RECONNECTING AND DISCONNECTING: RECOGNIZING AND...

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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

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DISCLOSURE

• NO DISCLOSURES TO DATE.

MITIGATION OF BIAS

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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)

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…

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

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.

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

INED CHINA

DENMARK1.6%

USA8%, GENTILE ET

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?

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

LEARN TO PLAY GUITAR260 H

PLAY A SPORT DURING

INTRAMURAL SEASON

PLAY A SPORT DURING

INTRAMURAL SEASON

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.

REFERENCES

PLEASE EMAIL ME FOR FULL REFERENCE SHEET:

SREEBYE@GMAIL.COM

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

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other treatment modalities 3. Describe what a Fibroscan is, how to request it, interpret it and

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