Virtual CME course on PIMU

Family Guide to Video Gaming

Young people very excitedly play video games

Video games are a popular form of entertainment for kids of all ages, but are particulary popular with young men and boys. A quarter of teens believe they spend too much time playing video games, while a similar share feels they spend too little time doing so.

Motivations behind video gaming vary depending on the child or teen, but research shows that video games allow youth to escape their problems, to try on different personalities, to socialize, and to engage in challenging and reward-based experiences.

What are the primary ways kids play video games?

There are many different ways to play video games, including:

  • Console gaming, such as the PlayStation, Xbox, or Nintendo Switch
  • Handheld video gaming, such as the Nintendo 3DS or Nintendo Switch Lite
  • Computer gaming, played on a desktop computer or laptop, either as a downloaded game, in a web browser, or through a service like Steam
  • Mobile gaming, such as those played on a smartphone or tablet via an app
  • Virtual Reality (VR) gaming, including the HTC Vive and Meta/Oculus headsets
  • Augmented Reality (AR) gaming, which can be played on a variety of devices

Regardless of the platform, many games have an online component, in which the game is played either partially or entirely online against other players. There are a vast number of different types of video game genres (and many games fit into several categories), but a few popular genres include:

  • First-person shooters (Counter Strike: Global Offensive, Call of Duty)
  • Battle royale games (Fortnite, PUBG, Apex Legends)
  • Role-playing games (The Witcher 3: Wild Hunt, Path of Exile)
  • Multiplayer online battle arena (Dota 2, League of Legends: Wild Rift)
  • Action-adventure (Grand Theft Auto V)
  • Social simulation games (Animal Crossing, The Sims)

How are video games rated?​

Every game has a rating set by the Entertainment Software Rating Board (ESRB) in North America and the Pan European Game Information (PGEI) in Europe to help parents make informed decisions when it comes to their child’s gaming. While these ratings can be helpful, it is always best to read reviews of a game, and watch your child or teen play, in order to get a better understanding of the content and if it is optimal for your child.

What do I need to know about violent video games and kids?​

Many parents wonder if violent video games can make their children or teens aggressive or violent. Unfortunately, there is no easy answer to this question, as violence is a complex issue. While research in the area of violence is ongoing, researchers have spent a lot of time studying how violent video games affect children and teens.

Evidence shows that playing violent video games has the potential to temporarily increase aggression. Parents should know that aggression can include increased angry or hostile feelings as well as reduced empathy for others (meaning that children might be less likely to help others in distress). Some children can become desensitized if they are continually exposed to violence in video games. Researchers are continuing to study how violent video games affect health and behavior.

Parents should make decisions regarding violent video games based on your child’s developmental readiness. Consider how well they talk about their feelings, calm themselves following upsetting or stressful events, and self-regulate their use of engaging media.

Can cyberbullying happen in online gaming?​

Many online games allow the player to interact with others via text or voice chat. These features are often unmoderated, and players may be exposed to threats, offensive language, or other objectionable content. Female gamers in particular are often targets of sexual harassment. Unfortunately, many children and teens think that cyberbullying and aggression, such as insulting others and arguing via text or voice chat, are a common part of online gaming culture.

Can video games be educational?​

Video games created specifically for education can help children learn in the classroom. However, just because a mobile game may be labeled as educational in an app store, doesn’t mean that it can actually help children and teens learn. Video gaming has the potential to improve functions such as visual processing and how the brain understands information, and many teens believe that playing certain games helps their problem-solving skills.

What is the connection between video games and health?​

Video games can both contribute to, and harm, the overall health and wellbeing of children and teens.

Physical Health

Video gaming before bed can contribute to a variety of sleep problems, including poor quality sleep and not enough sleep.

Research looking into the relationship between playing video games and weight gain as well as obesity has found mixed results. There is evidence that advergames can promote unhealthy eating habits, video game playing can contribute to increased calorie consumption, and younger children who play video games may have a higher BMI in their teens.

Exergames are a type of video game that require players to interact physically with the game. Exergames are available in virtual reality, mobile, computer, and console formats. Exergaming can be an enjoyable way to encourage physical activity, reduce obesity, and improve balance, agility, and speed.

Playing video games can help improve motor functioning, including spatial skills, such as knowing where objects are in relation to others, and motor skills, such as those needed for driving.

Social Health

Children can learn prosocial behaviors, such as helping, sharing, and cooperating, by playing video games that include social activity (for example, interacting with video game characters as opposed to a puzzle game). Youth can also increase their ability to cooperate, share, and maintain positive relationships with others outside of gaming.

Players who engage in multiplayer online video games experience lower loneliness and social anxiety, as these games encourage social interaction often in the form of cooperation and/or competition.

Mental Health

Children and teens who struggle with Problematic Interactive Media Use in the form of video game playing may be more likely to develop anxiety. On the other hand, research also shows that video games may help reduce anxiety in youth.

Youth who already experience depressive symptoms have a higher chance of developing Internet Gaming Disorder, while some video game playing has the potential to alleviate depression and anxiety.

Some video games offer loot boxes, which are virtual, in-game items that players can purchase with real-world money without knowing what the box contains. These virtual items could help a player level-up or change the look of their avatar. Many adolescents play games that offer loot boxes, and mobile games aimed at younger children often have loot boxes as well. Adolescents buy loot boxes for various reasons, including increasing their competitive edge in video games, gaining specific items or characters, enjoying opening the boxes, changing the appearance of their avatar, believing that loot boxes are of high value, and earning money.

Adolescents can experience more intense symptoms of ADHD when playing video games, and children who have ADHD may be more likely to develop Problematic Interactive Media Use. Specialized video games used by clinicians can also help assess and treat ADHD.

Can my child be addicted to video games?​

The idea of video game “addiction” has also become popular recently, with both the World Health Organization and the American Psychological Association identifying “gaming disorder” as a behavioral health concern. If you are concerned that your child or teen may be struggling with their sleep, grades, or other health-related issues as a result of their gaming, please contact the Boston Children’s Hospital Clinic on Interactive Media and Internet Disorders (CIMAID) to explore care options by emailing cimaid@childrens.harvard.edu or calling (617) 355-9447.

Digital Wellness Tips​

To help your child use video games in a healthy way, consider the following tips:

It is easy to become involved in a game and play for hours at a time, but children benefit from a variety of activities. Agree on a certain amount of time to play games and suggest other activities they might enjoy.

Remember, the content of what your kids play is just as important as the amount of time they spend playing. When your children ask you for a new game, do your homework before you agree to purchase it. Learn about the game’s ESRB rating, read reviews, and even play the game first before you allow your kids to play. If the game isn’t appropriate for their age or doesn’t match your value system, find an alternative game.

By keeping gaming systems (including mobile devices) in family areas, you can see how, and how often, they are being used. You can also more easily keep track of time limits. Studies show that children with electronic media in their bedrooms are more likely to be overweight and have sleep problems.

Many games can be livestreamed and/or are multiplayer in nature, allowing your child to chat or share content with other players who they may not know in real life. Be sure to set up these accounts with your kids and let them know that you have their passwords should they ever need help. Discuss the importance of acting respectfully and maintaining privacy in these online environments with your teen, and consider disabling these features entirely for younger children.

Video games are fun and challenging for adults too! Parents can spend time with their kids by having a family gaming night (just make sure that the games are appropriate for everyone involved).

Help your child or teen understand that in-game purchases are costly, and set limits on whether they can or cannot make these types of purchases. Parents can also consider restricting or disabling these features.


References

Adachi, P. J., & Willoughby, T. (2013). More than just fun and games: the longitudinal relationships between strategic video games, self-reported problem solving skills, and academic grades. Journal of youth and adolescence, 42(7), 1041–1052. https://doi.org/10.1007/s10964-013-9913-9

Anderson, C. A., Bushman, B. J., Bartholow, B. D., Cantor, J., Christakis, D., Coyne, S. M., Donnerstein, E., Brockmyer, J. F., Gentile, D. A., Green, C. S., Huesmann, R., Hummer, T., Krahé, B., Strasburger, V. C., Warburton, W., Wilson, B. J., & Ybarra, M. (2017). Screen violence and youth behavior. Pediatrics, 140(Suppl 2), S142–S147. https://doi.org/10.1542/peds.2016-1758T

Arriaga, P., Monteiro, M.B. & Esteves, F. (2011), Effects of playing violent computer games on emotional desensitization and aggressive behavior. Journal of Applied Social Psychology, 41, 1900-1925. https://doi.org/10.1111/j.1559-1816.2011.00791.x

Bediou, B., Adams, D. M., Mayer, R. E., Tipton, E., Green, C. S., & Bavelier, D. (2018). Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills. Psychological Bulletin, 144(1), 77–110. https://doi.org/10.1037/bul0000130

Bickham D. S. (2016). The influence of violent media on aggression in adolescents. Adolescent medicine: state of the art reviews, 27(2), 276–290. https://pubmed.ncbi.nlm.nih.gov/29462520/

Blasi, M. D., Giardina, A., Giordano, C., Coco, G. L., Tosto, C., Billieux, J., & Schimmenti, A. (2019). Problematic video game use as an emotional coping strategy: Evidence from a sample of MMORPG gamers. Journal of behavioral addictions, 8(1), 25–34. https://doi.org/10.1556/2006.8.2019.02

Borecki, L., Tolstych, K., Pokorski, M. (2013). Computer Games and Fine Motor Skills. In: Pokorski, M. (eds) Respiratory Regulation – Clinical Advances. Advances in Experimental Medicine and Biology, vol 755. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4546-9_43

Chan, P. A., & Rabinowitz, T. (2006). A cross-sectional analysis of video games and attention deficit hyperactivity disorder symptoms in adolescents. Annals of general psychiatry, 5, 16. https://doi.org/10.1186/1744-859X-5-16

Chaput, J. P., Visby, T., Nyby, S., Klingenberg, L., Gregersen, N. T., Tremblay, A., Astrup, A., & Sjödin, A. (2011). Video game playing increases food intake in adolescents: a randomized crossover study. The American journal of clinical nutrition, 93(6), 1196–1203. https://doi.org/10.3945/ajcn.110.008680

Christie, D., & Viner, R. (2005). Adolescent development. BMJ (Clinical research ed.), 330(7486), 301–304. https://doi.org/10.1136/bmj.330.7486.301

Comeras-Chueca, C., Marin-Puyalto, J., Matute-Llorente, A., Vicente-Rodriguez, G., Casajus, J. A., & Gonzalez-Aguero, A. (2021). Effects of active video games on health-related physical fitness and motor competence in children and adolescents with overweight or obesity: Systematic review and meta-analysis. JMIR serious games, 9(4), e29981. https://doi.org/10.2196/29981

Darius, Z., Raynaud, J-P., & Revet, A. (2020). Therapeutic and preventive use of video games in child and adolescent psychiatry: A systematic review. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00036

Folkvord, F. & van‘t Riet, J. (2018). The persuasive effect of advergames promoting unhealthy foods among children: A meta-analysis. Appetite, 129, 245-251. https://doi.org/10.1016/j.appet.2018.07.020.

Fox, J., & Tang, W. Y. (2017). Women’s experiences with general and sexual harassment in online video games: Rumination, organizational responsiveness, withdrawal, and coping strategies. New Media & Society, 19(8), 1290–1307. https://doi.org/10.1177/1461444816635778

Glover, J., Ariefdjohan, M., & Fritsch, S. L. (2022). #KidsAnxiety and the Digital World. Child and adolescent psychiatric clinics of North America, 31(1), 71–90. https://doi.org/10.1016/j.chc.2021.06.004

Goodman, W., Jackson, S.E., McFerran, E., Purves, R., Redpath, I., & Beeken, R.J. (2020). Association of video game use with body mass index and other energy-balance behaviors in children. JAMA Pediatr, 174(6):563–572. https://doi.org/10.1001/jamapediatrics.2020.0202

Granic, I., Lobel, A., & Engels, R. C. (2014). The benefits of playing video games. The American psychologist, 69(1), 66–78. https://doi.org/10.1037/a0034857

Halbrook, Y.J., O’Donnell, A.T., & Msetfi, R.M. (2019). When and how video games can be good: A review of the positive effects of video games on well-being. Perspectives on Psychological Science : A Journal of the Association for Psychological Science, 14(6), 1096–1104. https://doi.org/10.1177/1745691619863807

Hale, L., Kirschen, G. W., LeBourgeois, M. K., Gradisar, M., Garrison, M. M., Montgomery-Downs, H., Kirschen, H., McHale, S. M., Chang, A. M., & Buxton, O. M. (2018). Youth Screen Media Habits and Sleep: Sleep-Friendly Screen Behavior Recommendations for Clinicians, Educators, and Parents. Child and adolescent psychiatric clinics of North America, 27(2), 229–245. https://doi.org/10.1016/j.chc.2017.11.014

Harrington, B. & O’Connell, M. (2016). Video games as virtual teachers: Prosocial video game use by children and adolescents from different socioeconomic groups is associated with increased empathy and prosocial behaviour. Computers in Human Behavior, 63, 650-658. https://doi.org/10.1016/j.chb.2016.05.062.

Herodotou, C., Kambouri, M., & Winters, N. (2014). Dispelling the myth of the socio-emotionally dissatisfied gamer. Computers in Human Behavior, 32, 23-31. https://doi.org/10.1016/j.chb.2013.10.054

Ho, S.S., Lwin, M.O., Sng, J.R.H., & Yee, A.Z.H. (2017). Escaping through exergames: Presence, enjoyment, and mood experience in predicting children’s attitude toward exergames. Computers in Human Behavior, 72, 381-389. https://doi.org/10.1016/j.chb.2017.03.001

Huang, J., Zhong, Z., Zhang, H., & Li, L. (2021). Cyberbullying in social media and online games among chinese college students and its associated factors. International Journal of Environmental Research and Public Health, 18(9), 4819. http://dx.doi.org/10.3390/ijerph18094819

Kowal, M., Conroy, E., Ramsbottom, N., Smithies, T., Toth, A., & Campbell, M. (2021). Gaming your mental health: A narrative review on mitigating symptoms of depression and anxiety using commercial video games. JMIR Serious Games, 9(2):e26575 https://doi.org/10.2196/26575

Kracht, C.L., Joseph, E.D. & Staiano, A.E. (2020). Video games, obesity, and children. Curr Obes Rep 9, 1–14. https://doi.org/10.1007/s13679-020-00368-z

Lee, J., Luchini, K., Michael, B., Norris, C. & Soloway, E. (2004). More than just fun and games: assessing the value of educational video games in the classroom. In CHI ’04 Extended Abstracts on Human Factors in Computing Systems (CHI EA ’04). Association for Computing Machinery, New York, NY, USA, 1375–1378. https://doi.org/10.1145/985921.986068

Li, L., Chen, R., & Chen, J. (2016). Playing action video games improves visuomotor control. Psychological Science, 27(8), 1092–1108. https://doi.org/10.1177/0956797616650300

Liu, W., Zeng, N., McDonough, D. J., & Gao, Z. (2020). Effect of active video games on healthy children’s fundamental motor skills and physical fitness: A systematic review. International journal of environmental research and public health, 17(21), 8264. https://doi.org/10.3390/ijerph17218264

Makarova, E. A., & Makarova, E. L. (2019). Aggressive behavior in online games and cybervictimization of teenagers and adolescents. International Electronic Journal of Elementary Education, 12(2), 157–165. https://www.iejee.com/index.php/IEJEE/article/view/856

Martončik, M. & Lokša, J. (2016). Do World of Warcraft (MMORPG) players experience less loneliness and social anxiety in online world (virtual environment) than in real world (offline)? Computers in Human Behavior, 56, 127-134. https://doi.org/10.1016/j.chb.2015.11.035

McInroy, L.B. & Mishna, F. (2017). Cyberbullying on online gaming platforms for children and youth. Child Adolesc Soc Work J, 34, 597–607. https://doi.org/10.1007/s10560-017-0498-0

Meyer, M., Zosh, J.M., McLaren, C., Robb, M., McCaffery, H., Golinkoff, R.M., Hirsh-Pasek, K. & Radesky, R. (2021) How educational are “educational” apps for young children? App store content analysis using the Four Pillars of Learning framework, Journal of Children and Media, 15(4), 526-548. https://doi.org/10.1080/17482798.2021.1882516

Peñuelas-Calvo, I., Jiang-Lin, L.K., Girela-Serrano, B., Delgado-Gomez, D., Navarro-Jimenez, R., Baca-Garcia, E., & Porras-Segovia, A. (2022). Video games for the assessment and treatment of attention-deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry, 31, 5–20. https://doi.org/10.1007/s00787-020-01557-w

Perrin, A. (2018). 5 facts about Americans and video games. Pew Research Center.  https://www.pewresearch.org/fact-tank/2018/09/17/5-facts-about-americans-and-video-games/

Przybylski, A. K., Weinstein, N., Murayama, K., Lynch, M. F., & Ryan, R. M. (2012). The ideal self at play: the appeal of video games that let you be all you can be. Psychological science, 23(1), 69–76. https://doi.org/10.1177/0956797611418676

Razjouyan, K., Khademi, M., Dorandish, Z. Y., & Davari-Ashtiani, R. (2020). An investigation into the frequency of addiction to video games in children with attention-deficit hyperactivity disorder. Journal of family medicine and primary care, 9(2), 669–672. https://doi.org/10.4103/jfmpc.jfmpc_464_19

Trepte, S., Reinecke, L., & Juechems, K. (2012). The social side of gaming: How playing online computer games creates online and offline social support. Computers in Human Behavior, 28(3), 832-839. https://doi.org/10.1016/j.chb.2011.12.003

Wang, R., Yang, S., Yan, Y., Tian, Y., & Wang, P. (2021). Internet gaming disorder in early adolescents: gender and depression differences in a latent growth model. Healthcare (Basel, Switzerland), 9(9), 1188. https://doi.org/10.3390/healthcare9091188

Willoughby, T., Adachi, P. J., & Good, M. (2012). A longitudinal study of the association between violent video game play and aggression among adolescents. Developmental psychology, 48(4), 1044–1057. https://doi.org/10.1037/a0026046

Zendle, D., Meyer, R., & Over, H. (2019). Adolescents and loot boxes: links with problem gambling and motivations for purchase. Royal Society Open Science, 190049190049. https://doi.org/10.1098/rsos.190049