Challenging Case: “Digital Addiction” in a Neurodivergent Adolescent

Adam is a 15-year-old boy who was born prematurely, with prenatal substance exposure, and was diagnosed in early childhood with combined-type attention-deficit hyperactivity disorder and oppositional defiant disorder. He was not found to meet criteria for fetal alcohol spectrum disorder. Despite treatment with stimulant medications and other adjunctive medications, Adam experienced ongoing difficulties with impulse control, sleep, and aggression. Adam was introduced to digital devices at an early age, resulting in unfiltered, poorly supervised, and prolonged screen exposure.Over time, Adam's digital use escalated into late-night gaming and engaging with social media platforms. Attempts by parents and other caregivers to apply parental controls were inconsistent because of family instability and ongoing caregiver substance use. Exposure to disturbing online content (including violence and conspiracy narratives) disrupted Adam's sleep and resulted in increased emotional lability, often triggering nightmares and severe irritability.The school also implemented restrictions on electronic device use (including phones and laptops). Related disciplinary consequences contributed to social stress and peer conflict. In addition, the patient disclosed a history of childhood sexual trauma, which occurred during unsupervised online interactions, further deepening his reliance on digital environments as a coping mechanism. Subsequent identification and treatment of posttraumatic stress disorder helped to alleviate some of the associated distressing emotional symptoms for Adam but did not alter his compulsive use of digital technology.Finally, when consistent efforts were made to limit Adam's screen time, it provoked severe mood dysregulation, aggressive outbursts, and even suicidal ideation.How can clinicians effectively manage digital addiction in a neurodivergent adolescent when restricting device use provokes severe emotional dysregulation and suicidal ideation?What multimodal treatment strategies can balance behavioral containment with trauma-informed care?How can families and clinicians collaboratively establish digital boundaries that promote recovery without triggering psychological destabilization?What does this case reveal about the need for early screening, prevention, and family education regarding digital addiction in neurodivergent youth?