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DEAR DOCTOR: It's a real nightmare trying to pry our two grandsons away from their online video games when they are visiting. There's always a fight followed by hours of sulking and crankiness. Our son and his wife say it's easier to just let the kids play. Could they be addicted?

DEAR READER: Anyone who has ever interacted with a digital screen, be it a smartphone, tablet or computer, knows all too well the lure -- and allure -- of electronic devices. They draw you in, engage your brain at a startlingly deep level, and time and awareness just vanish. Up the ante with the dynamic visuals and mesmerizing world of a video game, and non-gamers often find themselves in a losing battle for the time and attention of their loved ones.

When it comes to the question of addiction, no less an authority than the World Health Organization has recently added "gaming disorder" as a new mental health condition to the 11th edition of its International Classification of Diseases, or ICD. However, the bar for someone to earn this new -- and somewhat controversial -- diagnosis is quite high. According to the ICD, gaming disorder is "a pattern of gaming behavior ('digital-gaming' or 'video-gaming') characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences."

Not only that, the digital devotion must so powerful that it severely impairs all interactions, including with family and friends, at work or school, and in areas of self-care. Finally, the behavior must take place for at least one year before an official diagnosis is possible.

With that definition in mind, it's unlikely that your grandkids qualify as addicted. But that doesn't make the situation you describe any less challenging. The boys are choosing a world visible and meaningful only to themselves over the cooperative dynamics of family life. Lost in the flow of the game, their universe is a potent mix of questions, answers, penalties, risks and rewards. And with the way these games are engineered, particularly the role-playing games, there is no logical place to stop -- or even pause.

On the plus side, immersive games can expand the imagination, foster collaboration and sharpen cognitive skills. But when kids are parked in front of a screen, they're missing out on activities, experiences and events that will help them become healthy and productive adults. In your case, the challenge seems to be that the parents don't see enough of a problem to intervene. However, when the boys are visiting your home, you can make a point of engaging them in the analog world.

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Give them a set time for gaming and be firm when that time limit is up. Then be prepared with something interesting for them to do. Think of activities with distinct start and finish times, and with concrete end products or the potential for rewards. Show them that even in the real world, they can achieve the video gaming world's enthralling sense of flow.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.

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