Tweets, texts, and twerks: A Framework for Understanding Problematic Internet Behaviors in Adolescents
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This document provides a framework for understanding problematic internet behaviors in children and adolescents. It defines problematic internet behaviors as excessive internet usage that causes functional impairment. The document discusses screening tools for problematic internet behaviors, including the Chinese Internet Addiction Scale and Young's Internet Addiction Test. It also reviews treatment approaches such as CBT, medication, family therapy, and approaches to working with teens and parents. The key messages are to screen for problematic behaviors at well-visits, consider psychiatric co-morbidities, educate parents, and empower teens to make thoughtful decisions online.
Tweets, texts, and twerks: A Framework for Understanding Problematic Internet Behaviors in Adolescents
- 1. Tweets, texts, and twerks: A framework for understanding problematic internet behaviors in children and adolescents Tristan Gorrindo, MD Principal Investigator, The Digital Family Project Managing Director, The Clay Center for Young Healthy Minds Assistant Professor of Psychiatry, Harvard Medical School www.pathstodream.org
- 2. Disclosures Dr. Gorrindo has no disclosures to report. www.pathstodream.org PAGE 2
- 3. Objectives • Define Problematic Internet Behaviors • Screening and Recommendations • Working with Teens and Parents www.pathstodream.org PAGE 3
- 4. WHAT IS A PROBLEMATIC INTERNET BEHAVIOR? www.pathstodream.org PAGE 4
- 5. Case 1 • Elaine is a 16 y/o WF with no past psychiatric history. Presents to ED with superficial scratches to forearm after argument with friend. • Reports that her friend texted her that she was going to see a movie with another friend. • Had exchanged >60 texts with the friend over the course of the day, and became distraught when the last text she received from her friend was a simple text saying, “k” (short for “okay”). • Mom reports patient has a history of misinterpreting social cues. www.pathstodream.org PAGE 5
- 6. Case 2 • Rory is a 15 y/o WF with history of mood disorder, NOS, and SIB, living with father and stepmother. • Reported to be “addicted to technology”: staying up late at night on computer and texting; history of sexting. • Parents feel unable to control use; whenever restrictions are imposed, patient acts out/selfharms, requiring hospitalization. • Recently admitted to inpatient unit after posting on Facebook, “What would you do if I killed myself?” and becoming suicidal after other kids posted, “Just do it.” www.pathstodream.org PAGE 6
- 7. Case 3 • Greg is a 17 y/o WM with no past psychiatric history. Adopted at 2 y/o, recently “came out” as gay; quite introverted. • Joined Neutral Zone, a youth-driven teen center; felt more accepted, but still had difficulty forming romantic relationships; patient based self-worth on this. • Brought to outpatient clinic after Neutral Zone counselor told mother that Greg had posted “Game over” on Facebook. • Greg endorsed depressed mood and poor selfesteem, but denied true SI with plan or intent. No history of suicide attempt or self-injurious behaviors. www.pathstodream.org PAGE 7
- 8. What is a Problematic Internet Behavior? Don’t forget to look for the usual suspects: ADHD Social Phobia Depression Mania OCD PDD www.pathstodream.org Excessive Usage Impulse Control Functional Impairment PAGE 8
- 10. Internet Addiction Screening • Chinese (or Chen) Internet Addiction Scale (CIAS) (S. Chen et al., 2003) • Compulsive Internet Use Scale (CIUS) (Meerkerk et al., 2009) • Generalized Problematic Internet Use Scale (GPIUS) (Caplan, 2002) • Internet Addiction Scale (IAS) (Nichols & Nicki, 2004) • Internet Addiction Test (IAT) (Young, 1998) • Internet-Related Addictive Behavior Inventory (IRABI) (Brenner, 1997) • Internet Related Problem Scale (IRPS) (Armstrong et al., 2000) • Online Cognition Scale (OCS) (Davis et al., 2002) • Pathological Internet Use Scale (PIUS) (Morahan-Martin & Schumacher, 2000) • Problematic Internet Use Questionnaire (PIUQ) (Demetrovics et al., 2008) • Use, Abuse and Dependence on Internet (UADI) (Gnisci et al., 2011) www.pathstodream.org PAGE 10
- 11. Young’s Internet Addiction Test Never Sometimes Always 1. Stay online longer than intended 2. Neglect household chores to stay online 3. Form new relationships with fellow online users 4. Others complain about how long you stay online 5. Grades or school work suffer because of the amount of time spent online 6. Check your email before something else you need to do 7. Job performance or productivity suffers because of the internet 8. Become defensive or secretive when anyone asks you what you do online 9. Block out disturbing thoughts about your life with soothing thoughts of the internet 10. Find yourself anticipating when you will go online again Presumed 11. Fear that life without the internet would be boring, empty, and joyless 12. Snap, yell, or act annoyed if someone bothers you while you are online PIB Score 13. Lose sleep due to late-night logins range 14. Feel preoccupied with the internet when offline, or fantasize about being online 15. Find yourself saying “just a few more minutes” when online 16. Try to cut down the amount of time you spend online and fail 17. Hide how long you have been online 18. Choose to spend more time online over going out with others 19. Feel depressed, moody, or nervous when offline, which goes away when you are back online 20. Prefer the excitement of the internet to intimacy with your boyfriend or girlfriend ? Source: Modified from Young’s Internet Addition Test in Widyanto, Cyberpsychology & Behavior, 2004:7:4:443 www.pathstodream.org
- 12. How do you define abnormal? • 8-10 y/o : 8+ hours per day Teens: >11 hours per day • 84% of teens have internet access; 75% have cell phones • 88% of teens text (3364 texts per month) • 20% adolescents sent/ received sexually explicit content Source: Pediatrics 2013;132:958–961 www.pathstodream.org 12
- 13. AAP Screening Guidelines 1) How much recreational screen time does your child or teenager consume daily? 2) Is there a TV set or an internet-connected electronic device (computer, iPad, cell phone) in the child’s or teenager’s bedroom? Source: Pediatrics 2013;132:958–961 www.pathstodream.org PAGE 13
- 14. AAP Screening Guidelines 1) How much recreational screen time does your child or teenager consume daily? 2) Is there a TV set or an internet-connected electronic device (computer, iPad, cell phone) in the child’s or teenager’s bedroom? Source: Pediatrics 2013;132:958–961 www.pathstodream.org PAGE 14
- 15. AAP Screening Guidelines • Take a more detailed media history with children or teenagers who demonstrate aggressive behavior; are overweight or obese; use tobacco, alcohol, or other drugs; or have difficulties in school • Examine your own media use habits; pediatricians who watch more TV are less likely to advise families to follow AAP recommendations Source: Pediatrics 2013;132:958–961 www.pathstodream.org PAGE 15
- 16. Screen Positive, Dig Deeper • Excessive Use – – – – – Depression ADHD Increased alcohol use Truancy “Academic troubles” • Cyberbullying – – – – – www.pathstodream.org Low self-esteem Depression Suicidal ideation Delinquency Substance use PAGE 16
- 18. Treatment of Problematic Internet Behaviors Medication • SSRI • Stimulants Others CBT • Adults 12 session protocol ~Good outcome at 6 mo. Residential Treatment • China ~75% had axis I co-morbidity Family Therapy • Study of families in Taiwan ~high adolescent-parent conflict www.pathstodream.org PAGE 18
- 19. Treatment of Problematic Internet Behaviors Working with Teens •Complicate their thinking •Practice skills •Feedback from peers www.pathstodream.org PAGE 19
- 20. Before you post, “W.A.I.T.” W •Wide-audience A •Affect I •Intent T •Today? Source: Gorrindo T, FOCUS: The Journal of Lifelong Learning in Psychiatry. 2012;10(3):282-92 www.pathstodream.org PAGE 20
- 22. Parents are here Kids are here DIGITAL DIVIDE www.pathstodream.org PAGE 22
- 23. Treatment of Problematic Internet Behaviors Working with Parents • Education • Develop ambivalent stance • Facilitated conversation www.pathstodream.org PAGE 23
- 24. Treatment of Problematic Internet Behaviors • Education – Limit entertainment screen time to <2 hours per day – No screens for children <2 years – Monitor websites, video games, and TV – Model active parenting Media curfew TV and internet out of the bedroom www.pathstodream.org PAGE 24
- 25. Treatment of Problematic Internet Behaviors • 94% of parents of 0-2 year olds use technology to cope with the stress or loneliness of being a new parent. • Among parents of 0-2 year olds, 54% think it is appropriate for children under 2 to spend at least one hour per day in front of a screen. • 79% of new parents have felt distracted from their baby's needs because of time spent using technology. • 58% of parents use protective settings to limit the websites their elementary schooler (6-11 year old) visits. www.pathstodream.org PAGE 25
- 26. Treatment of Problematic Internet Behaviors • Ambivalent Stance – Technology is not all good or all bad – Moderation – Encourage curiosity • Avoid hypocrisy Source: Pediatrics 2013;132:958–961 www.pathstodream.org Allow tech at the dinner table: 18% of kids 34% of parents PAGE 26
- 29. Take Home Points • Screen at each well-visit • Remember psychiatric co-morbidities • Complicate thinking • Educate and empower parents • Stay educated www.pathstodream.org PAGE 29