Background: Mental health professionals are often asked to give advice about managing children’s aggression.
Good quality evidence on contributory environmental factors such as seeing aggression on television and in video
games is relatively lacking, although societal and professional concerns are high. This study investigated possible
associations between seeing aggression in such media and the aggressive behaviour of children attending
specialist outpatient child and adolescent mental health services (CAMHS).
Methods: In this mixed methods study, forty-seven British children aged 7–11 years with behavioural/emotional
difficulties attending CAMHS and their carers participated in a survey; twenty purposively-selected children and a
parent/carer of theirs participated in a qualitative study, involving semi-structured interviews, analysed using the
Framework Analysis Approach; findings were integrated.
Results: Children attending CAMHS exhibit clinically significant aggression, of varying types and frequency. They
see aggression in multiple real and virtual settings. Verbal aggression was often seen, frequently exhibited and
strongly associated with poor peer relationships and low prosocial behaviour. Children did not think seeing
aggression influences their own behaviour but believed it influences others. Carers regarded aggression as resulting
from a combination of inner and environmental factors and seeing aggression in real-life as having more impact
than television/video games.
Conclusions: There is yet no definitive evidence for or against a direct relationship between aggression seen in the
media and aggression in children with behavioural/emotional difficulties. Future research should take an ecological
perspective, investigating individual, developmental and environmental factors. Carers, professional organisations and
policy makers should address aggression seen in all relevant area of children’s lives, primarily real-life and secondly
virtual environments