There is no shortage of hyperbole when politicians of all stripes describe the nature and effects of video games. Republican presidential candidate Mitt Romney proclaimed, "Pornography and violence poison our music and movies and TV and video games. The Virginia Tech shooter, like the Columbine shooters before him, had drunk from this cesspool."1 Democratic presidential candidate Hillary Clinton spoke of the game, "Grand Theft Auto, which has so many demeaning messages about women, and so encourages violent imagination and activities, and it scares parents."2
Some researchers have echoed similar sentiments, noting that Columbine High School shooters Dylan Harris and Eric Klebold were avid computer gamers.3 Several television pundits quickly drew a link between the recent Virginia Tech shootings and video games, as well. (Ironically, Seung-Hui Cho's college roommates found it odd that he never joined them in playing video games.4)
Do these assumptions about video-game violence leading to similarly violent behavior among child and adolescent players make sense? A review of the research gives us insights into which patterns of video game play may serve as potential markers of more serious problems among children and adolescents, and which are normal or even possibly beneficial.
Additional research and case studies may shed some light on parents' concerns, such as whether video games are addictive or dangerous. Finally, we will offer recommendations on what parents can do to reduce potential risks and to maximize potential benefits of video game play.
The biggest fear of clinicians and the public alike—that violent video games turn ordinary children and adolescents into violent people in the real world—is not borne out by the data. Analyses of school shooting incidents from the US Secret Service5 and the Federal Bureau of Investigation National Center for the Analysis of Violent Crime6 do not support a link between violent games and real-world attacks. But what does research show about more subtle behaviors, such as bullying or changes in game players' perceptions of violence?
Going from lab to street
An August 2007 search of the OVID database for titles incorporating some variation on "video game" yielded 30 articles; a similar search of PsycINFO (limited to peer-reviewed journals) found 418 articles. Most reports focused on studies of the effects of violent video games on aggressive cognitions, emotions, and behavior.
This body of research, however, is of limited use to clinicians for a range of reasons.7 The most-cited studies are laboratory experiments on college students, generally involving brief exposures to a single violent game. Correlational studies typically involve small, nonrepresentative samples, and assess playing time rather than game content. The terminology is vague, and some researchers use "aggression" and "violence" interchangeably, implying that one inevitably leads to the other. Studies done in the 1980s and 1990s are outdated because of rapidly evolving content and technologies. Recent studies that involve child or adolescent exposure to violent game content represent a tiny fraction of this literature.
In the sections below, we review some findings relevant to clinicians, including our own surveys and focus groups with young adolescents. Unless otherwise specified, "video games" refers to console and handheld games as well as games played on computers.
In a 2005 national sample, the Kaiser Family Foundation surveyed 2032 children in grades 3 to 12 about their media use, including computers and video games.8 On average, children aged 8 to 18 years spent 49 minutes per day on video games (console or handheld) and 19 minutes on computer games. Boys aged 8 to 10 years were the heaviest users of video games; 73% played on a typical day for an average of an hour and a half.
To learn more, we surveyed 7th- and 8th-grade students at 2 middle schools in Pennsylvania and South Carolina. Virtually all eligible children attending school on that day participated.9 For most, electronic game play was a routine activity. Of 1254 children surveyed, only 6% had not played any electronic games in the 6 months before the survey. (These nonplayers were excluded from most analyses.) Gender differences were striking. Boys typically said they played video games 6 or 7 days per week; girls typically played 1 day per week.
To assess exposure to various types of game content, we asked children to list the games they had played "a lot in the past months." We found that 68% of boys and 29% of girls aged 12 to 14 years included at least one M-rated (for those aged 17 years and older, often because of violent or sexual content) game on this list of frequently played games.
Why kids play
We presented children and adolescents with a list of 17 possible reasons for playing video games. More than half cited creative reasons for play, such as "I like to learn new things" and "I like to create my own world."
"To relax" was chosen as a reason to play by the majority of boys and close to half of girls. "To get my anger out" was selected by 45% of boys and 29% of girls; 25% of boys and 11% of girls said that they played to "cope with anger." Violent video games might provide a safe outlet for aggressive and angry feelings.10
This use of video games to manage emotions came up repeatedly in focus groups we conducted with 42 young adolescent boys. A typical comment was, "If I had a bad day at school, I'll play a violent video game, and it just relieves all my stress."
Children also play violent electronic games for predictable developmental reasons, such as rebellion, curiosity about the forbidden, and testing the limits of acceptable behavior in a safe environment.11 "You get to see something that hopefully will never happen to you," said one boy in our focus groups. "So you want to experience it a little bit without actually being there."
In both surveys and focus groups, boys described video game play as a social activity. Although most boys played games alone at times, most also routinely played with one or more friends. Just 18% of boys and 12% of girls surveyed said they always played alone.
Markers of problems
Our survey results, combined with other research, hint at some markers of abnormal (though not necessarily unhealthy) game play patterns. It is uncommon for girls to be frequent, heavy players of video games, especially violent games. One third of girls in our survey played electronic games for less than an hour per week on average. By contrast, it was unusual for boys to rarely or never play video games; just 8% of boys played for less than an hour per week. (Since game play is often a social activity for boys, nonparticipation could be a marker of social difficulties. These boys were also more likely than others to report problems such as getting into fights or trouble with teachers.) Finally, boys and girls who exclusively play games alone are atypical.
In our survey of young adolescents, we found significant correlations between routine play of M-rated games and greater self-reported involvement in physical fights, with a stronger association for girls. It is likely that aggressive or hostile youths may be drawn to violent games. There is limited but suggestive evidence that persons with trait anger or aggression may be affected differently by violent games.12 In one study, players tended to be less angry after playing a violent game, but this was not true for subjects who scored high on trait anger and aggression.13 Thus, another possible marker of unhealthy video game use may be increased anger after a round of play.
It must be emphasized that correlational studies, including ours, cannot show whether video games cause particular behaviors. Far too frequently, this important distinction between correlation and causation is overlooked.
Case Vignette: Games and Attention/ Learning Disorders
Alex, a 13-year-old boy, spends 6 to 7 hours a day playing video games. He locks himself in his room, misses meals, and often stays up most of the night, which results in school tardiness. He learns "cheats" (tricks to find quick solutions to game-based problems) online, converses with players in chat rooms, and has accumulated a great deal of knowledge about the intricacies of the many, often violent, games he plays.
Although very bright, Alex has a nonverbal learning disability, social difficulties, poor athletic skills, and attention problems, and he was often made fun of at school. The primary source of his self-esteem, beyond academic achievement, is his video game prowess.
His parents have no understanding of the games, nor of the video games' central importance in his life. Other children in school often come to him for advice about games and strategies and ask to play with him. This has become his claim to fame in and out of school.
While his parents need to educate themselves about the games he is playing and to set limits on his game play, their initial response to curtail them has been modified over time, allowing for an important avenue in the socialization of their son.
Therapy for Alex and his parents involved their appreciation of the role and meaning of games in his life. His parents needed to understand that competence is a crucial component of positive self-esteem—something Alex needed tremendously in order to take on academic and social challenges. Video games provided a means for Alex to feel more confident in moving ahead in these areas. With a greater understanding of the role the games played in his life, his parents were much more tolerant of his game playing.
The therapist continues to work with Alex and his parents and teachers to find additional ways for him to build a stronger sense of himself, improve his self-worth, and learn new ways of connecting with peers. His increased sense of competence has translated into greater academic achievement and the development of friendships outside the realm of video games.
Little research has been done on how subgroups of children, including those with diagnosed mental illness or learning difficulties, may be differentially affected by video games—for better or worse.14 Our survey included Pediatric Symptom Checklist subscales15 on attention and internalizing symptoms. Boys whose responses put them over a threshold level for attention-deficit/ hyperactivity disorder (ADHD) symptoms were more likely than others to use games to cope with angry feelings.
Among girls with ADHD symptoms, twice as many (almost 1 in 4) played games to make new friends compared with girls who did not have ADHD. In moderation, these are probably healthy uses of video games. As in the case of Alex above, children with ADHD often are adept at playing video games and using computers. This can provide a highly valued source of self-esteem.
Might video games be helpful with other illnesses, such as depression? In our survey, children who endorsed internalizing symptoms, such as feeling sad, hopeless, and worthless were much more likely to select "to forget my problems" as a reason for playing video games. These children did not spend significantly more time with video games, but they were more likely to play alone. Unfortunately, we do not know enough to say whether using video games to manage emotions is healthy or unhealthy for depressed children in general, or any child in particular. It may be that temporary or intermittent immersion in a game is therapeutic, while playing games alone for hours most days after school makes matters worse. Talking with a child about where, when, why, and how he or she uses electronic games could provide some useful insights.
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