International trends in bullying

The English HBSC team collaborated on an international paper exploring the temporal trends of bullying victimization across Europe and North America. The paper entitled “Cross-national time trends in bullying victimization in 33 countries among children aged 11, 13 and 15 from 2002 – 2010” was published earlier this year as part of a supplement in the European Journal of Public Health¹. The supplement focuses on international trends in young people’s health and their social determinants.

Bullying describes intentional harmful behaviours, which are carried out repeatedly against a weaker individual². Bullying can take many forms including physical, verbal, relational and cyber (for more information on cyberbullying click here for our previous blog post).

Bullying is recognised as a health problem across Europe and North America. Studies have demonstrated that being a victim of bullying is associated with serious health consequences. Cross-national data from the HBSC study conducted in 1998 identified young people who were bullied were more likely to experience both physical (e.g. headaches and stomach aches) and psychological (e.g. feeling low and loneliness) symptoms, with a higher risk of symptoms as the frequency of bullying increased³. Moreover the consequences of bullying have been shown to persist into later life; longitudinal research has established victims of bullying were more likely to experience adverse health outcomes in adult life⁴. It is not just the victims of bullying who experience poor health outcomes, the bullies themselves fare worse than their peers not involved in bullying. A Finnish study found symptoms of anxiety and depression were equally as common among bullies and victims⁵, and bullies were most likely to engage in health risk behaviours such as excessive alcohol consumption and taking drugs⁶.

As bullying is a proven determinant of young people’s health and wellbeing it is important to monitor trends in bullying victimisation, and drawing on cross national comparisons allows lessons to be shared across countries.

The paper highlights that bullying is still a fairly common occurrence in the 33 countries which took part in the study. Since 2002 a third of countries have demonstrated significant downward trends in bullying for both boys and girls. Only one country (French Belgium) reported significant increasing trends in both occasional and chronic bullying. Gender differences in time trends were evident, with some countries presenting a decline in bullying for only one gender.

The paper raises important questions regarding the need for gender specific programmes to address bullying among both boys and girls, and the necessity for sustained effort in order to ensure the decline in bullying is continued across time.

For a more thorough discussion of the study’s findings read the full paper by clicking here.

1. Chester, K. L., Callaghan, M., Cosma, A., Donnelly, P., Craige, W., Walsh, S. & Michal, M. (2015). Cross-national time trends in bullying victimization in 33 countries among children aged 11, 13 and 15 from 2002 – 2010. Eur J Public Health, 25 (Suppl 2), 61-64.
2. Olweus, D. (1993). Bullying at School: What We Know and What Can We Do. Oxford, England: Blackwell Publishers.
3. Due, P., Holstein, B. E., Lynch, J., et al. (2005). Bullying and symptoms among school-aged children: international comparative cross sectional study in 28 countries. Eur J Public Health, 15, 128–132.
4. Wolke, D., Copeland, W. E., Angold, A. & Costello, E. J. (2013). Impact of bullying in childhood on adult health, wealth, crime, and social outcomes. Psychological science, 24(10), 1958-1970.
5. Kaltiala-Heino, R., Rimpela, M., Rantanen, P. & Rimpela, A. (2000). Bullying at school – an indicator of adolescents at risk for mental disorders. Journal of Adolescence, 23 (6), 661-674.
6. Alikasifoglu, M., Erginoz, E., Ercan, O., Uysal, O. & Albayrak-Kaymak, D. (2007). Bullying behaviours and psychosocial health: results from a cross-sectional survey among high school students in Istanbul, Turkey. Eur J Pediatr, 166, 1253-1260.      

What we think

The following blog post was written by Roman and Vato, both 15 years old, during their time spent with the HBSC England team for work experience. After studying HBSC England data they have provided an insightful account of adolescent life in order to interpret the findings. 

As students on work experience, we were given the chance to look at some data in order to interpret it; giving our own opinions on what that data could mean and why. Since adolescents are often tokenised and not really taken seriously, we were relieved when we actually had the chance to express ourselves.

Our main concern was the fact that so much adult attention was focused on the usage of risk behaviours in our age group. The media and even those in power seem to think that adolescents are all potheads that have replaced their blood with alcohol and their brains with nicotine. Safe to say, this is not actually true, and anyone who happens to believe this may want to contact their local GP. In any case, the risk behaviours were never truly significant anyway. They are simply a way for adolescents to entertain themselves and even escape reality, despite being extremely detrimental to one’s health. But honestly young people have learned this already.

With the education system constantly churning out new ways to teach both adolescents and children about the risk behaviours, our generation is more cautious about these dangers. Due to the past high levels of substance consumption, risk behaviours have almost become social norms and so they are not seen as “cool” anymore, which has led to the rates of consumption decreasing. From looking at the data, we theorised that the consumption of risk behaviours could be fluctuating. If this were the case, it might be that in a few years, the rates of consumption could increase yet again.

Honestly though, there is little point in focusing on risk behaviours. They are not the causes of adolescent problems, they are the effects. Teenagers turn to drugs when they are depressed. They smoke when they are lonely. They drink when they are stressed. Just a few examples of reality that should have been obvious. Substance usage happens because of a large variety of different internal problems, and while it could be that educating adolescents on substances is helpful, the focus should not be on the usage, it should be on why they are used, and what one could do instead. And even better, there should be so much more attention paid to the fact that Internal Problems Are Real.

When the government expects us to learn and develop at school, what they don’t realise is that they have given us three options:

1. Good Grades                       
2. Good Health                          
3. A Social Life

And told us we can choose two.

With the current education system, adolescents are usually left almost completely busy with school work, meaning they barely have time for the activities they need to actually develop as human beings.

Let’s calculate it shall we?

6 hours of school per day, and for healthy living young people require 9-11 hours of sleep. Now we aren’t unfair, so we’ll go with 10. 6+10 = 16. This leaves 8 hours awake at home. Now maybe homework is not so intensive before GCSE’s, but it still eats quite a large amount of time, and when GCSE’s come into the picture, homework can take up to 5 hours per day. The government also recommends 1 hour of physical activity per day.

So. For an adolescent doing GCSE’s to be healthy and do work, they are left with 2-3 hours to eat, socialise, rest, pursue their interests, deal with the problems of puberty, connect with their family, deal with various drama and friendships, develop as humans, find out who they are beyond schoolwork, learn about the news of the world which will definitely concern them later on, think about life and what they want to do in the future, and actually live as nature intended.

2 hours. To do that. What the hell is wrong with you? (This is not to say all teenagers are left with 2 hours to live, it is simply a base picture. This can and does happen quite a bit.) In all seriousness, there is little wonder that adolescents are faced with so many internal struggles; stress, anxiety, depression. Not helpful when society and medial interaction states that they should be perfect or they won’t be loved. Not helpful when school rules dictate that if you forget a sock in P.E you will be faced with an after-school detention (I am not joking with you; this is actually what happens to us).

And beyond that, young people face the challenge of trying to communicate their problems to adults who don’t realise that even if their past seemed easy for them, it does not mean that now is easy for us. Some of them don’t even believe in mental health problems just because they can’t see them. Depression doesn’t leave bruises, but it still harms us. It still exists.

There are thousands of ways we could conclude this, talking about stereotype, empathy, the government. Michael Gove. But all we can truly do is give you what we have written. Take from it what you will.

Thank you for reading.

Roman and Vato.

Video gaming: it's all about moderation!

We have recently published an article in the Journal of Youth Studies entitled “Video gaming in adolescence: factors associated with leisure time use”¹.

Since video games first emerged in the 1970’s, with the likes of Pong and Space Invaders, the video game industry has become a significant sector of the economy; in the UK alone 1.4 million copies of Call of Duty Black Ops™ were bought on the games launch day². Video games are now a regular feature of adolescent leisure time, with a recent UK based study suggesting 3 out of 4 young people play video games on a daily basis³. Technological developments have resulted in the gaming experiencing becoming increasingly more versatile; with the ability to play online with friends, interact physically with games and access games through mobile apps.

Traditionally much research has focused on the negative effects of playing video games. Studies have suggested video game play is associated with poorer mental health⁴ and impaired academic achievement^5. In particular there is considerable debate around the implications of playing violent video games, with research suggesting that violent video game playing may be linked to an increase in aggressive behaviours⁶. More recently, research has begun to address the positive aspects of video gaming including improved social skills and problem solving⁷. Przybylski (2014) suggested a more nuanced understanding of gaming compared with the traditional dichotomous good vs bad divide; young people who played games for up to 1 hour a day demonstrated more positive outcomes than those who didn’t play at all, while the opposite was true for those who played for more than 3 hours a day.

Considering the potential negative outcomes of video game play, many countries and associations have issued recommended guidelines. In the UK, the Public Health Outcomes Framework⁹ is concerned with the negative impact of game play beyond moderate leisure time use, and as such is committed to monitoring levels of game play exceeding 2 hours or more. 

Data from the 2010 Health Behaviour in School-aged Children (HBSC) study in England¹⁰ identified  20% of girls and 55% of boys were playing video games for two or more hours on weekdays. Figure 1 (summarising HBSC England 2010 data) shows boys are more likely than girls to report playing video games for 2 or more hours a day during the week across all ages. Compared with data from the HBSC England 2006 survey, the proportion of both boys and girls who reported playing for more than two hours had significantly increased.

Our paper identified associations between young peoples’ video gaming levels and their social environment as well as their health and wellbeing. In line with previous work³, our research suggests video gaming is not intrinsically positive or negative. For boys, being in the middle category for game play was associated with having more friends of the opposite sex than those in the lowest category; and for girls it was associated with engaging in more family activities. In contrast, the highest levels of video gaming were found to be associated with negative aspects for both boys and girls. In particular, boys who reported playing video games for more than 4 hours a day during the week were more likely to report going to bed hungry, bullying others and being bullied.

The analysis demonstrates the important role parents play in structuring and regulating levels of video gaming among young people. Young people who reported their parents had a say in deciding how they spent their free time were less likely to play video games at the higher levels compared with those who had no parental input. However we found an interesting relationship between level of parental control and video gaming which supports the “boomerang effect” where young people with strictest parental mediation actually played video games more frequently!

For a more thorough discussion of this research you can access the published paper by clicking here.    

By clicking here, you can also read a guest blog post written by Sam and Tom (both aged 15) to find out what young people themselves think about video games.

References

1. Brooks, F.M., Chester, K.L., Smeeton, N.C. & Spencer, N. (2015). Video gaming in adolescence: factors associated with leisure time use. Journal of Youth Studies, DOI: 10.1080/13676261.2015.1048200
2. Dring, C. (2010). Black Ops smashes UK day 1 record. Retrieved 18th March 2015, from http://www.mcvuk.com/news/read/black-ops-smashes-uk-day-1-record
3. Przybylski, A.K. (2014). Electronic gaming and psychosocial adjustment. Pediatrics, 134(3), 1-7.
4. Page, A.S., Cooper, A.R., Griew, P. & Jago, R. (2010). Children's screen viewing is related to psychological difficultiesirrespective of physical activity. Pediatrics, 126(5), e1011-e1017.
5. Jaruratanasirikul, S., Wongwaitaweewong, K. & Sangsupawanich, P. (2009). Electronic game play and school performance of adolescents in southern Thailand. CyberPsychology & Behavior, 12(5), 509-512. 
6. Gentile, D.A., Lynch, P.J., Linder, J.R. & Walsh, D.A. (2004). The effects of violent video game habits on adolescent hostility, aggressive behaviors, and school performance. Journal of Adolescence, 27(1), 5-22.
7. Adachi, P.J.C. & Willoughby, T. (2013). More than just fun and games: the longitudinal relationships between strategic videogames, self-reported problem solving skills, and academic grades. Journal of Youth and Adolescence, 42(7), 1041-1052.
8. Department of Health. (2012). Report of the Children and Young Person’s Health Outcomes Forum. Retrieved 18th March 2015, from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216852/CYP-report.pdf
9. Brooks, F., Magnusson, J., Klemera, E., Spencer, N. & Morgan, A. (2011). HBSC England National Report. Findings from the2010 HBSC study for England. Hatfield: University of Hertfordshire.

The guest of our blog Dr Wendy Wills asks an interesting question!

WHAT YOUNG PEOPLE BUY TO EAT AND DRINK CLOSE TO THEIR SCHOOL

Research conducted by the University of Hertfordshire suggests many young people at secondary school buy food and drink from shops close to their school, rather than in the school cafeteria. This is for several reasons, including that local shops are friendly and don’t mind young people hanging out with their friends there; they provide cheap food and drink that appeals to young people and also that local shops are nicer places to spend the lunch break, compared with schools.

We are making a film to highlight these research findings and we need YOUNG PEOPLE  to help us decide on a title for the film!

Some suggestions so far are:

Bargaining Chips: Why Young People Buy Food and Drink Outside School

Fry Days: Why Young People Buy Food and Drink Outside School

Come Fry with Me: Why Young People Buy Food and Drink Outside School

Do you have other suggestions? Please let us know! The deadline is the end of July.

Our work experience students, Vato and Roman wrote the blog post about their conference presentation in UH

Conference for Public Engagement with Research

On the 23^rd June 2015, a conference was held in which many researchers got together to display various examples of public engagement in their projects. As young people participating in youth research through work experience, we were invited to this event to give our opinions during a presentation.

The day started out with a welcome from Professor John Senior, the Pro Vice-Chancellor, who gave a short introduction to the idea of public engagement. He then introduced Sophie Duncan, the Deputy Director for the National Co-ordinating Centre for Public Engagement (NCCPE).

She then proceeded to give a brief talk about the importance of public engagement with research, providing various statistics and information on the public’s desire to get involved, the best ways of engaging them, and how to integrate public engagement into projects; funding, methods, writing etc.

Although the delivery included much specialist vocab which myself and Roman didn’t understand, we were nonetheless kept engaged (funny joke) as Sophie Duncan interacted with the audience by asking them a number of thought-provoking questions.

With our heads full of public engagement knowledge, we eagerly awaited the rest of the conference. There were many presentations departing much information, and so we decided to pick out our personal favourites of the bunch.

Ever tried to quit at something? Such as smoking or perhaps just trying to change your sleeping pattern? Well it is no secret that changing behaviour is a hard ordeal, especially when the help we seek is often just ineffective. The presentation brought by Ben Fletcher however, brought to light his possible solution, the Do Something project. Usually, programs that help with addiction or changing behaviour are focused on altering the way we think, relying on our willpower as humans. As you can see, this had little willpower of its own behind it (surprise?). Ben Fletcher explained to us that in order to break addiction or alter behaviour, one has to alter their habits. Humans are habitual creatures because habits are quick and easy. This means that once certain habits are formed, it is not only those, but the whole situation that creates a hard foundation, making it difficult to change. For example, a smoker cannot rely on willpower alone to break their habit, they need to shift their outlook and leave their comfort zone. Ways of doing this include taking different routes to places to disrupt routinely life, and in general just trying to view things differently. While this is hard in itself, it is certainly easier than willpower, and I was glad I could listen to this presentation as it truly fascinated me.

Robots are usually pictured as giant, shiny machines that shoot lasers from their eyes…but in reality, they’re designed to help humans complete certain tasks. Anna Dumitriu and Alex May helped explain this as they began discussing their new research-related robot: HARR1. They used HARR1 to experiment with how the public reacted to different situations involving robots. For example, they programmed HARR1 to imitate the emotion of care through physical interaction (touching a person’s face), as well as then reprogramming him to exhibit boredom by first tracking movement and then looking elsewhere for motion if there was none. One of their experiments used a robot that would change its face to fit the participant’s own features. This was to see if it made a robot more appealing to have around the house or if it scared the living daylights out of them. One participant was even seen to run away and hide behind a corner which I thought was particularly funny, even though this seems rather cruel. All in all, I found this very interesting and would like to see how they further develop the robots.

Overall, the conference was very useful for us both, giving us an overview of the sharing and communication that goes into research. The presentations themselves were inspiring, and have led us to think about certain things differently, as well as giving us some cool facts. The experience of the conference (while somewhat tiring and leg-numbing), is something we’ll be hard-pressed to forget.

 

                                         Roman and Vato

Teacher connectedness as a health asset

The HBSC England and HBSC Spanish team have recently collaborated to explore the role of teacher connectedness in young people’s well-being. The findings have been published in the Health Education Journal in a paper titled “Subjective well-being in adolescence and teacher connectedness: A health asset analysis”.

Teacher connectedness can be viewed as a feature of overall school connectedness, which Blum and Libbey (2004)¹  define as an academic environment in which young people believe adults care about them and their learning. Teacher connectedness refers to constructive and supportive student-teacher relationships. Extensive research has demonstrated the positive outcomes school and teacher connectedness can have on young people's health and well-being, including risk behaviours^2,3,4.

The paper sought to establish whether teacher connectedness was associated with well-being in young people of different ages and from different countries. Moreover, this research aimed to identify whether teacher connectedness has the same effect on well-being irrespective of young people's academic performance.  

The study included a total of 9444 students aged 11-, 13- and 15 years old, who completed the 2010 Health Behaviour in School-aged Children survey in Spain and England. Teacher connectedness was measured through a 5 item scale assessing student-teacher relationships, which was originally developed and validated within the HBSC network⁵. Items included "my teachers are interested in me as a person", and students responded on a 5 point scale ranging from strongly disagree to strongly agree. Young people's well-being was assessed with KIDSCREEN-10, a measure of health related quality of life specifically designed for young people⁶. KIDSCREEN-10 is derived from the more extensive KIDSCREEN-52, and measures physical, social, emotional and behavioural components of well-being.  School performance was measured through the question "In your opinion, what does your class teacher(s) think about your school performance compared to your classmates?", with response options "very good", "good", "average" and "below average".

Analysis demonstrated that teacher connectedness was positively associated with young people's well-being despite gender, age or country. While small differences between age and country were identified, overall it appears teacher connectedness can be viewed as a universal health asset for young people's well-being. Moreover, the association between teacher connectedness and well being was independent of perceived school performance; young people who reported below average school performance benefitted from teacher connectedness also.

For a more detailed discussion of this research you can access the published paper by clicking here.

References

1. Blum, R. W. & Libbey, H. P. (2004). school connectedness - Strengthening health and education outcomes for teenagers - Executive summary. Journal of School Health, 74(7), 231-232.
2. McNeely, C. & Falci, C. (2004). School connectedness and the transition into and out of health-risk behavior among adolescents: a comparison of social belonging and teacher support. J Sch Health, 74(7),284–92.
3. Brooks, F., Magnusson, J., Spencer, N. & Morgan, A. (2012). Adolescent multiple risk behaviour: An assets approach to the role of family, school and community. Journal of Public Health, 34(S1), 48–56.
4. Blum, R. W. (2005). A case for school connectedness. Educational Leadership, 62(7), 16–20.
5. Torsheim, T., Wold, B. & Samdal, O. (2000). The teacher and classmate support scale: Factor structure, test–retest reliability and validity in samples of 13- and 15-year old adolescents. School Psychology International, 21(2), 195–212.
6.  Ravens-Sieberer, U., Herdman, M., Devine, J., Otto, C., Bullinger, M., Rose, M., & Klasen, F. (2014). The European KIDSCREEN approach to measure quality of life and well-being in children: development, current application, and future advances. Quality of Life Research, 23(3), 791–803.

What is the point of playing video games?

This is a guest blog post co-authored by Sam and Tom. Sam and Tom are both year 11 students from a local school who joined the HBSC England team to gain work experience. They were tasked with writing a blog post on a topic which is important to young people. Carry on reading to see what they have to say about video games…

What is the point of playing video games?

What is the point of playing a video game? Well, what is the point of reading a book? What is the point of watching TV or listening to music? It is because it is something that we enjoy doing but that is not the only upside.  It has been proven that not only do video games give you faster reaction times and make you make fewer mistakes ¹, because you are required to come up with ideas quickly, they also give you a level of critical thinking that will aid you for the rest of your life, and they even give you a level of educational prowess without any of the boredom and toil of classrooms and school. A study by Deakin University in Australia found that young people who had been playing games on consoles such as the Wii or the Kinect were better at kicking, catching and throwing a ball. In some cases video games can even be used as a way of relieving some of the stress that builds up over the day ². Playing games as a family is one of the most exciting ways of playing video games, and even just playing with friends is a lot of fun and helps you to develop social skills. If you love to read books and you just can’t wait for the next chance to whip out a book and get reading then some games are perfect for you, those focused on the art of storytelling. The story of a video game is normally as in depth as the story of a book and, like a book, a video game can improve your story telling by giving you an example to work from. Well just pop in the disk for The Last of Us or for The Walking Dead and be swept down an emotional roller coaster by two of the most amazing stories ever told in a video game. Do you like music and you love to listen to it at every opportunity? Well if you do then just put in the disc for Skyrim or for Metal Gear Solid: Snake Eater to hear some of the most awarded soundtracks in gaming’s short but commendable history. If you are feeling particularly adventurous you could go for one of thousands of indie games, from Prison Architect to Kerbal Space Program. You can even go out to one of the hundreds of arcades where many others are playing games and having fun together. Anything that you could ever want, from educational to strategy, from fighting to keeping pets, it all awaits you in the world of video games.

Computer games have long been a source of controversy among parents, but recent research suggests that there are many positive effects of adolescents playing video games not just the increased aggression and violent behaviour that the media suggests. In a recent study done by Kevin Durkin and Donnie Barber ³ it was found that various positive factors such as intelligence, leadership, interpersonal, mechanical and computer skills saw a significant improvement in adolescents that reported a high use of computer games compared to those who reported never playing. Not only this but it also led to lower levels of risk behaviours such as disobedience, substance use and truancy, only increasing levels of aggression, however the raise in aggression is so small it is negligible.

Not only do computer games have an effect on the individual, but they also have an effect on the friends that the adolescent chooses³. It was found that adolescents who reported never playing computer games were found to have riskier friends than those who reported a low or high use.  There are also other studies that have found that video games have various positive physical effects, not just mental. It found people who played video games showed an improvement in development of visual discernment and separation of visual attention, cognitive development in scientific/technical aspects as well as spatial representation. There have also been more in depth studies in to these cognitive and special abilities where it was found that those that play 10hrs of action games saw improvements in both special attention and mental rotation with these effects being most prevalent in women⁴. These skills gained from video games can be important in various practices such as mathematics and engineering sciences.

Video games are also now being considered as a future key tool of education ^5,6,7. Due to technological advances it means that video games are now better than ever for training adolescents how to do various tasks. These could be a great tool as it allows for adolescents to be educated in an effective way that makes it more interesting and is also easier to cater to their learning needs than traditional methods and has been shown to boost results. It can help in many subjects as well such as mathematics, history and engineering. 

Not only is it useful in education it is also becoming a tool that doctors use in the treatment of adolescents. In a test done on several young cancer patients a group were selected to play a video game that addressed the issues of cancer treatment and care for young patients. It was found that those who took part in the video-game intervention their treatment was significantly improved and they had a better understanding of their treatment ⁸. Not only have video games been used in the treatment of cancer but they have also been used in training young doctors and surgeons providing an effective tool for learning key features of their profession¹.

So as you have seen there are as many good points for playing video games as there are bad and whether it is helping your reaction time, your critical thinking or your storytelling every genre has got something completely different to offer you. Some studies show that video games can even be useful to help surgeons perform at their best¹, so if it can be used to help people with such a difficult job and show good results they must be useful.   Some studies show that not only are many of the reports about video games greatly exaggerated they mislead people into not buying something that could greatly improve their living standards⁷. The study by Kevin Durkin and Bonnie Barber ³ shows that video games are some of the most useful and yet undervalued tools not only for entertaining but for teaching, for psychology and for socialising. The games on the screen may look mindless but just remember that on that screen not only is there entertainment, education and a mind set to help finish puzzles but a whole world of fun, excitement and above all else personal development. The most important thing to remember is that next time you see someone playing video games on a console or on a computer, why don’t you go and join them?

1. Rosser, J. C., Lynch, P. J., Cuddihy, L., Gentile, D. A., Klonsky, J. & Merrell, R. (2007).

The impact of video games on training surgeons in the 21^st century. Arch Sur, 142, 181-186.

2. Deakin University (2012). Kids who play interactive video games have better motor skills. Retrieved 5^th November 2014, http://www.deakin.edu.au/news/2012/240712childrenmotorskills.php

3. Durkin, K. & Barber, B. (2002). Not so doomed: computer game play and positive adolescent development. Applied developmental psychology, 23, 373-392.

4. Feng, J., Spence, I. & Pratt, J. (2007). Playing an action video game reduces gender differences in spatial cognition. Psychological Science, 18, 850-855.

5. de Aguilera, M. & Mendiz, A. (2003). Video games and education (Education in the face of a ‘parallel school’). Computers in Entertainment, 1, 1-14.

6. Williamson Shaffer, D., Squire, K. R., Halverson, R. and Gee, J. P. (2005). Video games and the future of learning. Phi Delta Kapplan, 87, 104-111.

7. Squire, K. (2003). Video games in education. International Journal of Intelligent Games & Simulation, 2, 49-62.

8. Kato, P., Cole, S., Bradlyn, A. S. & Pollock, B. H. (2008). A video game improves behavioural outcomes in adolescents and young adults with cancer: A randomised trial. Pediatrics, 122, e305-e317.