Current Psychiatry Reports

, Volume 14, Issue 5, pp 590–597 | Cite as

Emerging Association Between Addictive Gaming and Attention-Deficit/Hyperactivity Disorder

  • Aviv Weinstein
  • Abraham Weizman
Attention-Deficit Disorder (R Bussing, Section Editor)


Children’s and adolescent’s use of computer games and videogames is becoming highly popular and has increased dramatically over the last decade. There is growing evidence of high prevalence of addiction to computer games and videogames among children, which is causing concern because of its harmful consequences. There is also emerging evidence of an association between computer game and videogame addiction and attention deficit/hyperactivity disorder (ADHD). This is indicated by the occurrence of gaming addiction as a co-morbid disorder of ADHD, common physiological and pharmacological mechanisms, and potential genetic association between the two disorders. A proper understanding of the psychological and neurotransmitter mechanisms underlying both disorders is important for appropriate diagnostic classification of both disorders. Furthermore, it is important for development of potential pharmacological treatment of both disorders. Relatively few studies have investigated the common mechanisms for both disorders. This paper reviews new findings, trends, and developments in the field. The paper is based on a literature search, in Medline and PUBMED, using the keywords addictive gaming and ADHD, of articles published between 2000 and 2012.


Addictive gaming Attention-deficit/hyperactivity disorder ADHD Computer games and video games Reward Internet addiction Problematic internet use 



A. Weinstein: grant from the Israeli Anti-Drug Authority and support for travel to meetings for study or other purposes from National Institute for Psychobiology in Israel; A. Weizman: none.


Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major importance

  1. 1.
    •• Weiss MD, Baer S, Allan BA, Saran K, Schibuk H. The screens culture: impact on ADHD. ADHD Atten Def Hyp Disord. 2011;3:327–34. This is an updated review regarding gaming addiction and ADHD. CrossRefGoogle Scholar
  2. 2.
    •• Weinstein A. Computer and video game addiction. Am J Drug Alc Abuse. 2010;36(5):268–76. This is a comprehensive review on gaming addiction. CrossRefGoogle Scholar
  3. 3.
    •• Weinstein A, Lejoyeux M. Internet addiction or excessive internet use. Am J Drug Alc Abuse. 2010;36(5):277–83. This is a comprehensive review on internet addiction. CrossRefGoogle Scholar
  4. 4.
    Harris Interactive Videogame Addiction 2007.
  5. 5.
    Grusser SM, Thalemann R, Albrecht U, Thalemann CN. Excessive computer usage in adolescents--results of a psychometric evaluation. Wien Klin Wochenschr. 2005;117(5-6):188–95 [Article in German].PubMedCrossRefGoogle Scholar
  6. 6.
    Grusser SM, Thalemann R, Griffiths MD. Excessive computer game playing: evidence for addiction and aggression? Cyberpsycho Behav. 2007;10(2):290–2.CrossRefGoogle Scholar
  7. 7.
    Woelfling K, Thalemann R, Grusser SM. Computer game addiction: a psychopathological symptom complex in adolescence. Psychiat Prax. 2008;35(5):226–32 [Article in German].CrossRefGoogle Scholar
  8. 8.
    Rehbein F, Kleimann M, Mößle T. Prevalence and risk factors of video game dependency in adolescence: results of a German nationwide survey. Cyberpsychol Behav Soc Netw. 2010;13(3):269–77.PubMedCrossRefGoogle Scholar
  9. 9.
    Johansson A, Götestam KG. Problems with computer games without monetary reward: similarity to pathological gambling. Psychol Rep. 2005;95(2):641–50.CrossRefGoogle Scholar
  10. 10.
    Griffiths MD, Hunt N. Dependence on computer games by adolescents. Psychol Rep. 1998;82(2):475–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Tahiroglu AY, Celik GG, Uzel M, Ozcan N, Avci A. Internet use among Turkish adolescents. Cyberpsychol Behav. 2008;11(5):537–43.PubMedCrossRefGoogle Scholar
  12. 12.
    Griffiths MD. A “components” model of addiction within a biopsychosocial framework. J Sub Use. 2005;10:191–7.CrossRefGoogle Scholar
  13. 13.
    Griffiths MD. Videogame addiction: further thoughts and observations. Int J Ment Health Addiction. 2008;6:182–5.CrossRefGoogle Scholar
  14. 14.
    Griffiths MD. Videogame addiction: fact or fiction? In: Willoughby T, Wood E, editors. Children’s Learning in a digital world. Oxford: Blackwell Publishing; 2007. p. 85–103.CrossRefGoogle Scholar
  15. 15.
    APA. Diagnostic and statistical manual of mental disorders (DSM-IV). Washington, D.C: American Psychiatric Association; 1994.Google Scholar
  16. 16.
    APA. Diagnostic and statistical manual of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  17. 17.
    •• Blum K, Chen AL-C, Braverman EB, Comings DE, Chen TJH, Arcuri V, Blum SH, Downs BW, Waite RL, Notaro A, Lubar J, Williams L, Prihoda TJ, Palomo T, Berman MO. Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatr Dis Treat. 2008;4(5):893–918. This is a highly relevant review on ADHD and reward. PubMedGoogle Scholar
  18. 18.
    Miller D, Blum K. Overload: Attention deficit disorder and the addictive brain. Salt Lake City, Utah: Woodland Publishing Company; 2008.Google Scholar
  19. 19.
    • Ko CH, Yen JY, Chen CS, Yeh YC, Yen CF. Predictive values of psychiatric symptoms for internet addiction in adolescents: a 2 year prospective study. Arch Pediatr Adolesc Med. 2009;163(10):937–43. This is the only prospective study on internet addiction. PubMedCrossRefGoogle Scholar
  20. 20.
    Chan PA, Rabinowitz T. A cross-sectional analysis of video games and attention deficit hyperactivity disorder symptoms in adolescents. Ann Gen Psychiatry. 2006;5:16.PubMedCrossRefGoogle Scholar
  21. 21.
    Ha JH, Yoo HJ, Cho IH, Chin B, Shin D, Kim JH. Psychiatric comorbidity assessed in Korean children and adolescents who screen positive for internet addiction. J Clin Psychiatry. 2006;67(5):821–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Yen JY, Ko CH, Yen CF, Wu HY, Yang MJ. The comorbid psychiatric symptoms of internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility. J Adolesc Health. 2007;41(1):93–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Yen JY, Yen CF, Chen CS, Tang TC, Ko CH. The association between adult ADHD symptoms and internet addiction among college students: the gender difference. Cyberpsychol Behav. 2009;12(2):187–91.PubMedCrossRefGoogle Scholar
  24. 24.
    Yoo HJ, Cho SC, Ha J, Yune SK, Kim SJ, Hwang J, Chung A, Sung YH, Lyoo IK. Attention deficit hyperactivity symptoms and internet addiction. Psychiatry Clin Neurosci. 2004;58(5):487–94.PubMedCrossRefGoogle Scholar
  25. 25.
    • Han D, Lee Y, Na C, Ahn J, Chung U, Daniels M, Haws C, Renshaw P. The effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder. Compr Psychiatry. 2009;50(3):251–6. This is the only pharmacologic study of internet and gaming addiction with ADHD. PubMedCrossRefGoogle Scholar
  26. 26.
    Green CS, Bavelier D. Action video game modifies visual selective attention. Nature. 2003;423:534–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlstrom K, Gillberg CG, Forssberg H, Westerberg H. Computerized training of working memory in children with ADHD a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry. 2005;44(2):177–86.PubMedCrossRefGoogle Scholar
  28. 28.
    Chumbley J, Griffiths M. Affect and the computer game player: the effect of gender, personality, and game reinforcement structure on affective responses to computer game-play. Cyberpsychol Behav. 2006;9(3):308–16.PubMedCrossRefGoogle Scholar
  29. 29.
    Thalemann R, Wolfling K, Grusser SM. Specific cue reactivity on computer game-related cues in excessive gamers. Behav Neurosci. 2007;121(3):614–8.PubMedCrossRefGoogle Scholar
  30. 30.
    • Ko CH, Liu GC, Hsiao S, Yen JY, Yang MJ, Lin WC, Yen CF, Chen CS. Brain activities associated with gaming urge of online gaming addiction. J Psychiatr Res. 2009;43(7):739–47. This is a brain imaging study on gaming addiction. PubMedCrossRefGoogle Scholar
  31. 31.
    Ko CH, Hsiao S,, Liu GC, Yen JU, Yang MJ, Yen CF. The characteristics of decision making, potential to take risks, and personality of college students with Internet addiction. Psychiatry Res; 2010:121-125.Google Scholar
  32. 32.
    • Han DH, Young SL, Yang KC, Kim EY, Lyoo IK, Renshaw PF. Dopamine genes and reward dependence in adolescents with excessive internet video game play. J Addict Med. 2007;1(3):133–8. This is a genetic study on internet and gaming addiction. PubMedCrossRefGoogle Scholar
  33. 33.
    • Lee Y, Han D, Yang K, Daniels M, Na C, Kee B, Renshaw P. Depression like characteristics of 5HTTLPR polymorphism and temperament in excessive internet users. J Affect Disord. 2009;109(1):165–9. This is a genetic study on internet and gaming addiction. CrossRefGoogle Scholar
  34. 34.
    Shaw P, Gornick M, Lerch J, Addington A, Seal J, Greenstein D, Sharp W, Evans A, Giedd JN, Castellanos FX, Rapoport JL. Polymorphisms of the dopamine D4 receptor, clinical outcome, and cortical structure in attention-deficit/ hyperactivity disorder. Arch Gen Psychiatry. 2007;64:921–31.PubMedCrossRefGoogle Scholar
  35. 35.
    Swanson JM, Kinsbourne M, Nigg J, Lanphear B, Stefanatos GA, Volkow N, Taylor E, Casey BJ, Castellanos FX, Wadhwa P. Etiologic subtypes of attention-deficit/hyperactivity disorder: brain imaging, molecular genetic and environmental factors and the dopamine hypothesis. Neuropsychol Rev. 2007;17:39–59.PubMedCrossRefGoogle Scholar
  36. 36.
    Volkow ND, Wang GJ, Newcorn J, Telang F, Solanto MV, Fowler JS, Logan J, Ma Y, Schultz K, Pradhan K, Wong C, Swanson JM. Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2007;64:932–40.PubMedCrossRefGoogle Scholar
  37. 37.
    Blum K, Kozlowski GP. Ethanol and Neuromodulator influences. A cascade model of reward. In: Ollat H, Parvez S, Parvez H, editors. Alcohol and behaviour: basic and clinical aspects progress in alcohol research. Utrecht, Netherlands: VSP; 1990.Google Scholar
  38. 38.
    Blum K, Cull JG, Braverman ER, Comings DE. Reward deficiency syndrome. Am Sci. 1996;84:132.Google Scholar
  39. 39.
    Blum K, Kozlowski GP. Ethanol and neuromodulator influences a cascade model of reward. In: Ollat H, Parvez S, Parvez H, editors. Alcohol and behaviour: basic and clinical aspects. Progress in alcohol research. Utrecht, Netherlands: VSP; 1990.Google Scholar
  40. 40.
    Blum K, Payne JE. Alcohol and the addictive brain: new hope for alcoholics from biogenetic research, vol. xiv. New York: Free Press; 1991. p. 320.Google Scholar
  41. 41.
    Faraone SV. Report from the 4th international meeting of the attention deficit hyperactivity disorder molecular genetics network. Am J Med Genet B Neuropsychiatr Genet. 2003;121:55–9.CrossRefGoogle Scholar
  42. 42.
    Blum K, Sheridan PJ, Wood RC, Braverman ER, Chen TJ, Cull JG, Comings DE. The D2 dopamine receptor gene as a determinant of reward deficiency syndrome. J R Soc Med. 1996;89:396–400.PubMedGoogle Scholar
  43. 43.
    Blum K, Braverman ER, Holder JM, Lubar JF, Monastra VJ, Miller D, Lubar JO, Chen TJ, Comings DE. Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. J Psychoactive Drugs. 2000;32(Suppl i-iv):1–112.Google Scholar
  44. 44.
    Comings DE, Gade-Andavolu R, Gonzalez N, Wu S, Muhleman D, Blake H, Chiu F, Wang E, Farwell K, Darakjy S, Baker R, Dietz G, Saucier G, MacMurray JP. Multivariate analysis of associations of 42 genes in ADHD, ODD and conduct disorder. Clin Genet. 2000;58:31–40.PubMedCrossRefGoogle Scholar
  45. 45.
    Volkow ND, Fowler JS, Wolf AP, Schlyer D, Shiue CY, Alpert R. Effects of chronic cocaine abuse on postsynaptic dopamine receptors. Am J Psychiatry. 1990;147:719–24.PubMedGoogle Scholar
  46. 46.
    Volkow ND, Fowler JS, Wang GJ, Hitzemann R, Logan J, Schyler DJ. Decreased dopamine D2 receptor availability is associated with reduced frontal metabolism in cocaine abusers. Synapse. 1993;14:169–77.PubMedCrossRefGoogle Scholar
  47. 47.
    Volkow ND, Wang GJ, Fowler JS, Logan J, Gatley SJ, Hitzemann R. Decreased striatal dopaminergic responsiveness in detoxified cocaine-dependent subjects. Nature. 1997;386:830–3.PubMedCrossRefGoogle Scholar
  48. 48.
    Martinez D, Broft A, Foltin RW, Slifstein M, Hwang D-R, Huang Y, Perez A, Frankel WG, Cooper T, Kleber HD, Fischman MW, Laruelle M. Cocaine dependence and D2 receptor availability in the functional subdivisions of the striatum: relationship with cocaine-seeking behavior. Neuropsychopharmacology. 2004;29:1190–202.PubMedCrossRefGoogle Scholar
  49. 49.
    Koepp MJ, Gunn RN, Lawrence AD, Cunningham VJ, Dagher A, Jones T, Brooks DJ, Bench CJ, Grasby PM. Evidence for striatal dopamine release during a video game. Nature. 1998;393:266–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Zald DH, Boileau I, El-Dearedy W, Gunn R, McGlone F, Dichter GS, Dagher A. Dopamine transmission in the human striatum during monetary reward tasks. J Neuroscience. 2004;24(17):4105–12.CrossRefGoogle Scholar
  51. 51.
    Volkow ND, Wang G-J, Fowler JS, Logan J, Jayne M, Franchesi D, Wong C, Gatley SJ, Gifford AN, Ding Y-S, Pappas N. “Nonhedonic” Food Motivation in Humans Involves Dopamine in the Dorsal Striatum and Methylphenidate Amplifies This Effect. Synapse. 2002;44:175–80.PubMedCrossRefGoogle Scholar
  52. 52.
    Farde L, Nordström AL, Wiesel FA, Pauli S, Halldin C, Sedvall G. Positron emission tomography analysis of central D1 and D2 dopamine receptor occupancy in patients treated with classical neuroleptics and clozapine. Arch Gen Psychiat. 1992;49:538–44.PubMedCrossRefGoogle Scholar
  53. 53.
    Volkow ND, Wang GJ, Fowler JS, Logan J, Schlyer D, Hitzemann R, Lieberman J, Angrist B, Pappas N, MacGregor R, Burr G, Cooper T, Wolf AP. Imaging endogenous dopamine competition with [11 C] raclopride in the human brain. Synapse. 1994;16:255–62.PubMedCrossRefGoogle Scholar
  54. 54.
    Booij J, Korn P, Linszen DH, van Royen EA. Assessment of endogenous dopamine release by methylphenidate challenge using iodine-123 iodobenzamide single-photon emission tomography. Euro J Nuc Med. 1997;24(6):674–7.Google Scholar
  55. 55.
    Krause J, Dresel SH, Krause KH, la Fougere C, Ackenheil M. The dopamine transporter and neuroimaging in attention defi cit hyperactivity disorder. Neurosci Biobehav Rev. 2003;27:605–13.PubMedCrossRefGoogle Scholar
  56. 56.
    Krause J, Krause KH, Dresel SH, la Fougere C, Ackenheil M. ADHD in adolescence and adulthood, with a special focus on the dopamine transporter and nicotine. Dialogues Clin Neurosci. 2006;8:29–36.PubMedGoogle Scholar
  57. 57.
    Krause J, la Fougere C, Krause KH, Ackenheil M, Dresel SH. Influence of striatal dopamine transporter availability on the response to methylphenidate in adult patients with ADHD. Europ Arch Psychiatry Clin Neurosci. 2005;255:428–31.CrossRefGoogle Scholar
  58. 58.
    Volkow ND, Wang GJ, Newcorn J, Telang F, Solanto MV, Fowler JS, Logan J, Ma Y, Schulz K, Pradhan K, Wong C, Swanson JM. Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2007;64:932–40.PubMedCrossRefGoogle Scholar
  59. 59.
    Volkow ND, Wang GJ, Newcorn J, Fowler JS, Telang F, Solanto MV, Logan J, Wong C, Ma Y, Swanson JM, Schulz K, Pradhan K. Brain dopamine transporter levels in treatment and drug naïve adults with ADHD. Neuroimage. 2007;34:1182–90.PubMedCrossRefGoogle Scholar
  60. 60.
    Elkins IJ, McGue M, Lacono WG. Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry. 2007;64:1145–52.PubMedCrossRefGoogle Scholar
  61. 61.
    Volkow ND, Wang J-J, Tomas D, Kollins SH, Newcorn JH, Teland FW, Fowler JS, Logan J, Wong CT, Swanson JM. Methylphenidate-elicited dopamine increases in ventral striatum are associated with long-term symptom improvement in adults with attention deficit hyperactivity disorder. J Neurosci. 2012;32(3):841–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Byun S, Ruffini C, Mills JE, Douglas AC, Niang M, Stepchenkova S, Lee SK, Loutfi J, Lee JK, Atallah M, Blanton M. Internet addiction: meta synthesis of 1996-2006 quantitative research. Cyberpsychol Behav. 2009;12(2):203–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Swanson J, Gupta S, Guinta D, Flynn D, Agler D, Lerner M, Williams L, Shoulson I, Wigal S. Acute tolerance to methylphenidate in the treatment of attention deficit hyperactivity disorder in children. Clin Pharmacol Ther. 1999;66:295–305.PubMedCrossRefGoogle Scholar
  64. 64.
    Schachter HM, Pham B, King J, Langford S, Moher D. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ. 2001;165(11):1475–88.PubMedGoogle Scholar
  65. 65.
    Gillberg C, Melander H, von Knorring A-L, Janols L-O, Thernlund G, Hägglöf B, Eidevall-Wallin L, Gustafsson P, Kopp S. Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms a randomized, double-blind, placebo-controlled trial. Arch Gen Psychiatry. 1997;54(9):857–64.PubMedCrossRefGoogle Scholar
  66. 66.
    Biederman J, Boellner SW, Childress A, Lopez FA, Krishnan S, Zhang Y. LisdexamfetamineDimesylate and mixed amphetamine salts extended-release in childrenwith ADHD: a double-blind, placebo-controlled, crossover analog classroom study. Biol Psychiatry. 2007;62:970–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Perwien AR, Kratochvil CJ, Faries DE, Vaughan BS, Spencer T, Brown RT. Atomoxetine treatment in children and adolescents with attention-deficit hyperactivity disorder: what are the long-term health-related quality-of-life outcomes? J Child Adolesc Psychopharmacol. 2006;16:713–24.PubMedCrossRefGoogle Scholar
  68. 68.
    Spencer T, Biederman J, Heiligenstein J, Wilens T, Faries D, Prince J, Faraone SV, Rea J, Witcher J, Zervas S. An open-label, dose ranging study of atomoxetine in children with attention deficit hyperactivity disorder. J Child Adolesc Psychopharmacol. 2001;11:251–65.PubMedCrossRefGoogle Scholar
  69. 69.
    Spencer TJ, Faraone SV, Michelson D, Adler LA, Reimherr FW, Glatt SJ, Biedeman J. Atomoxetine and adult attention-deficit/hyperactivity disorder: the effects of comorbidity. J Clin Psychiatry. 2006;67:415–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Nuclear MedicineSourasky Medical CenterTel AvivIsrael
  2. 2.Research UnitGeha Mental Health CenterPetah TiqvaIsrael

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