Moderate vs. Excessive Video Gaming: Distinct Neurocognitive and Neural Activation Profiles in Preadolescence.

The pervasive rise of video gaming in adolescent life necessitates a clearer understanding of its complex impact on cognitive and mental health development, as previous research has yielded conflicting results due to small sample sizes and unaddressed confounding factors. Here we leverage the Adolescent Brain Cognitive Development (ABCD) Study dataset (N = 9,712; mean age 9.92 years) to examine relationships between varying video gaming exposure levels and neurocognitive, behavioral, and neural outcomes. Controlling for critical environmental and demographic covariates, we show that associations between gaming and developmental outcomes are not uniform. Moderate gaming (<1 h/day) was associated with enhanced cognitive performance, including elevated fluid and total IQ, and lower externalizing and aggressive behavior scores compared to non-gamers. Conversely, excessive gaming (≥3 h/day) correlated with significantly higher attention problems and ADHD scores. Notably, all gaming cohorts outperformed non-gamers on the N-back task, with heavy gamers exhibiting significantly increased BOLD activation in the right precuneus and right middle frontal gyrus. These findings provide a comprehensive neurodevelopmental framework, supporting the hypothesis that while excessive use presents behavioral risks, moderate video gaming may be associated with enhanced cognitive and mental health profiles.