The impact of Internet pornography on children and adolescents: A systematic review.

OBJECTIVES: Young people's exposure to online pornographic material has increased in the past years. Its impact is a complex topic but an important issue due to growing concerns. Therefore, we reviewed the literature on Internet pornography consumption and its impact on children and adolescents. Furthermore, we examined young people's thoughts about pornography and their reasons for consumption. METHOD: We performed a systematic literature search in the online databases ERIC, PsycARTICLES, PsycINFO, and PSYNDEX for peer-reviewed articles in English, published between 2000 and 2022 and additionally identified secondary references. RESULTS: We could determine associations between pornography consumption and demographic variables (e.g., age, gender), personal characteristics (e.g., [sexual] sensation seeking, sexual interest and experience, general risk behavior), environmental variables (e.g., peers, family), attitudes (e.g., gender role attitudes, permissive sexual attitudes), behavior (e.g. sexual risk behaviour, sexting) and sexual aggression (e.g., sexual cybervictimization, grooming). Moreover, we found that girls have a more negative attitude towards pornography than boys who have an ambivalent opinion on the subject. Most adolescents are aware that the majority of pornographic material is exaggerated and unrealistic. Furthermore, pornography is not only watched out of curiosity and for sexual arousal but also used as a source of sexual information, especially by minority groups. DISCUSSION: Many effects that impair children's development have been documented. The results found in this review are often contradictory. Therefore, further replication studies are needed. In addition, we propose several preventive measures, e.g., sexual health education at schools for both heterosexuals and LGBT (Lesbian, Gay, Bisexual, and Transgender) people.

Assessment and Diagnostic Classification Using DC:0-5 in Early Childhood Mental Health Clinics: The Protocol for the Developmental Psychiatry Diagnostic Challenges Study (DePsy).

Mental health problems in early childhood are common, but there is a lack of psychiatric research on this age group. DC:0-5 is a multiaxial classification system for mental disorders in early childhood, providing a framework for standardizing clinical practice and research. However, research on the validity of DC:0-5 is scarce. The Developmental Psychiatry Diagnostic Challenges Study (DePsy) is a multi-site, prospective clinical study including six German early childhood mental health (ECMH) clinics. The main objective of the study is to contribute to the validation of Axis I and Axis II of DC:0-5. A second aim of the study is to describe the population of the participating clinics regarding diagnoses, family context, and treatment outcomes. Additionally, the impact of environmental risk factors, including parental Adverse Childhood Experiences (ACEs) and media use, on child psychopathology and caregiver-child relationships will be examined. Over two years, patients aged 0.0-5.9 years old will be enrolled in the study. Assessments include ICD-10 and DC:0-5 diagnoses, developmental tests, video-based observations of caregiver-child interactions, and questionnaires on child psychopathology, media use, parental stress, and treatment satisfaction. Study results will promote the standardization of assessment and treatment in ECMH clinics aiming to improve the development of patients and their families.

Familial context influences media usage in 0- to 4-year old children.

Background: The use of digital media (e.g., smartphones, tablets, etc.) and the Internet have become omnipresent for every age group and are part of children's and parents' everyday life. Focusing on young children, the availability of media devices, their use as well as associated problems (e.g., in social, emotional and motor development) have increased in recent years. Of particular interest for prevention of these problems in early childhood is the relationship between the familial context (parental digital media use, Problematic Internet Use, school graduation, presence of siblings) and the digital media use of infants and toddlers. The present study's goal was to describe media usage in 0-4-year-old children and to identify the potential relationship between familial context factors and child media usage. Methods: The sample included N = 3,035 children aged 0 to 3;11 years (M = 17.37 months, SD = 13.68; 49.13% female). Recruitment took place within the framework of a restandardization study for a German developmental test. The parents of the participants answered a questionnaire on socio-demographics, on child media use, and on parental media use. Questions on parental media use included the full version of the Short Compulsive Internet Use Scale (S-CIUS). Results: Significant increases in media usage times with child age were identified, but no significant gender differences. A multiple regression analysis revealed that increasing maternal total media usage time, a higher parental S-CIUS score, lower school leaving certificate of both mother and father, and increasing child's age led to higher child media usage time. Having siblings diminished young children's media usage in this study. Having more than one child and having children aged over a year was associated with a higher parental S-CIUS score. Conclusion: Family factors such as maternal media use time, Problematic Internet Use and lower school graduation are significantly associated with young children's digital media use. Parents should be aware of their personal influence on their children's media use which might be due their role in terms of model learning.

Problematic Internet Use among Adolescents 18 Months after the Onset of the COVID-19 Pandemic.

Studies in recent years and especially since the beginning of the COVID-19 pandemic have shown a significant increase in the problematic use of computer games and social media. Adolescents having difficulties in regulating their unpleasant emotions are especially prone to Problematic Internet Use (PIU), which is why emotion dysregulation has been considered a risk factor for PIU. The aim of the present study was to assess problematic internet use (PIU) in adolescents after the third wave (nearly 1.5 years after the onset in Europe) of the COVID-19 pandemic. In the German region of Siegen-Wittgenstein, all students 12 years and older from secondary-level schools, vocational schools and universities were offered a prioritized vaccination in August 2021 with an approved vaccine against COVID-19. In this context, the participants filled out the Short Compulsive Internet Use Scale (SCIUS) and two additional items to capture a possible change in digital media usage time and regulation of negative affect due to the COVID-19 pandemic. A multiple regression analysis was performed to identify predictors of PIU. The original sample consisted of 1477 participants, and after excluding invalid cases the final sample size amounted to 1268 adolescents aged 12-17 (x = 14.37 years, SD = 1.64). The average prevalence of PIU was 43.69%. Gender, age, digital media usage time and the intensity of negative emotions during the COVID-19 pandemic were all found to be significant predictors of PIU: female gender, increasing age, longer digital media usage time and higher intensity of negative emotions during the COVID-19 pandemic were associated with higher SCIUS total scores. This study found a very high prevalence of PIU among 12- to 17-year-olds for the period after the third wave of the COVID-19 pandemic, which has increased significantly compared to pre-pandemic prevalence rates. PIU is emerging as a serious problem among young people in the pandemic. Besides gender and age, pandemic-associated time of digital media use and emotion regulation have an impact on PIU, which provides starting points for preventive interventions.

Preschool Temperament as a Factor of Risk and Protection for Later Childhood Psychopathology.

Background: Temperament might be considered as a risk factor as well as a resilience factor for later externalizing and internalizing disorders. Therefore, this study examines different dimensions of temperament in preschool age with regard to their predictive value for psychopathology later in childhood. Methods: A total of 76 patients (63.2% male) were assessed in a special psychiatric consultation for preschool age at measuring point time t1 (x = 4.2) and measuring point time t2 (x = 9.2). At t1, the Integrative Child Temperament Inventory (ICTI) was used for assessment. At t2, parents completed the Strengths and Difficulties Questionnaire SDQ. Multiple regression analyses were used to test if the temperament factors of the ICTI predicted clinical abnormalities in the SDQ subscales or total difficulties score. Results: SDQ total difficulties score as an indicator of total psychiatric disturbance in childhood appears to be good predicted by the temperament factor frustration/anger. Sensory sensitivity in preschoolers serves as a risk factor for later emotional symptoms, whereas high activity levels appear to prevent later emotional symptoms. Behavioral inhibition appears to protect against hyperactivity/inattention. Conclusion: Our data suggests that preschool temperament contributes differently to the development of externalizing and internalizing problems in childhood. The temperament factor frustration/anger in preschool children might be a strong predictor of the general mental condition in childhood at nine years of age and can therefore be used as a target for prevention of psychopathology in children. On one hand, high sensory sensitivity can be a predictor to identify preschool children at risk for later emotional symptoms, on the other hand, activity level acts as a protective factor against later emotional symptoms. An increased level of behavioral inhibition might be protective against the development of hyperactivity/inattention symptoms. Overall, this study illustrates the complexity and ambiguity of temperament in child development.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review.

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Emotional Dysregulation in Preschool Age Predicts Later Media Use and Gaming Disorder Symptoms in Childhood.

Background: The aim of this study was to evaluate the role of early Emotional Dysregulation (ED) at preschool age as a risk factor or predictor of later media use behavior and Gaming Disorder (GD) in school age. Methods: 80 patients (63.7% male; mean age = 4.2, SD = 1.23) who had attended a special outpatient program for preschoolers at measuring point time t1 were contacted at measuring point time t2 (mean age = 9.2, SD = 2.03). At t1, the comprehensive clinical assessment comprised Child Behavior Checklist-Dysregulation Profile (CBCL-DP). At t2, parents completed a questionnaire on their children's media availability, usage times, and GD. Results: ED predicts a more intense use of digital media in the future. The daily average screen-use time at t2 varies significantly between the groups (148 min for children with ED at t1 and 85 min for children without ED at t1). The intensity of media use can be considered a significant predictor for the presence of a GD in dimensional assessment. When GD is classified categorically, according to the DSM-5 criteria, there is no significant correlation between ED and later GD diagnosis, neither between screen-use time and GD diagnosis. However, at dimensional level, preschool children with ED show significantly higher GD symptom scores at 9 years of age. Conclusion: ED at preschool age is strongly associated with time spent video gaming and GD symptoms 5 years later. Our results strongly indicate that emotion dysregulation in preschool children is a risk factor for later problematic video game playing behavior. This strengthens the concept of ED in the etiology of media use and provides potential targets for early GD prevention.

Electronic Media and Early Childhood: A Review.

BACKGROUND: This review summarizes the state of knowledge of use of new media on the development in early childhood in 6 sections: descriptive utilization data, psychosocial and emotional development, cognition and language, motor development, nutrition and sleep, and influence of parental media consumption. METHODS: The review is based on a literature search of this topic in peer-reviewed journals. We included 87 articles, books, and book chapters. The used literature data bases were ERIC, PsycARTICLES, PsycINFO and PSYNDEX. RESULTS: Manifold studies describe in young children's utilization data the pervasive nature of digital exposure and impressive usage times and availability. They confirm adverse influences of electronic media use (television, video games) on children's emotional and behavioral problems and well-being, e. g. on physical activity, sleep and obesity. In general a positive effect in sense of knowledge transfer of age could be found for high quality educational media, however predominantly the impact of media use at younger age was negative. CONCLUSIONS: High frequent media use in early childhood is likely to have a negative impact on psychosocial development, positive effects such as knowledge transfer may be seen beyond the age of 18 months. As parental media use is a strong predictor of child media habits, reducing parental media use and enhancing parent-child interactions might be important areas to address when trying to change the media behavior of young children. In view of the scarcity of studies for early childhood, it is advisable to use digital play and communication devices cautiously and restrictively in this vulnerable development phase.

Gaming Disorder and Computer-Mediated Communication in Children and Adolescents with Autism Spectrum Disorder.

Background: This study investigates how children and adolescents with autism spectrum disorder (ASD) make use of computer gaming and computer-mediated communication (CMC) in comparison to their nonautistic peers. Method: Parents filled out a standardized questionnaire on media use, gaming disorder (GD), and CMC. Sixty-two boys with a diagnosis of ASD aged 4 to 17 years (mean = 11.5; SD = 3.2) were compared to 31 healthy control boys (mean = 11.5; SD = 3.7). Results: Children and adolescents with ASD used CMC less frequently than their nonautistic peers but played video games for longer times than the controls. They preferred playing alone rather than in company of others and less frequently in multiplayer mode. Levels of GD symptoms were higher in boys with ASD. Conclusions: Children and adolescents with ASD seem to be an especially vulnerable subpopulation for GD. For them, the gaming situation (alone and in single-player mode) and CMC behavior seem to correspond to social patterns in real life. Our findings also provide support for the inclusion of offline gaming in the GD definition.

Internet gaming disorder in children and adolescents: a systematic review.

AIM: Internet gaming disorder (IGD) is a serious disorder leading to and maintaining pertinent personal and social impairment. IGD has to be considered in view of heterogeneous and incomplete concepts. We therefore reviewed the scientific literature on IGD to provide an overview focusing on definitions, symptoms, prevalence, and aetiology. METHOD: We systematically reviewed the databases ERIC, PsyARTICLES, PsycINFO, PSYNDEX, and PubMed for the period January 1991 to August 2016, and additionally identified secondary references. RESULTS: The proposed definition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides a good starting point for diagnosing IGD but entails some disadvantages. Developing IGD requires several interacting internal factors such as deficient self, mood and reward regulation, problems of decision-making, and external factors such as deficient family background and social skills. In addition, specific game-related factors may promote IGD. Summarizing aetiological knowledge, we suggest an integrated model of IGD elucidating the interplay of internal and external factors. INTERPRETATION: So far, the concept of IGD and the pathways leading to it are not entirely clear. In particular, long-term follow-up studies are missing. IGD should be understood as an endangering disorder with a complex psychosocial background. WHAT THIS PAPER ADDS: In representative samples of children and adolescents, on average, 2% are affected by Internet gaming disorder (IGD). The mean prevalences (overall, clinical samples included) reach 5.5%. Definitions are heterogeneous and the relationship with substance-related addictions is inconsistent. Many aetiological factors are related to the development and maintenance of IGD. This review presents an integrated model of IGD, delineating the interplay of these factors.

Practitioner Review: School-based interventions in child mental health.

BACKGROUND: School-based interventions (SBIs) are well-established and effective treatments for improving child mental health. Specific school-based topics include prevention (Tier I-III) and interventions (e.g. cognitive-behavioural programmes and daily report cards). METHODS: We performed a systematic literature search in five commonly used online databases (ERIC, MEDLINE, PsycARTICLES, PsycINFO and PSYNDEX) for English-language articles published between 1993 and 2015. Additional sources included reference lists of relevant articles and book chapters. RESULTS: We identified a number of successful behavioural or cognitive-behavioural programmes yielding moderate to strong effects for a range of emotional and behavioural problems. The implementation of these programmes and the collaboration of the involved settings (school and home) and persons are important factors for their effectiveness under real-life conditions. CONCLUSIONS: Effective SBIs are valuable tools for students with mental health problems if evidence-based cognitive-behavioural interventions are applied and rules of translational algorithms and implementation science are respected.

Anxiety disorders and behavioral inhibition in preschool children: a population-based study.

This study assessed the prevalence of anxiety disorders in preschool children and their associations with behavioral inhibition as a temperamental precursor. A representative sample of 1,342 children aged 4­7 years (M = 6;1, SD = 4.80) was examined with a standardized parental questionnaire, including items referring to anxiety disorders at the current age and behavioral inhibition at the age of 2 years. The total prevalence of anxiety disorders was 22.2 %. Separation anxiety (SAD) affected 7 %, social phobia (SOC) 10.7 %, specific phobia (PHOB) 9.8 % and depression/generalized anxiety (MDD/GAD) 3.4 % of children. The prevalence of most types of anxiety was higher in girls except for separation anxiety, which affected more boys. Behavioral inhibition in the second year of life was associated with all types of anxiety. Anxiety disorders are common but frequently overlooked in preschool children. Different subtypes can be differentiated and are often preceded by behavioral inhibition. Assessment, prevention and treatment of anxiety disorders are recommended in preschool children.