Video games and young people: when is it an addiction

“Every day after school he goes to his room and does not come out until dinner. If I call him, he shouts. I think he is addicted.” That is how this conversation usually begins — the mother at one end of the sofa, the boy who would rather be anywhere else at the other. And my first question is not how many hours he plays. My first question is: when did this start, and what else changed in his life at the time?

Over the last decade video games have become the main scene of the family argument about screens, and at the same time one of the most misunderstood areas in children’s mental health. Some parents think it is harmless fun that will pass on its own. Others think every hour on a console is a step towards addiction. The truth is more precise, and more useful, than either.

What the diagnosis is and what it is not

Gaming disorder has been included in the International Classification of Diseases since 2019. That matters, because it gave the concept clear criteria for the first time — and those criteria are considerably stricter than most people imagine.

It describes a pattern lasting as a rule at least twelve months, with three components at once: impaired control over gaming, gaming taking precedence over other activities and duties to the point of displacing them, and continuation or escalation despite clear negative consequences. A fourth element must accompany all three: noticeable harm in personal, family, educational or occupational functioning.

The American DSM-5 is more cautious. It placed internet gaming disorder in the chapter of conditions requiring further study — a proposal, then, not a diagnosis. That gap between two manuals is itself informative: the field is not united. If you want to know what a diagnosis is and what it does not tell you, I have written about it in the piece on a diagnosis being a map, not a name.

How often this actually happens

Here is the most useful figure in the whole piece. Prevalence meta-analyses land at roughly one to three per cent of young players, with the lower estimates coming from studies using strict criteria and the higher ones from studies with loose questionnaires.

What does that mean for a parent? That the probability your child plays a lot is fairly high, and the probability they have a disorder is low. This difference is not a consolation but a direction: if you treat every adolescent who plays a lot as an addict, you will miss the ones who genuinely need help and needlessly set the family against the rest.

Longitudinal studies — among them well-known work by the Kuss and Griffiths group and years of follow-up by Dutch researchers — also show that in a large share of young people this is a transient state. A good many of those who meet the criteria in one year no longer meet them two years later, without anyone intervening.

Why games work so well

Games are not accidentally enjoyable. They are designed to hit precisely three psychological needs that self-determination theory describes as fundamental: a sense of competence, a sense of autonomy and a sense of relatedness to others.

In a game you progress in steps that are demanding at just the right level. Feedback comes immediately and is fair — if you did well, it shows. You decide for yourself what you will do. And in a team you have a place where somebody expects you and where you are responsible for something.

Now compare that with the school where the boy lost his footing, the sport where he stopped being good enough, and the classroom where he has nobody. The game is not a competitor to real life. The game is the only place where he still receives those three things. That is why taking the game away without restoring those needs never works.

Hours are not the measure

The most common mistake I see is counting hours. Parents arrive with a precise log and expect me to say which number is still acceptable. There is no such number, and anyone who offers you one has made it up.

The reason is simple: the same number of hours means two entirely different things in two children. One plays a lot because it is his main hobby, he has friends outside it too, he sleeps, he goes to school and would happily go to the seaside at the weekend. The other plays just as long but has stopped going out, does not sleep, does not eat with the family and falls apart when interrupted.

The field calls this difference high engagement versus pathological use. Research by Przybylski and colleagues has repeatedly shown that screen time alone predicts mental well-being very poorly — conflict, displacement and the loss of other activities predict it far better. The question is not how much, but what has disappeared because of it.

When the game is a consequence, not a cause

This is the part that is hardest to hear in a family conversation. In a large share of the young people whose parents bring them in because of games, the game is not the primary problem. The primary problem is social anxiety, low mood, an attention disorder, or something happening at school that was never mentioned at home.

In such a case the game is the most reasonable solution the child has found: a place where you do not have to speak face to face, where nobody judges you by how you look, and where the thing that humiliated you in the classroom does not exist. If that background goes unaddressed, taking the device away is only taking away the one safe room. I have written about how a symptom does its job in the piece on the symptom as a message.

But there is also the reverse direction, and it would not be honest to leave it out. Playing at night genuinely worsens sleep, worse sleep worsens mood and concentration, that worsens school, which increases the retreat back into the game. That loop is real and does not open on its own — I have written about the bodily side of this pattern in the piece on hyperarousal and insomnia.

When the game stops being fun and becomes a duty

Something parents often do not see is that modern games are not built like a book that ends. They are built as a service that keeps running: daily tasks expiring at midnight, seasons that run out, streaks that break if you miss a day. All of these are design decisions whose purpose is to bring you back.

So an adolescent sometimes plays not because it feels good, but because otherwise he will lose something. When I ask parents whether their child looks happy while playing, after some thought they often say no — that he looks tense. To me that is a more important sign than hours: a game that has turned into an obligation no longer delivers what made it good.

The same goes for the pressure of a team. If five people are waiting for you at eight in the evening, when you stop is no longer your decision. Many a boy whom his parents experience as indifferent is in fact carrying a sense of responsibility he cannot explain — and anxiety when he lets the team down. I have written about how the body holds such tension in the piece on what happens in the brain during anxiety.

Loot boxes: gambling inside a child’s game

Something that should worry parents more than hours is in-game purchasing. Paid boxes with random contents have the structure of gambling: you pay, you do not know what you get, and an occasional big prize sustains the behaviour better than a constant one.

Research, including substantial work by Zendle and Cairns, has repeatedly found associations between spending on these boxes and signs of gambling problems in young people. Several countries have therefore restricted or banned them. If you see a child hiding spending or borrowing money, that is a more serious sign than any number of hours in front of a screen.

Where this piece does not hold

Now against myself. Everything I have written about caution over diagnosis may reassure a parent too much. I know families where “it will pass” was exactly the wrong move — where a boy dropped out of school, lost every contact, and at twenty could no longer hold a conversation with anyone face to face. There the parents were not exaggerating. They simply waited too long.

It is also true that part of the professional scepticism about the diagnosis is ideological. Some researchers oppose the concept out of a principled resistance to pathologising youth culture, and that is as much a bias as the moral panic on the other side. Data from Asian countries, where the phenomenon is better researched and where specialised programmes exist, show that a severe form exists and that it is serious.

And a third point: a twelve-month criterion is long in an adolescent’s life. A great deal happens to a fifteen-year-old in a year. If you waited for every criterion to be met, you would miss the moment when it was still easy. So in practice I do not wait for a diagnosis — I go by the harm that is visible now.

What I do with parents

The first thing I suggest is unpopular: for two weeks, stop counting hours and start observing function. When does he go into the game — after school, after an argument, when he is alone? What was different on the days when he played less? That log tells you ten times more than a clock.

The second thing: rules agreed in advance work, rules announced mid-game do not. A child forced to shut down the computer in the middle of a match with his team does not experience a boundary, he experiences a betrayal in front of his friends. The agreement about when it ends has to be made in the morning and not at nine at night. I have written about setting boundaries that hold in the piece on setting boundaries.

The third thing: never take away without offering something back. If the game is the only place where a child is good at something, decides for himself and belongs somewhere, an empty room will only silence him. Look together with him for where those three things could also be found — and expect it to take months rather than days.

And the fourth, the hardest: if a child is withdrawing because he is in pain, then the game is not the target, what he is fleeing is. That is when a conversation with a professional makes sense, and in family work the greatest movement often comes once people stop talking about the screen.

What to remember

Gaming disorder exists, but it is rare and has strict criteria: impaired control, the displacement of other activities and persistence despite harm, as a rule for at least a year. The vast majority of young people who play a lot do not meet them.

The number of hours alone says nothing. Three other signs do: what has disappeared because of the game, how the child responds to interruption, and whether concealment has begun — especially concealment of money spent on loot boxes.

The game is often a solution, not an illness. That is why removal without replacement does not work. If you take away a child’s only place where he is capable, decides for himself and belongs, you need something to give back that covers those three things — otherwise you have merely switched off a screen and switched on an argument.