International school-related sedentary behaviour recommendations for children and youth.

BACKGROUND: Existing sedentary behaviour guidelines for children and youth target overall sedentary behaviour and recreational screen time, without any specific recommendations regarding school-related sedentary behaviours (i.e., sedentary behaviours performed during the school day, or within the influence of school). The purpose of this paper is to describe the development of international evidence-based recommendations for school-related sedentary behaviours for children and youth, led by the Sedentary Behaviour Research Network (SBRN). METHODS: A panel of international experts was convened by SBRN in November 2020 to guide the development of these recommendations for children and youth aged ~ 5-18 years. The recommendations were informed by 1) age-relevant existing sedentary behaviour guidelines, 2) published research on the relationship between overall sedentary behaviour and health, 3) a de novo systematic review on the relationship between school-related sedentary behaviours and health and/or academic outcomes, and 4) a de novo environmental scan of the grey literature to identify existing recommendations for school-related sedentary behaviours. Draft recommendations were presented to the Expert Panel in June 2021. Following thorough discussion and modifications, updated recommendations were distributed for stakeholder feedback from July 9-26. Feedback was received from 148 stakeholders across 23 countries, leading to additional updates to the recommendations. Following further rounds of discussion and updates with the Expert Panel in August and September 2021, consensus was achieved on the final recommendations. RESULTS: A healthy day includes breaking up extended periods of sedentary behaviour and incorporating different types of movement into homework whenever possible, while limiting sedentary homework. School-related screen time should be meaningful, mentally or physically active, and serve a specific pedagogical purpose that enhances learning. Replacing sedentary learning activities with movement-based learning activities, and replacing screen-based learning activities with non-screen-based learning activities, can further support students' health and wellbeing. DISCUSSION: This paper presents the first evidence-based recommendations for school-related sedentary behaviours for children and youth. These recommendations will support the work of parents, caregivers, educators, school system administrators, policy makers, researchers and healthcare providers interested in promoting student health and academic success.

Internet Gaming Disorder as a formative construct: Implications for conceptualization and measurement.

Some people have serious problems controlling their Internet and video game use. The DSM-5 now includes a proposal for 'Internet Gaming Disorder' (IGD) as a condition in need of further study. Various studies aim to validate the proposed diagnostic criteria for IGD and multiple new scales have been introduced that cover the suggested criteria. Using a structured approach, we demonstrate that IGD might be better interpreted as a formative construct, as opposed to the current practice of conceptualizing it as a reflective construct. Incorrectly approaching a formative construct as a reflective one causes serious problems in scale development, including: (i) incorrect reliance on item-to-total scale correlation to exclude items and incorrectly relying on indices of inter-item reliability that do not fit the measurement model (e.g., Cronbach's α); (ii) incorrect interpretation of composite or mean scores that assume all items are equal in contributing value to a sum score; and (iii) biased estimation of model parameters in statistical models. We show that these issues are impacting current validation efforts through two recent examples. A reinterpretation of IGD as a formative construct has broad consequences for current validation efforts and provides opportunities to reanalyze existing data. We discuss three broad implications for current research: (i) composite latent constructs should be defined and used in models; (ii) item exclusion and selection should not rely on item-to-total scale correlations; and (iii) existing definitions of IGD should be enriched further.

The bidirectional relationships between online victimization and psychosocial problems in adolescents: a comparison with real-life victimization.

Although peer victimization is of major concern and adolescents spend increasing amounts of time on the Internet, relatively little is known about the psychosocial antecedents and consequences of online victimization. The main aim of this study was to compare the psychosocial antecedents and consequences of online versus real-life victimization. More specifically, the bidirectional relationship between online and real-life victimization on the one hand and psychosocial problems (i.e., loneliness and social anxiety) on the other was examined. In addition, the moderating role of online aggression in the relationship between online victimization and subsequent psychosocial problems was studied. This prospective study, consisting of three annual measurements, was conducted among a sample of 831 adolescents (50.3 % girls) aged 11-15, of which most (80.2 %) had a Dutch ethnic background. The results indicate a unidirectional relationship whereby loneliness and social anxiety predict an increase in latter online victimization rather than the reverse. A bidirectional relationship was found for real-life victimization: loneliness (but not social anxiety) predicted an increase in latter real-life victimization, which in turn predicted an increase in subsequent social anxiety (but not loneliness). No moderating effects of online aggression were found. The findings of the present study suggest that negative online and in real life peer interactions have a differential meaning for, and impact on adolescents' well-being.

Associations Between Type and Timing of Physical Activity and Sedentary Behavior With Mental Health in Adolescents and Young Adults.

BACKGROUND: This cross-sectional study analyzed the association of leisure-time physical activity (PA) and sedentary behavior (SB), nonleisure PA and SB, and total PA and SB in different time segments of the day with mental health among Dutch adolescents and young adults. METHODS: A total of 881 participants aged 16-25 years completed an online survey. Mental health was assessed using the Mental Health Inventory-5, and participants also reported sex, age, and income. They filled out a questionnaire of types of PA and SB for each hour of the day. Activities were categorized into nonleisure and leisure, during the morning, afternoon, evening, and for the whole day. RESULTS: Participants (52.8% female, on average 20.8 y) generally engaged in more leisure-time PA and SB during weekends compared with weekdays, and more nonleisure activities on weekdays. Associations varied between time segments and days of the week. Positive associations of leisure-time and total PA during the whole day and evenings with mental health were observed on weekdays. Total, leisure-time, and nonleisure-time SB were associated with worse mental health. Nonleisure PA was not associated with mental health. CONCLUSIONS: Leisure-time PA was found to have a favorable association with mental health, particularly in the evenings of weekdays and afternoons of weekend days. On the other hand, leisure SB was associated with poorer mental health in most of the time segments analyzed, and nonleisure SB in the evenings was also related to worse mental health. The type and timing of PA and SB behaviors play an important role in the relationship with mental health.

Error processing and response inhibition in excessive computer game players: an event-related potential study.

Excessive computer gaming has recently been proposed as a possible pathological illness. However, research on this topic is still in its infancy and underlying neurobiological mechanisms have not yet been identified. The determination of underlying mechanisms of excessive gaming might be useful for the identification of those at risk, a better understanding of the behavior and the development of interventions. Excessive gaming has been often compared with pathological gambling and substance use disorder. Both disorders are characterized by high levels of impulsivity, which incorporates deficits in error processing and response inhibition. The present study aimed to investigate error processing and response inhibition in excessive gamers and controls using a Go/NoGo paradigm combined with event-related potential recordings. Results indicated that excessive gamers show reduced error-related negativity amplitudes in response to incorrect trials relative to correct trials, implying poor error processing in this population. Furthermore, excessive gamers display higher levels of self-reported impulsivity as well as more impulsive responding as reflected by less behavioral inhibition on the Go/NoGo task. The present study indicates that excessive gaming partly parallels impulse control and substance use disorders regarding impulsivity measured on the self-reported, behavioral and electrophysiological level. Although the present study does not allow drawing firm conclusions on causality, it might be that trait impulsivity, poor error processing and diminished behavioral response inhibition underlie the excessive gaming patterns observed in certain individuals. They might be less sensitive to negative consequences of gaming and therefore continue their behavior despite adverse consequences.

"Don't Gamble With Children's Rights"-How Behavioral Design Impacts the Right of Children to a Playful and Healthy Game Environment.

Gaming is an important pastime for young people to relax, socialize and have fun, but also to be challenged, show creativity and work together to achieve goals. The design of games can have an impact on their behavior. With the changing revenue models of games, we see that game design is increasingly taking forms that do not always have a positive impact on children and may interfere with, or even violate, children's rights. This article examines how evolving revenue models of games impact user's behavior via game design. Behavioral design in games thus raises questions about children's rights to play and recreation, to health, to protection from economic exploitation and to data protection.

The relationship between mental well-being and dysregulated gaming: a specification curve analysis of core and peripheral criteria in five gaming disorder scales.

Gaming disorder (also known as dysregulated gaming) has received significant research and policy attention based on concerns that certain patterns of play are associated with decreased mental well-being and/or functional impairment. In this study, we use specification curve analysis to examine analytical flexibility and the strength of the relationship between dysregulated gaming and well-being in the form of general mental health, depressive mood and life satisfaction. Dutch and Flemish gamers (n = 424) completed an online survey containing five unique dysregulated gaming measures (covering nine scale variants) and three well-being measures. We find a consistent negative relationship; across 972 justifiable regression models, the median standardized regression coefficient was -0.39 (min: -0.54, max: -0.19). Data show that the majority of dysregulated gaming operationalizations converge upon highly similar estimates of well-being. However, variance is introduced by the choice of well-being measure; results indicate that dysregulated gaming is more strongly associated with depressive mood than with life satisfaction. Weekly game time accounted for little to no unique variance in well-being in the sample. We argue that research on this topic should compare a broad range of psychosocial well-being outcomes and explore possible simplifications of the DSM-5 gaming disorder criteria. Given somewhat minute differences between dysregulated gaming scales when used in survey-based studies and largely equivalent relationships with mental health indicators, harmonization of measurement should be a priority.

Addressing problematic video game use: A multimethod, dual-context perspective on leisure-time use.

A more integrative approach to the prevention of problematic gaming behavior is recommended in Király et al.'s review. We discuss the Dutch policy responses to problematic gaming behavior and suggest two alternatives to the dominant survey research approach to achieve this. Employing time-use/diary studies allows us to map out the full scope of leisure-time use and employing log-data analysis improves our understanding of gamer behavior within the virtual context. All of these approaches would benefit from accounting for the diversity of within-virtual context behavior. The approach is summarized as a multimethod, dual-context approach to understanding leisure-time behavior.

Fear of Missing Out as a Predictor of Problematic Social Media Use and Phubbing Behavior among Flemish Adolescents.

Fear-of-missing-out (FOMO) refers to feelings of anxiety that arise from the realization that you may be missing out on rewarding experiences that others are having. FOMO can be identified as an intra-personal trait that drives people to stay up to date of what other people are doing, among others on social media platforms. Drawing from the findings of a large-scale survey study among 2663 Flemish teenagers, this study explores the relationships between FOMO, social media use, problematic social media use (PSMU) and phubbing behavior. In line with our expectations, FOMO was a positive predictor of both how frequently teenagers use several social media platforms and of how many platforms they actively use. FOMO was a stronger predictor of the use of social media platforms that are more private (e.g., Facebook, Snapchat) than platforms that are more public in nature (e.g., Twitter, Youtube). FOMO predicted phubbing behavior both directly and indirectly via its relationship with PSMU. These findings support extant research that points towards FOMO as a factor explaining teenagers' social media use.

Gamers' insights into the phenomenology of normal gaming and game "addiction": A mixed methods study.

In response to calls for further research into the phenomenology of Internet gaming disorder (IGD), we used a community-engaged consensus development approach to evaluate how members of the "gamer culture" describe problematic gaming and the relationship of these descriptions to the proposed IGD criteria. Two focus groups of gamers were recruited at a video game convention. Participants were asked to submit suggestions for signs of game "addiction". Participants discussed and ranked the criteria in order of conceptual importance. The rankings were analyzed quantitatively, and then a multidisciplinary team compared the ranked criteria to the DSM-5 IGD proposed criteria. The strongest agreement between participants' rankings and IGD symptomatology was found for harms/functional impairment due to gaming, continued use despite problems, unsuccessful attempts to control gaming, and loss of interest in previous hobbies and entertainment. There was less support for other IGD criteria. Participants also offered new content domains. These findings suggest that collaborative knowledge-building approaches may help researchers and policymakers understand the characteristics and processes specific to problematic video game play and improve content validity of IGD criteria. Future efforts may benefit from multi-stakeholder approaches to refine IGD criteria and inform theory, measurement and intervention.

A weak scientific basis for gaming disorder: Let us err on the side of caution.

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.

Lost in the chaos: Flawed literature should not generate new disorders.

The paper by Kuss, Griffiths, and Pontes (2016) titled "Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field" examines issues relating to the concept of Internet Gaming Disorder. We agree that there are serious issues and extend their arguments by suggesting that the field lacks basic theory, definitions, patient research, and properly validated and standardized assessment tools. As most studies derive data from survey research in functional populations, they exclude people with severe functional impairment and provide only limited information on the hypothesized disorder. Yet findings from such studies are widely used and often exaggerated, leading many to believe that we know more about the problem behavior than we do. We further argue that video game play is associated with several benefits and that formalizing this popular hobby as a psychiatric disorder is not without risks. It might undermine children's right to play or encourage repressive treatment programs, which ultimately threaten children's right to protection against violence. While Kuss et al. (2016) express support for the formal implementation of a disorder, we argue that before we have a proper evidence base, a sound theory, and validated assessment tools, it is irresponsible to support a formal category of disorder and doing so would solidify a confirmatory approach to research in this area.

Clinical validation of the C-VAT 2.0 assessment tool for gaming disorder: A sensitivity analysis of the proposed DSM-5 criteria and the clinical characteristics of young patients with 'video game addiction'.

AIMS: Clinicians struggle with the identification of video gaming problems. To address this issue, a clinical assessment tool (C-VAT 2.0) was developed and tested in a clinical setting. The instrument allows exploration of the validity of the DSM-5 proposal for 'internet gaming disorder'. METHOD: Using C-VAT 2.0, the current study provides a sensitivity analysis of the proposed DSM-5 criteria in a clinical youth sample (13-23years old) in treatment for video gaming disorder (N=32). The study also explores the clinical characteristics of these patients. RESULTS: The patients were all male and reported spending extensive amounts of time on video games. At least half of the patients reported playing online games (n=15). Comorbid problems were common (n=22) and included (social) anxiety disorders, PDD NOS, ADHD/ADD, Parent-Child relationship problem, and various types of depressive mood problems. The sensitivity of the test was good: results further show that the C-VAT correctly identified 91% of the sample at the proposed cut-off score of at least 5 out of 9 of the criteria. As our study did not include healthy, extreme gamers, we could not assess the specificity of the tool: future research should make this a priority. CONCLUSION: Using the proposed DSM-5 cut-off score, the C-VAT 2.0 shows preliminary validity in a sample of gamers in treatment for gaming disorder, but the discriminating value of the instrument should be studied further. In the meantime, it is crucial that therapists try to avoid false positives by using expert judgment of functional impairment in each case.

Video Gaming in a Hyperconnected World: A Cross-sectional Study of Heavy Gaming, Problematic Gaming Symptoms, and Online Socializing in Adolescents.

AIMS: Examining online social interactions along with patterns of video gaming behaviors and game addiction symptoms has the potential to enrich our understanding of disorders related to excessive video game play. METHODS: We performed latent class analysis in a sample of 9733 adolescents based on heavy use of games, social networking and instant messaging, and game addiction symptoms. We used latent class regression to determine associations between classes, psychosocial well-being and friendship quality. RESULTS: We identified two types of heavy gaming classes that differed in probability of online social interaction. Classes with more online social interaction reported fewer problematic gaming symptoms than those with less online social interaction. Most adolescents estimated to be in heavy gaming classes had more depressive symptoms than normative classes. Male non-social gamers had more social anxiety. Female social gamers had less social anxiety and loneliness, but lower self-esteem. Friendship quality attenuated depression in some male social gamers, but strengthened associations with loneliness in some male non-social gamers. CONCLUSIONS: In adolescents, symptoms of video game addiction depend not only on video game play but also on concurrent levels of online communication, and those who are very socially active online report fewer symptoms of game addiction.

Commercial Video Games As Therapy: A New Research Agenda to Unlock the Potential of a Global Pastime.

Emerging research suggests that commercial, off-the-shelf video games have potential applications in preventive and therapeutic medicine. Despite these promising findings, systematic efforts to characterize and better understand this potential have not been undertaken. Serious academic study of the therapeutic potential of commercial video games faces several challenges, including a lack of standard terminology, rapidly changing technology, societal attitudes toward video games, and understanding and accounting for complex interactions between individual, social, and cultural health determinants. As a vehicle to launch a new interdisciplinary research agenda, the present paper provides background information on the use of commercial video games for the prevention, treatment, and rehabilitation of mental and other health conditions, and discusses ongoing grassroots efforts by online communities to use video games for healing and recovery.

Scholars' open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal.

Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.

A critical review of "Internet addiction" criteria with suggestions for the future.

AIMS: In the last 5 years a deluge of articles on the topic of Internet addiction (IA) has proposed many candidate symptoms as evidence of this proposed disease. We critically reviewed the current approach to the measurement and identification of this new excessive behavior syndrome. METHODS: Three popular models of IA were discussed: Griffith's components model; Young's Internet Addiction Test (IAT); and the criteria by Tao et al. (2010). We selected these models because they are widely cited and propose specific criteria for IA disorder. Our approach is not meant to provide an exhaustive review, but to discuss and critique the most salient trends in the field. RESULTS: The models of Internet addiction share some criteria, including feeling a loss of control over Internet use; ensuing psychological, social, or professional conflict or problems; and preoccupation when not using the Internet. Other criteria inconsistently mentioned include: mood management, tolerance, withdrawal, and craving/anticipation. The models studied here share the assumption that the Internet can produce a qualitative shift to a diseased state in humans. CONCLUSIONS: We critically discussed the above criteria and concluded that the evidence base is currently not strong enough to provide support for an Internet addiction disorder. Future research areas are suggested: (1) Focusing on common impaired dimensions, (2) exploring neuroimaging as a model building tool, and (3) identifying shifts in the rewarding aspects of Internet use. Given the lack of consensus on the subject of Internet addiction, a focus on problem behaviors appears warranted.

The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents.

AIMS: The current study explored the nature of problematic (addictive) video gaming (PVG) and the association with game type, psychosocial health, and substance use. METHODS: Data were collected using a paper and pencil survey in the classroom setting. Three samples were aggregated to achieve a total sample of 8478 unique adolescents. Scales included measures of game use, game type, the Video game Addiction Test (VAT), depressive mood, negative self-esteem, loneliness, social anxiety, education performance, and use of cannabis, alcohol and nicotine (smoking). RESULTS: Findings confirmed problematic gaming is most common amongst adolescent gamers who play multiplayer online games. Boys (60%) were more likely to play online games than girls (14%) and problematic gamers were more likely to be boys (5%) than girls (1%). High problematic gamers showed higher scores on depressive mood, loneliness, social anxiety, negative self-esteem, and self-reported lower school performance. Nicotine, alcohol, and cannabis using boys were almost twice more likely to report high PVG than non-users. CONCLUSIONS: It appears that online gaming in general is not necessarily associated with problems. However, problematic gamers do seem to play online games more often, and a small subgroup of gamers - specifically boys - showed lower psychosocial functioning and lower grades. Moreover, associations with alcohol, nicotine, and cannabis use are found. It would appear that problematic gaming is an undesirable problem for a small subgroup of gamers. The findings encourage further exploration of the role of psychoactive substance use in problematic gaming.

Video game addiction test: validity and psychometric characteristics.

The study explores the reliability, validity, and measurement invariance of the Video game Addiction Test (VAT). Game-addiction problems are often linked to Internet enabled online games; the VAT has the unique benefit that it is theoretically and empirically linked to Internet addiction. The study used data (n=2,894) from a large-sample paper-and-pencil questionnaire study, conducted in 2009 on secondary schools in Netherlands. Thus, the main source of data was a large sample of schoolchildren (aged 13-16 years). Measurements included the proposed VAT, the Compulsive Internet Use Scale, weekly hours spent on various game types, and several psychosocial variables. The VAT demonstrated excellent reliability, excellent construct validity, a one-factor model fit, and a high degree of measurement invariance across gender, ethnicity, and learning year, indicating that the scale outcomes can be compared across different subgroups with little bias. In summary, the VAT can be helpful in the further study of video game addiction, and it contributes to the debate on possible inclusion of behavioral addictions in the upcoming DSM-V.