Problematic Internet Use

Problematic Internet Use (PIU) incorporates a range of repetitive impairing behaviors, such as excessive video gaming, cybersex, online buying, gambling, streaming, social media use, online searching for health-related info and other purposeful behaviors. The reported prevalence of ‘internet addiction’(Young 1999) ranges from 1% to 36.7%(Ko, Yen et al. 2012).

Even though the direction of causality remains unclear, PIU is reported to be associated with a range of mental health, physical health and addictive disorders including depression, anxiety disorders, substance-use disorders (SUDs), obsessive-compulsive disorder (OCD), sleep disorders, attention-deficit/hyperactivity disorder (ADHD) and autism-spectrum disorders (ASDs) (Carli, Durkee et al. 2013, Carter, Rees et al. 2016, Ioannidis, Chamberlain et al. 2016). Although more studies are needed, cognitive dysfunction relating to decision-making, executive function (e.g., set-shifting difficulties), and impulse control might be implicated in the pathogenesis of PIU (Chamberlain, Ioannidis et al. 2018). Most people with PIU would have one or more other impulsive-compulsive disorders. It is possible that PIU can also occur as stand-alone problem and thus account for impaired quality of life and decline in relationships quality (Finkenauer, Pollmann et al. 2012).

Although use of Internet enables individuals with autistic traits to interact with others in a safe and structured environment with reduced contextual, auditory, and visual cues, there is growing concern about its potential addictive properties (van den Eijnden, Meerkerk et al. 2008, Liu, Yu et al. 2017). Our mission is to better understand the relationship between problematic internet use and compulsive, impulsive and autism spectrum disorders (CIASD) and to develop targeted digital therapies for its treatment.

Digital phone applications (‘apps’), which remotely and objectively monitor the use of the internet and send an alert to the patient, perform individual skills assessments or connect with health care provider when needed might be an innovative approach to better understand PIU and its comorbidities.  Space app (formerly Breakfree) available on Google Play can not only  assess user’s daily phone usage, but also provides trends of phone use information over the course of 60 days. iOS Moment app allows to track how many hours per day a person uses iPhone and iPad and to set daily limits. Valera health represents a digital intervention, which empowers  patients with depression and anxiety with self-help tools and connects with health care providers when necessary.  Identifor  app  was created to  identify individual strengths, weaknesses and interests and to provide a virtual coach or avatar to help with goal directed behaviors.

Children with a clinical diagnosis of compulsive, impulsive and autism spectrum disorders (CIASD) often experience feelings of loneliness (Bauminger, Shulman et al. 2003, Storch, Ledley et al. 2006). These traits are linked with a tendency for repetitive and stereotypical behavior, and could predict compulsive Internet use (Finkenauer, Pollmann et al. 2012). 30% of individuals with ASD may have comorbid ADHD (Joelsson, Chudal et al. 2016, So, Makino et al. 2017). Prevalence of internet addiction among adolescents with ASD alone, ADHD alone and with comorbid ASD and ADHD is reported to be 10.8, 12.5, and 20.0% respectively (So, Makino et al. 2017).

 

In order to better understand comorbidity between PIU and compulsive, impulsive and autism spectrum disorders (CIASD) large scale longitudinal analysis of comprehensive clinical and behavioral data in a real-world population is required. We aim to fill this gap by doing the following:

 

1. Identify biomarkers to improve early detection and intervention of PIU and Compulsive, Impulsive and Autism Spectrum Disorders (CIASD).

We will identify clinical biomarkers for main PIU behavior and its comorbidities, as well as clinical markers of ASD, impulsivity, compulsivity and reward processing. We will identify genetic biomarkers, associated with PIU and CIASD using Genomind Genecept assay.

 

2. Discover and develop effective digital health interventions both for PIU and CIASD.

We will use novel phone and web-based  interventions (Space, Moment, Valera Health, Identifor, Autism Track, Mind Nest health)  and Empower me technology by Brain Power to discover its individual strengths and weaknesses and to empower patients with tools to alleviate burden of their conditions.  We will use acquired knowledge to network and develop relationships with these digital health interventions vendors and possibly enhance their products with a goal to deliver targeted treatment for people with PIU and CIASD.

 

3. We will create a support network for the individuals with PIU and CIASD to facilitate their integration in the workplace environment.

 

Bibliography:

  1. Bauminger, N., C. Shulman and G. Agam (2003). "Peer interaction and loneliness in high-functioning children with autism." J Autism Dev Disord 33(5): 489-507.

  2. Carli, V., T. Durkee, D. Wasserman, G. Hadlaczky, R. Despalins, E. Kramarz, C. Wasserman, M. Sarchiapone, C. W. Hoven, R. Brunner and M. Kaess (2013). "The association between pathological internet use and comorbid psychopathology: a systematic review." Psychopathology 46(1): 1-13.

  3. Carter, B., P. Rees, L. Hale, D. Bhattacharjee and M. S. Paradkar (2016). "Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis." JAMA Pediatr 170(12): 1202-1208.

  4. Chamberlain, S. R., K. Ioannidis and J. E. Grant (2018). "The impact of comorbid impulsive/compulsive disorders in problematic Internet use." J Behav Addict: 1-7.

  5. Finkenauer, C., M. M. Pollmann, S. Begeer and P. Kerkhof (2012). "Brief report: examining the link between autistic traits and compulsive Internet use in a non-clinical sample." J Autism Dev Disord 42(10): 2252-2256.

  6. Ioannidis, K., S. R. Chamberlain, M. S. Treder, F. Kiraly, E. W. Leppink, S. A. Redden, D. J. Stein, C. Lochner and J. E. Grant (2016). "Problematic internet use (PIU): Associations with the impulsive-compulsive spectrum. An application of machine learning in psychiatry." J Psychiatr Res 83: 94-102.

  7. Joelsson, P., R. Chudal, D. Gyllenberg, A. K. Kesti, S. Hinkka-Yli-Salomaki, J. P. Virtanen, J. Huttunen, T. Ristkari, K. Parkkola, M. Gissler and A. Sourander (2016). "Demographic Characteristics and Psychiatric Comorbidity of Children and Adolescents Diagnosed with ADHD in Specialized Healthcare." Child Psychiatry Hum Dev 47(4): 574-582.

  8. Ko, C. H., J. Y. Yen, C. F. Yen, C. S. Chen and C. C. Chen (2012). "The association between Internet addiction and psychiatric disorder: a review of the literature." Eur Psychiatry 27(1): 1-8.

  9. Liu, S., C. Yu, B. T. Conner, S. Wang, W. Lai and W. Zhang (2017). "Autistic traits and internet gaming addiction in Chinese children: The mediating effect of emotion regulation and school connectedness." Res Dev Disabil 68: 122-130.

  10. So, R., K. Makino, M. Fujiwara, T. Hirota, K. Ohcho, S. Ikeda, S. Tsubouchi and M. Inagaki (2017). "The Prevalence of Internet Addiction Among a Japanese Adolescent Psychiatric Clinic Sample With Autism Spectrum Disorder and/or Attention-Deficit Hyperactivity Disorder: A Cross-Sectional Study." J Autism Dev Disord 47(7): 2217-2224.

  11. Storch, E. A., D. R. Ledley, A. B. Lewin, T. K. Murphy, N. B. Johns, W. K. Goodman and G. R. Geffken (2006). "Peer victimization in children with obsessive-compulsive disorder: relations with symptoms of psychopathology." J Clin Child Adolesc Psychol 35(3): 446-455.

  12. van den Eijnden, R. J., G. J. Meerkerk, A. A. Vermulst, R. Spijkerman and R. C. Engels (2008). "Online communication, compulsive Internet use, and psychosocial well-being among adolescents: a longitudinal study." Dev Psychol 44(3): 655-665.

  13. Young, K. S. (1999). "The research and controversy surrounding internet addiction." Cyberpsychol Behav 2(5): 381-383.