Internet gaming disorder and smartphone addiction in children and adolescents: a clinical parent treatment intervention

<p dir="ltr">In the face of rapidly evolving technology, children and adolescents’ exposure to screens has resulted in increasing recreational screentime over the past decade. Increasing numbers of children and adolescents present with overuse or problematic use that can widely be described as screen related disorders. </p><p dir="ltr">The central aim of this thesis is to address the lack of data around the prevalence and developmental impacts of Internet Gaming Disorder (IGD), Gaming Disorder (GD) and smartphone addiction in Australian children and adolescents. This is presented in Chapter 4 which represents the first prevalence study of Australian children and adolescents since the COVID-19 lockdowns, along with the youngest (Year 4 – 8) cohort studied in the country to date (N=1993). Medium to high smartphone addiction was found in 9.9% of the sample, whilst 4% of children met clinical (1.2%) or sub-clinical (2.7%) levels of IGD, with no differences across age ranges. A pattern of increasing developmental impacts (Screen Developmental Impact Questionnaire- SDIQ) for smartphone addiction and IGD was found. This study found evidence for the need for increasing parent education and a focus on early intervention programs in primary school. </p><p dir="ltr">In addition, this body of work identifies a lack of parent treatment interventions available in the field, culminating in Chapter 2 detailing the first systematic review of parent treatment studies for IGD and smartphone addiction. The review found evidence for parent-based treatment interventions for children and adolescents with IGD symptoms. However, multiple gaps in the body of research were identified including: a need for more robust randomised control trials, no parent clinical trials that focus on smartphone addiction, and a lack of parent treatments that are delivered remotely via E-Health tools. </p><p dir="ltr">Finally, this thesis addresses the identified gaps in research by developing and evaluating the Tech Diet Parent Program (TDPP). Chapter 3 details the process that was undertaken in developing TDPP to be empirically and quantitatively studied. The theoretically underpinnings ix of the treatment are outlined, the 14 psychoeducation and parent strategies (online video modules), along with the rationale for the E-Health delivery. </p><p dir="ltr">Evaluation of the TDPP program is detailed in Chapter 5, a case series (N=5) feasibility trial using pre and post measures of IGD, smartphone addiction, and developmental impacts. While this study was designed as an RCT, the clinical sample (N=218) identified in Chapter 4 was found to be apathetic towards accepting intervention via the TDPP. A majority (85%) of parents were classified as “non-starters” after not responding or declining the invitation, and a further 83% of parents who started the program “dropped out”. While the study provides qualitative evidence for the efficacy of TDPP, the primary outcomes around the challenges of optimal intervention design and retention rates are explored. Further evaluation of TDPP was conducted and outlined in Chapter 6, a manuscript that presents quantitative intervention trial data on the efficacy of TDPP. A total of N=689 parent participants (with school aged children) completed baseline measures, and 153 parents provided 6-week follow up data after completing the TDPP. Fifty-nine percent had a child at baseline with high levels of IGD and/or smartphone addiction symptoms. At 6-week follow up 60% of children with high levels of IGD symptoms and 32% of high levels of smartphone addiction were significantly lower post-program completion. Increased levels of program dosage and compliance were found to be important factors in reductions to IGD and smartphone addiction symptoms, particularly for the high symptom sample, along with developmental impacts. </p><p dir="ltr">The body of work contained in this thesis make a significant contribution to the field of IGD and smartphone addiction, most notably in prevalence and developmental impact data, the development of the SDIQ as a screening tool, and the development of an evidence-based parent treatment intervention program. The clinical and population health implications from this body of work are noteworthy as TDPP offers a parent intervention that can be used in conjunction with individual therapy, or in isolation if the child or adolescent is resistant. It also offers an intervention program that is cost effective and easy to scale for frontline health professionals encountering IGD or smartphone addiction symptoms in children and adolescents.</p>