ABSTRACT
Internet gaming addiction (IGA) is a growing concern among adolescents, exacerbated by recent COVID-19 restrictions. The World Health Organization has recently included IGA in the 11th International Classification of Diseases. However, the validity and reliability of the proposed criteria are subjected to controversy 1. Despite growing neurobiological evidence in IGA, most systematic reviews have focused on adults or mixed adult/adolescent populations. Therefore, this systematic review explored the neuroimaging literature in adolescents with IGA. Altogether, 2263 primary studies were identified from PubMed, CINAHL Plus, PsycINFO, and Web of Science. After applying inclusion and exclusion criteria (appropriate title, , comparison group used within study, English-language, neuroimaging, and mean age under 18), 25 articles were included in this review. Functional and structural brain alterations in IGA were noted across several imaging modalities, including electroencephalogram (EEG), functional magnetic resonance imaging (fMRI), and structural magnetic resonance imaging (MRI). Compared with healthy controls, adolescents with IGA demonstrated functional impairment in emotional regulation, reward-seeking, inattention and, inhibition control circuits, leading to increased risky decision making. Structural changes in gray and white matter were noted due to repetitive brain stimulation associated with visual, auditory, and spatial working memory. With regards to brain region processing self-concept, adolescents utilize the medial prefrontal region while having game character thoughts, compared to adults who utilize the left angular gyrus 2. In conclusion, adolescents with IGA showed common neurological findings consistent with other behavioral addictions and psychiatric disorders. Future studies are needed for potential neuroimaging markers that apply to diagnosis and informing treatment.