Harvard Health Letter

Today, the average elementary school child plays video games between nine and 11 hours a week

Violent and possibly addictive, video games have become a major part of American childhood. What should parents do?

It's been decades since the game Pong first bounced digital tennis balls across our TV screens. Since then, video games have become a ubiquitous entertainment phenomenon, as well as a major slice of the electronics industry's profits. Adults, especially parents, worry about the health effects, and there's lots of debate about the social and cultural ramifications of video games.


The stereotypical video game player is the solitary teenage boy. While teens are the most avid players, more than half of American adults also play video games, according to some surveys, although the likelihood of being a gamer decreases with age. More women and girls are playing. And while people do play games alone, often gaming has a social element to it, either with people in the same room or over the Internet.

Part of the reason gaming has become so popular is that the games can be played on such a wide range of devices: not only computers and gaming consoles (Playstation, Xbox, Wii), but also handheld devices (Game Boy, Nintendo DS, PSP) and, increasingly, cell phones. The games themselves are equally varied. Many are as benign as Pong. Not surprisingly, the violent action games are the most controversial. The bloodshed is often graphic and the content unsavory. In the best-selling Grand Theft Auto series, players adopt the personae of violent criminals as they roam city streets dealing drugs, shooting rival gang members, and soliciting prostitutes.


Over 30 years of research have shown that exposure to movie and TV violence increases aggressive behavior in children. In most of these studies, aggressive behavior has been broadly defined as physical and nonphysical acts intended to injure or even just irritate. Researchers study aggressive behavior because it is easier to measure in experimental settings, but they've also found that even mildly aggressive behavior correlates with violent behavior -- defined as physical aggression with a risk of harm.

But violent behavior is influenced by so many factors -- innate personality, abusive parents, substance abuse, cultural beliefs -- that it's difficult to tease out media violence, of any sort, as a cause. Some experts are skeptical that any kind of direct connection can be made between exposure to media violence and the real thing.

Although fewer studies have looked specifically at video games, results seem to follow a similar pattern. A number of randomized experiments have shown that playing violent games reliably produces short-term increases in aggressive behavior. A study of children and teens in the United States and Japan, published in Pediatrics in 2008, found a correlation between heavy violent video game playing and acts of physical aggression (hitting or kicking). It would be quite a stretch, though, to cite that result as proof of cause and effect.

Many adults worry in particular about the effects of the bloody "first-person shooter" games like Halo and Doom, which are played from the perspective of someone shooting a gun. While it seems plausible that they might be a potent catalyst for violent behavior, the direct link to real-world violent acts has yet to be proved. However, players who participated in first-person violent games in experimental settings were more likely to assign aggressive traits to themselves after play. And brain scan research has shown that aggressive thoughts and violent scenes in shooter games activate similar parts of the brain.

On the other hand, some researchers say action games may have some real benefits, including improved spatial reasoning and sharper attention skills. Others reference the long history of make-believe play in which children act out scenes from the adult world, some of them quite violent. Since adolescence is a time when aggression normally spikes, especially among boys, some researchers posit that violent games may have a useful cathartic effect.

One question that needs exploration is whether playing violent games sets in motion more subtle aggressive effects that might result in, for example, bullying (although bullying, like violent behavior, has many contributing factors). Other issues that deserve attention include how personality type, home life, and other factors influence children's responses to video games, and how play patterns and reactions to games evolve as they mature.


Today, the average elementary school child plays video games between nine and 11 hours a week; boys in their young teens top the list at about 13 hours of weekly play. Reports of video game addiction have been surfacing since the 1980s, leading to the creation of "detox" facilities for gamers and an Online Gamers Anonymous 12-step program.

The standard definition of addiction includes escalating compulsion to continue a behavior despite its negative effects. Researchers have attempted to home in on the distinctions between heavy play and a true addiction by applying criteria used to identify problem gamblers.

A study published in the May 2009 issue of Psychological Science surveyed over 1,100 children and teens about their level of involvement with video games. Researchers asked not only about the amount of play, but also if gaming was used to avoid problems in life, caused them to shirk schoolwork or household chores, or led to spending too much money on games. Their results revealed that about one in 12 of young video game players showed signs of addiction.

But addiction is a loaded, inflammatory term in many contexts. It's been said that all pleasing activities can be viewed as having addictive qualities, at least in the way psychiatrists define behavioral addiction. Moreover, adults have frequently demonized pop culture phenomena that capture the imaginations of young people. Comic books, television, rock music, rap music, the Internet -- they've all been condemned as corrupting, addictive, or worse.


Video game play has been implicated as the cause of other physical and emotional health complaints. Habitual players have developed "Playstation thumb" and "Nintendoitis" -- repetitive strain injuries in their arms and hands from manipulating controllers. Other documented hazards of excessive play include fatigue and headaches.

Although "screen time" in general has a negative effect on children's fitness levels, video games are perhaps not as detrimental as television. One explanation: People are less likely to snack than when watching TV because their hands are occupied. Movement-based games such as Dance Dance Revolution are also bringing physical activity into the gaming world.

A serious concern is the effect video games have on sleep. Japanese researchers recorded sleep patterns and other physiological measurements for young boys who played an exciting computer game shortly before bedtime. The players had a higher heart rate after playing than nonplayers, and took longer to fall asleep. Key phases of sleep were also disrupted. In another study, children who played video games before bed showed a measurable decrease in memory and verbal thinking ability the following day.


Understand where a child is developmentally. For example, children under age 8 have a hard time distinguishing fantasy from reality, so vivid, violent images may be upsetting.

Use the rating system. Most video and computer games display an Entertainment Software Rating Board (ESRB) code similar to the designations used for movies and TV programs. The code consists of two parts: a letter indicating the age-appropriateness of the game (C for Early Childhood; E for Everyone; T for Teen; M for Mature) and a brief description of the content, such as "strong language," "violence," or "suggestive material." Parents need to be prepared to deal with the "forbidden fruit" problem: an M rating presents a nearly irresistible attraction for many kids.

Use control settings on gaming consoles. The latest generation of video game consoles can be programmed to restrict games with certain rating codes. Some models allow other limits to be set, such as when and how long kids play and who they interact with. (Hint to parents: it's a good idea to be involved in the setup of a new console so you retain control of the PIN that accesses gaming restrictions.) But parents shouldn't just pick on video games. Ideally, gaming should be folded into discussions about setting limits on other absorbing activities and meeting one's responsibilities.

Keep consoles out of the bedroom. The presence of gaming consoles in children's bedrooms is associated with more gaming time in general and more M-rated play.

Offer alternatives. Just saying no isn't very effective. If children today are spending too much time gaming, adults can help by getting more involved in their lives. Reading to a child can counteract the lure of the video game. So can playing a board game, exercising together, even watching television together (in small amounts and not before homework is done). This is harder to do as children become teens who need their independence. - Harvard Health Letter


If you've ever spent hours in bleary-eyed determination trying to vanquish the last wave of invaders of your planet, you know that video games can be long, complex, and difficult. The intellectual challenges inherent in sophisticated video games may be exactly what makes them so enthralling -- and perhaps edifying.

Games like Rise of Nations and SimCity tap into educational concepts such as critical thinking, advance planning, and collaborative problem solving. In this vein, the National Education Association publishes resources for teachers who want to incorporate video games into their teaching.

There's interest in parlaying the social and interactive aspects of game play into awareness of civic and political issues. Food Force, an educational game created by the United Nations World Food Program, casts participants in the role of humanitarian workers faced with a hunger crisis on a fictitious island. Gamers can also assume either side in the Israeli-Palestinian conflict in Peacemaker, which allows players to take part in English, Arabic, or Hebrew.

Gaming has also made its way into the medical arena. For young children, therapeutic games such as Packy and Marlon (about a pair of cartoon elephants coping with diabetes) can foster adjustment to a chronic condition. Video games have also proved to be a powerful pain management tool for children receiving treatment for cancer and sickle cell disease.

Some mental health conditions appear to benefit from video games, as well. For children with attention problems, moderate use of video games offers a welcome respite from the stress of school. Virtual reality systems -- in which a player explores a digital environment via a helmet fitted with video screens -- have been used successfully by people struggling to overcome phobias and anxiety disorders.

The Wii system, which incorporates a player's physical movement into video gaming, has spawned fitness-oriented "exergames," as well as applications that augment rehabilitation therapy.


© Harvard Health Letter







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