Gadget/Screen/

Internet Addiction Click icon to add picture

Kuliah Hasrini Rowawi, dr., Sp.KJ(K), MHA

Introduction
increasing reliance on technology devices
children are excessively immersed in electronic
gadgets

Study in Asia : children aged from 12 to 18 years

held ownership of smartphones at a rate of 62%
overall

Gadget/Screen Addiction : Dependency to gadget 

problem in social and daily activities

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 Kai Yee, Hon & Bee Seok, Chua & Hashmi, Shazia. (2016). WHY GADGET USAGE AMONG
PRESCHOOLERS SHOULD MATTER TO TEACHERS? A PILOT STUDY. Education Science and
Psychology. 3. 98-111.
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 Screen Dependency Disorders (SDD): Diagnostic
Diagnostic criteria typically include the terms commonly used in the classification of screen-
following features: related dependencies
• preoccupation • Internet addiction disorder
• Internet Gaming Disorder
• withdrawal symptoms • Problematic internet use
• increasing tolerance • Compulsive internet use
• failure to reduce or stop screen activities • Pathological video game use
• Video game addiction
• loss of outside interests • Pathological technology use
• continuation despite negative • Online game addiction
consequences • Mobile phone dependence
• Social network site addiction
• lying about extent of use • Facebook addiction
• use to escape adverse moods • Internet pornography addiction

Sigman A. Screen Dependency Disorders: a new challenge for child neurology. JICNA 2017, 17:119
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 Biological Evidence

NEUROADAPTA NEURORECEP
TION TOR
ABNORMALITI
ES
STRUCTURAL SCREEN FUNCTIONAL
ABNORMALITIES DEPENDENC ABNORMALITI
Y ES

DOPAMINERGIC CHANGES IN
DYSFUNCTION MESOLIMBIC
SYSTEM
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NEUROADAPTAT
ION
exposure to videogame playing during
childhood  neuroadaptation and
structural changes in neural regions
associated with addiction

increased video game play is directly or

indirectly associated with delayed
development of the microstructure in
extensive brain regions
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Changes in MD over 3 years were observed in
clusters spread throughout gray and white matter
areas of the left basal ganglia, left medial
temporal, bilateral thalamus, ventral parts of the
prefrontal cortex, right insula, left middle and
inferior temporal, fusiform and left occipital
lobe.(Takeuchi et al 2016)
DOPAMINERGIC
DYSFUNCTION
Videogame playing has been associated with
dopamine release similar in magnitude to that of
drugs of abuse
Nuclear imaging research indicates that SDD is
associated with dysfunction of dopaminergic
systems.
Abnormal dopamine regulation of the prefrontal
cortex [PFC]enhanced motivational value and
loss of control over screen activity such as
gaming, typical of ‘addicted’ subjects
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 NEURORECEPTOR
ABNORMALITIES
Reduced dopamine D2 receptor availability
in the striatum compared to controls
low level of dopamine D2 receptor in the striatum
was correlated with decreased glucose metabolism
in the orbitofrontal cortex loss of control and
compulsive behavior
increased levels of endogenous dopamine
enhance neurotoxicity in the striatum
induced by other agents and processes
exposing either striatal neurons to dopamine
 ‘dose-dependent cell death’
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CHANGES IN MESOLIMBIC SYSTEM
repeated exposure to nondrug rewards can
induce neural plasticity in addiction-related
circuitry. In some children, this may
contribute to compulsive engagement in
screen-related activities that resembles
substance addiction
mediated by the gene transcription
factor ΔFosB
STRUCTURAL
ABNORMALITIES
Ventral tegmental area, nucleus accumbens,
caudate nucleus, putamen, thalamus and
amygdala, as well as cortical projection areas such
as the prefrontal cortex (PFC), orbitofrontal cortex,
anterior cingulate cortex and insula

Regions highlighted in yellow/orange indicate significantly less

Fractional Anisotrophy and Axial Diffusivity measures of WM
integrity of cingulum bundle fibers in the hippocampus of
subjects classified as mobile phone dependent. Wang, Zou,
Song et al. 2016)
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 FUNCTIONAL
ABNORMALITIES
• abnormal functional connectivity within central executive networks and
effective connectivity within salience network along with inefficient
interactions between the two in IGD adolescents (Yuan et al. (2016))

• reduced regional centralities in the prefrontal cortex, left posterior

cingulate cortex, right amygdala, and bilateral lingual gyrus, and
increased functional connectivity in sensory-motor-related brain
networks

Sigman A. Screen Dependency Disorders: a new challenge for child neurology. JICNA 2017, 17:119
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 RISK FACTORS
Environtment :
Prenatal exposure to higher levels of
androgens and a resultant ‘hyper-male Availability of Gadget
brain organization’ are associated with and
‘problematic video gaming behavior’ Internet
and ‘video game addiction’
Psychological
The type and amount of media children
consume (violent) has been associated with a
ADHD
specific gene 5-HTTLPR polymorphism, in Depression
5 to 9 year olds and it is thought that due to Social Anxiety
their genetic disposition, children may
actively seek specific media content
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 DIAGNOSIS

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 Diagnostic Criteria

DSM-V

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision.American
Psychiatric Association Publishing;2022.
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In the ICD-11 definition, GD is categorized as a disorder due to addictive
behaviors, and is “a pattern of persistent or recurrent gaming behavior (“digital
gaming” or “video-gaming”), which may be online (i.e., over the Internet) or
offline, and manifested by the following three criteria:
(1) impaired control over gaming (e.g., onset, frequency,
intensity, duration, termination, context),
(2) increasing priority given to gaming to the extent that
gaming takes precedence over other life interests and daily
activities, and
(3) continuation or escalation of gaming despite the
occurrence of negative consequences
ICD-
11
World Health Organization. International Classification of Disease 11th Revision. World Health Organization.; 2022. Tersedia dari:
https://icd.who.int/en.
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For gaming disorder to be diagnosed, the
behavior pattern must be of sufficient severity
to result in significant impairment in personal,
family, social, educational, occupational, or
other important areas of functioning.
The pattern of gaming behavior may be
continuous or episodic and recurrent.
The gaming behavior and other features are
normally evident over a period of at least 12
months in order for a diagnosis to be
assigned, although the required duration may
be shortened if all diagnostic requirements are
met and symptoms are severe
 Effect of Internet/Gadget Addiction
Brain Psychology
• Lower Focus Ability • Anger
• Lower Memory • Anxiety
Capacitty • Aggresion
• Negative Social • Loneliness
Cognition • Risk of Suicide

Physical
Social
• Unbalanced • Relationship problems
Nutrition with friends of Family
• Sleepiness and
Tiredness
• Visual Problem
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 TREATMENT
• CBT
• Multidimensional Family
Therapy Approach (MDFT)
• Commorbidity

Pharmacotherapy +
cognitive behavioral therapy
(CBT) or multi-level
counseling (MLC) to be the
best treatment
Chang CH, Chang YC, Yang L, Tzang RF. The Comparative Efficacy of Treatments for Children and Young Adults with Internet Addiction/Internet Gaming Disorder: An
Updated Meta-Analysis. Int J Environ Res Public Health. 2022 Feb 24;19(5):2612. doi: 10.3390/ijerph19052612. PMID: 35270305; PMCID: PMC8909504.

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 PREVENTION
Digital Detoxification Limit Internet or Screen
• Turn-Off Notification
• Alternative activities
Usage
• 1 Day Per week stop • <1.5 y.o : 0 hour
Playing • 1.5-2 y.o : 0-1 hour
• 2-5 y.o : < 1 hour
• 6-17 y.o : 2 hour beside
schoolwork

Pappas, S. (2022, June 30). What do we really know about kids and screens? Monitor on Psychology, 51(3).
https://www.apa.org/monitor/2020/04/cover-kids-screens
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 Case
• A seven-year-old boy was brought to a mental health clinic with complaints of
refusing to go to school and spending most of his time on his smartphone. The
parents mentioned that since the age of 2, they had accustomed their child to
using a smartphone to watch videos from social media platforms. They did this
to keep the child calm and prevent them from becoming fussy or crying.
Currently, the child refuses to be separated from their gadget. The parents have
tried to limit its usage, but the child becomes angry and insists on having the
smartphone.

• The child was diagnosed with gadget addiction and received therapy to reduce
the dependency.
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Thank
you
 REFERENCES

Sigman A. Screen Dependency Disorders: a new challenge for child neurology.

JICNA 2017, 17:119
Chang CH, Chang YC, Yang L, Tzang RF. The Comparative Efficacy of Treatments for
Children and Young Adults with Internet Addiction/Internet Gaming Disorder: An Updated
Meta-Analysis. Int J Environ Res Public Health. 2022 Feb 24;19(5):2612. doi:
10.3390/ijerph19052612. PMID:
Pappas, S. (2022, June 30). What 35270305; PMCID:
do we really PMC8909504.
know about kids and screens? Monitor on
Psychology, 51(3). https://www.apa.org/monitor/2020/04/cover-kids-screens

World Health Organization. International Classification of Disease 11th Revision. World

Health Organization.; 2022. Tersedia dari: https://icd.who.int/en.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders

Fifth Edition Text Revision.American Psychiatric Association Publishing;2022