New research explores how attention difficulties, sleep disruption, and cognitive control challenges intersect with internet use patterns, highlighting lifestyle factors like exercise that may help reduce risk while underscoring the need for cautious interpretation of cross-sectional findings.
Study: The interplay between attention deficit/hyperactivity disorder and internet addiction: executive dysfunction and insomnia as mediators and the role of physical activity. Image Credit: Melinda Nagy / Shutterstock
In a recent study published in the journal Frontiers in Psychiatry, researchers assessed the relationship between ADHD (attention deficit hyperactivity disorder) symptoms, insomnia, executive dysfunction, and IA (internet addiction) in college students.
ADHD is a neurodevelopmental disorder characterized by hyperactivity, inattention, cognitive deficits, emotional impulsivity, and learning difficulties. IA has also emerged as a substantial public health concern. IA and ADHD are closely related, with individuals showing ADHD symptoms more likely to report IA. Despite evidence of co-occurrence, the precise directional relationship remains unclear. Because this study used a cross-sectional design, causal relationships cannot be established, and the findings should be interpreted as associations rather than cause-and-effect relationships.
Executive Dysfunction, Insomnia, and Behavioral Regulation
Executive dysfunction is a common comorbidity in ADHD, affecting domains such as attention control, working memory, inhibitory control, and planning. Executive function (EF), which broadly refers to cognitive processes involved in self-regulation, organization, and goal-directed behaviour, plays a key role in impulse control. Deficits in EF may elevate the risk of IA among individuals with ADHD. Insomnia, which is also common in people with ADHD, may further aggravate executive dysfunction. These relationships may be bidirectional, as problematic internet use itself can worsen sleep patterns.
Physical Activity as a Potential Modifying Factor
Previous studies have reported that physical activity can reduce IA symptoms and improve mental health outcomes. Physical activity may also alleviate executive dysfunction and insomnia. However, most prior research has examined these factors in isolation, with limited attention to their combined effects. Consequently, the complex interactions among physical activity, sleep, executive function, and IA remain underexplored, particularly in non-Western educational settings such as Chinese universities, where digital engagement patterns may differ.
Study Design and Participant Characteristics
In the present study, researchers evaluated associations among ADHD symptoms, IA, insomnia, and executive dysfunction. Students aged 16 years and older from six universities in Hunan, China, were recruited, and surveys were administered in June 2024. The Adult ADHD Self-Report Scale (ASRS) was used as a screening tool, comprising hyperactivity and inattention subscales, with scores ranging from 0 to 9.
A total ASRS score greater than nine indicated clinical-level ADHD symptoms rather than a formal diagnosis, as the scale functions as a screening instrument. Executive dysfunction was assessed using the Barkley Deficits in Executive Functioning Scale, Short Form (BDEFS-SF), with higher scores indicating more severe impairment. Insomnia was assessed using the Athens Insomnia Scale (AIS), which ranges from 0 to 24, with scores of 6 or higher indicating increased risk of insomnia.
Assessment of Internet Addiction and Physical Activity
IA was assessed using the Chinese IA Scale, Revision (CIAS-R), which evaluates compulsive use and withdrawal, tolerance, time management problems, and interpersonal and health-related concerns. A total CIAS-R score above 53 indicated clinically significant IA symptoms. Information on physical activity, including duration, frequency, and type, was also collected.
Participants were categorized into high-, moderate-, and low-physical-activity groups and compared with inactive individuals. Group differences were assessed using chi-squared tests for categorical variables, and Mann–Whitney U tests for continuous variables. Mediating effects of insomnia and executive dysfunction in the relationship between ADHD symptoms and IA were evaluated using structural equation modelling. This method identifies statistical associations but cannot confirm causality or temporal ordering.
Key Findings on ADHD, IA, and Lifestyle Factors
The study initially recruited 2,188 students, of whom 263 were excluded due to incomplete responses, yielding an analytic sample of 1,925 participants. Among these, 14 percent met criteria for IA symptoms, and 12.5 percent met criteria for ADHD symptoms. No significant differences in age, sex, or academic grade were observed between participants with and without IA symptoms.
Participants with IA symptoms had higher ASRS, BDEFS-SF, and AIS scores than those without IA. They also reported lower exercise intensity, fewer exercise habits, poorer adherence to exercise routines, and shorter exercise duration per session.
Mediation by Executive Dysfunction and Insomnia
ADHD symptoms were associated with IA symptoms, with executive dysfunction and insomnia statistically mediating this relationship. Because the data were cross-sectional, these mediation findings should be interpreted cautiously, as temporal sequencing cannot be confirmed. Participants who reported regular exercise habits had lower CIAS-R, BDEFS-SF, and AIS scores and were more likely to be male and in lower academic grades.
Compared with no physical activity, moderate physical activity was negatively associated with IA symptoms, and this association was stronger at high levels of physical activity. These relationships were also mediated by executive dysfunction and insomnia. Low levels of physical activity were not significantly associated with IA symptoms. Unmeasured factors such as stress, mood symptoms, or academic pressure may also have influenced these associations.
Conclusions and Implications
Overall, ADHD symptoms were associated with IA symptoms in Chinese college students, with insomnia and executive dysfunction acting as mediating factors. Moderate and high levels of physical activity were associated with lower IA risk, with the association mediated by sleep quality and executive function. These findings suggest that interventions for IA may benefit from addressing sleep, physical activity, and executive functioning. However, reliance on self-reported data, regional sampling, and a cross-sectional design limits generalizability and causal interpretation. Longitudinal and interventional studies are needed before firm clinical recommendations can be made.
GLP-1 weight-loss drugs show early promise for treating addiction