According to ESRB, this game contains: Cartoon Violence, Crude Humor 

Parents are more likely to be plain bemused by Twisted! than offended. Although some of the mini-game contexts are a little crude, the game's universal suitability (and appeal) is never in doubt. This really is a game that anyone and everyone can enjoy.

Specifically, Deaf and Hard of Hearing gamers can rest assured that the digitized speech is used for nothing more than encouraging or chastising the player with appropriate grunts and cheers and sighs and "Ah-yeah!"s. And thankfully—for all gamers—Twisted! upholds its predecessors' venerable tradition of imparting mini-game instructions within one or two words and barely as many seconds. If only all games were so economical…

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