Doctors’ Notes


Gaming Addiction

Gaming addiction? This is something I had no knowledge of until a good friend told me about her teenage neighbor who was flunking out of school because he was spending so much time “gaming” on the internet. His parents were at their wits’ end trying to find ways to help him. They’d tried discontinuing their internet service, but he would go to a friend’s house to play. In our offices, I’ve personally witnessed children so engrossed in their hand held video games that they aren’t able to answer questions unless the device is turned off.

We all know about the positive effects of the internet, but what about those negative effects?

One definition of addiction is “any pleasurable behavior that renders a person unable to stop once started and which is pursued in spite of negative consequences. The person develops a tolerance and stops feeling satisfied at a certain level of use and requires more activity to get the original euphoria”.  Cyber addiction is a relatively new phenomenon that is increasingly relevant to our adolescent population. One study done in 2009 showed that 8.5% of young video gamers exhibited similar symptoms to other behaviors that have been officially classified as addiction in other areas such as alcohol, drugs and gambling. Modern games are fast-paced and fantasy-filled, which allows the person playing them to feel he’s actually a part of the game, which is very appealing to some children.

Children and teens who have poor social skills, who have low self-esteem, who are bored and lonely, or who have learning disabilities or mood disorders can be more vulnerable to the negative effects of gaming. Online gaming communication helps teens with low self-esteem and/or poor social skills feel safer, because they don’t have to worry about face-to-face encounters.


Multiplayer online games such as Everquest, World of Warcraft, Lord of the Rings, Company of Heroes, Guild Wars, Final Fantasy, Call of Duty and Halo 3, require the player to advance or “level up.” As tasks are completed, rewards such as increased abilities, better equipment and specialized skills are given, which gives a sense of accomplishment and improves self-esteem. These games involve a joint effort of several individuals o complete a mission. Individuals belong to cliques or guilds that are organized teams. The more successful an individual is at completing certain tasks, the more sought-after he becomes as a member of one of these teams. This satisfies the need for belonging to a group and gives a sense of power and status.


Some children and teens have difficulty separating the consequences/actions of video games from reality. The gaming character they represent has no consequences in the real world. So in the real world, social skills may become even worse, which can lead to anxiety and depression. Success in some online games often involves mastering anti-social behavior, such as killing and robbery. This anti-social behavior may lead to aggression and an indifferent attitude to human pain and suffering. As the teen becomes more and more involved in these online games, there is an increased disconnection from family and friends and increased vulnerability in forming online contacts and relationships. Often these relationships can become dangerous with the exchange of real information such as phone numbers and face-to-face meeting with strangers they only know from being in an online game.


  • Sleep deprivation, including difficulty waking for school, which leads to increased school absenteeism and driving accidents
  • Decline in academic performance, which can lead to dropping out of school
  • Unsuccessful attempts to decrease gaming time
  • Increased use of stimulants such as Rock Star and Red Bull
  • Increased temper tantrums
  • Arguments/violent behavior with attempts to limit internet use
  • Aggression toward the outside world
  • Choosing to play online games instead of spending time with peers and family
  • Agitation/aggression when the internet is not available to game
  • Losing track of time
  • Neglecting chores, homework, personal hygiene, and other hobbies
  • Talking a lot about gaming and asking to play
  • Denial, rationalization, and minimization about the amount of time spent gaming
  • Loss of friendships
  • Power struggles surrounding homework
  • Actual or threatened violence when steps are taken to stop gaming — this means there is a very serious problem


Before purchasing a video/internet game:

  • Conduct a family meeting that involves active listening to discuss gaming, internet use, and electronic entertainment
  • Have a plan involving gaming and internet use
  • Be familiar with gaming content, such as appropriateness for age and interests
  • Check content ratings and parental advisories of games
  • Enforce a curfew for gaming use, and have no video games on Sundays, holidays, or school nights
  • Develop and agree upon consequences for not following the rules
  • Do not allow internet in the bedroom
  • Read about the games and posted comments if you are paying for a monthly subscription
  • Install firewalls and purchase software that sets limits on computer gaming
  • Check-in frequently with teens about online activities
  • Look for research from independent sources not from the gaming industry
  • Remind your child that online game characters are strangers
  • Consult a medical therapist before taking games away if your child has a medical diagnosis such as depression or Asperger’s

It’s very important to try to maintain a trusting and supportive relationship with your teen when enforcing rules with regards to gaming.  Sometimes a formal intervention with older teens involving a therapist is needed to break through the addict’s denials and to help them face reality.  This intervention should be a loving and caring communication between the addict and family and friends, discussing how his behavior is affecting the person and other around him. Children already exhibiting antisocial behaviors such as delinquency, angry outbursts, truancy, theft, problems with drugs or alcohol should not be allowed to play violent video games at all.

One of our responsibilities as parents is to raise a well-balanced person with the skills needed to succeed in life as an adult. Computers have become a big part of our lives.That’s why it’s vitally important to help our children mange a healthy relationship with the internet.

Terri Bailey is a Certified Registered Nurse Practitioner, and the newly elected President of the Three Rivers chapter of the National Association of Pediatric Nurse Practitioners.