Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder among adolescents with Internet addiction. The case approached the tertiary speciality centre for management of issues related to gaming. Clinical interview was used to elicit the psychopathology as well as use of technology. The case reflect the lack of screening or management of these issues in school setting. The lack of attention to these issues leads use of online modality to feel good among user with ADHD.
ADHD; Technology; Coping
Internet Use is the most common and popular medium for recreational use among todays generation. But it do manifest as problematic to addictive use among certain group of users. Studies from different parts of the world suggest that overall prevalence of Internet addiction in adolescents ranges between 2% and 18% [1]. The prevalence of Attention deficit hyperactivity disorder (ADHD) in one of the Southern states of India was 5.76% with 3.8% among girls and 1.9% among boys between 6 to 11 years old children. Many researchers and clinicians have noted that a variety of mental disorders co-occur with Internet Addiction Attention deficit hyperactivity disorder(ADHD) is the most common psychiatric disorder among adolescents with Internet addiction who have been referred for psychiatric treatment [2,3]. The association was seen with attention deficit being the most associated symptom of Internet addiction, followed by impulsivity [4]. Whereas others found association of multiple factors i.e especially high fun seeking and behavioural inhibition system scores, with the severity of Internet addiction symptoms among adolescents with ADHD [5]. The case approached the tertiary speciality centre for management of issues related to gaming.
16 years old boy presented with history of inattention, increased activity and excessive time spent on gaming for the last two years. There was family history of Attention deficit disorder in father. Father functioning reported to be grossly adequate. He used to attend regular school. Due to inattention problems, he was finding it difficult to be good in academic. There were school complaints of distracting other school mates. He used to receive verbal remark for not completing school work. It led to loss of interest in academic and frequent absenteeism from school. He did not have any other leisure activity as well as offline friends. He used to spend his time at home. The mental consultation was initiated and he was diagnosed attention deficit hyperactive disorder. The behavior therapy was initiated for management of ADHD. It led to improvement in attending school but issue of not completing assignment as well as distracting other persisted. He got introduced to gaming two years back through peer. He started enjoying playing Online Multiple Player battle arena games. He started spending significant amount of time in chatting with online friends. He started appreciating the recognition he was getting from other for his play. He reached good rank in gaming within short span of time. He starting contemplating of becoming gamer. He won few monetary rewards also from gaming tournament Parent reported improvement in his behaviors whenever he was allowed to play. He started expressing resistance for attending school and stopped attending school. He attributed gaming to lack of recognition in school, not having friends, feel guilt for not being able to sustained attention, all these factors also contributed to solitary life style and boredom. whereas in online gaming, he used to feel comfortable due to stimulating nature of games, activity involved, not having pressure to perform, he was getting rewards which he never got in offline world. He was in precontemplation stage for seeking treatment. He did not want to quit or change his gaming habit. The parent also reported no other behavioural issues besides spending excessive amount of time on gaming. Clinical interview revealed presence of craving, loss of control, using it as modality to feel good and consequences in from sleep disturbance, irregular food habits, behavioural issues inn from of anger and irritability towards parents whenever advised to reduce gaming, school absenteeism. He did not follow up for treatment. The psychological work initiated with parent to give them understanding of gaming addiction, role of ADHD in excessive use of gaming, building up leisure time activities for themselves as well as with child, relaxation exercise and problems solving approach was demonstrated to parent.
The case reflect the lack of screening or management of these issues in school setting. The lack of attention to these issues leads use of online modality to feel good. It was gaming in this case. Review of literature also suggest use of online activity as a form of self-medication exchange of online message and chatting also compensate for what user lacks in real life [6,7]. In the compensatory internet use theory found that the relationship between stress and excessive online gaming was mediated by escapism, a motivation for play that is often linked to problematic outcomes [8]. It can be understood in terms of biopsychosocial mechanism for the coexistence between ADHD and Internet addiction. Firstly, the individuals with ADHD are usually easily bored and have an aversion for delayed reward. The Internet provides rapid response and immediate reward to reduce the feeling of boredom. Secondly, striatal dopamine is released during video gaming, which may help the players keep focused on gaming and have better performance. Thirdly, adolescents with ADHD have abnormal brain activities associated with impaired inhibition, which may cause individuals with ADHD to become vulnerable to Internet addiction. Fourthly, motivation deficits and less arousal to punishment, are typical features of ADHD [9,10]. Internet activities such as online gaming usually provide immediate response and reward, and thus contribute to high vulnerability to Internet addiction among people with ADHD. The model proposed that “being easily bored” and “having an aversion for delayed rewards” are two main ADHD symptoms and Internet use provides multiple windows with a variety of activities at the same time and immediate reward may decrease the boredom feeling and reward quickly. This feature makes people with ADHD addicted to Internet more easily. So its the reasons, screening and motives to access online gaming need to be address as preventive strategy in school setting.
Non funded clinic work Dr Manoj Kumar Sharma
There was no conflict of interest in relation to present work as well as informed consent of the human subjects had been taken prior to inclusion in the study.
Not applicable
Authors of the paper did not have any conflict of interest.
The studies have been approved by the Institutional and/or national research ethics committee.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- Petersen KU, Weymann N, Schelb Y, Thiel R, Thomasius R (2009) Pathological Internet use- epidemiology, diagnostics, cooccurring disorders and treatment. Fortschr Neurol Psychiatr 77: 263-271. [Crossref]
- Cash H, Rae CD, Steel AH, Winkler A (2012) Internet Addiction: A Brief Summary of Research and Practice.Current Psychiatry Reviews 8: 292-298. [Crossref]
- Bozkurt H, Coskun, M, Ayaydin, H, Adak I, Zoroglu (2013) Prevalence and patterns of psychiatric disorders in referred adolescents with Internet addiction. Psychiatry Clin Neurosci 67: 352-359. [Crossref]
- Yen JY, Yen CF, Chen CS, Tang TC, Ko CH (2009) The Association between Adult ADHD Symptoms and Internet Addiction among College Students: The Gender Difference.Cyberpsychol Behav 12: 187-191. [Crossref]
- Chou WJ, Liu TL, Yang P, Yen CF, Hu HF (2015) Multi-dimensional correlates of Internet addiction symptoms in adolescents with attention-deficit/hyperactivity disorder.Psychiatry Res 225: 122-128. [Crossref]
- Bessière k,Kiesler S, Kraut S, Boneva B (2008) Effects of internet use and social resources on changes in depression Information, Communication and Society11: 47-70.
- Caplan S, High A (2011) Online social interaction, psychosocial well-being, and problematic internet use in K.Young,C.Abreu(Eds.),Internet addiction: A handbook and guide to evaluation and treatment,John Wiley & Sons Inc,Hoboken, NJ, US, 35-53.
- Kardefelt-Winther D (2014) Problematizing excessive online gaming and its psychological predictors Computers in Human Behavior 31: 118-122
- Ko CH, Yen JY, Yen CF, Chen CS, Chen CC (2012) The association between Internet addiction and psychiatric disorder: a review of the literature. Eur Psychiatry 27: 1-8. [Crossref]
- Berger A, Kofman O, Livneh U, Henik A (2007) Multidisciplinary perspectives on attention and the development of self-regulation. Prog Neurobio 82: 256-286. [Crossref]
