Core symptoms and directional pathways of problematic smartphone use in high-risk adolescents: A large-scale...

Problematic smartphone use (PSU) has emerged as a pressing public health issue among adolescents, particularly those at high risk of it. While most studies focused on prevalence, risk factors, and outcomes, little is known about how symptoms interact in high-risk adolescents or how these processes differ by gender. A large sample of 9030 high-risk adolescents (M_age = 12.96, SD = 1.51; 55.94% boys), identified via the Smartphone Addiction Scale-Short Version (SAS-SV). Gaussian Graphical Models (GGMs) were used to examine symptom interconnections, and Directed Acyclic Graphs (DAGs) were applied to explore potential pathways. The GGM revealed that Plan Disruption, Distraction, and Physical Pain clustered into one community. Core symptoms differed by gender: Anxiety and Compulsion for boys, Loss of Control and Mental Preoccupation for girls. DAG analyses revealed gender-specific progression patterns. In boys, Anxiety quickly led to Dependency, whereas Distraction rarely developed into terminal symptoms. In girls, both Distraction and Mental Preoccupation acted as triggers, rapidly leading to Physical Pain, Overuse, or Dependency through three short paths. By focusing on high-risk adolescents, this study highlights gender-specific core, trigger symptoms, and short directional paths of problematic smartphone use. The findings point to tailored intervention targets-such as anxiety regulation for boys and management of distraction and preoccupation for girls-to inform more effective, gender-sensitive prevention and treatment strategies.