Win or Lose: What to Do About Videogaming

2:59 Dr. Marc N. Potenza introduces Cam Adair, founder of Game Quitters. Adair shares his personal experience with videogame addiction. Initially, he explains, gaming was fun and felt like a nice escape from real life; eventually, however the habit began interfering with his personal and professional goals, as well his mental health. Adair describes how he kicked the habit and ultimately became an advocate for safe videogame use; he then offers advice to parents on how to keep their children’s gaming habits under control.

14:32 Dr. Douglas A. Gentile, Professor of Developmental Psychology at Iowa State University, highlights the real life effects that gaming can have on children. He notes the significance of game content and describes the details of a study to show how games have many of their subtle effects. Gentile closes by emphasizing the positive social features that video games can offer.

36:27 Dr. Edward Spector, a nationally recognized psychologist specializing in digital addiction, speaks about gender as it relates to gaming, as well as the increase in gaming during COVID-19. Spector offers practical guidance for ensuring that children maintain healthy gaming patterns amidst the pandemic. It is helpful, he notes, not just to limit gaming, but to point your kids toward other types of activities that promote a fulfilling life.

52:12 Potenza opens up the discussion to attendees, who have the opportunity to engage with speakers through a live question-and-answer session. In an insightful dialogue, panelists share their thoughts on how much time children should spend gaming, the importance of diversity in their activities, and tips for parental mediation of game play, including strategies for non-punitive management of children’s routines.

[Dr. Pamela Hurst-Della Pietra]: Welcome and thank you for joining us for this week’s Ask the Experts workshop. I am Dr. Pamela Hurst-Della Pietra, President and Founder of Children and Screens Institute of Digital Media and Child Development and host of this popular weekly series. Children and Screens is a leading convener, funder, and curator of scientific research and public educator on the topic of digital media and child development. Today’s workshop will explore the latest scientific research and clinical expertise on young people’s video game use and will address everything from the social aspects of games, especially during the pandemic, to how parents can spot signs of overuse or problematic gameplay. Our panel of esteemed experts will offer evidence-based guidance on how parents can talk to their kids about appropriate game content, manage the hours that they play, and ensure generally healthy gaming habits. Our panelists have reviewed the questions you submitted and will answer as many as possible during and after their presentations. If you have additional questions during the workshop please type them into the Q and A box at the bottom of your screen and indicate whether or not you would like to ask your question live on camera or if you would prefer that the moderator read your question. Please know that we may not be able to answer all of your questions, but we’ll answer as many as time permits. We are recording today’s workshop and hope to upload a youtube video in the coming days. Tomorrow you’ll receive a link to our youtube channel, where you’ll find videos from our past webinars as well. It is now my great pleasure to introduce our moderator Dr. Marc Potenza. Marc is a professor of psychiatry, child study and neurobiology at Yale University School of Medicine where he is the Director of the Center of Excellence and Gambling Research and the Women and Addictive Disorders Core. Marc also directs Yale’s Program for Research on Impulsivity and Impulse Control Disorders and is a world-renowned expert on addiction psychiatry and impulsivity. Welcome Marc.

 

[Dr. Marc N. Potenza]: Thank you. Thank you for organizing this wonderful webinar and for all the great work that Children and Screens has been doing over the many years, with meetings going back over the past five years focusing on topics that are timely, relevant, and impactful for how children are developing in a an ever-changing digital age. The meeting that you convened earlier this year on nerve development and screen time bringing together international experts on the topic to consider how neurodevelopment and cognition may be impacted by screen time  was a very important meeting, and there should be a forthcoming article in JAMA Pediatrics related to that. Without further ado, I would like to move into today’s webinar and introduce Cam Adair, who is an international speaker and entrepreneur who focuses on video game addiction. He is best known for being the founder of Game Quitters, a support community for gamers from 95 countries. In April 2020, Cam founded INTENTA with a mission to equip mental health professionals with resources on digital disorders by closing the clinical skill gap. We’re delighted to have him here to speak about gaming, his experiences, and how we can help people.

 

[Cam Adair]: Thank you so much Marc, and I’m delighted to be here. It’s a true honor, and I guess I always like to to start these presentations off with kind of sharing my personal story, which is ultimately how I got into all the work that I do now and so I’m a former video game addict. I played video games a lot growing up. A fairly hardcore gamer. But, my gaming wasn’t always a problem. So I started gaming when I was about 11 years old, and at first, you know it was just a fun way to kind of relax or destress after going to school or playing hockey. I’m from Canada, and so that’s kind of the routine that you had. I’m very much the first generation of boys who grew up with high-speed internet and online gaming, and when I began to experience a lot of bullying when I was 13 years old, my gaming went from just being a side hobby I had to being more of an escape and that’s really where a lot more of my problems with gaming began to occur. I ended up actually starting the game almost all day every day. I stopped wanting to go to school. I stopped wanting to play hockey. And so I was gaming up to 16 hours a day. Basically my full day other than sleeping. I dropped out of high school. I never went to college, and I even started to pretend to have jobs and deceive my family. My gaming became my priority anything that stood in the way of me being able to game needed to be removed, and so you know, that was pretending to have jobs, that was deceiving my family, that was, you know, throwing temper tantrums to scare my parents into giving in to boundaries they were trying to set. As much as gaming allowed me to escape, though it didn’t actually fix any of my problems, and unfortunately I got to a point where I kind of hit rock bottom, and that was a night when I wrote a suicide note, and it was kind of that night where I realized that my situation had got very serious. It I no longer felt safe with myself. I no longer felt like I could prioritize my health and well-being and I just want to game and game and game, and so I started to see a counselor with the help of my father. And this counselor really helped me to begin to turn things around. I got a job. I decided to stop gaming and, you know, I really began to turn my life around ultimately. During the course of my journey, I was curious what help was out there for people who were struggling with this issue because I figured I wasn’t the only one out there. I mean, every gamer knows someone who plays too much. It’s not like it’s a big secret in the gaming community, and when I looked for help online I didn’t find any and that left me really frustrated. So I decided to share my story and when I did I started to hear from tens of thousands of people all over the world who were gamers themselves really looking to improve their lives, and that’s what led to gamequitters.com and that’s kind of what has now led to very much working on the front lines of this issue over the last 10 years. What’s important for me to share with you today, other than my story, is just the, how fundamental gaming has become in our society. Gaming has become normalized. Gaming is highly prevalent amongst pretty much all teenagers are playing. If you’re not gaming, you could be a social outcast at school nowadays and gaming prevalence being where it is has caused a lot of gaming to become kind of the central cultural force especially in an adolescent’s life. Now if we think about those adolescents who are almost all playing video games over 80 percent of teenage girls play games in almost all boys. Well that’s the next generation of college students and that’s the next generation of our workforce as we go forward over the course of the next decade almost all kids growing up are going to be gamers. Gaming has become a huge source of the culture, and we’re also seeing a lot of integration between kind of popular culture including entertainment products and gaming, and COVID-19 has obviously had a huge impact on that, especially when it came to Esports, which is kind of organized professional gaming. Traditionally, Esports was only for kind of as a job. It was it was part of if you became a professional like a traditional sports athlete, but over the last couple years it came into colleges and last year into high schools across the U.S, and now beginning this September in middle schools across the U.S as well, and I predict next year elementary schools, and so again, organized competitions for games will be from as early as elementary school all the way up through high school, through college, and through professional sports and COVID-19 has accelerated that greatly, especially in U.S colleges because they need new places for their students to interact especially when it’s online. Understanding why a player plays and understanding what’s driving their behavior including not just the needs that gaming might be fulfilling from a place of for me, it was escape, it was to be social, it was to be able to see my progress, and it was to feel a sense of purpose along with the cultural aspects of being able to fit in at school, being able to to master a game and potentially have the option to be a professional or to get the prestige and also just to be a part of the the expanding culture in society. Understanding what’s driving that behavior is is fundamental to being able to prevent gaming problems and to reduce them if they are occurring, and as parents, it’s very important that you take a more curious stance towards video games now instead of judging them, stigmatizing them, thinking that those aren’t your real friends, thinking that gaming isn’t a meaningful experience in a young person’s life because it is, and if anything it might be the most meaningful experience for many young people’s lives these days, so really being curious about games and not attacking it, but also making sure that you’re putting practical tips in place that we’ll talk a lot about today to ensure that gaming doesn’t become a problem or you reduce it if it has become a problem is really important. So, thank you for being here and I’m really looking forward to interacting in the chat and with all of your questions.

 

[Dr. Marc N. Potenza]: Wonderful. Thank you for sharing that experience, and we have time for a question or two. One that just came in was whether you could define gaming for the audience.

 

[Cam Adair]: Yeah so video games. How do you define gaming? So video games are kind of fun experiences that people have. There are many different types of games now because there’s different genres, there’s there’s different types. So there’s story-based games. There’s competition-based games, and there’s ones where you’re playing by yourself, and there’s ones where you’re playing with a lot of different people, and so games themselves have also as the industry has grown the industry has grown to a point where they’re trying to appeal to as many people as possible and thus, they offer entertainment products to as many people and as many people’s interests as possible, and there’s different types of games. VR, virtual reality, augmented reality, and of course PC and consoles and and now mobile gaming as well is a big part of the industry.

 

[Dr. Marc N. Potenza]: That sounds like it’s an ever-growing area. We have time, I think for another question before we move to the next presenter, and and we were going to invite perhaps a live participant in the audience to ask that question.

 

[Cam Adair]: He is muted.

 

[Dr. Marc N. Potenza]: Okay he is muted so I’m just going to read the question. Should my child quit gaming completely?

 

[Cam Adair]: Hi Robert. Thank you for the question. A few years ago if you asked me this question, I would have been a lot more certain about the answer, but now because gaming is is so prevalent I think it’s first most important to understand the severity of the situation and people like Ed and Doug can speak to this more fully to help you grasp you know what are these different factors you want to pay attention to. But if someone’s gaming and it’s not a big problem in their life, then it is possible to game in moderation. If it is a big problem then you may need to reduce it for a period of time. It’s very important to understand different risk factors and also different vulnerabilities, and so in my personal experience, the amount of effort that it takes me to game in moderation is significantly more effort than than is worth the prize of being able to play. So I prefer to put my interest into things like music production and DJing and surfing and traveling and working on a business. For other people, though, they are able to play in moderation and even if their gaming becomes a problem, if you reduce the problematic areas maybe that’s different game types. Maybe that’s building different habits like exercise and time in nature and face-to-face interactions. Then they could game to some moderation. So I think it’s very important to understand a case-by-case basis but also to understand yourself which is, in my opinion, what this journey is all about. So I hope that answers at least part of that question and gives you some direction, but I’ve seen everything in in our community from people who quit for a period of time and were able to reintroduce it to people who are able to learn to moderate to people who quit and just have never looked back, and all of them are living healthy and productive lives in their own way so it depends on what you’re looking for. 

 

[Dr. Marc N. Potenza]: Thank you for your insight from the large community in which you’re involved. For the sake of time we’ll move on to the next speaker, and Dr. Douglas Gentile is an award-winning research scientist, educator, author and is a professor of psychology at Iowa State University. He focuses on the positive and negative effects of video games on children in several countries, how screen time contributes to youth obesity, and to gaming disorder. So thank you for being here, and we look forward to your presentation.

 

[Dr. Douglas A. Gentile]: Well thank you. I’m particularly grateful to have an opportunity to get fully dressed. So it’s a it’s been a while. And and I guess I’d just like to recognize that you know there these are kind of weird times we’re in, where even those of us who worry about children’s screen time what do we do now when every child has to be on a screen all day long, and what what what is this going to mean for the future? And we really don’t know the answer to that. But I can start with some of the things we do know. That there are a lot of different effects that games can have, and some of these are intentional effects, like educational games, and the research on educational games demonstrates that they’re fantastic. If your kid plays Reader Rabbit, reading skills improve. If your kid plays Math Blaster, math skills improve. So it it they can be very effective. Unfortunately, they certainly don’t get the amount of money put into them that a modern AAA game gets. There are games designed to help children manage chronic health care problems such as diabetes or asthma, and it turns out that if you play a video game that talks about how to recognize those symptoms, kids are much more compliant with our health care behaviors than if you gave them a pamphlet with exactly the same information. Violent games have a wide range of effects. We’ll just talk about two of them. One is that they can improve visual attention skills so that you get better at picking up information off of screens off a wider useful field of view, noticing tinier and tinier differences. These are the types of skills that an air traffic controller needs to have, for example. But of course what most people know about this research is the research on violent video games and how they can increase aggressive thoughts feelings and potentially behaviors. I’ll come back to this as an example of kind of all of these effects in a little bit. But again it’s not that games are bad or games are good. The content matters greatly, and so in a number of studies we’ve also shown that when kids play prosocial games where you help for or help care about other characters help them out with things that in fact, kids gain in empathy and increase their helpful and cooperative behaviors. But then there are other problems too, that that playing some types of games can increase uh racial and gendered stereotypes and prejudice and even discrimination. There’s a lot of research on school performance showing that, in general, greater screen time leads to worse school performance, and there is starting to be a literature demonstrating that with greater screen time come greater attention problems. And of course what we’ve already heard a fair amount about is gaming disorder, where which I would define as gaming in such a way that it is damaging to multiple areas of your life. Not just one area of your life because anything you love you will sacrifice other areas of your life for. If you love golfing, you’ll sometimes skip out of work early to go golfing. Does that hurt your work? Yes it does. But what we’re talking about when we get to the level of a disorder or an addiction is that it’s damaging multiple areas of your life at once. Damaging your family functioning, your social functioning, your occupational functioning, your school functioning, your social functioning, your emotional functioning, your psychological functioning. That’s when it starts to become a disorder, and I started studying this back in 1999 because I thought there was no way it could be true. It turns out I was wrong, and how do I as a researcher know that my work is having an impact? Well, when Jimmy Fallon talks about it. He said ‘A new study shows that about one out of every 10 kids who plays video games is addicted. you know what they really need is rehab. That rehab’s such an awesome game, it’s on Xbox and PlayStation. I played it for six hours yesterday.’ My answer? six hours? Sissy, that’s, that’s nowhere near what these kids are actually playing if they’re having this problem. So there are hundreds upon hundreds of high quality studies now on a wide range of effects. Some of these are intended, and but most of them are unintended. And these are just some of the empirically identified effects. I haven’t gone into all of the possible ones that are here, but I’d like to talk about one particular study to try to help you understand when I when we talk about what’s happening with a game interacting with a human, what do we mean? So this is a longitudinal latent growth curve. It’s from a study of 3,000 children that we followed across three years, and the ‘I’ here means the intercept. It means, where do they start at the beginning of this study? And the ‘S’ is the slope. How do they change across the three years of the study? And what we found is that children who start off the study playing more violent video games, so that’s the video game your violent game exposure, they also start off the study with higher aggressive cognitions. Now we measured three types of aggressive thinking in this study. The first, the technical name is hostile attribution bias. What this is is we all know people who when something annoying happens can let it roll off their back, give the person the benefit of the doubt. We also know people who take everything very personally. This is more like that, that you have a bias for attributing hostility toward other people’s actions. So you think they meant to make you angry, and of course if you’re playing a violent video game, you’re practicing a hostile attribution all the time. You’re constantly scanning the screen waiting, expecting something to jump out and be unkind to you. The second type of aggressive cognition we measured is called normative beliefs about aggression. Simply put, This is how acceptable you think it is to behave aggressively when provoked, and we all know people who say you should never hit back and we also know people who think you should hit back a lot harder. This is more like that, and of course playing a violent video game, that’s what you get rewarded for. If someone something comes out and attacks you, you get reinforced for an aggressive reaction to it, and in fact often you’ll get punished if you don’t respond aggressively to it. The third type of aggressive cognition we measured was aggressive fantasy. Simply put, this is how much time you spend thinking about how you would like to hurt other people, and of course the whole time you’re playing a violent video game you’re practicing aggressive fantasies. So what we find is that kids who spend more time playing violent games also have more of all three of these aggressive cognitions. What we then find is that as kids change to play more violent video games, all three of those types of aggressive cognitions increase. Why does this matter? Well your thoughts predict your behavior, and so kids who have higher aggressive cognitions are behaving more physically aggressively at the end of the study. There is this long-term effect just from two years back if they were playing a lot of violent video games, that’s giving extra predictive kick to how physically aggressive they are in the real world. Now why do I tell this to you? Because I think this shows the truth of how the effect happens. You haven’t heard the truth in the news because the news wants to reduce it to a sound bite like violent games cause school shootings. Oh no, they do not. This is what really happens. Let’s imagine what this looks like in the real world. Let’s take one of these kids who spent a lot of time playing a lot of violent video games. He’s in the school hallway and another kid comes along and bumps him. Now because he’s practiced expecting other things to be aggressive toward him, it’s a tiny little shift he makes. He stops assuming it was an accident. He starts assuming the other kid meant to do it or meant to make him mad. Now the other thing another thing practiced in violent video games is quickly reorienting your attention to an aggressive stimulus. So that’ll happen he’ll quickly turn to see the kid who just bumped into him, and he’ll call to mind what should he do? Well the thing that comes to mind first is the thing we’ve practiced the most. It’s called the availability heuristic in psychology if you’re keeping track on your lucky psychology jargon scorecard, and of course if you’ve practiced playing violent video games you’ve practiced an aggressive response to an aggressive stimulus thousands and thousands and thousands of times. So that’s what’s going to come to mind first, is he he should do something he should say something mean to this kid who retreated, he should push back. But even having it come to mind isn’t enough to make you do it because there’s a there’s a high threshold before you’re willing to do it. But because you’ve been reinforced over and over and over in the games for behaving aggressively, that lowers the threshold. And so what you can see is that the odds have shifted in a very predictable way that make it more likely this kid will say something unkind or push back, and if he does say something unkind or push back, then the odds of this turning into a full-blown fight skyrocket. Now here’s the interesting thing. When that fight breaks out in the school hallway, it looks nothing like what they were playing in games. Kids aren’t copying. That’s not how the effect works. It changes the way we see the world and the way we think and we take the way we see the world and think with us everywhere and it just subtly changes the odds, making it a little more likely in various encounters that we will behave aggressively. And that’s why violent video games are linked scientifically to aggressive behaviors. Now what can we do about this in a study of over 1 300 families, we followed them across a school year, and we talked to the kids we talked to the parents. We talked to the teachers. We talked to the school nurses. We got a lot of information about these families, and we found that parents who set limits on how much time and the content of the types of media kids are involved in, well first of all, they are consuming less. They’re they have lower total screen time, and they are also consuming less violent screen screen time. But the interesting thing is when we go out to the end of the school year those kids whose parents set more limits on amount and content of their media they’re getting more sleep, which in turn related to lower weight gain. So they’re at lower risk for obesity. They’re getting better grades in school. They are more pro-social in their behaviors as rated by teachers, which is remarkable because the teachers don’t know what parents’ rules are for media at home, but they can see the behaviors in the classroom. And they are less aggressive again as rated by teachers. Now there are two things that fascinate me about this. First, those are not the same types of outcome variables. That’s physical health and school performance and social wellness. Those three different types of outcome indicators don’t usually co-occur like this, but this one simple thing of setting limits on amount and time amount and content of children’s screen media influences all of them. So it’s a protective factor that has a ripple effect and the ripple is wide and out into the future. But the more interesting thing to me is that no parent will ever know they’re having this effect because you’re not going to know that your child gained less weight than he would have or is getting better grades than she would have or is more prosocial than he would have been. You can only know what your child is, and this is why parents feel powerless. They can’t see the effect that they’re having. It takes someone like me who comes in and studies it from the outside to be able to see it. But parents are in a much more powerful position than they realize. The simple thing of setting limits on amount and content of children’s media is a powerful protective factor across a wide range of health and wellness indicators, and I’ll stop there.

 

[Dr. Marc N. Potenza]: Thank you for that wonderful presentation. I think we have a question from the audience that we will that will be asked of you.

 

[Audience Member]: Thank you so much for the opportunity to ask a question. It’s okay to jump in?

 

[Dr. Douglas A. Gentile]: Yes.

 

[Audience Member]: Okay thank you so much. I’m a counselor at an all-girls school in Canada so another Canadian Cam. And what I’m really interested in is, what we see a lot, is that there’s a subculture of girl gaming happening. And it’s not necessarily all bad. It’s a way for them to access some social dynamics that they’re not able to access in a really high pressure, high stress environment of an all-girls school, and I’m also really interested in the work that Jane McGonigal does around the positive benefits of gaming, and I wonder if you can chat just a bit about girls in gaming or some of the positive effects.

 

[Dr. Douglas A. Gentile]: Sure. So there are lots of positive effects, and this is why I just hate the question of are games good or bad it really depends which of these effects you care most about and we didn’t even go into all all the positive ones. But but the easiest positive one is that they’re entertaining. There’s nothing wrong with being entertained, and the next big positive one is that they actually can allow you to connect with other people so they do have this social aspect. So one of the theory of human motivation called Self-determination theory. It says there’s an ABC of human motivations. The ‘A’ is autonomy. That we like to feel that we’re in control of what we’re doing. The ‘B’ is belongingness. We like to feel connected to other people, and the ‘C’ is competence. We like to feel good at what we do and so if your job gives you those three things. You get to choose how you you are working during the day, you get to connect with other people and you feel like you’re good at it, you love your job. And if your job doesn’t give you those things, you hate your job, and it really kind of is that simple. Games are fantastic at all three of these things. You’re holding a controller, you’re in control. If you play say you know World of Warcraft, you can be online with 11 million of your closest friends, and then you can go to school and talk about games or you can have them over and be in the same room and play games or you can play online with. So there are lots of ways to get your social need met through games, and then a well-designed game teaches you how to be competent. You know it starts you off at a low level, and it gives you the training to become competent. And so this is why they’re so intrinsically motivating because they do meet all three of these basic human needs. And and so Cam mentioned, you know, if someone’s having a problem we want to figure out why it is. This is part of that. If you can figure out which of these needs they’re meeting in games but perhaps not as much in the real world, if we just take the games away from them we’ve still left that hole. They’re going to fill it with some probably some other negative behavior. If instead we backfilled, we give them another way to get that need met, then we’ll have an easier time you know solving the problem. But I think you know your point is these games do provide a way for them to come in and talk to each other about their shared interests. I mean what is the number one question kids ask each other to be friends? It’s something usually what’s your favorite color, what’s your favorite dinosaur, what’s your favorite show, what’s your favorite song. They’re looking for shared interests, and so I think this is a really powerful part of you know you call it gaming culture, and I think I think that’s true.

 

[Dr. Marc N. Potenza]: Thank you. Thank you both. Perhaps you might comment a bit on females versus males and the gaming environment.

 

[Dr. Douglas A. Gentile]: Well from my standpoint I’m always looking at what effects games have, and so I don’t see differences because I’m looking at you know almost all the things I mentioned are learning effects, right you practice it, you get better at it. That’s true for boys and girls. That’s true for Americans and Japanese kids and Australian kids and Chinese kids you know. So what i’m looking at is generally what effect they have, and you know, girls, for example are less likely to be physically aggressive as a base rate. They’re also less likely to play violent video games as base rate, but it turns out the girls who play violent games are the girls who hit. The effect is the same when they expose themselves to it. So I don’t you know what my research has looked at hasn’t been focused on that which is not to say there aren’t important differences. There really are. But not so much at the psychological level of what effects do games have. So it might be a better question for Ed to talk about or Cam to talk about the whole Gamergate aspect because that’s where these gender differences become very toxic.

 

[Cam Adair]: Marc if you don’t mind I I can comment really briefly on on just gaming and girls. And Marc actually might be a great one to to share because he has a great study on girls and gaming disorder that just came out recently with Dr. Daniel King. Overall from a gaming disorder girls and gaming standpoint, there’s a couple of things to consider. So the first is that gamers overall are about 50/50 between males and females, and the average age of a gamer is 33 years old 32 for males, 34 for females. Often gaming I I think still today is viewed as something that young people do and young boys do but again over 86 percent of teenage girls also play games regularly. So it is becoming much more popular for both sexes or all sexes to to be playing games. They do play different types of games generally. So generally boys will play more competitive based games whereas girls will play more social games, and that’s one of the reasons why gaming disorder may be more prevalent in boys than it is in girls. But another reason is that because of the bias that we have towards gaming being something that boys do quite quite a bit more than what we think girls do, there’s there is a research bias and a sampling bias in in some of these studies. So I on on our website we see it’s about 90 percent of the audience coming forward looking for help is male, but we have seen an increase in females coming forward over the last like two three years and I I also think that you know boys are a little bit more isolated and a bit more likely to be searching for help online whereas girls may be more likely to be presenting with anxiety or depression and to be going into a you know go see a counselor. So I do think any clinicians or counselors or or anyone working with young people here it’s very important that you check what your biases are towards games, and if you’re assuming that girls don’t play games or not as much that you are screening for you are having those discussions because especially as we go forward it will be much more prevalent amongst everyone than just boys.

 

[Dr. Marc N. Potenza]: Thank you very much for for responding to that and also for mentioning our article with Dr. King that was published in the Journal of Adolescent Health that describes understanding gaming behaviors in girls and in women as an area that we need to investigate further because there’s a relative deficit of our understanding in this area. So I would like to, for the sake of time, move forward to our next presenter. So, we’re delighted that Dr. Ed Spector is here, and he’s a nationally recognized expert in digital addiction. Since 2009, he has specialized in the treatment of compulsive technology use in his Maryland-based private practice. He’s also well known on the topic of innovative and groundbreaking treatments for addiction and mental health as related to digital media. So without further ado, Dr. Spector.

 

[Dr. Edward Spector]: Thanks for that introduction, and it’s great to be here. I’ll just piggyback on that discussion because it was fascinating about gender with one additional sort of comment. So I have a practice that is entirely focused on digital addiction, but I have no female clients. I am a hundred percent testosterone in my practice. So I and I think that happens for two reasons. One, there are more female therapists than there are male therapists, and often people want to go to a therapist who’s their same gender. And second of all, there’s this army of young savvy female therapists who are really comfortable with talking about technology but there are so few male therapists that I just on a practical level, I end up referring out when I get female clients referred to me but I very rarely do. So this sort of speaks to Cam’s bias theory, which is that people generally are not identifying the problems when they’re they’re happening to girls, but the guys are getting to the front of the line and getting referred quickly. So I spent an embarrassing amount of time trying to figure out what I was going to say to everyone today, and that’s notable because I’ve been doing this for 10 years and I give talks all the time so this should be a really easy topic to talk about what is problematic gaming and what are the signs and what do you look for. And the curve ball that is making it hard for me is that it’s during a global global pandemic right? I mean that’s the, the ultimate challenge here. And normally when my guys come in to see me and they’re you know and they meet that criteria of gaming disorder that the World Health Organization has put out about a year and a half ago, it’s not it’s not subtle. It’s pretty obvious. They have for over a year been demonstrating very significant sort of obsessiveness with gaming to a point where major areas of their life are suffering. So they have dropped out of school. They’ve failed out. They’re not able to work. They’re living in their parents’ basement. They’re gaming for hours and hours and hours, like 12 hours a day or so, or more sometimes. So but during a pandemic, and those behaviors by the way have to really impact some major domains as as Doug talked about. That it needs to focus on you know there has been major clinical impairment in work, in school, and in social. But of course during a pandemic, we’re all experiencing significant clinical impairment in these three domains. So we all look like gaming addicts because if you are a gamer and you’re gaming more than you would normally and you’re not going out and being social and school is really challenging for you and and or you can’t work, you look like a gamer. So how do we distinguish coping with the pandemic and the pandemic itself versus no I have a real budding disorder happening here? So I spent a lot of time thinking about this. Now one is that clearly it is exceedingly hard to to diagnose this problem given the current situation and so it may be that the answer is you really can’t diagnose it, but I think you can, and here’s my argument for that. When you think about sort of a pie chart that there’s this you know pie chart with different pieces of the pie each one is the domains of your life and the things that you’re doing whether it’s social life or a certain amount of your time is being occupied doing these different things. That that pie chart, you know, in a normal world, there’s only one piece of the pie. It’s just gaming. When when you have gaming disorder, it’s whittled away to a point where there really is only one occupation that you’re doing. During COVID, the pie has shrunk. But there’s still and maybe some of those pieces of the pie have gone away like you can’t work but there should still be other pieces of the pie there that are represented. And so when someone has the ability to for instance be social in a COVID friendly way, so to go you know sit on the lawn with someone else socially distanced away and talk with them, do they choose to do that or do they just decide to game instead? And that should should serve as sort of a red flag because in that case you’re not doing what’s even available to you, which gets at the heart of this problem. You are prioritizing one activity over others to a point where you really suffer and obviously social interaction even the limited kind that we can get right now is just so important, and so to to sort of forego that would be an indication maybe that there’s a problem. The other thing I’ll say as I’m giving advice is the the universe is full of really great advice given to the wrong person, and so I want the listeners and I think particularly in this context where we’re talking to a screen and we don’t know who we’re talking to, that it’s your job to really scrutinize as we come up with ideas or things you might try. You have to decide whether that’s right for you, for your kid, for your family, for your values and the answer might be no, that’s a terrible idea. And so I really want you to just sort of have that in mind as you’re hearing us bounce around ideas because normally when I’m giving advice to a patient, I know them extremely well. I’ve I’ve talked with them for quite a while, I get a sense of the parents, their strengths and weaknesses. And so when I’m making recommendations they come from a real place of specificity and here what another piece where I was struggling to sort of figure out what to say is that had to be generic advice, advice that was good for most people. So instead of trying to sort of banter around what the right diagnostics would be let’s just talk about five things that I want you to pay attention to as you’re living through COVID and watching your kid game a lot and what might be things that I would want you to pay attention to that might be red flags. And I came about with these five because these are the things that are always the askew for my clients who meet the criteria. so someone who comes in, these five things are really messed up. And so they’re a good thing to keep in in mind, realizing that there are of course more things and maybe more things will come up as we sort of discuss it in the Q and A. So the five things. The first three are sort of the Holy Trinity of mental health from from my perspective. These are the things that they’re like the glue that binds mental health and resilience to you, and that’s sleep, nutrition, and exercise. I’m just going to talk very briefly about each. And I’m pleased that Doug mentioned some of them which means you know sort of validates my my my puntifications over the last week because I was thinking about what to say to everyone. So sleep. My guys come to me, they’re nocturnal and I don’t you know, we know that technology use affects sleep, and the research is coming out trying to delineate that and maybe Marc can speak to that more specifically but it might be that the blue light is affecting all the active exposure to blue light is what’s affecting sleep. It might be the dopaminergic thrill of maybe doing something really fun that it’s just a super stimulating activity. It might be the opportunity cost or that you’re not outside exercising, getting sun exposure, and and running around moving your body, but there’s something about this problem that comes with really disrupted sleep. My guys will stay up upwards of 20 hours gaming, then they’ll crash they’ll be and one of the reasons why they actually like to be nocturnal, and they like to be nocturnal often, is because everyone else is asleep so they can do their stuff without being impaired without having the watchful eyes of their parents. So one thing I would really want you to look at is sleep, and make sure that you toe the line on good sleep hygiene. I know this is hard. I know that there are exceptions and it might be that the choice is to not be so police-y about it. But in general, if you sleep, if your sleep is healthy, if you’re diurnal which is you know daytime hours you are awake during the day, you are better off and healthier and if you are nocturnal and you’re dysregulated in terms of your sleep, your immune system suffers. Many different things suffer, including your mental health. So one is sleep. Nutrition. This is a tricky one. A lot of my guys come to me and their idea of a nutritious day of food is junk food and Monster drinks. And they come to me, they have a vitamin D deficiency because they haven’t been outside. They haven’t seen a vegetable or a fruit in weeks. And if your brain does not have the building blocks it needs to create neurotransmitters, it can’t produce them adequately, and so we would anticipate and expect someone to not function well, to be depressed to be whatever. And when my guys come to see me they they don’t look right, they’re physically you know exhausted, they’re morbidly obese they’re or or very very thin. They’re not sleeping well and their their nutrition is is awful. I you know I I recently saw a recommendation that you have over 20 at least 20 different vegetables and fruits per week that the diversity within your diet is what really really benefits your sort of butt giome, your, your gut your gut biome, and now obviously that’s pretty unrealistic if you got a nine-year-old kid, but if you want some smoothie recipes, I can I got myself to 15. I tried it using just a couple different smoothies and if with enough chocolate syrup man it’s all it’s all good. You can really sneak it in there, and it’s not huge quantities of everything. It’s just diversity. So sleep, nutrition, now exercise. My guys are not exercising. Sometimes, they have bed sores because they’ve just been sitting too long in the same position. They’re not exercising at all. When I have someone who’s in recovery, who’s decided they’re gonna stop gaming or reduce significantly their gaming, one of the things that I’ll have them do is exercise twice a day for 45 minutes. Go for a walk, once in the morning once in the evening if the weather is terrible then you can skip it skip one of those two workouts, but you have to work out. It’s really important. The way I describe it to my clients is it’s sort of like rebooting the computer, which of course is a metaphor they understand. Most computer problems and most phone problems you have if you turn it off and turn it back on it kind of magically goes away that solves like 90 percent of your problems. Exercise is rebooting your body. It really chemically kind of puts things in the right place and the nice thing about these three things is they sort of bind together. If you exercise, chances are you’re going to eat healthier food and you’re probably going to sleep better. They seem to kind of cleave together so that’s something that’s really important to pay attention to. So sleep, exercise, and nutrition. The last two sort of are bound together and similar one is just looking at your diversity of activities. Most informed parents will understand that you want a developing kid to have lots of different experiences, that the more different experiences, interests, hobbies, activities that they do, it’s better for them. And the reason is every different activity that you do has a different skill set necessary. You develop different problem solving skills. You also adapt to that situation and you learn how to cope with that situation and as you progress doing lots of different activities, you get an arsenal of tools and strategies you can use so that as an adult, if you’ve had a childhood that’s enriched like that, as an adult you can pretty much handle anything, even a global pandemic. You’re like I got strategies. I know what to do because I did all those things as a kid. And so one of the most challenging aspects of being a hardcore gamer is you’re spending too much time gaming and as a result, your other interests are suffering, as Doug talked about with his golf analogy. You know there’s there’s a real deficit in my guys. There’s only one interest and hobby and everything else has slipped away. And then for my guys who are in their 20s and this is really upsetting they they quit the game they we get them off and then they’re like ‘oh my god I’m 21, I’ve never kissed a girl, I don’t have a driver’s license, I have no interests or hobbies, what am I going to do?’ And you don’t want to be that person it’s really devastating and it’s one of the most sort of disheartening and upsetting moments in the treatment that i do when you have to help someone sort of face that. So we want diversity of interest and hobbies. One of the things that I did with my own kids and I’ve recommended to pretty much everyone who has been under my care is that you create a series of lists. Lists of and each list is a category that’s important to you and your values. And for different families, it’s going to be different things, but generally like, in my family we had one that was exercise and there was sort of intellectual, there was art/music. There was a bunch of them. A social was one that was a really important one. And I had each kid, and I did this myself as well, sort of fill that list up with what are things you can do during a global pandemic? What are things that actually are safe? And we had this long list, and we talked about making sure you hit each list every day. Now in practicality to be honest because I’m a parent, you know parenting in the real world, the list didn’t play out the way I really intended it to. I thought, you know, my kid would like go to the list, pick something out, and do it and that didn’t play out quite the way that it did. But we generated this list and this rubric that was really important speaking to diversity and that made all of the other difficult challenging discussions that happened later as we were all coping with this much easier because the rubric was there. So diversity of activities cannot be you know sort of under underemphasized. And the last is opportunity cost. I actually have a degree in economics which I’m not using right now, but opportunity cost is a great construct that I use with clients and in my treatment of people. And the the premise is what’s the cost of that one hour of gaming? And if the cost is what you would have done had you not been gaming, so what would you have learned, what would you have done, what benefit would you have if you had not been gaming for that hour. Now the first hour or two of gaming, you’re actually gaining a lot from that gaming activity. Games teach you all kinds of things. They have all kinds of great benefits it’s a primary way that you can be social right now, and so that’s you can game with your friends and that’s great. But after hour one or hour two, there’s diminishing returns to that activity. You’re not learning any new more strategies and you’re not getting any of these other categories hit. Your diversity is suffering. So the cost, the opportunity cost, goes way up, and if you just if you’re gaming like some of my clients gaming six, seven hours, you just take one of those hours and put it into playing guitar for example and then you’re learning a whole different skill and a whole different set of stuff, and then you’re benefiting greatly from it. So, opportunity cost and diversity are sort of important factors. So I’m going to pause there because i’ve been talking for a while and I think there’s there’s so many good questions guys we’re just they’re sort of almost overwhelming, and I’ll try to field one.

 

[Dr. Marc N. Potenza]: That sounds great. I think we’re going to go first to a live question.

 

[Dr. Edward Spector]: Now I can hear you.

 

[Sarvelia Peralta-Duran]: Oh thank you so much. Thank you so much for taking my question. I’m a university administrator in Pennsylvania, and I have a 13-year-old and an 11-year-old, and my question is how to set healthy video game limits you know both on time and also in the type of games that they play without being punitive or judgmental. Because many times, you know,  some of their friends are playing the same game, but maybe we don’t want to allow something like that, then it feels like it’s a punishment and not like we’re setting healthy limits for for our children.

 

[Dr. Edward Spector]: I get this question a lot. It’s really challenging. There isn’t a clear answer. Otherwise you would have come by it. But let me let me attempt to and realize that whenever we do as panelists I’m sure any all these guys will agree with me like we try to answer questions spontaneously and and then I guarantee you tonight when I’m going to sleep I’ll think of three things that I wish I had said and maybe one or two things I was like maybe I shouldn’t have said that so just you know you can always email me, and I’m sure I can give you a second pass at this if you don’t like my answer. So we are parenting in the village, not alone anymore, but it still is your job to teach your values to your kids, right. So you have to do this sort of there’s sort of two aspects of this. One is that you have to know where you stand. So if it’s violent content that you object to, if it’s the way that women are treated in the in the game that you object to, that’s a teaching moment, and it’s not that this is an evil but it’s a great opportunity for you to have ongoing dialogue with your kids as they get older. And you want to do that you don’t want to shut down conversation. So it’s important that they understand at first where, you know, where your values are and what you believe and why you would have problems with what’s going on with them. I encounter it all the time parents, you know, their kid gets you know that the kids’ friendship group goes to a game like Call of Duty or something and the parents are like ‘oh my god, I hate this game, it’s so violent and I’m really scared about what it’s going to do to my kid,’ and you have two options. You can ostracize that kid and say, okay you can’t play with them while they’re playing that game, and get the fallback from that, or you can educate that kid about what your concerns are and you know what what do you think the impact is going to be and try to minimize the damage as best you can, both by your words and your education, and possibly by having to set limits particularly if your kid demonstrate that they can’t handle that particular gaming situation. So you know it’s sort of, you’re looking for signs that there’s actually wear and tear happening with your kid so if they’re getting aggressive or if they’re, you know, changing in ways that you don’t like and you think that’s the influence, you still have to step in even though you might have to be the bad guy in that situation. You know there are times when our kids form friendships with a group of people you don’t approve of right? And that was true when we were growing up, and it’s especially true now, and you still have to handle it you know even though you might be unpopular. I don’t know if that answers it or if you have a follow-up you want for me, but that’s my first attempt.

 

[Sarvelia Peralta-Duran]: How about in terms of the time that they’re gaming because that also feels you know sometimes in terms of the punitive aspect I I agree a conversation is very helpful sometimes what we do is just literally take away the controllers and say okay after this time, this is it. 

 

[Dr. Edward Spector]: Yup. So a lot of different ways you can swing this. I like to focus on the other things you’re going to do because it’s less punitive. So what are the other things that you’re going to do with your day? So and the way you you know, my poor kids, being raised by a psychologist who does this, I mean god help them, they put up with a lot, but I you know I went down this morning, I talked to my son right before school started and I said ‘Alright, what’s the plan for the day? What you know what are you doing during the breaks’ And you know I just let him talk, and he knows through a gajillion conversations I’ve had what I mean by ‘what are you doing with your free time’ which is, ‘how much screen are you going to have,’ and he knows also that because school is Zoom that he’s on-screen the entire day, and it actually gives him headaches by the end of the day, and so you know, what are what are the breaks you’re gonna have to make sure you don’t get a headache tonight. What are the breaks you’re going to do to fill your buckets, all those categories? And so he’ll he’ll talk to me right away. I’ll just come in, ‘what’s the plan for the day?’ He lays it out for me. Of course, he’s not going to tell me, ‘Hey, I’m just going to play you know this video game for 16 hours and blow off school,’ but we’re also periodically checking in on him to make sure he’s okay. So one is to focus on what are you going to do and why are those things important and sort of fighting those, sometimes they’re battles, and then and then the other is to sort of agree about what is a reasonable amount of time, realizing that they might not agree, especially if they’re younger. By the way, my son is 13. I think you said you had a 13-year-old. And you know if they don’t understand then you have to say just really clearly where you are, what you think the right amount is, and then enforce it, and just you have to make sure that you do enforce it with with reasonableness. Now some places where it gets sticky is that some kids don’t have very good executive functioning skills, so they end up in these very social situations where they’re in the middle of a match with it might be 12 people playing, right, including them. Six on the other team, five on their team. It might be with friends that are in their community, and then you come down because they haven’t paid attention to the time and it’s six o’clock and it’s dinner and it’s time to get off, but if you yank them, it’s sort of like going up to a basketball game that’s actively happening, walking into the middle of the court, grabbing your kid by the ear, and pulling them out and saying ‘I don’t care. This game’s over’. Like you’ve just done something, and they’ve they’ve ended up in a really ugly situation. So while it’s you know in terms of hours, you know, I’m, you have to sort of look at what the total picture is. You also have to recognize that they may need some support there in terms of navigating the entrance and the exit from technology, and they might you know even with an alarm might not be that great at that. And to not focus on the shaming part of it, ‘oh why can’t you do this,’ but just sort of like what are the things that are missing right now in terms of the prerequisite skills that would be necessary for my kid to be able to handle this situation and then how do we either provide scaffolding, teach them that skill, or make sure that they’re in an environment where you can get the best version of them.

 

[Dr. Marc N. Potenza]: Thank you for that answer. As we transition into the full Question and Answer period, perhaps we can see if the other panelists have something to add at this point.

 

[Dr. Douglas A. Gentile]: Well I do. I think this, these are exactly the right questions to be asking. And, and I totally agree with that, that there’s not going to be a one-size-fits-all answer, but there are some things that I’ve heard from several different parents that have worked for them. With the time, you’re setting limits on time, for example. Some parents create an allowance. They even sometimes make a token economy, and you get coupons for half hour of screen time or whatever, and they give them a certain amount, you know, per week, and this is an interesting approach because why do we give kids a monetary allowance? We don’t give them a monetary allowance because we think children deserve money, right. We give them monetary allowance so that they can learn how to manage it. So when they start their allowance, the day they get it, they all they blow it all on candy, right, and then later that month, they’re sad they have no money. And after a while they learn to save some for later in the month, and then after a while, they learn how to save it you know across many months so they can buy something big. And then the point is, by the time they’re 18 and they they leave your house, they can actually manage their money. We could do a very similar thing with screen time, that they got a certain allowance. I, you know, go usually with the old American Academy of Pediatrics recommendations of no more than one to two hours of screen time a day for entertainment purposes. If it’s for school work, that’s that’s free. It doesn’t count. So say 10 hours a week and they can, you’ve got to be willing to give up a lot, some of the control, like if they want to binge it all on one long day on Saturday, they get to then. That’s like buying, using all their allowance on candy, but then they’ll be sad later in the week, and they’ll learn to, you know, dole it out. You’ll have to make a decision whether you’re allowing them to save it, so they can have you know multiple days or not. But again, the idea is, this is training them to not just fall back on turning something on to see if something’s on or because they don’t know what else to do. They have to make an active choice. I’m going to spend my time this way. So that then, by the time they they leave your house at 18, they’ve learned how to manage their screen time. The, you know, the point about discussing these things with your kids is tremendously important. So in the parental monitoring literature, there are four types of ways parents can be involved. First is co-viewing, so you sit and you watch with your kid or you play with your kid. The second, we’ve talked a bit about, is setting limits on amount. The third is setting limits on content, and the fourth is what’s known in the literature as active mediation. This is where you discuss why you choose to watch what you choose, why you choose not to watch these things, what the effects could be from whose point of view is it being seen, whose point of view isn’t being shown. You know, this is more critical level of thinking about it. You know, and the research shows that three of these four are fantastic for kids. Setting limits on amount and content. You’ve already seen some of the data on how fantastic those can be. Active mediation is even better. The research shows that when parents are in a habit of actively discussing these things with their kids, it seems to mitigate almost all of the negative effects of media and it enhances the positive effects of media. The dangerous one is co-viewing. If you sit and you watch with your kid or you play with your kid and don’t talk about it, it enhances the negative effects because then you’re giving tacit approval to whatever carnage is being seen on the screen. So the important thing is this act of mediation. Now this is a lot easier to start if your kids are young than if you’re already working with teenagers, but teenagers actually can understand it perhaps better and really engage in these conversations. And, you know, I’ll just talk about my personal, as you can imagine I was very strict with my kids. And I made the choice when my daughter was two that I was just going to raise a freak who was not allowed to watch anything her kids were being allowed to watch and it turns out that did not make her a freak. She still, you know, Lord of the Rings movies came out, I was not about to let her see those. I love those films, but not good for kids. They’re terrifying, and yet, we were walking through Kmart one day and she’s, you know, looking at the t-shirts ‘that one’s Frodo and that one’s Sam’ and that how the hell does she know this, because I’ve never let her seen it. But the point is any of these things that are that big in the culture, they’re still going to be able to have the conversations with their friends about even if you don’t allow them to ever see them. So I, you know, this is again a decision everyone has to make for themselves, but I haven’t seen real problems coming from being too strict, and this whole idea of the forbidden fruit aspect, the research does not seem to bear it up. It doesn’t seem to work that way, that kids once they leave your house go off and go crazy. It’s not that there aren’t anecdotes of some people doing it, but that does not seem to be typical. The more typical thing is if you were really strict they grow up and move out and are able to manage themselves better.

 

[Dr. Marc N. Potenza]: Thank you for sharing and building upon that, that response, of the answers that Dr. Spector provided and to provide another view, complementary view, on the topic. One question that came in was that, aside from Cam Adair, do the remainder of the panelists and hosts have personal experiences with gaming?

 

[Dr. Edward Spector]: Maybe, Doug, do you want me to go first? All right.

 

[Dr. Douglas A. Gentile]: Go right ahead.

 

[Dr. Edward Spector]: So I, I play a lot of games. I don’t play the way my clients do. I, you know, I have sort of a weird world I’m in. My technology is all in my office, so I game at times to experience the things that my clients are dealing with. I also have older clients. The average age of my clients are 19 with a bell curve around that. So the young kids, where maybe the the sort of the violent stuff is sort of less of an issue, it’s not that, it’s not an issue, but it’s sort of a less pressing one, and it’s more the quantity and how it’s overcoming their other sort of functions. But so I, I do play games and I, I do play games with my kids, mostly my son, who’s 13. But I, you know, I think every parent has to decide about content and, you know, you use these things to teach your values. So my kids know where I am and where I’m not about various aspects of media, and that’s really the rub is sort of staying in the game with your kid enough not just to be silent, but to have the dialogue. It’s the dialogue that’s so important. If you’re a real stranger to what they’re doing and they’re doing it for hours and hours, it can be really problematic. Anyway, so I play lots of games. I love minecraft. I don’t know what else to say. But, you know, I do it in moderation. Like on a weekend when I’m home, I’m with my family. I’m, you know, mowing the lawn. I’m doing all these things. The idea that somehow they’d be in the house and I’d be in the house but we wouldn’t be doing something together is abhorrent to me. So it’s all at my office mostly, so anyways.

 

[Dr. Marc N. Potenza]: So may I ask a question then? You know, during this COVID-19 time, where there’s such time spent online, learning, school, and how do you get your children to or how does one get a child to go to that balance of limiting the video gaming in this current setting?

 

[Dr. Edward Spector]: So it’s the current setting, but also the age of the child really matters, right. So, the younger the kid, the more likely it is I’m just going to do parent consultation. so I’m just going to be instructing the parents what to do. It’s that mediation category. How are they going to directly interact and manage the household differently so that they get a better outcome? As the kids get older in their upper middle school and high school then there’s sort of something to work with in terms of really being able to engage with them about developing strategies for setting limits and recognizing the importance of it. Usually you can, if if you build enough rapport with them, they’ll recognize that there are problems in their life, and they’ll talk about them, and then you’ll have something to work with and about how their tech use might be impacting, you know, the overall course of their life and where it’s going. What do they want to do? I teach them about opportunity costs. I teach them about all of these kind of things that we’re talking about. I’ll share research with them if I think it’s appropriate. I’ll talk about neurotransmitters and dopamine and and how gaming impacts dopamine. And and, you know, these studies that show that people who meet the criteria for gaming addiction, their brains look the same as heroin addicts, it really does morphologically and functionally change your brain, and that often speaks because to them because I’m, I don’t have a dog in the fight. They know that I game. They know that I don’t see this as just evil or good but like there’s, you know, everything in moderation, and then we try to sort of slowly move the course. So by the time they come to see me, they’re having problems though, so it’s easier. They’re usually, you know, especially if they failed out of school, it’s kind of hard for them to argue ‘yeah my life’s going well, things are great,’ and so they’re they’re usually ready to moderate themselves at that point. But you have to evaluate the age of the kid and whether it’s really expected that they can control themselves and realize that even teenagers, their frontal lobes are not fully developed, they’re going to struggle with that, so you have to provide enough scaffolding so that they can learn to control and an enough judgment-free environment so that if they mess up, it’s not embarrassing to them or shameful. That they’re struggling with this for good reason because it’s really hard. And if they have additional things going on like ADHD or depression or anxiety, if they’re autistic, then they need, these things need to be taken into account as well. It can’t be that we’re just talking generically about all kids. So once you have special needs added to the mix then it really becomes important to sort of form expectations based on who your kid is not who you want them to be or who you wish they were. 

 

[Dr. Marc N. Potenza]: Thank you, and I think Doug you are going to also respond?

 

[Dr. Douglas A. Gentile]: Oh sure. Yeah, no, I’m I I’m a longtime gamer. I’ve coded for games. I currently run an old school MUD, which is the freak, you know, predecessor of massively multiplayer online games. I’m currently obsessed with Ark: Survival Evolved, and if you doubt the life-changing effects games can have, I met my wife in a video game.

 

[Dr. Marc N. Potenza]: Okay, thank you. Maybe we can think of the ways in which children are using video games. For example, many games have scenarios where children can play in constructive versus violent ways, maybe they’re not mutually exclusive, how do these relate to children and how they might develop and what parents might do with respect to these constructive versus violent types of ways of behaving?

 

[Dr. Edward Spector]: I feel like that one’s getting punted to me without anyone saying anything. Doug, do you have something first or do you want me to dive in? 

 

[Dr. Douglas A. Gentile]: What I’d say is pretty simplistic, which is that your grandmother was a great neuroscientist. She told you practice makes perfect. She was right, actually what we know now from modern neuroscience is practice makes permanent in the brain. If you want to do something perfectly you have to practice it perfectly, but whatever they’re practicing in games is one more learning trial, and so it’s not a simple answer that just playing a violent game somehow is going to make them aggressive because depending on how they’re playing it, that matters too. If they’re going in with a prosocial motivation to help their team, that might be the thing they’re practicing even though what you’re seeing on the screen looks like aggression, and so it’s a it’s fairly complicated, but it, you know, here’s where it matters that you’re paying attention to how are they spending their time.

 

[Dr. Edward Spector]: Yeah, Doug, I thought you handled that well. It is, there are games where you you choose what role you have, and you might be a support role where you’re just healing people or you might have a game where you’re being, you know, a damage dealer and you’re doing as much damage as possible. And I think there’s an enough there’s more to be said also of just picking what kind of community and game there’s out there because there are there are communities that are really toxic and known to be toxic where it’s not just the games you’re playing, but it’s, the game itself that’s playing, but it’s the interaction with the other players. And so and some games like League of Legends are just known to be profoundly toxic and I’ll hear people say ‘yeah I just don’t like playing that game because the people are just so awful in it, and they treat you so poorly’ and that, you know, it’s pretty common for someone to say ‘oh you should go kill yourself’ or ‘your trash.’ Or there are other communities like Animal Crossing, where you’re not going to get that kind of, you know, reaction from people. They’re going to be like ‘oh cool island’ or whatever. And so steering kids to games that are consistent with what you want them to be practicing, to to take from Doug, is helpful and but realize that there are sort of underbellies in almost every game. So if your kid really wants to, they can do something kind of negative. So it really speaks to you really knowing what they’re doing and watching them and understanding what they get out of it, and, you know, often it’s just asking ‘so what do you think’s really cool about this game’ and and, you know, ‘what do you do?’ ‘What do your friends do?’ ‘What’s the craziest thing that’s happened?’ ‘What’s the funniest thing?’ And just get them talking, and then sometimes they’ll really give you the answers you need to evaluate like is this a good thing or not. The other thing you can look at, and one of the great questions I saw was how do you manage your child’s emotions when they’re gaming when they get overwhelmed particularly when they lose, is you want to pay attention to their emotions. Their emotions are a great guide to whether or not they’re in the right place. So if they’re getting overwhelmed in a game, they’re rage quitting or tilting, these are all sort of words that we gamers use, then there’s two options, right. One is that they don’t belong there because they’re playing with older kids or they’re playing a game that’s meant for older people and so it’s not the right place for them. The other option is that they are, they have emotional problems. They’re having a hard, they own the prerequisite emotional regulation skills, you know. So if they were playing baseball and they struck out, you know, if they destroy half of the team’s equipment in some sort of rageful MLB-like experience, then you know that they need a therapist to learn that and that’s what therapists do. They help, they can, they can help with that, help, you know, you develop the kind of self-talk and the cognitions necessary to manage disappointment whether that happens in a game or happens in real life. So you’re getting some feedback if it is the kids really showing signs that there’s problems.

 

[Dr. Marc N. Potenza]: Cam I’m curious about some of your thoughts on this and having grown playing video games and then at some point realizing that it was problematic and whether there was something that you’re hearing that might have resonated with you or may have been done differently.

 

[Cam Adair]: So the only game I play today is Chess, and absolutely love Chess, and Chess has never really been a problem for me whereas a game like World of Warcraft was a very big problem for me, and last year, when World of Warcraft: Classic came out, which was an iteration of the game that I played, you know, 15 years ago, I had cravings to play the game from the announcement for an entire year, where regularly I’d find myself, you know, before a presentation, I remember in Connecticut I was in an Airbnb. I was like, ‘Oh maybe I should just play World of Warcraft in this apartment by myself because no one else has to see it and it just won’t become a problem’ and trying to negotiate with myself or I’m writing a book,  ‘Oh I need to start playing games again so I can remember what they were like back when they were a problem’, really bargaining in that way. And the reason I bring up Chess is that different types of games impact different people differently, and so games like World of Warcraft that are endless, that go on forever. There’s an unlimited number of missions to work on. They’re large, open worlds to explore. They’re ongoing even when you’re not playing, so other people are progressing and you’re not. Or competitive based games like Counter-Strike, which I also played a lot. Those games tend to in, in the research show that people tend to develop problems with them more often than single player story based games. Now there’s different types of games and different players like different types of games. I am not someone who really played story based games, but if I wanted to play games now, those are the types of games that I would go to because they’re less risky for me. And Chess is immersive but it’s not super social and and some of these different factors that really gravitate, I gravitate towards. So especially when you’re introducing games to younger kids, I think introducing them to more story based games, single-player offline type games, is a better option than having a nine-year-old playing Fortnite, where it’s so immersive. It’s so engaging, and that game it has, has elements in it for every type of player. Whether they’re a competitive based player, a social player, or an explorer, Fortnite is designed to capture their attention and to encourage them to spend money. And so you want to be very aware of different types of games people play, and finally I’ll mention that the type of game and the way in which someone plays it can give you a lot of information as to what their interests are. For instance, I’m a very competitive person so I play those types of games. So other activities like music production, coding, anything that has competition in it, sports, is very appealing to me and is a, is a good replacement for gaming whereas people who are playing more role-playing games, where they get to create characters, they get to create different experiences, they like to create different experiences, so things like drama or theater or improv are really good outlets for them. And often because kids start gaming so young these days, two, three, four, five years old, they may have never even had the chance to develop other interests or other activities and certainly they may have never had the chance to try an activity like theater or improv that turns out they may really love. And one member of our community, a 17-year-old named Andrew, he stopped playing games one weekend after playing basically all weekend behind his parents back and instead he picked up his family’s camera and discovered that his great passion, his great talent in the world was actually as a photographer, and what’s so fascinating to me about Andrew is the family camera was there the whole time. He just never had the chance to pick it up because he was so immersed in games, but after picking it up, a natural talent was there, and he’s traveled all over the world now with National, National Geographic. He’s been to many different countries, and just overall, his life is in a really amazing place. The final thing I want to end on is that just because he picked up photography doesn’t mean that he didn’t have a passion for gaming or that other kids don’t have a passion for gaming, and I think we really need to be cautious of seeing the hours he spends spends in photography versus the hours he spent in gaming. For him, photography has not impacted, in multiple different areas of his life, in a negative way whereas gaming was. And for another kid, gaming might not be impacting their life in the way that it was Andrew. So we need to be cautious there, but I do think that that’s a valuable story.

 

[Dr. Marc N. Potenza]: Thank you for sharing that. Maybe we can get some final thoughts from the, the panelists before I turn the Zoom stage back over to our, our overall host Dr. Hurst-Della Pietra.

 

[Dr. Edward Spector]: I’ll jump in first if that’s okay. Cam, you highlighted something for me that I do with my clients. It’s called bringing it IRL. So we evaluate their gaming and why it’s really getting under their skin and for every person, there’s some game out there that can get under your skin. And, and we try to figure out what need is getting sort of met in the game and how do we bring that IRL, in real life, and if we can do that, the whole situation pivots for them because when, you know, you can build self-esteem in a game, but it doesn’t really transport well. But if you build it IRL, if your self-esteem isn’t something that is brick and mortar, that’s real, it really does make you more confident to try other things in real life as well. And so we try to find the, the outlets that are in real life, and when we can do that, it really makes a huge difference. In terms of, I just wanted to add one other point which I didn’t make which I was trying to make,  which was for managing kids with emotional responses to gaming, they often have to learn how to tolerate that and I’ll do this thing where I’ll create a ladder of gaming situations from easy to difficult and, and we’ll go through them and practice them. We are teaching social skills and we’re teaching self-regulation in those moments, and it might be like losing a game is at the top of your ladder, but for someone else it might be different and we are slowly sort of working on those things together, practicing them, including setting limits or accepting limits, and these kinds of things have to be practiced. It’s not that you’re born, your kid’s are not born knowing how to do this or being good at it, but if you do it right they can learn it, and often it’s by, by rehearsal so I’ll stop there, thanks.

 

[Dr. Douglas A. Gentile]: And I’ll end by trying to put this back into the bigger picture. You know, we’ve spent most of this time talking about some of the problems and that makes a lot of sense because that’s what people are worried about, but if we’re talking about gaming disorder, depending on the study and country and population, the percentage seems to vary somewhere between one percent and 10 percent of gamers have, have the problem. That means 90 percent can game in a way that’s not disruptive to their lives. So, so it’s not like this is monolithic problem that everyone has to worry about. Everyone should be on alert for so that you can see some of the warning signs that Dr. Spector pointed out. With, there was a question about how large is the effect size. This the answer to that is best known for violent games and aggressive behavior. The effect size, in correlation terms, is somewhere about 0.15 to 0.2 from the meta-analyses. Now what does that mean? Well that’s about the same size as coming from a broken home. That coming from a broken home, we all know it’s a risk factor for aggressive behavior, but it doesn’t force anyone to be aggressive, and that’s what we’re talking about here is that each of these types of effects that games can have, it’s just shifting the odds in one direction or another. It’s not actually forcing a kid to do anything because it’s not that, none of them are that big of a risk factor, thank god, but that’s not unimportant. So just because it’s a small risk doesn’t make it an unimportant one primarily because it’s one of the few risk factors that we can actually control. You can’t control very easily if kids are being bullied at school, have been abused in the past, live in a violent neighborhood, live in poverty. I mean these are all risk factors for aggression, and you can’t just tell families get out of poverty. If they could, they would, but even that family with very limited means can say no don’t play this game, play this one instead. And I think that’s what makes games and other media really worth looking at in this way because in fact they’re one of the few risk factors that we do have a lot more control over than many of the other ones in children’s lives. 

 

[Dr. Marc N. Potenza]: So we are nearing the end of the hour and a half, and I would like to thank all of the panelists and turn this back over to Dr. Hurst-Della Pietra.

 

[Dr. Pamela Hurst-Della Pietra]: Thank you all for coming and for participating in this critically important conversation, and thank you Marc, Ed, Doug, and cam for your expertise and guidance. We hope that this webinar has given you a glimpse into the current scientific research and clinical expertise on video game use, as well as clinic, as well as practical advice for promoting healthy game habits in your kids. To continue learning about this topic and for more great tips, be sure to visit our website where we will post additional insights in the coming days. We will also be posting a YouTube video of today’s workshop, which we encourage you to share with your fellow parents, teachers, clinicians, researchers, and friends. For more from Children and Screens, please follow us on social media at the accounts shown on your screen. Our discussions about digital media use and children’s well-being will continue through the rest of the year with weekly Wednesday workshops. Next Wednesday, September 30th, at noon EDT, we will be discussing key issues in online privacy and tips for how to protect children’s data. Panelists will explain what third parties really know about your family and will equip you with actionable information to protect your child’s online presence. The following week, our webinar will explore the rise of persuasive technology and what parents can do to mitigate its effects. When you leave the workshop, you will see a link to a short survey. Please click on the link and let us know what you thought of today’s webinar. Thanks again, and everyone be safe and well.