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RECONNECTING AND DISCONNECTING: RECOGNIZING AND MANAGING CYBER ADDICTIONS
Dr. Smita Naidoo
Hot & Current Topics Webinar SeriesThu March 5 2019 | 1900-2000 PST
Smita N. Naidoo, MD, MPH, FRCP(C)Hot & Current Topics Webinar SeriesTuesday, March 5, 7-8pm, PST
YOU HAVE BEEN MUTED. PLEASE DO NOT UNMUTE
DISCLOSURE
• NO DISCLOSURES TO DATE.
MITIGATION OF BIAS
• NOT APPLICABLE.
ABOUT ME…
Child & Adolescent Psychiatrist: Emergency & Private Practice settings
Clinical Faculty at UBC, Psychiatry Department
Passion: transition age youth (18-25), educating school systems
Created a mental health platform: Paperclouds(www.papercloudsproject.com)
Love my iPhone…
DESCRIBE THE POTENTIAL CLINICAL IMPLICATIONS AND IMPACT ON HEALTH OF CYBER-DEPENDENCY (CD)
DESCRIBE THE CURRENT CLINICAL AND NEUROSCIENTIFIC EVIDENCE FOR CYBER ADDICTION (CD)
IDENTIFY CYBER ADDICTIONS AND DISCUSS BEST MANAGEMENT PRACTICES OF (CD)
LEARNING OBJECTIVES
AGENDA
IDENTIFYING CYBER-DEPENDENCY (CD)
CURRENT CLINICAL & AND NEURO-SCIENTIFIC EVIDENCE FOR (CD)
CLINICAL & HEALTH IMPACT OF (CD)
BEST MANAGEMENT PRACTICES OF (CD)
Q+ A
PART 1.
IDENTIFYING CYBER DEPENDENCY
TECHNOLOGY IS NEITHER GOOD NOR BAD, NOR IS IT NEUTRAL.
-MELVIN KRANZBERG
DEFINITIONS
CYBER DEPENDENCY: INTERNET ADDICTION + VIDEO GAME ADDICTION
INTERNET ADDICTION: CYBER SEXUAL, CYBER-RELATIONAL, INTERNET COMPULSIONS, INFORMATION OVERLOAD, COMPUTER ADDICTION.
DSM 5: “INTERNET GAMING DISORDER”, CONDITION FOR FUTHER STUDY (APA 2013).
INTERNET GAMING DISORDER- DSM 5
TYPES OF ADDICTIONS
USUAL DEFINITION(S) PROCESS ADDICTIONS
PUTTING SOMETHING INTO YOUR BODY
STEALING (KLEPTOMANIA)
IVDU (HEROIN) PATHOLOGICAL GAMBLING
SNORTING (COCAINE) HAIR PULLING (TRICHOTILLOMANIA)
INGESTING (ALCOHOL) INTERNET-GAMING…
IDEN
TIFY
ING
TH
E P
RO
BLE
MQUICK SCREENING QUESTIONS WITH FAMILIES (CPA, 2017)
WHAT SCREEN(S) ARE IN YOUR HOME (TV, TABLETS, PHONES)
WATCHING TV A SHARED ACTIVITY? OR IS IT IN THE BACKGROUND?
SCREENS USED AT MEALTMES?
CHILD/TEEN WATCH ALONE OR WITH YOU?
ENCOURAGE CONVERSATION/DISCUSSION WHILE USING SCREENS?
CHILD USE SCREENS WHEN YOU’RE DOING CHORES AROUND THE HOUSE?
SCREEN-BASED ACTIVITIES IN YOUR CHILD’S DAY CARE PROGRAM/SCHOOL?
USE OF SCREENS BEFORE BEDTIME? HOW LONG BEFORE?
GUIDELINES FOR SCREEN USE IN YOUR HOME?
ASSESSMENT TOOLS
IAT: INTERNET ADDICTIONS TEST (20 ITEM, SELF-REPORT)
YOUNG OF THE INTERNET ADDICTION QUESTIONNAIRE (YDQI)
CHEN’S INTERNET ADDICTION SCALE (CIAS), 26 ITEMS
INTERNET ADDICTION SCALE (IAS): 20 ITEM
PART 2.
NEURO-SCIENCE & EVIDENCE
NEU
RO
-EVI
DEN
CE
AD
DIC
TIO
NS
MO
DEL
Pathological Gambling Internet-Gaming D/O
Chasing money Chasing points (avatars)
Value money Value items/points/skills
Casinos tier system (Fixed Ratio)
Games tier system (Fixed ratio)
Rewards at random(Variable Ratio)
Games use random rewards (Variable Ratio)
T. Black & M. Chow. PAX 2012 addictions.
AD
DIC
TIO
NS
PAT
HW
AYPATHOLOGICAL GAMBLING DSM-CRITERIA
TOLERANCE * NEED INCREASING AMOUNT TO ACHIEVE SAME LEVEL OF EXCITEMENT
WITHDRAWAL * IRRITABLE, RESTLESS IF THEY CUT DOWN
CAN’T STOP UNSUCCESSFUL EFFORTS TO CONTROL GAMBLING
PRE-OCCUPATION PRE-OCCUPATION, PLANNING, GETTING $
SOOTHING * GAMBLES WHEN FEELING DISTRAUGHT
CHASING - IF THEY LOSE $, WON’T STOP, RETURN TO GET EVEN
SHAME/HIDING LIES ABOUT EXTENT OF ADDICTION
SIG. LOSSES INTER-PERSONAL, JOB, EDUCATIONAL OPPORTUNITIES
BURDENS OTHERS- RELIES ON OTHERS TO RELIEVE DESPERATE FINANCIAL SITUATIONS
RISK FACTORS FOR CD?
YOUNGER AGE
MALE GENDER
EARLY EXPOSURE TO THE INTERNET
FREQUENCY OF USE
AVAILABILITY OF TIME
NAT
ION
AL
STU
DIE
S
CO
MB
INED CHINA
10%
DENMARK1.6%
USA8%, GENTILE ET
AL
NORWAY4%
PREVALENCE INTERNET/GAMING ADDICTIONS*2% WORLDWIDE*
PART 3.
CLINICAL EVIDENCE& HEALTH IMPLICATIONS
TOP 3 ASPIRATIONS OF CHILDREN TODAY:
SPORTSMAN, POP STAR, ACTOR.
25 YEARS AGO…TEACHER, BANKER, DOCTOR.
-YALDA T. UHLS
USA: 80% MOBILE MEDIA USE (2-4 YO), 2013
CANADA: >2 H PER DAY (3-5 YO), 2014
UK: 51% USE TOUCH SCREEN DAILY (6-11 MONTHS), 2016
VISIT:
https://www.cps.ca/en/documents/position/screen-time-and-young-children
0-5 YRS HABIT FORMINGOVERUSE/ADDICTION
LATER IN LIFE
6 MONTHS CATCH & HOLD ATTENTION
6-14 MONTHS IMITATE
18 MONTHS RECALL BRIEF SEQUENCES
24 MONTHS HARD TO TRANSLATE 2D3D, FACE-TO-FACE TRUMPS SCREENS
IS IT ALL BAD? (0-5 YRS)Q U A L I T Y P R O G R A M I N G
F O S T E R S C O G N I T I V E D E V E L O P M E N T
I M P R O V E S R E T A I N I N G D A T A , E X P R E S S I V E L A N G U A G E ( * O N L Y I F I N T E R A C T I V E )
E A R L Y L A N G U A G E A N D L I T E R A C Y
IS IT ALL BAD? (0-5 YRS)
L A N G U A G E D E L A Y ( > 2 H / D U S A G E )
A T T E N T I O N D I F F I C U L T I E S ( M I X E D E V I D E N C E , > 5 - 7 H / D )
B A C K G R O U N D T V / S C R E E N S : S T U N T S E X E C F U N C T I O N , C O G D E V E L O P M E N T , A T T E N T I O N ( < 5 Y O )
S H O R T T E R M M E M O R Y I S S U E S
D I S T I N G U I S H I N G R E A L I T Y F R O M S C R E E N T I M E
FAMILY MEAL?
INSTANT GRATIFICATION (VIRTUAL ESCORTS)
LEGALISATION OF CANNABIS & FURTHER DECLINE IN MOTIVATION FOR LONG-TERM PURSUITS
GAMING FULFILLS COMPETITIVE NATURE
“SILENT ADDICTION”: EXPERIENCE THE PLEASURE IN LIFE VS. HAVING MAJOR TRAUMATIC EXPERIENCES
LACK OF INTIMACY, IP CHALLENGES
SECOND LIFE HAS > 20 MILLION USERS
USE OF TECH AS THE MEDIATOR FOR CHAOTIC ELEMENTS IN OUR LIVES
CHANGES OUR EXPERIENCES
OBLITERATES DISTANCEINCREASES LONELINESS
KEEPS US IN TOUCH FOSTERS SOCIAL ANXIETY DISORDER
TECH AS “SAFE” WARM BODIES AS “RISKY”
PART 4.
BEST MANAGEMENT PRACTICES
HOW DO YOU SPEND YOUR TIME?
SLEEP
TIME AT SCHOOL/WORK
DOING HOMEWORK
DOING CHORES
PLAYING SPORTS
HANGING OUT WITH FRIENDS
BEING OUTDOORS IN NATURAL ENVIRONMENTS
WATCHING TV
SCREEN TIME AND SOCIAL MEDIA (TEXTING, TWEETS, APPS, SUM OF ALL ELECTRONIC ACTIVITY)
PLAYING VIDEO GAMES
START WITH INSIGHT!
VIDEO GAMES676 H
(ANNUAL AVG, TEEN MALE)
VIDEO GAMES676 H
(ANNUAL AVG, TEEN MALE)
LEARN A NEW LANGUAGE
205 H
LEARN A NEW LANGUAGE
205 H
LEARN TO PLAY GUITAR260 H
LEARN TO PLAY GUITAR260 H
PLAY A SPORT DURING
INTRAMURAL SEASON
32 H
PLAY A SPORT DURING
INTRAMURAL SEASON
32 H
SMARTER SCREEN TIME & VALUES
WATCH WITH YOUR CHILDREN + MENTOR THEM (CO-VIEWING)
PRIORITIZE EDUCATIONAL CONTENT/APPS
COMBINE TOUCH SCREENS AND INTERACTIVE PLAY
LIMIT SCREEN TIME IN PUBLIC PLACES/FAMILY ROUTINES (MEALS)
LIMIT 1-2 HOURS BEFORE BEDTIME
TURN OFF ALL DIGITAL DEVICES AT THE SAME TIME (CURFEW FOR ALL VS. PUNISHMENT FOR YOUTH)
SMALL ACCOMPLISHMENTS BIGGER ONES
EMOTIONAL REGULATION: ROUTINE FOR PFC
FINANCIAL CONTROL
HEALTH BENEFITS: ANCHOR GOOD SLEEP HYGEINE
FUTURE-ORIENTED
RESIST DAILY TEMPTATIONS
MAKE YOUR BED. MINIMIZE SCREEN TIME.
CHANGE THE WORLD.
WHAT CAN SCHOOLS DO?
TEACH LIFE SKILLS: PERSONAL FINANCE, JOB INTERVIEWS, DEATH OF A RELATIVE, BUDGET, BAN HOMEWORK
INTERACTIVE LEARNING: PROMOTE DISCUSSION, CLARITY IN CLASSROOMS
EMPLOY HEALTH EDUCATORS: PERSONAL BOUNDARIES, POSITIVE ASPECTS OF INTIMACY, FERTILITY AND AGEING
CLINICAL PEARLS CD AFFECTS US AT ALL STAGES OF LIFE (<5. 15, 25+)
2% PREVALENCE WORLDWIDE
CLINICAL IMPLICATIONS OF CD: COGNITIVE, SOCIAL, ACADEMIC/OCCUPATIONAL DOMAINS
ASSOCIATED WITH: ADHD, ANXIETY DISORDERS, MDD, IP-ISSUES, AGGRESSION
MANAGEMENT: IMPROVE INSIGHT (LOGGING), SMARTER SCREEN TIME, ROLE MODELING, SCHOOL SYSTEM.
AVOID DIGITAL DETOX! FOCUS ON HEALTHY RELATIONSHIP WITH TECH.
THANK YOU!
THE HIGHEST AND MOST BEAUTIFUL THINGS IN LIFE ARE NOT TO BE HEARD ABOUT, NOR READ ABOUT,
NOR SEEN BUT, IF ONE WILL, ARE TO BE LIVED.
- SOREN KIERKEGAARD
42
Hot and Current Topics Webinar Series
Join us on May 28th 2019, 19:00-20:00, for our next webinar in this series:
Non-alcoholic fatty liver disease: How concerned should we be and what to do beyond
recommending weight loss?
Presented by Dr. Vladimir Marquez
After this talk you will be able to:1. Describe the risk of cirrhosis posed by fatty liver disease2. Review the effect of weight loss, physical activity, vitamin E, and
other treatment modalities 3. Describe what a Fibroscan is, how to request it, interpret it and
know who should get it4. Know when to refer to a hepatologist
