Assessment of Hazardous Gaming in children and its dissimilarities and overlaps with Internet Gaming Disorder.

Background and aims: Children have been vastly overlooked in Internet Gaming Disorder (IGD) and Hazardous Gaming research so far. The diagnoses are listed in different ICD-11 chapters (addiction vs. problematic health condition) and are thus considered as distinct constructs. However, screening tools for children do not exist yet. We aimed to investigate the psychometric properties of an existing IGD screening tool modified to also assess Hazardous Gaming in children. Further, we aimed to compare the dissimilarity and overlap between (subclinical) IGD and Hazardous Gaming in children. Methods: The study analyzed data from a mixed school and clinical sample. Data from N = 871 children aged between 8 and 12 years of age (M = 10.3, SD = 0.90) were analyzed. Data were collected via the Video Game Dependency Scale (CSAS) in its parent report version, which was adapted to assess Hazardous Gaming symptoms in addition to the IGD symptoms. Item analyses and reliability and factor analyses were conducted on the Hazardous Gaming version. Results: The results show that the adapted CSAS version that assesses Hazardous Gaming symptoms in children mostly shows acceptable psychometric properties. Explorative Factor Analysis (EFA) shows a two-factor structure with one factor of higher order. Additionally, results show that 35.2% of all children meeting the threshold for Hazardous Gaming exclusively meet criteria for Hazardous Gaming but not for (subclinical) IGD. Vice versa, 91.3% of children with IGD also meet the criteria for Hazardous Gaming. Discussion: Hazardous Gaming and (subclinical) IGD are distinct constructs with some overlaps and might have a temporal relation. We recommend adding four items to assess Hazardous Gaming using the CSAS and further evaluate the validity. The assessment of Hazardous Gaming in children is crucial because it might occur earlier than subclinical or full-syndrome IGD.

Procrastination Predicts Future Internet Use Disorders in Adolescents but Not Vice Versa: Results from a 12-Month Longitudinal Study.

BACKGROUND: Use of Internet applications is often associated with postponing real-life obligations. Previous cross-sectional studies have reported a positive association between procrastination and Internet use disorders (IUDs). Further, procrastination is included in theoretical models explaining the development of IUDs. However, little is known about the temporal relationship; thus, longitudinal studies identifying the specific predictive direction are required. METHODS: Using a cross-lagged panel design, a total of 240 students who were at high risk for IUDs, aged between 12 and 18 years (M = 15.17, SD = 1.66) were assessed at baseline (t1) and reassessed one year later (t2) with standardized measures for IUDs and procrastination. RESULTS: Our results showed that IUD symptom severity at t2 was significantly predicted both by IUD symptom severity at t1 and procrastination at t1. However, procrastination at t2 was predicted only by procrastination at t1 but not by IUD symptom severity at t1. CONCLUSIONS: We could not find a reciprocal relationship between procrastination and IUD symptom severity. Procrastination appears to be a causal risk factor for IUDs, but not a consequence. As a modifiable risk factor, procrastination is a promising starting point for preventive and therapeutic interventions for IUDs.

Problem gaming-related harm experienced by partners and parents of individuals with gaming problems and their help-seeking experiences.

Background and aims: Limited research has investigated how individuals' problem gaming affects significant others. The present study investigated the extent to which partners and parents were personally affected by their partner or child's problematic gaming behavior and what steps, if any, were taken in relation to treatment and other help-seeking by the gamers and the respondents themselves. Methods: Two targeted samples (parents, n = 104; partners, n = 264) in Australia were recruited and administered an online survey. The survey assessed gaming-related harm across multiple domains, including financial, relationship, emotional wellbeing, physical health and work/study. Treatment and help-seeking questions referred to seeking psychological assistance, self-help, and community support. Non-parametric tests compared groups on harm measures based on GD status. Results: Parents and partners of individuals rated in the 'problem gaming' range reported significantly greater harms compared to those in the at-risk and non-problem categories. The most frequently endorsed harms were in the relationship domain, including neglected household responsibilities, withdrawal from social events, and relationship conflict. Some parents consult with friends and family (15%) to resolve their child's gaming-related problems. Partners reported to seek outside support and assistance for themselves, including 30% who sought a psychologist. No partners reported having consulted a psychologist for their gaming partner. Discussion: Problem gaming affects significant others across multiple life areas, but few seek outside help or support, suggesting there may be significant unmet needs. Conclusions: Further research should examine factors that influence acceptance and engagement with problem gaming help options. Harm indicators may be useful for evaluating targeted interventions and other measures to reduce problem gaming.

Predictors of Students' Mental Health during the COVID-19 Pandemic: The Impact of Coping Strategies, Sense of Coherence, and Social Support.

Young people and women seem to suffer more from social restrictions due to the COVID-19 pandemic than do others. Findings from pre-pandemic surveys identified students as a specific risk group for developing anxiety and depressive symptoms. Recent studies have indicated that students especially denoted a decrease in mental health during the pandemic. In a sample of n = 1938 university students (67.6% female), we investigated protective factors that are associated with mental health (defined as the absence of any mental disorder) and more specifically, the absence of major depression during the pandemic despite social restrictions. Investigated protective factors were social support, sense of coherence and situational coping strategies. The results of the multiple logistic regression analyses revealed that male gender, high sense of coherence and specific coping strategies could be identified to be associated with mental health in general and the absence of major depression. Protective coping strategies that were related to mental health in general were lower substance use, lower behavioral disengagement, higher positive reframing and lower self-blame. Protective coping strategies that were associated with the absence of major depression specifically were higher use of instrumental support, lower substance use, lower behavioral disengagement, higher positive reframing, higher emotional support, lower self-blame and lower humor. Social support was related to the absence of major depression, but not to mental health in general. Higher age in university students was associated with better mental health, but not with the absence of major depression specifically. These findings indicate that sense of coherence and situational coping strategies can buffer the adverse effect of social restrictions on mental health and thus, can serve as important resilience factors. Moreover, they highlight the political relevance of promoting specific coping strategies to foster mental health in students encompassing adverse events and social restrictions.

Effectiveness of Cognitive Behavioral Therapy-Based Intervention in Preventing Gaming Disorder and Unspecified Internet Use Disorder in Adolescents: A Cluster Randomized Clinical Trial.

Importance: Behavioral addictions were introduced as novel mental disorders in the International Classification of Diseases, 11th Revision, based on evidence that human behavior itself can become addictive, similar to addiction to substances. However, previous studies on prevention of gaming disorder and unspecified internet use disorder lacked randomization, follow-up measurements, and diagnostic interviews that assessed incidence rates; this trial was intended to fill this gap. Objectives: To investigate whether the PROTECT (Professioneller Umgang mit technischen Medien [Professional Use of Technical Media]) intervention can reduce the symptom severity and prevent full syndrome and subthreshold onset of gaming disorder and unspecified internet use disorder in at-risk adolescents. Design, Setting, and Participants: A multicenter cluster randomized clinical trial conducted recruitment, screening, intervention delivery, and data collection among at-risk adolescents aged 12 to 18 years in 33 high schools in Germany. Inclusion criteria for the study and symptom severity analyses were elevated symptoms of gaming disorder and unspecified internet use disorder. A subsample that met the inclusion criteria for incidence analyses (no full syndrome of gaming disorder or unspecified internet use disorder, depression, or anxiety at baseline) was analyzed for illness onset. Participants were randomized to either the PROTECT intervention group or the assessment-only control group. Participants were assessed at baseline, 1-month follow-up, 4-month follow-up, and 12-month follow-up between October 1, 2015, and September 30, 2018. Based on intent-to-treat principle, data analyses were conducted from February 8, 2019, to May 7, 2021. Interventions: PROTECT, a theory-driven, manualized, cognitive behavioral therapy-based indicated preventive group intervention that is delivered in 4 sessions by trained psychologists. It targets changes in addictive reward processing and pathological cognitive mechanisms. Main Outcomes and Measures: The primary outcome was symptom severity (measured by CSAS [Computerspielabhängigkeitsskala], a modified German video game dependency scale with a score range of 0-56 [higher scores indicating greater pathology]) along with incidence rates (assessed by a structured clinical interview) after 12 months. Secondary outcomes were comorbid psychopathology and problem behaviors. Results: A total of 422 at-risk adolescents (mean [SD] age, 15.11 [2.01] years; 229 female participants [54.3%]) were randomized to either the PROTECT intervention group (n = 167; mean [SD] risk score, 29.05 [6.98]) or the assessment-only control group (n = 255; mean [SD] risk score, 26.21 [5.01]) and were included in the symptom severity analyses. Compared with the control group, the PROTECT group showed a significantly greater reduction in symptom severity of gaming disorder or unspecified internet use disorder (γ11 = -0.128; 95% CI, -0.246 to -0.011; P = .03), reflecting a 39.8% vs 27.7% reduction of symptoms with an effect size of Cohen d = 0.67 (baseline vs 12-month follow-up) for the PROTECT group. Differences in incidence rates did not reach statistical significance. The PROTECT group showed a significantly greater decrease in procrastination (γ11 = -0.458; 95% CI, -0.735 to -0.180; P < .001) over 12 months, but no significant differences were found for other secondary outcomes. Conclusions and Relevance: Results of this trial showed that the PROTECT intervention effectively reduced symptoms of gaming disorder and unspecified internet use disorder over 12 months. The intervention did not change incidence rates of gaming disorder or unspecified internet use disorder. Trial Registration: ClinicalTrials.gov Identifier: NCT02907658.

Randomized Controlled Evaluation of a Group-Based Training for Parents of Adolescents with Gaming Disorder or Social Network Use Disorder.

BACKGROUND: Internet Use Disorder (IUD), Gaming Disorder (GD), and Social Network Use Disorder (SNUD) are common phenomena among adolescents and young adults. Negative consequences of such disorders can be observed in the individuals themselves and in the family system. Although parents can influence their children in many ways, they are rarely considered in interventions. The present study examines the effectiveness of a group-based training for parents of adolescents with IUD, GD, or SNUD. METHODS: A total of 76 parents of adolescents (12 to 20 years) were randomly assigned to the intervention group (IG) or the waiting list control group. Parents in the IG participated over eight weeks in six sessions of training (topics: psychoeducation, parenting behaviour, parent-child relationships, parent-child communication, and stress and relaxation). Questionnaires on adolescent symptomatology, parent-child relationships, and parental burden were collected before and after the intervention/waiting period. RESULTS: The training reduced the IUD symptomatology of adolescents from the parents' perspective. GD symptomatology improved for at-risk users, though not for pathological users. Some aspects of the parent-child relationships improved in the mothers' judgment. Parental stress was already low before the training. CONCLUSIONS: The presented parent group training can be used to improve IUD symptomatology in adolescents and is effective in the context of early intervention for at-risk computer gamers.

Depression and Social Anxiety Predict Internet Use Disorder Symptoms in Children and Adolescents at 12-Month Follow-Up: Results From a Longitudinal Study.

Trajectories of internalizing disorders and behavioral addictions are still largely unknown. Research shows that both disorders are highly comorbid. Previous longitudinal studies have focused on associations between internalizing disorders and behavioral addictions using screening instruments. Our aim was to develop and examine a theory-based model of trajectories, according to which internalizing disorders foster symptoms of Internet use disorders, mediated by a reward deprivation and maladaptive emotion regulation. We applied clinically relevant measures for depression and social anxiety in a prospective longitudinal study with a 12-month follow-up investigation. On the basis of an at-risk population of 476 students (mean age = 14.99 years, SD = 1.99), we investigated the predictive influence of clinically relevant depression and social anxiety at baseline (t1) on Internet use disorder symptoms at 12-month follow-up (t2) using multiple linear regression analyses. Our results showed that both clinically relevant depression and social anxiety significantly predicted symptom severity of Internet use disorders one year later after controlling for baseline symptoms of Internet use disorders, gender and age. These results remained robust after including both depression and social anxiety simultaneously in the model, indicating an independent influence of both predictors on Internet use disorder symptoms. The present study enhances knowledge going beyond a mere association between internalizing disorders and Internet use disorders. To our knowledge, this is the first study investigating clinically relevant depression and social anxiety to predict future Internet use disorder symptoms at 12-month follow-up. In line with our model of trajectories, a significant temporal relationship between clinically relevant internalizing disorders and Internet use disorder symptoms at 12-month follow-up was confirmed. Further studies should investigate the mediating role of reward deprivation and maladaptive emotion regulation, as postulated in our model. One implication of these findings is that clinicians should pay particular attention to the increased risk of developing behavioral addictions for adolescents with depression and social anxiety.

[Examining the effects of dissonance-based primary prevention of Internet and computer-game addiction on attitudes toward gaming among grade 5 pupils: A pilot study]. / Überprüfung der Effekte dissonanzbasierter Primärprävention von Internet- und Computerspielabhängigkeit in der Jahrgangsstufe 5 auf die Einstellung zum Gaming: Eine Pilotstudie.

Examining the effects of dissonance-based primary prevention of Internet and computer-game addiction on attitudes toward gaming among grade 5 pupils: A pilot study Abstract. Objective: To date, childhood has hardly been considered in the development of effective prevention and intervention programs for gaming disorder and Internet addiction. PROTECTdissonance was therefore designed as a 1-hour dissonance-based, universal primary prevention program for grade 5 high-school students. This pilot study examines the immediate effects of dissonance induction on attitudes toward gaming. Method: A single-arm A+B design with three measurement points (T0, T1, T2) assessed attitudes toward gaming using the Gaming Attitude Test (GAT). The baseline sequence (sequence A, T0 to T1, subsample) included N = 83 high-school students (age: M = 10.27; SD = 0.48) and the intervention sequence (sequence B, T1 to T2, total sample) included N = 200 pupils (age: M = 10.24; SD = 0.47). Acceptance and satisfaction were recorded after the intervention. Results: Hierarchical linear growth models showed a significant reduction of GAT symptoms through the intervention, both in the total GAT score and on the subscale "Trivialization of Negative Consequences." There were no changes in the natural course (baseline sequence A). Pupils correspondingly reported a high rate of satisfaction with PROTECTdissonance. Conclusions: A brief, targeted dissonance-induction exercise shows immediate effects on an attitudinal measure of gaming. To follow up on this promising approach, future studies should investigate whether reduced trivialization of negative consequences of gaming is actually reflected in behavioral change.

Estimated Prevalence of Unreported IGD Cases in Routine Outpatient Children and Adolescent Psychotherapy.

Internet Gaming Disorder (IGD) has been included in the DSM-5 as a diagnosis for further study, and Gaming Disorder as a new diagnosis in the ICD-11. Nonetheless, little is known about the clinical prevalence of IGD in children and adolescents. Additionally, it is unclear if patients with IGD are already identified in routine psychotherapy, using the ICD-10 diagnosis F 63.8 (recommended classification of IGD in ICD-10). This study investigated N = 358 children and adolescents (self and parental rating) of an outpatient psychotherapy centre in Germany using the Video Game Dependency Scale. According to self-report 4.0% of the 11- to 17-year-old patients met criteria for a tentative IGD diagnosis and 14.0% according to the parental report. Of the 5- to 10-year-old patients, 4.1% were diagnosed with tentative IGD according to parental report. Patients meeting IGD criteria were most frequently diagnosed with hyperkinetic disorders, followed by anxiety disorders, F 63.8, conduct disorders, mood disorders and obsessive-compulsive disorders (descending order) as primary clinical diagnoses. Consequently, this study indicates that a significant amount of the clinical population presents IGD. Meaning, appropriate diagnostics should be included in routine psychological diagnostics in order to avoid "hidden" cases of IGD in the future.

Problematic Gaming in Youth and Its Association with Different Dimensions of Quality of Life.

Objective: The problematic use of computer games was included in the DSM-5 and in the ICD-11. Initial research revealed associations between problematic gaming (PG) and quality of life (QoL). However, clarification is needed concerning which dimensions of the multidimensional construct QoL are particularly relevant for PG. Method: To answer this question empirically, we asked 503 parents (mean age: 47.63 years) to rate their 503 children (average age: 14.60 years) regarding QoL and PG, using validated questionnaires on parental assessments of adolescent PG and health-related QoL to collect the data. Correlation analyses were calculated to determine bivariate relations, and a multiple linear regression was used to conduct a multivariable analysis. Results: In the bivariate analyses, a higher severity of PG was associated with a lower health-related QoL in all five surveyed dimensions. In the multivariable model (corrected R2 = 0.35), we observed statistically significant associations between higher severity of PG and male sex and lower age of the adolescent as well as lower QoL in the dimensions of physical well-being and school environment. Conclusions: According to the findings of the present study, physical well-being and school environment should be especially focused on in preventive approaches against the development of PG in youth.

[Inclusion of gaming disorder as a behavioral addiction in ICD-11]. / Einzug der Computerspielstörung als Verhaltenssucht in die ICD-11.

Inclusion of gaming disorder as a behavioral addiction in ICD-11 Abstract. With the inclusion of the new category "disorders due to addictive behaviors" in ICD-11, it has been officially recognized by the WHO that highly rewarding behaviors, analogous to psychotropic substances, can become addictive. In addition to gambling disorder, which was already listed in ICD-10, computer gaming disorder was added as a new diagnosis in this category. The phenotype is characterized by loss of control, priority of gaming over other activities, continuation of gaming despite negative consequences, and the condition of significant impairment caused by the symptomatology. Disorder-typical pathomechanisms include consumption-dependent factors, developmental factors, changes in reward sensitivity and processing, and biased reward expectations (cognitions). Psychotherapeutic care for children, adolescents, and young adults with this disorder, who now comprise a substantial proportion of outpatient care, is challenging. In addition to the development of valid diagnostic tools and effective intervention methods, there is a great need for further training in child and adolescent psychiatry and psychotherapy on this new disorder.

Treatment outcomes of a CBT-based group intervention for adolescents with Internet use disorders.

BACKGROUND AND AIMS: Instances of Internet use disorders (IUD) including Internet gaming disorder (IGD) and non-gaming pathological Internet use (ng-PIU) have the extent that they are now a growing mental health issue. Individuals suffering from IUD show a large range of symptoms, high comorbidities and impairments in different areas of life. To date there is a lack of efficient and evidence-based treatment programs for such adolescents. The present registered single-arm trial (ClinicalTrials.gov: NCT03582839) aimed to investigate the long-term effects of a brief manualized cognitive behavioral therapy (CBT) program for adolescents with IUD. METHODS: N = 54 patients (16.7% female), aged 9-19 years (M = 13.48, SD = 1.72) received the CBT group program PROTECT+. IUD symptom severity (primary outcome variable) as well as comorbid symptoms, risk-related variables and potentially protective skills (secondary outcome variables) were assessed at pretest, posttest, as well as 4 and 12 months after admission. RESULTS: Patients showed a significant reduction in IUD symptom severity at the 12-month follow-up. Effect sizes were medium to large depending on the measure. Beyond the statistical significance, the clinical significance was confirmed using the reliable change index. Secondary outcome variables showed a significant reduction in self-reported depression, social anxiety, performance anxiety and school anxiety as well as in parental-reported general psychopathology. DISCUSSION AND CONCLUSIONS: The present study shows long-term effects of a manual-based CBT treatment for adolescents suffering from IUD. The results indicate that even a 4-session brief intervention can achieve a medium to large effect over 12 months. Future work is needed to confirm the efficacy within a randomized controlled trial (RCT).

Screening and assessment tools for gaming disorder: A comprehensive systematic review.

The inclusion of gaming disorder (GD) as an official diagnosis in the ICD-11 was a significant milestone for the field. However, the optimal measurement approaches for GD are currently unclear. This comprehensive systematic review aimed to identify and evaluate all available English-language GD tools and their corresponding evidence. A search of PsychINFO, PsychArticles, ScienceDirect, Scopus, Web of Science, and Google Scholar identified 32 tools employed in 320 studies (N = 462,249 participants). The evaluation framework examined tools in relation to: (1) conceptual and practical considerations; (2) alignment with DSM-5 and ICD-11 criteria; (3) type and quantity of studies and samples; and (4) psychometric properties. The evaluation showed that GD instrumentation has proliferated, with 2.5 tools, on average, published annually since 2013. Coverage of DSM-5 and ICD-11 criteria was inconsistent, especially for the criterion of continued use despite harm. Tools converge on the importance of screening for impaired control over gaming and functional impairment. Overall, no single tool was found to be clearly superior, but the AICA-Sgaming, GAS-7, IGDT-10, IGDS9-SF, and Lemmens IGD-9 scales had greater evidential support for their psychometric properties. The GD field would benefit from a standard international tool to identify gaming-related harms across the spectrum of maladaptive gaming behaviors.

Predictors of Spontaneous Remission of Problematic Internet Use in Adolescence: A One-Year Follow-Up Study.

Problematic use of the Internet is becoming increasingly important and especially for adolescents, high prevalence rates are reported in many countries. Despite the growing international research activities and the reported prevalence estimates, comparatively very few studies have focused on spontaneous remission and its possible causes. In a risk population of 272 adolescents, we used standardized diagnostic instruments to investigate which socio-demographic and psychosocial characteristics at baseline (at t1) predicted spontaneous remission of problematic Internet use one year later (at t2). The predictors were determined by bivariate and multivariate logistic regression analyses. In the bivariate regressions, we found male gender, higher self-efficacy (t1), a lower level of maladaptive emotion regulation strategies (t1), lower depression (t1), lower performance and school anxiety (t1), lower social-interaction anxiety (t1), and lower procrastination (t1) to predict spontaneous remission of problematic Internet use at t2. In the multivariable analysis, a lower level of maladaptive emotion regulation strategies (t1) was the sole statistically significant predictor for the remission one year later (t2). For the first time, the high relevance of emotion regulation for spontaneous remission of adolescent problematic Internet use was observed. Based on these findings, emotion regulation could be specifically trained and promoted in future prevention measures.

[Effectiveness of an early intervention program for adolescents with Internet Gaming and Internet Use Disorder: Medium-term effects of the PROTECT+ Study]. / Die Wirksamkeit eines Frühinterventionsprogramms für Jugendliche mit Computerspiel- und Internetabhängigkeit: Mittelfristige Effekte der PROTECT+ Studie.

Effectiveness of an early intervention program for adolescents with Internet Gaming and Internet Use Disorder: Medium-term effects of the PROTECT+ Study Abstract. Objective: Internet Gaming and Internet Use Disorder (IGD and IUD) have gained increasing attention in the scientific community over the last few years. The inclusion of "Gaming Disorder" in the ICD-11 (International Statistical Classification of Diseases and Related Health Problems) promoted the need for evidence-based and effective treatments. PROTECT+ is such a cognitive-behavioral group therapy program for adolescents with IGD and IUD. The present study evaluates the medium-term effects after 4 months. Method: N = 54 patients, aged 9 to 19 years (M = 13.48, SD = 1.72), participated in the early intervention study between April 2016 and December 2017 in Heidelberg, Germany. Symptom severity was assessed at baseline, at the end of the treatment, and at 4-month follow-up using standardized diagnostic tools. Results: Multilevel analyses showed a significant reduction in symptom severity using the Video Game Dependency Scale (CSAS) at 4-month follow-up. We found a small effect size in self-reported reduction of symptom severity (d = 0.35) and a moderate effect size in parental ratings (d = 0.77). The Reliable Change Index measured by the Compulsive Internet Use Scale (CIUS) indicated a high heterogeneity in individual symptom changes over time. Patients showed high satisfaction regarding the treatment program at 1- und 4-month follow-up. Conclusions: This study is internationally one of the few to show a significant reduction of IGD and IUD symptoms after 4 months.

School-Related Risk Factors of Internet Use Disorders.

A growing body of research focusing on the risk factors of Internet use disorder (IUD) underlines the effect of sociodemographic variables like age and gender or comorbid mental disorders on IUD symptoms. The relation between IUD symptoms and school-related variables has to date been insufficiently studied. The present study closes this gap by investigating the relation between school-relevant factors such as absenteeism, school grades, procrastination, school-related social behavior, and learning behavior and IUD symptoms in a high-risk sample. n = 418 students between 11 and 21 years of age (M = 15.10, SD = 1.97), screened for elevated risk of IUD, participated in the study. Sociodemographic data, school grades and absent days, Internet use variables (time spent online and gaming), as well as school-related psychological variables (procrastination, learning behavior, and social behavior) were assessed via self-report questionnaires. IUD symptoms were assessed with an adapted version of the German Video Game Dependency Scale (CSAS), which is based on the 9 criteria for Internet gaming disorder in the DSM-5. The instrument was adapted to include the assessment of non-gaming IUD symptoms. Taking the hierarchical structure of the data into account, a multilevel modeling approach was used to analyze the data. Procrastination, time spent online, and gaming were significant predictors of IUD symptoms at the individual level, whereas social behavior significantly predicted symptoms of IUD at the school level. In addition to previous findings on risk factors of IUD, this study indicates the importance of school-related factors in the development of IUD, especially psychological factors that play a role in the school setting. The early age of IUD onset and the high relevance of prevention of IUD at the school age underline the relevance of this finding.

A Phenotype Classification of Internet Use Disorder in a Large-Scale High-School Study.

Internet Use Disorder (IUD) affects numerous adolescents worldwide, and (Internet) Gaming Disorder, a specific subtype of IUD, has recently been included in DSM-5 and ICD-11. Epidemiological studies have identified prevalence rates up to 5.7% among adolescents in Germany. However, little is known about the risk development during adolescence and its association to education. The aim of this study was to: (a) identify a clinically relevant latent profile in a large-scale high-school sample; (b) estimate prevalence rates of IUD for distinct age groups and (c) investigate associations to gender and education. N = 5387 adolescents out of 41 schools in Germany aged 11-21 were assessed using the Compulsive Internet Use Scale (CIUS). Latent profile analyses showed five profile groups with differences in CIUS response pattern, age and school type. IUD was found in 6.1% and high-risk Internet use in 13.9% of the total sample. Two peaks were found in prevalence rates indicating the highest risk of IUD in age groups 15-16 and 19-21. Prevalence did not differ significantly between boys and girls. High-level education schools showed the lowest (4.9%) and vocational secondary schools the highest prevalence rate (7.8%). The differences between school types could not be explained by academic level.

An analysis of integrated health care for Internet Use Disorders in adolescents and adults.

Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients' compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization.

A randomized efficacy trial of a cognitive-behavioral group intervention to prevent Internet Use Disorder onset in adolescents: The PROTECT study protocol.

BACKGROUND: The reduction of prevalence rates of Internet Use Disorder (IUD) and its effective treatment are at high priority in both public health and educational policies. School-based preventive interventions facilitate a low-threshold approach for individuals with IUD, who are typically characterized by high therapy avoidance. Moreover, indicated approaches which target adolescents at high-risk show larger effects than universal prevention programs. Simultaneously, they reduce unnecessary burden for the majority of high-school students that is not at-risk. The PROTECT group intervention for indicated prevention of IUD in school settings was developed based on these preventive strategies. METHODS: Three-hundred and forty adolescents, aged 12-18 years, from 40 secondary schools in Germany, screened for high-risk of IUD onset, are randomly assigned to a) PROTECT preventive intervention group or b) assessment only control group. The tested intervention consists of a cognitive-behavioral 4-session brief-protocol. Follow-up assessments are at 1, 4 and 12 months after admission. Primary outcome is the 12-months incidence rate of IUD. Secondary outcomes are the reduction of IUD and comorbid symptoms as well as the promotion of problem solving, cognitive restructuring and emotion regulation skills. CONCLUSION: The indicated preventive intervention PROTECT follows the APA-guidelines for psychological prevention, i.e., it is theory- and evidence-based and addresses both risk-reduction and strength-promotion, it considers current research and epidemiology and ethical standards such as professional secrecy and is designed as a systemic intervention at the school-level. It is expected that the intervention decreases risk of IUD onset (incidence rate). TRIAL REGISTRATION: ClinicalTrials.gov: NCT02907658.

A Monte Carlo investigation of factors influencing latent class analysis: an application to eating disorder research.

OBJECTIVE: Latent class analysis (LCA) has frequently been used to identify qualitatively distinct phenotypes of disordered eating. However, little consideration has been given to methodological factors that may influence the accuracy of these results. METHOD: Monte Carlo simulations were used to evaluate methodological factors that may influence the accuracy of LCA under scenarios similar to those seen in previous eating disorder research. RESULTS: Under these scenarios, the aBIC provided the best overall performance as an information criterion, requiring sample sizes of 300 in both balanced and unbalanced structures to achieve accuracy proportions of at least 80%. The BIC and cAIC required larger samples to achieve comparable performance, while the AIC performed poorly universally in comparison. Accuracy generally was lower with unbalanced classes, fewer indicators, greater or nonrandom missing data, conditional independence assumption violations, and lower base rates of indicator endorsement. DISCUSSION: These results provide critical information for interpreting previous LCA research and designing future classification studies.