Research into the effect games can have on growing children has been a point of much debate in recent years, but that debate typically erupts after the research is released.
That wasn't the case this week, as a new study on pathological gaming in the journal Pediatrics was preemptively decried by the Entertainment Software Association in a press release last week. The industry trade group called the study "flawed," taking issue with the researcher's methods and touting his "long anti-video game history."
Defending his research, Dr. Douglas Gentile of Iowa State University said, "A lot of people assume if you talk about pathological gaming, you're talking about something's wrong with games. And that's not at all what's going on here…I don't think it's about the game; I think it's about the player," he concluded.
Gentile surveyed 3,034 Singapore school children about their gaming habits, looking at which children were in his estimation "pathological gamers." He broke the groups down into children who were pathological gamers throughout the study, those who became pathological or stopped being pathological over the course of the study, and those who never had a problem with it.
While gaming addiction is not at present a diagnosable disorder, Gentile adapted a test for pathological gambling to give to the children. He asked the children a series of 10 questions designed to determine if other areas of their lives are suffering due to their game play habits. One question asked if players sometimes skipped homework to play games. Others asked if they unsuccessfully tried to cut back on gaming time, played games to escape from problems and bad feelings, or ever stole money in order to play. Respondents could answer "yes," "no," or "sometimes." Every "sometimes" response counted as half of a "yes." If a child wound up with five or more affirmative responses, Gentile said they should be considered pathological gamers.
The survey was similar to one he released about US school children in 2009, although that test had 11 questions, and six or higher was the threshold. That study deemed 8.5 percent of the surveyed children as being addicted to games. In the new study, Gentile found that 9.9 percent of gamers were pathological at the time of the first survey, with 7.6 percent considered addicted at the third survey. Additionally, he said that levels of depression, anxiety, and social phobias rose in gamers who became addicted and fell in those who had fewer problematic gaming traits.
Gentile is not the only researcher looking into the issue. A similar study was published in Pediatrics in November. That research, conducted by a group of doctors from the Yale University School of Medicine's psychology department, asked three questions to determine if a student had a game-related impulse-control disorder. Of the more than 4,000 students surveyed, 5.9 percent of the boys responded in the affirmative to all three questions (qualifying them as having a disorder for the purposes of the research), compared to 3 percent of the girls.
Pathological gambling parallels are commonly used in gaming research because it is the only medically recognized behavioral addiction, Gentile said. While there are studies about "addictions" to sex and shopping, those aren't medically recognized afflictions. And while Gentile didn't look at gaming as a substance addition in this study, he does see similarities.
"When you play the games, your biochemistry does change," Gentile said, "and it changes in many of the same ways that it does if you take cocaine. Your brain does release dopamine. That adrenaline rush you feel from playing violent games is really adrenaline. That's epinephrine coursing through your veins. You also get other stress hormones--glucocorticoids and catecholamines like cortisol and testosterone. And over time, you get desensitized. You get a tolerance for them, and so you need more new games to get that excitement back again. And that looks an awful lot like a substance addiction."
Gentile said his new study was the first time research has pointed to something more than a correlation between games and mental health disorders, but he stopped short of calling it a causal link.
"We've got hints of causality because we know that something happened before something else," Gentile told GameSpot, "but that doesn't mean we know what caused it."
Gentile also expressed concern about pathological gaming being a comorbid disorder. He said mental health disorders often come in groups, and when someone develops a second one, it makes the first one worse, and so on in a vicious cycle.
"I think this study shows we can't ignore the way the kids are gaming as if it's really unimportant and only the depression is the important thing," Gentile said. "When you take that kid into the therapist to get help, you can try to medicate the depression and work on the social anxiety and the phobias, but if the kid goes home and still spends 40 hours a week playing games, they're not getting experience with other kids, they're not doing their homework, they're still doing things that are going to make treating those other problems harder. That's the sense that I'd like people to take away from this. We've looked at gaming as unimportant in a sense. 'It's just a game.' That doesn't mean the way some kids do it isn't damaging."
As for the ESA's public critique of his work, Gentile dismissed it as the trade group protecting its members' interests.
"They don't really provide any evidence in their statement of anything being seriously flawed," Gentile said. "That doesn't mean all studies don't have limitations; they certainly do. But just having limitations doesn't necessarily invalidate any of the results from it, either."
Regarding the criticism he gets from the gaming community at large, Gentile said the negative response is partly due to a misunderstanding.
"I tend to believe--and there are people who disagree with me--is what we're looking at here is an impulse control disorder," Gentile said. "You know you should do your homework, but you just can't stop playing. You know you have to go to bed, but you have to get just one more level. What needs to be changed is not the game. What needs to change is players need to learn to put it back into balance."