Warning signs include sleep problems, difficulty completing homework and social isolation

More than half of GPs have seen at least one, and often several, patients in the last month who are exhibiting signs of excessive game use, from disturbed sleep to school struggles to social isolation and even aggression and violence, a Healthed survey of more than 1700 doctors indicates.

Video game addiction, overuse and related behavioural issues are more common than you might think. Macquarie University research found 3% of Australian kids can be classified as having a gaming disorder, and 10% fall into a hazardous category. The figures are in line with other Western countries, particularly for children aged between 10 and 16 years old.

In Healthed’s survey, 52% of GPs had seen one of more patients experiencing problematic effects of too much gaming, and 8% had seen six or more, in the past month.

And it’s not just kids who are gaming to excess—14% of GPs said the problem was often reported by the person’s partner, suggesting that some adults are getting caught in the tech industry’s sticky web.

People who excessively game are withdrawing socially and from their families, and experiencing disturbed sleep and impacted academic performance, more than 60% of surveyed GPs reported.

Weight problems and antisocial behaviour were also commonly cited. More than a third of GPs had seen patients who exhibit violent or aggressive behaviour, which they believed resulted from excessive gaming. And more than one in five had patients who were gaming so much it impacted on their ability to hold down a job or contributed to financial difficulties.

How to assess for ‘problem gaming’

Brad Marshall, a psychologist and director of the Screens and Gaming Disorder Clinic in Sydney, says in his experience sleep disturbance is the key warning sign, and he has some tips for determining changes in social activity and academic performance among kids.

“Reduced social activity is tricky to gauge, given adolescents spend significant time socialising online. I half joke to parents that in the last holidays, if your teenage son or daughter didn’t leave the room and your social life was more interactive than theirs, then that’s a warning sign,” Marshall says.

“For academic performance, what I encourage GPs and clinicians to do is to not screen for a drop in overall marks, but to look for issues with completing homework, and especially assessments.”

Marshall says the IGDT-10 screening tool is a good start for assessing patients. As it can be quite clinical, he layers more parent-friendly questions on top.

Psychiatrist Dr Kim Le uses the WHO criteria for gaming disorder, which characterises a lack of control, prioritisation of gaming over other activities, and continued gaming despite negative consequences.

“Ask how much time they’re spending in games over a week. If the hours are similar to a full time job, that is excessive gaming,” says Dr Le.

A crucial factor to keep in mind is comorbidity. Singapore’s National Addiction Clinic, where Dr Le spent time working, showed that 42% of teenagers who game excessively had a previous mental heath diagnosis, most commonly ADHD.

“Even before video games were invented, young people suffered from social phobia. Throw in a pandemic and a diagnosis of autism or ADHD, and young people will want to escape those distressing feelings,” he says.

“I get the diagnosis and understanding right first. It’s only really if they have comorbid major depression, generalised anxiety disorder, ADHD, or autism that I would consider medication. If they are young, I’m quite conservative about starting medication.”

Parents need to set limits

The Healthed survey also found that in most cases GPs see a parent of the person with a problem, but 29% typically see the person themself, and 14% typically see the person’s partner.

When parents come in on their own, it’s important to first help them understand that their child’s behaviour isn’t a personal attack.

“About 3% of Australian kids qualify for this disorder. Do they know that’s 120,000 kids? And how these games are made to be addictive?” Marshall asks.

“It takes the onus away from ‘you have a child who is being nasty to you and hates you’, to ‘you have a child who needs help because they are being preyed on by the tech industry’. That’s a powerful first step.”

“The next step is about how to put healthy boundaries around tech use in place in the home, like limiting mobile data on their mobile phone and managing the home WiFi better. Taking away a phone or Xbox in isolation doesn’t work, and screen time apps can be hacked by tech savvy kids.”

Dr Kimberley O’Brien, a child psychologist, says discussions around limiting access can provoke a negative and sometimes violent response, but a negotiation can always be reached.

“I encourage parents to set time for gaming. Maybe just Friday afternoons or Sunday afternoons after the weekend has been enjoyed outdoors or with family,” Dr O’Brien says.

“We try to fill the gaps from gaming with lots of structure. After six weeks, if a patient has not been gaming, you see all those lovely social skills coming back. So we know it works when they push through the withdrawal.”

Dr Le says consulting with the parent first can help to avoid a situation where they shame or berate the child, and can also provide a more objective picture of the extent of the problem.

Dr Le also consults a number of ‘Warcraft widows’ at his private practice.

“The partner feels like they’re doing all the housework and there’s lack of intimacy. They’ll give the person gaming an ultimatum: choose the game or me. Often people cannot see that the game is actually causing a wedge between them and their partners,” he says.

A problem that is not going away

“It’s become normalised to game every day and game quite excessively,” says Dr Le.

“In Asian cultures, it gets picked up a lot earlier because there’s a higher focus on academic performance, but in Australia, there’s not as much emphasis on performance. So people aren’t coming for help. They’re seeking help for other things, like school refusal or anxiety or ADHD.”

“By the time they come to me, the parents have tried every strategy under the sun. It’s really by chance or by the clinician being aware of the problem and referring on.”

At Dr O’Brien’s Quirky Kid clinic, behavioural issues related to gaming and screen time are the second most common referral, after anxiety-related issues.

“I think it’s more common than parents would like to admit and is underreported because of the stigma associated with gaming,” she says.

“When we’re doing all the background checks with parents, it’s about 45 minutes in where they’ll say the child has got some pretty serious screen withdrawal symptoms. Parents need to have a significant amount of trust before they’ll share those details with a GP. We need to normalise the problem and make more help available.”

What’s next?

Brad Marshall and Associate Professor Wayne Warburton of Macquarie University are trialling a new parent and child friendly screening tool for gaming disorder that they hope will supersede the IGDT-10. Marshall anticipates it will become available in around 12 months.

They are also running a trial involving 2,500 school kids, the largest trial to date, to determine the degree of the problem in Australia since the pandemic. Results will be made available later this year.

“What we’re going to see is some pretty astronomical average screen use per day,” Marshall says.

Results from a three-month intervention program to reduce gaming time in Australian teens will also be available later this year. Associate Professor Warburton is overseeing the program, which is based on German research. He and the program were recently featured on Australian Story.

Credits

Survey conception and design– Dr Ramesh Manocha

Writing and reporting–Ben Falkenmire

Survey analysis and visualisation– Yasmin Clarke

Editing– Lynnette Hoffman