The question of whether violent video games have a harmful effect on children is a hotly disputed one.
And not just between the entertainment industry and medical experts.
It’s also a contentious point among professionals who deal with children’s health issues.
The topic is prominent enough that it prompted the American Academy of Pediatrics (AAP) to issue a recommendation last month about children watching violent movies and playing violent video games.
The report’s authors stated they are frustrated by resistance to accept studies that link violence to the video games as well as the lack of action on the issue.
“Although there is broad scientific consensus that virtual violence increases aggressive thoughts, feelings, and behaviors, there has been little public action to help mitigate children’s exposure to it,” the authors wrote.
Aggression but not crime
A task force report released in August 2015 by the American Psychological Association (APA) concluded there’s a definite link to increased aggression in children who play violent video games.
However, the task force members said it’s uncertain whether that aggression correlates with criminal violence or juvenile delinquency.
The research was the first in this field to examine the breadth of previous studies, and to undertake multiple approaches to reviewing the literature.
The data demonstrated a consistent relationship between violent video game use and increases in aggressive behavior, cognition, and effect, according to the APA Task Force on Violent Media report.
Video game violence also leads to decreases in pro-social behavior, empathy, and sensitivity to aggression, the task force added.
Scientists have looked into the use of violent video games for more than 20 years, but task force chairman Mark Appelbaum, Ph.D., said, “There is very limited research addressing whether violent video games cause people to commit acts of criminal violence.”
“However, the link between violence in video games and increased aggression in players is one of the most studied and best established in the field,” Appelbaum, a psychology professor at the University of California at San Diego, said in a press release.
The APA report went on to say that no single risk factor consistently leads a person to act aggressively or violently, but rather it is an accumulation of risk factors that leads to the aggressive or violent behavior.
Violent video game use is one such risk factor.
Dr. Vic Strasburger, distinguished professor of pediatrics emeritus at the University of New Mexico School of Medicine, said it goes deeper than violent video games.
“I've treated several school shooters and my best guess is that these kids have four factors that apply,” Strasburger told Healthline. “One: They've been abused or bullied. Two: They have mental illness. Three: They are socially isolated. And four: They play violent video games.”
“All four factors taken together produce a perfect storm,” he added.
Other theories arise
The APA report was contradicted seven months later by another study that focused on children in Europe.
Researchers at Columbia University’s Mailman School of Public Health published their findings in the journal Social Psychiatry and Psychiatric Epidemiology.
The team of 13 researchers looked at the video game playing habits of more than 3,000 children across Europe in 2010.
They concluded children who played at least five hours of games a week had fewer psychological problems than students who didn’t play the games.
The students’ teachers also rated the video game players as better students.
"I think what we're seeing here is the evolution of gaming in modern society. Video games are now a part of a normal childhood," said Katherine Keyes, one of the 13 authors, and a professor of epidemiology at Columbia, in a U.S. News and World Report article. "It's no longer that kids who play a lot video games are the isolated, techy, brainy kids. What we're seeing here is that kids who play a lot of video games are socially integrated, they're pro-social, they have good school functioning, and we don't see any association with adverse mental health outcomes."
Keyes added there are down sides to playing a lot of video games.
"I want to be sure that we're not suggesting in this study that parents should let kids play unlimited video games because it's good for their mental health," she told U.S. News and World Report.
Another study that was published in October 2015 concluded that parents were an important factor in determining how much time children spend playing violent video games.
Researchers at Iowa State University used an online survey of both parents and children aged 8 to 12 for their conclusions.
They said children of “restrictive” parents who set firm rules spent less time playing violent video games.
In addition, children of “warm” parents who show approval through affection also played fewer video games.
However, the children of “anxious/emotional” parents who are often overprotective spent more time playing video games.
Association urges changes in industry
There are calls for the video game industry to clean up its act.
After its study, the APA urged the video game industry to design games that include increased parental control over the amount of violence the games contain.
They also want developers to design games that are appropriate to users’ age and psychological development.
In addition, they are encouraging the Entertainment Software Rating Board to refine its video game rating system. The hope of the APA is that the games’ ratings “reflect the levels and characteristics of violence in games.”
Entertainment Software Association (ESA) officials vehemently disagreed with the findings of the research in the latest APA report.
“Considering the APA’s long-standing bias against, and attacks on video games, this slanted report is not surprising. Numerous medical professionals, researchers, and courts all debunk the fundamental thesis of their argument,” they said in a statement to the video game news site Polygon.
When boiled down, Strasburger said that it’s easy to pin aggressive behavior on violent video games but not necessarily crime.
“Many people would like to link first-person shooter video games and mass murders or even single murders, but that's virtually impossible to do from a scientific research point of view,” he said. “Murder is rare. Video games are extraordinarily common.”
Strasburger has come up with a simple hypothesis based on the research.
“The best we can say is that first-person shooter video games are probably not healthy for children and teens,” he concluded.
Editor’s Note: This story was originally published on August 14, 2015, and was updated by David Mills on August 18, 2016.