Neural correlates of problematic gaming in adolescents: A systematic review of structural and functional magnetic resonance imaging studies

The addictive use of digital games (problematic gaming [PG]) is a phenomenon with rising prevalence, especially in adolescents. The period of adolescence is characterized by intense brain maturation processes and increased vulnerability for mental disorders. However, no recent systematic review on functional and structural neural correlates of PG is available exclusively for this age group. This paper aimed to close this gap by describing neuroimaging findings and derive clinical implications. A systematic literature search was performed via PubMed, PsycInfo, and PSYNDEX including magnetic resonance imaging (MRI) studies on structural and functional changes in problematic gamers under 20 years of age until December 2020. The findings suggest especially prefrontal brain areas (important for cognitive control functions) but also temporoparietal regions (associated with attention processes and self-concepts), as well as frontolimbic and subcortical regions (connected to emotion regulation and reward processing) to be significantly altered in adolescents with PG compared with healthy controls. Reduced interhemispheric connectivity and altered network activity further support theories of neurofunctional imbalance as well as structural deficits to explain addictive behaviours. Based on these findings, interventions should specifically address executive and cognitive-affective deficits together with adolescent-specific developmental tasks such as personality formation. Methodological limitations including heterogeneous PG classifications need to be considered. Additional neuroimaging studies on PG based on the DSM-5 or ICD-11 framework for the (Internet) gaming disorder in adolescents with larger sample sizes and prospective designs are highly warranted to understand potential causality and to generate valid and reproducible results.