Gambling-like gaming, offline leisure, and help-seeking in problematic gaming amongst Flemish adolescents: a three-wave longitudinal examine

1.1. Understanding problematic gaming: danger and protecting components

One significantly related agent-level area considerations gambling-like and monetization-related options embedded in modern video games. Cross-sectional research persistently report associations between adolescents’ engagement with gambling-like options and elevated ranges of problematic gaming (Chang et al., 2024; Hing et al., 2023). However, the out there proof stays restricted and is predominantly cross-sectional, limiting conclusions about temporal ordering (Rehbein et al., 2010; Saini and Hodgins, 2023). This has led to specific requires extra analysis utilizing interactionist frameworks that study how participant traits and recreation design options collectively contribute to dysregulated gaming patterns (Flayelle et al., 2025). Although some longitudinal research have begun to look at particular mechanics comparable to loot-box buying, follow-up durations are sometimes quick and broader multi-wave exams stay scarce (González-Cabrera et al., 2023). In addition, the literature has predominantly targeted on remoted options—particularly loot bins—reasonably than on the broader combos of gambling-like and monetization-related components that adolescents are more likely to encounter in modern video games (Gibson et al., 2022; Montiel et al., 2022; Siste et al., 2025). Yet these options usually co-occur inside wider monetized gaming environments, suggesting {that a} slender give attention to single mechanics could present solely a partial view of adolescents’ publicity (Denoo et al., 2025; King and Delfabbro, 2020).

In the current examine, we undertake a broader publicity perspective. However, there isn’t any consensus on terminology for gambling-related options in digital video games. Labels comparable to simulated playing, digital playing, gamble-play media, and non-monetary playing are used inconsistently throughout the literature (Dupont et al., 2024). Following Declerck (2025), we use the umbrella time period gambling-like gaming to discuss with gambling-adjacent options in digital video games, with out implying that these options ought to essentially be categorised as formal playing in a subject marked by ongoing authorized and conceptual debate. Such options have been argued to share key structural traits with financial playing, together with chance-based rewards and reinforcement dynamics (Griffiths and Nuyens, 2017; King et al., 2015). In this examine, gambling-like gaming is operationalized as adolescents’ engagement over the previous 12 months with frequent gambling-adjacent options in video games, together with buying and buying loot bins, promoting loot field contents, enjoying social-casino model video games, and utilizing chance-based spin mechanics. We additionally take into account engagement with microtransactions, outlined as purchases made with actual cash, or with premium in-game foreign money purchased with actual cash, for digital items or providers comparable to beauty gadgets, extra content material, season passes, or gameplay benefits. Because these buying options usually co-occur with gambling-like components inside broader monetized gaming environments (King and Delfabbro, 2020), inspecting them collectively gives a broader view of adolescents’ publicity to interconnected monetization-related options, reasonably than specializing in a single mechanic in isolation (Denoo et al., 2025).

Potentially related influences are usually not restricted to recreation design. Adolescents’ offline leisure lives could form how central gaming turns into in on a regular basis life. One potential rationale is that point and funding dedicated to gaming could scale back engagement in different developmentally significant actions, an thought usually mentioned when it comes to displacement (Lee, 2009). Gaming unfolds inside socio-ecological contexts (e.g., household, college, friends, golf equipment) that may both heighten vulnerability or present various sources of construction and belonging (Bronfenbrenner, 1977; Mihara and Higuchi, 2017; Zhuang et al., 2023). Some rising longitudinal proof means that larger ranges of bodily exercise could also be related to a decrease danger of later gaming-related issues (Nowotarski et al., 2024). At the identical time, offline leisure is incessantly promoted in prevention as a protecting technique by emphasizing significant options to gaming (American Academy of Pediatrics, 2026; Stevens et al., 2021). However, empirical assist for offline leisure as a protecting issue stays restricted and far of the out there analysis continues to be cross-sectional. Existing research additionally are inclined to give attention to particular actions, reasonably than inspecting broader patterns of offline engagement throughout leisure domains (Nowotarski et al., 2024; Ropovik et al., 2023; Zhuang et al., 2023).

In addition, participation in offline leisure actions alone could not seize whether or not offline contexts operate as significant options to gaming. Offline actions could also be significantly related once they present adolescents with experiences of competence, which might scale back reliance on gaming as a main supply of feat and recognition (Ryan and Deci, 2000). Yet this dimension has acquired even much less consideration in empirical analysis than exercise participation itself (Zhuang et al., 2023). The current examine subsequently distinguishes between two features of adolescents’ offline lives at baseline: the variety of offline interest actions by which they take part, and their perceived competence in extracurricular domains comparable to sports activities, music, and creativity.

An extra query considerations whether or not adolescents with larger ranges of problematic gaming are related to potential sources of assist. From a harm-reduction perspective, help-seeking issues as a result of well timed assist could forestall gaming-related issues from turning into extra impairing. Yet in youth psychological well being and addictions, recognizing a necessity for assist, realizing the place to go, and truly utilizing providers usually don’t coincide (Degenhardt et al., 2017; Wang et al., 2004). In adolescent behavioral and psychological well being care, pathways into assist are sometimes adult-mediated, and self-recognition doesn’t reliably translate into service use (Bore et al., 2025; Zwaanswijk et al., 2003). Emerging work in gaming dysfunction likewise means that adolescents at elevated danger is probably not extra inclined to hunt skilled assist than their friends (Jeon et al., 2022; Yu et al., 2024). However, the proof stays restricted and is drawn largely from East Asian contexts and treatment-seeking samples, limiting generalizability to neighborhood adolescents in Western European settings.

In response to those limitations in earlier analysis, the current examine makes use of knowledge from three annual waves in a big Flemish college cohort. Specifically, the examine addresses 4 questions. First, we offer method-comparable estimates of problematic gaming prevalence, mean-level change, and temporal stability in an under-documented Western European context (RQ1). Second, we study whether or not baseline engagement with gambling-like gaming and microtransactions predicts subsequent change in problematic gaming signs over one- and two-year intervals (RQ2). Third, we examine whether or not two indicators of adolescents’ offline lives—breadth of participation in offline interest actions and perceived competence in extracurricular domains—are related to baseline ranges and subsequent change in problematic gaming signs (RQ3). Fourth, we study whether or not adolescents know the place they may search assist and whether or not they have sought assist for gaming-related issues, thereby distinguishing perceived assist pathways from precise help-seeking habits. We additionally study whether or not baseline symptom ranges are prospectively related to subsequent help-seeking (RQ4).

2.1. Procedure

Ethical approval for the examine was obtained from the KU Leuven Social and Societal Ethics Committee [SMEC; reference no. G-2021-3439-R2(AMD)m]. Data have been collected at three measurement factors throughout three consecutive educational years in a pattern of secondary colleges in Flanders, the northern Dutch-speaking area in Belgium. The first knowledge gathering, hereafter known as T1, occurred between November 2021 and February 2022, with two extra knowledge collections administered at roughly one-year intervals. The second and third measurement factors, T2 and T3 respectively, additionally occurred between November and February within the subsequent years. The examine types half of a bigger interdisciplinary undertaking on gaming, playing and psychological well being in adolescence.

Before the baseline (T1) evaluation, colleges have been approached by means of an informational letter and subsequently recontacted by e mail or phone to substantiate participation. School choice targeted on making certain variation in instructional tracks inside the Flemish secondary schooling system (which includes a normal/educational observe, a technical observe, a vocational observe, and an arts observe, usually enrolling pupils aged 12–18) and the inclusion of pupils from the primary 12 months of secondary schooling onward, in order that members may very well be adopted longitudinally throughout a number of waves. School recruitment aimed to seize heterogeneity throughout college contexts and academic tracks, reasonably than to realize proportional representativeness on the college or regional stage. School principals supplied written consent on behalf of the establishment; following college approval, mother and father or authorized guardians have been knowledgeable and will decline their baby’s participation by way of passive consent procedures. Pupils have been briefed on the examine’s goals and knowledge assortment procedures and have been reminded that participation was voluntary and that they may discontinue at any level. Recruitment was not restricted based mostly on gaming habits; all enrolled pupils have been eligible. However, solely pupils who indicated that they performed video video games at the very least often have been offered with the gaming-related part of the questionnaire and are included within the current analyses.

Most respondents accomplished the questionnaire on-line throughout common class hours utilizing college computer systems. In a subset of colleges, the survey hyperlink was distributed by means of the varsity’s digital studying platform and accomplished at residence. All supplies have been administered in Dutch. The survey required roughly 30 min to finish at every measurement level.

To allow correct linkage of members’ responses throughout measurement waves, pupils supplied figuring out info throughout knowledge assortment, together with their title and sophistication. These identifiers have been used solely for longitudinal matching. After knowledge linkage, private identifiers have been changed by random numerical codes. The linkage key connecting identifiers to codes was saved securely and individually from the analytical dataset, which contained coded participant data solely.

A subset of the measures used on this examine has been employed in earlier publications stemming from the identical broader analysis undertaking Game(e)(a)ble. Specifically, earlier cross-sectional and longitudinal analyses have used the gadgets on gambling-like components in video video games and the GADIS-A indicators of problematic gaming. The current examine, nevertheless, addresses distinct analysis questions — particularly, the longitudinal prediction of modifications in problematic gaming from medium-related (gambling-like gaming options, microtransactions) and environment-related (extracurricular engagement and perceived competence) variables, in addition to help-seeking patterns — that haven’t been analyzed or reported elsewhere.

2.2. Participants

Participants supplied knowledge on background variables by way of self-report measures at every measurement level. Sociodemographic traits for the complete pattern at T1, T2, and T3 are offered in Table 1. For the potential analyses, we used the subset of adolescents who participated at baseline and accomplished the problematic gaming measure at the very least as soon as at follow-up; traits of this longitudinal subsample are additionally proven in Table 1.

2.3. Measures

Problematic gaming: problematic gaming was assessed utilizing the Dutch, validated adaptation (Grosemans et al., 2025) of the 9-item Gaming Disorder Scale for Adolescents (GADIS-A; Paschke et al., 2020). Participants rated how strongly every assertion utilized to them over the last 12 months on a five-point Likert scale starting from 1 (utterly disagree) to five (utterly agree). Items seize cognitive-behavioral signs and adverse penalties of gaming (e.g., “I continue to play games even though it negatively affects my performance at school, during my internship, or at work.” and “I neglect my daily tasks because I prefer to play games.”). Internal consistency of all of the gadgets was excellent in any respect three measurement factors, with Cronbach’s alphas of 0.85 at Wave 1, 0.86 at Wave 2, and 0.87 at Wave 3.

We operationalized problematic gaming in two methods. First, we used a steady rating for every participant at every measurement level, computed because the imply of all 9 GADIS-A gadgets. Second, we derived a medical cut-off classification distinguishing adolescents with problematic versus non-problematic gaming at every measurement level. Following the scoring pointers proposed for the GADIS-A (Grosemans et al., 2025; Paschke et al., 2020), adolescents have been categorised as assembly the brink for problematic gaming once they concurrently exceeded (a) a imply rating of > 2.00 on the 4 adverse penalties gadgets, (b) a imply rating of > 3.34 on the 5 cognitive–behavioral signs gadgets, and (c) a imply rating of > 2.23 throughout all 9 gadgets. In addition, members answered an merchandise assessing how usually they’d skilled issues attributable to gaming previously 12 months on a four-point Likert scale, by which they have been required to report “during extended periods” or “almost daily” on this merchandise to fulfill the problematic gaming cut-off.

Environment: engagement in extracurricular actions: on the first timepoint, adolescents reported their participation in extracurricular actions by indicating whether or not they engaged in a number of interest classes (e.g., being a member of a sports activities membership, exercising often exterior of a membership, taking part in a youth group, enjoying a musical instrument or attending music courses, partaking in artistic hobbies comparable to drawing or coding). Response choices allowed members to pick out all actions that utilized, in addition to indicating “none of the above”. Based on these responses, we constructed a three-level index reflecting the breadth of extracurricular engagement: 0 (no extracurricular actions), 1 (engagement in a single exercise), and a couple of (engagement in two or extra actions).

Environment: perceived competence in extracurricular domains: perceived competence in extracurricular domains was measured on the first timepoint utilizing three gadgets assessing how adolescents evaluated their very own talents relative to their friends in sports activities, music, and artistic actions. For every area, members supplied a ranking on a steady slider starting from 0 (“much worse than peers”) to 100 (“much better than peers”). This composite was meant as a practical index of broader perceived offline competence, reasonably than as proof that sport, music, and artistic competence kind a single unidimensional assemble. To create a standardized indicator of perceived competence, scores on all three domains have been first transformed into z-scores. A composite perceived competence rating was then computed because the imply of the three standardized area scores, with larger values indicating larger self-evaluated competence throughout extracurricular domains.

Medium: engagement with gambling-like components in video video games: on the first measurement level, adolescents indicated how usually they’d engaged in a set of 5 gambling-like options embedded in video video games through the previous 12 months, utilizing a 7-point frequency scale (1 = by no means, 2 = a couple of instances a 12 months, 3 = as soon as a month, 4 = a couple of instances a month, 5 = as soon as every week, 6 = a couple of instances every week, 7 = daily). These behaviors included buying free loot bins, buying loot bins with actual cash, promoting loot field contents, pores and skin betting, enjoying social on line casino video games and spinning in-game wheels for in-game rewards. Responses have been aggregated right into a scale rating reflecting general engagement with gambling-like recreation components in video video games. Internal consistency of this scale was good, with a Cronbach’s alpha of 0.75.

Medium: engagement with microtransactions: engagement with in-game microtransactions was measured on the first wave utilizing two self-report indicators. Participants reported how incessantly they bought gaming-related gadgets (e.g., beauty skins) by way of microtransactions on a five-point scale starting from by no means to usually. They additionally indicated their approximate month-to-month spending on microtransactions in euros. To align spending with the frequency scale, month-to-month expenditure was recoded into 5 ordered of classes (0; 1–9; 10–29; 30–99; ≥100 euros). A composite index was computed by averaging the frequency and spending indicators. Because the measure consisted of two gadgets, inner consistency was evaluated utilizing the inter-item Pearson correlation (r = 0.31) and was sufficient.

Help-seeking: help-seeking associated to gaming issues was assessed on the third measurement level utilizing two dichotomous gadgets. Participants indicated (0 = no, 1 = sure) (a) whether or not they knew the place to go in the event that they wanted assist for gaming-related difficulties and (b) whether or not they already sought assist from somebody of their surroundings for issues associated to gaming.

2.4. Plan of research

Analyses have been carried out in a number of steps, similar to the examine’s analysis questions. All analyses have been carried out in R. First, to handle RQ1, we computed descriptive statistics for problematic gaming (each with a cut-off rating and a steady rating) and help-seeking at every measurement level. For the continual problematic gaming scores, we examined whether or not particular person adolescents confirmed significant modifications of their problematic gaming ranges over time. To achieve this, we estimated a linear mixed-effects mannequin with random intercepts for members. This mannequin captures whether or not particular person adolescents’ scores improve or lower over time, accounting for between-person variations in baseline ranges. In addition to inspecting within-person change, we additionally in contrast the common stage of problematic gaming throughout the complete pattern at every measurement level. Follow-up pairwise comparisons between waves have been carried out utilizing estimated marginal means with Holm-adjusted p-values. These comparisons take a look at whether or not the imply stage of problematic gaming within the group on the first measurement level differs from the imply on the second and the third measurement level, no matter whether or not particular person adolescents personally elevated or decreased.

Second, to handle RQ2 and RQ3, we restricted the pattern to adolescents who supplied baseline (T1) knowledge on all medium-related (i.e., Engagement with Gambling-like Elements in Video Games and with Microtransactions) and environment-related (i.e., engagement and perceived competence in extracurricular actions predictors) and who additionally accomplished the problematic gaming questionnaire at the very least as soon as at a later measurement level. Prior to operating the longitudinal fashions, we computed descriptive statistics and bivariate associations between all background, medium and surroundings variables and problematic gaming throughout all three measurement factors.

Next, multivariate analyses of variance (MANOVAs) have been carried out with all background variables (age, gender, instructional observe, household construction, and perceived monetary consolation) entered concurrently as predictors and all examine variables as outcomes. Background variables exhibiting important multivariate results have been retained as covariates for the longitudinal analyses.

To study longitudinal results of medium and surroundings variables on modifications in problematic gaming, two autoregressive regression fashions have been estimated (i.e., fashions by which the result at a later time level was predicted by scores on the identical variable on the previous time level, thereby predicting change over time). The first mannequin predicted problematic gaming on the second measurement level from all predictors whereas controlling for baseline ranges; the second did so for the third measurement level. By together with baseline problematic gaming as a predictor, these fashions estimate distinctive associations between the medium and surroundings variables and modifications in problematic gaming over one- and two-year intervals, adjusted for the consequences of the opposite predictors. In a ultimate step, interplay phrases between gender and every medium variable have been added to each fashions to check whether or not results on modifications in problematic gaming differed for girls and boys.

3.1. Prevalence of problematic gaming and help-seeking

To study how frequent problematic gaming was on this cohort, whether or not imply symptom ranges modified over time, and the way steady problematic gaming was throughout three annual waves, all adolescents who stuffed within the related surveys are included within the analyses. At the primary measurement level, 33 out of 1863 adolescents who performed video video games (1.8%) scored above the problematic gaming cut-off. At the second measurement level, 35 out of 1807 members (1.9%) exceeded the cut-off, and on the third measurement level, 27 out of 1748 members (1.5%) met the brink. Out of the 344 adolescents who participated within the problematic gaming survey in any respect three measurement factors, 14 scored above the problematic gaming cut-off at the very least at one measurement level (4.1%), and three of them at two measurement factors (0.9%). None of them met the brink in any respect measurement factors.

In phrases of the continual rating on problematic gaming, a linear-mixed results mannequin confirmed that problematic gaming modified considerably inside members over time (F(2, 2919.5) = 17.68, p < 0.001), indicating that people’ scores weren’t steady throughout measurement factors. Pairwise comparisons of the group means confirmed that the common stage of problematic gaming at T1 (M = 1.88) was considerably larger than at T2 (M = 1.80; p < 0.001) and T3 (M = 1.80; p < 0.001). However, the imply scores at T2 and T3 didn’t differ considerably from one another (p = 0.30).

To study whether or not adolescents with larger ranges of problematic gaming signs knew the place to hunt assist and reported having sought assist for gaming-related issues, help-seeking was examined on the third measurement level. At T3, 933 adolescents (53.4%) reported realizing the place they may search assist in the event that they skilled gaming-related issues, whereas 61 adolescents (3.5%) reported that they’d already sought assist. Out of those 61 who indicated to have sought assist, 6 (9.8%) scored above the problematic gaming cut-off on the third measurement level. None of them scored above the problematic gaming cut-off at T1 or on T2. Overall, these descriptive findings recommend that information of the place to hunt assist was comparatively frequent, whereas precise help-seeking was uncommon.

3.2. Longitudinal analyses: descriptive statistics and correlations

As a primary step in inspecting whether or not medium-related and environment-related components have been linked to problematic gaming over time, analyses have been restricted to adolescents who accomplished baseline (T1) knowledge on these predictors and who additionally accomplished the problematic gaming measure at T1 and at the very least one follow-up evaluation at T2 or T3. Associations between background, medium-, and environment-related variables and problematic gaming scores throughout measurement factors have been then examined utilizing Spearman rank-order correlations as a result of a number of variables deviated from normality.

Correlations between background, surroundings, medium variables, and steady scores on problematic gaming are offered in Table 2. Problematic gaming scores have been reasonably steady throughout waves, with important optimistic associations between T1 and T2 (ρ = 0.52, p < 0.001), T1 and T3 (ρ = 0.50, p < 0.001), and T2 and T3 (ρ = 0.60, p < 0.001).

With respect to background variables, larger problematic gaming scores have been persistently related to being male in any respect three measurement factors (ρs = 0.26–0.37, ps < 0.001). Older age confirmed small adverse associations with problematic gaming at T1 and T3 (ρ = −0.09, p < 0.01 and −0.10, p < 0.05, respectively). Being enrolled within the educational observe (ρ = −0.12, p < 0.001), dwelling in a two-parent household (ρ = −0.07, p < 0.05), and better perceived monetary consolation (ρ = −0.14, p < 0.001) have been every negatively correlated with problematic gaming at baseline, with much less constant associations at later waves.

Regarding the environment-related variables, baseline engagement in extracurricular actions was negatively correlated with problematic gaming at T1 (ρ = −0.10, p < 0.01), however not at T2 or T3. It was additionally positively related to enrollment within the educational observe (ρ = 0.11, p < 0.001), dwelling in a two-parent household (ρ = 0.12, p < 0.001), and better perceived monetary consolation (ρ = 0.17, p < 0.001). Perceived competence in extracurricular domains was not considerably related to problematic gaming at any time level.

Concerning medium-related variables, engagement with gambling-like components in video video games at T1 was reasonably positively related to problematic gaming at T1 (ρ = 0.33, p < 0.001), T2 (ρ = 0.32, p < 0.001), and T3 (ρ = 0.31, p < 0.001). These have been among the many strongest bivariate associations within the correlation matrix. Similarly, engagement with microtransactions at T1 was positively correlated with problematic gaming throughout all three waves (ρs = 0.26–0.37, ps < 0.001).

Finally, help-seeking information at T3 confirmed a small optimistic affiliation with gambling-like gaming (ρ = 0.11, p < 0.01). Help-seeking at T3 confirmed solely small and restricted correlations, together with with problematic gaming at T3 (ρ = 0.09, p < 0.05) and with microtransaction engagement reported within the baseline evaluation (ρ = 0.08, p < 0.05).

3.3. Longitudinal analyses: autoregressive regression fashions predicting modifications in problematic gaming

We subsequent examined whether or not medium- and environment-related components predicted subsequent modifications in problematic gaming over one- and two-year intervals. To determine which background variables to manage for within the ultimate analyses, multivariate analyses with all background variables (adolescents’ gender identification, age, instructional stage, household construction and the perceived monetary consolation of their household) as predictors and all examine variables (baseline problematic gaming, engagement with gambling-like gaming components, engagement with microtransactions, engagement in extracurricular actions, and perceived competence in extracurricular domains) as outcomes have been carried out. Significant multivariate results have been discovered for all background variables, age [Wilks’ Λ = 0.98, F(5, 828) = 4.24, p < 0.001], gender [Wilks’ Λ = 0.83, F(5, 828) = 33.81, p < 0.001], kind of schooling [Wilks’ Λ = 0.97, F(5, 828) = 5.98, p < 0.001], household construction [Wilks’ Λ = 0.97, F(5, 828) = 4.93, p < 0.001], and family earnings [Wilks’ Λ = 0.94, F(5, 828) = 11.21, p < 0.001].

Next, longitudinal analyses have been carried out to check the consequences of medium and surroundings variables on modifications in problematic gaming utilizing autoregressive regression fashions. Two units of hierarchical linear regression fashions have been examined; one predicting modifications in problematic gaming from the primary to the second timepoint, and one predicting modifications in problematic gaming from the primary to the third timepoint. By together with baseline problematic gaming as a covariate, these fashions estimated the distinctive associations between baseline predictors and subsequent modifications in problematic gaming. Given gentle deviations from normality, sturdy customary errors (HC3) have been used to calculate p-values. In every set of fashions, background variables and baseline problematic gaming have been entered first, adopted by the surroundings variables (Step 2a) and the medium variables (Step 2b). In Step 3, each units of predictors have been included concurrently, and in Step 4 the 2 gender-by-medium interplay phrases have been added.

For the prediction of modifications from the primary to the second measurement level, engagement with gambling-like components in video video games confirmed a small however important optimistic impact throughout steps, whereas not one of the different surroundings or medium variables have been related to modifications in problematic gaming. Boys additionally confirmed higher will increase in problematic gaming. For the prediction of modifications from the primary to the third measurement level, not one of the surroundings or medium variables have been important predictors, whereas boys once more exhibited bigger will increase. No important interplay results between gender and the medium variables emerged. Full mannequin estimates are offered in Table 3.

4.1. Prevalence and temporal stability of problematic gaming

With respect to RQ1, problematic gaming had a low prevalence and restricted categorical stability throughout adolescence. Between 1.5 and 1.9% of adolescent avid gamers met the GADIS-A cut-off at every wave, and amongst those that participated in any respect three waves, 4.1% met the cut-off at the very least as soon as, whereas none did so persistently throughout all assessments. In this neighborhood pattern, problematic gaming subsequently appeared much less to mirror a steady categorical standing than fluctuating symptom severity over time. This suggests {that a} steady symptom method could also be extra informative than a strict case classification in longitudinal analysis on adolescent problematic gaming. Accordingly, the findings are finest interpreted as indicating change in symptom ranges over time reasonably than steady transitions in case standing. However, this interpretation needs to be made cautiously, as adolescents with larger symptom ranges could have been extra more likely to drop out over time, which might have led to an underestimation of persistence. Even so, prevalence on this Flemish pattern was decrease than that reported in different adolescent samples utilizing the identical scoring algorithm (e.g., roughly 3.7–4.0%) (Nazari et al., 2023; Paschke et al., 2020).

4.2. Engagement with gambling-like gaming options as a potential danger issue for symptom progress

A central discovering of this examine associated to RQ2 is that adolescents who reported higher engagement with gambling-like gaming options at baseline confirmed larger problematic gaming signs 1 12 months later, even after adjustment for baseline signs and related background covariates, together with age, gender, instructional observe, household construction, and perceived monetary consolation. This potential affiliation was not noticed on the two-year follow-up, suggesting that gambling-like engagement could also be extra related to short-term symptom escalation than to sustained symptom change on this cohort.

This potential affiliation on the one-year follow-up was not defined by extra normal spending involvement. Although microtransaction engagement was correlated with problematic gaming in any respect three waves, it didn’t independently predict later symptom change as soon as baseline signs and gambling-like engagement have been taken under consideration. This means that microtransactions could primarily sign broader involvement in monetized video games and partly overlap with gambling-like options. Together, these outcomes recommend that the hyperlink between baseline engagement with gambling-like gaming options and later will increase in problematic gaming signs is unlikely to be defined by involvement in monetized gaming extra typically. Instead, gambling-like engagement seems to mirror a definite danger issue associated to the gaming medium itself for symptom will increase on the one-year follow-up.

We discovered no proof that this affiliation differed between girls and boys. This contrasts with González-Cabrera et al. (2023), who discovered that the potential affiliation between loot-box buying and later gaming-related issues was current for ladies, however not for boys.

Our findings lengthen a literature that has been dominated by cross-sectional research (Siste et al., 2025) and by a slender give attention to single mechanics comparable to loot bins (Gibson et al., 2022; Montiel et al., 2022). Rather than isolating one function, we examined a broader set of gambling-like affordances alongside microtransactions throughout three annual waves. The outcomes recommend that gambling-like design options could matter in their very own proper, reasonably than merely reflecting typically excessive involvement in gaming (Delfabbro and King, 2020; Hing et al., 2023; King and Delfabbro, 2020).

Several mechanisms mentioned in prior literature could assist clarify why gambling-like engagement might precede symptom escalation. Chance-based rewards could reinforce repeated play or spending by means of intermittent reinforcement, and experimental work on loot bins means that they’ll improve arousal and the urge to proceed enjoying (Brady and Prentice, 2021; Larche et al., 2021). “Near-miss” suggestions could likewise lengthen play and improve the urge to proceed, as near-misses are recognized to encourage continued engagement in playing contexts (Dixon et al., 2011). Reward cues can also draw adolescents again into the sport and set off renewed urges to play (Zhang et al., 2016). Games that encourage ongoing spending and development can also make disengagement tougher as soon as adolescents have already invested money and time (King and Delfabbro, 2018).

Building on these findings, future longitudinal work might observe gambling-like engagement over time, together with when adolescents begin, proceed, scale back, or cease utilizing these options. This would make it potential to check adolescents with completely different cumulative publicity patterns—for instance, those that are by no means uncovered, briefly uncovered, repeatedly uncovered, or more and more uncovered—and to look at whether or not these patterns matter in a different way in earlier versus later adolescence.

Taken collectively, these findings recommend that gambling-like engagement needs to be understood inside broader monetized gaming environments reasonably than solely when it comes to remoted mechanics.

4.3. From single mechanic to clustered publicity

The findings for RQ2 additionally level to a broader conceptual challenge: adolescents are more likely to encounter gambling-like options as a part of wider monetized gaming environments reasonably than as single, remoted mechanics. In this examine, gambling-like actions tended to co-occur reasonably than seem as separate behaviors, suggesting that adolescents could also be uncovered to broader clusters of monetized and gambling-like options reasonably than to 1 remoted mechanic. Importantly, this doesn’t indicate that particular mechanics are unimportant or innocent. Rather, it means that danger could accumulate by means of repeated publicity to combos of gambling-like affordances inside broader monetized gaming environments.

From this angle, our findings recommend that the extra informative query shouldn’t be which single mechanic is most dangerous in isolation, however how the breadth, depth, and mixture of gambling-like affordances accumulate throughout adolescents’ gaming trajectories.

From a harm-reduction perspective, this means that responses mustn’t focus solely on particular person mechanics. Because gambling-like options usually co-occur inside broader monetized gaming environments, interventions that focus on just one mechanic could deal with solely a part of the broader danger context. This concern can be mirrored within the coverage literature, which has argued that regulatory responses ought to look past loot bins alone and take into account broader gambling-like and monetized options in digital video games (Cerulli-Harms et al., 2020; Children’s Commissioner for England, 2019). Implementation proof additionally signifies that chance disclosure insurance policies could supply solely restricted safety. For instance, analysis on loot field disclosures has proven inconsistent compliance and poor visibility, suggesting that disclosure alone is unlikely to be ample as a safeguard (Xiao and Newall, 2022). Belgium illustrates a unique limitation: even in a context the place paid loot bins have been categorised as unlawful, adolescents nonetheless report entry and workarounds, suggesting that narrowly focused bans could also be circumvented in observe (Denoo et al., 2023). Taken collectively, these concerns assist prevention and coverage approaches that deal with broader patterns of gambling-like and monetized publicity reasonably than remoted options.

Building on these findings, future analysis and coverage analysis ought to mannequin publicity as a dynamic sample reasonably than a static, single-feature attribute. Repeated evaluation throughout adolescence might assist determine whether or not completely different combos and trajectories of publicity are differentially related to problematic gaming, whether or not these associations differ throughout regulatory contexts, and which safeguards are more than likely to scale back hurt.

4.4. Offline leisure as a dynamic context reasonably than a static protecting issue

With respect to RQ3, baseline participation in offline hobbies and perceived competence in extracurricular domains didn’t predict subsequent decreases in problematic gaming signs over one- and two-year follow-ups. These findings problem a easy displacement assumption in prevention discourse—that higher engagement in offline leisure actions robotically protects towards problematic gaming. Offline interest participation was additionally socially patterned on this cohort, exhibiting small optimistic associations with being enrolled within the educational observe, dwelling in a two-parent household, and reporting higher perceived monetary consolation. This means that participation breadth could partly mirror differential entry to structured actions reasonably than a uniformly out there protecting useful resource.

Importantly, these findings shouldn’t be interpreted as proof that offline leisure contexts are irrelevant. Rather, they recommend that participation breadth alone could also be too restricted to seize whether or not offline leisure features as a significant protecting useful resource. Perceived competence in extracurricular domains likewise didn’t predict later symptom change, suggesting that this baseline, domain-general competence self-view didn’t function as a detectable protecting issue within the current fashions. Together, these outcomes recommend that participation breadth and domain-general competence, as measured at baseline, could also be too coarse to seize the qualities of offline actions which are most related to gaming-related danger.

One potential clarification is that offline actions are usually not protecting just because they occupy time that may in any other case be spent gaming, however due to what they supply in adolescents’ every day lives. Offline actions differ of their construction, social embeddedness, and the extent to which they’re skilled as self-chosen reasonably than compulsory. If these qualities are restricted—or if the exercise doesn’t match the social, emotional, or identity-related features that gaming serves—merely “having hobbies” could not translate into fewer gaming-related issues over time. This interpretation is according to work suggesting that problematic on-line engagement could generally serve compensatory features, for instance by serving to adolescents deal with psychosocial difficulties or adverse temper states (Kardefelt-Winther, 2014). If so, substituting time is unlikely to matter until offline actions present adolescents with features which are related to their on a regular basis wants, together with a felt sense of effectiveness, mastery, and psychological fulfilment, as emphasised in self-determination idea (Ryan and Deci, 2000).

From a harm-reduction perspective, these findings warning towards prevention methods that rely totally on generic “get a hobby” messaging. A extra promising method could also be to strengthen the developmental high quality of adolescents’ on a regular basis contexts by supporting socially embedded and significant exercise settings, reasonably than assuming that rising exercise counts will by itself scale back danger (Coatsworth and Conroy, 2009; Denault and Poulin, 2009). In this view, the aim is to not change video gaming with offline leisure, however to domesticate offline contexts that may meaningfully assist adolescents’ psychological wants and general wellbeing.

Future longitudinal work ought to subsequently transfer past participation breadth to seize the extent of engagement in every exercise, together with exercise dose, continuity, setting high quality, and the psychological features that offline actions could serve for adolescents. Repeated measurement of offline contexts throughout adolescence might make clear how modifications in exercise involvement and expertise relate to trajectories of problematic gaming over time.

4.5. Help-seeking as a preliminary recognition–motion hole

Regarding RQ4, help-seeking for gaming-related difficulties was uncommon on this cohort, regardless of comparatively frequent experiences of realizing the place to show. This factors to a descriptive hole between perceived assist pathways and reported assist use. Notably, solely a small minority of those that reported help-seeking met the problematic gaming cut-off at T3, and none exceeded the cut-off at earlier waves. In addition, baseline problematic gaming didn’t prospectively predict later help-seeking: adolescents with larger symptom ranges at T1 weren’t extra more likely to search assist at T3. Together, these findings recommend that reported information of the place assist could also be out there and elevated symptom ranges don’t essentially coincide with reported assist use.

Help-seeking was captured at T3 by means of two broad indicators: whether or not adolescents reported realizing the place they may flip for gaming-related difficulties, and whether or not they had ever sought such assist. The information merchandise probably indexes a variety of perceived assist pathways, together with mother and father, friends, college employees, or skilled providers, whereas the habits merchandise displays a concrete step towards assist with out specifying the supply, timing, or context of that assist. This distinction helps contextualize why reporting information of the place to show was considerably extra frequent than reported help-seeking.

The discovering that many adolescents reported realizing the place to show for assist, whereas solely a small minority reported precise help-seeking, challenges the belief that low service use primarily displays a lack of expertise. Broader youth psychological well being literature gives a number of believable explanations for why perceived entry could not translate into assist use. Informational entry is just one prerequisite for help-seeking, and components comparable to low perceived want, stigma, uncertainty about downside severity, and privateness considerations can also inhibit motion even when assist choices are recognized (Gulliver et al., 2010; Rickwood et al., 2007). In addition, adolescents could not at all times acknowledge or interpret gaming-related difficulties as warranting formal assist (Jeong et al., 2018; Schneider et al., 2018). Gaming’s normative standing in adolescent peer cultures could additional scale back the perceived want for skilled assist by blurring when engagement turns into dangerous (Griffiths, 2015). Even when difficulties are acknowledged, adolescents can also anticipate adverse penalties of disclosure, or be unsure about what providers would really supply, making silence or self-management seem safer than reaching out (Rickwood et al., 2007; Schneider et al., 2018).

From a harm-reduction perspective, the hole between perceived entry to assist and reported assist use stays vital as a result of it means that informational consciousness alone could also be inadequate to advertise early help-seeking. Given this hole, info provision alone is unlikely to be ample to extend uptake. More promising responses could subsequently embrace low-threshold, non-stigmatizing types of assist in settings adolescents already inhabit, mixed with transient screening and steerage that may assist determine difficulties earlier than they intensify (Karcher et al., 2023). Strengthening adult-mediated identification and referral can also be vital, as help-seeking for adolescent behavioral and psychological well being considerations is usually initiated or facilitated by mother and father, colleges, and youth professionals reasonably than by adolescents themselves (Bore et al., 2025).

More promising methods to assist earlier help-seeking could embrace embedding transient screening and steerage in settings adolescents already inhabit. In addition, providers can normalize proportionate, non-pathologizing assist choices that don’t require adolescents to self-identify as “in need of treatment.” Future analysis can sharpen the popularity–motion hole by (1) distinguishing casual versus skilled sources and self-initiated versus adult-mediated pathways, and (2) straight assessing perceived limitations and facilitators (e.g., stigma, anticipated restriction, confidentiality considerations) in addition to perceived usefulness and match of accessible assist.

4.6. Implications for harm-reduction-oriented prevention

Taken collectively, these findings assist a harm-reduction method that’s proportionate to noticed danger and targets modifiable situations reasonably than gaming time alone. Framed by means of an agent–set–setting lens, three priorities emerge.

Agent: Among the candidate predictors examined on this examine, baseline engagement with gambling-like options supplied the clearest potential sign of elevated problematic gaming signs on the one-year follow-up. At the identical time, the broader sample of associations on this examine means that agent-level danger could also be higher understood not when it comes to a single remoted mechanic, however when it comes to adolescents’ publicity to combos of gambling-like and monetized options over time. From this angle, the extra informative query shouldn’t be which single mechanic is most dangerous in isolation, however how the breadth, depth, and mixture of gambling-like affordances accumulate throughout adolescents’ gaming trajectories. Harm-reduction efforts could subsequently profit from specializing in broader modifiable options of monetized gaming environments, reasonably than on single mechanics in isolation.

Setting: Our findings don’t assist prevention approaches that deal with offline leisure as an automated substitute for gaming. Because baseline interest participation was not prospectively related to symptom decreases, prevention could profit extra from strengthening the standard and accessibility of adolescents’ on a regular basis contexts than from selling exercise counts alone. The hole between realizing the place to show and truly in search of assist likewise means that low-threshold assist relies on accessible, adult-facilitated pathways. Parents, colleges, and youth providers could subsequently play a key function in early identification, non-stigmatizing conversations, and referral choices that don’t require self-labeling as “in need of treatment.”

Set: Finally, the findings level to the significance of individual-level processes in whether or not gaming-related difficulties escalate or result in support-seeking. In this cohort, baseline perceived competence in extracurricular domains was not related to later symptom decreases, suggesting that perceived offline competence could not, by itself, seize the broader offline processes that would form gaming-related danger. At the identical time, the help-seeking findings point out that symptom ranges don’t robotically translate into motion, underscoring the significance of downside recognition, perceived want, and readiness to hunt assist.

4.7. Methodological concerns, limitations, and future instructions

Several concerns body the interpretation of those findings and level to clear subsequent steps. First, key constructs have been measured in methods which are pragmatic for school-based surveys however restrict specificity. Gambling-like engagement was captured by way of an aggregated self-report index spanning co-occurring actions, which aligns with an ecosystem-oriented publicity idea however constrains inferences about particular person mechanics and could also be delicate to recall and interpretation variations. Moreover, offline leisure and help-seeking have been captured with pragmatic, transient indicators, which limits inference about exercise high quality, depth of engagement, and the character and timing of assist pathways. The extracurricular exercise measure, as an example, indicated whether or not adolescents participated throughout exercise domains, however didn’t seize frequency, period, dedication, subjective involvement, or continuity of participation. Similarly, perceived competence was operationalized as a broad index throughout sports activities, music, and artistic actions. Sensitivity analyses treating sport, music, and artistic competence as separate predictors yielded substantively unchanged outcomes, suggesting that the null discovering for perceived offline competence was not pushed by aggregation throughout domains. Accordingly, future longitudinal work ought to deal with publicity, leisure, and help-seeking as dynamic, multi-dimensional constructs—capturing depth, persistence, and alter over time; qualitative options of settings; and limitations, pathways, and outcomes of support-seeking—ideally with repeated measurement and, the place possible, multi-informant views (e.g., mother and father or college employees).

Second, the examine was carried out in Flanders, a context with comparatively excessive digital entry and a particular regulatory surroundings concerning gambling-like recreation options. This helps ecological validity for related settings however warrants warning when generalizing to areas with completely different market buildings, cultural norms, coverage regimes, extracurricular infrastructures, and school- or youth-based prevention methods. Longitudinal inference additionally depends on the subset retained over time, elevating the potential of selective attrition. If adolescents with larger symptom ranges have been much less more likely to take part in later waves, prevalence, persistence, and potential associations could also be underestimated. Cross-national longitudinal research with harmonized measures and specific modeling of attrition and coverage context are subsequently wanted to look at how cumulative publicity interacts with regulatory and cultural environments to form gaming-related danger.

Taken collectively, these concerns don’t diminish the worth of the findings; reasonably, they make clear what the current design can—and can’t—assist and delineate a targeted agenda for future analysis: stronger causal leverage, extra context-sensitive publicity measurement, richer evaluation of help-seeking pathways, and a extra functionally grounded measurement of offline protecting contexts.