Systematic review of children with emotional and behavioural problems with video games and television (Mitrofan et al., 2009)

Brought to you by Arthur Kirkland of Hetalia

Brought to you by the United Kingdom from Hetalia

I pulled this article out of the bottom of my studies’ barrel; it was dated on New Year’s Eve. This study, published from the United Kingdom, reviewed articles on the relation between children with behavioural and emotional difficulties and media use, mainly on television viewing and video game playing.



Possible associations between television viewing and video game playing and children’s aggression have become public health concerns. We did a systematic review of studies that examined such associations, focussing on children and young people with behavioural and emotional difficulties, who are thought to be more susceptible.


We did computer-assisted searches of health and social science databases, gateways, publications from relevant organizations and for grey literature; scanned bibliographies; hand-searched key journals; and corresponded with authors. We critically appraised all studies.


A total of 12 studies: three experiments with children with behavioural and emotional difficulties found increased aggression after watching aggressive as opposed to low-aggressive content television programmes, one found the opposite and two no clear effect, one found such children no more likely than controls to imitate aggressive television characters. One case-control study and one survey found that children and young people with behavioural and emotional difficulties watched more television than controls; another did not. Two studies found that children and young people with behavioural and emotional difficulties viewed more hours of aggressive television programmes than controls. One study on video game use found that young people with behavioural and emotional difficulties viewed more minutes of violence and played longer than controls. In a qualitative study children with behavioural and emotional difficulties, but not their parents, did not associate watching television with aggression. All studies had significant methodological flaws. None was based on power calculations.


This systematic review found insufficient, contradictory and methodologically flawed evidence on the association between television viewing and video game playing and aggression in children and young people with behavioural and emotional difficulties. If public health advice is to be evidence-based, good quality research is needed.

Wait, 12 studies? I understand if it was video games, but there should’ve been more studies on television since it’s been in existence for more than a generation.


They outlined the terminology used in their study in order to select the relevant articles:

  • Children or young people: 18 years or less.
  • Video games: Every synonym of video games, whether it’s PC, consoles or arcades.
  • Aggression: Direct, overt aggression. Physical and non-physical aggression is included, as well as its respective subtypes (i.e. symbolic, object). They included synonyms used in educational and health care settings (e.g. challenging behaviour, violence, antisocial behaviour).
  • Behavioural and emotional difficulties: Diagnostic criteria used in the ICD-10 and DSM-IV. Conduct disorder, Oppositional defiant disorder, Attention deficit/hyperactive disorder, separation anxiety disorder are among these difficulties. They excluded psychiatric conditions, such as mental retardation, psychoses, etc.

What they include, studies that examined children with these behavioural and emotional difficulties, what’s excluded are studies that’s aggression-related (i.e. feelings, thoughts, or mood.). This means a big chunk of the literature. They outlined which databases they searched in, the terms used and searched in numerous organizations’ publications.

They found 50 papers, but managed to get 48 full-text copies. Further investigations based on their criteria finally lead to the 12 papers. Most of the papers were conducted in the United States and two were published in Germany.

Here are the 12 papers they analysed:

  • Gadow, K. D. & Sprafkin, J. (1987) Effects of viewing high versus low aggression cartoons on emotionally disturbed children. Journal of Pediatric Psychology, 12, 413–427.
  • Gadow, K. D., Sprafkin, J. & Ficarrotto, T. J. (1987) Effects of viewing aggression-laden cartoons on preschool-aged emotionally disturbed children. Child Psychiatry and Human Development, 17, 257–274.
  • Sprafkin, J. & Gadow, K. D. (1986) Television viewing habits of emotionally disturbed, learning disabled, and mentally retarded children. Journal of Applied Developmental Psychology, 7, 45–59.
  • Sprafkin, J. & Gadow, K. D. (1988) The immediate impact of aggressive cartoons on emotionally disturbed and learning disabled children. The Journal of Genetic Psychology, 149, 35–44.
  • Sprafkin, J., Gadow, K. D. & Grayson, P. (1988) Effects of cartoons on emotionally disturbed children’s social behavior in school settings. Journal of Child Psychology, 29, 91–99.
  • Walters, R. H. & Willows, D. C. (1968) Imitative behavior of disturbed and non-disturbed children following exposure to aggressive and nonaggressive models. Child Development, 39, 79–89.
  • Hässler, F., Gierow, B., Tilch, P. & Langemann, I. (1993) [Television behavior of a pediatric and adolescent psychiatric patient population]. [German]. Pediatrie und Grenzgebiete, 31, 363–369.
  • Kronenberger, W. G., Mathews, V. P., Dunn, D.W., Wang, Y., Wood, E. A., Larsen, J. J., Rembusch, M. E., Lowe, M. J., Giauque, A. L. & Lurito, J. T. (2005) Media violence exposure in aggressive and control adolescents: differences in self- and parent-reported exposure to violence on television and in video games. Aggressive behavior, 31, 201–216.
  • Lowdermilk, J. L. (2004) A deconstruction and qualitative analysis of the consumption of traditional entertainment media by elementary-aged children diagnosed with emotional disorders. Dissertation-Abstracts-International: Section A, 65/08, 2950.
  • Möller-Nehring, E., Moach, A., Castell, R., Weigel, A. & Meyer, M. (1998) [Conditions facilitating social disorder in children and adolescents in a clinic referred sample]. [German]. Praxis der Kinderpsychologie und Kinderpsychiatrie, 47, 36–47.

There are seven experiments that examined the immediate effects of violent television, conducted either in school setting or laboratory settings; two case-control studies, two cross-sectional surveys and one qualitative study.


This is what they have to say (in jargon) about the studies they reviewed.

Quantitative studies: Relatively small sample size, impossibility to exclude Type II error, validity of outcome variables unclear, reliability in but two studies are unclear, non-random sampling, participants’ level of attention on the videos they watched, behavioural state of the participants prior of the experiment, and order presentation of the videos. Generalizations issues.

Experimental studies: inadequate description of the term ‘emotional disturbance’. Unclear whether experimenters were blind to the participants’ condition, unclear about their randomization process or their way of dealing attrition.

Case-control studies: population representativeness is an issue.

Qualitative study: Small sample size and convenience sampling. No way to know about validity or reliability of the study. It’s a qualitative study, a lot of subjective interpretation.

Mitrofan, O., Paul, M., & Spencer, N. (2009). Is aggression in children with behavioural and emotional difficulties associated with television viewing and video game playing? A systematic review. Child: Care, Health, and Development, 35 (1), 5-15.


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