Impulsivity facets and internet gaming disorder symptoms in male adolescents with ADHD: an exploratory...

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for problematic gaming. Although impulsivity has been linked to problematic gaming, it is unclear whether different impulsivity facets show distinct associations with heterogeneous DSM-5 Internet Gaming Disorder (IGD) symptom domains.

In this cross-sectional study, 45 male adolescents with ADHD (ages 12-17) presenting with excessive gaming concerns were recruited from two child and adolescent psychiatry outpatient clinics in Turkiye (December 2025-January 2026). ADHD diagnoses and comorbidity screening were confirmed with the K-SADS-PL-DSM-5-T semi-structured interview; comorbid psychiatric disorders expected to meaningfully affect impulsivity or gaming-symptom reporting were excluded. Impulsivity was assessed using the Barratt Impulsiveness Scale-11-SF (BIS-11-SF) (attentional, motor, non-planning) and IGD symptoms using the IGDS-27 (nine DSM-5 criteria). Spearman correlations were computed between impulsivity indices and IGD total/domain scores, with uncertainty quantified using 5,000-sample bias-corrected and accelerated (BCa) bootstrap 95% confidence intervals (CIs). Selected exploratory comparisons of dependent overlapping correlations were also conducted. Age, ADHD pharmacotherapy status, and parental psychiatric history were examined in sensitivity analyses.

Most participants reported gaming > 4 h/day on weekdays (73.3%) and weekends (75.6%). IGDS-27 total score was positively associated with non-planning impulsivity (ρ = 0.56, 95% CI [0.30, 0.74]), attentional impulsivity (ρ = 0.52, 95% CI [0.23, 0.74]), and motor impulsivity (ρ = 0.45, 95% CI [0.16, 0.69]). In a multivariable linear regression including all three impulsivity facets simultaneously, only non-planning impulsivity remained independently associated with IGD symptom severity (B = 4.15, 95% CI [1.63, 6.67], p = .002; model R² = 0.45). Selected exploratory comparisons suggested stronger associations of non-planning impulsivity with problems and deception than with preoccupation or escape. Age was not significantly correlated with impulsivity or IGD severity, and sensitivity analyses did not indicate differences by ADHD pharmacotherapy status or parental psychiatric history.

In this clinical sample of male adolescents with ADHD, IGD symptom severity was positively associated with all three impulsivity facets in bivariate analyses, while non-planning impulsivity retained an independent association in multivariable analysis after accounting for shared variance among facets. Facet-symptom level associations were exploratory and should be interpreted cautiously.

Not applicable.