Game Over: Helping a Teenager Quit a Video Game Addiction

A Parent Asks:

My teenaged son plays video games at least 3 hours per day, and he gets so angry when I ask him to stop playing. Is it possible that he is addicted to video games? If so, how can I help him?

The Parent Coach Advises:

With more than 1 billion people worldwide estimated to have played computer games in 2012 alone,¹ the pervasiveness of video games has necessitated medical experts to consider whether video game addiction is a true pathologic diagnosis in children, adolescents, and adults. The editors of the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) initially had proposed to include video game addiction as an official diagnosis, but controversy over the plan prompted the addition of Internet gaming disorder (IGD) and its proposed diagnostic criteria to the section on “Conditions for Further Study” (Figure 1).²

Compulsive video game use is not unique to the United States. For example, the problem has reached such epic proportions among China’s estimated 330 million online gamers—150 million of whom are below 19 years of age—that authorities there reportedly are developing their own criteria for online gaming addiction.³ In South Korea, where Internet gaming addiction is seen as a “significant concern for public health,” nearly 1 in 4 children diagnosed with it are hospitalized.¹

While the American Academy of Pediatrics recommends a maximum of 2 hours of daily screen time for adolescents and children, international studies show that heavy users play 20 to 30 hours and sometimes more than 40 hours per week.⁴ Most video gamers are male, and they often play well into their 20s. Female gamers may play for fewer hours, but they have higher rates of depression and social phobia than do male gamers.⁵

Contributing to the great interest in video game playing are massively multiplayer online role-playing games (MMORPGs), which are played by 46% of all online gamers⁶ and offer an experience that is distinct from that of traditional video games. MMORPGs allow players to develop their own character, work as part of a team, and even chat with any of the thousands of other gamers playing at the same time. The games are designed such that it is difficult to finish assignments, with new ones regularly introduced.¹ First-person shooter (FPS) games, including the popular Call of Duty, also have contributed to the growing popularity of online video games. FPS games are designed such that gamers have a first-person perspective, with their own gun or other weapon.

The Risk of Excessive Gaming

Numerous studies have documented the negative effects of excessive video game playing among young persons. These games may provide a “dualistic effect,” offering gamers a way to improve their symptoms of depression and low self-esteem while consequently hurting their chances at a normal social life and meeting daily needs.⁷ In one study of 1,178 U.S. school-aged children,⁸ pathologic gamers were more likely to have attention problems in school, involvement in physical altercations, and health problems worsened by gaming, including extremity pain; their likelihood of having an attention-deficit disorder diagnosis was double that of controls.

Evidence also supports prolonged gaming’s negative effects on adolescents’ sleep, with reports of lower-quality sleep, problems achieving deep levels of restorative sleep, and taking longer to fall asleep.⁹ Studies have shown a positive correlation between violent video game play and aggressive thoughts and behaviors, delinquency, and lack of empathy toward others.^10,11

Positive Effects of Video Games

Are there benefits to playing video games? They may increase participants’ motivation to solve a problem, which requires achieving certain goals while facing numerous obstacles. Social skills may be enhanced as a result of the cooperative nature of MMORPGs, which force players to interact with other players. Video games might enhance problem-solving skills and creativity; FPS games in particular might be associated with improved visuospatial processing and attention. Video games also can be used as a tool for cognitive and behavioral therapy to engage children who have certain mental health disorders.^12-14

Video games with an educational purpose or that promote physical movement have not been implicated in the discussion of negative aspects of video games. Interventions to curb video game playing are geared mainly toward gamers who play for an excessive time or who play games with violent content.

Addressing Gaming at Home

Parents can take a number of simple actions if they suspect their child has an addiction to video games. A major step is understanding the content and the rating system of the games their children play (Figure 2).¹⁵ A recent poll found that 38% of 2,278 U.S. adults surveyed knew nothing at all about the video game rating system.¹⁶ Some of the most popular video games that children play are rated M and are intended for children aged 17 years or older. Among the more popular M-rated games are Grand Theft Auto, Call of Duty, Assassin’s Creed, Halo, Medal of Honor, Mortal Kombat, Gears of War, and Dead Space.

Parents should remove the television, video games, and handheld devices from the child’s bedroom to ensure adequate supervision of content exposure. Although the child may be highly resistant at first, these measures likely will decrease total gaming time and improve sleep as a result of decreased exposure to the light emitted from the screen or gaming console. Instituting a check-in/check-out policy for electronics at certain times of day or night also can improve parental supervision.

Rules should be established that limit the time a child spends gaming, including measures such as no gaming until completion of homework or grade improvement, or gaming only on weekends. Parents simultaneously should encourage physical exercise and social activities—for example, joining a sports team or other extracurricular activity, or an outdoors program. 

It is also important for parents to discuss online interactions with others during the child’s interactive gaming sessions. Children should be aware of when discussions with others, particularly adults, are inappropriate and are to be avoided. A weekly electronics-free day can be instituted, during which the focus is on social interaction with the family, to help ensure that a child does not feel isolated because of his or her problem with video gaming. A 3- or 4-day electronics-free family vacation also can be a good opportunity for significant family interaction.

Before setting limitations and enforcing rules, it is important to have a family meeting to discuss the problem. Parents may face opposition from their children, but it is essential that they remain firm when enforcing limitations and rules about gaming. It is advisable that parents seek professional help from a pediatrician or a pediatric mental health care provider to reinforce concerns and subsequent recommendations.

Further Intervention

When behavioral interventions in the home are unsuccessful, other options may need to be considered. With 86% of persons with video game addiction having a comorbid mental health disorder, treatment of these underlying conditions might help resolve the addiction.¹⁷ Gamers often have high levels of depression, anxiety, and school problems, and referral to a mental health expert or pediatrician may be necessary.

Bupropion has been studied as a possible treatment for IGD.¹⁸ This antidepressant is effective in decreasing cravings and targeting the reward pathways in the brain in patients with substance addiction. In one study, after 6 weeks of treatment with sustained-release bupropion, participants’ cravings for Internet video game playing decreased, as did total game playing time.¹⁸ Inpatient centers are available in some areas, but these options usually are not covered by health insurance policies.

Increased public recognition of IGD, as well as the possible development of diagnostic criteria in the DSM-5, brings hope for further research on video game addiction among children and adolescents. As with any condition that affects a child’s well-being, a thorough psychosocial history must be obtained before a diagnosis of IGD is considered. Parents are urged to begin a dialogue about the effects of gaming on their child’s daily life.

Sarah Knapp is a medical student at the West Virginia University School of Medicine in Morgantown.

Lauren W. M. Swager, MD, is a child and adolescent psychiatrist and an assistant professor at the West Virginia University School of Medicine.

Linda S. Nield, MD—Series Editor, is a professor of pediatrics at the West Virginia University School of Medicine.

References

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2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:795.

3. China mulls domestic criteria for online gaming addiction. People’s Daily Online. February 18, 2013. http://english.peopledaily.com.cn/90785/8132332.html. Accessed April 22, 2014.

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15. ESRB ratings guide. Entertainment Software Rating Board Web site. http://www.esrb.org/ratings/ratings_guide.jsp. Accessed April 22, 2014.

16. Majority of Americans see connection between video games and violent behavior in teens; Harris Poll finds one-third of those with young game players do not censor games; majority of U.S. adults admit to understanding little or nothing about video game rating system [press release]. New York, NY: Harris Interactive; February 27, 2013. http://www.harrisinteractive.com/vault/Harris%20Poll%2010%20-%20Video%20Games_2%2027%2013.pdf. Accessed April 22, 2014.

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18. Han DH, Hwang JW, Renshaw PF. Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Exp Clin Psychopharmacol. 2010;18(4):297-304.