Addicted to video games?

Summary

Podcast Summary: Ask the Mediatrician – "Addicted to Video Games?"

Episode Overview

In this episode of Ask the Mediatrician (January 7, 2020), Dr. Michael Rich—a pediatrician, child health researcher, and filmmaker—alongside child development expert Christelle Lavallee, respond to a heartfelt question from Cindy, a parent concerned about her 15-year-old son's compulsive gaming habits. The episode delves deeply into what problematic interactive media use (PIMU) really is, its ties to underlying neurodevelopmental differences like ADHD and Asperger’s, and practical, compassionate guidance for families navigating gaming challenges. The tone is empathetic, practical, and rooted in both clinical insight and lived parenting experience.

---

Key Discussion Points and Insights

1. Understanding "Addiction" vs. Problematic Use

• Not Technically an "Addiction": Dr. Rich explains why most clinicians avoid calling compulsive gaming an “addiction”:
  • There are behavioral but not physiological changes typical of substance addictions.
  • The "addiction" label can discourage families from seeking help due to stigma.
  • Quote:

    “We're not calling it an addiction, even though it feels as impairing as an addiction…as a pediatrician, I’m concerned about the stigma of the word addiction. And what that does…is it keeps parents from bringing their children who are having troubles with this to medical care as early as they could.” (Dr. Michael Rich, 02:39)

• Prevalence & Impacts: More families are reporting issues like sleep deprivation, anxiety, social isolation, and academic struggles tied to media overuse. (03:40)

2. The State of Clinical Recognition & Support

• Medical Field is Catching Up: The need for more research and better clinical protocols is stressed; gaming disorder has only recently been recognized by the WHO and is still under scrutiny within major medical diagnostic manuals.
  • Quote:

    “The most recent version of the psychiatric diagnostic manual lists Internet gaming disorder, but says it needs more research before they will define it as a diagnosis. The World Health Organization… decided that gaming disorder was a diagnosis, but that is yet to really penetrate medical practice and more importantly, medical training.” (Dr. Michael Rich, 05:05)

• Need for Parental Advocacy: Parents often must advocate directly for their child because many clinicians lack training in this area.
  • Quote:

    “Absolutely. The squeaky wheel gets the GR always. Right. So she has to be very proactive and help them help her son.” (Dr. Michael Rich, 06:26)

3. Why Kids with ADHD & Asperger’s Are More Susceptible (06:26–08:26)

• Controlled Environments: For many kids with ADHD and/or Asperger’s, interactive media feels more manageable than the messy unpredictability of real life.
  • Computers/games are:
    • Structured and predictable (good for ADHD).
    • Easier to "read" socially (good for Asperger's).
  • Quote:

    “They go to it because they feel good there, they feel accomplished there, where they feel confused and out of control in the chaos of a classroom.” (Dr. Michael Rich, 07:12)

• Underlying Issues Expressed through Media: PIMU often amplifies existing vulnerabilities or conditions.

4. What Parents Can Do at Home (08:26–12:05)

• Engage—Don’t Just Police:
  • Use media together; sit down with your child, play the game, and enter their world.
  • Move devices into shared, public spaces (e.g., dining room table) to enable connection—not surveillance.
    • Quote:

      “Parents often say, tell me some hardware that will protect my child from this. … The best hardware is your dining room table.” (Dr. Michael Rich, 09:44)

• Promoting Self-Regulation:
  • Abstinence is not realistic—kids need to learn self-control, because media are integrated into education and daily life.
  • Quote:

    “In this case, they can't abstain from the interactive media world, the electronic world…so the goal is not abstinence, but self regulation. Much, much harder.” (Dr. Michael Rich, 10:22)

5. Redirection and Positive Alternatives (10:34–13:14)

• “Don’t just say no—offer compelling alternatives”:
  • Suggest activities with clear goals, a hint of competition, and a touch of risk/novelty (e.g., parkour, rock climbing, martial arts).
  • Physical outlets are especially helpful for releasing energy and building discipline and focus.
    • Quote:

      “But it also entails mindfulness, discipline and focus.” (Dr. Michael Rich, 11:58)

  • Christelle shares her personal experience with martial arts and the benefits of mindfulness training (12:10).
• Nature’s Role:
  • Nature offers calming, centering, and challenge—requiring real-world skills and building self-confidence.
  • Wilderness therapy is discussed as an option for cases resistant to outpatient care, though it is not always covered by insurance.
    • Quote:

      “Wilderness therapy…basically rebuilding yourself from the inside out in an unwired environment.” (Dr. Michael Rich, 14:10)

6. Concluding Guidance (15:00–15:42)

• Start at Home:
  • Take simple steps like camping trips or regular outdoor activities to disrupt screen routines.
  • Continue engaging, advocating, and sharing resources with care teams.
  • Stay involved—effective media parenting is about ongoing conversation, not quick fixes.

---

Memorable Quotes & Timestamps

• On Stigma of "Addiction":
  • “We're not calling it an addiction, even though it feels as impairing as an addiction…as a pediatrician, I’m concerned about the stigma of the word addiction.” (Dr. Michael Rich, 02:39)
• On the Best "Hardware":
  • “The best hardware is your dining room table…and the best software is between your kid's ears.” (Dr. Michael Rich, 09:44)
• On the Uniqueness of Media Overuse:
  • “The solution is abstinence, ultimately...In this case, they can't abstain from the interactive media world…the goal is not abstinence, but self regulation. Much, much harder.” (Dr. Michael Rich, 10:16)
• On Channeling Energy:
  • “We’re not trying to stop that energy in its tracks, but to redirect it in another direction, to respect it… point it toward things that make them better.” (Dr. Michael Rich, 12:47)
• On Nature as Therapy:
  • “Nature has two great aspects here. One is that it is calming and centering, but the other is it's implacable…it doesn't give an inch.” (Dr. Michael Rich, 13:19)

---

Timestamps for Key Segments

• 01:52 – Listener question introduction
• 02:39 – Defining addiction vs. problematic use; stigma concerns
• 05:05 – Challenges in clinical diagnosis and treatment
• 06:26 – The role of ADHD & Asperger’s in problematic gaming
• 08:26 – Advocacy and engaging the treating team
• 09:05 – Tips for at-home support and shared media use
• 10:22 – Why abstinence is not the goal; importance of self-regulation
• 11:34 – How to redirect energy into enriching activities
• 12:47 – Christelle’s martial arts story; the payoff of discipline
• 13:14 – The case for nature and "wilderness therapy"
• 15:00 – Practical wrap-up and encouragement

---

Summary

Dr. Rich and Christelle offer realistic and empathetic advice for parents grappling with kids’ problematic gaming. Their main message: understand the difference between compulsive media use and addiction, advocate for sensitized care, and proactively create opportunities for engagement, skill-building, and connection—at home, with nature, and with trusted professionals.

Final Advice:

“Enjoy your media and use them wisely, and enjoy your kids and raise them wisely.” (Dr. Michael Rich, 15:42)

Transcript

[Shopify Business Owner]

I started Ornod in 2013 and we make bike apparel. The best part of Shopify for me is our ability to run the business as essentially non technical people. We're able to admin everything on the back end, front end and sell things online easily. If Shopify were a bike accessory, I think it would actually be the bicycle. It's the thing that you do the thing on. We run the business on Shopify so start your free trial on shopify.com when

[Shopify Advertiser]

it's time to scale your business. It's time for Shopify. Get everything you need to grow the way you want. Like all the way. Stack more sales with the best converting checkout on the planet. Track your cha chings from every channel right in one spot and turn real time reporting into big time opportunities. Take your business to a whole new level. Switch to Shopify. Start your free trial today.

[Dr. Michael Rich]

Hey, it's Dr. Michael Rich, the Mediatrician. I'm a practicing pediatrician, child health researcher, and a lifelong filmmaker who understands how powerfully screens can engage and change us. As a doctor who takes care of kids every day, I see many of them who are struggling with their screen use and whose parents are worried and concerned that it's affecting their health in physical, mental and social ways. So what I'm trying to do for you is to bring my two worlds together to really understand how to raise healthy, happy, productive children in a world filled with digital screens. Mediatrix educator Christelle Lavallee joins me here each week to address your questions.

[Christelle Lavallee]

Yes, I happily do. Thanks Michael. And this week we heard from Cindy, a mom in Orlando, Florida who says my son is 15 and displays symptoms of video game addiction, including lying and sneaking, to try to gain access. He has Asperger's and adhd and regardless of what medication regimen we try to, the gaming obsession remains. I recently asked the psychiatrist to hospitalize him and treat him as they would other addicts, but they just changed his meds anyway. Even if he were treated, he needs the computer for school. Do you have any advice for me? So thank you Cindy so much for sharing what you're going through. You definitely came to the right place. Mediatrician what advice can we give to Cindy?

[Dr. Michael Rich]

Unfortunately, more and more families share your story Cindy I am having kids show up with sleep deprivation, anxiety, social isolation and find that they're struggling with problematic interactive media use of not just gaming, but sometimes of social media, pornography, even video binging with endless YouTube videos. We're not calling it an addiction, even though it feels as impairing as an addiction for a couple of reasons. One is it's not medically accurate in the sense that you're not physiologically changed either when using or withdrawing. You're certainly behaviorally changed, but not physiologically. But most importantly, as a pediatrician, I'm concerned about the stigma of the word addiction. And what that does, interestingly, is it keeps parents from bringing their children who are having troubles with this to medical care as early as they could.

[Christelle Lavallee]

Is that because they're embarrassed because their child, they don't want their child to be seen as an addict?

[Dr. Michael Rich]

It's partly that. It's partly that they're embarrassed that they feel guilty and responsible for it. But I think it's largely that we think of addicts as junkies in a shooting gallery or bums on skid row, not our 10 year old who's throwing a hissy fit because he has to stop playing Fortnite and go to bed.

[Christelle Lavallee]

Yeah, that's a good point.

[Dr. Michael Rich]

They don't get to us early enough, but their families are really disrupted by this. The kids are not sleeping. They're not getting up in the morning to go to school. Some of them are dropping out of school. And what's interesting in Cindy's case is that our clinical experience and research has shown us that young people with ADHD with attention deficit hyperactivity disorder may actually be more susceptible to. To PAI mu, problematic interactive media use with video games or social media. And very early research has shown us that adolescents who use social media compulsively may be at higher risk of developing ADHD or ADHD like behaviors. And part of why it's so hard for Cindy to get good treatment is we in the medical community are behind on this issue that is so present in society and in many homes. In fact, the most recent version of the psychiatric diagnostic manual lists Internet gaming disorder, but says it needs more research before they will define it as a diagnosis. The World Health organization just in 2018 decided that gaming disorder was a diagnosis, but that is yet to really penetrate medical practice and more importantly, medical training. So a lot of doctors, psychiatrists, psychologists, school guidance counselors really have no training in it and do not know how to respond to it.

[Christelle Lavallee]

Okay, so that actually makes a lot of sense when we're thinking about this question and what Cindy is going through. Because it sounds like Cindy has already set up her son in some sort of psychiatric care.

[Dr. Michael Rich]

Yes. And she should keep working with mental health professionals, but she should also recognize that we in the medical community are very early in recognizing and certainly in developing effective treatments for this, she should talk to her son's providers and make sure that they are able to recognize and respect the power of gaining or pai mu specific problems that he's having.

[Christelle Lavallee]

So she's really gonna have to advocate for her son's actual problems here as she goes to Seabees.

[Dr. Michael Rich]

Absolutely. The squeaky wheel gets the GR always. Right. So she has to be very proactive and help them help her son. And one of the things that's very interesting is that computers or interactive media are used in many ways as educational or therapeutic workarounds for young people with ADHD or with Asperger's syndrome, of which her son has both. In other words, if you think about it, ADHD is easy distractibility and hyperactivity. As a result, the computer environment is much more controlled, much more circumscribed. They know what they need to do, and in fact, it's a place of relative mastery for these kids.

[Christelle Lavallee]

That makes sense.

[Dr. Michael Rich]

Yeah. And so they go to it because they feel good there, they feel accomplished there, where they feel confused and out of control in the chaos of a classroom. The same thing with Asperger's syndrome, where one of the hallmarks is a difficulty in reading social cues, sort of emotional tone deafness, if you will. And so in that environment, which is much more stylized and simplified, they are able to succeed better.

[Christelle Lavallee]

They can read it. They can read that environment.

[Dr. Michael Rich]

Exactly. And they can practice reading it over and over and over again, whereas real life is endlessly variable. So what we are seeing in treatment in the clinic that we have for kids with interactive media and Internet disorders is that essentially all of them to date have some underlying disorder that we already understand that is only expressing itself for the first time, possibly, or in this severity in the interactive media environment. And so if we can identify and treat that underlying condition with therapy and or medication and that is optimized, then we are doing a lot better for these kids.

[Christelle Lavallee]

That makes sense. So we know that Cindy has to be the squeaky wheel here and kind of work with her son's doctors and let them know what's going on, and hopefully they'll get some guidance in the clinical sphere, just as you were suggesting. But what can Cindy do at home? What can she do for her son that can maybe help support that clinical care or, you know, accentuate it in some way. What can she do?

[Dr. Michael Rich]

Well, she can do many of the things that every parent can do with children who are not necessarily having severe problems, but are struggling with how to learn it. First of all, use those media with her kid, sit down next to him.

[Shopify Business Owner]

Yep.

[Christelle Lavallee]

So important.

[Dr. Michael Rich]

And play the game with him. Rather than getting annoyed by him playing the game, move his computer and his Internet access into a public space, a shared space.

[Christelle Lavallee]

What do you mean by a public or shared space?

[Dr. Michael Rich]

Instead of going into his room, his bedroom with his computer, have it on the dining room table.

[Christelle Lavallee]

Oh, so like where family traffic happens? Family traffic, Gotcha. Absolutely.

[Dr. Michael Rich]

This is not to surveil him or monitor him so much as to be present with him when he's using it. Parents often say, tell me some hardware that will protect my child from this.

[Christelle Lavallee]

And I say, yeah, we get that a lot.

[Dr. Michael Rich]

Yeah. And I say, the best hardware is your dining room table.

[Christelle Lavallee]

You've already got it.

[Dr. Michael Rich]

The best software, it's already there. And the best software is between your kid's ears.

[Christelle Lavallee]

I would love that.

[Dr. Michael Rich]

Right. So you're giving him the tools to self regulate, which is really the issue here. And that's another, actually another difference from addiction, which is in addictions to heroin, to alcohol, to tobacco. The solution is abstinence, ultimately.

[Christelle Lavallee]

Right? Yeah.

[Dr. Michael Rich]

In this case, they can't abstain from the interactive media world, the electronic world.

[Christelle Lavallee]

Yeah.

[Dr. Michael Rich]

Cindy noted that to question it in school and in work, et cetera. So the goal is not abstinence, but self regulation. Much, much harder.

[Christelle Lavallee]

Yep. Self control.

[Dr. Michael Rich]

Yeah, absolutely. So if she can create an environment in the home that is conducive to him using these media in public spaces, sharing them back and forth, having them be part of the family discourse, it makes it a lot easier and makes it harder for him to dive into these worlds and disappear. Now, here's the other thing you gotta do. You don't say no, you say yes. In other words, we don't say, stop playing that game because they're not gonna listen to that. Right. You're saying, here's something even cooler you could do. So I've had really good luck with giving diverse activities for the kid that are really cool. Some things that have been, you know, really good are things that have clear goals and are achievable clear goals so that they are competitive and they grab that competitive instinct that is driving him into the games. Also, if they're a little outrageous and a little worrisome to mom, they're even better. So things like parkour is really good. Rock climbing, you know, a rock gym, martial arts is really good. Not only because it's a little outrageous and it's very competitive. And it gets his yayas out, his physical Yaya's out.

[Christelle Lavallee]

Yeah. Yeah.

[Dr. Michael Rich]

But it also entails mindfulness, discipline and focus.

[Christelle Lavallee]

Oh, Michael, I don't know if you know this, but I actually am a karate kid.

[Dr. Michael Rich]

Wax on.

[Christelle Lavallee]

My mom put me in lessons. So I can definitely speak to kind of the mindfulness aspect that you're referring to, and that's self discipline.

[Dr. Michael Rich]

So should I be afraid of you? Is the question.

[Christelle Lavallee]

Yes. No, no, no, no. But, I mean, I can tell you, even when I start to feel, it doesn't happen very often. But when I start to feel really angry, my sensei's voice comes back to me, and I just hear him talking about breathing and those breathing exercises that I learned as a kid. And it just. I mean, it recenters me still, and that was years ago that I took those lessons.

[Dr. Michael Rich]

Well, this is why I use martial arts often as a metaphor for what we're doing when we're trying to treat these kids with paimu, which is we're not trying to stop that energy in its tracks, but to redirect it in another direction, to respect it, care about it, understand it, but point it toward things that make them better. Another thing that can do this is nature.

[Christelle Lavallee]

Absolutely. Oh, my gosh. Nature. Yes. Let's get them out there.

[Dr. Michael Rich]

Right. Nature has two great aspects here. One is that it is calming and centering, but the other is it's implacable. It doesn't give an inch. So if you do the wrong thing, if you don't put your ted up, you get wet.

[Christelle Lavallee]

Oh, yeah, right.

[Dr. Michael Rich]

Been there camping, and you're there by yourself or with others, but you are responsible for yourself. So what happens with a lot of these kids is that they are unable to really know themselves and to know their own strengths and their own confidence. So I've actually found that with some kids who have not done well with outpatient treatment, as in therapy, medication, that. Wilderness therapy. Putting on a backpack.

[Christelle Lavallee]

What does that mean?

[Dr. Michael Rich]

It's putting on a backpack and hiking into the mountains or the desert or the woods with a therapist and basically rebuilding yourself from the inside out in an unwired environment. In other words, because a lot of these kids feel completely lost when they can't get online. And so one of the options for Cindy's son might be to wilderness therapy. Do wilderness therapy with a reputable place. Unfortunately, just like with paimu, this is not yet part of the common medical practice or the common medical parlance. So oftentimes, these things need to be worked so that they can get paid for. And unfortunately, many times, insurance companies will not pay for wilderness therapy.

[Christelle Lavallee]

Well, maybe Cindy can take her son out on a camping trip too. Just get him out there, get him into nature, do something. Do something like that Cindy. And thank you so much for sharing your question with us. Please follow up with us and let us know how your son's gaming is going to and for everyone else out there. You can find links to all of our [e-mail] including the clinic for Interactive Media and Internet Disorders, which Michael leads at Boston Children's Hospital. Remember that you can connect with our Mediatrician on Twitter ediatrician, and you can submit your own question, which we'll answer for [e-mail] and finally, make sure you subscribe and share this podcast.

[Dr. Michael Rich]

Enjoy your media and use them wisely, and enjoy your kids and raise them wisely.

[Podcast Narrator]

Ask the Mediatrician is hosted by Dr. Michael Rich, joined by Mediatrix educator Christelle Lavallee. Jill R. Kavanagh is our Chief Knowledge Officer. Original music composed by Christopher Cerf Podcast and music recorded, mixed and edited at Saturn Sound Studios Executive Producer Alicia Heywood.

[Ryan Reynolds]

Hey, it's Ryan Reynolds here for Mint Mobile.

[Instacart Advertiser]

Now.

[Ryan Reynolds]

I was looking for fun ways to tell you that Mint's offer of unlimited premium wireless for $15 a month is back. So I thought it would be fun if we made $15 bills, but it turns out that's very illegal, so there goes my big idea for the commercial. Give it a [e-mail] Switch upfront payment

[Shopify Advertiser]

of $45 for three months, $90 for six months, or $180 or 12 month plan required $15 per month equivalent taxes and fees Extra initial plan term only greater than 50gb me slow when network is busy.

[Instacart Advertiser]

See terms Instacart understands that not all bananas are created equal. Some people want them green, some want them ripe, some want them ready right now. With Instacart's Preference Picker, now available at most retailers, you can choose how you like certain items like banana ripeness, deli thickness, even avocados before your shopper even starts. So instead of crossing your fingers and hoping for the best, you get groceries picked the way you would pick them. It's a small thing, but it makes a big difference. Download the app and get bananas just how you like. With Instacart.