Association of emotional and behavioral problems with Internet addiction among children and adolescents: A prospective cohort study

The longitudinal associations between emotional and behavioral problems and Internet addiction, including how transitions between problem patterns influence risk, remain underexplored. This study investigated these associations using longitudinal data from 5123 primary and secondary school students in Jiangsu Province, China. Latent class analysis and latent transition analysis were applied to identify patterns and transitions in emotional and behavioral problems, and generalized estimating equations were used to examine their associations with subsequent Internet addiction. Emotional symptoms, conduct problems, hyperactivity/inattention, peer problems, and prosocial behavior were all significantly associated with Internet addiction. Three latent classes were identified: high difficulties, social difficulties, and low symptoms. The high difficulties group exhibited the greatest risk of Internet addiction. Compared with those maintaining stable classes, participants transitioning from the low symptoms class to the social difficulties or high difficulties classes showed elevated risks of Internet addiction (odds ratio OR = 2.37, 95% confidence interval CI = 1.58–3.55; OR = 5.62, 95% CI = 3.23–9.78). Conversely, those moving from the high difficulties class to the social difficulties or low symptoms classes had reduced risks (OR = 0.58, 95% CI = 0.36–0.94; OR = 0.28, 95% CI = 0.13–0.60). These findings suggest that both emotional and behavioral problems and their dynamic transitions are closely linked to Internet addiction risk in children and adolescents. Early identification, continuous monitoring, and timely interventions to promote positive transitions are critical for effective prevention.