Problematic Interactive Media Use

Excessive Internet Use

For most young people (and adults), the strategies in the Building Better Tech Habits article will be enough to build a healthy relationship with screen devices.

In some cases, though, the issue is more serious. Problematic Interactive Media Use (PIMU) is defined as “the uncontrolled use of interactive screen media that results in negative consequences affecting an individual’s functioning,”[1] or, in plainer language, the “inability to regulate use of interactive media with negative effects on key elements of [young people’s] lives, including: sleep, nutrition, academic performance, social life, relationships [and] mental health.”[2]

The Centre for Addiction and Mental Health recommends using terms such as PIMU, rather than “addiction,” to reduce stigma and avoid pathologizing children’s experiences.[3] Unlike addiction, as Dr. Michael Rich of the Digital Wellness Lab at Boston Children's Hospital puts it, PIMU “is in fact overuse of what is now a necessary resource … there is continued use despite negative consequences and our therapeutic goal however, is not abstinence but self regulation. Since they need interactive media to study to connect with each other, we need them to continue it in a monitored and regulated way.”[4] Other researchers have also found that “complete disconnection … may not always constitute the most appropriate recovery goal.”[5] But “when addiction is invoked, not only is the young person’s strength of character questioned but the label can give them permission to plead helplessness and succumb to its draw.”[6]

The Digital Wellness Lab has developed a screener for PIMU that is focused not on how much time kids are spending on media, but on the impact it has on their functioning: as Director of Research David Bickham puts it, “We’re really trying to frame it not as how bad is this for you, but it’s ‘Tell us what this sort of overall functioning looks like for you.’”

The screener consists of the following questions:

I have trouble waking up when I need to be somewhere or do something.
A) Never
B) Rarely
C) Sometimes
D) Often
E) Almost always
I stop using screen media…
A) Before 8pm
B) Between 8pm and 10pm
C) Between 10pm and 12am
D) Between 12am and 2am
E) After 2am
I wake up early to use screen media.
A) Never B) Rarely C) Sometimes D) Often E) Almost always
My grades are...
A) A lot higher than they used to be
B) A little higher than they used to be
C) About the same as they used to be
D) A little lower than they used to be
E) A lot lower than they used to be
While I am doing homework, I also use my phone, computer, or other screen media to do something else.
A) Never
B) Rarely
C) Sometimes
D) Often
E) Almost always
When I am at home and family is there, I spend time by myself….
A) Never
B) Rarely
C) Sometimes
D) Often
E) Almost always
I argue/fight with my parents/caregivers about my screen media use.
A) Never
B) Rarely
C) Sometimes
D) Often
E) Almost always
I have lost interest in hanging out in person with my friends/peers
A) Strongly disagree
B) Disagree
C) Neither agree nor disagree
D) Agree
E) Strongly agree
Compared to my friends/peers, I use screen media...
A) A lot less
B) A little less
C) The same amount
D) A little more
E) A lot more
I have lost interest in non-screen activities or hobbies that I used to enjoy.
A) Strongly disagree
B) Disagree
C) Neither agree nor disagree
D) Agree
E) Strongly agree
I prefer to use screen media over any other activity (e.g., sports, hobbies, dance, crafts).
A) Never
B) Rarely
C) Sometimes
D) Often
E) Almost always

Youth with no “D” or “E” responses are considered to be of minimal concern; one or more “D” responses indicates potential concern; and one or more “E” responses means significant concern.[7]

While many people, including youth, are willing to describe themselves as being “addicted” to some kind of interactive media, PIMU appears to be relatively rare. While 18 percent of adult Instagram users described themselves as being addicted to the app, just two percent showed any risk signs of being addicted.[8] The Digital Wellness Lab has found a prevalence of around five percent among youth.[9] However, it is much more common among youth with conditions such as attention deficit hyperactivity disorder (56 percent of whom show signs of PIMU), anxiety disorder, autism spectrum disorder and depression. Though excessive media use can worsen some of these, in many cases kids with these conditions are likely to fall into excessive use because media experiences offer opportunities to be in control, show mastery, communicate clearly or to seek out support: “these are usually pre-existing conditions that either have been subclinical, well compensated or recognized and undertreated until they got into the interactive media environment and really sought out the comfort and mastery of that space to feel better.”[10] Similarly, PIMU may develop as a response to trauma, with youth using media as a way of distracting or soothing themselves, looking to it for connection or validation, seeking a sense of control or a predictable environment, or re-exposing themselves to stressful content.[11] PIMU is also associated with sleep problems in both directions, with PIMU leading to more sleep disturbances that lead to more problematic use.[12]

Fortunately, there’s evidence that PIMU and similar conditions are not as likely to persist as some other mental health issues: boys who have symptoms of Internet Gaming Disorder at age ten, for example, are only slightly more likely than average to have them in their mid and late teens.[13] Studies of adults with gaming disorder have identified six “recovery pathways” that may lead to reduced symptoms or impacts:

axiological shift (in which gaming becomes a less important part of a person’s life);
social enforcement (where gaming becomes less frequent due to relationships with people such as friends, family members and employers);
gradual regulation (where the person becomes better able to control their gaming);
reflexive transformation (where a single moment or event causes a change in behaviour);
healing comorbidity (where treatment of an associated condition leads to recovery); and
environmental transformation (where changes in the person’s life conditions – such as a new job or relationship – lead to recovery).

The same researchers found that “gaming-related problems were largely triggered by specific environmental configurations: particular game platforms, competitive social cultures, and situational stressors that intensified regulatory or escapist functions. Recovery therefore involved a transformation in the relationship between gaming and life more generally.”[14]

If you’re concerned that your child may be experiencing PIMU, be careful to avoid putting them on the defensive: as Dr. Richard Chung, pediatrician and member of the American Academy of Pediatrics Committee on Adolescence, puts it,

Instead of saying, “You’ve been acting really strange these past few weeks,” you could start with an example: “I noticed you hate coming down to dinner lately – and you don’t seem hungry at other times. I wondered if something in your life is making it hard for you to enjoy stuff you usually love, like my killer oatmeal cookies.”[15]

[1] Pluhar, E., Kavanaugh, J. R., Levinson, J. A., & Rich, M. (2019). Problematic interactive media use in teens: comorbidities, assessment, and treatment. Psychology Research and Behavior Management, 447-455.

[2] Rich, M. (2022) Identifying & Addressing Problematic Interactive Media Use (PIMU)

[3] (2026) Youth, Smartphones and Social Media Use. Centre for Addiction and Mental Health.

[4] Rich, M. (2026, February 12.) Identifying and Addressing Problematic Interactive Media Use. [Conference Session] Boston Children’s Hospital. Virtual.

[5] Jin, Y., Adamkovic, M., Martončik, M., & Karhulahti, V. M. (2026). Natural Recovery and Gaming Disorder: A Case Series.

[6] Rich, M. (2024). The Mediatrician's Guide: A joyful approach to raising healthy, smart, kind kids in a screen-saturated world. Harper Horizon.

[7] Bickham, D. (2026, February 12.) Epidemiology, Risk Factors, and Screening for PIMU. [Conference Session] Boston Children’s Hospital. Virtual.

[8] Anderson, I. A., & Wood, W. (2025). Overestimates of social media addiction are common but costly. Scientific Reports, 15(1), 393

[9] Bickham, D. (2026, February 12.) Epidemiology, Risk Factors, and Screening for PIMU. [Conference Session] Boston Children’s Hospital. Virtual.

[10] Rich, M. (2026, February 12.) Identifying and Addressing Problematic Interactive Media Use. [Conference Session] Boston Children’s Hospital. Virtual.

[11] Sinclair-McBride, K. (2026, February 12 Trauma-informed Approach to Digital Wellness: Hacking Consumerism, Body Image, Substance Use, Hate, Sexuality, & Companion AI. [Conference Session] Boston Children’s Hospital. Virtual.

[12] Ren, Z., Lu, H., Ma, X., Min, G., Liu, L., Wu, L., ... & Yu, K. (2026). Longitudinal Association between Problematic Social Media Use and Sleep Problems among Adolescents: A Random Intercept Cross-Lagged Panel Model and Sex Differences. Journal of Youth and Adolescence, 55(1), 119-134.

[13] Wichstrøm, L., Hygen, B. W., Kuss, D. J., Stavropoulos, V., Skalická, V., Rodríguez‐Cano, R., ... & Steinsbekk, S. (2026). Structure and stability of internet gaming disorder from childhood to late adolescence: A 5‐wave birth cohort study. Addiction, 121(2), 413-422.

[14] Jin, Y., Adamkovic, M., Martončik, M., & Karhulahti, V. M. (2026). Natural Recovery and Gaming Disorder: A Case Series.

[15] Chung, R. (2025) Teen Mental Health: How to Know When Your Child Needs Help. HealthyChildren.org. <https://www.healthychildren.org/English/ages-stages/teen/Pages/Mental-Health-and-Teens-Watch-for-Danger-Signs.aspx>