Sunday, September 28, 2014

Video Game Addiction

Dear Lisa,

 My nine year old son plays his video games constantly.  He rather play his video games then go outside and play with friends.  If I tell him to stop, he gets really upset.  I am afraid that it is becoming an obsession.   I don’t know if I am overacting or not.  Is there a problem with children playing too many video games? 

“Worried about Video Addiction”

Dear “Worried about Video Addiction”,

Your concern is quite common.  I come across a lot of children, especially boys who seem excessively interested in video games.  Many parents complain that playing video games consume all of their time and limits their interest in other activities.  Our world has become so dominated with electronics that it doesn’t surprise me that children choose to play video games instead of playing outside.   

Video gaming has become such an issue that the editors of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposed the addition of Internet Gaming Disorder (IGD) as an official diagnosis.   There was controversy over the plan and as a result the addition of Internet Gaming Disorder was added to the section on “Conditions for Further Study”.   So it seems that excessive video gaming goes beyond the issue of parental concern and more research needs to be done regarding this behavior.    

Internet Gaming Disorder is characterized by persistent and recurrent use of the internet to engage in games leading to clinically significant impairment or distress.  Children at risk seem preoccupied with the games, experience withdrawal symptoms when the game is taken away, experience loss of interest in previous hobbies, use games to escape or relieve a negative mood and deceive others regarding the amount of time they spend playing videos.   International studies show that heavy users tend to play 20 to 30 hours and sometimes more than 40 hours per week(1).  Most video gamers are male and often play well into their twenties.  These young adults often jeopardize their relationships with significant others, or lose educational and job opportunities because of their game playing.

In one study of 1,178 U.S. school aged children; pathologic gamers were more likely to have attention problems in school, involvement in physical altercations, and health problems worsened by gaming, including extremity pain(2).  In addition, children that excessively play video games have a greater likelihood of having Attention Deficit Disorder.  Excessive gaming has also been linked to sleep problems.   Adolescents experience lower-quality sleep, have problems achieving deep levels of restorative sleep, and take a longer time to fall asleep(3). 

There has been much debate in the media regarding the relationship between violent video games and violent behavior in children.  Studies have shown a positive relation between violent video game play and aggressive thoughts and behaviors, delinquency and lack of empathy towards others(4,5).  Some may argue that children with these attributes are attracted to the video games and it is not the video games that causes the child to become violent.  Clearly more research needs to be done in this area.  Since some of the most popular video games that children play are rated M, it is important for parents to become aware of the rating system and monitor the games that they are playing.  Rated M games contain mature content which may include intense violence, blood and gore, sexual content and strong language.  Exposure to these topics is not intended for children under 17 years old.

Being that your child is only nine years old, it seems that the problem has not become out of control.  It is a good idea to monitor your child and understandable that you are concerned about the negative implications of excessive gaming.  You did not mention how often your child plays video games or if the gaming interferes with his relationships or school work.  If the gaming interferes with your child’s sleep, school performance or family life it would be a good idea to discuss this with your Pediatrician or Nurse Practitioner. 

According to The American Academy of Pediatrics, screen time should be limited to 2 hours per day.  Simple measures to assist parents in curtailing video gaming include removing gaming devices from your child’s bedroom, not allowing your child to play games until homework and chores are finished and using a timer to limit the time playing.   Removing the game from the child’s bedroom will prevent the child from sneaking to play games, keep the child from being tempted to stay up too late at night and will decrease the exposure to light during bedtime which may interfere with sleep. 

In order to encourage outside play and socialization with other children parents may consider signing up their child for extracurricular activities such as sports, school clubs or musical instrument training.   Parents can set up a system that allows the child to earn hours playing the video game, by collecting points for engaging in outside activities or exercise.  Some parents may perceive this idea as being too controlling, but in some cases it is necessary if children can’t seem to control their time away from the screen on their own.   In addition, it gives children the message that the balance of many activities is healthy, human contact is enriching, and time management is essential for success. 

Most importantly, children learn by what they see, not necessarily simply by what they are told.  Many times I observed parents give their child a video game when they are misbehaving in order to keep them quiet.  In essence, what they are showing their children is that an electronic game is necessary to keep them busy and quiet.  Although, this may seem like the only option at the time, the message may not be beneficial, especially for children who already have an issue with impulse control or socializing with others.  One option is to play verbal word games (21 questions, Eye Spy) with your child in situations when they need to stay focused or quiet.  Being a role model will help your child understand the importance of balance.  If a child sees their parents spend an exorbitant amount of time on the computer, not socially connected to others and little time outdoors exercising, they will likely follow their example.  A family trip free from electronics, or an electronic free day visiting friends or family may be a good way to teach your child the importance of human contact and face to face communication.  

(1)Knapp S, Swager L, Nield L. Consultant for Pediatrics.  Game Over:  Helping a Teenager Quit a Video Game Addiction.  2014.  June:266-268.
(2)Haagsma M, Pieterse M, Peters O.  The Prevalence of Problematic Video Gamers in the Netherlands.  Cyberpsychol Behav Soc Netw. 2012:15(3):162-168.
(3)King D, Gradisar M, Drummond A, et al.  The Impact of Prolonged Violent Video-gaming on Adolescent Sleep: an Experimental Study. J Sleep Res. 2013:22(2)137-143.
(4)Anderson C, Dill K,  Video Games and Aggressive Thoughts, Feelings and Behavior in the Laboratory and in Life.  J Pers Soc PSychol.  2000;78(4):772-790.
(5)Anderson C, Shibuya A, Ihori N, et al.  Violent Video Game Effects on Aggression, Empathy and Prosocial Behavior in Eastern and Western Countries: a meta-analytic review.  Psychol Bull.  2010;136(2):151-173.

Lisa-ann Kelly R.N., P.N.P.,C. Certified Pediatric Nurse Practitioner