Psychopathology and Gaming Disorder in Adolescents

Importance Although gaming disorder is recognized as a diagnosable behavioral addiction, uncertainty remains regarding its directional association with adolescent psychopathology. Clarifying this association is crucial for refining diagnostic frameworks and developing targeted interventions. Objective To examine directional longitudinal associations between psychopathology and gaming disorder among adolescents using the Interaction of Person-Affect-Cognition-Execution model as a theoretical framework. Design, Setting, and Participants This cohort study used data from the Adolescent Brain Cognitive Development Study (release 5.1), analyzing 4289 adolescents in the US who played video games and completed 3 waves of data collection (at ages 11-12, 12-13, and 13-14 years) between January 1, 2018, and December 31, 2022. Statistical analysis was performed from December 2024 to March 2025. Main Outcomes and Measures Psychopathology was assessed using caregiver reports from the Child Behavior Checklist, which provided measures of depression, attention-deficit/hyperactivity disorder (ADHD), social problems, anxiety, and conduct disorder or aggression. Additional person-centered core characteristics (eg, negative life events, family conflict, bullying, and impulsivity) were incorporated. Gaming disorder was measured using the Video Game Addiction Questionnaire, which aligns with the DSM-5 criteria for internet gaming disorder. Results This cohort comprised 4289 adolescents (mean [SD] age, 168.8 [8.2] months; 2391 of 4288 [56%] males). Household income varied widely, with 1374 of 3877 households (35%) reporting an income from $100 000 to $199 000. Cross-lagged panel models (CLPMs) demonstrated that higher baseline levels of psychopathology were associated with an increased risk for subsequent gaming disorder from the 2-year to the 3-year follow-up (β = 0.03 [95% CI, 0.002-0.06]; P = .003) and from 3-year to the 4-year follow-up (β = 0.07 [95% CI, 0.04-0.10]; P < .001). Even when controlling for other personal core characteristics associated with increased risk, there was still a small to medium effect size of psychopathology associated with gaming disorder from the 3-year to the 4-year follow-up (β = 0.04 [95% CI, 0.002-0.07]; P = .04). In contrast, gaming disorder was not associated with later increases in psychopathology. Hierarchical mixed-effects models that accounted for both the panel structure and grouping of the data corroborated the results from the CLPMs. Conclusions and Relevance The results of this cohort study suggest that psychopathology is significantly associated with the development of gaming disorder among adolescents. Clinical efforts to address underlying mental health issues, particularly for internalizing symptoms such as depression, anxiety, social problems, and ADHD, may reduce the incidence and severity of gaming disorder.