Association Between Dysfunctional Parenting Practices and Suspected Gaming Disorder Among Japanese Male Junior High School Students: A Cross-Sectional Study of Parental Assessment
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThank you for the opportunity to review this manuscript.
Line 66 requires a citation: "In fact, a few studies have reported an association between parenting style and adolescent GD."
Parenting styles should be described with greater clarity and grounded in relevant academic literature since this is a significant concept with respect to your paper.
2.1 Study participants requires further elaboration. Explain how you know that participants were being honest in self-identifying. What was the screening process? Why did you not ask about the age of children? Why did you choose to survey parents versus speaking to adolescents themselves? How did you decide you wanted 300 participants? More discussion of simply is required here.
Overall the findings are not strongly demonstrated. Correlation is not causation. A better way to test whether parenting style and assessments of GD are accurate would be to measure this with testing on adolescents. In other words, parent suspect GD and young people are administered tools to test for GD to see if they meet the diagnostic criteria.
Author Response
Dear Reviewer 1
Thank you so much for the review and valuable comments, indeed. We have revised our manuscript according to your comments. In the revised manuscript, all of the changes we have made are highlighted with red color. Our responses to your comments are shown in an attached file. Please find the attached file.
With best wishes,
Daisuke Nonaka
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsI'm attaching the file.
Comments for author File: Comments.pdf
Author Response
Dear Reviewer 2
Thank you so much for the review and valuable comments, indeed. We have revised our manuscript according to your comments. In the revised manuscript, all of the changes we have made are highlighted with red color. Our responses to your comments are shown in an attached file. Please find the attached file.
With best wishes,
Daisuke Nonaka
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsThe article addresses a pertinent issue, and the methodology is generally sound, but the limitations substantially diminish the credibility of the findings.
The title specifies “Japanese Adolescents in Tokyo, Japan”. However, it is important to note that only the parents of the boys were included in the sample. This is a significant limitation that is not explicitly stated in the title. It is advisable to revise the title of the article to clarify that the research was based on parental assessments, without the involvement of the teenagers themselves. Furthermore, the research is confined to a specific group - elementary school boys in Tokyo. The authors frequently refer to “adolescents” in a broad sense, particularly in the final section and practical suggestions. It is important to indicate that the findings are limited to this specific group, excluding girls, and to address in the “Limitations” section how the exclusion of girls affects the generalizability of the results. This is a matter of great significance, as the authors cite data on a higher incidence among boys (7.6% compared to 2.5%), but they fail to provide an explanation for the complete exclusion of girls from consideration. This is not a matter of “gender control” in the study, but rather the exclusion of a specific group from the study design. Also, it is essential to clarify in the article’s title that the focus is exclusively on male participants.
When creating the research sample, the researchers omit children who do not engage in gaming. This is a valid approach, but it is important to note that the findings cannot be generalized to the entire population. The results only apply to boys who participate in gaming. This aspect should be explicitly mentioned in the “Limitations” section.
It is worth mentioning that the article employs the term “suspected GD” (suspected gaming disorder) based on a parental questionnaire. How closely does this threshold align with the clinical diagnosis as defined by ICD-11? In the section titled “Discussion”, the level of 24 percent is contrasted with 7.1 percent from the meta-analysis, as cited in lines 242 and 243, but it is important to note that these may represent entirely distinct constructs. The authors ought to exercise caution when interpreting such a high incidence, as it could potentially be attributed to “false positive” responses on the scale.
It is interesting to observe that in Table 3, for the variable “Child difficulties”, the odds ratio in the highest tertile is 4.34 (1.73-10.89), which is a more significant predictor than Overreactivity (odds ratio 1.75). This raises the question: why is the discussion primarily centered on Overreactivity rather than Child difficulties? This suggests that it is the child’s behavioral and emotional challenges that contribute to both gaming disorders and a reactive parenting approach (a reverse causality). This aspect must be addressed in the Discussion section.
The authors extensively explore the idea that excessive reactivity can lead to psychological distress, which in turn contributes to GD. However, one should note that the study design is limited to a snapshot in time, and it is possible that the relationship between GD and reactive behavior is bidirectional. Children with GD may engage in more active play, perform less well academically, and engage in conflicts with their parents, which can in turn trigger more reactive and irritable behavior in the parents. This is a crucial constraint that must be explicitly articulated in the relevant section. Moreover, this aspect must be revisited and reflected upon in the “Discussion” section as well.
Author Response
Dear Reviewer 3
Thank you so much for the review and valuable comments, indeed. We have revised our manuscript according to your comments. In the revised manuscript, all of the changes we have made are highlighted with red color. Our responses to your comments are shown in an attached file. Please find the attached file.
With best wishes,
Daisuke Nonaka
Author Response File: Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for AuthorsThe paper examines the association between dysfunctional parenting practices - specifically Overreactivity and Permissiveness as measured by the Parenting Scale (PS) - and suspected gaming disorder (GD) among parents of male junior high school students in urban Tokyo. The paper makes a meaningful contribution to the literature on family-level risk factors for adolescent GD by focusing on specific, observable parenting behaviours rather than broad typological classifications. Gaming disorder in adolescents is a topic of growing public health relevance, and the focus on modifiable parenting behaviours will interest professionals across developmental psychology, psychiatry, and public health. The Japanese setting and use of culturally validated instruments add specificity of interest to researchers working in East Asian contexts.
The theoretical framing is appropriate and coherently motivated. Positioning the Parenting Scale as a more operationally precise instrument than broad parenting style classifications is well-argued, and the rationale for examining Overreactivity and Permissiveness as distinct constructs is good. The self-medication hypothesis is invoked competently to explain the Overreactivity–GD pathway, and the cited empirical support is adequate.
But several conceptual issues require attention. The restriction of the sample to male adolescents is epidemiologically defensible but theoretically underdeveloped. The authors note the well-documented gender disparity in GD prevalence and cite relevant data, yet they do not discuss whether the mechanisms linking parenting style to GD are expected to differ by gender, or whether the male-only design is intended to control for gender as a confound or to enable gender-specific inference. At least one cited study suggests that parental engagement operates differentially by gender, a finding that makes the absence of theoretical elaboration on this point more evident.
The operationalisation of GD through parental report is acknowledged as a limitation, but its conceptual implications are insufficiently explored. When both the predictor (parenting style) and the outcome (suspected GD) are rated by the same subject (the parent), the risk of shared method variance exaggerating the observed association is substantial. A parent who perceives their child's behaviour as disordered may simultaneously report higher levels of reactive discipline — not because overreactive parenting caused the disorder, but because both ratings reflect a generalised negative perception of the child. This threat to validity extends well beyond simple prevalence overestimation and warrants explicit discussion.
The manuscript is clearly written and logically organised. The English is generally fluent, with only minor grammatical inaccuracies.
The Methods section is well organised and the Results are reported clearly, but several terminological issues require attention. The term "suspected GD" is used consistently to denote children who meet the GADIS-P threshold, which is appropriate for a screening instrument. However, the manuscript would need an explicit statement clarifying that the GADIS-P is a screening classification, and that the label "suspected GD" is used deliberately. Without this clarification, readers unfamiliar with the instrument may confuse screening positivity with confirmed disorder.
The empirical and theoretical basis for the GADIS-P cut-off scores (first factor ≥ 10, second factor ≥ 6, timing item ≥ 2) is not explained. Given that these thresholds determine the classification of the primary outcome variable, their derivation should be cited or briefly described.
In Section 2.5, the justification for the choice of statistical tests is incomplete. The authors state that an independent samples t-test was used because "the predictor variables are normally distributed," but do not specify how normality was assessed or by what criterion. The rationale for applying an independent samples t-test to PS factor scores while using the Mann–Whitney U test for continuous covariates should be made explicit and internally consistent.
The reference list is largely relevant and adequately current. But two references - Wu et al. (2026) and Tateno et al. (2026) - requires clarification. The manuscript draws heavily on Chinese and South Korean empirical literature to contextualise findings from a Japanese sample. A brief discussion of the cultural transferability of these findings would strengthen the contextual grounding of the study.
The sample of 300 parents is modest but adequate. But the recruitment of participants through an Internet research company introduces a selection bias that is only partially acknowledged. The authors note the potential for prevalence overestimation, but the more consequential concern — that the association between parenting style and GD may itself be distorted in a panel characterised by heightened Internet engagement — is not addressed. This distinction should be discussed explicitly in the limitations section.
The age range implied by the junior high school restriction (approximately 12 to 15 years) covers a period of considerable developmental variability in gaming behaviour and susceptibility to parental influence. School grade is included as a covariate in Model 2 and does not emerge as a significant predictor, but the possible developmental moderation of the Overreactivity–GD association is not discussed. A sensitivity analysis stratified by school grade, or at minimum a brief discussion of this possibility, would strengthen the developmental specificity of the findings.
The in-sample validation of the Japanese PS is a worthy contribution. The convergent validity assessments and internal consistency estimates are appropriately reported. However, the confirmatory factor analysis results — specifically the model fit indices (e.g., CFI, RMSEA, SRMR) — are described as having been conducted but are absent from the manuscript. Given that the two-factor structure of the PS is a foundational assumption of the analytical strategy, the omission of fit statistics is a significant gap that must be addressed.
The GADIS-P is described as having established linguistic validity in its Japanese version, but no psychometric properties are reported for the present sample. At minimum, the internal consistency of each GADIS-P factor should be reported, given that the instrument is the primary outcome measure.
The Statistical analyses is generally sound, but several issues require resolution. The categorisation of parental mental health (K10) and child difficulties (SDQ) into tertiles for regression inclusion is not justified. Tertile categorisation entails a loss of statistical power and may obscure dose-response relationships that would be visible in continuous analyses. The authors should either retain these variables as continuous predictors or provide a clear rationale for the chosen categorisation. Neither model is accompanied by an overall fit statistic (e.g., Nagelkerke R², Hosmer–Lemeshow test). These indices are standard in logistic regression reporting and would allow readers to assess the proportion of variance explained and the adequacy of model fit.
The tables are clearly structured, and data are presented in a readable format. The manuscript contains no figures. While this is not a requirement, a forest plot displaying the adjusted odds ratios with confidence intervals from Model 2 would improve the accessibility of the multivariate results for readers less familiar with logistic regression output.
The discussion is focused and engages appropriately with the main findings, but several interpretive concerns require attention. The explanation offered for the null Permissiveness finding - that permissive parenting may preserve children's autonomy - confuses permissive and inconsistent discipline with deliberate autonomy support, as noted above. The authors should either offer a more theoretically precise account of the null finding. The discussion does not adequately address reverse causation. Several passages imply a directional causal pathway from overreactive parenting to GD that the cross-sectional design cannot establish. The conclusion that parental psychological support "can contribute to the prevention and treatment of GD" moves directly from associational evidence to intervention recommendation without acknowledging that children's gaming behaviour may equally plausibly elicit overreactive parenting responses.
The limitations section, while is clear regarding sampling and parental report bias, does not address other important limitations such as the absence of child self-report, the geographic restriction to a single urban area of Tokyo, or the inability to determine the temporal ordering of predictor and outcome variables.
The application of the Parenting Scale to examine specific dysfunctional parenting behaviours in relation to adolescent GD in a Japanese sample represents a meaningful methodological refinement over broad typological approaches. The identification of Overreactivity as an independent predictor of suspected GD has clear implications for intervention targeting but should be strengthened by longitudinal evidence and the unresolved reverse-causation concern. The manuscript is clearly written and logically structured. The logistic regression framework is appropriate, and the sequential modelling strategy is well-conceived, but the weakness above mentioned undermine the reproducibility and inferential validity of the findings.
The manuscript is written in clear and accurate English. Grammatical errors are infrequent and do not substantially obstruct comprehension. An editorial review is recommended to address minor syntactic inaccuracies.
In conclusion, the paper presents a focused and clinically relevant investigation, with central finding statistically robust and practically meaningful, but several issues require substantive revision, as we indicated above, before the manuscript can be considered for acceptance.
Author Response
Dear Reviewer 4
Thank you so much for the review and valuable comments, indeed. We have revised our manuscript according to your comments. In the revised manuscript, all of the changes we have made are highlighted with red color. Our responses to your comments are shown in an attached file. Please find the attached file.
With best wishes,
Daisuke Nonaka
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsThe manuscript has improved considerably since the previous review round. The authors have undertaken a thorough revision of the paper and have responded constructively to the comments and recommendations provided. These revisions have significantly enhanced the clarity, coherence, and overall scientific quality of the manuscript.
The study now presents a more robust and well-developed contribution to the field, and the manuscript is written and organized to a standard appropriate for scholarly publication. In its current form, I consider that it meets the criteria for publication in a peer-reviewed scientific journal.
Reviewer 3 Report
Comments and Suggestions for AuthorsThe content of the study has undergone a significant revision, which has enabled the authors to refine the structure and enhance the scholarly significance of the research.
Reviewer 4 Report
Comments and Suggestions for AuthorsIn its revised form, the manuscript is suitable for publication and can be accepted without further modifications.
