Assessment of Hazardous Gaming in children and its dissimilarities and overlaps with Internet Gaming Disorder.

Background and aims: Children have been vastly overlooked in Internet Gaming Disorder (IGD) and Hazardous Gaming research so far. The diagnoses are listed in different ICD-11 chapters (addiction vs. problematic health condition) and are thus considered as distinct constructs. However, screening tools for children do not exist yet. We aimed to investigate the psychometric properties of an existing IGD screening tool modified to also assess Hazardous Gaming in children. Further, we aimed to compare the dissimilarity and overlap between (subclinical) IGD and Hazardous Gaming in children. Methods: The study analyzed data from a mixed school and clinical sample. Data from N = 871 children aged between 8 and 12 years of age (M = 10.3, SD = 0.90) were analyzed. Data were collected via the Video Game Dependency Scale (CSAS) in its parent report version, which was adapted to assess Hazardous Gaming symptoms in addition to the IGD symptoms. Item analyses and reliability and factor analyses were conducted on the Hazardous Gaming version. Results: The results show that the adapted CSAS version that assesses Hazardous Gaming symptoms in children mostly shows acceptable psychometric properties. Explorative Factor Analysis (EFA) shows a two-factor structure with one factor of higher order. Additionally, results show that 35.2% of all children meeting the threshold for Hazardous Gaming exclusively meet criteria for Hazardous Gaming but not for (subclinical) IGD. Vice versa, 91.3% of children with IGD also meet the criteria for Hazardous Gaming. Discussion: Hazardous Gaming and (subclinical) IGD are distinct constructs with some overlaps and might have a temporal relation. We recommend adding four items to assess Hazardous Gaming using the CSAS and further evaluate the validity. The assessment of Hazardous Gaming in children is crucial because it might occur earlier than subclinical or full-syndrome IGD.

Internet Use Disorders: Subjective Importance of Online Friends in the Context of Real-Life Social Support and Comorbid Mental Disorders.

INTRODUCTION: Previous studies analyzing friendships with people only known through the Internet mainly focused on quantitative aspects (e.g., the number of online friends or the time spent with them). Little is known about the perceived quality of online compared to real-life friends in individuals with an Internet use disorder (IUD). This study aimed to analyze associations of the increased subjective importance of online friends and IUD by controlling for the perceived real-life social support and comorbid mental disorders. METHODS: Based on a general population sample, 192 participants who were screened positive for risky Internet use took part in face-to-face clinical diagnostic interviews. IUD was assessed using the structure of the Munich-Composite International Diagnostic Interview (M-CIDI) and the adapted criteria of Internet gaming disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The number and the increased subjective importance of online compared to real-life friends were assessed with the Online and Real-Life Friends scale (ORLF), real-life social support was assessed with the Berlin Social Support Scales (BSSS), and comorbidity was assessed with the M-CIDI. Data were analyzed with binary regression models. RESULTS: Of 192 participants with risky Internet use, 39 participants (19 men; age M = 29.9, SD = 12.2) fulfilled the criteria of IUD in the last 12 months. IUD was not associated with the number or perceived social support of online friends per se. In multivariate analyses, IUD was associated with increased subjective importance of online friends, independently from comorbid anxiety or mood disorders. However, when controlling for real-life social support, associations of IUD and increased subjective importance of online friends were no longer present. CONCLUSION: These findings highlight the necessity of therapeutic interventions aimed at strengthening social skills and engaging in real-life relationships in the prevention and therapy of IUD. Due to the small sample size and the cross-sectional analysis, however, further research is needed.

Addressing taxonomic challenges for Internet Use Disorders in light of changing technologies and diagnostic classifications. •.

Drawing a distinction between mobile and non-mobile Internet Use Disorders is an important step to clarify blurred current concepts in the field of behavioral addictions. Similarly, future technological advances related to virtual or augmented reality, artificial intelligence or the Internet of things might lead to further modifications or new taxonomies. Moreover, diagnostic specifiers like offline/online might change with technological advances and trends of use. An important taxonomical approach might be to look for common structural characteristics of games and applications that will be amenable to new technical developments. Diagnostic and taxonomical approaches based on empirical evidence are important goals in the study of behavioral addictions.

The role of inhibitory control and decision-making in the course of Internet gaming disorder.

BACKGROUND AND AIMS: Internet gaming disorder (IGD) is associated with impaired inhibitory control and more impulsive decision-making. However, it remains unclear whether these associations are cross-sectional or predictive. We aimed to test the hypotheses that lower inhibitory control and more impulsive decision-making correlate with, are predicted by and predict more time spent on gaming and higher IGD severity. METHODS: A stratified convenience sample of 70 male participants (18-21 years) was recruited to achieve broad data variability for hours spent on gaming and IGD severity. In three annual assessments (T1, T2, T3), we measured gaming behaviour and IGD severity using the Video Game Dependency Scale (CSAS-II). Both gaming-related measures were correlates (T1), predictors (T2), or outcomes (T3) of inhibitory control and decision making, which were assessed at T2 using a go/no-go task and an intertemporal-choice task, respectively. RESULTS: Higher IGD severity at T1 predicted more impulsive decision-making at T2 (ß = 0.45, 95% CI = 0.14-0.76). Lower inhibitory control at T2 predicted more hours spent on gaming at T3 (ß = -0.13, 95% CI = -0.25 to -0.02). We found weak or no evidence for the other associations. DISCUSSION AND CONCLUSIONS: Lower inhibitory control predicts more time spent gaming, possibly due to insufficient top-down regulation of the behaviour. Impulsive decision-making is rather a consequence of IGD than a predictor, which may be due to altered reward learning. One-dimensional etiological assumptions about the relationship between neurocognitive impairments and IGD seem not to be appropriate for the complexity of the disorder.

School-Related Risk Factors of Internet Use Disorders.

A growing body of research focusing on the risk factors of Internet use disorder (IUD) underlines the effect of sociodemographic variables like age and gender or comorbid mental disorders on IUD symptoms. The relation between IUD symptoms and school-related variables has to date been insufficiently studied. The present study closes this gap by investigating the relation between school-relevant factors such as absenteeism, school grades, procrastination, school-related social behavior, and learning behavior and IUD symptoms in a high-risk sample. n = 418 students between 11 and 21 years of age (M = 15.10, SD = 1.97), screened for elevated risk of IUD, participated in the study. Sociodemographic data, school grades and absent days, Internet use variables (time spent online and gaming), as well as school-related psychological variables (procrastination, learning behavior, and social behavior) were assessed via self-report questionnaires. IUD symptoms were assessed with an adapted version of the German Video Game Dependency Scale (CSAS), which is based on the 9 criteria for Internet gaming disorder in the DSM-5. The instrument was adapted to include the assessment of non-gaming IUD symptoms. Taking the hierarchical structure of the data into account, a multilevel modeling approach was used to analyze the data. Procrastination, time spent online, and gaming were significant predictors of IUD symptoms at the individual level, whereas social behavior significantly predicted symptoms of IUD at the school level. In addition to previous findings on risk factors of IUD, this study indicates the importance of school-related factors in the development of IUD, especially psychological factors that play a role in the school setting. The early age of IUD onset and the high relevance of prevention of IUD at the school age underline the relevance of this finding.

Policy and prevention efforts for gaming should consider a broad perspective.

Internet gaming disorder is gaining attention around the world. Some efforts have been directed toward preventing gaming problems from developing or persisting, but few approaches have been empirically evaluated. No known effective prevention intervention exists. Reviewing the broader field of prevention research should help research and best practices move forward in abating problems that arise from excessive gaming.

Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective.

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

Internet Gaming Disorder in Children and Adolescents.

The American Psychiatric Association recently included Internet gaming disorder (IGD) as a potential diagnosis, recommending that further study be conducted to help illuminate it more clearly. This paper is a summary of the review undertaken by the IGD Working Group as part of the 2015 National Academy of Sciences Sackler Colloquium on Digital Media and Developing Minds. By using measures based on or similar to the IGD definition, we found that prevalence rates range between ∼1% and 9%, depending on age, country, and other sample characteristics. The etiology of IGD is not well-understood at this time, although it appears that impulsiveness and high amounts of time gaming may be risk factors. Estimates for the length of time the disorder can last vary widely, but it is unclear why. Although the authors of several studies have demonstrated that IGD can be treated, no randomized controlled trials have yet been published, making any definitive statements about treatment impossible. IGD does, therefore, appear to be an area in which additional research is clearly needed. We discuss several of the critical questions that future research should address and provide recommendations for clinicians, policy makers, and educators on the basis of what we know at this time.

Brief assessment of subjective health complaints: Development, validation and population norms of a brief form of the Giessen Subjective Complaints List (GBB-8).

OBJECTIVE: Although there is no causal relationship to medical morbidity, routine clinical assessment of somatic symptoms aids medical diagnosis and assessment of treatment effectiveness. Regardless of their causes, somatic symptoms indicate suffering, distress, and help-seeking behavior. The aim of the present study was to develop and validate a brief self-report questionnaire to assess somatic symptom strain. METHODS: A brief form of the Giessen Subjective Complaints List (GBB-8) was developed and validated in a large population sample representative of the Federal Republic of Germany (N=2008). Psychometric analyses included confirmation of factor structure, classical item analysis, and measurement invariance tests. The sample furthermore served as a norm group. As indicators of construct validity, correlations with measures of anxiety, depression, alexithymia, and primary care contact were computed. RESULTS: Psychometric analyses yielded excellent scale properties regarding item characteristics, factor structure, and measurement invariance tests (Cronbach's alpha=0.88; CFI=0.980, TLI=0.965, RMSEA=0.049) for the second-order four-factor model; strict invariance was confirmed for gender, depression status, and physician contacts; strong invariance was confirmed regarding age and age×gender. CONCLUSIONS: The GBB-8 with its four subscales exhaustion, gastrointestinal complaints, musculoskeletal complaints, and cardiovascular complaints proves to be an economic measure of subjective symptom strain. Psychometric analyses deem it suitable for epidemiological research. The availability of norms makes it a potential everyday tool for general practitioners and psychosomatic clinics.

Internet Gaming Disorder in the DSM-5.

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes in its research appendix a potential new diagnosis-Internet gaming disorder. This article outlines the debate surrounding non-substance addictions and the rationale for including this condition in the "Conditions for Further Study" chapter in DSM-5 Section III. It also describes the diagnostic criteria that DSM-5 recommends and methods to assess Internet gaming disorder. The paper details international research related to prevalence rates, demographic, psychiatric, and neurobiological risk factors, the natural course of the condition, and promising treatment approaches. The paper concludes by describing important issues for research to address prior to official recognition of this condition as a mental disorder.

Prevalence of Internet gaming disorder in German adolescents: diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample.

BACKGROUND AND AIMS: Internet gaming disorder (IGD) is included as a condition for further study in Section 3 of the DSM-5. Nine criteria were proposed with a threshold of five or more criteria recommended for diagnosis. The aims of this study were to assess how the specific criteria contribute to diagnosis and to estimate prevalence rates of IGD based on DSM-5 recommendations. DESIGN: Large-scale, state-representative school survey using a standardized questionnaire. SETTING: Germany (Lower Saxony). PARTICIPANTS: A total of 11 003 ninth-graders aged 13-18 years (mean = 14.88, 51.09% male). MEASUREMENTS: IGD was assessed with a DSM-5 adapted version of the Video Game Dependency Scale that covered all nine criteria of IGD. FINDINGS: In total, 1.16% [95% confidence interval (CI) = 0.96, 1.36] of respondents were classified with IGD according to DSM-5 recommendations. IGD students played games for longer periods, skipped school more often, had lower grades in school, reported more sleep problems and more often endorsed feeling 'addicted to gaming' than their non-IGD counterparts. The most frequently reported DSM-5 criteria overall were 'escape adverse moods' (5.30%) and 'preoccupation' (3.91%), but endorsement of these criteria rarely related to IGD diagnosis. Conditional inference trees showed that the criteria 'give up other activities', 'tolerance' and 'withdrawal' were of key importance for identifying IGD as defined by DSM-5. CONCLUSIONS: Based on a state-wide representative school survey in Germany, endorsement of five or more criteria of DSM-5 internet gaming disorder (IGD) occurred in 1.16% of the students, and these students evidence greater impairment compared with non-IGD students. Symptoms related to 'give up other activities', 'tolerance' and 'withdrawal' are most relevant for IGD diagnosis in this age group.

A brief form of the Perceived Social Support Questionnaire (F-SozU) was developed, validated, and standardized.

OBJECTIVES: Development of a brief instrument (F-SozU K-6) for the measurement of perceived social support in epidemiologic contexts by shortening a well-established German questionnaire (F-SozU K-14). STUDY DESIGN AND SETTING: The development of the F-SozU K-6 consisted of two phases; phase 1: the F-SozU K-14 was presented to a general population sample representative for the Federal Republic of Germany (N = 2,007; age: 14-92 years). Six items for the short form were selected based on the maximization of coefficient alpha. Phase 2: the new short form (F-SozU K-6) was evaluated and standardized in an independent second population survey (N = 2,508, age: 14-92 years). RESULTS: The F-SozU K-6 showed very good reliability and excellent model fit indices for the one-dimensional factorial structure of the scale. Furthermore, strict measurement invariance was detected allowing unbiased comparison of means and correlation coefficients and path coefficients between both sexes across the full lifespan from adolescence (14-92 years). Well-established associations of perceived social support with depression and somatic symptoms could be replicated using the short form. CONCLUSION: The F-SozU K-6 presents a reliable, valid, and economical instrument to assess perceived social support and can thus be effectively applied within the frameworks of clinical epidemiologic studies or related areas.

An international consensus for assessing internet gaming disorder using the new DSM-5 approach.

AIMS: For the first time, the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduces non-substance addictions as psychiatric diagnoses. The aims of this paper are to (i) present the main controversies surrounding the decision to include internet gaming disorder, but not internet addiction more globally, as a non-substance addiction in the research appendix of the DSM-5, and (ii) discuss the meaning behind the DSM-5 criteria for internet gaming disorder. The paper also proposes a common method for assessing internet gaming disorder. Although the need for common diagnostic criteria is not debated, the existence of multiple instruments reflect the divergence of opinions in the field regarding how best to diagnose this condition. METHODS: We convened international experts from European, North and South American, Asian and Australasian countries to discuss and achieve consensus about assessing internet gaming disorder as defined within DSM-5. RESULTS: We describe the intended meaning behind each of the nine DSM-5 criteria for internet gaming disorder and present a single item that best reflects each criterion, translated into the 10 main languages of countries in which research on this condition has been conducted. CONCLUSIONS: Using results from this cross-cultural collaboration, we outline important research directions for understanding and assessing internet gaming disorder. As this field moves forward, it is critical that researchers and clinicians around the world begin to apply a common methodology; this report is the first to achieve an international consensus related to the assessment of internet gaming disorder.

Low 2D:4D values are associated with video game addiction.

Androgen-dependent signaling regulates the growth of the fingers on the human hand during embryogenesis. A higher androgen load results in lower 2D:4D (second digit to fourth digit) ratio values. Prenatal androgen exposure also impacts brain development. 2D:4D values are usually lower in males and are viewed as a proxy of male brain organization. Here, we quantified video gaming behavior in young males. We found lower mean 2D:4D values in subjects who were classified according to the CSAS-II as having at-risk/addicted behavior (n = 27) compared with individuals with unproblematic video gaming behavior (n = 27). Thus, prenatal androgen exposure and a hyper-male brain organization, as represented by low 2D:4D values, are associated with problematic video gaming behavior. These results may be used to improve the diagnosis, prediction, and prevention of video game addiction.

Media use and school achievement--boys at risk?

In work done at the German Criminological Research Institute of Lower Saxony (KFN) various methods have been used to investigate how specific inappropriate media usage patterns affect academic performance in children and adolescents. The findings are paralleled by current international research indicating a negative relationship between these two variables. Based on a cross-sectional survey of 5,529 fourth grade students and a longitudinal panel study with 1,157 primary schoolchildren, a key finding can be demonstrated: the more time students spend on consuming media and the more violent its contents are, the worse are their marks at school, even when controlling for vital factors such as family, educational, or immigrant background. In particular, boys who gender-specifically are better equipped with electronic media devices, who partially have extensive media usage times and who strongly prefer violent media content, are at the risk of showing poor school performance. In fact, a decrease in academic performance of boys can be observed in German school statistics. By presenting first results of a school-based intervention programme, a promising approach to the reduction of detrimental effects of electronic media use on school performance is introduced.

Prevalence and risk factors of video game dependency in adolescence: results of a German nationwide survey.

In this article, results of a German nationwide survey (KFN schools survey 2007/2008) are presented. The controlled sample of 44,610 male and female ninth-graders was carried out in 2007 and 2008 by the Criminological Research Institute of Lower Saxony (KFN). According to a newly developed screening instrument (KFN-CSAS-II), which was presented to every third juvenile participant (N = 15,168), 3% of the male and 0.3% of the female students are diagnosed as dependent on video games. The data indicate a clear dividing line between extensive gaming and video game dependency (VGD) as a clinically relevant phenomenon. VGD is accompanied by increased levels of psychological and social stress in the form of lower school achievement, increased truancy, reduced sleep time, limited leisure activities, and increased thoughts of committing suicide. In addition, it becomes evident that personal risk factors are crucial for VGD. The findings indicate the necessity of additional research as well as the respective measures in the field of health care policies.