Studies have persuasively demonstrated that depictions of extreme violence in video games like "Mortal Kombat" and "Grand Theft Auto: Vice City" harm youngsters' mental health, according to pediatricians who disagreed with part of a U.S. Supreme Court decision striking down a California ban on video game sales to children.
However, the mental health experts agreed with the justices that ultimately, parents have a responsibility to vet and control what their children watch and play.
"The studies are actually very strong," said Dr. Laura Davies, a child and adolescent psychiatrist at California Pacific Medical Center in San Francisco. She had just read a paper published this past weekend in the journal Pediatrics that found violent videos disrupted preschoolers' sleep.
"Every one of us -- child psychiatrists, behavioral pediatricians and regular pediatricians, see in our practices every day that when children (younger than 7) are exposed to violence and to trauma, they act out ... by biting, hitting, kicking, name-calling, wetting themselves, poor sleep, poor eating," Davies said. "Older kids act out by fighting, with academic problems, social problems, bullying, anxiety, fearfulness, withdrawal from friends."
Writing for the high court's 7-2 majority, Justice Antonin Scalia agreed with a lower court that the state of California failed to prove that depictions of "killing, maiming, dismembering or sexually assaulting an image of a human being" were sufficiently harmful to young minds to justify carving out a free speech exception solely for children.
For centuries, young children have been exposed to "no shortage of gore" in "Grimm's Fairy Tales," he wrote. "Cinderella's evil stepsisters have their eyes pecked out by doves. And Hansel and Gretel (children!) kill their captor by baking her in an oven."
Davies, however, said the impact of reading "Grimm's Fairy Tales" on the page cannot be compared with the visual and aural assault of a violent video: "It's much more vivid and much more traumatic," she said. On another level, though, repeatedly playing these fictional, interactive videos distorts children's concept of death, she said.
"When I interview kids in my forensic practice, and they've killed somebody, they don't think the person is going to stay dead," she said. "They think that what they see on TV with these video games, with the movies, is that you kill them and you get another life."
Dina L. G. Borzekowski, an associate professor of health, behavior and society at the Johns Hopkins School of Public Health in Baltimore, said she concurred with Justice Stephen Breyer's dissent, in which he found a "compelling interest in protecting the physical and psychological well-being of minors."
As video games, more than half of which are rated as containing violence, become increasingly sophisticated, "it is very scary to think how children and adolescents will be sold products where they can practice violence," Borzekowski said.
"I think that parents can use more tools, not fewer, to guide their children in better media choices," she said. The Supreme Court decision "allows children to buy the virtual boxing gloves, and yes, the virtual guns."
As deplorable as she finds violent videos, Borzekowski said she opposes censorship. Instead, she would limit children's exposure to them with age restrictions, much like film ratings limit at what age children can see movies depicting sex, drugs or bad language.
That's the same approach advocated by the non-profit American Academy of Pediatrics, which represents 60,000 child specialists.
The academy considers exposure to violence in television, movies, music and video games "a significant risk to the health of children and adolescents," AAP President Dr. O. Marion Burton wrote in a June 17 letter to Rep. Joe Baca, D-Calif. "Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed."
Dr. Niranjan S. Karnik, a child psychiatrist and sociologist at the University of Chicago, said that as much as he is bothered by the influence of violent media on children, the court decision was "not unreasonable." He said the same kind of censorship that could block children from buying video games also could be used to ban library books.
"In my heart, I'm sympathetic to what the legislature was trying to do," he said. "I work with aggressive kids all the time. I get why they want to reduce this influence. But I don't think that removing the images will remove the issue."
He said most of his young patients are savvy enough computer users to work around a sales ban. "It's not just purchasing games at the store down the block. It's now purchasing games online. All they need is mom's and dad's credit card," he said.
However, parents have the power to take away all the sources of inappropriate material.
"Your kid doesn't have a right to the video game box, to the computer, to the X-Box, or the television," he said. "I've told parents to get rid of the router at home. The e-mails can probably wait until you get to work tomorrow."
Parents express "shock and horror," Karnik said. But, as he tells them: "If you remove those things, then the issue actually goes away."