Children who watched more than the two hours per day maximum recommended by the American Academy of Pediatrics were 1.5 to two times more likely to show attention problems, U.S. researchers say. (IStock)Video game addiction is not an official diagnosis, but studies estimate eight per cent of all children and teens are affected.

Researchers are just starting to address questions like: "What seems to make some games more addictive than others?" and "Is video gaming associated with attention problems in children?"

In the meantime, young people are spending more time watching TV, playing video games, sending texts or using social media. A 2009 survey by the Centre for Addiction and Mental Health (CAMH) in Toronto of about 9,000 students in Grades 7 to 12 in Ontario suggested nearly 10 per cent get seven or more hours of "screen time" each day. Just over 10 per cent reported a video gaming problem in the previous year.

Video gaming problems are often defined like problem gambling or alcoholism. The key is to look not at how much gaming is done, but whether it is disrupting aspects of a player's life — school, work, family relationships — and if it leads to experiences like needing more to get the same effect or feeling unable to stop, said Edward Swing, a graduate assistant at Iowa State University in Ames.

Swing co-authored a study published online in July 2010 in the journal Pediatrics that found a moderate link between television watching or video game playing and attention problems in more than 1,300 children eight to 11 years old, based on assessments by teachers.

Children who watched more than the two hours per day maximum recommended by the American Academy of Pediatrics were 1.5 to two times more likely to show attention problems, the researchers found.

But not all video games may be equal. Some evidence suggests educational TV is not associated with increased attention problems and there are theoretical reasons to believe that slower paced, educational, non-violent content is less likely to cause attention problems. More studies are planned to test this idea, Swing said.

Role-playing games

The social aspect of gaming is also thought to make a difference in its addictive potential. Online role-playing games like World of Warcraft tend to be the most addictive, said Dr. Brent Conrad, a clinical psychologist in Halifax who runs the website TechAddiction.ca. Conrad has worked with children and teens who spend 40 or more hours a week playing online games — the equivalent of a full-time job.

Most people can play most games without becoming addicted, just as most adults can drink alcohol on occasion without becoming addicted or gamble from time to time without losing their life savings, Conrad said.

Most play within healthy limits. But for the less than 10 per cent who develop excessive gaming habits, achievements in the virtual world become a priority that hinders success and development in the real world, Conrad said.

In some virtual games, it's impossible to progress without joining a team. Once part of a team, players are expected to be available for important missions or raids that often involve hours of daily commitment, as well as the social pressure to keep one's character strong and gaming skill sharp, which can also encourage unhealthy levels of play, the psychologist noted.

Wilson Wu, 37, of Toronto said he's "addicted" to a text-based fantasy game similar to Dungeons & Dragons. Wu first started playing the game during university in 1995. It's easy to spend five to seven hours playing daily, he said.

"Coming home from work and then logging on to check email often leads to playing the game since it's free and I don't need to leave the apartment or get changed," Wu said in an email. "This usually means I don't have time for other things like grocery shopping or cleaning the apartment."

Planned events in the game, such as a group mission, easily take up to seven hours a day, meaning Wu has to reschedule meetings with friends in the real world around his virtual gaming events.

Addictive or social?

Research suggests social gaming often winds up being a compulsive behaviour compared to solitary gaming, said Dmitri Williams, an assistant professor in the Annenberg School for Communication at the University of Southern California in Los Angeles.

"You ironically don't get much addictive behaviour for stand-alone games," said Williams. "You need the presence of a lot of other people. This raises the question of if this is really addictive behaviour or are you super compelled to be social because it's so ingrained in us."

At Iowa State University, Swing's supervisor and co-author, Douglas Gentile, a professor of psychology at Iowa State, published data on video game addiction in the U.S. in the journal Psychological Science in 2009. The study showed 8.5 per cent of video game players showed pathological patterns of play, defined as exhibiting at least six out of 11 symptoms of damage to family, social, school, or psychological functioning — a definition similar to that for pathological gambling.

Gentile said he doesn't consider video game addiction to be a public health threat yet, adding there are several important questions that still need to be answered.

For example:

• Who is most at risk?
• How long does the problem last?
• What types of help do people need?

But Gentile noted he's concerned about video game addiction in children and teens because "the data kept showing me that I should be."

There aren't good quality studies testing whether the social aspect of online gaming contributes to its potential addictive effects, but there is theory to suggest it matters, Gentile said. He pointed to self-determination theory of human behaviour, which argues there are three basic needs driving our motivation:

• Need for autonomy: Feeling like we are in charge of what we're doing.
• Need for competence: The desire to feel we're good at things.
• Need for relatedness: Wanting to feel connected with others.

All games satisfy autonomy and competence needs, but virtual games add the third dimension, Gentile said.

Seeking treatment

Dr. Bruce Ballon, head of CAMH's Adolescent Clinical and Educational Services for problem gambling, gaming and internet use, said his practice focuses on 16- to 24-year-olds, including those who have dropped out of school because they're hooked.

The term internet addiction doesn't mean much, Ballon said, since it carries a stigma and internet technology plays such a major role in many of our lives today.

Ballon said his colleagues' study of Ontario students spending seven hours of day in front of screens supports the thinking that these students are getting into use of technology that seems a "bit out of control."

Often the youth that Ballon sees have other issues such as depression, anxiety and autism spectrum disorder. If the kids don't want to be social in the real world, parents often clue in that something is going on. CAMH, therefore, takes a broad psychiatric and psychological history to check that nothing is missed.

Its important to involve parents In the treatment since they're often the ones picking up the tab for internet service at home, Ballon said.

It is unrealistic to say, "Just don't use the internet," since people are often expected to access email at work or in school. The key is to have a healthy relationship with the virtual world, he said.

With files from CBC's Jessica Wong