**Ki Hyeon Kwak, Hyun Chan Hwang, Sun Mi Kim and Doug Hyun Han \***

Received: 23 October 2019; Accepted: 7 January 2020; Published: 9 January 2020

Department of Psychiatry, Chung Ang University Hospital, 102 Heuk seok ro, Dongjak gu, Seoul 06973, Korea; letter2kh@naver.com (K.H.K.); mossflower28@naver.com (H.C.H.); cryslake@naver.com (S.M.K.)

**\*** Correspondence: hduk70@gmail.com; Tel.: +82-2-6299-3132

**Abstract:** While pro-gamers play according to defined living habits and planned schedules, adolescents with internet gaming disorder (IGD) exhibit irregular lifestyles and unregulated impulsive gaming behavior. Fourteen IGD adolescents and 12 pro-gaming students participated in this study. At baseline and after one year, demographic data, the Child Behavior Check List (CBCL), depressed mood, anxiety, and resting-state functional magnetic resonance imaging were assessed. Over the year, IGD adolescents played games as per their usual schedule, while pro-gamer students played according to their school's team schedule. After one year, the pro-gamers' scores had decreased in the CBCL-total (total problematic behaviors), CBCL-externalizing (under-controlled behavior, like impulsivity and aggression), and CBCL-internalizing (over-controlled behavior like depression and anxiety) compared to those of the IGD adolescents. Both groups displayed increased brain activity in the parietal lobe (a component of the attention network) over the years. Compared to pro-gamers, IGD adolescents showed higher brain activity within the left orbitofrontal cortex. Brain activity within the orbitofrontal cortex was associated with CBCL-externalizing scores. These results suggest that gaming had increased the attention network's brain activity, but a well-organized support system could lead to different results, in terms of improved behaviors and suppressing brain activity within the orbitofrontal cortex.

**Keywords:** internet gaming disorder; pro-gamers; Child Behavior Check List; resting-state functional magnetic resonance imaging
