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Current Psychiatry Reports

, 16:472 | Cite as

Adolescents and the Internet: What Mental Health Clinicians Need to Know

  • Malak Rafla
  • Nicholas J. Carson
  • Sandra M. DeJong
Child and Adolescent Disorders (TD Benton, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Child and Adolescent Disorders

Abstract

The Internet’s permeation into daily life has profoundly changed the practice of psychiatry with adolescents, who mobilize online social media and related technologies in their efforts to develop identity and “hang out” with peers. Technology offers both challenges and opportunities to mental health professionals working with teens. Practitioners will need a new skill-set, including keeping abreast of technological developments; professionally incorporating technology into clinical assessment and practice; identifying the negative impacts of technology on teens’ physical and mental health and the particular vulnerabilities of at-risk patients in a digital world; and guiding patients and parents about interventions. Particular patient factors related to race/ethnicity, gender and sexual orientation, mental health and trauma history, family culture, parenting style, and personality traits will need to be considered. This article provides an overview of the literature on adolescents and the Internet focusing on recent research on Internet and digital technologies used for social communication among youth.

Keywords

Adolescence Internet Social media Cyberbullying Text messaging Mental health Trauma Social identity Problematic internet use Professionalism Child psychiatry Psychotherapy Formulation Parent guidance 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Malak Rafla is employed by Cambridge Health Alliance.

Nicholas J. Carson is employed by Cambridge Health Alliance and has received honoraria and paid travel accommodations from Four Winds Hospital (Grand Rounds). Dr. Carson is also a member, Media Committee, American Academy of Child and Adolescent Psychiatry.

Sandra M. DeJong is employed by Cambridge Health Alliance. Dr. DeJong also is a PRITE editorial board member and has received honoraria and paid travel and accommodations for talks and Grand Rounds at various medical schools and psychiatric societies. She has received royalties from Elsevier for her book Blogs and Tweets, Texting and Friending: Social Media and Online Professionalism in Health Care (2014). She is also a member of the AACAP Ethics Committee.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Pew Research Center. Internet use over time. 2014. http://www.pewinternet.org/data-trend/teens/internet-use/. Accessed 1 May 2014.
  2. 2.
    Rideout VJ, Foehr UG, Roberts DF. Generation M2: Media in the lives of 8-to 18-year-olds. Henry J Kaiser Family Foundation. 2010.Google Scholar
  3. 3.
    Madden M, Lenhart A, Cortesi S, Gasser U, Duggan M, Smith A et al. Teens, social media, and privacy. 2013.Google Scholar
  4. 4.
    Madden M. Teens haven’t abandoned Facebook (yet). Pew Internet Research Project. http://www.pewinternet.org/2013/08/15/teens-havent-abandoned-facebook-yet/. Accessed 1 May 2014. 2013.
  5. 5.••
    Lenhart A, Madden M, Smith A, Purcell K, Zickuhr K, Rainie L. Teens, kindness and cruelty on social network sites: how american teens navigate the new world of “digital citizenship”. Pew Internet & American Life Project. 2011. Another recent and detailed report describing how US teens behave in online spaces. Google Scholar
  6. 6.••
    Boyd D. It’s Complicated: The Social Lives of Networked Teens. Yale University Press; 2014. This book is a sociological overview of the impact of technology on teens’ lives. It includes clinical examples from Boyd’s decade of qualitative research at Microsoft, New York University, and Harvard University’s Berkman Center for Internet and Society. She argues that technology is scapegoated and dystopias over-emphasized by adults. It provides an interesting socio-cultural backdrop for clinicians and parents. Google Scholar
  7. 7.
    Palfrey JG, Gasser U. Born digital: Understanding the first generation of digital natives. New York: Basic Books; 2013.Google Scholar
  8. 8.••
    Steiner-Adair C, Barker TH. The big disconnect: Protecting childhood and family relationships in the digital age. HarperCollins; 2013. An overview of the known and potential impacts of technology on the wellbeing, development and relationships of children and families written by a psychologist at Harvard for a lay audience. It is based on the author’s clinical experience and qualitative research and is useful for parent guidance. Google Scholar
  9. 9.
    Pew Research Project Internet Survey. Internet user demographics. http://www.pewinternet.org/data-trend/internet-use/latest-stats/. Accessed 24 April 2014. 2014.
  10. 10.
    Pew Research Project Internet Survey. Cell phone and smartphone ownership demographics. http://www.pewinternet.org/data-trend/mobile/cell-phone-and-smartphone-ownership-demographics/. Accessed 24 April 2014. 2014.
  11. 11.
    Calamaro CJ, Mason TB, Ratcliffe SJ. Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning. Pediatrics. 2009;123(6):e1005–10.PubMedCrossRefGoogle Scholar
  12. 12.
    Kim JH, Lau C, Cheuk K-K, Kan P, Hui HL, Griffiths SM. Brief report: predictors of heavy internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc. 2010;33(1):215–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Berkey CS, Rockett HR, Colditz GA. Weight gain in older adolescent females: the internet, sleep, coffee, and alcohol. J Pediatr. 2008;153(5):635-9. e1.CrossRefGoogle Scholar
  14. 14.
    Kautiainen S, Koivusilta L, Lintonen T, Virtanen SM, Rimpelä A. Use of information and communication technology and prevalence of overweight and obesity among adolescents. Int J Obes. 2005;29(8):925–33.CrossRefGoogle Scholar
  15. 15.
    Foss RD, Goodwin AH, McCartt AT, Hellinga LA. Short-term effects of a teenage driver cell phone restriction. Accid Anal Prevent. 2009;41(3):419–24.CrossRefGoogle Scholar
  16. 16.
    Best P, Manktelow R, Taylor B. Online communication, social media and adolescent wellbeing: a systematic narrative review. Child Youth Serv Rev. 2014;41:27–36.CrossRefGoogle Scholar
  17. 17.
    O’Keeffe GS, Clarke-Pearson K. The impact of social media on children, adolescents, and families. Pediatrics. 2011;127(4):800–4.PubMedCrossRefGoogle Scholar
  18. 18.•
    Jelenchick LA, Eickhoff JC, Moreno MA. “Facebook depression?” Social networking site use and depression in older adolescents. J Adolesc Health. 2013;52(1):128–30. Evaluates the association between SNS use and depression in an older adolescent sample.PubMedCrossRefGoogle Scholar
  19. 19.
    Miniño AM. Mortality among teenagers aged 12–19 years: United States, 1999–2006. Hyattsville: National Center for Health Statistics; 2010.Google Scholar
  20. 20.
    Westerlund M, Wasserman D. The role of the internet in suicide prevention. In: Wasserman D, Wasserman C, editors. Oxford textbook of suicidology and suicide prevention: A global perspective. UK: Oxford University Press; 2009. p. 525–32.Google Scholar
  21. 21.
    Bell J. Harmful or helpful? The role of the internet in self-harming and suicidal behaviour in young people. Ment Health Rev J. 2014;19(1):61–71.CrossRefGoogle Scholar
  22. 22.
    Brooks M. Prosuicidal posts on Instagram ‘Alarming’. In: Medscape psychiatry and mental health. 2014. http://www.medscape.com/viewarticle/824518?src=wnl_edit_cfna. Accessed 8 May 2014.
  23. 23.
    Dunlop SM, More E, Romer D. Where do youth learn about suicides on the Internet, and what influence does this have on suicidal ideation? J Child Psychol Psychiatry. 2011;52(10):1073–80.PubMedCrossRefGoogle Scholar
  24. 24.
    Lewis SP, Heath NL, St Denis JM, Noble R. The scope of nonsuicidal self-injury on YouTube. Pediatrics. 2011;127(3):e552–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Lewis SP, Mahdy JC, Michal NJ, Arbuthnott AE. Googling self-injury: the state of health information obtained through online searches for self-injury. JAMA pediatrics. 2014.Google Scholar
  26. 26.
    Belfort EL, Mezzacappa E, Ginnis K. Similarities and differences among adolescents who communicate suicidality to others via electronic versus other means: a pilot study. Adolesc Psychiatry. 2012;2(3):258–62.CrossRefGoogle Scholar
  27. 27.
    Lewis SP, Arbuthnott AE. Searching for thinspiration: the nature of internet searches for pro-eating disorder websites. Cyberpsychol Behav, Social Netw. 2012;15(4):200–4.CrossRefGoogle Scholar
  28. 28.
    Rouleau CR, von Ranson KM. Potential risks of pro-eating disorder websites. Clin Psychol Rev. 2011;31(4):525–31.PubMedCrossRefGoogle Scholar
  29. 29.
    Hinduja S, Patchin JW. Cyberbullying: neither an epidemic nor a rarity. Eur J Dev Psychol. 2012;9(5):539–43.CrossRefGoogle Scholar
  30. 30.
    Hinduja S, Patchin JW. School climate 2.0: Preventing cyberbullying and sexting one classroom at a time. SAGE; 2012.Google Scholar
  31. 31.
    Jones LM, Mitchell KJ, Finkelhor D. Online harassment in context: trends from three Youth Internet Safety Surveys (2000, 2005, 2010). Psychol Violence. 2013;3(1):53–69.CrossRefGoogle Scholar
  32. 32.
    Mishna F, Khoury-Kassabri M, Gadalla T, Daciuk J. Risk factors for involvement in cyber bullying: victims, bullies and bully–victims. Child Youth Serv Rev. 2012;34(1):63–70.CrossRefGoogle Scholar
  33. 33.
    Schneider SK, O’Donnell L, Stueve A, Coulter RW. Cyberbullying, school bullying, and psychological distress: a regional census of high school students. Am J Public Health. 2012;102(1):171–7.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.••
    Gerson R, Rappaport N. Cyber cruelty: understanding and preventing the new bullying. Adolesc Psychiatry. 2011;1(1):67–71. A useful review including information on definitions, prevalence, impact, screening, and tips for clinicians and parents.CrossRefGoogle Scholar
  35. 35.
    Bazelon E. How to stop the bullies. The Atlantic. 2013.Google Scholar
  36. 36.
    Sticca F, Perren S. Is cyberbullying worse than traditional bullying? Examining the differential roles of medium, publicity, and anonymity for the perceived severity of bullying. J Youth Adolesc. 2013;42(5):739–50.PubMedCrossRefGoogle Scholar
  37. 37.
    Kowalski RM, Limber SP. Psychological, physical, and academic correlates of cyberbullying and traditional bullying. J Adolesc Health. 2013;53(1, Supplement):S13–20.PubMedCrossRefGoogle Scholar
  38. 38.
    English B. Yik Yak app raises bullying concerns. Boston Globe. 2014.Google Scholar
  39. 39.
    Bannink R, Broeren S, van de Looij-Jansen PM, de Waart FG, Raat H. Cyber and traditional bullying victimization as a risk factor for mental health problems and suicidal ideation in adolescents. PLoS One. 2014;9(4):e94026.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Bauman S, Toomey RB, Walker JL. Associations among bullying, cyberbullying, and suicide in high school students. J Adolesc. 2013;36(2):341–50.PubMedCrossRefGoogle Scholar
  41. 41.•
    van Geel M, Vedder P, Tanilon J. Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis. JAMA Pediatr. 2014;168(5):435–42. A methodologically rigorous review of one of the most clinically important associations of online aggression.PubMedCrossRefGoogle Scholar
  42. 42.
    Gámez-Guadix M, Orue I, Smith PK, Calvete E. Longitudinal and reciprocal relations of cyberbullying with depression, substance use, and problematic internet use among adolescents. J Adolesc Health. 2013;53(4):446–52.PubMedCrossRefGoogle Scholar
  43. 43.
    Lenhart A. Teens and sexting. Washington: Pew Research Center; 2009.Google Scholar
  44. 44.
    The National Campaign to Prevent Teen and Unplanned Pregnancy. Sex and tech: results from a survey of teens and young adults. http://thenationalcampaign.org/resource/sex-and-tech. Accessed 10 May 2014. 2008.
  45. 45.•
    Weigle P, Reid D. Social Media Use in Adolescents. Adolescent Psychiatry.2014. An up-to-date review on social media and their effects on adolescent mental health. Google Scholar
  46. 46.
    Temple JR, Paul JA, van den Berg P, Le VD, McElhany A, Temple BW. Teen sexting and its association with sexual behaviors. Arch Pediatr Adolesc Med. 2012;166(9):828–33.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Houck CD, Barker D, Rizzo C, Hancock E, Norton A, Brown LK. Sexting and sexual behavior in at-risk adolescents. Pediatrics. 2014;133(2):e276–82.PubMedCrossRefGoogle Scholar
  48. 48.
    Rice E, Rhoades H, Winetrobe H, Sanchez M, Montoya J, Plant A, et al. Sexually explicit cell phone messaging associated with sexual risk among adolescents. Pediatrics. 2012;130(4):667–73.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Kaye R. How a cell phone picture led to girl’s suicide. CNN Living. http://www.cnn.com/2010/LIVING/10/07/hope.witsells.story/. Accessed 6 May 2014. 2010.
  50. 50.
    Wolak J, Finkelhor D, Mitchell KJ. How often are teens arrested for sexting? Data from a national sample of police cases. Pediatrics. 2012;129(1):4–12.PubMedCrossRefGoogle Scholar
  51. 51.
    Spada MM. An overview of problematic Internet use. Addict Behav. 2014;39(1):3–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Yau YH, Crowley MJ, Mayes LC, Potenza MN. Are Internet use and video-game-playing addictive behaviors? Biological, clinical and public health implications for youths and adults. Minerva Psichiatr. 2012;53(3):153.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Chakraborty K, Basu D, Vijaya Kumar K. Internet addiction: consensus, controversies, and the way ahead. East Asian Arch Psychiatr. 2010;20(3):123–32.Google Scholar
  54. 54.
    Weinstein A, Lejoyeux M. Internet addiction or excessive internet use. Am J Drug Alcohol Abuse. 2010;36(5):277–83.PubMedCrossRefGoogle Scholar
  55. 55.
    Moreno MA, Jelenchick L, Cox E, Young H, Christakis DA. Problematic internet use among US youth: a systematic review. Arch Pediatr Adolesc Med. 2011;165(9):797–805.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.••
    Carli V, Durkee T, Wasserman D, Hadlaczky G, Despalins R, Kramarz E, et al. The association between pathological Internet use and comorbid psychopathology: a systematic review. Psychopathology. 2012;46(1):1–13. An up-to-date and detailed review on the association between Problematic Internet Use and psychiatric disorders.PubMedCrossRefGoogle Scholar
  57. 57.
    Aboujaoude E. Problematic Internet use: an overview. World Psychiatr. 2010;9(2):85–90.Google Scholar
  58. 58.
    Bozkurt H, Coskun M, Ayaydin H, Adak İ, Zoroglu SS. Prevalence and patterns of psychiatric disorders in referred adolescents with Internet addiction. Psychiatry Clin Neurosci. 2013;67(5):352–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Ko C-H, Yen J-Y, Yen C-F, Chen C-S, Chen C-C. The association between Internet addiction and psychiatric disorder: a review of the literature. Eur Psychiatr. 2012;27(1):1–8.CrossRefGoogle Scholar
  60. 60.
    Ha JH, Kim SY, Bae SC, Bae S, Kim H, Sim M, et al. Depression and Internet addiction in adolescents. Psychopathology. 2007;40(6):424–30.PubMedCrossRefGoogle Scholar
  61. 61.
    Wells M, Mitchell KJ. How do high-risk youth use the Internet? Characteristics and implications for prevention. Child Maltreat. 2008;13(3):227–34.PubMedCrossRefGoogle Scholar
  62. 62.••
    Szwedo DE, Mikami AY, Allen JP. Qualities of peer relations on social networking websites: predictions from negative mother–teen interactions. J Res Adolesc. 2011;21(3):595–607. An important study for its focus on SNS and traumatized youth and families followed longitudinally.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    Carson N, Lê Cook B, Chen C-N, Alegria M. Racial/ethnic differences in video game and internet use among U.S. adolescents with mental health and educational difficulties. J Child Media. 2012;6(4):450–68.CrossRefGoogle Scholar
  64. 64.
    Erikson EH. Identity: Youth and crisis, vol. 7. New York: WW Norton & Company; 1968.Google Scholar
  65. 65.••
    Valkenburg PM, Peter J. Online communication among adolescents: an integrated model of its attraction, opportunities, and risks. J Adolesc Health. 2011;48(2):121–7. A useful synthesis of research on SNS effects on adolescent identity, intimacy, and sexuality including risks and benefits.PubMedCrossRefGoogle Scholar
  66. 66.
    Valkenburg PM, Peter J. Social consequences of the internet for adolescents a decade of research. Curr Dir Psychol Sci. 2009;18(1):1–5.CrossRefGoogle Scholar
  67. 67.
    Jackson LA, Von Eye A, Witt EA, Zhao Y, Fitzgerald HE. A longitudinal study of the effects of Internet use and videogame playing on academic performance and the roles of gender, race and income in these relationships. Comput Hum Behav. 2011;27(1):228–39.CrossRefGoogle Scholar
  68. 68.
    Jackson LA, Von Eye A, Biocca FA, Barbatsis G, Zhao Y, Fitzgerald HE. Does home internet use influence the academic performance of low-income children? Dev Psychol. 2006;42(3):429.PubMedCrossRefGoogle Scholar
  69. 69.
    Branson CE, Clemmey P, Mukherjee P. Text message reminders to improve outpatient therapy attendance among adolescents: a pilot study. Psychol Serv. 2013;10(3):298.PubMedCrossRefGoogle Scholar
  70. 70.
    Spence SH, Donovan CL, March S, Gamble A, Anderson R, Prosser S, et al. Online CBT in the treatment of child and adolescent anxiety disorders: issues in the development of BRAVE–ONLINE and two case illustrations. Behav Cogn Psychother. 2008;36(04):411–30.CrossRefGoogle Scholar
  71. 71.
    Nauert R. Avatars reduce depression rates in young adults. PsychCentral. http://psychcentral.com/news/2013/02/12/avatars-reduce-depression-rates-in-young-adults/51509.html. Accessed 12 May 2014. 2013.
  72. 72.
    Van Ameringen M. Social Anxiety Disorder and Technology-Based Communication, Symposium SCR03: Using the web for education and clinical support American Psychiatric Association 167th Annual Meeting; New York, NY. 2014.Google Scholar
  73. 73.
    DeJong SM. Blogs and Tweets, Texting and Friending: Social Media and Online Professionalism in Health Care. Academic Press; 2013.Google Scholar
  74. 74.
    DeJong SM, Benjamin S, Anzia JM, John N, Boland RJ, Lomax J, et al. Professionalism and the internet in psychiatry: what to teach and how to teach it. Acad Psychiatr. 2012;36(5):356–62.CrossRefGoogle Scholar
  75. 75.
    Gabbard GO, Kassaw KA, Perez-Garcia G. Professional boundaries in the era of the Internet. Acad Psychiatr. 2011;35(3):168–74.CrossRefGoogle Scholar
  76. 76.
    Federation of State Medical Boards Inc. Model guidelines for the appropriate use of the Internet in medical practice. http://www.fsmb.org/pdf/2002_grpol_use_of_internet.pdf. Accessed 11 May 2014. 2002.
  77. 77.
    Federation of State Medical Boards Inc. Model policy guidelines for the appropriate use of social media and social networking in medical practice. www.fsmb.org/pdf/pub-social-media-guidelines.pdf. Accessed 11 May 2014. 2012.
  78. 78.
    Council on Communications. Children, adolescents, and the media. Pediatrics. 2013;132(5):958.Google Scholar
  79. 79.
    Recupero PR. The mental status examination in the age of the internet. J Am Acad Psychiatr Law Online. 2010;38(1):15–26.Google Scholar
  80. 80.
    Clinton BK, Silverman BC, Brendel DH. Patient-targeted googling: the ethics of searching online for patient information. Harv Rev Psychiatr. 2010;18(2):103–12.CrossRefGoogle Scholar
  81. 81.
    Gentile DA, Reimer RA, Nathanson AI, Walsh DA, Eisenmann JC. Protective effects of parental monitoring of children’s media use: a prospective study. JAMA Pediatr. 2014;168(5):479–84.PubMedCrossRefGoogle Scholar
  82. 82.
    Winters NC, Hanson G, Stoyanova V. The case formulation in child and adolescent psychiatry. Child Adolesc Psychiatr Clin N Am. 2007;16(1):111–32.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Malak Rafla
    • 1
  • Nicholas J. Carson
    • 1
  • Sandra M. DeJong
    • 1
  1. 1.Division of Child and Adolescent PsychiatryCambridge Health Alliance/Harvard Medical SchoolCambridgeUSA

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