Let’s Talk About Gaming, with Dr Kim Le

 

Tracey Challenor

Hello, I’m Tracey Challenor and welcome to the Life Ed podcast where we support parents to raise happier, healthier, and more resilient kids. You’ve probably heard of gaming disorder, also known as internet addiction or video game addiction. Getting kids off their devices can be a huge stress for many parents.

But in some cases, a hobby becomes an addiction with serious consequences for young people’s mental and physical health. Doctor Kim Le is a psychiatrist and internet gaming disorder specialist. You might have seen him as the host of SBS documentary: Are you addicted to technology?

Well Doctor Le is among a group of experts who are concerned about the long-term cognitive impacts of gaming disorder and the working on ways to tackle the problem. Doctor Kim Lee, welcome to the Life Ed podcast.

Dr Kim Le

Thank you, Tracey!

Tracey Challenor

Well, it was big news a few years ago, wasn’t it, when the World Health Organisation added gaming disorder to its list of diseases, classing it as a behavioural disorder. Lots of young people like gaming. When does gaming become an addictive disorder?

Dr Kim Le

Essentially, it can become a problem when someone loses control over their gaming time. Where it starts to eat into all aspects of their daily life, their family, their relationships, school, work and life. And then they start developing negative consequences due to excessive gaming and continue to game even though they’re suffering from those consequences. And then gaming takes priority over other important things, and typically the symptoms should be there for at least a year. But when you see a specialist and the symptoms are severe, then the specialist may diagnose that in a young person, in an adult, earlier.

Tracey Challenor

You help a lot of young people in your telehealth practice. Who’s most affected by gaming addiction? Is it worse for boys? And what is the age range of young people you’re seeing?

Dr Kim Le

Well, typically it is more of a male-oriented activity. The gaming companies do sort of say that it’s a 50/50 split between male and female, or heading towards that way in terms of gaming, but definitely boys are more motivated to play. The games are generally more targeted to that population and in the, I guess pathological level, but problematic level of gaming, it is typically more the 15 to early 20s at risk period whereby gaming becomes more important. Friendships connecting with people online and then that can take over, and you might see young men having this problem where they sort of have failure to launch and sort of early adulthood and not really getting into university or TAFE or education or a trade or a relationship, and more focused on the online world. There was a Macquarie University study that found that approximately 2.8% of all students – teenagers in high school – had  gaming disorder, and so if you apply that to the whole nation, you’re looking at about 100,000 Aussie teenagers who have this problem. So, that’s like filling up the MCG on grand final day.

Tracey Challenor

Wow, that, that’s a lot, isn’t it?

Dr Kim Le

It’s a massive amount and it’s growing because you know my Ted talk in 2015, I used national data that was available to me back then and it was 75,000 people, so that’s, you know, an Adelaide Oval stadium on a good day, but now it’s 100,000. In terms of girls, there was an interesting study from a psychologist named Jean Twenge. She looked at a cohort of UK children who’ve been followed up since birth and she gave them a number of tests and surveys when they turned 15 and she found out of all screens, it’s actually the 15-year-old girl who’s on social media and using social media excessively, who fares the worst low self-esteem – low life satisfaction, more depressed, more anxious, and more likely to deliberately self-harm.

Tracey Challenor

So, what’s happening in homes across Australia? What sort of stories are you hearing from parents about the impact that screen addiction, gaming addiction is having on families?

Dr Kim Le

It’s tearing families apart. I mean, just today I saw a family from Perth. Their young teenage son refuses to see me via the telehealth link that we’ve set up. He’s refused to see his local mental health service face to face. He’s refused to see the gaming disorder clinic face to face. He’s been admitted to hospital before. And the parents have had to call up Telstra a number of times. They’ve had to call in Geeks2U, a service that comes to your house and sorts your IT. And then it’s trying to find a simple solution to manage their son’s internet use, their gaming time and moving the computer out of the bedroom. And with that simple intervention, they’ve finally found a solution where he’s now cut down his gaming time. He’s now brighter. He’s leaving the home. He’s having dinner with the family. He’s interacting well. He’s talking more. He’s less depressed.

And these are just very everyday common scenarios. I mean, another mother told me that her son, who’s 12 years old, who’s on the autism spectrum. She was able to manage his screen use for 12 years of his life until he got into year seven and was given a school laptop.

Tracey Challenor

Right

Dr Kim Le

And she did the courteous thing to ask the school permission to install some basic software to block him from accessing games rather than sort of distracting himself in the classroom. And the IT department said I’m sorry, it’s the too-hard basket.

And so, he’s developed this addiction. He’s seeing me. He’s seeing two psychiatrists. My colleague referred him to me, and I just sent an email to the school principal. I said, ‘Hey, why don’t you allow the mother to install the software and they said Alright, we’ll sort it out and now his behaviour’s improved with a simple intervention like that, so parents are just fighting an uphill battle. They’re losing this war against the games in their own homes. They often get told it’s your responsibility, you’re to blame for your child not going to school your child staying up late, falling asleep at the desk in the classroom, the list goes on.

I could talk to you for all day.

Tracey Challenor

Yeah, it’s a very tough one to tackle by the sounds of it.

And recent research is pointing to seriously reduced cognition in kids with severe screen addiction, we’re talking about. What do we know already about the longer-term consequences for brain health and mental health?

Dr Kim Le

Great question. This was some data that was released by Macquarie University.

And they looked at a number of studies and they essentially found that there’s a snowball effect and it doesn’t matter whether it’s just straight internet you-tubing, you know, social media versus video games. If your child has problematic gaming and you don’t intervene, then their ability to critically think, use their higher powers, their frontal lobes, their judgement, their impulsivity, their emotional regulation. It just gets worse and worse and worse.

And so, every now and then I will see an adult who’s in their 40s, who’s been gaming their whole lives. And you know, I’m 40 this year and I’ve seen the evolution of video games. So, these men have seen all the different types of games that have come out over the decades and are now playing these new games that young kids are playing now and they’re getting hooked to those games? One gentleman, he was playing 150 hours a week.

That’s only a couple of hours sleep per night.

Tracey Challenor

Oh gosh.

Dr Kim Le                                                                                                                                                                   It was what the equivalent of almost three full time jobs. Is that right? Four full time jobs are, I don’t know. My math today is not very good, but when I published some data from a clinic that I worked in in Singapore, this was back in 2015.

Over 2 years, kids presenting to the gaming disorder clinic in Singapore. On average, those kids were playing 45 hours per week.

That’s more than a full-time job, and so when you’re looking at how severe is your child’s gaming habits. Just do the calculations. How much on a weekday school night? How much on a weekend? Calculate it all up. If it’s more than a full-time job, you potentially could have a problem on your hands.

Tracey Challenor

Yeah. Well, and you know firsthand Kim, how addictive these games can be because you’ve talked publicly about your own journey with technology addiction. They can really have a hold, can’t they? What was your experience?

Dr Kim Le

Yeah. Look, I’ve spoken about it in my documentary. I play the game Pokémon Go. I realised I was addicted to this game. I mean, I played Pokémon when I was a teenager, so I had a very nostalgic connection to this game. But when the Pokémon Go came out in 2016, you know, everyone went gangbusters over. Everyone was just downloading and playing it.

And it was the first really sort of augmented reality game where you could play it wherever. And the problem with that kind of game is that the cues, the triggers for your habit; they’re everywhere.

So, you’re reminded by, like a stop here, or a place where you caught a Pokémon there and it’s very hard to resist and even though someone as smart as me, someone who treats this every day, you can still get caught playing this game to point where it’s going. You gotta question yourself, OK? Is this eating up into my daily life, and when I decided to quit playing for the first time after a year and never in my life before had I played the same game for over a year, I said to myself, look, I gotta take some of my own medicine. Let’s just see if I can take a break for 90 days. And a 90-day detox is a very typical type of intervention that people do on game quitters. So, game quitters is an online self-help group. Everyone is there talking about and journaling their journey 90 days free without playing their game. I failed within the first week.

Tracey Challenor

Oh wow.

Dr Kim Le

The game offered me a reward that I’d been waiting for that I could not refuse, and I had just had to log in.

One of my friends that I played the game with messaged me and said: ‘Kim, they’re releasing this, you know, hop back on’ and I couldn’t resist, and the habit had well and truly been formed so it can happen to anyone. And yeah, it’s one of those ironic situations.

Tracey Challenor

Hmm. Well, it gives you an understanding when you’re working with your patients, doesn’t it? And as you’ve mentioned in the past, video game designers are genius at building these addictive gambling aspects into the games. What is the psychology behind it?

Dr Kim Le

The video game designers, you can look this up, a YouTube clip, 20-minute video. It’s called Let’s go whaling. I tell parents and families to watch it together all the time because it gives you a very quick summary, 20-minute-long video of all the tricks they use to hook players in. One of those theories is called the three Hs. – hook, habit, hobby. Hook them rewards, make it a habit of playing every day and then once you get to the point where it becomes a hobby, then it’s part of your life and then people start spending lots of money in those games to maintain that lifestyle. What I see in my clinic is the five hs.

It’s the hook, habit, hobby, then hazard and then harm. So, people playing to the point where it’s hazardous to their health, they might be, you know, losing some sleep here and there. They might be handing in assignments late or missing dinner or, you know, not hanging out with their friends. And then to the Fiona Stanley Hospital, where I consult. So, we set up essentially the first ever gaming disorder clinic and we’re seeing all different types of complications due to excessive gaming: people on the brain injury rehab unit, people presenting to the emergency department. Had a case presented to me the other day, someone developed pressure sores to the point where their bones were rotting.

Tracey Challenor

Oh, my goodness.

Dr Kim Le

This is the most rare severe cases that I’ve never heard of before, I thought I’d –

Tracey Challenor

Seen everything, yeah.

Dr Kim Le

Seen it all but, but when you work in a hospital system you tend to see all different types of patients. And so, I’m getting people who are collapsing. Yeah, it’s not going to happen to everyone. I must stress that you know, a lot of people do enjoy games, but to that sort of, you know, 1 to 3% of people who experience this problem, parents should be aware of, grandparents should be aware of. Teachers should be aware of is that for some people, they get stuck, and their life can be quite miserable. Yeah.

Tracey Challenor

And we’re not trying to alarm parents, so let’s take a step back from gaming addiction. If a child wants to start gaming or is gaming, what steps do I put in place as a parent to create a safe gaming environment?

Dr Kim Le

Yeah, it’s a very hard question to answer because the games are just evolving so quickly. It’s very hard for me to stay on top, but you should be buyer aware. So, look up on websites like Common Sense Media, look at the age classification guidelines. You know there’s a legal system where all games must have this classification, and so some of the rules are going to get changed to sort of look at whether we should be warning parents about loot boxes. That’s all being sort of in discussion in Parliament at the moment. If there’s a guideline, use it.

The problem is, is that children now download games without their parents’ permission. So, in the past people, kids used to ask their parents, ‘Can you buy this for me’ in the shop physically, now it’s just downloaded in front of their parents’ eyes under their noses without them knowing.

And they could be doing a number of things. Uh, it changes from different ages, but look, you want to have some kind of balanced lifestyle. Your child should be having breaks. Your child shouldn’t be playing for hours on end. Have a conversation with them. Make sure that they’re getting the important things done first: chores, homework, eating, all those types of things in all their regular sensible interventions, timings and calendars and schedules. But what I’m finding now is that parents are now having to use technology to help them be the gaming police.

Tracey Challenor

Yes, to police the technology.

Dr Kim Le

But no one wants to supervise all the time, right?

Tracey Challenor

No, not practical

Dr Kim Le

There are softwares out there, there are different devices out there. And my colleague Brad Marshall, the unplugged psychologist, he swears by a particular modem. He doesn’t get any shares in this, but he’s looked at all the different devices. He’s consulted various experts and the TP link Deco M5. It’s a Wi-Fi extender. What you’re meant to do is change the password to your modem, funnel all the data through this extender and then the extender has inbuilt software that you can control via your smartphone and look at each single device that gets the internet and turn it on and off and schedule it.

So, you know a no brainer would be to shut down everything after a certain time, and then if someone needs it for work or for homework, then you have the power to give them a little bit of time. The other day, a mother and a daughter were discussing with me how the mother uses the inbuilt Apple software – parenting software.

And what happens is, it shuts off, but then the child on their device gets the option to request an extra 15 minutes and so the child’s just spamming, just clicking frantically to the point where somehow it glitches and then gives them a whole, you know, hour or so, but there’s no system that’s foolproof.

You just have to be aware that there’s stuff out there. Yeah, very challenging to stay.

Tracey Challenor

Yeah, very challenging to stay a step ahead. What are the signs of gaming addiction to look out for? And how can parents approach that conversation to help children understand that, look it’s becoming a bit of a problem.

Dr Kim Le

Yes, so changes in behaviour. Children behaving out of character, getting more irritable when they’re coming off their games, not going to school, missing out on school, you know, complaining of some kind of physical illness and staying at home where it’s comfortable.

There’s a very good study from University of Adelaide and Flinders Uni where they found volunteers who gave up their passwords to their favourite game over a period of 84 hours over a long weekend – so Friday midday to Monday midday – and they gave them a whole bunch of again surveys and screening tools and they realised that a break as simple as that can reduce some of these, what we call negative cognitions or negative thoughts.

Belief systems that we develop when we play games daily. So, thoughts like I need to play to feel good about myself, my teammates need me. You know, if I don’t log on, something bad’s going to happen. Some of these really ingrained belief systems loosen up, and then reduce overtime with a simple intervention as giving your brain a rest.

Tracey Challenor

About finding those circuit breakers, isn’t it?

Dr Kim Le

Exactly. That’s a good term I should start using that term – circuit breaker, yes, exactly circuit breaker.

Tracey Challenor

It’s interesting that gamification is being used in a positive way in education settings now to engage with kids and we hear that gaming can promote spatial reasoning, problem solving, improve visual perception, those sorts of things. Are there some video games that you would give the tick of approval, particularly for primary school age?

Dr Kim Le

Oh look, no! Look, I have used Roblox before to engage young people with autism, so you know I often get paediatricians refer to me, young people on the spectrum and they refuse to see them, and they refuse to see me. And then as soon as I tell their mum? Oh, you know, I’ve downloaded Roblox. I’ve got an account. How about I chat to your child on there and then you know their ears prick up and they’re like, yeah, yeah, like I want to chat to you, and they engage with me like that. So, in that kind of sense, it’s a therapeutic sort of intervention. Right?

Tracey Challenor

Mm-hmm. OK.

Dr Kim Le

You know, the other day my brother goes to me. Oh, my son. Who? My nephew who’s eight. My brother goes, ‘Oh, do you mind checking out this mathematics game that he’s playing?’ It’s this game that’s been sort of rolled out in primary schools, right? And I’m looking over his shoulder. And it’s a role-playing game. And you got these math puzzles, but he’s not learning any maths. He’s just clicking whatever buttons through the multiple choice and then trying to get to the next point as quickly as possible and not really actually doing the mathematical part of the game. And then I ask him. You know what? What is it about this game? What are some of the bad things about it? And then he’s telling me that him and his friends are sick of all the ads that the game gives you. Cause it’s a free game, but they sell you these upgrades.

And it’s a very aggressive tactic and kids feel pressured to test their parents to spend money to get the premium version of the game. So, you need to look at websites like Commonsense Media, look at the reviews, look at what other parents are saying, what other children are saying about these games and being an active player in the decision making within your own home.

Tracey Challenor

Yeah, Common Sense Media – it’s a great website, isn’t it? And it rates all sorts of things like games and TV shows, so parents know what their kids are watching.

Kim has all heard about the top earning gamers who are raking in millions. How do parents counter that argument that gaming can be lucrative because clearly not everyone is going to become a gamer millionaire, but a young person might clock up thousands of gaming hours trying to become one. What do you say to that argument?

Dr Kim Le

There is none. They’re like, you know, it’s everyone’s dream, right?

But I’ve treated a few esports professionals, and you know, they’re teenagers. They might be earning tens of thousands of dollars, but when you break down how much time they’re investing in these games, it works out to be about 30 bucks an hour, and look for any teenager 30 bucks an hour playing video games…Who wouldn’t want to do that? But the problem is, is that those careers are very short lived.

They are retiring in the early 20s. They can’t keep up; their skills deteriorate, and they burn out.

And so, the reason why I’ve been asked to see these people is because they collapse from not having a break. They’re just playing, training, uploading videos, interacting with their audience. Most of the time, they’re not actually making most of the money from their winnings. They’re actually making money from streaming. They’re getting advertising dollars and eyeballs looking at them because they are charismatic. They are fun to watch, they engage their audience. It’s very, very, very controversial. But you know it it’s every child’s dream and that there really isn’t any argument about it other than you do need a Plan B for when you retire.

And it’s, you know, even more competitive than any sort of tennis circuit out there. You know, you’ve got so many potential players from around the world. It’s really only the top handful of players who get any kind of money. And so, you know, I have burst young people’s bubbles before I have told them look.

You know when I’ve seen young people in the clinic at the women’s and kids’ hospital, I’ve got access to their whole medical file. And I’ll look back to when they were four years old, five years old, or I’ll see the occupational therapy report. And I’ll read it out loud to them.

I said, ‘were you aware that you got screened at this age and the OT said handwriting’s okay, but their hand stamina wears off?’ and they’re like ‘No, I didn’t realise that, but that’s true, my hands do get tired when I play over a certain number of hours’ and then I break the news to them.

I say, ‘Look, you’re never going to be a pro gamer. You need the stamina; you need to have ultra stamina to play these games.’

Tracey Challenor

So, Kim, what would you like to see happen? Is there anything that you’d like to see happen at a government level to combat the gaming addiction problem? It sounds like people like yourself are working very hard to work with children and young people once they have addiction, but is there anything that could be done to prevent it becoming such a problem in the first place?

Dr Kim Le

Yes, look we created an organisation, the Australian Gaming and Screens Alliance. I’m the chair of that organisation. We’re here to prevent this problem from growing any further. We don’t want to have a conversation in five years’ time and hear that 200,000 teenagers Australia-wide have this problem. We really want people to wake up, be aware of it. It’s about education. It’s about getting more funding for research to really understand.

The problem here in Australia.

We need to fund treatments. You know, we can’t just rely on people in sort of private practice dealing with this. There’s only one public clinic in Perth. We need this, you know, around Australia. We need better policies around games and how kids can engage with games in a more healthier way and restricting and regulating some of the predatory practices that they use. You know, in certain countries it’s mandatory to show the odds of you winning certain rewards and games.

There are laws to ban the gambling aspects on video games, but the problem is is it’s always about enforcement and who is actually going to police this, you know, is it going to be the e-Safety Commission? Is it going to be the communications minister? There was recently … the Australian Communications and Media Authority, they actually banned a website, a third-party website where people were gambling on video game items because it was essentially illegal gambling and so we need more interventions like that to regulate this industry and to protect kids and adults with disorder.

Tracey Challenor

And in the meantime, parents have to do their best to try and tackle the problem at home before it gets out of hand.

Dr Kim Le

Yes. Unfortunately, in our society we place a responsibility on the parents and it’s really quite unfair. Parents never signed up for this. Parents are not equipped, and they’re having to fight an uphill battle. And so, with podcasts like this, we’re really just scratching the surface and really just waking people up that this is a potential problem. This is what you can do in these situations and that there is help available. You just gotta go and ask.

Tracey Challenor

Well, Kim on that note, I want to thank you so much for sharing your expertise on gaming addiction, its impacts, and also for your great advice for parents on how to handle it. Thanks so much.

Dr Kim Le

Thanks Tracey.

Tracey Challenor

My guest was Doctor Kim Le, child and adolescent psychiatrist and gaming addiction specialist. And if you’d like more information on Kim’s work, head to our website. For listeners in Queensland, go to lifeeducationqld.org dot AU and for listeners in other states head to life ed dot org dot AU. You’ll find parent tip sheet and other resources. I’m Tracey Challenor. Until next time, thanks for joining us for The Life podcast.