Recent findings on the psychiatric and behavioral effects of video games on children with ADHD

Abstract

Introduction The relationship between symptoms of attentiondefi cit/ hyperactivity disorder (ADHD) and the playing of video games is not well understood. The American Medical Association and American Academy of Child and Adolescent Psychiatry have refl ected this ambi valence in recommendations and press releases [1,2]. Because video games are among the most popular pastimes of children and teenagers and ADHD is one of the most common childhood psychiatric diagnoses, pediatricians, family practice physicians, and child psychiatrists commonly encounter children with ADHD who play video games regularly. How are we to advise them and their families? Research historically has focused on the negative consequences of playing video games; however, recent studies are illuminating the possible benefi ts. It was argued in one publication that children with ADHD may be using video games as a form of self-medication [3]. Video games may boost self-esteem in a population of children who derive little of it from their schoolwork or family life [4]. Additional research has shown that for boys with ADHD, interactive games can improve classroom learning and social relationships [5]. Evidence indicates that the presence of a computer in the home of a preschool child can improve school readiness and cognitive development regardless of the frequency of access to or ownership of child electronic games or video games in the household, the socioeconomic status of the family, or the developmental stage of the child [6]. Lastly, some evidence suggests that action video games may briefl y improve certain cognitive functions [7]. The issue of the relationship between aggression and video game play is important but complicated by various studies suggesting that exposure to video game violence can increase, reduce, or have no infl uence on aggressive behavior. This relationship was examined in 13 studies published between 1984 and 1996. These different studies showed that playing video games can result in increased aggression, no aggression, or an increased calming effect [8]. A more recent review of the literature found an association between violent video games and short-term aggressive behavior; however, due to study limitations, the authors found it diffi cult to establish a causal effect between playing video games and long-term aggressive behaviors [9]. Some correlation seems to exist between the neurotransmission characteristics of people who play video games and people with ADHD, but this correlation also remains unclear. The dopamine hypothesis of ADHD implicates variants in dopamine receptor subtypes and dopamine transmission in the pathology of ADHD. Decreased dopamine release in the corticostriatal pathway has been observed in individuals with ADHD [10,11]. Some evidence indicates that video game play is associated with dopamine release and low-function D2-receptor polymorphism [12,13]. I believe that at the current state of research, it is premature to advise families to eliminate video games from the lives of children with ADHD, at least until the negative and potentially benefi cial effects of playing video games (colloquially known as gaming) are better characterized. The following is a summary of recent research fi ndings on the psychiatric and behavioral effects of video games on children with ADHD. I hope that this summary better prepares clinicians when they discuss video games with families. This commentary does not address ergonomic or physical problems associated with video games, a topic that has been reviewed elsewhere [14].