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Tracy Markle, MA & Brett Kennedy, Psy.D.
Autism Spectrum Disorder (ASD) is a common co-occurring diagnosis for people who struggle with technology addiction or digital media overuse. Few therapists, however, are trained to recognize the wide array of characteristics that a person on the autism spectrum can present. Portrayals of autism in the media also contribute to a stereotyped or limited understanding of ASD. This has resulted in many autistic people going undiagnosed their entire lives while struggling to compensate for their unmet needs through sensory-seeking behaviors like digital media overuse. Read on to gain a better understanding of the wide array of ASD characteristics and why people on the autism spectrum are often drawn to digital media and the internet. As well as why they can be at elevated risk for digital media overuse or addiction.
What is Autism Spectrum Disorder or ASD?
Autism spectrum disorder (ASD) refers to a neurodevelopmental difference that causes persistent social communication and social interaction challenges as well as restricted, repetitive patterns of behavior, interests, or activities.
In some cases, ASD is noticed by parents or caretakers before a child is a year old and diagnosed by the time they’re two. But today autism experts know that many autistic people go undetected until later when social requirements exceed their capacity to cope. Many autistic people make it all the way to adulthood without anyone, including themselves, realizing they’re autistic.
This is concerning because a growing body of evidence shows that early diagnosis can lead to improved quality of life for those on the autism spectrum and their families. Children on the autism spectrum are at increased risk for bullying at school and more likely to refuse to go to school because of bullying. But research has shown that classroom aides can serve as protective factors against this. People diagnosed on the autism spectrum as adults are significantly more likely to report lifetime experience of suicidal ideation than are individuals from a general population sample. Recently, a study of people who died by suicide in the UK found that 41% were likely on the autism spectrum, but undiagnosed. Which is a rate 19 times higher than that of the general population.
Autism used to be categorized under four different disorders in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Those were autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). But with the publication of the DSM-5 in 2013, these were all collapsed into the term autism spectrum disorder.
The DSM 5 also collapsed language delay into social communication difficulties, making it a possible manifestation of ASD criteria, but not necessary for diagnosis. In fact, some people on the autism spectrum are talented writers.
The new changes are meant to provide clinicians with a better understanding that autism might present in different ways, but it’s all autism. The DSM-5 also sought to expand diagnostic criteria to include people on the autism spectrum that are often overlooked, such as females and minorities.
What is Digital Media Overuse and Technology Addiction?
Digital media use occurs on a spectrum, with healthy use on one end and addiction on the other. In the middle, lies digital media overuse. The overwhelming majority of people who use the internet fall in the digital media overuse category, which is why we focus much of our work there.
Digital media addiction, sometimes called technology addiction or internet addiction, is an umbrella term that refers to an internet-based behavior disorder. There are five categories of digital media, internet, or technology addiction: video games, social media, online spending, pornography, and information overload. Autism and technology addiction are often co-occurring diagnoses.
Diagnostic criteria in the 11th edition of the World Health Organization (WHO) International Classification of Diseases (ICD-11) for internet-based behavior and impulse disorders include a persistent pattern of failure to control the behavior or impulse to the point that the individual is neglectful of health and personal care or other interests, activities, and responsibilities. The behavior must persist for at least 6 months and sometimes up to twelve months, despite numerous efforts to significantly reduce it and despite adverse consequences or deriving little or no satisfaction.
Only a small percentage of the population meets criteria for technology addiction with the most vulnerable age groups being college age followed by adolescents. This includes 13%-18% of US college students and 8.5% of US children ages 8-18. Studies show that autistic people are also at elevated risk for digital media overuse and addiction. In order to understand why, it’s important to understand the widespread lack of autism detection and why autistic people might engage in sensation seeking behaviors through various forms of internet-based media.
Conditions or Diagnoses that Commonly Co-Occur with Autism
Autism experts estimate that about 70% of autistic children have a co-existing diagnosis. Because of the many criteria necessary for an autism diagnosis, many people with undiagnosed autism will tend to collect a series of other diagnoses throughout the lifespan that represent either a small piece of their ASD presentation or a misdiagnosis. For this reason, it’s important that providers understand the conditions that commonly co-exist in people with ASD. The following are some, but not all of those conditions.
Suicidality
Multiple studies have established an increased risk for suicidality and death by suicide in people on the autism spectrum. The aforementioned British study found a sample of people who died by suicide were 19 times more likely to have undiagnosed autism spectrum disorder than the general UK population. And a nationwide retrospective cohort study in Denmark found that individuals with ASD were over three times more likely to attempt suicide than those without ASD. In the study, females with ASD were over 8 times as likely to attempt suicide as females without ASD. Males with ASD were 1.93 times more likely to attempt suicide than males without ASD. Individuals with ASD were also four times more likely than others to die by suicide. Of crucial importance in the Danish study was the finding that factors such as being married, living with someone, or being employed did not appear to act as protective factors to people with ASD. Suicide risk also increased with level of education.
Anorexia, Compulsive Exercise, and Disordered Eating
According to multiple studies, people with anorexia are more likely to be autistic than people who aren’t anorexic. Researchers place the prevalence anywhere from 4% to 52% of anorexia patients having autism or autistic traits. A 2020 study also reported that greater autistic social traits in childhood could represent a risk factor for the development of disordered eating in adolescence. Some researchers believe that food restriction can be a presentation of the restrictive and repetitive behavior criteria required for an autism diagnosis. And that excessive exercise, calorie counting, and obsession with body image could be a presentation of intense special interest commonly found in autistic people. Others believe that restricting calories and over-exercising is a sensation seeking behavior that helps autistic people (often undiagnosed) to cope with overwhelmingly difficult feelings brought on by their differences and by how they are treated by others.
ADHD
ADHD shows high concurrent comorbidity with other neurodevelopmental disorders including autism spectrum disorder. But diagnostic criteria for co-occurring ADHD and ASD didn’t happen until the publication of the DSM-5. So many providers still lack awareness and understanding of what it looks like when they co-occur. There’s also less guidance in the literature for how to treat those who have both disorders.
Depression
Studies show that autistic people are four times as likely to develop depression as typically developing people, And that key indicators for autistic people with clinical depression are insomnia/sleep problems and restlessness which differs from neuro-typical people with depression. Researchers say developing treatments that address these issues could be key to helping people with ASD and depression.
Gaming Disorder and Internet Addiction
Research has shown that children and adolescents on the autism spectrum are an especially vulnerable subpopulation for gaming disorder. In one study, adults with ASD endorsed more symptoms of video game pathology than did typically developing adults. In another, autistic traits predicted the severity of internet gaming disorder in adults that had an ASD diagnosis.
Why are ASD and Technology Addiction commonly co-occurring diagnoses?
Sensation Seeking
People with ASD are often hyper- or hypo-reactive to sensory input.
That means they can be hypersensitive to some kinds of light, sound, touch, texture, or smell to the point that they have an adverse response. Or they can be under responsive to some kinds of light, sound, touch, texture, or smell. Or they can be both.
When a person on the autism spectrum is exposed to sensory inputs that trigger an adverse response, it can be quite taxing. In some cases, it can lead them to shut down, flee, or act out in ways that look like willful disobedience, but are actually just attempts to regulate their nervous system.
On the other hand, a person on the autism spectrum who is hypo-reactive doesn’t register enough sensory input to feel alert or engaged. They require either a greater amount of sensory input or a different kind of sensory input that they find more stimulating.
What’s more, the same autistic person can be hyper-reactive to one sensory input and hypo-reactive to another.
To cope with any of these scenarios, an autistic person may engage in sensory-seeking behaviors that they find to have a positive effect. This is what is meant in the DSM-5 when it says that autism spectrum disorder may cause a person to present with “unusual interest in sensory aspects of the environment”.
Video games and other digital media are created using something called persuasive design. Designers use rewarding cues and prompts like exciting sounds, animation, and messages, as well as a variable reward schedule —the most addictive reward schedule known to man—to keep users on the platform. Sensation seekers, like those on the autism spectrum, are particularly vulnerable to the lure of persuasive design.
“Unusual interest in sensory aspects of the environment” appears under “repetitive and restrictive behavior” in the DSM-5. Because once an autistic person experiences a positive, stimulating, or soothing sensation, the likelihood they engage in that behavior repeatedly, to the exclusion of other activities, is high.
Social Challenges Make the Internet a Refuge
People on the autism spectrum often demonstrate a preference for solitary play as children and solitary leisure time as adults. Sometimes that’s because of difficulties regulating their nervous system around others. It can also be because of previous rejection from peers.
Many autistic people struggle to interpret non-verbal facial expression during in-person interactions. This makes the likelihood of feeling they don’t fit in high.
Often young autistic people who also self-identify as gamers report that the virtual world, such as in video games, is less nuanced and confusing than the offline world. It has a set of rules that make sense to them. They don’t have to worry about reading another person’s facial expressions and they can engage in logical thinking and visual skills. Both of which are strengths in many people on the spectrum.
Research shows that children diagnosed with ASD spend more time playing video games than their typically developing sibling. And those children on the autism spectrum are more sedentary than their typically developing cohorts, often because of their engagement in screen-based activities.
Restricted Interests Make the Internet Seductive
People on the autism spectrum display restricted, repetitive patterns of behavior, interests, or activities. One way this presents is that many autistic people have one or more special topics about which they show intense interest. Often to the point that it’s all they want to talk about or spend their time doing. The internet can provide endless content around any topic and, through persuasive design, platforms continually serve up targeted content to keep users logged in. This can be especially difficult for autistic people to resist.
Weaker Executive Functioning
Many people diagnosed on the autism spectrum have difficulty recognizing when persuasive design is being used to lure them into continued digital media use. Many also have difficulty perceiving the passage of time. Both of which can put them at greater risk for technology addiction or digital media overuse.
College, Autism, and Technology Addiction
Studies show that autistic students are more likely to drop out of college than neuro-typical students. The transition to college is especially challenging for students with autism because it’s at this time that family and special education supports fall away. Many autistic students aren’t prepared for the social demands, and they find it difficult to make friends. They also aren’t prepared for the amount of self-advocacy required as most universities lack adequate supports for students with disabilities.
As a result, many autistic students retreat into gaming and the internet. This can lead to long hours online that negatively affect their sleep patterns. Before they know it, their academic work is suffering, too. Universities are beginning to wake up to this issue but parents are advised to begin planning with their autistic student well before their junior year of high school about how they will transition to adult life. This can include focusing on the skills they’ll need to succeed and finding a post-secondary school with the proper supports.
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