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Emerging Association Between Addictive Gaming and Attention-Deficit/Hyperactivity Disorder

Abstract

Children's and adolescent's use of computer games and videogames is becoming highly popular and has increased dramatically over the last decade. There is growing evidence of high prevalence of addiction to computer games and videogames among children, which is causing concern because of its harmful consequences. There is also emerging evidence of an association between computer game and videogame addiction and attention deficit/hyperactivity disorder (ADHD). This is indicated by the occurrence of gaming addiction as a co-morbid disorder of ADHD, common physiological and pharmacological mechanisms, and potential genetic association between the two disorders. A proper understanding of the psychological and neurotransmitter mechanisms underlying both disorders is important for appropriate diagnostic classification of both disorders. Furthermore, it is important for development of potential pharmacological treatment of both disorders. Relatively few studies have investigated the common mechanisms for both disorders. This paper reviews new findings, trends, and developments in the field. The paper is based on a literature search, in Medline and PUBMED, using the keywords addictive gaming and ADHD, of articles published between 2000 and 2012.
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... Some studies have suggested that IGD is both a disorder that can be secondary to ADHD and a disorder that has a reciprocal relationship with it via reward-seeking [29]. Weinstein and Weizman mentioned the possibility of an IGD subtype that exhibits high reward addiction and that responds to in-game rewards due to a dopamine deficiency [30]. This hypothesis is supported by the parallel increase between ADHD and IGD symptoms and the comorbid ADHD diagnosis in a significant portion of individuals diagnosed with IGD [29,30]. ...
... Weinstein and Weizman mentioned the possibility of an IGD subtype that exhibits high reward addiction and that responds to in-game rewards due to a dopamine deficiency [30]. This hypothesis is supported by the parallel increase between ADHD and IGD symptoms and the comorbid ADHD diagnosis in a significant portion of individuals diagnosed with IGD [29,30]. It has also been suggested that excessive game play may provide an escape from real-life problems for individuals with ADHD (30). ...
... This hypothesis is supported by the parallel increase between ADHD and IGD symptoms and the comorbid ADHD diagnosis in a significant portion of individuals diagnosed with IGD [29,30]. It has also been suggested that excessive game play may provide an escape from real-life problems for individuals with ADHD (30). Furthermore, other traits of ADHD, such as low extraversion, disinhibition, social withdrawal, and low self-esteem, have been associated with problematic internet use [31][32][33]. ...
... [10] It has also been reported that addiction to the Internet and video games can be one of the predictors of ADHD and vice versa. [11] Disruptive behavior disorders (DBD), i.e., oppositional defiant disorder (ODD) and conduct disorder (CD), are common comorbid psychiatric disorders in children with ADHD. [12] However, there is some evidence that the presence of conduct symptoms is associated with risk of Internet addiction or gaming addiction (GA) in adolescents. ...
Article
Context: There is a dearth of studies on the risk of gaming addiction (GA) in children and adolescents with disruptive behavior disorders (DBDs) and its comorbidity with attention-deficit hyperactivity disorder (ADHD). Methods: Seventy participants aged 6–16 years diagnosed with ADHD and DBD were included in this cross-sectional, observational study and compared with 40 healthy controls. They were assessed for clinical details of gadget type, duration of use, and purpose on a semi-structured questionnaire. The intensity of video gaming was assessed using Game Addiction Scale (GAS). Behavioral symptoms were assessed on Child Behavior Checklist (CBCL). Descriptive statistics with t-test, analysis of variance, and Pearson's correlational analysis were used as applicable. Results: Use of gadgets for video games for ≥ 4 hours was found to be significantly higher (P = 0.001) in cases (61.5%) than in controls (10%). Most of the cases used Internet for communication (69.4%) and entertainment (58.3%). A significantly higher number of cases (37.1%) fulfilled criteria for video game addiction and the numbers were significantly higher in ADHD + DBD groups as compared to only ADHD or only DBD group. Children with GA had significantly higher scores in all domains of CBCL as compared to those without GA. The GAS score had a significant positive correlation with aggressive behavior, social problems, rule breaking, and attention problem domains of CBCL. Conclusions: GA was significantly higher in ADHD and/or DBD than normal children and adolescents. Comorbidity of ADHD and DBD further increases the risk of GA. Therefore, children with these disorders should be screened routinely for GA.
... Indeed, "Internet gaming disorder" (IGD) is considered a behavioral addiction (1). IGD is associated with male gender (2) and attention-deficit hyperactivity disorder (ADHD) (3), the most prevalent neurodevelopmental disorder worldwide [prevalence ranges between 5 and 10%; (4)]. Despite the problematic side of the relationship between ADHD and video games, some video games, particularly those called "serious" video games, might be useful in either the diagnosis or treatment of ADHD. ...
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Objective To carry out a quasi-systematic review of the use of serious video games for health as a cognitive rehabilitative tool in patients diagnosed with attention-deficit hyperactivity disorder. Method A quasi-systematic review of serious video games used as an evaluative and rehabilitative tool in patients with ADHD was conducted. It included behavioral patterns in the use of video games and addiction problems in this population. For its elaboration the PRISMA GUIDES were followed. The search was carried out in three PubMed databases, MEDLINE, and PsycInfo using the keywords: [game OR serious game OR computer game) AND (psychotherapy OR rehabilitation OR intervention OR mental disorders) AND (adhd)], [(adhd) AND (Video game addiction)]. All articles written in English, Spanish, or Portuguese from January 1970 to June 2021 were included: those in which reference was made to the use of video games and/or new technologies as a therapeutic and evaluative tool in children and adults diagnosed with ADHD, as well as those that referred to behavioral and clinical patterns in the use of video games. Results We found 605 articles of which 128 were reviewed (44 observational studies, 26 quasi-experimental studies, 26 experimental studies, 8 systematic reviews, 9 narrative texts, 6 case reports, 7 pilot studies, 8 systematic reviews, and 2 meta-analyses). Serious video games can be used to ameliorate ADHD symptoms while improving adherence to treatment. Some serious video games show high accuracy properties assessing ADHD features. Conclusion Serious video games for health are increasingly being used as a cognitive rehabilitation tool in patients with attention-deficit hyperactivity disorder (ADHD). Systematic Review Registration [ www.crd.york.ac.uk/prospero ], identifier [CRD42021247784].
... As well described by Stavropoulos et al. [51], IGD may be bi-directionally associated with ADHD. Whereas some reports have suggested that ADHD features are predictors of IGD, others have shown that IGD behaviors emphasize ADHD symptoms [50,52], and that excessive gambling could be a way of escaping reality in people with ADHD [53]. An interesting study by Yen et al. [54] found that attention deficit and impulsivity were the two most commonly associated symptoms linking ADHD and IGD in college students, and that this association was stronger in females than males. ...
Article
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Internet gaming disorder (IGD) has been included in the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition in need of further study, and gaming disorder was recognized by the World Health Organization as a mental disorder in the International Classification of Disease (ICD-11) of 2018. IGD has different characteristics in the two sexes and is more prevalent in males than females. However, even if the female gamer population is constantly growing, the majority of available studies analyzed only males, or the data were not analyzed by sex. To better elucidate sex differences in IGD, we selectively reviewed research publications that evaluated IGD separately for males and females collected in approximately one hundred publications over the past 20 years. The available data in this narrative review indicate that IGD is strongly dimorphic by sex for both its psychological features and the involvement of different brain areas. Impulsivity, low self-control, anxiety, emotion dysregulation, and depression are some of the psychological features associated with IGD that show a sex dimorphism. At the same time, IGD and its psychological alterations are strongly correlated to dimorphic functional characteristics in relevant brain areas, as evidenced by fMRI. More research is needed to better understand sex differences in IGD. Animal models could help to elucidate the neurological basis of this disorder.
... 63 Besides affective disorders, gaming addiction was also found to be associated with attention-deficit hyperactivity disorders (ADHD). 64 Excessive internet gaming exposure was found to be associated with reduced striatal dopamine D2 receptors, leading to the dysfunction of the dopaminergic system, 65 which is also believed to underlie the pathogenesis of ADHD. ...
Article
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Background: Digital competence can help children and adolescents engage with technology for acquiring new knowledge and for broadening social contact and support, while reducing the risk of inappropriate media use. This study investigated the effects of digital competence on the risk of gaming addiction among children and adolescents. We explored whether students with good digital competence were protected from the adverse effects of media use and the risk of gaming addiction. Methods: 1956 students (690 primary and 1266 secondary) completed a digital competence assessment and a self-report questionnaire on their mental health status, use of digital devices, and experiences of cyberbullying. Multiple regression analyses with further mediation and moderation analyses were performed to investigate the association of digital competence with gaming addiction and mental health in children and adolescents. Findings: Regression analyses showed that children and adolescents with better digital competence were less likely to develop gaming addiction (β = -0.144, p < 0.0001) and experienced less cyberbullying behaviour as perpetrators (β = -0.169, p < 0.0001) and as victims (β = -0.121, p < 0.0001). Digital competence was found to mediate the relationship between digital device usage time and gaming addiction. Interpretation: Digital competence is associated with less gaming addiction and could potentially lead to better mental wellbeing by reducing the risks of gaming addiction and cyberbullying. Education that promotes digital competence is essential to maximize the benefits of media use, while reducing the potential adverse effects from the inappropriate use of digital devices.
... We should note, however, that although the longitudinal nature of this study allowed researchers to address the causality of the variables of interest to a certain degree, the fact that the experimenters could not actually control any of the variables makes it possible that these relationships are driven by an underlying cause rather than being causally related to each other. Nonetheless, it is worth noting that numerous other studies have also identified associations between video game addiction and impulsivity, and in some cases, adult attention deficit disorder (e.g., Ko et al. 2009;Weinstein and Weizman 2012;Yen et al. 2016). ...
Article
As the popularity of video games has risen so too has the worry about the problems associated with playing them. The authors review the research concerning problem gaming, its similarity to some clinical addictions like gambling and drug and alcohol abuse, and current treatment options. They conclude that, regardless of how researchers and medical professionals assess the nature of a gaming disorder, few who play video games experience negative consequences from doing so and, at best, only a small subset of players might be considered to suffer from an addiction to it.
... [7][8][9][10] Gaming disorder has been associated with depression, anxiety, low self-esteem, sleeping disorder, loneliness and low social competence but also to the neuropsychiatric conditions attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). 4,8,9,[11][12][13] Some scholars argue that the gaming itself might not be the issue, but the time spent that occur at the expense of other beneficial activities. 9 The number of hours spent on gaming have been shown to be associated with both the development of game addiction but also to independently increase the probability of adverse health consequences such as depressive symptoms. ...
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Background: Extensive gaming and the consequences thereof is frequently reported from child and adolescent psychiatry and school health care. The behavior is associated with compulsion, psychiatric and physical symptoms, impaired cognitive development and poorer school performance. This phenomenon has been described as an emergent health issue for men and little is known about its potential gender-specific characteristics. The aim of this study was to explore extensive gaming among male and female adolescents and to investigate whether the frequency of often feeling low, often feeling anxious, self-reported ADHD, self-reported ASD, being satisfied with one's own general health, poor sleep, loneliness, and having tried smoking, alcohol, and/or other substances differed among those with and without extensive gaming. Design and methods: This study was based on data collected through a public health survey distributed in 2016 to pupils in 9th grade of primary school and in second grade of secondary school, including a total of 13498 participants. The association between extensive gaming and different factors was estimated among male and female respondents separately. Results: Roughly 30% of the male and 5% of the female respondents were categorized as extensive gamers. Extensive gaming was associated with a higher prevalence of poor sleep and a lower prevalence of being satisfied with one's own health among boys and (to a higher degree) among girls. Conclusions: Altogether, our results contribute to the impression that extensive gaming is more heavily related to subjective health complaints among female than male adolescents.
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An important prerequisite for a non-discriminatory society is education equality. The result of the policy for equality of educational opportunity was the creation of conditions for inclusive education of all students in the schools of their neighbourhood. The purpose of this doctoral dissertation is to investigate the impact of interactive education-entertainment systems on the successful implementation of inclusive education of children with and without special educational needs and/or disabilities and to develop a new methodology for designing inclusive educational materials. For this purpose, an interactive educational system was designed, developed and evaluated taking into account basic guidelines of instructional design models and frameworks. The educational content of the system focuses on the activities of daily living and is called Waking Up In the Morning (WUIM). It was created based on a new transmedia methodology developed to enhance the motivation to learn by combining traditional games with modern film production processes as well as new media such as 360-degree video production, gaming elements and rules and virtual and augmented reality technologies. WUIM pedagogical documentation is based on the eclectic approach, which incorporates the prevailing educational interventions in the field of special education and training, the principles of so-called traditional learning theories, such as behaviourism, information processing theories and constructivism with its branches, differentiated instruction, universal design for learning, multimedia learning, transmedia learning, game design principles, cutting-edge technology and user experience research field. Traditional and contemporary theories of learning draw their content from educational psychology, that particular branch of psychology that specializes in understanding teaching and learning in educational environments. WUIM has been evaluated in the field by potential users (children with disabilities and specialist therapists). A new research scale was used as a data collection tool, which records all the factors that shape users' overall perceptions of the learning experience when playing games. The results of the evaluation led to the conclusion that WUIM qualifies as a good practice and content creation guide for inclusive education. As learning does not take place in a vacuum, with teachers being considered the key to success in implementing any innovation, the dissertation also raises research questions about teachers' attitudes towards inclusive education and digital educational games, as well as the ethical issues and concerns associated with the use of cutting-edge technology by children. Keywords: activities of daily living, augmented reality, digital educational games, educational technology, educational psychology, inclusive education, motivation, school psychology, transmedia learning, virtual reality, 360-degree video.
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Objective To investigate the prevalence of overweight and obesity in children and adolescents with ADHD and compare to other clinical samples. Method A retrospective chart reviewing of 165 ADHD and 305 other clinical participants aged 6 to 18 years. Results There was no statistically significant difference in terms of the prevalences of overweight and obesity between ADHD and other clinical participants. In ADHD group, the prevalences of overweight, obesity, and combined overweight/obesity were 15.8%, 20.0%, and 35.8%, respectively. In addition, male gender was significantly associated with increasing the prevalences of overweight and obesity in children and adolescents with ADHD. Conclusion The prevalences of overweight and obesity between ADHD and other clinical samples were not different in a clinical setting. Male gender was significantly associated with increasing the prevalences of overweight and obesity in children and adolescents with ADHD.
Article
Objectives: This review addresses important practical questions facing clinicians regarding internet gaming disorder (IGD) and attention-deficit/hyperactivity disorder (ADHD) in children and youth (C-Y). The authors investigated data concerning the risk that C-Y who have ADHD will develop IGD, whether effective treatment of ADHD positively influences the course of IGD in C-Y who have both, and other findings that might be of benefit to clinicians who treat C-Y with these conditions. Methods: We conducted a literature review using 4 databases: PubMed, Scopus, PsychInfo, and Embase. Results: C-Y with ADHD are at greater risk for developing IGD than those without ADHD. A close association exists between the severity of ADHD symptoms and the severity of IGD. It is unknown what proportion of C-Y with ADHD will develop IGD during their developmental trajectory; however, C-Y with IGD are at risk for developing ADHD, and ADHD can also increase the vulnerability of C-Y to IGD. Adolescents with ADHD and IGD have greater deficits in social skills than those with ADHD but no IGD. Lower parental occupational and socioeconomic status and poor family relationships are associated with more severe IGD symptoms. Atomoxetine and methylphenidate are equally effective in alleviating IGD symptoms comorbid with ADHD. Conclusions: C-Y with ADHD are at increased risk for developing IGD compared with C-Y without ADHD, but it has not been determined at what developmental stage IGD is likely to emerge. Since IGD and ADHD are strongly associated, it is imperative to consider ADHD as a significant risk factor for IGD and vice versa, which can help psychiatrists be alert for early signs of IGD and manage them accordingly.
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The aim of this study was to investigate Internet use habits and problematic Internet use (PIU) in Turkish adolescents. Participants were 3,975 undergraduate students, 7.6% of whom used the Internet for more than 12 hours weekly. The Online Cognition Scale (OCS) was used. The most common purpose for using the Internet was playing games, followed by general information search. Female users mostly preferred searching for general information; male users preferred playing games (p Ͻ 0.001, ␥ ϭ 995.205). The most preferred type of game was violent games. While preference for strategy and fantasy role-play (FRP) games increased with age, preference for other games decreased (p Ͻ 0.0001, ␥ ϭ 283.767). Participants who used the Internet mostly for general information searches and school-related searches had lower OCS scores (p Ͻ 0.0001). The highest OCS scores were related to violent games, followed by FRP, strategy, and sports and motor racing games. Computers and the Internet are useful, important inventions, but like other inventions, if used improperly, they may be harmful. Risk of harm raises concerns about who should use the Internet and computers, and where, when, and why the Internet and computers should be used.
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Positron emission tomography and selective radioligands were used to determine D1 and D2 dopamine receptor occupancy induced by neuroleptics in the basal ganglia of drug-treated schizophrenic patients. In 22 patients treated with conventional dosages of classical neuroleptics, the D2 occupancy was 70% to 89%. Patients with acute extrapyramidal syndromes had a higher D2 occupancy than those without side effects. This finding indicates that neuroleptic-induced extrapyramidal syndromes are related to the degree of central D2 occupancy induced in the basal ganglia. In five patients treated with clozapine, the prototype atypical antipsychotic drug, a lower D2 occupancy of 38% to 63% was found. This finding demonstrates that clozapine is also "atypical" with respect to the central D2 occupancy in patients. During treatment with clozapine, there is a low frequency of extrapyramidal syndromes, which accordingly may reflect the comparatively low D2 occupancy induced by clinical doses of clozapine. Classical neuroleptics, like haloperidol or sulpiride, did not cause any evident D1 occupancy, but the thioxanthene flupentixol induced a 36% to 44% occupancy. In four patients treated with clozapine, the D1 occupancy was 38% to 52%. The D1 occupancy induced by clozapine and flupentixol may contribute to the antipsychotic effect of these drugs.
Article
Background: We wanted to study the effects of amphetamine on symptoms of attention-deficit hyperactivity disorder (ADHD) over a longer period than has been reported in previous studies of central stimulants in this condition.Methods: Sixty-two children, aged 6 to 11 years, meeting DSM-III-R symptom criteria for ADHD participated in a parallel-group design, randomized, double-blind, placebo-controlled study of amphetamine treatment. Treatment was not restricted to children with "pure" ADHD, ie, some had comorbid diagnoses. In the amphetamine group, children received active treatment for 15 months.Results: Amphetamine was clearly superior to placebo in reducing inattention, hyperactivity, and other disruptive behavior problems and tended to lead to improved results on the Wechsler Intelligence Scale for Children—Revised. Treatment failure rate was considerably lower and time to treatment failure was longer in the amphetamine group. Adverse effects were few and relatively mild.Conclusion: The results of this long-term, placebo-controlled study of the central stimulant amphetamine in the treatment of ADHD indicate that there are remaining positive effects of the drug 15 months after starting treatment.
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Objective: The objective of this study was to determine if measures of broad clinical psychopathology or neuropsychological performance could aid in the prediction of therapeutic response to the highly selective norepinephrine transporter inhibitor, atomoxetine, among adults with attention-deficit/hyperactivity disorder (ADHD). Method: We analyzed data from 2 double-blind, placebo-controlled, parallel design studies of adult patients (Study I, N = 280; Study II, N = 256) with DSM-IV-defined ADHD who were recruited by referral and advertising. Subjects were randomly assigned to 10 weeks of treatment with atomoxetine or placebo and were assessed with Conners' Adult ADHD Rating Scales (CAARS), the General Well-Being Schedule (GWB), the Sheehan Disability Scale, the Stroop Color-Word Test (SCWT), and the Structured Clinical Interview for DSM-IV (SCID) before and after treatment. Results: Therapeutic improvement on atomoxetine as evidenced by reduced CAARS scores was reliably predicted by the presence of a lifetime comorbid diagnosis of depression or posttraumatic stress disorder at baseline, while improvement on subscales of the GWB and Sheehan Disability Scale were predicted by these and other SCID endorsements, such as alcohol and substance use, as well as demographics such as age and gender. In light of the exploratory nature of this work and the many comparisons that were examined in the corresponding regression models, these findings should be regarded as tentative pending replication and extension in another dataset. Conclusion: From these findings, we conclude that the variable responsiveness of individuals to atomoxetine cannot be largely accounted for by differences in broad-spectrum psychopathology or neuropsychological indicators of attentional capacity.
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• Positron emission tomography and selective radioligands were used to determine D, and D2 dopamine receptor occupancy induced by neuroleptics in the basal ganglia of drug-treated schizophrenic patients. In 22 patients treated with conventional dosages of classical neuroleptics, the D2 occupancy was 70% to 89%. Patients with acute extrapyramidal syndromes had a higher D2 occupancy than those without side effects. This finding indicates that neurolepticinduced extrapyramidal syndromes are related to the degree of central D2 occupancy induced in the basal ganglia. In five patients treated with clozapine, the prototype atypical antipsychotic drug, a lower D2 occupancy of 38% to 63% was found. This finding demonstrates that clozapine is also "atypical" with respect to the central D2 occupancy in patients. During treatment with clozapine, there is a low frequency of extrapyramidal syndromes, which accordingly may reflect the comparatively low D2 occupancy induced by clinical doses of clozapine. Classical neuroleptics, like haloperidol or sulpiride, did not cause any evident D, occupancy, but the thioxanthene flupentixol induced a 36% to 44% occupancy. In four patients treated with clozapine, the D1 occupancy was 38% to 52%. The D, occupancy induced by clozapine and flupentixol may contribute to the antipsychotic effect of these drugs.
Article
OBJECTIVE Cases of excessive computer gaming are increasingly reported by practitioners in the psychiatric field. Since there is no standardized definition of this symptom complex, the aim of this study is to access excessive computer gaming in German adolescents as an addictive disorder and its potential negative consequences. METHOD Psychopathological computer gaming behavior was diagnosed by applying the adapted diagnostic criteria of substance-related-addictions as defined by the ICD-10. At the same time demographic variables, state of clinical anxiety and underlying cognitive mechanisms were analyzed. RESULTS 6.3 % of the 221 participating pupils - mostly boys with a low educational background - fulfilled the diagnostic criteria of a behavioral addiction. Clinically diagnosed adolescents exhibited limited cognitive flexibility and were identified to utilize computer gaming as a mood management strategy. CONCLUSIONS These results can be interpreted as a first hint for a prevalence estimation of psychopathological computer gaming in German adolescents.