Longitudinal associations between digital media use and ADHD symptoms in children and adolescents: a systematic literature review

“Two of the most important activities commonly affected by extensive use of digital media are physical activity [e.g., reviews 30, 31] and sleep [e.g., 32].”

“However, it has been argued that criteria similar to those described above for IGD can also be applied to social media use [13–16].”

“…such as executive functions (i.e., working memory, inhibitory con-trol, and planning), delay aversion and emotion regulation, given that these functions have been linked to digital media use [81–83], other types of additions such as alcohol/drug addiction or gambling [84, 85], and ADHD [86].”

“There are now several reviews and meta-analyses investigating the link between digital media in general and ADHD [4, 5], as well as more specific reviews focusing on the link between gaming and ADHD [6, 7] or ADHD symptom levels for individuals diagnosed with Internet gaming disorder [8, 9].”

“…such as executive functions (i.e., working memory, inhibitory con-trol, and planning), delay aversion and emotion regulation, given that these functions have been linked to digital media use [81–83], other types of additions such as alcohol/drug addiction or gambling [84, 85], and ADHD [86].”

“…it has been hypothesized that children who have high levels of screen time have a harder time paying attention to less interesting activities, possibly because they lose the ability to regulate their attention internally after having gotten used to external regulation through digital media [21].”

“More specifically, several reviews [8, 9, 36, 37] have shown that there is an overrepresentation of ADHD among children/adolescents with problematic use of digital media (often defined as symptoms of IGD or Internet addiction).”

“Of importance here is also the “social compensation hypothesis,” which states that individuals with poor social networks offline try to compensate for this by focusing more on online relations [e.g., 29].”

“More specifically, several reviews [8, 9, 36, 37] have shown that there is an overrepresentation of ADHD among children/adolescents with problematic use of digital media (often defined as symptoms of IGD or Internet addiction).”

“In addition, excessive use of digital media early in life has been shown to be associated with lower levels of social interaction [e.g., 33] and delayed speech development [e.g., 34], which in turn can have a negative impact on peer relations.”

“Two of the most important activities commonly affected by extensive use of digital media are physical activity [e.g., reviews 30, 31] and sleep [e.g., 32].”

“Individuals with ADHD also often have problematic peer relations [e.g., 26] and show poor academic achievement [e.g., 27].”

“In addition, excessive use of digital media early in life has been shown to be associated with lower levels of social interaction [e.g., 33] and delayed speech development [e.g., 34], which in turn can have a negative impact on peer relations.”

“Because adolescence is a period of substantial restructuring of the brain, it has been argued to be an especially sensitive period, also regarding the influences of digital media use [73].”

“Second, it has been argued [71] that when controlling for baseline levels in longitudinal studies, even small associations should be considered meaningful when there is high stability in the outcome variable.”

“Two of the most important activities commonly affected by extensive use of digital media are physical activity [e.g., reviews 30, 31] and sleep [e.g., 32].”

“Their results are in line with previous studies demonstrating a link between sleep and both digital media use [32] and ADHD [80].”

“These characteristics include infinite scrolling, autoplay, rewarding users for merely using their services, and photo filters that encourage unhealthy beauty ideals [e.g., 91, 92].”

“A previous meta-analysis [72] even found that moderate use of digital media (i.e., less than 2 h/day) was related to lower levels of mental health problems compared to no digital media use at all, while the reverse was true for more excessive use.”

“Importantly, previous research [e.g., 89, 90] has shown that, in many countries, the average screen time for children greatly exceeds these limits, with averages continuously increasing and families with low SES being less likely to follow recommendations.”

“…measure of use of computers, game consoles, mobile phones, and TV), the results of the current review show that eight studies found significant positive associations with later ADHD symptom levels or with symptoms of inattention when controlling for baseline levels of screen time [44, 47, 52–57].”

“Finally, Gentile et al. [54] found that attention problems were related to later video game playing.”

“Violent media content has also been linked to ADHD symptoms, most likely because violent media are high in arousal, and the characters in this type of media often act impulsively [22].”

“Ferguson [6] concluded that computer gaming is not significantly associated with inattention, while another study [38] found an association between Internet use in general and ADHD symptom levels.”

“Interestingly, previous research has found associations even when infants are only exposed to a TV in the background [e.g., 78] or when parents are disrupted by their digital media devices when interacting with their preschool child [e.g., 79].”

“This is sometimes referred to as the “Reinforcing Spiral Model” [10], which indicates that individuals with, for example, ADHD choose specific media content that is in line with their prevailing predisposition, which in turn may reinforce problematic behaviors.”

“Thus, escapism can be both a predictor of IGD and a mediator between digital media use and poor mental health [review by 28].”

“…such as executive functions (i.e., working memory, inhibitory con-trol, and planning), delay aversion and emotion regulation, given that these functions have been linked to digital media use [81–83], other types of additions such as alcohol/drug addiction or gambling [84, 85], and ADHD [86].”

“The “scan and shift hypothesis” [20] states that the fast pace of digital media may encourage using attentional resources to quickly scan and shift, making it more difficult to later engage in tasks requiring sustained attention.”

“…greatest in preschool children, owing to the rapid cognitive and socioemotional development that takes place during this period in life, and research has shown that early screen time does have effects on cognition [e.g., 75], externalizing behaviors [76] and attentional networks in the brain [77].”

“Regarding studies examining associations between ADHD symptoms and later gaming addiction, all studies except three [41, 42, 46] found significant relations [61–63, 65– 67 ], when controlling for baseline levels.”

“More specifically, several reviews [8, 9, 36, 37] have shown that there is an overrepresentation of ADHD among children/adolescents with problematic use of digital media (often defined as symptoms of IGD or Internet addiction).”

“With regard to ADHD, it has been suggested that individuals with this disorder are more attracted than others to fast-paced activities, creating high arousal and delivering immediate rewards [5, 25].”

“Regarding studies examining associations between ADHD symptoms and later gaming addiction, all studies except three [41, 42, 46] found significant relations [61–63, 65– 67 ], when controlling for baseline levels.”

“Regarding studies examining associations between ADHD symptoms and later gaming addiction, all studies except three [41, 42, 46] found significant relations [61–63, 65– 67 ], when controlling for baseline levels.”

“Individuals with ADHD also often have problematic peer relations [e.g., 26] and show poor academic achievement [e.g., 27].”

“It has also been shown that media multitasking is related to inattention, the hypothesis being that individuals engaged in media multitasking have difficulties focusing on one task, because they are accustomed to task-switching between media activities and other (offline or online) activities [23].”

“In addition, three studies [40, 48, 49] only found relations when not controlling for baseline levels.”

“…greatest in preschool children, owing to the rapid cognitive and socioemotional development that takes place during this period in life, and research has shown that early screen time does have effects on cognition [e.g., 75], externalizing behaviors [76] and attentional networks in the brain [77].”

“Although a few studies included in the present review examined Internet addiction (i.e., a combined measure of all types of digital media activities), only two of them [45, 46] focused specifically on social media.”

“These characteristics include infinite scrolling, autoplay, rewarding users for merely using their services, and photo filters that encourage unhealthy beauty ideals [e.g., 91, 92].”

“Finally, one study [56] failed to find a moderating effect of sex.”

“However, we believe that parents need to monitor their child’s digital media use carefully as early prevention is important and parents play a vital role in teaching children how to use digital media in a balanced way [69, 70].”

“However, Peeters et al. [66] found that the effect of attention problems in relation to later symptoms of IGD was stronger for adolescents who had fewer close relationships and who were less satisfied with life.”

“Regarding mediators and covariates, there are studies showing that only the effects of school performance and peer problems [63] or sleep problems [53] remained significant when investigating the association between digital media use and later ADHD symptoms.”

“…measure of use of computers, game consoles, mobile phones, and TV), the results of the current review show that eight studies found significant positive associations with later ADHD symptom levels or with symptoms of inattention when controlling for baseline levels of screen time [44, 47, 52–57].”

“More specifically, several reviews [8, 9, 36, 37] have shown that there is an overrepresentation of ADHD among children/adolescents with problematic use of digital media (often defined as symptoms of IGD or Internet addiction).”

“Interestingly, previous research has found associations even when infants are only exposed to a TV in the background [e.g., 78] or when parents are disrupted by their digital media devices when interacting with their preschool child [e.g., 79].”

“Hygen et al. [42] found that symptoms of IGD at age 10 years were related to ADHD symptom levels both 2 and 4 years later, although these associations were only found in the between-subject (with and without control for baseline levels) and not in the within-subject analyses.”

“These health-promoting activities are also linked to ADHD symptoms [35], and excessive use of digital media might therefore amplify pre-existing difficulties with maintaining unhealthy behaviors that children and adolescents with ADHD may already display due to the nature of their diagnosis.”

“…such as executive functions (i.e., working memory, inhibitory con-trol, and planning), delay aversion and emotion regulation, given that these functions have been linked to digital media use [81–83], other types of additions such as alcohol/drug addiction or gambling [84, 85], and ADHD [86].”

“…greatest in preschool children, owing to the rapid cognitive and socioemotional development that takes place during this period in life, and research has shown that early screen time does have effects on cognition [e.g., 75], externalizing behaviors [76] and attentional networks in the brain [77].”

“It has also been suggested that a Social Media Disorder (SMD) should be included as a psychiatric disorder in the next version of the DSM, the argument being that social media use can be just as addictive and have just as serious effects on mental health as excessive gaming [16–19].”

“With regard to more specific measures of screen time, McNamee et al. [45] found a significant relation between screen time for social media and later ADHD symptom levels in within-subject analyses, whereas Boer et al. [46] only found a significant association when not controlling for base-line…”

“…[44, 54, 61], four studies found unidirectional associations between digital media use and later ADHD symptoms [42, 46, 47, 56], two studies found unidirectional associations between ADHD symptoms and later digital media use [40, 62], and one study did not find any significant associations [59].”

“Significant associations were found in some studies of younger children [48, 49], but not in other studies looking at children of a similar age [58].”

“Regarding studies examining associations between ADHD symptoms and later gaming addiction, all studies except three [41, 42, 46] found significant relations [61–63, 65– 67 ], when controlling for baseline levels.”

“However, we believe that parents need to monitor their child’s digital media use carefully as early prevention is important and parents play a vital role in teaching children how to use digital media in a balanced way [69, 70].”

“…[44, 54, 61], four studies found unidirectional associations between digital media use and later ADHD symptoms [42, 46, 47, 56], two studies found unidirectional associations between ADHD symptoms and later digital media use [40, 62], and one study did not find any significant associations [59].”

“Regarding studies examining associations between ADHD symptoms and later gaming addiction, all studies except three [41, 42, 46] found significant relations [61–63, 65– 67 ], when controlling for baseline levels.”

“It has also been suggested that a Social Media Disorder (SMD) should be included as a psychiatric disorder in the next version of the DSM, the argument being that social media use can be just as addictive and have just as serious effects on mental health as excessive gaming [16–19].”

“Importantly, previous research [e.g., 89, 90] has shown that, in many countries, the average screen time for children greatly exceeds these limits, with averages continuously increasing and families with low SES being less likely to follow recommendations.”

“Only three reports included in the present review [40–42] used interviews to assess digital media addiction and/or ADHD symptom levels, and this should clearly be considered an important strength of these studies.”

“…to find associations when controlling for ADHD symptom levels at baseline (or failed to control for baseline levels altogether) investigated screen time in general [51, 63, 64], screen time for multitasking [47], social media [46], violent games [50], and Internet bullying/sexual harassment [64].”

“…screen time for violent media (usually violent computer games) and later ADHD symptom levels, one study failed to find a significant association [60], while another study [54] found a significant association, although it did not remain significant when controlling for ADHD symptom levels at…”

“A third study [44] found that screen time for violent media at Time 1 was not related to ADHD symptoms at Time 2.”

“With regard to ADHD, it has been suggested that individuals with this disorder are more attracted than others to fast-paced activities, creating high arousal and delivering immediate rewards [5, 25].”

“In addition, three studies [40, 48, 49] only found relations when not controlling for baseline levels.”

“However, four studies [48–51] failed to control for baseline levels altogether.”

“However, one study found support for a stronger association between violent media and ADHD symptoms among boys [50], and another study found some support for a stronger association between media multitasking and ADHD symptoms among girls [47].”

“…longitudinal data and larger cohorts other than the ABCD Study cohort, we found weak but significant correlations between screen time and adolescents’ internalizing and externalizing behavior symptoms, including depression, anxiety, ADHD, somatic, ODD, and conduct symptoms [12, 57, 84, 110, 111].”

“Passive social media use is defined as observing content, nighttime social media consumption, and engaging in appearance-based activities, while active social media use is associated with cyberbullying or sexting (Prasad et al., 2023).”

“…to online gambling, minors (who cannot legally gamble) constitute a population that requires additional safeguards (Gibson et al., 2022) as children appear to be more vulnerable to developing problematic use of digital media, particularly when they present other comorbities (Thorell et al., 2022).”