New research has shown that video games can change the brains of teenagers. But reducing screen time has seen remarkable repairs.
It was in the middle of the night 18 months ago when Jude realised her teenage son Rhys had developed a serious problem with video games.
"I found him commando-crawling out of my bedroom, trying to take a device I'd hidden away," she said. "It just hit me in that moment, we're in trouble."
Jude had already tried everything she could think of to moderate her son's excessive gaming.
She locked away devices at night, switched off the home internet connection and installed apps to restrict his screen time. But nothing worked.
Rhys's behaviour only spiralled, especially during the pandemic lockdowns, when Rhys was home from school and gaming for up to nine hours a day.
On occasion, if he wasn't allowed to game, he would smash laptops and phones.
"It's living on the edge, never quite knowing what's going to happen," she told Australian Story.
Jude had no idea where to turn.
Across Australia, tens of thousands of parents are experiencing the same frustrations when trying to regulate their teenage children's screen time, according to Macquarie University psychologist associate professor Dr Wayne Warburton, who specialises in problem gaming.
According to his research, as many as 10 per cent of kids who game meet the criteria for "hazardous gaming" while 3 per cent of that group could be diagnosed with a more serious "gaming disorder".
"The research is pretty clear that with screen addiction it's quite common for the kids to become quite aggressive and sometimes quite violent when the screens are taken away," Dr Warburton said.
He believes this volatile behaviour may stem from changes to the brain caused by excessive gaming, which could impact the pre-frontal cortex, making it difficult for teenagers to regulate their emotions, focus on tasks and function in the offline world.
It's often referred to as "gaming addiction", although the term is controversial among experts in this rapidly evolving field of research.
Nevertheless, for the small minority of teenagers who become problem gamers, the result can be a raft of compulsive and anti-social behaviours.
In other cases, Dr Warburton has observed, children have become so violent when screens were taken away that their parents have had to take out an apprehended violence order.
"I've seen kids who are very depressed, very anxious, sometimes suicidal," he said.
Convinced that the problem with excessive gaming is about how it re-wires the brain, Dr Warburton has been devising a solution he hopes can reverse the changes to young minds.
For the past three years, he's been working with German psychiatrist Dr Kerstin Paschke and her team at the German Centre for Addiction Research in Childhood and Adolescence, a Hamburg-based research institution which has developed a program to help teenagers who are gaming excessively.
The program has shown such promising results in Germany that Dr Warburton set about revising it for "Australian conditions" in the hope it can be used to treat problem gamers here.
Late last year, the developmental psychologist launched a free 12-week pilot program for 11 teenagers, aged 13 to 17, in Wyong on the NSW Central Coast.
Australian Story gained exclusive access to the program and tracked the progress of two boys through the sessions.
For parents like Jude, whose son Rhys took part in the pilot, it couldn't have come at a better time.
"I've been at the end of my tether many, many times in the past few years and that's just being an honest parent," Jude said.
"Then I found out about Wayne Warburton and I thought, hallelujah."
A hand on the shoulder that changed everything
Dr Warburton still remembers the moment his "whole world exploded" in a hail of broken glass and buckling metal.
Originally a plumber by trade, in 1995 he was driving with his apprentice when he became involved in a traumatic car crash.
"I thought I was going to die," he said. "They cut a hole in the wreckage and the ambulance driver reached through … and put his hand on my shoulder."
As rescuers toiled for an hour to cut him free, the ambulance officer stayed with him, talking him through the procedure with care and compassion, his hand never leaving his shoulder.
The car crash up-ended his life. He was carrying not just physical injuries but mental ones too.
"I went on to develop post-traumatic stress disorder," he said. "I had horrific nightmares, flashbacks."
It soon became clear he couldn't continue his work as a tradie, so he enrolled in psychology at Macquarie University.
After decades of study, he's now a leader in his field, according to his colleague and program facilitator, Deborah Delaney. "And he's extremely passionate about young people and helping families."
"I've always thought I would love to be that person with the hand through the wreckage on someone's shoulder," Dr Warburton said, "because it's such an important role when somebody's traumatised."
'Can't stop, won't stop': Taking back control
According to Dr Warburton, many kids across Australia are gaming at dangerous levels and "as a society, we need to do something about it."
The program he has developed, called RESAT@-A, aims to put teenagers back in control by strengthening their resources, skills and knowledge about the impacts of hazardous gaming.
"We want them to be in control of the games, not the games in control of them," he said.
The focus is on teaching them how to regulate their emotions and communicate with people in the "offline world".
"There's some of what we would call cognitive behavioural therapy stuff in there, which is, you know, restructuring the way we think about things," he said.
His wife Sandi Warburton, herself a psychotherapist, says he wants to take away the idea that parents need to police their children.
"The idea is simple, and it is to equip the kids with their own skills on how to manage it," she said.
"Wayne is so personally involved with these kids and wants to make a real difference in their lives, not just in the short term but in the long term."
Dr Warburton is at pains to point out that for the majority of teenagers, gaming is an enjoyable pastime that causes no issues in their life.
But for some, it can become all-consuming.
That was the case for 13-year-old Caleb, one of the participants in the trial along with 15-year-old Rhys.
Like Rhys, Caleb's gaming started taking over his life during the COVID-19 lockdown. His family saw his screen time escalate and his behaviour change.
"It's like, can't stop, won't stop," he said. "Normally I'd just play and play and play. If I lose three games in a row, I don't stop playing until I win a game, otherwise, it's just not fun."
But problem gaming can't simply be measured by looking at the number of hours a teen spends on screens, Dr Warburton says.
The real indicator of when it has tipped into hazardous territory is when gaming starts affecting other areas of a teenager's life like school, sleep and social activities.
Alana, Caleb's mother, says her son was always a sporty kid with lots of friends until his gaming took over.
"He [stopped] interacting with the family and with his friends and you know, just really starting to live in the one space," she said.
Alana started fearing Caleb would become a recluse, "unable to do anything outside of playing a game".
But many parents struggle to break the cycle.
Some switch off the wi-fi or lock their child's devices, "but what usually happens is that the kids are much smarter than parents with all the technical things so they know ways to get around," Dr Warburton said.
By the time they come to him, they have often run out of strategies. That was Jude's situation before her son Rhys attended Dr Warburton's pilot program.
"I thought if you've got a gaming addiction, take it away, like take the electronics away," she said.
"Yes, you do limit it but it's about actually nurturing them to find other opportunities in their life and allowing them to learn skills to control their habit."
Rhys feels he fits the profile of a so-called "gaming addict".
It was seriously impacting his family life, his schooling, sleep and the time he spent with friends.
He had become volatile, and his temper would erupt over "small things", he says, putting incredible strain on his family.
"Sometimes I'm just in such an angry mood that I'm unaware of, like, the people around me and how they feel," he said.
"When my behaviour has been at my worst, I was probably like throwing stuff, yelling, kicking things and punching walls."
But the more his mother Jude tried to police Rhys's behaviour, the more she felt like she was saddling him with guilt and shame.
"It's that fine line you're always running between trying to say that that's not okay, but not shaming them for the behaviour, for the out-of-control behaviour," she said.
"It's been a very tricky line to follow."
Dr Warburton believes his approach offers a better way forward. By helping teens reduce their own screen time over a few months, he believes the brain can be re-wired.
"One of the take-home messages for the boys is that any changes to their brain that might have happened across the course of their gaming, is that we think it might be reversible," he said.
How to repair young brains
Dr Kerstin Paschke, who heads the original program in Germany, has spent the last few years studying what that reversal looks like.
She says MRI scans reveal visible differences between the brains of healthy adolescents without a gaming problem and those with a gaming disorder around the pre-frontal cortex, a brain region that contributes to emotion regulation.
She has conducted a small study tracking what happens in the brains of problem gamers over the 12-week program in Germany, which offers some promising results warranting further investigation.
An MRI study of participants' brains shows the changes that occurred over the course of the program.
At the outset of the study, the gamer group exhibits a greater difference in activation in the ventrolateral prefrontal cortex (VLPFC), a brain region that contributes to emotion regulation.
Once the 12-week study is concluded, the difference disappeared, bringing the activation in line with the control group.
As part of the study, participants also undertook an emotion regulation task whilst being scanned, a task that should use the prefrontal cortex.
Before treatment, the left ventrolateral prefrontal cortex (VLPFC) shows significant difference in activation between the control group and the group with gaming addiction.
The gaming group are working harder in the VLPFC to do the emotion regulation task.
After 12 weeks, the gamers' VLPFC activation is clustered closer to the baseline and the difference between the groups is no longer significant.
That means that the gaming group is working less hard to do the emotion regulation task, suggesting that the VLPFC is working more effectively than it was 12 weeks before.
The VLPFC activation between the control group and the gamer cohort was a notable finding, Dr Paschke said.
"We do see a difference after 12 weeks, which is good," she said, adding that it meant "changes might not have to be permanent".
So far the study has only been conducted with a small sample of 20 teenagers with a gaming problem.
Although Dr Paschke has presented her findings to several conferences, the study is yet to be published or peer-reviewed.
Dr Warburton says the MRI study needs to be replicated with a larger group before researchers have "categorical proof this is happening".
But he's encouraged that with a good program and treatment, it appears that brains can be re-wired so teenagers can better self-regulate their gaming.
"The take-home message from the study in Germany is that the brain is plastic," he said.
"If you're not using it in a way that's making it grow, then it can be shrinking and losing function. But if you start to use it again, then it starts to grow again. You start to get more function back."
This is potentially great news for Rhys, who had come to fear his long hours of gaming might have changed him permanently.
"I know that I have to actually put the steps in, like actually not spend so much time on gaming for this to actually work."
Rhys is on the autism spectrum, which Dr Warburton says adds to his challenges of reducing screen time.
A disproportionately high number of teens with autism spectrum disorder have a problem with gaming, he said, while stressing that excessive gaming also impacts widely on children who are not neurodivergent.
'I'm much healthier and happier'
In February, Rhys and Caleb graduated from the three-month course. Both have reduced their gaming and are more engaged with the offline world.
"The course has changed a lot of things in my life," Rhys said.
"I'm now a lot more social with my friends. I've reduced my hours more and I've just been able to get much more sleep and better sleep. And it's led to me being much more healthy and happier."
Dr Warburton said although Rhys had a couple of "roadblocks" during the program, he was very pleased where he finished up.
"The program isn't the panacea, but it's a kickstart to a journey and for someone like Rhys it's been a very powerful kickstart," Dr Warburton said.
Jude said despite the improvements, she knows that Rhys will often struggle with screens and that it will be a lifelong journey for him.
Rhys was frank too.
"I know that after I come out of this course, it's not going to be like, 'Yippee, yay! I'm cured and now I no longer have a gaming addiction,'" he said.
But he said he now has strategies to help.
"I definitely would recommend for boys who do have a gaming addiction to do a course like what I've done as it has been absolutely amazing," he said.
Caleb was initially reluctant to do the program, but in the end, he excelled.
"I feel very positive about both how Caleb is going and how things will work out for him in the long run," Dr Warburton said.
Caleb said after graduating from the program he was the happiest he had been for a very long time. He is spending a lot more time outside with his friends.
"If I hadn't have found this course, I would probably be in the same area as what I was, you know, two months ago — never leaving my room."
Dr Warburton hopes to publish the findings of his program later this year.
"On the whole, the outcomes for kids have been really, really positive," he said.
"It certainly exceeded my expectations and given the huge need in Australia, I believe that this program or programs like it really need to be widely rolled out in this country."
Watch Game Changer on Australian Story on ABC iview.
Credits
Reporting: Janine Cohen
Additional writing: Matt Henry
Digital Production: Megan Mackander
Photography: Jack Fisher
Graphics: Julie Ramsden, Jack Fisher
Australian Story video: Quentin Davis
