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Review Article | DOI: https://doi.org/10.31579/2688-7517/005
1 University of Miami/Miller School of Medicine.
*Corresponding Author: Tiffany Field, PhD, 2889 McFarlane Rd. Miami, Florida 33133, USA
Citation: Field T (2019) Adolescent Internet Gaming Disorder: A Narrative Review. Addiction Research and Adolescent Behaviour 2(1): Doi: 10.31579/2688-7517/005
Copyright: © 2019 Field T. This is an open-access article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 11 May 2019 | Accepted: 03 June 2019 | Published: 10 June 2019
Keywords: internet gaming; adolescent internet gaming disorder; central nervous system function
This narrative review is based on a literature search on PsycINFO and PubMed that involved entering the terms adolescent internet gaming for papers published during the last five years. Following exclusion criteria, 72 papers could be classified as internet gaming or internet gaming disorder/addiction studies including research on the prevalence, effects/comorbidities, risk factors and interventions for those problems. The prevalence of both internet gaming and internet gaming disorder has varied by culture. The effects/comorbidities have included hyperactivity, inattentiveness, cyberbullying, depression, anxiety and substance use. The risk factor studies have focused on impulsivity, sensation-seeking, and aggressivity. Altered autonomic and central nervous system function have also been notable including decreased heart rate variability and fMRI data showing less activation of the prefrontal cortex, ventral striatum and amygdala (areas that are involved in modulating impulsivity, reward-seeking and aggression respectively) as well as reduced gray and white matter. Surprisingly, given the prevalence and severity of internet gaming disorder, very little prevention/intervention research appears in this recent literature. Research is also missing on peer relationships/rejection as potential risk factors. Like other literature on adolescent problems, this research is limited by primarily deriving from self–report and parent report and by the absence of longitudinal data that might inform whether the behavioral and brain data being reported are effects of or risk factors for internet gaming addiction.
This narrative review is based on a literature search on PsycINFO and PubMed that involved entering the terms adolescent internet gaming for papers published during the last five years. Following exclusion criteria (case studies and non-English papers), 72 papers could be classified as internet gaming or internet gaming disorder/addiction including research on the prevalence, effects/comorbidities, risk factors and interventions. The prevalence of both internet gaming and internet gaming disorder has varied by culture. The effects/comorbidities have included hyperactivity, inattentiveness, cyberbullying, depression, anxiety and substance use. The risk factor studies have focused on impulsivity, sensation-seeking, and aggressivity. Altered autonomic and central nervous system function have also been notable including decreased heart rate variability and fMRI data showing less activation of the prefrontal cortex, ventral striatum and amygdala (areas that are involved in modulating impulsivity, reward-seeking and aggression respectively) as well as reduced gray and white matter.
Surprisingly, given the prevalence and severity of internet gaming disorder, very little prevention/intervention research appears in this recent literature. Research is also missing on peer relationships/rejection as potential risk factors. Like other literature on adolescent problems, this research is limited by primarily deriving from self–report and parent report and by the absence of longitudinal data that might inform whether the behavioral and brain data being reported are effects of or risk factors for internet gaming addiction. Accordingly, these topics are discussed in the following sections.
The Nature of the Prevalent Games
A videogame developer has provided interesting insights on the different types of Internet games that have become increasingly popular including power games, making-choice games, incremental games and online role–playing games [1]. He has described power games as similar to the power game called Oasis that was featured in Spielberg’s 2018 movie called “Ready Player One”. Others he identified as power games include Final Fantasy, World of Warcraft, Diablo, Sky Room and the game he is designing called Destiny. In these games, he suggests that the driving purpose is to achieve higher levels and greater numbers, much as in pursuing power. Other games he described are for “making choices” and “mastering the mechanics of the game” including The Walking Dead series and Over watch. The third type of game he described is called incremental games in which the player does not have to interact with the game but simply observes. These include games like Titans, Quicker Heroes and Idol Heroes. Finally, the online role-playing games involve repetitive activity again designed to increase one’s power. Examples he gave are World of Warcraft, Ever quest, Dark Agent, and Ultimo Online. Given Irby’s graduate studies on Sri Lankan Buddhism and Hinduism, it’s interesting that he analogizes these online games to the severe meditative practices of Buddhist and Hindu ascetics who reputedly engaged in the severe meditation to achieve power [1]. This author who continues to develop these games may not realize how prevalent and addictive gaming has become, although he mentioned the chemical dependency that derives from the brain’s reward system releasing dopamine as individual’s progress through the videogames [1].
In addition to chemical dependency, the thousands of hours of playtime that are required to make progress in these games have been associated with excessive sedentary activity. In a recent study in the Journal of the American Medical Association, the number of sitting hours for adolescents has significantly increased from an average of 7 to 8.2 over the last 10 years [2]. In addition, the percentage of adolescents who spend at least one hour a day outside of school time using the computer has doubled over the last decade from 30 to 62%. This is considered problematic given that sedentary behavior has increased the risk for diabetes, heart disease, some cancers and even early mortality [2].
The Prevalence of Internet Gaming in Different Cultures/Countries
The prevalence of Internet gaming has varied widely across different cultures/countries. In the Youth Risk Behavior Survey of 15,624 US high school students, 19% of the adolescents spent five or more hours daily on video gaming [3]. A greater percentage of female adolescents than male adolescents reported spending no time or five or more hours on gaming (21% for female vs. 18% for male adolescents). For female adolescents, a greater prevalence of mental problems was associated with increased time spent whereas a J-shaped curve for the male adolescents suggested an initial decrease followed by a slow increase and then a rapid increase beginning at four hours or more. Spending no time or five hours or more daily in video gaming was associated with increased mental problems for both sexes. Spending one hour or less was associated with fewer depressive symptoms and suicidal behavior when compared with no use or excessive use. In another large sample study (N = 5045), 56% of the students were gamers based on the 12-item Problematic Online Gaming Questionnaire [4]. Latent profile analysis revealed that 5% of the adolescents belonged to a high risk group and 13% to a low risk group.
A higher incidence of gaming (80%) has been reported for Saudi Arabia students based again on a self–report questionnaire [5]. These students reported that the most important motivator for gaming was fun and excitement, followed by getting rid of boredom. The drawbacks noted were interference with sleep time, physical activity and real-life. Although the students’ basal metabolic index was not associated with gaming, academic performance was lower and the prevalence of smoking, road traffic accidents and violence was especially noted among those who preferred racing games and those gaming in cyber cafés.
A similarly high prevalence of gaming has been noted in the Australian Child and Adolescent Survey of Mental Health and Well-being which involved the completion of questionnaires by 2967 11–17-year-olds (85%) [6]. Once again, psychological distress and problem behavior were twice as prevalent for girls as for boys, and those with emotional problems spent the most time playing games. Although it is not possible to determine the direction of effects, multivariate analysis showed that problem behavior, attempting suicide, experiencing high levels of psychological distress, using alcohol and living in a poorly functioning family were associated with more gaming. An even higher incidence of gaming (94%) was reported in a study on 503 Hong Kong adolescents [7]. These rates of gaming are extremely high and, fortunately, the more serious Internet Gaming Disorder/addiction is not as prevalent.
Prevalence of Internet Gaming Disorder/Addiction
Internet Gaming Disorder or Internet Gaming Addiction has been recently defined by the American psychiatric Association as a diagnostic category, and its prevalence has been noted to range between 1% and 9
Research on prevalence, risk factors and effects data comprise most of the recent literature on gaming addiction in adolescents. Only a few interventions were noted in this recent literature including monitoring by parents as well as cognitive behavior therapy. Methodological limitations of this research include reliance on self-report questionnaires that often do not include time spent online gaming and online gaming behaviors. And, the self-report data are discordant with clinical interview data, as was noted in at least one recent study [68]. Smaller sample interview, observational and laboratory studies are needed to understand specific gaming behaviors and the risk factors associated with gaming addiction in adolescents. For example, social anxiety would seem to be associated with gaming which, in turn, may be a safer way of interacting with peers.
Different measures have been used in different studies making it problematic to compare prevalence, effects and risk factors across studies. Cultural differences exist, as noted, but different measures have been used in different cultures. And the scales are typically long and based on pathological conditions. Some have criticized the developers of the scales for borrowing criteria from other addiction research like that of substance abuse. And, using the DSM-V criteria for internet gaming disorder has yielded false positives as well as false negatives.
Gaming addiction is associated with so many other demographic, psychological and behavioral problems as well as comorbid conditions like cyberbullying and depression and addictions like substance abuse. Determining the degree to which each of these contributes to the variance on gaming addiction. Research is also missing on important variables like peer relationships/rejection as potential risk factors. Like other literature on adolescent problems, this research is limited by primarily deriving from self–report and parent report and by the absence of longitudinal data that might inform whether the behavioral and brain data being reported are effects of or risk factors for internet gaming addiction. More multivariate research is needed as well as profile/regression/structural equation modeling that can identify the relative variance explained by these variables. Identifying high risk profiles could then be translated into clinical interventions.
Most of the recent studies are correlational so that the direction of effects cannot be determined. The usual problems of correlation analyses apply to these studies including the lack of control over confounding variables. Regression, mediation/moderation and structural equations analysis models could have been used in these large sample studies to control for potentially confounding variables and to determine the relative contribution of these variables to the outcome variance on gaming addiction in adolescents
Interventions that have been effectively used with other addictions could be explored with adolescents who are experiencing gaming addiction including, for example, the parent monitoring protocols, exercise programs, massage therapy, yoga, meditation and cognitive behavior therapy. Further, the occurrence of gaming addiction and other addictions like internet addiction as early as pre-adolescence highlights the need for school-based education programs for both parents and students along with teacher and peer monitoring of these addictive behaviors.
Unfortunately, the internet and cell-phone technology that was intended for communication and educational purposes has become addictive and problematic for many aspects of the health and well-being of younger and younger adolescents. The survey studies reviewed here have highlighted the prevalence, risks and effects of gaming addiction. However, more small-scale empirical studies are needed to explore the specific gaming addiction behaviors Research is also missing on peer relationships/rejection as potential risk factors. Like other literature on adolescent problems, this research is limited by primarily deriving from self–report and parent report and by the absence of longitudinal data that might inform whether the behavioral and brain data being reported are effects of or risk factors for internet gaming addiction. And related addiction behaviors, the personality and non-gaming activity profiles of the adolescents and the underlying mechanisms to inform the even more needed early intervention/prevention studies.
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