Table 2.

Brief case vignettes of youth use of technology on a spectrum from normal to problematic use

Vignette 1. Presentation. Art is a 17-year-old male who is texting a lot to others about hobbies, recent events, and morbid thoughts. Friends notified his mother who contacted his past therapist. (He has a history of depression and was in therapy at age 11 after losing interest in school/hobbies and conflict with his siblings and parents.) He was texting to friends about stories in the paper in which people died; his friends seemed to be withdrawing and he complained about that. He went on to say that “So what if someone died…it’s not that big of a deal.” His mother’s question was “Is this just teen angst or a sign of a problem?” Triage/assessment/plan. A prompt phone call was helpful and a plan was put together: (1) the parents would check in with Art to try and understand the situation better; (2) the mother would speak with his teachers(s) and guidance counselor; and (3) a new clinical intake would be set up for Art. Moderate (but not imminent) risk of danger was based upon: (1) history of depression, (2) peer concerns over his text messaging, and (3) morbid thoughts.

Vignette 2. Presentation. Tameka is a 13-year-old female whose parents report nearly continuous use of social media since she got her new smartphone (e.g., texting friends during meals, sharing Instagram pictures throughout family vacations, and watching YouTube videos and chatting online while during her homework). Tameka continues to maintain her grades, but her family wants to know “How much is too much?” Triage/assessment/plan. In this scenario, Tameka’s family is concerned about Tameka’s Internet use, but it has not affected her grades (yet). The clinician or school counselor might consider screening for problematic Internet use (PIU) using the PRIUSS-3 and if Tameka scores a 3 or higher, she could then be evaluated with the PRIUSS-18 to identify whether she may have a problematic Internet use (PIU) syndrome. Whether or not Tameka has a problematic Internet use, Tameka and her family may benefit from a Family Media Use Plan per the American Academy of Pediatrics to build shared expectations, goals, and rules for media use.

Vignette 3. Presentation. Joseph is a 15-year-old boy who was referred to a psychiatrist for inattention, hyperactivity, falling grades, and increasingly oppositional behavior. Joe had previously earned good grades and did well on sports teams, so they did not pursue evaluation or treatment. Now, he seems not to care about homework, is failing one subject, and his other grades are low. Notably, he did not sign up for baseball. The family wondered about drug use, but a urine drug test was negative. Last week his father found him playing a video game at 4:00 a.m. Triage/assessment/plan. In this scenario, Joseph may have symptoms of ADHD or depression and/or PIU. A full psychiatric assessment is indicated, including information from parents, pediatrician, and teachers. A full media-use history (PRIUSS-18 and/or questions from Table 3) may be especially helpful. Non-judgmental rapport-building will be crucial to engaging Joseph to learn what gaming means to him and how it got out of hand (e.g., escape from stresses, to maintain contact with peers, and/or as stimulation-seeking). Psychoeducation will help the family structure and limit his online time (e.g., after he completes homework). Moving the gaming console from his bedroom to a better place to monitor in the house may also help.

Vignette 4. Presentation. Aaron, an 11-year-old boy is popular and well-connected who begins to post pictures of drug use and YouTube links with mature themes after hours. He no longer spends face-to-face social time with friends but continues to do well academically. Furthermore, his friends have told their parents about his postings, and about an “alternate” Instagram persona Aaron has named “Andre the Giant,” where he posts his most provocative pictures and links. Triage/assessment/plan. It is important for Aaron’s parents to share their and others’ specific concerns regarding online content. Rules for responsible Internet use should be reviewed in line with family values and beliefs (e.g., respectful and responsible posts). The parents may also remind Aaron that social media and phone use are a “privilege” and not a “right,” and set up consequences for problematic posts.