Family Factors in Adolescent Problematic Internet Gaming: a Systematic Review

J Behav Addict. 2017 Sep; half-dozen(3): 321–333.

Family factors in adolescent problematic Net gaming: A systematic review

Luke A. Schneider

^oneSchool of Psychology, The University of Adelaide, Adelaide, Commonwealth of australia

Daniel Fifty. Male monarch

ⁱSchool of Psychology, The University of Adelaide, Adelaide, Australia

Paul H. Delfabbro

¹School of Psychology, The University of Adelaide, Adelaide, Australia

Received 2017 Mar 5; Revised 2017 May nine; Accepted 2017 Jun 4.

Abstract

Background and aims

Familial influences are known to affect the likelihood of an adolescent becoming a problem gamer. This systematic review examined some of the cardinal findings in empirical research on family factors related to adolescent problem gaming.

Methods

A total of 14 studies in the past decade were evaluated. Family unit-related variables included: (a) parent status (due east.m., socioeconomic status and mental wellness), (b) parent–child relationship (e.m., warmth, conflict, and abuse), (c) parental influence on gaming (e.g., supervision of gaming, modeling, and attitudes toward gaming), and (d) family environment (e.grand., household composition).

Results

The bulk of studies have focused on parent–child relationships, reporting that poorer quality relationships are associated with increased severity of problem gaming. The paternal relationship may be protective against problem gaming; therefore, prevention programs should leverage the support of cooperative fathers.

Discussion

The intergenerational furnishings of problem gaming crave further attention, in light of developed gamers raising their children in a gaming-centric environs. Research has been limited by a reliance on adolescent self-written report to empathize family dynamics, without gathering corroborating data from parents and other family members. The very high rates of problem gaming (>x%) reported in general population samples raise concerns about the validity of current screening tools.

Conclusions

Interventions for adolescents may be more effective in some cases if they can address familial influences on problem gaming with the active co-participation of parents, rather than enrolling vulnerable adolescents in individual-based training or temporarily isolating adolescents from the family arrangement.

Keywords: Cyberspace gaming disorder, addiction, family, adolescence, risk, DSM-5

Introduction

Internet gaming activities play a major role in the leisure and social pursuits of adolescents. Enquiry has identified benefits associated with normal engagement in gaming, such every bit improved relationships with family unit (Durkin & Barber, 2002) and peers (Kuntsche et al., 2009; Valkenburg & Peter, 2009), too every bit some concrete and cerebral benefits (Blumberg, Altschuler, Almonte, & Mileaf, 2013; Subrahmanyam, Greenfield, Kraut, & Gross, 2001). Withal, excessive gaming tin can increase the risk of low and anxiety (King, Delfabbro, Zwaans, & Kaptsis, 2013), and negative impact on school achievement, exercise, and sleep (Ferguson, Coulson, & Barnett, 2011; Kim et al., 2010). In 2013, Cyberspace gaming disorder (IGD) was proposed as a condition warranting further study in Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Clan, 2013). The IGD nomenclature aimed to ameliorate consistency in the conceptualization of gaming-related bug, which had interchangeably been referred to every bit an "habit," "pathology," "syndrome," or "impulse control disorder," amidst other terms (King, Haagsma, Delfabbro, Gradisar, & Griffiths, 2013). The DSM-five IGD category has besides been used to guide interventions for adolescents who screen positively for problem gaming (King et al., 2017). Given some interventions for Internet habit (including gaming) have employed family approaches (eastward.g., Liu et al., 2015), or involved modification of family-related variables (east.g., parent–child communication) (Yeun & Han, 2016), it was considered timely to evaluate the testify based on family factors related to problematic gaming behaviors in adolescence.

Several familial influences, such equally the parent–child relationship, parental restriction and monitoring of media apply, and parents' marital and socioeconomic status, may affect the likelihood that an adolescent becomes a problem gamer. A large torso of empirical research has examined the association between adolescents' electronic media use and family functioning, with much of this work drawn from East Asian populations (Koo and Kwon 2014; Xiuqin et al., 2010); however, studies with a specific focus on trouble gaming are less common. Chiu, Lee, and Huang (2004) reported that Taiwanese youth from families with higher functioning relationships had much lower levels of problematic gaming. The authors suggested that family functioning may be protective against problem gaming considering more than diligent family unit members are likely to direct the adolescent's attending away from games and toward other activities. Similarly, a study of 600 adolescents by Jeong and Kim (2011) reported that less engagement with family activities was associated with problematic gaming. It is oftentimes unclear from these studies and others whether family unit and gaming variables are in fact causally related. Excessive gaming may displace opportunities for family unit interaction, or poor family relationships may lead an boyish to seek out social engagement in gaming activities (Wang & Wang, 2013). Another possibility is a third, more than underlying factor, such equally a developmental disorder, might explain a preference for gaming and lack of normal bonding or social interests.

Research studies of parental restriction and monitoring of gaming appear to exist more equipped to examine the impact of parenting style. This is because the line of questioning is oftentimes more than explicit in reference to the parents' influence on gaming, asking questions such as Do you set limits on how long your child tin can play games? Nevertheless, there is however dubiety most whether parents are aware of the extent of gaming activities and whether parental restrictions or other strategies are consistently employed. This may partly consider for the mixed findings in relation to parental supervision and trouble gaming (Choo, Sim, Liau, Gentile, & Khoo, 2015; Kwon, Chung, & Lee, 2011; Liau et al., 2015; Rehbein & Baier, 2013). It may also depend on whether parents' restrictiveness or permissiveness had preceded or adult later on the gaming problem began. For instance, in a study of 2,021 adolescents, Wu, Wong, et al. (2016) reported that parental brake was ane.9 times college in adolescents who used the Internet excessively compared with other adolescents. More restrictive parents may endeavor, perhaps unsuccessfully, to respond to gaming bug after they accept emerged or restriction may increase the adolescent'due south desire for gaming, thereby creating a cruel wheel of further restriction and increasing parent–child conflict.

Other studies study that adolescents with family unit relational trauma may use online activities as a coping mechanism. Schimmenti, Passanisi, Gervasi, Manzella, and Fama (2014) surveyed 310 young adults to assess problematic Internet use and relational trauma. They reported that problematic Internet users were significantly more probable to have suffered childhood experiences of concrete and sexual abuses and report insecure attachment attitudes. Another study past Schimmenti, Guglielmucci, Barbasio, and Granieri (2012) surveyed 250 players of massively multiplayer online games about their attachment styles. Virtually half (47%) of the problem gamers reported features of disorganized attachment and playing to escape from painful memories of abuse. These findings highlight the circuitous family unit backgrounds in some cases of problem gaming, the limitations of basic demographic surveys for capturing this information, and the challenge of addressing a gaming problem when gaming may be seen as the simply feasible coping strategy in an unstable, rejecting, or risky family environs (Li et al., 2016).

In response to the perceived growing public health threat of problem gaming, at that place has been an increase in prevention studies targeting adolescent gaming (King et al., 2017). A meta-analysis by Yeun and Han (2016) identified 37 studies, including a total of 1,490 participants, with most conducted in schools, normally in groups, and employing cognitive-behavioral strategies and other training programs. The majority of these studies (36/37) have been conducted in South korea. A report past Lim (2012) provides a useful account of the reasons that young people in East Asian regions may be particularly vulnerable to problem gaming. Lim stated that the growing accessibility and affordability of gaming resulting from industrialization, the declining nascence charge per unit and single-child family structure (eastward.thou., the one-child policy in China), and cultural and familial pressures to achieve loftier academic achievement have led to lonely, stressed, and shamed adolescents who retreat into Internet cafes. Standard interventions in these regions have involved stress direction, self-discipline, and idea challenging (Yeun & Han, 2016), on the assumption that this equips the adolescent to ameliorate handle familial and cultural expectations and reduce reliance on gaming. It may exist debated whether such interventions can in fact address familial influences that drive problem gaming behaviors, including the possibility that certain programs may reinforce shame and resentment by punishing adolescents and isolating them from their parents (e.g., "boot campsite" approaches; see Koo, Wati, Lee, & Oh, 2011) or indirectly absolving the parent of offer support or having other responsibilities by not including them in interventions.

The nowadays review

The objective of this review was to summarize the research on family factors associated with adolescent problem gaming. The aim was to identify the factors with consistent links to trouble gaming, while highlighting potential weaknesses or inconsistencies for the attention of future research. A disquisitional examination of this literature may help researchers and practitioners to pay greater attending to more than external influences, particularly modifiable variables that could be targeted in interventions, rather than focusing on the personality traits, capabilities, and difficulties of a vulnerable population. Reviewing familial influences may also inform holistic models of problem gaming and related behavioral addictions.

Methods

Inclusion criteria

The scope of this review included quantitative studies of boyish problem gaming published in the last decade (2007–2016). This time frame (10 years) was chosen because (a) it was a standard fourth dimension frame in reviews and (b) gaming activities had not profoundly changed within this menstruum, in terms of their online capabilities and presence inside the family abode. To be eligible for inclusion, studies were required to include a measure of problem gaming, present data on participants aged under xviii years, and include at least i family-related variable. Family unit-related variables included: (a) parent status (eastward.one thousand., gender, socioeconomic condition, and mental health), (b) parent–child human relationship (e.g., warmth, conflict, and corruption), (c) parental influence on gaming (i.e., supervision of gaming, modeling, and attitudes toward gaming), and (d) family unit environment (e.g., household composition and quality of family relationships). Annotation that the term "parent" is used to refer collectively to the principal carer of the kid and includes primary caregivers who are non biological parents.

Identification of studies

Database searches were conducted using the following databases: Medline, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection (via EBSCOhost), Spider web of Scientific discipline, and ScienceDirect. Each database was searched by i of the authors (LAS) in July 2016. The search terms and logic were developed past two authors (LAS and DLK). Searches involved combinations of keywords, subject headings, and MeSH terms. Each database required some minor adjustments due to variations in functionality. For example, where i database enabled searching by "subject headings," another enabled keyword searches only. Search terms were bundled into four groupings reflecting: (a) family factors, (b) problem gaming, (c) technology-related term (due east.g., "video gaming" and "Cyberspace"), and (d) the population of involvement. The four groupings were separated past "AND" to ensure essential components were captured by the search. The complete search results and reference list for each database search are available from the respective writer.

Figureone presents a summary of the search and inclusion procedure for this review. The database searches identified a total of v,039 manuscripts across the six databases. After removing duplicates, 3,678 articles remained for the next stage of screening. The evaluation of titles and abstracts resulted in three,573 studies being excluded due to not coming together inclusion criteria. Two studies were identified from the reference lists of those included articles. Of the 105 full-text articles evaluated by the offset author and an independent reviewer, a full of xiv studies were identified equally suitable for review.

Catamenia diagram of study selection

Data extraction

Table1 presents an overview of the extracted information from the 14 studies. These included authors and date, land of data collection, sample size, historic period of participants (hateful, standard deviation, and range), written report population, study design, trouble gaming measurement, family factors nether study, and the principal findings and significance of the study.

Table one.

Summary of recent research on family factors underlying problematic Net gaming among adolescents

Authors	Country	Due north	Age range	Sample	Pattern	IGD measure out	Family unit factors	Findings
Choo et al. (2015)	Singapore	two,974	ten–14	Schoolhouse students	1-year longitudinal survey	Modified DSM-Four-TR pathological gambling criteria	Parent–child closeness	Higher parent–child closeness at baseline was associated with decreased trouble gaming symptoms of 1 year later on. Parental restriction of video gaming had no effect on pathological gaming. The upshot of parent–child closeness on gaming was stronger in boys than girls.
							Parental restriction on child's video gaming
Da Charlie, HyeKyung, and Khoo (2011)	Singapore	ii,527	ten–eighteen	Schoolhouse students	3-year longitudinal survey	Modified DSM-IV-TR pathological gambling criteria	Parent–child relationship	Pathological gamers perceive their family environment as being less comfortable, and more argumentative, than normal gamers. Problem gamers reportedly take weaker parental relationships, peculiarly with fathers, than normal gamers.
							Family environment
Jeong and Kim (2011)	South korea	600	12–15	School students	Cantankerous-sectional survey	Modified Young'due south Internet Addiction Scale (translated)	Social activities with parents	Gaming addiction scores were:
							Gaming activities with parents	Negatively associated with self-efficacy in real globe
								Positively associated with social efficacy in virtual world
								Negatively associated with social activities with parents
								Negatively related to parental attitude toward gaming
Kim and Kim (2015)	South Korea	624	Non reported	School students	Cross-sectional survey	IGAS	Parent–child attachment	Cyberspace gaming addiction was negatively associated with forcefulness of parental zipper. Adolescent problematic gamers reported higher scores on parental rejection than normal adolescents.
							Adolescents' attitude toward parents' parenting
							Socioeconomic status
Kwon et al. (2011)	South Korea	1,136	12–xv	Schoolhouse students	Cantankerous-sectional survey	Modified Young'due south Internet Habit Scale (translated)	Perceived parent–child relationship	Internet gaming addiction was positively associated with parent hostility toward the child, and negatively associated with parent affection and supervision. Problematic gamers reported gaming to escape from their self and reality.
							Parental supervision
Liau et al. (2015)	Singapore	iii,034	Not clear	School students	ii-year longitudinal survey	Modified DSM-4-TR pathological gambling criteria	Parent–child closeness	Parent–child connectedness and a warm family environment were protective factors against pathological gaming at two-yr time bespeak. Improvements in family environment related to decreased trouble gaming and increased emotion regulation skills among adolescents.
							Parental involvement in kid'southward media employ
							Parental supervision
							Family environment
Rehbein, Kleimann, and Mossle (2010)	Germany	15,168	fourteen–16	Schoolhouse students	Cross-sectional survey	VGDS	Parental teaching	When included in a model with a big number of predictor variables, childhood concrete abuse was not a meaning predictor of problematic video gaming.
						ICD-ten dependency	Parental physical abuse
Rehbein and Baier (2013)	Deutschland	406	Time i: ix–10; Time 2: xiv–16	Schoolhouse students	5-twelvemonth longitudinal survey	CSAS	Single/two-parent household	Children from unmarried-parent households were at increased take a chance of video game addiction, perchance due to fewer resources for culling leisure activities. There was a negative relationship between CSAS score and paternal devotion and parental supervision.
							Parental devotion
							Parental supervision
							Conflict between parents
							Parental physical corruption
Rikkers, Lawrence, Hafekost, and Zubrick (2016)	Australia	six,310 carers	iv–17	Community sample	Cross-sectional survey	Instrument adapted from European union Kids Online Survey	Family type	Problematic Internet use and electronic gaming were associated with living in poorer functioning family. Increased prevalence of problematic gaming behavior in children with parents with histories of mental issues.
							Parental didactics/occupation
		2,967 children					Parental mental health
							Family performance
Vadlin, Aslund, Hellstrom, and Nilsson (2016)	Sweden	Study one: one,868	Study 1: 12–xvi	Community and clinical samples	Cross-sectional survey	GAIT	Threats and violence between parents	Adolescents with experiences of family maltreatment and bullying had increased the probability of problematic gaming, but these relationships were non causal.
		Study ii: 242	Study 2: 12–18				Threats and violence between parent/due south and child
Wang et al. (2014)	Hong Kong	503	12–18	Schoolhouse students	Cross-sectional survey	Chinese version of brusque-form GAS	Parental education	Gaming habit was correlated with degree of perceived family disharmony, which included relationship quality, level of obedience, and level of intendance received from a parent.
							Parental marital status
							Family unit economic status
							Family harmony
Wu, Ko, Wong, Wu, and Oie (2016)	Taiwan	two,104	12–13	School students	Cross-sectional survey	Modified CIAS	Parental gaming attitudes	Weak correlation betwixt gaming-related positive expectancy and parental gaming attitudes, parental Internet game use, and parental invitation to play Internet games. Severity of problem gaming positively associated with frequency of parental gaming and invitation to play games.
							Parental gaming use
							Parental gaming invitations
Zhu, Zhang, Yu, and Bao (2015)	Mainland china	833	11–14	School students	1-yr longitudinal survey	Modified Young's IAS (translated)	Parent–child relationship	Low quality parent–adolescent relationship predicted Cyberspace gaming addiction indirectly through schoolhouse connexion and enhancement of affiliation with deviant peers.
Zorbaz, Ulas, and Kizildag 2015	Turkey	396	ix–12	School students	Cross-sectional survey	SGAC	Family relationships	Negative family relationships, specifically discouraging parenting style, were a predictor of problem gaming.
							Parental instruction

Annotation. CIAS: Chen Internet Habit Scale, IAS: Net Habit Scale, IGAS: Internet Game Addiction Scale for Korean adolescents, CSAS: Children'due south Separation Anxiety Calibration, GAIT: Gaming Addiction Identification Test, GAS: Gaming Addiction Scale, SGAC: Scale of Game Addiction for Children, VGDS: Video Game Dependency Scale.

Results

Study pattern and context

Nine of the 14 studies were cross-sectional survey studies. The remaining five were longitudinal survey studies, with follow-upwards at 1 year (Choo et al., 2015; Zhu et al., 2015), 2 years (Liau et al., 2015), 3 years (Da Charlie et al., 2011), and 5 years (Rehbein & Baier, 2013). Well-nigh studies were conducted in East Asian nations, including Singapore (n = 3), South Korea (n = three), Taiwan (n = one), Mainland china (n = one), and Hong Kong (n = ane), with remaining studies from Germany (n = 2), Australia (n = 1), Sweden (n = 1), and Turkey (n = one). The majority of studies were conducted in either primary, middle, or secondary schools, or a combination of these contexts (Choo et al., 2015; Da Charlie et al., 2011; Jeong & Kim, 2011; Kim & Kim, 2015; Kwon et al., 2011; Liau et al., 2015; Rehbein & Baier, 2013; Rehbein et al., 2010; Wang et al., 2014; Wu, Ko, et al., 2016; Zhu et al., 2015; Zorbaz et al., 2015).

2 studies presented nationally representative survey information (Rehbein et al., 2010; Rikkers et al., 2016). Vadlin et al. (2016) recruited a prospective community-based cohort and a sample of adolescents seeking commencement contact with child and adolescent psychiatric clinics in Sweden. All studies with one exception (Rikkers et al., 2016) surveyed merely the kid or adolescent and did not collect information from the parent or caregiver, or another external rater. The mean sample size of the included studies was 2,894 (SD = four,214) and ranged from 396 participants (Zorbaz et al., 2015) to 15,168 participants (Rehbein et al., 2010). Non including Rehbein et al. (2010), the hateful sample size was ane,793 (SD = 1,674).

Problem gaming: Measurement

There was a considerable variability in problem gaming instrumentation. Three studies (Choo et al., 2015; Da Charlie et al., 2011; Liau et al., 2015) employed a screening tool based on the DSM-Iv-TR pathological gambling criteria (American Psychiatric Clan, 2000). 3 studies (Jeong & Kim, 2011; Kwon et al., 2011; Zhu et al., 2015) employed modified and translated versions of the Immature Net Habit Test (Young, 1998). Two studies (Rehbein & Baier, 2013; Rehbein et al., 2010) used measures based on the ICD-x (World Health Organization, 1992). Half-dozen studies employed modified and/or translated instruments (Kim & Kim, 2015; Rikkers et al., 2016; Vadlin, Åslund, & Nilsson, 2015; Wang et al., 2014; Wu, Wong, et al., 2016; Zorbaz et al., 2015). Although not consistently reported, the prevalence estimates of problem gaming (or "gaming habit," as information technology was often termed) were high, including figures of 9.8% (Vadlin et al., 2016), 9.9% (Choo et al., 2015; Liau et al., 2015), 11.7% (Da Charlie et al., 2011), 13.four% (Kim & Kim, 2015), and fifteen.six% (Wang et al., 2014).

Family factors: Overview of variables

The most ofttimes studied family cistron was the parent–child human relationship, which was presented in 11 studies. This factor was assessed with cocky-report measures of parent–kid closeness or zipper in seven studies (Choo et al., 2015; Da Charlie et al., 2011; Kim & Kim, 2015; Kwon et al., 2011; Liau et al., 2015; Rehbein & Baier, 2013; Zhu et al., 2015). In the remaining studies, the parent–child relationship was inferred by the boyish'due south perceptions of the family unit environment, family harmony, parenting quality, and social engagement with parents (Jeong & Kim, 2011; Rikkers et al., 2016; Wang et al., 2014; Zorbaz et al., 2015). Only three studies distinguished between maternal and paternal relationships (Da Charlie et al., 2011; Kim & Kim, 2015; Rehbein & Baier, 2013). All measurements of the parent–child relationship involved a cocky-written report survey. Studies did not include interviews, observations, or external reports to complement the surveys.

The second most mutual gene was parent status. Eight studies examined variables related to the parent/due south, such as marital condition (n = 3; Rehbein & Baier, 2013; Rikkers et al., 2016; Wang et al., 2014), mental health status (Rikkers et al., 2016), and socioeconomic status (northward = 7; Choo et al., 2015; Kim & Kim, 2015; Rehbein & Baier, 2013; Rikkers et al., 2016; Wang et al., 2014; Zhu et al., 2015; Zorbaz et al., 2015). Four studies used proxy measures of socioeconomic status, including house size and blazon (i.eastward., government housing, private, etc.; Choo et al., 2015) and parental education (Rehbein et al., 2010; Wang et al., 2014; Zorbaz et al., 2015). In Kwon et al.'s (2011) study, the school administrators informed the researchers that most students were from heart socioeconomic form families.

The 3rd factor was parental influence on gaming. 5 studies examined parent's noesis and attitudes toward gaming, parental involvement in gaming, and parental supervision of the adolescent's activities (including supervision of non-gaming activities) (Choo et al., 2015; Jeong & Kim, 2011; Liau et al., 2015; Rehbein & Baier, 2013; Wu, Ko, et al., 2016). Of the 14 studies, only three specifically asked participants nearly parental restriction of Internet gaming (Choo et al., 2015; Liau et al., 2015; Rehbein & Baier, 2013). These three studies contained survey questions most parental restriction of certain types or genres of games and limits on the duration of gaming time.

The concluding and to the lowest degree studied variable was parental abuse of the kid, which was assessed in three studies, all conducted in Europe. Rehbein et al. (2010) investigated the frequency of astringent physical abuse sustained by the kid before the age of 12 years, whereas Rehbein and Baier (2013) asked participants whether they had sustained physical abuse from a parent in the by four weeks. Rehbein and Baier (2013) included a survey particular related to conflict between parents. Vadlin et al. (2016) examined family maltreatment with items concerning threats and violence betwixt parents, and between parent and child.

Family unit factors: Main findings

The well-nigh consistent finding was a poorer parent–kid human relationship that was associated with increased trouble gaming (Choo et al., 2015; Da Charlie et al., 2011; Kim & Kim, 2015; Zhu et al., 2015). Related findings included: (a) problem gamers spent less time engaged in social activities with their parents (Jeong & Kim, 2011), (b) problem gamers reported greater parental hostility and less parental affection (Kwon et al., 2011), and (c) problem gamers reported receiving lower quality parenting (Kim & Kim, 2015) and having a worse family surround compared with normal gamers (Da Charlie et al., 2011; Rikkers et al., 2016; Wang et al., 2014; Zorbaz et al., 2015). The three studies that differentiated between paternal and maternal relationships reported inconsistent findings. For example, paternal devotion was negatively correlated with problem gaming, whereas maternal devotion was not significant (Rehbein & Baier, 2013). In Kim and Kim'southward (2015) study, both maternal and paternal rearing attitudes and alienation scores were negatively correlated with problem gaming, but paternal trust and communication were not significantly related to trouble gaming. Finally, in Da Charlie et al.'due south (2011) study, problem gamers reported better relationships with mothers than fathers, but overall had poorer relationships with both parents than normal gamers.

Longitudinal studies reported that a positive parent–child relationship may ameliorate the hazard for afterwards problem gaming or reduce existing problem gaming symptoms. Liau et al. (2015) reported that parent–child connectedness and positive perceptions of the family surroundings were protective confronting later problem gaming, and that greater warmth in the family environment was associated with decreases in problem gaming. Choo et al. (2015) reported that greater parent–child closeness at baseline was associated with fewer symptoms of trouble gaming at 1-twelvemonth follow-up, peculiarly for male gamers. Zhu et al. (2015) reported that the relationship between negative parent–child relationship and trouble gaming was mediated by decreasing school connectedness and greater association with deviant peers.

Adolescents from single-parent (Rehbein & Baier, 2013) and composite (Rikkers et al., 2016) families were at greater risk of reporting problem gaming than those from 2-parent families. Nevertheless, Wang et al. (2014) constitute no significant outcome of parental marital status on gaming problems. Choo et al. (2015) reported that living in private housing, which reflected the highest level of socioeconomic status, was negatively related to symptoms of trouble gaming, whereas six other studies found no relationship between socioeconomic status and gaming problems. Trouble gaming was more prevalent amid adolescents with parents with histories of mental health issues (Rikkers et al., 2016).

Studies on parental attitudes toward gaming and parental gaming behavior have produced inconsistent findings. Wu, Ko, et al. (2016) reported significant positive relationships between the frequency of parental gaming, the frequency of parental invitations to play games, and boyish problem gaming. Jeong and Kim (2011) reported that negative parental attitudes toward gaming were associated with more than symptoms of problem employ. In 2 studies (Kwon et al., 2011; Rehbein & Baier, 2013), parental supervision was negatively associated with problem gaming, whereas two other studies reported no significant associations (Choo et al., 2015; Liau et al., 2015). Just one of the three studies that examined parental concrete abuse reported that adolescents with a history of maltreatment were more likely to report problem gaming (Vadlin et al., 2016).

Further findings from longitudinal studies

Longitudinal studies support the notion that the parent–child relationship tin can influence the likelihood of developing problem gaming behavior. Choo et al. (2015) reported that greater parent–child closeness at baseline was associated with decreased problem gaming 1 yr after. They as well reported that parental restriction of gaming at baseline had no effect on problem gaming 1 yr afterward, irrespective of the quality of the parent–child relationship. Liau et al. (2015) reported that both parent–child connexion and a warm family unit surround at baseline were protective factors for trouble gaming at 2-year follow-up. Moreover, greater family warmth at baseline was associated with reductions in problem gaming one twelvemonth later. Zhu et al. (2015) reported that the longitudinal relationship between parent–child relationship and problem gaming was mediated by school connectedness and deviant peer affiliation. A 5-year longitudinal report by Rehbein and Baier (2013) reported that increased paternal devotion and higher parental supervision in childhood predicted lower rates of problem gaming in boyhood. A 3-year written report past Da Charlie et al. (2011) reported that trouble gaming was associated with reductions in the quality of the parent–kid relationship over time. While there was no initial divergence between problem and normal gamers in terms of their parent–child relationships, past the third yr, problem gamers reported significantly poorer relationships with their parents.

Discussion

This review examined the oft overlooked office of family factors in adolescent problem gaming. A consistent finding in this review was poorer quality of the parent–child human relationship that was associated with increased severity of problem gaming. Both maternal and paternal relationships were negatively associated with problem gaming, with longitudinal evidence indicating that the paternal bond in particular was a protective factor confronting trouble gaming. Long-term adolescent problem gaming likewise has marked negative effects on the family unit organization. One longitudinal report reported an increasing deterioration of the parent–kid human relationship over a 3-year menstruation following onset of trouble gaming (Da Charlie et al., 2011). This review shows that parenting tin increase the adventure of problem gaming in multiple ways. For example, Zhu et al.'south (2015) study reported that the parent–kid human relationship may influence trouble gaming via the mediating influence of decreasing school connectedness and greater association with deviant peers. The negative familial influence on gaming behavior may therefore be more pronounced when it impacts on the boyish's sense of belonging across multiple social contexts.

The findings of this review underscore the need for families to be involved in interventions for adolescents exhibiting symptoms of problem gaming. The family approach to trouble gaming, while less researched than individual-based therapies (Yeun & Han, 2016), has already been trialed with some successful outcomes. For example, a study by Liu et al. (2015) assessed a family-based intervention, which involved reducing high and unreasonable expectations and criticism by parents, and identifying alternative ways for adolescents to satisfy needs for competence and relatedness. The authors reported that the rate of trouble gaming reduced from 100% at baseline to only iv.8% at the cease of the intervention. The charge per unit of problem gaming was only 11.1% at the three-month follow-up assessment. Such a finding demonstrates the value of recognizing and conceptualizing the dysfunctional family unit dynamics in cases of adolescent problem gaming. Prevention approaches that focus on working with adolescents only may be perceived by the boyish equally blaming and fail to address one of the primary reasons for using games excessively.

Studies of parental supervision and gaming accept produced some mixed prove. While Kwon et al. (2011) and Rehbein and Baier (2013) reported negative associations betwixt parental supervision and trouble gaming, Liau et al. (2015) constitute no such relationship. Similarly, in Choo et al.'s (2015) longitudinal study, level of parental supervision did not influence subsequent development of problem gaming. Notably, the studies by Liau et al. (2015) and Choo et al. (2015) only measured the parental supervision of adolescent gaming, whereas the studies past Kwon et al. (2011) and Rehbein and Baier (2013) included more general measures of parental supervision and involvement in adolescents' activities [due east.g., "When I am outside, my female parent knows where I am" (Kwon et al., 2011)]. These differences suggest that parental monitoring and regulation of gaming devices may not be constructive on their ain, but broader parental supervision and involvement are required. Educational materials and awareness campaigns should, therefore, consider promoting messages on supervision of gaming media inside broader statements on parental care and responsibleness.

There was some show that parental modeling can impact on adolescents' gaming attitudes and behaviors. Potential intergenerational effects of problem gaming may become increasingly relevant equally more than children are born to parents who play games or have gaming histories. Positive parental attitudes toward gaming and greater parental involvement in gaming were associated with increased gaming past adolescents. Liau et al. (2015) reported that parents who modeled high levels of gaming increased the risk of having children engaged in excessive gaming, irrespective of the restrictions on gaming in the household. Therefore, gaming restrictions and monitoring may be compromised by parents if their modeling is inconsistent with their rules and restrictions. Given that males are known to exist more often than not more likely to play games excessively (Ferguson et al., 2011), fathers may tend to exist the stronger negative modeling influence. On this basis, including cooperative fathers who play games in family-based interventions for adolescents may be beneficial to all parties.

Adolescents from unmarried-parent or composite families were reportedly at greater risk of problem gaming than those from 2-parent families. This was consistent with studies of problematic Internet use (Ko, Yen, Yen, Lin, & Yang, 2007; Lam, Peng, Mai, & Jing, 2009; Li, Garland, & Howard, 2014; Tsitsika et al., 2011; Yen, Yen, Chen, Chen, & Ko, 2007), but multiple reasons could business relationship for these differences. Outset, it may reflect an adolescent's desire to escape from the stress of a complex family situation (east.one thousand., a strained human relationship with a step-parent). 2nd, adolescents living with a single parent may straight greater frustration toward this parent or wish to seek out surrogate parental figures, thereby making the opportunities for stress release and social connectivity in online games more appealing. It is also possible that adolescents in single-parent families have fewer opportunities for alternative activities due to the parent having less time and fewer resources to support the adolescent's interests. Another, less studied, variable was parental concrete corruption, which was positively associated with trouble gaming in i of the three studies. Vadlin et al. (2016) reported that adolescents with a history of family unit maltreatment were 2.5 times more likely to be problem gamers. The sensitive nature of this topic may arrive difficult to examine finer in cocky-report survey studies, peculiarly in the school context where the boyish may fear personal data being disclosed. The intersection of adolescent gaming bug with circuitous family unit backgrounds besides presents challenges for interventions. In that location may be special circumstances where a family unit-based approach, or the involvement of specific guardians or family members, is contraindicated due to irresolvable conflicts or risk issues. Collaboration and respect between parent and adolescent are essential to overcome this barrier. Equally noted by Ramirez et al. (2011), parental brake of screen time was only effective when at that place was joint understanding on the rules. When at that place was disagreement, parents tended to implement more rules that led to increased media use by the adolescent.

It is often assumed that adolescents with family unit-related difficulties engage in gaming not only to escape only likewise to seek out more comfortable or less threatening online relationships (Caplan, 2010; Rex & Delfabbro, 2014). Still, studies take non yet examined the types of social connectivity that occur in adolescent gaming and how they may relate to problem gaming. In that location may be varying risks across types of games based on their adequacy to facilitate social status, group bonds, and obligations among players. For example, some online games with cooperative elements may exist used to satisfy an adolescent'south need for social inclusion and want for acceptance and validation by others. In contrast, skill-based games with online ranking systems may run into an adolescent's need to exist recognized for accomplishment or mastery, which may exist lacking in their family unit surround. In addition to these varying online gaming subcultures, this review highlights the need to consider family factors within the relevant cultural context. Current knowledge of the families of adolescent trouble gamers is predominantly based on East Asian experiences, and it is likely that family dynamics and responses to gaming issues vary across regions.

Limitations and futurity directions

This review has limitations that warrant acquittance. Many of the identified studies predated the DSM-v IGD classification, and therefore, some inconsistency in screening for trouble gaming should exist expected. This review focused on problem gaming, as singled-out from general Internet use, which has a larger research base, and therefore, some studies of potential relevance may take been excluded. Studies not published in English language were also non identified past the search protocol. The methods of this review highlighted the consistencies in results but did non provide meta-analytic insights. Relatedly, the presented analysis considered familial factors discretely to identify full general trends across studies, rather than examining interactions among familial influences with other variables.

The family factors documented in this review may provide a useful guide for further empirical enquiry. Similar other areas of investigation into IGD, the research base of operations is limited by inconsistent approaches to screening, and the high prevalence rates of IGD (>x%) in general population samples suggest a need for more than careful delineation of normal and problem gaming. There is also a relative lack of longitudinal studies and no family interview-based studies, which would offer major advantages over cross-sectional surveys. Relying on cantankerous-exclusive surveys may impact the quality of particular and agreement of the causal pathways between family factors and adolescent trouble gaming. Hereafter research could include a more comprehensive assessment of family factors to examine potential interactions. Finally, studies should recruit from youth mental health services to include verified clinical cases.

Conclusions

Although problem gaming is a growing area of study, relatively less enquiry has assessed the important role of familial influences on adolescent gaming and problem gaming. This may reflect an unintended bias to consider adolescents in much the same way as adults, as independent, autonomous individuals, rather than a special population whose gaming tends to occur and interact within a family system. This review found that almost all studies on family factors have not collected data from families, just have instead relied on adolescents' own insight and view of family dynamics. Notably, too, the same screening tools used in studies of adult gamers are too used for adolescents, including children every bit young as 10 years old (due east.g., Choo et al., 2015), with reported prevalence rates that exceed other known mental disorders in this population (eastward.yard., 15%; Wang et al., 2014). Considering adolescents as adults may overlook relevant contributing factors that explain the evolution of problem gaming, particularly when problems tin can be traced to families with fewer nurturing relationships, less structure and more conflict, and low back up for alternative activities. The influence of the family system is vitally important to address within interventions for adolescents.

Acknowledgements

The authors would similar to thank Dr. Ashleigh Smith for guidance on conducting the systematic review and Ms. Amy Garrett for secondary screening of the selected full-text articles.

Funding Statement

Funding sources: This work received financial support from a Discovery Early Career Researcher Accolade (DECRA) DE170101198 funded by the Australian Enquiry Quango.

Authors' contribution

LAS designed the review and wrote the protocol. LAS conducted the review under DLK'due south supervision. LAS wrote the first draft of the manuscript under DLK's supervision and all authors contributed to and have canonical the final manuscript.

Conflict of involvement

The authors written report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

References

• American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Clan. [Google Scholar]
• American Psychiatric Clan. (2013). Diagnostic and statistical transmission of mental disorders (DSM-5) (fifth ed). Washington, DC: American Psychiatric Clan. [Google Scholar]
• Blumberg F. C., Altschuler Due east. A., Almonte D. East., Mileaf 1000. I. (2013). The impact of recreational video game play on children's and adolescents' cognition. New Directions for Child and Boyish Development, 139, 41–l. doi:10.1002/cad.20030 [PubMed] [Google Scholar]
• Caplan S. E. (2010). Theory and measurement of generalised problematic Internet use: A ii-step approach. Computers in Homo Behavior, 26, 1089–1097. doi:x.1016/j.chb.2010.03.012 [Google Scholar]
• Chiu S.-I., Lee J.-Z., Huang D.-H. (2004). Video game addiction in children and teenagers in Taiwan. CyberPsychology & Behavior, seven, 571–581. doi:10.1089/cpb.2004.7.571 [PubMed] [Google Scholar]
• Choo H., Sim T., Liau A. Thou. F., Gentile D. A., Khoo A. (2015). Parental influences on pathological symptoms of video-gaming among children and adolescents: A prospective study. Journal of Kid and Family unit Studies, 24, 1429–1441. doi:x.1007/s10826-014-9949-9 [Google Scholar]
• Da Charlie C. W., HyeKyung C., Khoo A. (2011). Role of parental relationships in pathological gaming. Procedia – Social and Behavioral Sciences, 30, 1230–1236. doi:10.1016/j.sbspro.2011.10.238 [Google Scholar]
• Durkin K., Barber B. (2002). Not so doomed: Computer game play and positive adolescent development. Journal of Practical Developmental Psychology, 23, 373–392. doi:10.1016/S0193-3973(02)00124-7 [Google Scholar]
• Ferguson C. J., Coulson M., Barnett J. (2011). A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social issues. Periodical of Psychiatric Research, 45, 1573–1578. doi:10.1016/j.jpsychires.2011.09.005 [PubMed] [Google Scholar]
• Jeong E. J., Kim D. H. (2011). Social activities, self-efficacy, game attitudes, and game addiction. Cyberpsychology, Behavior, and Social Networking, 14, 213–221. doi:10.1089/cyber.2009.0289 [PubMed] [Google Scholar]
• Kim Thou., Kim Thousand. (2015). Net game addiction, parental attachment, and parenting of adolescents in South korea. Journal of Kid & Adolescent Substance Corruption, 24, 366–371. doi:10.1080/1067828X.2013.872063 [Google Scholar]
• Kim Y., Park J. Y., Kim South. B., Jung I.-K., Lim Y. S., Kim J.-H. (2010). The effects of Internet addiction on the lifestyle and dietary beliefs of Korean adolescents. Nutrition Research and Exercise, 4, 51–57. doi:10.4162/nrp.2010.4.1.51 [PMC costless article] [PubMed] [Google Scholar]
• King D. L., Delfabbro P. H. (2014). My Facebook family: Should boyish psychiatric evaluation include information about online social networks? Australian & New Zealand Journal of Psychiatry, 48, 805–808. doi:10.1177/0004867414542031 [PubMed] [Google Scholar]
• King D. L., Delfabbro P. H., Doh Y. Y., Wu A. Yard. Southward., Kuss D. J., Mentzoni R., Pallesen Southward., Carragher N., Sakuma H. (2017). Policy and prevention approaches for disordered and chancy gaming and Net use: An international perspective. Prevention Science. doi:10.1007/s11121-017-0813-1 [PubMed] [Google Scholar]
• King D. L., Delfabbro P. H., Wu A. M. South., Doh Y. Y., Kuss D. J., Mentzoni R., Pallesen South., Carragher N., Sakuma H. (2017). Treatment of Internet gaming disorder: An international systematic review and CONSORT evaluation. Clinical Psychology Review, 54, 123–133. doi:10.1016/j.cpr.2017.04.002 [PubMed] [Google Scholar]
• King D. L., Delfabbro P. H., Zwaans T., Kaptsis D. (2013). Clinical features and axis I comorbidity of Australian boyish pathological Internet and video-game users. Australian & New Zealand Journal of Psychiatry, 47, 1058–1067. doi:10.1177/0004867413491159 [PubMed] [Google Scholar]
• Male monarch D. 50., Haagsma M. C., Delfabbro P. H., Gradisar Grand., Griffiths 1000. D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331–342. doi:10.1016/j.cpr.2013.01.002 [PubMed] [Google Scholar]
• Ko C.-H., Yen J.-Y., Yen C.-F., Lin H.-C., Yang Yard.-J. (2007). Factors predictive for incidence and remission of Cyberspace addiction in young adolescents: A prospective study. CyberPsychology & Behavior, ten, 545–551. doi:10.1089/cpb.2007.9992 [PubMed] [Google Scholar]
• Koo H. J., Kwon J. H. (2014). Take chances and protective factors of Internet addiction: A meta-analysis of empirical studies in Korea. Yonsei Medical Journal, 55, 1691–1711. doi:10.3349/ymj.2014.55.6.1691 [PMC gratis article] [PubMed] [Google Scholar]
• Koo C., Wati Y., Lee C. C., Oh H. Y. (2011). Net-addicted kids and Due south Korean government efforts: Boot-camp case. Cyberpsychology, Behavior, and Social Networking, 14, 391–394. doi:10.1089/cyber.2009.0331 [PubMed] [Google Scholar]
• Kuntsche E. Simons-Morton B. ter Bogt T. Sanchez-Queija I. Tinoco 5. M. de Matos M. M., Santinello Thou., Lenzi M., & HBSC Peer Civilisation Focus Group. (2009). Electronic media advice with friends from 2002 to 2006 and links to face-to-face contacts in boyhood: An HBSC study in 31 European and North American countries and regions. International Journal of Public Wellness, 54, 243–250. doi:10.1007/s00038-009-5416-6 [PMC free article] [PubMed] [Google Scholar]
• Kwon J. H., Chung C. S., Lee J. (2011). The effects of escape from self and interpersonal human relationship on the pathological employ of Internet games. Community Mental Wellness Periodical, 47, 113–121. doi:10.1007/s10597-009-9236-1 [PubMed] [Google Scholar]
• Lam Fifty. T., Peng Z., Mai J., Jing J. (2009). Factors associated with Cyberspace addiction amongst adolescents. CyberPsychology & Behavior, 12, 551–555. doi:x.1089/cpb.2009.0036 [PubMed] [Google Scholar]
• Li D., Zhang W., Li X., Zhou Y., Zhao L., Wang Y. (2016). Stressful life events and boyish Internet addiction: The mediating part of psychological needs satisfaction and the moderating role of coping mode. Computers in Human Behavior, 63, 408–415. doi:10.1016/j.chb.2016.05.070 [Google Scholar]
• Li Westward., Garland E. L., Howard M. O. (2014). Family unit factors in Cyberspace habit among Chinese youth: A review of English- and Chinese-language studies. Computers in Human Behavior, 31, 393–411. doi:x.1016/j.chb.2013.11.004 [Google Scholar]
• Liau A. K., Choo H., Li D. D., Gentile D. A., Sim T., Khoo A. (2015). Pathological video-gaming among youth: A prospective study examining dynamic protective factors. Habit Research & Theory, 23, 301–308. doi:10.3109/16066359.2014.987759 [Google Scholar]
• Lim South. South. (2012). Regulatory initiatives for managing online risks and opportunities for youths – The Eastward Asian experience In Walrave M. (Ed.), e-Youth: Balancing between opportunities and risks? (pp. 271–290). Brussels, Belgium: Peter Lang. [Google Scholar]
• Liu Q. X., Fang X. Y., Yan N., Zhou Z. K., Yuan X. J., Lan J., Liu C. Y. (2015). Multi-family unit grouping therapy for adolescent Internet addiction: Exploring the underlying mechanisms. Addictive Behaviors, 42, 1–8. doi:10.1016/j.addbeh.2014.10.021 [PubMed] [Google Scholar]
• Ramirez E. R., Norman G. J., Rosenberg D. Due east., Kerr J., Saelens B. E., Durant N., Sallis J. F. (2011). Adolescent screen time and rules to limit screen time in the home. Journal of Adolescent Wellness, 48, 379–385. doi:10.1016/j.jadohealth.2010.07.013 [PMC complimentary commodity] [PubMed] [Google Scholar]
• Rehbein F., Baier D. (2013). Family-, media-, and school-related risk factors of video game addiction: A 5-twelvemonth longitudinal study. Journal of Media Psychology: Theories Methods and Applications, 25, 118–128. doi:10.1027/1864-1105/a000093 [Google Scholar]
• Rehbein F., Kleimann G., Mossle T. (2010). Prevalence and risk factors of video game dependency in adolescence: Results of a German nationwide survey. Cyberpsychology, Behavior, and Social Networking, xiii, 269–277. doi:x.1089/cyber.2009.0227 [PubMed] [Google Scholar]
• Rikkers W., Lawrence D., Hafekost J., Zubrick S. R. (2016). Internet use and electronic gaming by children and adolescents with emotional and behavioural problems in Australia – Results from the 2d Child and Adolescent Survey of Mental Health and Wellbeing. BMC Public Health, 16, 399. doi:10.1186/s12889-016-3058-1 [PMC free article] [PubMed] [Google Scholar]
• Schimmenti A., Guglielmucci F., Barbasio C., Granieri A. (2012). Attachment disorganization and dissociation in virtual worlds: A study on problematic Internet utilise among players of online role-playing games. Clinical Neuropsychiatry, 9, 195–202. [Google Scholar]
• Schimmenti A., Passanisi A., Gervasi A. M., Manzella S., Fama F. I. (2014). Insecure attachment attitudes in the onset of problematic Internet use among belatedly adolescents. Child Psychiatry & Human Development, 45, 588–595. doi:ten.1007/s10578-013-0428-0 [PubMed] [Google Scholar]
• Subrahmanyam K., Greenfield P., Kraut R., Gross East. (2001). The bear on of computer use on children's and adolescents' development. Journal of Applied Developmental Psychology, 22(1), 7–xxx. doi:10.1016/S0193-3973(00)00063-0 [Google Scholar]
• Tsitsika A., Critselis E., Louizou A., Janikian M., Freskou A., Marangou East., Kormas G., Kafetzis D. A. (2011). Determinants of Internet addiction among adolescents: A example-control study. The Scientific World Journal, 11, 866–874. doi:10.1100/tsw.2011.85 [PMC free commodity] [PubMed] [Google Scholar]
• Vadlin S., Aslund C., Hellstrom C., Nilsson One thousand. W. (2016). Associations betwixt problematic gaming and psychiatric symptoms amongst adolescents in two samples. Addictive Behaviors, 61, 8–15. doi:ten.1016/j.addbeh.2016.05.001 [PubMed] [Google Scholar]
• Vadlin Due south., Åslund C., Nilsson G. Westward. (2015). Development and content validity of a screening instrument for gaming addiction in adolescents: The Gaming Addiction Identification Test (GAIT). Scandinavian Journal of Psychology, 56, 458–466. doi:x.1111/sjop.12196 [PubMed] [Google Scholar]
• Valkenburg P. M., Peter J. (2009). The effects of instant messaging on the quality of adolescents' existing friendships: A longitudinal report. Journal of Communication, 59, 79–97. doi:10.1111/j.1460-2466.2008.01405.x [Google Scholar]
• Wang C. W., Chan C. Fifty. W., Mak Thousand. G., Ho S. Y., Wong P. W. C., Ho R. T. H. (2014). Prevalence and correlates of video and Internet gaming addiction among Hong Kong adolescents: A airplane pilot report. The Scientific World Journal, 2014, 874648. doi:10.1155/2014/874648 [PMC free article] [PubMed] [Google Scholar]
• Wang E. Due south., Wang M. C. (2013). Social support and social interaction ties on Internet addiction: Integrating online and offline contexts. Cyberpsychology, Beliefs, and Social Networking, xvi, 843–849. doi:ten.1089/cyber.2012.0557 [PubMed] [Google Scholar]
• Globe Health Organization. (1992). The ICD-ten classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health Arrangement. [Google Scholar]
• Wu C. S. T., Wong H. T., Yu 1000. F., Fok G. W., Yeung S. M., Lam C. H., Liu 1000. M. (2016). Parenting approaches, family functionality, and Internet habit among Hong Kong adolescents. BMC Pediatrics, 16, 130. doi:10.1186/s12887-016-0666-y [PMC free commodity] [PubMed] [Google Scholar]
• Wu J. Y. W., Ko H. C., Wong T. Y., Wu 50. A., Oei T. P. (2016). Positive outcome expectancy mediates the relationship between peer influence and Internet gaming habit amid adolescents in Taiwan. Cyberpsychology, Behavior, and Social Networking, 19, 49–55. doi:10.1089/cyber.2015.0345 [PubMed] [Google Scholar]
• Xiuqin H., Huimin Z., Mengchen Fifty., Jinan W., Ying Z., Ran T. (2010). Mental health, personality, and parental rearing styles of adolescents with Cyberspace addiction disorder. Cyberpsychology, Behavior, and Social Networking, 13, 401–406. doi:x.1089/cyber.2009.0222 [PubMed] [Google Scholar]
• Yen J. Y., Yen C. F., Chen C. C., Chen South. H., Ko C. H. (2007). Family factors of Internet addiction and substance use experience in Taiwanese adolescents. CyberPsychology & Behavior, 10, 323–329. doi:10.1089/cpb.2006.9948 [PubMed] [Google Scholar]
• Yeun Y. R., Han Due south. J. (2016). Furnishings of psychosocial interventions for school-aged children's Cyberspace habit, self-command and self-esteem: Meta-analysis. Healthcare Informatics Research, 22, 217–230. doi:10.4258/hir.2016.22.3.217 [PMC free article] [PubMed] [Google Scholar]
• Immature Grand. S. (1998). Caught in the net: How to recognize the signs of Internet addiction – And a winning strategy for recovery. New York, NY: John Wiley & Sons. [Google Scholar]
• Zhu J. J., Zhang W., Yu C. F., Bao Z. Z. (2015). Early on adolescent Cyberspace game addiction in context: How parents, school, and peers affect youth. Computers in Man Behavior, fifty, 159–168. doi:x.1016/j.chb.2015.03.079 [Google Scholar]
• Zorbaz Due south. D., Ulas O., Kizildag Due south. (2015). Relation betwixt video game addiction and interfamily relationships on primary schoolhouse students. Educational Sciences: Theory & Practise, fifteen, 489–497. doi:10.12738/estp.2015.2.2090 [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700711/