Predicting Internet Gaming Disorder symptoms in young adolescents: A one-year follow-up study

Highlights

• An increasing number of adolescents develops problematic gaming behavior.

• Social vulnerability and attention problems may increase the risk for problematic gaming.

• There is a cumulative effect of risk factors on problematic gaming behavior.

Abstract

Background and Aims

Problematic gaming behavior in adolescence is becoming a bigger societal problem. An increasing number of adolescents have difficulties in controlling their game play and are at risk for the development of Internet Gaming Disorder (IGD) symptoms already at a young age.

Design

In this longitudinal study, 354 adolescents (mean age = 13.9, 48.9% boys) were followed over 12 months. It was hypothesized that attention problems, social vulnerability, and life satisfaction uniquely and interactively predict increase in IGD symptoms.

Results

The findings of a zero-inflated model revealed main effects of social vulnerability (B = 0.297, SE = 0.142) and attention problems (B = 0.298, SE = 0.134) on IGD symptoms while controlling for gender differences. In addition, the effect of attention problems on IGD was the strongest among adolescents who were more socially vulnerable (B = −0.681, SE = 0.140) and less satisfied with life (B = −0.485, SE = 0.199).

Conclusions

Adolescents with attention problems might have difficulties in directing their attention towards other tasks, placing them at an increased risk for developing problematic gaming behavior. This risk is further exacerbated by social vulnerability and dissatisfaction with life.

Introduction

Since the introduction of online video games (Massively Multiplayer Online Role Playing Games, MMORPG), compulsive gaming has become a significant and growing societal problem (Van Rooij et al., 2010, Young, 2009). Depending on the definition of gaming addiction that has been used, prevalence rates among adolescents fluctuate between five and ten percent (Kuss & Griffiths, 2012). In the Netherlands, about 3% of the adolescents between 13 and 16 years has been identified as addicted to online gaming (van Rooij et al., 2014, van Dorsselaer et al., 2016). In addition, a nearly 6% increase in the number of addicted gamers (adolescents and adults) looking for professional help has been reported from 2013 (N = 514) to 2014 (N = 544) by the Dutch addiction care system (Leeuwen & Goossens, 2016). The American Psychiatric Association (APA) recognizes the fact that game addiction can be a serious threat to the psychosocial development of adolescents, since Internet Gaming Disorder (IGD) has been added to Section III as a “condition warranting further study” in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Although an increasing number of studies have addressed possible risk factors causing the shift from normal to compulsive gaming behavior in adolescents, important research questions remain unanswered because most existing research uses cross-sectional designs (Bavelier et al., 2011). Hence, there is a strong need for comprehensive longitudinal research on gaming addiction (Petry & O'Brein, 2013) that would utilize a generally accepted definition and diagnostic criteria, for instance the definition and criteria used by the DSM-5. Although some researchers (Griffiths et al., 2016) have criticized this DSM-5 definition, they appear to agree that the nine DSM-5 criteria for IGD reflect problematic gaming behavior. For this reason, rather than applying strict criteria to identify adolescents with IGD (cf. Gentile et al., 2011), i.e., those who meet five out of nine criteria, the aim of this study is to address increased symptoms of IGD and look at possible risk factors underlying this increase. By doing so, we try to get a better understanding of the risk factors involved in the development of IGD symptoms. In the following we will therefore refer to problematic gaming behavior instead of gaming addiction.

One of the problems of studying IGD in young adolescents is the low prevalence rates of IGD symptoms (van Rooij et al., 2014), contributing to analytical difficulties and challenges. A way of dealing with the many zero counts on IGD symptoms is using a zero-inflated model (ZIP; Peeters et al., 2012). The present study will use such zero-inflated model to evaluate three different theoretical models that could non-exclusively explain the increase in IGD symptoms in adolescence. To the best of our knowledge, this longitudinal study will be the first to use advanced statistical methods (ZIP-models) that allow us to look at a continuous outcome measure while taking into account the many zeros which are characteristic for low prevalence rates such as with IGD symptoms in young adolescents.

A possible explanation for why some adolescents are more likely to engage in game play and eventually develop IGD is that it could serve basic psychological needs, such as the need for belonging, autonomy, and competence (Przybylski, Rigby, & Ryan, 2010). Those who have difficulties in social relationships and who lack social skills (i.e. are social vulnerable) may be more likely to find reassurance in gaming (Lemmens, Valkenburg, & Peter, 2011). Games have the potential to create new (online) social relationships, and playing games might increase feelings of belongingness and increase perceived social competence of adolescents (Beranuy et al., 2013, Forrest et al., 2016, King and Delfabbro, 2014, Young, 2009, van Rooij et al., 2014). For socially vulnerable youngsters, power and status attainment through playing games may be particularly rewarding since these youngster may more likely experience low social power and social status in the real world (King & Delfabbro, 2014). Particularly boys appear to be sensitive for the achievement of status and power in competitive settings (Byrnes et al., 1999, Wilson and Daly, 1985, de Boer et al., 2016). The need to achieve status might therefore particularly place boys at increased risk for excessive game play, which could partly explain the higher rates of IGD among boys (Gentile et al., 2011).

Social vulnerability is a broad concept used in different fields of research and capturing several aspects of social dysfunction (Crick & Dodge, 1994). In this paper we will operationalize social vulnerability as the degree to which individuals experience problems with social relationships such as forming and maintaining friendships. We hypothesize that individuals who have difficulties with friendship formation in real life, and thus feel more social vulnerable, might be more attracted towards playing games to fulfill the need of belonging and social competence (Przybylski et al., 2010).

As is the case for many addictive behaviors, gaming could also be a result of coping with negative emotions and unwanted feelings (Young, 2009). Playing games could help some individuals to cope with the negative emotions in daily life (cf. review Kuss & Griffiths, 2012; for a detailed overview). Nevertheless, playing games to deal with negative emotions may be a risky coping strategy with respect to the development of problematic gaming behavior. That is, coping motives for the engagement in certain behaviors (e.g. eating, drinking, drug use) are associated with many compulsive and addicted behaviors, like alcohol misuse (Cooper, 1994, Littlefield et al., 2010), drug misuse (Sinha, 2007), and they could in a similar way be related to compulsive game play (Bischof-Kastner et al., 2014, Kuss and Griffiths, 2012).

Kuss, Louws, and Wiers (2012) found that specifically MMORPG players who indicate escapism motives as reasons for playing are at risk for excessive and compulsive game play. A qualitative study by Beranuy et al. (2013) among addicted game players in therapy, revealed that escapism of conflict in daily life was one of the three reasons why these gamers continued playing games. In addition, Festl, Scharkow, and Quandt (2013) found that problematic gamers were less satisfied with life, which may indicate that problematic gaming may be a way to escape from reality. Lemmens et al. (2011) found that lower life satisfaction among adolescents (11–17 years) was associated with pathological gaming cross-sectional, though in their study life dissatisfaction did not predict increase in pathological gaming six months later. Together, these studies suggest that playing games can serve as a coping strategy for dealing with negative emotions and conflict in reality. Coping motives and strategies have been associated with increased risk for addictive behavior (Cooper et al., 1995, Kuntsche et al., 2005, Sinha, 2007). Possibly, adolescents who are less satisfied with life and thus are more likely to have to deal with negative emotions and thoughts (Hagström & Kaldo, 2014) are at a greater risk for developing IGD symptoms. We therefore hypothesize that individuals who are less satisfied with life might play games to avoid negative thoughts and emotions, and as such show an increased risk for problematic gaming.

Lastly, it is proposed that adolescents who experience problems with attention and cognitive control are at risk for developing IGD symptoms. Cross sectional studies have indeed found a relation between video game use and attention problems in adolescents (Swing, Gentile, Anderson, & Walsh, 2010). In contrast, Ferguson and Olson (2013) found no relation between the amount of playing games in general and ADHD symptoms. Though it was found that individuals with ADHD reported more coping motives (e.g. stress, anger, escaping) as reason for their game play. Moreover, Gentile, Swing, Lim, and Khoo (2012) found a bidirectional association over time between playing games and attention problems. Adolescents who played games reported an increase in attention problems after playing games. In addition, the authors found that both attention and behavioral control were predictive of time spent on playing games; adolescents with attention problems and weaker behavioral control skills spent more time on playing games. Ferguson and Ceranoglu (2014) studied pathological gaming and found that attention problems prospectively predicted pathological gaming in adolescents. These longitudinal findings suggest that attention problems might be a risk factor for the development of IGD symptoms in adolescents.

Adolescents with deficits in attention and cognitive control more likely have difficulties in organizing and planning behavior in the long-term (Corbetta and Shulman, 2002, Engle, 2002) and are more inclined to pursue immediate satisfaction (Barkley, 1997). When adolescents with attention problems play games, they might be more preoccupied with the game, and have more difficulties in regulating their attention towards other tasks that require deliberation (Gentile et al., 2012). This preoccupation with the game, also known as “flow” (Kim and Davis, 2009, Kuss and Griffiths, 2012), refers to the psychological process of being absorbed by the game and lose everything else out of sight. This flow might be more pronounced in adolescents with attention problems who already have trouble with anticipating other tasks and organizing their behavior (Barkley, 1997, Engle, 2002). Moreover, the adolescents who otherwise encounter problems in focusing on a specific task may perceive the experience of being able to pay attention to a specific task, in this case game play, as extra rewarding. These adolescents might therefore be at greater risk for developing IGD symptoms.

In this longitudinal study, we evaluated three different theoretical mechanism (social vulnerability, life dissatisfaction, attention problems) that could explain an increase in IGD symptoms and perhaps shed light on the social or cognitive risk factors involved in the development of IGD in adolescents. Recent studies (cf. Ferguson and Olson, 2013, Przybylski et al., 2010) suggest that adolescents can have different social (e.g. social interaction) and cognitive (e.g. stress reduction) motivations for playing games. Ferguson and Olson (2013) found that the need for autonomy and control was the highest amongst those with mental health problems. They argued that because of the fact that individuals with mental health problems, and more specifically with attention problems, might experience a lower level of autonomy and control in real life, it is perhaps reason for them to search for these needs in games. This suggests that there might be a cumulative risk of the different mechanism proposed. Therefore, interactions between the three mechanisms are examined. The two central questions in this study are:

• Do differences in social vulnerability, life satisfaction, and attention problems predict an increase in IGD symptoms (one-year follow-up) in young adolescents?

• Do interactions between social vulnerability, coping, and attention predict an increase in IGD symptoms (one-year follow-up) in young adolescents?