the television on anymore, she and her husband were able to sleep in a little longer in the mornings, despite the fact that the kids continued to get up earlier than they did. “So what do the kids do instead of watch cartoons?” I asked. “We let them play on our phones,” she replied. Mystery solved! The boys’ daily fifteen or twenty minutes of phone play was enough to disorganize their nervous systems and set the tone for the day. She and her husband began taking turns getting up early, stopped the phone play, and smoother mornings soon followed.
Another ESS behavioral symptom we’ve already touched on is poor impulse control. Impulsiveness refers to the tendency to act without thinking, such as hitting a sibling without regard for consequences, running into the street without looking for cars, continually interrupting others, and so on. Children with attention problems and hyperactivity are typically impulsive as well, and thus they tend to engage in more risk taking, resulting in more frequent accidents. Consistently, impulsivity has been found to be a risk factor for problematic gaming and Internet use,46 and it seems to be a product of them as well. That is, just as there is a bidirectional relationship between gaming and poor attention, impulsivity and video games have been found to be mutually reinforcing. Violent games may pose an additional risk for poor impulse control.47
Violence and Delinquency
Violent aggression and delinquency are serious behavioral issues that are linked to excessive electronic media, particularly with violent content,48 but also with screen-time in general49 and with disturbed sleep.50 I have already discussed this connection in several places, and how the mood dysregulation, hyperarousal, and attentional fatigue that occur with gaming can lead to meltdowns and aggression. In general, aggression and delinquency are associated with poor frontal lobe functioning, which is a clear consequence of excessive screen-time.
These links have been demonstrated no matter what content is viewed. Importantly, research suggests that total time spent gaming is a stronger predictor of aggression than the level of violence in the games played.51 As with ESS in general, “It’s the medium, not the message.” That said, violent games pose a unique risk, and studies suggest that both violent and competitive games increase the risk of aggression compared to prosocial games.52 This risk is especially strong in violent games where players team up to face a common enemy.53 There’s something about the social nature of these games that makes them risky for both aggression and addiction.
While content is not the most important factor in the development of ESS, because of their highly stimulating nature, violent games are likely to cause more severe ESS symptoms. I used to believe that parents already realized that violent games were harmful, and therefore I didn’t spend much time driving this point home. What I didn’t realize was that many — if not most — video games (including those made for younger children) are violent. More than 90 percent of games rated as appropriate for children ten and older are violent, and the majority of boys play mature, or M-rated, games.54 Parents may be in the dark about how violent games really are, and ratings for video games are unreliable. Furthermore, many video games don’t display any sex or violence on the cover or in their advertisements, masking their true nature. Violent games also often portray female characters in a degrading manner and can contain sexual violence (including rape) and racist content. Thus, it’s advisable that parents watch or even play a game in order to screen it.
At this point, six decades of research have solidified the connection between acts of violence and aggression and exposure to media violence in television and movies,55 while the past decade has seen an explosion of research on violent gaming in particular.56 Do not be fooled by studies claiming there is no connection or that it’s inconclusive; an overwhelming majority of evidence tells otherwise, and there is a strong consensus not only within the medical community but among researchers whose work is unbiased and non-industry-affiliated. Violent video game playing is associated with poor school performance; increased aggressive thoughts, feelings, and behavior; increased physiological arousal; and decreased empathy and prosocial behavior.57 One reason for this is desensitization — that is, a blunting of our mental and physiological aversion to violence, whether real or virtual. Studies of violent video games have documented desensitization by measuring brain, cardiovascular, skin, and empathy responses.58 Disturbingly, one study showed the desensitization response occurred after just twenty minutes of play.59 As one young man explained to me, “I don’t know if I’m addicted, but I tell you one thing, it’s true what they say about violent video games and desensitization. … I don’t feel any reaction at all to seeing violence. … I mean nothing. [Laughs] I could see someone get torn apart by a machete and it’s the same to me as looking at someone walking down the street.”
Children with mental health issues — especially boys — who play violent games and those who have addictive tendencies are at high risk for aggression, as are children who have a poor sense of reality or who have a tendency to attribute hostile intentions to others.60 Newer, more technologically advanced games are more strongly linked to aggressiveness than older games, a trend researchers attribute to more realistic and vivid graphics and heightened “feelings of presence” (the sense that you are actually there).61 Indeed, each generation of games creates higher levels of risk for both aggression and addiction than the one before: lifelike realism creates higher levels of arousal, hyperarousal is linked to both addiction and aggression, and addicted players are more likely to be aggressive.
In regard to other delinquent behavior, studies suggest that excessive screen-time (including smartphone use) in teens and preteens is associated with risky behaviors such as school truancy, experimenting with drugs and alcohol, and having unprotected sex — behaviors consistent with poor impulse control.62 Interestingly, one study found that higher amounts of computer use was a stronger risk factor for delinquent behaviors than high television or video game use.63 Lastly, research shows that poor sleep — which goes hand and hand with technology use — is in itself a risk factor for high-risk behaviors.64
Aside from the obvious safety issues surrounding aggressive acts, aggression is a leading reason why children are placed on psychotropic medication, misdiagnosed as having bipolar disorder, suspended or expelled from school, and charged with criminal activity. Needless to say, it’s important to create environments that reduce this behavior, especially in high-risk populations.
Arrested Social Development
Children who experience social anxiety — feeling discomfort or distress in social situations — or who are socially incompetent are particularly at risk for developing dependence on electronic media. This is true whether the preferred agent be the Internet, video games, or a smartphone.65 The more a child hides behind a screen, the more socially awkward he or she becomes, creating a self-perpetuating cycle. In contrast, a shy child who continually works at overcoming social anxiety is likely to overcome it. In the past, the strong desire to belong to a social group during adolescence helped override resistance to social interaction, which would lessen over time simply due to practice. Nowadays, socially anxious or awkward children and teens aren’t forced to practice face-to-face and eye-to-eye interaction because some of their social needs are met online. Thus, in socially anxious children, the ability to tolerate the physical presence of others never builds, and “walls” are erected instead to keep the child feeling safe. An adolescent with somewhat poor social skills in high school can easily become reclusive as a young adult, spending more and more hours online and less and less time interacting in real life. This pattern makes it increasingly harder to make and keep friends. Relationship problems show up at home, too; research indicates that the more time a child spends using the Internet, the less healthy the parent-child relationship becomes.66 Thus, social incompetence and screen-time represent another bidirectional relationship.
Interacting with young people with screen-related social anxiety can be awkward or even irritating: they tend to make poor eye contact, seem distracted or “not present,” or squirm with discomfort. Often, they seem apathetic and demonstrate passive body language, like a weak handshake. They can take long pauses before answering questions and may be unable to engage in meaningful, reciprocal conversation. When they do