Video Game Addiction - Recent Findings to Blow Your Mind

By Cathy Cassata 04/29/14
Limits should be set on gaming habits to curb bullying, desensitization, and other potential problems.

It’s a typical day. Your son comes home from school, throws his book bag down and dashes to the Wii. You go back and forth. Should you tell him to stop? Let him play for a bit? Make him run around outside or require he does his homework first? Options abound, but uncertainty strikes. 

As concerns rise about the negative effects of video games, more and more parents find themselves wondering when the virtual world of jumping, dashing, building, and shooting becomes too much, and whether or not playing too often can lead to video game addiction. 

Mental health professionals differ in their opinion. In 2012, the Diagnostic and Statistical Manual of Mental Disorders (DSM) Task Force and Work Groups proposed that “internet use disorder,” which primarily refers to maladaptive video-gaming or internet gaming behavior, should be included in the DSM. As of now, it still isn’t included (DSM5 has categorized it as needing further study), but some mental health and medical professionals say this doesn’t mean it doesn’t exist. 

“I’m getting one to two referrals a week for children who are dealing with what I call pathological video game use,” said pediatrician and “mediatrician” Michael Rich, MD, founder of the Center on Media and Child Health at Boston Children’s Hospital, Harvard Medical School, and Harvard School of Public Health.

However, Rich says take caution when throwing around the word “addiction” in this sense. A national study published in Psychological Science in 2009 reported that 12% of boys and 8% of girls who play video games exhibit pathological patterns of play, and fit the DSM category of addiction. The study also showed that pathological gamers are twice as likely to have ADD or ADHD.

“Rarely do I see pathological video game playing in a child who doesn’t have an underlying issue, such as anxiety, depression, oppositional defiant disorder, ADD, or who falls within the autism spectrum,” said Rich. 

Why is this? Rich says there is a clear explanation. Children with ADD are attracted to video games because they provide a much more manageable environment and have built-in structure, giving the player a circumscribed environment with clear, consistent rules. “The real world has no clear, consistent rules or boundaries, so for someone with ADD, everyday life is very chaotic, confusing and distracting,” Rich explained.

For children who are on the spectrum, Rich says since they have difficulty reading clues from the environment, like facial expressions, video games simplify these signals and make outcomes predictable. “Video games have a much more controlled and limited vocabulary of symbols to learn, symbols that don’t rely on human expressions. Human faces and body language are the hardest thing for kids on the autistic spectrum to learn to read. In fact, skills-building video games can be positive for these children – there are wonderful apps and games that are specifically designed to help kids on the autism spectrum,” he said.

Who else is at risk?

Hilarie Cash, PhD, psychologist, author of Video Games & Your Kids: How Parents Stay in Control and co-founder of reSTART Internet Addiction Recovery Program in Fall City, Wash., agrees that people with mental health conditions are at higher risk for video game addiction. 

“Conditions like Asperger’s, or other painful conditions like depression, anxiety, and PTSD, are conditions which make life and being successful in life difficult. It’s easier to be successful in a video game, get recognition, have standing within a community much more than you can in the real world, so if you’re not having much success academically, or if you are, you’re not feeling socially successful, and you just don’t feel like you’re achieving what you want to achieve, you can instead turn to the world of video games and pretty quickly [receive] recognition, be admired and feel like you’re making a place for yourself in the world,” Cash said.

Cash also says simply being a teenager makes a person vulnerable. “The mere challenge of being a teen can be enough to drive kids to escape the challenges of adolescence. Some do this with pot and other substances, but now they have a handy escape right in their back pocket,” she said. “A poorly attached adolescent who doesn’t have a good family relationship is very vulnerable. Add a mental health illness on top of that, and they’re really set up for this addiction.”

Early exposure is another risk factor adds Cash. According to a Kaiser Foundation Report from 2010, elementary aged children use an average 7.5 hours per day of entertainment technology, including TV, video games, internet, movies, and cell phones. “Parents that are handing their kids devices early on are encouraging them to get drawn into, and even addicted to, these screens because their brains are developing very rapidly and wired for screens rather than wired for the rest of life,” she says. 

Are video games addictive by nature?

While some kids might be more prone to pathological gaming, you may wonder if video games themselves cause the problem. Cash says they certainly play a part. “If an addiction has to do with an elevation of chemicals in the pleasure region of the brain, think of video games as providing layers of pleasure. At the very simplest layer, there’s something called intermittent reinforcement, which is the unpredictability of reward, so you take an action and you don’t know if you’re going to be happy or unhappy with the outcome. You move one way and it’s the right move and you’re ahead. You move the other way and it’s the wrong move and you’re dead, well that’s intermittent reinforcement. It’s the basis of gambling addiction,” said Cash.

Rich adds that the goal of the video game developer is to hook people in using very established psychological techniques based on giving the gamer a challenge that can be mastered. “As they advance level after level, they get a nice squirt of dopamine each time, and are rewarded with another harder challenge. The creator thoughtfully figures out how to make it just hard enough to stymie someone just long enough so that they feel a great sense of satisfaction when they succeed at it, but not turn anybody off by being too hard. Addictive qualities are built in so the game player seeks that sense of accomplishment,” he said.

Cash says the most addictive games have deep layers of reward. “The fact that they can be played on and on for hours is a big part of the problem cause you’re overdoing it for hours on end and the brain is completely inundated with those chemicals that undergo the changes we call addiction,” she noted.

The idea that overplaying video games is solely due to the win factor doesn’t tell the whole picture says Geoffrey Ream, PhD, associate professor at the Adelphi University School of Social Work in Garden City, N.Y. “There’s a piece that can be explained medically and a piece that can’t. Dopamine is the obvious medical explanation because we produce it every time we feel like we’re ‘winning’ at something – gambling, shopping, sex, porn, etcetera. However, the idea that ‘behavioral addiction’ is all about dopamine kind of breaks down when it comes to video games. Some things people connect with in video games have nothing to do with winning or scoring points,” he said.

As part of a team who conducted research on the intersection of video game addiction and substance use for the National Institute on Drug Abuse, Ream discovered that the games that were more strongly associated with problem video play were games that involved identification with a fictional character. “Many people think massively multiplayer online role playing games, such as World of Warcraft, are the most addictive. However, when we looked at the full spectrum of genres, we found it was one of several genres with higher-than-average problem play potential. What all such genres seem to have in common is identification with a fictional character. There’s no medical explanation for this,” he said.

The study also found that while, according to earlier research, substance use usually peaks in young adulthood and diminishes later on in life, video gaming among study participants peaked in late high school and began to diminish in young adulthood. “With substance use, for most people, they get on with life. They get a job, they have a partner and have kids. They can’t keep smoking weed or whatever they were doing. Research calls this ‘role incompatibility.’ But there is a minority who doesn’t follow the normative curve downward. Their use levels keep getting higher, probably because they developed addictive patterns,” Ream said. “We can think of teenagers who play a lot of video games like we think of college students who drink a lot – yeah, we’re concerned, but most of them are going to calm down on their own. Who we’re worried about are the few who develop addictive patterns that will follow them through life and interfere with their development into adulthood and achievement of life goals.”

Symptoms of Video Game Addiction - What are the warning signs?

Cash says parents should be concerned when a child:

  • Isn’t respecting boundaries around video games or won’t accept and walk away from the game when a parent says it’s time to stop
  • Is lying and being deceptive in order to find ways to play video games
  • Has lost interest in things that were interesting in the past, such as playing with friends, engaging in sports and other hobbies
  • Used to get good grades, but suddenly starts getting lower grades
  • Is chronically tired from sleep being disrupted 
  • Allows the video game playing to get in the way of eating


What is too much?

Cash says less playing time is better and recommends setting limits. “In early elementary school, maybe no more than half an hour. In later elementary years, maybe up to an hour. In junior high, maybe up to two hours. In senior high, maybe up to three hours,” she says. “This is only if kids show maturity and responsibility about it, and they’re not fighting about it with their parents,” she said. 

Rich suggests a slightly different approach. “Limiting playing time should happen if a child is disabled by their play, in the sense that they are dropping out of their normal life and video game play displaces a rich, diverse set of experiences. It’s not necessarily a factor of time in the sense that if they go over X number of hours, it’s a problem,” he stated. He says it’s more about how the play fits into a child’s day. Starting with kids as young as 5, he suggests planning their 24 hours of the day with activities they need and activities they enjoy. “You can say to them, ‘you need this many hours of sleep, this many hours of school, this much time for homework, this much time for meals, this much time for basketball practice, and let’s see what’s left over at the end of the day for video games and TV,’” he explained. He says presenting it to kids this way helps them prioritize what’s important to them instead of having video games be so special that they need to be restricted. He also says this approach teaches kids time management skills and to take ownership of their play time. “You’re helping them learn some really valuable skills while putting their media use and video game use in context of all their interests. Instead of parents shaming them and saying ‘Playing Call of Duty is going to make you stupid and evil,’ kids can realize ‘You know, I don’t like the fact that I haven’t been outside or seen my friends recently.’” 

If you’re looking for a way to limit gaming time that is more specific to your child’s development, Rich says consider your child’s attention span. While in general, the younger a child is, the shorter his or her attention span is, Rich says the way to recognize a child’s attention span is to watch them in free play. “When they’re very young, you can observe when they stop playing with blocks and pick up a book, then put the book down to do something else. You’ll notice rhythms and that kids have a very specific time frame in which they can stay on a single task. However, screen media disrupts that rhythm because it operates on a different time frame. Whether it’s watching TV or playing a game, the time structure is dictated by the program or game creators,” he explained. “What you want to do is allow a child to use screen media based on his or her natural rhythms not the time required for a TV program or video game level to be completed. If your kid has a 15-minute attention span, let him play for 15 minutes then try another activity, otherwise he will run the risk of getting sucked in and then will be very upset and cranky when he is stopped, whether it be minutes or hours later. It similar to sleep cycles in a very young child – try not to disrupt or interrupt a sleep cycle or an attention cycle.” 

What age should kids be allowed to play?

Cash used to recommend that children not play video games until 7 years-old, but now she says wait until they’re 13. “There are many complex things physically and socially that children need to learn how to do and they only learn how to do them by doing them. Video games, which are so mesmerizing, will keep kids locked on a screen rather than doing all these things,” she said. 

Rich says the age issue isn’t so much about video game addiction or pathological playing as it is about content. “Interactive screen media, such as video games and a lot of websites are arguably one of the best educational technologies we’ve developed in the sense that you can create virtual realities and set up conditions where the role of the player is to drive the narrative and in driving that narrative they will learn a set of actions,” he said. “Those actions can be good or detrimental. It could be basketball or it could be killing. Decision on when to start a child with video games is really more of when a child is at a developmental stage where they’re able to take optimal advantage of that learning environment and when they are ready to and need to learn the content.  For example, math games when kids are first learning arithmetic can be fun and challenging and help them learn to do practical math in that interactive environment,” he said.

A child’s ability to distinguish fantasy from reality is another factor, says Rich. “Kids can’t make this distinction until the age of about 8. This means until 8 years-old Wily Coyote getting squashed by an anvil is as real as a kid getting punched in a playground,” he said. “Young children are building their understanding of the world and of themselves and how they fit into this world all the time.”

Normalizing violence, encouraging bullying

Rich says addiction to video games isn’t the most prevalent issue for children playing video games. Since first person shooter video games are so popular, it is the effects on children of playing violent games that concern him. However, he explains that the relationship is not as simple as violent video games causing children to be violent. 

“A common belief about violence in media is that violent media causes violence in children, that they see violence in video games or movies and copycat it. They think of high profile incidents like Columbine where the kids played Doom and made violent videos before their tragic attack. Fortunately, school shootings are extraordinarily rare events but many kids are playing violent video games. It is difficult to prove a causal link with playing a video game or watching a movie,” he said. “The real concern is that violence in video games normalizes violence and makes it a more acceptable way of overcoming conflict, getting your way, and prevailing. Measurable changes are consistently found in young people who use violent media, including even mild mannered people. They get desensitized. Violence doesn’t bother them as much. Some kids feel more vulnerable, more fearful and anxious when they play because entertainment portrays the world as a mean, violent dog-eat-dog place where the most violent prevail. Interestingly, the least prevalent effect is that some kids, and we don’t know who they are in advance, become more aggressive in their thoughts and behaviors.”

Rich says these responses to violent media relate to the three components for bullying. “In order for bullying to occur, there has to be a bully, a victim and bystanders, people who don’t stand up for the victim, sometimes even cheer the bully on. “Look at how those three responses map onto the outcomes we consistently see from media violence,” he said. “The question isn’t so much ‘Does this video game make my child more violent?’ but ‘What are the changes occurring with my child from spending time [engaging with] this media?’ and ‘Are they changes I want to see in my child?’"

How is Video Game Addiction Treated?

When playing video games does become an addiction or interferes with a person’s ability to live a healthy life, treatment can help, says Cash. At reSTART, she treats young men 18 years and older and sees children on an out-patient basis. “In our retreat center, we start by getting them unplugged so in some ways it’s similar to getting someone away from a substance, but we realize that at some point in their lives they are going to have to be able to reintegrate computers in some way, unlike a substance,” she said.

In the first stage of treatment, the men are completely cut off from electronics. “They are getting good sleep, good nutrition, lots of exercise (we have a cross fit gym), and building the life skills that will support them living as independent adults. We teach them skills of emotion management, social skills, and practical skills,” she explained.

The men also receive counseling from outside groups who run psychoeducational sessions, as well as a 12-step group called Internet and Technology Addicts Anonymous. “Before the men can go into our second phase, they need to develop a good plan for future life balance with technology,” said Cash.

During the second phase of treatment, Cash says, “they’re living on their own with someone else in recovery, going back to work and school, and slowly reintroducing computers into their lives. Most of our clients arrive depressed and anxious, and, for most, these problems begin to dissipate over 45 to 90 days as their addicted brains pass through withdrawal, and return to more normal functioning.”

Watch a discussion on video game addiction from a gamer's perspective:

Cathy Cassata is a regular contributor to The Fix, based near Chicago. She last wrote about keeping kids off drugs and exercise addiction.

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Cathy Cassata is a freelance writer who writes about health, mental health and human behavior for a variety of publications and websites. She is a regular contributor to Everyday Health and Healthline. View her portfolio of stories at Connect with her on Twitter at @Cassatastyle.

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