Internet addiction and attention-deficit / hyperactivity disorder symptoms in adolescents with autism spectrum disorder

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Abstract

Aim

Several studies have reported that internet addiction (IA) is more prevalent in adolescents with autism spectrum disorder (ASD). However, the characteristics of ASD adolescents with IA are unclear. The objective of this study was to investigate the prevalence of IA in ASD adolescents, and compare the characteristics between the IA and the non-IA groups in adolescents with ASD.

Methods

The study included 55 participants who were outpatients at Ehime University Hospital and Ehime Rehabilitation Center for Children in Japan, aged 10–19 years, diagnosed with ASD. Patients and their parents answered several questionnaires including the Young's Internet Addiction Test (IAT), Strengths and Difficulties Questionnaire (SDQ), Autism Spectrum Quotient (AQ), and Attention Deficit Hyperactivity Disorder Rating Scale-IV (ADHD-RS).

Results

Based on the total IAT score, 25 out of 55 participants were classified as having IA. Although there were no significant differences in AQ and Intelligence Quotient, the higher scores of ADHD symptoms in SDQ and ADHD-RS were observed in the IA group than the non-IA group. The IA group used portable games more often than the non-IA group.

Conclusion

The ADHD symptoms were strongly associated with IA in ASD adolescents. More intensive prevention and intervention for IA are needed especially for the ASD adolescents with ADHD symptoms.

Introduction

Network services are becoming important tools for adolescents. Serious problems associated with internet addiction (IA) among adolescents include refusal to go to school and mental health problems, such as loneliness, low self-esteem, insufficient sleep, anxiety, and depression (Kim et al., 2006). IA has been defined as an inability to control one's use of the internet despite adverse consequences and persists over a significant period (Kardefelt-Winther et al., 2017). In addition, some psychological problems have been documented as having associations with problematic behaviors using the internet, such as a lack of inhibition and problems in making self-controlled choices (Dong, Devito, Du, & Cui, 2012). Although IA has not been formally included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) or International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a disorder, IA has become a severe worldwide mental health problem. DSM-5 lists internet gaming disorder under “conditions for further study,” and “gaming disorder” will be included in the ICD-11 (World Health Organization, 2018).

Several studies have identified the association between IA and psychiatric disorders. Ho et al. (2014) reported that IA had been significantly associated with alcohol abuse, attention deficit hyperactivity disorder (ADHD), depression, and anxiety. ADHD is the most common psychiatric disorder among adolescents with IA (Bozkurt, Coskun, Ayaydin, Adak, & Zoroglu, 2013). In addition, a 2 year prospective study revealed that ADHD was the leading risk factor for IA in young adolescents (Ko, Yen, Chen, Yeh, & Yen, 2009). Therefore, ADHD should be well-evaluated and treated among cases of IA. In addition, the association between ADHD and IA might suggest that people with ADHD should be important target group of preventive scheduling for IA.

In clinical situation, IA coexists with autism spectrum disorder (ASD) and the association between two disorders is higher than expected by chance. However, there has been no enough data about this comorbidity.

Mazurek and Engelhardt (2013) reported that children with ASD spent more time playing video games and had higher problematic levels of video game use than children with normal development. Children with ASD were particularly related to excessive and problematic video game and internet use (MacMullin, Lunsky, & Weiss, 2016). These studies only compared IA between children with ASD and typically developing children. Children comorbid with ASD and IA might be also an important target group of preventive scheduling for IA. People with ASD tend to devote themselves to video games or internet use and prolong their addictive behaviors because of their autistic traits: restricted, repetitive patterns of behavior, interests, or activities. However, ASD adolescents with IA has not been well-evaluated or treated, either. Moreover, there have been few studies to investigate the characteristics of ASD with and without IA in a clinical setting. We hypothesized that the characteristics of ASD with IA were different from those of ASD without IA. The objective of this study was to compare the characteristic of ASD between the IA and the non-IA groups.

Section snippets

ASD population sampled

The participants of this study were outpatients in Center for Child Health, Behavior and Development, Ehime University Hospital, the only University Hospital in Ehime prefecture and Ehime Rehabilitation Center for Children, the only governmental center in Ehime prefecture. Almost 150 new patients per year were performed medical examination in the Center for Child Health and about 60 out of 150 patients were diagnosed as ASD. In the Ehime Rehabilitation Center for Children, almost 450 new

Prevalence of IA

A flowchart of the recruitment process is depicted in Fig. 1. There were 55 eligible participants with ASD (42 males and 13 females) who completed this study with a 71.4% response rate. The mean age of the participants was 13.4 ± 2.0 years (male, 13.4 ± 2.1 years; female, 13.2 ± 1.8 years). The participants included 15 children in elementary school, 26 children in junior high school, 13 children in high school, and 1 adolescent college student. Twenty participants were diagnosed with comorbid

Discussion

The primary results of this study revealed that 45.5% (25/55) of the participants with ASD were classified as having IA, and their mean IAT score was 46.4 ± 20.9. The prevalence of IA among adolescents with ASD was significantly higher as 11.8% were identified as having IA in a general adolescent population in our previous study (Kawabe, Horiuchi, Ochi, Oka, & Ueno, 2016). Our findings indicate that the prevalence of IA in ASD is higher than in the general population and complement those

Disclosure statement

The authors declare no conflict of interest. There are no sources of funding associated with this submission.

Author contributions

K.K., F.H., T.M., K.A., and T.J. collected the data. K.K. analyzed the data. K.K. and F.H. interpreted the results. F.H. and S.U. supervised all aspects of collection, analysis, and interpretation of the data. K.K. wrote the manuscript. E.I. and S.U. revised it. All authors contributed to and approved the final manuscript.

Acknowledgments

This work was supported by a Grant-in-Aid for Scientific Research (KAKENHI; 17K16383) from the Japan Society for the Promotion of Science (JSPS). The funding sources had no role in study design, collection, analysis, interpretation of data, and the decision to submit the article for publication.

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