The Facts about Video Gaming

Dr. Sam Goldstein

Over the past twenty years, video gaming has become the number one pastime, not only among adults but among children and teenagers. For all ages, playing video games has overtaken all other leisure time activities, including watching television. With the advent of modern cell phones, video game playing has skyrocketed. The video gaming industry continues to grow at an exponential pace. Two Thousand Eighteen marked the eighth consecutive year in which consumer spending increased on video game playing to an astonishing forty-three billion dollars. The Entertainment Software Association reports that nearly two thirds of households own a video game device, 60% of Americans play video games daily, and the average adult age of a video gamer is thirty-four years. These data do not include games played on personal devices such as a cell phone. Interestingly, adults represent more than 70% of video game users and play at a slightly higher rate than women. According to available sales figures, the best-selling video games are very clearly directed at adults (e.g., Call of Duty, God of War, Grand Theft Auto), as well as sport video games involving basketball, football and soccer.

Until recently, little attention was paid to the possibility that excessive video game use would in and of itself be a problem as opposed to a symptom of another problem such as depression. Newer diagnostic criteria have focused on disorders related to gaming but up until recently have primarily been directed to gambling alone. More recently, new criteria have been proposed by researchers for future diagnostic manuals focusing specifically on the narrow classification of digital gaming disorder, internet gaming disorder and video gaming disorder. The criteria proposed include the following:

  • Gaming disorders are characterized by the inability to resist an intense internal drive to engage in gaming behavior (digital gaming or video gaming), which may be online (over the internet) or offline, manifested by:
    • (1) Impaired control over gaming (onset, frequency, intensity, duration, termination, context).
    • (2) Increasing priority given to gaming to the extent that gaming takes precedence over other required activities such as work or school.
    • (3) Continuation or escalation of gaming despite the occurrence of negative consequences. The behavior pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
  • The pattern of gaming behavior may be continuous or episodic and recurrent. The gaming behavior and other features are normally evident over a period of at least twelve months in order for a diagnosis to be assigned although the required duration may be shortened, if all diagnostic requirements are met and symptoms are severe.

At this moment, there is no formal diagnosis of video, internet or digital gaming disorder. Available research over the past twenty years suggests that the rate of this type of gaming disorder is somewhere between 1% to 3%, with some studies suggesting as high as 10%. As with other mental health conditions, currently the issue is not so much what you do or how long you do it but rather the level of impairment the activity causes. Further, at this time, other than creating prosthetic environments that simply do not allow access to video gaming, there are no defined medical or psychological treatments for this problem.

Critics of this type of diagnosis have noted that you could replace video gaming with another activity such as cooking or exercising. While this may be the case, if those activities cause impairment then they may too represent a disorder. Interestingly, in the 1930’s radio addiction was a topic of interest and Congress held hearings in the mid-1950’s on reported “comic book addiction.”

Research has yet to demonstrate whether those at risk to become addicted to video game playing are also those who share equal risk to become addicted to illicit substances, alcohol or sexual activities. It remains the case that the majority of the population can in fact modulate these types of behaviors without causing significant impairment in their daily lives.

In light of these data and the current trends, what are parents to do? In a previous article, I reviewed research suggesting that children and teens should not spend more than two hours each day in front of screens (The Complexities of Child Development in the 21st Century). This recommendation was based on well-documented research supporting the two hours as a recommended threshold. I also noted that these two hours included all kinds of screens, not just video gaming. In my experience with the children with whom I work, it is typically the case that excessive video gaming is also accompanied by other developmental, emotional or behavioral challenges. For some, gaming offers an activity because they have little else to do. For others it provides an escape from things they do not want to do. Still for others, it may truly reflect an addiction and an inability to stop. Seeking professional help, beginning with a consultation with the child or teen’s pediatrician, is clearly a good place to begin if parents have concerns. The best question to ask: “Is my child engaging in video gaming to the exclusion of other necessary life activities, including school work, family and friends; and if so, is gaming itself becoming a bigger problem than whatever challenges my child or teen faces?”