Association of Extensive Video Gaming and Cognitive Function Changes in Brain-Imaging Studies of Pro Gamers and Individuals With Gaming Disorder: Systematic Literature Review

BACKGROUND

The World Health Organization announced the inclusion of gaming disorder (GD) in the International Classification of Diseases, 11th Revision, despite some concerns. However, video gaming has been associated with the enhancement of cognitive function. Moreover, despite comparable extensive video gaming, pro gamers have not shown any of the negative symptoms that individuals with GD have reported. It is important to understand the association between extensive video gaming and alterations in brain regions more objectively.

OBJECTIVE

This study aimed to systematically explore the association between extensive video gaming and changes in cognitive function by focusing on pro gamers and individuals with GD.

METHODS

Studies about pro gamers and individuals with GD were searched for in the PubMed and Web of Science databases using relevant search terms, for example, "pro-gamers" and "(Internet) gaming disorder." While studies for pro gamers were searched for without date restrictions, only studies published since 2013 about individuals with GD were included in search results. Article selection was conducted by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

By following the PRISMA guidelines, 1903 records with unique titles were identified. Through the screening process of titles and abstracts, 86 full-text articles were accessed to determine their eligibility. A total of 18 studies were included in this systematic review. Among the included 18 studies, six studies included pro gamers as participants, one study included both pro gamers and individuals with GD, and 11 studies included individuals with GD. Pro gamers showed structural and functional alterations in brain regions (eg, the left cingulate cortex, the insula subregions, and the prefrontal regions). Cognitive function (eg, attention and sensorimotor function) and cognitive control improved in pro gamers. Individuals with GD showed structural and functional alterations in brain regions (eg, the striatum, the orbitofrontal cortex, and the amygdala) that were associated with impaired cognitive control and higher levels of craving video game playing. They also showed increased cortical thickness in the middle temporal cortex, which indicated the acquisition of better skills. Moreover, it was suggested that various factors (eg, gaming expertise, duration or severity of GD, and level of self-control) seemed to modulate the association of extensive video game playing with changes in cognitive function.

CONCLUSIONS

Although a limited number of studies were identified that included pro gamers and/or individuals who reported showing symptoms of GD for more than 1 year, this review contributed to the objective understanding of the association between extensive video game playing and changes in cognitive function. Conducting studies with a longitudinal design or with various comparison groups in the future would be helpful in deepening the understanding of this association.

Development of a Search Task Using Immersive Virtual Reality: Proof-of-Concept Study

BACKGROUND

Serious games are gaining increasing importance in neurorehabilitation since they increase motivation and adherence to therapy, thereby potentially improving its outcome. The benefits of serious games, such as the possibility to implement adaptive feedback and the calculation of comparable performance measures, can be even further improved by using immersive virtual reality (iVR), allowing a more intuitive interaction with training devices and higher ecological validity.

OBJECTIVE

This study aimed to develop a visual search task embedded in a serious game setting for iVR, including self-adapting difficulty scaling, thus being able to adjust to the needs and ability levels of different groups of individuals.

METHODS

In a two-step process, a serious game in iVR (bird search task) was developed and tested in healthy young (n=21) and elderly (n=23) participants and in a group of patients with impaired visual exploration behavior (ie, patients with hemispatial neglect after right-hemispheric stroke; n=11). Usability, side effects, game experience, immersion, and presence of the iVR serious game were assessed by validated questionnaires. Moreover, in the group of stroke patients, the performance in the iVR serious game was also considered with respect to hemispatial neglect severity, as assessed by established objective hemispatial neglect measures.

RESULTS

In all 3 groups, reported usability of the iVR serious game was above 4.5 (on a Likert scale with scores ranging from 1 to 5) and reported side effects were infrequent and of low intensity (below 1.5 on a Likert scale with scores ranging from 1 to 4). All 3 groups equally judged the iVR serious game as highly motivating and entertaining. Performance in the game (in terms of mean search time) showed a lateralized increase in search time in patients with hemispatial neglect that varied strongly as a function of objective hemispatial neglect severity.

CONCLUSIONS

The developed iVR serious game, "bird search task," was a motivating, entertaining, and immersive task, which can, due to its adaptive difficulty scaling, adjust and be played by different populations with different levels of skills, including individuals with cognitive impairments. As a complementary finding, it seems that performance in the game is able to capture typical patterns of impaired visual exploration behavior in hemispatial neglect, as there is a high correlation between performance and neglect severity as assessed with a cancellation task.

Scenting Entertainment: Virtual Reality Storytelling, Theme Park Rides, Gambling, and Video-Gaming

There has long been interest in both the tonic and phasic release of scent across a wide range of entertainment settings. While the presentation of semantically congruent scent has often been used in order to enhance people's immersion in a particular context, other generally less successful attempts have involved the pulsed presentation of a range of scents tied to specific events/scenes. Scents have even been released in the context of the casino to encourage the guests to linger for longer (and spend more), at least according to the results of one controversial study. In this narrative review, I want to take a closer look at the use of scent in a range of both physical and digital environments, highlighting the successes (as in the case of scented theme park rides) and frequent failures (as, seemingly, in the context of scent-enabled video games). While digitally inducing meaningful olfactory sensations is likely to remain a pipe dream for the foreseeable future, the digital control of scent release/delivery provides some limited opportunities to enhance the multisensory experience of entertainment. That said, it remains uncertain whether the general public will necessarily perceive the benefit, and hence be willing to pay for the privilege.

Changes to the playing field: A contemporary study of actual European online sports betting

BACKGROUND AND AIMS

Online sports wagering is a popular and still growing gambling activity around the world. Like other types of gambling, it can lead to problems that include devastating financial, social, and health-related harms. The first analysis of actual online sports wagering activity (LaBrie et al., 2007) suggested that levels of financial and time involvement were more moderate than anticipated from earlier self-report studies. However, these findings are now more than a decade old.

METHODS

The current study examined actual online sports wagering activity of a similar cohort of 32,262 gamblers who subscribed to a European online betting platform in February 2015 to understand how sports betting might have changed in ten years. Measures included subscriber characteristics, betting activities, and transactional activities.

RESULTS

Players placed a median of 15 bets during the 8-month study period, made a median of 2.5 bets per betting day, had a median bet size of 6.1 euros, and experienced a median net loss of 25 euros. We were able to distinguish highly involved bettors in the top 2% of total wagered, net loss, and number of bets, whose behavior differed from that of the rest of the sample.

DISCUSSION AND CONCLUSIONS

Sports wagering behavior has remained relatively stable over time despite legislative changes and an increase in popularity, with a small subset of subscribers exhibiting disproportionately high engagement, transactional activity, and in-game betting. Further investigation of individual trajectories of wagering behavior and engagement with different types of sports wagering products is merited.

Are There Differences in Video Gaming and Use of Social Media among Boys and Girls?-A Mixed Methods Approach

Gaming is widespread among adolescents and has typically been viewed as an activity for boys. There are however a growing number of female gamers and we need to learn more about how gender affects gaming. The aim of this study is to both quantify gaming among Norwegian adolescents and explore how gender differences are perceived. A mixed method approach was used to capture gaming experiences among boys and girls. Survey data (N = 5607) was analyzed descriptively, and five focus groups were conducted, applying thematic analysis. Statistics showed that boys from the age of 14 use video games up to 5 times more than girls, while girls are much more on social media. From the focus groups, we found that boys did not view social media as socially significant as gaming and that there is a greater social acceptance of gaming among boys than among girls. Gender differences in video gaming are not necessarily a problem per se, as they may reflect gender-specific motivations and interests. However, the study also finds that girls feel less encouraged than boys to play video games due to different gender-related experiences of video gaming. Therefore, gendered barriers in video gaming must be explored in future research.

Developing Adaptive Serious Games for Children With Specific Learning Difficulties: A Two-phase Usability and Technology Acceptance Study

BACKGROUND

Specific learning difficulties (SpLD) include several disorders such as dyslexia, dyscalculia, and dysgraphia, and the children with these SpLD receive special education. However, the studies and the educational material so far focus mainly on one specific disorder.

OBJECTIVE

This study's primary goal is to develop comprehensive training material for different types of SpLD, with five serious games addressing different aspects of the SpLD. The second focus is measuring the impact of adaptive difficulty level adjustment in the children's and their educators' usability and technology acceptance perception. Receiving feedback from the children and their educators, and refining the games according to their suggestions have also been essential in this two-phase study.

METHODS

A total of 10 SpLD educators and 23 children with different types of SpLD tested the prototypes of the five serious games (ie, Word game, Memory game, Category game, Space game, and Math game), gave detailed feedback, answered the System Usability Scale and Technology Acceptance Model (TAM) questionnaires, and applied think-aloud protocols during game play.

RESULTS

The games' standard and adaptive versions were analyzed in terms of average playtime and the number of false answers. Detailed analyses of the interviews, with word clouds and player performances, were also provided. The TAM questionnaires' average and mean values and box plots of each data acquisition session for the children and the educators were also reported via System Usability Scale and TAM questionnaires. The TAM results of the educators had an average of 8.41 (SD 0.87) out of 10 in the first interview and an average of 8.71 (SD 0.64) out of 10 in the second interview. The children had an average of 9.07 (SD 0.56) out of 10 in the first interview.

CONCLUSIONS

Both the educators and the children with SpLD enjoyed playing the games, gave positive feedback, and suggested new ways for improvement. The results showed that these games provide thorough training material for different types of SpLD with personalized and tailored difficulty systems. The final version of the proposed games will become a part of the special education centers' supplementary curriculum and training materials, making new enhancements and improvements possible in the future.

Examining Student Motivation to Use a Gamified System in an Immunology and Immunization Training Course

Background:

Gamification is the process of adding game elements into classroom activities to encourage student participation and motivation. Classcraft^® is a gamified learning system designed to integrate easily with normal classroom activities and to enhance collaboration and teamwork.

Educational activity and setting:

This study explored the use of the Classcraft^® system in an Immunology and Immunization Training course, specifically examining students’ motivation to use the system and potential impacts on their motivation.

Findings:

Results showed that value and enjoyment motivated students to use Classcraft^®. Furthermore,the ease of use of the system positively impacted students’ enjoyment of the system. Students’ choice regarding how much they were required to engage with the system positively impacted the value and enjoyment that they experienced with the system.

Summary:

Students’ demonstrated motivation to use Classcraft^® provides a foundation for further research into the use of gamified learning systems within pharmacy classrooms. Research is needed to understand if use of a gamified learning system positively impacts learning outcomes.

Current Competencies of Game Facilitators and Their Potential Optimization in Higher Education: Multimethod Study

Background

Serious games can be a powerful learning tool in higher education. However, the literature indicates that the learning outcome in a serious game depends on the facilitators’ competencies. Although professional facilitators in commercial game-based training have undergone specific instruction, facilitators in higher education cannot rely on such formal instruction, as game facilitation is only an occasional part of their teaching activities.

Objective

This study aimed to address the actual competencies of occasional game facilitators and their perceived competency deficits.

Methods

Having many years of experience as professional and occasional facilitators, we (n=7) defined requirements for the occasional game facilitator using individual reflection and focus discussion. Based on these results, guided interviews were conducted with additional occasional game facilitators (n=4) to check and extend the requirements. Finally, a group of occasional game facilitators (n=30) answered an online questionnaire based on the results of the requirement analysis and existing competency models.

Results

Our review produced the following questions: Which competencies are needed by facilitators and what are their training needs? What do current training courses for occasional game facilitators in higher education look like? How do the competencies of occasional game facilitators differ from other competencies required in higher education? The key findings of our analysis are that a mix of managerial and technical competencies is required for facilitating serious games in higher educational contexts. Further, there is a limited or no general competence model for game facilitators, and casual game facilitators rarely undergo any specific, formal training.

Conclusions

The results identified the competencies that game facilitators require and a demand for specific formal training. Thus, the study contributes to the further development of a competency model for game facilitators and enhances the efficiency of serious games.

Factors related to Internet and game addiction among adolescents: A scoping review

Background

Understanding factors influencing Internet and game addiction in children and adolescents is very important to prevent negative consequences; however, the existing factors in the literature remain inconclusive.

Objective

This study aims to systematically map the existing literature of factors related to Internet and game addiction in adolescents.

Methods

A scoping review was completed using three databases - Science Direct, PROQUEST Dissertations and Theses, and Google Scholar, which covered the years between 2009 to July 2020. Quality appraisal and data extraction were presented. A content analysis was used to synthesize the results.

Results

Ultimately, 62 studies met inclusion criteria. There were 82 associated factors identified and grouped into 11 categories, including (1) socio-demographic characteristics, (2) parental and family factors, (3) device ownership, Internet access and location, social media, and the game itself, (4) personality/traits, psychopathology factors, self-efficacy, (5) education and school factors, (6) perceived enjoyment, (7) perceived benefits, (8) health-compromising behaviors, (9) peers/friends relationships and supports, (10) life dissatisfaction and stress, and (11) cybersafety.

Conclusion

Internet and game addiction among adolescents are multifactorial. Nurses should consider the factors identified in this study to provide strategies to prevent and reduce addiction in adolescents.

Using a Web-Based Quiz Game as a Tool to Summarize Essential Content in Medical School Classes: Retrospective Comparative Study

BACKGROUND

Kahoot! is a web-based technology quiz game in which teachers can design their own quizzes via provided game templates. The advantages of these games are their attractive interfaces, which contain stimulating music, moving pictures, and colorful, animated shapes to maintain students' attentiveness while they perform the quizzes.

OBJECTIVE

The aim of this study was to evaluate the use of Kahoot! compared with a traditional teaching approach as a tool to summarize the essential content of a medical school class in the aspects of final examination scores and the perception of students regarding aspects of their learning environment and of process management.

METHODS

This study used an interrupted time series design, and retrospective data were collected from 85 medical students. Of these 85 students, 43 completed a Kahoot! quiz, while 42 students completed a paper quiz. All students attended a lecture on the topic of bone and joint infection and participated in a short case discussion. Students from both groups received the same content and study material, with the exception that at the end of the lesson, students in the Kahoot! group completed a quiz summarizing the essential content from the lecture, whereas the other group received a paper quiz with the same questions and the teacher provided an explanation after the students had finished. The students' satisfaction was evaluated after the class, and their final examination was held 2 weeks after the class.

RESULTS

The mean final examination score in the Kahoot! group was 62.84 (SD 8.79), compared to 60.81 (SD 9.25) in the control group (P=.30). The students' satisfaction with the class environment, learning process management, and teacher were not significantly different between the 2 groups (all P>.05).

CONCLUSIONS

In this study, it was found that using Kahoot! as a tool to summarize the essential content in medical school classes involving a lecture and case discussion did not affect the students' final examination scores or their satisfaction with the class environment, learning process management, or teacher.

The Moderating Role of Coping Mechanisms and Being an e-Sport Player Between Psychiatric Symptoms and Gaming Disorder: Online Survey

BACKGROUND

The emerging popularity of playing video games (gaming) as a hobby and as a professional sport raises awareness about both the benefits and possible downsides of the activity. Although a healthy and passionate hobby for most, a minority of gamers experience addiction-like symptoms and are considered to have gaming disorder (GD). GD has previously been found to be related to aversive conditions, such as depression or anxiety, as well as putatively maladaptive coping strategies.

OBJECTIVE

The aim of this study is twofold: to explore the moderating effect of different coping strategies and type of video game usage (professional [e-sport] or recreational) on the relationship between psychiatric symptoms and GD.

METHODS

A sample of 3476 gamers (n=3133, 90.13% males; mean age 23.20, SD 6.48 years) was recruited via the website and social networking site of the most popular gaming magazine in Hungary (GameStar).

RESULTS

The main effect of psychiatric symptoms was moderate to large in all models, whereas the moderation effects were significant (P<.001) for 4 out of 8 coping strategies (ie, self-blame/self-distraction, denial, emotional/social support, and active coping). However, the explained variance of the models only increased negligibly (from 0.3% to 0.5%) owing to the moderation effect. The direction of the moderations was as expected (ie, putatively maladaptive strategies were associated with more GD symptoms when the level of psychiatric symptoms was high, while putatively adaptive strategies were associated with less). Furthermore, no considerable moderation effect of the player type (recreational vs professional players) was found on the association between psychiatric symptoms and GD (β=.04; P=.02; 0.1% change in the explained variance).

CONCLUSIONS

Future studies should be designed to better understand coping-related mechanisms in the context of video gaming and GD.

Usability of a Psychotherapeutic Interactive Gaming Tool Used in Facial Emotion Recognition for People with Schizophrenia

The objective of the study was to test the usability of ‘Feeling Master’ as a psychotherapeutic interactive gaming tool with LEGO cartoon faces showing the five basic emotions, for the assessment of emotional recognition in people with schizophrenia in comparison with healthy controls, and the relationship between face affect recognition (FER), attributional style, and theory of mind (ToM), which is the ability to understand the potential mental states and intentions of others. Nineteen individuals with schizophrenia (SZ) and 17 healthy control (HC) subjects completed the ‘Feeling Master’ that includes five basic emotions. To assess social cognition, the group with schizophrenia was evaluated with the Personal and Situational Attribution Questionnaire (IPSAQ) for the assessment of attributional style and the Hinting Task (ToM). Patients with SZ showed significant impairments in emotion recognition and their response time appeared to be slower than the HC in the recognition of each emotion. Taking into account the impairment in the recognition of each emotion, we only found a trend toward significance in error rates on fear recognition. The correlations between correct response on the ‘Feeling Master’ and the hinting task appeared to be significant in the correlation of surprise and theory of mind. In conclusion, this study demonstrated that the ‘Feeling Master’ could be useful for the evaluation of FER in people with schizophrenia. These results sustain the notion that impairments in emotion recognition are more prevalent in people with schizophrenia and that these are related with impairment in ToM.

Developing the Next Generation of Augmented Reality Games for Pediatric Healthcare: An Open-Source Collaborative Framework Based on ARCore for Implementing Teaching, Training and Monitoring Applications

Augmented Reality (AR) provides an alternative to the traditional forms of interaction between humans and machines, and facilitates the access to certain technologies to groups of people with special needs like children. For instance, in pediatric healthcare, it is important to help children to feel comfortable during medical procedures and tests that may be performed on them. To tackle such an issue with the help of AR-based solutions, this article presents the design, implementation and evaluation of a novel open-source collaborative framework that enables to develop teaching, training, and monitoring pediatric healthcare applications. Specifically, such a framework allows for building collaborative applications and shared experiences for AR devices, providing functionalities for connecting with other AR devices and enabling real-time visualization and simultaneous interaction with virtual objects. Since all the communications involved in AR interactions are handled by AR devices, the proposed collaborative framework is able to operate autonomously through a Local Area Network (LAN), thus requiring no cloud or external servers. In order to demonstrate the potential of the proposed framework, a practical use case application is presented. Such an application has been designed to motivate pediatric patients and to encourage them to increase their physical activity through AR games. The presented games do not require any previous configuration, as they use ARCore automatic surface detection technology. Moreover, the AR mobile gaming framework allows multiple players to engage in the same AR experience, so children can interact and collaborate among them sharing the same AR content. In addition, the proposed AR system provides a remote web application that is able to collect and to visualize data on patient use, aiming to provide healthcare professionals with qualified data about the mobility and mood of their patients through an intuitive and user-friendly web tool. Finally, to determine the performance of the proposed AR system, this article presents its evaluation in terms of latency and processing time. The results show that both times are low enough to provide a good user experience.

Using Virtual Simulation To Increase Deep Learning in Radiography Students

PURPOSE

To discuss recent studies that validate the combination of traditional teaching and virtual simulation training in reducing common errors, enhancing students' confidence, improving their performance, and increasing deep learning.

METHODS

Multiple electronic databases were searched for learning environment concepts such as deep- vs surface-learning approaches, online vs face-to-face instruction, and the usefulness of virtual simulation laboratories between 1999 to the present.

RESULTS

Deep-learning approaches allow students to engage in higher-quality learning (eg, understanding of the discipline and thinking critically) than do surface-learning approaches. Instructors are shifting from traditional face-to-face learning environments to online environments, including virtual simulation. Virtual simulation alone does not guarantee deep learning; instructional design and guidelines determine whether students use deep- or surface-learning approaches.

DISCUSSION

Most radiologic technology programs currently use a traditional x-ray laboratory to teach students positioning and radiation dose techniques. Virtual simulation offers a harmless and convenient learning environment that permits students to practice techniques without the risks of irradiating patients. Instructors can foster deep learning in virtual simulation laboratory environments by designing the software around particular course outcomes (eg, cognitive and psychomotor skills) and engaging with sound educational strategies and theory.

CONCLUSION

By understanding deep learning that is taking place in radiologic science laboratory learning environments, educators will be able to design virtual simulation courses that foster deeper learning.

Young people who purchase loot boxes are more likely to have gambling problems: An online survey of adolescents and young adults living in NSW Australia

BACKGROUND AND AIMS

Loot boxes are a common feature in video games where players win, buy or are gifted a virtual box or other container that is unwrapped to reveal virtual items of value, such as skins, weapons, in-game currency or special abilities. The current study aimed to relate the use of loot boxes to gambling problems and harm.

METHODS

An online survey was conducted with 1,954 adolescents and young adults from NSW Australia, 59.9% female (aged 12-24), recruited by online panel aggregator, Qualtrics.

RESULTS

Buying and selling loot boxes was associated with higher 12-month gambling frequency and gambling problems in young adults, aged 18-24 (Problem Gambling Severity Index). Young adults who bought loot boxes additionally had more gambling-related harms (Short Gambling Harms Screen). Young women, aged 18-24, who opened, bought and/or sold loot boxes spent more money in the last 12 months on gambling. In adolescents, aged 12-17, buying loot boxes was similarly associated with gambling problems (DSM-IV-MR-J). Furthermore, adolescent girls who bought and/or sold loot boxes viewed gambling more positively than other girls (Attitudes Towards Gambling Scale). There was no evidence, however, that longer-term experience in opening or purchasing loot boxes, a differentiating feature of the survey, is associated with current gambling problems.

DISCUSSION AND CONCLUSIONS

This study suggests that loot boxes may be attractive to people who are already predisposed to engage in other gambling, and females who use loot boxes may have unique vulnerabilities to gambling problems that could be explored in future research.

Validation and Psychometric Properties of the Persian Version of the 21-Item Game Addiction Scale With a Sample of Adolescents and Young Adults

Background: Excessive gaming has become a psychological health issue for both gamers and their social environments. This observation holds true for western but also non-western countries such as Iran. The aim of the present study was to translate and validate a Persian version of the Game Addiction Scale 21 (GAS 21) using a sample of adolescents and adults. Methods: A total of 412 participants (mean age: 22.16 years; 55.3% females) took part in the study. They completed questionnaires covering sociodemographic information and gaming-related information, as well as the Persian version of the GAS 21, the GAS 7, the Internet Addiction Test, and the Generalized Self-Efficacy Scale. Results: Of the initial 21 items of the Persian version of the GAS 21, five proved redundant and were eliminated. Factors analyses yielded four factors explaining 66.35% of the variance: 1. Withdrawal; 2. Feelings of guilt and addiction; 3. Mood modification; 4. Issues of time budget. Cronbach's alphas were satisfactory (alphas > 0.87). To validate the results, scores on the translated version were compared with the well-established Young Internet Addiction test. Factors correlated positively (rs between 0.21 and 0.31) with overall score on this latter test but, against expectations, positively with the generalized self-efficacy scale. Conclusions: A Persian version of the Game Addiction Scale-21 proved to be a useful tool for assessing the risk of game addiction behavior. Further, the solution with 16 items loading on four factors appears respond to the ecological need of parsimony.

Linking Gaming Disorder Tendencies in Children to Their Personality and Parental Gaming Behavior

Playing computer and video games (so-called gaming) is of great popularity among children and adults. But for some people, gaming gets out of hand and can result in a Gaming Disorder (GD). Among others, high neuroticism and low conscientiousness are considered to play a role in the etiology of GD. Next to personality traits, environmental variables are debated such as the parental influence on children's gaming behavior. In detail, parental gaming behavior could have role model functions for children. Based on empirical observations and theoretical frameworks, it was hypothesized that higher tendencies to GD in children are associated with higher neuroticism, lower conscientiousness, and higher parental tendencies to GD. In an online survey N = 493 parents (n = 472 females; age: M = 36.30, SD = 5.46) rated their own and their children's (n = 233 girls, n = 260 boys; age: M = 6.03, SD = 2.30) tendencies to GD by the Gaming Disorder Test (GDT) and their children's personality by the Big Five Inventory (BFI). Neuroticism was significantly correlated with the GDT scores of boys (rho = 0.256, p = 0.001) and girls (rho = 0.300, p = 0.001), while a significant correlation with conscientiousness was only present for boys (rho = -0.196, p = 0.010). Parents' and children's general playing of computer and video games were interdependent [χ²(1) = 29.14, p < 0.001]; hence, if parents reported to be gamers, their children were more likely gamers as well. The GDT scores of parents and children were positively correlated (boys: rho = 0.36; p = 0.002; girls: rho = 0.33, p = 0.004). The results indicate that already in children the personality traits neuroticism and conscientiousness are associated with tendencies toward GD. Moreover, as gaming of parents and children was related to each other, it is conceivable that parents influence their children's gaming behavior via their own gaming behavior. Therefore, parents should be aware of their exemplary function for children and may overthink their own gaming behavior. But it has to be mentioned that the correlational nature of the present work allows no insights regarding causal relations.

Prevalence of Behavioral Addictions and Their Relationship With Stress and Anxiety Among Medical Students in Saudi Arabia: A Cross-Sectional Study

Behavioral addiction is identified as any compulsive, repeated, and persistent behavior that leads to significant and functionally impairing harm or distress. The aim of this study is to determine the prevalence of internet, video-gaming, and pornography addictions among medical students in Western region. In addition, we intend to investigate the relationship between these behavioral addictions with stress and anxiety. Our study was a cross-sectional study with a sample size of 225. The study participants were medical students in their 3rd, 4th, and 5th academic years from five different medical colleges in Western region. The questionnaire included demographics and adapted five different pre-validated scales: Young's Internet Addiction Test - Short Version (IAT-SV), Internet Gaming Disorder Scale 9 - Short Form (IGDS9-SF), (PPC scale), Perceived Stress Scale (PSS), and Generalized Anxiety Disorder 7-item scale (GAD-7). The IAT-SV scale showed: 71 (31.6%) of the participants had normal internet usage, 51 (22.7%) participants showed problematic usage, and 103 (45.8%) used the internet pathologically. The IGDS9-SF scale had observed the following values: 220 participants (97.8%) were non-disordered, and 5 participants (2.2%) were found to be disordered. Statistical analysis showed a highly significant association between stress and problematic pornography consumption (P < 0.01), and internet addiction (P <0.001). Moreover, there was a significant association between anxiety and internet gaming disorder (P < 0.01). This study showed high prevalence of internet addiction and low prevalence of internet gaming disorder. Also, it gave more understanding to a possible association between these behavioral addictions with stress and anxiety.

Designing an Escape Room to Increase Pharmacy Preceptor Knowledge of the Pharmacists' Patient Care Process

Objective. To design and assess the use of an escape room for pharmacy preceptor development.Methods. An escape room for preceptor development that focused on the Pharmacists' Patient Care Process (PPCP), preceptor resources, and the school of pharmacy's mission and vision was created. Teams had to solve digital and practical puzzles to escape a pharmacy. The team to correctly solve all the puzzles the fastest was considered to have escaped the pharmacy. Escape room puzzles included digital locks, cipher wheels, a rebus puzzle, riddle, hidden object, and other puzzles. Preceptor's knowledge of the PPCP and perceptions of the game were evaluated using a pre- and post-activity test and survey.Results. Fifteen preceptors with a variety of practice sites and precepting experience participated in a matched pre-and post-activity survey. Preceptor knowledge of the order of the PPCP improved, with nine (60%) preceptors answering correctly before participating in the activity vs 13 (87%) after. However, the preceptors were less likely to correctly answer the type of approach the PPCP uses after completing the escape room activity, with 14 (93%) answering correctly before vs 10 (67%) after. Participants' perceptions of the game were positive and all preceptors agreed or strongly agreed that they would recommend participating in this activity to another preceptor.Conclusion. A preceptor development escape room was viewed positively by preceptors. Future research should focus on digital-only escape rooms for preceptors to increase availability and participation.

Social Capital-Accrual, Escape-From-Self, and Time-Displacement Effects of Internet Use During the COVID-19 Stay-at-Home Period: Prospective, Quantitative Survey Study

BACKGROUND

COVID-19 has spread like wildfire across the globe, prompting many governments to impose unprecedented stay-at-home orders to limit its transmission. During an extended stay-at-home period, individuals may engage in more online leisure activities. Internet use is a double-edged sword that may have both desirable and undesirable effects on psychological well-being, and this study sought to disentangle adaptive from maladaptive internet use amidst this unusual health crisis.

OBJECTIVE

The objectives of this study were to assess the prevalence of probable depression during the COVID-19 stay-at-home period and to test three hypothesized risk reduction or risk elevation mechanisms, namely social capital-accrual, escape-from-self, and time-displacement effects.

METHODS

This study took place from March to May 2020 at the early stage of the pandemic. The study adopted a prospective design, with an online survey administered to 573 UK and 474 US adult residents at two assessment points 2 months apart.

RESULTS

The prevalence of moderate to severe depression was 36% (bootstrap bias-corrected and accelerated [BCa] 95% CI 33%-39%) at Time 1 (ie, initial time point) and 27% (bootstrap BCa 95% CI 25%-30%) at Time 2 (ie, follow-up time point). The results supported the social capital-accrual hypothesis by showing that the approach coping style was inversely associated with Time 2 depression through its positive associations with both social networking and perceived family support. The results also supported the escape-from-self hypothesis by revealing that the avoidant coping style was positively associated with Time 2 depression through its positive associations with both gaming and cyberbullying victimization, but the serial mediation model was no longer significant after Time 1 depression and some demographic risk factors had been controlled for. Finally, the results supported the time-displacement hypothesis by showing that gaming was positively associated with Time 2 depression through its inverse associations with social networking and perceived family support.

CONCLUSIONS

During the extended stay-at-home period in the early stages of the COVID-19 pandemic, the prevalence of probable depression during the 2-month study period was high among the UK and US residents. Individuals with distinct coping styles may engage in different types of online leisure activities and perceive varying levels of social support, which are associated with risks of probable depression.

Gambling in children and adolescents

INTRODUCTION

Children are susceptible to problems with gambling because of developmental and cognitive immaturities, as well as a sensitivity to peer pressure and marketing.

SOURCES OF DATA

This review uses recent UK data from the Gambling Commission and from the Avon Longitudinal Study of Parents and Children, and evidence from recent reviews of gambling in children and adolescents.

AREAS OF AGREEMENT

The prevalence of gambling in children worldwide and in the UK is stable, having generally decreased since 2013. Online gambling is increasing in children and young people. A small minority of adolescents who gamble develop a gambling disorder. Adolescents who have problems with gambling tend to have lower self-esteem and a history of hyperactivity and impulsivity, are more likely to have parents who gamble, report less parental supervision and to use more alcohol than their peers.

AREAS OF CONTROVERSY

Children's access to slot machines, the relationship between gaming and gambling, and social media advertizing of gambling targeting children.

GROWING POINTS

An increase in online gambling and in-play sports betting by adolescents and the use of skins betting in video gaming.Areas timely for developing research: impact on young people of betting on e-gaming. How best to protect children from early exposure to gambling in the current internet age.

IMPLICATIONS FOR CLINICIANS

Need to be aware of the growing and complex phenomenon of gaming and gambling, and implications for the mental health of children and adolescents. The effective management of gambling disorders in children and adolescents requires close working with families.

The Role of the Avatar in Gaming for Trans and Gender Diverse Young People

A significant proportion of trans and gender diverse (TGD) young people report membership of the gaming community and resultant benefits to wellbeing. To date their experiences and needs regarding a key feature of games, the avatar, are largely unexplored, despite increasing interest in the therapeutic role of avatars in the general population. The aim of this study was to better understand the role of the avatar in gaming, its impact on TGD young people’s mental health, and their unique needs regarding avatar design. N = 17 TGD young people aged 11–22 years (M = 16.3 years) participated in four focus groups. A general inductive approach was used to thematically analyze the transcribed data. TGD young people report considerable therapeutic benefits of using avatars with positive mental health implications. Importantly, TGD young people use avatars to explore, develop and rehearse their experienced gender identities, often as a precursor to coming out in the offline world. They also report negative experiences of feeling excluded due to the constraints of conventional notions of gender that are widely reflected in game design. Participants described simple design features to better reflect gender diversity, such as increased customization. Such changes would facilitate the positive gains reported by participants and better reflect the diversity of young people who use games. The findings have important implications for both recreational and serious or therapeutic game design.

Evidence of an Effect of Gaming Experience on Visuospatial Attention in Deaf but Not in Hearing Individuals

Auditory cortex in congenitally deaf early sign language users reorganizes to support cognitive processing in the visual domain. However, evidence suggests that the potential benefits of this reorganization are largely unrealized. At the same time, there is growing evidence that experience of playing computer and console games improves visual cognition, in particular visuospatial attentional processes. In the present study, we investigated in a group of deaf early signers whether those who reported recently playing computer or console games (deaf gamers) had better visuospatial attentional control than those who reported not playing such games (deaf non-gamers), and whether any such effect was related to cognitive processing in the visual domain. Using a classic test of attentional control, the Eriksen Flanker task, we found that deaf gamers performed on a par with hearing controls, while the performance of deaf non-gamers was poorer. Among hearing controls there was no effect of gaming. This suggests that deaf gamers may have better visuospatial attentional control than deaf non-gamers, probably because they are less susceptible to parafoveal distractions. Future work should examine the robustness of this potential gaming benefit and whether it is associated with neural plasticity in early deaf signers, as well as whether gaming intervention can improve visuospatial cognition in deaf people.

The Relationship Between Cognition and Sensorimotor Behavior in an F1 Driving Simulation: An Explorative Study

Sensorimotor control simultaneously engages multiple cognitive processes, like decision making, intention, processing, and the integration of multisensory signals. The reciprocal relationship of cognition and sensorimotor learning is well documented. However, little is known if the status of cognitive skills relates to immediate sensorimotor performance of performing a novel skill. Thus, we aim to explore whether cognitive skills in general and executive functions (EFs) in particular may relate to novel sensorimotor performance and adaptive skills. Therefore, 23 male participants engaged in a novel driving simulation for 2 days. On the first day, they accustomed to the F1 simulation until meeting a preset threshold (adaption). On the second day, they aimed to drive as fast as possible (performance). In addition, we measured EFs and global cognition. We found meaningful relationships between response inhibition (Stroop Color and Word Test), the driving performance (r = 0.48, p = 0.013), and the adaptive ability (r = 0.34, p = 0.012). All other tests of executive functioning and global cognition remained non-significant. Our results illustrate an association of driving performance and adaptive abilities and the EF selective attention/inhibition in a novel F1 simulation. Given the novelty of the task, the ability to adjust sensorimotor behavior to keep the car on the track seems to be the primary necessary skill to navigate the lap and achieve fast times.

Mobile and non-mobile Internet Use Disorder: Specific risks and possible shared Pavlovian conditioning processes. •

This commentary addresses a recent article by Montag et al. (2019) about the relevance of distinguishing between mobile and non-mobile Internet Use Disorder (IUD). In response to the review, we reflect on the clinical relevance of this distinction and, in parallel, we propose some Pavlovian conditioning processes as possible mechanisms underlying different IUDs. We believe that, from a clinical point of view, it is of fundamental importance assessing both specific "forms" of IUDs and the underlying mechanisms that would be shared across different IUDs, like multiple and parallel classes of Pavlovian responses and the influences of Internet cues on Internet-related addictive behaviors that may be influenced by the probability of obtaining Internet rewards.