[Digital media use and mental health in adolescents-a narrative review]. / Digitale Mediennutzung und psychische Gesundheit bei Adoleszenten ­ eine narrative Übersicht.

The opportunities and hazards of digital media, especially with regard to children and adolescents, are currently the subject of frequent family, school, and social debates.Digital platforms can support the accomplishment of adolescent developmental tasks through gaming and social exchange as well as communication and contact promotion, learning, and health promotion, and are widely used for entertainment. In Germany, almost all adolescents own a smartphone. During the COVID-19 pandemic, an intensification of the use of digital games, social media, and streaming offers by adolescents was observed. Exposure to age-uncensored content such as the depiction of violence, extreme political views, and conspiracy theories, as well as personal attacks through cyberbullying, unfiltered initiation of contact including cybergrooming, dysfunctional role models, and addiction-promoting aspects are associated with mental health risks.Cyberbullying affects about 5% of children and adolescents in Germany. A bidirectional relationship with mental health could be shown. The gaming disorder is the first digital media use disorder (DMUD) that has been included in the ICD-11 and thus internationally recognized as a mental illness. Adolescents are affected disproportionately often and experience impairments in their mental development and levels of functioning.Services are available to promote adolescent media literacy, and their expansion, structured application, and evaluation are needed. Evidence-based prevention and treatment options for DMUD are currently largely lacking. Their development, review, and dissemination should be further supported.

Emotional dysregulation predicts problematic gaming in children and youths: a cross-sectional and longitudinal approach.

Adolescents show a high vulnerability for addictive gaming patterns on the one hand and immature emotion regulation (ER) abilities as a risk factor for mental disorders on the other hand. We investigated the predictive value of ER difficulties on problematic gaming (PG) considering age groups (children vs. youths) and gender cross-sectionally and prospectively in a representative sample of German adolescents via online survey with two measurement points 14 months apart. General Poisson, logistic, and multinomial regression models were estimated to predict gaming patterns by ER difficulties controlling for age group and gender. Results revealed ER difficulties to be significantly associated with PG. Moreover, subgroup analyses indicated differing ER patterns for children vs. youths and boys vs. girls: for children, higher PG values were associated with emotional awareness and emotional clarity whereas for youths it was the acceptance of emotional responses. Moreover, gender differences implicated that boys with PG had more deficits in goal-oriented behavior as well as emotional awareness while affected girls were lacking emotional clarity and had problems with the acceptance of their emotional responses. Interestingly, procrastination was a significant predictor for PG irrespective of subgroups. Furthermore, longitudinal analyses indicated that difficulties in ER promoted PG while stronger procrastination tendencies maintained it. With the inclusion of procrastination, which can be understood as a maladaptive ER strategy, a broader picture of ER difficulties as a risk factor for PG could be drawn. The findings support a better understanding of PG etiology and the development of targeted prevention and intervention measures.

Parents Rate Problematic Video Streaming in Adolescents: Conceptualization and External Assessment of a New Clinical Phenomenon Based on the ICD-11 Criteria of Gaming Disorder.

In recent years, video streaming (VS) increased substantially. Adolescents are at significant risk of presenting problematic VS patterns associated with a spectrum of mental-health difficulties. Because VS platforms rely on similar mechanisms as digital games, the ICD-11 criteria for Gaming Disorder (GD) have been successfully implemented to measure Streaming Disorder (StrD) in adolescents. For proper diagnoses, external rating scales are urgently required in addition to self-reports. The Streaming Disorder Scale for Parents (STREDIS-P) was created and validated in a representative sample of n = 891 adolescent-parent dyads. Mental health problems were assessed with standardized instruments. Confirmatory factor analysis was conducted to examine the underlying factor structure. Cutoff scores were determined using ROC analysis. Accordance between parental and adolescents' self-ratings was calculated. Consistent with the results of previous validation studies for screening instruments assessing similar phenomena based on ICD-11-GD criteria, two factors, cognitive-behavioral symptoms and negative consequences, were confirmed. STREDIS-P demonstrated good to excellent internal consistency, criterion validity, and discriminatory power. Accordance with adolescents' self-ratings was moderate. STREDIS-P is the first screening tool for assessing StrD in adolescents by parental ratings. It is highly relevant for conceptualizing a new phenomenon in clinical routine and academic research.

An app-based training for adolescents with problematic digital-media use and their parents (Res@t digital): protocol for a cluster-randomized clinical trial.

Background: Digital media-use disorders (DMUD) in adolescents are a rising phenomenon associated with psychological distress, comorbid mental disorders, and high burden on affected families. Since the ICD-11 introduced criteria for gaming disorder, these can now be transferred to describe additional DMUD associated with social media platforms and streaming services. Most evidence for effective treatments comes from cognitive-behavioral therapy (CBT). However, interventions based on theoretical models for adolescents and their parents are widely missing, leading to a significant clinical gap. Methods: Res@t digital (Resource-Strengthening Training for Adolescents with Problematic Digital-Media Use and their Parents) is the app-based translation of the first model-based digital intervention for adolescents with DMUD and their parents based on CBT. It comprises separate but content-related modules for adolescents (Res@t-A) and parents (Res@t-P), applying multimodal techniques. The effectiveness of Res@t will be evaluated within a multicenter cluster-randomized controlled evaluator-blinded pre-post follow-up trial with the waitlist control group (CG). In addition to the Res@t program in the intervention group, both groups will receive treatment as usual within primary child and adolescent psychiatric/psychotherapeutic healthcare. The primary outcome addresses DMUD symptom reduction after 10 weeks. Secondary outcomes are related to a reduction in psychological and family-related problems and an increase in parental self-efficacy. All outcomes will be assessed using standardized self-report measures. A total of 1,334 participating adolescent-parent dyads from a large clinical network throughout Germany are planned to be included in the primary analyses based on an intention-to-treat approach, applying linear mixed models. Discussion: Assuming superiority of Res@t over the control condition, the intervention has the potential to provide evidence-based treatment for a significant number of help-seeking families, supporting local healthcare structures and resources. It is a promising program for practicable implementation and flexible use in different settings. Clinical trial registration: https://drks.de, DRKS00031043.

Resource-Strengthening Training for Parents of Adolescents with Problematic Gaming (Res@t-P): A Clinical Pilot Study.

Background: Problematic gaming (PG) has become an increasing mental health issue among adolescents during the preceding years. The role of parents and the family environment in the development of PG has been repeatedly emphasized. However, the structured involvement of parents in the therapy is still largely insufficient. Resource-strengthening training for parents of adolescents with PG (Res@t-P) is a new parent-centered 8-week group intervention to fill this substantial gap. The present pilot study aimed to collect first information on its potential effectiveness in improving parental and family factors. Methods: The study was conducted in a clinical setting with N = 43 parents of adolescents with PG, applying a pre- and post-follow-up design. Standardized questionnaires on psychological stress perception, family communication, family functioning, media rules, and adolescent PG symptoms were applied at three measurement points (before, at the end of, and 6 weeks after the training). Conditional growth models were estimated. Results: Over time, an improvement in parental and family aspects as well as a reduction in adolescent PG symptoms could be observed. Conclusions: The results of the present pilot study on the effectiveness of Res@t-P are promising. No causal inferences can be drawn at this stage. A randomized-controlled intervention study is highly warranted.

Applying ICD-11 criteria of Gaming Disorder to identify problematic video streaming in adolescents: Conceptualization of a new clinical phenomenon.

Background and aims: Internet video streaming (VS) has become a popular leisure activity among the majority of adolescents, especially under the COVID-19 pandemic. Research on binge watching patterns in adults suggests an addictive potential of VS. To date, no unified conceptualization on problematic VS and no standardized assessment tools for adolescents exist even though they might be especially vulnerable. Methods: STREDIS-A is based on the ICD-11 criteria of gaming disorder. It was validated in a representative sample of 959 dyads of 10- to 17-year old adolescents with frequent VS and a respective parent using standardized questionnaires on Internet addiction, depressive and anxiety symptoms, insomnia, loneliness, and academic performance in an online survey. Item structure was investigated by factorial analyses. Cutoffs were estimated and latent profile analysis was performed. Results: The two-factorial structure of STREDIS-A describes cognitive-behavioral symptoms and negative consequences of VS. Internal consistency and criterion validity were good to excellent. It could excellently discriminate between affected and non-affected adolescents. Discussion and conclusions: The present study makes a significant contribution to the conceptualization of a new phenomenon. It provides the very first tool to assess streaming disorder in adolescents for clinical and research settings. Clinical validation is highly warranted.

International Classification of Diseases-11-Based External Assessment of Social Media Use Disorder in Adolescents: Development and Validation of the Social Media Use Disorder Scale for Parents.

Social media use disorder (SMUD) is associated with substantial impairments in daily functioning, and adolescents are particularly at risk. The 11th revision of the International Classification of Diseases (ICD-11) criteria of gaming disorder (GD) could be shown to be suitable to describe SMUD in adolescents. Since adolescents' insight might be limited due to young age or symptom denial, it is essential to include their parents in the diagnostic process. The development and validation of a parental scale are, therefore, of great interest to clinicians and scientists. The Social Media Use Disorder Scale for Parents (SOMEDIS-P) was developed by clinical experts and validated in 944 parent-child dyads. Adolescents were 10-17 years old and frequently used social media (SM). Besides SM use times, standardized questionnaires were applied to assess SM use patterns according to ICD-11 and Diagnostic and Statistical Manual of Mental Disorders-5 criteria of (Internet) GD, psychological stress, and depressive symptoms in an online survey. Item structure was investigated by confirmatory factorial analysis. Receiver operating characteristic curve analyses to determine cutoff values and accordance with adolescent self-ratings were computed. A presumed two-factorial structure of SOMEDIS-P could be confirmed describing cognitive-behavioral symptoms and negative consequences. The instrument showed good to excellent internal consistency and criterion validity with moderate to strong correlations, excellent discriminatory characteristics, and moderate accordance with the adolescents' self-ratings. As the first successfully validated tool for the assessment of ICD-11-based SMUD in adolescents by parental judgment, SOMEDIS-P can make an important contribution to reliable SMUD screening in clinical practice and research.

Substance-Use Disorders in Children and Adolescents.

BACKGROUND: The most common substance use disorders in childhood and adolescence have to do with alcohol and cannabis. These disorders begin as early as puberty, are often accompanied by other mental disorders, and, if untreated, very frequently persist into adulthood. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed on substance use disorders in children and adolescents. RESULTS: Substance use disorders are among the commonest mental disorders in childhood and adolescence. In Germany, approximately 10% of adolescents have tried cannabis at least once. The prognosis is negatively affected by individual (bio-)psychological traits, mental comorbidities, laws that facilitate consumption, socioeconomic disadvantage, consuming peers, and parental substance use disorders. A timely diagnosis, motivation by the pediatrician, and referral to specialized child and adolescent psychiatric services helps assure that those affected receive appropriate treatment, with the goal of abstinence from the substance as well as improvement in emotional regulation, affectivity, and attention. According to studies from the English-speaking countries and considering all treatment forms, treatment is completed by approximately 60% to 65% of children and adolescents; 20% to 40% of these patients are abstinent six months after the end of treatment. No studies of this type have been carried out to date in Germany. CONCLUSION: As the results of treatment are generally poor, there is a major need for research on the treatment and care of children and adolescents with substance use disorders. In particular, the interfaces between outpatient and inpatient care need further improvement.

Neural correlates of problematic gaming in adolescents: A systematic review of structural and functional magnetic resonance imaging studies.

Problematic gaming in adolescents is associated with neural alterations in structural and functional imaging studies. Especially frontal regions, associated with cognitive control functions, as well as temporoparietal areas, responsible for attention processes and self-concepts, and frontolimbic and subcortical regions, connected to emotion regulation and reward processing, are affected. The differences provide a further explanation for addictive disorders and emphasize the importance of interventions that address executive and cognitive-affective deficits.

Requirements of a Group Intervention for Adolescents with Internet Gaming Disorder in a Clinical Setting: A Qualitative Interview Study.

Internet gaming disorder (IGD) has become an important health concern in a significant proportion of adolescents. Intervention studies in this age group are scarce, mostly follow quantitative designs, and rarely consider adolescents' experiences. This study aimed to evaluate the requirements for a group therapy program for adolescents with IGD. A qualitative interview study was conducted in a German clinic for addictive disorders in childhood and adolescence with nine participants (seven IGD patients (12-18 years, M = 15.86, SD = 1.95) and two psychotherapists). The semi-structured interviews addressed helpful contents, general conditions, and suggestions for alterations for an effective group intervention. Data were analyzed using content structuring qualitative analysis. Patient interview data resulted in 234 codings with eight main categories. Expert interview data yielded 151 codings with six main categories. The following treatment components were described as effective by the participants and experts: psychoeducation, emotion management, behavior analysis and modification, social skills training, parent participation, and relapse prevention. Additionally, adolescents emphasized the importance of group functionality for coherence, feedback and rewards, content presentation, physical activity and fun. The results are a valuable addition to findings from quantitative studies on IGD interventions and an interesting starting point for further representative studies.

Pregnancy complications, substance abuse, and prenatal care predict birthweight in adolescent mothers.

BACKGROUND: Reduced birthweight is associated with adverse physical and mental health outcomes later in life. Children of adolescent mothers are at higher risk for reduced birthweight. The current study aimed to identify the key risk factors affecting birthweight in a well-characterized sample of adolescent mothers to inform preventive public health efforts. METHODS: Sixty-four adolescent mothers (≤ 21 years of age) provided detailed data on pregnancy, birth and psychosocial risk. Separate regression analyses with (1) birthweight and (2) low birthweight (LBW) as outcomes, and pregnancy complications, prenatal care, maternal age, substance abuse during pregnancy, socioeconomic risk, stressful life events and the child's sex as independent variables were conducted. Exploratively, a receiver operating characteristic (ROC) analysis was performed to investigate the quality of the discriminatory power of the risk factors. RESULTS: The following variables explained variance in birthweight significantly: prenatal care attendance (p = .006), pregnancy complications (p = .006), and maternal substance abuse during pregnancy (p = .044). Prenatal care attendance (p = .023) and complications during pregnancy (p = .027) were identified as significant contributors to LBW. Substance abuse (p = .013), pregnancy complications (p = .022), and prenatal care attendance (p = .044) showed reasonable accuracy in predicting low birthweight in the ROC analysis. CONCLUSIONS: Among high-risk adolescent mothers, both biological factors, such as pregnancy complications, and behavioural factors amenable to intervention, such as substance abuse and insufficient prenatal care, seem to contribute to reduced birthweight in their children, a predisposing factor for poorer health outcomes later in life. More tailored intervention programmes targeting the specific needs of this high-risk group are needed.

ICD-11-Based Assessment of Social Media Use Disorder in Adolescents: Development and Validation of the Social Media Use Disorder Scale for Adolescents.

Background: A problematic social media use (PSMU) in adolescents is a rising phenomenon often associated with higher perception of psychological stress and comorbid psychiatric disorders like depression. Since the ICD-11 introduced the very first internet-use related disorders, criteria for gaming (and online gambling) disorder can now be transferred to assess social media use disorder (SMUD). Therefore, the development and validation of a self-rating screening instrument for SMUD is of value to researchers and clinicians. Method: The previously validated ICD-11-based Gaming Disorder Scale for Adolescents (GADIS-A) was adapted to measure SMUD (Social Media Use Disorder Scale for Adolescents, SOMEDIS-A). A representative sample of 931 adolescents aged 10 to 17 years and a respective parent participated in an online study. Item structure was evaluated by factorial analyses. Validated DSM-5-based instruments to assess PSMU by self- and parental ratings (SMDS, SMDS-P), adolescent depressive symptoms (PHQ-9), and stress perception (PSS-10) as well as single items on time spent with social media (SM, frequency and duration) were applied to assess criterion validity. Discrimination between pathological and non-pathological users was examined based on ROC analyses retrieved cut-off values and the results of a latent profile analysis. Results: The new scale is best described by two factors reflecting cognitive-behavioral symptoms and associated negative consequences. The internal consistency was good to excellent. The SOMEDIS-A-sum score was positively correlated with PSMU, depression, and stress scores as well as the time spent with SM in a moderately to highly significant manner. Thus, good to excellent criterion validity is suggested. Conclusions: SOMEDIS-A is the first successfully validated instrument to assess SMUD in adolescents based on the ICD-11 criteria of GD. Thus, it can support early detection in order to prevent symptom aggravation, chronification, and secondary comorbidities. It can contribute to the development of a standardized conceptualization and its two-factorial structure offers promising new insights into the evaluation of SM usage patterns. Further examination including clinical validation is desirable.

Risk factors for prospective increase in psychological stress during COVID-19 lockdown in a representative sample of adolescents and their parents.

BACKGROUND: COVID-19 lockdown measures imposed extensive restrictions to public life. Previous studies suggest significant negative psychological consequences, but lack longitudinal data on population-based samples. AIMS: We aimed to prospectively identify increased psychological stress and associated risk factors in parent-child dyads. METHOD: We conducted a prospective, observational online study on a representative German sample of 1221 adolescents aged 10-17 years and their parents. Psychological stress and psychosocial variables were assessed before the pandemic (baseline) and 1 month after the start of lockdown (follow-up), using standardised measures. We used multilevel modelling to estimate changes in psychological stress, and logistic regression to determine demographic and psychosocial risk factors for increased psychological stress. RESULTS: The time of measurement explained 43% of the psychological stress variance. Of 731 dyads with complete data, 252 adolescents (34.5%, 95% CI 31.0-37.9) and 217 parents (29.7%, 95% CI 26.4-33.0) reported a significant increase in psychological stress. Baseline levels were lower than in dyads without increased psychological stress. Risk factors for increased psychological stress included sociodemographic (e.g. female parents, severe financial worries) and emotion regulation aspects (e.g. non-acceptance of emotional responses in parents, limited access to emotion regulation strategies in adolescents), explaining 31% of the adolescent (Nagelkerke R2 = 0.31) and 29% of the parental (Nagelkerke R2 = 0.29) model variance. CONCLUSIONS: This study is the first to prospectively show an increase in psychological stress during COVID-19 lockdown in a representative family sample. Identified demographic and psychosocial risk factors lead to relevant implications for prevention measures regarding this important public health issue.

Validity and Psychometric Properties of the Internet Gaming Disorder Scale in Three Large Independent Samples of Children and Adolescents.

BACKGROUND: Problematic gaming has become a major health issue in children and adolescents resulting in the need for targeted valid and reliable screening instruments. This study aimed to explore the psychometric properties and criterion validity of the widely used 9-item Internet Gaming Disorder Scale (IGDS) in young gamers. METHODS: Three independent samples were drawn from socio-demographically representative cross-sectional telephone surveys collected in the years 2016 (N = 762), 2017 (N = 777), and 2018 (N = 784) and analyzed separately. RESULTS: The IGDS revealed psychometric properties suitable for screening in large samples. Cronbach's alpha was 0.563, 0.724, and 0.778. The unidimensionality assumption was challenged. At-risk and pathological gamers compared to normal gamers reported longer digital media use and more emotional symptoms and hyperactivity/inattention with clinical relevance to medium effect sizes. The comparison of at-risk and pathological gamers indicated a partial distinction between the two problematic gaming groups. CONCLUSIONS: The IGDS could be shown to be an overall suitable and valid tool to identify pathological gamers in childhood and adolescence according to the DSM-5 criteria on a population level. However, the polythetic structure limits comparability with the recent ICD-11 criteria. At-risk gamers appeared as a heterogeneous group warranting more research.

Assessing Problematic Social Media Use in Adolescents by Parental Ratings: Development and Validation of the Social Media Disorder Scale for Parents (SMDS-P).

BACKGROUND: The problematic use of social media (SM) is a rising phenomenon, especially in adolescents. It can be assessed by self-rating screeners such as the Social Media Disorder Scale (SMDS). However, young age or symptom denial might reduce adolescent assessment accuracy. Therefore, the development and validation of a parental scale (SMDS-P) is desirable. METHOD: A representative sample of 961 parents and corresponding frequently SM-using children aged 10 to 17 years participated in an online study. Factorial analyses were performed to determine item structure. Adolescents' SMDS self-reports, SM usage time, emotional dysregulation, and academic performance were used to assess validity. The SMDS-P cut-off value was calculated by ROC-analysis. RESULTS: A one-factorial structure of the SMDS-P could be confirmed. The internal consistency was good (Cronbach's α = 0.85, McDonald's ω = 0.88) and the accordance between parental and self-ratings moderate (kappa = 0.51). SMDS-P was positively associated with adolescents' self-ratings (r = 0.68), SM usage time (r = 0.26) and frequency (ϱ = 0.16) as well as with emotional dysregulation (r = 0.35) in a highly significant manner. CONCLUSIONS: SMDS-P offers a promising new approach to assess problematic SM usage in adolescence. Further studies including clinical validations are required.

Assessing ICD-11 gaming disorder in adolescent gamers by parental ratings: Development and validation of the Gaming Disorder Scale for Parents (GADIS-P).

BACKGROUND AND AIMS: The addiction to digital games is associated with substantial impairments in daily functioning and adolescents are particularly at risk. Screening instruments for the new ICD-11 diagnosis Gaming Disorder (GD) are rare and only include self-ratings thus far. Since adolescents' insight might be limited due to young age or symptom denial, external ratings are essential. We therefore aimed to develop and validate the Gaming Disorder Scale for Parents (GADIS-P) in a representative sample of parents and young gamers. METHODS: GADIS-P was developed as an adaptation of a recently published self-rating scale. It was validated in 800 parents and their frequently gaming children between 10 and 17 years with standardized questionnaires in an online survey. Item structure was investigated by confirmatory factorial analysis. Gaming time, pathological gaming according to DSM-5, emotional dysregulation, and academic performance were used to derive criterion validity. Accordance with self-ratings was determined. ROC-Analyses were computed to determine cut-off values. RESULTS: A presumed two-factorial structure of GADIS-P could be confirmed describing cognitive-behavioral symptoms and negative consequences. The instrument showed good to excellent internal consistency (Cronbach's α = 0.89-0.92, McDonald's ω = 0.92-0.95) and criterion validity with moderate to strong correlations regarding gaming behavior (r/ϱ = 0.35-0.76), excellent discriminatory power, and moderate accordance with the adolescents' self-ratings (kappa = 0.47-0.58). DISCUSSION AND CONCLUSIONS: As the first successfully validated tool for the assessment of ICD-11 GD in adolescents by parental judgment, GADIS-P can make an important contribution to reliable GD screening in clinical and research settings.

Chronic Sleep Reduction in Childhood and Adolescence.

BACKGROUND: Habitually shortened nighttime sleep is a common phenomenon in childhood and adolescence, sometimes associated with chronic sleep reduction (CSR). CSR is associated with impairments of performance ability and emotional well-being. The extent to which children and adolescents in Germany suffer from CSR is unclear; it is also unclear what factors are predictive of CSR. METHODS: In the present study, we carried out a telephone survey in a representative sample of 998 children and adolescents aged 12 to 17, asking them about their sleep behavior, sleep disturbances, and mental well-being. A standardized method was used. RESULTS: The point prevalence of CSR was found to be 12.5% (95% confidence interval, [10.5; 14.6]). Children and adolescents affected by CSR reported a significantly higher frequency of insomnia, delayed sleep-phase syndrome, restless legs syndrome, and obstructive sleep apnea. Female sex, pro - longed absence from school or vocational training, emotional and behavioral disturbances, age over 15 years, bedtimes after 10:38 pm on nights before school (or vocational training), getting up after 10:04 on days off, and reported insomnia were all associated with CSR, with odds ratios (OR) ranging from 2.2 to 21.1 (R2 = 0.32 in a logistic regression model). CONCLUSION: One in eight persons aged 12 to 17 in Germany, particularly girls, meets the criteria for CSR. CSR is associated with sleep disturbances and significantly impaired mental health and should, therefore, always be kept in mind in routine clinical practice. We provide a set of indicators for possible CSR that patients can easily be asked about.

Phosphatidylethanol Reliably and Objectively Quantifies Alcohol Consumption in Adolescents and Young Adults.

BACKGROUND: Alcohol contributes to numerous annual deaths and various societal problems not just in adult, but also in adolescent, populations. Therefore, it is vital to find methods for reliably detecting alcohol use for early preventative measures. Research has shown phosphatidylethanol (PEth) to be superior to self-report instruments and indirect biomarkers for alcohol consumption in adult populations. However, the transferability onto an adolescent population has not yet been investigated. METHODS: N = 106 adolescents and young adults aged between 13 and 21 years were included. PEth analysis using high-pressure liquid chromatography-tandem mass spectrometry was performed on dried blood spot samples. Self-report questionnaires for alcohol consumption (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C, and Timeline Followback, TLFB) and drug and alcohol consumption (Detection of Alcohol and Drug Problems in Adolescents, DEP-ADO) were completed by each participant. RESULTS: AUDIT-C scores showed large correlations with PEth 16:0/18:1 (rs  = 0.732) and PEth 16:0/18:2 (rs  = 0.661) concentrations. AUDIT-C with a cutoff value ≥3 was largely correlated with PEth 16:0/18:1 (η = 0.411) and showed a medium-sized correlation with PEth 16:0/18:2 (η = 0.397) concentrations. Using an AUDIT-C cutoff value ≥5 showed large correlations with both PEth 16:0/18:1 (η = 0.510) and PEth 16:0/18:2 (η = 0.497) concentrations, respectively. ROC curves indicated higher PEth concentrations are a good model for detecting positive AUDIT-C cutoff values (AUROC range: 0.800 to 0.849). PEth concentrations showed medium to large correlations with DEP-ADO and TLFB subscales (range rs  = 0.469 to 0.746). CONCLUSION: The results suggest that PEth is a reliable and objective marker for quantifying alcohol consumption in adolescents and young adults. This could be of importance for early preventative measures against hazardous alcohol consumption, which is increasingly common at younger ages.

[Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]. / Medienbezogene Störungen im Kindes- und Jugendalter: Evidenzpapier der Gemeinsamen Suchtkommission der kinder- und jugendpsychiatrischen und psychotherapeutischen Fachgesellschaft und Verbände (DGKJP, BAG, BKJPP).

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.