The worldwide prevalence of problematic video game use is increasing and this can have negative effects on physical and mental health, and may cause behavioural problems. Excessive use of video games can lead to hand/wrist pain, anxiety, depression, video game addiction and aggression, in addition to impacting self-esteem and school performance in children. Individuals with ADHD can have difficulties with sustaining attention and stimulus integration, and often exhibit a lack of self-control, which puts them at risk of substance abuse and possibly video game addiction. Although some studies have found no relationship between ADHD and the frequency and duration of video game use, other studies have reported higher rates of problematic video game use in children with ADHD compared with those without ADHD. The relationship between ADHD and video game use therefore remains unclear, and this study sought to investigate patterns of video game use and addiction in Thai children with ADHD compared with typically developing controls.
This study was conducted between 2014 and 2016, and included 80 Thai children with ADHD (median age 9.5 years) diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition, and a control group of 102 typically developing Thai children (median age 10.0 years) who were confirmed not to have ADHD using the screening questionnaire. Information regarding video game use within the last month, the frequency (days per week) and duration (hours per day) of video game use during weekdays and weekends, the participant’s use of video games in their bedroom, and the time of day that the participant usually played video games until was obtained from the parents of the study participants. The Thai version of the Game Addiction Screening Test (GAST)* was also completed by the parent of each study participant.
There were no significant differences in the majority of demographic characteristics between participants; however, a greater proportion of the ADHD group were male, whereas the ratio of males to females was equal in the control group. Those with ADHD had a lower grade point average (GPA) compared with participants without ADHD (median GPA 3.00 vs 3.85; p<0.001). Video game use within the last month, the time of day until which participants played video games, and the number of participants playing video games in their bedroom were comparable between those with and those without ADHD (p>0.05 for all). Participants with ADHD were more likely to spend ≥2 hours per day playing video games during weekdays than participants without ADHD (40.0% vs 19.6%; p=0.02). However, at weekends, more than half of all study participants in each group spent ≥2 hours per day playing video games.
Results from the GAST indicated a higher rate of compulsive video game use in children with ADHD compared with those without ADHD (37.5% vs 11.8%; p<0.001); however, game addiction was comparable between study participants. There were no significant differences in the pattern of video game use and problematic use between males and females with ADHD; however, males without ADHD scored significantly (p=0.023) higher on the GAST (median score 13.0; interquartile range [IQR] 5–21) compared with females without ADHD (median score 9.0; interquartile range [IQR] 3–15).
The study reported a number of limitations. Firstly, although a separate analysis was performed for each gender, the sample size for each group was too small to have the statistical power to detect differences in the studied variables, therefore limiting the analysis of the pattern of video game use and problematic use between genders. In addition, participants without ADHD were included on the basis of a teacher-reported screening questionnaire only, and not based on clinical assessment, which may limit the confidence in support of a true negative diagnosis for ADHD in these participants. Furthermore, information on the pattern of video game use and screening for video game addiction was solely parent-reported, whereas information obtained from the participants themselves may have yielded different results. Finally, different genres of video games were not accounted for in this study, which may have affected the pattern of video game use and addiction in these participants.
Overall, these results indicated that compared with children without ADHD, children with ADHD were more likely to spend more time playing video games and exhibit problematic video game use. The authors concluded that video game use should be thoroughly monitored in both children with and without ADHD so that video game addiction can be detected early, enabling prompt intervention.
*The parent version of the Thai Game Addiction Screening Test (GAST) exhibited a sensitivity of 0.92 and a specificity of 0.88 at a cut-off score of 20. Total scores between 0–19 were defined as “normal video game playing”, whereas scores ranging from 20–29 were classified as “compulsive video game use” and scores ≥30 were categorised as “game addiction”
Kietglaiwansiri T, Chonchaiya W. Pattern of video game use in children with ADHD and typical development. Pediatr Int 2018; 60: 523-528.