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Should children be able to play violent video games?

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Should children be able to play violent video games?

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Are children affected long term from playing violent video games?

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Are children affected long term from playing violent video games?

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Are the effects different for boys and girls?

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Are the effects different for boys and girls?

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It would be able to help them get their anger out.

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It would be able to help them get their anger out.

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How is their education affected, if so at all?

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How is their education affected, if so at all?

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It leads to children thinking physical harm is okay.

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It leads to children thinking physical harm is okay.

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14 mass killings have been linked to the shooter playing video games at young ages

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14 mass killings have been linked to the shooter playing video games at young ages

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At TAG Counseling we frequently work with teens who suffer from video game and/or screen addictions. More and more kids are playing violent games early in childhood resulting in increasingly difficult social problems we're dealing with as a society. Moving to Learn recently posted the following article as to why children under the age of 12 should not play violent video games... and the information is sobering.

Video games are a ubiquitous form of entertainment in today's children and youth, and while fun and exciting, video games have a dark side that parents, teachers and clinicians can no longer afford to ignore. The recent rise in mass killings by gun, knife and moving vehicles, has wrongly focused on gangs and gun control as a primary intervention. Society would be wise to shift attention toward understanding the underlying components of a mass killer.

While there are likely multiple factors contributing to the origins of mass killers, we do know that all shooters are gamers, and that gangs use video games to practice the art of shooting. Immersion in a virtual reality of violence has profound impact on developing brains, highlighting the urgency in looking at what type and how much violent media our children are exposed to, and at what age.

Regarding brain and body development, what children do determines who they become. Children who excessively engage in mindless, fast paced, violent media content, will have a much different brain and body than a child who plays outside in nature. The new generation video games contain substantial amounts of increasingly realistic representations of physical and sexualized violence. The mature nature of such games is not suitable for children under the age of eighteen, yet many children I work with are playing violent, mature content as young as age 3.

Managing video game use by children is not easy, but well worth considering with reference to the negative ramifications of gaming overuse on child health and wellness. Three parameters are important to consider in video game management: duration, content, and age of first exposure. Children who start gaming later in childhood, and who follow expert guidelines for game duration and content (see below), will demonstrate less negative effects. Whereas children who play fast paced, violent video games for long periods, and who start gaming as a young child, will exhibit a greater number of below noted negative effects.

It is advised that children who experience 3 or more of the following escalating conditions should work with their parents, physician and/or therapist to reduce video game duration, change to non-violent content, and quit violent gaming altogether if < 12 years of age. This is a hard step for most parents to take, and an even harder step for parents with children exhibiting adverse effects of video games. Parents cannot continue to look away from these potential or real problems in their children. What we resists, persists; what we look at, disappears.

When children are gaming their bodies are sedentary and their hearts and brains overstimulated, causing significant physical harm. Developing bodies crave movement, yet video games entrance and hypnotize the brain into telling the body to sit still, often for very long periods. Psychiatrist Dr. Victoria Dunckley author of "Reset your child's brain" reports that when children play video games, their sympathetic nervous system responds with a hyperarousal state of "flight or fight" characterized by adrenaline release from adrenal glands and dopamine production in the brain. We know that sustained high blood pressure and increased heart rate from prolonged gaming, increases risk for heart attack and stroke in later years. A child who plays video games who is also taking stimulant medication for ADHD, or a gaming child who is physically unfit, increases their risk for eventual heart attack and stroke. In over 30 years as a pediatric occupational therapist, I have observed rapid escalation in prescription of stimulant medications to incredibly unfit children who refuse to participate in PE or outdoor activities. Causal factors for video game induced hyperarousal are fast paced and violent content, bright lights, rewards, multitasking, and interactivity. Long term high adrenaline stress states can result in chronic adrenal fatigue, implicated in a number of physical illnesses including cancer and autoimmune disorders.
Question: Is your child physically healthy? To Do: More green time, less screen time. Only allow screens if homework finished and kids have played outside for at least one hour after school. Get out the bikes; do more family-based activities.
To achieve functional efficiency during brain development, the brain prunes or cuts away neuronal tracks to areas of the brain that are not being used. The frontal lobes of the brain are known for executive functions such as attention, memory, and impulse control which are critical for academic success. Because brains develop in conjunction with stimuli in the surrounding environment, media content in high screen users is key regarding brain pruning. Exposure to mindful or educational content results in active or constructive learning, which maintains and strengthens neuronal tracks to frontal lobes. Whereas exposure to mindless or entertainment content such as fast paced and violent video games, constitutes passive or destructive learning which research shows rarely requires use of frontal lobes, resulting in frontal lobe pruning. Again, 'what you do determines who you become'. Numerous research studies have documented frontal lobe atrophy in children who game over 4-5 hours per day. While brain development has a degree of plasticity or ability to repair damage, over half of the brain is hard wired at age 12, and the majority of the brain is hard wired at age 20 years. Children have the right to a childhood free from violence. Encouraging outdoor play in nature can heal the neurological damage created by overexposure of violent media content.
Question: Is your child impulsive or has difficulty paying attention? To Do: Talk with your child's teacher to see how they are doing academically, and ensure your child is not allowed to game at school.
The National Sleep Foundation reports that over 60% of children and youth are chronically sleep deprived. While we know that sleep is essential for brain repair and body health, what the general public doesn't know is that sleep deprivations increases incidence of obesity, diabetes, poor academic performance, risk taking, heart problems (stroke and heart attack) and even cancer. During my classroom-based Tech Talks, 75% of students report they are allowed screens in their bedrooms and 50% report they use screens when they should be sleeping.
Question: Is your child using screens late or in the middle of the night? To Do: Prohibit all screen usage one hour prior to bed; book, bath, bed. Do not allow screens in bedrooms, or any other area where you can't monitor content e.g. back seat of car, bathroom, when you're not home.
With rise in video gaming, prolific research is documenting concomitant rise in violence and aggression. In 2009 the American Academy of Pediatrics profiled extensive studies showing media violence is causally linked to child aggression, desensitization to violence, nightmares, and fear of being harmed. Early exposure to violent media content has been shown to increase risk of violent behavior. The American Academy of Pediatrics published a policy statement Virtual Violence in July 2016 advising pediatricians, parents, industry and policy makers regarding current video game research and recommendations. Regarding research findings, Virtual Violence policy states: "Summarizing the results of > 400 studies including violent media of all types, researchers found there was a significant association between exposure to media violence and aggressive behavior, aggressive thoughts, angry feelings, and physiologic arousal. Another study performed a similar analysis focusing only on video games. The results, based on 140 such studies, found slightly larger negative effect sizes. Some contend, rightly, that these correlations are in the small to moderate range, but they are stronger than the associations between passive smoking and lung cancer, and many municipalities have banned smoking because of that risk". APA goes on to recommend that children under the age of 6 years have no exposure to media violence, and first-person shooter games should be restricted from children under the age of 12 years.

Click image to enlarge.
Question: Has your child threatened to harm you or themselves if video games are restricted? To Do: Get your family physician on board to talk with your child about video games and if needed, get a referral for a family counselor or therapist immediately. This is an urgent situation and requires assistance from trained professionals. Check out Common Sense Media's list of non-violent video games! Question: Does your child "see or hear" video games when not playing, or act out behaviors endemic in the video game? To Do: In addressing the recent rise in mass killings, a prevention protocol should include restriction of violent media content for developing brains. Banning video games for children < 12 years is an excellent start toward protecting civilians from those intent on mass killings.
Media imagery affects behavior, a fact capitalized on by the advertising industry. Video game imagery is increasingly realistic and highly immersive, even more so with the onset of large screens and virtual reality headsets. Research is now documenting Game Transfer Phenomena, where gamers retain visual imagery and violent behaviors endemic in the game and transfer these to real life. A study of adult gamers showed 71% visualized video game imagery with eyes closed after gaming; 31% visualized imagery with eyes open. This raises the question of what children experience following video game immersion. The problem with younger children is that they are more impressionable, and what they see on TV or video games, they act out in real life. Gamer brain is becoming increasingly problematic in schools where children act out scenes from violent mature video games resulting in acts of sexualized and physical violence toward other students.

One 9-year-old boy I assessed who spoke incessantly about playing Halo Zombies, threw a rock at a passing truck breaking the window stating "I thought I saw zombies in it". Matthew de Grood, a noted 'chronic video gamer', killed five college students stating "I thought they were zombies". Dr. Andrew Haag testifying psychiatrist in the trial proceedings, stated that de Grood "was having delusional symptoms which had a profound impact on how he perceived reality". The recent mass shooting in a Saskatchewan school killing 4 students was by a noted 'loner and video gamer'. Serial killer Dillan Millard reported he played Halo 4 hours per day using Zombie bullets which explode upon entry. ISIS recently created the ARMA III video game to train ISIS recruits. The recent mass shooting in Florida killing 49 people was by an ISIS militant.
Question: Do you think your child is happy? To Do: Children want to play with their parents and friends. Put the phone down, pick up your kids, and go do something fun outside...now.
The Canadian Mental Health Association reports 1 in 7 children and youth have a diagnosed mental illness. Douglas Gentile's 2009 study indicated 1 out of 10 children aged 8-18 years are addicted to technology, with Common Sense Media reporting 50% of youth self-report screen addiction. Never in the history of humankind have there been child addictions. Difficult and expensive to treat, very soon this will become the job of every health and education professional...treating child and youth screen addictions. Schools wouldn't give children cocaine or crack, yet they readily hand out equally as damaging and addictive devices to students on a daily basis, unmonitored. I routinely walk behind students in the hallways, playground, and classrooms and observe social networking, video games, and even pornography.

A 14-year old youth I was assessing for aggression toward other children told me he played violent video games "almost all the time". When asked why he hurts other children stated "I get a rush when I hurt others". While this boy reported he understood there could be a link between violent video game use and aggression, he did not believe that playing video games had any impact on his liking to hurt other children. When asked if he could do the "Unplug Challenge" and not use any screens for 24 hours, he immediately responded with "No way". With increasing research showing harmful effects of screens on child and youth mental health, prohibiting violent media content in children under the age of 12 years is urgently needed. Prohibiting personal device usage in school settings makes a strong statement to children and their parents of the need to limit screen usage.

Children learn social skills from watching and interacting with their parents. If parents rarely communicate with each other or their children, these children fail to learn social skills, and go onto a life strife with communication and behavioral issues. There is a critical period at 6-18 mo. of age for attaining social ability. Infants who spend too much time in front of screens, and too little time interacting with their parents, have increased risk of developing autism and oppositional defiance disorder. Parents model functional (or dysfunctional) relationships, which dictate to a large degree how their child will relate to others. Parents who have good relationships with each other, generally understand how to relate to and meet the needs of their children, who in turn pass these social skills onto their siblings and friends. Children who live in a virtual world for long periods, have great difficulty dealing with problems and demands in the real world. Children who's parents overuse screens feel neglected, and consequently find solace in screens. Hilarie Cash, director of reSTART internet addiction recovery center, states in this video that youth and young adults in her program tell her that there are a number of steps parents can take to prevent gaming addiction including:
Question: Does your child have real (not screen-based) friends? To Do: Prepare and eat dinner together screen-free every night and invite conversation and dialogue with your children, spend at least half a day once per week in screen free outdoor activity, spend your family holiday screen free. One hour per day, one day per week, one week per year screen free.

Help your child develop alternate interests to video games;

Repair your own relationship;

Do not expect perfection in your child;

Be attune to your child's needs;

Set rules and guidelines for internet usage;

Model those rules yourselves.

As social skills are key in establishing primary relationship with partners, as well as securing jobs upon graduation, children and youth who have social anxiety or are socially phobic will have much greater difficulty experiencing meaningful relationships and finding work.
Question: Is your child struggling at school? To Do: Talk with your child's teacher to see how they are doing academically, and ensure your child is not allowed to game as a reward at school.
Regarding early exposure to violent media content, Dimitri Christakis study on fast paced, violent cartoons in 2011 exposed 4-year-old children to 9 min. of SpongeBobs, and found significant decreases in memory, concentration and attention...after only 9 minutes! Research by Jay Hull in 2015 found that moderate gamers who use less than 4 hours per day of video games show increased risky behaviors (sex, reckless driving, drugs/alcohol, smoking), increased defiance, and decreased executive function (attention, concentration, memory). Heavy gamers who use > 4 hours per day of video games, have 4-5 times increased incidence of previously noted effects. While high school drop out rates have steadily declined over the past decade, gamers are at much higher risk than non-gamers for dropping out of high school and university. Increasing incidence of absenteeism and tardiness of children and youth in schools always has me asking students what they were doing at home, and not surprising to hear they were gaming late into the night. Students who are good at gaming often tell me that school is "boring" or "too hard", and that they don't get rewarded for trying to do their work.

Many students I work with outright refuse to do school work, and many teachers are turning to using video games as a reward for produced work at school. We are all aware that high school dropouts have much greater difficulty finding and sustaining jobs, as do video game addicts who again are looking for rewards and achievement in their work that they find favorable in video games. One alarming Canadian statistic is that 42% of 20-29-year-old men are living at home, neither working nor attending school; up from 27% in 1981 and 32% in 1991. What is this potential work force doing at home, and why are parents allowing it to happen?
Question: Have you asked your child if they are using porn? To Do: Watch what video games your child is using or ask them and look up rating on Common Sense Media; remove access to all sexualized content.
42% of children have viewed pornography by age ten. Early exposure to porn is linked to hypersexualized behaviors including early entry into sex, sexting (sending sexualized messages and photo's), high risk sex, and sexual violence. What studies fail to include in their data is that all video games rated Mature contain graphic sexual content and sexualized violence. One of the major "enhancements" in Grand Theft Auto 5 is that the player can not only rape and kill women, but they've now added torture scenes. It is imperative that parents investigate and continuously monitor what their child is watching/playing on their device.
Question: Are you scared of your child? To Do: Have your child urgently assessed by a medical professional e.g. physician, psychiatrist, or psychologist. Engage in more healthy activities as a family. Listen to your child's concerns and stories, don't talk and lecture.
Children are curious about sex, and while it's natural to ask questions and want to know more about sex, there is nothing natural about what children are readily viewing on the internet. The dark web is now easily accessible and contains slasher videos and extremely violent porn. In 2017 the UK reported a rise of 71% of sexual assaults by children on children over the past 4 years which they attributed to internet porn. Utah was the first state to declare pornography is a public health crisis. Again, what children watch is who they become.

Some (but not many) parents I talk to who have children with problematic gaming issues, tell me their child has threatened the parent or themselves with harm should they proceed with video game restrictions. When a child threatens harm to self or others, they are clearly in trouble and not in control of themselves or their actions. If a parent feels threatened when trying to implement video game restrictions, then it is imperative they seek assistance from a medical professional e.g. physician, psychiatrist or psychologist. While most shooters are gamers (14 mass murders are linked to violent video games), this does not mean most gamers will become shooters. What parents, teachers, clinicians, and government can do to prevent mass killers is stop letting children under the age of 12 be exposed to violent media content. Student education regarding impact of violent media content by trained teachers in schools is paramount, as is parent education by counsellors and clinicians (RN's, Dr.'s, therapists, psychologists). Government should legislate video game industry to include clear warnings on all video games referencing harmful effects of video games on children. Parents spending more time with their children and less time on screens will improve child mental health and lessen problematic behaviors and acts of violence.

This article was written by Cris Rowan, pediatric occupational therapist, biologist, international speaker, and advocate for children.

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Ten Reasons why Children Under the Age of 12 Should NOT Play Violent Video Games

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At TAG Counseling we frequently work with teens who suffer from video game and/or screen addictions. More and more kids are playing violent games early in childhood resulting in increasingly difficult social problems we're dealing with as a society.

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Sandy Hook Shooter was obsessed with video games like call of duty and grand theft auto.

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Sandy Hook Shooter was obsessed with video games like call of duty and grand theft auto.

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Adam Lanza, the 20-year-old who convulsed America when he shot dead 20 young children and six of their adult carers at Sandy Hook elementary school in Connecticut last December, was obsessed with mass murders in the run-up to his meticulously-planned attack and kept photocopies of newspaper articles on shootings of children dating back to 1891.

A 48-page summary of the official investigation into the tragedy in Newtown on 14 December 2012 has revealed new details about Lanza's behaviour as he set in train one of the worst mass shootings in US history. The report notes that he had compiled a spreadsheet recording mass murders over the years, giving information on each event.

He had a particular fixation with the Columbine high school tragedy of April 1999, in which two students killed 12 other students and a teacher in Colorado. Lanza also kept a cutting from the New York Times on a 2008 shooting at Northern Illinois university and was in possession of a book, Amish Grace: How Forgiveness Transcended Tragedy, about a 2006 rampage in an Amish school in Nickel Mines, Pennsylvania.

The report also illuminates the lengths to which Lanza went in planning the killings. GPS routes found on a device he purchased showed that he had scouted out Sandy Hook elementary school the day before he carried out the attacks.

The new evidence of Lanza's state of mind in the lead up to the Sandy Hook killings will fuel the debate about mental-health treatment and gun-control laws in the US. Despite making it a top priority of his second term in office, President Barack Obama has struggled to persuade Congress to move forward on new legislation to tighten background checks on gun sales.

But the report makes it clear that there was no evidence Lanza had received formal medical treatment for any mental-health issues he might have had. In 2005 he was given a diagnosis of Asperger's, a syndrome on the autism spectrum, and was described to investigators as "presenting with significant social impairments and extreme anxiety". But he declined to take any medication for his condition and would not engage in therapy. The report concludes: "It is important to note that it is unknown what contribution, if any, the shooter's mental health issues made to his attack ... Those mental health professionals who saw him did not see anything that would have predicted his future behavior."

People affected by the terrible events of last December, as well as participants in the heated debate about gun laws in the US, have been hoping that the state attorney's report would offer clues to the shooter's motivation and prior treatment. But the report largely draws a blank on many of the most pressing questions. It finds clearly that Lanza acted alone, and as a result declares the investigation officially closed. But beyond that investigators confess to being baffled.

The report says: "The obvious question that remains is: 'Why did the shooter murder 26 people, including 20 children?' Unfortunately, that question may never be answered conclusively, despite the collection of extensive background information on the shooter through a multitude of interviews and other sources."

It goes on: "The evidence clearly shows that the shooter planned his actions, including the taking of his own life, but there is no clear indication why he did so, or why he targeted Sandy Hook elementary school."

One aspect of the report that is likely to be pored over by both sides of the gun control debate is the evidence of Lanza's computer game obsessions that was discovered in his bedroom in the basement of his Newtown home. The investigation report lists 12 video games, found in the gaming area of the room, which had violent content, including popular titles such as Call of Duty and Grand Theft Auto . Others included Left for Dead, Dead Rising, Vice City and Doom.

A computer game called School Shooting, which features a character controlled by the player who enters a school and shoots students, was also found.

The report gives a chronology of the events of 14 December which underlines the scale of violence that Lanza inflicted in a remarkably compressed time frame. The first 911 call was received by Newtown police department at 9.35.39am. The last gunshot, believed to be the shot with which Lanza killed himself, was heard at 9.40.03 - just four minutes and 24 seconds later. In that time he killed 20 children, aged five and six, and six of their school guardians. The report gives a sense of how he managed it: in total he was armed with 301 live rounds of ammunition, 154 of which he fired, mainly with his Bushmaster .223-caliber semi-automatic rifle.

In response to Newtown, Obama tried to have semi-automatic weapons removed from sale in the US. He was rebuffed by both chambers of Congress.

The report also highlights the tragedy of Lanza's mother, Nancy, who he killed at the home he shared with her before setting off for Sandy Hook school. All the guns used in the incident - the Bushmaster, a Glock pistol which he used to kill himself, a Savage Mark II rifle with which he shot his mother in her bed, and others - were owned by Nancy Lanza.

She took her son to shooting ranges, to learn how to use guns. She had also written out a check which she intended to give her son as a Christmas present - it would allow him to buy himself a CZ 83 pistol. In another painful irony, Nancy and Adam both took gun safety courses offered by the National Rifle Association.

Computer games found in Adam Lanza's bedroom. Photograph: AP Photograph: AP

Nancy was concerned enough about her son's Asperger's to read on the subject - in her house investigators found copies of two books, Look Me in the Eye - My Life With Asperger's, and Born on a Blue Day - Inside the Mind of an Autistic Savant. The report says: "The mother took care of all of the shooter's needs. The mother indicated that she did not work because of her son's condition. She worried about what would happen to the shooter if anything happened to her.

"One witness indicated that Lanza did not have an emotional connection to his mother. Recently, when his mother had asked him if he would feel bad if anything happened to her, he had replied, 'No.'"

The newly-released material includes photographs taken from Lanza's bedroom, including some of his firearms and video games. But it does not include pictures of the victims. The law was changed in Connecticut in the wake of the massacre, to prevent such images becoming public.

The decision to release only a heavily edited summary of the police report, as opposed to the full version that is thought to run to thousands of pages, has landed the lead investigator in the Sandy Hook tragedy, state's attorney Stephen Sedensky, in controversy. Normal procedure would be for the full report to be put out first, though in this case the authorities have come under intense pressure from families of the children who died.

In a separate event in a court in New Britain, Connecticut, on Monday, Sedensky argued before a judge that the recordings of 911 calls at the time of the shootings should not be released, in order to spare the agony of bereaved parents. The Associated Press has been pressing for the 40-minutes of recordings to be released and the Connecticut freedom of information commission has agreed. The courts will make a final decision on the dispute.

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Sandy Hook report - shooter Adam Lanza was obsessed with mass murder

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Authorities release summary of investigation into December 2012 school shooting in which 20 children and six adults died

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Violent video games give kids a scapegoat instead of doing the thing in real life.

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Violent video games give kids a scapegoat instead of doing the thing in real life.

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Violent video games often show the consequences aswell

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Violent video games often show the consequences aswell

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IE: in GTA for committing crimes the police will arrest you.

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IE: in GTA for committing crimes the police will arrest you.

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Some studies have actually shown that it can have a positive effect on kindness, civic engagement, and prosocial behaviors.

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Some studies have actually shown that it can have a positive effect on kindness, civic engagement, and prosocial behaviors.

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It can desensitize them to real life violence.

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It can desensitize them to real life violence.

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The rating is there for a reason, why ignore it?

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The rating is there for a reason, why ignore it?

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The reason children are able to get their hands on these games is by adults buying it for them. But when something has an M for Mature on it which means 17 or older... Why buy it for them?

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The reason children are able to get their hands on these games is by adults buying it for them. But when something has an M for Mature on it which means 17 or older... Why buy it for them?

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They might become immune to real life violence and think of it as alright.

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They might become immune to real life violence and think of it as alright.

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In those studies that say their are effects, boys are effected much more

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In those studies that say their are effects, boys are effected much more

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Jason E. Goldstick, PhD, 1, ² Jessica S. Roche, MPH, 1, 2, ³ Patrick M. Carter, MD, 1, 2, ³ Brooke J. Arterberry, PhD, ⁵ Erin E. Bonar, PhD, ⁵ Maureen A. Walton, MPH, PhD, 2, ⁵ Marc Zimmerman, PhD, 2, 3, ⁴ and Rebecca M. Cunningham, MD 1, 2, 3, 4, ⁶

Abstract

Video gaming, a remarkably popular hobby in the United States, has been consistently identified as a correlate of aggressive behavior, and this association is not limited to violent video gaming. Prior studies of sex differences in the association between video gaming and aggression have not controlled for other well-known violence correlates (e.g., substance use, community violence exposure, violence attitudes) or focused primarily on high-risk youth. In this study, we used data from an emergency department in Flint, Michigan ( N = 409, 59.9% female, 93.4% African American) to identify sex differences in the association between video gaming and serious peer violence. Youth aged 14 to 20 years were recruited from October 2011 to March 2015, and self-administered computerized surveys including measures of demographics, violence perpetration, gaming frequency, substance use, community violence exposure, and violence attitudes. The primary outcome was an indicator of any serious violence perpetration (e.g., choking, burning, weapon violence) in the past 2 months. Using logistic regression, we estimated the association between gaming and serious violence perpetration, and how it varied by sex, while controlling for demographics, substance use, community violence exposure, and violence attitudes. Approximately 36.6% of males and 27.3% of females reported past 2-month serious violence. On adjusted analysis, hours spent gaming was associated with violence among females (odds ratio [OR] = 1.40, 95% confidence interval [CI] = [1.16, 1.78]), but not males (OR = 1.03, 95% CI = [0.89, 1.19]); in the model including both males and females, the interaction between hours gaming and sex was significant ( p < .01). Our findings suggest video gaming is a stronger marker of severe violence perpetration in females than males among at-risk youth. Violence interventions among females may be improved by including content related to video gaming and identifying other prosocial activities for youth as an alternative to video gaming. Additional research is required to clarify the causal process underlying the identified associations, and to determine what aspects of video gaming are risk-enhancing.

Keywords: youth violence, video gaming, alcohol, drugs

Introduction

Video gaming is a regular activity in 63% of U.S. households ( Entertainment Software Association, 2016) and was identified by the Institute of Medicine as a violence prevention priority ( National Research Council, 2013). The association between video game use and aggression is multifaceted. Specifically, empirical research suggests a clear and reproducible association between violent video gaming and aggression ( Anderson et al., 2010). This association is often conceptualized as arising through violence desensitization ( Carnagey, Anderson, & Bushman, 2007), attitudinal shifts in favor of violent behavior ( Simpson Beck, Boys, Rose, & Beck, 2012), or aggressive individuals choosing violent video games ( Slater, Henry, Swaim, & Anderson, 2003). Other evidence indicates that excessive gaming frequency, not specific to violent games only, is linked to increased aggression ( Kim, Namkoong, Ku, & Kim, 2008; Lemmens, Valkenburg, & Peter, 2011), suggesting that the association between video gaming and aggression may also arise from the clustering of nonnormative behaviors. Individual-level cognitive and emotional traits are theorized to modify susceptibility to media effects on violence ( Valkenburg & Peter, 2013), and some empirical evidence supports that supposition; for example, there is a higher association between video game violence exposure and aggression among individuals with higher levels of trait aggression ( Ferguson et al., 2008). In the current study, we focus on the moderating role of sex on the relationship between video gaming frequency and severe aggression.

Existing literature on sex differences in the association between gaming and aggression has produced mixed results. Some researchers have found that violent video gaming is more strongly associated with aggressive behavior among males ( Anderson & Dill, 2000; Bartholow & Anderson, 2002). Others found that problematic gaming, defined in terms of addictive characteristics of game use, is more strongly associated with aggression-and other negative health factors-in females, concluding that gaming was more normative among males ( Desai, Krishnan-Sarin, Cavallo, & Potenza, 2010). A meta-analysis of the aggression and video game violence exposure concluded that there was no evidence of moderation by gender ( Anderson et al., 2010), but the authors noted trends of a larger association among females in experimental and longitudinal studies, and a larger association among males in cross-sectional studies, further underscoring the inconsistent results.

There are two primary gaps in the current literature on sex differences in the association between gaming and aggression that we seek to address. First, there are several known risk factors for violence among youth, such as substance use ( Goldstick et al., 2015; Nordfjaem, 2017), community violence exposure ( Goldstick et al., 2017), and violence attitudes ( Carter et al., 2015); yet, none of the aforementioned studies control for those factors when estimating sex differences in the gaming/aggression association. Different distributions of those factors among the different study populations may explain the inconsistent results observed. Second, we know of no literature on sex differences in the gaming/violence relationship that focuses on predominantly African American populations and/or populations at high risk for violence. Given that homicide is the leading cause of death among African American youth ( Centers for Disease Control and Prevention, 2015), this is a notable literature gap.

In this study, we used data from an urban emergency department (ED) to study sex differences in the association between video gaming frequency and severe peer violence among youth aged 14 to 20 years, controlling for violence risk factors including substance use, community violence exposure, and violence attitudes. By using an ED-based sample, we were able to recruit youth from an underresourced community ( Pines et al., 2011), many of whom did not attend school, and are thus harder-to-reach. In this way, we were able to study a high-risk, and predominantly African American, sample. We also explored whether our results were specific to a given video game genre preference (violent vs. nonviolent genres).

Methods

Study Protocol

We examined baseline (i.e., pre-intervention or, in the case of controls, prior to receiving the control condition) measurements from a community-based youth violence prevention study. Participants (ages 14-20) were recruited at a Level 1 ED in Flint, Michigan, between October 2011 and March 2015, 2:30-10:00 p.m. daily, with occasional midday shifts (8:30 a.m.-4:00 p.m.; 11:30 a.m.-7:00 p.m.). Eligibility was based on residence in one of two Flint neighborhoods. Exclusion criteria included presentation for sexual assault, suicidal ideation/attempt, and medical/cognitive conditions precluding consent. Individuals below age 18 required parental consent (with youth assent) to participate. Consenting participants self-administered computerized questionnaires (~25 min), receiving US$20 compensation. Individuals were assessed at baseline and at 2 months post intervention. Greater details on the study design can be found in a prior paper describing the study outcomes ( Carter et al., 2016). Protocols were approved by institutional review boards (IRBs) at the University of Michigan and Hurley Medical Center.

Measurements

The outcome was severe non-partner physical violence perpetration over the past 2 months, and was assessed using the modified Conflict Tactics Scale (CTS; Straus, Hamby, Boney-McCoy, & Sugarman, 1996). Violence was considered severe if it included behaviors listed on the severe end of the CTS, which included hitting with something that could hurt, choking, slamming against the wall, beating up, burning, kicking, and weapon violence. Individuals were coded "Yes" for the outcome if they reported any of the aforementioned violent behaviors.

Explanatory variables included validated measures of alcohol use severity, cannabis use frequency, proviolence attitudes, community violence exposure, sociodemographic characteristics (age, sex, public assistance, race, parental cohabitation), and reason for ED visit (violent vs. nonviolent injury). Alcohol use was measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) summary score (range: 0-12; Chung et al., 2000), and cannabis use frequency was measured by the NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) frequency question (range: 0-6; Humeniuk et al., 2008). Each was modified to assess the same past 2-month window used for violence perpetration. Proviolence attitudes (range: 0-5) were measured using the average of four 5-point items from the Youth Empowerment Survey ( Caldwell, Rafferty, Reischl, De Loney, & Brooks, 2010), and community violence exposure (range: 0-4) was measured by the average of five 4-point items from the Things I Have Seen and Heard survey ( Richters & Saltzman, 1990). For additional measurement details, see Carter et al. (2016).

The primary predictor of interest is video gaming frequency, measured as hours per day, rounded up, and capped at 10. While this measure is limited in its ability to ascertain both violent video gaming frequency, we did also measure individuals' preferred video game genre. Specifically, youth reporting >0 hours per day of video game use were asked "What type of video games do you play the most?" and had five response options: action games, fighting games, shooter games, sports games, and role-playing games, with parenthetical examples of each. Using this measure, we were able to ascertain a preference for violent video games based on selecting fighting, shooter, or action games as their preferred genre. To clarify our choice to place "action games" among the violent category, we note that the parenthetical examples given to the participant for action games were Assassin's Creed, Grand Theft Auto, and Splinter Cell-all games that include graphic violence.

Data Analysis

We descriptively compared individuals who did, versus did not, have past 2-month severe violence perpetration, on each explanatory variable. We used logistic regression to estimate adjusted odds ratios (AORs) relating gaming frequency with the odds of past 2-month severe violence perpetration. Models were fit to each sex separately, followed by a joint model to test whether the effect of gaming on violence perpetration varied by sex. Models were adjusted for demographics (age, race, public assistance, living with parents), ED visit reason (violent or nonviolent injury), alcohol and marijuana use, proviolence attitudes, and community violence exposure.

Sensitivity Analysis

To determine, to the greatest extent possible, whether our results were specific to violent video gaming, we conducted sensitivity analysis based on self-reported video game genre preference. We refitted the logistic regression model described above while excluding (a) those who reported a preference for violent video games and (b) those who reported a preference for nonviolent (sports, role-playing) games. Note that individuals reporting 0 hours of gaming per day did report a genre preference, and thus were included in both analyses.

Results

Descriptive Analysis

At baseline, the study sample ( n = 409) was 59.9% female and 93.4% African American; 79.0% received public assistance, 75.3% lived with their parents, and 8.8% were seeking ED care for a violent injury; for greater detail, see the main study outcomes paper ( Carter et al., 2016). Gaming frequency was significantly higher ( p < .001) among males ( M = 2.5 hr/day, SD = 2.8) than females ( M = 0.8 hr/day, SD = 1.8). Of the n = 193 (47.2%) reporting any video gaming, a majority of males (69/118 = 58.5%) and females (52/75 = 69.3%) reported action, fighting, or shooter games as their favorite genre. Approximately 31.0% of respondents ( n = 127) reported past 2-month severe physical violence perpetration, including 36.6% of males and 27.3% of females; the increased rate of severe violence perpetration among males was not statistically significant ( p = .06). Table 1 shows unadjusted comparisons of those with versus without severe violence perpetration. Those reporting past 2-month severe violence were younger, more likely to have presented for violent injury, and scored higher on measures of proviolence attitudes, community violence exposure, alcohol use severity, and cannabis use frequency. Gaming frequency was higher among females who had severe violence than those who did not, but we did not find a difference in gaming frequency between males who did versus did not have severe violence.

Table 1

Severe Violence (n = 127)

No Severe Violence (n = 282)

p

Public assistance

100 (80.0%) a

223 (79.4%) b

.927

Adjusted Analysis

Table 2 displays logistic regression models, stratified by sex, and with both sexes combined, adjusted for all other factors listed in the table. Gaming was a risk factor for violence perpetration in females ( p < .01), with each additional hour corresponding to an estimated 40% increase in violence risk. We found no association between gaming frequency and violence among males.

Table 2

Male (n = 162) OR (95% CI)

Female (n = 244) OR (95% CI)

With Interaction (N = 406) OR (95% CI)

Age

0.76 [0.61, 0.95]*

0.69 [0.56, 0.84]***

0.73 [0.62, 0.84]***

Violent injury (Ref. = no)

7.51 [2.22, 18.17]***

1.84 [0.41, 8.84]

4.16 [1.86, 9.73]***

Violence attitudes mean

1.65 [1.01, 3.21]*

1.68 [1.04, 2.76]*

1.69 [1.18, 2.44]**

AUDIT-C sum (alcohol use severity)

1.20 [0.98, 1.54]

1.12 [0.90, 1.40]

1.16 [1.00, 1.34]*

Community violence

2.46 [1.40, 4.51]**

2.52 [1.44, 4.56]**

2.41 [1.62, 3.62]***

Gaming (hours)

1.03 [0.89, 1.19]

1.40 [1.16, 1.78]**

1.02 [0.89, 1.17]

Gaming × Female

NA

NA

1.38 [1.10, 1.80]**

In the combined model, we found a gaming-by-sex interaction ( p < .01); the AOR relating gaming with violence perpetration was approximately 38% larger among females. Among both sexes, proviolence attitudes and community violence were risk factors for violence perpetration. Violent injury at baseline was a risk factor for males, but not females, while increasing age was associated with less violence perpetration in both males and females. Alcohol use was associated with more violence in all models, but was only significant in the combined model. Model fit was good in all cases, with an area under the receiver operating characteristic (ROC) curve of at least 0.8 in all models.

Sensitivity Analysis

Our sensitivity analyses sought to determine whether video game genre preference affected our results. When removing 72 respondents (23 female, 49 male) reporting video gaming but no preference for violent games, gaming frequency remained a risk factor in the adjusted model for violence among females (AOR = 1.30, 95% confidence interval [CI] = [1.04, 1.67]), but not males (AOR = 0.97, 95% CI = [0.79, 1.17]); in the combined model, the gender/gaming interaction was significant ( p = .047). When removing the 121 (52 female, 69 male) individuals reporting a preference for violent video games, we found qualitatively similar results. Gaming frequency was not a risk factor in the adjusted model among males (AOR = 1.07, 95% CI = [0.87, 1.31]), but was among females (AOR = 1.88, 95% CI = [1.23, 3.36]); in the combined model, the sex/gaming interaction remained significant ( p = .040).

Discussion

Among high-risk, predominantly African American, youth from an underresourced community, sex differences were evident in the association between severe violence perpetration and video gaming frequency. After controlling for demographics, substance use, community violence exposure, and violence attitudes, video gaming frequency was a significantly larger risk factor for violence among female youth than male youth. In particular, increased video gaming frequency corresponded to substantial excess risk of severe violence perpetration (40% increased odds per hour of gaming) in females, but not males; the gender difference was significant. Those results were robust to the video game genre preference, with the same findings present when restricted to those preferred violent video game genres, and to those who preferred non-violent video game genres. Our findings are consistent with prior work indicating that video gaming was a stronger correlate of health behaviors in females than males ( Desai et al., 2010). We extend prior work by focusing on a clinical sample of high-risk youth living in an urban, low-resource environment, and by establishing that this sex-specific association between gaming and violence stands after controlling for traditional violence risk factors, such as substance use, proviolence attitudes, and community violence exposure. The contrast of our findings with a preponderance of other studies of gender as a moderator of the gaming/violence link ( Anderson et al., 2010) underscores potentially important substantive differences in our study population with regard to gaming and severe violence.

One interesting feature of our findings was that the observed associations between video gaming frequency and severe aggression were not specific to those with a preference for violent genres (action, shooter, fighting) of video games. Specifically, significant gender differences in the association between video gaming frequency and severe aggression were found (with large positive effects for females, and null effects for females), both when restricted to those who preferred violent genres of games, and when restricted to those who did not. Those results indicate that video gaming, without specificity to those with a preference for violent genres of video games, is a robust correlate of severe violence perpetration among females in this population. If video game genre preference can be taken as a proxy for the types of games individuals played during their reported hours per day, this may suggest that video game violence exposure was not what drives the observed associations between gaming frequency and severe violence. These findings may suggest that exposure to video game violence does not specifically correspond to excess risk of violence among high-risk youth, such as those living in environments with increased violence exposure, although future studies with direct measurement of video game violence exposure are required in similar populations to reevaluate that hypothesis. Study limitations include self-reported cross-sectional data, our video gaming frequency measure, and geographic generalizability. Although our measurements are based on self-report, the use of validated measures, private computerized administration, and assurance of confidentiality lessens concerns about their veracity. Although causal conclusions are limited by a cross-sectional design, our results add valuable information for future research via a novel study population; future studies in similar populations are therefore advised to evaluate the direction of the identified associations. Our video gaming measures were limited in their ability to rigorously assess violent video gaming exposure. Yet, given that our sensitivity analyses restricting the genre preference (e.g., violent genres versus nonviolent genres) of those reporting video game use produced similar results, we remain confident that our measure did not substantially bias our results. Nevertheless, future studies in similar populations with more comprehensive video gaming measures would be useful. Relatedly, given that this is a low-resource study population, it would be useful to know to what extent lack of video game availability explained low video gaming frequency. Finally, our study occurred at a single ED in a disadvantaged community, although Flint is comparable with other mid-sized cities (e.g., Oakland, California; Camden, New Jersey) in terms of demographics and crime rates. Thus, the results may generalize to other similar urban contexts.

Our results suggest that video gaming is a stronger marker of severe violence (e.g., burning, choking, and weapon violence) perpetration in females than males among at-risk youth aged 14 to 20 years, even after controlling for known correlates of violence-such as substance use, proviolence attitudes, and community violence exposure-which has potential utility for intervention design. Youth violence interventions among females may be improved by including content related to video gaming, perhaps by focusing on identifying other prosocial activities as an alternative to video gaming, such as organized sports activities, church/extra-curricular activities, and other forms of community engagement. This would be consistent with multibehavioral interventions that have been effective ( Walton et al., 2010) by focusing on multiple aspects of a behavioral cluster (in this case video gaming and violent behavior). Additional research is required to clarify the causal direction of the identified associations, and on the design of violence interventions that harness the findings observed here. In addition, future research with more comprehensive questioning on video gaming habits, content, and preferences is needed to more carefully parse what aspects of video gaming are risk-enhancing and what factors might help mitigate the association between video gaming and violence.

Acknowledgments

The authors thank patients and medical staff of the Hurley Medical Center (HMC) for their support of this project.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by CDC 5-U01-CE-001957-03 and, in part, by CDCP 1R49CE002099, NIH/NIDA K23DA039341, NIH/NIDA K23DA036008, and NIH/NIAAA T32AA007477. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies.

Biographies

Footnotes

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

Centers for Disease Control and Prevention. Fatal injury reports, national, regional and state, 1981-2015. Retrieved from www.cdc.gov/injury/wisqars.

Entertainment Software Association. Essential facts about the computer and video game industry: 2016 sales, demographic and usage data. 2016 Retrieved from http://www.theesa.com/wp-content/uploads/2016/04/Essential-Facts-2016.pdf.

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Sex Differences in the Association Between Gaming and Serious Violence Among Predominantly African American Youth

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Video gaming, a remarkably popular hobby in the United States, has been consistently identified as a correlate of aggressive behavior, and this association is not limited to violent video gaming. Prior studies of sex differences in the association between ...

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Studies show their is no real link or relation between these two.

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Studies show their is no real link or relation between these two.