Michelle Colder Carras was concerned about her teenage sons playing video games for at least an hour or two each day, more on weekends. But then she tried playing Dance Dance Revolution, a musical game that challenges players to match dance step instructions scrolling up the screen while standing on a foot-controlled pad, and she found herself getting in better shape the more she played. Colder Carras, a postdoctoral fellow in the Bloomberg School of Public Health's Department of Mental Health, had also witnessed her oldest son, diagnosed with Asperger's syndrome, connect with others through video games, and even learn to program his own. She asked herself a question: "How can we figure out how to make use of games but also make sure we're not causing problems related to too much gaming?"
Colder Carras had read several studies that described a group called "engaged gamers"—people who gamed heavily but whom researchers did not consider addicted—and she wondered whether online social interactions might help account for certain gamers' relative mental health. She and a team of public health researchers analyzed 2009-2012 data from the Monitor Internet and Youth study, which consists of an annual survey given by a Dutch addiction research institute to approximately 10,000 teenage students across the Netherlands. Their findings, published in the March 2017 issue of Computers in Human Behavior, suggest that teenagers who play video games heavily (defined as four or more hours per day) may not feel as addicted or display problematic symptoms such as loneliness or social anxiety if they are socially engaged through activities like instant messaging or communicating on social media, either while gaming or at other times throughout the day.
To conduct the study, Colder Carras and her colleagues grouped people by patterns of heavy video game play, social networking, and instant messaging, along with symptoms of video game addiction. Among the subtypes of male heavy gamers, she found that those who had more social interaction online were associated with fewer symptoms of video game addiction and less loneliness and social anxiety than their heavy-gaming counterparts who were less social. The findings were similar for the heavy-gaming girls subtypes, though they also tended to be associated with lower self-esteem. When Colder Carras took into account friendship quality, she found that for one small group of boys, who had good-quality friends on- and offline, the association with depression went away altogether. In other words, for some young people, gaming is not an isolating, addictive behavior so much as a component of an active social life, like eating dinner at a friend's house. "There are boys out there who are gaming a lot, are very social, and have high-quality friends," Colder Carras says. "Even heavy amounts of gaming every day may not be a sign of addiction when put into the proper social context."
The fact that games are a newer technology adds to the stigma, Colder Carras says. "There's a long history of society's being fearful of new technology," she says. "When you think about it, the idea of binging on TV—that's accepted, and it's promoted." Not so with playing video games. The World Health Organization and American Psychiatric Association have both proposed classifying internet gaming disorder as a condition similar to substance abuse or pathological gambling, a move Colder Carras and study co-author Antonius van Rooij, a senior researcher with Ghent University, view as both problematic and premature. The two hope their findings will encourage clinicians to look at teens' habits in context before jumping to a diagnosis. "People are quick to attribute causal influences," van Rooij says. "These games aren't necessarily causing the problems; it might just as well be the other way around. People are not functioning, they suffer from social anxiety, they're lonely, etc., and they flee into the games because it's an excellent coping mechanism." Researchers need to investigate which symptoms constitute internet gaming disorder—and whether it's an actual addiction or more an issue of impulse control—before the APA formalizes the definition in its diagnostic manual, Colder Carras says.
Treating heavy gamers who are depressed for addiction rather than depression could do more harm than good, Colder Carras adds. Parents often try to limit kids' screen time to break the behavior, which can worsen their depressive symptoms by increasing family conflict and cutting them off from the social support they receive from online friends. In countries like China, Japan, and South Korea, some parents go so far as to send their children to boot camp to try to break them of "gaming addiction." "Saying, 'You need to play fewer video games,' is not taking into account what kids are doing with their time on the video game—whether they're spending it with friends, whether they're building magnificent block structures in Minecraft," Colder Carras says. "You just have to take a more nuanced approach."