Temporal Stability of Repeated Assessments of Problematic Internet Use Among Adolescents: A Prospective Cohort Study

The growth of Internet usage has been phenomenal in the last decade. According to the latest statistics on worldwide usage of the Internet, there has been a 4-times increase in the number of users.1 In terms of regional distributions by geographic locations, Asia is the area with the highest number of Internet users in the world in 2009 with more than 764.4 millions.1 With such a large population of Internet users, misuse and loss of control in the use of the Internet should not be expected rare events. Problematic Internet use has been identified as a potential mental health issue that exhibits some signs and symptoms similar to other established additions since the mid-90s.2-5 Since then the term “Internet Addiction” has been proposed and different opinions have been put forward as to whether problematic Internet use should be considered as a psychiatric disorder or a mental illness similar to other well established addictive disorders.6-11 Until now, “Internet Addiction” is not included as a disorder in the latest version of the Diagnostic and Statistical Manual of Mental Disorders-IV Text Revision (DSM-IV-TR) as well as in the International Classification of Diseases-10 (ICD-10).12-13 The major contention of whether the problematic use of the Internet should be considered as an addiction in the conventional sense, such as in the case of substance dependent disorder, is how well Internet addiction can fulfil the validation criteria as a psychiatric disorder.14 Robins and Guze, who first proposed a set of formal criteria for establishing the validity of psychiatric diagnoses, suggested five criteria.15 These include: a clear clinical description of the disorder; evidence from laboratory studies; exclusion of other disorders; follow-up studies; and family studies.15 In terms of the first criterion, a volume of work by many researchers has provided an informative debate.6-11 Evidence from laboratory studies implies the possibility of bio-markers and validated psychiatric and psychological assessments. Recent studies using imaging techniques have provided some results for supporting differences in brain activities between problematic and normal Internet users.1618 Studies on the co-morbidities of problematic Internet use have been paving the way for the establishment of a clear picture for differential diagnoses of “Internet Addiction”.19 Follow-up studies, as suggested by George, reflect the ability of demonstrating temporal