Background: The convergence of digital gaming and online gambling is increasingly recognised as a behavioural continuum, particularly among adolescents. Features such as loot boxes, fantasy sports betting, and gamified reward systems can act as gateways, facilitating a transition from recreational gaming to pathological gambling. This progression is often under-recognised in clinical settings, especially in low- and middle-income countries like India.

Objective: To illustrate the clinical and behavioural trajectory of adolescents transitioning from gaming to gambling, and to explore the role of neurodevelopmental vulnerabilities, digital access, and psychosocial contexts in this evolution.

Method: This case series presents three adolescents from a child and adolescent psychiatry clinic in India, each exhibiting a transition from online gaming to covert gambling. Detailed case histories were collected, including behavioural patterns, psychiatric assessments, and management plans. Standardised rating scales were used to screen for ADHD, emotional dysregulation, impulsivity, and conduct traits.

Results: All three adolescents displayed progression from gaming to real-money gambling via mobile applications or fantasy sports platforms. Case 1 involved a 14-year-old male with ADHD and conduct traits; Case 2, a 16-year-old female with emotional dysregulation and subthreshold attentional symptoms; and Case 3, a 15-year-old male with impulsive conduct traits and reactive anxiety. Each case demonstrated significant functional impairments, including academic decline, family conflict, and emotional distress. None had prior psychiatric consultations, underscoring gaps in early identification.

Conclusion: This series underscores a concerning trend of adolescents slipping from gaming into gambling, facilitated by impulsivity, emotional vulnerability, and an unregulated digital ecosystem. Clinical vigilance, early screening, digital literacy, and regulatory reform are essential to mitigate this emerging public health concern. Further research is needed to develop culturally appropriate tools and interventions in low-resource settings.