Shared and Unique Patterns of Dysregulated Dual Systems Between Adolescent Problematic Video Gaming and ADHD

Abstract

The association between problematic video gaming (PVG) and ADHD has long attracted attention. Dual-systems models posit that reward sensitivity (RS, the tendency to pursue rewards), inhibitory control (IC, the capacity to suppress prepotent responses), and the imbalance between them (where one system predominates over the other) constitute a useful framework for explaining their association. However, empirical tests of whether and how specific dual-system mechanisms explain the association or phenotypic differentiation of PVG and ADHD remain limited. We hypothesize that (H1) both RS and IC predict PVG and ADHD symptoms; (H2) the degree of imbalance between RS and IC is associated with both PVG and ADHD. Additionally, we explore whether the specific associations between imbalance and symptoms differ between PVG and ADHD. Two waves of data from 10,973 participants (52.43% male, aged 12–14 years) from the Adolescent Brain Cognitive Development (ABCD) study were analyzed. Cross-lagged panel models (CLPM) and Response Surface Analysis (RSA) were used to assess shared and unique relationships of RS, IC, and their imbalance with PVG and ADHD. CLPM analyses found that RS predicted subsequent IC, IC predicted subsequent ADHD, and ADHD predicted subsequent PVG, suggesting H1 was only partially supported. RSA revealed that a greater degree of imbalance was associated with more severe PVG and ADHD symptoms (supporting H2), and that imbalance configurations exhibited both shared and disorder-specific patterns between PVG and ADHD. Specifically, reward sensitivity showed a linear association with PVG but a curvilinear association with ADHD, and IC correlated with ADHD only. We observed similarities between PVG and ADHD in the degree of dual-systems imbalance, alongside differences in imbalance configuration. These findings provide theoretical insight into dual-systems features linking PVG and ADHD and may inform future research on early identification and prevention in high-risk populations.

Keywords

ADHD / dual-systems / inhibitory control / problematic video gaming / reward sensitivity / transdiagnostic

References

[1] Achenbach, T. M.2015. “Achenbach System of Empirically Based Assessment (ASEBA).” In The Encyclopedia of Clinical Psychology, edited by R. L. Cautin and S. O. Lilienfeld. John Wiley & Sons, Ins. https://doi.org/10.1002/9781118625392.wbecp150.

[2] Adisetiyo, V., and K. M. Gray. 2017. “Neuroimaging the Neural Correlates of Increased Risk for Substance Use Disorders in Attention-Deficit/Hyperactivity Disorder-A Systematic Review: Neuroimaging ADHD at High Risk for SUD.” American Journal on Addictions 26, no. 2: 99–111. https://doi.org/10.1111/ajad.12500.

[3] Andreassen, C. S., T. Torsheim, G. S. Brunborg, and S. Pallesen. 2012. “Development of a Facebook Addiction Scale.” Psychological Reports 110: 501–517.

[4] Asendorpf, J. B.2021. “Modeling Developmental Processes.” In The Handbook of Personality Dynamics and Processes, edited by J. F. Rauthmann, 815–835. Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-813995-0.00031-5.

[5] Barch, D. M., M. D. Albaugh, S. Avenevoli, et al. 2018. “Demographic, Physical and Mental Health Assessments in the Adolescent Brain and Cognitive Development Study: Rationale and Description.” Developmental Cognitive Neuroscience 32: 55–66. https://doi.org/10.1016/j.dcn.2017.10.010.

[6] Barkley, R. A.1997. “Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing a Unifying Theory of ADHD.” Psychological Bulletin 121, no. 1: 65–94. https://doi.org/10.1037/0033-2909.121.1.65.

[7] Carver, C. S., and T. L. White. 1994. “Behavioral Inhibition, Behavioral Activation, and Affective Responses to Impending Reward and Punishment: The BIS/BAS Scales.” Journal of Personality and Social Psychology 67, no. 2: 319–333. https://doi.org/10.1037/0022-3514.67.2.319.

[8] Casey, B. J., S. Getz, and A. Galvan. 2008. “The Adolescent Brain.” Developmental Review 28, no. 1: 62–77. https://doi.org/10.1016/j.dr.2007.08.003.

[9] Castellanos-Ryan, N., M. Struve, R. Whelan, et al. 2014. “Neural and Cognitive Correlates of the Common and Specific Variance Across Externalizing Problems in Young Adolescence.” American Journal of Psychiatry 171, no. 12: 1310–1319. https://doi.org/10.1176/appi.ajp.2014.13111499.

[10] Centers for Disease Control and Prevention. 2024. “Data and Statistics on ADHD.”

[11] Chaarani, B., J. Ortigara, D. Yuan, H. Loso, A. Potter, and H. P. Garavan. 2022. “Association of Video Gaming With Cognitive Performance Among Children.” JAMA Network Open 5, no. 10: e2235721. https://doi.org/10.1001/jamanetworkopen.2022.35721.

[12] Chen, C., S. Zhang, H. Hong, et al. 2024. “Psychometric Properties of the Chinese Version of the Quick Delay Questionnaire (C-QDQ) and Ecological Characteristics of Reward-Delay Impulsivity of Adults With ADHD.” BMC Psychiatry 24, no. 1: 251. https://doi.org/10.1186/s12888-024-05706-2.

[13] Constantinidis, C., and B. Luna. 2019. “Neural Substrates of Inhibitory Control Maturation in Adolescence.” Trends in Neurosciences 42, no. 9: 604–616. https://doi.org/10.1016/j.tins.2019.07.004.

[14] Dong, G., and M. N. Potenza. 2014. “A Cognitive-Behavioral Model of Internet Gaming Disorder: Theoretical Underpinnings and Clinical Implications.” Journal of Psychiatric Research 58: 7–11. https://doi.org/10.1016/j.jpsychires.2014.07.005.

[15] Dong, H., H. Zheng, M. Wang, S. Ye, and G. H. Dong. 2022. “The Unbalanced Behavioral Activation and Inhibition System Sensitivity in Internet Gaming Disorder: Evidence From Resting-State Granger Causal Connectivity Analysis.” Progress in Neuro-Psychopharmacology and Biological Psychiatry 119: 110582. https://doi.org/10.1016/j.pnpbp.2022.110582.

[16] Duell, N., L. Steinberg, J. Chein, et al. 2016. “Interaction of Reward Seeking and Self-Regulation in the Prediction of Risk Taking: A Cross-National Test of the Dual Systems Model.” Developmental Psychology 52, no. 10: 1593–1605. https://doi.org/10.1037/dev0000152.

[17] Evans, J. S. B. T., and K. E. Stanovich. 2013. “Dual-Process Theories of Higher Cognition: Advancing the Debate.” Perspectives on Psychological Science 8, no. 3: 223–241. https://doi.org/10.1177/1745691612460685.

[18] Fairchild, G.2011. “The Developmental Psychopathology of Motivation in Adolescence.” Developmental Cognitive Neuroscience 1, no. 4: 414–429. https://doi.org/10.1016/j.dcn.2011.07.009.

[19] Ferguson, C. J., and T. A. Ceranoglu. 2014. “Attention Problems and Pathological Gaming: Resolving the ‘Chicken and Egg’ in a Prospective Analysis.” Psychiatric Quarterly 85, no. 1: 103–110. https://doi.org/10.1007/s11126-013-9276-0.

[20] Funder, D. C., and D. J. Ozer. 2019. “Evaluating Effect Size in Psychological Research: Sense and Nonsense.” Advances in Methods and Practices in Psychological Science 2, no. 2: 156–168. https://doi.org/10.1177/2515245919847202.

[21] Garavan, H., H. Bartsch, K. Conway, et al. 2018. “Recruiting the ABCD Sample: Design Considerations and Procedures.” Developmental Cognitive Neuroscience 32: 16–22. https://doi.org/10.1016/j.dcn.2018.04.004.

[22] Grassi, G., C. Moradei, and C. Cecchelli. 2024. “Prevalence and Clinical Phenotypes of Adult Patients With Attention Deficit Hyperactivity Disorder and Comorbid Behavioral Addictions.” Journal of Behavioral Addictions 13: 473–481. https://doi.org/10.1556/2006.2024.00020.

[23] Han, D. H., Y. S. Lee, C. Na, et al. 2009. “The Effect of Methylphenidate on Internet Video Game Play in Children With Attention-Deficit/Hyperactivity Disorder.” Comprehensive Psychiatry 50, no. 3: 251–256. https://doi.org/10.1016/j.comppsych.2008.08.011.

[24] He, X., Y. Chen, W. Zhang, and C.-S. R. Li. 2025. “Elevated Loss Sensitivity in the Reward Circuit in Adolescents With Video Game but Not Social Media Addiction.” Computers in Human Behavior 165: 108554. https://doi.org/10.1016/j.chb.2025.108554.

[25] L. Hechtman, ed. 2016. Attention Deficit Hyperactivity Disorder. Vol. 1. Oxford University Press. https://doi.org/10.1093/med/9780190213589.001.0001.

[26] Jeong, E. J., C. J. Ferguson, and S. J. Lee. 2019. “Pathological Gaming in Young Adolescents: A Longitudinal Study Focused on Academic Stress and Self-Control in South Korea.” Journal of Youth and Adolescence 48, no. 12: 2333–2342. https://doi.org/10.1007/s10964-019-01065-4.

[27] Karaca, S., A. Saleh, F. Canan, and M. N. Potenza. 2017. “Comorbidity Between Behavioral Addictions and Attention Deficit/Hyperactivity Disorder: A Systematic Review.” International Journal of Mental Health and Addiction 15, no. 3: 701–724. https://doi.org/10.1007/s11469-016-9660-8.

[28] Kim, D., D. Lee, J. Lee, K. Namkoong, and Y.-C. Jung. 2017. “Association Between Childhood and Adult Attention Deficit Hyperactivity Disorder Symptoms in Korean Young Adults With Internet Addiction.” Journal of Behavioral Addictions 6, no. 3: 345–353. https://doi.org/10.1556/2006.6.2017.044.

[29] Knoch, D., L. R. R. Gianotti, A. Pascual-Leone, et al. 2006. “Disruption of Right Prefrontal Cortex by Low-Frequency Repetitive Transcranial Magnetic Stimulation Induces Risk-Taking Behavior.” Journal of Neuroscience 26, no. 24: 6469–6472. https://doi.org/10.1523/JNEUROSCI.0804-06.2006.

[30] Koncz, P., Z. Demetrovics, Z. K. Takacs, M. D. Griffiths, T. Nagy, and O. Király. 2023. “The Emerging Evidence on the Association Between Symptoms of ADHD and Gaming Disorder: A Systematic Review and Meta-Analysis.” Clinical Psychology Review 106: 102343. https://doi.org/10.1016/j.cpr.2023.102343.

[31] Li, Q., Y. Wang, Z. Yang, et al. 2020. “Dysfunctional Cognitive Control and Reward Processing in Adolescents With Internet Gaming Disorder.” Psychophysiology 57, no. 2: e13469. https://doi.org/10.1111/psyp.13469.

[32] Lindgren, K. P., C. S. Hendershot, J. J. Ramirez, et al. 2019. “A Dual Process Perspective on Advances in Cognitive Science and Alcohol Use Disorder.” Clinical Psychology Review 69: 83–96. https://doi.org/10.1016/j.cpr.2018.04.002.

[33] Liu, H., X. Qiao, and X. Shi. 2025. “Longitudinal Associations Between Sleep Disturbance Trajectories and Internet Gaming Disorder Mediated by Self-Control: A Six-Wave Longitudinal Investigation.” Psychology Research and Behavior Management 18: 169–180. https://doi.org/10.2147/PRBM.S488974.

[34] Luman, M., J. Oosterlaan, D. L. Knol, and J. A. Sergeant. 2008. “Decision-Making in ADHD: Sensitive to Frequency but Blind to the Magnitude of Penalty?” Journal of Child Psychology and Psychiatry 49, no. 7: 712–722. https://doi.org/10.1111/j.1469-7610.2008.01910.x.

[35] Luman, M., G. Tripp, and A. Scheres. 2010. “Identifying the Neurobiology of Altered Reinforcement Sensitivity in ADHD: A Review and Research Agenda.” Neuroscience & Biobehavioral Reviews 34, no. 5: 744–754. https://doi.org/10.1016/j.neubiorev.2009.11.021.

[36] Luna, B., and C. Wright. 2016. “Adolescent Brain Development: Implications for the Juvenile Criminal Justice System.” In APA Handbook of Psychology and Juvenile Justice, edited by K. Heilbrun, D. DeMatteo, and N. E. S. Goldstein, 91–116. American Psychological Association. https://doi.org/10.1037/14643-005.

[37] Marrero, R. J., A. Fumero, D. Voltes, M. González, and W. Peñate. 2021. “Individual and Interpersonal Factors Associated With the Incidence, Persistence, and Remission of Internet Gaming Disorders Symptoms in an Adolescents Sample.” International Journal of Environmental Research and Public Health 18, no. 21: 11638. https://doi.org/10.3390/ijerph182111638.

[38] Meisel, S. N., W. D. Fosco, L. W. Hawk, and C. R. Colder. 2019. “Mind the Gap: A Review and Recommendations for Statistically Evaluating Dual Systems Models of Adolescent Risk Behavior.” Developmental Cognitive Neuroscience 39: 100681. https://doi.org/10.1016/j.dcn.2019.100681.

[39] Meng, S.-Q., J.-L. Cheng, Y.-Y. Li, et al. 2022. “Global Prevalence of Digital Addiction in General Population: A Systematic Review and Meta-Analysis.” Clinical Psychology Review 92: 102128. https://doi.org/10.1016/j.cpr.2022.102128.

[40] Murray, A. L., X. Zhu, J. H. Mirman, D. Ribeaud, and M. Eisner. 2021. “An Evaluation of Dual Systems Theories of Adolescent Delinquency in a Normative Longitudinal Cohort Study of Youth.” Journal of Youth and Adolescence 50, no. 7: 1293–1307. https://doi.org/10.1007/s10964-021-01433-z.

[41] Nestler, S., S. Humberg, and F. D. Schönbrodt. 2019. “Response Surface Analysis With Multilevel Data: Illustration for the Case of Congruence Hypotheses.” Psychological Methods 24, no. 3: 291–308. https://doi.org/10.1037/met0000199.

[42] Orth, U., D. A. Clark, M. B. Donnellan, and R. W. Robins. 2021. “Testing Prospective Effects in Longitudinal Research: Comparing Seven Competing Cross-Lagged Models.” Journal of Personality and Social Psychology 120, no. 4: 1013–1034. https://doi.org/10.1037/pspp0000358.

[43] Owens, M. M., A. Potter, C. S. Hyatt, et al. 2021. “Recalibrating Expectations About Effect Size: A Multi-Method Survey of Effect Sizes in the ABCD Study.” PLoS One 16, no. 9: e0257535. https://doi.org/10.1371/journal.pone.0257535.

[44] Pang, T., L. Yang, Y. Liu, and S. Chang. 2025. “The Trajectory of Attention Deficit Hyperactivity Disorder Symptoms and Its Dynamic Relationship With Inhibitory Control.” Journal of Child Psychology and Psychiatry jcpp.14112: 980–993. https://doi.org/10.1111/jcpp.14112.

[45] Peeters, M., T. Oldehinkel, and W. Vollebergh. 2017. “Behavioral Control and Reward Sensitivity in Adolescents' Risk Taking Behavior: A Longitudinal TRAILS Study.” Frontiers in Psychology 8: 231. https://doi.org/10.3389/fpsyg.2017.00231.

[46] Persson, E., M. Heilig, G. Tinghög, and A. J. Capusan. 2020. “Using Quantitative Trait in Adults With ADHD to Test Predictions of Dual-Process Theory.” Scientific Reports 10: 20076. https://doi.org/10.1038/s41598-020-76923-4.

[47] Pfeifer, J. H., and N. B. Allen. 2016. “The Audacity of Specificity: Moving Adolescent Developmental Neuroscience Towards More Powerful Scientific Paradigms and Translatable Models.” Developmental Cognitive Neuroscience 17: 131–137. https://doi.org/10.1016/j.dcn.2015.12.012.

[48] Rhodes, J. D., C. R. Colder, E. M. Trucco, et al. 2013. “The Interaction Between Self-Regulation and Motivation Prospectively Predicting Problem Behavior in Adolescence.” Journal of Clinical Child & Adolescent Psychology 42, no. 5: 681–692. https://doi.org/10.1080/15374416.2013.773515.

[49] Romer, D., V. F. Reyna, and T. D. Satterthwaite. 2017. “Beyond Stereotypes of Adolescent Risk Taking: Placing the Adolescent Brain in Developmental Context.” Developmental Cognitive Neuroscience 27: 19–34. https://doi.org/10.1016/j.dcn.2017.07.007.

[50] Rueda, M. R., J. Fan, B. D. McCandliss, et al. 2004. “Development of Attentional Networks in Childhood.” Neuropsychologia 42, no. 8: 1029–1040. https://doi.org/10.1016/j.neuropsychologia.2003.12.012.

[51] Scheres, A., M. Balan, M. Paraskevopoulou, and A. Schellekens. 2024. “Preference for Immediate Rewards in Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder: A Shared Intermediate Phenotype?” Current Addiction Reports 11, no. 4: 607–615. https://doi.org/10.1007/s40429-024-00558-y.

[52] Schönbrodt, F. D.2015. “RSA: An R Package for Response Surface Analysis (Version 0.9.7) [Computer Software].”

[53] Senkowski, D., T. Ziegler, M. Singh, et al. 2024. “Assessing Inhibitory Control Deficits in Adult ADHD: A Systematic Review and Meta-Analysis of the Stop-Signal Task.” Neuropsychology Review 34, no. 2: 548–567. https://doi.org/10.1007/s11065-023-09592-5.

[54] Shiels, K., and L. W. Hawk. 2010. “Self-Regulation in ADHD: The Role of Error Processing.” Clinical Psychology Review 30, no. 8: 951–961. https://doi.org/10.1016/j.cpr.2010.06.010.

[55] Shulman, E. P., A. R. Smith, K. Silva, et al. 2016. “The Dual Systems Model: Review, Reappraisal, and Reaffirmation.” Developmental Cognitive Neuroscience 17: 103–117. https://doi.org/10.1016/j.dcn.2015.12.010.

[56] Soares, L., L. B. Thorell, M. Barbi, G. Crisci, S. B. Nutley, and J. Burén. 2023. “The Role of Executive Function Deficits, Delay Aversion and Emotion Dysregulation in Internet Gaming Disorder and Social Media Disorder: Links to Psychosocial Outcomes.” Journal of Behavioral Addictions 12, no. 1: 94–104. https://doi.org/10.1556/2006.2023.00007.

[57] Sonuga-Barke, E. J. S.2003. “The Dual Pathway Model of AD/HD: An Elaboration of Neuro-Developmental Characteristics.” Neuroscience & Biobehavioral Reviews 27, no. 7: 593–604. https://doi.org/10.1016/j.neubiorev.2003.08.005.

[58] Steinberg, L.2008. “A Social Neuroscience Perspective on Adolescent Risk-Taking.” Developmental Review 28, no. 1: 78–106. https://doi.org/10.1016/j.dr.2007.08.002.

[59] Sugaya, N., T. Shirasaka, K. Takahashi, and H. Kanda. 2019. “Bio-Psychosocial Factors of Children and Adolescents With Internet Gaming Disorder: A Systematic Review.” BioPsychoSocial Medicine 13: 3. https://doi.org/10.1186/s13030-019-0144-5.

[60] Sun, T. H., J. W. Yeom, K.-Y. Choi, et al. 2023. “Potential Effectiveness of Digital Therapeutics Specialized in Executive Functions as Adjunctive Treatment for Clinical Symptoms of Attention-Deficit/Hyperactivity Disorder: A Feasibility Study.” Frontiers in Psychiatry 14: 1169030. https://doi.org/10.3389/fpsyt.2023.1169030.

[61] Tang, D., and Z. Wen. 2002. “Statistical Approaches for Testing Common Method Bias: Problems and Suggestions.” Journal of Psychological Science 43, no. 1: 215–223. https://doi.org/10.16719/j.cnki.1671-6981.20200130.

[62] Tejeiro Salguero, R. A., and R. M. B. Morán. 2002. “Measuring Problem Video Game Playing in Adolescents.” Addiction 97, no. 12: 1601–1606. https://doi.org/10.1046/j.1360-0443.2002.00218.x.

[63] Thorell, L. B.2007. “Do Delay Aversion and Executive Function Deficits Make Distinct Contributions to the Functional Impact of ADHD Symptoms? A Study of Early Academic Skill Deficits.” Journal of Child Psychology and Psychiatry 48, no. 11: 1061–1070. https://doi.org/10.1111/j.1469-7610.2007.01777.x.

[64] Van Den Bos, W., and B. Eppinger. 2016. “Developing Developmental Cognitive Neuroscience: From Agenda Setting to Hypothesis Testing.” Developmental Cognitive Neuroscience 17: 138–144. https://doi.org/10.1016/j.dcn.2015.12.011.

[65] Van Ewijk, H., A. P. Groenman, M. P. Zwiers, et al. 2015. “Smoking and the Developing Brain: Altered White Matter Microstructure in Attention-Deficit/Hyperactivity Disorder and Healthy Controls.” Human Brain Mapping 36, no. 3: 1180–1189. https://doi.org/10.1002/hbm.22695.

[66] Wang, X., and T. Feng. 2023. “The Mechanism of “Cool/Hot” Executive Function Deficit Acting on the Core Symptoms of ADHD Children.” Advances in Psychological Science 31, no. 11: 2106–2128. https://doi.org/10.3724/SP.J.1042.2023.02106.

[67] Wartberg, L., L. Kriston, M. Zieglmeier, T. Lincoln, and R. Kammerl. 2019. “A Longitudinal Study on Psychosocial Causes and Consequences of Internet Gaming Disorder in Adolescence.” Psychological Medicine 49, no. 2: 287–294. https://doi.org/10.1017/S003329171800082X.

[68] Wasserman, A. M., L. J. Crockett, and L. Hoffman. 2017. “Reward Seeking and Cognitive Control: Using the Dual Systems Model to Predict Adolescent Sexual Behavior.” Journal of Research on Adolescence 27, no. 4: 907–913. https://doi.org/10.1111/jora.12321.

[69] Wei, L., S. Zhang, O. Turel, A. Bechara, and Q. He. 2017. “A Tripartite Neurocognitive Model of Internet Gaming Disorder.” Frontiers in Psychiatry 8: 285. https://doi.org/10.3389/fpsyt.2017.00285.

[70] Weintraub, S., S. S. Dikmen, R. K. Heaton, et al. 2014. “The Cognition Battery of the NIH Toolbox for Assessment of Neurological and Behavioral Function: Validation in an Adult Sample.” Journal of the International Neuropsychological Society 20, no. 6: 567–578. https://doi.org/10.1017/s1355617714000320.

[71] Zhang, Q., and J. J. Li. 2022. “Explaining the Prospective Association of Positive and Negative Parenting Behaviors and Child ADHD Symptoms: Pathways Through Child Executive Function and Reward Responsivity.” Journal of Attention Disorders 26, no. 13: 1774–1787. https://doi.org/10.1177/10870547221104079.

[72] Zhao, T., Y. Zhang, Y. Li, et al. 2024. “Resting-State Brain Networks Alterations in Adolescents With Internet Gaming Disorder Associate With Cognitive Control Impairments.” Frontiers in Psychiatry 15: 1404050. https://doi.org/10.3389/fpsyt.2024.1404050.

[73] Zhou, Y., M. Yao, S. Fang, and X. Gao. 2022. “A Dual-Process Perspective to Explore Decision Making in Internet Gaming Disorder: An ERP Study of Comparison With Recreational Game Users.” Computers in Human Behavior 128: 107104. https://doi.org/10.1016/j.chb.2021.107104.

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