The addictive use of digital games (problematic gaming [PG]) is a phenomenon with rising prevalence, especially in adolescents. The period of adolescence is characterized by intense brain maturation processes and increased vulnerability for mental disorders. However, no recent systematic review on functional and structural neural correlates of PG is available exclusively for this age group. This paper aimed to close this gap by describing neuroimaging findings and derive clinical implications. A systematic literature search was performed via PubMed, PsycInfo, and PSYNDEX including magnetic resonance imaging (MRI) studies on structural and functional changes in problematic gamers under 20 years of age until December 2020. The findings suggest especially prefrontal brain areas (important for cognitive control functions) but also temporoparietal regions (associated with attention processes and self‐concepts), as well as frontolimbic and subcortical regions (connected to emotion regulation and reward processing) to be significantly altered in adolescents with PG compared with healthy controls. Reduced interhemispheric connectivity and altered network activity further support theories of neurofunctional imbalance as well as structural deficits to explain addictive behaviours. Based on these findings, interventions should specifically address executive and cognitive‐affective deficits together with adolescent‐specific developmental tasks such as personality formation. Methodological limitations including heterogeneous PG classifications need to be considered. Additional neuroimaging studies on PG based on the DSM‐5 or ICD‐11 framework for the (Internet) gaming disorder in adolescents with larger sample sizes and prospective designs are highly warranted to understand potential causality and to generate valid and reproducible results.
Adolescents show a high vulnerability for addictive gaming patterns on the one hand and immature emotion regulation (ER) abilities as a risk factor for mental disorders on the other hand. We investigated the predictive value of ER difficulties on problematic gaming (PG) considering age groups (children vs. youths) and gender cross-sectionally and prospectively in a representative sample of German adolescents via online survey with two measurement points 14 months apart. General Poisson, logistic, and multinomial regression models were estimated to predict gaming patterns by ER difficulties controlling for age group and gender. Results revealed ER difficulties to be significantly associated with PG. Moreover, subgroup analyses indicated differing ER patterns for children vs. youths and boys vs. girls: for children, higher PG values were associated with emotional awareness and emotional clarity whereas for youths it was the acceptance of emotional responses. Moreover, gender differences implicated that boys with PG had more deficits in goal-oriented behavior as well as emotional awareness while affected girls were lacking emotional clarity and had problems with the acceptance of their emotional responses. Interestingly, procrastination was a significant predictor for PG irrespective of subgroups. Furthermore, longitudinal analyses indicated that difficulties in ER promoted PG while stronger procrastination tendencies maintained it. With the inclusion of procrastination, which can be understood as a maladaptive ER strategy, a broader picture of ER difficulties as a risk factor for PG could be drawn. The findings support a better understanding of PG etiology and the development of targeted prevention and intervention measures.
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