Clinical Question

Is frequent use of digital media associated with the development of attention-deficit/hyperactivity disorder (ADHD) symptoms in high school students?

Bottom Line

High school students who reported a high frequency (many times per day) of digital media use (e.g., social networking, streaming movies or music, texting) were significantly more likely to self-report symptoms of ADHD over two years of follow-up (10% higher symptom reporting rate). It remains uncertain whether the association is causal and whether efforts to reduce exposure can result in less symptom development. (Level of Evidence = 1b)

Synopsis

The investigators analyzed data obtained from a longitudinal cohort survey of adolescents enrolled in 10 high schools in the Los Angeles, Calif., area. Beginning in the fall of 10th grade, eligible students (n = 2,587) initially classified as not having ADHD symptoms based on a previously validated evaluation tool, provided follow-up self-reported symptom scores at six, 18, and 24 months. At baseline and at 12 and 24 months, students also indicated how frequently they engaged in various digital media activities in the past week (none, one to two times per week, one to two times per day, or many times per day). The authors performed various analyses to address potential confounders, including age, sex, family income, history of delinquent behavior, race/ethnicity, depressive symptoms, substance use, and family history of substance use.

More than one-half (54.1%) of the students reported high frequency of checking social media, which was the most common media activity. High-frequency engagement in digital media activity at baseline was significantly associated with a higher odds of reporting symptoms of ADHD at follow-up (odds ratio = 1.10; 95% confidence interval, 1.05 to 1.15). In addition, the mean rate of having ADHD symptoms at follow-up was significantly increased among the 51 students who reported 14 high-frequency media use activities and the 114 students who reported seven high-frequency media use activities at baseline compared with the 495 students who reported no high-frequency media use over the preceding week (10.5% and 9.5% vs. 4.6%, respectively).

Study design: Cohort (prospective)

Funding source: Government

Setting: Population-based

Reference: Ra CK, Cho J, Stone MD, et al. Association of digital media use with subsequent symptoms of attention-deficit/hyperactivity disorder among adolescents. JAMA. 2018;320(3):255–263.