Autism and ADHD associated with video game 'addiction'

Behind the Headlines

Friday August 2 2013

Children with ASD play video games for two hours a day

“Children with autism or ADHD spend twice as much time playing video games and are more likely to become addicted to them,” the Mail Online reports.

Research has previously suggested that children with autistic spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are at risk for problematic video game use, or so-called “video game addiction”.

A new study, following up on this issue, asked the parents of 56 boys with ASD, 44 boys with ADHD, and 41 boys with “normal” development, how much time their sons spent playing video games.

The main observations were that boys with ASD spent significantly longer playing video games – on average around an hour more per day. Also, boys with ASD and ADHD were more likely to have video game access in their rooms and have higher scores on a test for problematic video game use.

One, arguably positive, finding is that children with ASD were less likely to play violent first-person shooters compared to “normal” children, and preferred role-playing games. 

Ultimately, it is difficult to interpret much from the findings of this small study. It cannot tell us whether excessive use of video gaming puts boys at risk of these conditions, or, conversely, whether the characteristics of these developmental conditions cause these children to play video games more. 

The researchers highlight a need for further observational research to better understand predictors and outcomes of video game use in children with ASD and ADHD, and this seems a fair conclusion.

Video game recommendation for parents

Video games, in spite of their bad press, can help stimulate a child’s imagination and improve a range of cognitive skills. A recent study suggested that game playing improved reading abilities in children with dyslexia.

 

However, there are a number of issues to be taken into consideration:

  • never assume that a game is child friendly – many games are designed for adults only, so always check the rating (similar to a cinema rating) before buying
  • online play using a microphone may not be suitable for younger children – many online gamers use offensive terms and swear words
  • watch out for “in-game” purchases – many so-called free-to-play games offer bonuses or extras in exchange for real money – make sure any iTunes or Google Play account you have is password protected
  • everything in moderation – the American Academy of Pediatrics recommends limiting any type of a child's “screen time” to no more than one to two hours a day

Where did the story come from?

The study was carried out by researchers from the University of Missouri, and Thompson Center (sic) for Autism and Neurodevelopmental Disorders, Missouri, and was funded by a grant from the University of Missouri Research Board.

The study was published in the peer-reviewed medical journal Pediatrics and has been made available on an open access basis so it is free to download.

The Mail Online’s reporting of this study is fair, though it shouldn’t be interpreted that ADHD or ASD make boys more likely to become addicted to video games, or alternatively, video games can trigger the onset of ADHD or ASD. This study is not able to explore the reasons behind any of the observations.

 

What kind of research was this?

This was a cross sectional study that assessed the amount of time boys with autistic spectrum disorders (ASD) or attention deficit hyperactivity disorder (ADHD) spent playing video games compared with “normally developing” boys.

The researchers say that previous research has suggested that children with ADHD and ASD can be at risk for preoccupation with video games and have difficulty disengaging from them.

Autistic spectrum disorders are characterised by problems with:

  • social interaction with others (eg not being able to respond to others’ emotions)
  • communication (eg difficulties in having a conversation)
  • having a restricted, repetitive collection of interests and activities, rigid routine and rituals

As the researchers suggest, these symptoms may be related to the development of problematic video game playing patterns. Children with Asperger syndrome tend to have average or above average intelligence and normal language skills, while children with autism tend to have below average intelligence and significant problems with language.

ADHD covers a group of behavioural symptoms, including having a short attention span, poor impulse control, being restless or fidgeting a lot, and being easily distracted.

The researchers aimed to examine only boys, who are known to be at higher risk form both ASD and ADHD than girls. They say that no previous known research has examined whether there is a difference in video game playing between boys with ASD, ADHD and “normal development”.  

However, the current cross sectional study cannot prove causation or explain the reason for any link between the two.

 

What did the research involve?

This research included parents of 56 boys with ASD, 44 boys with ADHD, and 41 boys with “normal” development, who ranged in age from 8 to 18 years (average age 11.7 years). Boys with ADHD and ASD had been recruited through paediatric medical centres, and all had confirmed diagnoses of these conditions.

Of the boys with ASD, just under half were diagnosed with autism, a quarter with Asperger syndrome, and the remainder had ASD not further specified.

Only four of the boys with ASD had an IQ of less than 70. Children with normal development were recruited through use of community flyers and word-of-mouth methods, and were reported by their parents to be free of these medical conditions.

Video game use was assessed by parent-completed questionnaire. Parents reported the number of hours per day their child spent “playing video or computer games” during out-of-school hours (assessments were only made during school term). Parents were also asked “Does your child have a video game system in his room?” in addition to being asked their child’s three most commonly played games, which were grouped according to genre category (eg action, adventure, puzzle etc).

“Problematic” video game use was assessed using a modified version of the Problem Video Game Playing Test (PVGT). The original test was said to have been developed as a self-report measure based on a model previously used to assess other forms of addiction. A parent-report version had been modified for use with children. 

The parent-report version includes 19 questions (such as “has your child ever failed to complete school work due to too much time playing video games?”) rated on a 4-point scale ranging from 1 (Never) to 4 (Always), with a total PVGT score then calculated. 

Validated rating scales were used to measure current symptoms of ADHD (the Vanderbilt Attention Deficit/Hyperactivity Disorder Parent Rating Scale, VADPRS) and ASD (the Social Communication Questionnaire-Current, SCQ).

 

What were the basic results?

There was no difference between the three groups of boys in age, ethnicity or number of siblings. The ASD group had higher scores on the SCQ than the two other groups, as would be expected.

The ADHD group had higher ADHD symptom scores than the “normal” group, but not the ASD group (many children with ASD also have problems related to attention and hyperactivity).

Following adjustment for household income and marital status, boys with ASD spent significantly more time playing video games than boys with normal development (2.1 hours a day compared with 1.2 hours a day). However, boys with ADHD did not differ significantly from either boys with normal development or boys with ASD.

Both the ASD and ADHD groups had greater in-room video game access than boys with normal development, and did not differ significantly from each other.

Both the ASD and ADHD groups also had higher problematic video game use scores than boys with normal development, and did not differ significantly from each other. In both the ASD and ADHD groups, the presence of a higher number of inattentive symptoms was associated with higher problematic game use scores. 

By genre, “normal” boys showed greater preference for shooter games than the ASD group, and greater preference for sports games compared with the ADHD group. In boys with ASD only, preference for role-playing games was associated with higher problematic video game use scores.

 

How did the researchers interpret the results?

The researchers say that boys with ASD spend more time playing video games than boys who are developing normally. And boys with ASD and ADHD are at greater risk for problematic video game use than are boys with normal development.

They highlight the association of inattentive symptoms with higher problematic video game use scores for boys with both ADHD and ASD, and the association between role-playing game preferences and higher scores in boys with ASD.

 

Conclusion

This research has strengths in that it has included children with valid clinical diagnoses of ASD and ADHD and has used an established measure to examine problematic video game use.

It found that boys with ASD spent significantly longer playing video games than other boys, and that both boys with ASD and ADHD demonstrated greater problematic video game use than boys with “normal” development. However, the main difficulty with this cross sectional study is that it cannot tell us how these developmental conditions and video gaming habits are related to each other.

Importantly it cannot tell us whether excessive use of video gaming may put boys at risk of these conditions; or whether conversely the characteristics of these developmental conditions may cause these children to play video games more. It also does not tell us what the effects of problematic video game use will be.

There may also be many other health-related, lifestyle and environmental confounding factors associated with both higher use of video games and the presence of these development conditions than this study has been able to take account of (it adjusted for household income and parent marital status only). No assessment was made for whether the boys in any of the groups were playing on their own or with others.

ASD in particular can be socially isolating, but video game playing may in fact have a positive effect in being a tool to start interaction with others. And role-playing games, where a player is asked to take on the identity of a character who then is typically faced with a series of challenges, may help increase feelings of self-confidence. Unfortunately these aspects were not addressed.

A further weakness in the study design was that the parents were asked to fill out a questionnaire on the amount and type of game use, but it is highly unlikely that parents of teenage boys would be able to accurately report this. Despite this flaw, even if they were in possession of this knowledge, there is still the possibility of inaccurate recall of the amount of video game use. 

A further limitation is that the results were based on only small samples of boys with each of these three conditions. Given that ADHD and ASD are relatively common, it would be valuable to examine larger samples of boys with these conditions to see if the results still hold.

The researchers suggest that their findings highlight a need for further observational research to better understand predictors and outcomes of video game use in children with ASD and ADHD, and this seems a fair conclusion.

If you are worried that your child is spending too much time playing video games, then one step you could take is to activate the console or the computer’s parental control. This will allow you to prevent your child from “booting up” the device without a password. 

Analysis by NHS Choices. Follow Behind the Headlines on Twitter.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

Children with autism or ADHD spend twice as much time playing video games and are more likely to become addicted to them. Mail Online, August 1 2013

Addictive gaming more common with autism and ADHD. Reuters July 31 2013 

Links to the science

Mazurek MO, Engelhardt CR. Video Game Use in Boys With Autism Spectrum Disorder, ADHD, or Typical Development. Pediatrics. Published online July 29 2013

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