The World Health Organization (WHO) seems ready to declare gaming as a mental health disorder in their newly updated International Classification of Diseases manual (ICD-11) set to be published in 2018. The manual hasn’t been updated since 1990.
Gaming disorder isn’t yet recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), used by clinicians in North America and around the world, however, now that the WHO is recognizing gaming disorder, therapists and clinicians will surely be taking note and watching for the signs. According to the New Scientist, the WHO’s draft notes that someone with gaming disorder devotes so much attention to gaming “to the extent that gaming takes precedence over other life interests.”
When the American Psychiatric Association (APA) published the latest edition of the DSM, the fifth edition known in short form as the DSM-V in May 2013, they cited Internet Gaming Disorder in Section III of the manual as “a condition warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder.”
Pending further research into what the APA at the time called a “new phenomenon”, the APA say they are keeping track of the latest evidence demonstrating how "gamers", especially in Asia are playing to such an extent that their addiction is having serious consequences in their day-to-day lives.
“People with this condition endanger their academic or job functioning because of the amount of time they spend playing,” notes the APA. “They experience symptoms of withdrawal when kept from gaming.”
Dr. Unmesh Jain is a Child and Adolescent Psychiatrist at the Hospital for Sick Children in Toronto, Ontario, Canada. He founded the Canadian ADHD Resource Alliance (CADDRA) in 2008. He is currently drafting guidelines for the amount of time children with Attention Deficit Hyperactivity Disorder (ADHD) should be spending on screens such as tablets, phones, and televisions where they’re usually found playing games. He concurs with the APA that the research out of Asia, especially South Korea with regards to gaming is alarming and should serve as a warning for clinicians here.
“We’re not there yet. We’re lucky,” says Dr. Jain. “This is a country that doesn’t simply have morbidity related to screen addiction, they have mortalities related to screen addictions. People die. Their kids die.”
There is literature mainly from South Korea, one of the most connected online countries in the world that shows that prior to the age of 12, the most common reason for Internet Addiction Disorder, (IAD), sometimes referred to as Electronic Screen Disorder, is ADHD. Over the age of 12, the number one causality is depression and the second is ADHD.
“We’re nowhere near South Korea today,” says Dr. Jain. “South Korea has faster broadband speed than Canada and the U.S. which actually has old infrastructure. Canada is where South Korea was five years ago.”
In South Korea, over 200,000 children have screen addictions and there are over 4000 therapists working in the field. That should provide North America with time to look at ways to prevent and treat gaming addiction notes Dr. Jain.
“If you look at the South Korean experience, the moment our broadband speed starts increasing to meet the demands of the new gamers, you’re going to see a precipitous rise in the amount of addictions and the majority of those people are going to be kids with ADHD,” says Dr. Jain.
To help kids overcome gaming addiction in South Korea, they are sent to Internet boot camp.
“They do it cold turkey,” explains Dr. Jain. “They take obese South Korean kids that have been sitting inside for most of their lives to boot camp for three weeks and cut them off cold turkey and restructure the family dynamics because the kids have taken over and held the family hostage.”
There are horror stories coming out of South Korea related to gaming addiction. One youth played for 50 hours straight and died of exhaustion. And it’s not just children and youth who are being affected. One mother and father let their baby starve while playing an online game non-stop, ironically about caring for a virtual child.
“South Korea is where we’re going to be in five years,” warns Dr. Jain. “Learning from their example, the data shows very clearly that the vast majority of people who have internet addiction, also have ADHD.”
For those with ADHD, it’s about the need for stimulation. It’s the same feeling that a gambler has about going to a slot machine. It tickles their brain’s nucleus accumbenes. It creates such an intense level of stimulation that it creates a craving response and they want it back again. We know that the nucleus accumbenes is where psycho-stimulating medication sits. They block the nucleus accumbenes, creating an alternative way of being able to stop the need for high stimulation by artificially giving it to you. It’s so successful, it will also block the need for other self-stimulating activity like the use of cannabis or cocaine.
“Their brain is being affected,” says Dr. Jain. “It’s altering their cortical structure. It changes the nature of the biological connections. It’s not a simple innocuous entertainment vehicle.”
Evidence shows screen time functionally changes the neuro-chemical neuro-connections in the brain by softening and altering cortical structures.
“There’s a physical end point where we don’t know leads to,” says Dr. Jain who is recommending that children with ADHD should be given no screen time when it comes to gaming. “Would you want to expose your kid to a risk that’s going to affect their brain because you want a break? Send the kid outside with the dog.”
Dr. Jain wonders why we aren’t exposing kids to more physical activity. He believes computers and electronics are too easy to come by and speaks to the social structure of how children’s evolution has changed and how reflective it is of the busyness of families.
Just this past June, the Canadian Pediatric Society released their new guidelines on screen time for children under the age four, recommending that doctors speak to parents about how to minimize screen time for their young children. They didn’t make any changes to their recommendations from 2003 which states that children under the age of two should have absolutely no screen time and that children ages two to five should have no more than one hour a day of screen time. According to the American Academy of Pediatrics, children under the age of two can have limited screen time per day.
In a study published in the Journal of Scientific Reports in 2016, over 50 per cent of babies aged six to nearly a year old use a touchscreen every day. In the U.S., the amount of time children aged two to four spend on mobile media increased from 39 to 80 per cent between 2011 and 2013.
“The crystal ball of where will be there is already there,” says Dr. Jain. “The literature coming out of South Korea is shattering. They are our future. If we could predict what’s going to happen, don’t you think we should do something now to preempt what may very well be a huge epidemic and concern for this country? We better do something.”
Andrew K. Przybylski, Ph.D., Netta Weinstein, Ph.D., Kou Murayama, Ph.D., (February 2016), The American Journal of Psychiatry, Internet Gaming Disorder: Investigating the Clinical Relevance of a New Phenomenon, https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2016.16020224?journalCode=ajp
Timothy Revell, (December 2017), New Scientist, Video gaming disorder to be officially recognised for first time, https://www.newscientist.com/article/2157042-video-gaming-disorder-to-be-officially-recognised-for-first-time/
Patricia Tomasi, (June 2017), The Huffington Post, Should Kids With ADHD And ASD Be Barred From Screen Time?, http://www.huffingtonpost.ca/2017/06/01/screen-time-kids-adhd_n_16910564.html
Celeste H. M. Cheung, Rachael Bedford, Irati R. Saez De Urabain, Annette Karmiloff-Smith & Tim J. Smith, (November 2016), Scientific Reports, Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset, https://www.nature.com/articles/srep46104
American Psychiatric Association, (2013), Internet Gaming Disorder, file:///C:/Users/PTomasi/Downloads/APA_DSM-5-Internet-Gaming-Disorder.pdf
Canadian Paediatric Society, (2017), Screen time and young children: Promoting health and development in a digital world, https://www.cps.ca/en/documents/position/screen-time-and-young-children
Active Healthy Kids Canada, (2014), Is Canada In The Running, http://www.participaction.com/sites/default/files/downloads/Participaction-2014FullReportCard-CanadaInTheRunning_0.pdf
BBC News, (August 2005), South Korean Dies After Games Session, http://news.bbc.co.uk/2/hi/technology/4137782.stm
Mark Tran, (2000), Girl starved to death while parents raised virtual child in online game, https://www.theguardian.com/world/2010/mar/05/korean-girl-starved-online-game