Addictive Behaviors 110 (2020) 106540

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Addictive Behaviors
journal homepage: www.elsevier.com/locate/addictbeh

Validation of smartphone addiction scale – Short version (SAS-SV) in T

Brazilian adolescents
⁎
André Luiz Monezi Andradea, , Adriana Scatenab, Gabriella Di Girolamo Martinsa,
Bruno de Oliveira Pinheirob, Andressa Becker da Silvac, Carla Cristina Enesa,
Wanderlei Abadio de Oliveiraa, Dai-Jin Kimd
a
Center of Life Science, Pontifical Catholic University of Campinas, Campinas, Brazil
b
Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, Brazil
c
Department of Psychology, University of Sorocaba, Sorocaba, Brazil
d
Department of Psychiatry, The Catholic University of Korea, Seoul, Republic of Korea

H I GH L IG H T S

• This is the first study on the adaptation and validation of a smartphone addiction scale to adolescents in Brazil.
• We detected a prevalence of 53.2% of adolescents with problematic smartphone user.
• SAS-SV showed a very good reliability, temporal stability, predictive and convergent validity.
• Problematic smartphone users by order: tolerance, withdrawal and preoccupation.

A R T I C LE I N FO A B S T R A C T

Keywords: The objectives of this study were to analyze the psychometric properties of the Smartphone Addiction Scale –
Adolescent Short Version (SAS-SV) as follows: (i) the factor structure of the SAS-SV using different statistical methods; (ii)
Additive behavior the evidence of convergence; (iii) the temporal stability of the SAS-SV; and (iv) predictive SAS-SV validity. A
Addiction total of 451 adolescents participated in this study (age M = 13.1; SD = 1.22) by completing a sociodemographic
Smartphone
questionnaire (including items evaluating the perception of smartphone use), the Internet Addiction Test (IAT),
Internet
and the SAS-SV. It was found that 53.2% demonstrated problematic smartphone use. The SAS-SV showed good
reliability (α = 0.81; ω = 0.78), and all of its items were kept. The network analysis indicated that the items
evaluating the withdrawal and preoccupation symptoms had the greatest influence on the network. The in-
traclass correlation coefficient was 0.846 and indicated good temporal stability of the SAS-SV 20–30 days after
the first application. The receiver operating characteristic (ROC) curve analysis indicated 33 points as the best
cutoff for the SAS-SV (AUC = 0.739; sensitivity = 65.37%; specificity = 72.26). The instrument also showed a
moderate correlation with the variables related to smartphone use (time spent on smartphones, number of
messages sent and received, and number of times the smartphone is checked). These data indicate that the SAS-
SV may be a reliable instrument for use with Brazilian adolescents.

1. Introduction 2020). In a meta-analysis comprising 41,871 individuals, the authors

found a significant increase in the incidence of emotional problems
The association between problematic smartphone use (PSU) and among excessive smartphone users in the last 10 years (Sohn, Rees,
health care outcomes has increasingly been the focus of studies, parti- Wildridge, Kalk, & Carter, 2019). In that study, 25% of the children and
cularly those concerning emotional problems (Andrade, Scatena et al., adolescents displayed PSU, and the most commonly identified

⁎
Corresponding author at: Pontifical Catholic University of Campinas (PUC-Campinas), Av. John Boyd Dunlop, S/N – Jardim Ipajussara, Campinas, SP Zipcode:
13034-685, Brazil.
E-mail addresses: andre.andrade@puc-campinas.edu.br (A.L.M. Andrade), gabriella.dgm@puccampinas.edu.br (G.D.G. Martins),
andressa_becker@hotmail.com (A. Becker da Silva), carla.gomes@puc-campinas.edu.br (C.C. Enes), wanderlei.oliveira@puc-campinas.edu.br (W.A. de Oliveira),
kdj922@catholic.ac.kr (D.-J. Kim).

https://doi.org/10.1016/j.addbeh.2020.106540
Received 7 April 2020; Received in revised form 1 July 2020; Accepted 2 July 2020
Available online 04 July 2020
0306-4603/ © 2020 Elsevier Ltd. All rights reserved.

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A.L.M. Andrade, et al.
emotional symptoms in this population were depression, sleep pro-
blems, anxiety, and a high level of perceived stress (Sohn et al., 2019).
Although PSU is not considered a specific mental disorder in the
Diagnostic and Statistical Manual of Mental Disorders-V, it is composed
of a pattern of behaviors that reflects a behavioral dependency (Yu &
Sussman, 2020). In this sense, the adaptation and development of
screening instruments for PSU are important because they can help to
identify the pattern of smartphone use early, especially among children
and adolescents, the populations most vulnerable to excessive use. This
population has a high frequency of PSU, and some studies have iden-
tified significant associations between specific parameters of smart-
phone use and clinical symptoms (Chóliz, Villanueva, & Chóliz, 2009).
Therefore, there is a need to develop or adapt existing questionnaires
with psychometric requirements suitable for this population. This
procedure strengthens the validity of the SAS-SV construct.
Of the instruments used to assess the use of smartphones in different
countries, only two of them have been translated and adapted for this
purpose in Brazil. The first was the Smartphone Addiction Inventory
(SPAI), which was adapted only for university students (Khoury et al.,
2017). More recently, the Smartphone Addiction Scale – Short Version
(SAS-SV) was adapted for both university students (Andrade, Kim et al.,
2020; Mescollotto, Castro, Pelai, Pertille, & Bigaton, 2019) and the
general adult population (Andrade et al., 2020).
The SAS-SV is a 10-item instrument developed by researchers from
South Korea (Kwon, Kim, Cho, & Yang, 2013). The SAS-SV was derived
from the original (long) version of the scale that has 33 items that
evaluate six characteristics of use (Kwon, Lee et al.. 2013). The SAS-SV
has already been translated and adapted for adolescents from some
countries, such as Switzerland (Haug et al., 2015), Spain, France
(Lopez-Fernandez, 2017), Turkey (Akın, Altundağ, Turan, & Akın,
2014), Morocco (Sfendla et al., 2018), Italy (De Pasquale, Sciacca, &
Hichy, 2017), Egypt (Fathalla, 2019), Indonesia (Arthy, Effendy, Amin,
Loebis, Camellia, & Husada, 2019), and Pakistan (Khalily, Saleem,
Bhatti, Ahmad, & Hussain, 2019).
One of the main advantages of the SAS-SV is that even its shortest
version is also able to track the frequency of six PSU-related symptoms.
Lopez-Fernandez (2017) proposed that the SAS-SV would be able to
evaluate the following symptoms related to PSU: (i) “loss of control”
(Items 1 and 8), “disruption” (items 2 and 10), “disregard” (items 3 and
7), “withdrawal” (items 4 and 5), “preoccupation” (item 6), and “tol-
erance” (item 9). The criteria were established based on the symptoms
of dependence on substance use and disorders related to pathological
gambling from the DSM-V. These symptoms were strongly correlated
with the total SAS-SV score in other studies (Andrade, Kim et al., 2020;
Sfendla et al., 2018).
The present study aimed to determine the validity of the SAS-SV for
Brazilian adolescents. We hypothesized that (i) the SAS-SV unifactorial
solution proposed in the original version would be similar for Brazilian
adolescents; (ii) the intraclass correlation coefficient would show high
values between the SAS-SV test and retest, indicating good temporal
stability of the instrument; (iii) the receiver operating characteristic
(ROC) analysis indicating predictive validity would present similar
sensitivity and specificity to that of the original SAS-SV version using
the Internet Addiction Test (IAT) as the reference; (iv) the total SAS-SV
score would show a strong correlation with the adolescents' smartphone
usage characteristics (duration of use, number of messages received and
sent, etc.) and the six PSU-related symptoms proposed by Lopez-
Fernandez (2017), thereby indicating convergent validity.
2. Methods
2.1. Participants
The minimum sample size was calculated by considering the sta-
tistical tests used, the degrees of freedom, significance level (α ≤ 0.05),
and the desired level of power (β ≥ 0.8). This study comprised a
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Addictive Behaviors 110 (2020) 106540
convenience sample of 451 adolescents aged between 10 and 16 years
(M = 13.10; SD = 1.22). All were regular students from a public school
in a city in the state of São Paulo. More than half of the sample were
boys (51.50%), and most participants studied in the afternoon
(66.30%). Participants' average age the first time they used the Internet
was 7.60 years (SD = 2.03), and the primary means of daily Internet
access were smartphones (87.10%), followed by desktop computers
(4.90%).
The researchers presented the study to the school's teachers, and the
study was approved by its Board of Directors, which signed a document
consenting to the students' participation. Only those students who
completed an online consent form were surveyed.
The retest was performed in 311 adolescents between 20 and
30 days after the initial collection. All of them received detailed in-
formation about the research and filled out an informed consent form
before the start of the study. Only those who had a smartphone with
access to the Internet and used the Internet at least once a day for
different activities (games, social networks, browsing websites, among
others) were included.
2.2. Instruments
The sociodemographic questionnaire was used to characterize the
sample on four general questions (age, sex, grade, study shift).
Participants also answered seven specific questions related to the per-
ception of Internet use from their smartphones that were used to raise
the convergent validity of the SAS-SV instrument (see Table 1).
The SAS-SV comprises 10 items rated on Likert scales ranging from
1 (strongly disagree) to 6 (strongly agree). The SAS-SV total score
ranges between 10 and 60 points, and the original version of the in-
strument (Kwon, Kim et al., 2013) showed good internal among items
(α = 0.91). In the original version, the cutoff identifying the proble-
matic use of smartphones was estimated at 31 for men and 33 for
women. In the present study, we used a cutoff point of 33 for all par-
ticipants, as these scores demonstrated the best sensitivity (65.37%)
and specificity (72.26%) according to the ROC curve (see Table 3). The
SAS-SV was translated and adapted in Brazil for university students and
adults by Andrade, Kim et al. (2020), and its items showed good in-
ternal consistency (α = 0.81).
The Internet Addiction Test (IAT) is one of the most widely used in-
struments to evaluate Internet usage in different populations. This in-
strument comprises 20 questions with a total score ranging from 0 to
100 points. A score ≥ of 50 is considered to indicate problematic
Internet use. The IAT was validated in Brazil (Conti et al., 2012) and
showed good internal consistency (α = 0.85).
2.3. Procedures
All study procedures were conducted in accordance with the
Helsinki Declaration and were approved by the Research Ethics
Committee of the Institution (CAAE 75837417.1.0000.5481; no.
2383838). SAS-SV validation was authorized by the authors of the
original version (Kwon, Kim et al., 2013).
The SAS-SV has been qualitatively evaluated in a version translated
and adapted for college students and adults (Andrade, Kim et al., 2020).
This stage (pilot study) was conducted with 10 students, enrolled in a
mix of morning and evening classes, who completed the instrument.
After the completion of the instrument, there was a discussion about the
difficulty of understanding the instructions for the SAS-SV instructions
as well as possible difficulties in understanding its 10 questions. Stu-
dents did not report comprehension difficulties, so the same version of
the instrument was used in this study. In this step, some possible dif-
ficulties were found in using the virtual collection system (Survey-
Monkey® platform), and some syntax errors of the system and in the
database were corrected. These data were not used in the final sample
of this study.
A.L.M. Andrade, et al. Addictive Behaviors 110 (2020) 106540

Table 1 2.4.2. Factor structure and internal consistency

Sociodemographic characteristics, SAS-SV scores, and frequency of symptoms The Kaiser-Meyer-Olkin method was used to evaluate the suitability
among adolescents classified as problematic smartphone users (n = 240) or of the data for factor analysis (KMO = 0.868) and the Bartlett test of
non-problematic smartphone user (n = 211). sphericity (p < .001) to identify sample suitability. The factorial
PSU Non-PSU Test p Effect size structure was initially adjusted by confirmatory factor analysis (CFA)
using the weighted means of least squares method with a one-factor
N % N % solution. The following adequate adjustment criteria were considered:
Sex 0.03 0.84 0.00
comparative fit index (CFI = 0.95 or higher), Tukey-Lewis index
Male 125 53.6 108 46.4 (TLI = 0.95 or higher), and root mean square error of approximation
Female 115 52.8 103 47.2 (0.08 or lower). The CFA did not show a good fit in the adjustments
Elementary grade 1.76 0.62 0.06 (CFI = 0.901; TLI = 0.873; SRMR = 0.05; RMSEA = 0.09
Sixth 57 56.4 44 43.6
[95%CI = 0.07–0.10]).
Seventh 67 52.8 60 47.2
Eighth 67 55.3 54 44.7 Thus, it was conducted a principal component analysis (PCA) with
Ninth 49 48.0 53 52.0 oblique rotation because it: (i) the PCA described the highest amount of
Does your smartphone 5.21 0.02 0.10 variance in the data; (ii) the EFA did not show good suitability, and
use harm to your
three items had a factor load lower than 0.3, whereas all the items had a
everyday life?
Yes 121 58.7 85 41.3
factor load > 0.3 in the PCA; (iii) PCA has been used to evaluate the
No 114 47.9 124 52.1 internal structure of the SAS-SV in other studies (Andrade, Kim et al.,
M SD M SD Test p Effect size 2020; Sfendla et al., 2018; Lopez-Fernandez, 2017); (iv) the PCA
SAS-SV showed a one-factor solution, similar to that found in the original
Total score 39.8 5.60 24.4 5.50 867 ** 0.66
version of the instrument. The internal consistency of the SAS-SV was
Loss of control 3.72 1.09 2.41 0.940 184 ** 0.30
Disruption 3.79 1.07 2.38 0.910 222 ** 0.33 verified by the Cronbach alpha and McDonald ω coefficients.
Disregard 3.51 1.14 2.17 0.950 183 ** 0.29
Withdrawal 4.39 1.15 2.38 1.03 375 *** 0.45
Preoccupation 4.30 1.41 2.35 1.33 227 *** 0.34 2.4.3. Network analysis
Tolerance 4.64 1.24 3.33 1.49 103 ** 0.19 Network analysis estimates the way that items are grouped through
Smartphone use
their correlation strength. This method allows the estimation of several
First-time use (age) 7.60 2.15 7.62 1.89 0.030 0.86 0.00
Time spent on 6.03 2.77 4.45 2.68 37.5 ** 0.08 psychometric measures, such as the degree of connectivity (between-
smartphone ness centrality), the strength of these connections (degree centrality),
(hours/day) and the distance (closeness centrality) between the SAS-SV items.
Number of messages 147.7 131.7 110.9 122.1 9.26 ** 0.02 Graphs were generated using the least absolute shrinkage and se-
sent daily
lection operator (LASSO) regularization method to estimate a network
Number of messages 165.1 140.1 131.6 131.9 6.70 * 0.01
received daily of partial correlations between items. This method avoids overfitting
Number of 45.4 34.5 34.3 30.0 13.1 *** 0.03 the model because it does not consider associations of low magnitude
smartphones (Friedman, Hastie, & Tibshirani, 2008). In the graphical representation
checks daily
(Fig. 1A and B), the correlations between items (nodes) are visualized
Note: PSU = problematic smartphone user, non-PSU = non-problematic
by edges that can vary in color and intensity. Green indicates a positive
smartphone user, N = participants; SD = standard deviation; p = significance correlation between the nodes, and red indicates a negative correlation.
level; η2 = effect size calculated by using eta-squared test. * p < .05, ** Thicker edges indicate stronger correlations, and the thinner edges in-
p < .01, *** p < .0.001. dicate weaker correlations. The nearness of a node to the center of the
graph was determined by a specific algorithm according to the number
Next, the participants of the current study were taken in small and magnitude of the associations of each SAS-SV item (node). The final
groups during physical education classes to the computer laboratory, model consisted of a finite interval of parameters from the information
where they filled out the questionnaires online using the of residual extended Bayesian information criteria (Chen & Chen,
SurveyMonkey® platform. Between 20 and 30 days after the initial 2008). This procedure was based on previous SAS-SV validation studies
collection, the SAS-SV retest was performed to assess the temporal (Andrade, Kim et al., 2020).
stability of the scale. After the data collection, all the students received
feedback on their scores on the instrument, and discussions were held
2.4.4. Temporal stability of the SAS-SV
in the classroom about the importance of using the Internet safely.
We used the intraclass correlation coefficient (two-way mixed
After the study concluded, all adolescents were invited to partici-
model; absolute agreement type) to calculate the correlation between
pate in conversation groups coordinated by the researchers outside of
the SAS-SV scores at different times (test–retest). The correlations were
their class schedules. In these groups, several topics related to the
evaluated according to the following values: (i) 0.0 ≤ 0.40 (weak); (ii)
problematic use of smartphones (mental diseases, cybersecurity, cy-
0.41 ≤ 0.60 (moderate); (iii) 0.61 ≤ 0.80 (strong); and (iv)
berbullying, and pornography, among others) were discussed.
0.81 ≤ 1.00 (very strong).

2.4. Data analysis 2.4.5. Predictive validity

2.4.1. Sociodemographic data
The sociodemographic data were analyzed using a one-way analysis
of variance (one-way ANOVA), and intragroup differences were de-
tected using the Scheffé a posteriori test. The nominal or categorical
variables were analyzed using the chi-squared (χ2) test. To test effect
size, the Cramer V test was used for the nominal variables and eta-
squared (η2) for the continuous variables (Cruz, Scatena, Andrade, & De
Micheli, 2018; Yamauchi, Andrade, Pinheiro, Enumo, & Micheli, 2019).
Predictive validity was analyzed by comparing the total SAS-SV
scores with the total IAT scores, as has been performed in other studies
(Kheradmand, Amirlatifi, Sohrabi, & Meybodi, 2019). A ROC curve
analysis was designed to evaluate the ability to predict smartphone
addiction through the IAT instrument. In this study, area under the curve
(AUC) values of 0.7 or higher were considered acceptable. The SAS-SV
scores were compared with IAT classification (problematic user > 50
or nonproblematic user < 49). The SAS-SV cutoff point accounted for
the sensitivity and specificity levels of the scores.

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Table 2
Item analyses, scores, loadings, and reliability of SAS-SV.
Items M SD Item loading Corrected item total r α if item deleted ω if item deleted

ENG: Missing planned work due to smartphone use. 2.91 1.50 0.43 0.32 0.783 0.785
PT: Deixo de fazer tarefas ou trabalhos planejados devido ao uso do celular
ENG: Having a hard time concentrating in class, while doing assignments, or while working due to smartphone use 2.63 1.52 0.50 0.38 0.776 0.778
PT: Tenho dificuldade para me concentrar na aula, nas lições de casa ou no trabalho devido ao uso do celular
ENG: Feeling pain in the wrists or at the back of the neck while using a smartphonePT: Sinto dor nos punhos ou pescoço enquanto uso o celular 2.87 1.67 0.46 0.35 0.781 0.782
ENG: Won’t be able to stand not having a smartphone 3.55 1.76 0.65 0.50 0.762 0.764
PT: Não há nada mais difícil do que ficar sem meu celular
ENG: Feeling impatient and fretful when I am not holding my smartphone 3.35 1.70 0.71 0.57 0.752 0.754
PT: Eu fico impaciente e irritado quando estou sem meu celular
ENG: Having my smartphone in my mind even when I am not using it 3.38 1.68 0.72 0.59 0.751 0.752

4
PT: Fico pensando no meu celular mesmo quando não o estou usando
ENG: I will never give up using my smartphone even when my daily life is already greatly affected by it 2.90 1.55 0.56 0.43 0.771 0.773
PT: Eu nunca vou deixar de usar meu celular, mesmo se este uso cause problemas ou efeitos negativos na minha vida
ENG: Constantly checking my smartphone so as not to miss conversations between other people on Twitter or Facebook 3.31 1.66 0.64 0.50 0.763 0.765
PT: Tenho que checar constantemente meu celular para não perder as publicações nas redes sociais (WhatsApp, Twitter, Facebook, Instagram, por
exemplo)
ENG: Using my smartphone longer than I had intended 4.03 1.51 0.57 0.45 0.769 0.771
PT: Uso meu celular por mais tempo que pretendia
ENG: The people around me tell me that I use my smartphone too much 3.63 1.64 0.57 0.44 0.769 0.772
PT: As pessoas à minha volta me dizem que uso excessivamente o celular

Note: SD = standard deviation. The extract method was performed by using principal component analysis with Kaiser normalization. A cutoff of 0.30 was used for inclusion. Bartlett's test of sphericity: p < .001; KMO
overall 1st application = 0.858. The 1st application overall Cronbach's α was 0.819, and the 1st application overall McDonald's ω was 0.788. The eigenvalue was 3.47, and the total variance explained of SAS-SV was
34.7%.

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Table 3
Receiver operating characteristic analysis for the best SAS-SV score to predict smartphone addiction in adolescents. LR = Likelihood Ratio.
Cutoff Sensitivity (%) 95CI% Specificity (%) 95CI% +LR -LR Youden's index

> 14 97.08 92.7–99.2 3.880 2.00–6.70 1.01 0.75 0.009

> 15 97.08 92.7–99.2 4.210 2.30–7.10 1.01 0.69 0.012
> 16 97.08 92.7–99.2 4.850 2.70–7.90 1.02 0.60 0.019
> 17 96.35 91.7–98.8 5.830 3.50–9.10 1.02 0.63 0.021
> 18 95.62 90.7–98.4 7.440 4.80–11.0 1.03 0.59 0.030
> 19 95.62 90.7–98.4 10.68 7.50–14.7 1.07 0.41 0.063
> 20 95.62 90.7–98.4 13.59 10.0–17.9 1.11 0.32 0.092
> 21 94.89 89.8–97.9 16.18 12.3–20.8 1.13 0.32 0.110
> 22 94.16 88.8–97.4 19.42 15.2–24.3 1.17 0.30 0.135
> 23 93.43 87.9–97.0 21.68 17.2–26.7 1.19 0.30 0.151
> 24 91.97 86.1–95.9 25.24 20.5–30.5 1.23 0.32 0.172
> 25 89.05 82.6–93.7 27.83 22.9–33.2 1.23 0.39 0.168
> 26 88.32 81.7–93.2 32.36 27.2–37.9 1.31 0.36 0.206
> 27 87.59 80.9–92.6 38.83 33.4–44.5 1.43 0.32 0.264
> 28 84.67 77.5–90.3 43.37 37.8–49.1 1.50 0.35 0.280
> 29 81.75 74.3–87.8 48.87 43.2–54.6 1.60 0.37 0.306
> 30 78.83 71.0–85.3 52.43 46.7–58.1 1.66 0.40 0.312
> 31 76.64 68.7–83.4 56.63 50.9–62.2 1.77 0.41 0.332
> 32 74.45 66.3–81.5 62.14 56.5–67.6 1.97 0.41 0.365
> 33 72.26 64.0–79.6 65.37 59.8–70.7 2.09 0.42 0.376
> 34 69.34 60.9–76.9 68.93 63.4–74.1 2.23 0.44 0.382
> 35 67.15 58.6–74.9 70.87 65.5–75.9 2.31 0.46 0.380
> 36 61.31 52.6–69.5 76.05 70.9–80.7 2.56 0.51 0.373
> 37 57.66 48.9–66.1 77.35 72.3–81.9 2.55 0.55 0.350
> 38 53.28 44.6–61.9 81.55 76.8–85.7 2.89 0.57 0.348
> 39 49.64 41.0–58.3 83.82 79.2–87.7 3.07 0.60 0.334
> 40 44.53 36.0–53.3 87.06 82.8–90.6 3.44 0.64 0.315
> 41 40.88 32.6–49.6 89.64 85.7–92.8 3.95 0.66 0.305
> 42 35.04 27.1–43.6 91.91 88.3–94.7 4.33 0.71 0.269
> 43 27.74 20.4–36.0 93.53 90.2–96.0 4.29 0.77 0.212
> 44 21.90 15.3–29.8 96.12 93.3–98.0 5.64 0.81 0.180
> 45 17.52 11.6–24.9 97.73 95.4–99.1 7.73 0.84 0.152
> 46 16.06 10.3–23.3 98.38 96.3–99.5 9.92 0.85 0.144
> 47 13.87 8.60–20.8 98.71 96.7–99.6 10.71 0.87 0.125
> 48 11.68 6.85–18.3 99.03 97.2–99.8 12.03 0.89 0.107
> 49 8.030 4.10–13.9 99.03 97.2–99.8 8.27 0.93 0.070
> 50 7.300 3.60–13.0 99.35 97.7–99.9 11.28 0.93 0.066
> 51 5.840 2.60–11.2 99.68 98.2–100.0 18.04 0.94 0.055

2.4.6. Convergent validity non-PSU group.

The convergent validity was analyzed using the Spearman correla-
tions between the total SAS-SV score and the following variables: time
using the smartphone, number of messages received, number of mes-
sages sent, and number of times the smartphone is checked. These
variables were chosen because they were used in other validation stu-
dies of the SAS-SV for adolescents in different countries (Haug et al.,
2015; Kwon, Kim et al., 2013; Kwon, Lee et al.. 2013). Convergent
validity was also assessed based on the six symptoms evaluated by the
10 SAS-SV items, as proposed by Lopez-Fernandez (2017).
The ROC curve analysis was carried out using the MedCalc software
(version 19.3.1) and the remaining analyses using JASP version 0.12.1.
In all analyses, a significance level of 5% was adopted.
3. Results
3.1. SAS-SV scores and sociodemographic profile of the participants
Participants' sociodemographic data are shown in Table 1, which
compares the PSU and non-PSU groups. It was observed that 53.2% of
the adolescents were classified as demonstrating PSU, but no sex dif-
ferences were detected between the PSU and non-PSU groups. More-
over, almost 60% of the participants in the PSU group reported that
they believed that their daily smartphone use pattern caused them some
kind of life loss. The total SAS-SV score and the mean score of all
symptoms proposed by Lopez-Fernandez (2017) were significantly
higher (Sheffé test p < .001) in the PSU group. This group also re-
ported spending more hours on the Internet, sending and receiving
more messages, and checking their smartphones more often than the
3.2. Internal consistency and SAS-SV factorial structure
The SAS-SV achieved excellent reliability, with α = 0.819 and
ω = 0.788 for the instrument with 10 items (Table 2). The CFA analysis
considered fit parameters similar to the original SAS-SV version (Kwon,
Kim et al., 2013) and indicated a poor fit. Thus, the SAS-SV structure
was evaluated using the PCA method. All items had a factor
loading > 0.3 and were kept in the final version of the SAS-SV, with the
average score ranging from 2.63 (item 2) to 4.03 (item 9).
Fig. 1A represents the network of partial correlations between all
items (nodes) using the LASSO method. The colors of the nodes re-
present the symptoms proposed by Lopez-Fernandez (2017) for the 10
SAS-SV items. The items that showed the most significant correlation
strength in the IT4-IT5 network (Unable to stand not having a smart-
phone; Feeling impatient and fretful when I am not holding my smartphone)
(r = 0.299) evaluated the symptoms of withdrawal. Interestingly, the
nodes IT5-IT6 (Feeling impatient and fretful when I am not holding my
smartphone; Having my smartphone in my mind even when I am not using it)
(r = 0.366), which evaluated, respectively, symptoms of withdrawal
and preoccupation, also showed a strong correlation, possibly due to
their cognitive content.
Fig. 1B represents the network of partial correlations among only
the six symptoms proposed by Lopez-Fernandez (2017). The symptoms
of withdrawal and preoccupation showed the strongest correlations
(r = 0.405), followed by symptoms of loss of control and disruption
(r = 0.199). Among the central mean values of the 10 SAS-SV items
(Fig. 1C), items 5 and 6 (Feeling impatient and fretful when I am not

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Fig. 1. Gaussian graphical model based on network analyses according to the 10 SAS-SV items (1A), all symptoms proposed by Lopez-Fernandes (2017) (1B), and
three centrality measures of the 10 SAS-SV items (1C). The nodes with stronger inter associations appear in the center for the network. Each green edge represents the
zero-order positive correlation between the variables, and thickness corresponds to the magnitude of the correlation. Legend: Green nodes represent “disregard”
symptoms; violet node represents “tolerance” symptoms; yellow nodes represent “disruption” symptoms; red nodes represent “loss of control” symptoms; sapphire
nodes represents “preoccupation” symptoms; light-blue nodes represent “withdrawal” symptoms. (For interpretation of the references to color in this figure legend,
the reader is referred to the web version of this article.)

holding my smartphone; Having my smartphone in my mind even when I am
not using it) showed a higher degree of connectivity (betweenness) with
the other items, shorter connections between items (closeness), and a
higher frequency of strong correlations (degree). This result indicates
that withdrawal and preoccupation symptoms should be observed with
greater attention.
3.3. Temporal stability
We performed the SAS-SV retest in 311 adolescents 20–30 days after
the first application. The intraclass correlation coefficient was 0.846
[95% CI: 0.820 - 0.870], indicating a robust correlation between the
test and retest (F = 6.49; df1 = 310; df2 = 6.510; p < .001).
3.4. Predictive validity
Fig. 2 shows the ROC analysis for predicting dependence on
smartphones, and Table 3 shows the SAS-SV cutoffs, taking the IAT
classification as a reference (see Method section). The ideal cutoff point
for the SAS-SV was considered to be 33 (sensitivity = 72.26;

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Fig. 2. Receiver operating characteristic analysis for the best SAS-SV score to predict internet addiction in adolescents. Legend: AUC = Area Under ROC Curve;
p = significance level. Youden index J = 0.382.

specificity = 65.37; AUC = 0.739; Youden index J = 0.382). Table 4

Spearman correlation coefficients between the total score of SAS-SV and the
3.5. Convergent validity IAT smartphone usage behaviors and SAS-SV symptoms, as proposed by Lopez-
Fernandez (2017).
The convergent validity was analyzed from the correlations between Variables SAS-SV total score [95% CI] (ρ) p
the SAS-SV total score and the following variables: (i) total score of the (ρ)
TAI; (ii) six symptoms evaluated by the SAS-SV according to the Lopez-
SAS-SV symptoms
Fernandez criteria (2017); (iii) all behaviors involving the perception of Loss of control 0.696 [0.645–0.740] ***
smartphone use. As shown in Table 4, a moderate correlation coeffi- Disruption 0.695 [0.644–0.740]
cient was found between the total SAS-SV score and the total IAT score. Disregard 0.672 [0.618–0.720] ***
Total SAS-SV scores also showed significant positive correlations with Withdrawal 0.766 [0.726–0.802] ***
Preoccupation 0.697 [0.646–0.742] ***
all the symptoms and behaviors of smartphone use, especially with
Tolerance 0.553 [0.486–0.614] ***
adolescents' perception of Internet use. Total of symptoms 0.916 [0.900–0.930] ***

Smartphone usage
4. Discussion Time spent on smartphone (hours) 0.328 [0.243–0.408] ***
Number of messages received daily 0.158 [0.060–0.247] ***
In this study, we aimed to evaluate the psychometric properties of Number of messages sent daily 0.191 [0.100–0.279] ***
the SAS-SV instrument for adolescents. Our main results indicate that Number of smartphone checks daily 0.215 [0.125–0.302] ***

the SAS-SV demonstrated reliable psychometric properties based on the IAT

different validity criteria studied. Total Scores 0.501 [0.428–0.567] ***
Excessive use 0.394 [0.313–0.470] ***
The prevalence of adolescents with PSU was 53.2%, a value lower Neglect of social life 0.256 [0.167–0.341] ***
than the 55.7% found in Pakistani adolescents (Khalilyet al., 2019) but Neglect of work 0.328 [0.243–0.409] ***
higher than the 12.50% identified in participants from Spain, 21.5% in Anticipation 0.369 [0.286–0.446] ***
Belgium (Lopez-Fernandez, 2017), 16.5% in Switzerland (Haug et al., Salience 0.475 [0.400–0.544] ***
Lack of control 0.439 [0.360–0.511] ***
2015), 23.9% in Indonesia (Arthy et al., 2019), and 34% in South Korea
(Kwon, Kim et al., 2013). This heterogeneity could be linked with Note: IAT = Internet Addiction Test; SAS-SV = Smartphone Addiction Scale –
cultural aspects, and to the fact that the SAS-SV does not have rigorous Short Version. ρ = intraclass correlation coefficient. p = significance level. ***
criteria for the diagnosis of PSU (Arthy et al., 2019; Khoury et al., 2017; p < .001.
Lin et al., 2015).

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A.L.M. Andrade, et al.
For example, Kwon, Kim et al. (2013) compared the prevalence of
smartphone addiction between the SAS-SV and a structured clinical
interview based on the DSM-V addiction criteria. While the SAS-SV
indicated a prevalence of 34% among adolescents, the clinical inter-
view identified that only 16.6% of the boys were considered dependent.
In addition, a lack of differences between sexes was also observed by
Lopez-Fernandez (2017).
The cutoff of the SAS-SV score (33 points) may also have con-
tributed to an overestimation of the number of adolescents with PSU
since we used the IAT score as the gold standard in our ROC analysis.
Some authors have reported a high prevalence of Internet addiction
among adolescents (Cruz et al., 2018), which in turn could also increase
the prevalence of PSU as found by the SAS-SV.
The level of reliability of the SAS-SV was also satisfactory
(α = 0.819) and was higher than that found in some studies (Arthy
et al., 2019; De Pasquale et al., 2017; Khalily et al., 2019) but lower
than in other works (Lopez-Fernandez, 2017; Haug et al., 2015; Kwon,
Kim et al., 2013). Regarding the factorial structure, we initially used the
CFI method, but our findings did not indicate a good fit. These results
may be related to the socio-cultural aspects of each country, sample
size, participant profile, and SAS-SV questions. In the latter aspect, it is
possible that some questions on the scale are not sensitive to identify
specific aspects of smartphone use among Brazilian adolescents. Thus,
we performed a PCA analysis and identified a one-factor structure, si-
milar to other authors' findings (Lopez-Fernandez, 2017; Sfendla et al.,
2018).
Based on the network analysis, there were robust partial correla-
tions of the items, especially among those assessing withdrawal and
preoccupation symptoms. In the study by Andrade, Kim et al. (2020),
the network analysis identified that preoccupation and withdrawal
were the symptoms with the highest levels of centrality. Lin et al.
(2015) proposed diagnostic criteria for smartphone dependence based
on DSM-V symptoms and the pattern of cell phone use measured by a
specific app. Among the main symptoms, the authors identified high
levels of concern about the use of mobile devices, which indicates the
relevance of this symptom in the clinical context of adolescents with
PSU.
The items “Feeling impatient and fretful when I am not holding my
smartphone” and “Having my smartphone in my mind even when I am not
using it” stood out in the network analysis. Clinicians should, therefore,
give these characteristics of users with PSU greater attention because
they portray cognitive components of addiction, which should be
treatable by cognitive-behavioral therapy (Malinauskas &
Malinauskiene, 2019).
Regarding temporal stability, the SAS-SV showed a high intraclass
correlation coefficient, similar to that observed in other studies
(Mescollotto et al., 2019). These data may be similar due to the period
of SAS-SV retest. While we tested 20–30 days later, other authors car-
ried out the retest one week later. Another possibility is that both stu-
dies were conducted in Brazil, which strongly suggests the influence of
cultural aspects. Besides, the factorial structure of the scale may also
have influenced because the authors also identified a unifatorial solu-
tion tested among university students (Mescollotto et al., 2019).
Our predictive validity findings indicated that the cutoff for the
classification of PSU was 33 points, using the IAT instrument as the gold
standard. These findings are particularly interesting because the IAT
was able to discriminate a cutoff point similar to that found in the
original SAS-SV version for girls (33 points) (Kwon, Kim et al., 2013)
and for boys (31 points). The authors evaluated the SAS-SV predictions
through a structured clinical interview. In our study, we did not identify
differences related to sex, and we suggest that a single cutoff be adopted
for all adolescents.
Regarding convergent validity, the SAS-SV correlated moderately
with the variables related to the use of smartphones (time spent on the
smartphones, number of messages sent and received, number of times
the cell phone is checked). Our data are in agreement with the findings
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Addictive Behaviors 110 (2020) 106540
of other authors who indicated a positive correlation between the SAS-
SV score and the use of smartphones (Arthy et al., 2019, Fathalla, 2019;
Mescollotto et al., 2019; Haug et al., 2015; Kwon, Kim et al., 2013).
These data suggest that subjective perception of smartphone use can
also be an important tool for PSU screening, especially in countries with
few specific scales. We also found a moderate correlation between total
SAS-SV score and IAT score. Particularly in this context, Internet access
can increase the addictive potential of smartphones based on two im-
portant elements related to behavioral dependence: access and avail-
ability. Furthermore, the dimensions of IAT (excessive use, neglect of
social life and work, anticipation, salience, lack of control) are similar
to those of the symptoms evaluated by the SAS-SV. These findings
therefore indicate that these instruments evaluate behaviors re-
presenting behavioral dependencies.
Among the strengths of the present study, we evaluated the psy-
chometric properties of the SAS-SV based on different validity models
(convergent, criterion, internal, predictive, and temporal stability). The
different statistical analyses used (CFI, PCA, network) also favored more
robust conclusions about the quality of the instrument and the weight
of each of the items on the scale. This study also has limitations that
should be considered. The sample of adolescents was collected only in
one Brazilian city, and all adolescents were students of a public school.
The psychometric properties of the scale were not compared to those in
adolescents at a private school. Considering that family income may be
a predictor of PSU, this comparison should be made in the future.
5. Conclusions
This study is considered relevant because, in addition to presenting
different robust statistical methods, it presents evidence that the SAS-
SV is valid for use, and this is the first such study conducted with
adolescents in Brazil. The results show a high prevalence of PSU, i.e., an
indicator of risk of dependence on smartphones, and it can also be used
as a screening method for psychological intervention programs for
adolescents who present excessive and problematic use of digital media.
Thus, the SAS-SV has the potential to be used not only in future studies
but also with a social scope for the evaluation and psychological in-
tervention in psychotherapeutic practice.
6. Contributors
ALM Andrade; A Scatena, CC Enes and WA Oliveira were re-
sponsible for the draft the manuscript. ALM Andrade, GG Martins, BO
Pinheiro and D Kim contributed to data acquisition. ALM Andrade
conducted the statistical analyses. All authors provided critical revi-
sions of the manuscript to improve the intellectual content and ap-
proved the final version.
7. Role of funding source
This study was financed in part by the Pontifical Catholic University
of Campinas.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influ-
ence the work reported in this paper.
Acknowledgements
The authors thank to Department of Psychiatry from the Catholic
University of Korea due to the partnership in this study.
A.L.M. Andrade, et al.
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