الفهرس 
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Abstract
According to the analysis of Worldwide digital population as in January 2021, there were 4.66 billion active internet users worldwide - 59.5 percent of the global population. Of this total, 92.6 percent (4.32 billion) accessed the internet via mobile devices.
During adolescence substantial changes occur in prefrontal cortex and the changes within dopamine and serotonin systems leading to engagement in impulse control disorders and the same pleasure and reward response responsible for the addictive behaviour. On the other hand, nowadays, computer use by adolescents is encouraged, and in some courses is required. Therefore, adolescents are considered as the most vulnerable group.
Types of Internet addiction are Internet addiction disorder (IAD), Internet Gaming Disorder (IGD), Social Media Disorder (SMD), Cybersex and internet pornography, Cyber-relationships, online stock trading or gambling and information surfing.
The considerable variance of the prevalence rates reported for IAD (between 0.3 % and 38 %). The estimated worldwide prevalence of adolescent internet addiction ranges between 1.6% and 36.7 %.
This study included 248 adolescent school students aged 11- 18 years old of both genders in Cairo, Egypt from International Schools. Data collection took place between May 2019 and August 2021 by convenient sampling.
The current study results represent the participants included in this study were 114 Male students (46 %) and 134 Female students (54 %) with average age of all students participating 14.9 years old with an average 5.04 hours spent online per day. Application of the tools was carried out in the sequence of; Section I tools: Young Internet Addiction test (IAT), Internet Gaming Disorder (IGD) Scale, Social Media Disorder (SMD) Scale and Youth Self report (YSR), then were interviewed to complete Section II tool: The Mini International Neuropsychiatric Interview for children and adolescents (Mini KID) assessment by the Psychiatrist to diagnose any comorbidities.
Regarding severity of Internet addiction, this study shows that severe internet addiction is 3.6 % in 9 adolescents, moderate internet addiction is 35.1 % in 87 adolescents, mild internet addiction is 42.3 % in 105 adolescents and non- internet addiction is 19 % in 47 adolescents.
Regarding Internet Gaming Disorder, this study shows that using the 9-item Internet Gaming disorder scale, the disordered gamers are 10.5 % which are 26 adolescents, the risky gamers are 31.5 % which are 78 adolescents, and the normal gamers were 58.1% which were 144 adolescents.
Regarding Social Media use, the existing study showed that prevalence of problematic social media disorder use was 34.3 % in 85 adolescents out of total 248 participants using Social Media Disorder 9-item scale.
Regarding Comorbid Psychiatric disorders, this study shows using the Mini-kid Psychiatric Interview questionnaire that the prevalence of the highest observed psychiatric disorders were Major Depressive episodes 9.3% followed by Generalized Anxiety disorder 7.7%, Alcohol dependence 4.4%, Attention Deficit Hyperactivity disorder 4.4%, Social phobia 4% and Dysthymia 3.2%. Accordingly, 92 students (37.1%) had psychiatric disorders in which 60 students (24.4%) had one psychiatric disorder and more than one psychiatric disorder or comorbidities are collectively 32 students (12.9 %) and also in comparison of presence of psychiatric disorders and severity of Internet addiction, Internet gaming disorder, Social Media disorder and the mean of hours spent online per day, this study shows a higher percentage of positive psychiatric disorders among severe internet addiction 88.9% and among moderate addiction 70.6%, disordered gamers 92.3%, problematic social media users 60%, and a higher mean of hours spent online per day of 6.8 hours per day. These finding in the current study regarding comparison between the mean of hours spent online per day and Mini-kid psychiatric disorders according to ICD-11 shows that a higher mean of hours spent online per day among cases with mood disorders 7 hours, among cases with anxiety disorders 7.3 hours, among cases with substance use disorders 7 hours and cases with ADHD 7.2 hours.
Regarding the most used types of applications, this study shows the highest mean percentage of spent time utilized in online activities on the Internet in social media, messaging application 59.7% followed by online shopping 13.2%, internet information surfing 10.3%, online gaming 6.3%. In Comparison between gender of students and the mean percentage online on Internet in different activities using Internet Application Checklist (IAC) and using different social media applications, It was noticed that a higher mean percentage of time is spent on checking of emails among females 10.5% , online gaming among males 16.1% , online shopping among females 7.2% , pornography among males 0.74% and regarding social media applications a higher mean usage of WhatsApp among males 14.1% and TikTok application among females 6.7% .
The number of students participating in this study during the year 2019 were 63 (25.4 %) before COVID-19 pandemic, during the year 2020 were 125 (50.4 %) and during the year 2021 were 60 (24.2 %) after COVID-19 pandemic. The COVID-19 pandemic increased the use of internet for both leisure activities and academic activities so due to the occurrence of COVID-19 during our data collection process the effect of COVID-19 pandemic was studied. The results regarding effect of COVID-19 on the study sample, leading to higher prevalence of moderate internet addiction in students examined after COVID-19 pandemic 37.3% and higher prevalence of severe addiction after pandemic 4.3%, while In comparison with Youth Self Report, shows a higher percentage of externalizing subscale behavioral traits (rule breaking behavior and aggressive behavior) among student after pandemic 13% and affected YSR Competencies leading to a higher percentage in extracurricular activities, social performance, and school performance among students after COVID-19 pandemic 38.9 %, 28.6%, and 30.3% respectively compared to students before COVID-19 pandemic. In comparison difference in the Mini Kid psychiatric disorders showing increase in number of positive overall cases 74 students (40%) after COVID-19 pandemic compared to 18 students (28.6%) before COVID-19 pandemic and in comparison between effect of COVID-19 pandemic and the mean percentage of time using different social media applications showing higher mean usage of Facebook before pandemic 12.5%, higher mean usage of Instagram before pandemic 11.1% and higher mean usage of TikTok application after pandemic 5.2%.
Regarding correlation data shows a highly significant positive correlation between Internet addiction severity and grades of Internet Gaming disorder and Problematic Social media disorder and shows a highly significant positive correlation between grades of internet addiction severity and the number of Mini Kid psychiatric disorders using spearman correlation coefficient.
Therefore, Problematic Internet use causes functional deterioration which is also evident by the Youth Self Report Competency scales affection, our study reported higher affection of extracurricular activities in severe internet addicts 100% and moderate internet addicts 70.1%, high affection of social performance in severe internet addicts 77.8% and moderate internet addicts 56.3% and higher affection of school performance in severe internet addicts 66.7% and moderate internet addicts 56.3%.
Limitations of this study:
First, obtaining approvals to perform studies in international schools was not easy. The researcher was able to only secure surveys from two schools. Moreover, the schools were located in Greater Cairo, hence results cannot be generalised to the rest of cities in Egypt, so we need more research in larger sample size and in different cities in Egypt.
Second, due to the unexpected fact of the COVID-19 epidemic situation that caused delay and difficulty in data collection therefore, impact of COVID 19 pandemic couldn’t be excluded and the researcher couldn’t reach the students during Lockdown peak usage time which was March 2020 to June 2020 that led to increase in the leisure online time then many schools resorted to online teaching which might have increased the online time for studying purposes