This essay from CHADD is included in Social Media, Gaming and Mental Health, our 2019 Children’s Mental Health Report.

Electronic device use in general — and video games in particular — can be benign in moderation but destructive in excess. This capacity, similar to drugs and alcohol, is why in 2018 the World Health Organization recognized internet gaming disorder. This disorder is distinguished from simple excessive video gaming by craving, impaired control, priority given to gaming over other activities, and continuation or escalation despite negative consequences. Both addiction and excessive use can interfere with normal development by occupying time needed for socialization and broader activities.

People with ADHD are more likely than typical peers to play video games excessively, although the majority of those with ADHD are not addicted. There is accumulating evidence that the same brain circuits and neurotransmitters that are low-functioning in ADHD are also low in individuals addicted to video games (whether or not they have ADHD), and that video games activate brain reward circuits and increase dopamine similarly to stimulant medication and addicting drugs. This suggests that people with ADHD, who have underactive reward circuits and low dopamine, are especially at risk for dependence not only on substances, but also on the pleasure, escape and fast action of video games.

Internet use and video gaming are part of the current culture. Therefore, parents of children with ADHD need to guide them in appropriate participation in that culture. Research suggests that up to an hour a day can build useful skills and up to two hours does not seem especially harmful, but additional time is increasingly associated with impairments mentally, socially, and emotionally.

Children may need support in limiting their device time. Parents may need to set smartphones to disable apps after a certain hour. Treatment of underlying mental health problems may be necessary. A person with ADHD might find medication useful in controlling gaming time along with other challenges of the disorder. In-person social or athletic activities may help fill the time previously occupied by video games. Accentuating the positive may help eliminate the negative.

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