• autism spectrum disorder
• autistic traits
• hikikomori
• internet gaming disorder
• pathological video gaming
• social withdrawal

Background: Pathological video game use is an emerging mental health problem which, in the form of Internet gaming disorder, was included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) among the conditions which require further studies. It mainly affects adolescents and young adults. While pathological video game use and hikikomori-like social withdrawal are considered closely associated, scant experimental research focused on this topic. Moreover, only a limited number of studies evaluated the association between pathological videogame use and autistic traits, generally highlighting a link between the two conditions. The aim of the present work was to investigate presence and correlates of autistic traits and hikikomori like-social withdrawal in pathological and non-pathological video-gamers recruited among university students enrolled in three-year, master’s, or single-cycle degree programs.

Methods: All participants were assessed with the Assessment of Internet and Computer Game Addiction (AICA-S), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), and the Hikikomori Questionnaire-25 (HQ-25) through an anonymous online form and classified in average, excessive and pathological gamers, based on the AICA-S scores.

Results: Results showed that pathological gamers reported greater autistic traits and hikikomori tendencies than other groups according to AdAS Spectrum and HQ-25 total and domain scores, while excessive video game users also scored higher than average users in most domains. Moreover, according to a set of regression analyses, AdAS Spectrum and HQ-25 total scores emerged as significant positive predictors of AICA-S total score, of a greater number of hours spent playing video games and of the presence of school-related issues attributed to video games. A linear regression performed using AICA-S total score as dependent variable and AdAS Spectrum and HQ-25 domains as independent variables showed that AdAS Spectrum Verbal communication and Empathy domains and HQ-25 Isolation domain emerged as significant positive predictors of higher AICA-S total score. Moreover, AdAS Spectrum Empathy and HQ-25 Isolation domains were statistical positive predictors of higher time spent gaming during weekdays, while AdAS Spectrum Inflexibility and Adherence to routine and HQ-25 Emotional support domains emerged instead as protective factors. AdAS Spectrum Childhood and Adolescence, Verbal communication, Non-verbal communication, Empathy and Restricted interest and rumination domains and HQ-25 Isolation domain were statistical positive predictors of school-related issues attributed to video games, while AdAS Spectrum Inflexibility and Adherence to routine and HQ-25 Socialization domains emerged as protective factors. A mediation analysis demonstrated significant direct effect, and indirect effect through the HQ-25, of the AdAS Spectrum total score on the AICA-S total score.

Conclusions: Our findings support the association between pathological use of video games and both autistic traits and hikikomori tendencies. Furthermore, significant associations emerged between specific symptomatic domains of the autistic spectrum and the hikikomori spectrum with different areas of functional decline, in particular with the number of hours spent playing and with academic problems related to videogame use. Interestingly, according to the regression models and mediation analysis, our findings suggest a predictive role of autistic traits on pathological videogame use, directly and indirectly, with a mediating effect of hikikomori behaviors.