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Internet and Gaming

Addiction
Mobile
legends

Loudella V. Calotes-Castillo, MD
Pediatric Neurologist

Clinical Associate Professor

University of the Philippines – Philippine General Hospital
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Disclosure/Disclaimer
Although I advocate for mental health as a child neurologist, I am not a child
psychiatrist, or a clinical psychologist or therapist.

I do not have any relevant conflicts of interest to declare.

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Pediatric Neurologist’s role

Solution

To recognize and treat childhood

diseases of the nervous system To ensure that the brain is
(brain, spinal cord, nerves and developing appropriately for age
muscles)
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Key Questions

How is the developing What is Internet and

1 brain affected by 2 Gaming Disorder (IGD)?
excessive digital media
use?

What are the red flags How can IGD be

3 of IGD? 4 prevented?
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Developing brain:
And digital media use OR screen time
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Brain development

EXPERIENCE-DEPENDENT SYNAPSE FORMATION

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Brain development
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Brain MRI and white matter

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Human connectome project

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Language Development affected by intensive digital media use

Speech PROCESSING
Clear correlation between intensive early childhood
digital media use and poorer microstructural integrity of
white-matter tracts between the language areas.
Speech PRODUCTION
Korte M. The impact of the digital revolution on human brain and behavior: where do we stand? Dialogues in Clinical Neuroscience. 2020.
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Higher digital media use

Executive functions

Literacy abilities

Behavioral measures

Korte M. The impact of the digital revolution on human brain and behavior: where do we stand? Dialogues in Clinical Neuroscience. 2020.
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Adolescent brain

Lack of effective effortful control

Highly activated reward circuitry

High impulsivity
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Internet gaming disorder:

Definition, epidemiology and neurobiology
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Internet Gaming Disorder

DSM-V (Conditions for further study)

Predominantly online gaming disorder is a

separate entity in the International
Classification of Diseases (ICD-11)

Internet Addiction (IA) or “compulsive internet

use,” problematic internet use”, “pathological
internet use”
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Internet Gaming Disorder

American Psychiatric Association

Persistent and recurrent use of the internet to

engage in games, often with other players,
leading to clinically significant impairment or
distress.

● Screening tools

● Clinical interview for red flags

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Internet Gaming Disorder

Pathologic video game use

Versus

High game play frequency

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Internet Addiction (IA)

IA is a non-chemical behavioral
addiction, which includes human-
machine (computer-internet) interaction.
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Adolescent brain

Lack of effective effortful control

Highly activated reward circuitry

High impulsivity
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How frequent is IGD?

Americans Dutch
8.5% of gamers
5.5 % among adolescents
(8-18 years) met
6 of 11 criteria

Singaporeans
9% among
Australians
elementary and
secondary schools 5% met 4 of 9
criteria
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51% in the Philippines

This is a big number to highlight an important data
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Four components essential to Internet addiction

diagnosis

Excessive Withdrawal Tolerance Negative

internet use symptoms Need to spend consequences
Loss of time or Mood swings increasing Loss of previous
neglecting basic amounts of time hobbies
functions on the internet
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Comorbidity

INTERNET ADDICTION

DEPRESSION

ADHD ANXETY

Tereschchenko S and Kasparov E. Neurobiological Risk Factors for the Development of Internet Addiction in Adolescents. Behavioral Sciences. 2019
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Red flags of IGD:

DSM-5 criteria
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5 or more of 9 criteria within a 12-month period

1 2 3 4 5
Preoccupation Withdrawal Tolerance Unsuccessful Loss of interest in
with games symptoms attempts to real-life relationships
control
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5 or more of 9 criteria within a 12-month period

6 7 8 9

Continued Deceived Use of games Jeopardized

excessive use of family and to escape or or lost
games friends relieve a relationship
Despite psychosocial Regarding negative
problems amount of mood
gaming
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Most at risk for developing symptoms of internet

addiction

● Impulsivity?
● Lower social competence?
● Higher amounts of game play?
● Negative parental attitudes
toward gaming
● Lower family functioning
● Adaptive problems
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Increased gaming time

Levels of depression

Academic declines

Worsened relationships with

parents over time

Increased aggressive tendencies

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Adverse effects of excessive internet use

Increased Decrease in Lower levels Sleep

aggressive empathy of prosocial deprivation
behavior behavior Metabolic
Violent video problems;
games increased in
stress levels
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Things on IGD we don’t know yet

Risk factors Course

Who is most at risk? Duration? Continuous vs intermittent?

INTERNET GAMING DISORDER

Effective treatment Type of video game
Insufficient evidence
associated with IGD
Characteristics of games, to
determine the direction of
influence
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Measures to prevent IGD:

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Primary care providers

are ”first responders”

For issues related to children’s

media use

Gentile DA et al. Internet and Gaming Disorders in Children and Adolescents. Pediatrics 2017
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Healthy Digital Media Use

For children younger than 2 years

● Media use should be very limited and
only when an adult is standing by to co-
view, talk, and teach.

● For example, video-chatting with family

along with parents.

AAP. (2016). Media and young minds. Pediatrics. http://doi.org/10.1542/peds.2016-2591.

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Healthy Digital Media Use

For children 18-24 months, if you

want to introduce digital media:

● Choose high-quality programming.

● Use media together with your child.
● Avoid solo media use.

AAP. (2016). Media and young minds. Pediatrics. http://doi.org/10.1542/peds.2016-2591.

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Healthy Digital Media Use

For children 2 to 5 years of age:

● Limit screen use to no more than 1 hour

per day.
● Find other activities for your children to
do that are healthy for their bodies and
minds.
● Choose media that is interactive, non-
violent, educational, and prosocial.
● Co-view or co-play with your children

AAP. (2016). Media and young minds. Pediatrics. http://doi.org/10.1542/peds.2016-2591.

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Healthy Digital Media Use

For grade-schoolers and teens:

● Don’t let media displace other important

activities such as quality sleep, regular
exercise, family meals, “unplugged”
downtime.
● Agree to set a duration (visible timer)

Media Use in childhood: Evidence-Based Recommendations for Caregivers. https://www.apa.org/pi/families/resources/newsletter/2019/05/media-use-childhood.

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Healthy Digital Media Use

For all ages:

● Be a media mentor
● Co-view media with your kids
● Media not be located in the bedroom
● Video game play not begin within half an
hour before sleep time

Media Use in childhood: Evidence-Based Recommendations for Caregivers. https://www.apa.org/pi/families/resources/newsletter/2019/05/media-use-childhood.

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Recommendations for educators

Education about IGD Screening in school

1 Routine inclusion in schools 2 Consistent link between IGD and
poor school performance

Provision of training
Schools and community
to parents and
3 educators
4 create nongaming
opportunities
To recognize potential
Together with parents
problems

Gentile DA et al. Internet and Gaming Disorders in Children and Adolescents. Pediatrics 2017
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Take home message

1 The developing brain is

vulnerable to excessive digital
2 Internet and Gaming Disorder
(IGD) is now included in DSM-5
media use.

Excessive internet use,

3 tolerance, withdrawal and 4 Start right with a healthy
digital media use
negative consequences are
essentials in IGD diagnosis
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lvcalotescastillo@up.edu.ph

Dr Loudella Calotes-Castillo

Dr Louddie Calotes-Castillo

Loudella Calotes-Castillo

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