The Internet and Digital Media Use in Children & Adolescent

Dr. Norharlina Bahar MD(UKM), MMed(Psych)(UKM), Child & Adol Psych(VIC), FCAP(MAL)

Consultant Child & Adolescent Psychiatrist, Hospital Selayang Malaysian Society of Internet Addiction Prevention

3 Aug 2018

What did they do? • Fluid multitasking communication, activity & entertainment (Lenhart

2015, Moreno 2012)

• Younger children and from lower-income families - more likely for entertainment purposes (Rideout 2013, Kabali 2015)

• Gamification = gaming elements to a real-world activity eg. Physical exercise – fitbit, apps

• Digital divide:

– ?Economic status (disputed by Kabali 2015)

– Access to quality & reliable Wi-Fi

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Benefits & Opportunities of Digital Media Use

Can Infants and Toddlers Learn From Screens?

• 12 to 24 months - can learn words

• But with parents to reteach (DeLoache 2010 Richert 2010)

• Building an emotional bond with an on-screen character improves learning potential (Calvert 2014)

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Are Touchscreens More Educational?

• > 15 months: can learn words from touchscreens

• BUT have trouble transferring this knowledge to the 3-dimensional world (Zack 2013)

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Media Use in Older Children and Teenagers: Increase Collaboration and Tolerance

• Help children learn, understand and empathize with marginalized groups (Kidds 2013)

• Communication, engagement, exposure to new ideas (Moreno 2013)

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Developmental & Behavioural Risks

Infants and Toddlers: Risk

• AAP’s discouragement for < 2 y.o, research on TV and videos (Brown

2011)

• Skills (cognitive, language, sensorimotor, social-emotional) required to transfer knowledge from a 2-dimensional platform to a 3-dimensional world (Barr 2013)

• Hands-on exploration & in-person interaction

• Attributable to lack of symbolic thinking, immature attentional controls and memory flexibility (Barr 2013)

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School-Aged Children & Teenagers: Risks

• Portrayal of risky health behaviors (Moreno 2016)

– Eg alcohol, illicit substance use, high-risk sexual behaviors, self-disruptive behaviors

• Peer viewers see these behaviors as normative and desirable (Litt 2011, Moreno 2009)

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Risk

• Digital footprint & future reputation

• Collective, ongoing record of one's Web activity

• Cyberbully, sexting, child Pornography & abuse

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Parents’ Media Use

• A strong predictor of child media habits (Schmidt 2008)

• Parents:

– a higher level of internet knowledge and awareness and

– hold a positive attitude towards the internet are more effective in guiding their adolescents in using the internet (Terras 2016, Lee 2016)

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Excessive Gaming/ Internet Use

Excessive gaming/ Internet use • A significant public health burden across the world (Kuss & Lopez-Fernandez,

2016; Mak et al, 2014)

• Links to:

– anxiety and depression (King, Delfabbro, Zwaans, & Kaptsis, 2013)

– physical health problems (Kelley & Gruber, 2012)

– school disconnection (Lawrence et al., 2015)

– decreased job productivity and unemployment (Young, 2010)

– social isolation (Ceyhan & Ceyhan, 2008)

• At risk: Young populations, prevalence rates of problematic use of

games/ online social networking - 8% (King, Delfabbro, & Delfabbro, 2012)

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Challenges on EIU/ Gaming • Gaming - considered ‘addictive’ for some (Griffiths, 2009), but not

classified harmful by all stakeholders.

• Differences with substance addiction (e.g. tobacco) – clear public health burdens, have clear research-informed guidelines on how harm is caused

• A challenge to define the levels of Internet use that are detrimental to users (Gentile, 2009)

• Functional uses of the Internet - adaptive, productive, socially significant, increase the psychological wellbeing of users (Yee, 2006)

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Terminology

• Addiction, Dependence, Overuse, Problematic Use

• Different terminologydifferent criteriadifferent assessment toolsdiferent results

• Smart media overdependence:

– Salience

– Failure of Self-control

– Serious consequences

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Organized prevention efforts

Do not intend to use internet at its lowest

possible point, nor impose restrictions upon

healthy users.

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EIU: Local Epidemiological Data • No nation-wide prevalence study

• Small scale, fragmented, mainly in big cities

• Secondary schools or college students

• Prevalence of problematic internet users are between 2.4% - 49.2%, depending on the populations studied and questionaires used (Mak 2014, Melissa 2015, Hasmida 2011, Yong 2011, Zainuddin 2013, Moslehpour 2014)

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Local Epidemiological Data

• The median total hours spent online by students during school days was 3 hours & 5 hours on weekends (Norharlina

2014)

• Social networking, getting information, playing games online (18.9%) and downloading songs or movies (Ke 2014,

Mak 2014, Melisa 2015)

• Almost all of the students accessed the internet from

their own homes (Mak 2014, Melisa 2015)

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Local Epidemiological Data: Parents’ Perspective

• 51.3% of parents felt that their child spent longer time online than necessary (Hasmida 2011)

• 36.7% of parents felt that their child's internet usage interfered with obligations at home/ school (Hasmida 2011)

• 18% felt that their child gave up social or recreational activities because of internet use (Hasmida 2011)

• Inverse link between internet addiction behaviour and academic performance (Zainudin 2013, Melisa 2015).

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Local Epidemiological Data: Comorbidities

• Low self-esteem (Melisa 2015)

• Depression, social anxiety (Norharlina 2013, Normala 2013, Wan Salwina 2013, Ke 2014)

• Significant behavior and social functioning problems (Norharlina 2013, Normala 2013, Wan Salwina 2013)

• Lower levels of personal contentment, sad, bored and unhappy (Ke 2014)

• ADHD (Saramah 2014, Akramul 2016)

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Recommendations from Literatures

1. For greater recognition of EIU and gaming issues in national health policies (Yang & Oh, 2007)

2. Collaboration between educational institutions and medical systems of care

3. Increase funding for school-based programs and epidemiological studies to assess the health impacts of EIU (Yang & Oh, 2007)

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Recommendations from Literatures

4. Expand universal prevention – greater cost-effectiveness and efficacy compared to treatment (Koo, 2013)

5. Highest priority for selective prevention:

• Primary school-aged children (8-12 years)

• Parents (Lee, 2012)

6. Health policies should support education for parents on internet monitoring and setting limits (e.g., software controls) (Lee, 2012).

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Recommendations from Literatures

7. Integrates clinical measures related to gaming or Internet use into existing adolescent development programs

8. Shutdown laws, may not have intended preventative effects but strengthen some players’ motivations for gaming (Davies and Blake 2016)

10. Internet gaming industry – to assume some responsibility for player welfare, recognize its ‘power over gamers’ (Blaszczynski, Ladouceur & Shaffer, 2004)

– at least inform consumers of known risks and provide customer care (Van Rooij et al., 2010).

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What’s New?

Gaming Disorder ICD11- June 2018 as version for preparation of

implementation.

Final version will be submitted in WHA in May 2019

Debates on Gaming Disorder

• Heterogeneity of internet/ gaming ‘addiction’

• Weak clinical relevance, reliable research, validity & consensus

• Pathologize normal gaming behavior and provoke moral panic

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Efforts for Consensus

1. WHO Meeting in Tokyo, Japan (2014)

2. WHO Meeting in Seoul, Republic of Korea (2015)

3. WHO Meeting Hong Kong, Hong Kong SAR (2016)

4. WHO Meeting Istanbul, Turkey (2017)

WHO Meeting Hong Kong (2016) WHO Meeting Istanbul, Turkey (2017) 27

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ICD 11 Gaming Disorder 4 criteria Discarded criteria with controversies

Loss of control Preoccupation

Prioritizing game over other activities Tolerance

Continued gaming despite negative consequents

Withdrawal

Significant impairment Lying

Escape/mood modification

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Gaming-Gambling?

• Gaming is becoming increasingly monetised and similar to gambling, with potentially major clinical and regulatory implications

• Microtransaction

• Loots box

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Esports

• Electronic sport

• Organized, multiplayer video competitive gaming

by professional gamers, staged in front of live

audience or steamed online or broadcast on TV

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The Most Prominent eSport Activities

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Global Players

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Global Audiences (million)

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Global Revenue • The largest overall prize pools in eSport is “The International 2017:

Dota 2 Championships” with USD 25 million (as of Nov 2017)

• China is the highest earnings country; 2,400 awarded players shared the prize pools of USD 67 million (as of Nov 2017)

• The world’s largest gaming market worth USD 24.6 billion in 2016

• Estimated the gaming revenues in 2021: USD 1 billion and Asia’s eSport market will reach USD 35 billion

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Future Development of eSport

• An official medal event in the 2022 Asian Games in Hangzhous

of China

• Potential programme in the Paris summer Olympic Games of

2024

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Gaming: Challenges

• Challenges related to game industry

– Strong opposition

– Big money, growing market

– Worries about possible introduction of regulating policies following the recognition of adverse consequences

– Admitting the addictive potentials negatively impact their public images & revenues

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Conclusions

• Digital media is not all bad but risks remain

• Ride the wave!

• Health professionals working with children:

– should increase their knowledge of digital technology

– ask appropriate questions on these issues and report any

suspicions of sexual abuse/exploitation.

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Thank you

harlinabahar@gmail.com

harlinabahar@yahoo.co.uk