Multi-Level Intervention for Problematic Internet Use and Internet Gaming Disorder Among Migrant Adolescents in Mainland China: A Pilot Trial of Treatment Effects, Feasibility, and Acceptability

Background: Although Internet has enhanced information acquisition and social communication, there is mounting concern that many Chinese youth are developing problematic Internet use (PIU) and Internet Gaming Disorder (IGD). Migrant workers’ children are typically vulnerable in developing PIU and IGD due to a lack of parental monitoring and support system compared to other adolescents. Thus, we developed a multi-level intervention combining cognitive-behavioral therapy and motivational interviewing for Chinese migrant adolescents with PIU/IGD. The intervention includes 8 sessions of individual counseling and one session of group therapy, and psychoeducation for parents and teachers regarding PIU and IGD. The individual and group sessions were led by MSW students who were trained using the intervention materials. This study presented preliminary outcomes of this intervention in treating PIU/IGD among Chinese migrant adolescents.  

Methods:  Pre-experimental design was used to evaluate the effects of the intervention vis-à-vis reducing severity of PIU/IGD among 25 adolescents (M age = 13, SD = 1.6). Among the 25 adolescents, 20 were boys and 5 were girls. Participants’ levels of PIU and IGD were measured at pre-and posttreatment, and 3-month follow-up using standardized self-report instruments (i.e., Young’s Diagnostic Questionnaire (YDQ) and DSM-5 IGD criteria). Repeated-measures ANOVA was used for outcome analyses. Hedges’g (i.e., g) was used to calculate effect sizes. Qualitative interviews were conducted with parents and teachers to better understand the acceptability and benefits of the intervention.

Results: Twenty-three adolescents who completed all assessments at pre-and posttreatment, and 3-month follow-up were included in the data analyses. Results of ANOVA revealed significant effects of time for participants’ scores on the YDQ (F(2, 43) = 43.44, p < .001), the number of DSM-5 IGD criteria (F(2, 43) = 33.94, p < .001), and the amount of time spent gaming on the Internet (F(2, 43) = 14.21, p < .001), indicating that participants evidenced significant reductions in their levels of PIU, number of signs and symptoms of IGD, and amount of time spent gaming during the course of the study. Post-hoc analyses revealed that participants had significantly lower levels of PIU (p < .05), met significantly fewer numbers of DSM-5 IGD criteria (p < .05), and reported significantly less amount of time spent on gaming (p < .05) at both posttreatment (g_PIU = 2.18, g_IGD = 1.85, g_time = 1.22) and 3-month follow-up (g_PIU = 2.55, g_IGD = 1.77, g_time= 1.07) compared to baseline. Qualitative interviews suggest that acceptability and perceived benefits of the intervention was high in adolescents, parents, and school teachers.

Conclusions and Implications: PIU/IGD is endemic among migrant adolescents in China. However, very few evidence-based interventions have been evaluated to address this problem. This pilot study demonstrates the effectiveness of this newly-developed multi-level intervention in treating PIU/IGD with large effect sizes. This intervention may be a promising approach to address PIU/IGD among Chinese adolescents. Implications for research and practice with migrant worker’s children in China will be discussed. Specifically, challenges and lessons regarding collaborating with school teachers and parents of migrant adolescents to address adolescents’ behavioral problems will be presented.