By Dr Ong Say How

I was anxious and restless when I went on a holiday recently.

I had begun to fret that I might miss important e-mail because I had no access to a computer.

Many people have reached the stage where cellphones, PDAs, computers and the Internet have impacted their lives in a tremendous - and irreversible - way.

There are already suggestions that excessive use of such Web-linked gadgets can lead to dependency or even an addiction.

It's still a controversial debate. Some studies claim that the use of computers beyond 28 hours a week in 'non-essential chores" could be regarded as some form of dependency. That's about four hours or more a day of computer gaming and non-essential Internet surfing.

However, the question remains as to whether computer dependency is a social problem or a mental disorder.

Regardless, with respect to children and young people, this phenomenon - almost unheard of five years ago - has many emotional, behavioural and psychological ramifications.

What's real is that I now see more and more young people at my clinic for problematic use of the computer and Internet.

My own view is that 'pure" cyber-addiction is probably uncommon. Many of my young patients experience some psychiatric or psychological symptoms.

One month ago, a bright teenage boy was referred to my clinic. He had become violent towards his parents when they stopped him from playing his favourite online games. Driven to despair, his parents finally literally pulled the plug - from the socket.

He went berserk and struck his parents, something he had never done before.

I questioned him and found him to be an introverted and socially awkward teen with few friends. Relating to other people through online gaming or Internet chatlines was easier for him.

I suggested social skills and time management training, among other behavioural strategies to cope with his dependence.

At my suggestion, his parents used computer time as an incentive to get him to leave his room for daily activities like family meals and outings.

The therapy worked well - the teen realised that hurting his family was not what he had wanted and he was motivated to control his computer usage.

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While the underlying causes vary from case to case, there are similarities between computer dependency and drug addiction. These include 'substance-seeking" behaviour with stepped-up usage to derive satisfaction, neglect of social and family obligations and impaired academic and social functioning.

Studies suggest that gaming - with its random gratification nature - and associated biochemical changes in the brain can help explain how computers and the Internet could cause dependency.

By the same token, treatment for cyber-addiction mirrors that for drug addiction somewhat. However, it is unrealistic to use 'cold turkey' - totally exclude computer use - in the context of today's social, work and school environment.

Moderation and controlled usage are key. Treatment must also target the addiction's primary cause - such as anxiety, depression, autism spectrum disorder and dysfunctional family dynamics.

Time away from the computer, such as temporary hospitalisation and camp, may be necessary to manage an acute crisis. Immersion in structured activities, including sports and group work, can be healthy and meaningful antidotes.

Parents and their teenage children must also learn realistic goal-setting and problem-solving skills and time management techniques.

Community resources can be tapped. The Touch Cyberwellness Centre offers a supervisory programme to help teens overcome computer problems through mentoring and counselling.

Family therapy to address unhealthy family dynamics and relationships can help unravel the dysfunction which perpetuates the problematic use of the computer.

Finally, individual psychotherapy and medication are used if necessary.

Cyber-addiction need not be a threat to parents' relationships with their teenagers.

Parents should build a strong and trusting relationship with their children when they are young. Be aware of their interests as they grow up; get involved rather than be a bystander. Teach them the dos and don'ts of computer usage and the Internet.

Careful supervision and timely guidance can ensure that they do not get entangled in the web of the Internet.

Dr Ong Say How is deputy chief in the department of child & adolescent psychiatry, Institute of Mental Health (IMH). The department provides psychological and psychiatric services for children and adolescents up to 19 years of age, most of whom have emotional and behavioural problems.

This story was first published in Mind Your Body, The Straits Times, on Oct 16, 2008.

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