Mark S. Kosins, M.D.
Mark S. Kosins, M.D.
Deborah J. Beaver, MS, LMFT
Deborah J. Beaver, MS, LMFT
Cindy Dupuie, MS
Cindy Dupuie, MS
Michael Roham, PA
Michael Roham, PA
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Mark Kosins MD & Michael Roham PA
302 N. El Camino Real #112
San Clemente, CA 92672
949 489 9898
Board Certified Psychiatrist
Professor of Psychiatry and Family Medicine
Western University of Health Sciences
We hope you know that we try to make your interaction with us a special experience. We are very committed to providing you with a kind and polite and respectful environment. When you engage our office on the phone with Ingrin  or Susan, we hope it is a helpful and pleasant experience. We hope that when you
come through the door you find a quiet, pleasant, and a safe environment. 
We are committed to seeing one person at a time, and we hope that you find the time spent with us demonstrates a sense of caring, is educational, and is compassionate. Any of you who know me know that I have tried to continually challenge
myself with new areas of knowledge dedicated to TO further complete myself as a physician. 
 Dr Kosins, Michael Roham PAC,  Ingrin Curry and Susan Villlasenor


With all the youth focussed on Digital Media, I thought this would be useful information.

MediaDigital Media and Symptoms of Attention-Deficit/Hyperactivity Disorder in Adolescents

JAMA. 2018;320(3):237-239. doi:10.1001/jama.2018.8932

Over the past 10 years, the introduction of mobile and interactive technologies has occurred at such a rapid pace that researchers have had difficulty publishing evidence within relevant time frames. While software applications such as Angry Birds and Pokémon Go reached adoption by an estimated 50 million global users within 35 and 19 days, respectively, of their release, most research studies encompass years from inception to publication of findings.1,2 As a result, crafting evidence-based recommendations that address all of the technologies children and adolescents currently use has been challenging.3 It is therefore an important contribution when a large, well-designed, longitudinal study accounting for multiple sociodemographic confounders is published.

Until recently, evidence of links between attention-deficit/hyperactivity disorder (ADHD) symptoms and media used was based on studies assessing television viewing and video gaming.4 A 2014 meta-analysis found a moderate correlation between media use and attention problems (R = 0.32) and a small but significant correlation with impulsivity (R = 0.11).5 However, television and gaming are sporadic activities because their devices are not always close at hand. By contrast, in 2018, 95% of adolescents reported having access to a smartphone (a 22-percentage-point increase from 2014-2015), and 45% said they were online “almost constantly.”5

In this issue of JAMA, Ra and colleagues6 explored current media-use behaviors by reporting the first longitudinal research on usage of new technologies and ADHD symptoms among adolescents. The authors surveyed adolescents in 10 Los Angeles, County, California, high schools over the course of 2 years. Among 2587 adolescents (age range, 15-16 years) without ADHD symptoms at baseline, high-frequency digital media use (defined as a past-week use of 14 different media activities, such as checking social media, liking or commenting on others’ posts, online browsing, or streaming videos many times a day) was associated with emergence of new ADHD symptoms. The mean number of the 14 digital media activities used at high frequency rate was 3.62. Youth who reported not engaging in media use at a high frequency at baseline had a lower rate of having ADHD symptoms (n=495, 4.6%) than did youth who had engaged in at least 7 activities (n=114, 9.5%) and youth who engaged in at least 14 activities (n=51, 10.5%) across follow-ups. However, ADHD symptom increases occurred at normative levels of digital media use (ie, 54.1% and 42.9% reported a high daily frequency of checking social media or browsing images or videos, which is consistent with the 44% of adolescents in a recent Pew internet survey stating that they go online several times a day).5 Although high-frequency media use was associated with only a 10% increased risk of later ADHD symptoms overall, associations were significantly stronger in boys and participants with more mental health symptoms.

The strengths of the study by Ra and colleagues include recruitment of a large, diverse sample from Los Angeles County high schools, as sociodemographic diversity has been a limitation of prior studies on digital media.7 The age range—from sophomore through junior years of high school—is a relevant age for social, cognitive, and academic development during which problematic internet use and gaming behaviors become a concern.8

The major limitation of the study, as acknowledged by the authors, is that the observed associations between media use and ADHD symptoms may be due to unmeasured confounders. Although the authors were able to adjust for income and mental health symptoms, they did not assess parent media use or whether the parents were involved in how the adolescents used media. Parent media use correlates with child media use,9 may interrupt parent-child activities,10 and is associated with child behavior difficulties in younger children.11 Adolescents with low to moderate media use in this study may have had parents who established more rules around media, such as setting device curfews, limited media use during homework, or talked with their child about the topics that children may experience through technology. Parents who are able to maintain this type of structure and involvement may themselves have fewer ADHD symptoms (and shared genetic risk with their children) or may provide more positive activities that allow children to build executive functioning skills.

Several novel mechanisms might explain the associations found in the study by Ra and colleagues. Prior associations between television viewing or video gaming and ADHD were attributed to violence exposure, arousal from fast-paced or violent content, or displacement of other activities that build attention span and executive functioning.4 Digital media is now designed with persuasive approaches meant to engage the user for longer periods, increase habit formation, or reward the user for repeated use.12 Therefore, additional cognitive mechanisms should be considered, including the experience of frequent attentional shifts and media multitasking, which has been associated with worse executive functioning in prior cross-sectional laboratory studies.13 As Ra and colleagues noted, instant access to highly engaging technologies may affect users’ impulse control and expectations for immediate feedback. Researchers have also hypothesized that the ubiquitous, “always-on” nature of mobile media displaces opportunities for the brain to rest in its default mode,14 tolerate boredom, or practice mindfulness. Attentional shifts triggered by notifications may reduce a child’s ability to stay focused on challenging, nonpreferred tasks that require top-down executive control. Displacement of sleep and exercise, both important to executive functioning,15 are also possible mechanisms that would explain the findings in this study.

Mechanisms involving media-induced emotional dysregulation as a cause of inattention and poor impulse control might also be considered as possible explanations for the findings. In the recent Pew internet survey, adolescents who reported feeling that the effect of media on humans was mostly negative cited interpersonal and emotional reasons such as bullying and rumor spreading, harm to relationships, unrealistic views of others’ lives, and peer pressure.5 The findings reported by Ra and colleagues that adolescents with more mental health symptoms showed stronger associations between media use and ADHD suggests that emotional dysregulation may be an important mechanism in some adolescents.

To explore novel mechanisms, however, studies will need to use methods that go beyond self-report. Studies of adolescent media use have started using unobtrusive browser loggers to capture social media behavior or rapid attentional shifts,16 passive sensing apps to examine diurnal patterns of mobile media use,17 or ecological momentary assessment to capture context and user emotional reactions to media.18 Because these methods have privacy implications and generate vast amounts of data, more research is needed to establish data analysis algorithms and standardized implementation approaches.

With more timely digital media research, parents may feel more confident in the evidence underlying recommendations for how to manage the onslaught of media in their households. The results reported by Ra and colleagues affirm the 2016 American Academy of Pediatrics guidelines to prioritize activities that promote adolescent executive functioning and well-being, including sleep, physical activity, distraction-free homework, and positive interactions with family and friends. Although not directly addressed by this study, the American Academy of Pediatrics recommendations for parent involvement in their adolescent’s media use—including discussions about prosocial uses of media, digital citizenship, misinformation, and persuasion awareness—are relevant to the cognitive and emotional reactions to digital media of adolescents.

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Article Information

Corresponding Author: Jenny Radesky, MD, University of Michigan School of Medicine, 300 N Ingalls St, 1107, Ann Arbor, MI 48108 (




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Mark Kosins, M.DTrained at University California Irvine-Graduated 1975-board certified-caring-willing to go the extra step to help you. He works closely with Michael Roham PA to provide comprehensive and quality care.

302 N. El Camino Real #112
San Clemente, CA 92672
 949 489-9898

To reach the office via e-mail, please click the Contact Us form on this website.  Thank you.

He specializes in innovative diagnosis and treatment planning for the full spectrum of emotional and psychiatric problems including DEPRESSION, ANXIETY  & PANIC DISORDERS, OCD, ADHD/ADD, BI POLAR, SUBSTANCE ABUSE  DISORDERS, EATING DISORDERS, FIBROMYALGIA AND PAIN SYNDROMES .

He can provide both psychotherapy and medication management, or can work with your therapist/ practitioner.
  He works closely with Michael Roham PA.

SKYPE visits now available when appropriate. My Skype name is mskosins.

Our approach is to combine conventional and (when appropriate and requested) alternative-holistic medicine using the most suitable method that will work best for you. Often this can reduce the need for high doses of medication. The bottom line is to do what will help you feel well with minimal or no side effects.

•   The patient gets a one-hour Psychiatric evaluation and often a nutritional evaluation as appropriate. The nutritional evaluation is generally done at a separate appointment.


IT’S NATURAL TO HAVE PROBLEMS, BUT DON’T WAIT TILL YOUR LIFE COMES APART. Dr Kosins has been treating patients ranging in age from 4 to 84 in Orange County for more than 20 years. Let him help you work toward a better life NOW. 

Send an e mail. call and ask a question, ( check me out further  ( or go to  or

See our nutritional health store at

Our approach is to combine conventional and alternative medicine using the modality that will work best for you. If you prefer only medications we can do that as well.  When appropriate, we use supplements to augment or replace the need for high doses of medication. At the same time, we will combine medications and or supplements based upon your symptoms and what you are comfortable with. We do not believe that you must comply with my plan for care. Instead, our approach is to partner with you regarding a plan of action that makes sense to you. We specialize in a wide variety of behavioral, learning and emotional problems for children, teenagers and adults with and without ADD/AHD. We also treat anxiety, depression, and bipolar disorder.

I have a reputation for evaluating and treating difficult diagnoses and chemical imbalances that may cause underachievement, school failure, depression, obsessive-compulsive disorders, bi-polar disorders, panic and anxiety, aggressiveness, and brain toxicity from drugs and/or alcohol abuse.

I work with a number of professionals on staff and in the community. These  professionals evaluate and treat a variety of  disorders, each specializing in specific areas of mental health ranging from stress, anxiety and depression to child, adolescent, family and geriatric therapy. This diverse expertise enables us to provide a broad range of quality mental health and other services to our community.

There are inexpensive genetic tests we can do to help determine which medicines will work best for you.

Mark Kosins, M.D. and Associates
302 N. El Camino Real
Suite 112

San Clemente, CA 92672
Phone: (949) 489-9898

Fax: (949) 489-2569

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Driving Directions


From the North:

 Get off at Palizada and go Right. Take Palizada two lights to El Camino Real and go Left on El Camino Real. My office is on the right two blocks down. 302 N. El Camino real  #112 San Clemente CA 92672.

Park in front or turn right on Miramir and park underneath.

 From the South:

Take 5 freeway north. Get of at Presidio and go left to El Camino Real. Turn right on El Camino Real and go about 1/2 mile (two blocks past Del Mar) and we are on the left.

We are in the big white Spanish building. Street Level. In Front.  #112.

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General Practice Info

We are currently welcoming new patients. 

Check out Mark Kosins MD on YouTube! And thanks for listening

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Office Hours

Our office hours are Monday through Thursday from 8:30 AM to 5:30 PM. Other times may be arranged by appointment.

No prescription refills are provided without a face to face visit. AHHD medications are the exception. We will give you enough meds till your next visit and refills. If you need a refill take your bottle or the prescription we gave you at your last visit to your pharmacy.Generally we must see you every three months at a minimum. 

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Insurances Accepted
At this time, Dr. Kosins is not affiliated with any insurance plans.  We can provide you with a "Superbill" at the end of your visit that you can submit to your insurance  for reimbursement, however, the amount that is reimbursed is entirely up to the discretion of your insurance company.


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Hospital Affiliation
Saddelback Memorial Hospital - Laguna HIlls

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