Letters to the Editor
Internet Use in Adolescents: Hobby or Avoidance
Dear Editor:
We report on 2 cases of excessive Internet use in adolescents presenting for psychiatric consultation. Is Internet use a hobby, an avoidance of relational deficits, or a contemporary manifestation of psychiatric symptomatolgy such as obsessive–compulsive disorder? There is mounting concern about the effects of computer use on behaviour and on social and mental health, owing to the increasing amount of time children and adolescents spend using computers. Unfortunately, there is limited research in this area; one study shows that girls who had high levels of conflict with parents or who were highly troubled were more likely than other girls to have close on-line relationships, as were boys who had low levels of communication with parents or were highly troubled, compared with other boys (1). Another study shows computer use is linked to slightly better academic performance. Although little evidence indicates that moderate use of computers to play games has a negative impact on children’s friendships and family relationships, recent survey data show that increased use of the Internet may be linked to increases in loneliness and depression (2). Although not formally recognized in the DSM-IV, some psychologists have assigned diagnostic criteria to Internet addiction disorder (IAD) that are very similar to the addictive model of tolerance, withdrawal, and impairment of social and occupational function (3,4). However, caution is needed in applying the concept of behavioural addiction to computer-related behaviour. Classifying individuals as exhibiting pathological computer use by using checklists based on adaptations of DSM criteria for pathological gambling is likely to overestimate the number of people addicted to computing activities (5).
Case Report 1
Tomas, aged 16 years, lives in a city with his middle-class professional parents. He was referred to the adolescent clinic for spending 16 hours daily using the Internet, for being absent from school, and for having lowered frustration tolerance and behaviour problems, such as stealing from home and charging costs to the home telephone. Tomas’ parents feel helpless in controlling their son’s behaviour. He has a history of impulsiveness, easy boredom, lacking capacity to postpone gratification, lacking close friendships, irritability and externalizing behaviours, and difficulty with coping skills. Psychometric testing reveals a full-scale IQ of 116, Thematic Apperception Test reveals themes of sadness and depression, isolation, and poor self-esteem.
Case Report 2
Leela, aged 14 years, was seen at her parents request after threatening to kill herself. The history reveals 6 months of ongoing family conflict owing to Leela’s refusal to attend school and to her spending all night using the Internet and refusing to sleep. She was not eating meals with the family. A crisis arose when Leela’s parents disconnected the Internet; she promised she would attend school if she could have the Internet back, but reneged on her promise. When asked to surrender the Internet, Leela threatened to kill herself (2). Leela is a Grade 9 student referred for school refusal. She has had a difficult time in school, being teased, and has found it difficult to make and keep friends. She has been shy and anxious. Since getting the Internet connection, however, Leela believes that she has friends in the chat rooms who understand her feelings and that she is able to say whatever she likes without fear of repercussion; for once, she does not feel “worthless.” Leela admits that she is using the Internet to the exclusion of everything else, but she cannot stop. She is irrational and argumentative around the issue of Internet use.
Discussion
These cases illustrate 2 different aspects of excessive Internet use. Case 1 seems to fit the addictive model, whereas in Case 2, there is evidence of anxious–avoidant traits that are being handled through the Internet. In both cases, the parents are helpless in curbing the behaviours and look to psychiatry to provide intervention and advice. In both cases, treatment of the underlying psychopathology was advised. In Case 2, successful treatment of the anxiety disorder with cognitive-behavioural therapy, social skills group, and parental behaviour interventions led to Internet use reduced to appropriate weekly hours and to school reintegration.
References
1. Wolak J, Mitchell KJ, Finkelhor D. Escaping or connecting? Characteristics of youth who form close online relationships. J Adolesc 2003;26:105–19.
2. Subrahmanyam K, Kraut RE, Greenfield PM, Gross EF. The impact of home computer use on children’s activities and development. Future Child 2000;10:123–44.
3. Wartella EA, Jennings N. Children and computers: new technology–old concerns. Future Child 2000;10:31–43.
4. Young KS. Psychology of computer use: XL. Addictive use of the Internet: a case that breaks the stereotype. Psychol Rep 1996;79:899–902.
5. Charlton JP. A factor-analytic investigation of computer ‘addiction’ and engagement. Br J Psychol 2002;93:329–44.
Felicia Iftene, MD, PhD
Clug Napoca, Romania
Nasreen Roberts, PhD
Kingston, Ontario
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