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Social media use linked to 10% increase in risk of new ADHD symptoms among teens

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Parents should be involved in children’s media use

This study is among the first to capture current media use because technology tends to outpace researchers’ ability to publish data “within relevant time frames,” Jenny Radesky, MD of the University of Michigan in Ann Arbor, said in an editorial.

While previous studies linking ADHD symptoms and media use analyzed use of media such as television shows and video games, this study analyzes smartphone use and “always-on” media such as social media in addition to traditional media, she said.

It should be noted that “high-frequency media use was associated with only a 10% increased risk of later ADHD symptoms overall.

“Although the authors were able to adjust for income and mental health symptoms, they did not assess parent media use or whether the parents were involved in how the adolescents used media,” Dr. Radesky said. “Parent media use correlates with child media use, may interrupt parent-child activities, and is associated with child behavior difficulties in younger children.”

She said the study affirms guidelines from the American Academy of Pediatrics to “prioritize activities that promote adolescent executive functioning and well-being, including sleep, physical activity, distraction-free homework, and positive interactions with family and friends.

“Although not directly addressed by this study, the American Academy of Pediatrics recommendations for parent involvement in their adolescent’s media use – including discussions about prosocial uses of media, digital citizenship, misinformation, and persuasion awareness – are relevant to the cognitive and emotional reactions to digital media of adolescents,” she added.

Dr. Radesky noted that the potential for the association between media use and ADHD symptoms to be influenced by confounders not measured in the study is a “major limitation.”

Dr. Radesky is at the University of Michigan, Ann Arbor. She receives grant support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. These comments summarize her editorial accompanying the article by Ra et al. ( JAMA. 2018;320:237-39 ).



Adolescents who frequently used digital media were more likely to develop subsequent symptoms of ADHD over a 2 year period, according to results from a prospective, longitudinal cohort study published in JAMA.

A teen looks at her smartphone while leaning against a school locker. monkeybusinessimages/iStock/Getty Images Plus

“Further research is needed to determine whether this association is causal,” cautioned the investigators.

Between fall 2014 (10th grade) and fall 2016 (12th grade), researchers studied 3,051 students from 10 different Los Angeles schools who were enrolled in the Happiness & Health Study and did not have significant ADHD symptoms; of these students, 2,587 adolescents (mean age 16 years, 54% girls) self-reported digital media use activities from 14 different types through surveys administered at baseline and again at 6-month, 12-month, 18-month and 24-month follow-up. Digital use activities included checking social media sites, engaging with social media content, texting, streaming music, and browsing or viewing images or videos, among others.

“Although some emerging research indicates that ADHD levels and use of certain forms of modern media may be concurrently associated, the role of modern digital media use in ADHD risk largely remains unclear from the prior literature due to limitations in exposure assessment and the application of designs incapable of supporting temporal or causal inferences,” wrote Chaelin K. Ra, MPH, of the University of Southern California, Los Angeles, and his colleagues. “The current study provides new longitudinal evidence on this topic using a 5-wave prospective design and comprehensive assessment across a wide continuum of digital media exposure, including numerous media platforms currently popular among youth.”

Students ranked their activities in a cumulative index and indicated whether they participated in those activities “0, 1-2 times per week, 1-2 times per day, or many times per day.” They also filled out the DSM-IV Current Symptoms Self-Report Form, which asked them to report whether they experienced any of nine different hyperactivity-impulsivity symptoms such as “difficulty organizing and completing tasks.”

Mr. Ra and his colleagues found that 81% of adolescents reported at least one digital media activity performed at a high-frequency rate, with 54% reporting they checked social media at a high-frequency rate. There was a mean of four baseline digital media activities performed at a high-frequency rate among students surveyed. Each additional digital media activity used at a high-frequency rate carried a statistically significant association of subsequent ADHD symptoms over the follow-up period (odds ratio 1.1; 95% confidence interval, 1.06-1.16), which remained after adjustment for covariates including age, sex, and subsidized lunch availability tied to family income (OR 1.1; 95% CI, 1.05-1.15). The researchers noted that there was a 5% mean prevalence of subsequent ADHD symptoms in follow-up among patients who reported no baseline high-frequency rate of digital media use, compared with 10% in students indicating 7 high-frequency activities and 11% in students indicating 14 high-frequency activities.

Limitations of the study included potential inaccuracies in self-reporting ADHD symptoms as opposed to students receiving a diagnosis through a clinical interview, the possibility of the association being influenced by ADHD symptoms not detected in the study, the fact that the media use measure in the study had not been validated, and use of a targeted age range in the sample of students that excluded students without surveys who had differing demographic data from the rest of the cohort, according to the researchers.

The authors reported having no relevant financial disclosures. The study was supported by a grant from the National Institutes of Health.

SOURCE: Ra CK et al. JAMA. 2018 Jul 17. doi: 10.1001/jama.2018.8931.

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