Expert appraisal of criteria for assessing gaming disorder: an international Delphi study.

BACKGROUND AND AIMS: Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD. METHODS: A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved. RESULTS: For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. CONCLUSIONS: This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective.

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

Evaluation of "Colorful Life": A Multi-Addiction Expressive Arts Intervention Program for Adolescents of Addicted Parents and Parents with Addiction.

This study evaluated an expressive arts intervention program ("Colorful Life") for adolescents with addicted parents and parents with addiction in Hong Kong. Different evaluation strategies were employed. Objective outcome evaluation adopting a one group pretest-posttest design showed positive changes in adolescents' (N = 43) beliefs about addiction. Both adolescents' and parents' (N = 21) psychosocial competencies were enhanced post-intervention. Subjective outcome evaluation from both adolescent (N = 47) and parent (N = 22) groups showed positive perceptions of the program content, implementers, and achievement of program objectives. Findings provided preliminary evidence to support and yielded practical implications for the adoption of the multi-addiction syndrome model, positive youth development, and expressive arts approaches in the development of interventions for high-risk adolescents and addictive parents.

Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention.

Online gaming has greatly increased in popularity in recent years, and with this has come a multiplicity of problems due to excessive involvement in gaming. Gaming disorder, both online and offline, has been defined for the first time in the draft of 11th revision of the International Classification of Diseases (ICD-11). National surveys have shown prevalence rates of gaming disorder/addiction of 10%-15% among young people in several Asian countries and of 1%-10% in their counterparts in some Western countries. Several diseases related to excessive gaming are now recognized, and clinics are being established to respond to individual, family, and community concerns, but many cases remain hidden. Gaming disorder shares many features with addictions due to psychoactive substances and with gambling disorder, and functional neuroimaging shows that similar areas of the brain are activated. Governments and health agencies worldwide are seeking for the effects of online gaming to be addressed, and for preventive approaches to be developed. Central to this effort is a need to delineate the nature of the problem, which is the purpose of the definitions in the draft of ICD-11.

Gambling related family coping and the impact of problem gambling on families in Hong Kong.

Despite substantial evidence that problem gambling is associated with a wide range of family difficulties, limited effort has been devoted to studying the negative impacts on family members as a result of problem gambling and how they cope and function under the impacts of problem gambling in Chinese communities. Among the very few Chinese-specific gambling-related family impact studies, none have examined how gambling-related family coping responses are related to gambling-related family impacts. Based on a sample of treatment-seeking Chinese family members of problem gamblers, this study aimed to explore: (1) the demographic characteristics and health and psychological well-being of the family members; (2) the gambling-related family member impacts (active disturbance, worrying behavior); (3) the family coping strategies (engaged, tolerant-inactive and withdrawal coping); (4) the relationship between gambling-related family member impacts, psychological distress and family coping strategies. It was hypothesized that positive significant relationships would be found between family member impacts, psychological distress and family coping strategies. From March 2011 to February 2012, a total of 103 family members of problem gamblers who sought help from Tung Wah Group of Hospitals Even Centre in Hong Kong were interviewed. Results showed that a majority of family members were partners or ex-partners of the gambler with low or no income. A large proportion of participants reported moderate to high psychological distress (72.6 %), poor to fair general health (60.2 %), and poor to neither good nor bad quality of life (61.1 %). Family member impacts were positively significantly correlated to all family coping strategies and psychological distress. Tolerant-inactive coping had the strongest relationships with family member impacts and psychological distress. Strong relationships between family member impacts and psychological distress were also found. The results provide preliminary support for aspects of the stress-strain-coping-support model in the Chinese culture. It is suggested that family member-specific treatment groups targeting family coping are required to alleviate the level of negative impacts of gambling disorder on family members.

Associations between pathological gambling and psychiatric comorbidity among help-seeking populations in Hong Kong.

Problem gambling is complex and often comorbid with other mental health problems. Unfortunately, gambling studies on comorbid psychiatric disorders among Chinese communities are extremely limited. The objectives of this study were to (a) determine the prevalence of comorbid psychiatric disorders among treatment-seeking pathological gamblers; (b) compare the demographic profiles and clinical features of pathological gamblers with and without comorbid psychiatric disorders; (c) explore the associations between pathological gambling and psychiatric disorders and their temporal relationship. Participants (N = 201) who sought gambling counseling were examined by making Axis-I diagnoses including mood disorders, schizophrenia spectrum disorders, substance use disorders, anxiety disorders, and adjustment disorder. Results showed that 63.7% of participants had lifetime comorbid psychiatric disorder. The most common comorbid psychiatric mental disorders were mood disorders, adjustment disorder, and substance use disorders. Pathological gamblers with psychiatric comorbidities were significantly more severe in psychopathology, psychosocial functioning impairment, and gambling problems than those without the disorders.

Assessment of problem gambling in a Chinese context: the Chinese G-MAP.

There is a severe lack of instruments to assess problem gambling in Chinese people. This study examined the psychometric properties of the Chinese version of the Maroondah Assessment Profile for Problem Gambling (Chinese G-MAP), based on the responses of eight problem gamblers and 125 pathological gamblers seeking help from a problem gambling treatment center. Reliability analyses showed that the G-MAP and its related domains and scales were generally internally consistent. There are also several lines of evidence suggesting that the Chinese G-MAP and the various domains are valid: (a) the various G-MAP domain and scale measures were significantly correlated among themselves, (b) the G-MAP measures were significantly correlated with pathological gambling behavior assessed by the 4th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and (c) the G-MAP total scale and domain measures were able to discriminate problem gamblers and pathological gamblers. The present study suggests that the Chinese G-MAP possesses acceptable psychometric properties that can be used in research and practice settings.