Category Archives: Adolescence
Regular readers of my blog will know that I have spent well over two decades carrying out research into various aspects of video gaming. Online video gaming has become an increasingly popular activity amongst teenagers and adults alike. For numerous reasons, perhaps in part because of its rapid growth, online gaming is also an activity that has become highly stereotyped. That is, it is an activity that has come to be associated in popular culture with a highly specific, caricatured and also negative image. This image is reflected in numerous television shows, print media, news reports, current affairs programs and other sources of popular culture. As Dr. D Williams and his colleagues noted in a 2008 issue of the Journal of Computer-Mediated Communication Monographs:
“Game players are stereotypically male and young, pale from too much time spent indoors and socially inept. As a new generation of isolated and lonely ‘couch potatoes,’ young male game players are far from aspirational figures”.
Understanding the formation of stereotypes about this group and how they are internalised may help us understand society’s attitudes towards this activity and how its participants are positioned within the status hierarchy. Where the stereotype of the pale teenage gamer came from and whether there is any truth to it are clearly important and interesting questions. Our recent research concerns the extent to which this social stereotype has been transformed into a cognitive stereotype, what form this cognitive stereotype takes, and what this can tell us about society’s attitude toward gaming as an emerging form of social or asocial activity.
Within popular culture, a clear characterisation of online gamers has emerged. Frequently caricatured, this ‘stereotype’ has been disseminated throughout the print media, as well as television and web based programs. One poignant example comes from the popular U.S. animated series South Park. In an episode devoted to the Massively Multiplayer Online Role Playing Game (MMORPG) World of Warcraft, the stereotypical gamer was portrayed as overweight, lazy, isolated, and aggressive. Additionally, the four main characters of the series became increasingly overweight, lazy, and developed acne as their immersion into the game deepened. One of the main characters (Penny) in the U.S. television series The Big Bang Theory also conforms to stereotypic expectations as she becomes obsessive, reclusive and unkempt upon playing a fantasy-based online game.
The highly successful web series, The Guild, took a more comical approach as they followed a group of online gamers who decide to meet each other in the offline world after many months of regular online interaction. In the opening scene of the first episode, the main character is told by her therapist that her online friends do not constitute a genuine support system, and that immersion in an imaginary social environment is stunting her personal growth. Within the first few minutes of this episode, themes of obsession, addiction, reclusiveness, and loneliness arise.
The stereotypical portrayal of an online gamer has also taken more serious forms. In an episode of Law and Order: SVU, a popular U.S. television series, two individuals are arrested and accused of neglecting their child due to their immersion in an online gaming world. In addition to the depiction of the more physical aspects of the stereotype (both suspects are overweight and have poor personal hygiene), the obsessive and addictive qualities of online gaming are implicated in a much more serious context of child neglect.
The problematic and addictive nature of video games is often highlighted by the news media, and a variety of internet websites, magazine articles, and news articles dispense advice for individuals with problematic playing behaviours. Taken together, these media portrayals, news reports, and internet articles present a consistent and negative image of online gaming and its participants. Online gaming is presented as a dangerous activity that may lead to social withdrawal, physical and mental ill health, and even suicide. These concerns are reflected in stereotypical portrayals of online gamers as socially anxious and incompetent, mentally stunted and withdrawn, and physically unhealthy (e.g., overweight, pale). The origins of this stereotypical image are unknown. It may be an extension of pre-existing stereotypes about similar activities (e.g., the violent film or video game and aggression hypothesis), a subtype of a broader ‘nerd’ stereotype, or a general cynicism about a new and rapidly spreading form of social activity and interaction. The social, psychological and historical factors that led to this stereotype are clearly interesting and worth exploring.
The occurrences of the cultural stereotype described are largely examples of the stereotype of an MMORPG player, rather than online gamers more generally. MMORPG players appear to be the prototype of online gamers, as caricatured by numerous television and web-based programs. In a study published in the Bulletin of Science, Technology and Society, Dr. Rachel Kowert, Dr. Julian Oldmeadow and myself collected some data on video gamer stereotypes. We asked our participants (both gamers and non-gamers) to indicate what most other people think online gamers are like. To the extent that stereotypical portrayals of online gaming and gamers have given rise to shared trait associations, there should be strong agreement across both gamers and non-gamers with regards to how gamers are perceived by others in general. A further aim of our study was to examine the extent to which these trait associations about gamers have been internalised as personal beliefs. A total of 342 participants completed our online survey in which they rated how applicable each of a list of traits was to the group of online gamers. Ratings were made for both personal beliefs (how participants themselves see gamers) and stereotypical beliefs (how most others see gamers). While these beliefs were highly consensual as stereotypes, personal beliefs varied suggesting that the cultural portrayal of online gamers is beginning to shift into cognitive associations.
Participants were asked to evaluate the list of adjectives and rate each one in terms of how applicable they believed the trait to be of online gamers. Responses were given on a 7-point Likert-type scale, ranging from 1 (“not at all applicable”) to 7 (“very applicable”). Participants were first asked questions relating to basic demographic information, as well as information about their online gaming habits (which games they play or had played, frequency of play, and whether they consider themselves a gamer). They were then asked to rate each of the 30 adjectives according to how they personally perceived online gamers (stereotype endorsement), and how they thought other people perceive online gamers (stereotype). The tasks were presented in this order to maximise the independence between personal and stereotypical ratings.
Even though online gamers are a relatively new social category within society, our results demonstrated that a collective stereotype about this population has emerged. All our participants showed an awareness of a shared stereotype that is in accordance with the anecdotal characterisations commonly portrayed by popular media. Stereotype ratings were consistent across gamers and non-gamers, suggesting that these beliefs are widely shared within society. Based on the results of this study, we concluded that the current stereotype of online gamers is largely negative, based on the traits of popularity, attractiveness, idleness, and social competence. Online gamers were stereotypically viewed as unpopular, unattractive, idle, and socially incompetent, a characterisation that seems to match common stereotypical portrayals in the media, television, and internet articles.
As this investigation was largely exploratory, care needs to be taken in interpreting the results and further research is needed to confirm the factors that emerged here. For instance, it is uncertain if the results found here are reflective of the generalized stereotype of gamers (including online gamers more generally) or the popularized prototype of the MMORPG gamer. While some have found that MMORPG gamers are viewed more negatively than the generalized construct of the online gamer, future research is needed to further examine the general stereotype in relation to the subgroups contained within it. This will hopefully provide clarification into the stereotypical differences amongst the broad categorization of online gamers as compared to more specific subgroups, such as MMORPG gamers or casual online gamers (e.g., individuals who play online games that require no major time commitment or special set of skills to complete, such as the highly popular Zynga game, Farmville). Future research may provide further insight into the progression of the shared beliefs about online gamers ‘out there’ developing into internalised cognitive associations ‘in here’. Somewhat fortuitously, the stereotype of online gamers is still undergoing formation within society, providing researchers with the unique opportunity to study this characterisation as it continues to evolve.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Additional input: Dr. Rachel Kowert and Dr. Julian Oldmeadow
Cole, H., & Griffiths, M. (2007). Social Interactions in Massively Multiplayer Online Role-Playing Games. CyberPsychology and Behavior, 10(4), 575 – 583.
Griffiths, M., Davies, M., & Chappell, D. (2003). Breaking the stereotype: the case of online gaming. CyberPsychology and Behavior, 6(1), 81 – 91.
Kowert, R., Griffiths, M.D. & Oldmeadow, J. (2012). Geek or Chic? Emerging stereotypes of online gamers. Bulletin of Science, Technology and Society, 32, 371-379.
Kowert, R., & Oldmeadow, J. (2012). The stereotype of online gamers: new characterization or recycled prototype. Paper presented at the Nordic DiGRA, Tampere, Finland.
Lucas, K., & Sherry, J. (2004). Sex differences in video game play: a communication-based explanation. Communication Research, 31(5), 499 – 523.
Ogletree, S., & Drake, R. (2007). College students’ video game participation and perceptions: gender differences and implications. Sex Roles, 56, 537 – 542.
Williams, D., Yee, N., & Caplan, S. (2008). Who plays, how much, and why? Debunking the stereotypical gamer profile. Journal of Computer-Mediated Communication Monographs, 13(4), 993 – 1018.
Yee, N. (2006). The demographics, motivations, and derived experiences of users of massively-multi-user online graphical environments. Teleoperators and Virtual Environments, 15(3), 309 – 329
Gaming addiction has become a topic of increasing research interest. Over the last decade there has been a significant increase in the number of scientific studies examining various aspects of video game addiction. This has resulted in a wide-ranging selection of review papers focusing on different aspects of the topic. These include general literature reviews of video game addiction, reviews of online (as opposed to offline) gaming addiction, reviews of the main methodological issues in studying video game addiction, reviews of structural characteristics and their relationship with video game addiction, reviews of video game addiction treatment, reviews of video game addiction and co-morbidity/convergence with other addictions such as gambling addiction and Internet addiction, and miscellaneous review papers on very specific aspects of video game addictions such as social responsibility, screening instruments, or reviews refuting that video game addiction even exists.
Furthermore, the amount and the quality of research in the gaming addiction field has progressed much over the last decade but is still in its infancy compared to other more established behavioural addictions, such as pathological gambling. Today’s blog briefly provides a considered (and somewhat speculative) examination of what might happen in the gaming addiction field from a number of different standpoints (e.g., methodological, conceptual, technological). These are taken from a paper I recently published in Current Psychiatry Reviews with Dr. Daniel King (University of Adelaide, Australia) and Daria Kuss (Nottingham Trent University, UK). These trends were loosely modeled on a 2011 paper I wrote on the technological trends in gambling and published in Casino and Gaming International.
- There is likely to be an even bigger increase in empirical research into problematic video game playing and video game addiction. This will of course be dependent on both appropriate funding streams and/or whether gaming addiction ends up being included in future psychiatric disorder classifications (e.g., Diagnostic and Statistical Manual, International Classification of Diseases, etc.). Future research is likely to include more epidemiological and/or general population data on media use, leading to better insights into the onset and course of problematic video game play and addiction.
- Given the many different screening instruments that have been developed over the last decade, there is likely to be a refinement of video game addiction measures and greater consensus on its conceptualization, either as a single disorder and/or incorporated into other known disorders (e.g., impulse control disorder). This is also likely to lead to improved assessment tools based on such conceptualization(s).
- Measures of gaming use and subsequent behaviour are likely to diversify in terms of media use, including social networking sites (SNS) and associated Internet resources. Already, games such as Call of Duty and Battlefield 3 are being released with their own SNS (e.g., COD Elite) that track player behaviour and provide feedback to players as to how to improve their game (thus functionally reinforcing video game play and thus have implications for excessive and/or potentially addictive play).
- Given the pressure on media enterprises to ‘monetize’ their business and look for different revenue streams, there is likely to be even greater media convergence between gaming and other more profit-making activities such as gambling. Given the well established addictive potential of gambling, this may also have implications for the incidence of video game addiction.
- Gaming on the move is likely to be a big growth area that may have implications for excessive gaming via ‘convenience’ hardware such as handheld gaming consoles, PDA devices, mobile phones, tablet computers, and MP3 players.
- Given the fact that the Internet is gender-neutral, there is likely to be increasing feminization of gaming where increasing numbers of females not only engage in the playing of online games, but also develop problems as a result. Casual gaming online is already popular among females. However, the biggest difference between male and female gaming is likely to be content-based (e.g., males may prefer competitive type gaming experiences whereas females may prefer co-operative type gaming experiences).
- Given the increasing number of research teams in the gambling field being given direct access to gambling companies behavioural tracking data, there is likely to be an increasing number of such collaborations in the gaming studies field.
- Given the increased importance of additional research into the structural and situational characteristics of consumptive behaviours (e.g., smoking nicotine, drinking alcohol, gambling, etc.), it is likely that research on design features within games and their psychological impact (including potential addiction) will increase as well. Such research has already begun (including quite a few studies by our gaming research unit).
- As the diagnosis of video game addiction becomes more legitimate in psychiatric and medical circles, it will lead to better randomized control trials on interventions for problematic video game play than the ones already carried out. There is also likely to be an increase in the online medium itself being used as a treatment channel. The reasons that people like to engage in some online leisure activities (i.e., the fact that the online environment is non-face-to-face, convenient, accessible, affordable, anonymous, non-threatening, non-alienating, non-stigmatizing, etc.) may also be the very same reasons why people would want to seek advice, help and treatment online rather than in face-to-face situations.
Based on our review paper there are several noticeable trends that can be drawn from our recent reviews of problematic video game play and video game addiction.
- There has been a significant increase in empirical research decade by decade since the early 1980s.
- There has been a noticeable (and arguably strategic) shift in researching the mode of video game play. In the 1980s, research mainly concerned ‘pay-to-play’ arcade video games. In the 1990s, research mainly concerned stand alone (offline) video games played at home on consoles, PCs or handheld devices. In the 2000s, research mainly concerned online massively multiplayer video games.
- There has been a noticeable shift in how data are collected. Up until the early 2000s, data about video game behaviour was typically collected face-to-face, whereas contemporary studies collect data online, strategically targeting online forums where gamers are known to (virtually) congregate. These samples are typically self-selecting and (by default) unrepresentative of the general population. Therefore, generalization is almost always one of the methodological shortcomings of this data collection approach.
- Survey study sample sizes have generally increased. In the 1980s and 1990s, sample sizes were typically in the low hundreds. In the 2000s, sample sizes in their thousands – even if unrepresentative – are not uncommon.
- There has been a diversification in the way data are collected including experiments, physiological investigations, secondary analysis of existing data (such as that collected from online forums), and behavioural tracking studies.
- There has been increased research on adult (i.e., non-child and non-adolescent) samples reflecting the fact that the demographics of gaming have changed.
- There has been increasing sophistication in relation to issues concerning assessment and measurement of problematic video game play and video game addiction. In the last few years, instruments have been developed that have more robust psychometric properties in terms of reliability and validity. However, there are still some concerns as many of the most widely used screening instruments were adapted from adult screens and much of the video game literature has examined children and adolescents. In other papers I have co-written with Dr. King, we have asserted that to enable future advances in the development and testing of interventions for video game-related problems, there must be some consensus among clinicians and researchers as to the precise classification of these problems. (In fact, we’ve just had a major review paper accepted on assessing video game addiction in Clinical Psychology Review which I examined in a previous blog).
Clearly, there exist a number of gaps in current understanding of problematic video game play and video game addiction. There is a need for epidemiological research to determine the incidence and prevalence of clinically significant problems associated with video game play in the broader population. There are too few clinical studies that describe the unique features and symptoms of problematic video game play and/or video game addiction. While the current empirical base is relatively small, gaming addiction has become a more mainstream area for psychological and psychiatric research and is likely to become an area of significant importance given the widespread popularity of gaming.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Additional input: Daria Kuss and Daniel King
Griffiths, M.D. (2010). Online video gaming: What should educational psychologists know? Educational Psychology in Practice, 26(1), 35-40.
Griffiths, M.D. (2011). Technological trends and the psychosocial impact on gambling. Casino and Gaming International, 7(1), 77-80.
Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.
King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2009). The psychological study of video game players: Methodological challenges and practical advice. International Journal of Mental Health and Addiction, 7, 555-562.
King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Video game structural characteristics: A new psychological taxonomy. International Journal of Mental Health and Addiction, 8, 90-106.
King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The role of structural characteristics in problem video game playing: A review. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. Located at: http://www.cyberpsychology.eu/view.php?cisloclanku=2010041401&article=6.
King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The convergence of gambling and digital media: Implications for gambling in young people. Journal of Gambling Studies, 26, 175-187.
King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Cognitive behavioural therapy for problematic video game players: Conceptual considerations and practice issues. Journal of CyberTherapy and Rehabilitstion, 3, 261-273.
King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.
King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy: An International Quarterly, 26, 43-56.
King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology: In Session, 68, 1185-1195.
King, D.L., Haagsma, M.C., Delfabbro, P.H.,Gradisar, M.S. &, Griffiths, M.D. (2013). Psychometric assessment of pathological video-gaming: A systematic review. Clinical Psychology Review, 33, 331-342.
Most regular gamblers will be well aware that technology is revolutionizing the way they can gamble and access gambling. One of the most notable innovations has been the proliferation of various gambling applications (‘apps’) for smartphones and computer tablets. A majority of the British bookmakers have launched sports betting apps including Betfred Mobile Sportsbook, William Hill iPhone, Ladbrokes Mobile, Betfair iPhone Client, and Paddy Power Mobile. Most of the apps allow sports bettors to gamble via their mobile phones and/or tablets (e.g., iPad) with all the same options that gamblers can get offline, and additionally keep track of the bets made. Combined with this, many operators have introduced iPhone compatible websites. Bookmakers have also launched similar apps and services for Android (i.e., non-Apple) products (e.g., Unibet’s mobile sports betting app). In short, mobile sports betting has gone mainstream.
There are also apps for games like Fantasy Football (such as the one offered by Betfred) but most gambling operators are moving into the mobile social betting market because it provides greater flexibility in predicting score lines and by making it easier to share the result outcomes with friends. Such services include Unibet Social Betting, SideBets Social BETworking, Bodugi Social Betting, King of Predictions, and Bet Tracker Pro. Gamblers also have access to a wide range of betting tips and betting odds apps via both iPhone and Android handsets. Gambling apps can also provide access to potentially useful information for the player (e.g., tips, strategy articles, the latest updates, etc.). In addition to he bookmaking industry, casino operators have followed suit and have also moved into the gambling app market on both iPhone and Android.
Once casino apps have been installed, players can instantly access their favourite casinos and casino games without searching for them via a web browser. A quick look at the commercially available gambling apps shows that almost all gaming operators offer attractive bonuses in an attempt to attract new clientele to download their gambling app software and spend some money (e.g., first deposit bonuses, reload bonuses, and various other seasonal promotions). The psychosocial impact of real money gambling apps is likely become a hot topic among those of us who carry out research in the gambling studies field.
As with online gambling more generally, the introduction of gambling apps and mobile gambling eliminates time and place constraints, allows 24/7 access all year round, provides convenience and flexibility, provides a wide range of games (e.g., slots, blackjack, video poker, roulette, etc.) and potentially increased gambling opportunities, and means that anyone can gamble anywhere at anytime providing there is network connection. Real money gambling apps arguably make gambling even easier for players. Whilst there are clearly many advantages for gamblers, these advantages may have a negative psychosocial impact on a small minority of gamblers.
The gambling app market is likely to be very lucrative for both game developers and gaming operators. In a recent report by Juniper Research, it was estimated that users of smartphones and tablets are expected to wager $100 billion annually on the devices by 2017, up from about $20 billion in 2011. However, Juniper Networks’ Mobile Threat Centre also reported that gambling apps pose the biggest security risk to smartphone users after over 1.7 million apps on the Google Play Store were analyzed between March 2011 and September 2012. Another study by German researchers at the Leibniz University (Hannover) and the Philipps University (Marburg) found that apps (including gambling apps) were leaking personal data, including bank account information. The study tested the 13,500 most popular free apps from the Google Play Store and found that 1074 of them (8%) used incorrect or inadequate coding. These studies also found that the gambling apps “blatantly overstepped permissions that were more than adequate for normal use” and that with malware they accessed a number of features of the users’ smartphones and tablets without justification. Racing apps were reported as causing the most concern with 99% of paid racing apps and 92% of free racing game apps being able to send SMS; half of free downloaded apps were able to use the camera; and 94 per cent of free games could make outgoing phone calls.
From a psychosocial impact perspective, one of the areas where gambling apps appear to be having most impact currently is in relation to in-play betting. For instance, Bet365 (the most successful gaming operator in the in-play market) have a free betting app that players can use for any of their ‘in-play’ markets (most notably football) from a smartphone. I argued in a previous blog that what the ‘in-play’ markets have done is take what was traditionally a discontinuous form of gambling like football betting – where gamblers made one bet every Saturday on the result of a football game – to one where consumers can gamble again and again and again. What’s more, gaming operators have quickly capitalized on the increasing amount of televised sport. In contemporary society, where there is a live sporting event, there will always be a betting consumer. ‘In-play’ betting companies using gambling apps have catered for both the natural betting demand and have initiated new clientele in the process.
If the reward for gambling only happens once or twice a week, it is almost completely impossible for a gambler to develop problems and/or become addicted. ‘In-play’ betting using gambling apps has changed that because we now have football matches on almost every day of the week making a daily 2-hour plus period of betting seven days a week. ‘In-play’ has fundamentally changed the way that people view and bet on sporting events. The speed of a game also influences the prevalence of problem gambling. Based on the relationship between event duration, event frequency, bet frequency, and payout interval, empirical research has consistently shown that games that offer a fast, arousing span of play, frequent wins, and the opportunity for rapid replay are those most frequently cited as being associated with problem gambling. These potentially problem-inducing structural characteristics have the capacity to be enhanced via gambling apps and in-play betting. The actual prevalence rate of problem gambling will of course depend on many factors other than speed of the game alone, but games with high and rapid event frequencies are most likely to impact on increased rates of problem gambling. ‘In-play’ betting via gambling apps appears to be an activity that is starting to blur the lines between continuous and discontinuous forms of gambling.
Frequency of opportunities to gamble (i.e., event frequency) appears to be a major contributory factor in the development of gambling problems. The general rule is that the higher the event frequency, the more likely it is that the activity will result in gambling problems for vulnerable and susceptible gamblers. Gambling addiction has been shown to be associated with the rewards, the speed of rewards, and payout rates. Therefore, the more potential rewards there are, and the higher the amount of the rewards, the more problematic the activity is likely to be. Given the time, money and resources, a vast majority of gambling activities are now ‘continuous’ in that people have the potential to gamble again and again. Therefore, in relation to problem gambling, ‘in-play’ betting via gambling apps is an activity that we really need to keep an eye on.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Griffiths, M.D. (2012). Gambling on Facebook? A cause for concern? World Online Gambling Law Report, 11(9), 10-11.
Griffiths, M.D. (2012b). Mind games (A brief psychosocial overview of in-play betting). i-Gaming Business Affiliate, June/July, 44.
Griffiths, M.D. & Auer, M. (2013). The irrelevancy of game-type in the acquisition, development and maintenance of problem gambling. Frontiers in Psychology, in press.
MacMillan, D. (2012). IPhones Become Mobile Casinos by Adding Real-Money Bets. Bloomberg Business Week, August 16. Located at: http://www.businessweek.com/news/2012-08-16/iphones-become-mobile-casinos-by-adding-real-money-bets
Manning, J. (2012). Android apps leaking personal, banking details. Stuff, October 23. Located at: http://www.stuff.co.nz/technology/digital-living/7852719/Android-apps-leaking-personal-banking-details
Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.211-243. New York: Elsevier.
Sharma, M. (2012). Free gambling apps top security risk list. Stuff, November 4. Located at: http://www.stuff.co.nz/technology/digital-living/7904180/Free-gambling-apps-top-security-risk-list
“When I got to pre-school, I discovered that thumb sucking was not the social norm. Other kids teased me: ‘Only babies suck their thumbs!’ This was terrible news. I didn’t want to be a baby, but there was no way for me to stop doing the only thing in the world that soothed me; the one thing I could do, in a violent home, to comfort myself and feel safe. So I compromised: I stopped sucking my thumb in public…But at home, or during any moment of privacy…my left thumb went automatically into my mouth. Rather than tapering off as I aged, my thumb sucking intensified, and I added a small swatch of cotton blanket to the ritual, rubbing it against my upper lip until it was soft and grey. My parents had split up, and I was moving from place to place with my mother and stepfamily, so nobody really had the energy to monitor my behavior. If anybody did notice and say something to me (‘Stop that, you’re going to ruin your teeth!’), I just popped the thumb out and waited 30 seconds before the coast was clear again” (Janice Erlbaum)
The opening quote is taken from Janice Erlbaum’s blog article “I was an adult thumbsucker” (a habit she managed to kick when she was 26 years old). From Erlbaum’s full account, I wouldn’t class the behaviour as an addiction although depending on what definition of addiction is used, an argument could perhaps be made. I have to admit that adult thumb sucking is something which I have often thought about as someone I know well has sucked her right thumb all her life. She’s now in her early forties and has two completely different shaped thumbs (one ‘normal’ and the other flat and very elongated) as a result of four decades of constant thumb sucking. She also tells me that her upper mouth palate has also changed shape and her thumb fits perfectly into the upper groove in her mouth. She also has a number of little routines she performs while sucking her thumb including the caressing of her eyelashes with her right index finger which when thumb-sucking is close to her eyes. She only ever does it when relaxing (such as when she’s watching television) and has learned not to do it in public. During her junior years and early adolescence, her parents tried to get her to stop, and at one point she was given a substance to coat her thumb in (which tasted disgusting when she put her thumb in her mouth). It didn’t work. She still sucked her thumb and put up with the horrible taste.
Most parents reading this will be aware that thumb-sucking tends to emerge in infancy (although there is some evidence that babies can suck their thumbs inside the womb. For instance, Professor Peter Hepper and his colleagues [Queen’s University, Belfast, Northern Ireland) have followed up children who were known to have sucked their thumbs as fetuses). Constant thumb-sucking is not necessarily problematic but depending on how the thumb is sucked, it can cause protruding teeth and other dental problems such as anterior open bite, malocclusion (i.e., misalignment of teeth or incorrect relation between the teeth of the two dental arches), and mucosal trauma. Other problems include deformity of the thumb (something which I have seen for myself first-hand) and speech problems. Thumb-suckers are also more prone to infections such as impetigo around the mouth (i.e., a highly contagious bacterial infection of the surface layers of the skin, which causes sores and blisters), and paronychia of the thumb (i.e., a skin infection that occurs around the nails). Basically, as children get older, the more of a problem thumb sucking is from a medical perspective. As one review of thumb sucking in the American Family Physician journal concluded:
“Major complications of thumb sucking, usually corrects spontaneously if thumb sucking ceases by six years of age. Thumb sucking in a child less than two years of age requires no treatment. In a three- to four-year-old child, thumb sucking may be secondary to changes in the child’s emotional environment, and treatment should be directed at correcting the underlying problem. Thumb sucking that persists beyond the age of six years should be treated”.
An article on thumb-sucking in Psychology Today by psychologist Dr. Susan Heitler looked at the topic of thumb-sucking. Dr. Heitler had been a thumb-sucker herself until she was nine-years old and had to endure “years of orthodonture” because of her childhood thumb-sucking. Her own daughter was also a thumb-sucker and her dentist told her that “trying to end thumbsucking will do more harm than good”, advice that she was not happy with given her own experiences. In her article, she wrote:
“Looks are hugely important to one’s success in life. Allowing thumbsucking to damage facial appearance is wrong advice. By the time a child is four or five, with the habit no longer socially appropriate and permanent teeth coming shortly, the risks of continuing to thumb or finger suck clearly outweigh the benefits…When does a bad habit qualify as an addiction? Usually it’s a function of how much the habit has become physiologically essential so that people feel craving when it is missing. That definitely happens with thumbsucking”.
Dr. Heitler’s article referred to empirical research that had been carried out on thumb-sucking although none of the main findings had any detail as to who had carried out the work, where the research was published, or what methodologies were employed (apart from very general information). Here are some of the main things she reported:
“In a study with premature infants, researchers found that infants who sucked their thumbs or a pacifier had shorter hospital stays. That was because rhythmic sucking soothed them so that they spent less energy in crying. In addition, sucking re-optimized their heart beats and breathing patterns if they were beginning to get upset…In studies of children who do or do not suck a thumb, finger or pacifier, it turns out that the suckers become emotionally more independent at a younger age. Researchers put a child and mom on one end of a long room. On the far end were appealing toys. The suckers ventured further and played with the toys away from Mom longer than the non-suckers…They just had higher self-confidence in being able to handle independent play, knowing that if they felt stressed they could suck for a bit, feel better, and resume playing on their own. It’s generally not until they become toddlers that the downsides of thumbsucking begin to outweigh the gains. Kids then tend to suck when they are trying to fall asleep, when they bored, when they are idling between activities, or to self-soothe when they are upset”.
One online article on thumb-sucking reports that it is a common activity among infants (30%-40% of those yet to start school) and around 10%-20% of children aged over six years. In a more academic source, Dr. Sherry Ellington and colleagues (in a 2000 issue of the Journal of Applied Behavior Analysis reported that thumb sucking is estimated to occur in 23% to 46% of children aged 1 to 4 years. As with the article by Dr. Heitler, it claims that thumb-sucking may have a psychological benefit for young children as it “allows them to consolidate emotions and handle their stresses”.
In a 1953 paper in the International Journal of Psychoanalysis, the Dr. Donald Winnicot presented his theory of transitional objects and phenomena. Dr. Winnicott compared thumb sucking with the use of external objects such as children’s use of comfort blankets drawing parallels between the two. He also a claims that childish actions like thumb sucking and objects like cuddly toys are the source of manifold adult behavior, amongst many others sexual fetishism. It is also claimed (particularly by psychodynamic psychologists) that such actions stem back to childhood trauma and that behaviours like thumb-sucking help facilitate the need to feel comforted and secure. Another early longitudinal study by Dr. Marjorie Honzik and Dr. John McKee published in the Journal of Pediatrics reported that after the first year of being born, girls more likely to suck their thumbs than boys. The main reason was speculated that “girls’ greater orality may involve greater pleasure from tactile stimulation”.
There doesn’t appear to be much empirical research on adult thumb sucking. A small 1996 study in the Journal of Clinical Psychiatry led by Dr. F. Castellanous found that in 12 intellectually normal adults with stereotypic movement disorder, eight of them displayed thumb-sucking and/or rocking behaviour (and 11 of them had an affective anxiety disorder suggesting that behaviours such as thumb-sucking may be engaged in to help reduce anxiety). A 2008 literature review by Dr Orlando Tanaka and colleagues in the American Journal of Orthodontics and Dentofacial Orthopedics reported some evidence that thumb-sucking might turn into nail biting. This might explain why there is such a seemingly low prevalence of thumb-sucking in adults. All the evidence suggests that thumb sucking in adults is not an addiction but in some people may be symptomatic of other underlying disorders.
Articles 2day (2012). Tic disorder and thumb sucking. July 2012. Located at: http://www.articles2day.org/2012/07/tic-disorder-and-thumb-sucking-other.html
Batista, E. (2012). Adult thumb sucking, January 12. Located at: http://www.edbatista.com/2012/01/adult-thumb-sucking.html
Castellanous, F.X., Ritchie, G.F., Marsh, W.L. & Rapoport, J.L. (1996). DSM-IV stereotypic movement disorder: persistence of stereotypies of infancy in intellectually normal adolescents and adults. Journal of Clinical Psychiatry, 57, 116-122.
Ellington, S.A., Miltenberger, R.G., Stricker, J.M., Garlinghouse, M.A., Roberts, J. & Galensky, T.I. (2000). Analysis and treatment of finger sucking. Journal of Applied Behavioral Analysis, 33, 41-52.
Erlbaum, J. (2012). It happened to me: I was an adult thumb sucker. August 2. Located at: http://www.xojane.com/it-happened-to-me/it-happened-me-i-was-adult-thumbsucker
Friman, P. C. (1987). Thumb sucking in childhood. Feelings and Their Medical Significance, 29, 11-14.
Heitler, S. (2012). Lessons from thumbsucking, the earliest addiction. Psychology Today, January 26. Located at: http://www.psychologytoday.com/blog/resolution-not-conflict/201201/lessons-thumbsucking-the-earliest-addiction
Hepper, P., Wells, D.L. & Lynch, C. (2004). Prenatal thumbsucking is related to postnatal handedness. Neuropsychologia, 43, 313-315.
Honzik, M.P. & John P. McKee, J.P. (1960). The sex difference in thumb-sucking. Journal of Pediatrics, 61, 726-732.
Leung, A.K. & Robson, W.L. (1991). Thumb sucking. American Family Physician, 44, 1724-1728.
Luke, L. S., & Howard, L. (1983). The effects of thumb sucking on orofacial structures and speech: A review. The Compendium of Continuing Education, 4, 575–579.
Tanaka, O.M., Vitral, R.W.F., Tanaka, G.Y., Pulido A. & Guerrero, & Camargoe, E.S. (2008). Nailbiting, or onychophagia: A special habit. American Journal of Orthodontics and Dentofacial Orthopedics, 134, 305-308.
Winnicott, D. (1953) Transitional objects and transitional phenomena. International Journal of Psychoanalysis, 34, 89-97.
To date, there has been a lack of agreement among researchers as to the precise name and definition of video game addiction (both online and offline). However, there is a general consensus that excessive gaming can lead to a wide range of physical and psychological problems, and therefore necessary to explore the nature and the scale of the phenomenon. In doing so, it is important to use psychometrically validated measurement tools. Unfortunately, there is lack of these in the literature so far. Along with some colleagues (led by Dr. Daniel King), we recently published a paper examining all the instruments that have been used to assess problematic video gaming in the journal Clinical Psychology Review.
Our paper noted that pathological video-gaming, or its proposed DSM-V classification of “Internet Use Disorder”, is of increasing interest to scholars and practitioners in allied health disciplines. Our systematic review was designed to evaluate the standards in pathological video-gaming instrumentation and guidelines for sound psychometric assessment. We assessed a total of 63 quantitative studies, including eighteen instruments (representing 58,415 participants). Our findings indicated that the instruments were generally characterized as inconsistent. The strengths of available measures included: (i) short length and ease of scoring, (ii) excellent internal consistency and convergent validity, and (iii) potentially adequate data for development of standardized norms for adolescent populations. However, the key limitations included: (a) inconsistent coverage of core addiction indicators, (b) varying cut-off scores to indicate clinical status, (c) a lack of a temporal dimension, (d) untested or inconsistent dimensionality, and (e) inadequate data on predictive validity and inter-rater reliability. An emerging consensus suggested that pathological video-gaming is commonly defined by (1) withdrawal, (2) loss of control, and (3) conflict.
Most of the tools in current use have been modified from other questionnaires without their reliability and validity being tested. This includes those based on internet addiction (e.g., Kimberley Young’s Internet Addiction Test), pathological gambling (using the DSM–IV criteria), or behavioural addictions. An additional problem is that many of the measures focus exclusively on Massively Multiplayer Online Role Playing Game (MMORPG) users. In order to cover the whole range of online gamers, I recently helped co-develop an empirically based questionnaire consisting of 18 items called the Problematic Online Gaming Questionnaire (POGQ) that we published in the journal PLoS ONE.
In a recent 2011 study, some of my Hungarian colleagues (led by Dr. Koronczai) claimed in the journal Cyberpsychology, Behavior and Social Networking that a suitable measure should fit the following six criteria. It should have: (i) comprehensiveness (i.e., examining more, possibly all, aspects of problematic online gaming); (ii) brevity (in order to assess the more impulsive population as well and to facilitate incorporation into time-limited surveys); (iii) reliability and validity for different methods of data collection (e.g., online, paper-and-pencil self-rating, face-to-face); (iv) reliability and validity for different age groups (e.g., adolescents and adults); (v) cross-cultural reliability and validity; (vi) been validated on clinical samples. The measure should also serve as a basis for defining cutoff scores for dependence.
The POGQ is a short comprehensive measure and therefore fits to the first two requirements. It was also found to be a psychometrically adequate measure in a large convenience sample of adult online gamers. However, there is great need for a measure that is also suitable for survey type research in an offline data collection setting, and is reliable and valid for adolescents. Therefore, we modified the original POGQ to a 12-item version and applied it to an offline adolescent sample using pen-and-pencil data collection method (and published the findings in the journal Cyberpsychology, Behavior and Social Networking). This way both the third and the fourth points of the six criteria above were fulfilled.
The aim of or most recent study was twofold. The first goal was to explore the psychometric properties of the POGQ on a nationally representative adolescent sample as until recently it had only been used on adult gamer samples. The second goal was to assess the prevalence of problematic online gaming in a nationwide adolescent sample, as there have been only two nationally representative studies carried out on adolescents in the US and Germany.
The results of or study showed that the 12-item POGQ-SF had appropriate psychometric properties according to the statistical analysis performed on a nationally representative sample of adolescents. The analysis showed that 8.2% of gamers (4.6% of the whole sample) belonged to the at-risk group. We also found an additional 13.3% of adolescents (23.9% of gamers) showed symptoms of problematic online gaming above the average. Gamers belonging to the at-risk class were more likely to be male, more likely to play for five or more hours a day, have lower grade point average, have lower self-esteem, and higher depression score than gamers belonging to the other two classes. All these results are in line with findings of other studies confirming the validity of the measurement tool.
Despite the robustness of the study, an important limitation was that it was only carried out among Hungarian adolescents. For generalizability it must be applied and psychometrically tested on cross-cultural samples as well (see the aforementioned Criterion 5). It is also a future goal to confirm the POGQ on clinical samples (Criterion 6). This would allow all the six criteria requirements presented in the introduction to be met. The current POGQ is both short (Criterion 2) and comprehensive (Criterion 1), and assesses problematic online gaming in different age groups (Criterion 4) with different data collection methods (Criterion 3). We hope that the POGQ will facilitate future research and will serve as an adequate tool for assessing problematic online gaming.
Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M.D., Pápay, O. & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone.0036417.
Gentile, D. (2009). Pathological video-game use among youth ages 8 to 18: A national study. Psychological Science, 20, 594-602.
Gentile, D.A., Choo, H., Liau, A., et al. (2011). Pathological video game use among youths: A two-year longitudinal study. Pediatrics, 127, E319-E329.
King, D.L., Haagsma, M.C., Delfabbro, P.H.,Gradisar, M.S., Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.
Koronczai, B., Urban, R., Kokonyei, G., et al. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.
Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in children and adolescents: A review of empirical reearch. Journal of Behavioral Addictions, 1, 3-22.
Pápay, O., Urbán, R., Griffiths, M.D., Nagygyörgy, K., Farkas, J. Kökönyei, G., Felvinczi, K., Oláh, A., Elekes, Z., Demetrovics, Z. (2013). Psychometric properties of the Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) and prevalence of problematic online gaming in a national sample of adolescents. Cyberpsychology, Behavior, and Social Networking, doi:10.1089/cyber.2012.0484.
Rehbein, F., Kleimann, M, & Mossle, T. (2010). Prevalence and risk factors of video game dependency in adolescence: results of a German nationwide survey. CyberPsychology, Behavior and Social Networking, 13, 269–277.