Did you know 2011

State of the literature Fragmented by multiple definitions (addiction vs. compulsion; Internet use vs. video games) Bias due to samples of convenience Cross cultural differences Literature is fragmented across many sources and many disciplines

Criteria for Internet Addiction Disorder (IAD) Do you feel preoccupied with the Internet (think about previous on-line activity or anticipate next on-line session)? Young (1996)

Criteria for Internet Addiction Disorder (IAD) Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?

Criteria for IAD Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use? Young (1996)

Criteria for IAD Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use?

Criteria for IAD Do you stay on-line longer than originally intended? Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet? Young (1996)

Criteria for IAD Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet? Young (1996)

Criteria for IAD Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?

Other Warning Signs Sleep problems. A decrease in one’s level of functioning at school or at work. A significant constriction in the one’s extracurricular activities or social network. A lack of balance in your life.

Prevalence Prevalence rates vary greatly across studies (1.5 to 20%). Many studies use samples of convenience. Of those who use the Internet excessively, 51.2% primarily play MMORPG’s (massive multiplayer Online Role-Playing Games)  Desai, RA, et al. (2010).

Comorbidity The comorbidity of IAD with other disorders is so high that many argue that IAD does not warrant it’s own diagnostic label in the DSM.

Comorbidity ADHD Depression Anxiety Low self-esteem PDD OCD

Technology

Vulnerability Introversion Poor social skills Learning Disability or processing quirks ADHD or other problems with executive functioning skills Untreated or undertreated emotional problems such as Anxiety, Depression, or low self-esteem

Vulnerability: the need to connect and cope. Kids with Learning Disabilities tend to play games for more hours per week. Kids with ADHD, LD, or other emotional issues are more likely to play games in order to feel less lonely, to get their emotions out and because they like guns and weapons. (Kutner and Olson, 2008)

Vulnerability Compulsive tendencies Novelty seeking, sensation seeking  Mehroof, M and Griffiths, MD (2010).

Vulnerability Interfamilial conflict Poor school performance

Smile frown (ineffective problem solving)

Treatment Inpatient, Residential, and Hospital Settings Cognitive Behavioral Therapy 12 step programs such as Online Gamers Anonymous (OLGA) Harm Reduction Therapy Self-help books

Video Games

Rating Systems ESRB ratings have two equal parts: 1. rating symbols suggest age appropriateness for the game. rating symbols 2. content descriptors indicate elements in a game that may have triggered a particular rating and/or may be of interest or concern. content descriptors

Ratings ESRB Rating Symbols: EARLY CHILDHOOD Titles rated EC (Early Childhood) have content that may be suitable for ages 3 and older. Contains no material that parents would find inappropriate.

Ratings ESRB Rating Symbols: EVERYONE Titles rated E (Everyone) have content that may be suitable for ages 6 and older. Titles in this category may contain minimal cartoon, fantasy or mild violence and/or infrequent use of mild language.

Ratings ESRB Rating Symbols: EVERYONE 10+ Titles rated E10+ (Everyone 10 and older) have content that may be suitable for ages 10 and older. Titles in this category may contain more cartoon, fantasy or mild violence, mild language and/or minimal suggestive themes.

Ratings ESRB Rating Symbols: TEEN Titles rated T (Teen) have content that may be suitable for ages 13 and older. Titles in this category may contain violence, suggestive themes, crude humor, minimal blood, simulated gambling, and/or infrequent use of strong language.

Batman arkam city

Ratings ESRB Rating Symbols: MATURE Titles rated M (Mature) have content that may be suitable for persons ages 17 and older. Titles in this category may contain intense violence, blood and gore, sexual content and/or strong language.

Call of Duty

Ratings ADULTS ONLY Titles rated AO (Adults Only) have content that should only be played by persons 18 years and older. Titles in this category may include prolonged scenes of intense violence and/or graphic sexual content and nudity.

What causes violence? Many variables mediate how children interpret and are impacted by violent media. Exposure to violent media is only one piece of the puzzle. “For every problem there is a solution that is simple, neat and wrong.” –H.L. Mencken ( ) from Kutner and Olson (2008)

Video Games: What is Normal? 97% play some kind of video game 99% of boys say they are gamers 94% of girls report that they play games Lenhart, Middaugh, et al. (2008)

Too much of a good thing? Game Play HabitsBoysGirls Less than 1 hour/week8%32% 6 or more hours/week45%14% 15 or more hours/week13%2% Often/always alone63%46% Kutner and Olson (2008)

What is Normal? Parental Monitoring 72% of parents check the rating. 31% play with their children. 62% of parents say video games have no effect. Lenhart, Middaugh, et al. (2008)

The ideal learning environment Well designed video games are great teachers. Risk free learning environment. One can employ trial-and-error learning and use the scientific model to solve problems. Learning is active. Newly acquired skills are immediately applied to the next level. Gee, P (2003)

The Well Tailored Suit The game is infinitely patient. Reinforcement for learning is consistent, immediate, and clear. The player is usually on the ideal portion of the learning curve. Gee, P (2003)

How electronic media may make you smarter “benefits of video gaming for visual attention, including greater attentional capacity, quicker attention deployment, and faster processing.” (Schmidt and Vandewater, 2008) “Video games may positively affect a variety of visual spatial skills.” (Schmidt and Vandewater, 2008)

How electronic media may make you smarter. May develop problem solving skills and inductive reasoning. Laparoscopic surgeons. The Justice system

What parents can do. Set limits. Help find alternative ways of feeling powerful I.R.L. Address the problems that are driving a child to escape. Young (1999).

What Helps? Family therapy Individual therapy: ◦External stoppers ◦Delay ◦Set realistic goals ◦Cultivate alternative activities ◦Support groups Young (1999).

Setting limits on the virtual world If you are at dinner with someone, under what circumstances should your phone be on the table? Should your phone be in your bedroom, should your phone ever be under your pillow? How often should you be checking your social networking site? At what point in the evening should you stop checking in with your technology?

Setting limits on the virtual world Should you buy your child a game that is rated for older children because his/her friends are all playing it? Should you allow your child’s s, texts, or Facebook entries to be private and unmonitored? What technology should be allowed in a child’s room?

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Technology and the brain