Can Video Games Make Kids Violent? Answers to Parents’ Top Gaming Questions

Dave Anderson PhD
By: Dave Anderson, PhD

Vice President, Public Engagement and Education; Senior Psychologist, ADHD and Behavior Disorders Center Read More

A child psychologist on Grand Theft Auto VI, aggression, meltdowns, and how to keep gaming in balance

A new installment of the mega-popular Grand Theft Auto video game will be released soon, and in a lot of homes the request has already landed: Can I play it? It’s one of the most anticipated game releases in years, and it has prompted a wave of questions from parents who listen to Thriving Kids, a podcast from the Child Mind Institute.

Parents are also wondering when gaming becomes a problem, what to do about meltdowns when it’s time to stop, and how to handle games that eat into sleep and schoolwork. Here are my answers to nine of the questions we received, starting with Grand Theft Auto VI.

My 13-year-old wants GTA 6. Should I let them play it?

Like earlier games in the series, GTA 6 involves committing acts of violence and robbery, a lot of swearing, and characters who draw players into all kinds of actions that would be crimes in real life. But it’s also a world that can be genuinely fascinating to explore and figure out.

There are a few ways to approach your child’s request. First, check the rating. GTA 6 is rated M for Mature (17+), and in some other countries it’s rated even higher. This is highly adult content.

Second, consider your child’s maturity level. Some 13-year-olds have already been exposed to this kind of content and handle it well, meaning it doesn’t seem to affect their behavior, their language, how they treat their peers, or basic habits like sleep and homework.

Other 13-year-olds may be more vulnerable. A child with ADHD, for example, may already struggle with executive functioning, time management, or stopping something they enjoy to do homework or go to sleep — playing video games may make those challenges worse. But these are concerns with any game a child engages with, whatever its content.

A child who already struggles with impulsiveness, verbal or physical aggression toward peers, or foul language may also be more vulnerable. We probably don’t want that child repeatedly practicing similar behavior through the game.

If you look at this content and decide it isn’t right for your 13-year-old, that’s a sound decision. And if you know your child well and feel they can handle it, you don’t need to feel guilty about that either.

Can playing Grand Theft Auto make kids more violent?

Parents have worried about violent video games encouraging kids to commit violence since the 1990s. Such a link is not supported by research.

But aggression is different from violence. A more developed body of research suggests that violent games may make kids who are already prone to impulsivity or aggression — such as verbal aggression, bullying, or physical aggression — more aggressive. Playing violent video games can also allow people to “rehearse” aggressive thoughts and acts, and some experimental research suggests this can translate to more aggressive thinking or behavior, especially when kids play a lot or play with friends.

But keep in mind: There are more powerful factors that can influence a child’s behavior. The effect of violent video games is small in relation to the quality of the parent-child relationship, whether a child has been exposed to violence or trauma at home, and how closely parents keep track of where their teens are and who they spend time with.

So, here’s the short answer: When it comes to violent acts, the research doesn’t support a link. When it comes to aggressive thoughts and a slightly higher chance of aggressive behavior, there is some evidence. And there are many real-world factors in a child’s life that matter more than the games they play.

My child says everyone else is playing GTA. How should I respond?

As a psychologist, I generally advise parents not to be the most permissive parent in their child’s friend group, but not to be the strictest, either. It’s best to aim for somewhere in the middle. The research on parenting points the same way. The goal is to lead with support and add structure when kids need it.

You may not think your child is ready for this content. You may worry it could make a mental health challenge worse, or your child may already be prone to aggressive speech or teasing that borders on bullying. Those are all good reasons not to let them practice those things in their free time, and you can feel confident holding that boundary. You might say: “Sometimes I’ll be in line with your friends’ parents, and sometimes I won’t. I love you, and I want to help you experience lots of other things in life.”

You can also try a middle path with conditions attached: Your child can only play the game in a shared space where you can see and hear what’s going on. They can explain the game to you, and you can keep an eye on their behavior outside the game, putting more limits if you see any concerning changes. But be clear with your child about what you’re worried about and what would lead you to step in. Gaming that starts cutting into sleep or schoolwork, for example, is a clear signal to set a limit.

My child watches Grand Theft Auto content on YouTube but doesn’t play the game. Is that different?

Lots of kids watch streamers play the games they like on YouTube or Discord or watch short-form clips on social media. For a child who isn’t allowed to play a popular game, watching can be a way to understand it and stay in the conversation with friends.

Still, it’s reasonable to be cautious. Research is still emerging on how short-form video affects kids’ attention — and an algorithm may keep feeding them more violent content. So, you might nudge your child away from short clips and toward longer videos that follow a story.

It can help to know what they’re watching. Is the channel about the graphics and gameplay? Is it about glorifying violent acts? Or is it about how a team works together to complete a quest? You might start by watching together and let your child watch on their own once you’ve approved the content, or only when you’re around to keep an eye on it.

Age matters here, too. For kids in middle school or younger, I’d monitor more closely — any site where they watch gaming videos will probably serve up more content with similar themes. With an older teen watching on their own device, it’s reasonable to say, something like, “Help me understand why this is valuable to you. Let’s watch some together, and then I’ll trust you to watch on your own.”

My child can focus on something like Grand Theft Auto for hours but can’t focus on homework. Why?

Almost everyone focuses better on something they enjoy than on something they don’t. It’s why so many of us procrastinate, scrolling social media or knocking out small, easy tasks instead of the one big thing we need to do. Kids are no different.

We want to teach kids how to sequence and prioritize tasks, how to bring their focus to something even when it isn’t the most interesting option, and how to build persistence. (My recent Thriving Kids episode with Julia Leonard, PhD, goes deeper on persistence.)

A helpful first step is bundling. If you’re going to allow your child to play video games, make sure it comes after homework. Your child shows you evidence that their homework is finished, and then they get access to games, whether that’s up until dinner, bath time, or getting ready for bed. They can also earn more time by getting down to work sooner. If you aren’t home in the afternoon, gaming can start once you get home.

Are some kids more vulnerable to problematic gaming than others?

Problematic gaming — excessive gaming at the cost of one’s well-being — follows a recognizable pattern. A child plays for very long stretches, more and more over time, and becomes increasingly distressed when they have to stop. Gaming starts to crowd out the things that matter for their development: schoolwork, real-life friendships, sleep, even eating properly.

Problematic gaming rarely happens on its own. Often a child has a co-occurring mental health condition. A child who is depressed may withdraw from activities and friends and find comfort and distraction in gaming, which then reinforces their depression. A child who struggles to make friends may find it easier to connect with people online and retreat into the digital world, making it harder to make friends in real life. A child with attention challenges may find it harder to put the brakes on fun and novel activities to do something less rewarding.

So yes, some kids are more vulnerable. But there are effective treatments both for the underlying conditions and for setting boundaries around gaming. For some kids, that means enforcing a break from gaming — for a short time or a longer one — because they can’t yet put on the brakes on gaming themselves. For others, it may mean moderation, with conditions in place to make sure their other responsibilities get done.

My child melts down when it’s time to stop playing. What should I do?

A meltdown at the end of gaming time can be a sign of problematic gaming, but on its own it’s just one indicator among several. It’s actually very common, especially for younger kids, to have a meltdown when they’re asked to stop something they enjoy and to do something less fun, like come to dinner, start homework, take a bath, or go to bed.

So, think of this as a lesson in emotion regulation, a set of skills kids learn in stages.

The first step to helping kids self-regulate is modeling. How do you regulate your own emotions, and do you talk about it out loud? Do you take deep breaths, step away for a break, reach out to someone, or do something distracting for a moment to reset?

The second step is reinforcement. How do you respond when your child does calm down? Do you give them positive feedback? Can they earn an activity or a special privilege when they practice these skills?

The third step is teaching these skills directly. Does your child know what emotion regulation looks like? (You can learn more about how to teach emotion regulation skills to kids of any age through the free resources, including short videos, that we have here.)

Finally, when your child does melt down, can you sit with their big feelings? As long as they aren’t screaming at you, refusing to go to bed, or getting physically aggressive, you can calmly acknowledge it by saying something like, “I know it’s hard to stop playing, but it’s time to get ready for bed.”

When that isn’t enough, a consequence can help. Tell your child that their gaming time depends on their ability to stop calmly. For example, a child who gets 30 minutes of gaming at night and melts down when it ends might lose 10 of those minutes the next day. Just make sure consequences, when needed, are applied consistently.

Many parents’ first instinct is simply to take the game away. That is an option, and you may need to use it. But try this process first — it can build skills that help with almost anything you’re trying to teach your child.

Should gaming be earned through chores, homework, or good behavior?

Much of life runs on a kind of social contract. When you get your responsibilities done, finish your homework, treat your sister kindly, and speak respectfully to your parents, you have access to certain privileges. For younger kids, that might be a favorite activity or dessert. As kids get older, it might be an allowance. For teenagers, it might be their social life, their curfew, rides, or a little money for meals out with friends. And in the working world, meeting your responsibilities is how you earn your salary.

That doesn’t mean every privilege has to depend on chores, homework, and good behavior. Systems like this take energy to run, so save them for when your child really needs to build a skill and fade them back as that need lessens. A child who does the dishes now and then, picks up their room, does their homework, and keeps safe hands around their sister may not need their 30 minutes of gaming tied to any of it. You can simply give them a set amount of gaming time each day.

When you are seeing problems with contributions at home, effort at school, or behavior, video games can absolutely be made contingent on those things.

What should parents do if they think gaming is affecting sleep, school, or friendships?

Sleep, school, and friendships are core areas of a child’s wellness and development.

Whenever parents ask about screens, video games, or phones, I go through a checklist. Think about your child’s diet and hydration, physical activity, sleep, mood, friendships online and off, investment in school and homework, and whether they take part in at least one extracurricular activity or hobby. We also want to think about their relationships with parents and friends, and whether they have a supportive adult in their life.

These are the building blocks of a child’s wellness. When a child’s screen time is in balance with them there is less cause for concern.

When gaming cuts into sleep, set a time when screens end, and keep all devices out of your child’s room at bedtime.

When schoolwork is slipping, structure the afternoon so homework comes before gaming.

When you’re worried about extracurriculars or time with friends in real life, look for ways to restore that balance. You can remove games for a short or long period if you need to. Kids don’t need games to live.

At the same time, we don’t want to dismiss kids’ interests or tell them gaming is terrible. You can say: “This is your interest, and I want to support you in it. I also want to support your wellness as a whole.”

Sometimes restoring that balance is still really hard. It may lead to a lot of conflict, big fights, or your child becoming more aggressive or disrespectful. That’s the time to reach out for help, perhaps with a school counselor or therapist.

This blog post is adapted from the Thriving Kids episode “Can Video Games Influence Children and Teen Behavior?” Listen on Apple Podcasts, watch on YouTube, or subscribe wherever you get your podcasts. Have a question for a future episode? Email podcast@childmind.org.

The post Can Video Games Make Kids Violent? Answers to Parents’ Top Gaming Questions appeared first on Child Mind Institute.

Preliminary diagnostic performance of the MOXO continuous performance test in young adults undergoing ADHD assessment

IntroductionAttention-deficit/hyperactivity disorder (ADHD) diagnosis in young adults is often challenging due to symptom overlap with affective disorders and the inherent subjectivity of clinical evaluations. While Continuous Performance Tests (CPTs) provide objective metrics, their preliminary diagnostic performance and concordance with clinical evaluations relative to self-report questionnaires require evaluation in clinical settings. This study explored the diagnostic performance of the MOXO-CPT and formally examined its incremental predictive value beyond commonly used self-report measures in young adults assessed for ADHD.Materials and methodsA total of 118 young adults (aged 18–25 years) consecutively referred with attention-related complaints completed the MOXO-CPT and self-report scales (ASRS, WURS-25, STAI, RRS-SF). ADHD diagnoses were established via comprehensive semi-structured clinical interviews based on DSM-5 criteria by an experienced psychiatrist blinded to test and questionnaire scores. Multivariable logistic regression and Receiver Operating Characteristic (ROC) analyses evaluated independent predictors and discriminative performance relative to this clinical reference standard.ResultsADHD was diagnosed in 58.5% (n=69) of the cohort, while the remaining 41.5% (n=49) comprised a clinical comparison group predominantly presenting with alternative psychiatric conditions (63.3%). Participants with ADHD showed poorer performance across all MOXO-CPT indices (attention, timing, impulsivity, and hyperactivity) compared to the non-ADHD clinical comparison group. In multivariable modeling, average or above-average performance on the attention and hyperactivity indices was independently associated with a lower likelihood of ADHD diagnosis. ROC analysis indicated that the MOXO-CPT attention index demonstrated favorable discriminative capacity relative to the clinical diagnosis (AUC = 0.87, sensitivity = 81.2%, specificity = 85.7%), whereas other indices showed acceptable-to-poor discriminative performance.DiscussionIn this help-seeking sample of young adults, the MOXO-CPT attention index demonstrated promising discriminative ability in differentiating ADHD from a non-ADHD clinical comparison group predominantly presenting with anxiety and depressive disorders. These preliminary findings suggest that distractor-embedded continuous performance testing may serve as a useful objective adjunct for distinguishing ADHD from common psychiatric mimics in outpatient settings, rather than a stand-alone tool or a general screening instrument for healthy populations.

What Is Sextortion?

Andy, a 16-year-old high school junior in New York City, received a message from a girl he didn’t know on Snapchat. She was cute, blonde, a freshman at the University of Wisconsin, and her greeting was Midwestern nice. He barely paused before responding. They chatted on the platform for a few days before she asked him to send a nude photo of himself. Andy didn’t know what to do, so he texted his closest friends for advice. They told him to find a nude photo of a stranger online and send that, so he did. And that’s when everything changed.

The person posing as a college girl threatened to share the photo everywhere online and claim it was him — unless Andy sent a $100 gift card. Scared, he went to the drug store and sent it right away. But the threats didn’t stop, and the messages got more frequent and intense. The person texting revealed that they were an adult overseas, not a college student, and would be tortured if they didn’t succeed in getting Andy to send more money. The amounts increased to $300 at a time, and he scrambled to do it, using his parents’ credit card. Over the course of a week, he racked up a bill of nearly $2,000.

This is just one example of sextortion, the use of explicit content to threaten someone with exposure if they don’t do what is demanded. One large U.S. survey found that approximately 5 percent of middle and high school students have been victims of sextortion, while about 3 percent admitted to targeting others. The National Center for Missing and Exploited Children (NCMEC) notes that they have seen a dramatic increase of cases reported to their CyberTipline, in particular from teenage boys.

Definition of sextortion

Sextortion is a form of exploitation where a child is threatened or blackmailed, most commonly with the possible public sharing of nude or sexual images of the child, by someone who demands additional sexual images or money.

A teen can be sextorted by a someone they know — often someone they are dating or used to date. But the perpetrator also can be an adult stranger pretending to be a teen to lure kids.   

With strangers, the interaction starts off innocuously enough: a friendly text or message online, often from someone who appears to be a similar age as the child and usually of another gender. That might be on video games such as Roblox or Minecraft for younger kids or Discord servers for teens. They may share connections in common on the platform because they’ve reached out to the child’s friends as well, so even though they’re a stranger, they don’t seem like one. “What’s tricky is who kids will describe as a friend versus a stranger is different than for adults,” says Megan Ice, PhD, a psychologist at the Child Mind Institute. “A kid may feel like they know this person” who they just met online and texted a few times.

The predator will establish a friendship or romantic relationship, then they may propose “I’ll show you mine if you show me yours” to ask for a nude photo. Or they will secretly record a video or live chat to get explicit content. In the era of generative AI and “nudify” apps, a kid doesn’t even have to provide a nude — they can use regular photos of a child to create sexual images for blackmailing purposes.

There is also sadistic sextortion, a newer but growing form of sextortion where the child is forced to do dangerous and disturbing things like torture pets or hurt themselves and write their name in blood on the wall, all performed on camera. A global network called 764 has targeted children and adolescents with sadistic sextortion, and the FBI has posted warnings about the group.

The pressure to comply is intense — the texts might come every few seconds, dozens of messages an hour and progressively faster, to create a sense of urgency. The blackmailer might have a package delivered or send the police to a child’s house on a false report (known as “swatting”) to show they know where they live, so the threat of retribution feels very real. The fear, shame, and hopelessness have led some kids to die by suicide after being sextorted.

Why teens are at risk for sextortion

While all age groups are at risk for sextortion, teens are often targeted because they are particularly vulnerable. During adolescence, changes in the brain can lead teens to feel social rewards intensely, so they care a lot about what others think of them, Dr. Ice says.  And that makes them more likely to underestimate the risks of doing something that feels good in the moment.

“Adolescents are exploring their identity, they’re exploring their sexuality,” says Justin Patchin, PhD, a professor of criminal justice at the University of Wisconsin–Eau Claire, who studies sextortion. Their prefrontal cortex is still developing, so short-term rewards are prioritized over long-term consequences. That means “they’re more vulnerable to acting impulsively and sharing explicit images with somebody that they’re interested in.”

“The other reason high school students make a particularly good target is because if a 16-year-old girl sends a topless picture to somebody online, they’ve now created and distributed child pornography, which is a crime. Whereas if an 18-year-old girl does that, it’s not a crime,” Dr. Patchin says. Blackmailers may tell teens who send sexual images or other explicit content that they’ve broken the law and could be prosecuted, which makes the extortion even more effective.

“I teach criminal justice, and sexting is the only behavior that I can think of where teens are treated more harshly by the system than adults,” Dr. Patchin says.

Teen groups at higher risk for sextortion

Research shows that LGBTQ+ kids are more at risk for sextortion. They often find community online, and it’s common for them to have friendships with people that they haven’t met in person.

Kids with autism, ADHD, or mental health issues such as social anxiety may also be particularly at risk. “Neurodiverse kids may develop strong friendships in online communities related to niche interests, making them vulnerable to predators who take advantage of the lack of supervision in these spaces,” Dr. Ice says. She is especially concerned about autistic kids, who may not question the intentions behind other members’ communications, and kids with ADHD, whose struggles with impulsivity may mean they act quickly when responding to a request.

“Kids who are hiding behavior from adults” — such as kids with eating disorders or who self-harm — tend to be very active in online communities like Reddit, Dr. Ice says. Predators will commonly target those communities to find the kids who are most vulnerable and then work to build relationships with them.

How to prevent sextortion

Parents can’t prevent sextortion from happening, but they can talk to their kids to make them aware of it — and advise them to speak up immediately if something happens. “I tell parents if there’s an incident in the news, if you see an article that you’re reading online, that’s a good prompt to have that conversation with your kid and say, ‘Hey, look at this story,’” Dr. Patchin says. “You can ask them, ‘Has anything like this happened to you? If it does, please come talk to me. We’ll deal with it together.’”

You can discuss the risks of sexting, Dr. Patchin says: “If that image does get online somewhere and a bunch of people see it, what kind of potential consequences there might be. And in an extreme, terrible situation, maybe it could be a crime if a prosecutor or a police officer wants to pursue it.”

It’s also important to be aware of common tactics and tell kids about them. For example, predators often move the conversation to messaging apps disguised to look like a clock or calculator app, but when you click on it, you have to enter a password. That can help them avoid detection, because mainstream apps often have content filters. Private messaging apps also make it harder for law enforcement to track and prosecute them.    

“Kids need to be educated, because there are people online who will take advantage of them not knowing what is safe,” Dr. Ice says. “Just like you would take certain safety precautions when you’re walking down the street, you need to take safety precautions online.”

While you want kids to understand the risks of engaging in these behaviors, you want to emphasize they should come to you for help no matter what. “You want to make clear that if they tell you, they will not lose access to their phone or all the things that keep them connected to their friends,” Dr. Ice says. “I think that fear is what keeps it secret a lot of the time.”

NCMEC has useful resources about sextortion, including an interactive activity for teens, noescaperoom.org.  

Signs of sextortion

Many signs of sextortion are similar to those of depression or even addiction, particularly online gambling. For example, a child might show sudden changes in eating or sleeping habits, uncharacteristic changes in behavior or routine, or engage in more secretive online behavior. Kids might become either distant or clingy because they are stressed out and afraid to tell you what is going on. According to NCMEC, other signs might include:

  • Receipt of anonymous gifts (physical or digital)
  • Law enforcement being called to your home under false pretenses
  • Random occurrences at your address, such as unexpected deliveries

Signs of sadistic sextortion might include:

  • Scarring on the thighs or forearms, especially if the scars form a pattern
  • Sudden interest in collecting tools including drills, screwdrivers, hammers, blow torches, or large knives with no clear purpose
  • Family pets or other animals being harmed or dying under suspicious circumstances

What to do if someone is blackmailing your child

If your child tells you they are being sextorted, “you want to avoid shaming and blaming — of yourself or the child,” Dr. Ice says,  because these are professional scammers who know what works. “Let them know they did the right thing to tell you, and you can help them.” Don’t pay the blackmailer more money because it rarely makes them stop. Here are some steps you can take:

  • Report the account on the platform where the interaction occurred.
  • Block the person, but don’t delete your child’s profile or messages — they can be helpful to track the person and stop the blackmailing.
  • Go to the police station to report the sextortion. You can also report the incident to the CyberTipline, run by NCMEC, which can connect you with legal, emotional, and other supports.
  • Use NCMEC’s Take It Down, which helps youth remove online nude, partially nude, or sexually explicit photos and videos taken before they were 18.

When Andy finally told his mom Jackie about the sextortion — about a week after that first message — it was nearly 11pm, but his dad took him to the police station to report it. The police said that they were the fourth family to come in that day about sextortion and reassured them that the perpetrators would not come after them. “Hearing that was the biggest relief,” Jackie said. “Once we wiped his phone and computer, it was over.”  

Frequently Asked Questions

What is sextortion?

Sextortion is a form of exploitation in which someone threatens to share a nude or sexual images unless the person comply with demands, typically for money, more explicit content, or other harmful actions. Kids are often targeted, and the perpetrator may be someone the child knows or a stranger who has built trust online by pretending to be a peer.

How can you get rid of blackmailers?

Experts advise not paying the blackmailer, because paying rarely makes the demands stop and often leads to requests for more money. Instead, report the account on the platform, block the person, save the messages as evidence, and contact law enforcement. If your child is being targeted, the National Center for Missing and Exploited Children has useful resources.

What should you do if someone is blackmailing you with nudes?

If someone is threatening you with intimate images, tell a trusted adult right away and remember that you are not alone. Report and block the offender, keep copies of messages and other evidence, and make a police report. If the images or videos were taken before you turned 18, the National Center for Missing and Exploited Children has a service called Take It Down to help you remove them from the internet.

The post What Is Sextortion? appeared first on Child Mind Institute.

Orexin receptor antagonists for sleep disturbance in attention-deficit/hyperactivity disorder and autism spectrum disorder: a systematic review

BackgroundSleep disturbance is among the commonest and most impairing comorbidities of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Melatonin has the strongest evidence base, but its action is chronobiotic, its maintenance effect inconsistent, and adult evidence sparse. Orexin receptor antagonists reduce wake drive rather than induce sedation, a mechanistically distinct alternative.MethodsReported in accordance with PRISMA 2020. PubMed, Europe PMC, OpenAlex and ClinicalTrials.gov were searched on 23 September 2026 using three complementary concept searches with backward citation tracking; Embase and PsycINFO were not searched. Screening applied a mechanical rule, and every candidate was assessed at full text by two independent reviewers. Eligible reports described a person with diagnosed ADHD or ASD given an orexin receptor antagonist, with a sleep, behavioural, cognitive or safety outcome. Risk of bias was appraised at domain level and certainty against the GRADE domains without categorical ratings. Pooling was precluded by heterogeneity and by the absence of comparable controlled effect estimates.ResultsEight reports representing seven patient groups described 41 exposed participants, 25 with ADHD and 16 with ASD. No completed trial provides peer-reviewed or registry-posted diagnosis-specific outcomes. The strongest signal is a one-month open-label study of daridorexant 50 mg in 24 adults with ADHD and insomnia, where median insomnia severity fell from 16 to 8 and actigraphic total sleep time rose by about 24 minutes, both surviving correction, and 62.5% responded; no cognitive outcome survived correction, one worsened, and the favourable attention results required excluding sleep non-responders. In ASD the evidence is case reports and small series confounded by co-medication, the only comparison-group report being null. No report provides ADHD-stratified paediatric outcomes. Of two registered trials one is recruiting and one completed, the latter’s sponsor releasing top-line data without diagnosis-stratified outcomes.ConclusionOrexin receptor antagonism is a mechanistically coherent approach to sleep disturbance in ADHD and ASD, but no appraisable, diagnosis-specific controlled evidence supports its use, and the evidence is too sparse and biased for causal inference. The signal that sleep gains may accompany attention gains requires a randomised test. Routine use cannot be recommended, and off-label prescribing requires individualised specialist assessment.

AI-assisted Home-based Intervention for ADHD Children

Conditions: ADHD – Attention Deficit Disorder With Hyperactivity; ADHD – Combined Type; ADHD – Inattentive Type

Interventions: Device: Generative artificial intelligence assisted diary platform home-based intervention; Behavioral: Consultations and psychoeducation on child emotional management

Sponsors: National Taiwan University Hospital

Recruiting

Pediatric psychotropic prescribing and polypharmacy, 2019-2022: a retrospective electronic health record study in Qatar

BackgroundReal-world evidence on pediatric psychotropic prescribing and polypharmacy in Gulf health systems remains limited. Characterizing medication-class patterns and multi-class prescribing is essential for medication safety surveillance in children and adolescents. This study examined psychotropic prescribing, potential polypharmacy, and recorded medication combinations among children and adolescents using public-sector electronic health records in Qatar.MethodsA retrospective observational study used electronic health record data from Hamad Medical Corporation and the Primary Health Care Corporation, Qatar’s principal public healthcare providers, from January 2019 to December 2022. Children and adolescents aged 0–17 years with at least one psychotropic prescription were included. Medications were classified as antidepressants, antipsychotics, anxiolytics, mood stabilizers, or attention-deficit/hyperactivity disorder (ADHD) medications. Potential cross-class polypharmacy was assessed as the recording of two or more medication classes per patient during the study period; available duration information did not permit confirmation of concurrent exposure. Logistic regression examined patient-level associations with this outcome.ResultsThe dataset included 2,941 eligible prescription records corresponding to 2,221 unique patients. The proportion of prescriptions for ADHD medications decreased from 28.7% in 2019 to 13.7% in 2022, whereas the proportion assigned to anxiolytics increased from 26.0% to 37.5%. ADHD medications predominated among prescriptions for children aged 5–11 years, while antidepressants and antipsychotics predominated among those for adolescents aged 12–17 years. The potential-polypharmacy criterion was met by 322 patients (14.5%), reaching 21.6% among adolescents. In a gender-adjusted model restricted to patients aged 1–17 years, each additional year of age was associated with higher odds of meeting the criterion (adjusted OR 1.13, 95% CI 1.10-1.16). After excluding patients with prescription-linked seizure disorder or cerebral palsy, the corresponding proportion was 16.96% (259/1,527). Among patients meeting the criterion, antidepressant-antipsychotic and ADHD medication-antipsychotic pairs were most frequent; methylphenidate-risperidone was the most common recorded individual-drug pair.ConclusionsThis study characterizes pediatric psychotropic prescribing and potential polypharmacy in Qatar’s public healthcare records and helps address the limited regional evidence from Gulf health systems. The observed patterns identify potential medication-safety surveillance priorities, particularly among adolescents and patients with antipsychotic-containing medication histories. Further assessment incorporating exposure duration and clinical outcomes is needed to establish concurrency and clinical significance.

Impulsivity is the principal correlate of problematic internet use in young adults with attention-deficit/hyperactivity disorder: a cross-sectional clinical study

IntroductionAttention-deficit/hyperactivity disorder (ADHD) and problematic internet use share clinical features such as impulsivity, emotional dysregulation and impaired inhibitory control, but most evidence comes from children, adolescents and non-clinical samples. It remains unclear which dimension carries this association in adults with a formally established diagnosis.MethodsRetrospective, cross-sectional study of young adults (aged 18 to 38 years) consecutively assessed at a second-level outpatient service for adult ADHD in Milan, Italy. Diagnosis was established with a semi-structured diagnostic interview (DIVA-5), which also yielded symptom counts for childhood and adult inattention and hyperactivity/impulsivity. Participants completed the Internet Addiction Test, the Barratt Impulsiveness Scale, the Difficulties in Emotion Regulation Scale, measures of depressive and anxiety symptoms, a quality-of-life questionnaire and two ADHD symptom questionnaires. Impulsivity and emotional dysregulation were prespecified variables of interest. Analyses comprised correlations with correction for multiple comparisons, group comparisons, multivariable linear regression and bootstrapped mediation.ResultsTwo hundred and fourteen patients had a valid Internet Addiction Test score (mean 52.96, standard deviation 15.16); 22.9% were average users, 62.1% problematic users and 15.0% highly problematic users. Problematic internet use correlated with impulsivity (rho = 0.345) and emotional dysregulation (rho = 0.229), both surviving corrections, while no significant association was detected with the four interview-derived symptom counts (rho from 0.004 to 0.119), the two symptom questionnaires, quality of life or trait anxiety. In the multivariable model impulsivity was the strongest correlate (b = 0.317, p < 0.001; standardized beta 0.33), whereas emotional dysregulation was weaker and varied across specifications (b = 0.091, p = 0.052). Severity, presentation, symptom counts and demographic and clinical covariates were not significantly associated with the outcome. Mediation analysis identified an indirect association between severity and internet use through impulsivity (indirect effect 1.56, 95% confidence interval 0.41 to 2.96).DiscussionIn young adults with ADHD, impulsivity is the dimension most consistently related to problematic internet use, whereas no association was detected with core symptom severity; the confidence intervals remain compatible with weak associations. Assessment of online behavior should not be restricted to the most severely affected patients. The design does not support causal inference.