The Groundskeeper Gaming Platform as a Diagnostic Tool for Attention-Deficit/Hyperactivity Disorder: Sensitivity, Specificity, and Relation to Other Measures

OBJECTIVE

The purpose of this study was to assess the relative accuracies of the Conners' Brief Rating Scale, Parent Version, the Conners' Continuous Performance Test II (CPT II), and a novel interactive game called "Groundskeeper" to discriminate child psychiatric patients with and without attention-deficit/hyperactivity disorder (ADHD).

METHODS

We administered the three assessments to 113 clinically referred ADHD and non-ADHD patients who had been diagnosed with the Kiddie-Schedule of Affective Disorders and Schizophrenia- Present and Lifetime (K-SADS-PL), Version 19.

RESULTS

As measured by the area under the curve (AUC) statistic from receiver operating characteristic (ROC) analysis, the diagnostic accuracy of Groundskeeper (0.79) was as high as the accuracy of the Conners' parent rating of inattention (0.76) and better than the CPT II percent correct (0.62). Combining the three tests produced an AUC of 0.87. Correlations among the three measures were small and, mostly, not significant.

CONCLUSIONS

Our finding of similar diagnostic accuracies between Groundskeeper and the Conners' inattention scale is especially remarkable given that the Conners' inattention scale shares method variance with the diagnostic process. Although our work is preliminary, it suggests that computer games may be useful in the diagnostic process. This provides an important direction for research, given the objectivity of such measures and the fact that computer games are well tolerated by youth.

Revealed Opportunism: How Physicians "Game" Prior Authorization Protocols Until They Are Rescinded

BACKGROUND

Prior authorization (PA) is a management technique that has been implemented to manage the utilization of expensive drugs and to improve the precision of drug prescribing. PA requirements may incentivize physicians to document adverse effects, sometimes falsely, to meet the eligibility requirements.

OBJECTIVES

To identify documentation patterns that may facilitate the quantitative analysis of physician gaming and underreporting behaviors associated with the prescribing of angiotensin-converting enzyme (ACE) inhibitors in a primary care setting, and to evaluate the effect of a PA requirement on the documentation of adverse events as a way to receive approval for more expensive drugs.

METHODS

We conducted a retrospective analysis of physician electronic reporting of adverse effects associated with ACE inhibitors before and after the revocation of a PA requirement for angiotensin receptor blockers (ARBs) between 2004 and 2013 in an Israeli HMO. The data were stratified into 2 groups-patients who were newly prescribed an ACE inhibitor or those who had been receiving an ACE inhibitor for at least 1 year. The annual rate of adverse events related to ACE inhibitors (ie, the number of reported cases of adverse events per 1000 patients receiving an ACE inhibitor) was calculated from data captured on the date the events were first reported for the 5 years before and 5 years after the revocation of the PA constraint.

RESULTS

A total of 151,845 patients treated with ACE inhibitors were identified during the 10-year study period. The reported adverse events among patients newly treated with an ACE inhibitor peaked in 2007 to 10 cases per 1000 patients, and gradually decreased to 4.6 cases in 2012, which was the year after the PA requirements for the ARBs valsartan and candesartan were rescinded by the HMO. Among previously treated patients, adverse events rates decreased from a high of 5.4 per 1000 patients in 2008 to 1.9 in 1000 patients in 2012, the year after the PA restraints for the last 2 ARBs with a requirement were revoked.

CONCLUSIONS

The PA requirement influenced physician propensity for reporting drug side effects, possibly encouraging reporting inaccuracies. The decline in the incidence of reported side effects, in both subpopulations in the study, with the revocation of the PA requirement confirms our hypothesis that physicians were incentivized to document the side effects related to ACE inhibitors to meet the eligibility requirements for the approval of an ARB by the HMO.

Play It, Learn It, Make It Last: Developing an Online Game to Create Self-Sufficient Library Information Users

Library orientation at an academic health sciences library consisted of a five-minute overview within new student orientation. Past experience indicated this brief presentation was insufficient for students to learn about library resources. In 2014, an effort was made to supplement orientation by developing an online game aimed at enabling students to become self-sufficient through hands-on learning. A gaming model was chosen with expectations that competition and rewards would motivate students. Although the pilots suffered from low participation rates, the experience merits further research into the potential of a broader model of online library instruction in the health sciences environment.

Evaluation of an Adaptive Game that Uses EEG Measures Validated during the Design Process as Inputs to a Biocybernetic Loop

Biocybernetic adaptation is a form of physiological computing whereby real-time data streaming from the brain and body is used by a negative control loop to adapt the user interface. This article describes the development of an adaptive game system that is designed to maximize player engagement by utilizing changes in real-time electroencephalography (EEG) to adjust the level of game demand. The research consists of four main stages: (1) the development of a conceptual framework upon which to model the interaction between person and system; (2) the validation of the psychophysiological inference underpinning the loop; (3) the construction of a working prototype; and (4) an evaluation of the adaptive game. Two studies are reported. The first demonstrates the sensitivity of EEG power in the (frontal) theta and (parietal) alpha bands to changing levels of game demand. These variables were then reformulated within the working biocybernetic control loop designed to maximize player engagement. The second study evaluated the performance of an adaptive game of Tetris with respect to system behavior and user experience. Important issues for the design and evaluation of closed-loop interfaces are discussed.

Distinguishing between gaming and gambling activities in addiction research

BACKGROUND AND AIMS

Gambling and gaming activities have become increasingly recognised as sharing many common features at a structural and aesthetic level. Both have also been implicated as contributing to harm through excessive involvement. Despite this, relatively little attention has been given to the fundamental characteristics that differentiate these two classes of activity, especially in situations where the boundaries between them may be particularly hard to distinguish. This is evident, for example, in digital games that incorporate free and paid virtual currencies or items, as well as the capacity for wagering. Such overlaps create problems for regulatory classifications, screening, diagnosis and treatment. Is the problem related to the gambling or gaming content?

METHODS

In this paper, we review the principal sources of overlap between the activity classes in terms of several dimensions: interactivity, monetisation, betting and wagering, types of outcomes, structural fidelity, context and centrality of content, and advertising.

RESULTS

We argue that gaming is principally defined by its interactivity, skill-based play, and contextual indicators of progression and success. In contrast, gambling is defined by betting and wagering mechanics, predominantly chance-determined outcomes, and monetisation features that involve risk and payout to the player. A checklist measure is provided, with practical examples, to examine activities according to features of design and function, which may inform guidelines for policy makers, researchers and treatment providers.

DISCUSSION AND CONCLUSIONS

We suggest that, in some instances, using category-based nomenclature (e.g., "gambling-like game") may be too vague or cumbersome to adequately organise our understanding of new gaming/gambling hybrid activities.

Influencing Trust for Human-Automation Collaborative Scheduling of Multiple Unmanned Vehicles

OBJECTIVE

We examined the impact of priming on operator trust and system performance when supervising a decentralized network of heterogeneous unmanned vehicles (UVs).

BACKGROUND

Advances in autonomy have enabled a future vision of single-operator control of multiple heterogeneous UVs. Real-time scheduling for multiple UVs in uncertain environments requires the computational ability of optimization algorithms combined with the judgment and adaptability of human supervisors. Because of system and environmental uncertainty, appropriate operator trust will be instrumental to maintain high system performance and prevent cognitive overload.

METHOD

Three groups of operators experienced different levels of trust priming prior to conducting simulated missions in an existing, multiple-UV simulation environment.

RESULTS

Participants who play computer and video games frequently were found to have a higher propensity to overtrust automation. By priming gamers to lower their initial trust to a more appropriate level, system performance was improved by 10% as compared to gamers who were primed to have higher trust in the automation.

CONCLUSION

Priming was successful at adjusting the operator's initial and dynamic trust in the automated scheduling algorithm, which had a substantial impact on system performance.

APPLICATION

These results have important implications for personnel selection and training for futuristic multi-UV systems under human supervision. Although gamers may bring valuable skills, they may also be potentially prone to automation bias. Priming during training and regular priming throughout missions may be one potential method for overcoming this propensity to overtrust automation.

Predicting Dynamic Foot Function From Static Foot Posture: Comparison Between Visual Assessment, Motion Analysis, and a Commercially Available Depth Camera

STUDY DESIGN :Controlled laboratory study.

OBJECTIVE

To evaluate the ability of 3 methods to assess static foot posture to predict rearfoot and midfoot kinematics during gait.

BACKGROUND

Static foot posture is commonly used clinically to infer dynamic function. Limitations of static clinical assessments may be overcome through advances in technologies, including commercially available depth cameras.

METHODS

The Foot Posture Index (FPI) of 31 males (average age, 22.5 years) was assessed using visual observation, a 3-D motion-analysis system, and a depth camera. Pearson correlations were used to evaluate relationships between FPI items and rearfoot and midfoot kinematics during walking. The ability of the static variables to predict dynamic function was assessed using multiple linear regression.

RESULTS

Most FPI items (85%) were not correlated with foot kinematics, regardless of assessment method. There were 6 fair to moderate correlations between visual FPI items and total rearfoot (r = -0.36 to -0.39, P<.05) and midfoot (r = 0.37 to 0.61, P<.05) motion, 2 fair correlations between 3-D motion-analysis FPI items and total midfoot (r = -0.43, P = .02) and peak rearfoot (r = -0.40, P = .03) motion, and 2 fair correlations between the depth-camera FPI items and average rearfoot (r = -0.38 to 0.44, P<.05) motion. Visual assessment of the FPI provided the best prediction model, explaining 37% of the variance in total midfoot inversion/eversion.

CONCLUSION

Static measures of foot posture are weakly correlated with rearfoot or midfoot kinematics, and have limited dynamic prediction ability. Our findings suggest that the FPI may not be an accurate representation of rearfoot or midfoot movement during walking, regardless of the measurement technique employed.

Commentary on: Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Defining and classifying non-substance or behavioral addictions

Multiple controversies exist currently in the field of behavioral addictions. The opinion article by Billieux, Schimmenti, Khazaal, Maurage and Heeren (2015) proposes an approach to considering which behaviors might be considered as foci for addictions. The article raises multiple important points that foster further dialog and highlight the need for additional research. Given that how specific behaviors are considered from diagnostic and classification perspectives holds significant public health implications, targeting and eliminating current knowledge gaps relating to behavioral addictions is an important undertaking.

3-D gaming environment preferences: Inversion of the Y-axis

Differences between preference groups based on the control scheme of the Y-axis or pitch (either default or inverted) in 3-D gaming were explored both with measures of pre-existing traits, as well as reactions to a short gaming session. Participants who preferred to invert the Y-axis controls showed significantly greater overall tendency for immersion than the non-inverters. Similarly, the participants who inverted the Y-axis also reported significantly higher levels of presence in the gaming task than the non-inverter. Finally, when participants' controls in the gaming task were mismatched to their preference, they exhibited significantly higher perceived workload in the gaming task. Implications of these findings focus on determining a basis for differences in the population, and how these differences may impact spatial reasoning and task-specific training, especially in aviation.

PRACTITIONER SUMMARY

Differing preferences for controlling a user’s visual perspective in a three-dimensional virtual environment were shown to exist in the population, with indications of increased workload when randomly assigned to use a non-preferred control scheme. These control preferences showed evidence of association with the user’s tendency for immersion in virtual environments.

Educational games for brain health: revealing their unexplored potential through a neurocognitive approach

Educational games link the motivational nature of games with learning of knowledge and skills. Here, we go beyond effects on these learning outcomes. We review two lines of evidence which indicate the currently unexplored potential of educational games to promote brain health: First, gaming with specific neurocognitive demands (e.g., executive control), and second, educational learning experiences (e.g., studying foreign languages) improve brain health markers. These markers include cognitive ability, brain function, and brain structure. As educational games allow the combination of specific neurocognitive demands with educational learning experiences, they seem to be optimally suited for promoting brain health. We propose a neurocognitive approach to reveal this unexplored potential of educational games in future research.

Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming

AIMS

Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) 'gaming', i.e. false reporting of smoking status to enter the scheme or gain an incentive.

DESIGN

Single-arm intervention study

SETTING

Antenatal clinic and community

PARTICIPANTS

A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period.

MEASUREMENTS

Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum.

FINDINGS

Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers.

CONCLUSIONS

Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes.

Therapists' perceptions of social media and video game technologies in upper limb rehabilitation

BACKGROUND

The application of technologies, such as video gaming and social media for rehabilitation, is garnering interest in the medical field. However, little research has examined clinicians' perspectives regarding technology adoption by their clients.

OBJECTIVE

The objective of our study was to explore therapists' perceptions of how young people and adults with hemiplegia use gaming and social media technologies in daily life and in rehabilitation, and to identify barriers to using these technologies in rehabilitation.

METHODS

We conducted two focus groups comprised of ten occupational therapists/physiotherapists who provide neurorehabilitation to individuals with hemiplegia secondary to stroke or cerebral palsy. Data was analyzed using inductive thematic analysis. The diffusion of innovations theory provided a framework to interpret emerging themes.

RESULTS

Therapists were using technology in a limited capacity. They identified barriers to using social media and gaming technology with their clients, including a lack of age appropriateness, privacy issues with social media, limited transfer of training, and a lack of accessibility of current systems. Therapists also questioned their role in the context of technology-based interventions. The opportunity for social interaction was perceived as a major benefit of integrated gaming and social media.

CONCLUSIONS

This study reveals the complexities associated with adopting new technologies in clinical practice, including the need to consider both client and clinician factors. Despite reporting several challenges with applying gaming and social media technology with clinical populations, therapists identified opportunities for increased social interactions and were willing to help shape the development of an upper limb training system that could more readily meet the needs of clients with hemiplegia. By considering the needs of both therapists and clients, technology developers may increase the likelihood that clinicians will adopt innovative technologies.

Perceptions of Technology and Its Use for Therapeutic Application for Individuals With Hemiparesis: Findings From Adult and Pediatric Focus Groups

BACKGROUND

Digital technology is becoming an increasingly popular means of delivering meaningful therapy to individuals with neurological impairments. An understanding of clients' technology use and their perspectives on incorporating technology into rehabilitation can provide researchers and designers with valuable information to inform development of technologies and technology-based rehabilitation programs.

OBJECTIVE

This study was designed to establish the current use and perceptions of gaming, social media, and robotics technologies for rehabilitative purposes from the perspective of adults and children with upper limb impairments to identify barriers and enablers to their adoption and use.

METHODS

We conducted three focus groups consisting of pediatric (n=7, mean age 11.0 years) and adult (n=8, mean age 60.8 years) participants with hemiparesis affecting their upper limb. We applied thematic analysis methods to the resulting data.

RESULTS

We identified three key themes: (1) clients' use of technology in everyday life and rehabilitation, (2) barriers to use, and (3) enablers to therapy. Participants had limited exposure to technology for therapeutic purposes, but all acknowledged the potential benefits in providing motivation and interest for the performance of repetitive task practice. Adult participants requested efficacious, simple, and easy-to-use technology for rehabilitation with programs that could be individualized for them and expressed that they wanted these programs to provide a motivating means of repeated practice of therapeutic movements. In contrast, pediatric participants emphasized a desire for technology for rehabilitation that offered opportunities for social interaction and interactive games involving their whole body and not only their affected limb. Perceived safety and privacy were concerns for both groups.

CONCLUSIONS

Our findings highlight that all participants were open to the integration of technology into rehabilitation. Adult participants were more pragmatically motivated by potential recovery gains, whereas pediatric participants were more intrinsically motivated by access to games.

Effectiveness of commercial video gaming on fine motor control in chronic stroke within community-level rehabilitation

PURPOSE

The purpose of this study was to investigate the effectiveness of commercial gaming as an intervention for fine motor recovery in chronic stroke.

METHODS

Ten chronic phase post-stroke participants (mean time since CVA = 39 mos; mean age = 72 yrs) completed a 16-session program using the Nintendo Wii for 15 min two times per week with their more affected hand (10 right handed). Functional recovery (Jebsen Hand Function Test (JHFT), Box and Block Test (BBT), Nine Hole Peg Test (NHPT)), and quality of life (QOL; Stroke Impact Scale (SIS)) were measured at baseline (pre-testing), after 8 sessions (mid-testing) and after 16 sessions (post-testing).

RESULTS

Significant improvements were found with the JHFT, BBT and NHPT from pre-testing to post-testing (p = 0.03, p = 0.03, p = 0.01, respectively). As well, there was an increase in perceived QOL from pre-testing to post-testing, as determined by the SIS (p = 0.009).

CONCLUSION

Commercial gaming may be a viable resource for those with chronic stroke. Future research should examine the feasibility of this as a rehabilitation tool for this population.

IMPLICATIONS FOR REHABILITATION

Stroke survivors often live with lasting effects from their injury, however, those with chronic stroke generally receive little to no rehabilitation due to a perceived motor recovery plateau. Virtual reality in the form of commercial gaming is a novel and motivating way for clients to complete rehabilitation. The Nintendo Wii may be a feasible device to improve both functional ability and perceived quality of life in chronic stroke survivors.

The effect of social support features and gamification on a Web-based intervention for rheumatoid arthritis patients: randomized controlled trial

BACKGROUND

Rheumatoid arthritis (RA) is chronic systematic disease that affects people during the most productive period of their lives. Web-based health interventions have been effective in many studies; however, there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients' behavioral and health outcomes.

OBJECTIVE

The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity, health care utilization, medication overuse, empowerment, and RA knowledge of RA patients. The effect of gamification on website use was also investigated.

METHODS

We conducted a 5-arm parallel randomized controlled trial for RA patients in Ticino (Italian-speaking part of Switzerland). A total of 157 patients were recruited through brochures left with physicians and were randomly allocated to 1 of 4 experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website. Data were collected at 3 time points through questionnaires at baseline, posttest 2 months later, and at follow-up after another 2 months. Primary outcomes were physical activity, health care utilization, and medication overuse; secondary outcomes included empowerment and RA knowledge. All outcomes were self-reported. Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time.

RESULTS

The best-fit multilevel models (growth curve models) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors. The growth curve analyses of experimental conditions were compared to the control group. Physical activity increased over time for patients having access to social support sections plus gaming (unstandardized beta coefficient [B]=3.39, P=.02). Health care utilization showed a significant decrease for patients accessing social support features (B=-0.41, P=.01) and patients accessing both social support features and gaming (B=-0.33, P=.03). Patients who had access to either social support sections or the gaming experience of the website gained more empowerment (B=2.59, P=.03; B=2.29, P=.05; respectively). Patients who were offered a gamified experience used the website more often than the ones without gaming (t91=-2.41, P=.02; U=812, P=.02).

CONCLUSIONS

The Web-based intervention had a positive impact (more desirable outcomes) on intervention groups compared to the control group. Social support sections on the website decreased health care utilization and medication overuse and increased empowerment. Gamification alone or with social support increased physical activity and empowerment and decreased health care utilization. This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 57366516; http://www.controlled-trials. com/ISRCTN57366516 (Archived by webcite at http://www.webcitation.org/6PBvvAvvV).

RELM: developing a serious game to teach evidence-based medicine in an academic health sciences setting

Gaming as a means of delivering online education continues to gain in popularity. Online games provide an engaging and enjoyable way of learning. Gaming is especially appropriate for case-based teaching, and provides a conducive environment for adult independent learning. With funding from the National Network of Libraries of Medicine, Pacific Northwest Region (NN/LM PNR), the University of Washington (UW) Health Sciences Library, and the UW School of Medicine are collaborating to create an interactive, self-paced online game that teaches players to employ the steps in practicing evidence-based medicine. The game encourages life-long learning and literacy skills and could be used for providing continuing medical education.

Normative perceptual estimates for 91 healthy subjects age 60-75: impact of age, education, employment, physical exercise, alcohol, and video gaming

Visual perception serves as the basis for much of the higher level cognitive processing as well as human activity in general. Here we present normative estimates for the following components of visual perception: the visual perceptual threshold, the visual short-term memory (VSTM) capacity and the visual perceptual encoding/decoding speed (processing speed) of VSTM based on an assessment of 91 healthy subjects aged 60–75. The estimates were modeled from input from a whole-report assessment based on a theory of visual attention. In addition to the estimates themselves, we present correlational data, and multiple regression analyses between the estimates and self-reported demographic data and lifestyle variables. The regression statistics suggest that education level, video gaming activity, and employment status may significantly impact the encoding/decoding speed of VTSM but not the capacity of VSTM nor the visual perceptual threshold. The estimates will be useful for future studies into the effects of various types of intervention and training on cognition in general and visual attention in particular.

An international consensus for assessing internet gaming disorder using the new DSM-5 approach

AIMS

For the first time, the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduces non-substance addictions as psychiatric diagnoses. The aims of this paper are to (i) present the main controversies surrounding the decision to include internet gaming disorder, but not internet addiction more globally, as a non-substance addiction in the research appendix of the DSM-5, and (ii) discuss the meaning behind the DSM-5 criteria for internet gaming disorder. The paper also proposes a common method for assessing internet gaming disorder. Although the need for common diagnostic criteria is not debated, the existence of multiple instruments reflect the divergence of opinions in the field regarding how best to diagnose this condition.

METHODS

We convened international experts from European, North and South American, Asian and Australasian countries to discuss and achieve consensus about assessing internet gaming disorder as defined within DSM-5.

RESULTS

We describe the intended meaning behind each of the nine DSM-5 criteria for internet gaming disorder and present a single item that best reflects each criterion, translated into the 10 main languages of countries in which research on this condition has been conducted.

CONCLUSIONS

Using results from this cross-cultural collaboration, we outline important research directions for understanding and assessing internet gaming disorder. As this field moves forward, it is critical that researchers and clinicians around the world begin to apply a common methodology; this report is the first to achieve an international consensus related to the assessment of internet gaming disorder.

Knowing You, Knowing Me (KYKM): an interactive game to address positive mother-daughter communication and relationships

This technical report describes an interactive game environment designed to bring mothers and their adolescent daughters together to discuss three issues that have previously been shown in the literature to be of concern to families, as young girls transition from middle childhood to the adolescent years. The game is called Knowing you, Knowing me or KYKM, and is used to help mothers and daughters discuss the following three topics: positive communication skills, relationship building, and managing risky behaviors in the social environment. As the game remains untested, its limitations and future implications of its utility are discussed.

The Physiologic and Behavioral Implications of Playing Active and Sedentary Video Games in a Seated and Standing Position

Previous studies have assessed physiologic response while playing video games per manufacturer instructions with participants standing during active video game play and seated during sedentary game play. It is not known whether an assigned seated or standing position affects positional preference and oxygen consumption (VO2) while gaming. The purpose of the study was to assess VO2 and preference of playing active and sedentary video games in a seated and standing position. VO2 was assessed in 25 participants during four, 20-minute conditions; resting, PlayStation 2 Madden NFL Football 2011, Nintendo Wii-Sports Boxing and Nintendo Wii Madden NFL Football 2011. Each condition was divided into two positional conditions (10 minutes seated, 10 minutes standing) and each participant indicated their positional preference after each 20-minute condition. Standing VO2 (4.4 ± 0.2 ml • kg-1 • min-1 PS2, 4.6 ± 0.1 ml • kg-1 • min-1 Wii Madden, 6.8 ± 0.3 ml • kg-1 • min-1Wii Boxing) was significantly (p ≤ 0.001) greater than seated VO2 (4.0 ± 0.1 ml • kg-1 • min-1 PS2, 4.2 ± 0.1 ml • kg-1 • min-1 Wii Madden, 6.1 ± 0.3 ml • kg-1 • min-1Wii Boxing) for each gaming condition. Participants preferred (p ≤ 0.001) to sit for all gaming conditions except Wii Boxing. Playing video games while standing increases VO2 to a greater extent than playing the same games in a seated position. Standing was only preferred for the most physiologically challenging game, Wii Boxing. Gaming position should be considered when assessing the physiologic and behavioral outcomes of playing video games.

Characteristics and treatment response of self-identified problematic Internet users in a behavioral addiction outpatient clinic

AIMS

Controversies remain about the validity of the diagnosis of problematic Internet use. This might be due in part to the lack of longitudinal naturalistic studies that have followed a cohort of patients who self-identify as having Internet-related problems.

METHODS

This retrospective study included 57 patients who consulted the Geneva Addiction Outpatient Clinic from January 1, 2007, to January 1, 2010. Patients underwent an initial clinical psychiatric evaluation that included collection of data on socio-demographics, method of referral, specific Internet usage, psychiatric diagnosis, and Internet Addiction Test (IAT) and Clinical Global Impression Scale (CGI) scores. Treatment consisted of individual psychotherapeutic sessions.

RESULTS

Of these patients, 98% were male and 37% were 18 years or younger. Most patients were online gamers (46% playing massively multiplayer online role-playing games). The mean IAT score was 52.9 (range 20-90). Sixty-eight percent of patients had a co-morbid psychiatric diagnosis, with social phobia being the most prevalent (17.8%). Patients who remained in treatment (dropout rate 24%) showed an overall improvement of symptoms: 38.6% showed significant or average improvement on their CGI score, 26.3% showed minimal improvement, and 14% showed no change.

CONCLUSIONS

Our results support the hypothesis that there are specific types of Internet use, with online gaming mainly affecting young male patients. As Internet addiction is not yet an official diagnosis, better instruments are needed to screen patients and to avoid false-negative and false-positive diagnoses. Successful care should integrate the treatment of co-morbid symptoms and involve families and relatives in the therapeutic process.