Mediating effects of attention problems on the link between parenting style and internet gaming disorder in adolescents

Background: Positive and negative parenting styles as well as psychiatric comorbidities including attention deficit hyperactivity disorder (ADHD) have been associated with internet gaming disorder (IGD) in children and adolescents. We hypothesized that ADHD and parenting style would be associated with IGD in adolescents. In addition, psychological status could mediate the link between parenting style and the severity of IGD.

Methods: A total of 256 adolescents with IGD and 211 healthy internet game players and their mothers participated in the current study. Demographic data, gaming patterns, and psychological status including ADHD were recorded for all adolescents. The parenting style of each adolescent’s mother was assessed using the Maternal Behavior Research Instrument (Korean version).

Results: There were significant differences in the internet game play patterns, psychological status, and parenting styles between the IGD group and healthy internet game players. In the hierarchical logistic regression analysis, higher ADHD scores, less affective parenting styles, and less autonomous parenting styles, were significant predictors of IGD. In the mediation test, the ADHD score was found to mediate the association between affective and autonomous parenting styles and the severity of IGD.

Conclusion: Attention problems could directly and indirectly mediate the relationship between positive parenting styles and the severity of IGD. Our findings have the potential to aid in the development of treatment plans for IGD and ADHD as well as to contribute to the development of educational resources regarding parenting styles.

Introduction

Parenting style and child and adolescent behavior

Parenting style is defined as the manner in which parents rear their children (1–3). Parenting behaviors are known to be associated with adolescents’ emotional and problem behaviors (1, 2). Schaefer et al. (3) suggested two independent parenting styles of emotion and control. The emotion dimension involves parents’ emotional attitude toward the child (affection vs. rejection), while the control dimension involves parents’ exerting control over the child’s behavior (autonomy vs. control) (3). According to Baumrind (4), with the combination of these two dimensions, four parenting styles can be derived: authoritative (highly supportive and flexible), authoritarian (lack of support and rigid control), permissive (lack of control), and neglecting (lack of support and control). Each parenting style is associated with children’s behavioral patterns and symptoms, and these are related to various socialization processes and emotional aspects. The authoritative parenting style is associated with positive outcomes including emotional adjustment and healthy self-esteem as well as low aggression, anxiety, and depression (5–7). In contrast, the other three styles are associated with negative outcomes including emotional lability, low sociality, and unstable attachment (7, 8). Children of authoritarian parents commonly exhibit withdrawn and hostile behavior. Children of permissive parents often encounter difficulties in regulating their behaviors and emotions and may struggle academically due to the low level of parental control. However, they tend to possess positive self-perception and demonstrate relatively lower levels of depressive symptoms. Finally, the neglecting parenting style is associated with the poorest outcomes in various developmental, behavioral, emotional, and social aspects in children. They often feel emotionally detached and report the highest levels of depression (4). While the authoritative parenting style is typically associated with positive outcomes, these findings do not universally apply to all of society. Gonzalez et al. (9) reported that in African-American college students, the authoritarian parenting style was related to seeking challenges and being competent. Similarly, McBride-Chang and Chang (10) reported that in students in Hong Kong, the authoritative parenting style was actually associated with negative outcomes such as low emotional autonomy.

Parenting style and adolescent with internet gaming disorder

Several studies have suggested that parent–child relational problems in the family are related to internet use patterns in adolescents (11–14). Trumello et al. (14) reported that excessive internet use was negatively associated with maternal care. Mother’s avoidance and father’s anxiety were also found to be directly associated with problematic internet use in adolescents (13). Furthermore, in a longitudinal study of 1,153 Taiwanese students, low family support, a less protective parenting style, and high attention deficit hyperactivity disorder (ADHD)-related symptoms were associated with problematic internet use (12). In addition, Arikan et al. (11) suggested that maternal attachment anxiety indirectly predicted the overuse of a social network service (SNS) in young adults via young adult attachment anxiety.

Among popular internet-related activities, internet game playing is also known to be associated with family functions and parenting style (15–18). In a study involving 682 Iranian adolescents, parenting style was significantly associated with the prevalence of internet gaming disorder (IGD) (15). A dominant permissive parenting style was associated with symptoms of IGD in children (17). Bonnaire and Phan (16) suggested that parental close monitoring the process of an adolescent’s internet use activity could decrease the risk of developing IGD. Throuvala et al. (18) reported that parental rejection could predict IGD through the mediating effect of core self-evaluation in adolescents.

Parenting style and adolescents with attention deficit hyperactivity disorder

ADHD is a prevalent mental disorder that impacts approximately 3 to 5% of students and is characterized by symptoms such as hyperactivity, inattention, and impulsive actions (19). Previous studies have shown that parents of children with ADHD are less authoritative and show an authoritarian parenting style. This parenting style is characterized by high expectations and strict rules set by the parents, and verbal communication is usually one-sided and lacks an emotional response. This can cause their children to feel isolated and depressed and increase their negative symptoms of ADHD (20).

Previous studies have also shown that the parents of children with ADHD have a greater tendency to use punishment to control children with hyperactivity than other parents, meaning they employ a more authoritarian parenting style. On the other hand, permissive parenting styles were lower than other parents (4, 21, 22).

Psychological status and adolescents with IGD

Many studies of IGD have suggested that comorbidities play a critical role in the development of IGD (23–26). In a cohort of 755 patients with IGD, Han et al. (24) suggested that age, family support, social factors, and psychological status including attention, anxiety, and mood could impact the initial and sustained responses to treatment for IGD. Ko et al. (25) suggested that psychiatric diseases including ADHD, major depressive disorder (MDD), and social anxiety disorder were significantly associated with the prevalence of IGD. Lee et al. (26) reported that a comorbidity of ADHD in patients with IGD was associated with a poor clinical course in response to treatment. Furthermore, Cudo et al. (23) suggested that depression could mediate the correlation between self-esteem and IGD.

Remondi et al. (27) also suggested that insecure attachment between adolescents and their parents had an indirect effect on the development of problematic use of mobile devices (smartphones and tablets) mediated by psychological risk factors. Similar to the findings of Remondi et al. (27), we speculated that psychological status could mediate the association between parenting style and the severityof IGD.

Hypothesis

We hypothesized that ADHD and parenting style would be associated with IGD in adolescents and that affective parenting styles would have particularly positive effects on IGD. In addition, psychological status could mediate the link between parenting style and the severity of IGD.

Methods

Participants

From August 2016 to July 2020, patients who visited the IT and Human Research Center at Chung Ang University Hospital for the treatment of IGD were asked to participate and recruited in the current study. The inclusion criteria were as follows: (1) diagnosis of IGD based on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (28); (2) adolescents aged from 13–18 years; and (3) adolescents living with their mothers. The exclusion criteria were as follows: (1) history of a psychotic disorder including bipolar disorder, schizophrenia, or severe depressive disorder with psychotic features; (2) history of developmental disorders including autism spectrum disorder (ASD) or intellectual disability (intelligence quotient (IQ) < 70); and (3) history of chronic medical conditions.

Of 374 consecutive patients who were eligible to participate in the current study, 295 patients and their mothers agreed to take part. Of 295 patients, 19 patients were excluded due to low intelligence, 11 patients were excluded due to ASD, five patients were excluded due to bipolar disorder, and four patients were excluded due to schizophrenia. Finally, 256 adolescents with IGD and their mothers participated in the research.

As a comparison group, healthy internet game players were recruited from the same hospital via flyers and banner advertisements. The inclusion criteria were as follows: (1) adolescents who played internet games for at least 2 hours per week [the mean game play time in Korean adolescents has been to be 2.5 h per week (Game Self-Governance Organization of Korea, GSOK, http://www.gsok.or.kr/gsok-news/?mod=document&uid=1914)]; (2) adolescents aged from 13–18 years; and (3) adolescents living with their mothers. The exclusion criteria were follows: (1) diagnosis of IGD based on the DSM-5 (28); (2) history of a psychotic disorder including bipolar disorder, schizophrenia, or severe depressive disorder with psychotic features; (3) history of developmental disorders including ASD or intellectual disability (IQ < 70); and (4) history of chronic medical conditions.

Of 233 individuals who wanted to participate in the current study, 211 healthy participants were recruited. Eleven participants were excluded due to a diagnosis of IGD. Five participants were excluded due to low intelligence. Three participants were excluded due to bipolar disorder. Three participants were excluded due to ASD.

All participants understood the study procedures and agreed to participate voluntarily in the current study. The current research received approval from the Chung Ang University Institutional Review Board (1990-007-386), and the participants completed and signed consent forms. Adolescents also provided written consent for participation from their parents or guardians. The study was conducted in accordance with the Declaration of Helsinki.

Measures

Demographic data were assessed which could affect bias. The severity of IGD was assessed using Young Internet Addiction Scale Korean version (29, 30). This scale consists of 20 items that measure problematic internet use including internet games and has good internal consistency (Cronbach’s α = 0.90). The cutoff values of the IAT were as follows: <20: below average users; 20–49: average users; 50–79: occasional/frequent problems; and 80–100: significant problems (29, 30).

Depressive mood was assessed using the Beck Depression Inventory II (BDI-II) (31), which consists of 21 self-report items that are rated on a 4-point Likert-type scale ranging from 0 to 3. The total BDI-II score can range from 0 to 63. The anxiety level was assessed using the Beck Anxiety Inventory (BAI) (32), which consists of 21 self-report items that are rated on a 4-point Likert-type scale ranging from 0 to 3. The total BAI score can range from 0 to 63. Both the BDI-II (Cronbach’s α = 0.89) (33) and BAI (Cronbach’s alpha = 0.95) (32) have good internal consistency.

IQ was estimated using the Korean Wechsler Intelligence Scale for Children IV (K-WISC-IV), which was administered by clinical psychologists (34) The K-WISC-IV is modified from WISC-IV and designed for persons aged from 6 years to 16 years 11 months. It consists of four sub-index scores: the Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index, and Processing Speed Index. IQ assessment was conducted by clinical psychologists in the same hospital, Chung-Ang University Hospital.

Attention problems were assessed using the Korean version of Dupaul’s ADHD Rating Scale (K-ARS) (35, 36), which includes 18 items including 9 items for assessing inattention and 9 items for assessing hyperactivity. The internal consistency of the K-ARS ranges from 0.77 to 0.89 (36). Behavioral control was assessed using the Behavioral Inhibitory System/Behavioral Activation System (BIS/BAS) Scale (37, 38). The BIS/BAS is composed of a four-point Likert scale with responses ranging from “not at all” to “strongly agree.” The total scores of the BIS/BAS range from 0 to 80. The internal consistency (Cronbach’s α) of the BIS/BAS has been reported to range from 0.78 to 0.79 (38).

The parenting style of each adolescent’s mother was assessed using the Maternal Behavior Research Instrument (MBRI-K) (Korean version) (3, 39). The MBRI-K is a 48-item, self-report instrument assessing maternal parenting attitudes. Parenting styles were classified into four types including affective, rejecting, autonomous, and controlling types. Each style has 12 items and is scored by summing the subscale responses (values ranging from 1 to 5). The sum of the subscale scores ranges between 12 and 60. Higher scores on each subscale indicate that the maternal parenting attitude shows a greater degree of that style.

Statistical analysis

The differences in demographic data including age, sex, education level, and smoking and alcohol habits between the IGD and healthy game play groups were analyzed using independent t-tests and the chi-square test. The differences in game play style including the genre of game play, mean game play time in a weekday, and mean game play time on the weekend between the IGD and healthy game play groups were analyzed using the chi-square test and independent t-tests. The differences in psychological scale scores including the YIAS, BDI-II, BAI, K-ARS, BISBAS, and KWAIS scores as well as the differences in parenting styles between the IGD and healthy game play groups were analyzed using independent t-tests.

The Durbin-Watson test was used to confirm the problem of collinearity of the data. Hierarchical logistic regression was used to assess how much the variables in the questionnaires, psychological scales, and parenting styles explained a statistically significant amount of the variance in the dependent variable of IGD. In a multiple hierarchical regression analysis of all participants, a discrete set of hierarchical variables, with IGD as the dependent variable, was added: demographic factors were included in model 1; model 1 factors + game play patterns were included in model 2; model 2 factors + psychological state were included in model 3; and model 3 factors + parenting style were included in model 4. The dependent variable of “IGD” was coded as “1,” and the healthy game players were coded as “0.” The definition of “IGD” coincided with the inclusion criteria above.

The mediating role of attention problems on the relationship between parenting style and IGD was assessed using Hayes’s PROCESS macro for SPSS (model 4) (40). The mediating effect verification model was divided into two models according to the factors related to the parenting method. The independent variable of Model A was set as a parent effective variable, and the independent variable of Model B was set as a parent autonomous variable. In addition, the dependent variable was set as the YIAS score, and the K-ARS score was set as a parameter to verify the direct and indirect effects of ADHD on the YIAS score through the parenting style. With the bootstrap confidential intervals (CIs) in PROCESS, the indirect effect was considered significant if the 95% CI did not include zero.

Results

Demographic data, game play pattern, psychological status, and parenting style

A total of 467 participants’ data were analyzed. There were no significant differences in age, sex distribution, education level, or smoking and alcohol habits between the IGD and healthy game play groups (Table 1).

TABLE 1

Table 1. Demographic data, psychological characteristics, and parenting style.

There was no significant difference in the game genre distribution between the IGD and healthy game play groups. However, those in the IGD group played internet games more times on weekdays and weekends than those in the healthy game play group. The IGD group showed increased YIAS scores compared with the healthy game play group.

The IGD group showed increased scores on the BDI-II, BAI, K-ARS, and BISBAS compared with the healthy game play group (Table 1). There was significant difference in the prevalence of a comorbidity of ADHD between the IGD and healthy game play groups (χ² = 103.7, p < 0.01). Of 256 individuals with IGD, 165 (64.5%) had a comorbidity of ADHD; in contrast, only 37(17.5%) of 211 healthy game players had a comorbidity of ADHD. However, there was no significant difference in the K-WAIS total scores between the IGD and healthy game play groups.

The scores for maternal affective attitudes and autonomic attitudes in the IGD group were significantly decreased compared with those observed in the healthy game play group (Table 1). The scores for controlling attitudes in the IGD group were decreased compared with those observed in the healthy game play group. There was no significant difference in the scores for controlling attitudes between the two groups.

Considering the results of the Durbin–Watson test, there was no autocorrelation in the current dataset. Of the four models suggested in the current study, models 2, 3, and 4 were significantly associated with IGD. In model 2, the model χ² (67.8, p < 0.01) and Nagelkerke’s R2 (0.181, 18.1% of the variance in the dependent variable of IGD) indicated that the model was adequate to predict IGD. When the practical usefulness of the model was assessed considering the classification accuracy, eight variables in model 2 enhanced the predictive accuracy of the group membership of the dependent variable to 65.7%. With the step χ²-value (Step χ² = 64.1, p < 0.01), game play pattern was found to be a predictive factor for IGD.

In model 3, the model χ² (109.7, p < 0.01) and Nagelkerke’s R2 (0.280, 28.0% of the variance in the dependent variable of IGD) indicated that the model was adequate to predict IGD. When the practical usefulness of the model was assessed considering the classification accuracy, 13 variables in model 3 enhanced the predictive accuracy of the group membership of the dependent variable to 70.2%. With the step χ²-value (Step χ² = 41.9, p < 0.01), psychological status was a predictive factor for IGD.

In model 4, the model χ² (147.8, p < 0.01) and Nagelkerke’s R2 (0.363, 36.3% of the variance in the dependent variable of IGD) indicated that the model was adequate to predict IGD. When the practical usefulness of the model was assessed considering the classification accuracy, 17 variables in model 4 enhanced the predictive accuracy of the group membership of the dependent variable to 72.8%. With the step χ²-value (Step χ² = 38.0, p < 0.01), parenting style was a predictive factor for IGD.

According to the Wald statistics for all independent variables, higher ADHD scores, less affective parenting styles, and less autonomous parenting styles were significant predictors of IGD (Table 2).

TABLE 2

Table 2. Hierarchical logistic regression analysis.

Testing for mediation

With the results of the hierarchical logistic regression analysis, attention problems, affective parenting styles, and autonomous parenting styles were determined to be significant predictive factors for IGD. With those factors, we performed tests for meditation.

Controlling for all the covariates, the scores for affective parenting style were negatively associated with the K-ARS scores (β = −0.271, p < 0.01), which in turn affected IGD (β = 0.630, p < 0.001). In addition, a significant residual direct effect was observed (β = −0.321, p < 0.01). This indicates that the K-ARS scores partially mediated the link between an affective parenting style and IGD (indirect effect = −0.171, SE = 0.074, 95%CI = −0.317 to −0.023; Figure 1).

FIGURE 1

Figure 1. Mediation effect of attention problems on the link between parenting style and the severity of internet gaming disorder *p < 0.05, **p < 0.01, ***p < 0.001 (A) The link between an affective parenting style (PS-affective) and the severity internet gaming disorder (IGD) as assessed with the Young Internet Addiction Scale (YIAS) is mediated by attention as assessed using the Attention Deficit Hyperactivity Disorder Rating Scale (Korean version) (K-ARS). Path values are the path coefficients (standard errors). Direct effect = −0.32, SE = 0.09, 95% CI (−0.435 to −0.039). Indirect effect = −0.17, SE = 0.07, 95% CI (−0.317 to −0.023). (B) The link between an autonomous parenting style (PS-autonomous) and the severity internet gaming disorder (IGD) as assessed with the Young Internet Addiction Scale (YIAS) is mediated by attention as assessed using the Attention Deficit Hyperactivity Disorder Rating Scale-Korean version (K-ARS). Path values are the path coefficients (standard errors). Direct effect = −0.22, SE = 0.10, 95% CI (−0.437 to −0.061). Indirect effect = −0.16, SE = 0.07, 95% CI (−0.301 to −0.019).

Controlling for all the covariates, the scores for autonomous parenting style were negatively associated with the K-ARS scores (β = −0.244, p < 0.01), which in turn affected IGD (β = 0.645, p < 0.001). Furthermore, a significant residual direct effect was observed (β = −0.218, p < 0.05). This indicates that the K-ARS scores partially mediated the link between an autonomous parenting style and IGD (indirect effect = −0.157, SE = 0.072, 95%CI = −0.301 to −0.019; Figure 1).

Discussion

In the current results, there were significant differences in the game play patterns, psychological status, and parenting styles between the IGD and healthy game play groups. In particular, the K-ARS scores, affective parenting styles, and autonomous parenting styles were significant predictive factors for IGD. In addition, attention problems could mediate the association between parenting style and the severity of IGD.

Comparison of the game play patterns, psychological status, and parenting styles between the IGD and healthy game play groups

In current study, the IGD group showed increased BDI-II, BAI, K-ARS, and BISBAS scores compared with the healthy game play group. Many studies have already suggested that IGD is associated with various comorbidities including MDD, anxiety disorders, ADHD, and impulse control disorders (41–43). These psychiatric comorbidities are associated with the cause of IGD (44) and aggravate the progression of IGD (24). Of several comorbidities, ADHD was the most common comorbidity in the IGD group (26). Lee et al. (26) reported that an IGD group with a comorbidity of ADHD showed a poor clinical course of IGD and that changes in ADHD symptoms were associated with changes in IGD symptoms. In the hierarchical regression analysis in the current study, problematic attention scores were found to predict IGD.

In the current study, the scores for maternal affective attitudes and autonomous attitudes in the IGD group were significantly decreased compared with those observed in the healthy game play group. Several studies have suggested that parenting style influences psychopathology and the severity of IGD in children and adolescents (45, 46). Durkee et al. (45) reported that low parental involvement could predict a high risk of internet addiction in children (46). In addition, a negative parenting style including strict attitudes, heavy punishment, and low affection was found to provoke internet addiction in middle school and college students (27). However, previous studies of the relationships between parenting style and internet addiction (or IGD) have suggested that negative parenting is associated with IGD but that positive parenting has controversial protective effects against IGD in children and adolescents (47).

Mediation effects of attention problems on the interaction between parenting style and IGD

As mentioned above, positive parenting may have protective effects against IGD in children and adolescents, but these remain controversial. However, in the current study, positive parenting styles including affective and autonomous parenting styles directly affected the severity of IGD. Consistent with the findings of previous studies (48–50), a less authoritative parenting style was found to be associated with IGD. On the other hand, there is controversy regarding the autonomous parenting style because both authoritative and autonomous styles share the characteristic of autonomy. Therefore, it is believed that the low level of autonomy characteristic of the autonomous parenting style may affect the severity of IGD. In contrast, in the current study, no association was found between the rejecting parenting style or controlling parenting style and IGD. Previous studies have indicated that the relationship between parenting style and IGD may vary depending on factors such as the age of the children (51). Specifically, whether the rejecting or controlling parenting style is associated with IGD remains disputed across studies. Therefore, the disparities in the findings of the literature may be attributed to differences in sample characteristics or the influence of parents with diverse cultural dynamics (51).

In the current study, attention scores were found to directly and indirectly mediate the relationship between affective attitudes and autonomous parenting styles and the severity of IGD. Several studies have suggested the mediation effects of ADHD symptoms on the risk of IGD in children and adolescents (52, 53). Jung et al. (52) reported that inattentive ADHD symptoms partially mediated the link between immersive tendencies and susceptibility to IGD. Lim et al. (53) showed that psychological status including anxiety, depression, and attention problems had a partial mediating effect on the link between aggression and the risk of IGD in 714 middle school students. It is possible that there is a bidirectional relationship between ADHD and IGD, in which the symptoms of ADHD contribute to an increased attraction to playing computer games and video games, while gaming, in turn, can worsen the symptoms of ADHD by reinforcing them. These symptoms may include inattention, disinhibition, impulsive response, and a strong desire for immediate rewards. In accordance with this, internet games have also been found to be used as a means of self-medication by children with ADHD (54).

Many studies have supported the relationships between affective and autonomous parenting styles and improving ADHD symptoms and mother–child relationships (55–57). Nelson et al. (56) reported a mediating effect of hyperactivity symptoms of ADHD on the relationship between mother and children. More severe hyperactivity symptoms of children at 5.5 years old was found to lead to increased maternal hostility to their children at 10 years old; in turn, this caused increased delinquent behaviors and aggression in adolescents (56). Thomassin and Suveg (57) also reported that parental support of autonomy moderated the link between ADHD symptoms and task perseverance in difficult puzzle tasks. Furthermore, Breaux et al. (55) suggested that an affective parenting style could facilitate the development of emotional regulation skills in children with ADHD.

Limitations

There were several limitations in the current study. First, data on parenting style were gathered from the participants’ mothers. The father’s parenting style is also known to play an important role in children’s behavior (58). Second, the cross-sectional design of current study could not show causality or directionality. Finally, with the exception of the K-WISC-IV, most of the scales used in this study relied on self-report measures, which could have introduced bias. Future studies should recruit fathers to assess parenting style as well as apply a longitudinal design to delineate the directionality of the relationships between parenting style and IGD.

Conclusion

The IGD group showed differences in K-ARS scores, affective parenting styles, and autonomous parenting styles compared with the healthy game play group. Moreover, attention problems were found to directly and indirectly mediate the relationship between positive parenting styles including affective and autonomous styles and the severity of IGD. Improved concentration through ADHD treatment could potentially help control the symptoms of IGD, making this treatment plan applicable in a clinical setting. In addition, providing parents with information about parenting styles that include emotional support may help to reduce the symptoms of both IGD and ADHD in children. In the future, our findings have the potential to aid in the development of educational resources regarding parenting styles.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving human participants were reviewed and approved by Chung Ang University Institutional Review Board. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

Author contributions

DH and SB designed the study and wrote the protocol. JL and HH conducted the statistical analysis. SC and HK wrote the manuscript. All authors contributed to the article and approved the submitted version.

Funding

This research was funded by Ministry of Culture, Sports and Tourism and Korea Creative Con-tent Agency (Project number: R2020040186).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. Pettit, GS, Laird, RD, Dodge, KA, Bates, JE, and Criss, MM. Antecedents and behavior-problem outcomes of parental monitoring and psychological control in early adolescence. Child Dev. (2001) 72:583–98. doi: 10.1111/1467-8624.00298

PubMed Abstract | CrossRef Full Text | Google Scholar

2. Resnick, MD, Bearman, PS, Blum, RW, Bauman, KE, Harris, KM, Jones, J, et al. Protecting adolescents from harm: findings from the National Longitudinal Study on adolescent health. JAMA. (1997) 278:823–32. doi: 10.1001/jama.1997.03550100049038

CrossRef Full Text | Google Scholar

3. Schaefer, ES, Bell, RQ, and Bayley, N. Development of a maternal behavior research instrument. J Genet Psychol. (1959) 95:83–104. doi: 10.1080/00221325.1959.10534247

CrossRef Full Text | Google Scholar

4. Baumrind, D. The influence of parenting style on adolescent competence and substance use. J Early Adolesc. (1991) 11:56–95. doi: 10.1177/0272431691111004

CrossRef Full Text | Google Scholar

5. Jackson, KA, Edwards-Jones, V, Sutton, CW, and Fox, AJ. Optimisation of intact cell MALDI method for fingerprinting of methicillin-resistant Staphylococcus aureus. J Microbiol Methods. (2005) 62:273–84. doi: 10.1016/j.mimet.2005.04.015

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Laible, DJ, and Carlo, G. The differential relations of maternal and paternal support and control to adolescent social competence, self-worth, and sympathy. J Adolesc Res. (2004) 19:759–82. doi: 10.1177/0743558403260094

CrossRef Full Text | Google Scholar

7. McKinney, C, Donnelly, R, and Renk, K. Perceived parenting, positive and negative perceptions of parents, and late adolescent emotional adjustment. Child Adolesc Mental Health. (2008) 13:66–73. doi: 10.1111/j.1475-3588.2007.00452.x

PubMed Abstract | CrossRef Full Text | Google Scholar

8. Laible, DJ, Carlo, G, and Roesch, SC. Pathways to self-esteem in late adolescence: the role of parent and peer attachment, empathy, and social behaviours. J Adolesc. (2004) 27:703–16. doi: 10.1016/j.adolescence.2004.05.005

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Gonzalez, A, Greenwood, G, and WenHsu, J. Undergraduate students’ goal orientations and their relationship to perceived parenting styles. Coll Stud J. (2001) 35:182–2.

Google Scholar

10. McBride-Chang, C, and Chang, L. Adolescent-parent relations in Hong Kong: parenting styles, emotional autonomy, and school achievement. J Genet Psychol. (1998) 159:421–36. doi: 10.1080/00221329809596162

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Arikan, G, Acar, IH, and Ustundag-Budak, AM. A two-generation study: the transmission of attachment and young adults’ depression, anxiety, and social media addiction. Addict Behav. (2022) 124:107109. doi: 10.1016/j.addbeh.2021.107109

PubMed Abstract | CrossRef Full Text | Google Scholar

12. Chen, YL, Chen, SH, and Gau, SSF. ADHD and autistic traits, family function, parenting style, and social adjustment for internet addiction among children and adolescents in Taiwan: a longitudinal study. Res Dev Disabil. (2015) 39:20–31. doi: 10.1016/j.ridd.2014.12.025

PubMed Abstract | CrossRef Full Text | Google Scholar

13. Marci, T, Marino, C, Sacchi, C, Lan, X, and Spada, MM. Problematic internet use in early adolescence: the role of attachment and negative beliefs about worry. J Behav Addict. (2021) 10:194–200. doi: 10.1556/2006.2021.00001

PubMed Abstract | CrossRef Full Text | Google Scholar

14. Trumello, C, Vismara, L, Sechi, C, Ricciardi, P, Marino, V, and Babore, A. Internet addiction: the role of parental care and mental health in adolescence. Int J Environ Res Public Health. (2021) 18:12876. doi: 10.3390/ijerph182412876

PubMed Abstract | CrossRef Full Text | Google Scholar

15. Areshtanab, HN, Fathollahpour, F, Bostanabad, MA, Ebrahimi, H, Hosseinzadeh, M, and Fooladi, MM. Internet gaming disorder and its relationship with behavioral disorder and mother’s parenting styles in primary school students according to gender in Iran. BMC Psychol. (2021) 9:1–7. doi: 10.1186/s40359-021-00616-4

CrossRef Full Text | Google Scholar

16. Bonnaire, C, and Phan, O. Relationships between parental attitudes, family functioning and internet gaming disorder in adolescents attending school. Psychiatry Res. (2017) 255:104–10. doi: 10.1016/j.psychres.2017.05.030

PubMed Abstract | CrossRef Full Text | Google Scholar

17. Maftei, A, and Enea, V. Symptoms of internet gaming disorder and parenting styles in Romanian adolescents. Psihologija. (2020) 53:307–18. doi: 10.2298/PSI190808008M

CrossRef Full Text | Google Scholar

18. Throuvala, MA, Janikian, M, Griffiths, MD, Rennoldson, M, and Kuss, DJ. The role of family and personality traits in internet gaming disorder: a mediation model combining cognitive and attachment perspectives. J Behav Addict. (2019) 8:48–62. doi: 10.1556/2006.8.2019.05

PubMed Abstract | CrossRef Full Text | Google Scholar

19. American Psychiatric Association Proposed Revision: Definition of a Mental Disorder (Retrieved December 20, 2011).

Google Scholar

20. Moghaddam, MF, Assareh, M, Heidaripoor, A, Rad, RE, and Pishjoo, M. The study comparing parenting styles of children with ADHD and normal children. Arch Psychiatr Psychother. (2013) 15:45–9. doi: 10.12740/APP/19375

CrossRef Full Text | Google Scholar

21. Keown, LJ, and Woodward, LJ. Early parent–child relations and family functioning of preschool boys with pervasive hyperactivity. J Abnorm Child Psychol. (2002) 30:541–53. doi: 10.1023/A:1020803412247

CrossRef Full Text | Google Scholar

22. McCleary, L, and Ridley, T. Parenting adolescents with ADHD: evaluation of a psychoeducation group. Patient Educ Couns. (1999) 38:3–10. doi: 10.1016/S0738-3991(98)00110-4

CrossRef Full Text | Google Scholar

23. Cudo, A, Szewczyk, M, Błachnio, A, Przepiórka, A, and Jarząbek-Cudo, A. The role of depression and self-esteem in Facebook intrusion and gaming disorder among young adult gamers. Psychiatry Q. (2020) 91:65–76. doi: 10.1007/s11126-019-09685-6

PubMed Abstract | CrossRef Full Text | Google Scholar

24. Han, DH, Yoo, M, Renshaw, PF, and Petry, NM. A cohort study of patients seeking internet gaming disorder treatment. J Behav Addict. (2018) 7:930–8. doi: 10.1556/2006.7.2018.102

PubMed Abstract | CrossRef Full Text | Google Scholar

25. Ko, CH, Liu, TL, Wu, HC, Yeh, YC, Tsai, WX, and Yen, JY. Psychiatric comorbidities and emotional intelligence in internet gaming disorder: attention deficit hyperactivity disorder, major depressive disorder, generalized anxiety disorder, and social anxiety disorder. Psychiatry Clin Neurosci. (2021) 75:352–4. doi: 10.1111/pcn.13295

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Lee, J, Bae, S, Kim, BN, and Han, DH. Impact of attention-deficit/hyperactivity disorder comorbidity on longitudinal course in internet gaming disorder: a 3-year clinical cohort study. J Child Psychol Psychiatry. (2021) 62:1110–9. doi: 10.1111/jcpp.13380

PubMed Abstract | CrossRef Full Text | Google Scholar

27. Remondi, C, Compare, A, Tasca, GA, Greco, A, Pievani, L, Poletti, B, et al. Insecure attachment and technology addiction among young adults: the mediating role of impulsivity, alexithymia, and general psychological distress. Cyberpsychol Behav Soc Netw. (2020) 23:761–7. doi: 10.1089/cyber.2019.0747

PubMed Abstract | CrossRef Full Text | Google Scholar

28. American Psychiatric Association, D. and American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5, vol. 5. Washington, DC: American Psychiatric Association (2013).

Google Scholar

29. Lee, K, Lee, HK, Gyeong, H, Yu, B, Song, YM, and Kim, D. Reliability and validity of the Korean version of the internet addiction test among college students. J Korean Med Sci. (2013) 28:763–8. doi: 10.3346/jkms.2013.28.5.763

PubMed Abstract | CrossRef Full Text | Google Scholar

30. Young, KS. Caught in the net: how to recognize the signs of internet addiction – and a winning strategy for recovery. New York, NY: Wiley (1998).

Google Scholar

31. Wang, X, Wang, Y, and Xin, T. The psychometric properties of the Chinese version of the Beck depression inventory-II with middle school teachers. Front Psychol. (2020) 11:548965. doi: 10.3389/fpsyg.2020.548965

PubMed Abstract | CrossRef Full Text | Google Scholar

32. Lee, HK, Lee, EH, Hwang, ST, Hong, SH, and Kim, JH. Psychometric properties of the Beck anxiety inventory in the community-dwelling sample of Korean adults. Korean J Clin Psychol. (2016) 35:822–30. doi: 10.15842/kjcp.2016.35.4.010

CrossRef Full Text | Google Scholar

33. Lee, EH, Lee, SJ, Hwang, ST, Hong, SH, and Kim, JH. Reliability and validity of the Beck depression inventory-II among Korean adolescents. Psychiatry Investig. (2017) 14:30–6. doi: 10.4306/pi.2017.14.1.30

PubMed Abstract | CrossRef Full Text | Google Scholar

34. Kwak, K. J., Oh, S. W., and Kim, C.T., (2011), Korean-Wechsler intelligence scale for children. 4th ed. Seoul: Hakjisa. 11–13.

Google Scholar

35. DuPaul, GJ, Power, TJ, Anastopoulos, AD, and Reid, R. ADHD rating scale – IV: checklists, norms, and clinical interpretation. Guilford Press: (1998). doi: 10.1177/0734282905285792

CrossRef Full Text | Google Scholar

36. So, YK, Noh, JS, Kim, YS, Ko, SG, and Koh, YJ. The reliability and validity of Korean parent and teacher ADHD rating scale. J Korean Neuropsychiatr Assoc. (2002):283–9.

Google Scholar

37. Carver, CS, and White, TL. Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: the BIS/BAS scales. J Pers Soc Psychol. (1994) 67:319–33. doi: 10.1037/0022-3514.67.2.319

CrossRef Full Text | Google Scholar

38. Kim, K, and Kim, WS. Korean-BAS/bis scale. Korean. J Health Psychol. (2001) 6:19–37.

Google Scholar

39. Choo, SK. The effects of mother’s child-rearing attitudes on young children’s intelligence, multiple intelligence, and emotional intelligence. J Gifted/Talented Educ. (2013) 23:479–99. doi: 10.9722/JGTE.2013.23.3.479

CrossRef Full Text | Google Scholar

40. Hayes, AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach Guilford Publications (2017). doi: 10.1111/jedm.12050

CrossRef Full Text | Google Scholar

41. Dullur, P, Krishnan, V, and Diaz, AM. A systematic review on the intersection of attention-deficit hyperactivity disorder and gaming disorder. J Psychiatr Res. (2021) 133:212–22. doi: 10.1016/j.jpsychires.2020.12.026

PubMed Abstract | CrossRef Full Text | Google Scholar

42. Ha, JH, Yoo, HJ, Cho, IH, Chin, B, Shin, D, and Kim, JH. Psychiatric comorbidity assessed in Korean children and adolescents who screen positive for internet addiction. J Clin Psychiatr. (2006) 67:821–6. doi: 10.4088/JCP.v67n0517

PubMed Abstract | CrossRef Full Text | Google Scholar

43. Ostinelli, EG, Zangani, C, Giordano, B, Maestri, D, Gambini, O, D’Agostino, A, et al. Depressive symptoms and depression in individuals with internet gaming disorder: a systematic review and meta-analysis. J Affect Disord. (2021) 284:136–42. doi: 10.1016/j.jad.2021.02.014

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Seong, W, Hong, JS, Kim, S, Kim, SM, and Han, DH. Personality and psychological factors of problematic internet gamers seeking hospital treatment. Front Psych. (2019) 10:583. doi: 10.3389/fpsyt.2019.00583

PubMed Abstract | CrossRef Full Text | Google Scholar

45. Durkee, T, Kaess, M, Carli, V, Parzer, P, Wasserman, C, and Floderus, B, et al. Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addiction. (2012) 107:2210–22. doi: 10.1111/j.1360-0443.2012.03946.x

CrossRef Full Text | Google Scholar

46. Karaer, Y, and Akdemir, D. Parenting styles, perceived social support and emotion regulation in adolescents with internet addiction. Compr Psychiatry. (2019) 92:22–7. doi: 10.1016/j.comppsych.2019.03.003

PubMed Abstract | CrossRef Full Text | Google Scholar

47. Karababa, A. Examining internet addiction of early adolescents in terms of parenting styles. Turk Psychol Couns Guid J. (2020) 10:229–54.

Google Scholar

48. Sun, Y, and Wilkinson, JS. Parenting style, personality traits, and interpersonal relationships: a model of prediction of internet addiction. Int J Commun. (2020) 14:23.

Google Scholar

49. Li, S, Lei, H, and Tian, L. A meta-analysis of the relationship between parenting style and internet addiction among mainland Chinese teenagers. Soc Behav Personal Int J. (2018) 46:1475–87. doi: 10.2224/sbp.7631

CrossRef Full Text | Google Scholar

50. Lukavská, K, Vacek, J, and Gabhelík, R. The effects of parental control and warmth on problematic internet use in adolescents: a prospective cohort study. J Behav Addict. (2020) 9:664–75. doi: 10.1556/2006.2020.00068

PubMed Abstract | CrossRef Full Text | Google Scholar

51. Özgür, H. The relationship between internet parenting styles and internet usage of children and adolescents. Comput Hum Behav. (2016) 60:411–24. doi: 10.1016/j.chb.2016.02.081

CrossRef Full Text | Google Scholar

52. Jung, D, Shim, EJ, Park, H, Lee, K, Lee, S, Kim, EY, et al. The association between excessive internet gaming behavior and immersive tendency, mediated by attention deficit/hyperactivity disorder symptoms, in Korean male university students. Psychiatry Investig. (2020) 17:403–11. doi: 10.30773/pi.2019.0173

PubMed Abstract | CrossRef Full Text | Google Scholar

53. Lim, JA, Gwak, AR, Park, SM, Kwon, JG, Lee, JY, Jung, HY, et al. Are adolescents with internet addiction prone to aggressive behavior? The mediating effect of clinical comorbidities on the predictability of aggression in adolescents with internet addiction. Cyberpsychol Behav Soc Netw. (2015) 18:260–7. doi: 10.1089/cyber.2014.0568

PubMed Abstract | CrossRef Full Text | Google Scholar

54. Weinstein, A, and Weizman, A. Emerging association between addictive gaming and attention-deficit/hyperactivity disorder. Curr Psychiatry Rep. (2012) 14:590–7. doi: 10.1007/s11920-012-0311-x

PubMed Abstract | CrossRef Full Text | Google Scholar

55. Breaux, RP, McQuade, JD, Harvey, EA, and Zakarian, RJ. Longitudinal associations of parental emotion socialization and children’s emotion regulation: the moderating role of ADHD symptomatology. J Abnorm Child Psychol. (2018) 46:671–83. doi: 10.1007/s10802-017-0327-0

PubMed Abstract | CrossRef Full Text | Google Scholar

56. Nelson, T, East, P, Delva, J, Lozoff, B, and Gahagan, S. Children’s inattention and hyperactivity, mother’s parenting, and risk behaviors in adolescence: a 10-year longitudinal study of Chilean children. J Dev Behav Ped: JDBP. (2019) 40:249–56. doi: 10.1097/DBP.0000000000000661

PubMed Abstract | CrossRef Full Text | Google Scholar

57. Thomassin, K, and Suveg, C. Parental autonomy support moderates the link between ADHD symptomatology and task perseverance. Child Psychiatry Hum Dev. (2012) 43:958–67. doi: 10.1007/s10578-012-0306-1

PubMed Abstract | CrossRef Full Text | Google Scholar

58. Allmann, AE, Klein, DN, and Kopala-Sibley, DC. Bidirectional and transactional relationships between parenting styles and child symptoms of ADHD, ODD, depression, and anxiety over 6 years. Dev Psychopathol. (2022) 34:1400–11. doi: 10.1017/S0954579421000201

PubMed Abstract | CrossRef Full Text | Google Scholar