ADHD in the Age of Smartphones

Today, everyone has a smartphone in their pocket. You’re probably reading this article on it. And while having the world at your fingertips is convenient, our constant-connectedness comes at an expense. For many of us, it’s getting more difficult to concentrate in our overly-distracted world. A University of Texas study found that our cognitive capacity, including attention and focus, is significantly reduced whenever our smartphones are nearby—even when they’re turned off. Now, adults, teens, and even toddlers are prone to phone addiction.

For kids, the situation may be even worse, especially as using digital devices becomes more common at earlier ages. A two-year-long USC study tracking 2,600 teens found that heavy users of digital devices are twice as likely to show symptoms of ADHD as those who are infrequent users. This is significant, as an ADHD diagnosis can lead to prescription medications like Ritalin. And unfortunately, frequent screen use may be blurring the line between true ADHD and screen-induced distractibility.

What Constitutes an ADHD Diagnosis?

“ADHD is what we would call a clinical diagnosis,” says Dr. Candida Fink, a board-certified child, and adolescent psychiatrist. “It’s a neurodevelopmental disorder that presents before age 12, and it includes a collection of signs and symptoms, both reported and observed, that occurs for a long enough duration that they come together to create a syndrome. Most importantly, it affects function.”

Based on symptoms (which can be seen here), there are three types of ADHD presentations: 1) inattention, 2) hyperactivity and impulsivity, and 3) combined, in which a patient presents symptoms of both inattention and hyperactivity-impulsivity. To meet the criteria for the first two presentations, patients must exhibit six or more symptoms from a specified set. For the combined presentation, they must exhibit six or more symptoms from each category.

For older teens and adults who present ADHD-like symptoms, doctors will typically place an ADHD diagnosis lower down on the list of possibilities. “More often, we find that people who present in adulthood have had issues for years but learned to compensate for them, or the issues were not causing a functional deficit,” says Dr. Fink. In some cases, the patient could be suffering from a progressive neurological disorder, a depressive episode, substance abuse, trauma, or another issue that’s impacting their attention.

Diagnosing ADHD in an Overly-Distracted World

As the world continues to change and our attention is pulled in seemingly more directions, the clinical diagnostic criteria for ADHD has not changed. Still, doctors and scientists are working to understand if—or how—the use of phones and other screens affects the frequency of an ADHD diagnosis. According to Dr. Fink, it’s unclear exactly how these devices impact our development of attention and focus.

“There’s still so much that we don’t know because smartphones are relatively new,” she says. And it’s not necessarily all bad news, as smartphones can also assist with productivity and learning. She mentions that it’s impossible to measure healthy versus unhealthy screen time in terms of a specific over/under number because it varies from person to person and task to task, but doctors do consider screen time when evaluating patients. The most important consideration is whether one’s screen use impacts a person’s function in a negative way. If it does, then it’s too much.

Distractibility vs. ADHD

 Distraction and ADHD fall under the same system and brain circuitry that control our focus and attention. Everyone has moments where they miss something, forget something, or have trouble concentrating—what’s more important is how often it happens and how it affects function.

According to Dr. Fink, attention takes up energy, so it’s a vulnerable system. It’s normal that inattention occurs more often when sitting down to complete a boring task than when we’re doing something we like.

“Even with ADHD, it can be easy to pay attention at a concert or something else you want to do because that helps to aid your attention,” she says. It’s more about a deficit of being able to regulate your attention and put it where you need it when you need it.

“The spectrum of inattention and impulsivity are measured within the realm of what’s typical,” says Dr. Fink. “Simple distractibility happens to all of us from time to time, but an ADHD diagnosis involves a pattern.”

Can Distractibility Be Misdiagnosed as ADHD?

Smartphones, stress, and even worrisome occurrences like the pandemic can muddy the waters of our attention, so it’s important that doctors rely on the foundations of solid diagnostic assessment, especially before prescribing medication like Ritalin.

“You need a history,” says Dr. Fink. “You need to gather information and really put the story together for it all to make sense.”

It’s important to realize that smartphones and other screens can push people on the cusp of an attention issue to a place with more symptoms.

“Even if making a diagnosis, you shouldn’t just jump to medication for any kid,” says Dr. Fink. “The availability of distractions may make it much harder for people to use the attentional skills they do have.” So, the first step should be to recognize distractions, remove them as much as possible, and then try to harness those skills.

Sleep deprivation also plays a key role in disrupting our attentional circuits, so sleep duration and quality are other key factors when balancing distractibility against a true ADHD diagnosis. “People with sleep apnea, for example, have terrible concentration problems and brain fog,” says Dr. Fink. “All of that gets so much better with better sleep.”

Even people who don’t have ADHD go through periods of time when they’re more or less attentive, but most come back to a baseline of being able to focus like their usual selves.

ADHD symptoms, however, are sustained. Symptoms present themselves and remain present, often for years—they don’t start and stop. They can become better or worse in certain situations, but fundamental challenges don’t just change or go away, says Dr. Fink.

How to Reduce Screen Time and Distractions

Screens are here to stay, but if you want to manage your screen time, you must first understand your routine and environment. Once you realize when and why you’re using your phone, you can place limits on that use.

“People on the other side of the screen are making money by keeping your eyes on them, so they’re really good at trying to draw us in,” says Dr. Fink. “Think about that, and teach your kids about that. It’s not a natural process—they’re trying to keep you from doing other things.” So, you must take it upon yourself to set boundaries. She suggests the following tips for reducing screen time:

• Don’t take your phone to bed. It interferes with the sleep you need to function fully the next day. Buy an alarm clock so you don’t have the excuse of using your phone as your wake up call.
• Supplement screen time with physical activity. Go outside and exercise, take the dog for a walk, stand up and stretch or have a dance party—whatever you need to put your phone down and get moving.

Take regular breaks, whether you’re working or playing video games. “This is a really important part of resetting our attentional machinery,” says Dr. Fink.