Playing video games is a hugely popular pastime, and not just with teenagers. The average age of the 225 million–plus people in the United States who play them is 31, according to the Entertainment Software Association.
Games can provide a much needed outlet for stress and a chance to connect with others when playing online. But they also can be addictive and cause eyestrain and overuse injuries in the hands and arms. And they encourage sedentary behavior, which may contribute to the risk of heart attack and stroke.
Boys with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) are especially vulnerable to the addictive qualities of gaming. According to data published in Pediatrics, the average daily playing time is 2.1 hours for boys with ASD and 1.7 hours for boys with ADHD, versus 1.2 hours for typically developing boys.
People with neurologic disorders who play games obsessively may skip physical therapy sessions or forget to take their medication, and playing could worsen their fatigue, says Pearce Korb, MD, FAAN, associate professor of neurology at Virginia Commonwealth University in Richmond.
To help gamers avoid these pitfalls and reap some benefits, Dr. Korb and other physicians make these recommendations.
Set limits. Restrict playing to a specific amount of time, says Jose Posas, MD, FAAN, a sports neurologist at Ochsner Health in New Orleans. The American Academy of Pediatrics recommends a daily limit of 30 to 60 minutes during the week and two hours on the weekend. Dr. Posas encourages players to stop before they advance to a new level in the game and save that for the next time allotment.
Play as a reward. Video games can be powerful tools for children with ADHD because they focus their attention, says Wendy Ross, MD, a developmental pediatrician and director of the Center for Autism and Neurodiversity at Jefferson Health in Philadelphia. But it's easy for them to get hooked. To avoid that, she encourages parents to offer games as a reward for doing homework or chores.
Choose games wisely. “Certain immersive video games [such as the “Mount & Blade” series] can be cognitively engaging,” says Craig Stark, PhD, professor of neurobiology and behavior at the University of California Irvine, who published a study about the effects of gaming on memory in the Journal of Neuroscience. “Even modest amounts of play—30 minutes a day—have been shown to improve memory ability in adults of all ages,” he says. Games also can build socialization skills for people with autism, says Dr. Ross. “Parents can use that to encourage face-to-face interaction.” Games that ask players to draw faces—such as “Pixicade”—can help them recognize social cues such as sadness or happiness, and games that require players to tend to farm animals, like “Harvest Moon,” build empathy, says Dr. Posas.
Keep play safe. Harsh or flashing lights might trigger a migraine or a seizure. Patients with migraine should use lower light settings, and those with epilepsy should be sure the video doesn't have flashing lights, says Dr. Posas. People who have sustained a concussion should refrain from video games for the first 24 to 48 hours following their injury, he adds. After that time, if they can focus on a video game, it may be a sign of progress. “When a parent tells me her concussed child can spend hours concentrating on a video game but gives up on schoolwork after a half hour, I know the child is getting better,” says Dr. Posas. “That's when I tell the child to start cracking the books.”
Don't lose sleep. “Sleep deprivation isn't good for anyone,” says Dr. Korb, a casual gamer himself. “I'm not saying don't play. I'm saying don't play till 2 a.m.” For people with epilepsy, sleep deprivation can increase the risk of a seizure, he says.
Mix in something active. Take breaks from gaming for physical activity—take a walk, dance to music, stretch—or do it right before or after playing. It will alleviate stiffness, which is important for everyone but especially for people recovering from a stroke or those with Parkinson's disease or multiple sclerosis.
Make play social. Games can be used to alleviate social isolation and depression, especially for older people who live alone, says Dr. Korb. One such patient told Dr. Korb that avidly playing “Call of Duty” with people around the world is good for his mental health. “Engagement is a way to stave off depression, which can negatively affect memory,” says Dr. Korb, who suggests finding a game that can be played side by side with a partner on the same screen or with others over the internet.
Use games for physical therapy. Many of the games that come with the Wii system can be incorporated into therapy for people with Parkinson's disease or those recovering from stroke, says Eric Anderson, MD, PhD, FAAN, a neurologist in Gulfport, FL. A study published in the Journal of Bodywork and Movement Therapies found that Wii-based therapy improved balance in patients with Parkinson's disease. For stroke patients, Wii-based movement therapy for the upper limbs improved functional movement, according to a 2017 study in Disability and Rehabilitation. Dr. Anderson recommends that patients review any games with their care teams before trying them to be sure they are appropriate and can be tailored to their specific needs.
A Prescription for Playing Games
Given the popularity of video games—more than 225 million Americans play them and the average age is 31—it’s not surprising that scientists are exploring their therapeutic value. At least one video game—“Endeavor Rx”—has even been approved by the US Food and Drug Administration for treatment of children ages 8 to 12 with attention deficit hyperactivity disorder (ADHD). In the game, players guide a character along a route filled with visual and auditory distractions, which requires players to focus on several things at once. In two clinical trials, Endeavor Rx improved the attention spans of children with ADHD.
In another clinical trial, funded by the National Institutes of Health, researchers developed and tested a game designed to address poor attention in children and teens with autism spectrum disorder. “We found that the game improved spatial attention and reduced ADHD symptoms, which are common in kids with autism spectrum disorder,” says Jeanne Townsend, PhD, director of the Research on Autism and Development Lab at the University of California San Diego, who conducted the trial with Leanne Chukoskie, PhD, of Northeastern University. Children play the game using an eye tracker, which forces their attention, Dr. Townsend explains. Based on that trial, she and Dr. Chukoskie founded BrainLeap, a company that markets this type of gaze-driven game to schools for use by children with learning disabilities.
This gaze-driven game has been adapted to enhance cognition in older adults. In an early-stage clinical trial, funded by the National Institute on Aging, it improved participants’ attention and information-processing speed and reduced distraction. “The aim of these studies is to test whether improvement in some basic cognitive functions can increase resilience during the onset of Alzheimer’s disease and related dementias,” says Dr. Townsend, who presented her findings at the 2020 annual meetings of the Society for Neuroscience and the Association for Psychological Science.
