Video games have become a popular entertainment among adolescents. Although some video games are educational, there are others with high content of violence and the potential for other harmful effects. Lack of appropriate supervision of video games use during adolescence, a crucial stage of development, may lead to serious behavioral consequences in some adolescents. There is also concern about time spent playing video games and the subsequent neglect of more developmentally appropriate activities, such as completing academic tasks. Self-administered questionnaires were used to assess video game use patterns and parental supervision among 55 adolescent patients 13-17 years old (mean age 14.4 years; 56.4% males) and their parents. Parental supervision /monitoring of the adolescents video games use was not consistent and gender related differences were found regarding their video game use. Close to one third (32%) of the participants reported video game playing had interfered with their academic performance. Parents who understood video games rating system were more likely to prohibit their use due to rating. These findings underscore the need for clear and consistently enforced rules and monitoring of video games use by adolescents. Parents need to be educated about the relevance of their supervision, video games content and rating system; so they will decrease time playing and exposure to potentially harmful video games. It also supports the relevance of addressing supervision, gender-based parental supervisory styles, and patterns of video games use in the evaluation and treatment of adolescents.