WikiJournal Preprints/Digital media use, ADHD, and "right brain dominance" - a multidisciplinary collaborative review

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Author: Peter James Chisholm Orcid icon.png [a], et al.

Chisholm, P; et al.. 




Abstract

Digital media use has been complicated by digital media overuse, variously termed digital addictions or digital dependencies. These constructs are biopsychosocial, cultural and medical phenomena, that behave differently in various societies and cultures. Their terminology should be based on the preference of the person who has the condition or the phenomenon. As each individual has risks and benefits from their interactions with pervasive modern technologies, consideration and treatment needs to be individualised and multidisciplinary.

The phenomena or medical conditions have been shown to be associated with the psychiatric category of attention deficit hyperactivity disorder. In order to address these correlated conditions, an ontological, meta-scientific debate is required. It should have a highly etymological leaning, involving all associated fields, including psychoanalysis and philosophy. This may assist in avoiding linguistic misunderstandings in the dominant language, the medical language, which may cause unintentional or perceived stigmatisation. Misunderstandings occur especially amongst the young and most marginalised, the most likely to be affected, or in moral panic due to increasing media attention.

Social media addiction has been suggested since 2009 or prior as a medical disorder, and internet addiction has been proposed since 1996. However, social media addiction is not recognised by the Diagnostic and Statistical Manual of Mental Disorders, partially due to longstanding medical controversies around the diagnosis of ADHD. The English term "addiction" has repetitively come under question when discussing these phenomena.

Social media and other digital media overuse has unintentionally often profoundly altered the ways that children and adolescents think, interact and develop, some in a positive way, and some in a very negative way. Whilst mental health problems have occurred throughout human history, scientists are unclear as to the direct links between social media and mental health outcomes at present. They appear to depend on the individual, and the social media platform used.

Those with risk of ADHD are at risk of developing other neuropsychiatric conditions when untreated. Multidisciplinary collaboration and destigmatisation of language is required to address these complex rapidly developing crises.

Background[edit]

A section of the internet mapped in 2005.
This map represents than 30% of the Class C internet networks reachable by the Opte Project's data collection program in early 2005

The internet is a worldwide network originally developed from the ARPANET, as a method of decentralising data and information storage and retrieval. It is made of cables, often optical fiber, computers, data centres, servers, routers, Wi-Fi and satellites.[1] It was commercialised in 1995. Currently, five Exabytes of information is transmitted with the network per day, which is equivalent to 40,000 films in Standard-definition per second.It is likely that the internet will use one fifth of global electricity by 2025.[2]

Social media began in 1997, with SixDegrees.com, which considered that everyone in the whole world can be connected with "Six Degrees of Separation". 100 million people had access to the Internet by 2000, and MySpace was the first true surge of use of social media. Facebook was invented in 2004, and has 2.27 billion active users in 2018. Facebook Inc also own the social media platforms of Instagram, and WhatsApp.[3]

Internet addiction has been recognised as a disorder for a number of years, especially in the nations of China and South Korea. Most research into technological disorders has focused on internet addiction and gaming disorders, rather than social media directly.[4] Use of the internet and broader subtypes of digital media has been complicated by digital media overuse, variously termed digital addictions or digital dependencies. These constructs are biopsychosocial and cultural phenomena, that behave differently in various societies and cultures.[5] They have been shown to have an association with mental health symptoms,[6] and have been under study and analysis for some years.[7] "Psychologists and sociologists have ... been studying and debating about screens and their effects for (some) years,"[8] as have some anthropologists[9][10] and medical experts.[11] Some reviews have considered evidence of benefits of digital media use, stating that current evidence shows "moderate use of digital technology is not intrinsically harmful and may be advantageous in a connected world",[12] however a 2019 systematic review of reviews found no evidence of net health benefits yet proven scientifically.[7]

From a medical perspective, in 2010, Professor Dimitri Christiakis published, "while not (at the time)... officially codified within a psychopathological framework, (internet addiction disorder is)... growing both in prevalence and within the public consciousness as a potentially problematic condition with many parallels to existing recognized disorders", and it may be "a 21st century epidemic".[11] He has also stated that "we're sort of in the midst of a natural kind of uncontrolled experiment on the next generation of children."[13]

A 2014 review of the proposed medical diagnosis of social media addiction stated "while the exclusion of social media addiction from the Diagnostic and Statistical Manual of Mental Disorders may give the impression that social media addiction is not a legitimate mental disorder, there is a growing body of evidence suggesting otherwise."[14][15] "There is empirical evidence indicating that compulsive social media use is a growing mental health problem, particularly among adolescent smartphone users."[15] The concept of social media and its relation to addiction has been examined since 2009.[16] However, the use of the English word "addiction" in relation to these phenomena and diagnoses has come under question.[17]

Attention deficit hyperactivity disorder, or ADHD, is a neuro-developmental disorder, that medical and allied health professionals treat in individualised ways. There are known correlations between Internet gaming disorder, internet addiction, ADHD and social media addiction.[18]ADHD is known to be highly heritable, with several candidate genes proposed. Genome wide association studies have found 12 candidate loci, including FOXP2, which has been studied since 2012.[19] Although inheritance of these and other unknown genes are familial, the environment of the individual and their risk factors in neurodevelopment, including education, internet use, socioeconomic status, and environmental exposures ultimately results in the ADHD symptamotology. The symptoms include inattention, hyper-focus (over-concentrating on specific interesting tasks such as games or social media), impulsivity, emotional dysregulation, and a wandering mind.[20]

A persons left hand with social media icons
Social media addiction

Some medical scientists have shown that girls and women are more likely than boys and men to develop a social media overuse disorder.[21] Girls and women are also less likely to be treated for ADHD, having different symptoms, genetic risk factors and complications. They also "appear to develop better coping strategies than males, and are better able to mask symptoms of ADHD throughout childhood. However, this may no longer work well when they face salient life challenges, such as leaving school, attending college or university, commencing employment, managing intimate relationships, and taking responsibility for their own life decisions."[22]

A meta-analysis by Cochrane Collaboration in 2015 has been controversial with respect to ADHD-related medical issues. Another meta-analysis published in The Lancet in 2018 re-analysed data utilised by the Cochrane publication, together with unpublished additional data, coming to a different conclusion. Both studies included careful methodology to assess the risk of bias in included studies,[23][24], and discussion is ongoing in consensus statements and guidelines.[20][25]

Childhood neurodevelopment[edit]

People with these traits may have been imperative for tribes and societies to respond to pre agrarian ice-ages

From the time they are infants until their early 20s, using the process of synaptic pruning, humans remove billions of neurons in their brain, as they learn and develop connections.[26][27] There is current theory that digital media for those who are susceptible, may affect this process.[28] This may manifest in the symptoms of ADHD, which include emotional dysregulation, inability to focus, hyperactivity and restlessness.[29]

There is long-standing evolutionary theory that the symptoms of ADHD are partially a product of modern society, and that prior to the agricultural revolution, they were adaptive. People with these "symptoms", may have been hunter gatherers in pre-agrarian society, and may have been imperative in advancing human culture especially in oral histories, responding to external environmental and physical threats, and developing novel solutions for difficult problems.[30] As English Wikipedia stated in 2004, whilst "post mortem diagnosis is questionable, it is intriguing to ponder the evidence that people such as Thomas Edison might have been diagnosed as having ADHD if the current DSM criteria had been developed sufficiently long ago. Other historical figures who have been proposed as ADHD candidates include: Hans Christian Andersen, Ludwig van Beethoven, Winston Spencer Churchill, Walt Disney, Benjamin Franklin, Robert and John F. Kennedy, Adolf Hitler, Theodore Roosevelt, Jules Verne and the Wright brothers. Some contemporary ADHD candidates have also been proposed, including George W. Bush, William J. Clinton, Whoopi Goldberg and Dustin Hoffman."[30][31]

Digital addictions have exacerbated these neurodevelopmental problems to such an extent, that all at any risk of addiction genetically, to any addictive substance, are now at high risk.[32] Empirically, the evolutionary theories remain hypothetical,[33] as these complex problems continue to be investigated from a multidisciplinary perspective. Many studies have shown that children’s technology use has greatly increased over the past two decades.[34][35] Moreover, it has been suggested that children in the future may experience having poorer muscle tone because of being hunched over while using the devices.[36]

One review considered "continued concerns about health and developmental/behavioral risks of excessive media use for child cognitive, language, literacy, and social-emotional development, (and) applied (the evidence to) clinical care".[37] Due to the ready availability of multiple technologies to children worldwide, the problem is bi-directional, as taking away digital devices may also have a detrimental effect.[38][39][35]

Although there are many significant sources claiming that the negatives outweigh the positives in children’s technology use, a 2010 study examined the effects of prosocial video game play, correlating it with a child’s ability to feel empathy.[40][41] The use of technology by children can also contribute to the overall improvements of fine motor skills, by playing interactive games and learning screen navigation using buttons.[42]

In regard to childhood technology use, the American Academy of Pediatrics (AAP) developed a Family Media Plan. The intention of such a plan would be to help parents assess and structure their family's use of electronic devices and media more safely.[43] The Canadian Paediatric Society produced a similar guideline. However, a systematic review of reviews published in 2019 commented that these and other national guidelines have been criticised in lacking evidence. They reviewed previous reviews on the issue, concurring that the evidence was of mainly low to moderate quality. However they considered that overall, there is evidence associating sceentime with poorer psychological health including symptoms such as inattention, hyperactivity, low self esteem, and behavioural issues in childhood and adolescence. They did not find evidence for any positive health benefits of screen time. In regard to quality of life, they discussed that "Suchert[44] reported that there was a positive association between screentime and poorer psychological well-being or perceived quality of life in 11/15 studies. Costigan[45] reported a negative association between screentime and perceived health in 4/4 studies.[7]

Multidisciplinary collaboration[edit]

Social media icons

Facebook and other social media companies have come under a lot of criticism over the last few years.[46] Many people together will continue to work on these problems all over the world together. These theories have been very controversial for a very long time.[47][48] However as the science rapidly develops, they are becoming more proven.

Pediatrics[edit]

Professor Dimitri Christiakis, of JAMA Pediatrics, was the lead author of the AAP's Family Media Plan. He especially recommends that parents "avoid digital media use, except video chatting, in children younger than 18 to 24 months."[49] Current research does not have a clear scientific answer as to how much is "too much" screen time or social media time for children. However, the American Academy of Pediatrics recommends limiting children 2-5 years of age to "one hour per day of high quality programming". Professor Christiakis does not recommend ceasing using social media use and other technology use in children, rather recommending parents "have to be mindful is what is being displaced" by technology. He notes that early results in a study involving real toys and iPads at Seattle Children's Hospital are investigating a difference whether very young children more "easily give ... back" real toys or iPads, and research is ongoing.[50]

Digital anthropology[edit]

Graffiti in a cave in Jordan

Anthropologists have been exploring "the borderland between anthropology, medicine and psychiatry" for some decades.[51] Professor Daniel Miller, a professor of anthropology at the University College London, commenced in 2018 a five year study called "ASSA", the Anthropology of Smartphones, Aging and Mental Health. It is based on ethnographies from 15 field sites in Brazil, Chile, industrial and rural China, England, India, Italy, Trinidad and Turkey.[52] He notes that the effects of social media are very specific to individual locations and cultures. He contends that "a layperson might dismiss these stories as superficial. But the anthropologist takes them seriously, empathetically exploring each use of digital technologies in terms of the wider social and cultural context." The University College London offers a free five week course in relation to this, entitled Anthropology of Social Media: Why we Post, as well as offering other free e-books in relation to the issue.[53] Professor Miller states that "On almost any day one can find newspaper articles which tell us we have lost our humanity to smartphone or selfie addiction." "Digital anthropology is an arena within which developments are constantly used to make larger normative and ethical arguments rather than merely observe and account for the consequences of technological change."[54]

Digital anthropology is a developing field which studies the relationship between humans and digital-era technology. Other names for the field include: techno-anthropology,[55] digital ethnography, cyberanthropology,[56] and virtual anthropology.[57] Brian Solis, a digital analyst, anthropologist and keynote speaker working in the field, in 2018 stated "we’ve become digital addicts: it’s time to take control of technology and not let tech control us."[58]

Digital sociology[edit]

Digital sociology, overlapping with digital anthropology and considering cultural geographies, explores "the ways in which people interact with and use digital media using both qualitative methodologies (such as interviews, focus groups and ethnographic research)." It also investigates the various contextualisations of longstanding concerns in relation to young peoples dependence on "these technologies, their access to online pornography, cyber bullying or online sexual predation."[59] A Turkish sociological study in 2012 noted that "various interpretations of religion enable culture-specific observations on Internet consumption patterns, and its relation with different levels of religiosity. The findings revealed that the level of religiosity has a significant effect on the patterns of Internet consumption."[60]

Romanian youths using smartphones

Andrew Przybylski, a psychologist asserted that the United States 2016 presidential election, followed by the publication of several but notably two books[61][62] "is what really inflamed the public's anxiety over the seductive power of screens." "Psychologists and sociologists have obviously been studying and debating about screens and their effects for years," says Przybylski. However, the combination of these elements led to alarmism, and moral panic around these metascientific theories whilst lacking direct evidence.[63] Przybylski also published a paper investigating a "Goldilocks" hypothesis from investigating a large representative sample of 120,115 adolescents in the United Kingdom, concluding "the evidence indicated that moderate use of digital technology is not intrinsically harmful and may be advantageous in a connected world." He suggested that this evidence may inform choices about adolescent's use of technology. However they concluded that "there is good reason to think that caregivers find enforcing existing digital screen guidelines extremely difficult," suggesting other ways of engaging with technology such as families using technologies together. [12]

A subsequent review published in Nature considered "that young people from different socio-economic backgrounds (may be) having very different experiences online," with lower income youths spending daily up to three hours more using digital devices. They considered that these same vulnerable groups "are more likely to receive negative feedback on social media, (may have) difficulties regulating their use of the Internet, and spend more time... passively viewing ... rather than actively engaging" others. It considered that this may be a new form of digital divide amongst the vulnerable.[64]

Three journalists from Guardian Media Group discussed the moral panic around screen time in 2018, considering it may be partially attributable to search algorithms, as "Google does not sort search output by quality; it ranks search input by popularity". They commented "there is very little good research in the area", and that "technology use is incredibly diverse, and while pretending it is a unitary concept may be convenient, it makes meaningful understandings or interventions impossible."[65]

Psychology[edit]

Psychology, sociology and social media

Psychologists have been working on reinterpreting the concepts of smartphone addiction, ADHD and the various digital dependencies for many years.[66] A psychological review published in 2016 stated that "studies have also suggested a link between innate basic psychological needs and social network site addiction." "Social network site users seek feedback, and they get it from hundreds of people—instantly. It could be argued that the platforms are designed to get users “hooked”."[67]

Some working in the field of philosophy published that the "excessive use of the internet and its resulting dependence ... (has) negative effects on wellbeing" from a psychological perspective. They considered its possible amelioration by considering ancient Eastern and Western philosophies, suggesting they "may give us inspiration to confront the challenges of technological enslavement in general."[68] Other psychologists considered "arguments in favor of reconsidering the Internet as an environment rather than as a tool, ... (exploring) the Internet's role in cognitive ecology, as well as the inadequacy of treating the Internet as a tool and thus of the current Internet-addiction model."[69]

"In early 2017, the Royal Society for Public Health (RSPH) conducted a UK-wide survey of 1,479 14-24 year olds asking them about five of the most popular social media platforms: Facebook, Instagram, Snapchat, Twitter and Youtube. The aim of the survey was to find out how they feel each of these platforms impacts their health and wellbeing (both positively and negatively) and make comparisons between these platforms." It concluded that Youtube was the only platform with a net positive rating "based on the 14 health and wellbeing-related questions", followed by Twitter, Facebook, and Snapchat, with Instagram having the lowest rating. Instagram was considered by the report to have some positive effects such including self expression, self identity, and community, but these were outweighed by its negative effects including on sleep, body image, and "fear of missing out".[70]

A Spanish psychologist, Marino Pérez-Álvarez, published in 2017 in regard to the diagnostic category of ADHD, that "the controversy cannot be resolved in empirical scientific terms, on the plane of facts, as if the facts spoke for themselves, which is where it now stands. A metascientific, philosophical assessment is required, with an ontological scope asking what ADHD is, and epistemological scope asking how science itself knows and molds what has ended up as the actual “ADHD”." He considered the diagnostic category in terms of "Aristotle's Four Causes", which are not empirical or scientific, but a construction he considered can be used as a method of enquiry for psychologists and allied clinicians, namely: material; formal; efficient; and final causes.[71]

Neuroscience[edit]

An old psychological and neuroscientific theory, around lateralisation of the brain has been considered oversimplified other than in non human vertebrates.[72] It became popular over social media once more during the digital dependency crisis,[73] with a fMRI study considering it again from a neuroscientific perspective.[74]

Neuroscientists have noted "brain anatomy alterations associated with social network site addiction".[75] The Trends in Cognitive Sciences Journal noted in 2015 that "Neuroscientists are beginning to capitalize on the ubiquity of social media use to gain novel insights about social cognitive processes."[76] Neuropsychopharmacology published a paper in 2018 entitled "Identifying substance use risk based on deep neural networks and Instagram social media data".[77] Nature published a review on "how data science can advance mental health research."[78] It also continues to publish rat model scientific research on addiction.[79] Many neuroscientific theories around addiction are considered to be outdated,[80] with some remaining based on the Rat Park experiments in the 1970s, which were published in Pharmacology Biochemistry and Behavior.[81]

A 2012 fMRI study noted impaired inhibitory control in the cingulate cortex in those with internet dependence as opposed to healthy peers, suggesting "the neurobiological underpinnings of internet addiction should be studied to unravel the potential heterogeneity in the disorder."[82] A theoretical model and review of internet dependencies from a neuroscientific and psychological perspective published in 2014 demonstrated "that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency." It considered "one therapy goal should enhance control over the Internet use by modifying specific cognitions and Internet use expectancies."[83] A 2018 neuroscientific review commented that this and other evidence "suggests an important interplay between actual social experiences, both offline and online, and brain development." It considered social media is good for "at least the following two important functions: 1. (social connection) with others (the need to belong) and 2. manag(ing) the impression individuals make on others (reputation building, impression management, and online self-presentation)." It called for further study, considering "adolescence a tipping point in development for how social media can influence their self-concept and expectations of self and others."[84]

Writers and Artists[edit]

How many young people have similar genetics to our abstract thinking ancestors?

Dr Lynne Kelly in Victoria, Australia, published a book titled The Memory Code, which "identified the powerful memory technique used by indigenous people around the world. She has discovered that this ancient memory technique is the secret behind the great stone monuments like Stonehenge, which have for so long puzzled archaeologists."[85] The Goldfields Library's Spring Program in 2016 promoted that "young writers can gain insights from (Dr Lynne Kelly's book), which cracks the mystery of Stonehenge."[86] It also promoted that "seniors can take advantage of digital literacy programs to learn the intricacies of social media, online music with iTunes, eLibrary resources and more." Young writers and artists often struggle with mental health problems. Learning that from an evolutionary perspective, that they may think abstractly and differently to other people, and that is potentially natural, rather than unwell, may assist with their self confidence, and self expression with their own writings and art.[11]

Journalism[edit]

A significant amount of awareness of ADHD and social media addiction has been raised over the last five years. Many journalists in the traditional and online media news outlets have been reporting in regards to this for many years.[87][88] The Australian Competition and Consumer Commission in December 2018 released a report that “proposes that a new or existing regulatory authority be given the task of investigating, monitoring and reporting on how large digital platforms rank and display advertisements and news content.” [89]

A newspaper stand in Philadelphia, Pennsylvania

Its chairman, Rod Sims, an economist that previously worked in development economics in Papua New Guinea, also noted that their “inquiry has also uncovered some concerns that certain digital platforms have breached competition or consumer laws, and the ACCC is currently investigating five such allegations to determine if enforcement action is warranted.”[89] Their report makes “preliminary recommendations aiming to address Google and Facebook’s market power and promote increased consumer choice”. The regulator “proposed a new body to monitor the algorithms that power Google searches and Facebook's news feed, and the traffic they send to publishers.” Facebook “has come out hard against the concept of an algorithm regulator, describing the proposal as "unworkable", "unnecessary" and "unprecedented".”[90]

Journalists and other organisations have advocated for some time that “every country needs an algorithm regulator.”[91][92][93] A future algorithm regulator must address which algorithms are affecting child and adolescent mental health the most, with a recent study showing that smartphone notifications directly relate to ADHD symptoms in adults.[94]

Technology[edit]

As awareness of these issues developed, many disciplines continued to work together to develop novel solutions for safe use of technology. Various technology firms have themselves implemented changes to mitigate the negative effects of excessive internet use. In December 2017 Facebook itself admitted passive consumption of social media could be harmful to mental health, though said active engagement can have a positive effect. In January 2018 the platform made major changes to increase user engagement.[95] [96] The ADDitude magazine online page continues to support those with the known correlated digital dependencies, to those with or without codified diagnoses, as well as providing a United States directory of educational resources for children.[97][98] Similar resources are available from many support or advocacy groups worldwide, including from the American Academy of Child and Adolescent Psychiatry.[99][100]

Alphabet Inc in 2018 released an update for Android smartphones, including a "dashboard" app that it considers will "enable (people) to set time limits via an app timer, and give you warnings when (they've) been using it for too long".[101] Apple Inc purchased a third party application and then incorporated it as "screen time", promoting it as an integral part of iOS 12.[102] Journalists have questioned the functionality and motivations of both of these interventions from these corporations for users and for parents.[101][103]

A 2008 protest in relation to Google, and Scientology, an organization well known to be politically active against the psychiatric profession

Two large investors in Apple Inc in 2018 "believe(d) both the content and the amount of time spent on phones need to be tailored to youths, and they are raising concern about the public-health effects of failing to act. They point to research from... a “growing body of evidence” of “unintentional negative side effects,” including studies showing concerns from teachers. The group wants Apple to help find solutions to questions like what is optimal usage and to be at the forefront of the industry’s response—before regulators or consumers potentially force it to act." [104] They published an open letter in regard to this.[105] Apple Inc responded that they have "always looked out for kids, and (they) work hard to create powerful products that inspire, entertain, and educate children while also helping parents protect them online," planning "new features and enhancements planned for the future, to add functionality and make these tools even more robust." They asserted "Apple would once again be playing a pioneering role, this time by setting an example about the obligations of technology companies to their youngest customers".[106]

A German technology startup developed an Android phone specifically designed for efficiency and minimizing screen time.[107] News Corp reported multiple strategies for minimizing screen time.[108] Facebook and Instagram announced "new tools" that they consider may assist with dependence on their products.[109]

Several researchers and multidisciplinary clinicians have instituted programs utilising smartphone technology to either assess or assist with mental health, some with innovative social media applications.[110][111] One collaboration aims to "reduce the risk of relapse in young people experiencing mental illness, to help young people and their families to experience a rich sense of accomplishment, meaning and purpose in their lives and to eliminate the barriers to seeking help for a mental health condition by creating free, intuitive online therapeutic platforms that encourage and sustain positive social connection between users."[112]

Psychiatry[edit]

People with ADHD have many symptoms, which result in general disorganisation including with paperwork.[29]

As the history of psychiatry shows, it is not as precise a medical profession as others such as neuroscience.[113] However some state that the profession is approaching "the new field of precision psychiatry",[114] which remains under discussion.[115] The profession uses the core principles of medical ethics to analyse and treat mental health conditions,[116] whilst advocating for and instituting preventative healthcare measures to avoid adverse mental health outcomes.[117] It also analyses its own constructs and diagnoses, reinterpreting them when necessary.[118][119] Some politicians support psychiatry as it does this, notably the current Mayor of Calgary, Canada, Naheed Nenshi, who in 2018 stated "we need to take a systems-wide view on mental health, on addiction and on crime prevention, and look at those things together."[120]

Psychiatry continues to analyse, treat and promote awareness and prevention of these worldwide problems together.[121] This continues to happen all across the world in many psychiatry and allied conferences and congresses. [122]

The updated European Consensus Statement on diagnosis and treatment of adult ADHD published in 2019 stated "the impairments associated with ADHD across the lifespan are impressive. ADHD is associated with learning difficulties, school dropout, underachievement at work, frequent job changes, chronic fatigue, financial problems, gambling and internet use, home and traffic accidents leading to increased mortality rates, relationship difficulties and intimate partner violence, early onset of addiction, teenage pregnancies and sexual transmitted diseases, a two-fold increased smoking rate, an increased number of suicide attempts and self-harm in adolescents, and increased criminality." It suggested that "licensing of stimulants for adult ADHD is urgently needed in European countries and beyond", noting that compared to other diagnostic groups, "youth with ADHD were significantly less likely to be referred, they were more likely to refuse referral, and a significant number remained in child services well beyond their 18th year. Studies also have found ... a lack of expertise on ADHD amongst adult clinicians. This suggests there is an urgent need for a multifaceted approach combining transition specific clinical guidelines, and funding for the training the training of clinicians, to ensure that those in need of ongoing intervention may successfully transition to adult services."[22]

Psychiatric experts have called for further studies to explore psychiatric correlates with digital media use in childhood and adolescence. "Over the past 10 years, the introduction of mobile and interactive technologies has occurred at such a rapid pace that researchers have had difficulty publishing evidence within relevant time frames." An "important contribution" of "a large, well-designed longitudinal study taking into account multiple sociodemographic confounders" was published in 2018, relating to Angry Birds and Pokemon Go, a game and a social media application that "reached adoption by an estimated 50 million global users within 35 and 19 days, respectively, of their release."[8] The cohort of 2587 15 and 16 year olds who used the applications, with no baseline symptoms of ADHD "self-reported higher-frequency digital media use was associated with self-reported ADHD symptoms over two years of follow-up. The frequent distraction and rapid feedback of digital media may disrupt normal development of sustained attention, impulse control, and ability to delay gratification. In addition, digital media may displace other activities that build attention span and executive function."[123] The director of the National Institute of Health of the United States, Francis Collins considered that "study represents a starting point, and there are some potential caveats to the findings," commenting that it only shows association, but not causality. "Nevertheless, the findings suggest that the recent rise in popularity of digital technologies could play a role in ADHD. The findings also serve as an important warning for teens, parents, teachers, and others as increasingly stimulating forms of digital media become ever more prevalent in our daily lives."[124] "Crafting evidence-based recommendations that address all of the technologies children and adolescents currently use has been challenging" for psychiatry and allied professions.[8]

Conclusion[edit]

Although social media dependence, and other digital dependencies are pervasive throughout the world, their exact pathophysiology, mechanisms and risk factors remain poorly understood by the medical, psychological, technological and anthropological communities. Treatments often need to be individualised, at high expense, and there is need for continuing medical education worldwide for these poorly recognised conditions. Social media overuse problems have parallels to the more widely recognised diagnosis of internet addiction, however they affect girls and women at a higher rate than boys and men. The female sex is also far less likely to be treated for ADHD, as their symptoms are often more subtle.

Concerta, a recommended medication for ADHD. Many ADHD medications, whilst low cost, are difficult for afflicted persons to access across the world.

The rapidly changing scientific consensus and publication of multiple reviews considering individulization of treatments, and optimisation of interactions with technologies for individuals have been invaluable. Further well designed prospective trials around the medical, educational, psychological and anthropological causes and treatments of ADHD, with its known links to digital dependence are imperative to address the worldwide mental health crisis. Technological advancement has far outpaced the ability of medical science to establish correlations and causalities, as each social media platform has its own benefits and challenges.

It is necessary and essential that the large technology corporations collaborate in an open-scope, multidisciplinary way with psychologists, neuroscientists, psychiatrists, anthropologists, sociologists, and other related disciplines to address the crises unintentionally caused or exacerbated by their firms. Legal mechanisms such as the Victorian Government's Royal Commission into Mental Health (in Australia) will also be required to address the crisis. Evidence based recommendations can come from such multi-disciplinary open scope collaboration in all associated fields.

The term "addiction" is also in need of consideration, as it has many times in the past by the psychiatric profession.[125] The English language consistently evolves, and this word has many negative connotations. There are many potentially less stigmatising words, such as "dependence" or simply "use". Loanwords from other languages are common in the English language, one of many examples being the South African Dutch word "trek". A new loanword, without any associated preconceptions may assist those who need assessment and treatment to advocate for themselves, as they navigate the complex and underfunded national healthcare systems. I suggest that the digital dependencies may be re-labelled as "bagaraps" - from the Papua New Guinean Tok Pisin language. The word bagarap, from English vernacular originally, now means to 4-6 million speakers of Tok Pisin, "broken down", "worn out", "spoilt", or "accident". The use of this word in Tok Pisin is interpreted entirely depending on the context in which it is spoken. These four metaphors are exactly what digital media platforms have become unintentionally, for some more than others. However, such a word may remind us that complex problems have and will continue to be solved. A new loanword will also allow involved parties worldwide and those affected by the phenomena to be consistently reminded that there are very clear distinguishing characteristics of the phenomena when compared to other other "dependencies" or "addictions".

Children in Papua New Guinea

ADHD as a diagnostic term itself, may benefit from some evolution in language. Whilst not empirically proven, given the longstanding evolutionary theories around ADHD, it is worth considering it may not be a "disorder".[30] Multiple speakers of the Romance languages, term it in what may be considered gentler linguistics, when retranslated back into English: "troubles with attention deficit and/or hyperactivity". However, people with ADHD think more abstractly in general, and an even less stigmatising term to consider may be "right brain dominance". This term aligns with current psychiatric theory around the division of the brain and how it potentially explains many things in mental health and human history.[126] This is not a mental health diagnosis, rather a meta-scientific and philosophical diagnosis. It may involve afflicted patients with a more edifying, philosophical construction of the ways they think different to other people. They may have never been unwell after all, just in need of care and understanding from their cultures and societies.

Additional information[edit]

Acknowledgements[edit]

I would like to thank the Canadian ADHD Resource Alliance for their longstanding invaluable collaboration and research, and for the education around ADHD provided to myself at the November 2018 Congress in Calgary, Canada.

I would also like to specifically thank the English Wikipedia user WsuTeam6 for their contributions to the English Wikipedia article Social media addiction in 2011.

Competing interests[edit]

I am the owner of What5words (Australia), What5words Tapui Limited (New Zealand) and What5words Ltd. (Bulgaria), a startup social enterprise that promotes cross cultural understanding and communication, whilst promoting awareness of these and other related conditions across the world.

File:The same in that different.webm
People with ADHD, or "Right brain dominance", may be the same in that they are different.

References[edit]

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