Concerned about children's unhealthy exposure to cyber violence and aggression via social media and reality-mimicking video games, the American Academy of Pediatrics (AAP) has issued an updated policy statement on media violence.
"This form of violence is not experienced physically; rather, it is experienced in realistic ways via new technology and ever more intense and realistic games," write lead author Dimitri Christakis, MD, MPH, a professor of pediatrics at the University of Washington in Seattle, and coauthors.
"Because the virtual experience is so much more intense, we reframed our new guidelines around virtual violence, rather than regular media violence. And the experience will become even more intense with the advent of virtual reality gaming," Dr Christakis told Medscape Medical News.
Published online July 18 in Pediatrics, the new policy statement updates the AAP's 2009 statement on media violence and its 2013 statement on children's media usage.
The AAP's Committee on Communications and the Media broadly summarized current evidence on the effect of virtual violence, which increasingly rivals the violence children see in television programs and movies, and made broad prophylactic recommendations for medical and nonmedical stakeholders.
"Like food diets, media diets can be healthy or unhealthy, balanced or imbalanced, or healthy in quality but unhealthy in quantity," Dr Christakis and associates write, adding that a national discussion on the risks for media violence "is necessary and critical for the health of our children and youth."
Because pediatricians are in a unique position of trust to advise parents and are increasingly fielding questions from concerned parents on media violence, the AAP directed the following recommendations to the profession:
Pediatricians should address children's "media diets" as an essential part of well-child examinations.
Pediatricians should encourage parents to monitor and guide the content of their children's media exposure, not just limit exposure time. Trustworthy ratings for healthier viewing are available on the Common Sense Media website.
Pediatricians can help parents understand that children younger than 6 years need shielding from virtual violence, as they are not always able to distinguish fantasy from reality. First-person shooter games focused on killing opponents are inappropriate for children of any age.
Pediatricians should advocate for more "child-positive" media and work with industry to develop violence-free shows and games.
The AAP notes that media-depicted violence has intensified in the years since the first congressional hearings on the possible connection between television violence and homicides in 1952. According to the 1998 National Television Violence Study, the typical US child will have seen 8000 murders and 100,000 violent acts before reaching middle school.
Counterbalancing those troubling numbers is research showing that exposing youngsters to prosocial media content can lower aggression and improve overall behavior. Three years ago, Dr Christakis led a randomized controlled study of preschoolers that found exposure to positive, prosocial television programming reduced aggression, regardless of the amount watched. "Parents can change children's media diet and effect changes in behavior," he told Medscape Medical News. "As pediatricians, we need to focus on helping parents make healthy media selections."
Although some observers continue to dispute any connection between media violence and real-world aggression, the preponderance of evidence from hundreds of studies on thousands of children supports it, Dr Christakis said.
According to the AAP statement, "A sizable majority of media researchers both in pediatrics and psychology believe that existing data show a significant link between virtual violence and aggression." The authors question why the contrarian position on media violence is so often presented when that is no longer the case for secondary smoke exposure.
"The effect of media violence on behavior is in the range of small to moderate, but it is of equal magnitude, or greater, to the connection between passive exposure to cigarette smoke and lung cancer, and many municipalities have laws against smoking," Dr Christakis said. "It's big enough that it should be taken seriously."
He likened this denial to that of climate change: Although the majority of scientists acknowledge the phenomenon, "it's always possible for a journalist to find a credible scientist who discounts it."
The AAP authors concede that although many methodologically heterogeneous studies have reported mixed results, meta-analyses provide an overall estimate of the risks. Summarizing more than 400 studies of violent media of all types, one meta-analysis found a notable association between depicted violence and four negative outcomes: aggressive behavior (effect size, 0.19; 95% confidence interval [CI], 0.19 - 0.20), aggressive thoughts (effect size, 0.18; 95% CI, 0.17 - 0.19), angry feelings (effect size, 0.27; 95% CI, 0.24-0.30), and physiologic arousal (effect size, 0.26; 95% CI, 0.20 - 0.31).
A 140-study analysis focusing only on video games found a slightly larger negative effect.
Broadening the guidelines' scope beyond the medical profession, the AAP committee also had recommendations for parents, government, and the entertainment industry. Among these:
Parents need to be aware of the games and shows preferred by their children and coplay games with them to monitor content.
Policy makers should consider legislation mandating specific details on media content and enact laws preventing minors from easily accessing violent media.
The federal government should help develop a reliable "parent-centric" rating system without waiting for the entertainment industry to do so.
The entertainment industry should avoid glamorizing carrying weapons and normalizing violence as conflict resolution.
The industry should refrain from presenting violence as comical, titillating, or trivial and should eliminate gratuitous presentations of interpersonal violence and hateful language.
Video games should not be based on killing targets, which can lead children to associate pleasure with inflicting pain and suffering.
The news and information media should acknowledge the evidence-based link between virtual violence and real-world aggression. It should stop portraying the connection as debatable and equating unscientific opinion and marketing-driven perspectives with peer-reviewed scientific research.
A related commentary outlined the rapid evolution of media violence in new platforms. "Pediatricians can help families navigate evolving forms of virtual violence by raising parent awareness of the complexities associated with youth recording, posting, texting, or viewing images of real violence with peers," write Rhea W. Boyd, MD, from Stanford University's Department of Pediatrics, Palo Alto, California, and Wendy Sue Swanson, MD, MBE, from the University of Washington School of Medicine in Seattle.
Dr Boyd and Dr Swanson note that young people experience real-world violence via a range of portable devices with internet, photo, and video capacity "that fundamentally change the scope, magnitude, and outcomes of virtual violence exposures by providing access to real violence that can be captured and consumed, virtually." Today, in addition to fictional violence, children can easily capture and share images of actual violent events on their smart phones.
Pediatricians can play an essential role in guiding parents to make their children more discerning about media content and help them safely process media-triggered emotions.
Neither the AAP statement nor the related commentary received external funding. The study authors and the commentators have disclosed no relevant financial relationships.