Predictors of Videogame Addiction in Adolescents with ADHD
In April 2023, I presented a poster on videogame addiction among adolescents with ADHD at the Southeastern School Behavioral Health Conference in Myrtle Beach, SC. My co-presenters were Nadia Ochoa (doctoral student) and Steven W. Evans (Ohio University).
We examined how middle school students with ADHD rate themselves on the Game Addiction Scale (GAS), a validated measure of disordered videogaming, and the degree to which these scores are predicted by ADHD symptomology (i.e., subtype) and sex assigned at birth. As expected, adolescents with ADHD were significantly more vulnerable to disordered gaming than a norm sample of typically-developing peers. Biological sex was a significant predictor of GAS total score, whereas symptomology was not. Screening for videogame addiction among adolescents with ADHD may be a critical component of intervention planning.
Videogame overuse and/or abuse is a potential disorder proposed for further study in the DSM-5-TR (“Internet Gaming Disorder”; APA, 2022). Children and adolescents with ADHD appear to be especially vulnerable to disordered gaming, which can exacerbate academic and social impairments for this population (Mathews et al., 2019).
A measure of disordered gaming, the Game Addiction Scale (GAS; Lemmens et al., 2009), has been validated for use with adolescents, but boys and girls respond differently. Boys report far greater use of videogames, while girls experience greater game-related impairment (André et al., 2022). One potential explanation is that game addiction is driven by hyperactivity-impulsivity, which is relatively rare for girls except in the case of severe ADHD (Stavropoulos et al., 2019). Thus, girls who report problematic gaming behaviors may also experience the most severe and impairing ADHD.
In the present study, we compared GAS responses from boys and girls and examined the degree to which disordered gaming can be predicted from ADHD symptomology.
Method. All procedures were pre-approved by the Institutional Review Boards at East Carolina University and Ohio University.
Thirty-one young adolescents with ADHD were recruited from middle schools in North Carolina and Ohio to participate in a pilot study examining a novel educational videogame (pre-registered with clinicaltrials.gov, NCT05048043). During intake, participants completed the 7-item short form of the Game Addiction Scale (Lemmens et al., 2009) while parents completed the ADHD Rating Scale-5 (ADHD-5; DuPaul et al., 2016). Demographic information was collected from parents using a standard clinic form. Results from these measures are summarized in Table 1.
Table 1: Sample Demographics and Rating Scale Data
We first assessed the degree to which our sample reported disordered gaming behavior, which we expected based on previous research. Using a single-sample t-test and comparing our group to the norm sample of the GAS (item-level mean = 1.54; Lemmens et al., 2009), our participants reported significantly higher levels of problematic gaming, t(30) = 7.59, p < .001, d = 1.33.
Next, we examined the correlations between biological sex (coded as Boys = 1, Girls = 2), the GAS, and the ADHD-5. Biological sex was weakly correlated with inattention (r = -.11) and hyperactivity-impulsivity (r = -.29), and was moderately correlated with total GAS score (r = -.45). GAS score was positively but only weakly correlated with inattentive (r = .21) and hyperactivity-impulsivity symptoms (r = .18).
Finally, we used hierarchical multiple regression to assess how well biological sex and ADHD symptomology predict participants' ratings on the GAS. We entered sex into the model in Step 1 and then the continuous symptom measures from the ADHD-5 in Step 2. The results are summarized in Table 2.
Table 2: Hierarchical Multiple Regression Results for the Total Score of the GAS
The model predicting GAS scores from biological sex (Step 1) accounted for a significant amount of variance, F(1, 30) = 7.47, p = .011. The addition of ADHD symptomology (i.e., inattentive and hyperactive-impulsive symptoms) in Step 2 did not significantly increase the amount of variance explained, F(3, 30) = 2.72, p = .064. The first model (Step 1) accounted for approximately 21% of the variance and appears to be the best fitting model. According to these results, boys are predicted to report a higher total score on the GAS by 5.70 points on average when compared to girls. The failure at Step 2 to improve the prediction suggests that symptomology does not provide helpful information. The relative distributions of GAS total score results for boys and girls are depicted in Figure 1.
Figure 1. Raincloud Plot of the GAS Total Score Results for Boys and Girls
Consistent with previous research, we found that young adolescents with ADHD report significantly more disordered gaming behaviors than do their typically developing peers. This was especially true for boys. Our results suggest that boys report a higher total score on the GAS—roughly 5.70 points on average—when compared to girls. Interestingly, the addition of ADHD symptomology did not improve the prediction of GAS scores, although it should be noted that all participants in this study were diagnosed with ADHD. Hence, our results appear to suggest that symptom profiles do not add significant predictive value beyond biological sex and any ADHD diagnosis. This finding is inconsistent with the hypothesis that disordered gaming is related specifically to hyperactive-impulsive symptoms.
Limitations. First, our sample size was limited, so the results must be interpreted with caution. For instance, we only examined GAS scores for 13 girls, and their distribution was clearly skewed, with two apparent outliers (see Figure 1). Second, the GAS was normed with Swedish adolescents in 2009, so our comparison to modern American adolescents may over- or under-estimate problematic gaming behaviors. And third, the GAS may have two or three discernable subscales (cf. Lemmens et al., 2009), but we were underpowered to test multivariate models. That said, the internal reliability of the GAS total score in this sample was good (α = .80), suggesting our analysis was reasonable.
Conclusions. Adolescents with ADHD report significantly more disordered gaming behaviors than typically developing peers, and this is most reliably predicted by biological sex: Boys are significantly more likely than girls to overconsume videogames. Thus, clinicians working with this population are strongly encouraged to monitor videogame use, especially among boys, and to consider whether academic or social impairments typically attributed to ADHD might be caused or exacerbated by problematic gaming behaviors (e.g., spending more time playing games than anticipated, neglecting important responsibilities).
André, F., Munck, I., Håkansson, A., & Claesdotter-Knutsson, E. (2022) Game addiction scale for adolescents—Psychometric analyses of gaming behavior, gender differences and ADHD. Frontiers in Psychiatry, 13, 791254. https://doi.org/10.3389/fpsyt.2022.791254
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Text Revision. American Psychiatric Association Publishing.
DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (2016). ADHD Rating Scale - 5 for Children and Adolescents: Checklists, Norms, and Clinical Interpretation. The Guilford Press.
Lemmens, J.S., Valkenburg, P.M., Peter, J. (2009). Development and validation of a game addiction scale for adolescents. Media Psychology, 12, 77–95. https://doi.org/10.1080/15213260802669458
Mathews, C. L., Morrell, H. E., & Molle, J. E. (2019). Video game addiction, ADHD symptomatology, and video game reinforcement. The American Journal of Drug and Alcohol Abuse, 45(1), 67-76. https://doi.org/10.1080/00952990.2018.1472269
Stavropoulos, V., Adams, B.L.M., Beard, C.L., Dumble, E., Trawley, S., Gomez, R., & Pontes, H.M. (2019). Associations between attention deficit hyperactivity and internet gaming disorder symptoms: Is there consistency across types of symptoms, gender and countries? Addictive Behaviors Reports, 9, 100158 https://doi.org/10.1016/j.abrep.2018.100158
The research in this presentation was supported in part by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A180219 to East Carolina University and Ohio University. The opinions expressed in this presentation are those of the authors and do not represent the views of the Institute or the U.S. Department of Education.
Ochoa, N., Schultz, B.K., & Evans, S.W. (2023, April 20). Predictors of videogame addiction in adolescents with ADHD [Poster Presentation]. Southeastern School Behavioral Health Conference, Myrtle Beach, SC, United States.