Both Internet and offline video gaming have become a normal aspect of child development, with estimates of children playing video games ranging from 90% to 97%. Research on problematic video gaming (PVG) has grown substantially in the last decade. Much of that research has focused on community samples, while research on clinically referred children and youth is lacking. The present study includes 5820 clinically referred children and youth across 44 mental health agencies, assessed using the interRAI Child and Youth Mental Health Assessment. Logistic regression analyses revealed that older age, male sex, extreme shyness, internalizing symptoms, externalizing symptoms, and poor relational strengths are all significant predictors of problematic video gaming (PVG). Further analyses suggested that, out of the internalizing symptoms, anhedonia was predictive of PVG in both males and females, but depressive symptoms and anxiety were not predictive of PVG when controlling for other variables in the model. Moreover, proactive aggression and extreme shyness were predictive of PVG in males, but not in females. The implications of these findings are discussed.