Sex specific temporal association between internet addiction and ADHD symptoms: A systematic review
A Khatiwada, E Guldbrandtsen, A Rawal, JD Dalgaard Guldager, K Bang Madsen, G Berg-BeckhoffAbstract
Background
Internet Addiction (IA) is a significant public health concern among children and adolescents. Likewise, Attention Deficit Hyperactivity Disorder (ADHD) is a commonly recognised neurodevelopmental disorder in young people worldwide. ADHD is defined by persistent patterns of inattention, hyperactivity, and impulsivity. Growing evidence suggests association between IA and ADHD symptoms; however, it remains unclear whether these associations differ between males and females. The aim of this systematic review is to examine sex‑specific longitudinal associations between IA and ADHD symptoms.
Methods
Following PRISMA 2020 guidelines and Prospero registration (CRD420251250943), PubMed, Web of Science, PsycINFO, and Scopus were searched (from year 2015 to 2025) for longitudinal studies examining associations between IA and ADHD symptoms among populations aged ≤18 years. Study quality was assessed using the National Institutes of Health quality assessment tool for observational and cohort studies.
Results
After screening 663 titles /abstracts and 36 full–text articles by two independent reviewers, five of the ten included studies reported sex‑specific subgroup analyses. All studies assessed ADHD using combined measures of inattention and hyperactivity. Statistically significant (p < 0.05) cross‑lagged associations between IA and ADHD symptoms were reported in two out of five studies. However, separated for sex, significant results were reported for both sexes in four of the five studies. Cross‑lagged effect estimates ranged from β = 0.07 to 0.09 among males and β = 0.06 to 0.08 among females.
Conclusions
Similar associations between IA and ADHD symptoms were observed in both sexes. In contrast to crude estimates, this pattern supports a confounding effect, suggesting that sex may mask but does not modify the association. However, substantial variability in study methods, data collection, and definitions of IA and ADHD limits comparability across studies.
Key messages
• The association between IA and ADHD symptoms is similar for both sexes.
• Future research should use standardized measures and assess associations across specific ADHD symptom domains.