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Table of Contents

    Topic review

    VGs' impact on Pediatric Age

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    Submitted by: Daniela Smirni

    Definition

    A growing number of children and adolescents play video games (VGs) for long amounts of time. The current outbreak of the Coronavirus pandemic has significantly reduced outdoor activities and direct interpersonal relationships. Therefore, a higher use of VGs can become the response to stress and fear of illness.

    1. Introduction

    The current systematic review focuses on some crucial outstanding issues within the debate on the effects of VGs on cognition and behavior in order to provide suggestions for parents, pediatricians, health providers and educators dealing with pediatric ages, especially in the complex pandemic period. Namely, it analyzes the most debated and educationally relevant problems on the relationship between video games, cognition and behavior: 1. video games’ effects on cognitive function; 2. video games’ effects on attention and addictive behaviors; 3. video games and prosocial or aggressive behavior. Therefore, the current analysis may be accounted as an original contribution to the practical dimension in the educational and rehabilitation field for parents and educators.

    Early common predominant opinions mainly focused on VGs according to dichotomous thinking, as enjoyable entertainment or harmful tools [1]. The recent literature instead provided evidence on the impact of VGs on the brain and its functional modifications while playing [2][3][4][5][6], showing that video games involve different cortical and subcortical structures, with cognitive and emotional competence, such as frontal and prefrontal regions, the posterior and superior parietal lobe, the anterior and posterior cingulate cortices, limbic areas, the amygdala, the entorhinal cortex and basal nuclei [7][8][9][10].

    Similarly, Lee et al. [4], found a thinner cortex and a smaller gray matter volume in critical areas for evaluating reward values, error processing and adjusting behavior, namely, the anterior cingulate cortex, the orbitofrontal cortex and the frontoparietal areas, in young male adults with internet gaming disorders, compared to age-matched healthy male controls. A neuroimaging study examined in individuals affected by gaming disorders the differences during the playing of a violence-related vs. a non-violence-related version of the same VG [5]. While functional connectivity of the reward-related network and the behavioral inhibition system was altered, the orbitofrontal cortex and anterior cingulate cerebral area were overstimulated, similarly to smart drug addiction [4][11].

    Recently, Kwak et al. [6] longitudinally compared 14 adolescents with internet gaming disorder to 12 professional internet gaming students who practiced for about ten hours a day, within a defined support system that included practice, physical exercise, lectures on team strategy, rest and mealtimes. After one year, both groups showed increased brain activity within the attention system of the parietal lobe. However, professional gamers improved problematic behaviors, impulsivity, aggression, depression and anxiety, while adolescents with internet gaming disorder showed no behavioral improvement and a dysfunctional brain activity within the impulse control network in the left orbitofrontal cortex.

    2. Effect of Video Games on Cognitive Functions

    Any modern VG requires an extensive repertoire of attentional, perceptual and executive abilities, such as a deep perceptual analysis of complex unfamiliar environments, detecting relevant or irrelevant stimuli, interference control, speed of information processing, planning and decision making, cognitive flexibility and working memory.
    Literature data in the last years have proven that VGs may improve a variety of cognitive domains [7][12] as, for example, even just 10 hours of VG could improve spatial attention and mental rotation [13][14]. A large variety of design studies reported in habitual players better performance in multiple cognitive domains, including selective attention [15][9][13][16], speed of processing [9][16], executive functions [17][18] and working memory [19]. Similarly, a large body of intervention studies have shown improvements in the same cognitive domains in non-players following training in action VGs [14][20][21][22][23][24][25]. Recently, Benoit et al. [26] examined in 14 professional VG players and 16 casual VG players various cognitive abilities, such as processing speed, attention, memory, executive functions, manual dexterity and tracking multiple objects in three dimensions [27]. Professional players showed a very large advantage in visual–spatial short-term memory and visual attention, and less in selective and sustained attention and auditory working memory. Moreover, they showed better speed thresholds in tracking multiple objects in three dimensions overall, though the rate of improvement did not differ in the two groups. In two previous meta-analyses, Bediou et al. [28] focused on the long-term effects of action VGs on various cognitive domains using both cross-sectional and intervention studies. Overall, the results documented a positive impact of action video gaming on cognition. In cross-sectional studies, a main effect of about half a standard deviation was found. The habitual action game players showed better performance than non-players. Likewise, intervention studies showed about a third of a standard deviation advantage in cognition domains in action VG trainees. Perception, spatial cognition and top-down attention were the three cognitive domains with the most robust impact [28].
    Homer et al. [29] examined the effectiveness of a custom-designed VG (‘alien game’) in a group of 82 healthy adolescents (age range 14–18 years; average = 15.5 years) trained to play for 20 min per week for 6 consecutive weeks. Such a digital game was devised to target, in a fun way, the specific executive ability of shifting, as the ability to shift between tasks or mental sets, hypothesizing that after playing the ‘alien game’ over a period of several weeks, adolescents would show significant improvements in the targeted ability. Pre- and post-test measures of another executive ability, inhibition, as the ability to control a prepotent response, were also recorded in order to examine the extent to which training would transfer from one executive ability to another. Significant advantages both in shifting and in inhibition abilities were found, providing evidence that VGs can be effective tools for training executive abilities [30][31].
    Similarly, Oei and Patterson [32] examined the effect of action and non-action VGs on executive functions. Fifty-two non-VG gamers played one of four different games for 20 h. Pre- and post-training tests of executive function were administered. The group that trained on the physics-based puzzle game, demanding high level planning, problem solving, reframing, strategizing and new strategies from level to level, improved in several aspects of executive function. In a previous study, the same authors [33] instructed 75 non-gamers, (average age 21.07 ± 2.12) to play for 20 h, one hour a day/five days a week over four weeks. They compared effects of action and non-action games to examine whether non-action games also improve cognition. Four tests pre- and post-training were administered. The results showed that cognitive improvements were not limited to training with action games and that different games improved different aspects of cognition. Action VGs have even been used to treat dyslexic children [34][35]. Only 12 h of action VGs, for nine sessions of 80 min per day, significantly improved reading and attentional skills [36].
    Moreover, several meta-analytic studies provide evidence that action VG training may become an efficient way to improve the cognitive performance of healthy adults. Wang et al. [37], in a meta-analysis, found that healthy adults achieve moderate benefits from action VG training in overall cognitive ability and moderate to small benefits in specific cognitive domains. In contrast, young adults gain more benefits than older adults in both overall cognition and specific cognitive domains.
    In summation, the studies on VG effects, by different methodologies, document both in adults and in children significant positive outcomes in different cognitive domains. Such performance improvements may be paralleled by functional brain remodelling [1].

    3. Video Games Effect on Attention and Addictive Behaviors

    Attentional problems are accounted as a crucial area of focus on outcomes of intensive game-play practices in children and adolescents. However, literature on the topic appears inconsistent. While some research has found mixed results [38] or a positive effect [39][40][41], or no relationship between VG practice and attention, other studies have linked VG playing with greater attention problems, such as impulsiveness, self-control, executive functioning, and cognitive control [41][42][43].
    Gentile et al. [44], examining longitudinally, over 3 years, a large sample of child and adolescent VG players aged 8–17 (mean = 11.2 ± 2.1), suggested a bidirectional causality: children who spend more time playing VGs have more attention problems; in turn, subjects who have more attention problems spend more time playing VGs. Therefore, children and adolescents with attention problems are more attracted to VGs (excitement hypothesis), and, in turn, they find it less engaging to focus on activities requiring more control and sustained attention, such as educational activities, homework or household chores (displacement hypothesis). According to such hypotheses, and to the operant conditioning model [45][46], VGs, providing strong motivational cues, become more rewarding for impulsive children and teenagers [39] who, in such contexts, experience a sense of value and feelings of mastery that they do not experience in their daily relationships [47].
    Actually, any modern VG is a highly engaging activity with a variety of attractive cues, such as, for example, violence, rapid movement, fast pacing and flashing lights [48][49]. According to the attractive hypothesis [44], it may provide a strong motivation and support for attention and even become addictive, especially in subjects with problems maintaining attention in usual, monotonous and poorly engaging tasks. Therefore, paradoxically, a greater VG exposure may improve visual attention skills involved in such engaging play [13], but it may impair the ability to selectively focus on a target for lasting time, without external exciting cues.
    Probably, in line with the bidirectional causality framework [44], such rewarding conditions could become the psychological context for the structuring of addictive behaviors, such as a sense of euphoria while playing, feeling depressed away from the game, an uncontrollable and persistent craving to play, neglect of family and friends, problems with school or jobs, alteration of sleeping routines, irregular meals and poor hygiene [1]. The most psychologically fragile subjects may be most attracted to an engaging and rewarding activity, ensuring an effective compensation to their fragility [1]. However, the topic of video game addiction continues to present today many outstanding issues. There is a large consensus that ‘pathological use’ is more debilitating than ‘excessive use’ of VGs alone [50][51][52]. Addictive behavior appears associated with an actual lowering in academic, social, occupational, developmental and behavioral dimensions, while excessive use may simply be an excessive amount of time gaming. According to Griffiths’ suggestions, ‘healthy excessive enthusiasms add to life, whereas addiction takes away from it’ [53]. However, it is sometimes difficult to identify the clear line between unproblematic overuse of gaming and the pathological and compulsive overuse that compromises one’s lifestyle and psychosocial adjustment [54][55][56]. Therefore, there may be a risk of stigmatizing an enjoyable practice, which, for a minority of excessive users, may be associated with addiction-related behaviors [57][58]. Przybylski and colleagues, in four survey studies with large international cohorts (N = 18,932), found that the percentage of the general population who could qualify for internet gaming disorders was extremely small (less than one percent) [59].
    In such a discussion of the pathological nature of VGs, another outstanding question is whether pathological play is a major problem, or if it is the phenomenological manifestation of another pathological condition. Several studies have suggested that video game play can become harmful enough to be categorized as a psychiatric disorder, or it could be a symptom of an underlying psychopathological condition, such as depression or anxiety. Moreover, the functional impairments observed in individuals with game addictions are also thought to be similar to the impairments observed in other addictions. Neuroimaging studies have shown that the brain reward pathways which are activated during video game playing are also activated during cue-induced cravings of drug, alcohol or other type of substances abuse [60][61][62].
    Some longitudinal studies [1][63][64] proved that pathological addictive behaviors, such as depression, are likely to be outcomes of pathological gaming rather than predictors of it [65][66]. Lam and Peng [67], in a prospective study with a randomly generated cohort of 881 healthy adolescents aged between 13 and 16 years, found that the pathological use of the internet results in later depression. Similarly, Liau et al. [68], in a 2-year longitudinal study involving 3034 children and adolescents aged 8 to 14 years, found that pathological video gaming has potentially serious mental health consequences, in particular of depression.
    In summary, attention problems and addictive behaviors in the context of VGs should be addressed in a circular and bidirectional way in which each variable can influence the others.

    4. Video Games Effect and Prosocial and Aggressive Behaviors

    The positive impact of video games also concerns the social and relational dimension, as occurs in the VG training of prosocial or educational skills. Several studies have reported that playing prosocial VGs, even for a short time, increases prosocial cognition [69], positive affect [70] and helping behaviors [71][69][70][72][73][74], whereas it decreases antisocial thoughts and the hostile expectation bias, such as the tendency to perceive any provocative actions of other people as hostile even when they are accidental [71][75]. Such findings have been found in correlational, longitudinal and experimental investigations [70][74][76].
    In four different experiments [71], playing VGs with prosocial content was positively related to increased prosocial behavior, even though participants played the VGs for a relatively short time, suggesting that VGs with prosocial content could be used to improve social interactions, increase prosocial behavior, reduce aggression and encourage tolerance.
    Following experimental, correlational, longitudinal and meta-analytic studies provided further evidence that playing a prosocial VG results in greater interpersonal empathy, cooperation and sharing and subsequently in prosocial behavior [76][77][78][79].
    Such literature’s data are consistent with the General Learning Model [80][81], according to which the positive or negative content of the game impacts on the player’s cognition, emotions and physiological arousal, which, in turn, leads to positive or negative learning and behavioral responses [82][83][84][85]. Therefore, repeated prosocial behavioral scripts can be translated into long-term effects in cognitive, emotional and affective constructs related to prosocial actions, cognition, feelings, and physiological arousal, such as perceptual and expectation schemata, beliefs, scripts, attitudes and stereotypes, empathy and personality structure [72][80].
    In the same conceptual framework, educational video games have been found to positively affect behaviors in a wide range of domains [82], school subjects [86] and health conditions [87][88]. In randomized clinical trials, for example, diabetic or asthmatic children and adolescents improved their self-care and reduced their emergency clinical utilization after playing health education and disease management VGs. After six months of playing, diabetic patients decreased their emergency visits by 77 percent [89]. Therefore, well-designed games can provide powerful interactive experiences that can foster young children’s learning, skill building, self-care and healthy development [90].
    Violence in VGs is a matter of intense debate, both in public opinion and in the scientific context [91][92]. A vast majority of common opinions, parents and educators consider the violence of VGs as the most negatively impacting feature to emotional and relational development of youth and children. Actually, studies agree on the negative impact of violent video games on aggressive behavior. Several meta-analyses have examined violent VGs [93][94][95][96] and, although they vary greatly in terms of how many studies they include, they seem to agree with each other. The most comprehensive [95] showed that violent VGs, gradually and unconsciously, as a result of repeated exposure to justified and fun violence, would increase aggressive thoughts, affect and behavior, physiological persistent alertnes, and would desensitize players to violence and to the pain and suffering of others, supporting a perceptual and cognitive bias to attribute hostile intentions to others.
    Similarly, experimental, correlational and longitudinal studies supported the causal relationship between violent VGs and aggression, in the short- and long-term, both in a laboratory and in a real-life context. A greater amount of violent VGs, or even a brief exposure, were significantly associated with more positive attitudes toward violence [97], higher trait hostility [98] and with increased aggressive behaviors [99], physical fights [100] and aggressive thoughts [101] and affect [102]. In a two-year longitudinal study, children and adolescents who played a lot of violent VGs showed over time more aggressive behaviors, including fights and delinquency [103]. Saleem, Anderson and Gentile [70] examined the effects of short-term exposure to prosocial, neutral and violent VGs in a sample of 191 children of 9–14 years old. Results indicated that while playing prosocial games increased helpful and decreased hurtful behaviour, the violent games had the opposite effect.
    In summation, the overall literature data support the opinion that violent video games, over time, affect the brain and activate a greater availability to aggressive behavior patterns, although some researchers have pointed out that the negative effects of violent VGs are small and may be a publication bias [1][104].

    The entry is from 10.3390/pediatric13030047

    References

    1. Bavelier, D.; Green, C.S.; Han, D.H.; Renshaw, P.F.; Merzenich, M.M.; Gentile, D.A. Brains on video games. Nat. Rev. Neurosci. 2011, 12, 763–768.
    2. Mondéjar, T.; Hervas, R.; Johnson, E.; Gutierrez, C.; Latorre, J.M. Correlation between videogame mechanics and executive functions through EEG analysis. J. Biomed. Inform. 2016, 63, 131–140.
    3. Mondéjar, T.; Hervás, R.; Johnson, E.; Gutiérrez-López-Franca, C.; Latorre, J.M. Analyzing EEG waves to support the design of serious games for cognitive training. J. Ambient Intell. Humaniz. Comput. 2019, 10, 2161–2174.
    4. Lee, D.; Park, J.; Namkoong, K.; Kim, I.Y.; Jung, Y.-C. Gray matter differences in the anterior cingulate and orbitofrontal cortex of young adults with Internet gaming disorder: Surface-based morphometry. J. Behav. Addict. 2018.
    5. Zvyagintsev, M.; Klasen, M.; Weber, R.; Sarkheil, P.; Esposito, F.; Mathiak, K.A.; Schwenzer, M.; Mathiak, K. Violence-related content in video game may lead to functional connectivity changes in brain networks as revealed by fMRI-ICA in young men. Neuroscience 2016.
    6. Kwak, K.H.; Hwang, H.C.; Kim, S.M.; Han, D.H. Comparison of Behavioral Changes and Brain Activity between Adolescents with Internet Gaming Disorder and Student Pro-Gamers. Int. J. Environ. Res. Public Health 2020, 17, 441.
    7. Palaus, M.; Marron, E.M.; Viejo-Sobera, R.; Redolar-Ripoll, D. Neural basis of video gaming: A systematic review. Front. Hum. Neurosci. 2017, 11, 248.
    8. Dye, M.W.G.; Bavelier, D. Differential development of visual attention skills in school-age children. Vision Res. 2010, 50, 452–459.
    9. Dye, M.W.G.; Green, C.S.; Bavelier, D. The development of attention skills in action video game players. Neuropsychologia 2009, 47, 1780–1789.
    10. Trick, L.M.; Jaspers-Fayer, F.; Sethi, N. Multiple-object tracking in children: The “Catch the Spies” task. Cogn. Dev. 2005, 20, 373–387.
    11. Sessa, M.; Di Mauro, G.; Mascolo, A.; Rafaniello, C.; Sportiello, L.; Scavone, C.; Capuano, A. Pillars and pitfalls of the new pharmacovigilance legislation: Consequences for the identification of adverse drug reactions deriving from abuse, misuse, overdose, occupational exposure, and medication errors. Front. Pharmacol. 2018, 9, 611.
    12. Operto, F.F.; Pastorino, G.M.G.; Marciano, J.; de Simone, V.; Volini, A.P.; Olivieri, M.; Buonaiuto, R.; Vetri, L.; Viggiano, A.; Coppola, G. Digital Devices Use and Language Skills in Children between 8 and 36 Month. Brain Sci. 2020, 10, 656.
    13. Green, C.S.; Bavelier, D. Action video game modifies visual selective attention. Nature 2003, 423, 534.
    14. Feng, J.; Spence, I.; Pratt, J. Playing an action video game reduces gender differences in spatial cognition. Psychol. Sci. 2007.
    15. Green, C.S.; Bavelier, D. Learning, attentional control, and action video games. Curr. Biol. 2012, 22, 197–206.
    16. Castel, A.D.; Pratt, J.; Drummond, E. The effects of action video game experience on the time course of inhibition of return and the efficiency of visual search. Acta Psychol. 2005, 119, 217–230.
    17. Andrews, G.; Murphy, K. Does Video Game Playing Improve Executive Functioning? In Frontiers in: Cognitive Psychology; Vanchevsky, M.A., Ed.; Nova Science Publishers: Hauppauge, NY, USA, 2006; pp. 145–161.
    18. Colzato, L.S.; Van Leeuwen, P.J.A.; Van Den Wildenberg, W.; Hommel, B. DOOM’d to switch: Superior cognitive flexibility in players of first person shooter games. Front. Psychol. 2010, 1, 8.
    19. Colzato, L.S.; van den Wildenberg, W.P.M.; Zmigrod, S.; Hommel, B. Action video gaming and cognitive control: Playing first person shooter games is associated with improvement in working memory but not action inhibition. Psychol. Res. 2013, 77, 234–239.
    20. Powers, K.L.; Brooks, P.J. Evaluating the Specificity of Effects of Video Game Training. In Learning by Playing: Video Gaming in Education; Blumberg, F.C., Ed.; Oxford University Press: New York, NY, USA, 2014; pp. 302–345.
    21. Spence, I.; Feng, J. Video games and spatial cognition. Rev. Gen. Psychol. 2010, 14, 92–104.
    22. Stern, Y.; Blumen, H.M.; Rich, L.W.; Richards, A.; Herzberg, G.; Gopher, D. Space Fortress game training and executive control in older adults: A pilot intervention. Aging Neuropsychol. Cogn. 2011, 18, 653–677.
    23. Maillot, P.; Perrot, A.; Hartley, A. Effects of interactive physical-activity video-game training on physical and cognitive function in older adults. Psychol. Aging 2012, 27, 589.
    24. McDermott, A.F.; Bavelier, D.; Green, C.S. Memory abilities in action video game players. Comput. Hum. Behav. 2014.
    25. Basak, C.; Boot, W.R.; Voss, M.W.; Kramer, A.F. Can training in a real-time strategy video game attenuate cognitive decline in older adults? Psychol. Aging 2008, 23, 765.
    26. Benoit, J.J.; Roudaia, E.; Johnson, T.; Love, T.; Faubert, J. The neuropsychological profile of professional action video game players. PeerJ 2020, 8, e10211.
    27. Smirni, D. The Raven’s Coloured Progressive Matrices in Healthy Children: A Qualitative Approach. Brain Sci. 2020, 10, 877.
    28. Bediou, B.; Adams, D.M.; Mayer, R.E.; Tipton, E.; Green, C.S.; Bavelier, D. Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills. Psychol. Bull. 2018, 144, 77–110.
    29. Homer, B.D.; Plass, J.L.; Raffaele, C.; Ober, T.M.; Ali, A. Improving high school students’ executive functions through digital game play. Comput. Educ. 2018, 117, 50–58.
    30. Smirni, D.; Precenzano, F.; Magliulo, R.M.; Romano, P.; Bonifacio, A.; Gison, G.; Bitetti, I.; Terracciano, M.; Ruberto, M.; Sorrentino, M.; et al. Inhibition, set-shifting and working memory in Global Developmental Delay preschool children. Life Span Disabil. 2018, 21, 191–206.
    31. Carotenuto, M.; Ruberto, M.; Fontana, M.L.; Catania, A.; Misuraca, E.; Precenzano, F.; Lanzara, V.; Messina, G.; Roccella, M.; Smirni, D. Executive functioning in autism spectrum disorders: A case-control study in preschool children. Curr. Pediatr. Res. 2019, 23, 112–116.
    32. Oei, A.C.; Patterson, M.D. Playing a puzzle video game with changing requirements improves executive functions. Comput. Hum. Behav. 2014, 37, 216–228.
    33. Oei, A.C.; Patterson, M.D. Enhancing cognition with video games: A multiple game training study. PLoS ONE 2013, 8, e58546.
    34. Franceschini, S.; Gori, S.; Ruffino, M.; Viola, S.; Molteni, M.; Facoetti, A. Action video games make dyslexic children read better. Curr. Biol. 2013, 23, 462–466.
    35. Franceschini, S.; Tancioni, L.; Lorenzoni, M.; Mattei, F.; Scardi, M. An ecologically constrained procedure for sensitivity analysis of Artificial Neural Networks and other empirical models. PLoS ONE 2019, 14, e0211445.
    36. Smirni, D.; Oliveri, M.; Turriziani, P.; Di Martino, G.; Smirni, P. Benton visual form discrimination test in healthy children: Normative data and qualitative analysis. Neurol. Sci. 2018, 39, 885–892.
    37. Wang, X.; Goh, D.H.-L. Video game acceptance: A meta-analysis of the extended technology acceptance model. Cyberpsychology Behav. Soc. Netw. 2017, 20, 662–671.
    38. Ferguson, C.J. Blazing Angels or Resident Evil? Can Violent Video Games be a Force for Good? Rev. Gen. Psychol. 2010, 14, 68–81.
    39. Bioulac, S.; Arfi, L.; Bouvard, M.P. Attention deficit/hyperactivity disorder and video games: A comparative study of hyperactive and control children. Eur. Psychiatry 2008, 23, 134–141.
    40. Chan, P.A.; Rabinowitz, T. A cross-sectional analysis of video games and attention deficit hyperactivity disorder symptoms in adolescents. Ann. Gen. Psychiatry 2006, 5, 1–10.
    41. Swing, E.L.; Gentile, D.A.; Anderson, C.A.; Walsh, D.A. Television and video game exposure and the development of attention problems. Pediatrics 2010, 126, 214–221.
    42. Christakis, D.A.; Zimmerman, F.J.; DiGiuseppe, D.L.; McCarty, C.A. Early television exposure and subsequent attentional problems in children. Pediatrics 2004, 113, 708–713.
    43. Landhuis, C.E.; Poulton, R.; Welch, D.; Hancox, R.J. Does childhood television viewing lead to attention problems in adolescence? Results from a prospective longitudinal study. Pediatrics 2007, 120, 532–537.
    44. Gentile, D.A.; Swing, E.L.; Lim, C.G.; Khoo, A. Video game playing, attention problems, and impulsiveness: Evidence of bidirectional causality. Psychol. Pop. Media Cult. 2012, 1, 62–70.
    45. King, D.L.; Delfabbro, P.H.; Griffiths, M.D.; Gradisar, M. Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clin. Psychol. Rev. 2011, 31, 1110–1116.
    46. Bushman, B.J. “Boom, Headshot!”: Violent first-person shooter (FPS) video games that reward headshots train individuals to aim for the head when shooting a realistic firearm. Aggress. Behav. 2019, 45, 33–41.
    47. Di Blasi, M.; Giardina, A.; Giordano, C.; Lo Coco, G.; Tosto, C.; Billieux, J.; Schimmenti, A. Problematic video game use as an emotional coping strategy: Evidence from a sample of MMORPG gamers. J. Behav. Addict. 2019, 8, 25–34.
    48. Gee, J.P. Good Video Games+ Good Learning: Collected Essays on Video Games, Learning, and Literacy; Peter Lang: Bern, Switzerland, 2007.
    49. Greenfield, P.M. Technology and Informal Education: What Is Taught, What Is Learned. Science 2009, 323, 69.
    50. Griffiths, M. Internet addiction-time to be taken seriously? Addict. Res. 2000, 8, 413–418.
    51. Griffiths, M. Internet and Video-Game Addiction. In Adolescent Addiction; Elsevier: Amsterdam, The Netherlands, 2008; pp. 231–267.
    52. Weinstein, A.; Lejoyeux, M. Internet addiction or excessive internet use. Am. J. Drug Alcohol Abuse 2010, 36, 277–283.
    53. Griffiths, M. Online therapy for addictive behaviors. CyberPsychology Behav. 2005, 8, 555–561.
    54. Griffiths, M.D. Gambling addiction on the Internet. In Internet Addiction: A Handbook and Guide to Evaluation and Treatment; John Wiley & Sons, Inc: Hoboken, NJ, USA, 2010; pp. 113–133.
    55. Charlton, J.P.; Danforth, I.D.W. Distinguishing addiction and high engagement in the context of online game playing. Comput. Hum. Behav. 2007, 23, 1531–1548.
    56. Charlton, J.P.; Danforth, I.D.W. Validating the distinction between computer addiction and engagement: Online game playing and personality. Behav. Inf. Technol. 2010, 29, 601–613.
    57. Kuss, D.J.; Griffiths, M.D.; Pontes, H.M. DSM-5 diagnosis of Internet Gaming Disorder: Some ways forward in overcoming issues and concerns in the gaming studies field: Response to the commentaries. J. Behav. Addict. 2017, 6, 133–141.
    58. Kardefelt-Winther, D. Problematizing excessive online gaming and its psychological predictors. Comput. Hum. Behav. 2014, 31, 118–122.
    59. Przybylski, A.K.; Weinstein, N.; Murayama, K. Internet gaming disorder: Investigating the clinical relevance of a new phenomenon. Am. J. Psychiatry 2017, 174, 230–236.
    60. Kuss, D.J.; Griffiths, M.D. Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sci. 2012, 2, 347–374.
    61. Thapa, R.; Nyamapfumba, S. Neuroimaging of Addiction. J. Addict. Nurs. 2013, 24, 63–68.
    62. Hummer, T.A. Media violence effects on brain development: What neuroimaging has revealed and what lies ahead. Am. Behav. Sci. 2015, 59, 1790–1806.
    63. Durlach, P.J.; Kring, J.P.; Bowens, L.D. Effects of action video game experience on change detection. Mil. Psychol. 2009.
    64. Gentile, D.A.; Choo, H.; Liau, A.; Sim, T.; Li, D.; Fung, D.; Khoo, A. Pathological video game use among youths: A two-year longitudinal study. Pediatrics 2011, 127, e319–e329.
    65. Ha, J.H.; Kim, S.Y.; Bae, S.C.; Bae, S.; Kim, H.; Sim, M.; Lyoo, I.K.; Cho, S.C. Depression and Internet addiction in adolescents. Psychopathology 2007, 40, 424–430.
    66. Morrison, C.M.; Gore, H. The relationship between excessive Internet use and depression: A questionnaire-based study of 1,319 young people and adults. Psychopathology 2010, 43, 121–126.
    67. Lam, L.T.; Peng, Z.-W. Effect of pathological use of the internet on adolescent mental health: A prospective study. Arch. Pediatr. Adolesc. Med. 2010, 164, 901–906.
    68. Liau, A.K.; Choo, H.; Li, D.; Gentile, D.A.; Sim, T.; Khoo, A. Pathological video-gaming among youth: A prospective study examining dynamic protective factors. Addict. Res. Theory 2015, 23, 301–308.
    69. Greitemeyer, T.; Osswald, S. Playing Prosocial Video Games Increases the Accessibility of Prosocial Thoughts. J. Soc. Psychol. 2011, 151, 121–128.
    70. Saleem, M.; Anderson, C.A.; Gentile, D.A. Effects of Prosocial, Neutral, and Violent Video Games on Children’s Helpful and Hurtful Behaviors. Aggress. Behav. 2012, 38, 281–287.
    71. Greitemeyer, T.; Osswald, S. Effects of prosocial video games on prosocial behavior. J. Pers. Soc. Psychol. 2010, 98, 211.
    72. Gentile, D.A.; Anderson, C.A.; Yukawa, S.; Ihori, N.; Saleem, M.; Ming, L.K.; Shibuya, A.; Liau, A.K.; Khoo, A.; Bushman, B.J. The effects of prosocial video games on prosocial behaviors: International evidence from correlational, longitudinal, and experimental studies. Personal. Soc. Psychol. Bull. 2009, 35, 752–763.
    73. Greitemeyer, T.; Osswald, S. Prosocial video games reduce aggressive cognitions. J. Exp. Soc. Psychol. 2009, 45, 896–900.
    74. Sestir, M.A.; Bartholow, B.D. Violent and nonviolent video games produce opposing effects on aggressive and prosocial outcomes. J. Exp. Soc. Psychol. 2010, 46, 934–942.
    75. Greitemeyer, T.; Traut-Mattausch, E.; Osswald, S. How to ameliorate negative effects of violent video games on cooperation: Play it cooperatively in a team. Comput. Hum. Behav. 2012, 28, 1465–1470.
    76. Greitemeyer, T.; Mügge, D.O. Video Games Do Affect Social Outcomes: A Meta-Analytic Review of the Effects of Violent and Prosocial Video Game Play. Personal. Soc. Psychol. Bull. 2014, 40, 578–589.
    77. Greitemeyer, T.; Osswald, S.; Brauer, M. Playing prosocial video games increases empathy and decreases schadenfreude. Emotion 2010, 10, 796–802.
    78. Prot, S.; Gentile, D.A.; Anderson, C.A.; Suzuki, K.; Swing, E.; Lim, K.M.; Horiuchi, Y.; Jelic, M.; Krahé, B.; Liuqing, W.; et al. Long-Term Relations Among Prosocial-Media Use, Empathy, and Prosocial Behavior. Psychol. Sci. 2014, 25, 358–368.
    79. Harrington, B.; O’Connell, M. Video games as virtual teachers: Prosocial video game use by children and adolescents from different socioeconomic groups is associated with increased empathy and prosocial behaviour. Comput. Hum. Behav. 2016, 63, 650–658.
    80. Buckley, K.E.; Anderson, C.A. A Theoretical Model of the Effects and Consequences of Playing Video Games. In Playing Video Games—Motives, Responses, and Consequences; Vorderer, P., Bryant, J., Eds.; LEA: Mahwah, NJ, USA, 2006; pp. 363–378.
    81. Gentile, D.A.; Reimer, R.A.; Nathanson, A.I.; Walsh, D.A.; Eisenmann, J.C. Protective Effects of Parental Monitoring of Children’s Media Use: A Prospective Study. JAMA Pediatr. 2014, 168, 479–484.
    82. Gentile, D.A.; Gentile, J.R. Violent video games as exemplary teachers: A conceptual analysis. J. Youth Adolesc. 2008, 37, 127–141.
    83. Bushman, B.J.; Huesmann, L.R. Short-term and Long-term Effects of Violent Media on Aggression in Children and Adults. Arch. Pediatr. Adolesc. Med. 2006, 160, 348–352.
    84. Huesmann, L.R.; Kirwil, L. Why Observing Violence Increases the Risk of Violent Behavior by the Observer. In The Cambridge Handbook of Violent Behavior and Aggression; Cambridge University Press: Cambridge, UK, 2007; pp. 545–570.
    85. Maier, J.A.; Gentile, D.A. Learning Aggression through the Media: Comparing Psychological and Communication Approaches. In The psychology of Entertainment Media: Blurring the Lines between Entertainment and Persuasion; Taylor & Francis: New York, NY, USA, 2012; pp. 267–299.
    86. Corbett, A.T.; Koedinger, K.R.; Hadley, W.H. Cognitive Tutors: From the Research Classroom to All Classrooms. In Technology Enhanced Learning: Opportunities for Change; Goodman, P.S., Ed.; Routledge: London, UK, 2001; pp. 253–263.
    87. Kato, P.M.; Cole, S.W.; Bradlyn, A.S.; Pollock, B.H. A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial. Pediatrics 2008, 122, e305–e317.
    88. Smirni, D.; Carotenuto, M.; Precenzano, F.; Smirni, P.; Operto, F.F.; Marotta, R.; Roccella, M. Memory performances and personality traits in mothers of children with obstructive sleep apnea syndrome. Psychol. Res. Behav. Manag. 2019, 12, 481–487.
    89. Lieberman, D.A. Management of Chronic Pediatric Diseases with Interactive Health Games: Theory and Research Findings. J. Ambul. Care Manage. 2001, 24, 26–38.
    90. Lieberman, D.A. What Can We Learn from Playing Interactive Games? In Playing Video Games: Motives, Responses, and Consequences; Routledge: London, UK, 2006; pp. 379–397.
    91. Jenkins, H. No The war between effects and meaning: Rethinking the video game violence debate. In Digital Generations: Children, Young People, and the New Media; Lawrence Erlbaum Associates Inc.: Mahwah, NJ, USA, 2006; pp. 19–36.
    92. Ferguson, C.J.; Kilburn, J. Much ado about nothing: The misestimation and overinterpretation of violent video game effects in Eastern and Western nations: Comment on Anderson et al. (2010). Psychol. Bull. 2010, 136, 174–178.
    93. Anderson, C.A.; Bushman, B.J. Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: A meta-analytic review of the scientific literature. Psychol. Sci. 2001, 12, 353–359.
    94. Anderson, C.A. An update on the effects of playing violent video games. J. Adolesc. 2004, 27, 113–122.
    95. Anderson, C.A.; Shibuya, A.; Ihori, N.; Swing, E.L.; Bushman, B.J.; Sakamoto, A.; Rothstein, H.R.; Saleem, M. Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: A meta-analytic review. Psychol. Bull. 2010, 136, 151–173.
    96. Sherry, J.L. The Effects of Violent Video Games on Aggression: A Meta-Analysis. Hum. Commun. Res. 2001, 27, 409–431.
    97. Funk, J.B.; Baldacci, H.B.; Pasold, T.; Baumgardner, J. Violence exposure in real-life, video games, television, movies, and the internet: Is there desensitization? J. Adolesc. 2004, 27, 23–39.
    98. Anderson, C.A.; Gentile, D.A.; Buckley, K.E. Violent Video Game Effects on Children and Adolescents: Theory, Research, and Public Policy. In Violent Video Game Effects on Children and Adolescents: Theory, Research, and Public Policy; Anderson, C.A., Gentile, D.A., Buckley, K.E., Eds.; Oxford University Press: Oxford, UK, 2007.
    99. Konijn, E.A.; Nije Bijvank, M.; Bushman, B.J. I wish I were a warrior: The role of wishful identification in the effects of violent video games on aggression in adolescent boys. Dev. Psychol. 2007, 43, 1038–1044.
    100. Gentile, D.A.; Lynch, P.J.; Linder, J.R.; Walsh, D.A. The effects of violent video game habits on adolescent hostility, aggressive behaviors, and school performance. J. Adolesc. 2004, 27, 5–22.
    101. Anderson, C.A.; Dill, K.E. Video games and aggressive thoughts, feelings, and behavior in the laboratory and in life. J. Pers. Soc. Psychol. 2000, 78, 772–790.
    102. Carnagey, N.L.; Anderson, C.A. The effects of reward and punishment in violent video games on aggressive affect, cognition, and behavior. Psychol. Sci. 2005, 16, 882–889.
    103. Hopf, W.H.; Huber, G.L.; Weiß, R.H. Media Violence and Youth Violence. J. Media Psychol. 2008, 20, 79–96.
    104. Ferguson, C.J. The Good, The Bad and the Ugly: A Meta-analytic Review of Positive and Negative Effects of Violent Video Games. Psychiatr. Q. 2007, 78, 309–316.
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