My brain is melting……..
Impact of Video Games on Children
Punam Kashyap M.D.
Associate Chief
Division of Developmental-Behavioral Pediatrics
Today’s discussion
• “Consumption” of video games by children &
adolescents
• Historical aspects of video: Pac-Man to the
present
• Commonly used video game devices- consoles,
handheld, smart phones, computers
• Video game ratings
• Popular recreational games
• What’s the empirical data on the good, bad and
unknown
• Video games in education
• Video games in health
• AAP Policy on media
Disclosures
I have no disclosures
historical timeline of devices
1972- Magnovox - Odyssey
1976- Atari – Atari Pong
1977 – Coleco releases Telstar series (Gemini, Colortron,
Ranger)
1982- Atari releases 5200 Super System
1985- Nintendo – Nintendo Entertainment System
1989- Nintendo- Gameboy (portable)
1989 – Sega – Sega Genesis
1991- Sega – Sega Game Gear (portable)
1991- Nintendo- Super Nintendo System
video game devices- timeline
1995 – Sony – PlayStation
1996 – Nintendo – Nintendo 64
1998 – Nintendo – Nintendo Gameboy color (portable)
2000 – Sony –PlayStation 2
2001 –Nintendo – Game Boy Advance (portable)
2001 – Microsoft- Xbox
2001 - Nintendo- Nintendo GameCube
2003- Nintendo- Gameboy Advance SP (portable)
2004- Nintendo- Nintendo DS (portable)
video game devices- timeline
2005- Sony –Playstation Portable (PSP)
2005- Microsoft- Xbox 360
2006 – Nintendo- Nintendo DS Lite (portable)
2006- Sony PlayStation 3
2006 - Nintendo – Wii
2009 – Nintendo – Nintendo Dsi
2011- Nintendo – Nintendo 3DS
2012- Sony – PS Vita
2012- Nintendo – WiiU
2013- Sony – PlayStation 4
2013- Microsoft- Xbox One
2015- Nintendo – New Nintendo 3DS (portable)
Nintendo series-timeline
1985- Nintendo – Nintendo Entertainment System
1989- Nintendo- Gameboy (portable)
1991- Nintendo- Super Nintendo System
1996 – Nintendo – Nintendo 64
1998 – Nintendo – Nintendo Gameboy color (portable)
2001 –Nintendo – Game Boy Advance (portable)
2001 - Nintendo- Nintendo GameCube
2003- Nintendo- Gameboy Advance SP (portable)
2004- Nintendo- Nintendo DS (portable
2006 – Nintendo- Nintendo DS Lite (portable)
2006 - Nintendo – Wii
2009 – Nintendo – Nintendo DSi
2011- Nintendo – Nintendo 3DS
2012- Nintendo – WiiU
2015- Nintendo – New Nintendo 3DS (portable)
Sony video game devices-timeline
1995 – Sony – PlayStation
2000 – Sony –PlayStation 2
2005- Sony –PlayStation Portable (PSP)
2006- Sony PlayStation 3
2012- Sony – PS Vita
2013- Sony – PlayStation 4
Teens, Video Games and Civics
(Pew Research Center’s Internet & American Life Project)
Amanda Lenhart et al, 2008
97% of teens ages 12-17 years play games on computer,
web, portable, or console.
86% of teens play on a console like the Xbox, PlayStation, or
Wii.
73% play games on a desktop or a laptop computer.
60% use a portable gaming device like a Sony PlayStation
Portable, a Nintendo DS, or a Game Boy.
48% use a cell phone or handheld organizer to play games.
Teens, Video Games and Civics
(Pew Research Center’s Internet & American Life Project)
Gender and age are key factors in describing teens’
video gaming.
99% of boys and 94% of girls play video games.
Younger teen boys are the most likely to play games,
followed by younger girls and older boys.
Older girls are the least “enthusiastic” players of video
games, though more than half of them play.
65% of daily gamers are male; 35% are female.
Teens, Video Games and Civics
(Pew Research Center’s Internet & American Life Project)
• Most teens play many different types (genres) of
games. Daily gamers more likely to play a wider range
of game genres than non-daily gamers.
• 80% of teens play five or more different game genres,
and 40% play eight or more types of games.
• 55% of daily gamers play eight or more types of games
• Girls play an average of 6 different game genres; boys
average 8 different types.
Top 100 video games sold according to genre
J Steadman, et al, 2014
25
18
12
11
10
8
5
5
3
2
1
Adapted from teens, video games and civics
Pew Research- 2008
Genres (examples)
Teens who play
Racing (NASCAR, Mario Kart, Burnout)
74%
Puzzle (bejeweled, Tetris, Solitaire)
72%
Sports (Madden, FIFA, Tony Hawk)
68%
Action (Grand Theft Auto, Devil May Cry, Ratchet, Clank)
67%
Adventure ( Legends of Zelda, Tomb Raider)
66%
Rhythm (Guitar Hero, Dance Dance Revolution, Lumines)
61%
Strategy (Civilization IV, StarCraft, Command and Conquer)
59%
Simulation (The Sims, Rollercoaster Tycoon, Ace Combat)
49%
Fighting (Tekken, Super Smash Bros, Mortal Kombat)
49%
First Person Shooter (Halo, Counter-Strike, Half-Life)
47%
Role- Playing (Final Fantasy, Blue Dragon, Knights of the Old
Republic; Sandbox RPG- Mine Craft)
36%
MMOG’s (World of Warcraft)
21%
Virtual Worlds (Second Life, Gaia, Habbo Hotel)
10%
Platform ( Super Mario, Donkey Kong)
ESRB Ratings
The Entertainment Software Rating Board (ESRB) ratings provide
concise and objective information about the content in video games
and apps so consumers, especially parents, can make informed
choices. ESRB ratings have three parts:
Rating Categories suggest age appropriateness
Content Descriptors indicate content that may have triggered a
particular rating and/or may be of interest or concern
Interactive Elements inform about interactive aspects of a product,
including users' ability to interact, the sharing of users' location with
other users, or the fact that personal information may be shared with
third parties”
Entertainment Software Rating Board (ESRB)
esrb ratings symbol for EC games
EARLY CHILDHOOD.
Content is intended for young children.
esrb ratings symbol for E-rated games EVERYONE
Content is generally suitable for all ages. May contain minimal cartoon, fantasy or mild violence
and/or infrequent use of mild language.
esrb ratings symbol for E10 games
EVERYONE 10+
Content is generally suitable for ages 10 and up. May contain more cartoon, fantasy or mild
violence, mild language and/or minimal suggestive themes.
esrb ratings symbol for T-rated games TEEN
Content is generally suitable for ages 13 and up. May contain violence, suggestive themes, crude
humor, minimal blood, simulated gambling and/or infrequent use of strong language.
esrb ratings symbol for M-rated games MATURE
Content is generally suitable for ages 17 and up. May contain intense violence, blood and gore,
sexual content and/or strong language.
esrb ratings symbol for AO-rated games ADULTS ONLY
Content suitable only for adults ages 18 and up. May include prolonged scenes of intense
violence, graphic sexual content and/or gambling with real currency.
popular videogames of 2014 (children)
• Super Smash Brothers- Teen T (cartoon violence; crude humor) Wii U, DS
• Plants vs Zombies: Garden Warfare – E10+ (animated blood, cartoon
violence)- PC, PS4, PS3, X360, XB1
• Skylanders Trap Team- rating – E10+ (cartoon violence, comic mischief)
3DS, iOS, PS4, Wii U, X360, XB1
• Disney Infinity 2.0 Marvel Super Heroes- E10+ (cartoon violence)- PS Vita
• Mario Kart 8- E (cartoon mischief)- Wii U
• Pokeman Omega Ruby & Alpha Sapphire –E (mild cartoon violence, comic
mischief)- Nintendo DS
• LEGO Batman 3; The LEGO Movie Videogame – E10+ (cartoon violence,
cartoon mischief) – 3DS, PC, PS4, Vita, Wii U, X360, XB1
• Disney Magical World- E (mild cartoon violence) – Nintendo DS
• Pokeman Art Academy- E – Nintendo DS
• LEGO Marvel Heroes – E10+ (cartoon violence) – PC, PlayStation, Wii,
Xbox
popular videogames 2014 Everyone- Mature
NBA 2K14- E
Madden – E
Titanfall- M (mature)- blood, gore, strong language, violence
Grand Theft Auto V- M- Blood and Gore, Intense Violence, Mature Humor,
Nudity, Strong Language, Strong Sexual Content, Use of Drugs and Alcohol
• Call of Duty Ghosts- M- Blood, Drug Reference, Intense Violence, Strong
Language; 1st person shooter
• HALO 4 – M- blood, violence; 1st person shooter
• World of Warcraft- T- Blood and Gore, Crude Humor, Mild Language,
Suggestive Themes, Use of Alcohol, Violence-massively multiplayer online
(MMO) role-playing game
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What do parents think…….
• Among parents of gamers:
• 90% of parents say they always or sometimes know
what games their children play.
• 72% say they always or sometimes check the ratings
before their children are allowed to play a game.
• 46% of parents say they always or sometimes stop
their kids from playing a game.
• 31% of parents say they always or sometimes play
games with their children.
What do parents think…….
• Parents of teens who play games are generally neutral on the effect of
games on their children, with nearly two-thirds believing that games have
no impact one way or the other on their offspring.
• 62% of parents of gamers say video games have no effect on their child
one way or the other.
• 19% of parents of gamers say video games have a positive influence on
their child.
• 13% of parents of gamers say video games have a negative influence on
their child.
• 5% of parents of gamers say gaming has some negative influence/some
positive influence, but it depends on the game.
Positive impact of video games
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Cognitive
Motivation
Emotional
Social
Physical
Educational
Health
Cognitive benefits of video games
Granic, Lobel, Engels- 2014
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Improvement in selective attention+ attention allocation
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improvement visual-spatial skills- specifically from playing 1st person shooter games (not
role playing or puzzle games)- “3D navigational spaces + fast paced demands require split
second decisions & acute attention to unpredictable changes in context”- Bavelier et al 2012
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problem solving- playing strategic games (role-playing)- self report of higher problemsolving skills & better academic grades –Adachi & Willoughby 2013
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Creativity- playing any kind of video game enhanced creativity- cross-sectional study of
500 12 year old students playing videogames positively associated with creativity –
Jackson et al 2012
digital natives, digital immigrants- do they really think
differently –Marc Prensky- 2007
• Brain plasticity and malleability – brains are
physically different amongst digital natives
• Rewiring of brain in those who play video games
• Children “attend” to games but not classrooms
which demands attention that is not interactive
• Concerns: reflection necessary for learning – but
lost in fast-paced video game environment
motivation in video games
Granic, Lobel, Engels- 2014
• Motivation: resilience in the face of failure
• “gaming may cultivate a persistent, optimistic motivational style- which
may generalize to school and work context”
• Video games use failure as motivational tools to offer intermittent rewards
in games
• Immediate feedback through points, coins etc. keep players motivatedbalancing optimal levels of challenges & frustration with sufficient success
• No empirical studies- direct relationship of playing video games to
persistence in face of failure, and real world success
• Ventura et al 2013- anagrams-riddle task to college students- video game
users were more persistence in solving the riddles than non- users. (corelational study- the gamers may already be persistent, therefore play
video games)
motivation & learning through gaming
reason why children master video games instead of doing
homework
• intrinsic motivation allows players to learn by
“engaging in something they want to do – any activity
valued by their peers”……..Henry Jenkins
• Motivation linked to challenging materials (Jenkins,
Gee); to interaction and control over their environment
(Bertoli & Nissam)
emotional benefits
Granic, Lobel, Engels- 2014
• Improved mood, + emotions, relaxation, reduce anxiety- Angry Birds,
Bejeweled II (Russoniello et al 2009)
• “most efficient way to enhance emotional state” (Russoniello et al 2009;
Ryan et al 2006)
• Gamers describe “fiero”- intense pride after succeeding against
adversity, flow, transportation while involved in highly rewarding with
high sense of control activity
• Children turn to vide games to regulate emotions- Olson 2009
unclear if gaming to regulate positive emotions is adaptive or
avoidant strategy
• Unclear if adaptive emotional-regulation skills are learned through
gaming – even though games like Portal 2, Pokeman, World of
Warcraft continually challenge emotional flexibility and re-appraisal
“joys” of video games
10 positive emotions experienced by gamers
Jane McGonigal, PhD
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joy
belief
love
surprise
pride
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curiosity
excitement
awe/wonder
contentment
creativity
social benefits of gaming
Playing video games is often a social experience for teens.
• Gaming is a major component of teens’ overall social experience. Teens play
with others in person, with others online, and by themselves.
• Just one-quarter (24%) of teens only play games alone
• three-quarters of teens play games with others at least some of the time.
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• 65% of game-playing teens play with other people who are in the room with them.
• 27% play games with people who they connect with through the internet.
• And nearly 3 in 5 teens (59%) of teens play games in multiple ways—with others in
the same room, with others online, or alone.
• 42% of teens who play games in multiple ways say they play most often with others
in the same room.
• 42% of teens who play games in multiple ways most often play alone.
• 16% of teens who play games in multiple ways play most often with those they are
connected to via the internet. (Teens, Games & Civics, 2008)
social aspects of video games
• Close to half of teens who play online games do so with
people they know in their offline lives.
• 47% of teens play online games with people they know in
their offline lives.
• 27% of teens play online games with people they first met
online.
• 23% of teens play with both friends and family known in
the offline world and people they met online.
Prosocial video games promote helping, empathetic behaviors
• Experimental studies: reduced aggressive thoughts +
behaviors; increased prosocial thoughts- empathy + helping
behaviors leading to prosocial behaviors
(Gentile, Anderson et al 2009; Greitmayer et al, 2010)
• Correlational studies: improved prosocial behaviors
• Longitudinal studies: prosocial games predicted enhanced
prosocial behaviors over 3-4 months
(Gentile, Anderson et al- 2009)
what are civic dimensions of gaming
• Civic learning opportunitiessimulations of civic or
political activities, helping
others, debating ethical
issues
• These opportunities
promote civic outcomes in
youth
• Video games can give
gamers these civic
opportunities – civic gaming
experiences
• 3 groups of youth with civic
gaming experience
• Teens in the top 25% of civic
gaming experiences- more
likely to engage in political
& civic opportunities, and
show more interest in civics
than the bottom 25% of the
group.
equal opportunities for civic engagement through gaming
(Teens, Video Games & Civics, 2008)
Research has found that high school civic learning opportunities
tend to be unequally distributed, with higher-income, higherachieving, and white students experiencing more opportunities
than their counterparts
Civic gaming experiences are more equally distributed than many
other civic learning opportunities.
Teens in this study, were equally likely to report having civic
gaming experiences regardless of race, age, or income.
Girls, who play a narrower band of games and spend less time
gaming, were less likely to have these experiences.
This stands in contrast to findings about the equality of access
to civic learning experiences in high schools.
civic engagement through gaming
(Teens, Video Games & Civics -2008)
• Caveat- Playing games with others in person was related to
civic and political outcomes, but playing with others online
was not.
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Among teens who play games with others in the room:
65% go online to get information about politics.
64% have raised money for charity.
64% are committed to civic participation.
26% have tried to persuade others how to vote in an
election.
Exergames (exercise & gaming) and physical activity
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1990’s - Dance Dance Revolution
Wii –WiiFit
Kinect Sports
Play Station 3 Move
• 2010 survey -40% U.S high school students play
exergames at least once a week
(Fulton, Song, Carroll, Lee, 2012)
Exergaming and energy expenditure (EE)
• 8 hours/week of sedentary
video games- burn 652cal vs.
1990 calories/week playing Wii
Boxing
• EE during active video game
play is comparable to moderateintensity walking – Graf et al 2009
• Wii Fit in lean adolescentsgreater EE than sedentary
gaming, but smaller than brisk
walking (5.3km/hr) or jogging
(8.4km/hr)-Graves et al, 2010
• Meta analysis of 18 studies
exergaming produces lightmoderate intensity activity
with EE > than sedentary
gaming, but < what’s
needed for aerobic fitnessBiddis & Irving, 2010
exergaming and cognitive training
• Aerobic exercise at moderate
intensity (acute and chronic PA)
improves EF- Best, 2010
• Exergames selectively enhanced EF –did
not have to be action video games –
Best, 2012
• Youth with greater physical fitness
show better EF than youth with
less fitness Themanson, et al, 2009
• Competitive exergame vs. cooperative
exergames improved EF in a 10 week study
of overweight-obese teens- improvement
of EF also associated with weight loss in
this 10 week period. Staiano et al, 2012
• Fast-paced video games (not
exergames) improve visual-spatial
processing, EF, attention control,
• In children 8 -21 years with ASD- playing
cognitive flexibility- Green & Bavalier,
exergames for 20 mins reduced repetitive
2003; Greenfield et al, 1994; Li et al,
behaviors, and improved EF on one task –
2009
Anderson-Hanley, et al, 2011
education & learning through gaming
Gaming is producing “new learners” – vs. traditional learner of a classroom
The new learner “learns” in a virtual, 3 dimensional environment, where
“space” is an important aspect
Gaming environment is “interactive” and “explorative”
Games lower the threshold of failure; foster engagement through immersion,
games link learning to goals & roles- games are multimodal- Henry Jenkins
Games are “hard fun” and demand learning- Seymore Papert
Simpson, 2005 –describes critical aspects of gaming
motivation, trial and error; competition & collaboration; rule based;
effort influences outcome – all aspects essential for an active leaner.
Many scholars reiterate the importance for educators and parents to
recognize that students see the world differently and discourage in trying to
mold them into traditional teaching practices………
video games- future of education?
• Quest To Learn- NYC Public School -mimics the action and design
principles of games by generating a compelling “need to know” in the
classroom. Students encounter a series of increasingly complex,
narrative challenges, games or quests, where learning, knowledge
sharing, feedback, reflection and next steps emerge as a natural
function of play.
• MinecraftEdu, SimCityEdu, Leapfrog
• Common Core – boon to educational technology with an array of
educational software/video games aligned with Common Core
standards
• Caution: there is limited data if use of educational video games improve
academic & class performance
• Study of 7-9 years old given 25 session of games to challenge their
working memory- conclusion- it did not improve working memory or
academic skills. Improved performance only for similar games –
Darren Dunning, 2013
• Survey of teachers- lower performing students seem to benefit from
educational games e.g. by improving motivation
video games for Special Educational Needs
• There is need for evidence-based rationale in the use of information
& communication technology for SEN (special educational needs)
• Challenges & appeal- video games could be difficult for students
with SENs- e.g. children with sensory and or motor impairment;
ADHD; communication and language disorders, but can be
appealing at the same time.
• ASD- Anecdotal, survey and experimental studies – children with
ASD strongly attracted to screen-based entertainment, including
virtual reality of video games.
• ADHD – Durkin et al, 2009, found NO differences in frequency or
duration of playing videogames when comparing children with
ADHD with typical peers.
can video games support learning in children with SENs
motivation & participation
• Wasterfors,2011- children with
cerebral palsy exerted themselves
to the “utmost” in sports video
games with unexpected intensity
& complexity of their physical
actions. “Children got an
opportunity to show new
competence in the eyes of others,
and thereby display an “able”,
rather than “disabled” identity”
• Single case reports have shown
increased motivation,
participation & enjoyment in
children with SENs
Cognition
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ADHD- 7-10 years old with ADHD
showed improvement in WM and also
generalization of skills with use of
computer based programs to improve
working memory- Klingberg et al 2002
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ADHD -Reduction in off-task behaviors
with CogMed program- Green et al, 2012
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ADHD- WM training improvement in
game condition vs. regular training –
Prins et al, 2011
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Numerical training using game-based
approach for children with Dyscalculia –
positive results – Wilson et al, 2006
Critics – empirical challenges, transfer of trained skills,
methodological limitations of studies
social promises of video games in children with SENS
• Children & adolescents with ASD “affected” interests in video
games as they understood that games are valued by typical peers –
Winter-Mesiers, 2007
• Anecdotal reports and case-studies- concur that games can help
children with SENs keep up with peer community
• Survey of 52 adolescents with ASD- most frequent social activity for
males was playing video games –also reported more positive
friendship when they played games with friends. Kuo et al, 2011
Electronic media & health education benefits
• Real potential for health related behavioral changes using video
games/computer games for nutrition, physical activity, asthma, diabetes, safety
behaviors, sexual risk behaviors
• Video games can motivate patients, improve health outcomes through their
repetitive nature, personalized message through creation of avatars & virtual
identities & provide immediate feedback to increase engagement.
• A Systematic Review of 19 studies- 17 studies reported at least one significant
effect of behavior change outcome- in increase in fruit/ vegetable
consumption, increase physical activity, improved asthma self- management,
acquisition of street & fire safety skills; and sexual abstinence.
Hieftje, Edelman et al, 2013
• Re-Mission 2- video game for children with cancer- players control a nanobot
who shoots cancer cells, overcomes infections, manages nausea &
constipation- aims to teach kids how best to adhere to their treatment.
Randomized control trial with Re-Mission- kids who played this showed greater
adherence to cancer protocol, self efficacy, cancer-related knowledgedistributed to 200,000 patients
• Caution- many games for behavioral +health improvement are not scientifically
evaluated
Negative impact of gaming
• Violent video games increase aggressive
thoughts, feelings and behaviors
• Desensitize to violence, reduce empathy
• Video game playing is negatively related to
school performance
• Video games may worsen attention problem
• Video game addiction
video games & aggression
• Experimental studies- playing violent games causes
immediate increase in aggressive behaviors, aggressive
thoughts, aggressive emotions-Anderson et al 2004; Barlett et al
• Cross-sectional studies- link violent games to high level of
aggression- Anderson 2007, Krahe et al 2004
• Longitudinal studies- violent games a significant risk factor
for later aggressive behaviors; games affect youth across
different cultures. Anderson et al 2008; Willoughby, Adachi, Good, 2012
• Meta-analysis of 136 research articles- Anderson, Shubuya, et
al 2010- strongest evidence that video games violence
increases the risk of aggression
mediators of aggression in violent video gaming
• 3 year longitudinal study of 3034 children &
adolescents 8-17 years- Gentile, Li et al- 1014
• Conclusion: habitual violent video game play
increased long term aggressive behaviors by
producing changes in aggressive cognition- this
occurred regardless of sex, age, initial
aggressiveness, & parental involvement
gaming and aggression
Several factors contribute to aggression after media violence exposure based on
social cognitive, social-learning & biological influences models……
1. Increase in aggressive thoughts- leading to hostile response to mild provocation
2. Increase in aggressive affect
3. Increase in general arousal
4. Direct imitation of recently observed behavior.
In addition, repeated media exposure can
1. Create more + attitudes, beliefs and expectations in using aggression as solution
2. Creates “aggressive scripts” that make it easily available and acceptable
3. Decrease accessibility to non-violent scripts when problems-solving a solution
4. Decreases the normal negative emotional response to violence
(Craig Anderson, 2010)
decreased empathy and gaming
• Desensitization to violence – reduced
emotional and physiological reactivity to
violence- habitual video gaming linked to
chronic desensitization
(Bartholow et al, 2011; Bailey et al 2011, Bushman et al 2009)
• Reduced empathy and emotional numbing –
leads to reduction in helping behavior
Gaming and ADHD
• Several studies show correlations between attention problems
in children and television- related to rapid change of focus and
exciting levels of videogames cannot compare to day-to-day
classroom activities and may weaken attention
• Swing, Gentile et al, 2010- in children amount of time playing
video games is associated with attention problems; similar in
magnitude to attention problems and television
• adolescents & young adults- amount of time on media
(TV+ video games) related to attention problems
• Gentile et al, 2012- longitudinal study of 3000 children over 3
years- bidirectional relationship between attention problems
and video games - the amount of time spent on gaming
mattered more.
problematic gaming- addiction
5.8% boys in a large survey of 4000 + adolescents showed
problematic gaming
3% girls showed problematic gaming (trying to cut back,
irresistible urge to play, growing tension that could only be
relieved by play)
Girls were more likely to report getting into serious fights,
carrying a weapon to school- Desai et al, 2010
Video game addiction rates vary from 3%- 11.3% in males in
different studies.
Correlates of problematic gaming- regular cigarette
smoking, drug use, depression, serious fights, social
distress, reduced sleep time, lower school achievement,
increased suicidal thoughts.
risk factors of problematic gaming
Risk factors- ADHD and gaming (share common mechanism of rewards &
sensitization; mediated by dopamine.)
Single prospective study of 2000 adolescents for 2 years showed ADHD as
the most significant predictor for development of internet addiction.
Ko et al,2009
Several cross-sectional studies show that ADHD as a significant risk factor
towards internet addiction, especially in girls.
Chan & Rabinowitz 2006, Yen 2007, Ha et al 2006
Effects of methylphenidate treatment for 8 weeks on 62 children with
ADHD + internet addiction- reduction in ADHD symptoms and video
games/internet use -Han et al 2009
problematic gaming & ADHD
• Vulnerability of ADHD- immediate feedback, multimodal
stimulating aspects of games, reward incentive &
motivation to go to next level, rapidly changing screens;
minimal demands on working memory and attention
• Video games believed to activate rewards pathways- some
research on youth with internet addiction have shown
higher reward dependency and increased polymorphisms
of dopamine receptor gene which are implicated in
gambling and alcoholism- Han et al 2007
• Bidirectional relationship- ADHD makes gaming attractiveleading to addiction- this worsens ADHD symptoms by
reinforcing rapid rewards, hyper-focused reactivity,
impulsivity.
video games and school performance
Increased time on screen media (TV, video games,
movies) is associated with poor school performance
National sample of 1491 children 10-19 years
This study found that adolescent gamers spent 34% less
time doing homework & 30% less time reading –
Cummings, Vandewater, 2007
Displacement hypothesis –gaming may displace time
spent in doing home work, reading, and interacting with
families
what’s the verdict?
• Electronic Gaming and Psychosocial Adjustment- Andrew Przybylski,
Pediatrics, 2014
• National sample of 2436 males, 2463 females; age 10-15 years in the UK
• Assessed through self-report
• Findings- low level of daily playing video games < 1 hour (compared to nonplayers) showed higher prosocial behaviors and life satisfaction; lower levels
of conduct problems, hyperactivity, peer problems, & emotional symptoms
• High level players ->3 hours daily- negative adjustment, higher levels of
externalizing & internalizing problems, lower prosocial and life satisfaction
• The moderate players 1-3 hours did not show any difference from the nonplayers
• Importantly- “the size effect of this study was not robust like factors such as
maternal deprivation, family functioning and school dynamics which have a
robust and enduring impact on a child’s psychosocial adjustment and well
being”.
• These findings can impact the way the American Academy of Pediatrics and
other organizations provide guidelines regarding use of videogames in
children and adolescents.
“do video games make kids Saints or Psychopaths”
• Studies are varied- some researchers say that effect
size is small in many studies, negative and positive
effects have been exaggerated; there is research bias
• Others say that the risk is cumulative- playing violent
video games may not be the one big risk factor leading
to aggression and violence, but it cannot be discarded
either.
• ….my 5 year old patient greatly under the influence of
Minecraft told me “my technological brain is
melting…..I take potions, I am afraid of zombies,
monsters, creeper, skeletons, slime”……
AAP Policy Statement
Children, Adolescents, and the Media- 2013
Concerns
daily use of media
8-10 year-old ~ 8 hrs/day
Older children & teens
> 11 hours/day
71% have TV in bedrooms
>75% 12-17 year olds have cell
phones
Concerns of: Media violence,
sex in media, substance use,
music & music videos, obesity,
displacement from other
activities- home work, sports,
family time
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Recommendations
Limit screen time <1-2
hours/day
Discourage screen exposure
for children <2 years
Keep TV, internet device out of
children’s bedrooms
Monitor media use
Co-view TV, movies, videos
Model active parentingenforce mealtime & bedtime
“curfew” for devices; establish
reasonable but firm rules for
media use
what should pediatricians do?
• Become educated on what's “popular” with children &
teens- what are they watching & playing??
• Become educated on critical media topics
• Know that media is woven into kids & teen life
• Know that this “good” or “bad” dichotomy is incorrect
• AAP suggests: Ask 2 media questions
how much media /day, TV & devices in bedrooms- Yes/ No?
• Tell parents that internet screens in bedroom increases
risk for obesity, substance use, exposure to sexual
content, decline in school performance, effect on sleep,
internet addiction
THANK YOU