Journal of Adolescent Health 41 (2007) 93–98

Original article

The Comorbid Psychiatric Symptoms of Internet Addiction: Attention

Deficit and Hyperactivity Disorder (ADHD), Depression, Social Phobia,
and Hostility
Ju-Yu Yen, M.D.a,b,c, Chih-Hung Ko, M.D.b,c, Cheng-Fang Yen, M.D., Ph.D.c,d,
Hsiu-Yueh Wu, M.S.a,e, and Ming-Jen Yang, M.D., Sc.D.c,f,g,*
a
Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
b
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
c
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
d
Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
e
Department of Nursing, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
f
Graduate Institute of Behavioral Science, Kaohsiung Medical University, Kaohsiung, Taiwan
g
Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
Manuscript received November 15, 2006; manuscript accepted February 16, 2007

Abstract Purpose: To: (1) determine the association between Internet addiction and depression, self-
reported symptoms of attention deficit and hyperactivity disorder (ADHD), social phobia, and
hostility for adolescents; and (2) evaluate the sex differences of association between Internet
addiction and the above-mentioned psychiatric symptoms among adolescents.
Methods: A total of 2114 students (1204 male and 910 female) were recruited for the study.
Internet addiction, symptoms of ADHD, depression, social phobia, and hostility were evaluated by
the self-report questionnaire.
Results: The results demonstrated that adolescents with Internet addiction had higher ADHD
symptoms, depression, social phobia, and hostility. Higher ADHD symptoms, depression, and
hostility are associated with Internet addiction in male adolescents, and only higher ADHD
symptoms and depression are associated with Internet addiction in female students.
Conclusion: These results suggest that Internet addiction is associated with symptoms of ADHD
and depressive disorders. However, hostility was associated with Internet addiction only in males.
Effective evaluation of, and treatment for ADHD and depressive disorders are required for adoles-
cents with Internet addiction. More attention should be paid to male adolescents with high hostility
in intervention of Internet addiction. © 2007 Society for Adolescent Medicine. All rights reserved.
Keywords: Internet addiction; Adolescent; ADHD; Depression; Hostility

The Internet is one of the most widely accessible media
in the world. Adolescents are required to learn about it for
academic and recreational reasons, however, addiction to
the Internet has resulted in negative impact on academic
performance, family relationships, and emotions for adoles-
cents [1,2]. This phenomenon has been defined as Internet
*Address correspondence to: Dr. Ming-Jen Yang, Department of Psy-
chiatry, Kaohsiung Medical University, 100 Tzyou 1st Rd., Kaohsiung
City 807, Taiwan.
E-mail address: m750141@ksts.seed.net.tw
1054-139X/07/$ – see front matter © 2007 Society for Adolescent Medicine. All rights reserved.
doi:10.1016/j.jadohealth.2007.02.002
addiction [3] and reported to be associated with depression
and attention deficit hyperactivity disorder (ADHD) [4].
However, Shaffer et al have countered that there is not yet
sufficient construct validity to establish it as a primary disor-
der and it is better explained by other primary disorders [5].
Because comorbidity of two disorders may indicate the causal
relationship or common etiology shared by them [6], the eval-
uation for comorbid psychiatric symptoms of Internet addic-
tion could reveal which psychiatric symptoms are associated
with the development or maintenance of the Internet addiction,
and shed light on the mechanism of Internet addiction.
94 J.-Y. Yen et al. / Journal of Adolescent Health 41 (2007) 93–98
Until now, there is no conclusive diagnostic definition for
Internet addiction. Diagnostic tools of Internet addiction have
been developed by Young [3]. However, there is no empirical
evidence such as sensitivity or specificity that provides support
for the contents or cut-off points for this tool. Ko et al [7] have
proposed diagnostic criteria for adolescent Internet addiction
(DC-IA-A) based on empirical diagnostic interview study.
Criterion A is met with six of nine characteristic symptoms of
Internet addiction: preoccupation, uncontrolled impulse, use
more than intended, tolerance, withdrawal, impairment of con-
trol, excessive time and effort devoted to the Internet, and
impaired decision-making. Criterion B describes functional
impairment secondary to Internet use. Criterion C lists the
exclusion criteria. These diagnostic criteria had the good
accuracy (95.4%), high specificity (97.1%), and accepted
sensitivity (87.5%) and could discriminate among those
individuals with different severities of Internet use [7].
Based on the diagnostic criteria, the diagnostic cut-off point
of a self-reported questionnaire, Chen Internet Addiction
Scale (CIAS), had been developed to be used in massive
epidemiological investigations [8]. Thus, Internet addiction
of adolescents was defined according to the cut-off point of
CIAS in this presenting study.
Depression has been repeatedly reported to be associated
with Internet addiction for adolescents [4,9]. However, the
validity for the cut-off point of the screening tool, Young’s
Internet Addiction Scale, was not provided in these re-
searches [10]. A diagnostic tool for Internet addiction with
validity for a cut-off point will clearly reflect what level of
Internet use is pathological and correlated with depression.
Attention deficit hyperactivity disorder (ADHD) is one
of the most common psychiatric disorders, diagnosed in 3%
to 5% of children [11]. ADHD has been reported to be
associated with Internet addiction for children [4,12]. Be-
sides, adolescents who play more console or internet video
gaming had been reported to have higher ADHD symptoms
[13]. However, the relationship between Internet addiction
and ADHD in adolescents had not been directly evaluated.
Social phobia has been reported to be positively associated
with Internet use in adolescents [14], yet the association
between social phobia and Internet addiction has not been
addressed by empirical community evaluation for adoles-
cents. Furthermore, hostility has been noted to be associated
with substance addiction in adolescents [15]. Until now, its
association with Internet addiction had not been evaluated.
Internet addiction and ADHD were reported to be more
prevalent in males and social phobia and depression were
more prevalent in females [16,17]. However, whether there
is a sex difference in the association between Internet ad-
diction and psychiatric symptoms are unknown. It is essen-
tial to evaluate the sex difference of this association because
it would be important in developing preventive strategies
for Internet addiction specified for males and females.
Thus, to explore the comorbid psychiatric symptoms of
Internet addiction, which could be provided to develop
preventive and therapeutic strategies specified for males and
females, the aim of this study is to: (1) determine the
association between Internet addiction and depression,
symptoms of ADHD, social phobia, and hostility for ado-
lescents; and (2) evaluate the sex differences of the associ-
ation between Internet addiction and the above psychiatric
symptoms among adolescents.
Methods
Three of 33 senior high schools, and 7 of 20 vocational high
schools in Kaoshiung City and County in Taiwan were se-
lected for evaluation. The selected schools included five, three,
and two schools from urban, suburban, and rural areas, respec-
tively. Two classes were randomly selected from each grade in
the 10 schools. A total of 2114 students (1204 male and 910
female) were recruited. The mean of their age was 16.26 years
(SD ⫽ .99, range 15 to 23 years). All students in the selected
classes were invited to complete the measurement anony-
mously after informed consent was obtained. A total of 224
participants (140 male, 84 female) were omitted because they
failed to complete all rating scale. There was no significant
difference on sex (␹2 ⫽ 3.14, p ⫽ .08), age (t2112 ⫽ ⫺.98, p ⫽
.33) and school type (␹2 ⫽ .008, p ⫽ .93) between enrolled and
excluded participants. One hundred sixty-seven excluded
participants responded to CIAS and demonstrated no
significant difference from participants entered in the final
analysis (t2055 ⫽ 1.35, p ⫽ .18). A total of 1890 participants
(1064 male, 826 female) who completed all scales entered the
final analysis. The mean of their age was 16.26 ⫾ 1.00 years
old. The study was approved by the Institutional Review Board
(IRB) of Kaohsiung Medical University Hospital.
Measures
Chen Internet Addiction Scale (CIAS). The CIAS contains
26 items on a four-point Likert scale that assesses five
dimensions of Internet-related problems with scaled score
ranging 26 to 104. The internal reliability of the scale and
the subscales in the original study ranged from .79 to .93
[18]. In this study, the internal reliability of the subscales of
compulsive, withdrawal, tolerance, interpersonal and health
problems, and time management problems and the total
scale were .80, .82, .75, .82, .79, and .94, respectively.
According to the DC-IA-A [7], the 63/64 cut-off point of
CIAS has the highest diagnostic accuracy (87.6%) and ac-
cepted sensitivity (67.8%) and specificity (92.6%) [8].
Accordingly, those with CIAS scores of 64 or more were
classified as the Internet Addiction group.
Attention-Deficit/Hyperactivity Disorder Self-Rated Scale
(ADHDS). The ADHDS was designed for this research to
measure self-reported ADHD symptoms. The 18 items in
the ADHDS were modified from Vanderbilt ADHD diag-
 J.-Y. Yen et al. / Journal of Adolescent Health 41 (2007) 93–98 95

nostic parent rating scale [19] and reflected the 18 diagnos-
tic symptoms for ADHD in the DSM-IV TR [20]. It is a
four-point Likert-type self reported questionnaire, ranging
from one (“Not at all”) to four (“almost always”). The
scores of questions 1 to 18 were summed to be ADHDS
scores and ranged from 18 to 72. The internal consistency of
ADHDS was .88 in this study. Higher scores indicated more
severe symptoms. Preliminary evaluation for psychometric
characteristics of ADHDS was performed on 54 adolescents
(41 males and 13 females). Their mean age was 14.9 ⫾ 2.46
years (range 10 –19 years). The internal Cronbach alpha value
of ADHDS scores was .90. There is a high intra-class corre-
lation coefficient (ICC) between self-reports and parents’ re-
ports (ICC ⫽ .78, p ⬍ .001). The difference between self-
reports and parents’ reports on ADHDS scores was
insignificant (t53 ⫽ .87, p ⫽ .39). The ADHDS scores were
also significantly (negatively) correlated with function scores
rated by parents (R ⫽ ⫺.49, p ⬍ .001; R ⫽ ⫺.47; p ⫽ .001;
R ⫽ ⫺.51, p ⬍ .001). The preliminary evaluation demon-
strated that ADHDS had accepted reliability and validity to
represent the severity of ADHD symptoms among adolescents.
The Center for Epidemiological Studies’ Depression Scale
(CES-D). The 20-item Mandarin-Chinese version [21] of
CES-D [22] is a self-administered evaluation assessing de-
pressive symptoms with a scaled score ranging from 0 to 60.
The Cronbach alpha of CES-D in the present study was .78.
Higher CES-D scores indicated more severe depression.
Social Phobia Inventory (SPIN). The SPIN, developed by
Connor et al, is a 17-item self-reported rating scale. Each
item ranges from zero to four with score ranging from 0 to
68. Higher total scores of SPIN indicate higher severity of
social phobia. The scale has good test-retest reliability (.89
and .78), internal consistency (.87–.94 and .82–.90), and
construct validity [23]. The internal consistency of SPIN in
this study was .94.
CES-D, SPIN, and CHI-SF. The associations between Internet
addiction and category variables, including demographic char-
acter and Internet behavior character, were evaluated by chi-
square analysis. T-tests were used to evaluate the association
between Internet addiction and scores of ADHDS, CES-D,
SPIN, and CHI-SF. Then, the associations between Internet
addiction and psychiatric symptoms were further examined by
the stepwise logistic regression model under control of sex,
age, and school. Then, the t-test and logistic regression were
conducted for male and female students, respectively. All sta-
tistical analyses were performed using the computer software
program SPSS 10.0 (SPSS Inc., Chicago, IL). A p-value ⬍ .05
was considered significant.
Result
Based on the scores of CIAS, 338 participants (17.9%)
were classified into the Internet addiction group. Table 1
indicates that the adolescents with Internet addiction are
more likely to be male, have higher educational grades, use
the Internet more than 20 hours/week, and have online
gaming habits in the main. Playing online games (42%) is
the most frequent Internet activity of Internet addicts, fol-
lowed by online chatting (30.3%), downloading (5.3%),
e-mail (2.1%), and adult sex webs (.9%).
Tables 2 and 3 illustrate that adolescents with Internet
addiction had higher scores on CES-D, SPIN, ADHDS, and
CHI-SF for male, female, and all students. Then, scores on
CES-D, SPIN, ADHDS, and CHI-SF were used to enter the
Table 1
The associations between internet addiction and demographic data and
internet behavior
Variables Internet addiction ␹2
Yes No

(n ⫽ 338) (n ⫽ 1552)
The Chinese Hostility Inventory-Short Form (CHI-SF). The Number (%) Number (%)
CHI-SF consisting of 20 Likert-type items was used to
assess four dimensions of hostility construct: hostility cog- Gender
Male 242 (71.6) 822 (53.0) 39.17***
nition, hostility affection, and expressive hostility behavior, Female 96 (28.4) 730 (47.0)
and suppressive hostility behavior. It was modified from 44 School
items of the Chinese Hostility Inventory [24]. The prelim- Senior high school 122 (36.1) 618 (39.8) 1.62
inary evaluation revealed that it had good psychometric Vocational high school 216 (63.9) 934 (60.2)
properties: the coefficient of internal consistency (Cronbach Grade
10 117 (34.6) 631 (40.7) 6.41*
alpha) was .93 for the whole inventory; 4-week test-retest 11 106 (31.4) 491 (31.6)
reliability was .80. In this study, the internal consistency of 12 115 (34.0) 430 (27.7)
CHI-SF was .93. The score ranges from 20 to 100 and Internet usea
higher score indicated higher hostility. ⱖ20 hours/week 131 (39.8) 237 (15.5) 101.07***
Besides this, the demographic data, the time consumed ⬍20 hours/week 198 (60.2) 1294 (84.6)
Internet activity
online, and the main Internet activity were also queried. Gaming 142 (42.0) 399 (25.7) 36.11***
Chatting 102 (30.2) 602 (38.8)
Study process and statistical analysis Others 94 (27.8) 551 (35.5)
All participants were arranged to complete the question- a
Mission value: 30.
naires detailing their Internet use and CIAS, ADHDS, * p ⬍ .05; *** p ⬍ .001.
96 J.-Y. Yen et al. / Journal of Adolescent Health 41 (2007) 93–98

Table 2 Table 4
The associations between age and scores of CES-D, SPIN, ADHDS, and The results of stepwise regression for internet addiction under control of
CHI-SF and internet addiction gender, age, and school
Variables Internet addiction T value Variables Internet addiction

Yes No Wald ␹2 OR 95% CI

(n ⫽ 338) (n ⫽ 1552) Age 1.04 1.07 .94–1.22

Number (%) Number (%) School 4.33* 1.33 1.02–1.74
Gender (male) 33.89*** 2.30 1.74–3.04
Age 16.39 ⫾ .97 16.23 ⫾ 1.00 2.77** ADHDS 65.38*** 1.08 1.06–1.10
CES-D 23.75 ⫾ 11.12 16.83 ⫾ 9.51 10.62*** CES-D 20.84*** 1.03 1.02–1.05
SPIN 27.07 ⫾ 13.98 22.14 ⫾ 13.54 6.03*** CHI-SF 8.56*** 1.02 1.01–1.04
ADHDS 43.93 ⫾ 7.94 37.65 ⫾ 7.14 13.40***
CHI-SF 67.72 ⫾ 11.59 60.16 ⫾ 11.44 10.97*** ADHDS ⫽ Attention-Deficit/hyperactivity disorder self-rated scale;
CES-D ⫽ The Center for Epidemiological Studies’ Depression Scale;
CES-D ⫽ The Center for Epidemiological Studies’ Depression Scale; SPIN ⫽ CHI-SF ⫽ The Chinese Hostility Inventory-Short Form.
Social phobia Inventory; ADHDS ⫽ Attention-Deficit/hyperactivity disorder
* p ⬍ .05; *** p ⬍ .001.
self-rated scale; CHI-SF ⫽ The Chinese Hostility Inventory-Short Form.
** p ⬍ .01; *** p ⬍ .001.
control, synchronous interactive quality, and the freedom of
self-representation of Internet activity may provide high
stepwise regression model for Internet addiction. The re- incentive motivation and highly reward adolescents with
sults among both all and male students revealed that if the ADHD. Furthermore, aversion for delayed reward and pref-
scores of ADHDS, CHI-SF, and CES-D increased, the odds erence for immediate reward has been reported to be an
of Internet addiction increased (Tables 4 and 5). However, endophenotype of ADHD [26]. The Internet activity, like
the odds of Internet addiction increased only when the gaming, which provides intermediate responses and re-
scores of the ADHDS and CES-D increased among female wards, may satisfy adolescents with ADHD more than other
students (Table 5). The ADHDS is the first variable entering adolescents. Moreover, adolescents with ADHD have ab-
the three regression models. normal brain activity associated with impairment of inhibi-
tions in performance [27]. The shortage of self-control may
cause adolescents with higher ADHD symptoms difficulty
Discussion
in controlling Internet use after being engaged in Internet
The results of the study revealed that adolescents with activity. As a result, under the design of the Internet, the
Internet addiction had higher self-reported ADHD symptoms, endless activity usually consumes a great deal of time and
which correlate with Internet addiction mostly in the regression deprives them of creative activities, thus making them
model for both male and female students. This is the first report progress to addiction.
to demonstrate an association between ADHD symptoms and Depressive disorder had been reportedly associated with
Internet addiction for adolescents. Because ADHD is a persis- Internet addiction [4,9]. Our results demonstrated that adoles-
tent and pervasive mental disorder with onset before age 7 cents with Internet addiction had higher depressive levels. Two
years [20], the preexisting neuropsychological characteristics models may account for the association. First, Kraut has re-
of ADHD could be used to explain the association. ported that Internet use results in negative effect on psycho-
Patients with ADHD had been reported to have an in- logical well-being [28], which may indicate that Internet ad-
creased sensitivity to reward [25]. The feeling of being in diction would lead to depression. However, the negative

Table 3
The gender differences of the association between age and scores of CES-D, SPIN, ADHDS, and CHI-SF and internet addiction
Male internet addiction Female internet addiction

Yes No T Value Yes No T Value

Mean ⫾ SD Mean ⫾ SD Mean ⫾ SD Mean ⫾ SD

Age 16.33 ⫾ .93 16.13 ⫾ .99 1.94 16.42 ⫾ .99 16.32 ⫾ 1.01 1.37
CES-D 23.26 ⫾ 11.02 16.25 ⫾ 9.30 9.00*** 24.98 ⫾ 11.35 17.49 ⫾ 9.70 6.17***
SPIN 26.71 ⫾ 14.09 22.15 ⫾ 13.86 4.48*** 27.98 ⫾ 13.74 22.13 ⫾ 13.19 4.07***
ADHDS 44.19 ⫾ 8.27 37.89 ⫾ 7.27 10.69*** 43.27 ⫾ 7.03 37.38 ⫾ 6.97 7.77***
CHI-SF 67.57 ⫾ 12.28 60.03 ⫾ 11.38 8.90*** 68.07 ⫾ 9.69 60.32 ⫾ 11.51 6.31***

CES-D ⫽ The Center for Epidemiological Studies’ Depression Scale; SPIN ⫽ Social phobia Inventory; ADHDS ⫽ Attention-Deficit/hyperactivity disorder
self-rated scale; CHI-SF ⫽ The Chinese Hostility Inventory-Short Form.
*** p ⬍ .001.
 J.-Y. Yen et al. / Journal of Adolescent Health 41 (2007) 93–98
Table 5
The gender differences of stepwise regression model for internet
addiction under control of age and school
Male internet addiction Female internet addiction
Wald ␹ 2
OR 95% CI Wald ␹2 OR 95% CI
Age .12 1.03 .88–1.20 1.78 1.16 .93–1.45
School 2.02 .79 .58–1.09 2.49 .66 .39–1.11
ADHDS 44.43*** 1.08 1.06–1.11 29.67*** 1.10 1.06–1.13
CESD 13.37*** 1.03 1.02–1.05 14.52*** 1.04 1.02–1.07
CHI-SF 5.29* 1.02 1.00–1.04
ADHDS ⫽ Attention-Deficit/hyperactivity disorder self-rated scale;
CES-D ⫽ The Center for Epidemiological Studies’ Depression Scale;
CHI-SF ⫽ The Chinese Hostility Inventory-Short Form.
* p ⬍ .05; *** p ⬍ .001.
impact decreased in the follow-up study [29]. Second, the
Internet could help develop a “virtual self” to leave the real
world off [30]. As the self-medication model for substance use
disorder indicates [31], adolescents with depression may adjust
their emotional condition by Internet use because it is per-
ceived as less harmful and more available than illegal sub-
stances. They could get a positive feeling, the pleasure of
control, and respect from others from the Internet [32], which
may compensate the imperfection in real life. However, if the
depression was not well treated, they would spend more and
more time on the Internet and progress to addiction. However,
lacking further prospective investigation, which model is more
conclusive could not be established in the present study.
Despite the causal relationships between Internet addic-
tion and ADHD symptoms and depression being inconclu-
sive, this study demonstrates that adolescents with Internet
addiction had higher ADHD symptoms and depression.
Until now, no comprehensive therapeutic strategy of Inter-
net addiction has been established. Well-established therapy
for ADHD and depression [33,34] could provide a decrease
in the deteriorating effect of comorbid symptoms for ado-
lescents with Internet addiction. Accordingly, ADHD symp-
toms and depression should be carefully evaluated and
treated in adolescents with Internet addiction.
The study revealed that adolescents with Internet addic-
tion had higher hostility levels. Hostility has been reported
to predict escape-avoidance coping styles and substance use
triggered by almost any cue, including negative emotional
states and tension [35]. For adolescents, higher hostility
usually leads to interpersonal conflict and rejection. Be-
cause substances are less available for them, the Internet
could provide a virtual world to escape from stress in the
real world. On the other hand, according to the social-
identity model of deindividuation effects [36], the decreased
self-monitoring in computer-mediated communication can
result in hostile, uninhibited, and flaming behaviors on the
Internet. However, whether this aggressive behavior will be
expressed in real life is unknown. The causal relationship
between hostility and Internet addiction should be further
evaluated in prospective studies.
97
Early aggressive behavior was found to be predictable
for later heavy substance use for males, but not for females
[37]. Sex difference was also found in the association be-
tween hostility and Internet addiction in the present study.
Because increased hostility among adolescents with Internet
addiction may manifest as anger and resistance to limitations
of Internet use, to establish therapeutic relationship with them
was difficult. Accordingly, male adolescents with high hostility
require more attention and patience in preventive strategies and
therapeutic interventions for Internet addiction.
The study revealed that adolescents with Internet addic-
tion had higher social phobia, however, it didn’t predict
Internet addiction after ADHD symptoms, depression, and
hostility were entered into the regression model. These
results may indicate that ADHD symptoms, depression, and
hostility are more proximal predictors than social phobia.
The results of this study revealed that males are more
likely to have Internet addiction than females, even when
comorbid psychiatric symptoms were controlled. This result
of sex difference was corresponded to previous reports on
Internet addiction [7]. It had been reported that more males
than females engaged in substance use for social bonding
and self-image [38]. Males may have the tendency to be
attracted by the social interaction and achievement provided
by Internet activities. In addition, female Taiwanese adoles-
cents often receive more family supervision than males,
which may prevent females from becoming addicted to
Internet. However, other biological and psychological fac-
tors should be further evaluated to account for the sex
difference of Internet addiction.
This study had the following limitations: first, because
the cross-section investigation design could not provide any
temporal relationship, the causal relationship between
ADHD symptoms, depression, hostility, and Internet addic-
tion could not be made clear in this study. Secondly, more
students of vocational high schools were selected in the
study population, although the type of school was controlled
in regression analysis. Thirdly, the ADHD symptoms relied
solely on self-report data. Previous research suggests that par-
ents may be more reliable indicators than adolescents for their
ADHD symptoms [39]. On the contrary, Cantwell et al re-
ported that adolescents report insignificantly more symptoms
than parents and the ICC between adolescent and parental
reports is .58 [40]. The results corresponded to our preliminary
data, which revealed that ADHD scores could represent the
severity of ADHD as parental observations do. However, more
than one information source to investigate ADHD should be
considered in further studies to provide clearer evidence.
Conclusion
The present research made clear that self-reported
ADHD symptoms, depression, and hostility are associative
factors of Internet addiction among adolescents. However,
hostility was associated with Internet addiction for male but
98 J.-Y. Yen et al. / Journal of Adolescent Health 41 (2007) 93–98
not for female students. Although the mechanism of the
association was beyond the scope of this study, it appears
reasonable to suggest that effective evaluation of, and treat-
ment for ADHD and depressive disorder are required for
adolescents with Internet addiction. Besides, male adolescents
with high hostility require more attention in preventive strate-
gies and therapeutic interventions for Internet addiction.
Acknowledgments
This study was supported by a grant from Department of
Health, Executive Yuan, ROC (DOH95-TD-M-113-039).
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