A study in in PLOS Mental Health suggesting that in teens with “internet addiction”, there is a disruption of the signalling between brain regions important for controlling attention and working memory – borne out by many youngsters who spend excessive time on social media battling to focus on things like homework or family – has been criticised by some experts.
After their review of 12 neuroimaging studies of a few hundred adolescents aged 10 to 19 between 2013 and 2022, the authors wrote in PLOS Mental Health that “behavioural addition brought on by excessive internet use has become a rising source of concern in the past decade”.
The criteria for clinical diagnosis of internet addiction in the included studies were “one’s persistent preoccupation with the internet, withdrawal symptoms when away from the internet, and sacrificing relationships (for) time to spend on the internet over an extended period of time”, said Max Chang, first author of the study and outreach case manager at the non-profit Peninsula Family Service in San Francisco.
“Given the changing state of adolescent brains compared with adults, understanding the impacts of internet addiction on the teenage participants’ brains was vital,” he said.
CNN reports that currently, in the United States, internet addiction isn’t included in the DSM-V — the Diagnostic and Statistical Manual of Mental Disorders, the standard classification of mental disorders used by mental health professionals in America.
It does, however, list internet gaming disorder.
All of the studies the authors reviewed were conducted in Asia and consisted of mostly male participants. China was the first country to declare internet addiction a “public health crisis”.
Limitations, say critics
“While this paper presents a straightforward systematic review suggesting that there are associations between functional connectivity in the brain and internet ‘addiction,’ there are a number of fundamental limitations … that are critical to any interpretation,” said Dr David Ellis, a behavioural scientist at the University of Bath’s Institute for Digital Security and Behaviour, who wasn’t involved in the study.
“Cause and effect cannot be drawn from these studies,” he added. “Second, the focus on functional connectivity comes at the expense of any critique about the key measure of interest. Specifically, internet ‘addiction,’ which was initially conjured up by (psychiatrist) Ivan K. Goldberg in 1995 as a joke.
“Today, the conceptualisation and measurement of internet ‘addiction’ is neither universally accepted and certainly not diagnosable using the survey instruments used in the studies included as part of the review,” Ellis added. “Similarly, the enormity of activities that the internet allows for immediately makes this definition somewhat redundant.”
He said that such definitions, despite being widely critiqued, “also have a tendency to move the focus away from genuine online harm and towards a conclusion that suggests the removal of technology from people’s lives will be helpful”.
“Solid evidence to suggest that removing the internet brings any tangible benefits has not been forthcoming.”
Chang and his team said their findings showed that “the pattern of behaviour results in significant impairment or distress in the individual’s life”, that when participants clinically diagnosed with internet addiction engaged in activities governed by the brain’s executive function network – behaviours requiring attention, planning, decision-making and impulse control – those brain regions showed substantial disruption in their ability to work together, compared with peers without internet addiction.
The authors said such signalling changes could suggest these behaviours can become more difficult to perform, potentially influencing development and well-being.
One point in time
Dr Eva Telzer, a professor of psychology and neuroscience at the University of North Carolina, who wasn’t involved in the study, pointed out that all of the studies were conducted at “one point in time”.
“Given that there are no longitudinal data,” she said, “it is very possible that adolescents who have underlying differences in brain connectivity patterns are more vulnerable to developing internet addiction.”
In similar vein, Dr Smita Das, an addiction psychiatrist and clinical associate professor of psychiatry and behavioural sciences at Stanford Medicine – who was also not involved in the study – said that if internet addiction is what caused the disruption in participants’ brain signalling, the reason why may have to do with neural pathways related to addiction.
The functional connectivity patterns in participants’ brains are, in fact, in line with those observed in people with substance addictions, said Dr Caglar Yildirim, an associate teaching professor of computer science at the Khoury College of Computer Sciences at Northeastern University in Boston. Yildirim wasn’t involved in the study.
“Overall, the mechanisms underlying internet addiction are more like an emerging pattern than a finished picture,” Chang’s team had said. “A lot of causality between what happens in the brain and what is displayed through behaviour is still being understood. As of now, observation using biomarkers such as functional connectivity helps bridge that gap.”
Behaviours like withdrawing from relationships were a telltale sign, he said. “Similar to substance and gambling disorders, internet addiction rewires the brain, making it harder to resist internet related stimuli.
“However, unlike gambling or substance usage, the internet is an important part of our lives. Balancing the usefulness and dangers of the internet is a field that is very crucial going forward in adolescent development.”
Das recommended parents talk to their child’s doctor to see if behavioural strategies can work – like cognitive behavioral therapy, mindfulness and motivational interviewing.
The latter, which originated in the field of addiction treatment, is a counseling method that aims to increase a patient’s motivation for, and commitment to, behavioural change by eliciting and exploring the patient’s own reasons for wanting change.
In severe cases, a psychiatrist may suggest medication to treat certain types of technology addiction, Das added.
“In addition to treating the internet addiction, there may be other underlying mental health conditions that should also be given attention. Other preventative measures include limiting screen time.”
Technology addictions have become prevalent enough for the American Psychiatric Association to include it as a topic in its presidential initiative for 2023 to 2024, said Das, immediate past-chair of the APA’s council on addictions.
Study details
Functional connectivity changes in the brain of adolescents with internet addiction: A systematic literature review of imaging studies
Max Chang, Irene Lee
Published in PLOS Mental Health on 4 June 2024
Abstract
Internet usage has seen a stark global rise over the last few decades, particularly among adolescents and young people, who have also been diagnosed increasingly with internet addiction (IA). IA impacts several neural networks that influence an adolescent’s behaviour and development. This article issued a literature review on the resting-state and task-based functional magnetic resonance imaging (fMRI) studies to inspect the consequences of IA on the functional connectivity (FC) in the adolescent brain and its subsequent effects on their behaviour and development. A systematic search was conducted from two databases, PubMed and PsycINFO, to select eligible articles according to the inclusion and exclusion criteria. Eligibility criteria was especially stringent regarding the adolescent age range (10–19) and formal diagnosis of IA. Bias and quality of individual studies were evaluated. The fMRI results from 12 articles demonstrated that the effects of IA were seen throughout multiple neural networks: a mix of increases/decreases in FC in the default mode network; an overall decrease in FC in the executive control network; and no clear increase or decrease in FC within the salience network and reward pathway. The FC changes led to addictive behaviour and tendencies in adolescents. The subsequent behavioural changes are associated with the mechanisms relating to the areas of cognitive control, reward valuation, motor coordination, and the developing adolescent brain. Our results presented the FC alterations in numerous brain regions of adolescents with IA leading to the behavioural and developmental changes. Research on this topic had a low frequency with adolescent samples and were primarily produced in Asian countries. Future research studies of comparing results from Western adolescent samples provide more insight on therapeutic intervention.
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