VIDEOGAMING AND ADHD; ADDICTIVE OR ADDICTION? Shervin Vakili Ph.D. Ben Grintuch MD Sam Chang MD

Transcription

1 VIDEOGAMING AND ADHD; ADDICTIVE OR ADDICTION? by and and Shervin Vakili Ph.D. Ben Grintuch MD Sam Chang MD

2 Disclosures Dr. Sam Chang Companies and Organizations Advisory Board Speaker Bureau Payment Grant Honorarium Patent Investments Clinical Trials Alberta Children's Hospital Foundation Bristol- Myers Squibb x x x Cell Tech x Eli Lilly x x x Janssen x x x Lundbeck REACH Institute (New York)/CanReach Otsuka x x x x Pfizer x x x Purdue x x x x Shire x x x x

3 DISCLOSURES Ben Grintuch None Dr. Vakili Purdue Pharma

4 OUTLINE OF VIDEOGAMING & ADHD Background and theory Practice and treatment International treatment practices

5 QUESTIONS: Who is the typical gamer? (age, gender)? What year was the first video game created? Should video game addiction be a new classification in DSM-V? Have you seen anyone with this problem in your practice? 5

6 VIDEO GAME MARKET STATS First game: Tennis for two, 1958 (Manhattan project) 2008 Gaming revenues topped $21bn in the U.S. WoW 12,000,000 active subscribed users* (Oct 2010, Gamespot) 56 million people play games on Facebook daily (69% women) Real Money Trade of Virtual Items to reach $5B in 2011 ( (e.g. Second Life) Average user age 35 years old. Gender ratio for puzzle and mobile (phone) games, fighting games are male dominated 40% of adults and 83% of teens are gamers Ivan Goldberg,

7 SENSATIONAL CASES 2007 Daniel Petric, 16, shoots mom and dad in head for taking away Halo 3 video game Played up to 18 hrs / day Defence claims he was not responsible due to video game dependence, sentence reduced Judge stated he didn t believe Daniel understood that death would be real Withdrawal/mental illness/or violent media? 7

8 GOVERNMENTS TAKE ACTION Chinese government & South Korea implement antiaddiction system since 2007 Log in with real names Internet slow down and restricted online times 8

9 PROBLEMS OF OVERUSE Excessive time played (M = 25 hrs/wk, 4% over 50 hrs/wk) AMA: recommends 1-2 hrs. total daily screen time, including video games In comparison: average American spends 31hrs/week watching TV Lowered academic, interpersonal, or occupational performance In severe cases, physical harm, including death Online game addiction is a new mental disorder (Rau, Peng & Yang, 2006)

10 PROBLEMS ASSOCIATED WITH EXCESSIVE GAMING More frequent players more likely to play in order to escape from problems (Wood, 2008) Heavy gamers show: lower satisfaction with daily life, decreased psychological wellbeing, more lonely, less sociable, prone to violence or aggression, (Lemmens et al., 2009 for review) Lose track of time (time distortion, dissociation) and play for longer than intended (Lemmens)

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14 Addictive Vs. Addiction

15 WHAT MAKES GAMES ADDICTIVE? ADDICTIVE ELEMENTS Unlimited play, content updated frequently Character creation and development Character advancement, achievement, pressure to keep up Built in reward systems similar to slot machines (virtual score, schedules of reinforcement, visual stimulus rewards, etc.) Increasingly rich environments mimic real life (immersion) 15

16 ARE SOME GAMES MORE ASSOCIATED WITH PROBLEMS? Smyth (2007) 100 students (18-20 yrs) assigned to play arcade, MMORPG, console, or solo computer games for one month. MMORPG player played 2-7 times longer than other types, had lower physical health, poorer sleep quality, reported more disruption of school. ALSO reported more friendship development Increasingly other types of games incorporating unlimited online social play (first person shooters etc.) (Call of Duty) 16

17 PROBLEM GAMERS: PERSONAL FACTORS Real life preexisting factors: stress, other life problems (Yee, 2002) Relationship has been found between shyness, anxiety, loneliness, depression, and self-consciousness on level of internet use Low self esteem (Armstrong et al. 2000, Ko et al., 2005, Yee, 2002) University Students Personality factors of sensation seeking, aggression and state and trait anxiety (Mehroof & Griffiths, 2010)

18 REPORTED POSITIVE USES OF VIDEO GAMES Useful because of distracting and absorbing qualities Pain management Stopped 8 year old child from face-picking (neurodermatitis & scarring) Children undergoing chemotherapy for cancer and sickle cell disease had lower nausea and systolic BP than controls Physiotherapy (stroke survivors) Teaching children with learning disabilities and developmental disorders Improved visuospacial cognition Griffiths, 2005 Enhanced Cognitive Control in older adults (Anguera, et. al., Nature (2013))

19 HANDY HOME ASSESSMENT KIT! (CALGARY GAMING MEASURE) 19

20 SCREEN CULTURE (PAST DECADE) Internet Downloadable Video Games Movies Music TV Social Networking

21 SCHOOL DAY 30 Percentage of Students Hrs TV/Internet > 3 Hrs Weiss et al. Atten Def Hyp Disord (2011) 3:

22 INTERNET ADDICTION RISK Daily Hours Normal Control Psychiatric Outpatient Weiss et al. Atten Def Hyp Disord (2011) 3:

23 INTERNET ADDICTION RISK Associated with: ADHD Social Phobia Depression Most significant predictors: ADHD Hostility Ko et al Arch Red Adol Med. 163(10): Bour JCACAP 20(2):86-94

24 ADHD VS. CONTROLS Equal in frequency and duration of video gaming However ADHD children have more addiction Bioulac, Arfi, Bouvar 2008 Eur Psychi. 23(2):

25 CHINESE RANDOMIZED SURVEY 2.5% of High School students have internet addiction Psychiatric comorbidity in 22% ADHD 12.5% C.D. 3% O.D.D. 3% M.D.D. 1.5% O.C.D. 1.5% Cao et al Eruro Psychi. 22:

26 CHINESE RANDOMIZED SURVEY Pros: Response Rate 94% Valid Rating / Assessment Scales Cons : KSADS Diagnostic Questionnaire for Internet Addiction (YDQ) Impulsivity Scale and measure of impulsivity Small number through well controlled and randomized (n = 2620) Cao et al Eruro Psychi. 22:

27 RATES AND GEOGRAPHY OF INTERNET ADDICTION %, some as high as 25% 2. Cultural factors plays a role China >> USA Weiss et al. Atten Def Hyp Disord (2011) 3:

28 RATES AND GEOGRAPHY OF INTERNET ADDICTION 3. Geographically diverse Korea Taiwan China Singapore Czechoslovakia Italy Greece Norway Romania Turkey USA Weiss et al. Atten Def Hyp Disord (2011) 3:

29 RATES AND GEOGRAPHY OF INTERNET ADDICTION 4. But no widely accepted diagnostic criteria or assessment instrument Examples: Chinese internet related addiction behaviour inventory Internet related addiction behaviour inventory Pathological internet use scale Generalized problematic internet use scale Internet addiction diagnostic questionnaire Internet Addiction Test Weiss et al. Atten Def Hyp Disord (2011) 3:

30 COMMON TRAITS IN ALL ADDICTIONS Impulsivity predictor of: Alcohol misuse Delinquency Problem Gambling Drug Addiction Internet Addiction Suggests orbitofrontal cortical dysfunction Barnes et al Psychol Addict Behav 19: Vitaro et al Addiction 94: Moeiler et al J. Subst. Abuse Treat 21:193-8 Cao et al 2007 Euro Psychi 22:

31 COMMON TRAITS IN ALL ADDICTIONS Ko et al., Journal of Psychiatric Research 43(2009) p

32 NEUROIMAGING COMMON TRAITS: SEQUELAE OF VIDEO GAME USE Video game addicts show decreased grey matter volume compared to controls in: Inferior temporal gyri Right middle occipital gyrus Left inferior occipital gyrus Similar to grey matter loss in cocaine addicts Han et al. 2012

33 LINK WITH ADHD In Korean samples, ADHD-gaming addiction comorbidity is reported at 32%-51% (Han et al., 2009) ADHD associated with reduced Dopamine release in prefrontal cortex Both stimulants and video gaming increase synaptic Dopamine (Han et al., 2009) Gaming could be self-medication for people with ADHD

34 INTERNET ADDICTION HIGH COMORBIDITY WITH ADHD VIDEO GAMERS Video gamers with ADHD 50% Internet video game Addiction Han et al 2009 Comp Psychi 50:251-56

35 MPH TREATMENT OF ADHD IMPROVE VIDEO GAME ADDICTION Dupaul ADHD scale Baseline P < Weeks (average dose 30.5 mg OROSMPH) Han et Al Compreh Psychi 50:251-56

36 MPH TREATMENT OF ADHD IMPROVES VIDEO GAME ADDICTION YIAS Baseline 8 Weeks Han et Al Compreh Psychi 50:251-56

37 CASE STUDY 37

38 ROB 16 year old Failing school, lack of social and family relations hrs/week Mood: depressed, angry Very low self-esteem Feedback re: time played, convert time to $ Increase social, family, academic, self-care activities Rewards for achievement Gaming under 20 hrs/week, grades up, relations improving

39 WEEKLY CHECKLIST (VAKILI, 2011) Name: Date: Skill Mon Tue Wed Thu Fri Sat Sun Taking care of yourself shower Brush teeth Exercise (gym, swim) School time Homework (minutes) gaming Total time, minutes Family time Dinner together Spend 15 minutes talking with parent Help with family 39

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42 Questions?