How do I know if my child has a video game addiction?

New rules introduced in China have once again curtailed the level of gaming for anyone under the age of 18. With a gaming regulator first introduced in 2018, the Chinese government has long been a harsh critic of video games, with spending limits and stringent registration with identification being introduced.

The latest round of restrictions, introduced in August, reduce time spent gaming online to three hours a week and strictly between the hours of 8pm to 9pm on Fridays, weekends and public holidays. The physical and mental implications of online gaming have been a concern for parents, who have called on the regulator for tighter measures.

It’s difficult to argue with the ethos of these restrictions, as harsh and dramatic as they may seem, considering we now understand and are witness to the addictive nature of the online world and our devices. China appears to equate the idea of addiction with time spent engaging with that activity with the understanding that cutting this time may negate potential obsessions or ease established addictions.

However, in 2018 the World Health Organisation classified gaming addiction as “a pattern of gaming behaviour characterised by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences”.

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In other words, a gaming addiction is not necessarily aligned with the time spent, but rather how gaming interferes with the attitudes and behaviours of those addicted. Listed as a mental health condition for the first time with this classification, there is a significant difference between being an avid gamer to being addicted.

Warning signs

“The core issue here is the loss of control by a young person when they cannot stop a game repeatedly,” says Dr Gerry McCarney, consultant child and adolescent addiction psychiatrist. “It is common enough for an adolescent to wait a few minutes more to progress through a passage of play. This happens in most cases. Warning signs are repeated long periods before they can exit, leading to longer periods sitting without moving, to missing family meals, to eating only at their desks, to spending most of their day in their room.

“This can progress to where they stop meeting with friends outside, stop going out with family, stop attending school or give up previous recreation such as sporting events. The preference for and allegiance to a new group of online friends is a significant shift and easily reinforces the new behaviour. The extreme end is when they do not leave their room, even to wash, toilet, or eat, for increasingly long periods. Thankfully, this is a minority.”

It must be stated there are positives to the world of gaming with social and recreational benefits. In addition, studies have shown the advantages of gaming to positive wellbeing. Research published in the journal Royal Society Open Science emphasised the collaboration of researchers with gaming companies Electronic Arts and Nintendo to acquire players' actual gaming behaviour. Studies in this area are limited as players are often required to report on their own behaviours, which is often flawed data. What the co-operation between the gaming companies and researchers found was that time limits may not have the expected response of alleviating assumed addictions, but that gaming in itself may, in actual fact, play a part in wellbeing.

With a degree of balance required, parents are left questioning whether strict time rules are necessary, especially in an era when our children’s use of devices and gaming was a necessary distraction from the world of lockdowns and restrictions. And how can a parent recognise and manage if gaming behaviour becomes uncontrolled?

Dr McCarney states that, during the pandemic, we have seen how some conditions have intensified, especially if they involve behaviours that are generally associated with social withdrawal. “The lockdown has increased the opportunity for longer periods away from the community, including medical care,” he says.

“Gaming disorder type behaviours fall into this category, as do eating disorders and social anxiety disorder. Not all adolescents have continued gaming to the same extent as during lockdown, with many falling back into the previous routine. The online access to friends was positive in many cases when face-to-face contact was not recommended. However, the intensification of symptoms in a small minority is likely to have caused increased concerns, and as pandemic restrictions lift, parents are advised to encourage more movement away from the screen.”

Behaviours

As China once again curtails online gaming for adolescents, what is being done here in Ireland to prevent addictions for Irish children? "We do not know statistically how big a problem it is in Ireland," says Dr McCarney, a representative of the College of Psychiatrists of Ireland, "but we have been contacted about some severe cases in the past few years, and it is likely that we are in keeping with international rates. It is important that we review current literature on treatment outcomes as the behaviours can be difficult to extinguish."

A child who can easily stop or close a video game in a reasonable amount of time when asked does not have an addiction. Neither does a child who engages in other activities or interests and socialises outside of gaming. Gaming is not a negative pastime and has many positive psychological benefits, including autonomy, connection and competence, along with other advantages such as problem solving and manual dexterity.

However, a concerned parent can look out for the following symptoms if worried about their child's level of gaming:
– Withdrawal symptoms such as irritability, sadness or anxiety.
– An inability to control their gaming habit, for instance, not being able to stop gaming, or have an increased need for gaming.
– Prioritising gaming over other interests and activities.
– Being deceptive about how much they are gaming and their gaming habits.
– Continuing to game despite negative consequences, such as missing school.

“We are at an early stage of highlighting the risks of excess internet or gaming usage,” says Dr McCarney. “Some of our residential addiction facilities are developing a treatment response but many problem users are under 18 and, to date, there is no obvious treatment pathway for them. Any parent can access information, ironically, online about the risks if they are concerned, and the first step is to sit with your child and talk, and to agree time constraints, scheduling and boundaries to manage the situation.”