Problematic Media Use: Screening and Intervention Tools for Clinicians

Problematic Internet Use (PIU) was initially developed as a term to encompass many types of online activities, including social media, digital media, video and online games, and app use. Based on a 2012 research study, PIU is defined as risky, excessive or impulsive in nature leading to negative consequences, specifically physical, emotional, social or functional impairments. It is often characterized by missing sleep, neglecting schoolwork and compulsive use for periods of time. In this resource, we’ll use the term Problematic Media Use (PMU) to represent this concept.

This definition focuses on a young person’s unique relationship with media and being online rather than a specific number of hours or type of platform. Because each child responds to technology differently, it is important to avoid a cookie-cutter approach.

When is media use problematic?

While some messages today often use the terms “problematic media use” and “addiction” interchangeably, they reflect two different conditions and approaches. The table below highlights some key differences between the two concepts and why PMU is preferred for media and technology use concerns:

Problematic Media Use	Addiction
Common types of internet use, such as social media use, have both risks and benefits	No health benefits associated with alcohol or substance use
Accepted terminology in medical and research communities	Stigmatizing and alarmist language
Describes a broad range of challenges experienced by a youth in their internet and technology use	Describes behaviors that are only at the extreme end of the spectrum
Recognizes some internet and technology use is due to “sticky” design features made to keep people online longer	Places blame on the child rather than “sticky” design features
A problem that can be solved with the right support and developing more digital literacy skills	Decreases self-efficacy and leads to feelings of inevitability and hopelessness

The following signs may help identify when a child or teen’s internet use is becoming problematic:

Changes in behavior: physically, emotionally, socially and functionally
Lower grades due to overuse of technology
Being emotionally withdrawn
Avoiding offline social connections
Important activities like sleep and exercise are being crowded out
Using technology and digital media as the primary way to calm emotions

Screening Tools

Clinicians and providers may use evidence-based tool tools to identify problematic internet and digital media use including:

For adolescents ages 11 and older:
- Problematic and Risky Internet Use Screening Scale Brief (PRIUSS 3): Quick screener as part of general adolescent health, can be followed by PRIUSS-18 if positive screen
- Problematic and Risky Internet Use Screening Scale Brief (PRIUSS-18): Full assessment for problematic Internet/technology use
For kids ages 11 and younger:
- Problematic Media Use assessment (completed by parents)

Prevention Tips: What Can Clinicians Do?

Consider the 5 Cs of Media Use
Develop a Family Media Plan; PMU may resemble normal family discourse, particularly when expectations around media use have not been set
Learn more about built-in parental control settings at the Glossary of Digital Media Platforms
Talk about digital media on a regular basis using the Conversation Starters for Families About Media
Parents modeling responsible use, spending more time with the child

Interventions

Therapy for underlying conditions (ADHD, anxiety, eating disorder, family interactions)
Parent psychoeducation – About the child’s motivations for media use, strengths/weaknesses that contribute to problematic media use, but also about the design of media they use
- Social media: Which platforms, who they follow, privacy/content settings
- Gaming: Online, single/multiplayer, chatting, rating, can it be paused?
Cognitive Behavioral Therapy and Dialectical Behavior Therapy interventions focused on self-monitoring and self-regulation
Parent training on limits; balancing child autonomy rather than punishment around media device curfews; clear and explicit rules
Parents modeling responsible use, spending more time with the child

Resources

Motivational Interviewing video series: This series of brief videos, based on concepts from the 5 Cs of Media Use, offers healthcare providers guidance on using motivational interviewing (MI) as a tool to engage in meaningful conversations with families about their child or teen’s media use.
Case Examples for Healthcare Providers: View our tips and recommendations for facilitating conversations with youth based on these case scenarios for Providers.

For more information, visit the Center of Excellence on Social Media and Youth Mental Health.

Download a PDF version of this Screening and Intervention Tools for Clinicians resource.

Funding for the Center of Excellence was made possible by Grant No. SM087180 from SAMHSA of the US Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the US Government.

Last Updated

07/23/2025

Source

American Academy of Pediatrics