Understanding ADHD & Why it's Commonly Found with Internet Addiction
Tracy Markle, MA, LPC &
Dr. Brett Kennedy, Psy.D.
One of the most common coexisting factors for people who struggle with internet addiction or digital media overuse is ADHD, (attention deficit hyperactivity disorder). Often our clients are unaware that they have ADHD and when they’re finally able to receive a formal diagnosis and get treatment for it, they often see their internet or video game use subside to a more manageable level as well as see improvements in their academic or professional performance and in their relationships. It’s for this reason that we want to bring more awareness to you about the latest research and thinking on ADHD so that you can begin to recognize whether ADHD could be an underlying factor in your life or in the life of your clients. Understanding of ADHD has come far in recent decades. So much so that most experts agree the name ADHD may be one of the most misleading of all neurological conditions described in the diagnostic manuals. We now know that ADHD symptoms are homogeneous. People with ADHD don’t always present with hyperactivity, and most are capable of intense hyperfocus while engaged in something they find rewarding. Finally, while the advent of the smartphone and technology screens have created attention span issues in the general population, they may also be the greatest aid people with ADHD have ever had at their disposal for executive functions like time management, organization, and working memory. Read on to learn.
Table of Contents
ADHD Treatment Plans: You Can’t Just Set Them and Forget Them
There have been significant advances in ADHD research over the last few decades and our understanding of this condition is continually being updated. This is just one of the challenges for people with ADHD and their caregivers and providers because it means that, even if someone has been diagnosed with ADHD and is on a treatment plan, it’s imperative they keep up with the latest research as new discoveries are constantly emerging. (We learned several while researching this article.) It’s also essential they continually check in with caregivers and providers about how their ADHD is presenting because we now know that ADHD symptoms change over the lifespan and treatment plans will need to be adjusted accordingly.
Understanding ADHD: 90% of Children Won't Outgrow It
Years ago, research on ADHD focused primarily on boys. This was because of the emphasis on hyperactivity and inattention that gave the disorder its name. As a result, many providers believed that ADHD was a childhood condition that primarily or exclusively afflicted young boys and that many ADHD patients outgrew it by adulthood. We now know that ADHD affects girls and boys, and that most don’t outgrow it, which means it effects men and women, too. We also know that the symptoms of ADHD evolve throughout the lifespan and present differently between the sexes, as well as vary from individual to individual.
Just this year, a longitudinal study was published that challenged the long-held belief that many kids outgrow ADHD. Why the disparity? Well, previous studies only took snapshots of people in time. The new study followed 558 people with childhood ADHD for 16 years. The average age of participants was 9.9 years old at the start and 25.12 at the end.1
The study’s authors report that, while approximately 30% of children with ADHD experienced full remission, for 60% of those, the remission was only temporary.
Of the entire group of subjects in the study, only 9.1% demonstrated sustained remission, or what the researchers would term recovery.
In other words, 90% of kids with ADHD in the study did not outgrow it by adulthood.
Of equal importance is the finding that the majority of the study’s participants—63.8%— had fluctuating periods of remission and recurrence over time.
This could explain why previous studies, that were not longitudinal, measured so many childhood ADHD patients in remission. They only measured subjects based on single endpoints—a snapshot in time—failing to consider longitudinal patterns of ADHD expression.
The remaining 26.4% of participants showed a stable persistence of either ADHD (10.8%) or partial remission (15.6%), a category the researchers say was composed of individuals that displayed “one classification change from persistent ADHD to partial remission that maintained until study endpoint.”
The study’s authors say the results challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood since 90% of children with ADHD in the study continued to experience residual symptoms into young adulthood.
The study underscores the importance of getting a diagnosis and assembling a treatment team and plan. Because if you have ADHD, your chances of having to manage it for the rest of your life are potentially very high.
But what’s to manage? Everyone suffers from a little forgetfulness or inattentiveness now and then. Is it really such a problem?
Understanding ADHD: It's More Than Just Executive Function Issues
If you think ADHD is all in your head, think again. ADHD is a serious neurological issue that effects the whole body. The following are just some of the health issues you are at elevated risk for if you have ADHD.
- Asthma– Patients with ADHD have higher risk of asthma and vice versa. In 2018, researchers conducted meta-analyses of 50 studies that included a total of 268,320 people with ADHD and more than 3.1 million without ADHD. They found that having asthma or ADHD increased the risk of having the other condition between 45% to 53%.2 The connection persisted even after researchers controlled for other factors such as mother’s age at birth, parent income and education levels, subject’s gestational age and weight at birth, and childhood eczema.
- Diabetes – A positive association has been found between ADHD and Type 2 diabetes in children, adolescents, and young adults. One study reported that adults with ADHD were twice as likely to have Type 2 diabetes as their non-ADHD counterparts, and that men with ADHD were affected slightly more than women with ADHD. The over-50 ADHD population was 72% more likely to have Type 2 diabetes than were their neurotypical peers.3
- Accidental Death – A study of nearly 2 million individuals in Denmark found that people diagnosed with ADHD were about twice as likely to die prematurely as people without the disorder, even after adjusting for factors known to affect the risk of early death including age, sex, family history of psychiatric disorders, maternal and paternal age, and parental education.4 This increased risk of premature death in people with ADHD was mainly driven by deaths from unnatural causes, more than half of which were caused by accidents. The risk of dying prematurely increased with age at diagnosis. For example, individuals diagnosed at age 18 years or older were more than four times as likely to die early compared with those without ADHD at the same age; whereas children diagnosed before the age of 6 years were at around double the risk of death compared with their healthy counterparts. The findings also reveal that girls and women with ADHD have a higher relative risk of premature death compared with boys and men with ADHD.
- Obesity – Multiple studies show that ADHD is a significant risk factor for obesity, especially once ADHD patients reach adulthood.5 One longitudinal study of men diagnosed with ADHD during childhood observed that they had significantly higher BMI and obesity rates than men without childhood ADHD.6 These differences remained significant after adjustment for socioeconomic status and lifetime mental disorders. Some researchers believe a combination of dopamine seeking and impulse control contribute to this connection, but there is also a lot of research being conducted on the genetic links that ADHD and obesity may share.
Now that we’ve hopefully got your attention about the significance of ADHD, let’s talk about why people with ADHD crave the internet and exhibit greater risk for internet addiction.
Why People with ADHD Crave the Internet
Research has shown a positive association between internet addiction and ADHD, especially among children and teens.7 To understand why this may be the case, we need to understand what’s going on inside the brain of a person with ADHD. Which is no small order since researchers are still constantly updating their own understanding. One of the prevailing theories, which has a substantial amount of research to support it, is that in people with ADHD, dopamine is not performing properly. Put another way, many experts believe that people with ADHD suffer from low dopamine.
Dopamine is a neurotransmitter responsible for cueing all kinds of vital functions throughout the body. In the brain, dopamine cues the activity of various circuits including many related to executive functioning.
- Dopamine allows individuals to focus by shutting out unnecessary visual and auditory information
- Dopamine provides motivational salience. The more dopamine there is in the brain, the more time and energy an individual is willing to invest to attain a future goal.
- Dopamine plays a key role in our perception of time. High levels of dopamine give an individual a slower sense of time passing. Lower levels of dopamine make time seem to go by very quickly.
Many experts accept the low dopamine hypothesis for ADHD because so many common ADHD symptoms and behaviors are also symptoms of low dopamine.
- Instead of being able to focus on one thing, people with ADHD often see and hear everything going on in the room, (and outside the window), which can lead to distractibility.
- People with ADHD have a hard time imagining future rewards, causing them to have trouble feeling motivated to begin many tasks. This is often described by researchers as difficulty with transitions because it’s hard to get someone with ADHD to stop doing something they enjoy and begin doing something they don’t enjoy or don’t enjoy as much. Sometimes it’s even hard to get them to start something they do enjoy!
- People with ADHD exhibit issues with time perception that experts sometimes call “time blindness”. They have difficulty estimating how long something will take as well as having the feeling that time is passing by without them being able to complete tasks accurately and well.
So, what does this have to do with internet addiction? There are 5 types of digital media overuse and most people who use the internet will have problems with one or more of these at some point:
- Video Gaming
- Social Media
- Compulsive Spending
- Information Overload
The reason so many people have trouble with these types of digital media is because tech companies design these platforms using something called persuasive design. Persuasive design uses the intermittent variable reward schedule—the most addictive reward schedule known to man—to create highly rewarding experiences that trigger dopamine in the user.
When the user receives a reward, such as a new weapon in a video game or a like on social media, dopamine is released in their brain. Every time this occurs, the motivation to engage in the behavior increases.
When people with ADHD, who have lower levels of dopamine than neurotypical people, use highly rewarding applications like video games, their dopamine is triggered to release at a higher rate, which motivates them to continue the behavior and leads to more immersion.
People with ADHD often enter a state known as hyperfocus—a common ADHD symptom—when they engage in something highly rewarding like video games.
They concentrate so completely that they lose track of everything else going on around them. Coupled with time blindness, the ADHD individual who can’t focus on homework or sit still in a meeting, can suddenly sit for hours playing a game, watching an entire series of a TV show, or researching the internet for the perfect gadget.
Teenagers are especially vulnerable to platforms designed around the intermittent variable reward schedule because teenagers have more dopamine receptors in their brains than at any other time in their lives. This causes them to have a high risk-reward drive.
If someone has ADHD, it doesn’t automatically mean they will have internet addiction or digital media overuse issues, but it can impact their ability to control their use.
Conversely, if someone has overuse issues, virtually all people with these issues show symptoms of ADHD. And getting them evaluated by a board-certified physician and assembling a treatment team if they do have ADHD can really be a game changer.
Does the Internet Cause ADHD?
Many studies have shown that overuse of the internet and smartphones is creating an attention span deficit in the general population.8 While this may mimic some of the symptoms found in people with ADHD, this type of shortened attention span clears up when the behavior is removed. ADHD, on the other hand, is hardwired in the brain. Studies show a large genetic component to ADHD and brain imaging reveals structural differences between the brains of people with ADHD and those without.9,10 ADHD is also chronic, which means it’s present across the lifespan. Moreover, ADHD is a condition that’s been documented since at least the 1700’s, so the internet didn’t create ADHD, but it can certainly exacerbate it.11 Everyone, regardless of whether they have ADHD, needs to set limits around their screen use to avoid a decrease in attentional capacity that negatively affects performance at school, work or in relationships.12 But with the right limits in place and problematic applications removed, mobile technology may be the most helpful thing people with ADHD have ever encountered.
Teenagers look to social media to find romantic partners.
For LGBTQ+ teens and others who feel marginalized, the internet is a place to find community and love.
Why Mobile Technology is the Best Thing Ever to Happen to People with ADHD
You may be surprised to read the above section title. Isn’t the whole point of our practice to get people to spend less time in front of their screens? Well, yes. But that doesn’t mean we eschew technology. Smartphones, notebooks, laptops and other portable technology can be tremendous aids for the kind of executive functioning challenges people with ADHD face every day. Those who used to constantly lose important paperwork can now hang on to electronic documents with relative ease as they are all contained in one device. Thanks to mobile scanning applications, they can scan paperwork onto their smartphones. Built-in cameras mean they can photograph and video things they need to remember on their smartphones, too. Mobile map applications with audio directions mean they are safer, better oriented drivers, something people ADHD struggle with. To say nothing of calendar and reminder apps that ensure people with ADHD don’t miss important appointments.
Another example of how mobile technology is changing the game for people with ADHD is in the classroom. While research shows that handwriting notes can increase learning, this isn’t necessarily true for people with ADHD. Due to low dopamine, they can struggle with fine motor coordination which means their handwriting can be slow and difficult to read.13 Low dopamine also means problems with their working memory so they often can’t hold information in their minds long enough to write it all down accurately. In other words, students with ADHD are not benefiting from handwriting notes the way neurotypical students are.
But thanks to mobile technology like smartphones, today people with ADHD can photograph a white board, or record a lecture. There are even apps that allow the user to record a lecture and take short notes that sync up with the correct spot in the recording. We don’t encourage our clients with ADHD to type their notes on a laptop because people who type their notes during a lecture tend to focus on typing verbatim instead of listening, processing and typing the important parts. Of course, to ensure that students who record lectures are learning, they should be trained to review their recording within 24 hours and to dictate a summary of what they learned as well as clarify any important points they recorded. Another recommendation we make to our ADHD clients is for them to ask their teacher to send them the notes electronically. Also, many colleges will provide a note-taker as an accommodation for a student with ADHD.
Resources for Understanding ADHD Better
In keeping with the theme of understanding ADHD, all of these resources are in the form of podcasts or videos. To understand why people with ADHD may learn better from recorded material than they do from written material, read this article.
- 3-Part Webinar Series “ADHD Ages & Stages” from ADDitude Magazine, the country’s number one destination for families and adults living with ADHD and its related conditions.
- “Understanding the ADHD Subtypes” – Hacking Your ADHD Podcast, hosted by William Curb. A short, manageable episode from a person with ADHD who decided to start a podcast to help others with the condition.
- “ADHD & How Anyone Can Improve Their Focus” – The Huberman Lab Podcast, hosted by Dr. Andrew Huberman, professor of neurobiology and ophthalmology at Stanford School of Medicine. Dr. Huberman goes deep into the brain science of low dopamine and treatment, for those who like that sort of thing. also available in video format
- “Help for College Students with ADHD: A Parent’s Guide to Improving Outcomes” [Video Replay & Podcast #371] – Another excellent webinar from ADDitude Magazine. This one is a must-listen, or watch, for parents of college students with ADHD. It’s full of useful, evidence-based tips about services, accommodations and interventions that benefit the college student with ADHD.
- Sibley, M., Arnold, L, Swanson, J. et.Al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032
- Cortese, S., Sun, S., Zhang, J., Sharma, E., Chang, Z., Kuja-Halkola, R., Almqvist, C., Larsson, H., & Faraone, S. V. (2018). Association between attention deficit hyperactivity disorder and asthma: a systematic review and meta-analysis and a Swedish population-based study. The Lancet Psychiatry, 5(9), 717–726. https://doi.org/10.1016/s2215-0366(18)30224-4
- Chen Q, Hartman CA, Haavik J, et al. Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: A population-based cross-sectional study. PLoS One. 2018;13(9):e0204516. Published 2018 Sep 26. doi:10.1371/journal.pone.0204516
- The Lancet. (2015, February 25). People with ADHD are twice as likely to die prematurely, often due to accidents. ScienceDaily. Retrieved October 29, 2021 from www.sciencedaily.com/releases/2015/02/150225205834.htm.
- Cortese S. (2019). The Association between ADHD and Obesity: Intriguing, Progressively More Investigated, but Still Puzzling. Brain sciences, 9(10), 256. https://doi.org/10.3390/brainsci9100256
- Cortese, S., Ramos Olazagasti, M. A., Klein, R. G., Castellanos, F. X., Proal, E., & Mannuzza, S. (2013). Obesity in men with childhood ADHD: a 33-year controlled, prospective, follow-up study. Pediatrics, 131(6), e1731–e1738. https://doi.org/10.1542/peds.2012-0540
- Wang, B. Q., Yao, N. Q., Zhou, X., Liu, J., & Lv, Z. T. (2017). The association between attention deficit/hyperactivity disorder and internet addiction: a systematic review and meta-analysis. BMC psychiatry, 17(1), 260. https://doi.org/10.1186/s12888-017-1408-x
- Lorenz-Spreen, P., Mønsted, B.M., Hövel, P. et al. Accelerating dynamics of collective attention. Nat Commun 10, 1759 (2019). https://doi.org/10.1038/s41467-019-09311-w
- ADHD Genetic Research Study. National Human Genome Research Institute (Mar. 2014). https://www.genome.gov/Current-NHGRI-Clinical-Studies/ADHD-Genetic-Research-Study-at-NIH
- Hoogman, M., et. Al., (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry, 4(4), 310–319. https://doi.org/10.1016/s2215-0366(17)30049-4
- Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. Attention deficit and hyperactivity disorders, 2(4), 241–255. https://doi.org/10.1007/s12402-010-0045-8
- Stokes, Audrey. “Expert Article: Kids and Multitasking.” Common Sense Education, 6 Apr. 2018, www.commonsense.org/education/articles/expert-article-kids-and-multitasking.
- Brossard-Racine, M., Majnemer, A., Shevell, M., Snider, L., & Bélanger, S. A. (2011). Handwriting capacity in children newly diagnosed with Attention Deficit Hyperactivity Disorder. Research in Developmental Disabilities, 32(6), 2927–2934. https://doi.org/10.1016/j.ridd.2011.05.010
4. Piper Sandler. (2021, April). Taking Stock With Teens: 20+ Years Of Researching U.S. Teens GenZ Insights SPRING 2021 (pdf). https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiv6bPBuLbzAhXQgGoFHdhbAdkQFnoECAIQAQ&url=https%3A%2F%2Fwww.deca.org%2Fwp-content%2Fuploads%2F2021%2F09%2FTaking-Stock-with-Teens-Spring-2021-Results.pdf
5. Citron, J. (2021, May 12). How We’re Making Discord More Welcoming for Everyone. Discord.Com. https://discord.com/blog/how-were-making-discord-more-welcoming-for-everyone
6. Source: Disboards.com October 11, 2021
7. Winkie, L. (2019, November 4). Teens Are Running Illicit Dating Channels on Discord. Medium. Retrieved October 9, 2021, from https://onezero.medium.com/despite-strict-ban-discord-is-a-hub-for-potentially-dangerous-underage-dating-6749383f5e90
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