title: Aggression in children with behavioural/emotional difficulties: seeing aggression on television and video games.
abstract: 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.
authors.affiliation: Academic Clinical Fellow, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK. oana.mitrofan@warwick.ac.uk.
authors.forename: Oana
authors.initials: O
authors.lastname: Mitrofan
authors.affiliation: Academic Clinical Fellow, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK. moli.paul@warwick.ac.uk.
authors.forename: Moli
authors.initials: M
authors.lastname: Paul
authors.affiliation: Academic Clinical Fellow, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK. s.weich@warwick.ac.uk.
authors.forename: Scott
authors.initials: S
authors.lastname: Weich
authors.affiliation: Academic Clinical Fellow, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK. n.j.spencer@warwick.ac.uk.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Spencer
mesh_terms: D000374:Aggression / Q000523:psychology*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D003625:Data Collection / Q000379:methods; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D013690:Television; D018910:Video Games / Q000009:adverse effects / Q000523:psychology*