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Does Your Loved One Have Any of the Following... 

Does your loved one have any of these signs that might indicate problematic video gaming?

• Playing more than 1-2 hrs a day of video games?
• Spending so much time playing video games that it causes problems with home, school and extracurricular activities?
• Neglecting sleep, physical activity, and other basic needs in order to spend time playing video games?
• Gets upset or irritable when it is time to stop playing, or when asked to stop playing?

If your loved one has one or more of these signs, then continue reading to learn more about problematic video gaming and what to do…

Jeff’s Story, Part 1

Jeff is a typical 16-yo teenager in high school, who lives with his loving parents and an older brother. Like many teens, he plays video games and connects with friends and peers online. In the past few months however, parents have noticed that Jeff has become irritable, moody, and has problems with poor hygiene. His parents are concerned and worried, and have tried talking to Jeff, but he denies anything is wrong. Parents wonder if maybe he’s just going through a phase… What’s going on with Jeff?

Introduction

Video games are a popular way for many children, youth and adults to spend their time.

While many people can play them without problems, there are a smaller number of individuals that have difficulties controlling their use, and who can develop severe problems from excessive use of video games.

What is Problematic Video Gaming?

According to the World Health Organization (WHO), ”Gaming Disorder” is a pattern of gaming behavior ('digital-gaming' or 'video-gaming') characterized by:

• Impaired control over gaming (e.g. the person is unable to recognize when to stop gaming)
• Increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities (e.g. the gamer spends so much time gaming that s/he doesn’t meet their obligations at school, work or home)
• Continuation or escalation of gaming despite the occurrence of negative consequences (e.g. the excessive gaming leads to problems at school, work, home or relationship problems)

Gaming disorder is not simply the occasional binge of video gaming, but rather it represents an extreme, where "the behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

How Common is Problematic Video Gaming?

Studies suggest 6-11% of gamers have problematic video gaming (Rehbein, 2010; King, 2011).

• Males are more vulnerable. Males are twice as likely to have problematic video gaming than females.
• All ages are affected. Problematic video gaming seems to affect youth and adults similarly.

What Causes Problematic Video Gaming?

Modern technologies such as video games are designed to be addictive, which in turn, provides revenue for the video game manufacturer. With advances in technology, today’s video games are far more addictive than video games just a decade or two ago.

Our hunter gatherer brains love dopamine and adrenaline, but the problem is that actual hunting and gathering takes a lot of effort. Not to mention being potentially dangerous.

Modern technology has been designed to give our brains that dopamine and adrenaline that they crave, without any effort. Not to mention with much less risk.

As a result, it is no wonder that everywhere we turn, we see people glued to their electronic screens. Once a person becomes used to ‘easy dopamine and adrenaline’, it becomes very difficult to get people to put down their devices and do other activities (e.g. go outside, amuse themselves without electronics, help with chores, etc.)

Many Factors Contribute to Video Game Addiction

Through no fault of their own, many people are at a higher risk of developing a video game addiction, such as those with:

• Anxiety and depression, which tend to make people withdraw from the real world
• Attention deficit hyperactivity disorder (ADHD), which makes them attracted to excitement and dopamine.
• Autism spectrum disorder (ASD), which makes it hard to relate to others.
• Male gender: Males appear to be at a higher risk, possibly due to the fact that many video games specifically have been created to target males in particular.

Community factors can include:

• Lack of safe places for children/youth to play outside;
• Lack of children/youth who play outside;
• Parents and families that are overwhelmed and thus the temptation is great to simply give the child a device to play with.

The Problem of Playing Too Much Video Games

Excessive video gaming (i.e. playing more than 2-hrs daily) has been linked to numerous problems (Zajac, 2017):

• Emotional and behavioural problems
  • Oppositional behaviour;
  • Problems with mood (e.g. depression), anxiety, as well as feeling suicidal;
  • Inattention/hyperactivity;
  • Substance abuse;
  • Sleep problems.
• Problems with function
  • Poor school achievement such as lower grades; increased chance of dropping out of school;
  • Poor social skills.
• Physical health problems
  • Excessive screen time leads to a sedentary lifestyle, and may lead to one neglecting one’s personal hygiene and health

Preventing Problematic Video Gaming: Advice for Parents

General Advice

Preventing problematic video gaming is much easier than having to deal with it. Here are some tips that might reduce the risk of problematic video gaming:

• Invest time and energy in having a good relationship with your children, as studies show that a strong parent-child relationship protects children from problematic video gaming (Zorbaz, 2015). Be emotionally available, i.e. When your children are sad, anxious or upset, be able to listen, empathize and support them with their difficult feelings.
  
  
• As a family, model to your kids the importance of healthy activities and routines such as:
  • Sleep
  • Face-to-face time with fellow humans, in particular parents and family.
  • Nature and physical activity.
  • Doing boring but necessary things such as homework and chores.

• Be a role model for responsible technology use. Don’t ignore your kids with your own technology use, but show to your children that face-to-face time is valuable. Try to reduce your own recreational screen time, i.e. watching less TV for entertainment.
  

How much recreational screen time? It depends on the age…

Summary of Screen Time Recommendations from various sources:

In detail

For infants / young children aged 0-2

• Recommended screen time is none at all (Canadian Sedentary Behaviour Guidelines, 2011).
• Exceptions would be video chatting (e.g. Facetime, Skype) with relatives.

For toddlers aged 3-5

• Recommended screen time max is 1 hr/day (Canadian Sedentary Behaviour Guidelines, 2011), though it is still better to have zero recreational screen time daily.

For school-aged children aged 5-12

• Maximum recreational screen time 1-2 hrs/day, though it is still better to have less screen time.
• A challenge arises in that many school-aged children now have screens in their classrooms all day, such as with smart boards and tablets.
• Children should not have access to cellphones until at least aged 12, and even then, the safest is to provide access to a ‘dumbphone’ rather than a ‘smartphone’.
• Due to internet privacy laws, social media is not permitted until at least age 12.

For teenagers aged 12-18

• Maximum recreational screen time 1-2 hrs/day, though it is still better to have less screen time.
• Use of smartphones and technology is so widespread amongst the average teenager, that it makes it hard for those parents who do want to set limits.
• Continue using technology contracts, many of which exist for teenagers.

Adapted from (1) Canadian Sedentary Behaviour Guidelines (2011); (2) Canadian Pediatric Society (2017) ; (3) Canadian Association of Optometrists; (4) Xiong, 2017.

Setting Healthy Limits: Strategies for Parents

Parents have a significant role to play in influencing a child’s healthy use of technology.

Here are some specific strategies for setting healthy limits:

• Connection before correction: Ensure that as a parent, you have a connection with your child, such as spending positive time together; being able to listen to your child; validating their feelings, etc.

• Be positive and affectionate with your child is a good place to start when guiding his behaviour. When you express gratitude by thanking your child for behaving well it encourages him to keep doing the right thing in the future.

• Before introducing technology such as video games, social media, or devices such as a cellphone, consider a technology / media contract – they are a good start to ensure everyone understands the limits, and it’s also a great opportunity for conversation about healthy use. Many examples exist online, including cut/pastable version on www.eMentalHealth.ca
  http://www.ementalhealth.ca/index.php?m=article&ID=57030

• Limits, or lack of, with technology should be attuned with a child’s maturity. The goal is to help them build healthy skills and habits, not just manage behaviour.
  
• It’s reasonable to expect that a child’s first response to a limit will be challenging – they may cry or yell when their time is up. It’s helpful to know that this is normal, to have some strategies in advance, and to plan how you can redirect, de-escalate, and plan to engage them in another activity.
  
• Your child’s friends will likely have different technology rules and limits. Prepare a response when your child brings this up.
  
• Any recommendations/boundaries that you offer your youth surrounding screen time, try to word it so that it is to his/her benefit. It alleviates a concern that they may have in their lives e.g. sleep, weight, friendship building.

• Be consistent. Effective boundaries are achieved through practice and habit – you start at square one every time you’re not consistent.

• Set limits and expectations on technology, for example:
  • Recreational electronics is a privilege that comes after expectations are met.
  • No technology at the dinner table or at bedtime
  • Limit technology use in the car. It may be tempting to allow your kids to watch movies in the car, but being in the car is an excellent opportunity to connect with your kids. Or for them to learn how to be ‘mindful’ while looking out the window, exploring their own thoughts, without needing to be distracted.
  • Have your child leave their phone in the kitchen when it’s study time. You can begin by trusting them during study hours that they are not on social media but if/when they do - you can block social media websites on their computer.
  • Limit recreational technology on weekdays. Many parents will limit video games on school days, while allowing them on weekends. This helps prevent addiction, by ensuring that there are several days during the week that are video game free.
    
• If your child is spending time at a friend’s house, be aware of what the availability and limits are there too.

When further boundaries are required:

• Limit wifi availability, such as turning it off overnight
  
• Change the wifi password daily.
  
• There are apps and arrangements that can be made directly with your Internet Service Provider (ISP) to limit connectivity for specific users or computers. The advantage of making arrangements with your ISP is that changes can only be made by an account holder.

• There are technological solutions such as Disney Circle.
  
• Remove controllers or cables when your youth will be unsupervised – this may mean taking them to work with you.
  
• If needed, consider removing devices completely.

Managing Problematic Video Gaming: Strategies for Parents

• Don’t waste your energy blaming yourself. Video games are purposely designed to be so addictive, that you can still be the best parent in the world, but your child can still become addicted.

• Seek support from family/friends. Caring for a child with an addiction can be exhausting, and it is important to attend to your own needs as well. Don’t isolate yourself. Talk and spend time with others in your support network.

• Ask yourself, what needs is your child meeting through video games?
  • Is your child trying to keep occupied? Find healthy activities and people.
  • Is your child looking for social connection? Find other ways to connect socially.
  • Is your child looking for others to validate and accept your child? If so, find responsible adults that can help your child feel accepted.
  • Is your child looking for adrenaline and excitement? Find ‘adrenaline’ sports such as mountain biking, kayaking, etc. to meet that need.

Screen Detox

Is your child/youth having problems, despite your best efforts?

Consider a 4-week screen detox, which is stopping all recreational technology for 4-weeks (Dunckley, 2014).

How to do a detox?

Step 1: Get to 0 hrs/day of recreational screen time.

• Are problems severe, with several hours daily of video gaming, and, severe problems at home and school?
  • If so, then consider a gradual detox, which involves gradually stopping over time. It might take several weeks (or longer) to reduce the daily recreational screen use to 0 hrs/day.

• Are problems mild (e.g. less than 1-2 hrs daily of video gaming and mild problems at home and school)?
  • If so, then consider stopping more suddenly, e.g. Going away for a family camping vacation for a week or so.

Step 2: Keep 0 hrs / day of recreational screen time for 4-weeks detox period.

• During the screen detox period of 4-weeks, Dr. Dunckley reports parents usually notice improvements in various areas such as the child’s mood, anxiety, social skills, connection and concentration.

What happens after the detox?

• After a period of screen detox, what happens next depends on the child and family.
• Some parents see so many benefits from zero recreational screen time, that they continue to have no recreational screen time.
• Other parents decide to re-introduce video games again, however with strict limits (e.g. 1-2 hrs max daily; or perhaps only on weekends and none on school days). What happens next depends on the child:

1. “Moderators”: Some kids do fine with video games in moderation, and are able to accept the limits on their video gaming.
2. “Abstainers”: On the other hand, other kids cannot accept limits, leading to parent frustration with limit setting. Or the kids do not do well, even with moderation. In these cases, total abstinence of video games may be a better option. 

NOTE:

• Technology is everywhere in modern society, along with the need to use phones, computers for work and education. Thus, for most people, a full detox from all technology is usually not possible. Rather, the goal is to have a better balance of technology use, such as more productive use, and less recreational use.

When to Seek Professional Help?

Is your loved one still struggling despite your best efforts?

If so, then consider seeking professional help by contacting an addictions treatment service, or addictions professional.

How is Video Game Addiction Treated?

The treatment of video game addiction is a relatively new area, however, the treatment of video game addiction is similar to quite similar treatments for other addictions.

Where does treatment happen?

1. In the community: Treatment usually starts with seeing a therapist in a community mental health clinic, or in their private practice.
2. Residential treatment: If community treatment is insufficient, then residential treatment might be helpful Residential treatment is where the child/youth stays at the treatment centre for a period of time, usually at least 21 days.

What happens in therapy?

Therapists use various types of interventions and treatments depending on the situation such as:

• Cognitive Behaviour Therapy (CBT): CBT is a type of therapy that helps people look at their thoughts, feelings and behaviours.
• Motivational Interviewing: Motivational interviewing helps look at a patient’s readiness for change, and explores ambiguity around their willingness to change problematic behaviours.
• Family therapy: Excessive video gaming can impair family relationships, and family interventions seek to improve relationships between the child/youth and family members.

Treatment goals may include:

• Helping the child/youth to find other activities and people to meet the needs that the video games meet. It can be helpful to explore what needs are being met by the video games. Is it a social need? Or is it a need for dopamine/adrenaline? Or is it a need for achievement? This can help in finding alternate activities, such as:

1. Finding other ways to give adrenaline/dopamine, such as time in nature or physical activity.
2. Finding other ways to have social connection, such as with family or friends.
3. Finding other ways to give mental stimulation, such as reading, learning, or other hobbies.

• Video game detox, as described earlier.

• Treating any other mental health conditions that the person has. People with excessive video gaming may have other conditions such as substance use problems, mood problems (such as depression) or anxiety problems, ADHD. Addressing these other conditions can be helpful.
  
• Addressing any other significant life stresses that the person may have. The person may have troubles coping with family stresses. Or stresses with bullying and peers. Video games may be a way of escaping and coping with stresses. Thus, addressing those life stresses can be helpful.

Where to Find Help

Are you in Ontario, and concerned about a loved one?

Contact Connex Ontario to find mental health / addictions services in your area.

1-866-531-2600 | www.connexontario.ca

Live outside of Ontario?

Contact 211 to find out where to access services in your area.

Jeff’s Story, Part 2

Jeff is a 16-yo teenager who has been playing more and more video games, to the point it is causing problems in his life.

Parents discover that the problem has been much more severe than they realized -- Jeff has been skipping school, and has failed multiple courses.

His parents do the following:

• They contact their local addictions agency, which provides support to parents, as well as support to Jeff. It is not an easy road, as Jeff refuses to acknowledge any problems.
• They reconnect to Jeff, such as setting aside regular 1:1 time with Jeff, in order to spend afternoons and evenings doing non-electronic activities and outings.
• They eventually start setting more limits, after being more connected emotionally to Jeff.

Over time, Jeff sees first hand the improvement in his symptoms and finally agrees with parents. It is now several months later, and Jeff is feeling much better. He still gets urges to play his favorite video game, but with the support of his family and a newer group of friends, is able to do other things instead.

Summary

Video game addiction is an increasingly prevalent, evolving problem in our current society. Fortunately, help is available, and research underway is helping us learn more to best support those with problematic video gaming.

For More Information

Readings and Websites for Parents

Reset Your Child's Brain: A Four-Week Plan to End Meltdowns, Raise Grades, and Boost Social Skills by Reversing the Effects of Electronic Screen-Time, by Dr. Virginia Dunckley. This book describes a four-week ‘electronic detox’ protocol for parents. Her website also has additional free tools and resources including webinars, and email newsletters.

www.drdunckley.com

Glow Kids by Nicholas Kardaras

Seeing Through the Cracks, by Elaine Uskoski, a mother’s account of video gaming addiction in her adult, university aged son.

Materials for Gamers

Cam Adair’s TEDX talk on Video Game Addiction
www.youtube.com/watch?v=EHmC2D0_Hdg

GameQuitters by Cameron Adair
www.gamequitters.com

References

American Psychiatric Association: DSM-5: Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Tremblay MS et al.: Canadian sedentary behaviour guidelines for children and youth. Appl Physiol Nutr Metab. 2011 Feb;36(1):59-64; 65-71. doi: 10.1139/H11-012.

https://www.ncbi.nlm.nih.gov/pubmed/21326378

Digital Health Task Force, Canadian Paediatric Society. Screen time and young children: Promoting health and development in a digital world. Canadian Pediatric Society website. http://www.cps.ca/en/documents/position/screen-time-and-young-children. June 1, 2017. Accessed Apr 22, 2020.

Canadian Association of Optometrists. Seeing Smart: Guidelines for Screen Use in Kids.
https://opto.ca/news/seeing-smart-guidelines-for-screen-use-for-kids Jan 12, 2018. Accessed Apr 22, 2020.

About this Article

Written by Peter Burke (Psychiatry Resident, uOttawa, Class of 2021); Michael Cheng (Psychiatrist, uOttawa) and health professionals at the Children’s Hospital of Eastern Ontario (CHEO). Special thanks to Elaine Uskoski for reviewing this article.

Conflict of Interest

Peter Burke, Psychiatry Resident, Class of 2021: No competing interests declared.

Michael Cheng, Psychiatrist: No competing interests declared.

Elaine Uskoski: Has written a book of her lived experiences supporting a family member with video game addiction.

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Disclaimer

Information in this fact sheet may or may not apply to your situation. Your health care provider is the best source of information about your health.