MEDLINE Abstracts: The Impact of Computer/Video Games on Youth

December 06, 2002

MEDLINE Abstracts: The Impact of Computer/Video Games on Youth

What's new concerning the impact of computer/video games on youth? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Psychiatry & Mental Health.



Charlton JP
Br J Psychol. 2002;93:329-344

Evidence supporting the application of Brown's (1991, 1993) conception of behavioural addiction to computing behaviour is presented. Questionnaire items tapping Brown's addiction criteria were factor-analysed along with others, including computer apathy-engagement and computer anxiety-comfort items of Charlton and Birkett (1995). Items relating to some of Brown's criteria (tolerance, euphoria, and cognitive salience) were found to be complex, an Addiction factor loading upon them but an Engagement factor loading more highly. Items tapping other criteria (conflict, withdrawal, behavioural salience, and relapse and reinstatement) were shown to be factor pure, with only the addiction factor loading highly upon them. It is concluded that Brown's conception of behavioural addiction can be applied to computer-related behaviour, although the relationship of milder facets of addiction, which are also merely indicative of high engagement, to computer-related addictions is non-unique. It is also concluded that classifying individuals as exhibiting pathological computer use using checklists based upon adaptations of DSM criteria for pathological gambling is likely to overestimate the number of people addicted to computing activities.

Walsh DA, Gentile DA, Van Brederode TM
Minerva Pediatr. 2002;54:1-11

Background: Numerous studies have documented the potential effects on young audiences of violent content in media products, including movies, television programs, and computer and video games. Similar studies have evaluated the effects associated with sexual content and messages. Cumulatively, these effects represent a significant public health risk for increased aggressive and violent behavior, spread of sexually transmitted diseases, and pediatric pregnancy. In partial response to these risks and to public and legislative pressure, the movie, television, and gaming industries have implemented ratings systems intended to provide information about the content and appropriate audiences for different films, shows, and games.
Methods: We conducted a panel study to test the validity of the current movie, television, and video game rating systems. Participants used the KidScore media evaluation tool, which evaluates films, television shows, and video and computer games on 10 aspects, including the appropriateness of the media product for children on the basis of age.
Results: Results revealed that when an entertainment industry rates a product as inappropriate for children, parent raters agree that it is inappropriate for children. However, parent raters disagree with industry usage of many of the ratings designating material suitable for children of different ages. Products rated as appropriate for adolescents are of the greatest concern. The level of disagreement varies from industry to industry and even from rating to rating.
Conclusions: Analysis indicates that the amount of violent content and portrayals of violence are the primary markers for disagreement between parent raters and industry ratings. Short-term and long-term recommendations are suggested.

Gillespie RM
Work. 2002;18:249-259

Children using computers and electronic games may adopt the kinds of sustained and awkward postures that are associated with musculoskeletal disorders in working adults. If they do, the physical demands of extensive use could lead to a wide range of adverse effects on developing children, including visual, neurological and physical changes. This article reviews the literature related to media use, ergonomics, epidemiology and pediatrics that address the physical impact of computer use by children. The literature establishes that computer use is common, but does not demonstrate a causal or statistical association with any physical disorders. Laboratory studies on vision, case reports of game-related tendonitis and ergonomic analyses of classroom computers suggest that concern is warranted.

Kasteleijn-Nolst Trenite DG, Martins da Silva A, Ricci S, et al
Epileptic Disord. 2002;4:121-128

Background: Video game seizures have been reported in photosensitive and non-photosensitive patients with epilepsy. The game Super Mario World, has led to many cases of first seizures. We examined whether this game was indeed more provocative than other programs and whether playing the game added to this effect.
Methods: We prospectively investigated 352 patients in four European cities, using a standard protocol including testing of a variety of visual stimuli. We correlated historical data on provocative factors in daily life with electroencephalographic laboratory findings.
Results: The video game, Super Mario World proved more epileptogenic than standard TV programs and as provocative as programs with flashing lights and patterns. Most striking was the fact that video game-viewing and-playing on the 50 and 100 Hz TV was significantly more provocative than viewing the standard program (P < 0.001, P < 0.05 respectively). Playing the video game Mario World on a 50 Hz TV, appeared to be significantly more provocative than playing this game on the 100 Hz TV (P < 0.001). Of 163 patients with a history of TV-, VG- or CG-seizures, 85% of them showed epileptiform discharges in response to photic stimulation, 44% to patterns, 59% to 50 Hz TV and 29% to 100 Hz TV.
Conclusions: Children and adolescents with a history of video game seizures are, in the vast majority, photosensitive and should be investigated with standardised photic stimulation. Games and programs with bright background or flashing images are specifically provocative. Playing a video game on a 100 Hz TV is less provocative [published with videosequences].

Walsh DA, Gentile DA, Van Brederode TM
Minerva Pediatr. 2002;54:1-11

Background: Numerous studies have documented the potential effects on young audiences of violent content in media products, including movies, television programs, and computer and video games. Similar studies have evaluated the effects associated with sexual content and messages. Cumulatively, these effects represent a significant public health risk for increased aggressive and violent behavior, spread of sexually transmitted diseases, and pediatric pregnancy. In partial response to these risks and to public and legislative pressure, the movie, television, and gaming industries have implemented ratings systems intended to provide information about the content and appropriate audiences for different films, shows, and games.
Methods: We conducted a panel study to test the validity of the current movie, television, and video game rating systems. Participants used the KidScore media evaluation tool, which evaluates films, television shows, and video and computer games on 10 aspects, including the appropriateness of the media product for children on the basis of age.
Results: Results revealed that when an entertainment industry rates a product as inappropriate for children, parent raters agree that it is inappropriate for children. However, parent raters disagree with industry usage of many of the ratings designating material suitable for children of different ages. Products rated as appropriate for adolescents are of the greatest concern. The level of disagreement varies from industry to industry and even from rating to rating.
Conclusions: Analysis indicates that the amount of violent content and portrayals of violence are the primary markers for disagreement between parent raters and industry ratings. Short-term and long-term recommendations are suggested.

Singh R, Bhalla A, Lehl SS, Sachdev A
Neurol India. 2001;49:411-412

Reflex epilepsy is the commonest form of epilepsy in which seizures are provoked by specific external stimulus. Photosensitive reflex epilepsy is provoked by environmental flicker stimuli. Video game epilepsy is considered to be its variant or a pattern sensitive epilepsy. The mean age of onset is around puberty and boys suffer more commonly as they are more inclined to play video games. Television set or computer screen is the commonest precipitants. The treatment remains the removal of the offending stimulus along with drug therapy. Long term prognosis in these patients is better as photosensitivity gradually declines with increasing age. We present two such case of epilepsy induced by video game.

No authors listed
Dis Manag Advis. 2001;7:187-190, 177

The challenges of managing a chronic disease are particularly tough on youngsters. However, one innovative new tool has shown that it can help the medicine go down a little easier in young patients. Studies show that a series of interactive games designed to educate and motivate children with chronic disease can not only help kids learn to cope with their disease in an entertaining way, it also can make a measurable impact on utilization.

Anderson CA, Bushman BJ
Psychol Sci. 2001;12:353-359

Research on exposure to television and movie violence suggests that playing violent video games will increase aggressive behavior. A metaanalytic review of the video-game research literature reveals that violent video games increase aggressive behavior in children and young adults. Experimental and nonexperimental studies with males and females in laboratory and field settings support this conclusion. Analyses also reveal that exposure to violent video games increases physiological arousal and aggression-related thoughts and feelings. Playing violent video games also decreases prosocial behavior.

Thompson KM, Haninger K
JAMA. 2001;286:591-598

Context: Children's exposure to violence, alcohol, tobacco and other substances, and sexual messages in the media are a source of public health concern; however, content in video games commonly played by children has not been quantified.
Objectives: To quantify and characterize the depiction of violence, alcohol, tobacco and other substances, and sex in video games rated E (for "Everyone"), analogous to the G rating of films, which suggests suitability for all audiences.
Design: We created a database of all existing E-rated video games available for rent or sale in the United States by April 1, 2001, to identify the distribution of games by genre and to characterize the distribution of content descriptors associated with these games. We played and assessed the content of a convenience sample of 55 E-rated video games released for major home video game consoles between 1985 and 2000.
Main Outcome Measures: Game genre; duration of violence; number of fatalities; types of weapons used; whether injuring characters or destroying objects is rewarded or is required to advance in the game; depiction of alcohol, tobacco and other substances; and sexual content.
Results: Based on analysis of the 672 current E-rated video games played on home consoles, 77% were in sports, racing, or action genres and 57% did not receive any content descriptors. We found that 35 of the 55 games we played (64%) involved intentional violence for an average of 30.7% of game play (range, 1.5%-91.2%), and we noted significant differences in the amount of violence among game genres. Injuring characters was rewarded or required for advancement in 33 games (60%). The presence of any content descriptor for violence (n = 23 games) was significantly correlated with the presence of intentional violence in the game (at a 5% significance level based on a 2-sided Wilcoxon rank-sum test, t(53) = 2.59). Notably, 14 of 32 games (44%) that did not receive a content descriptor for violence contained acts of violence. Action and shooting games led to the largest numbers of deaths from violent acts, and we found a significant correlation between the proportion of violent game play and the number of deaths per minute of play. We noted potentially objectionable sexual content in 2 games and the presence of alcohol in 1 game.
Conclusions: Content analysis suggests a significant amount of violence in some E-rated video games. The content descriptors provide some information to parents and should be used along with the rating, but the game's genre also appears to play a role in the amount of violent play. Physicians and parents should understand that popular E-rated video games may be a source of exposure to violence and other unexpected content for children and that games may reward the players for violent actions.

Committee on Public Education
Pediatrics. 2001;108:1222-1226

The American Academy of Pediatrics recognizes exposure to violence in media, including television, movies, music, and video games, as a significant risk to the health of children and adolescents. Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed. Pediatricians should assess their patients' level of media exposure and intervene on media-related health risks. Pediatricians and other child health care providers can advocate for a safer media environment for children by encouraging media literacy, more thoughtful and proactive use of media by children and their parents, more responsible portrayal of violence by media producers, and more useful and effective media ratings.

Tsai CC, Lin SS
Cyberpsychol Behav. 2001;4:373-376

This study explored the interplay between young people's attitudes toward computer networks and Internet addiction. Ninety possible Internet addicts were selected for examination after analyzing the questionnaire responses of an initial sample of 753 Taiwanese high school adolescents. It was found that the subjects' attitudes toward computer networks could explain many aspects of Internet addiction. However, actual behaviors on Internet usage and perceptions on the usefulness of Internet were more important than affective responses toward computer networks in predicting adolescents' Internet addiction.

Christensen MH, Orzack MH, Babington LM, Patsoaughter CA
J Psychosoc Nurs Ment Health Serv. 2001;39:40-47

Computer addiction is a newly recognized problem. While controversy exists about whether computer addiction should be considered a primary psychiatric disorder, clinicians are treating increasing numbers of clients experiencing problems caused by excessive computer use. Case studies are provided that include typical histories and symptoms. Behavioral cognitive therapy is discussed as a treatment approach. The stages of change theory is recommended as a strategy to help clients plan and implement change.

Dejoie JF
Rev Med Liege. 2001;56:523-530

The concept of Internet addiction, also called Internet addictive disorder or pathological Internet use, entered the medical dictionary in 1995. More and more authors have been preoccupied with it lately, and the majority conclude that this condition, on which some people cast doubt a few years ago, well and truly exists. Several forms of Internet addiction appear to exist, categorised according to the type of misuse it is subjected to: "cybersex", "chat rooms", "net gaming", the pathological search for information or video games being the most frequent. Psychiatric disorders most usually associated with Internet addiction seem to be bipolar disorders. As a consequence, efficient drugs would be those that act as thymo-stabilisers, undoubtedly because they are also effective against those bipolar disorders. Psychotherapeutic treatments as discussion groups on the Internet or group therapies have not yet been evaluated.

Plusquellec M
Arch Pediatr. 2000;7:209-210

Video games and the Internet cause enthusiasm but also worry. Among the possible risks, addiction (dependency), isolation, retiring within oneself, and loss of reality, are often put forward. Available data show that serious problems remain exceptional and non-specific, and that these new technological supports do not create new pathologies. Excessive use and isolation have to be solved on an educational basis. Nevertheless, virtual reality, whose applications for the general public are still considered part of the future, needs particular attention.

Emes CE
Can J Psychiatry. 1997;42:409-414

Objective: To provide mental health professionals with an up-to-date review of the literature regarding the effects of playing video games on the well-being of children.
Method: A computerized literature search of MEDLINE and PSYCHINFO of all articles written in English from 1966 to 1996 was performed. The various studies are organized into different sections.
Results: Playing video games is associated with a variety of physical effects including increased metabolic and heart rate, seizures, and tendinitis. Aggressive behaviour may result from playing video games, especially among younger children. There is no direct relationship between psychopathology or academic performance and playing video games.
Conclusions: Video games have some adverse effects, but they are also valuable learning tools. Research about the role of video games is inadequate. The data are also limited by the lack of long-term studies and inconsistent findings.

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