Inhibitory Control, Impulsivity and Internet Addiction: Testing the Mediating Role of Oppositional Defiant Disorder Among ADHD Adolescents With and Without Gaming Disorder

Inhibitory Control, Impulsivity and Internet Addiction: Testing the Mediating Role of Oppositional Defiant Disorder Among ADHD Adolescents With and Without Gaming Disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Inhibitory Control, Impulsivity and Internet Addiction: Testing the Mediating Role of Oppositional Defiant Disorder Among ADHD Adolescents With and Without Gaming Disorder Yanxue Wang, Xiaoli Liu, Yiling Wu, Anli Liang, Wenhao Zhuang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4499645/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aims To test whether inhibitory control and impulsivity are significant predictor of Internet addiction in adolescents with ADHD and ADHD + GD and whether the relationship between inhibitory control/impulsivity and Internet addiction is mediated by ODD in both groups. Methods 154 boys (ADHD, n = 90; ADHD + GD, n = 64) were tested on their inhibitory control, impulsivity, ODD, and Internet addiction. Regression analyses were used to test the predictive role of inhibitory control and impulsivity on Internet addiction. Moreover, mediation analyses were done to test whether ODD mediated the relationship between inhibitory control/impulsivity and Internet addiction. Results Both inhibitory control and impulsivity were significant predictors for Internet addiction in adolescents with ADHD + GD. In addition, inhibitory control and impulsivity had both direct and indirect effects via ODD on Internet addiction in adolescents with ADHD + GD. However, inhibitory control rather than impulsivity had indirect effects via ODD on Internet addiction in adolescents with ADHD. Conclusions The results of this study demonstrated that inhibitory control and impulsivity contributed to Internet addiction in adolescents with ADHD + GD. Furthermore, inhibitory control and impulsivity in two groups had different results in two models, suggesting different intervention strategies should be adopted for adolescents with ADHD and ADHD + GD. ADHD ADHD co-morbid GD inhibitory control impulsivity Internet addiction Figures Figure 1 Introduction Attention deficit hyperactivity disorder (ADHD) that affects 5%-7% children of worldwide (Polanczyk et al., 2014), is characterized by inattention and/or hyperactivity/impulsivity (Faraone et al., 2006; Kessler et al., 2007; Mannuzza et al., 1993). Due to delayed development of the executive control system, children and adolescents with ADHD are more likely to be addicted to watching television, playing Internet and video games (Weinstein & Weizman, 2012; Weiss et al., 2011). The characteristic even can predispose individuals to gaming addiction (Lee et al., 2017). Previous literature has reported that gaming disorder (GD) is a relatively common mental disorder comorbid with ADHD (González-Bueso et al., 2018). It refers to persistent and out-of-control gaming behavior (online as well as offline), gaming without regard for personal harm, and conflicts arising from gaming and dysfunction (World Health Organization, 2019). GD has been recognized as a behavioral addiction in the 11th edition of the Classification of Diseases (ICD-11) (World Health Organization, 2019). Recent systematic review and meta-analysis showed that the worldwide prevalence of GD was 3.05% with a higher prevalence in men (Stevens et al., 2021). Moreover, 39% of patients with GD diagnosed according to the new ICD-11 criteria had ADHD symptoms (Cabelguen et al., 2021). Internet addiction (IA) can be defined as excessive, uncontrolled and harmful use of the Internet (Dalbudak et al., 2013), which is a broader concept than gaming addiction (Burleigh et al., 2020). Some studies have shown that Internet addiction is significantly correlated with ADHD (Hong et al., 2021; Panagiotidi & Overton, 2018; Wang et al., 2017).Therefore, children and adolescents with ADHD may be at higher risk for Internet addiction. There are some explanations for the coexistence between ADHD and IA (Ko et al., 2012). One explanation is that adolescents with ADHD demonstrate impairment of inhibition (Barkley, 1997; Rubia et al., 2005), which may make it difficult for individuals with ADHD to control their use of the Internet. There is a moderate association between higher levels of ADHD symptoms and IA, but not all individuals with ADHD evolve into network problems or GD (Panagiotidi & Overton, 2018). Thus, there may be some differences in IA between adolescents with pure ADHD (ADHD) and adolescents with ADHD co-morbid GD (ADHD + GD), and it is unclear what and how risk factors affect Internet addition in both groups. Some studies indicated that impulsiveness and behavioral inhibition system were significant predictors of Internet addition among adults with ADHD (Li et al., 2016). Hence, adolescents with ADHD and ADHD + GD were recruited in this study to explore the effects of inhibitory control and impulsivity on Internet addition. Inhibitory control is an important factor of Internet addition. Broadly, inhibitory control refers to the ability to withhold an emotional or behavioral response in order to achieve a goal (Best & Miller, 2010; Nigg, 2000; van Goozen et al., 2004). When deficient in inhibitory control, it is more difficult for children to stop unwanted behavior. Accordingly, most of the literature on inhibition has focused on ADHD. The stop signal task (SST) is one of the measures to assess inhibitory control. The SST could be used to detect possible cases of ADHD in normal populations (Avila, 2001). A meta-analysis examined SST performance in patients with various psychiatric disorders and confirmed an inhibition deficit in ADHD patients. It also revealed that comorbid ADHD had different effects on inhibition in patients with other psychiatric disorders (Lipszyc & Schachar, 2010). In addition to impairment of inhibition, Internet addiction can also be conceptualized as an impulse control disorder (Mazhari, 2012; Treuer et al., 2001). One study showed that Internet gaming disorder (IGD) was associated with ADHD among young adults and those with both IGD and ADHD had higher impulsivity and hostility (Yen et al., 2017). Impulsivity can be measured by Barratt Impulsiveness Scale 11 (BIS-11). Cao et al. (2007) found that the Internet addiction scores were significantly and positively correlated with the score of the BIS-11. Impulsivity is a marker of susceptibility to Internet addiction (Lee et al., 2012), but it is unknown whether inhibitory control and impulsivity share the same influence mechanism with Internet addiction. In the comorbid psychiatric disorders of ADHD, oppositional defiant disorder (ODD, 54–67%) is the most frequent one (Barkley et al., 1990). Some studies found that children with ADHD + ODD were similar to children with pure ADHD on some aspects of executive function (Nigg et al., 1998; Oosterlaan et al., 1998). A few findings indicated that the performance in inhibition task of children with ADHD + ODD was significantly better than that of children with ADHD-only (Lipszyc & Schachar, 2010; Schachar et al., 2000; Verté et al., 2006). However, there were still some studies suggested that the ADHD + ODD group received higher parent scores on the inhibition subscales than the ADHD group (Qian et al., 2010). There is thus some doubt about how and to what extent the co-occurrence of ODD influences executive dysfunction in adolescents with ADHD. Based on the above researches and doubt, there are two aims of the current study: (1) To test whether or not inhibitory control and impulsivity are significant predictors of Internet addiction in adolescents with ADHD and ADHD + GD; (2) To test whether or not the relationship between inhibitory control/impulsivity and Internet addiction is mediated by ODD in both two groups. Methods Participants To be included in the study, each child received a diagnosis of ADHD (using DSM-V criteria) with or without GD (using ICD-11 criteria). The ICD-11 criteria were used in the diagnosis of GD as a recent Delphi study reached a consensus that the ICD-11 criteria were more useful than DSM-5 criteria which might lead to the over-pathologization of gamers (Castro-Calvo et al., 2021). Due to the higher male prevalence of ADHD and GD, the subjects recruited in our study were boys. A total of 154 boys (aged 10–17 years) with ADHD ( n = 90; age: 13.49 ± 1.45 years) and ADHD + GD ( n = 64; age: 13.59 ± 1.59 years) were recruited at Ningbo Kangning Hospital. All children had a confirmatory diagnosis from another psychologist or physician. For children, the following criteria should be met: (a) a confirmed diagnosis of ADHD or ADHD + GD by a child psychiatrist; (b) no other neurodevelopmental disorders (e.g., ASD, specific learning disabilities) or motor problems as the primary diagnosis; (c) no history of psychotic disorder, or, in the past 2 months, substance-related disorder. The research was approved by the Ethics Committee of Ningbo Kangning Hospital, and all experimental procedures were carried out following the guidelines of human medical research (Declaration of Helsinki). All enrolled patients and guardians signed an informed consent form and they were reassured that they could withdraw from the study at any time. Measures Stop-signal task Computerized version of the stop-signal task was used to assess inhibition of prepotent motor responses (Aron et al., 2003; Logan et al., 1984). Briefly, participants watched a computer screen with a series of five blocks (the first was a practice block) of 64 arrows per block. The arrows randomly pointed either to the right (50%) or the left (50%) and participant pressed the appropriate button. In a randomly assigned proportion (25%) of trials, an audible stop-signal was heard after presentation of the arrow and subjects were instructed to inhibit their motor response to these trials. The interstimulus interval (ISI) and the stop-signal delay varied according to the subject’s performance such that subjects were able successfully to inhibit their responses to 50% of the stop trials. The stop-signal paradigm assumed a race between the reaction to the go-stimulus and the reaction to the stop-signal, allowed estimating the stop signal reaction time (SSRT)—as a measure for response inhibition performance. Therefore, for each individual, SSRT was obtained by calculating the difference between mean RT on go-trials and the mean SSD (Verbruggen et al., 2019). Barratt Impulsiveness Scale 11 (BIS-11) The 11th revision of the Barratt Impulsiveness Scale (BIS-11) was commonly used to measure impulsivity (Barratt, 1985). Chinese version of BIS-11 (Xian-Yun et al., 2011) was used in this study which contained 30 items on a 4-point Likert scale with scaled total scores ranging 30–120. The scale was used to assess the multifaceted personality and behavioral construct of impulsiveness. Higher scores on the BIS reflect higher levels of impulsiveness. It consists of three subscales: attentional, motor, and non-planning impulsiveness. Examples of items from each of the subscales are — ‘I make up my mind quickly’ (motor impulsiveness), ‘I often have extraneous thoughts when thinking (attentional impulsiveness), and ‘I say things without thinking’ (non-planning impulsiveness). Young's Internet addiction test Young's Internet Addiction test (IAT) (YOUNG et al., 2009) was used to measure the degree of Internet addiction. The IAT consists of 20 questions with 5-point Likert scale ranging 20–100 and examined the degree of preoccupation, compulsive use, behavioral problems, emotional changes, and impact on life related to Internet usage. Higher scores on the IAT reflect higher levels of Internet addiction. Chinese version of the Swanson Nolan and Pelham, Version IV (SNAP-IV) Scale-Parent The SNAP-IV (parents) is a commonly used ADHD symptom assessment tool in China. This revised version (Jin-Bo et al., 2013) includes the DSM-IV symptoms for inattention (items 1–9), hyperactivity (items10-15), and impulsivity (items 16–18) of the criteria for ADHD, and the oppositional (OP) symptoms (tems19-26) of the criteria for ODD. The symptom severity of each symptom item is rated on a four-point rating scale(0 = “not at all”, 1 = “just a little”, 2 = quite a bit”, and3 =“very much”). Procedure When the children met the criteria, the families would be invited to our research laboratory for in-person assessments. The following were consent and assent procedures signed by the parent and child, respectively. Children were tested separately on their inhibitory control, impulsivity and Internet addiction (i.e., stop-signal task, BIS-11, IAT). All children’s Parents were asked to complete the ODD while their child was being tested. Statistical analysis In order to achieve these two objectives, there were several steps: Firstly, Pearson correlation coefficients between inhibitory control, impulsivity, ODD and Internet addiction were computed to find out whether there was a significant correlation between these variables. Secondly, hierarchical regulation analysis models were used to test the predictive effect of inhibitory control/impulsivity and ODD on Internet addiction. Finally, two mediation effect models were to ascertain whether ODD mediated the relationship between inhibitory control/impulsivity and Internet addiction in adolescents with ADHD and ADHD + GD. All statistical analyses were performed using the computer software program SPSS 22.0. Differences between groups of variables involving continuous data were computed using independent t-test. Pearson's correlations analysis was used to assess the correlation between the scores of scales and SSRT. Hierarchical regression was used to evaluate the associations between Internet addiction and personality characteristics. The mediation effect test was completed using PROCESS macro for SPSS (Hayes, 2013) and bootstrapping methodology (5,000 samples) was used in mediation effect test (Preacher & Hayes, 2008). Unless specifically noted, statistical significance was set at p < 0.05 and all tests were 2-tailed. Results The demographic and clinical characteristics of the ADHD and ADHD + GD groups are shown in Table 1 . 154 boys with ADHD ( n = 90; age: 13.49 ± 1.45 years) and ADHD + GD ( n = 64; age: 13.59 ± 1.59 years) were tested on Inhibitory control, ODD, Internet addiction and impulsivity. There was no statistically significant difference in age between the two groups ( t =-0.425, p > .05). In the SST, the adolescents with ADHD + GD had longer SSRT that suggested poorer Inhibitory control than peers with ADHD ( t =-3.961, p < .001). They also had significantly higher ratings on their ODD, Internet addiction, impulsivity than ADHD adolescents. Table 1 Mean Age, SSRT, ODD, Internet Addiction and BIS of Adolescents with ADHD and ADHD + GD. ADHD ( n = 90) ADHD + GD ( n = 64) Total M ( SD ) M ( SD ) t Cohen’s d Age (years) 13.49 (1.45) 13.59 (1.59) -0.425 -0.066 SSRT (ms) 144.82 (101.86) 213.54 (111.82) -3.961 *** -0.643 ODD 8.78 (3.89) 11.05 (3.87) -3.580 *** -0.585 Internet addiction 40.61 (9.41) 55.17 (9.93) -9.247 *** -1.505 Impulsivity 55.20 (9.37) 66.83 (10.76) -7.131 *** -1.153 Attention 12.41 (3.50) 14.84 (3.04) -4.488 *** -0.741 Motor 17.13 (3.37) 21.59 (5.38) -5.864 *** -0.994 Non-Planning 25.62 (4.23) 30.39 (4.12) -6.969 *** -1.142 ADHD, attention deficit hyperactivity disorder. ADHD + GD, attention deficit hyperactivity disorder and gaming disorder. ODD, oppositional defiant disorder. * p < 0.05. ** p < 0.01. *** p < 0.001. Table 2 Correlations Between Inhibitory Control, ODD, Internet Addiction, and Impulsivity in Children with ADHD and ADHD + GD. 1 2 3 4 ADHD ADHD + GD ADHD ADHD + GD ADHD ADHD + GD ADHD ADHD + GD 1. Inhibitory Control - - 2. ODD − .347 ** .573 *** - - 3. Internet Addiction − .142 .307 * − .275 ** .431 ** - - 4. Impulsivity .018 .241 − .223 * .308 * .548 *** .540 *** - - ODD: oppositional defiant disorder. * p < 0.05. ** p < 0.01. *** p < 0.001. Regression Analysis To test whether inhibitory control and impulsivity were both significant predictors of Internet addiction in adolescents with ADHD and ADHD + GD, bivariate correlations between inhibitory control, impulsivity, ODD, and Internet addiction were computed. There was a significant correlation between impulsivity and Internet addiction, in both groups ( r ADHD =.548, p < .001; r ADHD+GD =.540, p < .001), revealing that the better the impulsivity, the higher the Internet addiction, regardless of whether the children with ADHD were accompanied by GD. However, the correlation between inhibitory control and Internet addiction was significant ( r ADHD+GD =.307, p .05) (Table 2 ). Linear regression analyses were conducted for adolescents with ADHD and ADHD + GD, respectively using inhibitory control (model Ⅰ)/impulsivity (model Ⅱ) and ODD as predictors and Internet addiction as outcome variable. The results showed that inhibitory control or impulsivity was a significant predictor of Internet addiction in both groups. However, when ODD was put into regression models as a predictor, the two groups of subjects had different results in the two models. In model Ⅰ, regression coefficients of ODD and inhibitory control were significant for ADHD adolescents (ODD: β=-.368, t =-3.475, p = .001; inhibitory control: β=-.270, t =-2.546, p = .013), whereas only the regression coefficient of ODD rather than inhibitory control was significant in adolescents with ADHD + GD (ODD: β=-.380, t = 2.708, p = .009; inhibitory control: β=-.089, t = .634, p = .528). In model Ⅱ, only the regression coefficient of impulsivity but not ODD was significant in ADHD adolescents (ODD: β=-.161, t =-1.780, p = .079; impulsivity: β = .512, t = 5.662, p = .000), whereas regression coefficients were both significant for impulsivity and ODD in adolescents with ADHD + GD (ODD: β = .293, t = 2.744, p = .008; impulsivity: β = .449, t = 4.204, p = .000). Mediation Analysis To further test whether the relationship between inhibitory control (model Ⅰ)/impulsivity (model Ⅱ) and Internet addiction is mediated through ODD. The test of mediation models with inhibitory control/impulsivity as independent variable, Internet addiction as dependent variable, and ODD as mediator, was completed.The results of the mediation analysis are presented in Fig. 1 . In model Ⅰ, the direct effects suggested that inhibitory control significantly predicted Internet addiction in both groups. The direct effect of inhibitory control on Internet addiction remained significant (β = .0194, 95% CI [.0050, .0352]) after accounting for ODD for ADHD + GD adolescents, demonstrating that ODD was a partial mediator. But the direct effect of inhibitory control on Internet addiction was not significant after accounting for ODD in adolescents with ADHD (β = .0118; 95% CI [.0027, .0246]), so ODD acted as complete mediator. In model Ⅱ, the direct effect suggested that impulsivity was a significant predictor of Internet addiction. After accounting for ODD, the direct effect of impulsivity on Internet addiction remained significant (β = .0833; 95% CI [.0127, .1634]) in adolescents with ADHD + GD, with ODD as a partial mediator accounting for 99% (Effect ratio = 16.73%) of the variance. However, the direct effect after accounting for ODD was not significant (β = .0359; 95% CI [− .0054, .1045]) in adolescents with ADHD. Note Paths c′ reflects the impact of interference on Internet addiction before taking into account of the mediator ODD. The beta weights are significant based on 95% confidence intervals that do not include 0. Discussion The purpose of current study was twofold: (1) to test whether inhibitory control and impulsivity were significant predictors of Internet addiction in adolescents with ADHD and ADHD + GD; and (2) to test whether there were relationships mediated by ODD between inhibitory control/impulsivity in two groups. The results for aim (1) showed that inhibitory control and impulsivity were significant predictors of Internet addiction in adolescents with ADHD + GD, but only impulsivity was significant in ADHD adolescents. The current findings are consistent with those of previous studies (Di Nicola et al., 2015; Li et al., 2016; Qian et al., 2010). Moreover, the current finding that inhibitory control was not significantly associated with impulsivity is also consistent with past research (Antons & Matthias, 2020). The results of the present study for aim (2) demonstrated that the direct and indirect effects of ODD on the relationship between inhibitory control or impulsivity and Internet addiction in adolescents with ADHD + GD were significant. However, the indirect effect of inhibitory control rather than impulsivity was significant in adolescents with ADHD. Inhibitory control and impulsivity had significant direct effect on Internet addiction in ADHD + GD adolescents, indicating that inhibitory control and impulsivity per se can influence Internet addiction performance. Prior research also found that, IA and IAD + ADHD subjects performed worse in the internet-related condition during stop trial of the SST compared to internet-unrelated conditions (Nie et al., 2016). Additionally, adults with ADHD who were higher in impulsivity would spend more time on Internet activities than planned (Li et al., 2016). One neurobiological theory underlying such finding is that delays in cortical maturation which characterize ADHD and associated disruptive behavior disorders (e.g., ODD) contribute to increased levels of impulsivity, particularly during adolescence (Nigg & Casey, 2005; Shaw et al., 2007). Notably, impulsivity probably had an impact on Internet addiction via other factors, which requires further research. In addition, the significant indirect effect on Internet addiction through ODD revealed that inhibitory control and impulsivity influenced ODD, which in turn determined Internet addiction in adolescents with ADHD + GD. This finding suggested that ODD may be a critical pathway to Internet addiction in adolescents with ADHD + GD. On the other hand, in adolescents with ADHD, the indirect but not direct effects of ODD on the relationship between inhibitory control and Internet addiction was significant, demonstrating inhibitory control entirely influenced Internet addiction through ODD among adolescents with ADHD. One possible explanation is that impaired inhibitory control in children with ADHD causes difficulties in suppressing ODD, which in turn is more likely to lead to Internet addiction. Nevertheless, the mediation effect of ODD on the relationship between impulsivity and Internet addiction in adolescents with ADHD was not significant. The results of this study imply that there may be different between adolescents with ADHD and ADHD + GD in the psychological mechanisms of inhibitory control and impulsivity on Internet addiction. In addition, different preventative strategies should be adopted in the ADHD and ADHD + GD groups. Impulsivity is considered as key to ADHD and ODD (Martel et al., 2017). It appears to have much support for the role of impulsivity in explaining the link between ADHD and ODD (Bansal et al., 2023). Although it is critical that the present study found the different psychological mechanisms in adolescents with ADHD and ADHD + GD, it is still unclear whether the differences between impulsivity on Internet addiction may be attributed to the selection of laboratory measures. This can't be ignored because several previous reports in the field declared no correlation between rating scales and laboratory measures of impulsivity (Avila et al., 2004; Carrillo-de-la-Peña et al., 1993; White et al., 1994). Therefore, it is necessary to further investigate the similarities and differences between inhibitory control and impulsivity in two groups. In electrophysiological signals, lower beta-activity linked to impulsivity in ADHD patient (Snyder & Hall, 2006). A recent review (Burleigh et al., 2020) thought that reduced beta-activity among internet addicts may implicate higher levels of impulsiveness (Şalvarlı & Griffiths, 2022; Zhang et al., 2015). At a neurobiological level, a resting-state functional magnetic resonance imaging (fMRI) study reflected that the strength of functional connectivity between the PCC and cerebellum (crus II) was correlated with impulsivity in IGD subjects with childhood ADHD history (Lee et al., 2017). And their findings revealed that alterations in neural system for executive control in ADHD patients may contribute to the development of IGD (Lee et al., 2017). It thus might also be possible for future research to assess the different neural mechanism of inhibitory control and impulsivity on Internet addiction in adolescents with ADHD with and without GD. There were some limitations to the study. First, a healthy control group was not included as the focus of the study was on differences between ADHD and ADHD + GD;Second, impulsivity was measured using a self-rating scale and inhibitory control was measured using a behavioral task, which may have led to some measure-induced discrepancies༛Lastly, the use of a cross-sectional design limits the ability to ascertain causal effects of ADHD or ADHD + GD symptoms and effect on Internet addiction in this study. Nonetheless, these cross-sectional findings of mediational effects set the foundations for a more in-depth investigation and has implications for symptoms understanding and treatment. Conclusion Results of the current study demonstrate that inhibitory control and impulsivity contributed to Internet addiction in adolescents with ADHD + GD. Inhibitory control and impulsivity influenced Internet addiction directly and indirectly through the mediation of ODD in adolescents with ADHD + GD. But there were some different results in in adolescents with ADHD. Since inhibitory control and impulsivity both were a core problem of ADHD, knowing the role of inhibition and impulsivity in Internet addiction among adolescents with ADHD and ADHD + GD could improve our understanding of the cognitive mechanisms that underlie ADHD and how the core ADHD symptoms and comorbid symptoms affect behaviors and daily functions, such as Internet addiction in order to provide different intervention strategies. Abbreviations ADHD:Attention deficit hyperactivity disorder; GD: gaming disorder; ADHD+GD: ADHD co-morbid GD; IA: Internet addiction; ODD: oppositional defiant disorder. Declarations Acknowledgement None. Author contributions: All authors contributed to the design of the study. YW and XL participated in the design of the study and drafted the manuscript. YW, AL, WZ, JW, BW participated in the design of the study, collected the data, and helped to draft the manuscript. DZ, WZ,QC participated in the conceptualization or design and critical revision of the manuscript. All authors have reviewed and approved the manuscript. Funding This study was supported by the Zhejiang Provincia Natural Science Foundation of China under Grant No. LGF19H090009, The Ningbo Top Medical and Health Research Program No.2022030410. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate The research was approved by the Ethics Committee of Ningbo Kangning Hospital, and all experimental procedures were carried out following the guidelines of human medical research (Declaration of Helsinki). All enrolled patients and guardians signed an informed consent form and they were reassured that they could withdraw from the study at any time. Consent for publication Not applicable. Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. References Antons, S., & Matthias, B. (2020). Inhibitory control and problematic Internet-pornography use - The important balancing role of the insula. J Behav Addict , 9 (1), 58-70. https://doi.org/10.1556/2006.2020.00010 Aron, A. R., Dowson, J. H., Sahakian, B. J., & Robbins, T. W. (2003). Methylphenidate improves response inhibition in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry , 54 (12), 1465-1468. https://doi.org/10.1016/s0006-3223(03)00609-7 Avila, C. (2001). Distinguishing BIS-mediated and BAS-mediated disinhibition mechanisms: a comparison of disinhibition models of Gray (1981, 1987) and of Patterson and Newman (1993). J Pers Soc Psychol , 80 (2), 311-324. https://doi.org/10.1037/0022-3514.80.2.311 Avila, C., Cuenca, I., Félix, V., Parcet, M. A., & Miranda, A. (2004). Measuring impulsivity in school-aged boys and examining its relationship with ADHD and ODD ratings. J Abnorm Child Psychol , 32 (3), 295-304. https://doi.org/10.1023/b:jacp.0000026143.70832.4b Bansal, P. S., Goh, P. K., Southward, M. W., Sizemore, Y. J., & Martel, M. M. (2023). Impulsivity as key bridge symptoms in cross-sectional and longitudinal networks of ADHD and ODD. J Child Psychol Psychiatry . https://doi.org/10.1111/jcpp.13863 Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull , 121 (1), 65-94. https://doi.org/10.1037/0033-2909.121.1.65 Barkley, R. A., DuPaul, G. J., & McMurray, M. B. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. J Consult Clin Psychol , 58 (6), 775-789. https://doi.org/10.1037//0022-006x.58.6.775 Barratt, E. S. (1985). Impulsiveness subtraits: Arousal and information processing. Best, J. R., & Miller, P. H. (2010). A developmental perspective on executive function. Child Dev , 81 (6), 1641-1660. https://doi.org/10.1111/j.1467-8624.2010.01499.x Burleigh, T. L., Griffiths, M. D., Sumich, A., Wang, G. Y., & Kuss, D. J. (2020). Gaming disorder and internet addiction: A systematic review of resting-state EEG studies. Addict Behav , 107 , 106429. https://doi.org/10.1016/j.addbeh.2020.106429 Cabelguen, C., Rocher, B., Leboucher, J., Schreck, B., Challet-Bouju, G., Hardouin, J. B., & Grall-Bronnec, M. (2021). Attention deficit hyperactivity disorder and gaming disorder: Frequency and associated factors in a clinical sample of patients with Gaming Disorder. J Behav Addict , 10 (4), 1061-1067. https://doi.org/10.1556/2006.2021.00074 Cao, F., Su, L., Liu, T., & Gao, X. (2007). The relationship between impulsivity and Internet addiction in a sample of Chinese adolescents. Eur Psychiatry , 22 (7), 466-471. https://doi.org/10.1016/j.eurpsy.2007.05.004 Carrillo-de-la-Peña, M. T., Otero, J. M., & Romero, E. (1993). Comparison among various methods of assessment of impulsiveness. Percept Mot Skills , 77 (2), 567-575. https://doi.org/10.2466/pms.1993.77.2.567 Castro-Calvo, J., King, D. L., Stein, D. J., Brand, M., Carmi, L., Chamberlain, S. R., . . . Billieux, J. (2021). Expert appraisal of criteria for assessing gaming disorder: an international Delphi study. Addiction , 116 (9), 2463-2475. https://doi.org/10.1111/add.15411 Dalbudak, E., Evren, C., Aldemir, S., Coskun, K. S., Ugurlu, H., & Yildirim, F. G. (2013). Relationship of internet addiction severity with depression, anxiety, and alexithymia, temperament and character in university students. Cyberpsychol Behav Soc Netw , 16 (4), 272-278. https://doi.org/10.1089/cyber.2012.0390 Di Nicola, M., Tedeschi, D., De Risio, L., Pettorruso, M., Martinotti, G., Ruggeri, F., . . . Janiri, L. (2015). Co-occurrence of alcohol use disorder and behavioral addictions: relevance of impulsivity and craving. Drug Alcohol Depend , 148 , 118-125. https://doi.org/10.1016/j.drugalcdep.2014.12.028 Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med , 36 (2), 159-165. https://doi.org/10.1017/s003329170500471x González-Bueso, V., Santamaría, J. J., Fernández, D., Merino, L., Montero, E., & Ribas, J. (2018). Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review. Int J Environ Res Public Health , 15 (4). https://doi.org/10.3390/ijerph15040668 Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach . Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Hong, Y. P., Yeom, Y. O., & Lim, M. H. (2021). Relationships between Smartphone Addiction and Smartphone Usage Types, Depression, ADHD, Stress, Interpersonal Problems, and Parenting Attitude with Middle School Students. J Korean Med Sci , 36 (19), e129. https://doi.org/10.3346/jkms.2021.36.e129 Jin-Bo, Z., Lan-Ting, G., & Ying, C. (2013). Reliability and validity of the Chinese version of Swanson，Nolan，and Pelham Version IV Rating Scale-Parent Form for attention-deficit/hyperactivity disorder Chinese Mental Health Journal , 27 (6). Kessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., & Van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Int J Methods Psychiatr Res , 16 (2), 52-65. https://doi.org/10.1002/mpr.208 Ko, C. H., Yen, J. Y., Yen, C. F., Chen, C. S., & Chen, C. C. (2012). The association between Internet addiction and psychiatric disorder: a review of the literature. Eur Psychiatry , 27 (1), 1-8. https://doi.org/10.1016/j.eurpsy.2010.04.011 Lee, D., Lee, J., Lee, J. E., & Jung, Y. C. (2017). Altered functional connectivity in default mode network in Internet gaming disorder: Influence of childhood ADHD. Prog Neuropsychopharmacol Biol Psychiatry , 75 , 135-141. https://doi.org/10.1016/j.pnpbp.2017.02.005 Lee, H. W., Choi, J. S., Shin, Y. C., Lee, J. Y., Jung, H. Y., & Kwon, J. S. (2012). Impulsivity in internet addiction: a comparison with pathological gambling. Cyberpsychol Behav Soc Netw , 15 (7), 373-377. https://doi.org/10.1089/cyber.2012.0063 Li, W., Zhang, W., Xiao, L., & Nie, J. (2016). The association of Internet addiction symptoms with impulsiveness, loneliness, novelty seeking and behavioral inhibition system among adults with attention-deficit/hyperactivity disorder (ADHD). Psychiatry Res , 243 , 357-364. https://doi.org/10.1016/j.psychres.2016.02.020 Lipszyc, J., & Schachar, R. (2010). Inhibitory control and psychopathology: a meta-analysis of studies using the stop signal task. J Int Neuropsychol Soc , 16 (6), 1064-1076. https://doi.org/10.1017/s1355617710000895 Logan, G. D., Cowan, W. B., & Davis, K. A. (1984). On the ability to inhibit simple and choice reaction time responses: a model and a method. J Exp Psychol Hum Percept Perform , 10 (2), 276-291. https://doi.org/10.1037//0096-1523.10.2.276 Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M. (1993). Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. Arch Gen Psychiatry , 50 (7), 565-576. https://doi.org/10.1001/archpsyc.1993.01820190067007 Martel, M. M., Levinson, C. A., Lee, C. A., & Smith, T. E. (2017). Impulsivity Symptoms as Core to the Developmental Externalizing Spectrum. J Abnorm Child Psychol , 45 (1), 83-90. https://doi.org/10.1007/s10802-016-0148-6 Mazhari, S. (2012). Association between problematic Internet use and impulse control disorders among Iranian university students. Cyberpsychol Behav Soc Netw , 15 (5), 270-273. https://doi.org/10.1089/cyber.2011.0548 Nie, J., Zhang, W., Chen, J., & Li, W. (2016). Impaired inhibition and working memory in response to internet-related words among adolescents with internet addiction: A comparison with attention-deficit/hyperactivity disorder. Psychiatry Res , 236 , 28-34. https://doi.org/10.1016/j.psychres.2016.01.004 Nigg, J. T. (2000). On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychol Bull , 126 (2), 220-246. https://doi.org/10.1037/0033-2909.126.2.220 Nigg, J. T., & Casey, B. J. (2005). An integrative theory of attention-deficit/ hyperactivity disorder based on the cognitive and affective neurosciences. Dev Psychopathol , 17 (3), 785-806. https://doi.org/10.1017/s0954579405050376 Nigg, J. T., Hinshaw, S. P., Carte, E. T., & Treuting, J. J. (1998). Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: explainable by comorbid disruptive behavior or reading problems? J Abnorm Psychol , 107 (3), 468-480. https://doi.org/10.1037/0021-843x.107.3.468 Oosterlaan, J., Logan, G. D., & Sergeant, J. A. (1998). Response inhibition in AD/HD, CD, comorbid AD/HD + CD, anxious, and control children: a meta-analysis of studies with the stop task. J Child Psychol Psychiatry , 39 (3), 411-425. Panagiotidi, M., & Overton, P. (2018). The relationship between internet addiction, attention deficit hyperactivity symptoms and online activities in adults. Compr Psychiatry , 87 , 7-11. https://doi.org/10.1016/j.comppsych.2018.08.004 Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014). ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol , 43 (2), 434-442. https://doi.org/10.1093/ije/dyt261 Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods , 40 (3), 879-891. https://doi.org/10.3758/brm.40.3.879 Qian, Y., Shuai, L., Cao, Q., Chan, R. C., & Wang, Y. (2010). Do executive function deficits differentiate between children with attention deficit hyperactivity disorder (ADHD) and ADHD comorbid with oppositional defiant disorder? A cross-cultural study using performance-based tests and the behavior rating inventory of executive function. Clin Neuropsychol , 24 (5), 793-810. https://doi.org/10.1080/13854041003749342 Rubia, K., Smith, A. B., Brammer, M. J., Toone, B., & Taylor, E. (2005). Abnormal brain activation during inhibition and error detection in medication-naive adolescents with ADHD. Am J Psychiatry , 162 (6), 1067-1075. https://doi.org/10.1176/appi.ajp.162.6.1067 Şalvarlı, Ş. İ., & Griffiths, M. D. (2022). The Association Between Internet Gaming Disorder and Impulsivity: A Systematic Review of Literature. International Journal of Mental Health and Addiction , 20 , 92-118. Schachar, R., Mota, V. L., Logan, G. D., Tannock, R., & Klim, P. (2000). Confirmation of an inhibitory control deficit in attention-deficit/hyperactivity disorder. J Abnorm Child Psychol , 28 (3), 227-235. https://doi.org/10.1023/a:1005140103162 Shaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J. P., Greenstein, D., . . . Rapoport, J. L. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proc Natl Acad Sci U S A , 104 (49), 19649-19654. https://doi.org/10.1073/pnas.0707741104 Stevens, M. W., Dorstyn, D., Delfabbro, P. H., & King, D. L. (2021). Global prevalence of gaming disorder: A systematic review and meta-analysis. Aust N Z J Psychiatry , 55 (6), 553-568. https://doi.org/10.1177/0004867420962851 Treuer, T., Fábián, Z., & Füredi, J. (2001). Internet addiction associated with features of impulse control disorder: is it a real psychiatric disorder? J Affect Disord , 66 (2-3), 283. https://doi.org/10.1016/s0165-0327(00)00261-5 van Goozen, S. H., Cohen-Kettenis, P. T., Snoek, H., Matthys, W., Swaab-Barneveld, H., & van Engeland, H. (2004). Executive functioning in children: a comparison of hospitalised ODD and ODD/ADHD children and normal controls. J Child Psychol Psychiatry , 45 (2), 284-292. https://doi.org/10.1111/j.1469-7610.2004.00220.x Verbruggen, F., Aron, A. R., Band, G. P., Beste, C., Bissett, P. G., Brockett, A. T., . . . Boehler, C. N. (2019). A consensus guide to capturing the ability to inhibit actions and impulsive behaviors in the stop-signal task. Elife , 8 . https://doi.org/10.7554/eLife.46323 Verté, S., Geurts, H. M., Roeyers, H., Oosterlaan, J., & Sergeant, J. A. (2006). The relationship of working memory, inhibition, and response variability in child psychopathology. J Neurosci Methods , 151 (1), 5-14. https://doi.org/10.1016/j.jneumeth.2005.08.023 Wang, B. Q., Yao, N. Q., Zhou, X., Liu, J., & Lv, Z. T. (2017). The association between attention deficit/hyperactivity disorder and internet addiction: a systematic review and meta-analysis. BMC Psychiatry , 17 (1), 260. https://doi.org/10.1186/s12888-017-1408-x Weinstein, A., & Weizman, A. (2012). Emerging association between addictive gaming and attention-deficit/hyperactivity disorder. Curr Psychiatry Rep , 14 (5), 590-597. https://doi.org/10.1007/s11920-012-0311-x Weiss, M. D., Baer, S., Allan, B. A., Saran, K., & Schibuk, H. (2011). The screens culture: impact on ADHD. Atten Defic Hyperact Disord , 3 (4), 327-334. https://doi.org/10.1007/s12402-011-0065-z White, J. L., Moffitt, T. E., Caspi, A., Bartusch, D. J., Needles, D. J., & Stouthamer-Loeber, M. (1994). Measuring impulsivity and examining its relationship to delinquency. J Abnorm Psychol , 103 (2), 192-205. https://doi.org/10.1037//0021-843x.103.2.192 World Health Organization. (2019). International classification of diseases (11th ed.) . Geneva: World Health Organization. . https://doi.org/http:// icd.who.int/browse11/I-m/en. Xian-Yun, L. I., Phillips, M. R., Dong, X. U., Ya-Li, Z., Shao-Jie, Y., Yong-Sheng, T., & Zhi-Qing, W. J. C. M. H. J. (2011). Reliability and validity of an adapted Chinese version of Barratt Impulsiveness Scale. Yen, J. Y., Liu, T. L., Wang, P. W., Chen, C. S., Yen, C. F., & Ko, C. H. (2017). Association between Internet gaming disorder and adult attention deficit and hyperactivity disorder and their correlates: Impulsivity and hostility. Addict Behav , 64 , 308-313. https://doi.org/10.1016/j.addbeh.2016.04.024 YOUNG, Kimberly, S. J. C., & Behavior. (2009). Internet Addiction: The Emergence of a New Clinical Disorder. 1 (3), 237-244. Zhang, Y., Mei, S., Li, L., Chai, J., Li, J., & Du, H. (2015). The Relationship between Impulsivity and Internet Addiction in Chinese College Students: A Moderated Mediation Analysis of Meaning in Life and Self-Esteem. PLoS One , 10 (7), e0131597. https://doi.org/10.1371/journal.pone.0131597 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4499645","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":314161997,"identity":"aa90241d-5b47-4795-ab7c-dc59f685bd73","order_by":0,"name":"Yanxue Wang","email":"","orcid":"","institution":"South China Normal University","correspondingAuthor":false,"prefix":"","firstName":"Yanxue","middleName":"","lastName":"Wang","suffix":""},{"id":314161998,"identity":"87af8bb6-a4d3-4e1d-aa62-bea1bdcd7a89","order_by":1,"name":"Xiaoli Liu","email":"","orcid":"","institution":"Affiliated Kangning Hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Liu","suffix":""},{"id":314162000,"identity":"85126baa-e28b-41b6-a13d-9fa6881a97d5","order_by":2,"name":"Yiling Wu","email":"","orcid":"","institution":"South China Normal University","correspondingAuthor":false,"prefix":"","firstName":"Yiling","middleName":"","lastName":"Wu","suffix":""},{"id":314162002,"identity":"804a68a8-1303-45c2-8a9b-2f6c2d0bd26e","order_by":3,"name":"Anli Liang","email":"","orcid":"","institution":"South China Normal University","correspondingAuthor":false,"prefix":"","firstName":"Anli","middleName":"","lastName":"Liang","suffix":""},{"id":314162006,"identity":"d23e36ff-b7b2-4543-994f-786084884480","order_by":4,"name":"Wenhao Zhuang","email":"","orcid":"","institution":"Affiliated Kangning Hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Wenhao","middleName":"","lastName":"Zhuang","suffix":""},{"id":314162010,"identity":"67577a99-1a26-46e4-8f30-1ffe08d586dc","order_by":5,"name":"Jia Wei","email":"","orcid":"","institution":"Affiliated Kangning Hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Wei","suffix":""},{"id":314162011,"identity":"98579693-9881-4eef-af74-e2759a59d8b2","order_by":6,"name":"Beini Wang","email":"","orcid":"","institution":"Affiliated Kangning Hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Beini","middleName":"","lastName":"Wang","suffix":""},{"id":314162014,"identity":"cbd62c23-c1ef-4991-b66c-b6ebc9caa556","order_by":7,"name":"Qi Chen","email":"","orcid":"","institution":"Shenzhen University","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Chen","suffix":""},{"id":314162017,"identity":"883552e3-e92c-47be-bbac-ffa68754b96b","order_by":8,"name":"Dongsheng Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYHACNiBmZuBnYGwgUYtkA8laDA4Qq97gRvqzBx/brO2Nzx9ue/CDwU5Ol5BlBjcS0g1ntqUnbruR2G7Yw5BsbEbIOrMbCcekedsOJ5jdYGyT4GE4kLiNsJbENpAWe+P+g22Sf4jTkswG0sK4gQGolyhb7M88Y5OccS49cQbIOhkDIvwi2Z7+TOJDmbU9f//xZ5JvKuzkCGphEEhA5hkQUg4C/AQNHQWjYBSMghEPAIEKQZHm83C3AAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Kangning Hospital of Ningbo University","correspondingAuthor":true,"prefix":"","firstName":"Dongsheng","middleName":"","lastName":"Zhou","suffix":""},{"id":314162018,"identity":"0508fbf2-eb24-4233-a1a2-50bb48a7dcff","order_by":9,"name":"Wenwu Zhang","email":"","orcid":"","institution":"Affiliated Kangning Hospital of Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Wenwu","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-05-30 01:31:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4499645/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4499645/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59298357,"identity":"de2c0409-8947-486d-af52-2b6f06cccedf","added_by":"auto","created_at":"2024-06-28 21:46:07","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":537035,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic representation of beta coefficients and standard errors for the direct and indirect pathways of the mediating effect of inhibitory control (Model Ⅰ) and impulsivity (Model Ⅱ) on Internet addiction in adolescents with ADHD and ADHD+GD.\u003c/p\u003e\n\u003cp\u003eNote. Paths c′ reflects the impact of interference on Internet addiction before taking into account of the mediator ODD. The beta weights are significant based on 95% confidence intervals that do not include 0.\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4499645/v1/56ab047f89061cb8ec25bbe9.jpg"},{"id":66046753,"identity":"3f147646-2f34-44c0-b6ca-08b958c44401","added_by":"auto","created_at":"2024-10-07 07:17:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1139759,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4499645/v1/d20796c1-a952-460b-b43b-3a346945d2d2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Inhibitory Control, Impulsivity and Internet Addiction: Testing the Mediating Role of Oppositional Defiant Disorder Among ADHD Adolescents With and Without Gaming Disorder","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAttention deficit hyperactivity disorder (ADHD) that affects 5%-7% children of worldwide (Polanczyk et al., 2014), is characterized by inattention and/or hyperactivity/impulsivity (Faraone et al., 2006; Kessler et al., 2007; Mannuzza et al., 1993). Due to delayed development of the executive control system, children and adolescents with ADHD are more likely to be addicted to watching television, playing Internet and video games (Weinstein \u0026amp; Weizman, 2012; Weiss et al., 2011). The characteristic even can predispose individuals to gaming addiction (Lee et al., 2017). Previous literature has reported that gaming disorder (GD) is a relatively common mental disorder comorbid with ADHD (Gonz\u0026aacute;lez-Bueso et al., 2018). It refers to persistent and out-of-control gaming behavior (online as well as offline), gaming without regard for personal harm, and conflicts arising from gaming and dysfunction (World Health Organization, 2019). GD has been recognized as a behavioral addiction in the 11th edition of the Classification of Diseases (ICD-11) (World Health Organization, 2019). Recent systematic review and meta-analysis showed that the worldwide prevalence of GD was 3.05% with a higher prevalence in men (Stevens et al., 2021). Moreover, 39% of patients with GD diagnosed according to the new ICD-11 criteria had ADHD symptoms (Cabelguen et al., 2021).\u003c/p\u003e \u003cp\u003eInternet addiction (IA) can be defined as excessive, uncontrolled and harmful use of the Internet (Dalbudak et al., 2013), which is a broader concept than gaming addiction (Burleigh et al., 2020). Some studies have shown that Internet addiction is significantly correlated with ADHD (Hong et al., 2021; Panagiotidi \u0026amp; Overton, 2018; Wang et al., 2017).Therefore, children and adolescents with ADHD may be at higher risk for Internet addiction. There are some explanations for the coexistence between ADHD and IA (Ko et al., 2012). One explanation is that adolescents with ADHD demonstrate impairment of inhibition (Barkley, 1997; Rubia et al., 2005), which may make it difficult for individuals with ADHD to control their use of the Internet. There is a moderate association between higher levels of ADHD symptoms and IA, but not all individuals with ADHD evolve into network problems or GD (Panagiotidi \u0026amp; Overton, 2018). Thus, there may be some differences in IA between adolescents with pure ADHD (ADHD) and adolescents with ADHD co-morbid GD (ADHD\u0026thinsp;+\u0026thinsp;GD), and it is unclear what and how risk factors affect Internet addition in both groups. Some studies indicated that impulsiveness and behavioral inhibition system were significant predictors of Internet addition among adults with ADHD (Li et al., 2016). Hence, adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD were recruited in this study to explore the effects of inhibitory control and impulsivity on Internet addition.\u003c/p\u003e \u003cp\u003eInhibitory control is an important factor of Internet addition. Broadly, inhibitory control refers to the ability to withhold an emotional or behavioral response in order to achieve a goal (Best \u0026amp; Miller, 2010; Nigg, 2000; van Goozen et al., 2004). When deficient in inhibitory control, it is more difficult for children to stop unwanted behavior. Accordingly, most of the literature on inhibition has focused on ADHD. The stop signal task (SST) is one of the measures to assess inhibitory control. The SST could be used to detect possible cases of ADHD in normal populations (Avila, 2001). A meta-analysis examined SST performance in patients with various psychiatric disorders and confirmed an inhibition deficit in ADHD patients. It also revealed that comorbid ADHD had different effects on inhibition in patients with other psychiatric disorders (Lipszyc \u0026amp; Schachar, 2010).\u003c/p\u003e \u003cp\u003eIn addition to impairment of inhibition, Internet addiction can also be conceptualized as an impulse control disorder (Mazhari, 2012; Treuer et al., 2001). One study showed that Internet gaming disorder (IGD) was associated with ADHD among young adults and those with both IGD and ADHD had higher impulsivity and hostility (Yen et al., 2017). Impulsivity can be measured by Barratt Impulsiveness Scale 11 (BIS-11). Cao et al. (2007) found that the Internet addiction scores were significantly and positively correlated with the score of the BIS-11. Impulsivity is a marker of susceptibility to Internet addiction (Lee et al., 2012), but it is unknown whether inhibitory control and impulsivity share the same influence mechanism with Internet addiction.\u003c/p\u003e \u003cp\u003eIn the comorbid psychiatric disorders of ADHD, oppositional defiant disorder (ODD, 54\u0026ndash;67%) is the most frequent one (Barkley et al., 1990). Some studies found that children with ADHD\u0026thinsp;+\u0026thinsp;ODD were similar to children with pure ADHD on some aspects of executive function (Nigg et al., 1998; Oosterlaan et al., 1998). A few findings indicated that the performance in inhibition task of children with ADHD\u0026thinsp;+\u0026thinsp;ODD was significantly better than that of children with ADHD-only (Lipszyc \u0026amp; Schachar, 2010; Schachar et al., 2000; Vert\u0026eacute; et al., 2006). However, there were still some studies suggested that the ADHD\u0026thinsp;+\u0026thinsp;ODD group received higher parent scores on the inhibition subscales than the ADHD group (Qian et al., 2010). There is thus some doubt about how and to what extent the co-occurrence of ODD influences executive dysfunction in adolescents with ADHD.\u003c/p\u003e \u003cp\u003eBased on the above researches and doubt, there are two aims of the current study: (1) To test whether or not inhibitory control and impulsivity are significant predictors of Internet addiction in adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD; (2) To test whether or not the relationship between inhibitory control/impulsivity and Internet addiction is mediated by ODD in both two groups.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eTo be included in the study, each child received a diagnosis of ADHD (using DSM-V criteria) with or without GD (using ICD-11 criteria). The ICD-11 criteria were used in the diagnosis of GD as a recent Delphi study reached a consensus that the ICD-11 criteria were more useful than DSM-5 criteria which might lead to the over-pathologization of gamers (Castro-Calvo et al., 2021). Due to the higher male prevalence of ADHD and GD, the subjects recruited in our study were boys. A total of 154 boys (aged 10\u0026ndash;17 years) with ADHD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;90; age: 13.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45 years) and ADHD\u0026thinsp;+\u0026thinsp;GD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;64; age: 13.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59 years) were recruited at Ningbo Kangning Hospital. All children had a confirmatory diagnosis from another psychologist or physician. For children, the following criteria should be met: (a) a confirmed diagnosis of ADHD or ADHD\u0026thinsp;+\u0026thinsp;GD by a child psychiatrist; (b) no other neurodevelopmental disorders (e.g., ASD, specific learning disabilities) or motor problems as the primary diagnosis; (c) no history of psychotic disorder, or, in the past 2 months, substance-related disorder.\u003c/p\u003e \u003cp\u003e The research was approved by the Ethics Committee of Ningbo Kangning Hospital, and all experimental procedures were carried out following the guidelines of human medical research (Declaration of Helsinki). All enrolled patients and guardians signed an informed consent form and they were reassured that they could withdraw from the study at any time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eStop-signal task\u003c/h2\u003e \u003cp\u003eComputerized version of the stop-signal task was used to assess inhibition of prepotent motor responses (Aron et al., 2003; Logan et al., 1984). Briefly, participants watched a computer screen with a series of five blocks (the first was a practice block) of 64 arrows per block. The arrows randomly pointed either to the right (50%) or the left (50%) and participant pressed the appropriate button. In a randomly assigned proportion (25%) of trials, an audible stop-signal was heard after presentation of the arrow and subjects were instructed to inhibit their motor response to these trials. The interstimulus interval (ISI) and the stop-signal delay varied according to the subject\u0026rsquo;s performance such that subjects were able successfully to inhibit their responses to 50% of the stop trials. The stop-signal paradigm assumed a race between the reaction to the go-stimulus and the reaction to the stop-signal, allowed estimating the stop signal reaction time (SSRT)\u0026mdash;as a measure for response inhibition performance. Therefore, for each individual, SSRT was obtained by calculating the difference between mean RT on go-trials and the mean SSD (Verbruggen et al., 2019).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eBarratt Impulsiveness Scale 11 (BIS-11)\u003c/h2\u003e \u003cp\u003eThe 11th revision of the Barratt Impulsiveness Scale (BIS-11) was commonly used to measure impulsivity (Barratt, 1985). Chinese version of BIS-11 (Xian-Yun et al., 2011) was used in this study which contained 30 items on a 4-point Likert scale with scaled total scores ranging 30\u0026ndash;120. The scale was used to assess the multifaceted personality and behavioral construct of impulsiveness. Higher scores on the BIS reflect higher levels of impulsiveness. It consists of three subscales: attentional, motor, and non-planning impulsiveness. Examples of items from each of the subscales are \u0026mdash; \u0026lsquo;I make up my mind quickly\u0026rsquo; (motor impulsiveness), \u0026lsquo;I often have extraneous thoughts when thinking (attentional impulsiveness), and \u0026lsquo;I say things without thinking\u0026rsquo; (non-planning impulsiveness).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eYoung's Internet addiction test\u003c/h2\u003e \u003cp\u003eYoung's Internet Addiction test (IAT) (YOUNG et al., 2009) was used to measure the degree of Internet addiction. The IAT consists of 20 questions with 5-point Likert scale ranging 20\u0026ndash;100 and examined the degree of preoccupation, compulsive use, behavioral problems, emotional changes, and impact on life related to Internet usage. Higher scores on the IAT reflect higher levels of Internet addiction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eChinese version of the Swanson Nolan and Pelham, Version IV (SNAP-IV) Scale-Parent\u003c/h2\u003e \u003cp\u003eThe SNAP-IV (parents) is a commonly used ADHD symptom assessment tool in China. This revised version (Jin-Bo et al., 2013) includes the DSM-IV symptoms for inattention (items 1\u0026ndash;9), hyperactivity (items10-15), and impulsivity (items 16\u0026ndash;18) of the criteria for ADHD, and the oppositional (OP) symptoms (tems19-26) of the criteria for ODD. The symptom severity of each symptom item is rated on a four-point rating scale(0 = \u0026ldquo;not at all\u0026rdquo;, 1 = \u0026ldquo;just a little\u0026rdquo;, 2\u0026thinsp;=\u0026thinsp;quite a bit\u0026rdquo;, and3 =\u0026ldquo;very much\u0026rdquo;).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eWhen the children met the criteria, the families would be invited to our research laboratory for in-person assessments. The following were consent and assent procedures signed by the parent and child, respectively. Children were tested separately on their inhibitory control, impulsivity and Internet addiction (i.e., stop-signal task, BIS-11, IAT). All children\u0026rsquo;s Parents were asked to complete the ODD while their child was being tested.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIn order to achieve these two objectives, there were several steps: Firstly, Pearson correlation coefficients between inhibitory control, impulsivity, ODD and Internet addiction were computed to find out whether there was a significant correlation between these variables. Secondly, hierarchical regulation analysis models were used to test the predictive effect of inhibitory control/impulsivity and ODD on Internet addiction. Finally, two mediation effect models were to ascertain whether ODD mediated the relationship between inhibitory control/impulsivity and Internet addiction in adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD.\u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using the computer software program SPSS 22.0. Differences between groups of variables involving continuous data were computed using independent t-test. Pearson's correlations analysis was used to assess the correlation between the scores of scales and SSRT. Hierarchical regression was used to evaluate the associations between Internet addiction and personality characteristics. The mediation effect test was completed using PROCESS macro for SPSS (Hayes, 2013) and bootstrapping methodology (5,000 samples) was used in mediation effect test (Preacher \u0026amp; Hayes, 2008). Unless specifically noted, statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and all tests were 2-tailed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic and clinical characteristics of the ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. 154 boys with ADHD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;90; age: 13.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45 years) and ADHD\u0026thinsp;+\u0026thinsp;GD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;64; age: 13.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59 years) were tested on Inhibitory control, ODD, Internet addiction and impulsivity. There was no statistically significant difference in age between the two groups (\u003cem\u003et\u003c/em\u003e=-0.425, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05). In the SST, the adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD had longer SSRT that suggested poorer Inhibitory control than peers with ADHD (\u003cem\u003et\u003c/em\u003e=-3.961, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). They also had significantly higher ratings on their ODD, Internet addiction, impulsivity than ADHD adolescents.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Age, SSRT, ODD, Internet Addiction and BIS of Adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eADHD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eADHD\u0026thinsp;+\u0026thinsp;GD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.49 (1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.59 (1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSSRT (ms)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144.82 (101.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e213.54 (111.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.961\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.78 (3.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.05 (3.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.580\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet addiction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.61 (9.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.17 (9.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-9.247\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.505\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImpulsivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.20 (9.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.83 (10.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-7.131\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.153\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.41 (3.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.84 (3.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.488\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.13 (3.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.59 (5.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5.864\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.62 (4.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.39 (4.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.969\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eADHD, attention deficit hyperactivity disorder. ADHD\u0026thinsp;+\u0026thinsp;GD, attention deficit hyperactivity disorder and gaming disorder. ODD, oppositional defiant disorder.\u003c/p\u003e \u003cp\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01. *** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations Between Inhibitory Control, ODD, Internet Addiction, and Impulsivity in Children with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eADHD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eADHD\u0026thinsp;+\u0026thinsp;GD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eADHD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eADHD\u0026thinsp;+\u0026thinsp;GD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eADHD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eADHD\u0026thinsp;+\u0026thinsp;GD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eADHD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eADHD\u0026thinsp;+\u0026thinsp;GD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Inhibitory Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. ODD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.347\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.573\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Internet Addiction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.307\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.275\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.431\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Impulsivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.223\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.308\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.548\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.540\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eODD: oppositional defiant disorder.\u003c/p\u003e \u003cp\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01. *** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRegression Analysis\u003c/h2\u003e \u003cp\u003eTo test whether inhibitory control and impulsivity were both significant predictors of Internet addiction in adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD, bivariate correlations between inhibitory control, impulsivity, ODD, and Internet addiction were computed. There was a significant correlation between impulsivity and Internet addiction, in both groups (\u003cem\u003er\u003c/em\u003e\u003csub\u003eADHD\u003c/sub\u003e =.548, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; \u003cem\u003er\u003c/em\u003e\u003csub\u003eADHD+GD\u003c/sub\u003e =.540, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), revealing that the better the impulsivity, the higher the Internet addiction, regardless of whether the children with ADHD were accompanied by GD. However, the correlation between inhibitory control and Internet addiction was significant (\u003cem\u003er\u003c/em\u003e\u003csub\u003eADHD+GD\u003c/sub\u003e=.307, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05), revealing that the worse the inhibitory control, the higher the Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD but this relationship did not exist for ADHD adolescents (\u003cem\u003er\u003c/em\u003e\u003csub\u003eADHD\u003c/sub\u003e=-.142, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Linear regression analyses were conducted for adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD, respectively using inhibitory control (model Ⅰ)/impulsivity (model Ⅱ) and ODD as predictors and Internet addiction as outcome variable. The results showed that inhibitory control or impulsivity was a significant predictor of Internet addiction in both groups. However, when ODD was put into regression models as a predictor, the two groups of subjects had different results in the two models. In model Ⅰ, regression coefficients of ODD and inhibitory control were significant for ADHD adolescents (ODD: β=-.368, \u003cem\u003et\u003c/em\u003e=-3.475, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.001; inhibitory control: β=-.270, \u003cem\u003et\u003c/em\u003e=-2.546, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.013), whereas only the regression coefficient of ODD rather than inhibitory control was significant in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD (ODD: β=-.380, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.708, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.009; inhibitory control: β=-.089, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.634, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.528). In model Ⅱ, only the regression coefficient of impulsivity but not ODD was significant in ADHD adolescents (ODD: β=-.161, \u003cem\u003et\u003c/em\u003e=-1.780, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.079; impulsivity: β\u0026thinsp;=\u0026thinsp;.512, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.662, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.000), whereas regression coefficients were both significant for impulsivity and ODD in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD (ODD: β\u0026thinsp;=\u0026thinsp;.293, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.744, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008; impulsivity: β\u0026thinsp;=\u0026thinsp;.449, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.204, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.000).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMediation Analysis\u003c/h2\u003e \u003cp\u003eTo further test whether the relationship between inhibitory control (model Ⅰ)/impulsivity (model Ⅱ) and Internet addiction is mediated through ODD. The test of mediation models with inhibitory control/impulsivity as independent variable, Internet addiction as dependent variable, and ODD as mediator, was completed.The results of the mediation analysis are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eIn model Ⅰ, the direct effects suggested that inhibitory control significantly predicted Internet addiction in both groups. The direct effect of inhibitory control on Internet addiction remained significant (β\u0026thinsp;=\u0026thinsp;.0194, 95% CI [.0050, .0352]) after accounting for ODD for ADHD\u0026thinsp;+\u0026thinsp;GD adolescents, demonstrating that ODD was a partial mediator. But the direct effect of inhibitory control on Internet addiction was not significant after accounting for ODD in adolescents with ADHD (β\u0026thinsp;=\u0026thinsp;.0118; 95% CI [.0027, .0246]), so ODD acted as complete mediator.\u003c/p\u003e \u003cp\u003eIn model Ⅱ, the direct effect suggested that impulsivity was a significant predictor of Internet addiction. After accounting for ODD, the direct effect of impulsivity on Internet addiction remained significant (β\u0026thinsp;=\u0026thinsp;.0833; 95% CI [.0127, .1634]) in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD, with ODD as a partial mediator accounting for 99% (Effect ratio\u0026thinsp;=\u0026thinsp;16.73%) of the variance. However, the direct effect after accounting for ODD was not significant (β\u0026thinsp;=\u0026thinsp;.0359; 95% CI [\u0026minus;\u0026thinsp;.0054, .1045]) in adolescents with ADHD.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNote\u003c/strong\u003e \u003cp\u003ePaths c\u0026prime; reflects the impact of interference on Internet addiction before taking into account of the mediator ODD. The beta weights are significant based on 95% confidence intervals that do not include 0.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of current study was twofold: (1) to test whether inhibitory control and impulsivity were significant predictors of Internet addiction in adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD; and (2) to test whether there were relationships mediated by ODD between inhibitory control/impulsivity in two groups. The results for aim (1) showed that inhibitory control and impulsivity were significant predictors of Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD, but only impulsivity was significant in ADHD adolescents. The current findings are consistent with those of previous studies (Di Nicola et al., 2015; Li et al., 2016; Qian et al., 2010). Moreover, the current finding that inhibitory control was not significantly associated with impulsivity is also consistent with past research (Antons \u0026amp; Matthias, 2020).\u003c/p\u003e \u003cp\u003eThe results of the present study for aim (2) demonstrated that the direct and indirect effects of ODD on the relationship between inhibitory control or impulsivity and Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD were significant. However, the indirect effect of inhibitory control rather than impulsivity was significant in adolescents with ADHD. Inhibitory control and impulsivity had significant direct effect on Internet addiction in ADHD\u0026thinsp;+\u0026thinsp;GD adolescents, indicating that inhibitory control and impulsivity per se can influence Internet addiction performance. Prior research also found that, IA and IAD\u0026thinsp;+\u0026thinsp;ADHD subjects performed worse in the internet-related condition during stop trial of the SST compared to internet-unrelated conditions (Nie et al., 2016). Additionally, adults with ADHD who were higher in impulsivity would spend more time on Internet activities than planned (Li et al., 2016). One neurobiological theory underlying such finding is that delays in cortical maturation which characterize ADHD and associated disruptive behavior disorders (e.g., ODD) contribute to increased levels of impulsivity, particularly during adolescence (Nigg \u0026amp; Casey, 2005; Shaw et al., 2007).\u003c/p\u003e \u003cp\u003eNotably, impulsivity probably had an impact on Internet addiction via other factors, which requires further research. In addition, the significant indirect effect on Internet addiction through ODD revealed that inhibitory control and impulsivity influenced ODD, which in turn determined Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD. This finding suggested that ODD may be a critical pathway to Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD.\u003c/p\u003e \u003cp\u003eOn the other hand, in adolescents with ADHD, the indirect but not direct effects of ODD on the relationship between inhibitory control and Internet addiction was significant, demonstrating inhibitory control entirely influenced Internet addiction through ODD among adolescents with ADHD. One possible explanation is that impaired inhibitory control in children with ADHD causes difficulties in suppressing ODD, which in turn is more likely to lead to Internet addiction. Nevertheless, the mediation effect of ODD on the relationship between impulsivity and Internet addiction in adolescents with ADHD was not significant. The results of this study imply that there may be different between adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD in the psychological mechanisms of inhibitory control and impulsivity on Internet addiction. In addition, different preventative strategies should be adopted in the ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD groups.\u003c/p\u003e \u003cp\u003eImpulsivity is considered as key to ADHD and ODD (Martel et al., 2017). It appears to have much support for the role of impulsivity in explaining the link between ADHD and ODD (Bansal et al., 2023). Although it is critical that the present study found the different psychological mechanisms in adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD, it is still unclear whether the differences between impulsivity on Internet addiction may be attributed to the selection of laboratory measures. This can't be ignored because several previous reports in the field declared no correlation between rating scales and laboratory measures of impulsivity (Avila et al., 2004; Carrillo-de-la-Pe\u0026ntilde;a et al., 1993; White et al., 1994). Therefore, it is necessary to further investigate the similarities and differences between inhibitory control and impulsivity in two groups.\u003c/p\u003e \u003cp\u003eIn electrophysiological signals, lower beta-activity linked to impulsivity in ADHD patient (Snyder \u0026amp; Hall, 2006). A recent review (Burleigh et al., 2020) thought that reduced beta-activity among internet addicts may implicate higher levels of impulsiveness (Şalvarlı \u0026amp; Griffiths, 2022; Zhang et al., 2015). At a neurobiological level, a resting-state functional magnetic resonance imaging (fMRI) study reflected that the strength of functional connectivity between the PCC and cerebellum (crus II) was correlated with impulsivity in IGD subjects with childhood ADHD history (Lee et al., 2017). And their findings revealed that alterations in neural system for executive control in ADHD patients may contribute to the development of IGD (Lee et al., 2017). It thus might also be possible for future research to assess the different neural mechanism of inhibitory control and impulsivity on Internet addiction in adolescents with ADHD with and without GD.\u003c/p\u003e \u003cp\u003eThere were some limitations to the study. First, a healthy control group was not included as the focus of the study was on differences between ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD;Second, impulsivity was measured using a self-rating scale and inhibitory control was measured using a behavioral task, which may have led to some measure-induced discrepancies༛Lastly, the use of a cross-sectional design limits the ability to ascertain causal effects of ADHD or ADHD\u0026thinsp;+\u0026thinsp;GD symptoms and effect on Internet addiction in this study. Nonetheless, these cross-sectional findings of mediational effects set the foundations for a more in-depth investigation and has implications for symptoms understanding and treatment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eResults of the current study demonstrate that inhibitory control and impulsivity contributed to Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD. Inhibitory control and impulsivity influenced Internet addiction directly and indirectly through the mediation of ODD in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD. But there were some different results in in adolescents with ADHD. Since inhibitory control and impulsivity both were a core problem of ADHD, knowing the role of inhibition and impulsivity in Internet addiction among adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD could improve our understanding of the cognitive mechanisms that underlie ADHD and how the core ADHD symptoms and comorbid symptoms affect behaviors and daily functions, such as Internet addiction in order to provide different intervention strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADHD:Attention deficit hyperactivity disorder; GD: gaming disorder; ADHD+GD: ADHD co-morbid GD; IA: Internet addiction; ODD: oppositional defiant disorder.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the design of the study. YW and XL participated in the design of the study and drafted the manuscript. YW, AL, WZ, JW, BW participated in the design of the study, collected the data, and helped to draft the manuscript. DZ, WZ,QC participated in the conceptualization or design and critical revision of the manuscript. All authors have reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Zhejiang Provincia Natural Science Foundation of China under Grant No. LGF19H090009, The Ningbo Top Medical and Health Research Program No.2022030410.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved by the Ethics Committee of Ningbo Kangning Hospital, and all experimental procedures were carried out following the guidelines of human medical research (Declaration of Helsinki). All enrolled patients and guardians signed an informed consent form and they were reassured that they could withdraw from the study at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAntons, S., \u0026amp; Matthias, B. (2020). Inhibitory control and problematic Internet-pornography use - The important balancing role of the insula. \u003cem\u003eJ Behav Addict\u003c/em\u003e,\u003cem\u003e 9\u003c/em\u003e(1), 58-70. https://doi.org/10.1556/2006.2020.00010\u003c/li\u003e\n\u003cli\u003eAron, A. R., Dowson, J. H., Sahakian, B. J., \u0026amp; Robbins, T. W. (2003). Methylphenidate improves response inhibition in adults with attention-deficit/hyperactivity disorder. \u003cem\u003eBiol Psychiatry\u003c/em\u003e,\u003cem\u003e 54\u003c/em\u003e(12), 1465-1468. https://doi.org/10.1016/s0006-3223(03)00609-7\u003c/li\u003e\n\u003cli\u003eAvila, C. (2001). Distinguishing BIS-mediated and BAS-mediated disinhibition mechanisms: a comparison of disinhibition models of Gray (1981, 1987) and of Patterson and Newman (1993). \u003cem\u003eJ Pers Soc Psychol\u003c/em\u003e,\u003cem\u003e 80\u003c/em\u003e(2), 311-324. https://doi.org/10.1037/0022-3514.80.2.311\u003c/li\u003e\n\u003cli\u003eAvila, C., Cuenca, I., F\u0026eacute;lix, V., Parcet, M. A., \u0026amp; Miranda, A. (2004). Measuring impulsivity in school-aged boys and examining its relationship with ADHD and ODD ratings. \u003cem\u003eJ Abnorm Child Psychol\u003c/em\u003e,\u003cem\u003e 32\u003c/em\u003e(3), 295-304. https://doi.org/10.1023/b:jacp.0000026143.70832.4b\u003c/li\u003e\n\u003cli\u003eBansal, P. S., Goh, P. K., Southward, M. W., Sizemore, Y. J., \u0026amp; Martel, M. M. (2023). Impulsivity as key bridge symptoms in cross-sectional and longitudinal networks of ADHD and ODD. \u003cem\u003eJ Child Psychol Psychiatry\u003c/em\u003e. https://doi.org/10.1111/jcpp.13863\u003c/li\u003e\n\u003cli\u003eBarkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. \u003cem\u003ePsychol Bull\u003c/em\u003e,\u003cem\u003e 121\u003c/em\u003e(1), 65-94. https://doi.org/10.1037/0033-2909.121.1.65\u003c/li\u003e\n\u003cli\u003eBarkley, R. A., DuPaul, G. J., \u0026amp; McMurray, M. B. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. \u003cem\u003eJ Consult Clin Psychol\u003c/em\u003e,\u003cem\u003e 58\u003c/em\u003e(6), 775-789. https://doi.org/10.1037//0022-006x.58.6.775\u003c/li\u003e\n\u003cli\u003eBarratt, E. S. (1985). Impulsiveness subtraits: Arousal and information processing.\u003c/li\u003e\n\u003cli\u003eBest, J. R., \u0026amp; Miller, P. H. (2010). A developmental perspective on executive function. \u003cem\u003eChild Dev\u003c/em\u003e,\u003cem\u003e 81\u003c/em\u003e(6), 1641-1660. https://doi.org/10.1111/j.1467-8624.2010.01499.x\u003c/li\u003e\n\u003cli\u003eBurleigh, T. L., Griffiths, M. D., Sumich, A., Wang, G. Y., \u0026amp; Kuss, D. J. (2020). Gaming disorder and internet addiction: A systematic review of resting-state EEG studies. \u003cem\u003eAddict Behav\u003c/em\u003e,\u003cem\u003e 107\u003c/em\u003e, 106429. https://doi.org/10.1016/j.addbeh.2020.106429\u003c/li\u003e\n\u003cli\u003eCabelguen, C., Rocher, B., Leboucher, J., Schreck, B., Challet-Bouju, G., Hardouin, J. B., \u0026amp; Grall-Bronnec, M. (2021). Attention deficit hyperactivity disorder and gaming disorder: Frequency and associated factors in a clinical sample of patients with Gaming Disorder. \u003cem\u003eJ Behav Addict\u003c/em\u003e,\u003cem\u003e 10\u003c/em\u003e(4), 1061-1067. https://doi.org/10.1556/2006.2021.00074\u003c/li\u003e\n\u003cli\u003eCao, F., Su, L., Liu, T., \u0026amp; Gao, X. (2007). The relationship between impulsivity and Internet addiction in a sample of Chinese adolescents. \u003cem\u003eEur Psychiatry\u003c/em\u003e,\u003cem\u003e 22\u003c/em\u003e(7), 466-471. https://doi.org/10.1016/j.eurpsy.2007.05.004\u003c/li\u003e\n\u003cli\u003eCarrillo-de-la-Pe\u0026ntilde;a, M. T., Otero, J. M., \u0026amp; Romero, E. (1993). Comparison among various methods of assessment of impulsiveness. \u003cem\u003ePercept Mot Skills\u003c/em\u003e,\u003cem\u003e 77\u003c/em\u003e(2), 567-575. https://doi.org/10.2466/pms.1993.77.2.567\u003c/li\u003e\n\u003cli\u003eCastro-Calvo, J., King, D. L., Stein, D. J., Brand, M., Carmi, L., Chamberlain, S. R., . . . Billieux, J. (2021). Expert appraisal of criteria for assessing gaming disorder: an international Delphi study. \u003cem\u003eAddiction\u003c/em\u003e,\u003cem\u003e 116\u003c/em\u003e(9), 2463-2475. https://doi.org/10.1111/add.15411\u003c/li\u003e\n\u003cli\u003eDalbudak, E., Evren, C., Aldemir, S., Coskun, K. S., Ugurlu, H., \u0026amp; Yildirim, F. G. (2013). Relationship of internet addiction severity with depression, anxiety, and alexithymia, temperament and character in university students. \u003cem\u003eCyberpsychol Behav Soc Netw\u003c/em\u003e,\u003cem\u003e 16\u003c/em\u003e(4), 272-278. https://doi.org/10.1089/cyber.2012.0390\u003c/li\u003e\n\u003cli\u003eDi Nicola, M., Tedeschi, D., De Risio, L., Pettorruso, M., Martinotti, G., Ruggeri, F., . . . Janiri, L. (2015). Co-occurrence of alcohol use disorder and behavioral addictions: relevance of impulsivity and craving. \u003cem\u003eDrug Alcohol Depend\u003c/em\u003e,\u003cem\u003e 148\u003c/em\u003e, 118-125. https://doi.org/10.1016/j.drugalcdep.2014.12.028\u003c/li\u003e\n\u003cli\u003eFaraone, S. V., Biederman, J., \u0026amp; Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. \u003cem\u003ePsychol Med\u003c/em\u003e,\u003cem\u003e 36\u003c/em\u003e(2), 159-165. https://doi.org/10.1017/s003329170500471x\u003c/li\u003e\n\u003cli\u003eGonz\u0026aacute;lez-Bueso, V., Santamar\u0026iacute;a, J. J., Fern\u0026aacute;ndez, D., Merino, L., Montero, E., \u0026amp; Ribas, J. (2018). Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e,\u003cem\u003e 15\u003c/em\u003e(4). https://doi.org/10.3390/ijerph15040668\u003c/li\u003e\n\u003cli\u003eHayes, A. F. (2013). \u003cem\u003eIntroduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach\u003c/em\u003e. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach.\u003c/li\u003e\n\u003cli\u003eHong, Y. P., Yeom, Y. O., \u0026amp; Lim, M. H. (2021). Relationships between Smartphone Addiction and Smartphone Usage Types, Depression, ADHD, Stress, Interpersonal Problems, and Parenting Attitude with Middle School Students. \u003cem\u003eJ Korean Med Sci\u003c/em\u003e,\u003cem\u003e 36\u003c/em\u003e(19), e129. https://doi.org/10.3346/jkms.2021.36.e129\u003c/li\u003e\n\u003cli\u003eJin-Bo, Z., Lan-Ting, G., \u0026amp; Ying, C. (2013). Reliability and validity of the Chinese version of Swanson，Nolan，and Pelham Version IV Rating Scale-Parent Form for attention-deficit/hyperactivity disorder \u003cem\u003eChinese Mental Health Journal\u003c/em\u003e,\u003cem\u003e 27\u003c/em\u003e(6).\u003c/li\u003e\n\u003cli\u003eKessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., \u0026amp; Van Brunt, D. L. (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. \u003cem\u003eInt J Methods Psychiatr Res\u003c/em\u003e,\u003cem\u003e 16\u003c/em\u003e(2), 52-65. https://doi.org/10.1002/mpr.208\u003c/li\u003e\n\u003cli\u003eKo, C. H., Yen, J. Y., Yen, C. F., Chen, C. S., \u0026amp; Chen, C. C. (2012). The association between Internet addiction and psychiatric disorder: a review of the literature. \u003cem\u003eEur Psychiatry\u003c/em\u003e,\u003cem\u003e 27\u003c/em\u003e(1), 1-8. https://doi.org/10.1016/j.eurpsy.2010.04.011\u003c/li\u003e\n\u003cli\u003eLee, D., Lee, J., Lee, J. E., \u0026amp; Jung, Y. C. (2017). Altered functional connectivity in default mode network in Internet gaming disorder: Influence of childhood ADHD. \u003cem\u003eProg Neuropsychopharmacol Biol Psychiatry\u003c/em\u003e,\u003cem\u003e 75\u003c/em\u003e, 135-141. https://doi.org/10.1016/j.pnpbp.2017.02.005\u003c/li\u003e\n\u003cli\u003eLee, H. W., Choi, J. S., Shin, Y. C., Lee, J. Y., Jung, H. Y., \u0026amp; Kwon, J. S. (2012). Impulsivity in internet addiction: a comparison with pathological gambling. \u003cem\u003eCyberpsychol Behav Soc Netw\u003c/em\u003e,\u003cem\u003e 15\u003c/em\u003e(7), 373-377. https://doi.org/10.1089/cyber.2012.0063\u003c/li\u003e\n\u003cli\u003eLi, W., Zhang, W., Xiao, L., \u0026amp; Nie, J. (2016). The association of Internet addiction symptoms with impulsiveness, loneliness, novelty seeking and behavioral inhibition system among adults with attention-deficit/hyperactivity disorder (ADHD). \u003cem\u003ePsychiatry Res\u003c/em\u003e,\u003cem\u003e 243\u003c/em\u003e, 357-364. https://doi.org/10.1016/j.psychres.2016.02.020\u003c/li\u003e\n\u003cli\u003eLipszyc, J., \u0026amp; Schachar, R. (2010). Inhibitory control and psychopathology: a meta-analysis of studies using the stop signal task. \u003cem\u003eJ Int Neuropsychol Soc\u003c/em\u003e,\u003cem\u003e 16\u003c/em\u003e(6), 1064-1076. https://doi.org/10.1017/s1355617710000895\u003c/li\u003e\n\u003cli\u003eLogan, G. D., Cowan, W. B., \u0026amp; Davis, K. A. (1984). On the ability to inhibit simple and choice reaction time responses: a model and a method. \u003cem\u003eJ Exp Psychol Hum Percept Perform\u003c/em\u003e,\u003cem\u003e 10\u003c/em\u003e(2), 276-291. https://doi.org/10.1037//0096-1523.10.2.276\u003c/li\u003e\n\u003cli\u003eMannuzza, S., Klein, R. G., Bessler, A., Malloy, P., \u0026amp; LaPadula, M. (1993). Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. \u003cem\u003eArch Gen Psychiatry\u003c/em\u003e,\u003cem\u003e 50\u003c/em\u003e(7), 565-576. https://doi.org/10.1001/archpsyc.1993.01820190067007\u003c/li\u003e\n\u003cli\u003eMartel, M. M., Levinson, C. A., Lee, C. A., \u0026amp; Smith, T. E. (2017). Impulsivity Symptoms as Core to the Developmental Externalizing Spectrum. \u003cem\u003eJ Abnorm Child Psychol\u003c/em\u003e,\u003cem\u003e 45\u003c/em\u003e(1), 83-90. https://doi.org/10.1007/s10802-016-0148-6\u003c/li\u003e\n\u003cli\u003eMazhari, S. (2012). Association between problematic Internet use and impulse control disorders among Iranian university students. \u003cem\u003eCyberpsychol Behav Soc Netw\u003c/em\u003e,\u003cem\u003e 15\u003c/em\u003e(5), 270-273. https://doi.org/10.1089/cyber.2011.0548\u003c/li\u003e\n\u003cli\u003eNie, J., Zhang, W., Chen, J., \u0026amp; Li, W. (2016). Impaired inhibition and working memory in response to internet-related words among adolescents with internet addiction: A comparison with attention-deficit/hyperactivity disorder. \u003cem\u003ePsychiatry Res\u003c/em\u003e,\u003cem\u003e 236\u003c/em\u003e, 28-34. https://doi.org/10.1016/j.psychres.2016.01.004\u003c/li\u003e\n\u003cli\u003eNigg, J. T. (2000). On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. \u003cem\u003ePsychol Bull\u003c/em\u003e,\u003cem\u003e 126\u003c/em\u003e(2), 220-246. https://doi.org/10.1037/0033-2909.126.2.220\u003c/li\u003e\n\u003cli\u003eNigg, J. T., \u0026amp; Casey, B. J. (2005). An integrative theory of attention-deficit/ hyperactivity disorder based on the cognitive and affective neurosciences. \u003cem\u003eDev Psychopathol\u003c/em\u003e,\u003cem\u003e 17\u003c/em\u003e(3), 785-806. https://doi.org/10.1017/s0954579405050376\u003c/li\u003e\n\u003cli\u003eNigg, J. T., Hinshaw, S. P., Carte, E. T., \u0026amp; Treuting, J. J. (1998). Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: explainable by comorbid disruptive behavior or reading problems? \u003cem\u003eJ Abnorm Psychol\u003c/em\u003e,\u003cem\u003e 107\u003c/em\u003e(3), 468-480. https://doi.org/10.1037/0021-843x.107.3.468\u003c/li\u003e\n\u003cli\u003eOosterlaan, J., Logan, G. D., \u0026amp; Sergeant, J. A. (1998). Response inhibition in AD/HD, CD, comorbid AD/HD + CD, anxious, and control children: a meta-analysis of studies with the stop task. \u003cem\u003eJ Child Psychol Psychiatry\u003c/em\u003e,\u003cem\u003e 39\u003c/em\u003e(3), 411-425.\u003c/li\u003e\n\u003cli\u003ePanagiotidi, M., \u0026amp; Overton, P. (2018). The relationship between internet addiction, attention deficit hyperactivity symptoms and online activities in adults. \u003cem\u003eCompr Psychiatry\u003c/em\u003e,\u003cem\u003e 87\u003c/em\u003e, 7-11. https://doi.org/10.1016/j.comppsych.2018.08.004\u003c/li\u003e\n\u003cli\u003ePolanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., \u0026amp; Rohde, L. A. (2014). ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. \u003cem\u003eInt J Epidemiol\u003c/em\u003e,\u003cem\u003e 43\u003c/em\u003e(2), 434-442. https://doi.org/10.1093/ije/dyt261\u003c/li\u003e\n\u003cli\u003ePreacher, K. J., \u0026amp; Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. \u003cem\u003eBehav Res Methods\u003c/em\u003e,\u003cem\u003e 40\u003c/em\u003e(3), 879-891. https://doi.org/10.3758/brm.40.3.879\u003c/li\u003e\n\u003cli\u003eQian, Y., Shuai, L., Cao, Q., Chan, R. C., \u0026amp; Wang, Y. (2010). Do executive function deficits differentiate between children with attention deficit hyperactivity disorder (ADHD) and ADHD comorbid with oppositional defiant disorder? A cross-cultural study using performance-based tests and the behavior rating inventory of executive function. \u003cem\u003eClin Neuropsychol\u003c/em\u003e,\u003cem\u003e 24\u003c/em\u003e(5), 793-810. https://doi.org/10.1080/13854041003749342\u003c/li\u003e\n\u003cli\u003eRubia, K., Smith, A. B., Brammer, M. J., Toone, B., \u0026amp; Taylor, E. (2005). Abnormal brain activation during inhibition and error detection in medication-naive adolescents with ADHD. \u003cem\u003eAm J Psychiatry\u003c/em\u003e,\u003cem\u003e 162\u003c/em\u003e(6), 1067-1075. https://doi.org/10.1176/appi.ajp.162.6.1067\u003c/li\u003e\n\u003cli\u003eŞalvarlı, Ş. İ., \u0026amp; Griffiths, M. D. (2022). The Association Between Internet Gaming Disorder and Impulsivity: A Systematic Review of Literature. \u003cem\u003eInternational Journal of Mental Health and Addiction\u003c/em\u003e,\u003cem\u003e 20\u003c/em\u003e, 92-118.\u003c/li\u003e\n\u003cli\u003eSchachar, R., Mota, V. L., Logan, G. D., Tannock, R., \u0026amp; Klim, P. (2000). Confirmation of an inhibitory control deficit in attention-deficit/hyperactivity disorder. \u003cem\u003eJ Abnorm Child Psychol\u003c/em\u003e,\u003cem\u003e 28\u003c/em\u003e(3), 227-235. https://doi.org/10.1023/a:1005140103162\u003c/li\u003e\n\u003cli\u003eShaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J. P., Greenstein, D., . . . Rapoport, J. L. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. \u003cem\u003eProc Natl Acad Sci U S A\u003c/em\u003e,\u003cem\u003e 104\u003c/em\u003e(49), 19649-19654. https://doi.org/10.1073/pnas.0707741104\u003c/li\u003e\n\u003cli\u003eStevens, M. W., Dorstyn, D., Delfabbro, P. H., \u0026amp; King, D. L. (2021). Global prevalence of gaming disorder: A systematic review and meta-analysis. \u003cem\u003eAust N Z J Psychiatry\u003c/em\u003e,\u003cem\u003e 55\u003c/em\u003e(6), 553-568. https://doi.org/10.1177/0004867420962851\u003c/li\u003e\n\u003cli\u003eTreuer, T., F\u0026aacute;bi\u0026aacute;n, Z., \u0026amp; F\u0026uuml;redi, J. (2001). Internet addiction associated with features of impulse control disorder: is it a real psychiatric disorder? \u003cem\u003eJ Affect Disord\u003c/em\u003e,\u003cem\u003e 66\u003c/em\u003e(2-3), 283. https://doi.org/10.1016/s0165-0327(00)00261-5\u003c/li\u003e\n\u003cli\u003evan Goozen, S. H., Cohen-Kettenis, P. T., Snoek, H., Matthys, W., Swaab-Barneveld, H., \u0026amp; van Engeland, H. (2004). Executive functioning in children: a comparison of hospitalised ODD and ODD/ADHD children and normal controls. \u003cem\u003eJ Child Psychol Psychiatry\u003c/em\u003e,\u003cem\u003e 45\u003c/em\u003e(2), 284-292. https://doi.org/10.1111/j.1469-7610.2004.00220.x\u003c/li\u003e\n\u003cli\u003eVerbruggen, F., Aron, A. R., Band, G. P., Beste, C., Bissett, P. G., Brockett, A. T., . . . Boehler, C. N. (2019). A consensus guide to capturing the ability to inhibit actions and impulsive behaviors in the stop-signal task. \u003cem\u003eElife\u003c/em\u003e,\u003cem\u003e 8\u003c/em\u003e. https://doi.org/10.7554/eLife.46323\u003c/li\u003e\n\u003cli\u003eVert\u0026eacute;, S., Geurts, H. M., Roeyers, H., Oosterlaan, J., \u0026amp; Sergeant, J. A. (2006). The relationship of working memory, inhibition, and response variability in child psychopathology. \u003cem\u003eJ Neurosci Methods\u003c/em\u003e,\u003cem\u003e 151\u003c/em\u003e(1), 5-14. https://doi.org/10.1016/j.jneumeth.2005.08.023\u003c/li\u003e\n\u003cli\u003eWang, B. Q., Yao, N. Q., Zhou, X., Liu, J., \u0026amp; Lv, Z. T. (2017). The association between attention deficit/hyperactivity disorder and internet addiction: a systematic review and meta-analysis. \u003cem\u003eBMC Psychiatry\u003c/em\u003e,\u003cem\u003e 17\u003c/em\u003e(1), 260. https://doi.org/10.1186/s12888-017-1408-x\u003c/li\u003e\n\u003cli\u003eWeinstein, A., \u0026amp; Weizman, A. (2012). Emerging association between addictive gaming and attention-deficit/hyperactivity disorder. \u003cem\u003eCurr Psychiatry Rep\u003c/em\u003e,\u003cem\u003e 14\u003c/em\u003e(5), 590-597. https://doi.org/10.1007/s11920-012-0311-x\u003c/li\u003e\n\u003cli\u003eWeiss, M. D., Baer, S., Allan, B. A., Saran, K., \u0026amp; Schibuk, H. (2011). The screens culture: impact on ADHD. \u003cem\u003eAtten Defic Hyperact Disord\u003c/em\u003e,\u003cem\u003e 3\u003c/em\u003e(4), 327-334. https://doi.org/10.1007/s12402-011-0065-z\u003c/li\u003e\n\u003cli\u003eWhite, J. L., Moffitt, T. E., Caspi, A., Bartusch, D. J., Needles, D. J., \u0026amp; Stouthamer-Loeber, M. (1994). Measuring impulsivity and examining its relationship to delinquency. \u003cem\u003eJ Abnorm Psychol\u003c/em\u003e,\u003cem\u003e 103\u003c/em\u003e(2), 192-205. https://doi.org/10.1037//0021-843x.103.2.192\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2019). \u003cem\u003eInternational classification of diseases (11th ed.)\u003c/em\u003e. Geneva: World Health Organization. . https://doi.org/http:// icd.who.int/browse11/I-m/en.\u003c/li\u003e\n\u003cli\u003eXian-Yun, L. I., Phillips, M. R., Dong, X. U., Ya-Li, Z., Shao-Jie, Y., Yong-Sheng, T., \u0026amp; Zhi-Qing, W. J. C. M. H. J. (2011). Reliability and validity of an adapted Chinese version of Barratt Impulsiveness Scale.\u003c/li\u003e\n\u003cli\u003eYen, J. Y., Liu, T. L., Wang, P. W., Chen, C. S., Yen, C. F., \u0026amp; Ko, C. H. (2017). Association between Internet gaming disorder and adult attention deficit and hyperactivity disorder and their correlates: Impulsivity and hostility. \u003cem\u003eAddict Behav\u003c/em\u003e,\u003cem\u003e 64\u003c/em\u003e, 308-313. https://doi.org/10.1016/j.addbeh.2016.04.024\u003c/li\u003e\n\u003cli\u003eYOUNG, Kimberly, S. J. C., \u0026amp; Behavior. (2009). Internet Addiction: The Emergence of a New Clinical Disorder.\u003cem\u003e 1\u003c/em\u003e(3), 237-244.\u003c/li\u003e\n\u003cli\u003eZhang, Y., Mei, S., Li, L., Chai, J., Li, J., \u0026amp; Du, H. (2015). The Relationship between Impulsivity and Internet Addiction in Chinese College Students: A Moderated Mediation Analysis of Meaning in Life and Self-Esteem. \u003cem\u003ePLoS One\u003c/em\u003e,\u003cem\u003e 10\u003c/em\u003e(7), e0131597. https://doi.org/10.1371/journal.pone.0131597\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ADHD, ADHD co-morbid GD, inhibitory control, impulsivity, Internet addiction","lastPublishedDoi":"10.21203/rs.3.rs-4499645/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4499645/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eTo test whether inhibitory control and impulsivity are significant predictor of Internet addiction in adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD and whether the relationship between inhibitory control/impulsivity and Internet addiction is mediated by ODD in both groups.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e154 boys (ADHD, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;90; ADHD\u0026thinsp;+\u0026thinsp;GD, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;64) were tested on their inhibitory control, impulsivity, ODD, and Internet addiction. Regression analyses were used to test the predictive role of inhibitory control and impulsivity on Internet addiction. Moreover, mediation analyses were done to test whether ODD mediated the relationship between inhibitory control/impulsivity and Internet addiction.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBoth inhibitory control and impulsivity were significant predictors for Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD. In addition, inhibitory control and impulsivity had both direct and indirect effects via ODD on Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD. However, inhibitory control rather than impulsivity had indirect effects via ODD on Internet addiction in adolescents with ADHD.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe results of this study demonstrated that inhibitory control and impulsivity contributed to Internet addiction in adolescents with ADHD\u0026thinsp;+\u0026thinsp;GD. Furthermore, inhibitory control and impulsivity in two groups had different results in two models, suggesting different intervention strategies should be adopted for adolescents with ADHD and ADHD\u0026thinsp;+\u0026thinsp;GD.\u003c/p\u003e","manuscriptTitle":"Inhibitory Control, Impulsivity and Internet Addiction: Testing the Mediating Role of Oppositional Defiant Disorder Among ADHD Adolescents With and Without Gaming Disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-28 21:46:02","doi":"10.21203/rs.3.rs-4499645/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f413cc8-59af-43cf-bf66-6d62af7c86b1","owner":[],"postedDate":"June 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-07T07:09:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-28 21:46:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4499645","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4499645","identity":"rs-4499645","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}