The recent release of the US Surgeon General’s reportOur Epidemic of Loneliness and Isolation cited both social media and video games as causal factors for the alarming rise in isolation, loneliness and mental illness. While tech industry pushback was to be expected, it was a surprise to see regulated mental health professionals openly joining an industry that is profiting from harming children. A recent podcast on NPR’s OPB All Things Considered on May 31, ‘2023 by Yuki Noguchi called The impact of video games on child development is often misunderstood¹. was one-sided, misleading and potentially harmful. The pro-gaming information contained in this podcast was opinionated and not factual nor backed by any research yet alluded to be ‘expert’ testimony by a psychologist who profits from designing video games. Shouldn’t this be considered unethical?

Misinterpretation and misrepresentation of video game research can be extremely dangerous for children and youth and lead families down a dark hole of video game over usage that’s hard to reverse. In addition to lacking credible research, this NPR podcast neglects to provide comprehensive data on the impact of video games on children and does not offer expert guidance for parents regarding management of gaming duration and content. This article was written by a pediatric occupational therapist and intends to provide readers with balanced and research-referenced facts regarding the impact of video games on children and youth. This information will promote best practice management of video games by parents leading to the optimization of child health and safety. Author requests journalists consider referencing some (or all) of the following information in future articles to ensure readers receive accurate and balanced facts to make decisions regarding safe management of video game use by children and youth.

A meta-analysis of over 1000 video games in 2010² showed that violent video game exposure leads to an increase in aggressive attitude, aggressive cognition, and aggressive affect, as well as a decrease in empathy and prosocial behavior. In 2002 (and again in 2013/15/16) the American Academy of Pediatrics (AAP) released Policies on Children and Media³ stating NO screen exposure for 0-2 years, no more than one hour per day for 3-5 years and no more than 2 hours per day 6-12 years. In 2016 the AAP released its policy on violent media content Virtual Violence⁴ advising pediatricians, parents, industry and policymakers regarding current video game research and recommendations. Regarding research findings, Virtual Violence 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”. AAP goes on to state “Another study performed a similar analysis focusing only on video games and 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”. The Virtual Violence policy states that children under the age of 6 years should have NO exposure to violent media content and first-person shooter games should be restricted from children under the age of 12 years. In 2020 the American Psychological Association (APA) released the APA Resolution on Violent Video Games⁵ which states that “Scientific research and quantitative review of the violent video game literature have found a direct association between violent video game use and aggressive outcomes including increased aggressive behavior, aggressive affect, aggressive cognitions and decreases in prosocial behavior, empathy and moral engagement.” APA goes on to state “Longitudinal studies lasting longer than 2 years have demonstrated that these effects persist over at least some time spans.” The APA recommends engagement in public education and awareness activities disseminating these findings to children, parents, teachers, judges and other professionals working with children in schools and communities.

We’ve all seen children acting like characters recently viewed in cartoons, movies or video games. While these actions could be considered ‘normal’ and part of pretend play in early years, what is abnormal is when the child dissociates and becomes non-responsive to interactions with parents, teachers or other children. I have worked with numerous children in school settings who literally think they are a cartoon character or are ‘in’ a video game. These children are non-participatory, highly reactive, refuse to do school tasks and don’t socialize or interact with other students at great detriment to the classroom milieu. One kindergarten child sat silently at a table ‘playing’ a video game console, yet there was no console visible. When I ‘took’ the imaginary console away, this child exploded and told me he was going to “call the cops” and report me. I was referred to a grade 4 child who had previously thrown a rock at a passing truck breaking the window and when I asked why, this child told me there were “zombies” in the truck and he was “scared”. Early immersion in violent virtual content can create a condition I term ‘Gamer Brain’ when it appears as if the child’s brain has been consumed by gaming content. Another term adopted by researchers is Game Transfer Phenomena where the child adopts visual, auditory or character traits where they ‘see’, ‘hear’ and/or ‘feel’ the imagery of the video game. When asked if they are “in the game” now, children will respond by stating what they are seeing and experiencing visual and auditory imagery endemic in the game. These children are more likely to act out aggressively or violently as they mimic the characters in the video game. A 2014 study by Karolien Poels⁶ reports intensive video game playing, can cause elements from the game world to evoke thoughts and imagery outside the game world, influencing the perception and interpretation of stimuli in everyday life. Ortiz de Gortari in 2014⁷ reported that overreactions, avoidances, and involuntary limb movements were all reported by many gamers in response to real-life stimuli as if they were still playing video games.

In 2018 the World Health Organization (WHO) categorized Gaming Disorder⁸ as a mental illness indicating that video games have the potential, if not used in moderation, to be addictive and harmful.

Gaming disorder is defined in the 11th Revision of the International Classification of Diseases (ICD-11) as a pattern of gaming behavior characterized by the following 4 traits which must be evident for at least 12 months:

Why are we allowing children to use a substance that has proven to be addictive? We don’t allow children to use alcohol or drugs, or to smoke cigarettes because we understand that they don’t have the maturity to make good decisions regarding these substances. We also understand that children’s bodies and brains are growing and developing at a rapid pace, and we want them to have the best chance at a successful, healthy and happy adult life. Presently video games, social media and pornography are unregulated and unrestricted for children and youth, leaving them and their parents the ones making decisions as to how much, how often and what type of media they consume. Maybe this is not in our children’s best interest.

When children are gaming their bodies are sedentary and their brains overstimulated. Developing bodies crave movement, yet video games entrance and hypnotize the brain into sitting still, often for very long periods. Sedentary bodies delay physical development and impair fitness, while also overstimulating the brain and heart, causing serious and often irreversible physical impairments. Psychiatrist Dr. Victoria Dunckley9 author of Reset Your Child’s Brain reports that when children play video games, their sympathetic nervous system goes into a hyper-aroused state of “flight or fight” characterized by adrenalin release from adrenal glands and dopamine production in the brain. Sustained high blood pressure and increased heart rate from prolonged gaming, increases the risk of heart attack and stroke in later years. Hyperaroused states make it less possible for children to enjoy real-life human interactions as real life seems ‘slow’ and ‘boring’. The Raine ADHD Study10 in 2010 found that a child taking stimulant medication for ADHD who also plays video games, significantly increases the load on their hearts which can result in heart attacks. Causal factors for video game-induced hyperarousal are fast-paced and violent content, bright lights, rewards, multitasking, and interactivity. Long-term high adrenalin states can result in chronic adrenal fatigue, causally implicated in physical illnesses including heart attacks, cancer and autoimmune disorders.

Psychiatrist Dr. Victoria Dunckley in the Feb. 27, 2014 issue of Psychology Today article Grey Matters: Too Much Screen Time Damages the Brain¹¹ reports that multiple studies have shown atrophy (shrinkage or loss of tissue volume) in gray matter areas where “processing” occurs in internet/gaming addiction (Zhou 2011¹², Yuan 2013,¹³Weng 2013¹⁴). A little neuroanatomy lesson helps to understand this process. To achieve functional efficiency during brain development, the brain prunes or cuts 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, the ‘type’ of media content consumed by 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 the frontal lobes. Whereas exposure to mindless or entertainment content such as fast-paced and violent video games, constitutes passive or destructive learning which rarely requires the use of frontal lobes, resulting in frontal lobe pruning. A 2022 research study¹³ demonstrated that video game disorders in adolescents may lead to adverse behavioural, affective and cognitive outcomes. While brain development has a degree of plasticity or ability to repair damage, over half of the brain is hard-wired at age 12 years and the brain is effectively hard-wired at age 25 years. Gentile, D¹⁴ found in 2011 that ~ 9% of gamers exhibited ‘pathological gaming’ and that the presence of pathological gaming was found to be a strong predictor of low academic performance. Regarding brain functional and structural changes associated with video games, Kuhn in 2019 reports¹⁵ that existing studies reveal evidence for the involvement of the hippocampal, prefrontal, and parietal brain regions; however, studies differ immensely, which makes a meta-analytic interpretation vulnerable. This area requires additional definitive research, but existing studies do indicate potential brain damage from excessive video gaming.

Rojas-Jara¹³ found in 2022 a correlational relationship between gaming disorder and an increase in difficulty with psychosocial relationships, social skills deficits, and increased prevalence of low self-esteem and mental health-related illness in adolescents. Rasmussen in a 2014 study¹⁶ showing video games result in a variety of social disorders and stated that while adolescents were aware of changes relating to excessive video game use such as changes in personality, mood, diet, sleep habits, and behaviour, they did not view them as problematic. Seok in 2018¹⁷ reported study participants revealed serious symptoms of internet game addiction, which negatively affected their psychological health and self-identity. Participants also reported that they were aware of how video games negatively affected their daily lives and academic performance, and how their family relationships worsened once they became addicted to video games. Byeon in 2022 study¹⁸ reported that risky game users reported lower levels of happiness and satisfaction, as well as a significantly higher lifetime prevalence of major depressive disorder, alcohol dependence, and suicidal ideation.

A 2018 study published in the Journal of Sexual Health19 looked at 23722 video games from 1994 to 2013 and found that sexual content was present in 13% of the video games and that top-selling video games had 10.1% more sexual content across the period of study. Rebecca Collins in a 201720 research article reports that sexual content is highly prevalent in traditional media, and portrayals rarely depict the responsibilities and risks (e.g., condom use, pregnancy) associated with sexual activity. Gambling is endemic in video games with sports betting also growing in popularity, both of which are addictive. Ivoska’s study in 202221 surveyed grade 11-12 students who reported an increased incidence of problematic gambling in video games from 4.2% in 2018 to 8.3% in 2022. Ben Egliston wrote in Big Data and Society22 in 2022 that AI surveillance captures gamers actions and markets data for profit and that Epic, Electronic Arts and Activision explicitly state in licence agreements they capture user data. Egliston went on to state that even schools use gamification programs and apps to capture student data.

Chronic video game immersion does nothing to prepare children and teens for the rigours of work and social performance demanded by employers. Poor achievement of literacy, inability to problem solve, and inability to think critically and reason are huge detriments to sustainable employment. US Census Bureau²³ reports in 2022 that more young adults are living with their parents now than at any other time in history (see figure 1) and Statistics Canada²⁴ citing the same worrisome trend (see figure 2). What is surprising is that this situation appears acceptable and even preferable to many parents who have young adults living in their basement not working and not attending post-secondary school, who state to the author “At least I know where they are”. What are these youth and young people doing at home?

1. Manage video game duration and content. Due to accumulating research showing a correlation between video game play and aggression and risk of harm to others, precaution is key for harm reduction. A 2012 study by Willoughby²⁵ showed more violent video game play predicted higher levels of violence over Study by Saleem in 2012²⁶ showed that prosocial games reduce state hostility and increase positive state affect in college students while violent video games have the opposite effect. The chart below reflects current research and expert recommendations regarding video game duration and content and can be used by parents and teachers in the process of developing rules and policies. The author of this article strongly recommends video games not be allowed anywhere on school grounds due to compilation of detrimental effects on children and youth.

2. Reduce Impact and Monitor Device Use. Playing video games on smaller screens and prohibiting use of virtual reality devices lessens the negative impacts of gaming. A 2013 study²⁷ showed the realistic controller and large screen elicited higher hostility, presence, and excitement when playing violent video games than a standard mouse and small screen, Douglas Gentile reported in a 2014²⁸ study that parental monitoring of media has protective effects on a wide variety of academic, social, and physical child outcomes including body mass index, average weekly sleep, school performance, prosocial behavior, and aggressive behavior.

3. Get gaming devices out of bedrooms. Bedrooms are for sleep…period. When children and youth take screens into bedrooms, bathrooms and any unsupervised spaces, parents have no idea what they are viewing and who they are talking to. Study by Fu in 2017²⁹ found that the placement of electronic devices in child bedrooms is believed to negatively impact school readiness and the placement of game console was associated with lower social competence. The National Sleep Foundation³⁰ in 2020 reports that over 60% of children and youth are chronically sleep deprived yet 75% are allowed screens in their bedrooms increasing their risk for obesity, diabetes, poor academic performance, risk-taking, depression, anxiety, heart problems, and even cancer. Children who come to school tired from being up at night gaming and/or using social media are moody, volatile, and completely unable to pay attention, memorize facts, or assimilate information to promote learning Hale 2018³¹.

4. Go Outside and Play. Erasing the negative effects of screens can actually be this simple…go outside and play, yet many parents fear nature and their children, unfortunately, are kept inside. Walk through a neighborhood in the early evening or on the weekend and it’s rare to see children outside playing. Parents unfortunately think it’s safer to keep their children inside on screens, but forget when they are unsupervised and online are exposed to predators, cyberbullying, sexual and violent content, etc. Not only is playing outside good for children’s spirit, sociability and fitness, but a study by Singh in 2012³² found that participation in physical activity also has a positive effect on children’s academic Study by Bravender in 2020³³ reports that children who play freely in the great outdoors are healthier in body and mind and active engagement with the natural environment reduces stress and relieves depression in all ages and goes onto recommends physicians prescribe outdoor play for children. Study by White in 2019³⁴ proved that spending at least 120 minutes per week in nature improves health and well-being and Norwood found in 2019 study³⁵ that passive nature exposure promotes positive changes in attention, memory and mood, so why aren’t we adopting outdoor school concepts in every school district in North America?

5. Want to find out more? Consider taking the Reconnect Webinars – Technology Management 3-day webinar series and become certified in Balanced Technology Management. Too long? Check out the 3.5 hour parent condensed version. Have a teen who overuses screens? Show them Tech Talks for Teens webinar which contains the new Screenbuster online certification training program.