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 F:	Abstract
A great deal of attention has been focused on individuals who play video and computer games despite physical and psychological consequences.  Unfortunately, instruments that have been developed to determine problematic gaming have not completely measured the behavioral component of video game addiction.  Identifying the behavioral functions of video game play would allow for the development of behavioral interventions specifically targeted at reducing or replacing those functions.  A behavioral perspective may provide valuable information as to why gamers continue to play video games despite encountering difficulties in other areas of their lives as a result of their video gaming habits.  Therefore, the purpose of this study was to examine the four reinforcing functions that maintain video game play and develop an instrument to measure these functions.  Results supported a three-factor measurement model associated with the functions that maintain continued video game play, including (a) escape, (b) tangible, and (c) attention.  Discussion and implications are provided.

Keywords: Behavioral Addiction, Video Game Addiction, Behavioral Functions, Video Game Functional Assessment, Problematic Gaming, Internet Gaming Addiction

Establishing the Behavioral Function of Video Game Addiction:
Development of the Video Game Functional Assessment
	A great deal of attention has been focused on individuals who play video and computer games despite physical and psychological issues.  Research has demonstrated that some video gamers have experienced issues such as tension and anxiety that are only relieved by playing video games, aggression (Desai, Krishnan-Sarin, Cavallo, & Potenza, 2010), and pathological video gaming, particularly among adolescents, that interfered with important activities such as school and family responsibilities (Gentile, 2009).  A meta-analysis reviewing pathological gaming literature produced an overall prevalence rate of 3.1% of the general population (Ferguson, Coulson, & Barnett, 2011) and the incidence rate may be as high as 9% for adolescents (Gentile, Choo, Liau, Sim, Li, Fung, & Khoo, 2011).  Other literature has suggested that approximately 6-13% of individuals who play video games do so excessively (e.g., King, Delfabbro, & Zajac, 2009).  
The American Psychiatric Association (2007) issued a statement indicating that Psychiatrists are concerned about the well-being of children that spend a large portion of their time on video games because they fail to develop friendships, get appropriate outdoor exercise, and neglect their schoolwork.  Professionals have attempted to describe this phenomenon as video game addiction.  Addiction has generally been a term utilized to describe physical and psychological issues associated with alcohol and drug abuse.  In addition to the physical and psychological effects of excessive video gaming, the impact of violent video games on aggressive behaviors has been increasingly studied in recent years.  For example, Nauert (2007) found that adolescents who play violent video games may exhibit emotional arousal and diminished control, focus and concentration.  Likewise, they suggested that children that spend excessive amounts of time playing video games may be exposed to violence and may be at higher risks for behavioral and health problems.  
	 Technological addiction has been one term used to define video game addiction. Technological addictions refer to individuals who experience a dependent relationship with a machine.  Specifically, a person who is technologically addicted experiences strong urges to use the machine to which he or she is addicted (King, Delfabbro, & Zajac, 2011).  Technological addiction are also associated with a repeated urge to engage in behavior known to be counterproductive, resulting in increased tension until the behavior is completed (Marks, 1990).  An earlier study conducted by Fisher (1994) found that 60% (n=280) of the participants sampled played video games for the social connection to other players and 6% of the sample could be classified as pathological players.  Furthermore, participants that could be classified as pathological players tended to spend more money per week on video games and borrow money almost twice as frequently as the social players.  
Some researchers (e.g., Thalemann, Wolfing, & Grusser, 2007) have applied the criteria for pathological gambling (i.e., salience, tolerance, mood modification, withdrawal, relapse, conflict, problems) to describe pathological gaming whereas others have developed their own set of definitions utilizing DSM-IV TR criteria (e.g., Griffiths, 2010; King & Delfabbro, 2009; Salguero & Moran, 2002).  Due to the lack of a standardized set of criteria for operationally defining video game addiction, previous research has suggested that only a minority of video gamers experience symptoms traditionally associated with substance-related addictions (e.g., mood modification, tolerance, behavioral salience) (e.g., Kush & Griffiths, 2012; Hsu, Wen, & Wu, 2009; Ko, Liu, Hsiao, Yen, Yang, Lin, et al., 2009; Mehroof & Griffiths 2010; W�lfling, Thalemann, & Grusser-Sinopoli, 2008; Young, 2009).  The current DSM-5 has classified video game addiction under Internet Gaming Disorder [IGD] (merge between internet addiction and gaming addiction), found on Axis III (American Psychiatric Association [APA], 2013).  Unfortunately, the APA has stated that limited research has been conducted on excessive video game playing, and therefore video game addiction will continue to be connected to the umbrella disorder of IGD.
 A behavioral perspective may provide valuable information as to why gamers continue to play video games despite encountering difficulties in other areas of their lives as a result of their video gaming habits.  The basic principles of reinforcement can be applied to our understanding of pathological video gaming.  Skinner (1953) defined reinforcement as the process of a stimulus being provided contingent on the production of a behavior that strengthens the future probability of that behavior�s reoccurrence.  In other words, the stimulus that is presented following a behavior in a particular set of circumstances results in that behavior being strengthened and a person is therefore more likely to engage in the behavior in the future under similar circumstances. 
Research involving video game addiction has focused on the psychological or mental health symptoms related to video gaming such as tolerance, mood modification, and relapse (King, DelFabbro, & Zajac, 2009).  However, an instrument to identify the behavioral functions of video game play has yet to be developed.  Furthermore, identifying the behavioral functions of video game play would allow behavioral interventions specifically targeted at reducing or replacing those functions.  The reinforcing functions that maintain video game play despite negative consequences are not currently identified by any assessment used to diagnose problematic and pathological video gaming.  Therefore, the purpose of this study was to examine the four reinforcing functions that maintain video game play despite physical and psychological consequences.  Additionally, we intend to provide preliminary validation data on an instrument designed to measure those four functions. 
Behavioral Addiction
Social scientists have attempted to categorize the problem associated with excessive video game play by describing misuse associated with video games as an excessive, obsessive, and compulsive behavior (Griffiths & Hunt, 1995, 1998; Charlton & Danforth, 2007) that can lead to behavioral addiction (Griffiths, 2005).  Mendelson and Mello (1986) defined behavioral addiction (BA) as a behavior that is excessive, compulsive, uncontrollable, and psychologically or physically destructive (as cited in Lemmens, Valkenburg, & Peter, 2009).  Furthermore, BA is a recurring compulsion by an individual to engage in some specific activity, despite harmful consequences to physical health, mental health, or social life (Greenfield, 1999).  Components of BA related to video games have been described  by the Illinois Institute for Addiction Recovery (2013) as: (a) preoccupation with the game or thoughts about previous gaming activity or anticipation for future gaming activity, (b) use of the game in increasing amounts of time in order to achieve satisfaction, (c) repeated, unsuccessful efforts to control, cut back or stop game use, (d) feelings of restlessness, moodiness, depression, or irritability when attempting to cut down amount of game play, (e) gaming longer than originally intended, jeopardized or risked loss of significant relationships, job, educational or career opportunities because of game use, (f) lies to family members, friends, therapists, or others to conceal the extent of involvement with game play, and (g) use of the game as a way to escape from problems.  
As mentioned previously, some researchers have developed instruments utilizing criteria of pathological gambling or a modification of the DSM IV-TR criteria for substance abuse and dependence (e.g., Lemmens, Valkenburg, & Peter, 2009) to detect gaming issues.  In addition, researchers have developed video gaming addiction assessments that focus on such issues as difficulty controlling gaming behavior, experiencing withdrawal symptoms when unable to access video games, reduced or interrupted sleep schedules as a result of video gaming, using games to control moods, and constant preoccupation with video games (e.g. Rooij, Schoenmakers, Eijnden, Vermulst, & Mheen, 2012; King, Delfabbro, & Zajac, 2009; & Salguero & Moran, 2002).  These instruments measure psychological, emotional, and physical issues related to video gaming.  However, these instruments do not completely measure the reinforcing functions of video games that lead to the maintenance of video gaming behavior.  In order to determine the reinforcing functions that maintain unwanted or unhealthy behaviors, behavior analysts often make use of functional assessments.  Functional assessments identify one of four behavioral functions as the maintaining variable behind the persistence of unwanted or unhealthy behaviors.  These four functions can be categorized as access to social positive reinforcement, escape from demands, access to sensory stimulation, or access to tangible rewards (e.g. Dixon & Johnson, 2007).  The following section will discuss the literature related to these four behavioral functions in terms of their reinforcing properties that maintain video gaming behavior.
Behavioral Aspects of Video Game Addiction
Skinner (1953) identified the process of operant conditioning in shaping the behavior of animals and people, particularly behaviors that result in changes to the environment.  In operant conditioning, one process that strengthens or increases the probability of the future reoccurrence of a behavior is the process of reinforcement.  Reinforcement occurs when a stimulus change occurs contingent upon the performance of some kind of behavior and the stimulus change strengthens the future reoccurrence of that behavior.  Reinforcers are thus defined as stimulus consequences that occur contingent on the performance of some behavior and that result in the strengthening of that particular behavior.  
Skinner further expanded on the idea of reinforcement to include both positive and negative reinforcement.  Positive reinforcement occurs when a stimulus consequence is presented contingent upon the performance of a behavior and the presentation of that stimulus (which can be a pleasant stimulus, although it is not necessarily) results in the behavior being more likely to reoccur in the future.  For example, a child picks up his toys in his bedroom and puts them away.  Contingent on that, his father gives him a quarter.  If the presentation of the quarter contingent upon the child�s behavior of picking up toys and putting them away results in the child being more likely to pick up his toys and put them away in the future, the process of positive reinforcement has occurred and the quarter is a positive reinforcer.  In contrast, negative reinforcement occurs when a stimulus, typically an aversive or unpleasant stimulus, is removed contingent upon the performance of a particular behavior and the contingent removal of that stimulus results in an increase in the likelihood of the behavior reoccurring (strengthening) over time.  For example, assume it is a cold day outside.  A man steps out of his house and immediately experiences the stimulus sensation of cold (an unpleasant stimulus).  He then puts on a sweater, resulting in a reduction in the intensity of the sensation of coldness.  In this example, if the man is more likely to put on a sweater in the future when it is cold outside, the stimulus sensation of coldness functions as a negative reinforcer whose removal or reduction strengthened a particular behavior.  
Skinner also described the process of punishment and extinction in shaping behavior.  In the process of punishment, a stimulus is presented contingent upon the performance of some behavior that results in the behavior being less likely to reoccur in the future.  For example, a child raises his hand in class to answer a question.  He answers the question correctly and the teacher praises him profusely for his correct answer.  Following the presentation of the praise, the child, perhaps feeling embarrassed at receiving so much praise, is less likely to raise his hand and answer a question in class when the opportunity presents itself again.  In this example, a normally pleasant stimulus, praise, functions as a punishing stimulus if it results in the weakening of a behavior so that it is less likely to reoccur in the future.  In contrast, extinction occurs when a behavior that has previously resulted in the presentation of a stimulus consequence is performed but the stimulus consequence is no longer presented or delivered, resulting in a weakening of the behavior over time.  An example of extinction can be seen when a child whose behavior of tantruming at home previously resulted in the presentation of sweets and social attention no longer receives sweets or social attention for his outbursts.  Over time, if no reinforcing consequences follow the child�s tantruming behaviors, his tantruming behaviors will decrease. 
  Earlier behavioral research in treating problem behaviors such as self-injurious behavior focused on imposing contingencies of reinforcement for wanted, appropriate behaviors and punishment or extinction for unwanted behaviors (Mace, 1994).  However, Iwata, Dorsey, Slifer, Bauman, and Richman (1994) pointed out that the only behavioral interventions that traditionally showed consistent effectiveness in treating self-injurious behavior were those that used some form of aversive stimulus as punishing consequences for self-injury.  They argued that it would be important to determine the conditions that maintained unwanted behaviors in order to identify interventions that could remove reinforcing consequences for problematic behaviors and provide those reinforcing consequences for more appropriate behaviors.  This is particular important as two behaviors that are topographically similar, such as head-slapping, may be maintained by two different behavioral functions.  One child�s head-slapping may result in a decrease in academic tasks and demands whereas another child�s head-slapping might result in an increase in social attention from concerned caregivers.  The topography of the behavior of head-slapping might thus be maintained by behavioral functions that are individual to each child. 
Based on this argument, Iwata et al. (1994) developed the methodology of experimental functional analysis (EFA) to determine the conditions that maintained self-injurious behavior in children with intellectual disabilities.  Using a single-subject alternating treatments design, Iwata et al. exposed eight children who engaged in self-injurious behavior to four conditions in order to determine which condition was maintaining their behavior: social positive praise, escape from academic tasks and demands, unstructured play with toys that were freely available, and an alone condition where the child was placed in a therapy room without toys or any materials that might serve as stimulation.  In order to ensure that the children selected for the study would not be at risk of severe physical harm due to self-injury, Iwata et al. did not include children who were at risk of severely harming themselves.  They also ensured that a preset criterion for terminating sessions due to physical risk was in place for each child prior to conducting the study.  These criteria were based on the recommendations of a physician who examined the children.  In addition, physicians and nurses observed the sessions to assess the children�s level of self-injury and if a child�s criterion for terminating a session was met, the session was ended and the physician or nurse examined the child before approving the continuation of the sessions or recommending their postponement.  Using this methodology, Iwata et al. were able to determine the specific conditions for each child that maintained self-injurious behavior and they also demonstrated that the behavioral functions that maintained the problem behavior were different for each child.  They thus argued that it would be important to determine the functions maintaining unwanted or maladaptive behavior in order to apply effective behavioral treatments. 
Over the past two decades, experimental functional analyses have been used with individuals with autism and intellectual disabilities to determine the behavioral functions of their problematic behaviors such as self-injury, aggression, disruptiveness, inappropriate vocalizations, and property destruction (Beavers, Iwata, & Lerman, 2013).  However, experimental functional analyses are often time-consuming to conduct, utilize time, personnel, and material resources, and require a great deal of training to conduct safely and with procedural fidelity.  Other forms of functional behavioral assessment have arisen to aid therapists in determining the functions of behavior.  Functional behavioral assessment refers to procedures that can be used to determine the antecedents preceding the performance of some behavior and the consequences that maintain that behavior (Gresham, Watson, & Skinner, 2001).  Functional behavioral assessments may include experimental functional analyses but are also comprised of direct observations and descriptions of behavior, or indirect observations of behavior using interviews, inventories, and archival data.  Functional behavioral assessments are all aimed at determining the functions of behaviors that maintain their occurrence despite differences in forms of behavior.  They can greatly aid therapists in designing treatments that directly address the functions of behavior, which improves treatment outcomes (Vollmer & Northup, 1996).  
Behavior rating scales can help us to identify target functions of behaviors that could potentially be explored in more depth.  For example, Durand and Crimmings (1988) developed the Motivational Assessment Scale (MAS) that allowed for the identification of the four functions of self-injurious behavior.  The MAS was also able to determine individual behavioral functions for each client.  The primary difference between the MAS and Iwata et al.�s (1994) EFA is that the MAS is an indirect assessment, whereas the EFA is an analog assessment.  The MAS is designed to be completed by a caregiver who has observed the client�s behavioral patterns over time, thus allowing for the identification of specific antecedent and consequent contingencies that function to maintain problem behavior (i.e., social attention, escape from academic or task demands, tangible items, sensory stimulation).  The benefit of using a simple pencil and paper task that utilizes a numerical ranking system is that it provides a quantitative ranking of potential functions which maintain problem behavior.  The therapist can then investigate those functions in greater depth and develop intervention plans that directly address those behavioral functions.  Indirect assessments can also be beneficial because they provide a consistent format for conducting an interview, the task of asking each question requires little skill and preparation, and the process is quick and efficient (Iwata, Deleon, & Roscoe, 2013). Dixon and Johnson�s (2007) Gambling Functional Assessment is an example of a behavioral rating scale that identifies the functions that maintain the performance of another problematic behavior, pathological gambling.  The GFA was designed to identify potential controlling variables maintaining gambling in order to yield additional insight into treatment strategies.  The GFA was intended to identify positive reinforcing contingencies (i.e., tangible items, sensory experience, and social attention), and negative reinforcing contingencies (i.e., escape/avoidance).  The GFA differed from the MAS in that it was designed for a population outside of those with intellectual disabilities.  The GFA represented an attempt to apply behavioral assessment techniques to individuals who did not experience intellectual disabilities and who were engaged in socially significant problem behaviors.
	Another socially significant problem behavior that can be maintained by multiple behavioral functions is the problematic use of video games.  Problematic video game use can be characterized as video game play that is driven by a strong desire or compulsion to engage in the behavior, games becoming the most important activity in life, psychological and emotional preoccupation with games, experiencing a buzz or high from playing, and playing to escape or numb feelings (Oggins & Sammis, 2012).  A survey of over 3000 primary and secondary school students revealed that approximately nine percent of the respondents were problematic video gamers (Gentile et al., 2011).  Respondents who played an average of 31 hours of video games or more per week also tended to demonstrate poorer grades, poorer familial relationships, and aggressive fantasies.  Other studies conducted with adults video gamers estimated the prevalence of problematic video gaming at somewhere between 5% and 12% (Grusser, Thalemann, & Griffiths, 2007; Cypra, 2005).  
In a study conducted with Taiwanese gamers, Wan and Chiou (2006) discovered that the players reported playing for entertainment, to attain a sense of achievement, for excitement, as a means of coping with loneliness, to relieve boredom, stress, or anger, and to escape reality.  Similar themes were found in a study conducted with participants who played an online game named World of Warcraft (WoW), a massively multiplayer online roleplaying game (MMORPG) who reported that playing WoW helped to relieve negative feelings (Hussain & Griffiths, 2009).  Most players reported negative effects of the games such as neglecting sleep, work, school, or friends to play.  About 20% of those who played WoW also considered the game to be potentially addictive.  A further study conducted with WoW players indicated that 40% of 438 players surveyed were addicted to video games (Oggins & Sammis, 2012) and reported playing an average of 37.5 hours per week.  The extensive play time interfered with work activities, social interaction, and sleep schedules. 
Video game addiction is thus a problematic behavior that would merit behavioral and psychological intervention.  However, the behavioral functions of video game play have not been experimentally analyzed due to the difficulty in observing the antecedent stimulus events, video gaming behaviors, and the consequences for those behaviors over protracted periods of time.  Despite that, it is possible to conceptualize the functions that maintain excessive video game play from a behavioral standpoint.  There are several positive reinforcers that can maintain video game play.  For example, players may build up social networks with other players, particularly in online games and MMORPGs.  They may receive social attention from other players for in-game activities while similar social attention for real-world activities might be lacking.  People who play online games especially will be able to interact with individuals from various locations in the world and from various age groups and socioeconomic backgrounds (Chua, Jung, Lwin, & Theng, 2013).  They may also receive praise for completing certain challenges in the game or for being able to play the game well.  In addition to the positive social reinforcers, the players are also able to obtain in-game items such as improved equipment, new costumes, vanity items, and different titles for in-game activities, further encouraging video game play.  The acquisition of in-game items that maintains video game play can be seen as analogous to the acquisition of tangible items.  Although these in-game items are not physically tangible in the real world, their delivery following the performance of some form of in-game activity serves a function that is similar to the acquisition of real goods.  The presentation of positive social interactions and the acquisition of in-game items and rewards are thus two forms of positive reinforcement that maintain video gaming behavior. 
Aside from their positively reinforcing aspects, video games also serve negatively reinforcing functions.  For example, many people who play video games do so in order to escape from stress, boredom, worry, and anxiety related to real-world events (Hussain & Griffiths, 2009; Wan & Chiou, 2006).  Video gamers have reported playing video games in order to feel less upset when difficulties occur in their lives, or to escape or avoid having to experience the aversiveness of having to complete work, academic, or social tasks such as dealing with anxiety-provoking marital issues.  In essence, engaging in video game play behavior allows individuals to escape from or avoid aversive task demands in real life, at least temporarily.  This temporary removal of aversive task demands or difficult emotions represents a form of negative reinforcement which maintains video game play.  
Video games can also serve to provide sensory stimulation that maintains video game play.  Many video games currently have expertly designed graphics that are aesthetically pleasing.  In addition to aesthetically pleasing graphics, many video games also feature music that appeals to a wide demographic range and that are professionally produced.  The complexity of video games has also increased in the past few decades and this increase in complexity adds to the sensory stimulation that video games provide.  Players of current games have to perform more calculations, consider more options, and be more concerned about the allocation of resources in order to perform well in many current games compared to games that were created several decades ago.  Aside from that, many video games have an engaging storyline that serves to lead players to become invested in the characters and events that occur in the game.  All of these factors serve to provide a complex sensory experience that may maintain a person�s video game play.  There is also evidence to suggest that dopamine a neurotransmitter that affects the brain�s pleasure and reward centers, is released during video game play (Koepp, gunn, Lawrence, Cunningham, Dagher�Grasby, 1998), further providing evidence of the sensory functions of video games that maintain play behavior. 
Problematic video gaming may be maintained by one or more of the behavioral functions discussed above.  Indeed, each of the aforementioned functions of social attention, tangible rewards, escape from demands, and sensory stimulation may play a part in maintaining problematic video game play for each individual to some degree.  It would thus be important to determine the primary behavioral function that maintains problematic video gaming in order to design behavioral and psychological interventions that target that function.  However, most current problematic and pathological video game play assessments focus on the symptoms or topographical (formal) properties of video gaming behavior instead of their maintaining functions.  Therefore, the purpose of this study was to develop and provide some initial validation data for a video gaming assessment that will aid clinicians in determining the behavioral functions that maintain video game play despite negative social, financial, and personal consequences.  The assessment that we intended to discuss and validate is called the Video Gaming Functional Assessment (VGFA) and it is we sought to identify which of four maintaining functions (social attention, access to tangible rewards, escape from demands or aversive stimulation, and sensory stimulation) is primarily responsible for maintaining video game play. 
	  

	 




Methods
Participants
A total of 234 individuals were recruited for the initial analysis of the instrument.  Of those recruited, 34 individuals were eliminated from the data due to pre-established inclusion criteria: age restrictions (18 and above), inaccurate information (e.g., marking the same response for each question), duration to complete survey (one minute or less to complete), and missing information.  Therefore, a total of 200 participants were included in the first study and had a mean age of 24.82 (SD: 7.24, range 18-44), with 79% being male (n = 158), and 21% being female (n = 42).  Participants were generally white/Caucasian (n = 169; 84.5%); Black/African American and Hispanic or Latino each consisted of six participants (.03% for each group), Asian or Pacific Islander consisted of eight participants (.04%), and eleven participants indicated other (.055%).  
	A total of 230 video game players were recruited.  However, 19 participants did not meet pre-established inclusion criteria for the analysis of the revised VGFA.  Therefore, 211 individuals participated in the study and had a mean age of 22.35 (SD: 6.17, range 18-78), with 78.7% being male (n = 166), and 20.9% being female (n = 44).  Participants were generally white/Caucasian (n = 156, 73.9%); Black/African American accounted for 5.2% (n = 11), Hispanic/Latino(a) accounted for 7.6% (n = 16); 27 participants were of a different race (12.8%, n = 27).  Additional demographics are displayed in table 1.
   [INSERT TABLE 1 HERE]
Materials
The Video Game Functional Assessment (VGFA) was designed to be an informal functional assessment to ascertain the function of behavior for individuals who play video games via online or through a console.  The first version of the VGFA consisted of 20 questions across four functions: attention, escape, tangible, and sensory (see Table 2).  The concept of four categories was derived from the Gambling Functional Assessment (Dixon & Johnson, 2007) and the Motivational Assessment Scale (Durand & Crimmings, 1988).  Each function consisted of four direct-ended questions, and one double reverse question.  The second and final version of the VGFA consisted of 16 questions across three functions: escape, tangible, and attention. Participants were able to choose one of seven items on a Likert scale as their response to each question (i.e., Never, Almost Never, Seldom, Half the time, Usually, Almost Always, Always).
We originally developed pilot data consisting of a list of six questions per function (24 questions total).  The questions were assessed by 1 Clinical Psychologist, 2 PhD- level Certified Rehabilitation Counselors, and 4 Board Certified Behavior Analysts.  Furthermore, we interviewed self-diagnosed pathological video game players (i.e., time spent playing video games e" 30 hours) to ensure for correct terminology within the questions.  The instrument was then reviewed by each professional at three separate points.  After each review, the questions were modified and altered and redelivered to the professional.  After the third review, the instrument was considered suitable and we pilot tested the instrument by utilizing students (consisting of gamers and non-gamers) from an introduction to alcoholism and drugs course at a Midwestern University to review the questions for clarity and understandability.  A questionnaire was attached to the survey that requested the students� perception of each question, with regards to clarity and understandability.  A Factor Analysis was performed on this data to identify the questions that best represented each function.  A total of five questions per function were then utilized for the current version of the VGFA.  After collecting data in the first study and conducting the factor analysis, questions within the instrument were slightly modified in an attempt to more accurately measure four complete functions.  The reviewers from the original VGFA approved the changes.  However, after concluding that removal of the questions associated with the sensory function would increase the factorability of the remaining questions, a total of six questions per the escape and tangible function and four questions for the attention function were utilized for the revised version of the VGFA.  
Procedure
Prior to conducting both studies, permission from the Institutional Review Board was sought and granted.  The survey was then created in survey monkey, which is online survey software that allows the survey to be distributed via web link.  The survey was designed so that all questions required a singular response and no questions could be unanswered.  Once the survey was created, the students from the Introduction to Rehabilitation course were provided the survey monkey link and were instructed to evaluate whether the survey loaded correctly and report any issues with accessing and taking the survey (e.g., unable to provide a response).  After determining there were no apparent issues with the online survey, we requested permission to post the link to our survey on online forums and blog sites that were dedicated to different console and online video game platforms, such as www.opendune.com, www.pcgamerforum.com, and www.wow.com.  The participants were recruited through posting of new threads in the online forums and blog sites, and were given the following recruitment statement: 
�Click on the link below to access a survey on online gaming: https://www.surveymonkey.com/s/SIUGFA�.  
All participants were asked to initially complete an informed consent form, followed by a demographic survey, which included: age, gender, ethnicity, alcohol usage, and cigarette usage, hours playing a video game per week, type of game typically played, and which day is played the most.  Upon completing the demographic form, participants were asked to click the �Next� button located on the bottom of the screen, which took them to the VGFA assessment.  The questions were presented as seen in Appendix A & B, with the exception of circling an answer; a drop down screen was shown.  If at any time, the individual wanted to stop or discontinue with the study, they were allowed to by clicking the red �X� button on the top right part of their screen.  At completion of the study, the participants were debriefed.
Results 
The data were screened for Univariate outliers, and the minimum amount of data for factor analysis was satisfied, with a final sample size of 200.  Initially, factorability of the 20-item VGFA was examined using several well-recognized criteria.  A total of 18 of the 20 items correlated at a minimum of .30 with at least one other item, suggesting reasonable factorability.  Kaiser-Meyer-Olkin measure of sampling adequacy was .768, above the recommended value of .60 (Garson, 2013).  Bartlett�s test of sphericity was significant (�2 = (190) = 1411.664, p < .000).  Diagonals of the anti-image correlation matrix exceeded .4, supporting inclusion of each item in the factor analysis.  Communalities were all above .400, except question 4, confirming all other items shared some common variance.  Therefore, Factor Analysis was conducted with all 20 items.  
	Principle components analysis (PCA) was utilized because the primary purpose was to identify and compute scores for the factors underlying the revised VGFA.  The first factor explained 16.78% of the variance, second factor explained 15.77% of the variance, third factor explained 11.05% of the variance, and the fourth factor explained 9.96% of the variance.  The four factor solution, which explained 53.57% of the variance, was preferred because of its previous theoretical support (Hancock & Mueller, 2010).  There was little difference between the varimax and oblimin solutions, thus both solutions were examined in the subsequent analyses before deciding on a varimax rotation for the final solution.  A varimax rotation provided the best defined factor structure.  A total of 20 items had loadings over .4, and resulted in four complete factors.  The factor loading matrix for this final solution is presented in Table 2.  
[TABLE 2]
Internal consistency for the entire scale was examined using Cronbach s alpha, and resulted in good overall consistency, � = .839.  
	As noted earlier, the questions with low factor loadings or significant cross loadings were modified and the instrument was re-examined with data collection from a new sample.  PCA was utilized to analyze the factors underlying the VGFA.  The questions developed to measure the sensory function cross loaded on other functions.  We removed all of the sensory-related questions and re-examined that data by conducting another PCA on 16 items.  All of items had loadings above .50, resulting in three complete factors.  Kaiser-Meyer-Olkin measure of sampling adequacy was .760, above the recommended value of .60 (Garson, 2013).  Bartlett�s test of sphericity was significant (�2 = (120) = 1029.94, p < .000).  Diagonals of the anti-image correlation matrix exceeded .50, supporting inclusion of each item in the factor analysis.  Communalities were all above .40, except question 22.  Factor analysis was conducted with all 16 items.  The first factor (i.e., escape) explained 19.75% of the variance, second factor (i.e., tangible) explained 17.00% of the variance, and the third factor (i.e., attention) explained 14.92% of the variance.  The three factor solution explained 51.67% of the variance.  The varimax rotation was utilized and had factor loadings above .40, and resulted in three complete factors.  The factor loading matrix for this final solution is presented in Table 3.  
[TABLE 3]
The entire scale was re-examined and test-retest reliability was established by obtaining good overall consistency with a Cronbach s alpha score of � = .794.
Discussion
The necessity of identifying the function that maintains an individual s behaviors for the development of appropriate interventions are well documented (e.g. Durand & Crimmings, 1988; Iwata et al., 1994; Dixon & Johnson, 2007).  Early literature focused on gathering this information for individuals diagnosed with autism.  However, Dixon and Johnson utilized the methodology for pathological gamblers, in an attempt to better understand what is reinforcing the gambling behavior.  Unfortunately, an instrument that measures the behavioral functions of video game players has not been developed prior to this study.  Therefore, as indicated earlier, the purpose of this study was to develop an instrument to measure four behavioral functions of why gamers continue to play, including attention, escape, tangible, and sensory.  
Our first aim was to pilot the survey in an introductory to alcoholism and drug course to eliminate any issues that may be present (e.g., spelling, grammatical errors).  We originally piloted our survey in an introductory course in alcoholism and drugs to establish reliability and to check for issues related to the survey (e.g., clarity of instructions, clarity of questions).  After issues were corrected, we were interested in determining if the instrument could produce four viable factors.  As such, our factors in the original VGFA explained a substantial amount of the total variance (53.57%): escape explained 16.78 percent, tangible explained 15.77 percent, attention explained 11.06 percent, and sensory explained 9.96 percent.  Furthermore, our results showed that we were able to measure two behavioral functions: attention and tangible.  However, there are a few things to consider.  For instance, the factor loadings were above .400 for both functions; however, one tangible item (Q11) also loaded just below the .400 in the attention function.  Even though we considered loadings over .400 as inclusion criteria to be considered for a factor, the factor loading of this item must be considered because it is close to measuring two behavioral functions.  Moreover, one of the attention items (Q17) loaded higher in the sensory factor (.528).  
	The escape function had four questions (i.e., Q2, Q6, Q10, and Q18) that were well above the .400 parameter for inclusion.  Question 14 loaded at .355 in the Escape function, and loaded at .537 in the Sensory function.  In future versions of the instrument, revision to this question would be beneficial because it may be possible to completely measure this function with the change of this singular item.  The results of the sensory function displayed some issues.  Question 12 and 20 displayed high loadings within this function (.748, .643) and did not have high loadings in other functions.  Question 16 loaded at .411 within the sensory function but loaded at .396 in the escape function.  We believe small revision to the question may be beneficial in clearly displaying a sensory question.  Two questions within the sensory function needed complete revision (Q4, Q8).  These questions had low loadings (.093, .309) and loaded higher in the escape function (.429, .521).  One explanation may be that these questions were not clear and the participants perceived the meaning of the question differently then what we intended to measure.  When we revised the VGFA for the second study, we accounted for these mistakes and modified the questions (i.e., compare Appendix A & B)
	After concluding that some issues were still present after collecting data with the original VGFA, we decided to modify a few questions in attempt to measure four complete factors without cross-loadings.  We conducted a Factor analysis on the second set of data from the new sample and concluded that removal of the sensory questions resulted in three complete factors with high factorability and low cross-loadings.  Therefore, we were able to measure escape, tangible, and attention functions respectively but were unable to predict the sensory function.  The VGFA has the ability adequately predict the function of the behavior within individuals who engage in video game play.  Moreover, unlike other assessments which demonstrate video game addiction to be unitary behavior, the VGFA can be utilized to measure the hypothesis that multiple behaviors can serve to maintain the behavior.  That being said, the recommendations should be twofold: 1) targeted therapy for individuals who suffer from video game addiction should be based on the maintaining functions of the behavior, not the form of the behavior utilized in the DSM-5 (American Psychiatric Association, 2013).  For example, Cognitive Behavior Therapy (CBT) has shown to effectively identify triggers for other behaviors (e.g., pathological gambling [Petry, 2005]) which maintain the behavior.  By implementing the VGFA as an assessment tool, it can aid the therapeutic process.  2) Unlike other assessments which have to be modified for different cultures or ethnicities, the VGFA is universal in the sense that questions can be identified and classified regardless of whose perspective is taken, because the maintaining variables remain the same.  However, the function of the behavior can be different from culture to culture.  For example, Young�s Internet Addiction Survey (Young, 1996) has been widely utilized, but has also been modified several times for several different populations.  We recommend further investigation into cultural norming and a validated instrument that can accurately measure the sensory function.
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Appendix A
Video Gaming Functional Assessment (Original Survey)
Directions: Answer the questions below using the provided scale and write the corresponding number next to each question.

NeverAlmost NeverSeldomHalf the TimeUsuallyAlmost AlwaysAlways0123456
If I lose in battle, I can be assured that my fellow gamers can help me through it_______
I often game after a difficult day at work or school. _______
I enjoy the in-game achievements and statistics that are incorporated into video games_______
I like visually in depth games more than other games_______
I only enjoy the game if my friends are gaming with me_______
I tend to game when I am nervous or anxious_______
I play video games primarily for the accomplishments and achievements I can earn_______
I tend to play video games most frequently when there is nothing else going on and I have nothing better to do_______
After a disappointing day in gaming session, I get support from others to help me deal with it_______
Gaming helps me pass the time_______
If I were unable to gain perks, in-game incentives, or build up my character during video game play, I would probably not play much at all. _______
When playing video games, I have no clue what is going on around me_______
I enjoy the social aspect of playing video games with friends or with the online community_______
I often play video games after getting into arguments with peers or those close to me_______
I play video games more often when I am performing because of in-game achievements then when I do not_______
I find myself feeling a rush, and getting excited when I play video games_______
I enjoy the social aspect of playing video games with friends or with the online community_______
I usually play video games to avoid fulfilling responsibilities or taking a break_______
I play video games more often when I am performing because of in-game achievements then when I do not_______
When I play video games, the game turns into my reality_______


Appendix B
Video Gaming Functional Assessment (Revised Survey)
Directions: Answer the questions below using the provided scale and write the corresponding number next to each question.

NeverAlmost NeverSeldomHalf the TimeUsuallyAlmost AlwaysAlways0123456
I often game after a difficult day at work or school ____________
I will game more if I can obtain rare items within the game __________
I enjoy the thrill of battling others ________
I tend to game when I am nervous or anxious _________
I play video games primarily for the accomplishments and achievements I can earn _____
I enjoy games if my friends are gaming with me __________
I often game when I am upset or depressed _________
I play video games for the highest score possible _________
I play video games to avoid arguments _________
I would be less likely to play video games, if I were unable to gain perks, in game incentives, or build up  my character _______ 
I enjoy the social aspect of playing video games with friends or with the online community _________
I often play video games after getting into arguments with peers or those close to me ___
I play video games longer if I am closer to achieving the next level _________
I prefer a game with a multi-player component ________
I usually play video games to avoid fulfilling responsibilities or taking a break ________
I play games to unlock content _________




Escape
Tangible
Attention1.   ________2.    ________3.   ________4.   ________5.    ________6.   ________7.   ________8.    ________11. ________9.   ________10   ________14. ________12. ________13.  ________15. ________16.  ________

Table 1. Demographic Information of Study Participants.Study 1Study 2CategoriesFrequencyFrequency (%)Hours Played
  0 � 5
  6 � 10 
  11 � 16 
  17 � 22 
  23 + 
36 
43 
45 
19 
57 
50 (23.7%)
66 (31.3%)
49 (23.2%)
19 (9.00%)
26 (12.3%)Day of Week (Played Most)
  Monday
  Tuesday
  Wednesday
  Thursday
  Friday
  Saturday
  Sunday
9
0
22
21
18 
75 
55 
13 (6.2%)
11 (5.2%)
16 (7.6%)
8 (3.8%)
31 (14.7%)
99 (46.9%)
32 (15.2%)Game Genre Preference
  Role Playing
  First Person
  Real Time
  Simulation
  Sports
  Turn-based
  Facebook
Other
96 
41 
14 
1 
2 
8 
n/a
14
81 (38.4%)
42 (19.9%)
21 (10.0%)
4 (1.9%)
8 (3.8%)
19 (9.0%
6 (2.8%)
30 (14.2%)Note: Demographic information was gathered on cigarette smoking behaviors (# consumed daily) and alcohol usage (# consumed per week), but not included in this table.




Table 2. Factor loadings based on a principle components analysis with varimax rotation for 20 items from the Video Game Functional Analysis (VGFA) (N = 200)�AttentionEscapeTangibleSensoryQ1   � Attention .424.270.369.136Q5   � Attention.651.010.250-.085Q9   � Attention .591.155-.126.161Q13 � Attention .811.226.119-.048Q17 � Attention .454.162.108.528Q2   � Escape .202.698.041.276Q6   � Escape .010.757.170-.052Q10 � Escape .014.799.170-.046Q8   � Escape.162.521.057.309Q18 � Escape .100.682.012.070Q4   � Escape.109.429.	�������		 	8	<		�	�	�	�
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Table 3. Factor loadings based on a principle components analysis with varimax rotation for 16 items from the Video Game Functional Analysis (VGFA) (N = 211)�EscapeTangibleAttentionQ1 � Escape.696.156.006Q4 � Escape.763.069-.006Q7 � Escape.770.079-.090Q9 � Escape.694.035.054Q12 � Escape.734.074.042Q15 � Escape.435.208.098Q2 � Tangible.328.608.025Q5 � Tangible.096.734.112Q8 � Tangible-.093.470.361Q10 � Tangible-.026.694-.019Q13 � Tangible.174.619.091Q16 � Tangible .158.762.079Q3 � Attention.178.214.675Q6 � Attention-.164-.034.660Q11 � Attention.213.008.785Q14 - Attention-.066.122.836Note: These are the factor loadings after removal of the questions associated with the sensory items.  The function next to each question in the first column represents the predetermined function for each question from the reviewers prior to data analysis. After removal of sensory items, the data supported the pre-identified questions and associated functions. 










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