Expert consensus on diagnostic criteria for assessing video gaming disorder: a Delphi study Members of the study: Jesús Castro-Calvo (University of Valencia, project coordinator) Joël Billieux (University of Luxembourg, project leader) Naomi Fineberg (Hertfordshire Partnership University NHS Foundation trust, Management committee Chair) Samuel Robin Chamberlain (University of Cambridge, Management of Workgroup 1) Zsolt Demetrovics (Eötvös Loránd University, member of Workgroup 1) Matthias Brand (University of Duisburg-Essen, member of Workgroup 1) Daniel King (University of Adelaide, member of Workgroup 1) Lior Carmi (Tel Aviv University, member of Workgroup 1) Murat Yücel (Monash University, member of Workgroup 1) Hans-Jürgen Rumpf (University of Lübeck, member of Workgroup 1)
Transcript
Expert consensus on diagnostic criteria for assessing video
gaming disorder: a Delphi study
Members of the study:
Jesús Castro-Calvo (University of Valencia, project coordinator)
Joël Billieux (University of Luxembourg, project leader)
Naomi Fineberg (Hertfordshire Partnership University NHS Foundation trust, Management committee Chair)
Samuel Robin Chamberlain (University of Cambridge, Management of Workgroup 1)
Zsolt Demetrovics (Eötvös Loránd University, member of Workgroup 1)
Matthias Brand (University of Duisburg-Essen, member of Workgroup 1)
Daniel King (University of Adelaide, member of Workgroup 1)
Lior Carmi (Tel Aviv University, member of Workgroup 1)
Murat Yücel (Monash University, member of Workgroup 1)
Hans-Jürgen Rumpf (University of Lübeck, member of Workgroup 1)
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Disclosure of conflict of interest
Name of the author: Jesús Castro Calvo
The author declare no COI.
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Rationale behind this study
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GD has been recognized as a clinical condition by the DSM and the ICD:
Rationale behind this study
DSM-5 (section 3 –conditions for further study–): nine criteria to define Internet Gaming Disorder (IGD).
ICD-11 (Disorders due to addictive behaviors): Three criteria to define Gaming Disorder (GD).
…they are used in an increasing number of studies (i.e., epidemiological studies) (e.g., Rehbein, Kliem, Baier, Mößle, & Petry, 2015)
…they are used in the creation of several screening instruments (e.g., Király et al., 2017)
…they are used in the diagnosis of individuals presenting with mental health issues related to persistent gaming.
Although establishing the validity of GD criteria is still an ongoing process…
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Some scholars still claim against the recognition of this clinical condition (van Rooij et al., 2018).
There is a lack of consensus regarding basic aspects of GD diagnosis !
Some criteria included in the DSM-5 fail to distinguish high involvement from pathological gaming (Billieux et al., 2017).
Rationale behind this study
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An international consensus for assessing internet gaming disorder using the new DSM-5 approach (Petry et al., 2014):
Rationale behind this study
Aim: “achieve consensus about assessing internet gaming disorder as defined within DSM-5” (p. 1399).
Results: eight comments and debate papers have been published in response to this work.
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An international consensus for assessing internet gaming disorder using the new DSM-5 approach (Petry et al., 2014):
Rationale behind this study
Aim: “achieve consensus about assessing internet gaming disorder as defined within DSM-5” (p. 1399).
Results: eight comments and debate papers has been published in response to this work.
Limitations: 1) Low representativeness of experts in this study.
Limitations: 2) Criteria for selecting members of the expert’s panel were not clearly stated.
Limitations: 3) Countries that have generated substantial knowledge in the field were not represented.
4) Authors did not apply any structured approach to achieve the consensus between experts.
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To explore renowned experts’ appraisal of criteria for assessing gaming disorder:
Study aim
Using a structured approach to reach consensus.
Using transparent criteria to select representative experts.
Selecting experts from an international perspective.
Delphi technique
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Delphi Research design
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Structured method for gathering data from experts respondents with the aim of achieving consensus (Diamond et al., 2014).
Delphi technique in a nutshell
Anonymity between participants…
Controlled feedback provided in a structured manner…
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Facilitator responsible for methodology planning, recruitment of the experts and compilation of statements that experts will rate for the agreement.
Delphi technique in a nutshell
Facilitator gather responses from the members of the group using a pre-designed questionnaire and giving the possibility to add new statements.
Facilitator gives individualized feedback to experts about how their answers fit in with the answers of the rest of the panel before answering the new survey.
The Delphi study finishes when a pre-stablished level of consensus is achieved OR when responses are stable between rounds.
Statements that reach a pre-stablished level of consensus (to be included or to be excluded) are not rated in subsequent rounds.X
Experts are able to revise their responses and adopt group consensus or maintain their answers (explaining the rationale behind the decision).X
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Delphi Research design
Selecting the
expert panel
Definition: Experts were defined as «renowned professionals with clinical and/or research experience in Gaming Disorder».
- Operational criteria for assessing clinical experience: number of years treating patients with GD.
- Operational criteria for assessing research experience: number of papers related to GD published in peer-review journals as first/senior author.
Experts with both clinical and research experience.
Experts with large clinical experience (>5 years) but not research experience OR experts with large research experience (>20 papers) but not clinical experience.
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Selection and recruitment of the panel of experts:
I. Identification of potential worldwide experts with clinical and/or research experience on GD (~200 experts).
II. Selection and initial contacts with 40 selected experts.
III. 30 experts matched the criteria and were included in the experts’ panel.
Delphi Research design
Selecting the
expert panel
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20Countries
Delphi Research design
Selecting the
expert panel
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7.96
20.30
Average years assessing and treating patients with GD
Papers published on GD as first/senior author
Delphi Research design
Selecting the
expert panel
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Delphi Research design
Constructing the
questionnaireAssessment: 1) Source: DSM-5 and ICD-11 criteria to diagnose Gaming Disorder.
2) Items: Three questions for each DSM-5 and ICD-11 criteria.
Clinical validity
To what extent do you feel that this criterion is important in the manifestation of treatment-seeking gaming/pathological gaming?
Prognostic value
To what extent do you consider this criterion important to predict the chronicity –persistence and relapse– of pathological video game use?
Clinical utility
To what extent do you consider this criterion important as being able to distinguish normal from pathological videogame use?
3) Rating: 5-point Likert scale from 1 (unimportant) to 5 (extremely important), avoiding neutral mid-point (3 = moderately important).
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Delphi Research design
Definition of
consensusDecision: Rule proposed first by Langlands et al. (2007) and later by Law and Morrison (Law & Morrison, 2014).
- Inclusion consensus: items rated by 80% or more experts as “extremely important” or “very important” in the diagnosis of GD.
- Exclusion consensus: items rated by 80% or more experts as “unimportant” , “slightly” or “moderately important” .
- Re-rate: items that did not meet the above 2 conditions will be re-rated in the next study rounds.
Results
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DSM-5 Criteria (IGD)
Criteria Clinical utility Clinical validity Prognosis value
Criteria 1. Preoccupation.
Criteria 2. Withdrawal.
Criteria 3. Tolerance.
Criteria 4. Unsuccessful control attempts
Criteria 5. Loss of interests in previous hobbies and entertainment
Criteria 6. Continued use despite psychosocial problems.
Criteria 7. Deception (family members, therapists, or others).
Criteria 8. Mood regulation
Criteria 9. Jeopardized relationship / job / educational or career opportunity
Consensus for inclusion (relevant criterion)
Consensus for exclusion (irrelevant criterion)
Consensus in round 1 Consensus in round 2
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ICD-11 Diagnostic guidelines (GD)
Criteria Clinical utility Clinical validity Prognosis value
Diagnostic guideline 1. Impaired control
Diagnostic guideline 2. Loss of interest
Diagnostic guideline 3. Continued use
Diagnostic guideline 4. Functional Impairment
Consensus for inclusion (relevant criterion)
Consensus for exclusion (irrelevant criterion)
Consensus in round 1 Consensus in round 2
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Additional criteria suggested by experts
Criteria Clinical utility Clinical validity Prognosis value
Health consequences
Craving
Dissociation-like symptoms
Consensus for inclusion (relevant criterion)
Consensus for exclusion (irrelevant criterion)
Consensus in round 1 Consensus in round 2 Consensus in round 3
I. Health consequences resulting from gaming activity (e.g., significant sleep deprivation or changes in sleep patterns, significant weight changes due to a reduction of food intake
or due to extended periods of physical inactivity, back or wrist pain, etc.).
II. Craving or a strong desire or urge to play video games.
III. Dissociative-like symptoms while or after playing videogames (deep and absorbed state of consciousness while gaming, loss of time perception, deep immersion, inattention
to events happening around during gaming sessions or difficulty distinguishing games and real life).
Conclusions
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Some DSM-5 IGD criteria failed to reach consensus among experts using a structured approach.
Conclusions points
Three DSM-5 IGD criteria were considered irrelevant by >80% of the experts.
ICD-11 current GD criteria seems well positioned among researchers and clinicians to adequately diagnose GD.
I. Tolerance
II. Deception
III. Mood regulation
DSM-5 IGD criteria that reached consensus for inclusion were those who resembles ICD diagnostic guidelines.
Health consequences derived from gaming are considered as relevant as other “core criteria” for GD diagnosis.
