A primary care pediatrician’s guide to assessing problematic interactive media use
Abstract
PURPOSE OF REVIEW: To review the literature and provide a guide to assessing patients with problematic interactive media use (PIMU). RECENT FINDINGS: 0.3-1.0% of the world population meets criteria for internet gaming disorder (IGD). 26.8-83.3% of adolescents meeting criteria for internet addiction have comorbid attention-deficit/hyperactivity disorder. IGD is associated with increased anxiety and social anxiety/phobias. Group counseling, cognitive behavioral therapy, and sports intervention are associated with significant reductions in internet addiction. SUMMARY: With the Diagnostic and Statistical Manual of Mental Disorders-5 inclusion of IGD under 'Conditions for Further Study' and the addition of gaming disorder to International Classification of Diseases (ICD)-11, the idea that PIMU is a mental health disorder gained traction. Although certain populations may be at increased risk, all children and adolescents should be screened for PIMU given now-normal heavy media usage rates. Effective treatment of PIMU starts with identification and management of comorbid mental and behavioral health problems. Depending on their degree of functional impairment, patients may benefit from various forms of psychotherapy with coordinated outpatient management or may warrant higher level of care in one of several established residential treatment programs. Few studies have evaluated pharmacologic approaches to treating PIMU, but some medications targeting comorbid mental and behavioral health conditions improve PIMU-related behaviors.
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Adolescents with neurodevelopmental disorders have higher rates of social media use and may use screens to support social and communication skills.
“adolescents with neurodevelopmental disorders have higher rates of social media use [28] and may use screens to support social and communication skills [29]”
From The Conceptual and Methodological Mayhem of “Screen Time” (2020) · cites this paper as [28]
Cites
Auerbach, R. P., Collaborators, W. W.-I., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., et al. (2018) · Journal of Abnormal Psychology · doi:10.1037/abn0000362 · Cited by 2,522 · cited 1× · see citing works
“This confluence of factors likely contributed to the development of PIMU and a growing concern about the topic [52,53].”
BackgroundElhai, J. D., Dvorak, R. D., Levine, J. C., & Hall, B. J. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.08.030 · Cited by 1,689 · see citing works
Psychology of Computer Use: XL. Addictive Use of the Internet: A Case That Breaks the Stereotype
Young, K. S. (1996) · Psychological Reports · doi:10.2466/pr0.1996.79.3.899 · Cited by 1,108 · see citing works
The psychometric properties of the Internet addiction test
Widyanto, L., & McMurran, M. (2004) · CyberPsychology & Behavior · doi:10.1089/cpb.2004.7.443 · Cited by 1,073 · see citing works
Exposure and use of mobile media devices by young children
Kabali, H. K., Irigoyen, M. M., Nunez-Davis, R., Budacki, J. G., Mohanty, S. H., Leister, K. P., & Bonner, R. L. (2015) · Pediatrics · doi:10.1542/peds.2015-2151 · Cited by 1,053 · see citing works
The association between Internet addiction and psychiatric disorder: A review of the literature
Ko, C.-H., Yen, J.-Y., Yen, C.-F., Chen, C.-S., & Chen, C.-C. (2012) · European Psychiatry · doi:10.1016/j.eurpsy.2010.04.011 · Cited by 895 · cited 1× · see citing works
“Furthermore, some experts question whether PIMU represents a unique mental disorder at all, arguing it is rather a syndrome of behaviors driven by a previously subclinical or undertreated mental health disorder that manifests itself in the interactive media environment [12].”
BackgroundAnderson, E. L., Steen, E., & Stavropoulos, V. (2017) · International Journal of Adolescence and Youth · doi:10.1080/02673843.2016.1227716 · Cited by 722 · see citing works
The wired generation: Academic and social outcomes of electronic media use among university students
Jacobsen, W. C., & Forste, R. (2011) · Cyberpsychology, Behavior, and Social Networking · doi:10.1089/cyber.2010.0135 · Cited by 710 · see citing works
Factors associated with Internet addiction among adolescents
Lam, L. T., Peng, Z.-W., Mai, J.-C., & Jing, J. (2009) · CyberPsychology & Behavior · doi:10.1089/cpb.2009.0036 · Cited by 531 · see citing works
Internet addiction among Chinese adolescents: prevalence and psychological features
Cao, F., & Su, L. (2006) · Child Care Health and Development · doi:10.1111/j.1365-2214.2006.00715.x · Cited by 530 · see citing works
González-Bueso, V., Santamaría, J., Fernández, D., Merino, L., Montero, E., & Ribas, J. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15040668 · Cited by 487 · see citing works
Internet addiction: a brief summary of research and practice
Cash, H., D. Rae, C., H. Steel, A., & Winkler, A. (2012) · Current Psychiatry Reviews · doi:10.2174/157340012803520513 · Cited by 462 · see citing works
Griffiths, M., & University of Plymouth (1995) · Clinical Psychology Forum · doi:10.53841/bpscpf.1995.1.76.14 · Cited by 443 · see citing works
Cyber Disorders: The Mental Health Concern for the New Millennium
YOUNG, K. S., PISTNER, M., O'mara, J., & Buchanan, J. (1999) · CyberPsychology & Behavior · doi:10.1089/cpb.1999.2.475 · Cited by 384 · see citing works
Internet Gaming Disorder: Investigating the Clinical Relevance of a New Phenomenon
Przybylski, A. K., Weinstein, N., & Murayama, K. (2017) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2016.16020224 · Cited by 372 · see citing works
Ra, C. K., Cho, J., Stone, M. D., De La Cerda, J., Goldenson, N. I., Moroney, E., Tung, I., Lee, S. S., & Leventhal, A. M. (2018) · JAMA · doi:10.1001/jama.2018.8931 · Cited by 360 · see citing works
Han, D. H., Lee, Y. S., Na, C., Ahn, J. Y., Chung, U., Daniels, M. A., Haws, C. A., & Renshaw, P. F. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2008.08.011 · Cited by 344 · see citing works
Florindo, A. A., Barrozo, L. V., Turrell, G., Barbosa, J. P. D. A. S., Cabral‐Miranda, W., Cesar, C., & Goldbaum, M. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15040562 · Cited by 337 · see citing works
Han, D. H., Hwang, J. W., & Renshaw, P. F. (2010) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0020023 · Cited by 324 · see citing works
Greaves, C. J., Gillison, F., Stathi, A., Bennett, P., Reddy, P., Dunbar, J., Perry, R. A., Messom, D., Chandler, R., Francis, M., et al. (2015) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-014-0159-z · Cited by 299 · see citing works
Causes, effects, and practicalities of everyday multitasking
Carrier, L. M., Rosen, L. D., Cheever, N. A., & Lim, A. F. (2015) · Developmental Review · doi:10.1016/j.dr.2014.12.005 · Cited by 284 · see citing works
Internet Gaming Disorder in the DSM-5
Petry, N. M., Rehbein, F., Ko, C., & O’Brien, C. P. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0610-0 · Cited by 270 · see citing works
Internet Sex Addiction Treated With Naltrexone
Bostwick, J. M., & Bucci, J. A. (2008) · Mayo Clinic Proceedings · doi:10.4065/83.2.226 · Cited by 265 · see citing works
Psychiatric Comorbidity of Internet Addiction in College Students: An Interview Study
Ko, C., Yen, J., Chen, C., Chen, C.-C., & Yen, C. (2008) · CNS Spectrums · doi:10.1017/s1092852900016308 · Cited by 254 · see citing works
Treatment of Internet gaming disorder: An international systematic review and CONSORT evaluation
King, D. L., Delfabbro, P. H., Wu, A. M. S., Doh, Y. Y., Kuss, D. J., Pallesen, S., Mentzoni, R., Carragher, N., & Sakuma, H. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.04.002 · Cited by 247 · see citing works
Cohen, E., MacKenzie, R. G., & Yates, G. L. (1991) · Journal of Adolescent Health · doi:10.1016/0197-0070(91)90084-y · Cited by 230 · see citing works
Technology Use and Sleep Quality in Preadolescence and Adolescence
Bruni, O., Sette, S., Fontanesi, L., Baiocco, R., Laghi, F., & Baumgartner, E. (2015) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.5282 · Cited by 213 · see citing works
Treatment outcomes using CBT-IA with Internet-addicted patients
Young, K. S. (2013) · Journal of Behavioral Addictions · doi:10.1556/jba.2.2013.4.3 · Cited by 199 · see citing works
Han, D. H., & Renshaw, P. F. (2011) · Journal of Psychopharmacology · doi:10.1177/0269881111400647 · Cited by 196 · see citing works
Assessing the psychometric properties of the Internet Addiction Test (IAT) in US college students
Jelenchick, L. A., Becker, T., & Moreno, M. A. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2011.09.007 · Cited by 167 · see citing works
Olanzapine in the Treatment of Pathological Gambling
McElroy, S. L., Nelson, E. B., Welge, J. A., Kaehler, L. A., & Keck, P. E. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0314 · Cited by 157 · see citing works
Park, J. H., Lee, Y. S., Sohn, J. H., & Han, D. H. (2016) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2559 · Cited by 152 · see citing works
Jelenchick, L. A., Eickhoff, J. C., Christakis, D., Brown, R. L., Zhang, C., Benson, M., & Moreno, M. A. (2014) · Computers in Human Behavior · doi:10.1016/j.chb.2014.01.035 · Cited by 135 · see citing works
Yen, C., Chou, W., Liu, T., Yang, P., & Hu, H. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.05.025 · Cited by 125 · see citing works
Plugged in: Electronics use in youth and young adults with autism spectrum disorder
MacMullin, J. A., Lunsky, Y., & Weiss, J. A. (2015) · Autism · doi:10.1177/1362361314566047 · Cited by 120 · see citing works
Liu, J., Nie, J., & Wang, Y. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14121470 · Cited by 109 · see citing works
Wilderness adventure therapy effects on the mental health of youth participants
Bowen, D. J., Neill, J. T., & Crisp, S. J. (2016) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2016.05.005 · Cited by 94 · see citing works
Karaca, S., Saleh, A., Canan, F., & Potenza, M. N. (2016) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-016-9660-8 · Cited by 73 · see citing works
A case of problematic internet use successfully treated with an SSRI-antipsychotic combination
Atmaca, M. (2007) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2007.01.003 · Cited by 68 · see citing works
Santos, V. A., Freire, R. C. R., Zugliani, M. M., Cirillo, P. C., dos Santos, H. H. K., Nardi, A. E., & King, A. L. S. (2016) · JMIR Research Protocols · doi:10.2196/resprot.5278 · Cited by 64 · see citing works
Sattar, P., & Ramaswamy, S. (2004) · The Canadian Journal of Psychiatry · doi:10.1177/070674370404901225 · Cited by 64 · see citing works
Jelenchick, L. A., Eickhoff, J., Zhang, C., Kraninger, K., Christakis, D. A., & Moreno, M. A. (2015) · Academic Pediatrics · doi:10.1016/j.acap.2015.07.001 · Cited by 62 · see citing works
Borghese, M. M., Tremblay, M. S., Katzmarzyk, P. T., Tudor-Locke, C. E., Schuna, J. M., Leduc, G., Boyer, C., LeBlanc, A. G., & Chaput, J. (2015) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-015-0221-5 · Cited by 55 · see citing works
HEADS4: Social Media Screening in Adolescent Primary Care
Clark, D. L., Raphael, J. L., & McGuire, A. L. (2018) · PEDIATRICS · doi:10.1542/peds.2017-3655 · Cited by 40 · see citing works
A Role for Pharmacotherapy in the Treatment of “Internet Addiction”
Camardese, G., Risio, L. D., Nicola, M. D., Pizi, G., & Janiri, L. (2012) · Clinical Neuropharmacology · doi:10.1097/wnf.0b013e31827172e5 · Cited by 36 · see citing works
Rich, M., Tsappis, M. W., & Kavanaugh, J. R. (2017) · Springer Publishing Company eBooks · doi:10.1891/9780826133731.0001 · Cited by 24 · see citing works
An open-label trial of escitalopram in the treatment of impulsive-compulsive internet usage disorder
Osso, B. D., Altamura, A. C., Hadley, S. J., Baker, B., & Hollander, E. (2006) · European Neuropsychopharmacology · doi:10.1016/s0924-977x(06)80097-0 · Cited by 22 · see citing works
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The Conceptual and Methodological Mayhem of “Screen Time”
K. Kaye, L., Orben, A., A. Ellis, D., C. Hunter, S., & Houghton, S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17103661 · Cited by 304 · see citing works
“For example, vulnerable populations may have unique uses for screens, as is suggested from work showing that adolescents with neurodevelopmental disorders have higher rates of social media use [28] and may use screens to support social and communication skills [29].”
BackgroundCurrent Research and Viewpoints on Internet Addiction in Adolescents
Bickham, D. S. (2021) · Current Pediatrics Reports · doi:10.1007/s40124-020-00236-3 · Cited by 142 · see citing works
Houghton, S., Kyron, M., Lawrence, D., Hunter, S. C., Hattie, J., Carroll, A., Zadow, C., & Chen, W. (2022) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13579 · Cited by 51 · see citing works
A Bibliometric Analysis of the Health Field Regarding Social Networks and Young People
Martínez, P. A., Perea-Moreno, A.-J., Martínez-Jiménez, P., Redel-Macías, M. D., Abellán, M. V., & Pagliari, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16204024 · Cited by 44 · see citing works
Chetty-Mhlanga, S., Fuhrimann, S., Eeftens, M., Basera, W., Hartinger, S. M., Dalvie, M. A., & Röösli, M. (2020) · Environmental Research · doi:10.1016/j.envres.2020.109315 · Cited by 34 · see citing works
de Melo, E. A. S., Ferreira, L. E. D. S., Cavalcanti, R. J. F., Filho, C. A. D. L. B., Lopes, M. R., & Barbosa, R. H. D. A. (2021) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.67.02.20200746 · Cited by 24 · see citing works
Nereim, C., Bickham, D. S., & Rich, M. (2022) · JMIR Formative Research · doi:10.2196/30900 · Cited by 18 · see citing works
Social Media and Anxiety in Youth
Chochol, M. D., Gandhi, K., & Croarkin, P. E. (2023) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2023.02.004 · Cited by 16 · see citing works
Wu, J., Yang, Y., Zhou, Q., Li, J., Yang, W., Yin, X., Qiu, S.-Y., Zhang, J., Meng, M., Guo, Y., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0312654 · Cited by 8 · see citing works
Social Media and Development of Sexual and Gender Identity in Adolescents
Suto, D. J., Turban, J. L., & Belfort, E. L. (2024) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2024.08.004 · Cited by 5 · see citing works
Internet addiction: Theoretical models, assessment and intervention
Casale, S., & Fioravanti, G. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-818872-9.00143-6 · Cited by 4 · see citing works
Screening for Media Use in the Emergency Department Among Young Australians: Cross-sectional Study
Dullur, P., Joseph, J., Diaz, A. M., Lin, P., Jairam, R., Davies, R., Masi, A., Shulruf, B., & Eapen, V. (2023) · JMIR Formative Research · doi:10.2196/42986 · Cited by 3 · see citing works
Association Between Smartphone Attachment and Mental Health in Adolescents
Liu, X., Huang, L., McIntosh, C. W., Liu, J., & McDonald, C. C. (2025) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.70030 · Cited by 3 · see citing works
Carter, M. C. (2023) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2023.1056 · Cited by 2 · see citing works
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Weigle, P. E., Kaliebe, K., Dalope, K. A., Asamoah, T., & Shafi, R. M. A. (2021) · Springer eBooks · doi:10.1007/978-3-030-62113-1_18 · Cited by 2 · see citing works
Wu, J., Yang, Y., Zhou, Q., Li, J., Yang, W., Yin, X., Qiu, S.-Y., Zhang, J., Meng, M., Chen, J.-H., et al. (2024) · medRxiv · doi:10.1101/2024.10.12.24315388
- Authors
- Nereim, C., Bickham, D., & Rich, M.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Nereim, Cameron
- Venue
- Current Opinion in Pediatrics
- Published
- 2019-08
- Volume
- 31
- Issue
- 4
- Pages
- 435-441
- ISSN
- 1040-8703 (ISSN-L)
- 1531-698X
- OpenAlex
- W2942262327
- Cited by
- 16
- References
- 47
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 1
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Education › Child Development and Digital Technology
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Keywords
- internet gaming disorder, internet addiction, adolescents, children, social anxiety, screening, cognitive behavioral therapy, group counseling, sport-based intervention, residential treatment, pharmacotherapy, primary care
- MeSH terms
- Problem Behavior, Pediatricians, Adolescent, Child, Humans, Primary Health Care, Behavior, Addictive, Video Games, Internet, Diagnostic and Statistical Manual of Mental Disorders
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