Pathological video gaming in kids: How common is it? (updated)

ResearchBlogging.orgA few weeks ago, a new study made headlines in major newspapers across the country: Study Finds Some Youths 'Addicted' to Video Games, proclaimed the Washington Post. The Post article cited a figure of 8.5 percent of gamers age 8-18 nationwide showing signs of a behavioral addiction. Since the study found that 88 percent of children play video games, the scale of this problem is potentially vast -- as many as 3 million kids, addicted to video games.

The claim of "addiction" is quite serious. Just doing something a lot isn't enough to qualify as an addiction, it must have a detrimental effect on the rest of your life -- your friends, family, job, and so on. If you have a family member who's an alcoholic or a compulsive gambler, you know how devastating the consequences of addiction are. So we decided to take a closer look at this study to see if the media reports were accurate.

In 2007, Douglas Gentile commissioned a Harris poll of 1,178 American kids, age 8-18. Gentile says that while there have been previous studies of "internet addiction" or "gaming addiction," his is the first that sampled children from the full geographic distribution across the country, rather than just kids in a single school or school district. He was also careful to evenly distribute the respondents across the country, and to balance for age, gender, and ethnicity. The survey was conducted online, which may have led to some bias, but Gentile says that since 87 percent of American kids now have access to the internet, the bias is relatively small.

The key question, of course, is what it means to be "addicted" to games. Gentile based his assessment on the Diagnostic and Statistical Manual of Mental Disorders' criteria for pathological gambling. He created a set of 11 questions like "Over time, have you been spending much more time thinking about playing video games, learning about video-game playing, or planning your next opportunity to play." The kids responded with "yes," "sometimes," or "no." If they answered "yes" to six or more questions, then he classified the kids as pathological video-gamers. Using this measure, he found that 7.9 percent of the kids who played games were pathological gamers. But you might say that even an answer of "sometimes" should count as "yes" -- if they do it at all, then that's a symptom. Using this stronger measure, pathological gaming rose to 19.8 percent of gamers. As a compromise, Gentile decided to award a half-point for a "sometimes" response and 1 point for pure "yes" responses, and that's where the 8.5 percent figure from the Washington Post article came from.

The questions most commonly answered "yes" included the "thinking about games" question above, whether kids used the games to "escape from problems," "do you skip chores to play games," "do you skip homework to play games," and "have you done poorly on an assignment or test because you spent too much time playing games." Over 20 percent of kids responded "yes" to each of these questions. Less-common "yes" answers include lying, stealing, or spending more and more money on games. So while some kids clearly have a serious problem controlling their video-game habit, the worst symptoms of addiction don't seem to apply to most cases.

One tidbit that I found quite interesting in this study is how gaming habits change over time. Studies on TV have found that watching increases during elementary school, peaks in middle school, and declines during high school. But take a look at this graph of hours spent gaming every week:


There's no significant drop-off in time spent gaming as kids get older. This leads Gentile to believe that there may indeed be a pathological dimension to video gaming. The pathological gamers are significantly more likely to report getting lower grades and having trouble paying attention in school. The problems they experience in fact cross several dimensions:


The difference between the pathological and the nonpathological gamers is significant for every question except "Has TV in bedroom." Note especially the response to "Has felt 'addicted' to games." Most of the kids operationally defined as pathological gamers appear to be aware that their gaming causes problem. Gentile says that the fact that there's no significant difference in having a TV in pathological versus nonpathological gamers is also evidence that gaming addiction is a real condition and not just a symptom of some other problem.

But Gentile is quick to admit that since this study can only show correlations, there's no way to be certain that pathological gaming causes these problems. It could be that kids with attention problems are simply more likely to play games, or that more aggressive kids who are more likely to both get in fights and play video games. But one finding of the study stands out to me: even after controlling for sex, age, and time spent playing video games, being a pathological gamer still predicted poorer performance in schools. So the bad grades aren't simply a matter of games taking time away from homework.

Gentile says that much additional research is needed to find out who's at risk for becoming a pathological gamer, what can be done to prevent it, and how long it lasts. I was a bit of a compulsive gamer as a child, but I grew out of it late in high school. Perhaps pathological gaming is simply a phase of childhood and not a serious long-term problem like alcoholism or drug addiction.

I should also point out that some pundits have suggested that the sampling of this study isn't completely random. See this post for a very thorough discussion of the sampling in the poll.

Update: Several commenters have asked for the full set of criteria for pathological gaming. Here is the list of questions, along with the percentage of respondents answering "Yes" or "Sometimes":


Yes responses were scored "1", and Sometimes was scored "0.5". A total of 6 points were necessary to qualify as a pathological gamer.

Gentile, D. (2009). Pathological Video-Game Use Among Youth Ages 8 to 18: A National Study Psychological Science, 20 (5), 594-602 DOI: 10.1111/j.1467-9280.2009.02340.x

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...Remind me again why, when a kid goofs off instead of doing homework or chores, uses play as an escape, or spends money on frivolous items, it's a sign of "addiction"? I thought those were signs of being a kid. Since most of the population under discussion plays games, it seems to me that all this study has done is select out the kids with the poorest impulse control and label them with an additional diagnosis.

I'm calling bullshit on this one. As someone who spent my formative years infatuated with video games, as well as sports, music and all manner of other adolescent fascinations, I have seen nothing here to convince me that this is anything but an out of touch study.

I sought out games because they were more challenging and stimulating than many of my classes. Maybe that is something that needs to be looked at.

By Gelassenheit (not verified) on 13 May 2009 #permalink

I'd be interested to see the same study done with all references to video gaming changed to sporting -- especially in a sports-mad locale such as the UK or New Zealand.

It might be a case of Pluto-as-a-planet: if we're going to call this result addiction, there might be a whole swag of other interests that qualify for the same classification: playing or following sports, listening to music, watching television... even reading. Perform the same study for those activities, and see how they stack up.

I think it is definitely worthwhile considering whether or not the notion of addiction can be transported to other domains of human activity. An important step forward in addictionology was the concept that an addiction could be in relation to a process or behaviour, not just a substance.

This is an interesting observational study, and the authors appear to have found important correlations, particularly among poor grades and self-identified "addicts" vs normal grades and non-self-identified addicts.

I look forward to the next stage where correlations are tested for causality and hidden confounders. It would also be interesting to see the emergence of a validated instrument to guide clinicians.

I think the effort to identify kids at risk, whose gaming may be the main problem or simply a marker, is well worthwhile. Let's carefully distinguish them from kids who are ok and merely spend a lot of time playing games.

I'd have liked to see tighter initial criteria defining distress or dysfunction.

By Epictetus (not verified) on 13 May 2009 #permalink

I have an addiction. In the past year I have:

-Thought about Cognitive Daily
-Read Cognitive Daily instead of studying or doing chores
-Begun to read and think about Cognitive Daily much more often
-Used Cognitive Daily to esape from my problems
-Planned times of day when I might be able to read Cognitive Daily
-Performed poorly on an exam because I was thinking about/reading Cognitive Daily too much.

I am not sure if I understand the meaning of addicted right. So if someone plays video games for more than 6-8 hours per day over years isn't that addiction? Does the study capture this?

By Lotharloo (not verified) on 14 May 2009 #permalink

Yeah it would help if we had their full definition of addiction. Just feeling addicted and getting into an occasional fight isn't so convincing. What are the actual criteria they're using to distinguish Game Enthusiast from Game Addicted?

I would completely disregard this. When I was a teen, my brother and I spent every free hour playing on the Atari 2600. It was our whole life for a year or so. This study would call it an "addiction", but so what?

Yeah it would help if we had their full definition of addiction. Just feeling addicted and getting into an occasional fight isn't so convincing. What are the actual criteria they're using to distinguish Game Enthusiast from Game Addicted?

We have too many addictions in our society. Everything is so tempting. Looks good, smells good, tastes so good, so interesting etc. It's very hard not to get addicted to something. Food, drink, computer or video games. We all have to practice self control to overcome our addictions. The Media is responsible mostly for it, but we can not blame anybody else for our "weaknesses". We have to decide what is important for us and spend most of our time with it.

I think human beings are supposed to do things compulsively for a while such as when we are learning and mastering a new skill. But this propensity for compulsion can get 'hijacked' by lower level stuff like drinking and drugs or any behaviour which stimulates strong emotion as its 'reward'. Which may be why some people 'addictâ to destructive but exciting relationships or to becoming angry.

Compulsive gaming during formative years would, I guess, be a huge problem if it drives out the capacity for patience and subtlety from the developing young persons mind.

Stories have many motifs not just that of combat. But the combat motif seems to be overwhelmingly the one of choice for games. It might not just be what compulsive gaming is doing to the developing brain but also what extra levels of sensitivity the person is missing by not doing other things

Lucky for me, I grew out of my heroine addiction in early adulthood.

I scored a 4 on that test.

By funkotron (not verified) on 17 May 2009 #permalink

I replaced gaming references with reading, and suddenly I have a book addiction.

Yet my avid reading never interferes with my life to the point of causing problems. Sure I've studied less for a quiz because I was reading an unrelated book, but it's never been enough to actually lower my final grade.

On your May 11 post you have pointed out how easy it is to induce people's taste by loading their brain with false memory.

I am quite enclined to consider that the surge in positive answers to question related to howework and grades is somehow following the same "asparagus" effect.

Indeed how many kids throughout the world have heard their parent says: "you did not achieve well becaus you played to much VG. You are grounded so no game for you this week."

Now, true, usually the scores the student achieve during the week he is deprived of VG are most of the time higher than the previous week.
But is that beacuse he is not playing VG or because he has been hurt in his pride and wants to make up for it ?

I would tend to bet on pride because as far as VG are concerned, they can now be found everywhere : phones, computers, portable gaming console, that is is almost impossible for parents to actually stop a kid from playing them.

Wow. Bad questions.

Look, if these questions were applied to a substance, e.g. alcohol, drugs or even food (as in a person with an eating disorder), I would not have a problem with them, but they are inappropriate as applied to an activity. Kids who get a new game should spend more time thinking about it or planning strategies. Using an activity to temporarily distract from problems is a good method especially if a kid has anxiety issues.

Other questions are bad because they don't take into account the life stages of the kids in question. Skipping household chores and homework are normal for kids and teens (regardless of what is used to replace them); since they rarely earn much money, they frequently need family/friends to give them more money for hobbies; parents requesting that their kids cut down on an activity and the kids finding themselves unable to is common (especially if the kids have attention issues anyway); and I'm shocked that the 'lying to family/friends about amount of time playing video games' statistic isn't much higher.

The 2nd (more time/money for same excitement), the 4th
(become restless/irritable when you cut down), the 7th (stolen a game) and the 10th (doing poor schoolwork) questions seem much more targeted to addiction. But the others are so filled with common teen behaviors and conflating factors, that I would seriously question whether this study is identifying kids who are 'addicted' rather than kids who have more generalized problems.

For example, a kid who has a bad relationship with his parents could easily score 4 points (questions 5, 6, 8 and 9) on this without spending much time at all playing games. Add in normal thinking about a new game (#1), plus a low allowance (#11) and a bad grade the parent attributed to video games (#10): suddenly the kid has scored 7 points and is a pathological gamer. As someone with ADD, I had almost all of those types of behaviors growing up...just not over video games. But insert TV watching, book reading, internet use or theatre and I assure you I would have qualified as pathological at various points in my teen years. But you would have been measuring everything but my 'addiction' to those differing activities.

By DinaFelice (not verified) on 18 May 2009 #permalink

The easiest solution? Throw TV and games away.

That's not a solution.