Children’s high engagement makes disordered video game playing unique among addictive disorders

To the Editor

In two recent commentaries, Dullur and Starcevic (2018) and King et al. (2018) addressed several key points in the debate over whether or not excessive video game playing should be classified as a mental health disorder. While the commentaries each provide insight into this important question, I would like to add one additional consideration to the conversation: access by children.

Video games are unique objects of addiction in their very high levels of participation among children and adolescents, with one international study of 15-year olds in 60 countries finding that 40% played once a week or more (Borgonovi, 2016). Video games are, to my knowledge, the only Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recognized object of addiction that corporations can sell directly to minors. This is not the case in age-restricted products such as gambling or alcohol, nor is it the case for illegal drugs, all of which have some legal barriers (however imperfect) that keep children from accessing them.

This very high level of participation among children heightens the importance of points made on both sides of the discussion. The combination of a developing brain and direct access to potential objects of addiction is a legitimate concern and must be central to any discussion of a mental health diagnosis for gaming disorder.

Equally true is the idea that clinicians and researchers need to ensure that definitions of disordered gaming require more harmful consequences than what is typical of any activity that a child is highly engaged with. For example, many people (of all ages) spend more money on their hobbies than they intend to. This type of everyday harm must be the starting point for measuring harm in children’s video gaming, and not a symptom in itself. A definition that over-diagnoses the 40% of 15-year olds who play video games could lead to millions of misdiagnosed adolescents worldwide.

Gaming disorder is perhaps the most developed test case for a technological addiction, and decisions made about gaming disorder will impact future work on other technologies that may be overused including social media and smartphones. As a field, we will need clear and open discussions of opposing viewpoints, like those provided in this journal, in order to progress towards a useful, cogent understanding of gaming disorder and the other technological addictions that will need to be addressed in coming years.