European Psychiatry 22 (2007) 466e471

http://france.elsevier.com/direct/EURPSY/

Original article

The relationship between impulsivity and Internet addiction

in a sample of Chinese adolescents
Fenglin Cao a,b, Linyan Su a,*, TieQiao Liu a, Xueping Gao a
a
The 2nd Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan 410011, P.R. China
b
School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong 250012, P.R. China
Received 21 March 2007; received in revised form 27 May 2007; accepted 30 May 2007
Available online 31 August 2007

Abstract

Objective. e Previous studies regarding Internet addiction have investigated associated psychological variables such as shyness, loneliness,
self-consciousness, anxiety, depression and interpersonal relations. Few studies about the relationship between Internet Addiction and impulsiv-
ity have been done. This study aimed to assess whether Internet addiction is related to impulsivity among Chinese adolescents.
Method. e This study was performed in two stages. We screened for the presence of Internet Addiction among 2620 high school students(age
ranging from 12 years to 18 years) from four high schools of Changsha City using Diagnostic Questionnaire for Internet Addiction (YDQ). Ac-
cording to the modified YDQ criteria by Beard, 64 students were diagnosed as Internet addiction. Excluding current psychiatric comorbidity, 50
students who were diagnosed as Internet Addiction (mean age, 14.8  1.4 years) and 50 normal students in Internet usage(mean age,
14.5  1.8 years) were included in a case control study. The two groups were assessed using Barratt Impulsiveness Scale 11 (BIS-11) and be-
havioral measure of impulsivity (GoStop Impulsivity Paradigm).
Results. e Sixty-four students met the modified YDQ criteria by Beard, of whom 14 students suffered from comorbid psychiatric disorders,
especially comorbid ADHD. The Internet Addiction group had significantly higher scores on the BIS-11 subscales of Attentional key, Motor key,
and Total scores than the control group (P < 0.05). The Internet Addiction group scored higher than the control group on the failure to inhibit
responses of GoStop Impulsivity Paradigm (P < 0.05). There was a significant positive correlation between YDQ scores and BIS-11subscales
and the number of failure to inhibit responses of GoStop Impulsivity Paradigm.
Conclusion. e This study suggests that adolescents with Internet addiction exhibit more impulsivity than controls and have various comorbid
psychiatric disorders, which could be associated with the psychopathology of Internet addiction.
Ó 2007 Elsevier Masson SAS. All rights reserved.

Keywords: Internet; Disorders of environmental origin; Behavior; Addiction; Impulsivity; Adolescents

1. Introduction
The use of the Internet has increased considerably over the
last few years. Data from China Internet Network Information
Center (CNNIC), as of June 30, 2006, showed that 123 million
people had gone online, of which 14.9% were teenagers below
Abbreviations: YDQ, Diagnostic Questionnaire for Internet Addiction;
BIS-11, Barratt Impulsiveness Scale 11; GoStop, GoStop Impulsivity
Paradigm.
* Corresponding author. Tel./fax: 86 731 5531781.
E-mail address: caofenglin@gmail.com (L. Su).
18 years old. With this soaring number of Internet users, the
problem of Internet addiction has attracted high attention
from psychiatrists, educators, and the public. Internet addic-
tion is currently becoming a serious mental health problem
among Chinese adolescents. Chou and Hsiao reported that
the incidence rate of Internet Addiction among Taiwan college
students was 5.9% [7]. Wu and Zhu identified 10.6% of Chi-
nese college students as Internet addiction [20].
Internet addiction, also described as pathological Internet
use, is defined as an individual’s inability to control his or
her use of the Internet, which eventually causes psychological,
social, school, and/or work difficulties in a person’s life [8,22].

0924-9338/$ - see front matter Ó 2007 Elsevier Masson SAS. All rights reserved.
doi:10.1016/j.eurpsy.2007.05.004
 F. Cao et al. / European Psychiatry 22 (2007) 466e471
The description of Internet addiction has been based on the
definition for substance dependence or pathological gambling.
It shares characteristics like preoccupation, mood modifica-
tion, tolerance, withdrawal, and functional impairment
[10,12].
Noticeably, Internet addiction is also a problem that has been
observed in different cultures. Yoo et al. conducted a study in
which 535 Korean children were assessed. This study found sig-
nificance associations between attention deficit hyperactivity
disorder (ADHD) symptoms and the severity of Internet addic-
tion [21]. A survey carried out by Morahan-Martin and Schu-
macher reported that among 277 U.S. college students
pathological Internet users were more likely to be males and
to use online games as well as technologically sophisticated
sites [16]. With a Chinese Internet-related addictive behavior
Inventory version II and Diagnostic Questionnaire for Internet
Addiction (YDQ), Chou and Hsiao explored Internet addiction
in 910 Taiwanese college students and identified the high com-
munication pleasure score as a high predictor for Internet
dependence [7].
Since the initial recognition of Internet addiction, several
assessment instruments have been developed. Brenner devel-
oped an Internet Related Addictive Behavior Inventory
(IRABI) [4], which has 32 trueefalse questions that assess
users’ Internet experiences. Morahan Martin and Schumacker
introduced their scale PIUS (Pathological Internet Use Scale)
[16], with 13 questions to assess whether heavy Internet use
negatively affects academic and other work, interpersonal re-
lations, individual stress levels, social withdrawal, and mood
alteration. In 2002, Caplan published the Generalized Prob-
lematic Internet Use Scale (GPIUS) [5]. In addition,
a widely-used eight-item Internet Addiction Diagnostic Ques-
tionnaire (YDQ) was developed by Young [23], partly adapted
from DSM-IV criteria for pathological gambling. Young also
created a 20-item questionnaire, called the Internet Addiction
Test (IAT) [3]. Up to now, there exists yet no Internet Addic-
tion diagnosis in the DSM system.
By using the DSM-IV criteria, some authors suggest Internet
addiction is an impulse disorder or at least related to impulse
control [2,23]. Several studies have revealed a correlation be-
tween impulsivity and pathological gambling, substance abuse,
and alcohol abuse. Barnes et al. found that impulsivity was a sig-
nificant predictor of alcohol misuse for females and delinquency
for males [1]. Vitaro et al. used a prospective-longitudinal de-
sign to investigate whether impulsivity measured in 12e14-
year-olds could predict problem gambling in late adolescence.
They validated ‘‘a self-report measure of impulsiveness and
a card-sorting task that significantly predicted problem gam-
bling (even after controlling for socio-demographic variables),
early gambling behavior and other personality variables such
as aggressiveness and anxiety’’ [19]. Moelle et al. found that im-
pulsivity is a significant predictor of cocaine use and treatment
retention [15]. Cavedini et al. also explored the relationship be-
tween the ventromedial orbitofrontal circuits and pathological
gambling. The results suggest the existence of a link between
pathological gambling and drug addiction, all having dimin-
ished ability to consider future consequences, which may be
467
explained, at least in part, by abnormal functioning of the
orbitofrontal cortex [6].
Research into impulsivity found that pathological gambling,
drug addiction, and alcohol abuse have similarities in neuropsy-
chology and personality characteristic. If Internet addiction is
related to impulsivity, research is likely to demonstrate that
neuropsychological characteristics may be similar to other
disorders.
Previous studies regarding adolescent Internet addiction
have investigated associated psychological variables such as
shyness, loneliness, self-consciousness, anxiety, depression
and interpersonal relations. However, few studies about the re-
lationship between Internet Addiction and impulsivity have
been done.
The objective of this study was to assess whether Internet
addiction is related to impulsivity.
2. Methods
This study was performed in two stages. First we screened
for the presence of Internet addiction within a nonclinical
group using the Diagnostic Questionnaire for Internet Addic-
tion (YDQ) that has been commonly used. According to the
modified YDQ criteria by Beard and structured clinical inter-
view (excluding current psychiatric comorbidity), 50 students
who were diagnosed as Internet addicted (mean age,
14.8  1.4 years) and 50 students on normal Internet usage
(mean age, 14.5  1.8 years) were included in a caseecontrol
study. The two groups were assessed using Barratt Impulsive-
ness Scale-11 (BIS-11) and behavioral measure of impulsivity
(GoStop Impulsivity Paradigm).
2.1. Participants
Four high schools were selected randomly in Changsha
City (the capital of Hunan, in South-central China, a city
with a population of over 6 million). Over all four schools,
we then adopted a 2-stage sampling method to select 3 classes
respectively from four grades, namely, 1st grade (mean age,
13.1 years) and 2nd grade (mean age, 14.3 years) in junior
high schools and 1st grade (mean age, 16.5 years) and 2nd
grade (mean age: 17.1 years) in senior high schools. From
the selected classes, all students (a total of 2787 students) par-
ticipated in this study and completed the self-report question-
naires in class after the researchers had explained the
procedures and requirements. Questionnaires were collected
immediately after they were completed. A final 2620 eligible
questionnaires remained. The response rate was 94%.
Among the 2620 students, 100% were aged between 12 and
18 years, with the average age being 15.2  3.5 years. A sum-
mary of the participant characteristics is given in Table 1.
School approval and parental consent were obtained before
participation in the study. Investigators visited schools, ex-
plained the purpose of the study to students and teachers,
and also informed the parents the objective of the study, a guar-
antee of confidentiality, and a contact telephone number of the
prime investigator for any questions and concerns by sending
468 F. Cao et al. / European Psychiatry 22 (2007) 466e471

Table 1 intended? (6) Have you jeopardized or risked the loss of sig-
Age and gender distribution of subjects nificant relationship, job, educational or career opportunity be-
Grade Age Male students Female students Total cause of the Internet? (7) Have you lied to family members,
(years) n (%) n (%) n (%) therapist, or others to conceal the extent of involvement with
Grade 1 of junior 12e14 376 (54.1) 319 (45.9) 695 (26.5) the Internet? (8) Do you use the Internet as a way of escaping
high school from problems or of relieving a dysphoric mood (e.g., feelings
Grade 2 of junior 13e15 325 (51.3) 308 (48.7) 633 (24.2) of helplessness, guilt, anxiety, or depression)? Young asserted
high school that five or more yes responses to the eight questions indicate
Grade 1 of senior 15e17 296 (45.5) 355 (54.5) 651 (24.8)
high school
a dependent user. Beard modified the YDQ criteria. Respon-
Grade 2 of senior 16e18 319 (49.8) 322 (50.2) 641 (24.5) dents who answered ‘‘yes’’ to questions 1 through 5 and at
high school least any one of the remaining three questions were classified
Total 1316 (50.2) 1304 (49.8) 2620 (100.0) as suffering from Internet addiction [2]. Beard stated that the
modification may help strengthen Young’s proposed criteria.
In previous publications about YDQ, the split-half reliability
a letter. All parents were assured that they were free to refuse was 0.729 and the Cronbach a was 0.713 [11]. In our study,
if they did not agree with the objective of the study. The re- the calculation of a SpearmaneBrown coefficient resulted in
search project has been approved by Ethics Committee of a split-half reliability of 0.719.The consistency of the YDQ
the Second Xiangya Hospital. was tested with Cronbach’s a 0.722. Thus, the YDQ has
a good reliability and consistency.
2.2. Group selection

Internet addicted individuals who met the modified YDQ
criteria were administered a structured clinical interview (K-
SADS) for Diagnostic and Statistical Manual of Mental Disor-
ders, Fourth Edition. Participants who evidenced any DSM-IV
axis I disorder were not included. The diagnosis was made on
the basis of clinical observation and history provided by the
parents and the patients themselves. Finally, 50 students who
were diagnosed as Internet addicted were included in the
case group. Fifty normal students were matched by gender,
age and educational levels from among the lists of students
with the same age, gender, level of education and class. Inde-
pendent t-tests showed that age and educational levels did not
differ between the Internet Addiction group and the control
group (P > 0.05). Chi-square test indicated no differences be-
tween the groups in distribution of gender (P > 0.05).
2.3. Measures
2.3.1. Basic Information Questionnaire
We used the Basic Information Questionnaire to collect de-
mographic information such as age, gender, educational levels,
and Internet experience.
2.3.2. Diagnostic Questionnaire for
Internet Addiction (YDQ)
YDQ was adapted from DSM-IV criteria for pathological
gambling by Young [23]. YDQ consisting of eight ‘‘yes’’ or
‘‘no’’ questions was translated into Chinese. It includes the
following questions: (1) Do you feel preoccupied with the In-
ternet (think about previous online activity or anticipate next
online session)? (2) Do you feel the need to use the Internet
with increasing amounts of time in order to achieve satisfac-
tion? (3) Have you repeatedly made unsuccessful efforts to
control, cut back, or stop Internet use? (4) Do you feel restless,
moody, depressed, or irritable when attempting to cut down or
stop Internet use? (5) Do you stay online longer than originally
2.3.3. Barratt Impulsiveness Scale 11 (BIS-11)
BIS-11 is a questionnaire on which participants rate their
frequency of several common impulsive or nonimpulsive be-
haviors/traits on a scale from 1 (rarely/never) to 4 (almost al-
ways/always). The 11th version of the BIS consists of 30 items
and can be divided into three subscales including attentional
key, motor key, non-planning key, to determine overall impul-
siveness scores, all items were summed, with higher scores in-
dicating greater impulsivity [17]. We used the translated
version by Li et al.; its split-half reliability was 0.752, the
testeretest reliability was 0.825, and the Cronbach a coeffi-
cient was 0.794 [13].
2.3.4. GoStop Impulsivity Paradigm (GoStop)
GoStop is a response disinhibition procedure for assessing
the capacity to inhibit an already initiated response. For the
GoStop, subjects are shown a series of 5-digit numbers in
black on a computer screen. The randomly generated 5-digit
numbers appear for 500 ms, once every 2 s (500 ms on,
1500 ms off). Participants are told to respond when the num-
ber they see is identical to the previous number; this is a tar-
get trial. Half of all target trials feature a target-stop trial,
when the color of the matching target’s numerals changes
from black to red at 50, 150, 250, or 350 ms after its presen-
tation. Participants are instructed to respond to the identically
matching numbers before the number disappears from the
screen, but not to respond to a number that turns red. Target
and target-stop trials each occur 25% of the time. The re-
maining 50% of the trials consist of numbers that differ ran-
domly from the previous number. Within the target-stop
trials, the interval the target remains black (go) before turn-
ing red (stop) has an equal probability of a 50, 150, 250, or
350 ms duration [9].
The failure to inhibit responses was used as an indicator of
ability to withhold responses when presented with a stop-signal.
The number of target-stop stimuli that the participant did not
 F. Cao et al. / European Psychiatry 22 (2007) 466e471 469

respond to was used to calculate the number of failure to inhibit
responses from the total presentations for each delay condition.
A computer with a 14-inch monitor was used to administer
GoStop. Participants were asked to use their dominant hand
when responding on the task. They received standardized
task instructions before the computer tasks. All subjects com-
pleted one session of GoStop task.
attentional key, motor key, and total scores for the Internet
Addiction group (P < 0.05).
As can be seen in Table 3, there was significant difference
between the groups’ ability to withhold responses. The Inter-
net Addiction group demonstrated more difficulty withholding
responses than the control group at the 50, 150, 250, and 350
stop signal delays.

2.4. Statistical analysis 3.4. Relationship between Internet

Group differences in demographic variables were computed
using independent t-test and chi-square test. The differences in
BIS-11 and GoStop scores between Internet addiction group
and the control group were analyzed using independent t-
test. The correlation between Internet addiction and BIS-11
and GoStop scores was assessed using Pearson’s correlations
analysis. Statistical significances were defined at the 0.05
level, two-tailed.
3. Results
addiction and impulsivity
Pearson correlations were used to examine the relationship
between YDQ scores and impulsivity level. Table 4 shows
that, YDQ scores correlated positively with BIS-11 attentional
key, motor key, and non-planning key scores. There was a sig-
nificant positive correlation between YDQ scores and the
number of failures to inhibit responses of GoStop. There
was also a significant positive correlation between BIS-11
and GoStop scores. All correlations demonstrated statistical
significance (P < 0.05).

3.1. Ongoing main Internet activities

According to the students’ self-report, the Internet was used
mainly for virtual games (78.1%), chat room activity (14.2%),
school-related activities (4.1%), and other (3.6%). There was
no significant difference between the Internet Addiction group
and the control group (P > 0.05).
3.2. Psychiatric comorbidity
Of the 2620 participants who fully completed the survey, 64
participants met the criteria for Internet addiction. Of the 64
participants with Internet addiction, 1 participant fulfilled
DSM-IV criteria for obsessive-compulsive disorder (OCD), 2
for conduct disorder (CD), 2 for oppositional defiant disorder
(ODD), 1 for depressive disorder, and 8 for attention deficit
hyperactivity disorder (ADHD).
3.3. Comparison of impulsivity between Internet
Addiction group and control group
A comparison of average BIS-11 scores in the Internet Ad-
diction group and control group is shown in Table 2. Compared
to the control group, we observed significantly higher
4. Discussion
This study primarily focused on examining the relationship
between impulsivity and Internet addiction among Chinese ad-
olescents. As predicted, Internet addiction subjects were more
impulsive than controls as measured by both the BIS-11 and
GoStop. The Pearson correlation analysis indicated there was
a moderate positive relationship between YDQ scores and
BIS-11 scores, and the number of failures to inhibit responses.
This study supports the concept that Internet addiction should
be considered as an impulse control disorder [23]. Similar re-
search in other countries has also pointed out this relationship.
For example, a study by Treuer et al. reported that Internet ad-
diction is a new subtype of impulse control disorder [18].
Since the BIS-11 is considered more of a trait measure of
impulsivity, this supports the hypothesis that impulsivity is
a risk factor for the development of Internet addiction. How-
ever, since subjects were not abstinent from Internet overuse,
it cannot be ruled out that at least part of the increase in impul-
sivity in Internet Addiction subjects was due to effects of In-
ternet addiction. Further research is needed to conclusively
determine whether impulsivity per se is a significant risk factor
for development of Internet addiction, or a result of Internet
addiction, or both.

Table 2 Table 3
Difference between Internet Addiction group and the control on BIS-11 Difference between Internet Addiction group and the control on the number of
(mean  SD) failure to inhibit responses (GoStop) (mean  SD)
Variable Internet Addiction group Control group t P Trial type Trials Internet Addiction group Control group t P
(n ¼ 50) (n ¼ 50) (n ¼ 50) (n ¼ 50)
Attentional key 31.47  4.20 28.88  4.31 3.03 <0.05 50 ms Stop 20 6.96  2.44 3.66  1.70 7.85 <0.05
Motor key 24.33  3.94 22.20  4.20 2.58 <0.05 150 ms Stop 20 11.76  2.14 7.50  3.51 7.32 <0.05
Non-planning key 20.57  2.71 19.50  3.06 1.85 >0.05 250 ms Stop 20 15.10  2.35 10.86  2.88 8.07 <0.05
Total scores 76.37  8.56 70.69  9.77 3.06 <0.05 350 ms Stop 20 17.66  1.60 14.00  2.22 9.45 <0.05
BIS-11, Barratt Impulsiveness Scale-11. GoStop, GoStop Impulsivity Paradigm.
470 F. Cao et al. / European Psychiatry 22 (2007) 466e471
Table 4
Correlation matrix between psychometric variables
YDQ Attentional key Motor key Non-planning key
YDQ e 0.389** 0.409** 0.228*
Attentional key e 0.495** 0.607**
Motor key e 0.489**
Non-planning key e 0.251*
50 ms Stop
150 ms Stop
250 ms Stop
350 ms Stop
*P < 0.05; **P < 0.01. YDQ, Diagnostic Questionnaire for Internet Addiction.
We also found that the number of failures to inhibit re-
sponses on the GoStop was correlated with BIS-11 personality
factors, suggesting that this task may measure a similar con-
struct of impulsiveness with BIS-11 inventories.
This study differs from previous studies showing increased
impulsivity in that it included a variety of different measures
of impulsiveness, including behavioral and personality mea-
sures. In previous studies a single measure of impulsivity
was administered to Internet Addiction subjects. For example,
Lin and Tsai examined excessive Internet use of Taiwanese ad-
olescents and sensation seeking by using the Sensation Seeking
Scale Taiwan version. They found Internet-dependent adoles-
cents scored significantly higher in terms of overall sensation
seeking and disinhibition than the Internet non-dependents,
disinhibition being the most important predictor of Internet
dependence [14].
In addition, our results indicate that some adolescents use
the Internet excessively, and a total of 2.4% could be described
to suffer from ‘‘Internet addiction’’. Owing to the different
sample, and different social and cultural contexts, and also
the rigid modified YDQ criteria by Beard which we used, it
is difficult to compare the findings effectively. Nonetheless,
the Internet Addiction percentage varied considerably.
The students with Internet addiction suffered from comorbid
psychiatric disorders, especially comorbid ADHD. The result is
similar to another study which found significant associations
between the level of ADHD symptoms and the severity of Inter-
net Addiction in children [21]. Though we cannot conclude that
Internet addiction is a cause or consequence of these disorders,
clinicians must consider the comorbid psychiatric disorder in
cases of Internet addiction.
This study used YDQ scores of higher than 6 as an indicator
of Internet addiction. Although this questionnaire is a frequently
used instrument for assessing Internet addiction, its validity as
a diagnostic instrument has been questioned [3]. Future studies
may utilize other measures of assessing diagnostic criteria for
Internet addiction or severity of Internet addiction problems
to assess the relationship between impulsivity and Internet
addiction problems.
In conclusion, the results of this study show a specific rela-
tionship between impulsivity and Internet addiction and sup-
port the need for further research on impulsivity as a risk
factor for the development of Internet addiction. Subsequent
studies may investigate further the origin of impulsivity and
its relationship to Internet addiction.
50 ms Stop 150 ms Stop 250 ms Stop 350 ms Stop
0.461** 0.475** 0.460** 0.508**
0.297** 0.148 0.186 0.213*
0.225* 0.239* 0.274* 0.275*
0.157 0.096 0.220*
e 0.516** 0.445** 0.445**
e 0.627** 0.526**
e 0.633**
e
Acknowledgements
This work was supported by grants from National Natural
Science Foundation of China (No. 30370521) and National Nat-
ural Science Foundation of China (No. 30570659). The authors
do have not any competing interest in relation to this paper.
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