July 27, 2020


The most recent issue (July 2020) of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) has an article entitled, "Grasping Gaming: Parent Management Training for Excessive Videogame Use in Children."  Videogame use in boys along with excessive use of social media (Snapchat, Instagram, etc.) in girls have been particularly worrisome phenomenons since the lock downs preventing the spread of Covid 19 have been instituted.  I regularly receive reports of children spending up to eight hours or more daily on screens online.  Usual diurnal patterns of wake/sleep have also been disrupted (e.g. up until 4 am playing games and now waking up until 2 PM in the afternoon as a result).  These patterns have always existed but have become much more prevalent in the last four months.  I reprint below the recommendations to parents from this article:

  • 1. Screen time limits set by the parent and shared with the child. The American Academy of Pediatrics offers a Family Media Plan that is customizable for each family. Screen time limits should be specific to the child’s age, developmental level, emotional maturity, and behavioral responsibility.
  1. Parents should set limits as to when new games can be started, usually about 20 to 30 minutes before the child’s attendance is required
  2. The authors again caution about the extinction burst phenomenon and warn parents that behaviors will usually worsen before they get better when parents enforce new limits. Parents should consider consulting their pediatrician or behavioral specialist if negative behavior becomes difficult to manage.
  3. If a child’s behavior becomes dangerous or violent, we encourage parents to seek out a more formal gaming treatment program, such as those described in the article, as well as a psychiatric consultation to evaluate for any associated or confounding psychiatric conditions and required treatment (eg, ADHD, ASD, etc)
  • 2. Using video games as a reward in a behavior plan. A tantrum should not be rewarded with extra game time.
  • 3. Communicating with the child about appropriate versus inappropriate language and discussions.
  • 4. Removing payment options from the game if the child is not allowed to make purchases, and learning about refund policies and procedures for unauthorized or unsupervised gaming purchases placed by minors.

I would add that keeping any device in a child's room (TV, phone, gaming system) is a terrible idea because most children lack the ability to self-regulate use (particularly at night). 

I bolded the most difficult part of these recommendations because parents' have repeatedly told me they want to avoid this level of conflict with their child.  I understand parental unease and anxiety about taking such actions but can only add that this "extinction burst phenomen" will be time limited and last no more than a couple of days. 

I am not aware of any "formal gaming treatment program" in the Bay Area and would like to be informed if you know of one. 

Please feel free to otherwise send your comments or questions to me about this problem of excessive gaming and social media in children.


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