CoD (Call of Duty)

Summary

Ask the Mediatrician: "CoD (Call of Duty)"

Host: Dr. Michael Rich (The Mediatrician), with Kristelle Lavallee
Release Date: January 14, 2020
Episode Theme:
Navigating problematic video game use (specifically Call of Duty) in children: practical advice, medical insights, and parenting strategies for families concerned with excessive gaming and media influence.

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Main Theme and Purpose

This episode centers on a pressing question from Peter, a Kansas City parent, whose 10-year-old son has shifted from active physical hobbies to compulsive playing of "Call of Duty: Black Ops." Dr. Michael Rich and child development expert Kristelle Lavallee address how parents can recognize, understand, and navigate problematic interactive media use (PIMU) in children, with a focus on healthy interventions over punitive action.

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Key Discussion Points and Insights

1. Understanding the Problem: When Gaming Becomes "Problematic"

• Peter’s Question: Peter observes his son’s sudden loss of interest in previous sports and outdoor activities after getting into "Call of Duty." He’s concerned the child is "addicted" and wants to know how long "deprogramming" takes once the game is removed.

  • "My 10 year old used to be an avid skateboarder and baseball player. Until Call of Duty Black Ops arrived..." (01:29)

• Dr. Rich’s Immediate Perspective:

  • Removing the game is only the first step and is often viewed as punishment, potentially leading the child to subvert these efforts. Simply taking away the problem isn’t enough.
  • "He will see that as punishment rather than helping him... not as deprogramming him, but helping him find a better way to live his life." (02:14)

• Professional Help & Current Limitations:

  • The notion of "gaming disorder" is relatively new; while the World Health Organization classified it as a diagnosis in 2018, most clinicians and insurers in the U.S. have yet to recognize or reimburse treatment for it.
  • "Medical insurance doesn't pay for care for gaming disorder. So given that, there's still some steps that Peter can take..." (03:14)

2. Practical Steps for Parents

• Lowering Stimulation and the Need for Framing:

  • Taking away the game reduces overstimulation but must be paired with empathetic conversation, framing the issue as a health concern and not a punishment.
  • "He needs to frame his son's problematic gaming as a health issue to be treated, not a misbehavior that needs to be punished." (04:05)
  • Parents should explain their concern and express empathy, stating the goal is giving their child more control, not taking away pleasure.

• Finding Proper Support:

  • Move beyond punishment: Collaborate with professionals, create a health-based action plan, and, where possible, seek out a clinician knowledgeable about interactive media issues.

3. Problematic Interactive Media Use (PIMU): A New Understanding

• The Spectrum of Digital Problems:

  • Dr. Rich’s Clinic at Boston Children’s Hospital identifies four main types:
    • Excessive Gaming: Mostly boys.
    • Social Media Overuse: Mostly girls.
    • Pornography Use: Evenly split.
    • Information/Video Binging: Endless YouTube, etc.
  • "We are grouping them under the name of Problematic Interactive Media Use, or PIMU." (05:28)

• Why Not Just “Addiction”?

  • The term "addiction" is both medically inaccurate and stigmatizing, which stops families from seeking early intervention.
  • The problem isn't the technology itself but the user’s relationship and behaviors with it.
  • "We're not blaming it on the technology. It's our behavior that matters... We're also not calling it an addiction, which is both medically inaccurate but stigmatizing." (06:31)

• When Is It a Disorder?

  • The crucial threshold: When media use severely impairs life—schoolwork, sleep, relationships, mood, and self-care.
  • Many cases are associated with underlying conditions such as ADHD, anxiety, and mood disorders.
  • "This may not in fact be a diagnosis in and of itself, but may be the manifestation of underlying and already established in the medical community diagnoses such as attention deficit hyperactivity disorder, anxiety disorders, mood disorders..." (07:44)

4. Guidance for Parents and Clinicians

• Advice for Those Without Access to Specialist Clinics:

  • Be descriptive and honest with local clinicians. Use the language of “problematic interactive media use” and focus on underlying mental health patterns (ADHD, anxiety, etc.) as well as the gaming habit itself.
  • "Help the clinician, if they're not experienced with this, understand that this is important to deal with in a therapeutic way..." (09:05)

• Importance of Treating the Whole Child

  • Addressing solely the gaming may miss underlying issues; treating these mental health challenges can resolve problematic screen behaviors.

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Notable Quotes and Memorable Moments

• On Framing the Conversation:
  "He needs to frame his son's problematic gaming as a health issue to be treated, not a misbehavior that needs to be punished."
  — Dr. Michael Rich (04:05)

• On Stigma and Language:
  "We're also not calling it an addiction, which is both medically inaccurate but stigmatizing. So parents won't bring their kids to care as early as they could because they don't see them as a junkie in a shooting gallery. They just see them as a kid who's playing way too much video games."
  — Dr. Michael Rich (06:31)

• On the Root of the Problem:
  "This may not in fact, be a diagnosis in and of itself, but may be the manifestation of underlying and already established in the medical community diagnoses..."
  — Dr. Michael Rich (07:44)

• On Parenting in the Digital Age:
  "Enjoy your media, including your games, and use them wisely. But most importantly, enjoy your children and raise them wisely."
  — Dr. Michael Rich (10:36)

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Key Timestamps for Important Segments

• [01:29] — Listener Question from Peter: Kid's loss of interest in activities, gaming "addiction," and taking away the game
• [02:14] — First Steps, Game Removal and Seeking a Path Beyond Punishment
• [03:14] — Challenges in Clinical Treatment and Insurance Landscape
• [05:28] — Defining and Categorizing Problematic Interactive Media Use (PIMU)
• [06:31] — Why Not Call It "Addiction"? Stigma and Accuracy in Terminology
• [07:44] — Underlying Diagnoses: ADHD, anxiety, mood disorders, revealed via excessive media use
• [09:05] — Practical Advice for Parents and Communicating with Clinicians
• [10:36] — Dr. Rich's concluding advice to enjoy media (and children) wisely

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Resources and Further Information

• Clinic for Interactive Media and Internet Disorders (Boston Children’s Hospital)
• Ask the Mediatrician website: askthemediatrician.org
• Further reading and parental guides about PIMU available on podcast’s website

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Summary

This episode offers essential, compassionate insight for families grappling with excessive video game use in children. The hosts advocate for non-punitive, health-focused intervention, deep awareness of underlying psychological issues, and clear parent-clinician communication. Dr. Rich’s approach is rooted in reducing stigma, leveraging behavioral understanding, and empowering children and parents alike in the digital age.

Transcript

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[Dr. Michael Rich]

It's Dr. Michael Rich, the Mediatrician. I'm a practicing pediatrician and child health researcher who specializes in the effects of media on children. Because as a filmmaker I understand how screens engage and move us, change us in various ways. And at the same time I understand the science of child development and health. And so bringing these two together, I try to help parents, children, anyone who works with kids, to understand how we can best raise healthy, happy, productive kids in the digital age. I'm here with mediatrix educator Crystel Lavallee.

[Crystel Lavallee]

So Michael, you like musicals, right?

[Dr. Michael Rich]

Of course. Don't get me singing though.

[Crystel Lavallee]

That's true. Well, this is a question that I like to call Missouri Miserable. And it comes to us from Peter, who's a dad in Kansas City. And Peter wrote, My 10 year old used to be an avid skateboarder and baseball player. Until Call of Duty Black Ops arrived, I didn't in my wildest dreams think that he would become addicted to a video game. I have a 21 year old who played all of the games but was never ruled by them. Since my awakening, I have removed the game, but my son is miserable. How long does it take to deprogram him? So media attrition. How do we get the miserable out of Missouri without letting Peter son fall prey to spending hours on end playing those Black Ops?

[Dr. Michael Rich]

Well, this is a question that more and more parents are asking and more and more young people are being brought to me for Internet or video game behaviors that are causing real problems in their lives, impairing their functions to the point where they're dropping out of school and even worse outcomes such as attempting suicide. It sounds as if Peter's 10 year old son may fall into that category and unfortunately taking the game away may not be enough. First of all, he will see that as punishment rather rather than helping him. And if Peter can change to thinking about it differently, not as deprogramming him, but helping him find a better way to live his life. So he needs professional help.

[Crystel Lavallee]

So what can you tell Peter to expect when he seeks that kind of professional help? What are the treatment options?

[Dr. Michael Rich]

Well, unfortunately, at this point, they're still very limited. Even though the World Health Organization added gaming disorder to the international classification of diseases in 2018, our healthcare system doesn't yet recognize gaming disorder as a formal diagnosis. And as a result, we're not training clinicians to recognize or treat it, and we're not really taking it seriously in the sense of investing in infrastructure to address this. Medical insurance doesn't pay for care for gaming disorder. So given that there's still some steps that Peter can take to help his

[Crystel Lavallee]

son, well, it sounds to me like Peter's already taken that first step. I mean, he took away Black Ops, the video game that he's most concerned about his son playing.

[Dr. Michael Rich]

Yes, and that's very important to help lower the hypersensitivity, the hyperstimulation that his son has by this game. But it's only one step, and unfortunately, most kids see that simply as a punishment that then they subvert. Peter's son, if he truly has a gaming issue, will find other places or other ways to play the game. So I think the next step for Peter is to find a clinician that really understands this kind of problem and make an action plan with him. In the meantime, when he talks to his son about Black Ops, he needs to frame his son's problematic gaming as a health issue to be treated, not a misbehavior that needs to be punished. Peter needs to explain to his son that he sees how miserable his son is. And although he may not understand it yet, the goal here is not to punish him, but but to give him more control over his life.

[Crystel Lavallee]

So, Michael, I feel like Peter came to the perfect person because you are a clinician who understands this kind of problem inside and out. So can you kind of explain to Peter what that is like, what his son is dealing with and experiencing?

[Dr. Michael Rich]

Yes. Well, as the mediatrician, I have been referred kids for variations of interactive media problems for eight or more years now. And one interesting thing we are seeing, because now we have so many kids with this issue that we have a dedicated clinic for this at Boston Children's Hospital. The Clinic for Interactive Media and Internet Disorders, or simaid, is that we are actually seeing four types of problems with interactive media, and we are grouping them under the name of Problematic Interactive Media Use, or Pai mu. And the reason for that is that there Are to our count, more than 60 different names for variations on this problem, Some of which call it addiction, some of which call it a factor of gaming alone, as the WHO has.

[Crystel Lavallee]

World Health Organization.

[Dr. Michael Rich]

Yes. And some of which are social media or smartphones, et cetera. So the reason we are calling it problematic interactive media use is we're not blaming it on the technology. It's our behavior that matters, and it's what we do with this technology. We're also not calling it an addiction, which is both medically inaccurate but stigmatizing. So parents won't bring their kids to care as early as they could because they don't see them as a junkie in a shooting gallery. They just see them as a kid who's playing way too much video games. So what we're seeing actually is four manifestations of Pai Mu. We're seeing gaming excessively, predominantly in boys, Social media use in girls, predominantly pornography, interestingly, evenly balanced between the two sexes, and what we're calling information or video binging. These kids who watch endless YouTube videos, and all of these can be done in a normal, healthy life. And most of these kids, when they are brought in saying, I'm doing what everyone else is doing. But. But the real difference here is that they are doing it to the extent that it's impairing their lives. They are doing poorly in school, they are not getting enough sleep, they are having behavioral outbursts. They are isolating themselves from friends and family, withdrawing into their games or their social media, et cetera. And so this is when it becomes a problem. Now, one of the very interesting things we are seeing as we see more and more of these kids, is that this may not in fact, be a diagnosis in and of itself, but may be the manifestation of underlying and already established in the medical community diagnoses such as attention deficit hyperactivity disorder, anxiety disorders, mood disorders of various kinds. So what we're really seeing, pie muaz, is a syndrome that in. Is allowing these underlying issues to manifest themselves in this interactive media environment.

[Crystel Lavallee]

So it sounds like going back to Peter's son, he really has paimu under that category of video gaming here. He's not in Boston. If he's unable to get to Sim Aid, what language can he use when talking to a clinician that's available to him?

[Dr. Michael Rich]

I think he should express exactly what's going on with his son and help the clinician, if they're not experienced with this, understand that this is important to deal with in a therapeutic way and to really think through the commonalities of behavior, the commonalities of pathology that happen outside of the environment of interactive media as well as inside. Because most of these kids really benefit from identity identifying and treating that underlying adhd, anxiety, et cetera.

[Crystel Lavallee]

That's such really good information to have. And Peter will link to more information about problematic interactive media use or paimu, as well as also provide a link to that clinic, the Clinic on Interactive Media and Internet Disorders, which is at Boston Children's Hospital. All of those will be [e-mail] and just another big thanks for sharing your son's struggles, Peter. We hope for the best with you dealing with his gaming. If you could give us an update, we'd love to know how he's doing so you can find out more about this and many other topics related to healthy media habits, as well as figure out all the research and the [e-mail] you can also follow our Mediatrician on Twitter mediatrician and submit your own [e-mail] and please remember to subscribe and share this podcast with all of your friends.

[Dr. Michael Rich]

Enjoy your media, including your games, and use them wisely. But most importantly, enjoy your children and raise them wisely.

[Podcast Producer]

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 Haywood.

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