Video gaming while driving: not a good idea!
Posted: 05/18/2013 Filed under: Gamers, Health Consequences, Legal Action | Tags: computer games, flash, flicker, photosensitive epilepsy, photosensitivity, seizures, video games Leave a comment »
After this photo was published in the UK’s Daily Record newspaper, the “reckless” driver who played a game while driving was identified and charged.
This week a motorist in Scotland was seen—and photographed—playing the video game Real Racing on his iPad while driving on a highway at 65 miles per hour.
In this country some states have laws that prohibit texting or phoning while driving. Most people realize that using any electronic device while driving is a distraction that impairs the driver’s judgment and attention, placing him/her plus any passengers, pedestrians, and nearby drivers at risk. It’s risky and unwise, and illegal in some places, but it’s a widespread practice nonetheless.
Gaming while driving is beyond reckless. Think of it: what if, in addition to the game creating a dangerous distraction, the images trigger a seizure in the driver? Even a brief seizure of a few seconds, especially at 65 mph, could lead to tragedy.
I tested lots of “footage” of Real Racing on the flash and pattern analyzer that determines whether digital image sequences fall within safety guidelines for photosensitive epilepsy. Although this particular game tested within the safety limits for luminosity/flash rate/pattern movement, many other games don’t. Maybe this driver only drives while playing games that pass the seizure safety test…and plays the rest at home.
Scottish police have brought charges against the 20-year-old suspect. “Motoring groups and politicians have condemned his antics,” according to the Daily Record. Read more…
Open letter to the BioShock creative team
Posted: 04/18/2013 Filed under: Photosensitive Seizure Prevention, Seizure Warnings, Video Game Companies | Tags: BioShock, computer games, flash, flicker, photosensitive epilepsy, seizure warning, seizures, video games Leave a comment »
Congratulations on last month’s successful launch of BioShock Infinite. The reviews are extraordinary. BioShock Infinite is said to set a new standard for what the video game experience can be. Players are moved and enthusiastic about many aspects of the game and speak effusively about their unprecedented degree of involvement with the story and characters. With all the creative energy, care, and respect for players that went into developing BioShock, though, the game–like so many others–exposes players to visuals that can cause seizures.
I examined several BioShock launch trailers and some other “footage” – a total of eight clips of a few minutes each – and assessed them using an application that identifies video sequences that can trigger seizures. Most of the material was fine, but three of the clips contained brief flashing sequences that don’t meet criteria for safe viewing. It doesn’t take more than a brief exposure to trigger seizures in those who are vulnerable.
This BioShock scene uses safe levels of flash.
Contrary to what many gamers assume, eliminating seizure triggers doesn’t make a game boring to look at or play. Irrational Software created a visually stunning, highly engaging experience in which most of the scenes don’t pose a seizure risk. Reports of video game-induced seizures began surfacing in 1981 in newspapers and medical journals. A great deal is known about what types of images and sequences can provoke seizures.
Guidelines for seizure-free video sequences were developed in the UK more than 20 years ago. Since 1991 all television programming and commercials there are required to pass a seizure-safety test. Japan put in place a similar measure following the 1997 Pokémon broadcast that led to hundreds of seizures. In 2005 the International Telecommunication Union published recommended universal guidelines for reducing photosensitive seizures from televised material.
While all these efforts were made to reduce the risk to consumers of photosensitive seizures, video game publishers took their own action—providing printed seizure warnings. The warnings began appearing in the early ‘90s, after a few consumers filed personal injury lawsuits. Putting a seizure warning on video games has thus far provided legal cover for your industry, but offers little protection for customers.
Flash in this scene is safe, too.
The warnings all state that photosensitive seizures happen to “a very small percentage of people.” Seizures from flashing images are not rare, but people believe they are because that’s what the warnings say! The wording of these warnings is based on researchers’ estimates that were made decades ago, before today’s sophisticated graphics and before more recent studies that suggest that many photosensitive seizures could be going completely unnoticed. Many doctors continue to think these seizures are rare because that’s what they were taught.
If you haven’t heard many reports of seizures happening while playing BioShock, don’t assume the seizures aren’t occurring. They’re just not being identified. A person experiencing seizures is likely to lose awareness and not even realize what’s happening, or notice that a bit of time has passed that they can’t account for. Furthermore, most seizures don’t involve convulsions, and the only sign others might see could be as subtle as a short period of staring.
Whether or not a seizure is noticeable, it’s a serious event with real risks to health. It can impair health, thinking, and behavior for days afterward. Sometimes a seizure results in permanent disability.
But this screen capture from the Harding Flash and Pattern Analyzer shows that flash in the BioShock sequence shown at upper left failed seizure safety guidelines.
It’s not reasonable to expect parents to continually monitor their kids for possible signs of a seizure, particularly given that video games are played while people face a screen. So let’s turn to older teens and adults in the midst of a game, who might theoretically be more self-aware and responsible for their own well-being. Will they be vigilant for seizure symptoms such as odd sensations or altered consciousness?
Just last month in a New York Times interview your creative director Ken Levine said, “We work really hard to wear down the audience’s ability to even process. If players are immersed enough, they stop treating it as a piece of artifice and just start experiencing it.” Do you see the problem here? In this ideal game experience, how can players be expected to “immediately stop playing and consult a doctor” as the warning advises, if they develop symptoms consistent with a seizure?
With BioShock Infinite now brought to market, people are asking what your company will do next. You could easily raise the bar further for the industry by publicly committing to developing seizure-safe games. I live in the Boston area and would welcome the chance to begin a conversation about this at your headquarters in Quincy.
Lawsuits filed after games caused seizures
Posted: 04/06/2013 Filed under: Legal Action, Seizure Warnings, Video Game Companies | Tags: American Academy of Pediatrics, computer games, Nintendo, photosensitive epilepsy, photosensitivity, product liability, seizure warning, Sony, Ubisoft, video games Leave a comment »
No consumer has won a product liability/personal injury case against a game manufacturer whose video game triggered seizures. Cases were either dismissed, settled, or won by the game company.
Despite their limited usefulness to consumers, seizure warning notices do seem to provide legal protection to game publishers. And juries have a hard time awarding damages to plaintiffs with a pre-existing condition, even if plaintiffs didn’t know of their photosensitive epilepsy prior to the seizure(s) triggered by a video game.
In one case Nintendo actually conceded that its game had in fact triggered seizures, but that didn’t get in the way of the company winning the case. A judge later overturned the jury’s verdict because Nintendo had withheld critical information in contempt of court.
The cases date back to 1991, but the apparent total number of cases–ten–is pretty small. One has to wonder what percentage of the seizures triggered by exposure to video games are ever identified as visually induced seizures.
One of the few consumers to reach a settlement is John Ledford of Alabama, whose settlement agreement bars John from discussing his own case. John has found another way to raise awareness of video game seizures. He has researched other cases and reached out to epilepsy organizations around the globe to raise their awareness of the continuing seizure hazard from video game images. John’s Facebook page contains most of the history I’ve assembled here:
| Year Filed | State | Plaintiff(s) | Game(s)/Platform/Defendant | Outcome |
| 1991 | MI | 15-year old Laura Moceri had grand mal seizure while playing. | Kid Icarus (Nintendo) | Lost |
| 1993 | IL | Chicago boy suffered occasional seizures during many hours of game play. | Nintendo | Dismissed |
| 1995 | AL | John Ledford had his first ever grand mal seizure while playing game at an arcade. The seizure damaged his optic nerve and caused blindness in one eye. | King of the Monsters II (SNK Corp.) | Settled |
| 1998 | LA | 13 year-old Joey Roccaforte had clusters of violent seizures | Mega Man X (Super Nintendo) | Jury ruled for Nintendo; judge later vacated the decision because Nintendo withheld critical information before and during trial. |
| 2001 | LA | Esther Walker, mother of 30-year old Benjamin Walker, who died from hitting his head on a table and sustaining internal injuries during a game-induced seizure. | Nintendo 64 | Lost |
| 2001 | LA | 11 year-old Michael Martin, son of Eric Martin, mayor of St. Martinsville, LA. Seizures that began happening during games began occurring also during sleep. | Super Mario Kart (Nintendo 64) | Settled personal injury claim; lost case advocating better warnings. |
| 2001 | LA | 6 year –old Kynan Hebert, son of Lynette Benoit | Nintendo | Dismissed |
| 2002 | FL | 16 year-old Dominic Zummo | Star Wars Episode I: Jedi Power Battles (LucasArts Entertainment, SONY) | Unknown |
| 2007 | NY | While watching his brother play a game, 4 year-old boy had a seizure causing permanent injury. | Spyro: Enter the Dragonfly (Vivendi, SONY Playstation 2) | Last available information: attorney for plaintiff was seeking other plaintiffs for class action suit |
| 2011 | CA | Navy F-18 pilot John Ryan McLaughlin injured in a grand mal seizure that causes permanent loss of flight status | Oblivion: The Elder Scrolls IV (Bethesda Software), Sony Playstation 3. | Still pending; no other information available. |
What constitutes product liability?
In 1997 the criteria for product manufacturer’s liability for a product that has caused harm were revised by the American Law Institute, an independent body of legal experts that drafts and publishes restatements of common law in order to clarify and simplify it. Its work is used as a resource by state lawmakers, judges, and lawyers. Every state has its own laws concerning burden of proof, the awarding of damages, and the like.
The 1997 restatement of product liability law states, ”a product is defective when, at the time of sale or distribution, it contains a manufacturing defect, is defective in design or is defective because of inadequate instructions or warnings.” These conditions are then defined separately:
- A product “contains a manufacturing defect when the product departs from its intended design even though all possible care was exercised in the preparation and marketing of the product.”
- A product “contains a design defect when the foreseeable risks of harm posed by the product could have been reduced or avoided by the adoption of a reasonable alternative design by the seller or other distributor, or a predecessor in the commercial chain of distribution, and the omission of the reasonable alternative design renders the product not reasonably safe.”
- A product “is defective because of inadequate instructions or warnings when the foreseeable risks of harm posed by the product could have been reduced or avoided by the provision of reasonable instructions or warnings by the seller or other distributor, or a predecessor in the commercial chain of distribution and the omission of the instructions or warnings renders the product not reasonably safe.”
Some game companies are apparently working to make games that do not provoke seizures, but only Ubisoft has made a public commitment. Most are merely reworking their warnings. More on the problem with warnings in a forthcoming post.
Nintendo knew about, downplayed seizure risks: BBC report
Posted: 02/20/2013 Filed under: Legal Action, Seizure Risk, Seizure Warnings, Video Game Companies | Tags: computer games, flash, flicker, Nintendo, photosensitive epilepsy, seizures, video games 1 Comment »
Nintendo’s Mega Man X was one of the four games tested by the BBC for this investigative report that did not meet British TV seizure safety guidelines.
A BBC report on Nintendo revealed that the company knew more than 20 years ago which of its games were most likely to cause seizures–and downplayed the seizure risk to customers. A former Nintendo customer relations employee interviewed for the story said that many customers called to complain about experiencing seizures. Because he wanted to advise customers concerned about the seizure risk, he asked the company’s R & D group for a list of the games most likely to cause seizures.
Developers came up with a list of more than 30 games. Before the list was released to customers, he said, the company’s lawyers pared down the list to 12 – 15 titles. As customer complaints about seizures grew, Nintendo stopped releasing any seizure information about specific games. The Nintendo executive interviewed asserted that the company began making its games safer and started including seizure warnings with game instructions as soon as the problem came to their attention—in 1991.
The story, featured on the BBC’s Outrageous Fortune program in 2004, also includes an interview with photosensitive epilepsy expert Prof. Graham Harding. Using his own flash and pattern analyzer Prof. Harding shows the results of testing some Nintendo games for seizure safety.
To view the ten-minute segment about video game seizures in the report on Nintendo, first go to www.youtube.com/watch?v=0aFhW56c2Vg and fast forward to about 5:15 into the clip. The seizure segment continues at the beginning of this clip.
The documentary was never aired in the US, and I’d long since given up searching for it online. But I recently came upon it thanks to John Ledford, who has been tracking seizure lawsuits filed against the game industry. John became blind in one eye as a result of his first grand mal seizure—which occurred while he was playing a video game in 1994.
Today the sound, tomorrow the picture?
Posted: 01/20/2013 Filed under: Photosensitive Seizure Prevention, Political Action & Advocacy, TV, Video Game Companies | Tags: computer games, International Telecommunication Union, photosensitive epilepsy, photosensitivity, seizure prevention, Sony, video games 4 Comments »
Have you noticed that watching TV is less annoying lately? Commercials are now required to be no louder than the programming surrounding them. On December 13 an FCC regulation went into effect that was designed for just that. The CALM Act, approved by Congress in 2010, directed the Federal Communications Commission to make it possible to watch TV without constantly turning down the volume of advertisements.
Since the introduction of television in the 1950s, many consumers have complained to the FCC about the loudness of commercials. What prevented the FCC from doing anything in response was that the issue was technically complicated. Multiple factors can contribute to the perceived loudness of a broadcast, including the strength of the electrical signal, the degree to which the sound signal is compressed. In addition, there was no standard method for content creators and broadcasters to measure broadcast volume.
In 2006, the International Telecommunication Union–the same UN-affiliated standards body that has published specifications for protecting TV viewers from photosensitive seizures–proposed a new technique for measuring broadcast volume that allows uniform evaluation across national boundaries. In addition, the ITU proposed a numerical “target loudness” using the new loudness gauge. Thanks to the ITU, it became possible to define, comply with, and enforce limits on loudness.
Four years later the United States Congress passed the CALM Act with little debate, by unanimous vote in the Senate and by a voice vote in the House. California Congresswoman Anna Eshoo, who introduced the bill, said it was by far the most popular bill she’d ever sponsored. She said the bill “gives consumers peace of mind, because it puts them in control of the sound in their homes.” She was quoted saying, ”If I’d saved 50 million children from some malady, people would not have the interest that they have in this.” By that time the UK, France, Norway, Italy, Japan, Brazil, Israel, Germany, Austria, Switzerland, Poland, and the Netherlands were already limiting the loudness of commercials or had begun action on the issue.
These days even the video game industry is paying attention to some kind of audio standards, if only for consistency across products. According to an July 2012 interview in Designing Sound, Sony Computer Entertainment Europe is looking at smoothing out the volume among their own game titles.
Unfortunately, in this country making TV safer to watch for the visually sensitive–or making video games safer to play–isn’t on the legislative agenda. Consumers and policy makers aren’t aware of the need. The technical groundwork is already in place for regulations to prevent screen-induced photosensitive seizures, thanks to ITU specifications (and similar versions developed by the UK and Japan), and to similar guidelines adopted by the World Wide Web Consortium for web-based content.
Here’s where things stand at the moment in making US electronic screens safe for those with photosensitive epilepsy: Photosensitive epilepsy protection standards now apply to all federal agency websites. The Photosensitive Epilepsy Analysis Tool (PEAT) downloadable from the PACE Center at the University of Wisconsin at Madison makes available to website designers and software developers a free tool that tests screen content for compliance with seizure safety guidelines. The tool is not intended for entertainment industry developers, however; these companies need to buy commercially available assessment tools.
I’ve written previously about some of the complexities of bringing new screen safety standards to the American telecommunications industry. I”m going to learn more about the legislative process in coming months. My State Representative filed a bill last week to create a commission to study the issue of video game safety for minors at home and in school here in Massachusetts. It will take considerable time to even bring the bill to a public hearing, but as I’ve recently learned, all bills filed in the Massachusetts legislature receive a public hearing at some point in the two-year session. The two years just began this month. Stay tuned.
Top First-Person Shooters Fail Safety Test
Posted: 12/17/2012 Filed under: Photosensitive Seizure Prevention, Seizure Risk | Tags: Call of Duty Black Ops 2, computer games, first-person shooter, Halo 4, Medal of Honor: Warfighter, photosensitive epilepsy, photosensitivity, seizures, video games 2 Comments »
A while back, I looked at some MMORPGs (massive, multi-player, online role-playing games) and found that they typically don’t pose a high risk of triggering photosensitive seizures. Their appeal lies in the social world of collaborative missions, the acquisition of skills and material goods, and immersion in a detailed narrative.
First-person shooter (FPS) games are a different story, you might say. They offer continuous combat with lots of vivid, brightly flickering sequences, a scenario that is much more likely to bring on visually induced seizures. Because players watch from the shooter’s up-close perspective, the flashes from explosions brightly illuminate much of the entire screen. When more of the field of vision is exposed to flashes, more neurons are activated for visual processing, raising the seizure risk. Lots of quick scene cuts are typical while the shooter races and maneuvers through territory at top speed. In addition, the rapid fire of high-caliber weapons causes shaking and vibrating of the scene that adds to players’ visual processing load.
I don’t offer an opinion about the content, value, message, or age- appropriateness of video games. My purpose is to provide information on their potential to induce photosensitive seizures in people who may have this genetic vulnerability. But I will confess that I turned my attention to FPS games after the recent news that that Navy SEALS had shared classified information with the developer of Medal of Honor: Warfighter. I was curious as to whether the game was also likely to provoke seizures. In fact Warfighter does fail the test for seizure safety, and it also received poor reviews and didn’t sell well.
My testing showed that two blockbusters in this game genre, Halo 4 ($ 220 million in sales on launch day) and Call of Duty Black Ops 2 ($ 500 million during its first 24 hours), released last month, violate international guidelines for preventing photosensitive seizures. Given their huge popularity and the high ranking of many FPS games on reviewers’ best-of-the-year lists, it seemed like an appropriate time to look at the seizure safety of FPS games as a category.
I tested the 14 games on GameSpot’s list of the most popular FPS games (which includes all gaming platforms). To obtain representative scenes from each game, I downloaded official trailers and user-submitted video from YouTube. Most were less than 5 minutes long. If the first clips I tested for a game didn’t fail the safety test, I tested several more clips for each game, since it was possible that failing sequences weren’t included in a particular clip. In all I tested several dozen video segments on the Harding Flash and Pattern Analyzer.
As shown in the table below, the visuals in every game either exceeded the limits for photosensitive seizure safety or came close to the limits, a result that received a “Caution” grade from the analyzer software. Note that any game that didn’t actually fail cannot be deemed seizure-safe, since it could easily have unsafe sequences I didn’t locate.
FPS games from GameSpot’s “best games by popularity” list
The Caution designation by the analyzer software recognizes that every individual’s vulnerability to seizures changes in response to internal factors (such as fatigue, illness, alcohol, menstrual cycle, stress) and environmental conditions (proximity to/size of screen, screen brightness, duration of play). The risk of seizures for any individual using the same game on different occasions varies depending on these circumstances.
So caution when playing shooter games is certainly appropriate. Take breaks, don’t play when sleep-deprived, and don’t sit too close to the screen. A game that’s never triggered seizures before may trigger a seizure another time, even in people who’ve never had a seizure in their lives because photosensitivity is a latent trait until it is activated. Sometimes seizures are so subtle people may not realize they are happening, but even small seizures can affect mental and physical functioning for a day or two.
Bread and video games
Posted: 11/08/2012 Filed under: Diagnostic Challenges, Health Consequences, Medical Research | Tags: celiac, computer games, EEG, flash, gluten intolerance, photic stimulation, photosensitive epilepsy, photosensitivity, seizures 1 Comment »
What do a loaf of bread and an action video game have in common? Both are man-made and widely consumed, yet hugely underrecognized as potentially serious health hazards. There are a lot more parallels.
Sensitivity to gluten, the primary protein in wheat, and to the bright flash and rapidly moving patterns game of screens, are both considerably more pervasive than the medical community and the general public had realized. Awareness of gluten sensitivity has grown tremendously in the past decade, though, because a portion of the medical community broadened its understanding of a disorder once defined by very rigid diagnostic criteria.
Consider this comparison:
Progress on the gluten front
For decades the only type of gluten sensitivity recognized by doctors was celiac disease, a severe condition that often, but not always, manifests with gastrointestinal problems. The only diagnostic testing required an intestinal biopsy that–turns out–is easily falsely negative. After a negative biopsy, would be told that celiac disease had been ruled out, and that therefore it was OK to eat wheat and other grains containing gluten. In actuality many of these patients either had celiac–but a misleading biopsy that didn’t collect tissue samples from the affected area of the intestine–or they had a different form of gluten sensitivity that causes damage only to other body organs, rather than the intestine.
Because doctors were taught in medical school that celiac disease is very rare, occurring in only one in several thousand individuals, there seemed to be little reason to consider the diagnosis in patients, order a biopsy, or question a negative biopsy result. Some researchers suggest that ten percent or more of the American public has a sensitivity to gluten, in most cases with no obvious symptoms or symptoms that don’t suggest a food sensitivity. Even without obvious symptoms gluten intolerance can be a very serious disorder that affects daily functioning and quality of life.
Growing numbers of consumers without an official diagnosis of gluten sensitivity are being more proactive by experimenting on their own with a gluten-free diet as a healthier way to eat. Many notice a range of improvements in their well-being from this change. A rapidly expanding market of prepared gluten-free foods makes a gluten-free lifestyle less burdensome. An increasing number of restaurants offer gluten-free menus, and new gluten-free foods are a booming market for food retailers. Celiac and gluten-free support groups provide practical and moral support. In addition to peer-reviewed research, there are now a lot of books for consumers and online resources. Probably most consumers are learning about gluten sensitivity from these sources rather than their clinicians, and some are helping educate their doctors about it.
The photosensitive epilepsy front
Because doctors were taught in medical school that photosensitive epilepsy is very rare, occurring in only one in several thousand individuals, there has seemed to be little reason to consider the diagnosis in patients, order an EEG with photic stimulation, or question a negative or inconclusive EEG. There is no practical, reliable way to know how prevalent photosensitive epilepsy is in the general population. Even without obvious symptoms of a seizure, people who experience subtle seizures can experience impairments that affect daily functioning and quality of life.
Without an official diagnosis of photosensitivity, consumers can experiment with a screen-reduced or screen-free lifestyle–should they have an inkling that subtle seizure activity caused by screen exposure is affecting their health. However, at this time there are few products or supports to help them cut back on recreational screen time. A limited number of mental health providers offer therapy for Internet or video game addiction. Most focus on treating the addiction itself rather than on overcoming the physical and mental health consequences of exposure to potentially seizure-causing screens. Consumers are still essentially on their own to figure out the connection between video games and seizure activity, and there is little for them to read on the subject. Little research is being carried out in the US on photosensitivity and today’s electronic entertainment.
Perhaps there is reason to be encouraged by the progress in educating the public and clinicians about gluten-related health problems. In the face of similar obstacles to wider awareness and prevention, it should be possible for seizures induced by visually overstimulating electronic media to become better known, understood, and prevented. In the interim, a great deal of work lies ahead to empower consumers with the information they deserve about screen-induced seizures. Please help spread the word.
A continuum of visual sensitivity
Posted: 08/18/2012 Filed under: Diagnostic Challenges, Health Consequences, Medical Research | Tags: cartoons/animation, computer games, EEG, epilepsy, photic stimulation, photoparoxysmal response, photosensitive epilepsy, photosensitivity, SpongeBob Leave a comment »
Even readings outside the red zone may indicate the need for caution.
If a neurologist tells you that you don’t need to worry about seizures from electronic screen exposure, because you’re not photosensitive, what does that really mean?
It means that when you were tested for your response to a white strobe light, an EEG didn’t detect a particular abnormal electrical pattern in your brain. (I’ve noted some limitations of this procedure elsewhere.) Epileptology looks for yes or no, typically relying on EEG to rule out epilepsy. If yes, possibly medicate; if no, it’s not a case the clinician will pursue.
It does not indicate that bright flashing and/or patterns from electronic screens don’t adversely affect your brain function.
Researchers have gradually come to consensus on exactly what the EEG must look like to indicate photosensitive epilepsy (the photoparoxysmal response): certain spike/wave patterns that appear in both brain hemispheres. In arriving at these criteria, researchers excluded three other types of EEG abnormalities that in prior research “qualified” as a photoparoxysmal response. Epilepsy researchers aren’t certain what the significance of these other abnormalities is, but because the other patterns cannot conclusively be associated with epileptic seizures, there’s little interest in further research.
So these other EEG abnormalities from photic stimulation don’t count, in current neurology practice, and nobody would even tell you about them if they were found in your EEG. You’d be told the EEG was normal, period. But what if these other abnormalities were a sign that neurological function is in fact disturbed by visual stimuli, but not to the point of a seizure?
Let’s say you had one of the three other EEG abnormalities (which you wouldn’t know about, because the EEG was deemed normal). Maybe these indicate that you’re vulnerable to symptoms of a visual-overload-not-to-the-point-of-seizures syndrome. Neurologists have been examining the overlap between epilepsy, photosensitive epilepsy, and migraines. More about this in a future post, but actually there are many overlapping symptoms and correct diagnosis can be difficult. So if video game exposure or photic stimulation produces headaches and visual disturbances, and an inconclusive EEG, it may be that the visual overload is triggering migraines. Or perhaps the exposure is triggering another form of hyperexcitability in the brain’s visual cortex, which has been termed visual stress. While research has been done on this, it’s not part of a conventional neurology practice.
What about patients with more subtle or mood-related symptoms of a visual-overload-not-to-the-point-of-seizures problem? Who is treating these patients? Could be psychiatrists and psychologists, who view altered behavior and cognitive function through the lens of their respective training. Because there’s such a dearth of research of the gray areas of brain dysfunction following exposure to electronic screens, mental health providers have no basis for treating these patients for anything but mental health disorders. It’s clear that more research is needed and that more effects on the brain will be uncovered. One intriguing paper explores the contribution of fluorescent lighting to agoraphobia. The SpongeBob study published last year showed diminished executive function in children who viewed the cartoon.
In her Psychology Today blog, psychiatrist Victoria Dunckley recently posted a compelling piece about the effects on her patients of electronic screen time. She recommends creating a diagnostic category called Electronic Screen Syndrome to identify a dysregulation of mood, attention, or arousal level due to overstimulation of the nervous system by electronic screen media. She has seen dramatic improvements in hundreds of patients’ mood, behavior, and cognition after they go on an “electronic fast.” (Some have underlying psychiatric diagnoses, some don’t.) Maybe these patients were having very subtle seizures from electronic screens. Maybe the effects on the nervous system weren’t quite what epileptology defines as seizures. Either way, many kids exposed to electronic screens are experiencing diminished quality of life (as are their families) for a problem that medicine has not yet acknowledged.
ADHD, video games, and seizures
Posted: 08/04/2012 Filed under: Health Consequences, Medical Research, Seizure Risk, Video Game Companies | Tags: ADHD, American Academy of Pediatrics, computer games, photosensitive epilepsy, photosensitivity, seizures, video games Leave a comment »
I read an article this week about video games designed to treat ADHD. The concept sounds appealing: use some time already spent on recreational video games to instead play therapeutic video games, and make ADHD treatment enjoyable enough that kids will stick with it. Another plus that developers point out is that treatment provided via games would not cause the side effects of ADHD medications. Games designed to improve some aspect of physical or mental health or performance are a fast-growing growing sector, and there’s even a scholarly research journal that launched this year, Games for Health Journal.
Video games are not without side effects, though, including seizures. ADHD, video games, and seizure vulnerability haven’t been studied together, but by piecing together some studies dealing with two of the three factors, the interconnectedness between them can be considered. So here is some information on ADHD and video games, and separately, information on ADHD and seizures. Put them together and think about about video games and ADHD being a risk factor for game-induced seizures. Developers of games to treat ADHD need to be conscious that the same neurological abnormalities that cause attention problems may also make people with ADHD more vulnerable to seizures from a video game.
ADHD and video games
Evidence is accumulating that exposure to typical (non-educational, non-therapeutic) video games is associated with later attention problems. It’s a highly charged subject, because scientists can never account for all possibilities and variables in a single study, and people tend to feel very strongly one way or the other about video games. A lot more study is needed because so little has been done that follows the same children over time. Based on findings including the following, the American Academy of Pediatrics issued cautions parents about video game use.
“…[A]mount of time spent playing video games is associated with greater attention problems…[B]oth television viewing and video game playing were uniquely associated with attention problems…[T]he total time spent with screen media (both television and video games) was positively related to attention problems.
…Exposure to screen media was associated with later attention problems even when earlier attention problems and gender were statistically controlled. This provides stronger evidence…that screen media may influence attention problems; controlling for earlier attention problems…rules out the possibility that the association between screen media use and attention problems is merely the result of children with attention problems being especially attracted to screen media.
…[T]elevision viewing and video game playing were associated with attention problems in both middle childhood and late adolescent/early adult samples…These similar associations across age groups raise an important possibility about the persistence of television or video game exposure effects on attention problems. Whatever the ages at which watching television or playing video games may increase attention problems, the consequences may be quite long lasting or cumulative.”
–Edward Swing et al., “Television and Video Game Exposure and the Development of Attention Problems” in Pediatrics, August 2010
ADHD and seizures
While findings from one study were announced regarding the high rate of photosensitive epilepsy in autism, no studies have been published on photosensitive epilepsy in people with ADHD. What studies do show, however, is that in people with ADHD seizures of all types occur at a much higher rate than in the general population. The findings suggest that environmental influences, including video games, could place people with ADHD at higher risk for photosensitive seizures.
There is increasing evidence and acceptance of some underlying brain dysfunction shared by epilepsy and ADHD, and people with one disorder have more than the usual risk of having the other condition as well.
As one study puts it,
“It is likely that there is a common neurobiological predisposition for both a lower seizure threshold and ADHD behaviors that may involve both genetic and environmental factors… We found a 2.7 fold greater incidence of epilepsy among children with ADHD than in controls.”
– Shanlee Davis et al., “Epilepsy in Children With ADHD: A Population-Based Study” in Pediatric Neurology, May 2010
Another study found that children with the predominantly inattentive type of ADHD have a risk of developing seizures that’s 3.7 times the normal odds. The odds for children with the combined type of ADHD, which includes inattention and hyperactivity, are 3.3 times the normal rate.
“ADHD precedes the development of epilepsy, and ADHD or its determinants must be considered risk factors for epilepsy.”
–Dale Hesdorffer, et al., “ADHD as a Risk Factor for Incident Unprovoked Seizures and Epilepsy in Children” in Archives of General Psychiatry, July 2004***
This was specific to the inattentive type of ADHD, which is presumably the intended market for video games for helping with focus, memory, screening out distractions, etc.
ADHD + video games = higher likelihood of seizures
I don’t know if games-for-health developers, particularly people working on ADHD treatment games, are more concerned about the seizure hazard than developers of games for pure entertainment. Presumably a therapeutic application’s on-screen action would not be full of strobe effects. Without seeing the games, though, it’s hard to know for sure about the kinds of screens and effects that are used to congratulate users on their score, signal the end of the game, etc.
Let’s hope these games don’t do harm in their efforts to do good.
***Note that “incident unprovoked” in the study title refers to means a seizure that is not provoked by a medical situation unrelated to epilepsy: a head injury, fever, intoxication, and so on. A photosensitive seizure triggered by flash is not considered provoked, because that is the nature of reflex epilepsies, that they are triggered by a sensory experience. The terminology is more than just confusing. Because the words trigger and provoke are close to synonymous, the use of “unprovoked” in defining seizures typical of epilepsy seems to to exclude reflex seizures. The terminology both reflects and contributes to the relegation of reflex seizures to the sidelines of clinical training and research funding and and perpetuates the perception that they are rare.
The problem with irresistible
Posted: 07/21/2012 Filed under: Gamers, Health Consequences | Tags: computer games, Diablo III, video games Leave a comment »
According to a GameSpot review, Diablo III is “devilishly captivating and addictive.”
In a Taiwan Internet cafe last weekend, an 18-year-old identified only as Chuang died shortly after playing 40 uninterrupted hours of Diablo III. The exact cause of his death is still being investigated.
What would cause someone to lose touch with his surroundings so completely that a tragedy like this could happen? Whatever is found about the specific cause of death, the loss of this young man’s life is a reminder of the enormous power of some games to draw players in and keep some of them beyond spellbound.
To learn a bit about Diablo III, I read a review on GameSpot that was written shortly after the game’s release in May. In what is now a haunting foreshadowing, reviewer Carolyn Petit alludes a number of times to very positive game attributes that make players want to stay in the game. Staying in can turn dangerous when players lose all ability to connect with their judgment, their own bodies, and the world around them.
The problem with “irresistible” is that some people in fact absolutely cannot resist. Here are excerpts from the review:
- “The constant stream of gold and treasure you earn is irresistible. Blizzard has the recipe for crafting a habit-forming loot-driven action RPG down to a science, and in Diablo III, the results of that recipe are more exciting and more addictive than they’ve ever been.”
- “The rate at which you acquire new skills is part of what makes Diablo III so hard to pull yourself away from.”
- “It’s about employing those skills to slaughter the monsters you encounter as you travel the world, and collecting the loot the fiends drop. This is where Diablo III’s habit-forming pleasures lie.”
- “Loot is doled out at a pace that makes your victories fulfilling and makes fighting the next group of foes lurking in the shadows ahead nigh irresistible.”
- “The cycle of combat and loot and more combat is addictive, but without peril, it would eventually become unfulfilling. Thankfully, the hosts of hell become increasingly dangerous over time.”
- “You may ultimately be victorious at vanquishing the forces of hell, but if their true mission is to give you a compelling reason to sacrifice sleep as you keep clicking your mouse into the wee hours of the night, then they have won a decisive victory.”
I wonder if, since learning about what happened to Chuang, Ms. Petit has had any thoughts about what she wrote in her Diablo III review. Would she write it any differently now? In future reviews of other games would she write about their addictive qualities in the same way? Somehow, describing games with words like irresistible, habit-forming, hard to pull away from, and addictive doesn’t sound quite so positive anymore.
