My husband and son play the game Winda Benedetti

If you are the parent of a child or young adult who loves to play video games, then these are the moments when many frightening questions may be bouncing around inside your head.

Could playing video games make my child more aggressive? Do they make young adults antisocial? Most importantly: Can video games inspire a young person to walk into a school and open fire?

In the wake of the shootings at Sandy Hook Elementary School many politicians and pundits are holding up video games as a possible culprit. As a gamer, I question those who are quick to point the finger of blame at a pastime they don't necessarily understand. But as the mother of a kindergartner who loves to play video games, I share the same concerns for his mental health and well-being that any parent does.

Armed with questions, I interviewed two psychiatrists who know much about both kids' mental health ... and video games.

Dr. Tyler Black is Clinical Director of the Child and Adolescent Psychiatric Emergency Unit at BC Children's Hospital in Vancouver, BC, Canada. Dr. Matthew Chow is the Clinical Director of Telepsychiatry at BC Children’s Hospital. Both men have worked extensively with children and young adults dealing with a range of issues including addiction, violence and psychiatric disorders. And both are gamers.

As many parents are searching for answers in the wake of the recent tragedy, they offered some helpful insights into the affects video games may have on children and offer some suggestions for parents concerned about their child's love of gaming. Read on.

Question: In times like these, many parents worry that playing games could be harmful to their children. What advice would you offer to parents with these concerns?



Chow: Talk to your children about video games. Ask them what they are playing. Ask them why they play. Join them in play just as you would any other activity. Children need guidance about appropriate values and behavior in games just as much as in the real world. Children need to know the difference between what happens in a game and the real world.

Ultimately, I think the best way to find out if video games are harming your children is to ask, “Is this still fun for you?” Children should be playing games because they want to, rather than because they have to. A child who is playing video games because they want to stay home from school, avoid a particular person, or because they cannot sleep, is probably a child that is playing for the wrong reasons. In those situations, parents should look at the reasons for playing, rather than the video games themselves.

Black: Know the games. Read up on the ratings systems — they're excellent. A young child should no more play an M-rated video game than he or she should watch an R-rated movie. If you find a game your child enjoys, play it with them. If your child is spending time with online friends, get to know these friends as you would their real life counterparts.

Become a trusted person with your child's gaming, not a "person to avoid." The best effect of doing this is that you'll discover what Dr. Chow and I know from personal experience — gaming is fun, and children like it because it is fun.

Almost every time there has been a mass shooting in recent years, video games have been blamed, at least in part, at some point — sometimes even before we know whether the shooter even played games. Why do you think that is?

Black: The simple answer is that violence is complicated, and an easier answer is simpler to digest. It is so much easier to point at a video game and say, "That's the problem," than it is to look at our own society, our own laws, our own views on mental health, and our own systems in fostering a healthy society.

Video games have achieved the status of "moral panic." That is to say, that the narrative that people hold is that "video games are not healthy, and are bad for our children." This is very similar to how television used to be viewed, how jazz music was viewed before that, how novels were viewed before that, and how Shakespeare was viewed before even that.

Dr. Matthew Chow and Dr. Tyler Black of the BC Children's Hospital in Vancouver, Canada, encourage parents to play video games with their children. BC Children's Hospital

There has always been a moral panic that has us "worried for the future generation." I think video games are so prevalent, and yet so foreign to parents and the older generations, that it's easy to see them as "scary."

Video games have progressed from very primitive to very realistic, the M-rated games have become more violent, and the interactions more realistic. So people make this link that "increasing violence is due to increasing use of video games." However, the world is not more violent. In fact, violence in youth continues to decrease year-over-year. So the core concern is unfounded, yet the media and public narrative remains.



What can you tell me, from your own work in child and adolescent psychiatry, about the link between violent behavior and video games? Is there one?

Black: To be blunt, if there is a relationship, it looks like it is very small. Excellent scientific reviews of the literature (C.J. Ferguson has an excellent review here) have already shown that the existing research is tremendously biased, and doesn't actually show a lot of connection.

There are many contributions to violence — genetics, environment, social situation, abuse, education, etc., that video games likely rank very low on the list of contributions. Fortunately, the science is changing, and even some of the biggest names in the "violence caused by video game" camp are being forced to pivot to admit that, despite decades of research, there is very little evidence to suggest that real world violence has any significant relationship to video games.



Chow: I have seen violent behavior in people who play video games, and I have also seen violent behavior in people who do not play video games. That being said, it is becoming harder to find people who have never played a video game.

Almost everyone has played a game like 'Angry Birds' on their phone. Despite the proliferation of video games, I am not seeing any increase in violent behaviors in children. If someone wants to prove to me that video games cause violence, they need to explain why the incidence of violent crimes is falling in America while more people are playing video games.

I am struck by how very many different studies there are regarding how violent video games affect those who play them. Some studies suggest they are quite damaging. Other suggest the opposite. In your experience, what is the “truth”? What can we take away from this cavalcade of studies?

Chow: I have attended conventions where tens of thousands of video gamers have converged on a city. The most recent example was the Penny Arcade Expo in Seattle (see video below). Something like 75,000 video gamers showed up. If video games, and in particular violent video games, create violent, antisocial people then you should expect that attending PAX would be one of the most frightening experiences in my life.

It was quite the opposite. I found people to be very friendly. They waited in long lines without fighting or cheating. They complimented each other on their gaming skills and costumes. They met up with each other for dinner. I felt safer at night because there were so many people walking around the convention venues ... I challenge the researchers who say that video games are harmful to explain that.

Black: To follow up on my point about a "moral panic," one of the interesting things about the aspects of a moral panic is that only the research that confirms the panic ever sees the light of day.

In 2007, a paper published in the Journal of Pediatrics — The Public health risks of media violence: A meta-analytic review — showed that there is tremendous publication bias in the field of violence and video games. Quite simply, research that shows a negative or no relationship between video games and violence doesn't get published, while research that shows a strong connection is published.

The most striking example of why this research is biased comes from the populations they use. Many articles are published, using experiments run on college-age kids (students often in psychology courses, no less!), and yet their "results" are headlined as evidence for a link between children, violence, and video games.

Many people worry that video games can be very isolating to those people — especially young people — who play them. Is that the case?

Chow: Video games have evolved into a shared experience. No longer are people playing these games alone in their parents’ basement. People expect to be able to play online. People join online communities populated by tens of thousands of individuals around the world. They participate in prosocial behaviors such as cooperative play, trading, negotiating, forming alliances, and creating rules of conduct.

You need to be able to get along with a diverse community in order to succeed in online play. Antisocial people are often marginalized and even banned from popular communities. If you told me that a child was participating in an activity where she was cooperating with tens of thousands of people across the globe to accomplish a shared objective, I would probably label that as prosocial. People playing video games are doing this right now.

Black: Dr. Chow is completely right here. Games are no longer black-and-white. There are few examples of a simple "violent video game." Video games have moral lessons multiplayer objectives, cooperation, competition, and learning. Even some of the much-ballyhooed games have prosocial components. You can help others in shooting games, you can work together against a common enemy (in Call of Duty's case, zombies!), and you can communicate around the globe. There are problems that crop up from this, and there are real concerns, but video games are complicated now, and they would simply not be fun if there wasn't more to them.

The implication after these mass shootings is that video gaming is somehow not normal.

Chow: Video games are everywhere. People play them on phones, tablets, airplane entertainment systems, as well as the traditional Xbox and PlayStation. Revenues for the video game industry surpassed those of the movie and music industry years ago. Saying that video gaming is not normal would be like saying that going to a movie or listening to music is not normal. Almost everyone has played a video game. You can no longer separate video gamers and non-video gamers.

Black: A Pew Internet & Life Survey showed that 99 percent of American teenage boys and 97 percent of American teenage girls play video games. It is undoubtedly even higher now. Video gaming is a normal element of childhood now. Clinically, when I see children in my office, I don't ask "do you play video games," I ask, "What games do you play?" Being knowledgeable about video games and having that connection with children amplifies my ability to relate to the children I see.

Interestingly, we actually see that reflected in some of the disorders we see as well. For example, depression may actually be higher in children who play no video games or more than a few hours a day, than in children who play one or two hours a day. That isn't to say that video gaming treats depression — but it's now just a normal indicator of childhood function.

You have spoken before about how young people who struggle with things in “the real world” such as rewards, validation, mastery of skills will seek them out in video games. What do video games provide young people struggling to be successful in the real world? And is seeking that out in a game a positive thing?

Chow: Video games can provide a safe environment for people with several advantages over the "real world." People can pause or stop a game if it becomes too difficult. They can modify the settings. They can try out new approaches to a task without fear of "real world" or permanent consequences. They can recruit a diverse array of fellow video gamers from around the world to help them with a troublesome area.

In many ways, video games are the modern equivalent of a children’s playground. They provide an area where people can play hard and try new things, but there is always a soft surface to land on if you fall. This sense of security allows people with challenges to come out of their shells and thrive.

Black: Children who overuse of video games may actually be turning to video games because it gives them something they are lacking. One of the core beliefs we have in child psychiatry is that children, generally, do their best to succeed. If they cannot succeed in "real world" activities such as socializing, or school, they may find the success they can attain in an online or video game environment to be preferential.

The parent who says "my child plays too much" may be focusing their attention on the wrong thing. A better question might be, "what is causing difficulty in their life that makes play so preferential?" Enlisting help in getting the answer to that question may be the intervention that creates true health for a child who overuses games, rather than simply removing the game and the one thing they find enjoyable.

In the wake of shootings like these, as video games are brought up as a cause, what do you think the biggest misunderstanding about video games is?

Chow: People like to label things as good or bad. It makes the world simpler. Unfortunately, most things are not so black and white. For example, we have heard plenty of news about storms and flooding in the past few weeks. You may be tempted to conclude that ‘water’ is a very bad thing. It destroyed people’s homes and business. It even killed some people. Fortunately, we are not hearing calls to ban water because people know that would be ridiculous.

Video games are the same. They are neither good nor bad. They can be both. We can choose as a society to encourage the prosocial aspects of video games, or we can make misguided efforts to curtail or ban video games.

Black: The biggest misperception these days is that only social isolates play video games, and that these games cause the types of problems that lead to violence. Video gaming is so prevalent that saying someone "plays video games" is akin to saying they "breathe oxygen." Video gaming is normal. I like to think of myself as normal, I hold a number of jobs, I am married, and I regularly play basketball. I also play video games. I'm not an atypical gamer, I'm a gamer.

In moments when there is tragedy and we have so much thought and pause for introspection, it's so important to look at variables as "contributors," not causes. It helps to prevent leaping to wrong conclusions. Investigations will be done and information will be discovered, but at the end of the day, there are so many complicated reasons that violence happens in the world, that we as a society need to look at all we are doing (laws, education, health, weapons, etc.) to ensure that violent acts are as rare as they can possibly be.

Winda Benedetti writes about video games for NBC News. You can follow her tweets about games and other things on Twitter here @WindaBenedetti and you can follow her on Google+. Meanwhile, be sure to check out the IN-GAME FACEBOOK PAGE to discuss the day's gaming news and reviews.