“I’m seeing a 15-year-old boy who has been hospitalized for depression and for cutting himself. He’s bombing out of school, not because he wasn’t smart, but because he couldn’t cut down on the time he spent playing Worlds of Warcraft. He would spend 10 to 12 hours a day playing the game; he would play until somebody made him get off the computer. His parents would put controls on the computer to limit its use, but he would figure out ways to bypass them. He would pretend to go to sleep, and get up in the middle of the night to play. It turned into a battle of wills. He would get very upset and angry until he got his fix. Sometimes he wouldn’t make it to school and would sleep through the day because he’s been playing video games all night.”

Clearly this young man has significant problems that are interfering with his life. But is it really an addiction? That’s a term bandied about freely; we describe some people as “addicted to food” and others as “addicted to eBay.” There are three diagnostic hallmarks of an addiction:

1. •A compulsive, physiological craving for a substance
   

2. •Increased tolerance (needing a higher dose to get the same effect) following early use
   

3. •Well-defined and uncomfortable physiological symptoms during withdrawal.
   

Among drug addicts who use heroin, for example, these three hallmarks are obvious. We also see them clearly among alcoholics. With these and other classically addictive substances, we can see changes in the brains of addicts in response to both the substances’ introduction and their withdrawal.

Does this hold true for video games? The best answer today is: We don’t know. Playing video games that involve a lot of action has been associated with increased levels of two neurotransmitters in the brain, dopamine and norepinephrine, that help brain cells send messages to each other. These neurotransmitters are involved in both learning and in addiction.

Some of the children labeled as addicted to video games may be struggling with a compulsion similar to an obsessive-compulsive disorder. Their game playing behavior may be out of their control and interfering with their lives, but the underlying mechanism may be different than that of someone addicted to a drug. Others said to be addicted to games may simply be responding to the powerful reinforcements they receive every so often (a “variable-ratio reinforcement schedule”) when they play. These children may have more in common with recreational lottery players and casino gamblers than with drug addicts.

Some supposedly addicted game players may be behaving normally—but not in the ways that the adults around them believe to be normal. For example, many young children and preadolescents have difficulty making the transition from one activity to another, especially when the initial activity is pleasurable. We can see this when a parent asks a child to stop playing a game or to stop watching television in a minute, and get ready for dinner. The child promises to do exactly that, and makes that promise with great sincerity. But ten minutes later he’s still playing the game or watching TV, unaware that so much time has passed.

Is this a sign of addiction? No. It’s normal. In fact, it’s a reflection of brain development. But parents sometimes interpret this type of behavior as anything from spite to laziness. It’s not.

Finally, as parents we may unconsciously apply different standards to different behaviors. If a child plays basketball or plays the piano for four hours per day, we may describe him as a dedicated athlete or musician. A teenager who knows all the game statistics and trivia about a local professional football team, and who spends a lot of money buying jerseys and other memorabilia, is considered a true fan. It’s a socially acceptable hobby; in fact, it’s encouraged. But if that child takes the same approach to playing video games, spending hours each day at the computer and reveling in the details and strategies of play, we may worry about an addiction.

This concern leads parents and clinicians to focus on easily measured behaviors, such as the amount of time the child spends playing video games, instead of more useful indicators of a potential problem. Is your child finishing his schoolwork? Is he establishing balanced and reciprocal friendships with peers?

The danger in calling some children’s behavior a video game addiction if it’s not is that we might miss underlying problems such as depression. That’s a classic case of treating a symptom (e.g., a fever) and not the disease (e.g., a bacterial infection). On the other hand, if we don’t identify the behavior as a video game addiction when that’s what’s really going on, we may be distracted by other behavioral problems and miss the opportunity to treat the underlying cause.