DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY INVITED REVIEW Internet gaming disorder in children and adolescents: a systematic review FRANK W PAULUS 1 | SUSANNE OHMANN 2 | ALEXANDER VON GONTARD 1 | CHRISTIAN POPOW 2 1 Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. 2 Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria. Correspondence to Frank W Paulus at Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany. E-mail: frank.paulus@uniklinikum-saarland.de This article is commented on by Mueller on page 636 of this issue. PUBLICATION DATA Accepted for publication 2nd February 2018. Published online 6th April 2018. ABBREVIATIONS IGD Internet gaming disorder MMORPG Massively multiplayer online role-playing game AIM Internet gaming disorder (IGD) is a serious disorder leading to and maintaining pertinent personal and social impairment. IGD has to be considered in view of heterogeneous and incomplete concepts. We therefore reviewed the scientific literature on IGD to provide an overview focusing on definitions, symptoms, prevalence, and aetiology. METHOD We systematically reviewed the databases ERIC, PsyARTICLES, PsycINFO, PSYNDEX, and PubMed for the period January 1991 to August 2016, and additionally identified secondary references. RESULTS The proposed definition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides a good starting point for diagnosing IGD but entails some disadvantages. Developing IGD requires several interacting internal factors such as deficient self, mood and reward regulation, problems of decision-making, and external factors such as deficient family background and social skills. In addition, specific game-related factors may promote IGD. Summarizing aetiological knowledge, we suggest an integrated model of IGD elucidating the interplay of internal and external factors. INTERPRETATION So far, the concept of IGD and the pathways leading to it are not entirely clear. In particular, long-term follow-up studies are missing. IGD should be understood as an endangering disorder with a complex psychosocial background. Games are an integrative part of human behaviour and experience. During the past two decades, the availability and use of computer technology has dramatically increased and changed the world of leisure activities. Use of the Internet and computer game playing have become common activities for children and adolescents, in addition to social and traditional mass media. Recent data from the USA suggest that 8- to 10-year-olds are busy 8 hours per day, and adolescents more than 11 hours per day, with the recreational use of various electronic media (mobile phones, television and videos, computer use, music, print media, Web pages, social media, not including telephone conversations and text messages). This covers more time than they spend in school or with friends. 1,2 For most individuals, computer gaming is an enjoyable and stimulating activity. 3–5 Persons with various intra- and interpersonal risk factors may, however, become attracted to using computer gaming as a strategy to overcome indi- vidual problems. Gaming and seeking for game-related pleasure may lead to neglecting ‘normal’ relationships, school or work-related duties, and even basic physical needs. Computer gaming may thus be conceptualized as a continuum from an enjoyable activity to pathological and even addictive use. 6–8 The Diagnostic and Statistical Manual of Mental Disor- ders, Fifth Edition (DSM-5) 9 conceptualizes ‘Internet gam- ing disorder’ (IGD) in the chapter ‘Conditions for further study’ (p.795), suggesting that this proposal is not yet intended for clinical use but that research on this topic is encouraged. The essential feature of IGD is persistent and recurrent participation in computer gaming for typically 8 to 10 hours or more per day and at least 30 hours per week, typically in Internet-based group games (especially massively multiplayer online role-playing games [MMORPG]). Since IGD has been defined only in 2013, previous liter- ature uses various terms for describing this clinical entity, such as Internet or computer addiction (see ‘Definition’). While IGD is typical for adolescents and young adults, preschool and preadolescent children prefer non-Web- based games. Therefore, the American Psychiatric Associa- tion definition may not exactly fit for younger children and those playing offline. Although IGD may be a serious disorder leading to sig- nificant impairment of personal and social functioning, the definition, symptoms, prevalence, and aetiology have to be seen in view of heterogeneous, incomplete, and changing concepts, and only a few available clinical studies of scien- tific quality. We therefore decided to review the scientific © 2018 Mac Keith Press DOI: 10.1111/dmcn.13754 645