CADILLAC — The science is mounting that excessive video gaming may deserve its own mental health diagnosis.
The World Health Organization will include "gaming disorder" in its 11th International Classification of Diseases in 2018. The disorder entails persistent behavior that leads to increased priority given to gaming despite negative consequences.
In the United States, mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders for diagnoses, which contains a section focused on conditions that warrant further investigation, according to Sarah Domoff, who has been studying problematic media use at Central Michigan University.
Researchers like Domoff are putting the pieces together for a potentially new "Internet gaming disorder," but the research is still in its early stages.
For as long as video games have been in peoples' homes, parents have had concerns about their effects on their children's health, but screen time now impacts people across all age groups.
"They are really visually appealing," Domoff said of video games. "They really draw users in. They're developed to keep people wanting to play, to keep them coming back."
At the Family Health Lab at CMU, Domoff and students have developed an intervention to help adolescents engage in positive use of social media and develop coping and problem-solving skills to handle negative experiences online. Feedback from clinicians and adolescents will help take the intervention to a large-scale study that could be used by outpatient therapists.
While addictive gaming does resemble other addictive behavior and other mental health issues, Domoff said, it remains unclear if the behavior indicates a unique disorder.
"Up until recently there has not been a measure that captures younger children's excessive use," she said. "We have so many questions still to answer. We don't know if this is just reflecting other mental health symptoms, or something situational or the environment, or if this is a distinct disorder."
What parents should know
Parents are often concerned about the number of hours their children spend on video games, Domoff said, but clinicians want to know if gaming is interfering with their lives.
"Number of hours can matter to some degree, but what I'm looking for, as a clinician, is screen time getting in the way of things a child should be doing," she said.
Video games become problematic when they interfere with a child's sleep time. Parents should limit their child's screen time at night and keep screens out of their bedroom, Domoff said.
In addition to risking poor sleep, having a television in the bedroom can be an obesity risk factor, she added.
The American Academy of Pediatrics suggests limiting the amount of screen time for children ages 2-5 years to one hour or less of screen time per day. Screen time can be introduced to children as young as 18 months, but that time should involve parents, according to Jen Kraus, a social worker with Northern Lakes Community Mental Health.
Using Skype to connect with distant family, for example, can have positive social benefits.
"Children, especially very young children, benefit from interactions with their parents and other kids," Kraus said. "Through those interactions, they base how their world is constructed."
Studies have indicated that certain programs are healthier for children than others, Kraus said. Shows like "Sesame Street" and "Mr. Rogers' Neighborhood" have been shown to contain beneficial content for children.
Parents are encouraged to be involved in their child's digital life. Beyond knowing what their child is watching or playing, they should get involved and play along when possible.
The key to healthy use of technology is balance, Kraus said. Young children need time for physical play to develop fine and gross motor skills, but there are plenty of healthy ways to use technology.
"The conversation really involves how the parent can be incorporated into the playing of a video game with a child or having a conversation about what's real and what's pretend," she said. "Children have magical thinking, so it's hard for them to distinguish between what's vanity and what's reality."
There is no perfect set of rules for children and screens, Kraus added.
"There's no one-size-fits-all category," she said. "Every family views technology differently."
While parents worry about children, young men are among the most likely to play games, according to a Pew Research Center survey conducted in fall 2017. The study also showed that a diverse group of Americans play video games, and many video gamers work full-time.
Studies have shown a positive correlation between playing certain kinds of video games and visual processing and attention, but all games are different. It's undetermined which active ingredients in games are good for adult brains, and which aren't.
A study in 2016 by the Nielsen Company revealed adults in the United States spent nearly 11 hours each day consuming media, largely due to the prevalence of smartphones.
Most of the existing research on problematic use of media focuses on adolescents, but symptoms of addictive behavior and sleeplessness also impact adults.
There are numerous apps for Apple and Android phones that track the number of hours a person spends on their screen. Those apps can help parents monitor their child's use of smartphones or tablets.
Common Sense Media is a great resource for deciding which games are appropriate for kids, Domoff said, and which games may even provide some benefits.
"What we really want to see, when parents are choosing games for their children, is that they involve creativity or critical thinking, or areas of child development," she said.