Screening for Problematic Internet Use

Problematic internet use is a growing health concern in the US. As adolescents are in the age group that are highest users of the internet, this means that problematic internet use is a pediatric health concern.

Problematic internet use is more than just using the internet too much; it also addresses how one uses the internet. A previous research study defined problematic internet use as “Internet use that is risky, excessive or impulsive in nature, leading to adverse life consequences, specifically physical, emotional, social or functional impairment.” Thus, problematic internet use represents an abnormal relationship with the internet that has serious consequences.

Problematic internet use has been associated with negative consequences, including social, academic, and health consequences. Previous research studies have found that people who have problematic internet use are more likely to have poor academic performance, increased stress, and fewer positive health behaviors such as physical activity and sleep. 

Given that internet use begins increasingly earlier in adolescence and even into childhood, primary care physicians such as pediatricians and family physicians are in an ideal position to conduct early screening for problematic internet use.

In order to screen for problematic internet use, there must be a scale that has been tested and found to be accurate. The Problematic and Risky Internet Use Screening Scale (PRIUSS) was developed and validated for use among adolescents. The PRIUSS has 18 items (it is sometimes called the PRIUSS-18) and has been used in pediatric clinics, as well as in school-based health centers. It takes about five minutes for a teen to complete this screening test.

Even though five minutes is a pretty short time frame, it is still too long to be useful in a routine health visit, such as a sports physical or well-child check. As many parents know, these health supervision visits often include a variety of health screens, including screening for safety behaviors (i.e. sunscreen, bike helmets), sleep habits, and physical activity. Thus, in order to be easily used in routine health visits, a shorter PRIUSS tool would be helpful. A shorter screening tool could fit into existing adolescent screening tools, and for those that screen positive, the full PRIUSS-18 could be provided to that youth.

Our research team conducted a research study to develop a shorter version of the PRIUSS tool, our goal was to develop a short screen that had three questions. In order to develop a shorter version of the PRIUSS-18 we first examined the three subscales within the PRIUSS.

The PRIUSS has three subscales, which means that the scale includes questions that fall into three general categories. The three subscales of the PRIUSS are social impairment, emotional impairment, and risky/impulsive internet use. Our goal was to develop a three-item PRIUSS (PRIUSS-3) so that each subscale was represented by one question. 

In order to find the three PRIUSS-18 questions that best represented the screening test, we first wanted to look at which PRIUSS questions were most often correlated with the total PRIUSS score.

In order to be as thorough and thoughtful as possible, we looked at three separate datasets that all included PRIUSS results:
•    One from a sample of college students across five universities,
•    One from a sample of college students across two universities
•    One from a sample of high school adolescents.

In each dataset, we looked at the three subscales and selected the question with the highest correlation for each of the three subscales. This gave us two solid questions that were highly linked to the overall PRIUSS score. However, for one subscale there were several questions with similar correlation, so we needed to do more testing. We evaluated the wording of the questions, and conducted additional statistical analyses to select the question that best represented the subscale. We now had the PRIUSS-3!

The PRIUSS-3 includes three items addressing: 
1) Anxiety when away from the internet
2) Loss of motivation when on the internet
3) Feelings of withdrawal when away from the internet.

This scale can be completed within about a minute and could fit within existing adolescent health screens such as those based on the Guidelines for Adolescent Preventive Services. 

We have found in our clinic that having the experience of taking the PRIUSS can lead to some great conversations between the physician and the patient, as well as between patients and their parents.

Studies suggest that time spent using the internet is a highly salient concern for parents. A recent report found that approximately a third of parents reported concerns about their child’s internet use in the past year. Parents can play a valuable role in their child’s internet use by setting rules and limits, role modeling positive behaviors, and co-using technology together.

One tool parents can use to help prevent problematic internet use is the Family Media Use plan. This plan was developed by the American Academy of Pediatrics. The plan allows for parents and their children to develop rules for time and content on screens, including internet use time. It also provides a way for parents and their children to calculate appropriate amounts of “screen time” based on prioritizing health behaviors, social time, and academics first.

The Family Media Use planis free and available at: www.healthychildren.org/mediauseplan.

The PRIUSS tool available for download: http://smahrtresearch.com/use-our-methods/.