‘Fortnite’ has become one of the most popular video games available.

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Many parents are concerned about whether there’s a link between digital media use, in this case video-game playing, and ADHD.

And now there’s one game in particular that is becoming a favorite for many kids with ADHD: “Fortnite.”

If you have a child who plays video games, you’ve probably heard of “Fortnite: Battle Royale.” Since its launch in 2017, the game has skyrocketed to the highest levels of popularity with 125 million users.

In ADDitude magazine, an ADHD-focused outlet, “Fortnite” was mentioned as a new game that is particularly popular for children with ADHD, and that it has qualities that can make it especially attractive for people with ADHD.

Randy Kulman, PhD, the clinical director and president of South County Child and Family Consultants in Rhode Island, wrote the ADDitude article, and said in the article, he’s seen patients gravitate towards the game.

“The high level of risk, the need to remain alert for external distractors, and the opportunity to use hands-on skills for building make “Fortnite” and ADHD a natural match.”

For parents who see their kids use the game, there’s no debate about whether “Fortnite” and games like it have an addictive quality to them.

“Fortnite: Battle Royale” features a social component where players work together, and kids who aren’t texting yet also use the game’s communication mode to socialize.

Still, gameplay comes with a real — and sometimes alarming — bottomless-pit factor as well. And it’s more than a little violent. With all of that in mind, many parents are truly torn about what to think. Do I let my child play? If I do, will it get out of hand? Will setting limits even make a difference?

ADHD linked to digital media?

But is there evidence that kids with ADHD are more likely to spend more time playing “Fortnite” or looking at digital media in general?

A new study finds evidence there may be a link between screen time and ADHD.

Published last month in the Journal of the American Medical Association, the study found that children with frequent use of digital media showed subsequent symptoms of ADHD over a 24-month follow-up.

The study looked at 2,587 teenagers without symptoms of ADHD. The researchers asked them to rate their symptoms of ADHD including being inattentive or hyperactive.

The team followed the group over two years and looked at their digital media habits and their ADHD symptoms. They found the more teens were using digital media, including social media, the more likely they were to develop ADHD symptoms.

Adam Leventhal, PhD, and a professor at USC who co-authored the study, notes that the study he worked on did not result in confirmation of causation.

“This is maybe another piece that adds to the risk, but going back to our study, [which is] an observational study, we couldn’t confirm a causal effect of digital media use on ADHD,” he says, noting that researchers didn’t have control over how much the subjects were exposed to media.

Leventhal explained that the risk for developing ADHD symptoms comes down to a number of factors including genetic and environmental, and that more research needs to be done to understand how digital media and video games factor in.

“In the overall population, there are a number of different risk factors for ADHD symptoms, even among children who may not have any symptoms or may have very few symptoms,” he told Healthline. “When you think about digital media use, including video games, as one of many different types of risk factors that could increase someone’s risk beyond a threshold, you [also] take into account genetic factors and other environmental factors that have been implicated in ADHD. [That may be] the way to consider it, more broadly — that this may be another piece that adds to the risk.”

Dr. Victor Fornari, director, child and adolescent psychiatry, Zucker Hillside Hospital in New York, says, ADHD is one of the most heritable conditions in child psychiatry, “with the genetic components accounting for nearly 80 percent of the variants. I don’t know that playing a video game will cause ADHD symptoms.”

Fornari emphasizes the importance of time management. “If we don’t set limits on the amount of video games that young people play, they seem to be able to play without a limit,” he told Healthline.

Tips for parents

Leventhal suggests establishing a media-free zone or two in the home, where the rules apply to everyone.

Another option, either as an alternative or in addition to media-free zones, is to establish media-free time periods. “It’s helpful if families have those, and that includes the parents,” Leventhal says.

Ultimately, you can rest easy in most of these areas if you keep up with what your kids are doing when they play.

Leventhal says, “Excessive use and [the game] interfering with someone’s general responsibilities or roles, whether it be school or joining the family for dinner, are signals that it might be too much.”

Think about the big picture

“Fortnite” does indeed have a violent aspect to its gameplay. With time limits and supervision in place, Fornari’s concerns about “Fortnite” and games with similar levels of aggression, mainly reveal themselves with regard to children with histories of trauma or those who have an emotional disturbance.

Fornari’s notes that children in this category “may be vulnerable and react to violent games differently than youth who have not been traumatized or have an emotional disturbance. Since these games are [so readily] available, we have to recognize that for some young people who may be vulnerable, there may be a concern to exposing them to excessive violence and aggression.”

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