Teenagers who are constantly checking their phones are more likely to develop ADHD symptoms than their less social-media-engaged peers, US researchers say. In what the study authors say is the first longitudinal study investigating the issue, researchers found that the frequency of digital media use among over 2500 non-ADHD 15-and 16-year-olds was significantly associated with the subsequent development of ADHD symptoms over a two-year period of follow up. A high frequency of media activity – most commonly checking their smart phone was associated with an 10% increased likelihood of developing inattentive and hyperactive-impulsive symptoms in this teenage cohort. Associations were significantly stronger in boys and participants with more mental health symptoms, such as depressive symptoms and delinquent behaviours. But while the association was statistically significant, further research was needed to determine if the digital media use was the cause of problem, the US authors said in JAMA. “The possibility that reverse causality or undetected baseline ADHD symptoms influenced the association cannot be ruled out”, they said. To date, the potential risks of intense engagement in social media is largely an evidence-free zone, they said. Prior longitudinal studies on this topic have most commonly involved computers, televisions and video-game consoles. But the engagement associated with these devices is markedly different to that seen with modern media platforms especially in terms of accessibility, operating speed, level of stimulation and potential for high-frequency exposure. And as an accompanying editorial points out, television and gaming are sporadic activities whereas the current widespread use of smartphones means social media is now close at hand. “In 2018, 95% of adolescents reported having access to a smartphone (a 22-percentage-point increase from 2014-2015), and 45% said they were online ‘almost constantly’”, the US editorial author explained. This instant access to highly engaging content is designed to be habit-forming. Also the effect of current social media engagement not only involves exposure to violence in games and displacement of other activities that were the major issues in the past. Social media today has been designed to engage the user for longer periods and reward repeated users. New behaviours to consider include frequent attention shifts and the constant media multitasking, which might interfere with a person’s ability to focus on a single task, especially a non-preferred task. It is also hypothesised that the ready availability of desired information may affect impulse control (no waiting is required). And the ‘always-on’ mentality may be depriving young brains of ‘down time’, allowing the mind to rest, tolerate boredom and even practise mindfulness. The study researchers were keen to emphasise their research findings are a long way from proving digital media increases the risk of ADHD symptoms, and even if they did, the public health and clinical implications of this are uncertain. However, the editorial was more enthusiastic about the study’s implications. “With more timely digital media research, parents may feel more confident in the evidence underlying recommendations for how to manage the onslaught of media in their households,” it said. The editorial author suggested the findings support American Academy of Pediatrics guidelines that recommend adolescents focus on activities that have been proven to promote ‘executive functioning’ such as sleep, physical activity, distraction-free homework and positive interactions with family and friends – with the implication being – ‘switch the phone off’. Ref: JAMA 2018; 320(3): 255-263 doi:10.1001/jama.2018.8931 JAMA 2018; 320(3): 237-239