DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY INVITED REVIEW
Internet gaming disorder in children and adolescents:
a systematic review
FRANK W PAULUS
ALEXANDER VON GONTARD
1 Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. 2 Department of Child and Adolescent Psychiatry, Medical
University of Vienna, Vienna, Austria.
Correspondence to Frank W Paulus at Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany. E-mail: email@example.com
This article is commented on by Mueller on page 636 of this issue.
Accepted for publication 2nd February 2018.
Published online 6th April 2018.
IGD Internet gaming disorder
MMORPG Massively multiplayer online
Internet gaming disorder (IGD) is a serious disorder leading to and maintaining pertinent
personal and social impairment. IGD has to be considered in view of heterogeneous and
incomplete concepts. We therefore reviewed the scientiﬁc literature on IGD to provide an
overview focusing on deﬁnitions, symptoms, prevalence, and aetiology.
We systematically reviewed the databases ERIC, PsyARTICLES, PsycINFO,
PSYNDEX, and PubMed for the period January 1991 to August 2016, and additionally
identiﬁed secondary references.
The proposed deﬁnition in the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition provides a good starting point for diagnosing IGD but entails some
disadvantages. Developing IGD requires several interacting internal factors such as deﬁcient
self, mood and reward regulation, problems of decision-making, and external factors such as
deﬁcient family background and social skills. In addition, speciﬁc game-related factors may
promote IGD. Summarizing aetiological knowledge, we suggest an integrated model of IGD
elucidating the interplay of internal and external factors.
So far, the concept of IGD and the pathways leading to it are not entirely
clear. In particular, long-term follow-up studies are missing. IGD should be understood as an
endangering disorder with a complex psychosocial background.
Games are an integrative part of human behaviour and
experience. During the past two decades, the availability
and use of computer technology has dramatically increased
and changed the world of leisure activities. Use of the
Internet and computer game playing have become common
activities for children and adolescents, in addition to social
and traditional mass media. Recent data from the USA
suggest that 8- to 10-year-olds are busy 8 hours per day,
and adolescents more than 11 hours per day, with the
recreational use of various electronic media (mobile
phones, television and videos, computer use, music, print
media, Web pages, social media, not including telephone
conversations and text messages). This covers more time
than they spend in school or with friends.
For most individuals, computer gaming is an enjoyable
and stimulating activity.
Persons with various intra- and
interpersonal risk factors may, however, become attracted
to using computer gaming as a strategy to overcome indi-
vidual problems. Gaming and seeking for game-related
pleasure may lead to neglecting ‘normal’ relationships,
school or work-related duties, and even basic physical
needs. Computer gaming may thus be conceptualized as a
continuum from an enjoyable activity to pathological and
even addictive use.
The Diagnostic and Statistical Manual of Mental Disor-
ders, Fifth Edition (DSM-5)
conceptualizes ‘Internet gam-
ing disorder’ (IGD) in the chapter ‘Conditions for further
study’ (p.795), suggesting that this proposal is not yet
intended for clinical use but that research on this topic is
encouraged. The essential feature of IGD is persistent and
recurrent participation in computer gaming for typically 8 to
10 hours or more per day and at least 30 hours per week,
typically in Internet-based group games (especially massively
multiplayer online role-playing games [MMORPG]).
Since IGD has been deﬁned only in 2013, previous liter-
ature uses various terms for describing this clinical entity,
such as Internet or computer addiction (see ‘Deﬁnition’).
While IGD is typical for adolescents and young adults,
preschool and preadolescent children prefer non-Web-
based games. Therefore, the American Psychiatric Associa-
tion deﬁnition may not exactly ﬁt for younger children and
those playing ofﬂine.
Although IGD may be a serious disorder leading to sig-
niﬁcant impairment of personal and social functioning, the
deﬁnition, symptoms, prevalence, and aetiology have to be
seen in view of heterogeneous, incomplete, and changing
concepts, and only a few available clinical studies of scien-
tiﬁc quality. We therefore decided to review the scientiﬁc
© 2018 Mac Keith Press DOI: 10.1111/dmcn.13754 645