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Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents

Educational Objective
To learn whether use of digital media by adolescents is associated with symptoms of attention-deficit/hyperactivity disorder.
1 Credit CME
Key Points

Question  Is frequent use of modern digital media platforms, such as social media, associated with occurrence of ADHD symptoms during adolescence?

Findings  In this longitudinal cohort survey study of adolescents aged 15 and 16 years at baseline and without symptoms of ADHD, there was a significant association between higher frequency of modern digital media use and subsequent symptoms of ADHD over a 24-month follow-up (odds ratio, 1.11 per additional digital media activity).

Meaning  More frequent use of digital media may be associated with development of ADHD symptoms; further research is needed to assess whether this association is causal.


Importance  Modern digital platforms are easily accessible and intensely stimulating; it is unknown whether frequent use of digital media may be associated with symptoms of attention-deficit/hyperactivity disorder (ADHD).

Objective  To determine whether the frequency of using digital media among 15- and 16-year-olds without significant ADHD symptoms is associated with subsequent occurrence of ADHD symptoms during a 24-month follow-up.

Design, Setting, and Participants  Longitudinal cohort of students in 10 Los Angeles County, California, high schools recruited through convenience sampling. Baseline and 6-, 12-, 18-, and 24-month follow-up surveys were administered from September 2014 (10th grade) to December 2016 (12th grade). Of 4100 eligible students, 3051 10th-graders (74%) were surveyed at the baseline assessment.

Exposures  Self-reported use of 14 different modern digital media activities at a high-frequency rate over the preceding week was defined as many times a day (yes/no) and was summed in a cumulative index (range, 0-14).

Main Outcomes and Measures  Self-rated frequency of 18 ADHD symptoms (never/rare, sometimes, often, very often) in the 6 months preceding the survey. The total numbers of 9 inattentive symptoms (range, 0-9) and 9 hyperactive-impulsive symptoms (range, 0-9) that students rated as experiencing often or very often were calculated. Students who had reported experiencing often or very often 6 or more symptoms in either category were classified as being ADHD symptom-positive.

Results  Among the 2587 adolescents (63% eligible students; 54.4% girls; mean [SD] age 15.5 years [0.5 years]) who did not have significant symptoms of ADHD at baseline, the median follow-up was 22.6 months (interquartile range [IQR], 21.8-23.0, months). The mean (SD) number of baseline digital media activities used at a high-frequency rate was 3.62 (3.30); 1398 students (54.1%) indicated high frequency of checking social media (95% CI, 52.1%-56.0%), which was the most common media activity. High-frequency engagement in each additional digital media activity at baseline was associated with a significantly higher odds of having symptoms of ADHD across follow-ups (OR, 1.11; 95% CI, 1.06-1.16). This association persisted after covariate adjustment (OR, 1.10; 95% CI, 1.05-1.15). The 495 students who reported no high-frequency media use at baseline had a 4.6% mean rate of having ADHD symptoms across follow-ups vs 9.5% among the 114 who reported 7 high-frequency activities (difference; 4.9%; 95% CI, 2.5%-7.3%) and vs 10.5% among the 51 students who reported 14 high-frequency activities (difference, 5.9%; 95% CI, 2.6%-9.2%).

Conclusions and Relevance  Among adolescents followed up over 2 years, there was a statistically significant but modest association between higher frequency of digital media use and subsequent symptoms of ADHD. Further research is needed to determine whether this association is causal.

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Article Information

Corresponding Author: Adam M. Leventhal, PhD, University of Southern California Keck School of Medicine, 2001 N Soto St, Third Floor 302-C, Los Angeles, CA 90032 (

Accepted for Publication: June 6, 2018.

Author Contributions: Ms Ra and Dr Cho had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ra, Cho, De La Cerda, Goldenson, Moroney, Lee, Leventhal.

Acquisition, analysis, or interpretation of data: Ra, Cho, Stone, De La Cerda, Goldenson, Tung, Lee, Leventhal.

Drafting of the manuscript: Ra, Cho, De La Cerda, Goldenson, Moroney, Tung, Lee, Leventhal.

Critical revision of the manuscript for important intellectual content: Cho, Stone, Goldenson, Moroney, Tung, Lee, Leventhal.

Statistical analysis: Ra, Cho, Goldenson, Lee.

Obtained funding: Leventhal.

Administrative, technical, or material support: Cho, Stone, De La Cerda, Goldenson, Leventhal.

Supervision: Leventhal.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported.

Funding/Support: This research was supported by grant R01-DA033296US from the National Institutes of Health.

Role of the Funder/Sponsor: The funding agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Thomas  R, Sanders  S, Doust  J, Beller  E, Glasziou  P.  Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.  Pediatrics. 2015;135(4):e994-e1001. doi:10.1542/peds.2014-3482PubMedGoogle ScholarCrossref
Nyarko  KA, Grosse  SD, Danielson  ML, Holbrook  JR, Visser  SN, Shapira  SK.  Treated prevalence of attention-deficit/hyperactivity disorder increased from 2009 to 2015 among school-aged children and adolescents in the United States.  J Child Adolesc Psychopharmacol. 2017;27(8):731-734. doi:10.1089/cap.2016.0196PubMedGoogle ScholarCrossref
Larsson  J-O, Larsson  H, Lichtenstein  P.  Genetic and environmental contributions to stability and change of ADHD symptoms between 8 and 13 years of age: a longitudinal twin study.  J Am Acad Child Adolesc Psychiatry. 2004;43(10):1267-1275. doi:10.1097/01.chi.0000135622.05219.bfPubMedGoogle ScholarCrossref
Nikkelen  SW, Valkenburg  PM, Huizinga  M, Bushman  BJ.  Media use and ADHD-related behaviors in children and adolescents: a meta-analysis.  Dev Psychol. 2014;50(9):2228-2241. doi:10.1037/a0037318PubMedGoogle ScholarCrossref
Leventhal  AM, Strong  DR, Kirkpatrick  MG,  et al.  Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence.  JAMA. 2015;314(7):700-707. doi:10.1001/jama.2015.8950PubMedGoogle ScholarCrossref
Barkley  RA.  Attention-Deficit Hyperactivity Disorder: A Clinical Workbook. 2nd ed. New York, NY: Guilford Press; 1998.
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Text Revision. Washington, DC: American Psychiatric Publishing; 2004.
Adler  LA, Shaw  DM, Spencer  TJ,  et al.  Preliminary examination of the reliability and concurrent validity of the attention-deficit/hyperactivity disorder self-report scale v1.1 symptom checklist to rate symptoms of attention-deficit/hyperactivity disorder in adolescents.  J Child Adolesc Psychopharmacol. 2012;22(3):238-244. doi:10.1089/cap.2011.0062PubMedGoogle ScholarCrossref
Sonnby  K, Skordas  K, Olofsdotter  S, Vadlin  S, Nilsson  KW, Ramklint  M.  Validation of the World Health Organization Adult ADHD Self-Report Scale for adolescents.  Nord J Psychiatry. 2015;69(3):216-223. doi:10.3109/08039488.2014.968203PubMedGoogle ScholarCrossref
Sibley  MH, Pelham  WE, Molina  BS,  et al.  The delinquency outcomes of boys with ADHD with and without comorbidity.  J Abnorm Child Psychol. 2011;39(1):21-32. doi:10.1007/s10802-010-9443-9PubMedGoogle ScholarCrossref
Connor  DF, Edwards  G, Fletcher  KE, Baird  J, Barkley  RA, Steingard  RJ.  Correlates of comorbid psychopathology in children with ADHD.  J Am Acad Child Adolesc Psychiatry. 2003;42(2):193-200. doi:10.1097/00004583-200302000-00013PubMedGoogle ScholarCrossref
Yen  J-Y, Ko  C-H, Yen  C-F, Wu  H-Y, Yang  M-J.  The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility.  J Adolesc Health. 2007;41(1):93-98. doi:10.1016/j.jadohealth.2007.02.002PubMedGoogle ScholarCrossref
Elia  J, Ambrosini  P, Berrettini  W.  ADHD characteristics, I: concurrent co-morbidity patterns in children & adolescents.  Child Adolesc Psychiatry Ment Health. 2008;2(1):15. doi:10.1186/1753-2000-2-15PubMedGoogle ScholarCrossref
Thompson  MP, Ho  CH, Kingree  JB.  Prospective associations between delinquency and suicidal behaviors in a nationally representative sample.  J Adolesc Health. 2007;40(3):232-237. doi:10.1016/j.jadohealth.2006.10.016PubMedGoogle ScholarCrossref
Radloff  LS.  The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults.  J Youth Adolesc. 1991;20(2):149-166. doi:10.1007/BF01537606PubMedGoogle ScholarCrossref
Muthén  LK, Muthén  BO. Mplus, Statistical Analysis With Latent Variables Version. Los Angeles, CA: Unviersity of California; 2007;3.
Vittinghoff  E, Glidden  DV, Shiboski  SC, McCulloch  CE.  Regression Methods in Biostatistics: Linear, Logistic, Survival, and Repeated Measures Models. New York, NY: Springer Science & Business Media; 2011.
Benjamini  Y, Hochberg  Y.  Controlling the false discovery rate: a practical and powerful approach to multiple testing.  J R Stat Soc Series B Stat Methodol. 1995;57(1):289-300.Google Scholar
Zheng  F, Gao  P, He  M,  et al.  Association between mobile phone use and inattention in 7102 Chinese adolescents: a population-based cross-sectional study.  BMC Public Health. 2014;14(1):1022. doi:10.1186/1471-2458-14-1022PubMedGoogle ScholarCrossref
George  MJ, Russell  MA, Piontak  JR, Odgers  CL.  Concurrent and subsequent associations between daily digital technology use and high-risk adolescents’ mental health symptoms.  Child Dev. 2018;89(1):78-88. doi:10.1111/cdev.12819PubMedGoogle ScholarCrossref
Palmonari  A, Pombeni  ML, Kirchler  E.  Peergroups and evolution of the self-system in adolescence.  Eur J Psychol Educ. 1989;4(1):3. doi:10.1007/BF03172757Google ScholarCrossref
Giedd  JN.  Structural magnetic resonance imaging of the adolescent brain.  Ann N Y Acad Sci. 2004;1021(1):77-85. doi:10.1196/annals.1308.009PubMedGoogle ScholarCrossref
Szymanski  K, Sapanski  L, Conway  F.  Trauma and ADHD–association or diagnostic confusion? a clinical perspective.  J Infant Child Adolesc Psychother. 2011;10(1):51-59. doi:10.1080/15289168.2011.575704Google ScholarCrossref
Moffitt  TE, Houts  R, Asherson  P,  et al.  Is adult ADHD a childhood-onset neurodevelopmental disorder? evidence from a four-decade longitudinal cohort study.  Am J Psychiatry. 2015;172(10):967-977. doi:10.1176/appi.ajp.2015.14101266PubMedGoogle ScholarCrossref
Caye  A, Rocha  TB-M, Anselmi  L,  et al.  Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome.  JAMA Psychiatry. 2016;73(7):705-712. doi:10.1001/jamapsychiatry.2016.0383PubMedGoogle ScholarCrossref
Agnew-Blais  JC, Polanczyk  GV, Danese  A, Wertz  J, Moffitt  TE, Arseneault  L.  Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood.  JAMA Psychiatry. 2016;73(7):713-720. doi:10.1001/jamapsychiatry.2016.0465PubMedGoogle ScholarCrossref
White  JD.  Personality, temperament and ADHD: a review of the literature.  Pers Individ Dif. 1999;27(4):589-598. doi:10.1016/S0191-8869(98)00273-6Google ScholarCrossref
Gentile  DA, Swing  EL, Lim  CG, Khoo  A.  Video game playing, attention problems, and impulsiveness: evidence of bidirectional causality.  Psychol Pop Media Cult. 2012;1(1):62. doi:10.1037/a0026969Google ScholarCrossref
Johnston  C, Mash  EJ, Miller  N, Ninowski  JE.  Parenting in adults with attention-deficit/hyperactivity disorder (ADHD).  Clin Psychol Rev. 2012;32(4):215-228. doi:10.1016/j.cpr.2012.01.007PubMedGoogle ScholarCrossref
Padilla-Walker  LM, Coyne  SM, Fraser  AM, Dyer  WJ, Yorgason  JB.  Parents and adolescents growing up in the digital age: latent growth curve analysis of proactive media monitoring.  J Adolesc. 2012;35(5):1153-1165. doi:10.1016/j.adolescence.2012.03.005PubMedGoogle ScholarCrossref
Smith  VC, Wilson  CR; Committee on Substance Use and Prevention.  Families affected by parental substance use.  Pediatrics. 2016;138(2):e20161575. doi:10.1542/peds.2016-1575PubMedGoogle ScholarCrossref
Chen  Q, Yan  Z.  Does multitasking with mobile phones affect learning? a review.  Comput Human Behav. 2016;54:34-42. doi:10.1016/j.chb.2015.07.047Google ScholarCrossref
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