Risk of Gaming Disorders in Adolescents: A Multiperspective
Framework for Video Games Development
Federica Caruso
1 a
, Sara Peretti
2 b
, Maria Chiara Pino
3 c
and Tania Di Mascio
1 d
1
Department of Information Engineering, Computer Science and Mathematics, University of L’Aquila, L’Aquila, Italy
2
Center of Excellence DEWS, University of L’Aquila, L’Aquila, Italy
3
Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
Keywords:
Adolescence, Gaming Disorders, Video Game Development, Framework, Developers Education.
Abstract:
Adolescents face a high risk of gaming disorder due to neurodevelopmental imbalances. Despite its increasing
prevalence, awareness of this issue in video game development remains limited. Existing frameworks prior-
itize business-driven engagement over gamers well-being, lacking integration of psychological insights. To
address this gap, we propose a multiperspective framework that incorporates psychological and developmen-
tal considerations into video game design. This framework aims to guide developers in creating engaging yet
responsible games for adolescents, balancing entertainment with the need to mitigate gaming disorder risks.
Currently under development, it is intended to evolve into a practical tool for game developers.
1 INTRODUCTION
With the rapid advancement of digital technology,
video games have emerged as a dominant form of
interactive entertainment worldwide (Shliakhovchuk,
2024). By 2024, the global gaming population sur-
passed 3 billion, with 92.4% of gamers being adoles-
cents (Statista, 2025). While video games can en-
hance cognitive abilities and provide entertainment
(Li et al., 2020; Zhang et al., 2024) excessive gam-
ing has become a growing concern, leading to po-
tential mental and physical health issues (Satapa-
thy et al., 2024). For some individuals, gaming is
purely recreational, but for others, it results in neg-
ative consequences severe enough to cause functional
impairment (Kir
´
aly et al., 2023). Recognizing this,
the World Health Organization (WHO) officially in-
cluded Gaming Disorder (GD) in the 11th revision
of the International Classification of Diseases (WHO,
2025); GD is defined as a persistent or recurrent pat-
tern of gaming behavior that escalates despite nega-
tive consequences. (WHO, 2019). The global preva-
lence of GD is estimated to range between 3.05% and
4.6%, with adolescents and males being the most af-
a
https://orcid.org/0000-0002-6167-3896
b
https://orcid.org/0000-0001-9784-5816
c
https://orcid.org/0000-0003-2657-2122
d
https://orcid.org/0000-0002-8069-1168
fected groups (Griffiths et al., 2025). In Europe,
approximately 20% of adolescents exhibit signs of
GD (Colasante et al., 2022).
Adolescence itself is a critical risk factor for the
onset of GD due to ongoing neurobiological develop-
ment (Casey et al., 2019; Ravindranath et al., 2024).
During this period, the brain undergoes significant
structural and functional changes, with the prefrontal
cortex—the region responsible for executive function
and decision-making—maturing last, often not reach-
ing full development until the age of 30 (Friedman
and Robbins, 2022). In contrast, the limbic system,
which governs emotions, motivation, and reward pro-
cessing, matures earlier, leading to an imbalance that
makes adolescents more susceptible to risk-taking be-
haviors and addiction (Kumar and Jha, 2024). Addi-
tionally, the adolescent brain exhibits heightened ac-
tivity in the dopaminergic reward system, which rein-
forces behaviors associated with instant gratification,
including gaming (Dahl, 2004). The consequences
of GD can be severe, affecting vision, sleep, and
mental health while fostering social isolation (Kir
´
aly
et al., 2015). Despite these concerns, there are cur-
rently no specific guidelines for preventing GD. Exist-
ing recommendations for caregivers focus on limiting
screen time and encouraging breaks rather than ad-
dressing the underlying design elements of games that
contribute to addiction (Petry, 2019). Furthermore,
838
Caruso, F., Peretti, S., Pino, M. C. and Di Mascio, T.
Risk of Gaming Disorders in Adolescents: A Multiperspective Framework for Video Games Development.
DOI: 10.5220/0013467600003932
In Proceedings of the 17th International Conference on Computer Supported Education (CSEDU 2025) - Volume 2, pages 838-845
ISBN: 978-989-758-746-7; ISSN: 2184-5026
Copyright © 2025 by Paper published under CC license (CC BY-NC-ND 4.0)
within the video game industry, awareness of GD re-
mains low or unacknowledged (Petrovskaya and Zen-
dle, 2021). This lack of awareness can be attributed to
two main factors. First, game development rarely in-
corporates psychological expertise, leading to a fail-
ure in assessing the risks associated with game me-
chanics (Heinzen et al., 2015; Sachu et al., 2024).
Second, the industry prioritizes user engagement and
monetization, often employing mechanics designed
to maximize playtime at the expense of gamer well-
being (King and Delfabbro, 2019). Many of these
mechanics, such as loot boxes, mimic gambling be-
haviors and promote compulsive play.
Despite efforts from the Human-Computer Inter-
action (HCI) community to promote ethical game de-
sign (Aagaard et al., 2022), the dominant frameworks
used in game development remain focused on struc-
tural and business-driven aspects (McKenzie et al.,
2021; Junior and Silva, 2021). These frameworks
rarely integrate psychological perspectives, leaving
developers without guidance on minimizing GD risks.
To address these gaps, this paper start with Section 2
presenting background information. Section 3, pro-
poses a multiperspective framework designed to sup-
port developers in creating games that maintain bal-
ance between engagement and risks associated with
GD. Formative evaluation and the conclusions in Sec-
tions 4 and 5.
2 BACKGROUND
Game development is a complex, multidisciplinary
field that requires the integration of multiple perspec-
tives to address its inherent challenges (Borg et al.,
2019). These perspectives include insights from psy-
chology, practical development methodologies, theo-
retical frameworks, and regulatory strategies, all of
which contribute to understanding and managing the
risks associated with video games (McKenzie et al.,
2021). However, the fragmented application of these
perspectives has resulted in significant gaps, particu-
larly in addressing the risks of GD among adolescent
gamers (Sachu et al., 2024; Rehbein et al., 2024).
Psychologists have been studying the structural
characteristics of video games that contribute to GD
since the early 2000s (e.g., (Harrigan et al., 2010;
King et al., 2010)). Research has identified key el-
ements such as variable reward schedules, achieve-
ment systems, and social competition as significant
factors in compulsive gaming behaviors (King et al.,
2010). More recent studies have explored how these
game mechanics interact with psychological vulner-
abilities, reinforcing compulsive gaming tendencies
(e.g. (Rehbein et al., 2021; Saini and Hodgins, 2023)).
A Risk Characteristics Checklist for Games was de-
veloped to assess the potential for GD based on game
mechanics. However, this checklist is retrospective,
meaning it can only evaluate a game after its devel-
opment, rather than guiding developers in designing
safer games from the outset (Rehbein et al., 2024)
From a practical standpoint, the current game
development process primarily integrates technical
workflows, creative design, and business priorities.
Developers use Agile methodologies (e.g., Scrum,
Kanban) to structure their workflows, but these frame-
works do not address psychological risks (McKen-
zie et al., 2021; Shrestha et al., 2025). Even spe-
cialized models like the Game Development Life Cy-
cle (GDLC) remain software-centric and fail to ac-
count for the mental health impact of game mechan-
ics (Ramadan and Widyani, 2013), Redefining MDA
(RMDA) (Junior and Silva, 2021) provides concep-
tual guidance but lacks practical implementation sup-
port for addressing GD risks (Rehbein et al., 2021).
At the policy level, various countries have imple-
mented regulatory measures to limit addictive gaming
features, such as loot box bans in Belgium and play-
time restrictions in China and South Korea (Chambers
and Partners, 2024; China Legal Experts, 2025; BBC
News, 2018). However, these policies do not address
the root problem: the absence of a multi-perspective
approach in game development. Additionally, game
developers receive little education on the psycho-
logical implications of their design choices (Gil and
Arnedo-Moreno, 2020; Shrestha et al., 2025). While
HCI research has begun promoting the integration
of GD risks into game design training, these ef-
forts remain in their early stages (Gil and Arnedo-
Moreno, 2020; Aagaard et al., 2022). Given the so-
cial, health, and economic impact of GD, there is an
urgent need for a new approach that balances game
engagement with mental health considerations. Next
section presents a multiperspective framework pro-
viding structured guidance for developers in creating
video games that are engaging yet mindful of the risks
associated with GD.
3 THE MULTIPERSPECTIVE
FRAMEWORK
The multiperspective framework is developed it-
eratively using a user-centered design (UCD) ap-
proach (Norman and Draper, 1986) to address video
game developers’ attitudes and needs. A multidisci-
plinary team, including two researchers in computer
science (HCI, game design) and two in developmental
Risk of Gaming Disorders in Adolescents: A Multiperspective Framework for Video Games Development
839
and educational psychology, leads the process. The
first iteration is underway; it focuses on establish-
ing the main stages of the game development process,
identifying key aspects and elements, assessing their
impact on GD risks, and analyzing their interrelation-
ships. In particular, understanding user needs con-
sisted of a comprehensive literature analysis, partially
detailed in Sec. 2; defining system requirements iden-
tified critical stages and elements in game develop-
ment; designing and implementing solutions outlines
the framework, presented in Sec. 3.1; and evaluating
the first version refers to a formative evaluation, as
reported in Sec 4. Future iterations will introduce a
software tool based on the proposed multiperspective
framework, to support development workflows, of-
fering real-time recommendations and automated risk
assessments to further enhance responsible game de-
sign.
3.1 Framework Description
The multiperspective framework (shown in Fig. 1)
is structured into four sequential levels, covering key
stages of the game development process(Ramadan
and Widyani, 2013): Target Audience, Abstract
Level, Concrete Level, and Actual Level. These lev-
els, along with their related aspects and elements, are
outlined below:
TARGET AUDIENCE refers to the audience anal-
ysis activity in the pre-production stage of game de-
velopment. It includes key demographic elements
(e.g., Age, Biological Sex, Gender, Nationality, Cul-
ture) and target users’ needs and behaviors, consider-
ing Disabilities or Diseases, and Baseline knowledge.
ABSTRACT LEVEL refers to the ideation and
conceptual design activity in the pre-production stage
of game development, focusing on defining the
game’s overarching abstract vision. It includes el-
ements for understanding and defining the Serious
Aspects (i.e., those requiring careful psychological
evaluation during conceptual design) and Gaming
Aspects (i.e., elements shaping gameplay). Focus-
ing on Serious Aspects, its elements can be divided
into two primary groups. The first, Well-Being Fac-
tors, includes both Cognitive and Emotional Fac-
tors and Psychophysical Factors, which may be in-
fluenced by or have an impact on the next game-
play design. Cognitive and Emotional Factors ad-
dress psychological and behavioral elements critical
to the target audience (i.e., Adolescence), encompass-
ing sub-elements such as Craving, Sensation Seek-
ing, Emotional Regulation, Coping, and, notably, Ad-
diction. Meanwhile, Psychophysical Factors focus
on physical health concerns, including Obesity, Sleep
Disorders, Vision Problems, and Hearing Problems.
The second, the Stimulation Plan, encompasses el-
ements such as Play Time, Play Space, and Play
Supervision, which establish boundaries and guide-
lines for the gaming experience to ensure the video
game under design promotes a healthy gaming ex-
perience. Focusing on Gaming Aspects, it encom-
passes all elements shaping the game’s structure and
gameplay, including Game Genre, Rules, and Core
Mechanics. The latter is divided into Physics, Pro-
gression, Social Interaction, Tactical Maneuvering,
Internal Economy, and Rewards and Punishment Me-
chanics. In addition, Gaming Aspects include the
Game World—comprising the Scenario, Characters
(playable and non-playable), and Storyline—as well
as the Tutorial, which can be explicit or implicit.
CONCRETE LEVEL refers to the ideation and
concept design activity in the pre-production stage of
game development, transitioning from abstract con-
ceptual design to a more concrete focus. This level
defines key elements, including the technology used
to deliver the game (Technological Aspects) and how
it is presented and interacted with (Presentation As-
pects). Focusing on Technological Aspects, it in-
cludes Technological Devices, comprising Input De-
vices (e.g., mouse, keyboards, controllers, touchpads)
and Output Devices (e.g., smartphones, computers,
head-mounted displays). It also considers Technolog-
ical Drawbacks, referring to limitations or adverse
effects of specific technologies (e.g., cybersickness
from head-mounted displays). Focusing on Presenta-
tion Aspects, it includes elements shaping the gamer’s
experience. Sensory Elements, such as visual and au-
ditory components, form the User Interface. The In-
teraction Model defines how gamers engage with the
game world and characters (e.g., Avatar-based, Desk-
top, or Party-based interaction). The Camera Model
determines the gamer’s perspective, either personal
(e.g., first-person, third-person) or impersonal (e.g.,
isometric, top-down). Lastly, the Navigation Mecha-
nism specifies movement within the game world (e.g.,
Rail Movement, Point-and-Click navigation).
ACTUAL LEVEL refers to prototyping, technical
implementation, testing, and evaluation activities car-
ried out during the production and post-production
stages, culminating in the actual realization of the
video game. This level focuses on defining elements
related to Implementation Aspects and Evaluation
Aspects. Focusing on Implementation Aspects, it en-
compasses elements related to both Prototype and
Full Software implementation. Specifically, Proto-
type includes elements such as the Level of Interac-
tion (high-fidelity or low-fidelity prototype) and the
Type of Prototype (paper-and-pencil, 3D model, or
CSEDU 2025 - 17th International Conference on Computer Supported Education
840
software). Full Software, on the other hand, involves
elements essential for software implementation, such
as the Programming Language, the Game Engine, the
Graphics and Rendering Pipeline, and the develop-
ment of Artificial Intelligence. Focusing on Evalua-
tion Aspects, it encompasses elements such as Eval-
uation Type (expert-based, user-based, or software-
oriented) and Evaluation Focus (Usability, Risks as-
sociated with GD and its proxies, or Technical Func-
tionality).
In Figure 1, the first version of the multiperspec-
tive framework is conceptually outlined, illustrating
its levels and corresponding aspects that structure
the video game development process while empha-
sizing its iterative nature, by incorporating two types
of forward temporal/functional relationships (manda-
tory and suggested) and three types of backward
relationships (High Frequency/Low Cost, Medium
Frequency/Medium Cost, and Low Frequency/High
Cost). These relationships are defined based on pro-
cess flow, cost (effort and time), and execution fre-
quency. For instance, within the Abstract Level, revis-
iting Serious Aspects after defining Gaming Aspects
is a frequent, low-cost adjustment essential for bal-
ancing engagement and a healthy gaming experience.
Conversely, returning to the Abstract Level after eval-
uating a fully implemented video game is ideally in-
frequent, as reworking conceptual design at this stage
requires significant effort and time, making it a high-
cost endeavor.
In addition to the previously discussed relation-
ships, the multiperspective framework introduces the
influence relationship, which highlights how elements
within the framework interact. A subset of these re-
lationships specifically involves elements linked to
Addiction (under Well-Being Factors within Serious
Aspects), given adolescents’ heightened vulnerabil-
ity to GD (Sec. 1). Understanding these interactions
helps developers evaluate how design choices im-
pact GD risks. Building on this, the framework pro-
vides recommendations to minimize these risks while
maintaining gamer engagement and reducing poten-
tial harm. Subsec. 3.2 further explores how the frame-
work supports developers in integrating these consid-
erations, offering concrete strategies for designing en-
gaging games that mitigate GD risks.
3.2 How the Framework Can Supports
Developers?
The primary objective of the proposed framework is
to integrate psychological insights into video game
development, increasing developers’ awareness of
GD and the potential risks associated with flawed
design choices. By embedding these insights, the
framework aims to deepen developers’ understand-
ing of how specific design decisions may contribute
to GD among gamers. Additionally, it provides struc-
tured guidance for identifying and addressing game
design elements linked to addiction, enabling devel-
opers to create more balanced gaming experiences.
The framework also includes a set of integrated rec-
ommendations to help developers design games that
maintain engagement while mitigating GD risks (a
subset of these recommendations is presented in Ta-
ble 1).
For instance, as illustrated in Fig. 2, developers
using the framework will recognize that before de-
signing gameplay elements within the Gaming As-
pects category, they must first define the Stimulation
Plan, which includes Play Time and Play Supervi-
sion. These elements are particularly critical, as they
are closely linked to addiction. In particular, defin-
ing Play Time is essential because, if left unregulated
or poorly structured, it can lead to excessive gam-
ing sessions. To address this, the framework sug-
gests integrating natural breaks, pause prompts, and
playtime notifications into the gameplay to encour-
age self-awareness and prevent compulsive play. In
line with the conceptual model outlined in Fig. 1,
once the Serious Aspects have been defined, atten-
tion must shift to the Gaming Aspects. As shown in
Fig. 2, addiction is closely related to elements such as
Game Genre and the mechanics of reward and punish-
ment. With the framework’s guidance, developers can
proactively address these elements, making informed
design choices that align with the proposed recom-
mendations and help minimize GD-related risks.
4 FORMATIVE EVALUATION
The first design iteration of the framework defines
key stages, critical elements, and GD-related risks
in video game development. To evaluate its effec-
tiveness, a formative evaluation was conducted using
workshops, chosen for their ability to disseminate in-
formation and collect structured feedback. Given the
absence of game developers in the design team, ju-
nior and senior developers—including independents
and professionals—participated, along with master’s
students in computer engineering, who often pursue
careers in game development. The workshops had
two goals: (1) presenting the framework, including
its neuroscientific basis, adolescents’ susceptibility to
GD, and its health and economic impact; and (2) gath-
ering feedback through interactive discussions to re-
fine the framework. Specifically, two workshops were
Risk of Gaming Disorders in Adolescents: A Multiperspective Framework for Video Games Development
841
Figure 1: Conceptual View of the Multiperspective Framework: Levels, Aspects, and the temporal/functional relationships
that define its iterative nature.
Figure 2: Zoomed-in view of the Multiperspective Framework highlighting the influence relationships between Addiction and
other elements included in the framework.
conducted: the first, aimed at developers, was held at
DevFest
1
in Pescara on November 10, 2024, with ap-
proximately 50 participants; the second, designed for
students, took place at the University of L’Aquila on
November 21, 2024, involving 15 master’s students.
The qualitative analysis of feedback from both
workshops revealed four key themes:
1. Knowledge Gaps and Awareness
Participants showed strong interest in GD risks
but had limited knowledge of adolescent neuro-
biology and GD as a mental illness.
Some were unaware of the connection between
GD and game mechanics, such as loot boxes
1
https://devfest.gdgpescara.it/
and MMORPGs, which can increase suscepti-
bility to GD.
2. Ethical Responsibilities and Industry Practices
Developers often attributed GD risks to man-
ufacturers or regulators, overlooking their own
ethical role in game design.
Many felt disempowered due to the lack of ded-
icated frameworks and relied on PEGI((PEGI),
2009), which they found inadequate for ad-
dressing ethical concerns.
Students expressed frustration over the absence
of risk-aware design methodologies in their
coursework.
CSEDU 2025 - 17th International Conference on Computer Supported Education
842
Table 1: Subset of elements within the Framework that show a strong influence on Addiction, along with corresponding
recommendations for mitigating GD risks. Other relevant elements, such as Progression Mechanics, Player Character, and
Story, are omitted due to space constraints.
Element Framework
Hierarchy
Features Influence on GD Recommendations
Stimulation
Plan
Abstract
Level
Serious
Aspects
Play Time Unregulated playtime can lead
to excessive gaming (Farmer and
Lloyd, 2024).
Use natural breaks, pause prompts,
and playtime notifications to en-
courage self-awareness and prevent
compulsive play.
Play
Supervision
Unsupervised gaming can increase
risk of excessive play (Lopez et al.,
2024).
Provide parental controls to moni-
tor and limit playtime, preventing
excessive or unsupervised gaming.
Game
Genre
Abstract
Level
Gaming
Aspects
- Certain genres (e.g., MMO,
MMORPG, MOBA) have struc-
tural traits linked to higher GD
risk (Rehbein et al., 2021).
Account for GD risks in game gen-
res and design Rules and Core Me-
chanics to avoid features that pro-
mote compulsive play.
Reward
and
Punishment
Mechan-
ics
Abstract
Level
Gaming
Aspects
Core
Mechanics
Type of
Rewards
Among various rewards (e.g.,
points, achievements, loots, un-
lockables), XP are problematic, as
their feedback loop prolongs play
and favors short-term gains (Saini
and Hodgins, 2023).
Balance progression, cap XP re-
wards for excessive play, and of-
fer alternatives like narrative or un-
lockable content to promote health-
ier gaming.
Size of
Rewards
Rewards can be fixed (predictable)
or variable (random, like loot
boxes). The latter mimic gambling,
driving compulsive play through
uncertainty (Rehbein et al., 2021).
Use balanced rewards with grad-
ual progression, set limits and
cooldowns, prioritize fixed rewards,
and foster engagement through sto-
rytelling and gamer choice.
Frequency
of
Rewards
Controls reward frequency; contin-
uous rewards may lower long-term
motivation, while variable rewards
foster compulsive play through an-
ticipation (Guan and Chen, 2023).
Implement a progressively spaced
reward system, with frequent early
rewards that decrease over time
to maintain motivation without en-
couraging compulsive play.
Event
Frequency
&
Duration
Regulates event frequency and du-
ration; short, frequent events create
urgency and scarcity, pressuring ex-
cessive play (Jensen et al., 2023).
Hold events less often with longer
durations to reduce pressure and al-
low flexible participation without
continuous engagement.
Punishment
Features
Negative consequences for in-game
failures (e.g., losing progress, re-
sources, or health) influence behav-
ior. Inactivity penalties create obli-
gation, driving compulsive play to
avoid losses rather than for enjoy-
ment (Caffarone, 2023).
Schedule events less frequently
with longer durations to reduce
pressure, allowing gamers to partic-
ipate flexibly without feeling com-
pelled to engage continuously.
3. Framework Perception and Practical Applica-
tion
Developers valued the framework’s academic
foundation, recognizing academia as a crucial
source of awareness.
Students supported the development of a soft-
ware tool based on the framework, with many
eager to contribute via internships and thesis
projects.
4. The Role of Technology
Both groups acknowledged the positive poten-
tial of video games in skill development and
well-being, despite the risks of excessive use.
Overall, the workshops provided valuable feedback to
refine the framework, ensuring it fills identified gaps
and meets industry and developer needs.
Risk of Gaming Disorders in Adolescents: A Multiperspective Framework for Video Games Development
843
5 CONCLUSION AND FUTURE
WORKS
This paper presents a multiperspective framework to
support video game developers design adolescent-
focused games that balance engagement while mit-
igating GD risks. Most development approaches
prioritize engagement and revenue (Aagaard et al.,
2022), while few incorporate psychological in-
sights (Heinzen et al., 2015; Sachu et al., 2024). Due
to limited training and awareness of GD risks, de-
velopers often rely on personal judgment, as domain
experts are rarely involved in the process (Cormio
et al., 2024; Rehbein et al., 2024). A comprehen-
sive multiperspective framework is being developed.
As part of its initial design phase, a formative evalua-
tion involving developers and future developers was
conducted to gather feedback for refinement. The
qualitative analysis of feedback collected highlighted
two key findings: academia is perceived as a primary
source of awareness and knowledge, while technol-
ogy is seen as a means for improvement and positive
impact. Moreover, the idea of evolving the framework
into a software tool that actively supports and trains
developers throughout the video game development
process was widely appreciated.
By leveraging the perception of technology as a
“saving” force, the framework aims to elevate the de-
sign process by reframing technology as an exogenous
modulator. An exogenous modulator originates exter-
nally and complements endogenous changes, such as
the neurobiological transformations occurring during
adolescence that contribute to GD risk (Toga et al.,
2006; Kolb and Gibb, 2011). In this context, tech-
nology—specifically video games—is positioned as
a tool that can counterbalance these developmental
changes. The proposed framework, and its future im-
plementation as a software tool, aims to promote a
more conscious approach to game development, en-
suring that engagement is prioritized alongside the
mitigation of GD risks. Through this perspective,
video games could be redefined as exogenous modu-
lators that support adolescent neurobiological devel-
opment, transforming a potential risk factor into a
beneficial influence during this critical life stage.
ACKNOWLEDGEMENTS
This work has been funded by the European Union
- NextGenerationEU under the Italian Ministry of
University and Research (MUR) National Innovation
Ecosystem grant ECS00000041 - VITALITY - CUP
E13C22001060006
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