Video games have long been a source of controversy when it comes to childhood and adolescent development.

As an estimated 91 percent of children ages 2 to 17 play video games, the prevalence of gaming isn’t in question, but rather the potential adverse effects of excessive play.

It’s important to recognize that video game addiction isn’t officially recognized as a diagnosis or disorder in all places.

The World Health Organization included “gaming disorder” in its reference book, International Classification of Diseases, beginning in 2018.

It’s defined as “a pattern of gaming behavior… characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences” for at least 12 months.

However, the American Psychiatric Association’s manual, The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), doesn’t include a diagnosis of gaming disorder. Instead, gaming disorder is suggested as an area in need of further research.

At the same time, one 2018 review estimated that 2 to 5.5 percent of adolescents and young adults may have a video game addiction, raising concerns about the development of gaming disorders.

One area of concern for some parents is if there is a connection between video gaming and attention deficit hyperactivity disorder (ADHD), a common neurodevelopmental disorder known for causing chronic patterns of hyperactivity, impulsivity, and inattention.

Some studies have sought to understand whether those diagnosed with ADHD are more likely to show signs of gaming addiction. Some have also raised questions about whether video gameplay can contribute to the development of ADHD or ADHD-like symptoms.

However, it’s important to note that “contrary to multiple conspiracy theories on the internet, video games do not cause ADHD,” says Pareen Sehat MC, RCC, clinical director at Well Beings Counselling.

Video games can appeal to individuals with ADHD in numerous ways, explains Dr. Olivia Grace, a clinical psychologist who specializes in acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) for video game addiction and internet gaming disorder at The Mindful Gamer.

“Video games these days typically bombard the player with achievements, rewards, and goals to accomplish within the first few moments of playing,” says Grace.

“Most actions within video games are fast-paced, requiring intense focus and reaction time, which allow them to enter a deep state of focus that they find difficult to reach during any other activity.”

All of these aspects of gaming may particularly appeal to people with ADHD. However, while children with ADHD may have an increased risk for addictive behaviors toward video games, there’s no clear, definitive link between playing video games and the development of ADHD in children

It’s also important to differentiate between excessive video game use and an addiction to video games. And, finally, there may be some benefits to certain types of video game play.

Here, we break down what the latest research has to say about video games as they relate to ADHD.

Over the last several years, researchers have been studying whether children with ADHD may be more likely to exhibit excessive video game use, and possible symptoms of gaming addiction.

“Since children experiencing these conditions have difficulty focusing on certain things,” explains Sehat, “they can often find refuge in the fast-paced world of quick decision-making and activities that do not exert pressure on their mind.”

According to one such recent study published in 2021, excessive video game play was correlated with more severe ADHD symptoms. The researchers also noted a higher risk of excessive use of video games present in boys.

At the same time. the study also recommended further research to explore the possible benefits of video games. Indeed, the “stimulating screens help to grab the attention of the person and keep them there as opposed to looking at a whiteboard in a learning environment,” says Grace.

Another study from 2018 also explored video game use in children diagnosed with ADHD.

Here, researchers looked at 80 children with ADHD and 102 children without ADHD who played video games. They found a significant difference in compulsive video game use between the two groups: 37.5 versus 11.8 percent, respectively.

While the researchers noted a higher risk of gaming addiction in the children with ADHD, they also noted excessive video game use in both groups. These findings suggest that excessive video game use in children may be increasingly prevalent, but for certain groups of children, the risk of gaming addiction may be less of a concern.

A 2017 study relied on surveys of parents to evaluate video game use in children. Their results suggested that problems with video game play indicated boys were playing video games more frequently and for longer durations than their female peers.

As a result, boys were more often rated to be at risk of or of having a computer gaming disorder than girls.

The study indicated that children who had elevated ADHD scores also showed elevated computer gaming disorder scores. Researchers also noted that “clinically relevant inattention scores were associated with longer and more computer gaming.”

A 2018 review that evaluated the research on children with ADHD behaviors and overall screen use found that there is much that remains to be explored in future studies.

While the researchers acknowledged a small connection exists between media use and ADHD-related behaviors, they emphasized the need for more research to establish an understanding of possible causes or influential traits or characteristics.

A 2021 study looked broadly at digital media use in children with ADHD during the pandemic. Their findings suggested that children with ADHD that also showed signs of problematic digital media use (PDMU) experienced more challenges and symptoms than children with ADHD who did not show signs of PDMU. Issues included inattention, lower motivation, oppositional defiant behavior, anxiety, and issues with executive function.

The researchers suggest that increased adult supervision of child media use and increased physical exercise can have a positive impact on behavioral challenges and other stressors experienced by children who have a problematic level of screen time.

While the above studies suggest an increased incidence of video game play-related problems in children with ADHD, researchers are also looking at ways therapeutic video games may be helpful in treating ADHD.

One such study published in 2020 focused on children ages eight to 12. Researchers examined a therapeutic video game as an addition to the current standard of care, seeking to provide a new therapeutic option that may address some of the barriers to standardized treatments.

Here, participants were instructed to play video game-like designs for 25 minutes a day, and 5 days a week for 1 month. At the conclusion of the study, parents of the participants noted improvements in inattention and a low risk of side effects.

“Using certain video games to educate children with ADHD can prove to hold their attention far better than conventional teaching methods,” says Grace. “As for video game addiction directly worsening attentiveness in individuals, there is little to support this claim.”

The rise in popularity in video games as well as the potential compulsive use in children with ADHD has led some companies to create video game-based treatments. While this may seem counterintuitive, such games are designed to improve focus and attention, and they also come with time restrictions.

For example, in June 2020, the Food and Drug Administration (FDA) cleared a video game treatment called EndeavorRx, which is designed for the treatment of ADHD in children ages 8 to 12. The game is designed to target attention skills and is recommended to be played for about 25 minutes a day, 5 days a week. It’s not designed to be a stand-alone treatment or a replacement for medication.

However, the rollout of the technology isn’t without controversy. For one, some researchers have raised concerns over possibly prioritizing video games over proven, effective ADHD treatments, such as medications and therapies.

They also raise concerns that parents may confuse FDA clearance with the level of research required to be considered an evidence-based treatment (the gold standard for treatment), the latter of which EndeavorRx has not yet been granted.

Grace agrees. “As is the case with many forms of online treatment they are explicitly stated not to be used as a stand-alone therapy and are not a substitution for any existing medication,” she says.

“While they show some benefits with regards to attention span they should mainly serve as a supplementary aid to their existing treatment as the research is still very limited.”

It’s important to note that the latest research doesn’t suggest that children and adults with ADHD should refrain from video game use entirely.

Instead, it may be worth assessing current video game use and whether excessive play may worsen your child’s symptoms. It’s also important to look for signs of a disorder in relation to video games.

The DSM-5 currently recognizes internet gaming disorder, in which gaming causes “significant impairment or distress” in everyday life as warranting further research, not as an established diagnosis.

The symptoms being proposed for the disorder include:

  • excessive preoccupation with gaming
  • replacing other activities you once enjoyed with video games
  • inability to reduce gaming time
  • experiencing anxiety, sadness, and other withdrawal symptoms when you’re not gaming
  • continuing to play games despite disruptions to school, work, or relationships
  • tolerance to gaming; needing to spend more time playing to satisfy urges to play
  • deceiving friends and family about the amount of time spent with gaming
  • using gaming to relieve negative moods, such as hopelessness
  • risking or losing relationships or jobs because of gaming

Under the proposed criteria, a diagnosis of internet gaming disorder would require experiencing five or more symptoms within a year.

The condition includes gaming on the internet or any electronic device, though most people who experience such problems primarily use the internet for gaming. If you’re concerned about potential gaming disorders, contact your child’s pediatrician for help.

Another consideration is the social aspect of video games, which may appeal to some people with ADHD due to underlying social anxiety.

“Through video games,” explains Grace, “they have a place to meet friends with similar interests and interact with the anonymity and safety of the internet to protect them.”

Such social interaction does have benefits in helping children develop and maintain a certain kind of relationship. The downside, says Grace, is “when the interaction between friends online takes priority over real-life relationships and interactions.”

To establish a structured plan for appropriate screen time and video game play in the home, consider:

  • setting a schedule
  • using tools to monitor or limit screen usage
  • encouraging play both indoors and outdoors
  • promoting time spent with others that isn’t just virtual
  • working with your doctor or a mental health professional to address concerns

As a parent, it’s important to realize that an increased prevalence and popularity of smart technology and gaming consoles ultimately means your child may be exposed to more video games.

If your child enjoys playing them, it can be helpful to set a schedule together to avoid excessive use while still encouraging fun play, social interaction, and time spent outside.

However, if you’re concerned that video game use may be worsening ADHD symptoms or interfering with daily functioning or activities, it may be worth reaching out to a doctor or mental health professional to discuss your concerns.