Treatment of Gaming Disorder in Children and Adolescents: A Systematic Review

Abstract

Objectives

Given the disproportionate burden of gaming disorder (GD) on younger populations, there is a need to comprehensively evaluate the current evidence base around treatment for children and adolescents. This systematic review aimed to summarize the available literature on GD treatment in younger populations.

Methods

A systematic search of five databases was conducted. Studies were eligible if they 1) evaluated psychological or pharmacological interventions targeting GD in children, adolescents, or parents seeking help for their children; 2) had at least one outcome of GD severity or gaming duration/frequency; and 3) employed a randomized controlled trial or quasi-experimental design. Study quality was assessed using the Effective Public Health Practice Project tool.

Results

Thirty studies were included in the review, comprising 2157 participants. Interventions based on or delivered in combination with cognitive-behavioral therapy were the most frequently studied (n=19), while a diverse range of other treatments (e.g., pharmacotherapy, online psychoeducation, and equine-assisted therapy) were explored in fewer studies. Despite promising findings across studies, the overall quality of evidence was inconsistent, with many studies lacking randomization, control groups, and long-term follow-up. Additionally, cross-study comparisons may have been limited by the variability in GD measures across studies, with 19 different assessment tools identified.

Conclusion

Although research on the treatment of GD in children and adolescents has grown, it remains in its early stages. To advance evidence-based treatment, future research should prioritize methodologically rigorous designs, standardized outcome measures, and long-term follow-up assessments.

INTRODUCTION

The recognition of gaming disorder (GD) in the International Classification of Diseases (ICD-11) has promoted global efforts to advance knowledge on its prevalence, assessment, and treatment. Classified as a “disorder due to addictive behaviors,” GD is characterized by impaired control over gaming, increasing prioritization of gaming over other daily activities and life interests, and continued or escalating gaming despite negative consequences [1]. A recent meta-analysis found that the prevalence of GD was highest in children and adolescents (estimated at 6.6%), nearly double that observed in young adults, and more than three times as high as in the general adult population [2]. Given the disproportionate burden of GD on younger populations and the possible negative health, social, and academic impacts that may persist into adulthood [3], there is a need for evidence-based treatment that not only addresses symptoms, but also promotes long-term behavior change.

Treatment for GD has predominantly focused on psychotherapeutic approaches and targeted adolescents and young adults [4]. Similar to other mental health conditions, cognitive-behavioral therapy (CBT) appears to be the most widely studied and supported approach for short-term symptom reduction, often incorporating techniques such as cognitive restructuring and relapse prevention [5,6]. Other treatments, though less researched, include pharmacotherapy (predominantly using antidepressants), mindfulness interventions, family therapy, neuromodulation (e.g., transcranial direct current stimulation), exposure therapy via virtual reality, and a craving behavioral intervention [4,7]. However, several treatment studies of GD, including those evaluating CBT, have been limited by methodological concerns, such as inconsistencies in measuring gaming-related outcomes and the lack of control groups, randomization, and follow-up assessments [4,8-13]. Recognizing these limitations, previous systematic reviews have called for more rigorous treatment studies [4,13], which have recently contributed to gradual improvements in the quality of treatment evidence [5]. These advancements require ongoing, systematic evaluation to ensure continued progress and refinement in GD treatment research.

Although there are arguments that GD is a fairly transient condition without intervention [14,15], considerable evidence suggests that it may remain temporally stable [16-21]. As GD may impact healthy development, it is important to address GD in children and adolescents, as a lack of support or treatment may contribute to long-term difficulties in some individuals. Interventions for younger populations with GD should ideally be tailored to align with age-specific cognitive, emotional, and social factors that influence motivation and self-efficacy for behavioral change [22]. For some adolescents with GD, gaming may be embedded in their social identity and function both as a coping mechanism and an integral part of daily routine [23,24]. As such, it may be important that treatments facilitate the development of coping skills and address unique barriers to behavioral change that young individuals may encounter (e.g., peer pressure, parent-child conflicts, and academic stress) [25].

A systematic review of treatment for GD in children and adolescents was published in 2022, which found that CBT and CBT-based treatments were the most frequently used approaches, with pharmacotherapy recommended in cases of co-occurring disorders (e.g., depression) [13]. However, the scope of this previous review [13] appeared to extend beyond GD, encompassing studies on internet and smartphone addictions that lacked gaming-specific outcomes. GD is distinct from other specific forms of problematic usage of the internet and smartphone addiction as it involves problematic gaming behaviors, whereas other forms may involve shopping, use of social media, use of pornography, or other behaviors. Given this limitation, along with the expansion of GD treatment research in recent years, an updated and more precise review of the literature is warranted. The present systematic review aimed to summarize the existing literature on interventions targeting GD in children and adolescents. Treatment types, treatment efficacy, and the methodological quality of studies are reported.

METHODS

This systematic review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [26].

Inclusion and exclusion criteria

Studies were included on the basis of the following criteria: 1) included a psychological or pharmacological intervention or treatment for GD; 2) included child and adolescent participants (i.e., mean age of participants ≤19 years) or parents seeking help for their children; 3) the intervention was intended to reduce GD severity, gaming duration, or gaming frequency; 4) randomized controlled trials (RCTs) or quasiexperimental studies; and 5) at least one post-intervention outcome on GD severity, gaming duration, or gaming frequency. Studies were excluded if they 1) assessed prevention programs that aimed to reduce the risk of future harm or included participants who had not yet reported problems with gaming; 2) included game-based interventions targeting other health conditions such as depression; 3) included participants with an average age above 19 years; 4) were not available in English; and 5) were gray literature or case studies. Adolescents were defined as individuals aged 10–19 years, in accordance with the World Health Organization classification [27].

Search strategy and screening

A search of five databases (i.e., PubMed, PsycINFO, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials) was conducted in January 2025 using the following search terms: (gaming OR “video gaming” OR “video game*” OR “online gaming” OR “online game*” OR “internet gaming” OR “internet game*” OR “computer gaming” OR “computer game*”) AND (disorder* OR addict* OR problem* OR excessive OR compulsive OR patholog*) AND (treat* OR interven* OR therap* OR recover* OR manage*) AND (child* OR adolescent* OR young OR youth OR teen*). The search was limited to studies published in English in the last 20 years that exclusively involved human participants. To identify additional studies for inclusion, reference lists within relevant systematic reviews were searched [4,13]. Using the aforementioned inclusion and exclusion criteria, two researchers (J.J.P. and A.S.) independently and manually screened the titles and abstracts of studies using Rayyan (i.e., a web- and mobile-based systematic review tool; Rayyan Systems Inc.), followed by manual full-text screening. A third researcher (B.C.) was involved in resolving any disagreements.

Data extraction

Two researchers (J.J.P. and B.C.) independently extracted the following data from the included studies into a spreadsheet: sample size, participant demographics (i.e., age and sex), study design, problem-related inclusion criteria, outcome assessment points and tools, intervention characteristics, comparison conditions, and findings regarding GD severity, gaming duration, and gaming frequency. A third researcher (A.S.) was involved to address any discrepancies in the extracted data.

Quality assessment

The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies [28] was used to assess the methodological quality of included studies. The EPHPP assesses six domains: selection bias, study design, confounders, blinding, data collection method, and study attrition. Two independent researchers (A.S. and B.C.) provided a global rating of strong (no weak ratings), moderate (1 weak rating), or weak (two or more weak ratings) for each study. Discrepancies were resolved by a third researcher (J. J.P.). In addition to the EPHPP, the review assessed whether trials were formally registered or had an associated published protocol to provide further insight into the transparency and methodological rigor of the included studies.

RESULTS

Search results and study characteristics

The search identified 6638 studies, which included the following results from five databases: Web of Science (n=3985), Cochrane Central Register of Controlled Trials (n=1324), Embase (n=871), PubMed (n=254), and PsycINFO (n=204). An additional three records were identified in the reference lists of relevant systematic reviews that were not captured in the initial search. After removing duplicates, 5730 studies remained, of which 5560 were removed after title and abstract screening. Full-text screening was performed on the remaining 70 studies, with 40 studies excluded and 30 included in the review. The PRISMA flow diagram is presented in Fig. 1.

Fig. 1.

PRISMA flow diagram of study selection. GD, gaming disorder.

The studies included a total of 2157 participants, with sample sizes ranging from 9 to 689. Among these participants, around 40% (n=871) were parents seeking help for their children. The ages of child and adolescent participants ranged from around 5 to 19 years. Most youth were male (86%), with male representation ranging from 73% to 100% across studies. Notably, 13 studies exclusively focused on male children or adolescents.

Of the 30 included studies, 15 were RCTs, 12 were pre-post studies (i.e., evaluating change within a single treatment group), and three were non-RCTs (i.e., studies without random allocation to treatment and control groups). Most studies recruited participants from Asia (n=19), followed by Europe (n=10) and Oceania (n=1). GD severity was assessed post-treatment using various tools (n=19), with the Young Internet Addiction Scale (YIAS) and the Internet Gaming Disorder Scale, Short-Form (IGDS-SF9) being the most frequently used (n=5 and 4, respectively).

CBT-based treatment

Twelve studies (i.e., six RCTs and six pre-post studies) delivered CBT-based interventions for GD, two of which were standard CBT without any specification of additional or modified components (Table 1) [29,30]. Parental involvement was reported in four studies [29,31-33].

Table 1.

Characteristics of included studies (n=30), categorized by types of treatment

Study and country	Treatment and control	Design*	Sample size, age (yr)§, and sex	Problem-related inclusion criteria	Outcome assessment points and tools	Findings† and QA scores
CBT-based treatment
André et al., 2022 [34], Sweden	1. Individual relapse prevention	Pre-post	n=9; age range=13-17; 89% male	Met the DSM-5 criteria for IGD	Post-treatment at 7 weeks and follow-up at 6 months Severity: GASA	Severity: Statistically significant reduction from baseline to post and baseline to follow-up. No statistically significant reduction from post to follow-up. QA: Moderate
André et al., 2023 [35], Sweden	1. Individual relapse prevention 2. Control: Treatment as usual – e.g., counselling, medication for ADHD, antidepressants	RCT	n=102; age=14.4 (1.4); 74% male	Met the DSM-5 criteria for IGD	Post-treatment at 5-7 weeks and follow-up at 3 months Severity: GASA	Severity: The greater reduction in the relapse prevention group compared to the control group at 3 months was statistically significant. QA: Moderate
Brandhorst et al., 2022 [32], Germany	1. Group parental training	Pre-post	Parents: n=42; age=50.1 (5.7); 29% male Adolescents: n=31; age=15.8 (2.8); 97% male	Child in outpatient clinic for GD or internet use disorder	Post-treatment at 8 weeks Severity: CSAS-FE Duration: Average gaming time; gaming time on weekdays; gaming time on weekends (minutes, parent-reported)	Severity: Statistically significant reduction Duration: No statistically significant changes QA: Strong
Brandhorst et al., 2023 [31], Germany	1. Group parental training 2. Control: Waitlist	RCT	Parents: n=59; age=50.3 (4.3); 39% male Adolescents: n=44; age=14.7 (2.1); 88% male	GD, internet use disorder, or social network use disorder symptoms assessed by parents (researchers did not ask about specific criteria)	Post-treatment at 8 weeks Severity: CSAS-FE	Severity: No statistically significant differences between groups QA: Moderate
Han et al., 2018‡ [29], China	1. Group CBT (individuals with IGD, parents, and teachers)	Pre-post	n=56; age=16.8 (0.8); 100% male	Met the modified (Beard and Wolf) Young Diagnostic Questionnaire for Internet Addiction	Post-treatment NR in terms of days/weeks but specified as after 12 CBT sessions Severity: CIAS Duration: Gaming duration (hours per week)	Severity: Statistically significant reduction Duration: Statistically significant reduction QA: Strong
Hülquist et al., 2022 [33], Germany	1. Group parental training	Pre-post	Parents: n=43; age=48.7 (6.8); 28% male Adolescents: NR but the study defined “adolescents” as 10-19 years	Diagnosed with problematic gaming based on the ICD-11 and DSM-5 criteria	Post-treatment at 8 weeks and follow-up at 14 weeks Severity: PIGDS	Severity: Statistically significant reduction QA: Strong
Ji and Wong, 2023 [39], Hong Kong	1. Group CBT with a motivational approach 2. Control: Waitlist	RCT	n=77; age=16.4 (0.9); 88% male	CIAS (Gaming Version) ≥68	Post-treatment at 8 weeks and follow-up at 3 months and 6 months Severity: CIAS (Gaming Version) Duration: Gaming duration (hours per week, categorized 0-7, 8-14, 15-21, 22-28, 29-35, 36-42 or more than 42 hours)	Severity: The greater reduction in the CBT group compared to the control group was statistically significant. Duration: The greater reduction in the CBT group compared to the control group was statistically significant. QA: Moderate
Kochuchakkalackal Kuriala and Reyes, 2020 [36], Philippines	1. Acceptance and cognitive restructuring (group and individual) 2. Control: No treatment	RCT	n=40; age range=16-19; sex NR	Gaming duration >30 hours per week; met at least five of nine symptoms of IGD in the last 12 months using the IGDS-SF9	Post-treatment at 5 weeks Severity: IGDS-SF9	Severity: Statistically significant reduction in the acceptance and cognitive restructuring group. No statistically significant reduction in the control group. Group-by-time interaction effect NR. QA: Moderate
Kochuchakkalackal Kuriala and Reyes, 2023 [37], Philippines	1. Acceptance and cognitive restructuring (group and individual) 2. Control: No treatment	RCT	n=30; age range=16-19; sex NR	Gaming duration >30 hours per week; met at least five of nine symptoms of IGD in the last 12 months using the IGDS-SF9	Post-treatment at 8 weeks Severity: IGDS-SF9	Severity: Statistically significant reduction in the acceptance and cognitive restructuring group. No statistically significant reduction in the control group. Group-by-time interaction effect NR. QA: Weak
Li and Wang, 2013 [30], China	1. Group CBT 2. Control: Group basic counselling	RCT	n=28; age range=12-19; 100% male	Gaming duration >4 hours per day or 30 hours per week; OGCAS score >35; IAS–Chinese Revision score >3; maladaptive behaviors or distress due to online gaming	Post-treatment at 6 weeks Severity: OGCAS; IAS	Severity: Statistically significant reduction in OGCAS scores in both groups but no statistically significant group-by-time effect. No statistically significant reduction in IAS scores in either group and no statistically significant group-bytime effect. QA: Moderate
Moghaddas et al., 2023 [38], Iran	1. Group acceptance and commitment therapy	Pre-post	n=20; age=14.4 (1.5); 80% male	Met the DSM-5 criteria for IGD. Note: All participants had co-occurring ADHD (based on the DSM-5 criteria) and were under treatment of methylphenidate	Post-treatment at 8 weeks Severity: IGDS-SF9	Severity: Statistically significant reduction QA: Moderate
Szász-Janocha et al., 2021 [40], Germany	1. Group CBT-based emotional and behavioral regulation and skills training	Pre-post	n=54; age=13.5 (1.7); 83% male	Excessive gaming or Internet use (self-reported or parent-reported) associated with subjective psychological strain	Post-treatment at 4 weeks and follow-up at 4 months and 12 months Severity: CIUS; CSAS (CSAS-SR and CSAS-PR) Duration: Gaming hours on weekdays; gaming hours on weekends	Severity: Statistically significant reduction Duration: No statistically significant changes QA: Moderate Treatment combined with CBT
González-Bueso et al., 2018‡ [41], Spain	1. Individual CBT (with two subgroups; with and without group psychoeducation for parents)	Pre-post	n=60; CBT group age=15.5 (2.3), CBT+psychoeducation group age=16.1 (2.2); 100% male	Diagnosed with IGD and referred for assessment and outpatient treatment at a behavioral addiction center	Post-treatment not specified in terms of days/weeks but can be assumed that it is after 28 weeks Severity: DQVMIA	Severity: Statistically significant reduction in the treatment group. No statistically significant differences between the treatment subgroups. QA: Moderate
Hong et al., 2020 [46], South Korea	1. Group physical exercise intervention+ group CBT 2. Control: Group CBT only	RCT	n=50; CBT+PE group age=15.4 (2.9); Control group age=16.0 (2.5); 100% male	Met the DSM-5 criteria for IGD	Post-treatment at 14 weeks Severity: YIAS	Severity: The greater reduction in the physical exercise+CBT group compared to the CBT-only group was statistically significant. QA: Strong
Kim et al., 2012 [47], South Korea	1. Bupropion+group CBT 2. Control: Bupropion only	RCT	n=65; Bupropion+CBT group age=16.2 (1.4); Control group age=15.9 (1.6); 100% male	Gaming duration >4 hours per day or 30 hours per week; YIAS score >50; maladaptive behaviors or distress due to online gaming, based on the DSM-IV criteria for substance abuse. Note: participants also had major depressive disorder	Post-treatment at 8 weeks and follow-up at 12 weeks Severity: YIAS Duration: Gaming duration (hours per week)	Severity: The greater reduction in the bupropion+CBT group compared to the bupropion-only group during the 8 weeks was statistically significant. No statistically significant changes at 12 weeks in either group. Duration: The greater reduction in the bupropion+CBT group compared to the bupropion-only group during the 8 weeks was statistically significant. No statistically significant changes at 12 weeks in either group. QA: Moderate
Pallesen et al., 2015 [42], Norway	1. Family-based eclectic therapy (CBT, family therapy, solutionfocused therapy, motivational interviewing targeting child and mother)	Pre-post	n=12; age=15.7 (1.3); 100% male	GASA (short version) score ≥3 on all seven items and/or the mothers of individuals with problematic gaming scored 4 or 5 on all items of the parent version of the PVP	Post-treatment at 13 weeks Severity: GASA; PVP (self-report and parent-report)	Severity: Statistically significant reduction in parent-reported PVP. No statistically significant changes for GASA and PVP reported by child. QA: Weak
Pornnoppadol et al., 2020 [43], Thailand	1. Therapeutic residential camp (group CBT; media literacy; outdoor, recreational, and family activities) 2. Parent management training 3. Therapeutic residential camp+parent management training 2. Control: Waitlist	Non-RCT (selfselected)	n=104; age=14.3 (1.3); 79% male	Met the cutoff for problematic gaming on the GAST parent version; met the DSM-5 criteria for IGD	Follow-up at 1 month, 3 months and 6 months Severity: GAST (parent-report)	Severity: The reductions in all four groups were statistically significant, with statistically significant differences between the four groups. The smaller reduction in the control group compared to at least one of the treatment groups was statistically significant. QA: Moderate
Sakuma et al., 2017 [45], Japan	1. Therapeutic residential camp (CBT, medical lectures, personal counselling, outdoor activities)	Pre-post	n=10; age=16.2 (2.2); 100% male	Met the DSM-5 criteria for IGD; satisfied Griffith’s six components of addiction	Follow-up at 3 months Duration: Gaming hours per day; gaming hours per week Frequency: Gaming sessions (days per week)	Duration: Statistically significant reduction Frequency: No statistically significant changes QA: Moderate
Torres-Rodríguez et al., 2018 [44], Spain	1. Individual IGD-specific psychotherapy based on CBT 2. Control: Treatment-as-usual (standard CBT)	Non-RCT	n=31; Psychotherapy group age=15.2 (1.9); Control group age=14.7 (1.6); 100% male	Met the DSM-5 criteria for IGD; IGD-20 score ≥71	Post-treatment at 6 months and follow-up after 3 months Severity: IGD-20 Duration: Gaming hours per week (weekdays and weekends, excluding holiday periods) reported by participants and family members	Severity: Statistically significant reductions in both the treatment and control groups, with statistically significant differences after treatment between the groups. Group-by-time interaction effect NR. Duration: Statistically significant reductions in the treatment group. No statistically significant changes in the control group. Statistically significant differences after treatment between groups. Group-bytime interaction effect NR. QA: Moderate
Pharmacotherapy
Park et al., 2016 [48], South Korea	1. Atomoxetine 2. Methylphenidate	RCT	n=84; ATX group age=17.1 (1.0); MPH group age=16.9 (1.6); 100% male	Met the DSM-5 criteria for IGD. Note: All participants were diagnosed with ADHD (based on the DSM-5 criteria)	Post-treatment at 3 months Severity: YIAS	Severity: No statistically significant differences between groups QA: Moderate
Song et al., 2016 [49], South Korea	1. Bupropion 2. Escitalopram 3. Control: No treatment	RCT	n=119; bupropion group age=20 (3.6); escitalopram group age=19.8 (4.2); control group age=19.6 (4.0); 100% male	Met the DSM-5 criteria for IGD. All participants were screened with the Structured Clinical Interview for DSM-IV-TR	Post-treatment at 6 weeks Severity: YIAS	Severity: The reductions in the bupropion and escitalopram groups were statistically significant. The greater reduction in the bupropion group compared to the escitalopram group was statistically significant. QA: Moderate
Other treatment (not based on CBT and not delivered in combination with CBT/pharmacotherapy)
Han et al., 2012‡ [50], South Korea	1. Family therapy (families treated individually)	Pre-post	n=30; age=14.2 (1.5); sex NR	Gaming duration >4 hours per day and 30 hours per week; YIAS score >50; impairment or distress due to gaming, modified from the DSM-IV criteria for substance abuse	Post-treatment at 3 weeks Severity: YIAS Duration: Online gaming duration (hours per week)	Severity: Statistically significant reduction Duration: Statistically significant reduction QA: Strong
Kim et al., 2013 [52], South Korea	1. Individual game-based speaking and writing course 2. Control: Individual general speaking and writing course	RCT	n=59; age=17.5 (0.6); 100% male	Concerns with Dungeon & Fighter (MMORPG), defined as gaming duration >4 hours	Post-treatment at 2 months Duration: Online gaming duration (minutes on Dungeon & Fighter per day)	Duration: The greater reduction in the game-based course group compared to the general course group was statistically significant. QA: Weak
Lo et al., 2024 [57], Hong Kong	1. Group motivational interviewing for parents 2. Control: No treatment	Non-RCT	Parents: n=38; age=44.9 (6.5); 5% male Children: NR	Self-reported distress due to children’s problematic gaming	Post-treatment at 4 weeks Severity: IGDS-SF9 Duration: Gaming duration on a typical weekday and weekend	Severity: No statistically significant differences between groups Duration: No statistically significant differences between groups QA: Moderate
Marshall et al., 2024 [53], Australia	1. Individual web-based psychoeducation for parents	Pre-post	Parents: n=689; age NR; sex NR Children: n=689; age range=around 5-18; 74% male	Parents wanting help regarding managing problematic screen use in children	Post-treatment at 6 weeks Severity: IGDT-10-P	Severity: Statistically significant reduction QA: Weak
Nasiry and Noori, 2022 [56], Iran	1. Individual online attentional bias modification training 2. Control: No training	RCT	n=33; Training group age=14.4 (1.8); Control group age=14.8 (1.1); 73% male Met the DSM-5 criteria for IGD	Post-treatment at 16 days and follow-up at 2 months Severity: IGD-20	Severity: The greater reduction in the online attentional bias modification training group compared to the no training group was statistically significant. QA: Moderate
Nielsen et al., 2021 [51], Switzerland	1. Multidimensional family therapy (families treated individually) 2. Control: Treatment-as-usual (family therapy, with families treated individually)	RCT	n=42; age=14.9 (2.0); 98% male	Met the DSM-5 criteria for IGD; regularly referred for outpatient treatment from parents, schools, and treatment centers	Post-treatment at 6 months and follow-up at 12 months Severity: DSM-5-based Petry IGD scale (French version) Duration: TLFB (gaming duration) Frequency: TLFB (which days one played games)	Severity: Statistically significant reduction in the treatment and control group. Statistically significant differences between groups Duration: No statistically significant changes in either group Frequency: NR QA: Moderate
Park and Jung, 2024 [58], South Korea	1. Group equine-assisted learning	Pre-post	n=27; age=12.5 (1.3); sex NR	Diagnosed with IGD (specific criteria NR)	Post-treatment at 8 days and follow-up at 1 month Severity: K-scale	Severity: Statistically significant reduction QA: Moderate
Zamanian et al., 2020 [54], Iran	1. Group health education for adolescents and parents based on the Theory of Planned Behavior 2. Control: Waitlist but only received one educational session instead of eight RCT	n=64; age=13.8 (0.9); 100% male	Computer game dependency	Post-treatment NR in terms of days/weeks but specified as after 8 sessions and follow-up at 3 months Severity: CGDQ	Severity: The greater reduction in the treatment group compared to the control group was statistically significant at post-intervention, but not at 3 months. QA: Moderate
Zheng et al., 2022 [55], China	1. RI training 2. ApBM training 3. RI+ApBM training 4. Control: No treatment	RCT	n=80; RI group age=14.8 (1.4); ApBM group age=14.9 (1.6); RI+ApBM group age=14.7 (1.9); control group age=14.7 (1.2); 100% male	Met the DSM-5 criteria for IGD; OGAS score ≥20; mainly played “Glory Kings” (an online game) along with other games for at least 25 hours a week for more than 1 year	Post-treatment at 15 days and follow-up month at 1 month Severity: OGAS	Severity: Statistically significant reduction for RI group at 1 month. Statistically significant reduction for ApBM group at 15 days. Statistically significant reduction for RI+ApBM group at 15 days and 1 month. No statistically significant changes in control group. Statistically significant differences in changes over time between at least two groups (not specified). QA: Strong

*RCTs, non-RCTs (studies without random allocation to treatment and control groups), pre-post studies (studies evaluating change within a single treatment group); †statistical significance is defined as p<0.05; ^‡a healthy control group was recruited but not included in gaming-related outcome evaluations; ^§ages are presented as mean (standard deviation) or range value. ADHD, attention-deficit/hyperactivity disorder; ApBM, approach bias modification; ATX, atomoxetine; CBT, cognitive-behavioral therapy; CGDQ, Computer Game Dependency Questionnaire; CIAS, Chen Internet Addiction Scale; CIUS, Compulsive Internet Use Scale; CSAS-FE, Computer Game Addiction Scale, Parents’ Version (also known as the Video Game Dependency Scale, Parental Version); CSAS-PR, German Video Game Dependency Scale–parent-report; CSAS-SR, German Video Game Dependency Scale–self-report; DSM, Diagnostic and Statistical Manual of Mental Disorders; DQVMIA, Diagnostic Questionnaires for Video Games, Mobile Phone or Internet Addiction; GASA, Game Addiction Scale for Adolescents; GAST, Game Addiction Screening Test; GD, gaming disorder; IAS, Internet Addiction Scale; ICD-11, International Classification of Diseases; IGD, internet gaming disorder; IGD-20, Internet Gaming Disorder Test–20; IGDS-SF9, Internet Gaming Disorder Scale–Short-Form; IGDT-10-P, Internet Gaming Disorder Test–10 parent-report version; K-scale, Korean Scale for Internet Addiction; MMORPG, Massively Multiplayer Online Role-Playing Game; MPH, methylphenidate; NR, not reported; OGAS, Online Game Addiction Scale; OGCAS, Online Game Cognitive Addiction Scale; PE, physical exercise; PIGDS, Parental Internet Gaming Disorder Scale; PVP, Problem Video Game Playing Scale; QA, quality assessment; RCT, randomized controlled trial; RI, response inhibition; TLFB, TimeLine Followback; YIAS, Young Internet Addiction Scale

Relapse prevention emerged as a promising approach. A 7-week relapse prevention intervention was initially assessed in a pilot pre-post study, in which clinicians explored adolescents’ motivations for behavioral change and provided guidance for goal-setting and identifying high-risk situations [34]. Participants showed significant reductions in GD severity post-treatment and at follow-up. Building on these findings, an RCT of the same intervention (delivered over 5–7 weeks) found that the intervention group experienced significantly greater reductions in GD severity at follow-up compared to the treatment-as-usual control group (e.g., counselling and medication for attention-deficit/hyperactivity disorder [ADHD]) [35].

Three studies delivered acceptance-based therapy based on CBT but provided limited information on differential treatment effects over time between groups. Two RCTs evaluated 5 weeks [36] and 8 weeks [37] of acceptance and cognitive restructuring therapy, designed to restructure negative thought patterns, enhance self-esteem and relationships, develop coping skills, and cultivate a positive and goal-oriented mindset to support behavioral change for GD. Both RCTs found significant improvements in GD severity in the treatment group, whereas the no-treatment control group did not show significant improvements post-treatment. However, these studies did not report group-by-time interaction effects. In one prepost study involving adolescents with IGD and co-occurring ADHD, 8 weeks of acceptance and commitment therapy was found to significantly reduce GD severity post-treatment [38]. This therapy focused on acceptance of urges rather than suppression, fostering present-moment awareness, cognitive defusion, and determining value-based behavioral commitments to improve GD.

CBT with a motivational approach (e.g., drawing on strengths to facilitate goal-setting and plan development) and CBT focused on emotional/behavioral regulation (e.g., reducing boredom intolerance and promoting emotion regulation skills) both demonstrated generally positive results in two studies. Specifically, one RCT found that an 8-week motivational CBT group had significantly greater reductions in GD severity and gaming duration than the waitlist control group at post-treatment and follow-up [39]. A pre-post study evaluating a 4-week regulation-focused CBT program found significant reductions in both parent- and self-reported GD severity, although no significant changes in gaming duration were observed posttreatment or at follow-up [40].

More traditional CBT approaches yielded mixed results in terms of efficacy. Two studies delivered standard CBT, one of which was an RCT that provided a 6-week program and found significant reductions in GD severity in both the treatment group and the control group (receiving basic counselling) at post-intervention [30]. However, when a different measure of severity was used (i.e., the Internet Addiction Scale instead of the Online Game Cognitive Addiction Scale), there were no significant improvements in either group. No significant group-by-time effects were observed for either severity outcome. The remaining pre-post study provided 12 sessions of CBT to adolescents with IGD, parents, and teachers and found significant reductions in GD severity and gaming duration post-treatment [29].

Family-specific interventions based on CBT demonstrated inconsistent findings. Three studies implemented 8 weeks of parental training, which covered psychoeducation on media use and addiction, effective communication strategies, and personal and gaming-related boundary-setting for parents. Training also provided adolescents with guidance on alternative recreational activities and encouraged increased awareness of risky situations that may lead to problematic gaming behaviors. Two studies involved piloting the intervention before conducting an RCT. Although the pre-post pilot study found significant reductions in parent-reported GD severity among those who attended training, there were no significant changes in parent-reported gaming duration post-treatment [32]. Furthermore, the subsequent RCT found no significant differences in parent-reported GD severity between the training and waitlist control groups post-treatment [31]. A separate pre-post study [33] found significant reductions in parent-reported GD severity post-treatment and at follow-up.

Treatment combined with CBT

As indicated in Table 1, seven studies (i.e., three pre-post studies, two RCTs, and two non-RCTs) provided a combination of CBT and other interventions, with approximately half providing family therapy as part of treatment. Family therapy, including parental training, primarily involved increasing parental understanding of GD, reducing family conflict, enhancing communication and boundary-setting, and improving problem-solving skills [41-43].

Family therapy delivered in conjunction with CBT demonstrated potential for improving GD in adolescents, although findings remain inconclusive. In a pre-post study, family-based eclectic treatment (i.e., 13 weeks of family therapy, CBT, solution-focused therapy, and motivational interviewing targeting children and mothers) led to significant reductions in parent-reported GD severity, but no significant reductions in self-reported severity post-treatment [42]. Another form of GD-specific eclectic therapy, which involved 6 months of family therapy, psychoeducation, CBT, social skills training, and relapse prevention, was evaluated in a non-RCT [44]. This study found significant reductions in GD severity in both the eclectic therapy group and a control group receiving standard CBT, but only the eclectic therapy group showed significant reductions in gaming duration. At posttreatment, significant differences in severity and duration were reported between the groups, but group-by-time interaction effects were not assessed. A separate pre-post study found that a 28-week CBT program for adolescents with psychoeducation for parents demonstrated reduced GD severity post-treatment, but there were no significant differences compared with CBT without psychoeducation [41]. Finally, a non-RCT involved participants self-selecting into a 7-day therapeutic residential camp, where they did not have access to digital devices and participated in group CBT, family activities, media literacy sessions, and outdoor recreational activities [43]. This study included three additional groups, including an 8-week parental training group, a group receiving a combination of the camp and parental training, and a waitlist control. All four groups experienced reductions in GD severity over time, with significant differences observed between groups and the control group showing a smaller reduction in GD severity.

Another therapeutic residential camp incorporating CBT was identified. This 9-day camp did not incorporate a family therapy component but included medical lectures, personal counselling, and outdoor activities [45]. Evaluated in a pre-post study, results indicated a significant reduction in gaming duration at follow-up. However, no significant changes were observed in gaming frequency. Two additional studies evaluated interventions that did not combine family therapy with CBT. One RCT assessed a 6-week physical exercise intervention combined with CBT compared to a control group receiving CBT alone [46]. The physical exercise+CBT group exhibited significantly greater reductions in GD severity posttreatment than the CBT-only group. Another RCT investigated the effects of bupropion combined with group CBT versus bupropion alone over 8 weeks [47]. During the intervention period, the bupropion+CBT group showed significantly greater reductions in GD severity and gaming duration than the bupropion-only group. However, no significant changes were observed at follow-up in either group.

Pharmacotherapy

Two RCTs examined pharmacotherapy for adolescents with GD, yielding mixed findings (Table 1). Atomoxetine and methylphenidate were compared in participants with co-occurring ADHD [48]. Participants receiving methylphenidate began treatment at 10 mg/day, gradually increasing to 40 mg/day over the first two weeks based on individual symptoms. Similarly, those receiving atomoxetine started at 10 mg/day, with doses titrated to 60 mg/day over the first two weeks, according to individual symptoms. At the post-treatment assessment, no significant differences in GD severity were observed between the two groups. Another study examined bupropion and escitalopram compared to a no-treatment control group [49]. Participants receiving bupropion initiated treatment at 150 mg/day, increasing to 300 mg/day within the first week, while participants receiving escitalopram started at 10 mg/day, with doses titrated to 20 mg/day during the same period (based on individual symptoms). Significant reductions in GD severity were observed in the bupropion and escitalopram groups, and the bupropion group showed significantly greater reductions than the escitalopram group after treatment.

Other treatment

As presented in Table 1, nine studies (i.e., five RCTs, three pre-post studies, and one non-RCT) delivered other types of treatment that were 1) not based on CBT and 2) not delivered in combination with CBT or pharmacotherapy. Though some of these treatments may have components similar to those in CBT, the authors of each study did not explicitly indicate whether the interventions were CBT-based.

Two studies delivered family-based approaches that did not involve CBT or pharmacotherapy. A pre-post study tested 3 weeks of family therapy and found significant reductions in both IGD severity and gaming duration post-intervention [50]. An RCT comparing 6 months of multidimensional family therapy and treatment-as-usual family therapy found significant reductions in GD severity in both groups, with significant differences between the groups observed post-treatment and at follow-up [51]. However, no significant changes in gaming duration were observed in either group.

Educational interventions showed positive short-term results. In one RCT, a 2-month game-based speaking and writing course led to significantly greater reductions in daily gaming duration than a general course at post-treatment [52]. Similarly, a 6-week web-based psychoeducation program for parents resulted in significant reductions in GD severity post-treatment in a pre-post study [53]. In another RCT, adolescents and parents were provided with eight sessions of health education based on the Theory of Planned Behavior. The education program led to significantly greater reductions in GD severity in the treatment group compared to the waitlist control at post-intervention, although these effects were not maintained at follow-up [54].

Two RCTs assessed interventions addressing reward sensitivity and impulsivity related to GD, including response inhibition training and attentional bias modification training. Specifically, one study reported significant reductions in GD severity in the 15-day response inhibition training group at follow-up, while the 15-day approach bias modification training group showed significant reductions post-treatment [55]. Significant reductions in GD severity for the response inhibition+ approach bias modification group were observed at both post-treatment and follow-up, whereas no significant changes were observed in the control group. There were significant differences in changes over time between at least two groups, though the specific comparisons were not reported. Another study found similarly positive results for attentional bias modification training, where the group receiving 16 days of training experienced significantly greater reductions in GD severity than the no-training group at post-treatment and follow-up [56].

The present review identified two additional interventions that were distinct from other treatment approaches. A non-RCT evaluated a 4-week motivational interviewing program for parents, which did not result in significant differences in GD severity or gaming duration compared to the no-treatment control group at post-intervention [57]. Additionally, one pre-post study delivered 8 days of group equine-assisted learning, which led to significant reductions in GD severity post-treatment and at follow-up [58].

Quality assessment

The majority (n=20, 66.7%) of studies scored a “moderate” global rating on the EPHPP Quality Assessment Tool, as shown in Table 1. Six studies (20.0%) scored “strong” and four studies (13.3%) “weak” on the global rating. Of the 14 RCTs, only three were registered in a clinical trials registry, and none had a published trial protocol [35,39,51]. Only one of the three non-RCTs was registered [43].

DISCUSSION

This systematic review identified and synthesized 30 studies on GD treatments for children and adolescents. Notably, the most recent systematic review in 2022 included only half as many studies despite incorporating broader criteria (i.e., included internet and smartphone addictions) [13], which reflects the growth of research in this emerging field. Across reviews, CBT-based treatments remained the predominant approach for younger populations, though findings were mixed and methodological quality varied. The present review found that while all CBT-based studies reported reductions in GD severity and/or gaming duration, only a third of the identified RCTs [35,39] found significantly greater improvements compared to control groups at post-treatment and follow-up. Nonetheless, CBT remains a promising avenue for further research, given its capacity to modify maladaptive cognitions associated with problematic gaming behaviors, potentially more so than pharmacological interventions [6,59,60]. The effectiveness of CBT in addressing co-occurring conditions such as depression, anxiety, and ADHD may further support its potential as a first-line therapy for GD [6]. Generally, compared to other behavioral therapies, CBT tends to be particularly durable, and this may reflect continued improvement as individuals learn, practice, and effectively implement CBT skills [61,62]. Thus, longer-term studies of CBT in populations with GD are warranted.

Despite CBT being widely regarded as a leading treatment for GD, meta-analyses of treatment studies for adolescents with internet addiction and GD have suggested that CBT combined with medication may be the most effective approach, particularly for individuals with co-occurring concerns such as ADHD and depression [63,64]. The effect of pharmacotherapy on GD in younger populations appears to be understudied, with the present review identifying only three relevant studies (two RCTs on medication alone and one RCT on CBT+medication, showing promise in short-term symptom improvement) [47-49]. In contrast, a previous review of GD treatment including adult populations reported a similar ratio of CBT to medication studies, suggesting a more balanced research focus on treatment approaches. While the relative scarcity of pharmacotherapy studies for younger populations may indicate a research gap, it may also stem from ethical considerations and uncertainties regarding long-term tolerability. Medication may complement CBT and other psychotherapeutic interventions by addressing specific symptoms, but it may not be able to replace the role of therapy in targeting cognitive and behavioral patterns that contribute to problematic gaming or in equipping adolescents with skills to self-manage co-occurring concerns [65,66]. Future trials should include long-term follow-up to examine whether pharmacotherapy, alone or in combination with CBT, offers sustained benefits for adolescents beyond the short-term symptom improvements identified in this review. Careful monitoring of tolerability may be an important component of these trials [67,68].

Several studies in this review involved or specifically targeted parents. Parental involvement in psychotherapy may enhance treatment outcomes for children and adolescents by improving engagement and adherence [69,70]. Evidence suggests that family-based interventions can help address dysfunctional dynamics, reduce parent-child conflict, and support emotional regulation, all of which are potential contributors to and consequences of GD [71-74]. Despite the benefits of parental involvement, some help-seeking youth with gaming-related harm have expressed a desire for autonomy in treatment [22]. Thus, there is also a need for approaches suitable for late adolescence that foster independence, selfefficacy, and individual skill-building, while providing the option for support from mentors, role models, or peers who can provide accountability and guidance in a way that may feel less intrusive than parental involvement [8,75,76]. Given that most interventions in the present review were CBT-based and often involved parents, expanding treatment options would be important to meet the diverse needs and preferences of adolescents with GD. Ideally, in clinical practice, treatment should be person-centered and allow children and adolescents with GD to easily transition between different types and intensities of treatment [22].

Beyond CBT-based treatment for GD, this review identified multiple novel approaches that were piloted and showed promising results. Although many of these approaches have yet to be rigorously evaluated in larger trials, they highlight the diverse and evolving landscape of GD treatment. Some interventions were particularly novel in terms of the treatment type or delivery method, such as equine-assisted learning in a South Korean study [58] and web-based psychoeducation videos for parents in an Australian study [53], both published in 2024. The former introduced a less traditional therapeutic approach, while the latter employed a familiar psychoeducational framework but through an underutilized online modality (only two of the 30 identified studies involved webbased delivery). Despite the scalability and accessibility of online interventions [77-79], their application in GD treatment remains limited, even among studies with adult treatmentseekers. A systematic review of online interventions for internet-enabled addictive behaviors in adults identified only four studies on GD and an additional eight on other addictive behaviors (e.g., online gambling, pornography use, general internet use) [8]. Furthermore, novel interventions may introduce unique considerations for future research. For example, the same review found that, while the average posttreatment retention rate was 65%, it dropped to 24% at followup [8]. The web-based psychoeducation program identified in the present review experienced a similar concern, with the highest attrition rate of 78% post-treatment. Thus, efforts to maintain engagement and improve retention rates should be a priority in developing and evaluating online GD interventions for children and adolescents.

Studies in this review assessed the severity of GD using 19 assessment tools, which reflects the lack of consensus on standardized diagnostic criteria. To date, no single assessment tool has been found to be superior for measuring GD [80,81]. In the present review, the YIAS and IGDS-SF9 were the most frequently used measures of GD severity. Although the YIAS assesses internet addiction rather than GD specifically, the present review considered it a GD severity measure because the studies that utilized it identified it as such, and those studies evaluated treatment specifically targeting GD. Similar concerns have been noted in previous reviews, highlighting the ongoing challenge of the inconsistent use of assessment tools in GD research [4,13]. This inconsistency complicates the comparability of treatment outcomes across studies, as different assessment tools may emphasize different aspects of problematic gaming. The establishment of a gold standard for assessing GD in the future may enhance cross-study comparability and ensure that reported improvements reflect meaningful clinical change. Overall, standardizing GD outcome measurement would strengthen the evidence base for effective interventions and facilitate high-quality meta-analyses.

Limitations

Study limitations warrant mention. First, the review only included studies published in English, which may limit the generalizability of findings by excluding relevant research published in other languages. Second, the review solely focused on studies in which participants had GD (e.g., met the proposed DSM-5 criteria for IGD). However, evidence suggests that a substantial proportion of treatment-seeking youth do not meet GD/IGD diagnostic criteria (64% and 39%, respectively) [82], which suggests the need to examine studies that include individuals with varying levels of problematicgaming severity to better understand intervention effectiveness across the GD severity spectrum. For instance, a previous pre-post study included individuals seeking to reduce gaming regardless of severity, provided they experienced gaming-related harm and demonstrated motivation to change [83]. Finally, the review was limited to published studies, which may have introduced publication bias and excluded relevant findings from gray literature.

Conclusion

Research on GD treatment for children and adolescents has expanded in recent years but remains in its early stages, as evidenced by the limited number of RCTs (i.e., only half of the 30 identified studies). This review found that interventions based on or delivered in combination with CBT were the most frequently studied approaches. Multiple other treatments, from bupropion to equine-assisted therapy, were explored in fewer studies. While findings suggest the potential efficacy of emerging GD interventions, the current evidence base appears highly variable in quality, with many studies lacking longer-term follow-up assessments, control groups, and randomization. Additionally, inconsistencies in the measurement of GD severity may further limit the comparability of results across studies. To establish evidence-based treatment guidelines for children and adolescents, future research should employ rigorous study designs, standardized assessment tools, and longer-term evaluation of treatment effects.