The World Health Organization has classified gaming addiction as an addictive behavior disorder in the 11th Revision of the International Classification of Diseases (ICD), which comes into effect in 2022. This will be the first time a gaming disorder is recognized as a diagnostic classification; member states are urged to come up with prevention and treatment measures. In a relevant development, the American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual (DSM-5) listed internet gaming disorder as a condition for further study. Under DSM-5, internet gaming disorder refers to the persistent and recurrent use of the internet to engage in games leading to clinically significant impairments. After gambling disorders, internet gaming addiction may become the second behavioral addiction to be categorized in the DSM.

We live in a digital age where everyone owns one or even many smartphones. The trend and development of mobile gaming apps is constantly changing with new innovations and designs; its accessibility and convenience are now unparalleled. Internet gaming has also evolved into e-sports, with players representing their countries to compete in world tournaments. E-sports have become a massive and emerging industry which is continuously expanding its scale of operations with huge market potential. Even the SAR government is keen to encourage e-sports activities. Thus, not all gaming behavior is problematic. Internet gaming has a number of health benefits. This includes improving our cognitive skills and coordination as well as helping to relieve stress, regulating emotions, enriching lives and providing a social platform for young people to communicate.

Nevertheless, the WHO is reminding member states to pay attention and to adopt preventative measures to prevent gaming addiction. The problem is not "internet gaming" per se but "addiction" as it is believed that addictive gaming behavior can have harmful consequences. First of all, spending excessive hours playing games can damage our eyesight, affect our sleep quality, as well as our health when we neglect physical exercises. At the same time, an excessive focus on virtual reality can result in emotional fluctuations in behavior, or even affect people's ability to socialize, communicate and function in the real world. Excessive gaming can also have a negative impact on academic performance. Some games require players to buy point cards, which may lead to overspending or debt. There was a report on a youth whose excessive gaming habits triggered a serious mental health condition after spending more than 10 hours continuously playing games. Many YouTubers or key opinion leaders started out by teaching netizens to play games, attracting millions of followers. This shows the extent to which internet gaming and e-sports have invaded the lives of young people. Through these key opinion leaders, our center (Centre for Suicide Research and Prevention at The University of Hong Kong) is able to reach out to a group of hidden young people, some of whom have considerable mental health issues. According to our survey on internet usage and gaming habits of young people in Hong Kong, we found that the more time a person spends on the internet, the poorer that person's mental health status will be. But if internet use is limited to two hours per day, the negative effect is minimal and at the same time, the young people might gain something too.

Parents may feel helpless that their children are addicted to gaming. Other than setting a good role model for their children, they can also initiate different family activities according to their children's age, for example, physical exercise, arts and crafts and visits to museums. The most important message for children is to understand that gaming is not the only interesting activity they can do; there are obviously other choices available to them. Hong Kong lacks recreational space. For our young people, gaming may seem the only option available. To deal with this situation, our community can improve and expand our recreational space to provide them with other choices.

In addition to providing choices, children should also be encouraged to practice self-control strategies. Parents may often let their young children watch videos on their phones in exchange for a moment of peace and stability. While this may help their children practice a foreign language, it may also encourage their dependency on electronic devices. When their needs cannot be satisfied instantly, they will lose self-control and become angry. Gaming thus becomes a conduit for argument between parents and their children. Children who grow up in this environment are likely to think that once they enter adolescence, they can control their own lives, and as gaming consumes their everyday lives, family relationships become more intense with habitual arguments taking place. Why would parents mistakenly believe their children are capable of exercising self-control when they did not have an opportunity to learn this from a young age?

An observational study in New Zealand assessed the self-control of a group of people over a period of 40 years. It found that childhood self-control influences adult outcomes; therefore, children with better self-control skills perform better in various areas of their adult lives compared to those with low self-control skills. This includes health outcomes, substance abuse, criminal conviction history, financial issues and life satisfaction. The importance of self-control skills cannot be underestimated.

Hong Kong's demanding fast-paced lifestyle is not conducive to developing self-control skills and if we do not cultivate these, not only will it give rise to problems like gaming disorder, it will also have repercussions on other aspects of our lives.

The author is director of the Centre for Suicide Research and Prevention at the University of Hong Kong.

(HK Edition 05/31/2019 page13)