ARTICLE REVIEW

PSYC6060 : Advance Statistics and Research Methods

Screening for Internet Addiction: An Empirical Study on Cut-off Points for the Chen Internet
Addiction Scale: A review
Siti Inarah Hashim
G1515658
Instructor: Dr. Jusmawati Fauzaman
Department of Psychology
International Islamic University Malaysia

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Ko, C. H., Yen, C. F., Yen, C. N., Yen, J. Y., Chen, C. C., & Chen, S. H. (2005). Screening for
Internet addiction: an empirical study on cut-off points for the Chen Internet Addiction Scale.
The Kaohsiung Journal of Medical Sciences, 21(12), 545-551.

Internet addiction (IA) is viewed as a serious threat for psychological and physical well
being especially among the adolescents in Taiwan. Henceforth, this study was conducted as a
form of refinement for the already psychometrically established Chen Internet Addiction Scale
(CIAS) to produce the best cut-off point scores for screening and diagnosing of this condition. In
the view of the seriousness of IA, the authors felt that there is a need for a less time consuming
and easily used tool for diagnosing IA particularly in dealing with a large sample size, as in
epidemiology study. Before this study was carried out, the gold standard for diagnosis is using
the case study interviews by health care practitioner which was deemed impractical due to its
time consumption. In this study, it is expected that the outcome of this research could marked
score points not just for the purpose of the diagnosing but for screening as well. This easily
access and time saving self report test will enable early detection and appropriate intervention
before the state of IA could worsen.
This psychometric-based mix-method research was conducted by randomly recruited a
sample number of 468 students from two junior high school and one senior high school. All of
the participants were subjected to both the survey form of CIAS and their clinical case history
was obtained via the Diagnostic Criteria of Internet Addiction (DC-IA) based interviews by
seven psychiatrist. DC-IA was established based on both gambling addiction and substance
abuse criteria from DSM-IV while the CIAS is a 26 items with 4 points scale measuring the five
dimensions of IA symptoms. Apart from descriptive statistics, the scores were also analyzed
using sensitivity, specificity, diagnostic accuracy, positive predictive rate, negative predictive

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rate, likelihood ratio for a positive and negative test, Cohens Kappa and diagnostic odd ratio.
After the optimal cut off points for both diagnosis and screening were obtained, the values were
further reconfirmed by performing Chi-Square test to compare the mean groups for case and
non-case in term of internet usage and demographic data using both screening and diagnosis cutoff points. After careful scrutinizing of this paper, one cannot deny the multi-stages complexity
of the statistical analyses, thus knowledge in statistics is essential should one interested for this
study replication. Otherwise, the research processes was explained quite explicitly although one
can say its easier said than done.
It was found that 19.8% of the participants were diagnosed with IA using the gold
standard medical interview by the psychiatrists. As expected, from the analysis of Cohen Kappa
(0.5), there was an optimal cut-off point for screening for the possible cases of IA. It was shown
that for screening purpose, the score more than 57/58 is considered the most favorable with high
sensitivity of 85.6%, and acceptable specificity of 78.6%. But more importantly, it was also
found that the cut-off point for diagnosis is 63/64 with diagnostic accuracy of 87.6%.
Furthermore, for the purpose of validating these test cut-off points, the scores were subsequently
divided into screening group and diagnosis group based scores where each group was further
classified into case group and non-case group. Comparison between these groups with their
demographic data was done using Chi-squared test (p<0.05); which interestingly showed the
participants in both screening and diagnosis case group were more likely to be males, use the
internet every day, use 20 or more hours weekly on internet use, and involved in online games.
This again consolidated the evidence that CIAS can be used confidently as a screening and
diagnostic tool for IA especially in large scale research. Clinicians also wont have to rely on

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clinical case interviews which are more time consuming although it remains the gold standard in
diagnosing IA.
It was suggested in the conclusion that CIAS is to be used as a screening instrument for
IA in clinical setting and epidemiology research based on the statistical findings as discussed in
earlier part of this review. Apart from the significant and valid statistical outcomes, the
generalization was based on the adequacy of sample size and the random method by which it was
obtained. However, this will only be applicable in their local setting (Taiwan) as due to cultural
differences, one may have to validate and provide reliability measure to ensure compatibility for
adaption of this test. It was also suggested that further researches are to be done in exploring the
gender differences (males are more prone to get IA) and the online gaming tendencies in the
future, as this was left unexplained at the end of this research. Other than this, suggestion of
using long term observers (such as teachers or parents) for validating these cut-off scores should
also being considered, probably due to higher reliability of the information they may provide.
Apart from possible replication and adaptation in another culture, the outcome of this
study might enable exploration of factors related to IA (risk factors, prevalence, management and
others) to greater expanse. Nevertheless, one should always keep in mind that until this day we
are still lacking the formality of diagnostic criteria of IA, as DC-IA is merely a modification
based on gambling addiction and substance abuse in DSM-IV. Since DC-IA is used as a
benchmark in the process of obtaining the cut-off points in this research, one should question
whether it really encompassed the whole conceptualization idea of IA. The author also compared
CIAS with the most widely used Young Internet Addiction test (IAT) in the way that IAT failed
to provide empirical based cut-off point for diagnosis. Nonetheless, it should be noted that IAT is
more accessible to a wider age group as opposed to CIAS which being limited to only adolescent

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as the test takers. Despite these limitations, the adaptation of CIAS into Malaysian culture will
provide a convenient mean of mass screening and diagnosis of IA cases, since more and more
negative cultures associated with internet usage were reported among our youngsters nowadays.
One cannot deny the importance of the outcome of this study especially by looking at the
larger picture concerning the problem of IA. In order to delve deeper into a problem, as the first
step one must have means in identifying it. Fortunately in addressing the problem of IA in
Taiwan, this study had provided the first step needed to guide further researches in this matter. It
would signify greatly should interventions is developed and empirically studied in providing the
right course of actions in handling this phenomena. By looking at the rise of internet usage and
dependency in Malaysia, it is high time for us to follow their footsteps by looking into this
seemingly increasing problematic situation and establish the appropriate prevention and
intervention before it could get worse.