Researchers use several different terms to describe it: Video game addiction. Gaming disorder. Pathological gaming. But whatever the label, it’s a problem with serious consequences, and a disturbing number of kids are symptomatic. Learn the signs of pathological gaming, and how we can help kids lead more balanced lives.
Some kids spend long hours playing video games. Do they suffer from video game addiction? Not necessarily.
Kids might play video games with disturbingly violent themes. They might spend too much time on the couch, becoming more sedentary and socially reclusive. Kids might sometimes neglect their chores or homework, and they might fail to develop the ability to entertain themselves without screens. But such problems don’t mean that a child suffers from an addiction.
What’s an “addiction”?
Originally, the term referred to a physiological dependence on a drug. Nowadays, it’s not unusual to hear people use “addiction” to describe all sorts of excessive behavior, like eating too much chocolate. But the experts — psychiatrists and psychologists — take a more careful, measured approach.
These professionals are open to the possibility that certain repetitive behaviors — including video game use — can become excessive and compulsive. But is this really comparable to a substance addiction?
When you suffer from an addiction to a substance, you experience several distinctive, neurologically-based states, including
- a positive mood state, or “high”;
- tolerance (the need to increase your dosage over time to achieve the same effects);
- cravings; and
- withdrawal (if your usage decreases or stops).
It isn’t yet clear how similar proposed behavioral “addictions” are to substance use addictions (Grant and Chamberlain 2016), but the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes “internet gaming disorder” as a type of addiction, and the World Health Organization has classified “gaming disorder” as a disease characterized by addictive behavior (Higuchi et al 2021).
And regardless of what labels we favor, researchers have demonstrated that video gaming behavior can become pathological (Limone et al 2023).
So it isn’t unreasonable to speak of some individuals as “addicted” to gaming
Playing may give them a sense of euphoria, or at least a sense of relief from unpleasant feelings. They experience “withdrawal” if they are denied access to games. And gaming interferes with everyday functioning — disrupting sleep; undermining school performance; damaging “real world” social relationships; and fueling emotional problems (Gentile 2009; Limone et al 2023).
Does addiction imply that you are playing very frequently, or putting in long hours? Yes, pathological gamers tend to play a lot — more than two hours per day. Sometimes much more (Limone et al 2023).
But while total time spent gaming can be a red flag, it isn’t by itself, the core problem.
The core problem is that video games are interfering with healthy adjustment and development. They are taking over the player’s life.
How many kids are struggling with video game addiction?
Estimates vary. For example, when Pierpaolo Limone and colleagues reviewed international studies published between 2018 and 2022, they found that rates of video game addiction in children and teens ranged between 1-17%, and averaged at around 5% (Limone et al 2023).
But this reflected only individuals who were clinically diagnosed and who “met the full diagnostic criteria.” When the researchers considered less strict criteria — such as including any cases of problematic or disordered gaming — rates were in the range of 20-30% (Limone et al 2023).
Does my kid have a gaming problem?
To get an idea, let’s consider this screening tool developed by Douglas Gentile.
The Video Game Addiction Questionnaire
Gentile surveyed a random sample of 1178 American youth (aged 8 to 18), asking kids to answer each of the questions below with either a “Yes,” “No,” or “Sometimes.”
Kids were considered to be pathological gamers if they responded with a “Yes” or “Sometimes” to at least 6 of these 11 questions:
1. Over time, have you been spending much more time thinking about playing video games, learning about video-game playing, or planning the next opportunity to play?
2. Do you need to spend more and more time and/or money on video games in order to feel the same amount of excitement?
3. Have you tried to play video games less often or for shorter periods of time, but are unsuccessful?
4. Do you become restless or irritable when attempting to cut down or stop playing video games?
5. Have you played video games as a way of escaping from problems or bad feelings?
6. Have you ever lied to family or friends about how much time you play video games?
7. Have you ever stolen a video game from a store or a friend, or have you ever stolen money to buy a video game?
8. Do you sometimes skip household chores in order to spend more time playing video games?
9. Do you sometimes skip doing homework in order to spend more time playing video games?
10. Have you ever done poorly on a school assignment or test because you spent too much time playing video games?
11. Have you ever needed friends or family to give you extra money because you spent too much money on video game equipment, software, or game/Internet fees?
How should we evaluate a child’s answers?
Gentile offered two approaches. The looser one lumped together all “Yes” and “Sometimes” responses as indicators of potential pathology. Using this approach, approximately 20% of his sample met the criteria for a video game addiction.
By contrast, when Gentile counted only “Yes” responses, about 8% of the kids qualified as pathological gamers (Gentile 2006).
Either way, a lot of kids were reporting problematic behavior, and the problems seemed to affect children across a wide range of backgrounds. In Gentile’s study, pathological video game use was unrelated to cultural variables, like race or the type of school attended.
Yet despite their socioeconomic diversity, game addicts shared certain risk factors and dysfunctional outcomes. In Gentile’s study, pathological gamers spent about twice as much time playing games (24 hours per week) as their peers. They were also more likely to have game systems in their bedrooms, and they also reported
- more trouble paying attention in school
- poorer grades, and
- more health problems.
These themes are consistent with research conducted in other regions of the world, including Asia, Europe, and the Middle East. Addicted gamers tend to have poorer cognitive and academic performance, and they are more likely to suffer from sleep disruption, anxiety, and low self-esteem (Limone et al 2023).
Can we blame everything on pathological gaming?
The research tells us that addictive gaming is linked with a wide range of troubles. But this isn’t proof that gaming causes these problems, and it isn’t unlikely that causation can work in the other direction — to at least some degree.
For example, kids with anxiety problems may be more likely to seek relief by playing video games. And kids are at higher risk for developing a gaming disorder if they have attention deficit hyperactivitity, or ADHD (Simonelli et al 2024; Koncz et al 2022; Muzwagi et al 2021).
Nevertheless, it’s pretty evident that video game addiction makes a lot of things worse. That’s clear from Gentile’s questionnaire. Respondents who test “positive” for pathological gaming are self-identifing symptoms of compulsion and dysfunction.
Implications for parents: What does all of this mean?
Maybe you already know that you want your child to spend less time playing video games. Is it important to go further, and assess whether your child’s behavior is “addictive” in the sense we’ve discussed here? In other words, does it matter if we identify that a child’s gaming habits are pathological?
I think it does. Addictive behavior isn’t the same thing as exceeding recommended limits for screen time. We can imagine a situation where a child spends too much time playing video games, yet isn’t out of control, or suffering substantial, adverse affects.
A study conducted on children in Singapore illustrates this. Researchers found links between video game addition and worsened school performance. But they didn’t discover a correlation with time spent playing video games. What mattered was symptoms of addiction, rather than the frequency or duration of gaming sessions (Skoric et al 2009).
It’s also easy to appreciate how the presence of addictive symptoms is going to make it tougher for kids to reduce their involvement with gaming.
Players are going to need help coping with their cravings and impulses. We can impose limits and restrictions on kids, but if they don’t have the skills to cope — if they don’t know how to engage in alternative activities to deal with negative feelings or boredom — they will likely stay focused on getting that next video game fix.
So clinicians advise us to take pathological gaming seriously.
It isn’t “just a phase” that will get better on its own. We need to actively help kids learn how to replace their compulsive behavior with other, developmentally healthy pursuits.
And while more research is needed about treatment strategies, there’s good reason to think that kids with addiction-related symptoms may benefit from the same types of interventions that work for pathological gamblers or substance abusers — interventions like cognitive behavioral therapy (CBT), peer support groups, and “12 step” programs (e.g., Chang et al 2022; Torres-Rodríguez et al 2019; Kelly et al 2000).
In general, therapies are more effective when they include lots of social support, and involve children’s friends and family members. In fact, kids are less likely to develop pathological gaming to begin with if they have stronger social skills and higher-quality family relationships (Muzwagi et al 2021).
Finally, some thoughts about the qualities that make video games intensely absorbing, so that nothing else matters
It seems wise to be vigilant about gaming experiences that might overwhelm a child’s sense of self-control.
People can become completely immersed in video games. They can become supremely focused without having to make a conscious effort. They experience reduced self-awareness, and an altered sense of the passage of time. They are challenged enough to be motivated, but not so much that it becomes overwhelming and aversive.
They are, in effect, in a state of optimal arousal or engagement for performing tasks in the video game. Nothing else matters (van der Linden et al 2021; Gold et al 2020; Michailidis et al 2018; Rao et al 2006).
Psychologists call this experience flow, and it’s not a unique characteristic of video games. Plenty of other activities—including creative ones, like sculpting or composing music—can also create a sense of flow.
But some video games seem to have a peculiarly powerful effect, and I wonder how realistic it is to expect kids to keep their gaming habits in check.
So in addition to monitoring our children’s habits—and setting limits—we might also think seriously about ways to cope with the powerful draw of highly immersive games.
Some research suggests that the most “addictive” video games are the fantasy role-playing games, especially for kids who are shy or unpopular (Lee et al 2007). Perhaps, then, concerned parents should try to steer susceptible kids away from such games, and towards less overwhelming options, like electronic board games, puzzles, sports games, or simulation games.
And maybe adults can offer kids other, more productive or developmentally-stimulating ways to enjoy a sense of flow. Kids can lose themselves in the exploration of local wildlife or the construction of a model bridge. But do they?
It’s interesting to consider that while video games have become more popular, other opportunities for unstructured play have been shrinking. I’m not suggesting that video games are responsible. But perhaps the availability of video games has facilitated a major change in our lifestyles.
I remember when kids used to spend most of their free time outdoors, playing without the direct supervision of adults. Nowadays, this is judged to be too dangerous. The perception of danger may map onto reality for some families (such as those who live in high-traffic, high crime neighborhoods).
But regardless, it’s obvious that parents today are struggling with different norms and perceptions, and the 21st century status quo leaves kids with a gap that video games can try to fill. In a study of American fourth graders, researchers found that gaming addiction rates were higher among kids who perceived their environments as less safe (Pentz et al 2011).
Can we prevent pathological video gaming by greatly increasing kids access to freewheeling, social, outdoor play? I doubt there is any one, single solution. But I suspect this would be very helpful.
More information
For more information, I highly recommend Douglas Gentile’s public web page about video game addiction, violence in the media, and related topics.
In addition, see this collection of evidence-based articles about the effects of video games — good and bad.
References: Video game addiction
Chang CH, Chang YC, Yang L, and Tzang RF. 2022. The Comparative Efficacy of Treatments for Children and Young Adults with Internet Addiction/Internet Gaming Disorder: An Updated Meta-Analysis. Int J Environ Res Public Health. 19(5):2612.
Gentile D. 2009. Pathological video-game use among youth ages 8 to 18: a national study. Psychol Sci. 20(5):594-602.
Gentile DA, Choo H, Liau A, Sim T, Li D, Fung D, and Khoo A. 2011. Pathological video game use among youths: a two-year longitudinal study. Pediatrics. 127(2):e319-29.
Gold J, and Ciorciari J. 2020. A Review on the Role of the Neuroscience of Flow States in the Modern World. Behav Sci (Basel). 10(9):137.
Higuchi S, Nakayama H, Matsuzaki T, Mihara S, and Kitayuguchi T. 2021. Application of the eleventh revision of the International Classification of Diseases gaming disorder criteria to treatment-seeking patients: Comparison with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders Internet gaming disorder criteria. J Behav Addict. 10(1):149-158.
Kelly JF, Myers MG, and Brown SA. 2000. A multivariate process model of adolescent 12-step attendance and substance use outcome following inpatient treatment. Psychology of Addictive Behaviors. 14(4):376-389.
Koncz P, Demetrovics Z, Takacs ZK, Griffiths MD, Nagy T, Király O. 2023. The emerging evidence on the association between symptoms of ADHD and gaming disorder: A systematic review and meta-analysis. Clin Psychol Rev. 106:102343.
Lee MS, Ko YH, Song HS, Kwon KH, Lee HS, Nam M, and Jung IK. 2007. Characteristics of Internet use in relation to game genre in Korean adolescents. Cyberpsychol Behav. (2):278-85.
Limone P, Ragni B, and Toto GA. 2023. The epidemiology and effects of video game addiction: A systematic review and meta-analysis. Acta Psychol (Amst). 241:104047.
Michailidis L, Balaguer-Ballester E, and He X. 2018. Flow and Immersion in Video Games: The Aftermath of a Conceptual Challenge. Front Psychol. 9:1682.
Muzwagi AB, Motiwala FB, Manikkara G, Rizvi A, Varela MA, Rush AJ, Zafar MK, and Jain SB. 2021. How Are Attention-deficit Hyperactivity and Internet Gaming Disorders Related in Children and Youth? J Psychiatr Pract. 27(6):439-447.
Paulus FW, Sander CS, Nitze M, Kramatschek-Pfahler AR, Voran A, von Gontard A. 2020. Gaming Disorder and Computer-Mediated Communication in Children and Adolescents with Autism Spectrum Disorder. Z Kinder Jugendpsychiatr Psychother. 48(2):113-122.
Pentz MA, Spruijt-Metz D, Chou CP, and Riggs NR. 2011. High calorie, low nutrient food/beverage intake and video gaming in children as potential signals for addictive behavior. Int J Environ Res Public Health. 8(12):4406-24.
Rau PL, Peng SY, and Yang CC. 2006. Time distortion for expert and novice online game players. Cyberpsychol Behav. 9(4):396-403.
Simonelli V, Narzisi A, Sesso G, Salvati A, Milone A, Viglione V, Tolomei G, Masi G, and Berloffa S. 2024. Internet Gaming Disorder in Children and Adolescents with Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Brain Sci. 14(2):154.
Skoric MM, Teo LL, and Neo RL. 2009. Children and video games: addiction, engagement, and scholastic achievement. Cyberpsychol Behav. 12(5):567-72.
Sun DL, Ma N, Bao M, Chen XC, and Zhang DR. 2008.Computer games: a double-edged sword? Cyberpsychol Behav. 11(5):545-8.
Tejeiro Salguero RA and Bersabe Morán RM. 2002. Measuring problem video game playing in adolescents. Addiction 97(12): 1601-1606.
Torres-Rodríguez A, Griffiths M D, Carbonell X, Farriols-Hernando N, and Torres-Jimenez E. 2019. Internet Gaming Disorder treatment: A case study evaluation of four different types of adolescent problematic gamers. International Journal of Mental Health and Addiction 17(1): 1–12.
van der Linden D, Tops M, and Bakker AB. 2021. Go with the flow: A neuroscientific view on being fully engaged. Eur J Neurosci. 53(4):947-963.
Zastrow M. 2017. News Feature: Is video game addiction really an addiction? Proc Natl Acad Sci U S A. 114(17):4268-4272.
Content of “Video game addiction” last modified 3/2024. Portions of the text derive from earlier versions of this article, written by the same author.
image of three kids glued to their electronic devices by Alex Tihonovs / shutterstock
image of boy gamer ©iStockphoto.com/Darren Hendley