Skip to Main Content
Skip Nav Destination

Policy reviews science linking on-screen violence, real-world aggression :

July 18, 2016

It’s nearly impossible for U.S. children to escape media violence. They also are being exposed increasingly to “virtual violence” in first-person shooter games and other realistic video games and applications. These newer, more interactive immersion games have intensified the experience far beyond passively watching a violent movie.

Virtual violence games are likely to be expanded and intensified further with new technology, such as virtual reality headsets. These commercially available devices will make virtual reality affordable for many families and increase the opportunity for other less idyllic immersion experiences for children, such as being dropped virtually into war zones.

A new AAP policy statement titled Virtual Violence summarizes scientific knowledge regarding the effects of virtual violence on children’s attitudes and behaviors and makes recommendations for pediatricians, parents, industry and policymakers. The statement, from the AAP Council on Communications and Media, is available at and will be published in the August issue of Pediatrics. 

Data on the impact of virtual violence

A small but vocal number of researchers dispute the link between screen violence and real-world aggression, despite decades of research, hundreds of studies and multiple peer-reviewed meta-analyses that have found a connection.

How strong is the link?

A meta-analysis of over 400 studies encompassing violent media of all types found a significant association between exposure to media violence and aggressive behavior, aggressive thoughts, angry feelings and physiological arousal (Bushman BJ, Huesmann R. Arch Pediatr Adolesc Med. 2006;160:348-352).


Furthermore, a meta-analysis of 140 studies focusing only on video games (before virtual reality had arrived on the scene) found slightly stronger associations between exposure to violence and aggression (Anderson CA, et al. Psychol Bull. 2010;136:151-173).

To put the association between screen violence and real-world aggression in perspective, it is greater than the association between secondhand smoke exposure and lung cancer (Anderson CA, Bushman BJ. Am Psychol. 2002;57:448-450) as well as breast self-examination and reduced risk of death from cancer. Yet many municipalities have banned smoking because of its risks, and most clinicians advise women to perform regular self-exams.

It is true that a definitive link has not been found between screen violence and real-world violence (e.g., school shootings). While most school shooters have a heavy diet of screen violence, so do many non-school shooters. The rarity of shootings makes prospective studies infeasible.


The policy makes the following recommendations for pediatricians, parents, policymakers, the media and the entertainment industry:

Pediatricians need to make children’s media “diets” an essential part of all well exams. In particular, emphasis must be placed on content and not just quantity.

Parents should be mindful of what shows their children watch and which games they play. When possible, they should play games with their children to get a better sense of what the games entail. Children under the age of 6 should be protected from virtual violence because they do not always distinguish fantasy from reality.

  • Policymakers should consider promoting legislation that provides caregivers and children with more specific information about the content of all forms of media and should enact laws that prohibit easy access to violent media by minors. In addition, a federal “parent-centric” rating system should be developed.
  • Pediatricians should take a leadership role in advocating for more child-positive media and collaborating with the entertainment industry to help develop shows and games.
  • The entertainment industry should not glamorize weapons, and violence should not be portrayed as normal. Violence for laughs and gratuitous violence should be eliminated. When violence is portrayed, it should include the pain and loss suffered by the victims and perpetrators.
  • Video games should not use human targets or award points for killing.
  • The news media should acknowledge the association between virtual violence and real-world aggression in the same way as secondhand smoke is associated with health risks.

Parents repeatedly say they want and rely on their pediatricians for advice about media. Pediatricians should welcome this opportunity to engage parents in conversations about what their children watch and play, and share with them the data that link screen violence with aggression.

Dr. Christakis is lead author of the policy statement and a former member of the AAP Council on Communications and Media Executive Committee.

Close Modal

or Create an Account

Close Modal
Close Modal