arrive. Exposure to such notifications may draw attention away from focal tasks. Frequent distractions could disrupt normative development of sustained attention and organization skills.”

The speed at which digital media delivers stimulation may also make users more accustomed to rapid feedback, says the report, making it difficult for teenagers to develop impulse control and patience.

The report stops short of stating that digital media use can cause ADHD symptoms, but infers that data supports additional research in this area.

Adesman agrees with the need for further research and says that despite the association identified in the study between ADHD symptoms and frequent digital media use, the study did not prove a causative effect of digital media.

“This study did not solicit independent assessments of the teens’ attention span and it did not try to evaluate if there was any associated impairment of function-2 requirements for a diagnosis of ADHD,” he notes.

References:

1. Ra CK, Cho J, Stone MD, et al. Association of digital media use with subsequent symptoms of attention-deficit/hyperactivity disorder among adolescents. JAMA. 2018;320(3):255-263.