Be Aware That Some ADHD Patients May Have Problematic Internet Use

Comorbidities among youth with attention-deficit/hyperactivity disorder (ADHD) are not uncommon. One that has recently emerged is problematic internet use, said Michael Van Ameringen, M.D., a professor of psychiatry and behavioral neuroscience at McMaster University in Hamilton, Ontario. Fortunately, treatment options exist and they are not complicated, he noted during his Annual Meeting presentation on Wednesday.

Internet gaming disorder is a common comorbidity in youth with ADHD. However, Van Ameringen noted that psychiatrists might want to broaden how they conceptualize these youth and instead think of them as having problematic internet use because it encompasses additional activities such as compulsive web browsing, social media use, and consumption of online pornography. Using this broader definition, a large meta-analysis estimated that problematic internet use affected about 9% of people in Eastern countries and nearly 5% in Western countries.

There are varying data on the ADHD/problematic internet use comorbidity, but some recent estimates suggest that about 20% of individuals with problematic internet use/internet addiction have comorbid ADHD and a similar percentage of people with ADHD have comorbid problematic internet use/internet addiction. This is not surprising since both disorders are related to impulse control, Van Ameringen said. He noted that studies have pointed to a bidirectional relationship between excess use of screen media technologies and inattention and hyperactivity symptoms. Interestingly, one recent Japanese study found that screen time by itself was not a strong predictor of ADHD symptoms, indicating that active internet activity may be more important than just watching TV or videos.

But the overlap is good news in a way, as existing ADHD therapies have been shown to be effective for problematic internet use and related symptoms. An open-label study of methylphenidate in 62 children with comorbid ADHD and internet gaming addiction found it significantly reduced time spent gaming, and the degree of gaming reduction correlated to improvement in inattention scores. Another trial compared methylphenidate and atomoxetine head to head and found the former superior at reducing internet gaming frequency and addiction symptoms. Psychosocial interventions like cognitive-behavioral therapy or family therapy have also shown effectiveness at reducing symptoms of problematic internet use in youth with ADHD.

A second option (and one to consider when comorbid ADHD is not present) is the antidepressant bupropion. Two open-label studies of bupropion demonstrated an ability to reduce symptoms of internet gaming disorder, while a third head-to-head trial found bupropion superior to escitalopram.

Van Ameringen cautioned that all the trials were generally small and focused on internet gaming, since that is the area with the most diagnostic information available.

The studies also primarily involved male youth, whereas today’s survey data clearly show that women spend similar amounts of time gaming and on the internet as men. ■