ADHD Youth and Digital Media Use

The common conception of ADHD behavior as being unable to sit still in a classroom or “bouncing off the walls” is just one presentation of this common disorder, says psychologist Carey Heller, PsyD, of Heller Psychology Group. There are actually three primary types of ADHD:

• Predominantly inattentive presentation – primary symptoms relate to challenges with focus or attention
• Combined presentation – issues with attention, but also difficulties with hyperactivity and impulsivity
• Predominantly hyperactive/impulsive presentation – impulsive and hyperactive behavior 

ADHD youth often present in school and learning environments with the following possible behaviors, says Heller:

• Difficulty with staying focused at school and when doing homework 
• Struggling with organization (e.g., losing things, having a messy backpack with loose papers everywhere, etc.)
• Getting distracted easily
• Procrastination 
• Trouble following multi-step directions and completing tasks that involve multiple steps 
• Difficulty sitting still (e.g., excess fidgeting and body movement) 

Tendencies towards stimulation and procrastination – The desire for constant stimulation, as well as struggles with procrastination and delaying gratification, which are common in ADHD youth, are precisely what makes these youth more susceptible to becoming attached to digital media and difficulty disconnecting from it, says Heller. This can create an effect of media use worsening the symptoms of ADHD and of emotional dysregulation in these children, he notes. For example, a child may throw a temper tantrum when needing to disconnect from their video game to do homework, because both the highly stimulating nature of the game and its role in helping to procrastinate work feed into existing vulnerabilities in the ADHD brain. 

Difficulty with delayed gratification – Success in the “real world” involves a lot of patience, toleration for boredom and difficult tasks, as well as long-range planning with delayed rewards, notes Clifford Sussman, MD, a child and adolescent psychiatrist, specialist in gaming and internet use disorder, and Clinical Instructor of Psychiatry and Behavioral Science at George Washington University. “If you go into the video game world and the virtual world, you have a world of instant gratification, constant stimulation, and constant rewards.” Digital media becomes an easy escape for youth who struggle with this delayed gratification.

Youth with ADHD are more likely to develop a delayed sleep phase that can lead to insufficient sleep, says Anthony Yeung, MD, FRCPC, DRCSPC, Clinical Assistant Professor in the Department of Psychiatry at University of British Columbia. Adding digital media use to this situation can displace even more sleep time and lead to worsening ADHD symptoms during the day, he notes. “There have been several studies that suggest daytime sleepiness is noticed by teachers for specific teenagers with ADHD who have excessive media use.” With ADHD, sleep, and media use all affecting each other, it’s important to keep an eye on modulating all three to maintain child health, says Yeung.

The pleasure youth (and adults) derive from digital media use is partially due to the dopamine system in the brain, says Sussman. The constant “rewards” the brain experiences during digital media use results in a constant release of dopamine. However, much like alcohol use, the brain becomes “tolerant” to dopamine and requires even more media use to achieve the same pleasurable feeling.

When kids with ADHD get off their devices after being allowed to enjoy long stretches of use, their brains have become more intolerant of less stimulating activities and require even more dopamine from their real-world activities than before, shares Sussman. “They may be irritable, they may be even more bored than usual, they may have even more trouble paying attention in class than usual, and their executive functioning problems that they already have may even become enhanced,” he notes. These effects can and will persist if the child continues to engage in binge media use like binge gaming sessions.

Youth struggling with dopamine regulation after intense media use can reset their “baseline” by refraining from media use for three days and engaging regularly in “low-dopamine” activities that help better regulate brain chemistry, suggests Sussman. Low-dopamine activities include offline activities like assembly toys, books, arts and crafts, board games, sports, musical instruments, or puzzles, but can also include screen uses that involve some delayed gratification or require long-term focus, like coding, editing a photo in Photoshop, writing, or watching a long-form movie. Even just being bored is a low-dopamine “activity” that can be beneficial, he says.

Impacts of digital media overuse are particularly strong after long, uninterrupted sessions, according to Sussman. Sussman cautions against looking at total screen time as a measure of healthy use and says it’s much more important to avoid long continuous blocks of time or binges online. Older children can handle longer media blocks such as an hour, while younger children may do better with a 30 minute limit, he suggests.

“I recommend that people pick a reasonable block length of time and be consistent with that length of time for when children engage in what I call their high-dopamine activities like gaming, browsing, video-watching, or streaming,” says Sussman. This consistency in limiting the overstimulation of dopamine production will be beneficial to the child long-term.

Help set up youth with ADHD for success by creating physical space “cues” for focus spaces versus digital entertainment spaces, says Sussman. “Make sure that they’re not doing homework with three or four devices in front of them. Maybe even have an area in the house for the high-dopamine activities and an area in the house for the low-dopamine activities.” Physically changing spaces and leaving digital devices behind when it’s time for “low-dopamine” activities can help create the necessary separation.

Assistive technology consultant Shelley Haven, ATP, RET, BSME,  has found that active management of the physical environments in which youth with ADHD use digital media can help them develop better independent self-regulation and focusing skills during their media use windows. She suggests several possible strategies to help create better conditions for digital focusing:

• • Reduce auditory distractions through use of ear plugs, noise-canceling headphones, white-noise apps, and instrumental music. 
  • Declutter the personal work area. Remove personal pictures of friends or girl/boyfriends that may distract.
  • Put other homework out of view that isn’t related to the task at hand.
  • Use task lighting to spotlight the immediate task. 
  • Incorporate physical movement to help students better regulate their attention through the use of mindless or nondistracting fidget tools and workstations that integrate movement such as seats that can rock back and forth (e.g. wiggle cushions or a Hokki stool), or a sit/stand desk.
  • Use assistive listening devices in classroom environments that can help ADHD students distinguish between foreground (teacher) and background (distractive) sound. Apple AirPods with Live Listen can be used in this way.

Decluttering the virtual environment or screen can also help reduce visual distraction and focus attention on important tasks, says Haven, who finds that having multiple windows and apps open, or using complex web pages can contribute to problems focusing on work tasks. Haven notes options available for both Mac and Windows computers that can assist in visual decluttering, such as:

• • Both Mac and Windows operating systems allow a single keystroke to hide all other apps or make one app full screen. 
  • Microsoft Word (Mac, PC) hides all the toolbars and displays work fullscreen with a solid color background.
  • HazeOver app on Mac computers will dim all other apps and windows on a screen except the frontmost window and app.
  • Screen masking tools will highlight just one small area of the screen to help read/focus on smaller areas of a complex website.
  • Postlight Reader (a Google Chrome extension) and Safari Reader Mode (built into Safari browser on Mac, iPad, and iPhone) can help visually simplify complex webpages and reduce clutter.
  • Create separate “virtual desktops” with visual layouts specific to task categories, such as separate desktops for writing projects, general schoolwork organization/calendar, media projects, and social connection (e.g., email, social media).

Visual and auditory notifications and alerts are “calls to distraction,” notes Haven, who strongly suggests limiting what notifications are allowed on each device and how they appear.

Where to find notification settings (set banners, badges, sounds for specific notifications) on different devices: (as of January 2025)

• • Mac PC: System Preferences  =>  Notifications
  • Windows PC: Settings =>  System  =>  Notifications & Actions  =>  Focus Assist
  • iPad/iPhone: Settings  =>  Notifications 
  • Android: Settings  =>  Apps & Notifications  =>  Notifications 
  • Chrome: Settings  =>  Advanced Settings  =>  Privacy&Security  =>  Content Settings  =>  Notifications

Children with ADHD can have a difficult time responding to delayed consequences from breaking rules related to media overuse due to their brain’s predilection for immediate gratification. Sussman suggests meeting these youth “where they are at” by implementing immediate and logical consequences to media limit violations.

For example, using a delayed consequence such as tying screen privilege loss to academic grades at a delay of months apart isn’t as effective as an approach where the consequence of overuse is clear and immediate. An example Sussman provides: “‘You went 5 minutes over your high-dopamine block of time without changing activities. Therefore, we’re going to double that time and take ten minutes off of your next block of digital activity.'”

Youth are increasingly using social media platforms like TikTok and YouTube for online health information. While it can be helpful to find information about ADHD, youth and their caregivers should be aware that the quality of the information found online varies widely. A recent study published by Yeung and others found that of the top 100 TikTok videos on ADHD, over half contained misleading information about the condition. “My takeaway from this was that at any given moment in time, there’s probably a coin flip’s chance that you’re viewing some type of misinformation about ADHD on social media,” he says. This can even lead one to misdiagnose themselves with ADHD instead of a medical or psychiatric condition that may mimic ADHD symptoms.

Yeung encourages parents to help youth think critically about the ADHD-related information they are finding online, and to get them to ask questions of new information they find, such as:

• • Who made this video? 
  • Are there any potential conflicts of interest? 
  • Is a person trying to sell me something?
  • Is this from a reputable source with evidence or expert review?

Youth with ADHD can get stuck in a “distraction cycle” using sites like YouTube that are designed to entice continued use and provide constant dopamine rewards, says Haven. Using parental controls like blacklists and whitelists, which are built into every device, can shortcut this by limiting access.

• Blacklisting removes access to specific sites or apps
• Whitelisting limits access to only specific sites or apps.

Other tools are available online that may set time limits for app use, limit scheduled access to an entire device, or filter content. However, Haven urges parents and caregivers to implement strong controls like these only after discussion with youth rather than a unilateral top-down approach. Optimally, the child should feel like they are part of the decision process and understand why the rules are being imposed. “Tools work best when they’re coupled with thoughtfully selected strategies. Work with the students to help them understand the purpose of the tools, collaborate with parents and teachers to create workable strategies, and then allow time for practice and setbacks and self-awareness growth,” says Haven.

Tools like RescueTime for desktop computers or the Screen Time app on iPhones can help resolve parent-child bickering about how much time is being spent on screens, notes Haven. It can also help the child realize just how much time they are spending online and stimulate a desire for change. Sussman agrees – “It does break through that denial.” Parents may have the same denial about their own use, he notes, and tracking their use along with children can open a productive family conversation about appropriate limits for everyone.

Children are more likely to do what their parents do, not what they say, says Sussman. Parents and caregivers who are themselves binging on media and not following family rules are making it difficult to get youth to follow those rules and it’s important to model the healthy behavior you want to see in children. Encourage balance and structure, and engage in low-dopamine activities with children.

Writing out family media rules “can be really important” for this accountability, says Heller. “If you set an arbitrary rule and don’t enforce it, and there’s no way to even look back at it, it’s a lot harder to remember it and use it. If agreed-upon rules are written out and hung somewhere, it’s much easier, and the likelihood of enforcing them and everyone buying into them is certainly higher.”

Parents should look to support children in gaining the ability to self-regulate their own screen time before they launch into the adult world, notes Sussman. While children at younger ages may need more active parental limit-setting, “as they get older, you want them to find their own routines and their own ways to self-regulate,” he says. The summer before going to college can be a particularly unstructured time where binging on video gaming or other media use is common. This can be a particularly beneficial time to help a teen do a “dopamine detox” and establish structures that they can learn to utilize independently as they navigate their first year away from family-provided structure.

There are times where limit-setting and structure from the parents or caregivers may not be enough to help a child cope with the effects of digital media overuse. Sussman suggests keeping an eye out for “red flag” behavior that indicates it’s time to get some additional help from a mental health provider or a clinician. These can include:

• • aggression over screen use when you try to get them to stop;
  • excessive lying about screen use; and
  • suicidal threats when you try to take devices away.