Mental Health: Double Trouble – Problematic Internet Use and ADHD

Problematic internet use (PIU) has been highly deliberated in medical and social circles. Despite its general appeal for discussion, it remains a highly nebulous topic without a commonly agreed upon definition of symptoms. This article seeks to provide guidance on how to survey for PIU, its co-morbidity with attention-deficit/hyperactivity disorder (ADHD), and general behavioral recommendations.

Analysis of PIU

In a 2019 publication, Domoff et al. analyzed, and confirmed, the validity and reliability of the Problematic Media Use Measure (PMUM) and its Short Form (PMUM-SF) for 4- to 11-year-olds. The 27-item and nine-item surveys have scales from 1 “never” to 5 “always” and ask about thoughts, feelings and behaviors surrounding any screen use over the past month.¹ See the article in the references list below for more information about the testing and methods.

The Relationship Between ADHD and PIU

In a review by Hirota et al. of the prevalence of internet addiction in a population of adolescents with ADHD, multiple sources indicated a rate of 4%.² According to Bitsko et al., the prevalence rate of youth with ADHD is 9.8%.³ While ADHD is highly co-morbid with many psychiatric conditions, there is strong support for a bidirectional relationship between PIU and ADHD. Importantly, the hyperactive and inattentive symptoms of ADHD predicted PIU.^4,5 In addition to this well-documented relationship, Fineberg et al. demonstrated that youth with ADHD and social anxiety disorder were the most likely individuals to report PIU.⁵

PIU with ADHD functions as a force multiplier of negative cognitive symptoms. In Shuai et al.’s research study, PIU with ADHD in youth led to increased rates of negative emotions (e.g., anxiety and depression) that were not associated with other psychiatric conditions. These two conditions, compared to ADHD alone, increased symptoms of inattentiveness, emotional difficulties, executive dysfunction and severity of oppositional defiant disorder. Alongside these symptom elevations, PIU with ADHD also decreased learning motivation.⁶ Besides increased psychiatric symptoms, when considering age and gender, ADHD, hostility, depression and social anxiety have predictive effects on PIU.⁷

Limitations to Current Research

A strong gap in the current literature is an understanding of how ADHD treatment, such as medication management and psychotherapy, affects PIU symptoms. According to Thorell et al., another significant gap is a lack of longitudinal studies of clinically referred samples of children diagnosed with ADHD.⁸ 

Treatment Guidelines

Given the lack of clear data on the treatment of PIU, a general guideline is to limit overall electronic use while treating any co-occurring psychiatric illness. The American Academy of Pediatrics (AAP) website provides tips on how parents can communicate to children about screen use in an age-appropriate manner using the “5 Cs” mnemonic: Child, Content, Calm, Crowding Out and Communication. Generally, the AAP recommends developing an overall wellness plan that addresses electronic media use. Creating a developmentally appropriate behavior plan with rewards and consequences surrounding electronic use can significantly help in achieving this overall wellness goal.⁹

A free, evidence-based source of information regarding ADHD symptomatology, behavioral management tools and treatment options is the website parentsmedguide.org. This site from the American Academy of Child and Adolescent Psychiatry provides information about commonly prescribed medications in psychiatry, behavioral management tools for various psychiatric disorders, and supports for families.

In summary, ADHD and PIU are highly co-morbid and can significantly influence each other’s symptomatology. Early recognition and treatment of both conditions can help with overall wellness and symptom reduction.

References:

1. Domoff SE, Harrison K, Gearhardt AN, Gentile DA, Lumeng JC, Miller AL. Development and validation of the problematic media use measure: a parent report measure of screen media “addiction” in children. Psychol Pop Media Cult. 2019;8(1):2-11. PMID: 30873299. PMCID: PMC6411079. doi:10.1037/ppm0000163
2. Hirota T, McElroy E, So R. Network analysis of internet addiction symptoms among a clinical sample of Japanese adolescents with autism spectrum disorder. J Autism Dev Disord. 2021;51(8):2764-2772. PMID: 33040268. doi:10.1007/s10803-020-04714-x.
3. Bitsko RH, Claussen AH, Lichstein J, et al. Mental health surveillance among children — United States, 2013–2019. MMWR Suppl. 2022;71(Suppl-2):1-42. doi:10.15585/mmwr.su7102a1
4. Morita M, Ando S, Kiyono T, et al. Bidirectional relationship of problematic internet use with hyperactivity/inattention and depressive symptoms in adolescents: a population-based cohort study. Eur Child Adolesc Psychiatry. 2022;31(10):1601-1609. PMID: 34021782. PMCID: PMC9532284. doi:10.1007/s00787-021-01808-4
5. Fineberg NA, Demetrovics Z, Stein DJ, et al. Manifesto for a European research network into problematic usage of the Internet. Eur Neuropsychopharmacol. 2018;28(11):1232-1246. PMID: 30509450. PMCID: PMC6276981. doi:10.1016/j.euroneuro.2018.08.004
6. Shuai L, He S, Zheng H, et al. Influences of digital media use on children and adolescents with ADHD during COVID-19 pandemic. Global Health. 2021;17(1):48. PMID: 33874977. PMCID: PMC8054232. doi:1186/s12992-021-00699-z
7. Wang JL, Yin XQ, Wang HZ, King DL, Rost DH. The longitudinal associations between internet addiction and ADHD symptoms among adolescents. J Behav Addict. 2024;13(1):191-204. PMID: 38206342. PMCID: PMC10988408. doi:10.1556/2006.2023.00080
8. Thorell LB, Burén J, Ström Wiman J, Sandberg D, Nutley SB. Longitudinal associations between digital media use and ADHD symptoms in children and adolescents: a systematic literature review. Eur Child Adolesc Psychiatry. 2024;33(8):2503-2526. PMID: 36562860. PMCID: PMC11272698. doi:10.1007/s00787-022-02130-3
9. Center of Excellence Social Media and Youth Mental Health. The 5 Cs of media use. American Academy of Pediatrics. Last updated May 27, 2025. https://www.aap.org/en/patient-care/media-and-children/center-of-excellence-on-social-media-and-youth-mental-health/5cs-of-media-use/