Problematic internet usage among children in the new normal digital age: A kaleidoscopic view

Dear Editor,

As part of containment measures during the ongoing COVID-19 pandemic, schools have been shut down, and globally, an estimated 1.2 billion children from 186 countries are out of their classrooms (World Economic Forum, 2020). Concurrently, there has been a rise in digital learning or e-learning, wherein teaching is imparted remotely and through digital platforms. This adoption of e-learning approaches may continue and outlast the pandemic itself.

Increased screen time exposure coupled with possible low levels of parental supervision, amidst the pandemic induced disruption, means that children have unrestricted access to the internet, information, and peers. This may partly explain the documented rise in behavioral addictions, such as problematic internet usage (King et al., 2020) and gaming (Ko and Yen, 2020) during COVID-19, with the most significant impact among children and adolescents. This phenomenon is of particular relevance because Internet Addiction (IA) engenders structural and functional neurocircuitry changes in the brain with implications for subsequent mental health and substance use (Tripathi, 2017).

Evidence-based treatments for internet addiction include pharmacological interventions using anti-depressants, psychostimulants and a host of psychotherapies that focus on behavior modification such as cognitive behavior therapy, reality therapy, and multi-family group therapy (Winkler et al., 2013). In this report, we focus on the challenges involved in making a diagnosis of Internet Addiction (IA) and Internet Gaming Disorder (IGD), and by extension, problematic internet usage, during this new normal digital age, and provide suggestions from the standpoint of early recognition and intervention among children and adolescents.

1. Issues and challenges in making a diagnosis of IA/IGD during the digital age

Several criteria have been proposed to make a diagnosis of IA (Young, 1998) and IGD, including that by the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (American Psychiatric Association, 2013). There are many common elements to these criteria, and at least three of them; excessive time spent on internet activities, excessive efforts spent to obtain access to the internet, and use of the internet for a while longer than intended, are challenging to establish during times such as these because students have easy access to the internet and may require to be online even beyond their regular school hours to complete homework assignments and to maintain social connectedness.

Further, teachers may find it challenging to recognize internet addiction symptoms as schools are no longer functioning, and there is a lack of personalized attention during online teaching. It may also be difficult for parents to identify tolerance, defined as an increase in the duration of internet use to achieve satisfaction, which is another key criterion for diagnosing IA and IGD. Parents may also be more permissive towards internet usage and less likely to monitor for pathological internet use during these times. Due to these considerations, the possibility of both overdiagnosis and underdiagnosis of IA and IGD exists.

2. Suggestions for early recognition and intervention

• ØProvide orientation and sensitization about behavior addiction to key stakeholders – early warning signs and symptoms of behavioral addiction may be explained to parents, teachers, and students themselves. Examples of these include excessive irritability, difficulty completing homework, attentional deficits, and academic decline. Through online parent-teacher meetings, better communication between teachers and parents may help share concerns and facilitate early recognition of issues.
• ØEmphasis on specific diagnostic criteria - We suggest that more emphasis be paid to the salience of internet use; this may include excessive preoccupation with internet use and, simultaneously, loss of interest in age-appropriate activities such as playing games and reading. The behavioral patterns also need to be compared with pre-pandemic routines and behaviors, which will help recognize unusual and potentially dysfunctional behavior patterns early.
• ØGreater attention must be paid to at-risk individuals – these include those with a history of substance use disorders or other forms of behavioral addiction such as pornography or those hailing from dysfunctional family backgrounds with a history of domestic violence or discordant inter-personal relationships.⁴
• ØParental monitoring of children's internet usage can be conveniently done by installing parental control software, such as Qustodio and OpenDNS Family Shield. These prevent children from accessing inappropriate and unsuitable content online and help keep them safe from hackers, who may prey upon gullible young minds to further their nefarious designs.
• ØPrioritize activity scheduling for children – This includes adequate time for rest, leisure, and physical activities. Parents should act as role models for children by limiting their own screen time. Engaging in joint activities (such as playing videogames with children) is another method to establish some control over children's internet usage.

To sum up, there is a need to revisit diagnostic criteria and symptom thresholds for the diagnosis of IA and IGD during the present times. Early recognition and focus on high-risk sub-groups will help in early intervention and limiting the impact of emergent behavioral addiction on children and adolescents.

Declaration of Competing Interest

The authors declare no conflicts of interest relevant to the contents of the manuscript.