Exploring the Intersection of Gaming Addiction and Autism Spectrum Disorder: “Virtual Autism” - MAPS

Exploring the Intersection of Gaming Addiction and Autism Spectrum Disorder: “Virtual Autism”

Koichi Tanji

Greetings, MAPS Community,

During the recent Medical Academy of Pediatric Special Needs (MAPS) conference in the
Spring of 2024, I had the privilege of presenting on Screen Addiction and
Neurodevelopmental Disorders, which has been the focus of my research and clinical
practice. Specifically, I discussed how excessive screen use can exacerbate symptoms
across various neuropsychiatric disorders and even mimic diagnoses.

Drawing from my experience in treating patients with gaming addiction and
neurodevelopmental disorders, one question has persistently been on my mind: Could
individuals diagnosed with Autism Spectrum Disorder (ASD) who also meet the criteria
for gaming addiction inadvertently influence the outcomes of ASD treatment studies?

My hypothesis posits that some cases of gaming addiction might present symptoms
that closely mimic those of ASD, leading to the term “Virtual ASD.” In these cases,
individuals may receive an ASD diagnosis despite having fewer physiological
abnormalities typically associated with the condition. This overlap between gaming
addiction and ASD has the potential to impact the effectiveness of ASD treatments in
research settings significantly.

Simply stated, patients with gaming addiction (mimicking ASD) respond better to
addiction treatment. It doesn’t respond well to the biomedical treatments for ASD, such
as Folate, B12, Sulforaphane, Detox, etc., that we have learned from MAPS and other
brilliant providers. Yet, they were included in Autism research for those biomedical
treatments, potentially reducing the effectiveness of those treatments in research.

Gaming Addiction not Autism? Is this misdiagnosis.

This is not a misdiagnosis. ASD is diagnosed clinically, meaning diagnoses are based on
clinical observation. Whoever presents with the signs and symptoms of Autism and
meets the criteria will be diagnosed as Autism, including those with “Virtual Autism.”
However, the prognosis can be different among those with “Virtual Autism.” Successfully
treating the dependency on screens can drastically improve their Autism symptoms to
the point where some individuals no longer meet the criteria for diagnosis. A lack of
awareness of Gaming disorder also contributes to this, which is newly added to
diagnosable conditions in ICD-11. Autism individuals who have diagnosable conditions
as the underlying cause are not new to this field; approximately 20% of children with
ASD have a diagnosable genetic syndrome. These syndromes can be due to missing or
extra stretches of DNA, misspellings in genes, or biochemical abnormalities. (ASD and
Associated Genetic Conditions | CHOP Research Institute)

My child has a Gaming addiction. Does that mean my child has “Virtual Autism” and not
Autism?

Some people have “Virtual Autism,” and we don’t know the accurate prevalence, which
I’m planning to conduct research. Some are Classical Autism individuals who are also
addicted to Gaming. Nonetheless, both populations benefit from the treatment of
Gaming Addiction. “Virtual Autism” patients will likely improve more than classical
Autism individuals with gaming disorder, but treating gaming addiction improves
Autism symptoms for classical autism cases, too.

Step back, please; what is gaming disorder?

Gaming disorder is defined in the 11th Revision of the International Classification of
Diseases (ICD-11) as a pattern of gaming behavior (“digital-gaming” or “video-gaming”)
characterized by impaired control over gaming, increasing priority given to gaming over
other activities to the extent that gaming takes precedence over other interests and
daily activities, and continuation or escalation of gaming despite the occurrence of
negative consequences.

How is gaming disorder identified?

For gaming disorder to be diagnosed, the behavior pattern must be severe enough that
it results in significant impairment to a person’s functioning in personal, family, social,
educational, occupational, or other important areas and would normally have been
evident for at least 12 months.

What is “Virtual Autism”?

For those unfamiliar with the concept, “Virtual Autism” refers to a scenario where
individuals exhibit symptoms or behaviors resembling those of ASD, such as social
difficulties, repetitive behaviors, and communication challenges, without the typical
underlying physiological abnormalities observed in individuals with ASD. Interestingly,
treating screen dependency in these cases can drastically improve ASD-like symptoms.
The term “virtual” implies that the presentation of autism-like symptoms is not primarily
due to inherent neurological differences associated with ASD but may be influenced by
excessive screen use. It’s crucial to note that virtual autism is not recognized and
diagnosed as ASD. My concern lies in the potential misattribution of gaming addiction
symptoms to ASD, which could inadvertently include individuals in studies whose
physiological conditions differ significantly from traditional ASD cases. This could lead to
misleading conclusions in research findings or diminish the significance of biomedical
research outcomes.

To address this gap in understanding, I proposed three key research topics and am in
the process of conducting studies.

  • Prevalence of Gaming Disorder in ASD: Quantifying the number of ASD patients
    who also meet the diagnostic criteria for gaming disorder based on the ICD-11.
  • Comparison of Treatment Responses: Investigating whether gaming disorder
    comorbidity influences treatment response in individuals with ASD by replicating
    established biomedical treatment studies across ASD, ASD/Gaming Disorder, and
    typically developing control groups.
  • Effects of Screen Fasting: Assessing the impact of screen fasting on ASD symptom
    severity in ASD-only and ASD/Gaming Disorder populations to explore potential
    associations between gaming behavior and symptom improvement.

Our hypothesis suggests that the recent surge in ASD diagnoses may, in part, be
attributed to the inclusion of individuals with gaming disorders. We believe that these
researches have the potential to inform diagnostic practices, treatment approaches, and
future research directions in the field of neurodevelopmental disorders. I’m excited
about the potential implications of this work and look forward to updating you on our
progress at the next MAPS conference.

If you may also wonder,

  • How much is too much video game/Screen time?
  • Kids can’t make friends without video games or screen
  • School and work require computers, so it’s impossible to stay away from
  • What’s safer content? Is TV ok?
  • My kid is clearly addicted; how to treat it?

I will be presenting again about Screen Addiction at the Fall 2024 MAPS Conference. If
you want to learn more about it, please join us in the Fall!

Citations:

World Health Organization (WHO)

– Kushima M, Kojima R, Shinohara R, et al. Association Between Screen Time
Exposure in Children at 1 Year of Age and Autism Spectrum Disorder at 3 Years of
Age: The Japan Environment and Children’s Study. JAMA Pediatr. 2022;176(4):384-
391. doi:10.1001/jamapediatrics.2021.5778

– Harlé B. Intensive early screen exposure as a causal factor for symptoms of
autistic spectrum disorder: The case for «Virtual autism». Trends Neurosci Educ.
2019;17:100119. doi:10.1016/j.tine.2019.100119

– Christakis DA. Early Media Exposure and Autism Spectrum Disorder: Heat and
Light. JAMA Pediatr. 2020;174(7):640-641. doi:10.1001/jamapediatrics.2020.0659