TOP 59 - Relationship Between Video Game Features and Gaming Disorder in Young Children with Attention Deficit Hyperactivity Disorder

Publication Number: 3789.TOP 59

Emily Wassmer, Children’s Hospital of Philadelphia, Drexel Hill, PA, United States; Alex Holdaway, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Rachel Sanderlin, Childrens Hospital of Philadelphia, Brooklyn, NY, United States; Alexis Tomlinson, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Thomas Power, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: More than 80% of American children play video games, and evidence is accumulating that a substantial proportion of youth engage in problematic video game use. Recognizing the impact of video games on mental health, criteria for Internet Gaming Disorder (IGD) were proposed in DSM-5. These criteria have rarely been applied to clinical populations.

There is limited research on video game use in children with ADHD, a group vulnerable to developing addictive behaviors. There is also limited research examining the association of in-game features with the health and mental health of gamers. To our knowledge, there is no published research examining the impact of in-game features on children with ADHD.

AAP's screen time guidelines no longer recommend a maximum number of screen time hours by age, but instead encourage parents to focus on quality and content. Research is needed to inform pediatricians how to guide parents in selecting appropriate video games, especially in a vulnerable population like children with ADHD.

Objective: Examine the extent to which video game features - such as presence of a pause feature, online versus local play, use of voice chat during gameplay, and video game rating - are associated with problematic video game use in children with ADHD.

Design/Methods: IGD criteria were adapted into survey questions refined through feedback from community stakeholders, including caregivers and youth. This IGD screener was administered electronically to caregivers of children age 5-12 with diagnoses of ADHD who play video games. Exclusion criteria included diagnoses of autism and intellectual disability. Caregivers were asked for details about their child's video game play, such as which games they play and how long they typically spend playing. Caregivers were presented with a comprehensive list of video games in order to identify which video game their child spent the most time playing.

A total of 304 participants were enrolled. All data collection is complete.

Data Analysis Plan:
Covariates include age, sex assigned at birth, caregiver level of education, ADHD medication status, frequency of medication use, and medication type (stimulant vs non-stimulant). Predictor variables include time spent gaming on weekends, use of online chat while gaming, presence of a pause feature, and video game rating. Univariable and multivariable logistic regression models will be used to examine associations with screening positive for IGD.

Timeline:
Data analysis is currently ongoing and expected to be completed by December 2025.

Demographics
1n (%); Median (Q1, Q3)

50 subjects were excluded from the cohort, due to having no responses to the Vanderbilt measure. Gender and Assigned Sex were almost identical; 5 cases who were assigned female at birth noted gender as male (2), non-binary (1), or did not respond to the question (2). In Relationship to Child, other contained 1 adoptive father, and 1 grandmother, the rest were unknown. In `Race`, the `Unknown or Other` contained 1 American Indian or Alaska Native subject, 1 Asian and Hispanic subject, 1 Native Hawaiian or Pacific Islander subject, 1 Middle Eastern or North African subject, and 2 subjects of whom their race was unknown. IEP refers to an Individualized Education Plan, which offers specialized educational instruction and services under the Individuals with Disabilities Education Act (IDEA). IDEA is a law that makes available a free appropriate public education to eligible children with disabilities throughout the United States and ensures special education and related services to those children. 504 refers to a 504 Plan, which provides school-based accommodations for children with physical or mental challenges. Section 504 of the Rehabilitation Act of 1973 prohibits discrimination on the basis of disability in programs or activities that receive federal financial assistance from the U.S. Department of Education.

Preliminary Univariate Analysis
1n (%)

2Pearson's Chi-squared test; Fisher's exact test