Addictive Behaviors 39 (2014) 677–683

Contents lists available at ScienceDirect

Addictive Behaviors

Cognitive flexibility in internet addicts: fMRI evidence from

difficult-to-easy and easy-to-difficult switching situations
Guangheng Dong a,⁎, Xiao Lin a, Hongli Zhou a, Qilin Lu b
a
Department of Psychology, Zhejiang Normal University, Jinhua City, Zhejiang Province, PR China
b
School of Life Science, University of Science and Technology of China, Hefei, Anhui Province, PR China

H I G H L I G H T S

• IAD subjects engaged more endeavors in executive control.

• IAD subjects engaged more endeavors in attention shifting.
• IAD subjects show impaired cognitive flexibilities than healthy controls.

a r t i c l e i n f o a b s t r a c t

Keywords: Internet addiction disorder (IAD) has raised widespread public health concerns. In this study, we explored the
Internet addiction cognitive flexibility in IAD subjects using a color–word Stroop task. Behavioral and imaging data were collected
Cognitive flexibility from 15 IAD subjects (21.2 ± 3.2 years) and 15 healthy controls (HC, 22.1 ± 3.6 years). Group comparisons
Attention shifting found that IAD subjects show higher superior temporal gyrus activations than healthy controls in switching
Executive control (easy to difficult; difficult to easy) than in repeating trials. In addition, in difficult-to-easy situation, IAD subjects
show higher brain activation in bilateral insula than healthy controls; in easy-to-difficult situation, IAD subjects
show higher brain activation in bilateral precuneus than healthy controls. Correlations were also performed
between behavioral performances and brain activities in relevant brain regions. Taken together, we concluded
that IAD subjects engaged more endeavors in executive control and attention in the switching task. From another
perspective, IAD subjects show impaired cognitive flexibilities.
© 2013 Elsevier Ltd. All rights reserved.

1. Introduction Cognitive flexibility (also termed task switching or mental-shifting

Internet addiction disorder (IAD) (also as problematic internet use;
high internet use) is characterized as excessive or uncontrolled internet
use with negative consequences for aspects of psychological, social and/
or work difficulties (Young, 1998). IAD is often conceptualized as a ‘be-
havioral addiction’ since its proposed diagnostic criteria closely parallel
to substance use disorders and pathological gambling, although IAD is
not formally included in the current edition of the Diagnostic and Statis-
tical Manual of Psychiatric Disorders (DSM-IV) (Block, 2008). IAD has
increasingly raised widespread public health concerns (Dong, Lu,
Zhou, & Zhao, 2011; Kim et al., 2010; Niemz, Griffiths, & Banyard,
2005; Young, 1998). However, the neurobiological underpinnings of
this disorder have received less study (Block, 2006; Dong, Devito, Du,
& Cui, 2012; Dong, Lu, Zhou, & Zhao, 2010; Liu & Potenza, 2007; Yuan,
Qin, Liu, & Tian, 2011).
⁎ Corresponding author at: Department of Psychology, Zhejiang Normal University, 688
Yingbin Road, Jinhua, Zhejiang Province 321004, PR China. Tel.: +86 15867949909.
E-mail address: dongguangheng@zjnu.edu.cn (G. Dong).
ability) is the mental processes that people reconfigure mental
resources in an alternating sequence. This ability allows a person to
adapt to different situations rapidly and efficiently (Hampshire &
Owen, 2006; Loose, Kaufmann, Tucha, Auer, & Lange, 2006). It is gener-
ally assumed that the act of switching is sub-served by a set of functions
to complete the task (Logan & Gordon, 2001). When we shift from one
type of task to another, extra executive functions should be involved in
completing this process. Previous studies have found that IAD subjects
show impaired executive control ability (Dong, Devito, Du, et al.,
2012; Dong, Hu, Lin, & Lu, 2013; Dong, Shen, Huang, & Du, 2013;
Dong, Zhou, & Zhao, 2011; Lee et al., 2012; Mazhari, 2012; Zhou, Yuan,
& Yao, 2012) and decreased functional brain connectivity (Hong et al.,
2013; Lin et al., 2012) than healthy controls. Based on these results,
the impaired cognitive flexibility could be expected in IAD subjects.
However, studies also show that long time game playing enhanced
the brain synchronization in sensory–motor coordination (Dong,
Huang, & Du, 2012) and visual–spatial processing related brain regions
(Dong, Devito, Huang, & Du, 2012). From this point of view, task-
switching ability in IAD might be enhanced by the long time online
‘trainings’. These two inferences based on previous studies seem

0306-4603/$ – see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.addbeh.2013.11.028
678 G. Dong et al. / Addictive Behaviors 39 (2014) 677–683
contradicting. Thus, it is necessary to explore the task switching ability
in IAD subjects, to test which of these hypotheses is right and observe
the neural mechanisms under this process.
Plenty relevant functional neuroimaging literatures have confirmed
the importance of brain activity in frontal cortex regions when a mental
set switch is required (Buchsbaum, Greer, Chang, & Berman, 2005;
Wager, Jonides, & Reading, 2004). Two meta-analysis papers
(Buchsbaum et al., 2005; Wager et al., 2004) noted evidence across
studies found that anterior cingulate, sensorimotor regions, superior
temporal cortex, insula, thalamus, and striatum (Braver, Barch, Gray,
Molfese, & Snyder, 2001; Casey et al., 2004; Kim et al., 2012; Rubia
et al., 2006; Smith, Taylor, Brammer, & Rubia, 2004) are involved in
mental switching tasks. The widely activated brain regions suggest
that task switching is a task considered an executive demand integrat-
ing several cognitive operations. Based on the features of the task,
we speculated that at least two cognitive operations should be included:
First, the executive function, which involves the frontal network
(e.g., lateral prefrontal cortex, anterior cingulate cortex) (Eisenberg &
Berman, 2010; Pardo, Pardo, Janer, & Raichle, 1990) should show
some differences among different groups. Previous studies have already
found that IAD subjects show impaired inhibitory control and error
monitoring ability (Dong, Devito, Du, et al., 2012; Dong, Shen, et al.,
2013; Dong, Zhou, et al., 2011; Lee et al., 2012; Mazhari, 2012; Zhou
et al., 2012) than healthy controls. Thus, we first hypothesize that IAD
subjects show impaired cognitive flexibility than healthy controls,
which can be indexed by higher activated networks in executive func-
tion. Second, at a behavioral level, task switching is associated with a
‘switch cost’ (such as increased reaction times and error rates on switch
trials relative to repeat trials) reflecting enhanced cognitive or attention
demands (Monsell, 2003). Thus, the cognitive demand related brain re-
gions (such as dorsal lateral prefrontal cortex (DiGirolamo et al., 2001;
Smith et al., 2004)) and attention demand related brain areas (such as
precuneus (Remijnse et al., 2013) and parietal cortex (Sohn, Ursu,
Anderson, Stenger, & Carter, 2000)) should show some difference
among different group participants.
2. Methods
2.1. Participant selection
The experiment conforms to The Code of Ethics of the World Medical
Association (Declaration of Helsinki). The Human Investigations
Committee of Zhejiang Normal University approved this research.
Participants were university students and were recruited through ad-
vertisements. Participants were right-handed males (15 IAD subjects,
15 healthy controls (HC)). IAD and HC did not significantly differ
in age (IAD mean = 21.6, SD = 3.0 years; HC mean = 22.4, SD =
3.3 years; t(29) = 0.95, p N 0.05). Only males were included due to
higher IAD prevalence in men than women. All participants provided
written informed consent and underwent structured psychiatric inter-
views (M.I.N.I.) (Lecrubier et al., 1997) performed by an experienced
psychiatrist with an administration time of approximately 15 min. The
M.I.N.I. was designed to meet the need for a short but accurate struc-
tured psychiatric interview for multicenter clinical trials and epidemiol-
ogy studies. All participants were free of Axis I psychiatric disorders
listed in M.I.N.I. Depression was further assessed with the Beck Depres-
sion Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and
only participants scoring less than 5 were included. IAD and HC did
not fulfill DSM-IV criteria for abuse or dependence of substances, includ-
ing alcohol, although all IAD and HC participants reported alcohol
consuming in their lifetime. All participants were medication free and
were instructed not to use any substances of abuse, including coffee,
on the day of scanning. No participants reported previous experience
with illicit drugs (e.g., cocaine, marijuana).
Internet addiction disorder was determined based on Young's online
internet addiction test (IAT) (Young, 2009) scores of 80 or higher (This
cut-off is much stringent than the proposed 50 in Young's criteria.
Young's IAT consists of 20 items associated with online internet use in-
cluding psychological dependence, compulsive use, withdrawal, related
problems in school or work, sleep, family or time management. The IAT
was proved to be a valid and reliable instrument that can be used in
classifying IAD (Widyanto, Griffiths, & Brunsden, 2011; Widyanto &
McMurran, 2004). For each item, a graded response is selected from
1 = “Rarely” to 5 = “Always”, or “Does not Apply”. Scores over 50 indi-
cate occasional or frequent internet-related problems and scores over
80 mean ‘Your Internet usage is causing significant problems in your
life’) (www.netaddiction.com).
Internet addiction consists at least three subtypes: internet gaming
addiction (IGA), sexual preoccupations, and email/text messaging
(Block, 2006). In China, the most important subtype of IAD is IGA
(Dong, Huang, & Du, 2011; Dong, Shen, et al., 2013; Ko et al., 2013).
Thus, in present study, we only paid attention to the IGA subjects. We
added some specific limitations on Young's established measures of in-
ternet addiction, such as ‘you spend most of your time playing online
games (N 80%)’.
2.2. Task and procedure
Although there are many task switching paradigms, we decided to
use the classical color–word Stroop task in present study. The reasons
are: First, there are only a few features changed between congruent
and incongruent trials in Stroop task. The task difficulties might change
a lot in different trials. We can create specific task switching situations
easily (such as from difficult to easy, from easy to difficult). Second,
it's very hard for participants to find our real goal, we can manipulate
the whole process and make them focusing on the task. Third, the re-
sults might be easily explained because the Stoop task has been widely
used in cognitive neuroscience studies.
An event-related color–word Stroop task was used in our study.
Three target color words (e.g. red, green, yellow) were presented in
congruent (e.g., the word “RED” in red ink) or incongruent (e.g., the
word “RED” in green ink) trials. The task was comprised of 2 sessions
of 120 trials each. Each trial was presented for 2000 ms. Participants
were asked to press a button to indicate to the ink color of the
word as soon as possible using three buttons (i.e., green = thumb,
red = index finger, yellow = middle finger; counter-balanced be-
tween subjects) of a five-button response box (Invivo Corp.; http://
www.invivocorp.com/). A black screen was presented for a random in-
terval of 600–1400 ms (average 1000 ms) between trials (Fig. 1a).
Stimuli were presented and behavioral data were collected using
E-prime software (Psychology Software Tools, Inc.). Participants were
told that they would be paid a guaranteed 50 Yuan (≈8 US$) for partic-
ipation and, to encourage quick and accurate task performance, were
told they would be rewarded with an additional 0–50 Yuan based on
their task performance [1 / (reaction time ∗ error rate)]. Participants
completed an out-of-scanner practice session which continued until
they reached an accuracy rate of 90% or higher.
Although participants were told to perform a totally randomized
task, in fact, all trials were predetermined (pseudo-random design).
We created four types of conditions with this method: (1) Congruent
trial follows congruent trial (Con_Con); (2) congruent trial follows in-
congruent trial (Incon_Con); (3) Incongruent trial follows incongruent
trial (Incon_Incon); (4) Incongruent trial follows congruent trial
(Con_Incon) (Fig. 1b).
2.3. Image acquisition and pre-processing
Structural images covering the whole brain were collected using a T1-
weighted three-dimensional spoiled gradient-recalled sequence (176
slices, TR = 1700 ms, TE = 3.93 ms, slice thickness = 1.0 mm,
skip = 0 mm, flip angle = 15°, inversion time 1100 ms, field of
view = 240 ∗ 240 mm, in-plane resolution = 256 ∗ 256). Functional
 G. Dong et al. / Addictive Behaviors 39 (2014) 677–683 679

Fig. 1. The timeline of one trial and four conditions we created in the present study

a, The timeline of one trial in the Stroop task in the present study.
b, Four conditions we created by manipulating the sequence of congruent and incongruent trials in the present study.

MRI was performed on a 3 T scanner (Siemens Trio) with a gradient-echo
EPI T2 sensitive pulse sequence in 33 slices (interleaved sequence, 3 mm
thickness, TR = 2000 ms, flip angle 90°, field of view 220 × 220 mm2,
matrix 64 × 64). Stimuli were presented using Invivo synchronous
system (Invivo Company, www.invivocorp.com/) through a screen in
the head coil, enabling participants to view the stimuli.
2.4. First-level regression analysis
Imaging analysis was conducted using SPM5 (http://www.fil.ion.ucl.
ac.uk/spm). Images were slice-timed, reoriented, and realigned to the
first volume. T1-co-registered volumes were used to correct for head
movements. Images were then normalized to an MNI space (defined
by Montreal Neurological Institute) and spatially smoothed using a
6 mm FWHM Gaussian kernel. A general linear model (GLM) was ap-
plied to identify blood oxygen level dependence (BOLD) activation in
relation to separate event types. There were three types of trials: WIN,
LOSS and CONTROL. Six head-movement parameters derived from the
realignment stage were included to exclude motion related variances.
GLM was independently applied to each voxel to identify voxels that
were significantly activated for the each event that was modeled.
2.5. Second-level analysis
2.6. Correlation analysis
Correlation analyses were calculated between brain activities and
the behavioral performances to support our hypothesis. We calculated
three correlations: correlations between the brain activities (peak beta
value) in superior temporal gyrus in Con_Incon and Incon_Con
conditions and Stroop effect in the task (RT in incongruent trials
minus congruent trials), separately; correlation between the peak activ-
ities (peak beta value) in bilateral precuneus (mean peak values) and
the switch cost (RT in Con_Incon minus Incon_Incon) in all subjects.
3. Results
3.1. Behavioral performance
Behavioral results were performed using 2 (inter-group: IAD, HC) ∗ 3
(inner-group: incongruent, congruent) repeated measure analysis. We
paid attention to the group difference (IAD vs. HC) in different situations.
Although IAD subjects need longer reaction time than healthy controls in
all conditions, none of them reached statistical significance. In switch cost
(Incon_Con N Con_Con; Con_Incon N Incon_Incon), IAD subjects need
longer time than healthy controls, however, these differences also did
not reach statistical significance (Table 1).

Second level analysis treated inter-subject variability as a random Table 1

effect. First, we determined voxels showing a main effect in different Behavioral performances in different situations among IAD and healthy controls.
conditions relative to implicit baseline. Second, we tested for voxels
Group Mean (ms) Std. deviation F Sig.
that showed higher or lower activity in two contrasts of interest
(Incon_Con N Con_Con; Con_Inco N Incon_Incon). We first identified Con–Con HC 601.53 106.875 .250 .621
IAD 625.68 153.552
clusters of contiguously significant voxels at an uncorrected threshold Incon–Con HC 721.78 143.038 1.160 .291
p b 0.05, as also used for display purposes in the figures. We then tested IAD 768.49 174.071
these clusters for cluster-level FWE correction p b 0.05 and the AlphaSim Con–Incon HC 621.53 105.174 .645 .429
estimation indicated that clusters with 90 contiguous voxels would IAD 676.80 168.689
Incon–Incon HC 723.93 157.885 .533 .471
achieve an effective FWE threshold p b 0.05. The smoothing kernel used
IAD 770.34 188.860
during simulating false-positive (noise) maps using AlphaSim was Task switching
6.0 mm, and was estimated from the residual fields of the contrast Incon_Con N Con_Con HC 120.25 57.164 .740 .397
maps being entered into the one-sample t-test. The formula used to com- IAD 142.81 83.909
pute the smoothness is that used in FSL (see http://www.fmrib.ox.ac.uk/ Con_Incon N Incon_Incon HC −102.40 77.999 .111 .741
IAD −93.54 67.118
analysis/techrep/tr00df1/tr00df1/node6.html for more information).
680 G. Dong et al. / Addictive Behaviors 39 (2014) 677–683

3.2. Imaging results
BOLD data for task switching demonstrated significant between-
group differences. Using the whole-brain corrected threshold, we
compared the difference between IAD and healthy controls in different
switching situations.
3.2.1. Task switching: from difficult to easy (Incon_Con N Con_Con)
In Incon_Con N Con_Con, IAD subjects show higher brain activations
in bilateral insula and right superior temporal gyrus (STG) than healthy
controls (Fig. 2a, Table 2). Beta figures showed that the difference in STG
was caused by the enhanced brain activity in Incon_Con in IAD; the dif-
ference in bilateral insula was caused by the enhanced brain activity in
Con_Con and decreased activations in Incon_Con in IAD (Fig. 2c1, c2,
c3). Significant positive correlation was found between the brain
activities (peak value) in STG in Incon_Con and the Stroop effect (RT
in incongruent minus congruent) in all trials (r = 0.370, p = 0.044)
(Fig. 2b).
3.2.2. Task switching: from easy to difficult (Con_Incon N Incon_Incon)
In the comparison between Con_Incon and Incon_Incon, IAD sub-
jects show higher brain activation in bilateral precuneus, left STG and
angular gyrus (peaked in STG) (Fig. 3a, Table 2). Beta figures showed
that the difference in STG was caused by the enhanced brain activation
in Con_Incon in IAD; the difference in precuneus was caused by en-
hanced brain activation in Con_Incon in IAD (Fig. 3c1, c2). Significant
negative correlation was found between the brain activities (peak
value) in precuneus in Incon_Con and the switch cost (RT in Con_Incon
minus Incon_Incon) in all subjects (r = 0.449, p = 0.013). Although
the correlation between the brain activities (peak value) in STG in
Con_Incon and the Stroop effect (RT in incongruent minus congruent)
(r= 0.302, p = 0.105) did not reach statistical significance, the positive
trend is obvious (Fig. 3b1, b2).
4. Discussion
This study investigated the task switching ability in IAD subjects
using a Stroop task. The results provide us more knowledge in under-
standing the cognitive flexibility of IAD.
4.1. Inhibitory control during task switching
Inconsistent with our hypothesis, no prefrontal brain regions showed
significant difference between IAD and HC. Interestingly, the STG

Fig. 2. Group differences in imaging results when comparing Incon_Con to Con_Con.

a, The imaging results showed that IAD subjects show higher brain activation in right STG and bilateral insula.
b, Correlation between brain activation in STG in Incon_Con and Stroop effect of all trials.
c1, c2, c3, Beta figs. of the survived cluster in different conditions in IAD and HC.
 G. Dong et al. / Addictive Behaviors 39 (2014) 677–683 681

Table 2
Regional brain activity changes in different comparisons.

x, y, z a Hemisphere Peak intensity Number of voxelsb Regionc Brodmann's area

IAD (Con_Con N Incon_Con)–HC (Con_Con N Incon_Con)

Higher activated

42, −9, −6 R 4.72 465 Insula 13

−33, −6, 6 L 3.85 202 Insula 13
66, −24, 21 R 3.62 94 Superior_Temporal_Gyrus 42

IAD (Con_Incon N Incon–Incon)–HC(Con_Incon N Incon–Incon)

Higher activated

2, −51, 45 R 4.01 114 Precuneus 7, 31

−1, −48, 42 L 4.23 103 Precuneus 7, 31
−36, −57, 30 L 3.83 165 Superior_Temporal_Gyrus 39
Angular gyrus
a
Peak MNI coordinates.
b
We first identified clusters of contiguously significant voxels at an uncorrected threshold p b 0.05, as also used for display purposes in the figures. We then tested these clusters for
cluster-level FWE correction p b 0.05 and the AlphaSim estimation indicated that clusters with 90 contiguous voxels would achieve an effective FWE threshold p b 0.05. Voxel
size = 3 ∗ 3 ∗ 3.
c
The brain regions were referenced to the software Xjview (http://www.alivelearn.net/xjview8) and double checked with atlas.

displayed higher activation in IAD subjects compared to matched controls control in Stroop task. The STG has been found activated when inhibitory
in switching trials (Incon_Con N Con_Con; Con_Inco N Incon_Incon). The control was applied (Braver et al., 2001; Garavan, Ross, Murphy, Roche, &
STG was found activated during task shifting (Buchsbaum et al., 2005; Stein, 2002; Garavan, Ross, & Stein, 1999; Kiehl & Liddle, 2001). Further-
Wager et al., 2004), which is supposed to be responsible for inhibitory more, studies showed that cocaine-dependent patients showed lower

Fig. 3. Group differences in imaging results when comparing Con_Incon to Incon_Incon.

a, The imaging results showed that IAD subjects show higher brain activation in left STG and bilateral precuneus.
b1, Correlation between brain activation in STG in Con_Incon and Stroop effect of all trials.
b2, Correlation between brain activation in precuneus (mean peak value) in Con_Incon N Incon_Incon and switch cost (RT in Con_Incon N Incon_Incon) of all trials.
c1, c2, Beta figs. of the survived cluster in different conditions in IAD and HC.
682 G. Dong et al. / Addictive Behaviors 39 (2014) 677–683
gray matter density in STG than healthy controls (Franklin et al., 2002;
Sim et al., 2007). To make sure if the STG activations were caused by in-
hibitory process in this study, we performed correlation analyses between
STG activations and Stroop effect. The correlations in different switching
situations support the conclusion that STG activation in this study is relat-
ed with executive function. In present study, IAD subjects show higher
STG activation than healthy controls in both switching situations, which
suggests that IAD subjects engaged more endeavors than healthy controls
during the same task. From another perspective the inhibitory control
ability in IAD subjects is impaired, which is consistent with previous
literatures (Dong, Devito, Du, et al., 2012; Dong, Shen, et al., 2013; Dong,
Zhou, et al., 2011; Lee et al., 2012; Mazhari, 2012; Zhou et al., 2012).
4.2. Attention demands during task switching
Consistent with our hypothesis, IAD subjects show enhanced activa-
tion in attentional-demand related brain regions: Higher precuneus
activation was found in switching trials (Con_Incon) than in repeating
trials (Incon_Incon) when comparing IAD subjects to healthy control.
The results suggest that the activation was greater in switching than
repeating process in incongruent situation.
The precuneus activations during task switching have been pro-
posed to reflect attentional demands. The precuneus is near the superior
posterior parietal area (Gurd et al., 2002) implicated in the control of
attentional switching, and switching attention between visual attri-
butes (Le, Pardo, & Hu, 1998). Previous studies found that the precuneus
activities reflect increased visual attention due to more difficult task
demands (Barber & Carter, 2005; Remijnse et al., 2013). Studies on cog-
nitive inflexibility found lower precuneus activities in major depression
subjects which reflected deficits in attention control (Remijnse et al.,
2013). Astafiev found that the precuneus was more active in challenging
task than in simple task (Astafiev et al., 2003). All these results suggest
that precuneus activity increases with the attentional demands for
detection of stimuli. In this study, the correlation between precuneus
activation and the switch cost (RT in Con_Incon N Incon_Incon) also
supports the conclusion that precuneus activation in this study is
related with shifting ability. IAD subjects show enhanced precuneus ac-
tivation than healthy controls, which means that IAD subjects engaged
more endeavor in attentional shifting during the switching process
than healthy controls. From another perspective of view, IAD subjects
show impaired attention shifting ability than healthy controls.
4.3. Emotional experience during task switching
Another robust brain activation in Incon_Con N Con_Con is the
insula. IAD subjects show higher bilateral insula activations than HCs
in this comparison. This means that the insula activation was greater
in IAD subjects during switching than repeating trials in congruent
conditions. Previous studies on cognitive flexibility also found the insula
activated during task switching (Buchsbaum et al., 2005; Wager et al.,
2004). The insula is important for its role in subjective emotional expe-
rience. Functional imaging experiments have revealed that the insula
has an important role in the experience of a number of basic emotions
(Dong, Hu, & Lin, 2013; Gu, Liu, Van Dam, Hof, & Fan, 2013; Krawitz,
Fukunaga, & Brown, 2010). The higher insula activation in this study
suggests that participants experienced higher emotion than healthy
controls during this comparison.
4.4. Limitations
Studies showed that individuals who are suffering IAD might be re-
lated with a range of co-morbid psychological symptoms (Dong, Lu,
et al., 2011), such as depression (Guo et al., 2012), social isolation and
low self-esteem (Bernardi & Pallanti, 2009), and autism (Romano,
Osborne, Truzoli, & Reed, 2013). Romano et al., found correlations
between autism quotient (Baron-Cohen, Hoekstra, Knickmeyer, &
Wheelwright, 2006) and IAT scores, which suggests that those with
higher autism quotient scores would be over-represented in IAD
(Romano et al., 2013). Thus, the differences in task switching in
different groups might be caused by their higher or lower autism quo-
tient scorers. Future studies should measure all these psychological
symptoms in IAD subjects and take them into the final analysis.
5. Conclusion
We divided the switching process into several subtype mental
processes and found that IAD subjects engaged more endeavors in exec-
utive control and attention shifting during the same switching tasks.
Taken all, we conclude that IAD subjects show impaired cognitive
flexibility than healthy controls. The impaired cognitive flexibility can
also be found in people with other types of behavioral addictions. Stud-
ies found impairments in cognitive flexibility in problematic gambers
(Grant, Odlaug, Chamberlain, & Schreiber, 2012; Ledgerwood et al.,
2012; Mooney, Odlaug, Kim, & Grant, 2011; Odlaug, Chamberlain,
Kim, Schreiber, & Grant, 2011) and obese individuals (Duchesne et al.,
2010) relative to matched healthy volunteers. All these results suggest
that IAD shows great similarities to other addictive behaviors.
Role of funding sources
The funder had no further role in study design; in the collection, analysis and interpre-
tation of data; in the writing of the report; or in the decision to submit the paper for
publication.
Contributors
Dr. Guangheng Dong conducted the study design, supervised analyses and completed
the manuscript writing; Xiao Lin and Hongli Zhou contributed to data interpretation, and
preparation/presentation of tables/figures; Dr. Qilin Lu contributed to data analysis. All
authors approved the final version of the manuscript.
Conflict of interest
The authors have indicated that they have no personal financial relationships or
conflict of interest relevant to this article to disclose.
Acknowledgments
This research was supported by National Science Foundation of China (31371023).
The author thanks Yanjie Li from Yale for her help in manuscript preparation.
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