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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.
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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 resources@askthemediatrician.org 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 you@askthemediatrician.org 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.
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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.
“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)
“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)
“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)
“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)
“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)
“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)
“But it also entails mindfulness, discipline and focus.” (Dr. Michael Rich, 11:58)
“Wilderness therapy…basically rebuilding yourself from the inside out in an unwired environment.” (Dr. Michael Rich, 14:10)
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)