Video Games: When Does Play Become Pathology? Most Kids Have Fun and Don't Get 'Hooked', but Some Boys May Be at Particular Risk

Article excerpt

Nick, age 13, enjoys playing video games, but his parents think he may be "addicted." His primary care doctor has referred Nick to you for evaluation.

[ILLUSTRATION OMITTED]

Nick has played video games since age 7 and likes to share ideas with friends about to "beat" difficult games. Lately, though, he plays an online role-playing game, mostly alone, on the computer in his bedroom. Nick hasn't seen his friends outside of school for 6 weeks.

Nick's parents say he is growing short-tempered, and his grades have fallen for several months. He seems to worry a lot but becomes angry and storms out of the room when they try to talk with him about it.

Like Nick, 70% to 90% of American youths play video games, according to the American Medical Association (AMA). (1) Most boys and girls find the games fun, entertaining, or relaxing (Table 1, page 28) and do not encounter difficulties as a result of their play. (2) In some cases, however, they may:

* spend excessive time playing video games

* model inappropriate behavior from games

* over-invest in online relationships.

This article describes developmentally appropriate characteristics of play in general--and aspects of video game play in particular--to help you educate families about normative and excessive video game play.

An addiction?

Originally researchers believed video game play was not addictive and viewed excessive play as high engagement. More recently, efforts are being made to understand:

* how to classify excessive video game play that impairs psychosocial adjustment

* whether substance abuse models are appropriate for describing and treating pathologic video game play.

In June the AMA examined the emotional and behavioral effects of excessive video game play and decided that evidence is insufficient to conclude that this activity is an addiction. (1) The American Psychiatric Association (APA) stated that it does not consider "video game addiction" as a mental disorder at this time because it is not listed in DSM-IV-TR. The APA's DSM-V task force may consider whether to include this proposed disorder in the update due to be published in 2012. (3)

What is normative play?

Play is a motivating way for children to make sense of the world. By re-creating themes, relationships, places, or events in play children can control things that outside of play might be intimidating or overwhelming. Through play, children can explore situations in a setting that feels safe. (4,5) Video games offer children play opportunities to explore roles and worlds that otherwise are unavailable to them. (6)

Video game play is one of the most popular leisure-time activities for middle-school students. Our group (7) recently surveyed >1,200 students age 12 to 15 about their video game play and found:

* One-third of boys and two-thirds of girls played video games for [less than or equal to]2 hours/week.

* One-third of boys and 11% of girls played video games 6 or 7 days each week.

* Boys played more than girls, with 45% of boys playing for [greater than or equal to]6 hours/week.

* 12.6% of boys played [greater than or equal to]15 hours/week.

* One-half listed [greater than or to]1 games rated M for mature (Table 2) (7) among 5 games they played most frequently in the preceding 6 months. (2)

These findings on the frequency of play are similar to those of a Kaiser Family Foundation national study of children and adolescents age 8 to 18. (8) Thus, for middle school students, we could define a normative range of time playing video games as 10 minutes to 1 hour/day. Averaging >1 hour/day could be considered excessive. M-rated video game play is common among adolescents and might be considered normative--although not necessarily developmentally appropriate. (2)

Pathologic behavior. …