The Health Effects of Video Games in Children and Adolescents

The relationship between screen time, screen content for children aged 1-3, and the risk of ADHD in preschools

OBJECTIVE

This study investigates the relationship between screen time, screen content, and the risk of Attention Deficit Hyperactivity Disorder (ADHD) using data from a large sample. Specifically, it examines how different types of screen content (such as educational videos, cartoon videos, and interactive videos) are associated with the risk of ADHD. The aim is to offer a scientific foundation for the rational management of children's screen time and screen content.

METHODS

We collected data through a questionnaire survey involving a study population of 41,494 children from Longhua District, Shenzhen City, China. The questionnaire recorded the daily screen time and the type of content viewed by the children at ages 1-3 years and assessed their risk of ADHD using the Strengths and Difficulties Questionnaire (SDQ) at ages 4-6 years. Hierarchical logistic regression analysis, controlling for confounding factors, was employed to explore the associations between screen time, screen content, and ADHD risk.

RESULTS

In the total sample, 6.7% of the participants had screen time exceeding 60 minutes per day, with educational videos predominant type (63.4%). 16.5% of the participants were identified as being at risk for ADHD. Statistically significant positive associations with ADHD were observed across all categories of screen time (P<0.001). Moreover, as screen time increased, the risk of ADHD also rose (OR1~60 mins/d=1.627, 95%CI=1.460~1.813; OR61~120 mins/d=2.838, 95%CI=2.469~3.261; OR>120 mins/d=3.687, 95%CI=2.835~4.796). Significant positive associations with ADHD were observed across all categories of screen time in the educational videos and cartoon videos. For the educational videos group, the odds ratios were as follows: OR1-60 mins/day=1.683 (95% CI=1.481-1.913), OR61-120 mins/day=3.193 (95% CI=2.658-3.835), and OR>120 mins/day=3.070 (95% CI=2.017-4.673). For the cartoon videos group, the odds ratios were: OR1-60 mins/day=1.603 (95% CI=1.290-1.991), OR61-120 mins/day=2.758 (95% CI=2.156-3.529), and OR>120 mins/day=4.097 (95% CI=2.760-6.081). However, no significant associations with ADHD risk were found for any category of screen time in the interactive videos group (OR1~60 mins/d=0.744, 95%CI=0.361~1.534; OR61~120 mins/d=0.680, 95%CI=0.296~1.560; OR>120 mins/d=1.678, 95%CI=0.593~4.748).

CONCLUSION

Increased screen time is associated with a higher risk of ADHD, particularly for educational and cartoon videos, while interactive videos show no significant link. To mitigate this risk, parents and educators should implement strategies such as setting time limits, encouraging breaks, and promoting alternative activities. Future research should focus on longitudinal studies and intervention trials to further explore and address this relationship.

From Controller to Screen: A Narrative Review of Video Games in Medicine

Video games have become a global phenomenon in modern society as a means of entertainment, social interaction, and stress relief. Although they are often associated with negative effects, such as a lack of productivity and a sedentary lifestyle, research on video games displays potential benefits in everyday life and medical training. This narrative review provides an overview of video games and their contributions to stress relief, surgical dexterity, and cardiovascular health in the context of medical education and general wellness. To conduct this study, a comprehensive literature review search was performed utilizing PubMed and Google Scholar, placing emphasis on studies that discussed video games in society, in medicine, and in association with health. The following search terms were included: "video games in medicine," "video games and mental health," "video games and cardiovascular health," "video games and surgery," and more. Exclusion criteria for this review included papers not written in the native English language and case reports due to inherently small sample sizes. Video games show promise in relieving stress and increasing cognition, improving surgical dexterity and hand-eye coordination, and improving general cardiovascular health. They pose as a potential implementation to improve the health and wellness of medical trainees. Despite the negative societal implications of video games, there is evidence that they provide health benefits and help hone skills needed in medicine. By reducing stress, preventing long-term disease, and increasing surgical skills and dexterity, video games tap into factors from which all people, especially physicians and medical trainees, can benefit from.

Association Between TikTok Use and Anxiety, Depression, and Sleepiness Among Adolescents: A Cross-Sectional Study in Greece

INTRODUCTION

TikTok use is increasing, especially among children and adolescents. However, the negative effects of TikTok use have not been sufficiently investigated.

AIM

To examine the association between TikTok use and anxiety, depression, and sleepiness in adolescents.

METHODS

We conducted a web-based cross-sectional study in Greece. We employed a convenience sample of 219 adolescents in Greece. All participants had a TikTok account. We used the TikTok Addiction Scale (TTAS) to measure TikTok use and the Patient Health Questionnaire-4 (PHQ-4) to measure anxiety and depression. We constructed multivariable regression models, and we performed a stratified analysis according to gender.

RESULTS

The mean age was 18.5 years (standard deviation: 0.5, range: 18 to 19). In our sample, 81.3% were girls and 18.7% were boys. Mean daily TikTok usage and TTAS scores were statistically higher for girls than for boys. Our multivariable linear regression analysis was adjusted for age and showed that problematic TikTok use was associated with higher levels of anxiety and depression symptoms in both genders. In particular, we found a positive association between mood modification and anxiety score (beta = 0.404, p-value = 0.006). Moreover, we found a positive association between conflict and depression score (beta = 0.472, p-value < 0.001). Additionally, we found that the impact of TikTok on anxiety and depression was greater among boys than girls. We also found that problematic TikTok use was associated with increased sleepiness in both genders (mood modification: beta = 0.655, p-value < 0.001; conflict: beta = 0.674, p-value < 0.001).

CONCLUSIONS

Our findings showed a positive association between TikTok use and anxiety, depression, and sleepiness. Early identification of problematic TikTok users is essential to promote their mental health and well-being. Healthcare professionals should be alert to recognize symptoms of problematic TikTok use.

Child's-eye views of smartphone-based gaming content: objective insights from Aotearoa New Zealand

Children's engagement with smartphone-based (online) gaming content is rapidly increasing. There appears to be no existing objective evidence of children's exposure to this content captured in real time. Evidence on preteens' smartphone-based gaming is especially scarce. This study aimed to objectively explore the nature and extent of preteens' exposure to smartphone-based gaming content. Sixty-six children aged 11-13 years from 16 schools in the Wellington region of New Zealand used Zoom video teleconferencing software to record real-time, screen-shared internet use for 4 consecutive days. On average, children recorded 164 minutes each over the 4-day study period. Recordings were coded for gaming content by activity, using game applications and watching gaming content using social media. Game application characteristics were also recorded. Of every online hour recorded, 28.6% showed gaming content-using game applications (18%) and watching (10.7%). Male and low-deprivation children recorded more gaming content as part of their screen-shared internet use than female and high-deprivation children. Game application time comprised gameplay (56.6%), non-gameplay (43.4%), and included advertising 16.4% of the time. Most games were 'Advergames' [games including advertising (85.7%)], were free-to-play (98.4%), and included in-game purchases (87.3%). One-quarter (25.5%) included 'Random Items' (e.g. loot boxes) as part of these purchases, and 28.6% allowed users to interact with other users. While 'playing' using smartphone game applications, children are exposed to highly commercialized contexts that include manipulative design features, adult themes and advertising. Children, who are most vulnerable to online harms, must be protected in accordance with the United Nations Convention on the Rights of the Child.

The Impact of Parental Behaviors on Children's Lifestyle, Dietary Habits, Screen Time, Sleep Patterns, Mental Health, and BMI: A Scoping Review

BACKGROUND AND OBJECTIVES

Childhood obesity and being overweight are influenced by the family environment, diet, sleep, and mental health, with parents playing a key role in shaping behaviors through routines and practices. Healthy parental habits can encourage positive outcomes, while poor routines and stress often lead to unhealthy weight gain. This study analyzed the impact of parental behaviors on children's lifestyles and habits, as well as the trend and intensity of the effect of these behaviors on different age groups.

METHODS

A systematic review of 1504 articles from Web of Science, PubMed, Scopus, and APA PsycNet (as of 22 July 2024) included studies on parents and children aged 4-18 years, focusing on physical activity, sleep, screen time, nutrition, and mental health. Twenty-six studies were analyzed, including 19 cross-sectional and 7 longitudinal studies. The outcomes included physical activity, sedentary behaviors, eating and sleeping habits, mental health, and BMI. Bias was assessed using JBI tools according to the GRADE framework and Newcastle-Ottawa Quality Assessment.

RESULTS

The studies involved 89,545 youths and 13,856 parents. The key findings revealed associations between parental physical activity, sleep, dietary habits, mental health, screen time, and their children's BMIs. Parenting styles significantly influence children's behaviors. This review highlights the crucial influence of parenting styles and behaviors on children's physical activity, diet, sleep, and mental health, emphasizing the link between family dynamics and childhood obesity. The findings stress the importance of targeting parental habits in interventions focused on healthy routines and stress management. Longitudinal studies are needed to determine causality, while research involving diverse populations is essential to enhance the applicability of these findings.

Inclusivity is child's play: pilot study on usability, acceptability and user experience of a sensory-motor PC game for children with cerebral palsy (GiocAbile)

BACKGROUND

The use of video games in rehabilitation settings is gaining increasing popularity. However, the lack of commercial video games suitable for children with disabilities and the disappointing user experience of serious games limit their applicability. The aim of this study was to assess the usability, acceptability and user experience of GiocAbile, an active video game for children with cerebral palsy (CP).

METHODS

This multicenter pilot observational study was conducted from May to September 2022 at the participating institutions, and enrolled school-aged children affected by CP. Enrolled children played GiocAbile in single-player mode for one hour. The gaming experience was evaluated through self-assessment questionnaires. Non-parametric correlation analysis was conducted to examine the influence of motor and cognitive abilities (GMFCS, MACS, ICF) on declared usability and acceptability.

RESULTS

Nineteen children (9.01 ± 1.95 years, 63.1% male) with mild to severe CP were enrolled. The 100% of respondents expressed satisfaction and fulfillment associated with gameplay, with no reports of frustration or disappointment. The 83% would recommend the game to a friend. The controllers were generally deemed easy to use and maneuver, with very few reports of discomfort associated with their use. No correlations were found between usability/acceptability levels and measures of impairment (i.e., GMFCS, MACS, and ICF scales), while cognitive impairment positively correlated with satisfaction during gameplay.

CONCLUSIONS

GiocAbile is an accessible, user-friendly and enjoyable tool for children with CP, regardless of level of impairment. Based on existing literature, we hypothesize that GiocAbile may improve motivation, participation, and rehabilitation outcomes in children with CP, although further studies are needed to confirm our hypothesis.

The relationship between chronotype video game addiction and sleep quality in school-age children: A structural equation modeling approach

This study aimed to investigate the relationship between chronotype, video game addiction, and sleep quality in school-age children using structural equation modeling. It was performed using structural equation modeling, with 545 secondary school students in northern Turkey meeting the inclusion criteria. Data were collected through face-to-face interviews utilizing the Personal Information Form, the Morningness Eveningness Scale for Children (MESC), the Video Game Addiction Scale for Children (VASC), and the Sleep Quality Scale. The findings revealed that the average video game addiction score of children was 55.22, which was associated with poor sleep quality and efficiency. Additionally, chronotype was found to mediate the relationship between video game addiction and both sleep quality (β = 0.024; p < 0.001) and sleep efficiency (β = -0.068; p < 0.001). The model was found to be close to acceptable levels for the variables according to the fit indices.

Harmful compared to what? The problem of gaming and ambiguous causal questions

BACKGROUND AND AIMS

There has been much concern regarding potential harmful effects of video game-play in the past 40 years, but limited progress in understanding its causal role. This paper discusses the basic requirements for identifying causal effects of video game-play and argues that most research to date has focused upon ambiguous causal questions.

METHODS

Video games and mental health are discussed from the perspective of causal inference with compound exposures; that is, exposures with multiple relevant variants that affect outcomes in different ways.

RESULTS

Not only does exposure to video games encompass multiple different factors, but also not playing video games is equally ambiguous. Estimating causal effects of a compound exposure introduces the additional challenge of exposure-version confounding.

CONCLUSIONS

Without a comparison of well-defined interventions, research investigating the effects of video game-play will be difficult to translate into actionable health interventions. Interventions that target games should be compared with other interventions aimed at improving the same outcomes.

Digital Gaming and Exercise Among Youth With Type 1 Diabetes: Cross-Sectional Analysis of Data From the Type 1 Diabetes Exercise Initiative Pediatric Study

Background

Regular physical activity and exercise are fundamental components of a healthy lifestyle for youth living with type 1 diabetes (T1D). Yet, few youth living with T1D achieve the daily minimum recommended levels of physical activity. For all youth, regardless of their disease status, minutes of physical activity compete with other daily activities, including digital gaming. There is an emerging area of research exploring whether digital games could be displacing other physical activities and exercise among youth, though, to date, no studies have examined this question in the context of youth living with T1D.

Objective

We examined characteristics of digital gaming versus nondigital gaming (other exercise) sessions and whether youth with T1D who play digital games (gamers) engaged in less other exercise than youth who do not (nongamers), using data from the Type 1 Diabetes Exercise Initiative Pediatric study.

Methods

During a 10-day observation period, youth self-reported exercise sessions, digital gaming sessions, and insulin use. We also collected data from activity wearables, continuous glucose monitors, and insulin pumps (if available).

Results

The sample included 251 youths with T1D (age: mean 14, SD 2 y; self-reported glycated hemoglobin A1c level: mean 7.1%, SD 1.3%), of whom 105 (41.8%) were female. Youth logged 123 digital gaming sessions and 3658 other exercise (nondigital gaming) sessions during the 10-day observation period. Digital gaming sessions lasted longer, and youth had less changes in glucose and lower mean heart rates during these sessions than during other exercise sessions. Youth described a greater percentage of digital gaming sessions as low intensity (82/123, 66.7%) when compared to other exercise sessions (1104/3658, 30.2%). We had 31 youths with T1D who reported at least 1 digital gaming session (gamers) and 220 youths who reported no digital gaming (nongamers). Notably, gamers engaged in a mean of 86 (SD 43) minutes of other exercise per day, which was similar to the minutes of other exercise per day reported by nongamers (mean 80, SD 47 min).

Conclusions

Digital gaming sessions were longer in duration, and youth had less changes in glucose and lower mean heart rates during these sessions when compared to other exercise sessions. Nevertheless, gamers reported similar levels of other exercise per day as nongamers, suggesting that digital gaming may not fully displace other exercise among youth with T1D.

Exploring the Impact of Gaming Habits on Sleep Patterns Among Young Adults in Saudi Arabia: A Cross-Sectional Study

Background Video gaming is increasingly popular among young adults, potentially affecting health and daily routines, especially sleep patterns. In Al-Ahsa, Saudi Arabia, the impact of video gaming on sleep and health among young adults is not well understood. This study aims to explore this relationship, focusing on how video gaming habits influence sleep patterns and associated health outcomes. Methods This cross-sectional survey utilized an adapted online questionnaire to gather data on demographics, video gaming habits, sleep patterns, and body mass index from young adults in Al-Ahsa. Statistical analysis, including descriptive statistics, chi-square tests, and multivariable logistic regression, was applied to examine the associations between video gaming habits and sleep sufficiency. Results The study included 302 participants, including 165 (54.6%) females. A majority reported playing video games for less than one hour daily (36.1%), with 82.5% preferring online gaming. Notably, 54.3% of participants slept more than six hours nightly, yet challenges with sleep initiation were evident, as 48.0% went to bed past midnight. Multivariable logistic regression highlighted significant factors affecting sleep sufficiency: participants who played games after completing tasks had 80% lower odds of sleep insufficiency compared to those who played before tasks. Overweight participants were found to be 7.7 times more likely to experience sleep insufficiency compared to their underweight peers. Conclusion The study underscores a complex relationship between video gaming habits and sleep patterns among young adults in Al-Ahsa, with significant health implications. It suggests the necessity for interventions promoting balanced gaming habits and improved sleep hygiene to mitigate adverse health outcomes.

Exploring the Use of a Learning-Based Exergame to Enhance Physical Literacy, Soft Skills, and Academic Learning in School-Age Children: Pilot Interventional Study

BACKGROUND

There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children's interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant.

OBJECTIVE

The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration).

METHODS

This interventional study had a pre-post design and used the Play LÜ exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play LÜ requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play LÜ and a motor skills circuit behind the LÜ setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Grööve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Gaïa application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills.

RESULTS

The implementation of this exergaming program was welcomed by the school's administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6%; W=933.0; P=.002; rrb=-0.39, 95% CI -0.58 to -0.16) and motivation in mathematics (+0.7, +9.8%; W=381.5; P=.005; rrb=-0.44, 95% CI -0.66 to -0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups.

CONCLUSIONS

The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children.

Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation

BACKGROUND

Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality.

OBJECTIVE

This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps' general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB).

METHODS

Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps.

RESULTS

Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ≥4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change.

CONCLUSIONS

Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals.

Relations between Video Game Engagement and Social Development in Children: The Mediating Role of Executive Function and Age-Related Moderation

The global proliferation of video games, particularly among children, has led to growing concerns about the potential impact on children's social development. Executive function is a cognitive ability that plays a crucial role in children's social development, but a child's age constrains its development. To examine the association between video game engagement and children's social development while considering the mediating role of executive function and the moderating role of age, a questionnaire was distributed to a sample of 431 parents. The results revealed a negative relation between video game engagement and social development in children, with executive function found to mediate this relation fully. Additionally, the negative association between video game engagement and executive function became more pronounced as children grew older. In light of these findings, it is advisable to adopt proactive strategies to limit excessive video game use, consider the developmental characteristics of children at different ages, and prioritize the promotion of executive function to facilitate social development among children.

Impact of the COVID-19 Lockdown on Children's Psychosocial Well-Being: A Cross-Sectional Study in Saudi Arabia

Background The impact of COVID-19 on children is a vital topic to cover since the quarantine lasted for months, and limited research explored this effect locally in Arab countries. We studied the impact of the COVID-19 lockdown on the psychosocial well-being of children aged 1-18 years who were living in Saudi Arabia during the time of the pandemic. Method A total of 387 participants' responses were collected using online questionnaires (valid and reliable) composed of three sections with open and close-ended questions by the child's legal guardians. This cross-sectional study was conducted in Saudi Arabia and targeted children aged 1-18 years of both genders using a convenience sampling technique. One questionnaire assessed the child's behavior and sleep pattern, while the other evaluated child's activity and social skills. We analyzed the data using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY). Results Half of the children were 1-6 years (196; 50.6%), and the caregivers of more than half (225; 58.2%) were mothers. Two-thirds (234; 60.5%) of the children were male. Apart from a poor appetite for food and eating (non-nutritional) junk food, which was not significant (p-value > 0.05), all other factors, behavior, sleep patterns, activity, and social skills, all other factors were significantly affected by COVID-19 (p<0.05). Conclusion This study found that the COVID-19 pandemic had a negative impact on children's psychosocial well-being. It is recommended to implement actions that aim to enhance the ability of children to cope with challenges.