Adolescent Psychiatry - Volume 4, Issue 2, 2014

Background: The digital revolution has changed healthcare forever. In adolescent psychiatry, the infrastructure of our practice – billing, record-keeping and communication with patients and colleagues – is increasingly occurring electronically and online. Adolescent psychiatrists are likely to interface with technology in their practice, in part because of the high prevalence of use of social media among their patients and also among practitioners. Online professionalism means adhering to the clinical, ethical and legal principles of professional behavior while communicating via the Internet. Due to the unique characteristics of digital technology, professionalism breaches involving technology are easier to commit and have the potential for a broader impact than communication with traditional media. Physicians’ lapses in professionalism online have been documented by the media, researchers and state medical boards, and physicians have increasingly faced various kinds of censure for such lapses. Professional guidelines are emerging; however, these documents do not always provide straightforward answers to complex clinical scenarios. Method: This paper focuses on eight core issues in professionalism and digital technology: confidentiality, patient and practitioner privacy, liability, safety/mandated reporting, libel, netiquette, conflicts of interest and issues unique to psychotherapy. Each concept, as it applies to working with adolescents, is illustrated and discussed in the context of clinical vignettes. Thus, an overall conceptual framework and underlying thought process are emphasized here, rather than specific “do’s and don’ts.” While much of the research cited in this article is from studies of physicians, especially psychiatrists, the principles identified are applicable to all mental health professionals. Results: Online professionalism concerns for mental health professionals who work with adolescents cover a wide range of activities and types of communication. They may be usefully grouped into eight domains: 1) confidentiality, 2) privacy, 3) liability, 4) safety/mandated reporting, 5) libel, 6) “netiquette,” 7) conflicts of interest, and 8) issues unique to psychotherapy. Conclusions: Many situations do not have a clear-cut solution, but having an increased consciousness about and being able to think through relevant issues can prevent online professionalism breaches before they happen. Adolescent mental health providers need to exercise a judicious balance between embracing technology that serves to improve patient care and spurning online behaviors and digital modalities that threaten the fundamentals of professionalism.

Background: Although use of social media is an important part of adolescents’ lives, the mental health impact of this activity is largely unknown to practitioners. Methods: An extensive literature search was conducted regarding social media use among adolescents and the benefits and potential risks associated with that use. A PUBMED search was conducted using various terms including “social media and teens”, “social media and suicide”, “facebook and suicide”, “sexting”, “cyberbullying”, “facebook and teens”, “social media and self-injury”. Relevant articles were examined and used in this review. Also, reports on adolescent social media use from the Pew Internet and American Life Project were examined. Results: This newer form of communication has many benefits to adolescents and plays an important role in their social lives. Despite the numerous benefits of these technologies, there are also several potential risks that can be detrimental to the mental health and well-being of adolescents. Conclusions: It is critical that child psychiatrists and other mental health providers be informed of these potential risks so they can more effectively educate and treat their adolescent patients and their families.

Background: In recent years child and adolescent engagement in online activities and video games has increased dramatically to the point that it dominates the free time of many youth. Many young people seem unable to control their excessive use of technology in spite of consequences which impair aspects of their daily functioning. Methods: This article summarizes the literature regarding pathological video game and Internet use and presents proposed criteria and recommendations for assessment and treatment. Results: A sizable body of recently published research consistently demonstrates that a minority of youth develop symptoms consistent with a behavioral addiction to the Internet and video games, although there is no officially recognized diagnosis which describes the syndrome. Conclusions: Knowledge of current research findings, including epidemiology, will help enable mental health to recognize and appropriately care for patients suffering from these problems.

Background: Use of computer technologies, whether online or playing video games, can pose significant and inherent mental health risks for children and adolescents. Parents are in the best position to influence and control their child’s computer experiences and habits, and so it is the duty of mental health providers to inform parents about these risks and how they can be mitigated. Method: This article reviews trends in media use and mental health implications and outlines various steps that parents can take to prevent harmful aspects of such use. Practical challenges and solutions are discussed. Results: Many parents are unaware of what their children are doing online and the steps they can take to help keep them safe. Children do respond positively to parental monitoring, although this is often a source of conflict. Both external methods, such as placing controls on electronic devices and limiting access, as well as communication with children about safe and healthy use of electronic media are effective. Conclusions: Parents should monitor and as necessary restrict the amount and the content of computer use their children engage in. Parents should teach their children online etiquette and warn them about online risks including sexting and cyberbullying, and watch for signs of such problems.

Background: Cyber bullying has become a focus of attention as having significant negative impacts on adolescents’ mental health. Victims of cyber bullying tend to have an external locus of control (ELOC). They are typically counseled not to respond to the bully. This can lead to a sense of helplessness and resignation, and reinforcement of their view of themselves as helpless to control their environment. There is a need for a more efficacious approach. Methods: In this paper, we analyze the main strategies of coping with cyberbullying. We illustrate the difference between the active and the passive ways of avoidance by bringing up the concepts of “internal locus of control” and “external locus of control”. We describe how cyberbullying seems to be particularly suitable for developing or strengthening an internal locus of control. Finally, we propose the use of cognitive restructuring to encourage the internalization of the cyber victim’s locus of control. Results: Victims can be made to understand that choosing not to respond is actually taking an active role which denyies the bully the satisfaction of seeing the results of his or her behavior. Cognitive restructuring can transform the way in which the victim’s response is understood. Conclusions: Incorporating cognitive restructuring into individual therapy with adolescents could be helpful in promoting an internal locus of control among adolescent victims of cyber bullying.

Background: Video games (VGs) are increasingly becoming the pastime of choice for American youth. Recent US surveys indicate that up to 99% of adolescents play VGs regularly. Caregivers and clinicians are appropriately concerned about the effects of VGs on children’s well being. Adolescents'; play habits may expose them to negative effects associated with VG play on sleep. Methods: This article selectively reviews the literature documenting effects of video game play on sleep. A search of medical literature was carried out by using the keywords “video games” “computer games,” “sleep,” “mental health” and “adolescents.” Results: There is a small but growing body of literature examining the extent of VG play effects on sleep. Timing and duration of VG play are among the most significant circumstances that are associated with changes in sleep onset latency, total sleep duration and sleep efficiency. Findings on effects on sleep architecture are less consistent. Conclusions: VG play at night may lead to delay of sleep onset and interfere with sleep duration and efficiency. These effects appear to be particularly robust in children and young adolescents. Caregiver supervision is crucial in ensuring the appropriate use of VGs. Clinicians have a valuable opportunity to inform the public about these effects of VG play. More research focusing on mechanisms of these effects is needed.

Background: Adolescents have increasingly relied on social media for communication. Communication of feelings of despair and suicidal thoughts and intentions sometimes occur. These form a type of peer-to-peer communication, which may or may not result in a response that eventuates in appropriate intervention. Method: This article presents the case of an adolescent who was hospitalized after her mother discovered that she had posted suicide plans on Facebook. Results: The mother’s discovery was “accidental” in the sense that the girl had left her computer turned on with the screen showing the post. Prior to this discovery the mother had little awareness of her child’s on-line activities or of her depression. The suicide threat occurred in the context of cyber bullying and compulsive on-line activity. Interventions included family therapy at which rules governing computer and cell phone use were negotiated. Conclusions: Improved parental awareness of their child’s online activities is important for many reasons, especially for detection and intervention of high-risk activities.

Background: Internet addiction, also called Problematic internet use, has an estimated prevalence globally of 5- 10%, quickly becoming an increasingly important clinical problem in adolescent psychiatry. Method: A case of social media addiction in a 13-year-old girl is presented and discussed using Tam and Walter’s “Basic Model of PIU in Youth” (Tam and Walter, 2013). Potential treatment approaches are also reviewed. Results: While many cases of internet addiction focus on online gaming, problematic use of social media is also common, particularly in adolescent girls. Defined as internet use that creates difficulties in psychological, social, academic and/or work domains, it has lacked a unified conceptual and treatment approach. Conclusion: Internet addiction is an increasingly recognized clinical problem that arises in the context of a constellation of individual and parenting factors and that poses unique treatment dilemmas for clinicians.

Objective: The objective of this project was to investigate the online behaviors of adolescent and adult populations with respect to mental health information seeking, and identify differences in approaches within age groups and geographical location. Method: This content analysis approach identified and mapped patterns in online conversations. The search data was able to quantify who was looking for teen mental health information, where they were looking, and what they were looking for. Additional analysis included the preferred format of information presentation and how mental health searches varied over time. Results: The results of the analysis revealed that between 2006 (baseline) to 2010, a 200% increase in online activity regarding mental health was identified. Adults were most likely to ignite (initiate) conversations online about depression, followed by: anxiety, doctors, suicide, treatments, and OCD. For teens, depression was also the most ignited topic area, followed by: anxiety, alcohol, suicide, sexting and marijuana. While adults were often seeking information about the disorders and treatment options, teens tended to discuss concerns through the use of personal stories. Conclusion: This research provides insight into how digital and social media can be used to engage both youth and adult discussions about mental health. We report substantive audience driven differences that can inform the development of targeted mental health knowledge translation methods and activities. A broader understanding of the key mental health topics of interest was garnered, in addition to how online use varied between audiences. These results have several implications for mental health knowledge translation including tactics to connect with various stakeholders.

Objective: The aim of this study was to identify correlates that might constitute risk factors for Problematic Internet Use (PIU) among urban Tunisian high school students. Methods: This cross-sectional study was carried out on 587 secondary school students, aged 14 to 20 years. They were recruited from seven secondary schools randomly selected in the urban area of Sfax. The self-administered Young's 8-item questionnaire was used in this survey. To identify an associated video game addiction, Fisher’s 9-item questionnaire was used. The Hospital Anxiety and Depression (HAD) scale was administered to screen for anxiety and depression symptoms. Results: Individual risk factors were a lack of social activity (p=0.008), anxiety symptoms (p=0.000), an associated video game addiction (p=0.000), and the problematic consumption of tobacco (p=0.038) and alcohol (p=0.005). PIU was also significantly associated with poor relationships within the family (p=0.000), an interest in advertising on the Internet (p=0.02), time spent surfing the Internet per day (p=0.000), and mothers’ employment as mid to high level executives (p=0.003). Parental limitations on amount of time spent on the Internet emerged as an important protective factor (p=0.02). Conclusion: The identification of risk factors can help to identify individuals who may be at high risk, and alert mental health providers to be careful to screen these patients for PIU. Total avoidance of the Internet is unrealistic and inadvisable, but a preventive outreach for youth, their families and health professionals may help to limit the onset of PIU among young people.