Policy on unreliable game addiction diagnoses puts the cart before the horse.

Abstract

Internationally, several policies have been designed to prevent pathological or “problematic” gaming issues in youth, commonly referred to simply as ‘game addiction’. Particularly following the release of the World Health Organization’s (WHO) “gaming disorder” diagnoses, policy makers may be inclined to enact further policies on this matter. With new data reflecting lack of success for South Korea’s shutdown policy, the efficacy of current policy efforts remain in doubt. Given continued controversies regarding whether pathological gaming (PG) or gaming disorder (GD) is best conceptualized as a unique disorder rather than symptomatic of other, underlying disorders, little data has emerged to encourage policy interventions. By contrast, policy interventions at this juncture may risk doing considerable harm and wag the dog in the sense of reifying a pathological gaming disorder that remains problematic and under contentious debate in the field. We advise caution, ethnographic and qualitative research approaches, open science, etiological comprehension, and more time to fully understand whether pathological gaming is the best target for policy interventions and informing clinicians. In 2018 the World Health Organization (WHO) announced the release of their “gaming disorder” diagnosis, marking the first time that video gaming could be labeled as an addiction and a clinical disorder. Gaming disorder was defined by the WHO as gaming to an extent that it interferes with other life activities. The WHO did not provide further specific symptoms or clinical information, aside from classifying it as an addictive behavior, leaving much interpretation in the hands of clinicians. As clinicians rely heavily on clearly defined criteria, this may be considered an unorthodox approach not just to psychological research, but clinical research and utility which impacts millions of people everyday who seek out psychological services. By contrast, the American Psychiatric Association has proposed a category for further study, “internet gaming disorder” (IGD) which provides specific symptoms which are very similar to substance abuse and gambling disorder symptoms1. Research into this area has been convoluted at best suggesting the proposed criteria may not be measuring any meaningful construct which should be of concern to policy makers. However, as research on gaming overuse has been conducted for years prior without consistent results, the lack of solid conclusions should not be surprising. Even with the controversies surrounding problematic video gaming, clinics have been developed across the world to treat pathological gaming (PG) and gaming disorder (GD), even before the WHO’s official diagnosis. While some countries had already enacted policies designed to curb gaming overuse, potentially using poorly informed methods ultimately causing more harm than good, it appears probable that more countries may follow suit with policy efforts to curb gaming overuse. But are such policies effective, and is gaming overuse a conceptually valid target for such policies? This article focuses on evidence 1 For a discussion of the problematic origin of internet gaming disorder symptoms see (Nielsen 2018a, 2018b) regarding the efficacy of public policies targeting gaming overuse and provides suggestions for future policies. A Brief Overview of Gaming Overuse Research. Scholarship on gaming overuse began as early as 1983 when perhaps the first article on the topic referred to “junk-time junkies” (Soper & Miller, 1983). In the intervening 36 years a subject search on PsychINFO for [“pathological gaming” OR “video game addiction”] returned 101 articles. So this is definitely a topic of great interest. Several excellent reviews of this topic have been written from varying perspectives (e.g. Hellman et al., 2013; Pontes, 2018). A full summary of this nearly 4-decades old research field is beyond the scope of this paper. Thus our review here is summative. Much of the research has focused on the parameters of pathological gaming. These include issues such as it’s conceptual utility, means of diagnosis, biological or neurological markers (if any), distinguishing pathological from engaged gaming (e.g. Charlton & Danforth, 2007), cooccurrence with other mental disorders, as well as cultural reactions to new technology including technophobia and moral panic (Bowman, 2016). Despite several decades of research, opinions among scholars on these issues remain significantly divided. This is not to say that one view is correct and the other wrong, merely to note that a wide ranging literature has not always provided either consensus or clarity on these fundamental issues. Perhaps the one issue most scholars might agree upon is that some individuals play games instead of engaging in other life responsibilities. Yet, whether the games themselves are responsible for this, or whether gaming is a fun activity some people do to distract themselves from other mental health issues remains less clear. Nonetheless, several efforts have moved forward with implementing policies designed to target pathological gaming in hopes of reducing such behaviors. We now turn to a discussion of these policies. Currently Existing Policies Regarding Gaming Overuse Kiraly and colleagues (2018) present an important review of current policies targeted at the controversial pathological gaming (PG) concept. Policy approaches include those directed at limiting access to potentially overused technology, and those which are directed at providing warnings of some sort to users themselves. We briefly review each of these in turn. Policies Geared Toward Limiting Access. One way to reduce individuals’ risk of developing overuse of technology is to limit their access to that technology. Perhaps the most well-known example of a policy based on this premise is South Korea’s “shutdown” policy which attempts to limit minors’ access to the internet between the hours of midnight and 6am by requiring age verification for online use. This policy was implemented due to the perception that internet overuse had become prevalent among Korean youth and was impacting their health and grades. Thus, by carving out a particular “no use” time zone, the shutdown law is intended to free youth for adequate sleep and preparation for school and limit other mental health problems of overuse. The law was initiated in 2011, and has survived constitutional challenge in Korea but remains controversial. Regarding, the effectiveness of the shutdown law, evidence has generally not suggested the shutdown law is effective in improving youth mental health. Early work suggested that the law had little actual impact on youth internet use (Sung, 2014). More recently, the efficacy of the South Korean “shutdown” policy has been empirically evaluated (Lee, Kim & Hong, in press). This evaluation found that the policy increased youths’ nightly sleep totals by approximately 1.5 minutes and reduced the probability of developing gaming addiction by 0.7%, but only among female users. The authors concluded that the potential human rights costs of the policy and inappropriate regulation of speech were far greater than the modest gains in adolescent health. A more recent preregistered study (Przybylski, 2018) found that digital screen time had a small and non-practical effect (1.9% of the observed variability) on pediatric sleep. Przybylski additionally concluded that other contextual factors such as family life, school endeavors, and relationships were more culpable for a decline in sleep than screen time was. This finding further questions whether there is evidence for any form of regulation or shut down policy of the use of technology for children or adolescents. Other countries have also attempted shutdown laws of various sorts. Thailand enacted a shutdown law in the early 2000s, although later repealed it. Vietnam and China have also implemented or considered shutdown laws. In June 2018 French politicians voted to ban the use of mobile phones in primary and middle schools from September 2018. The reported aim of the legislation banning phones in schools is designed to improve students’ concentration and preventing cyberbullying and the watching of pornography. Criticisms of the ban have focused on the practicalities of teachers implementing and policing such a ban for all pupils. Fatigue Systems/Warning Messages. Fatigue systems are systems that disincentivized ongoing game play. These could take several forms, such as allotting fewer experience points, achievements, etc., to game play that occurs after a set time limit, or providing warnings to players once they’ve exceeded a certain time playing. At present, regulations regarding such systems appear limited to China (Kiraly et al., 2018) although they could be voluntarily included in platforms by designers themselves. Fatigue systems have received some critiques regarding potential privacy issues, and stopping points for game play that may cut-off play half-way through meaningful experiences. Empirical analyses of fatigue systems are few, although one analysis by Davies and Blake (2016) suggested that a system of soft warnings and gradually reduced incentives cause fewer disruptions that automatic shutdowns. However, incentives such as experience points only relate to a small part of gamer motivations and fatigue systems may have fewer impacts on intrinsic motivations such as those noted by Self-Determination Theory (Przybylski, Rigby & Ryan, 2010). In other words, if player motivations to play are intrinsic, manipulating extrinsic influences may produce few results. Ratings for Addictiveness. One other possibility would be to include potential ratings for a gamer’s addictiveness as part of ratings systems such as the Entertainment Software Ratings Board (ESRB) or Pan European Game Information (PEGI) systems. Likely, such ratings may be for specific mechanisms such as loot boxes (Drummond & Sa