Neuroplasticity ans ADHD

1. 1 NEUROPLASTICITY ADHD

2. 2 One of the biggest problems with the way ADHD is viewed today is the fact that many children are being diagnosed or over-diagnosed and prescribed narcotics (Ritalin) to treat ADHD. This affects their lives negatively, and the long term effects are uncertain. We want to address the problem by finding an alternative method to treat ADHD by exploring the executive functions and the way they can be developed with Neuroplasticity. “

3. 3 ADHD Executive functions and dysfunctions Diagnosis Brain functions ADHD-journey Digital tools Preventive work Mindgames Rafael Centeret Research summary Beginning of mapping ADHD other diagnoses Mapping while researching Mapping the school system Mapping patient journey First iteration Reliable methods Evaluation of concepts Implementation Mapping Rafael Centeret Mapping research on Neuroplasticity Last iteration of map Mapping research & result Mapping summary Early sketching Creative workshop Concept “Blinking ball” Concept “Physical controls” Concept “Utilising Kinect” Concept “iPad-game” Production of iPad-game The experience of the iPad- game Concept “Tangible Memory” Production of Tangible Memory The experience of Tangible Memory Production summary Reflections References 9 13 15 17 19 23 25 27 29 30 35 37 43 44 47 48 50 52 54 57 59 61 62 65 69 71 72 74 76 78 81 87 89 91 95 96 100 102 RESEARCH MAPPING PRODUCTION Index

4. 4 Valeria Gaitan STUDENTS SUPERVISORS Berit Killingbergtrø Havåg Charlotte Lunde Team Sven Håkon Voldum Mosse Sjaastad Birger Sevaldson

5. 5 Introduction for cognitive training that are beneficial for children with an ADHD-diagnose (amongst others). This was our starting point, and we have mainly focused on neuroplasticity and ADHD throughout the project. In our research phase we decided to go very broad to understand as much as possible of these areas and the related systems, which we then mapped out to gain an overview of it all and find our desired points of impact. We have divided this report into three sections; Research, mapping and production. This project was part of the course Systems Oriented Design at the Oslo School of Architecture and Design in the fall of 2013. We chose to work with the subject Neuroplasticity in collaboration with Charlotte Lunde (MD) and her company Lundelab. She is in the process of developing an iPad-game based on methods

7. 7 RESEARCH

8. 8 1775 MelchiorAdamWeikardmentionsADHD-like behaviourin“DerPhilosophischeArtz.” 1798 AlexanderCrichton “Diseasesofattention” Oneofthefirstdoctorstolookatmental diseasesfromapsychologicalperspective. Hewritesaboutthelackofattentionasa possibleindicatorofadisease. Healsorecognizedthatthechildrenwith ADHDneededspecialfascilitationinschool andthattheycouldnotconcentratenomatter howhardtheytried. 1846 HeinrichHoffmannwroteastory aboutafamilywhopresumably hadasonwithADHD,called “FidgetyPhil.” 1902 GeorgeFriedrichStill England’sfirstprofessorinchild medicinewroteaboutbehavioural problemsinchildrenwithnormal intelligence. Cognitive Traning Parents sometimes labelled “bad parents” because of unruly children “Normal”methods for disciplining the child can have opposite effect Genes Brain Trauma Smoking and drinking during pregnacy Chemical Exposure Culture Diet Bad parenting Stressful home environment Parents who refused to accept ADHD. Feeling of helplessness Many lack the tools for observing when it comes to ADHD or similar problems Observation 1 day, depending on the person observing. Procedure to identify ADHD: PPT (Pedagogisk Psykologisk Tjeneste) Is a local government advisory service that acts as an expert authority in matters of children, youth and adult education situations and special needs. Sit in an office to interview (Both parents and child). Teachers help children to take their pills during school day. 2-3 times per day. Physical training Cognitive training Suspect ADHD All factors combined: Is it likely to be ADHD? If yes: patient is referred to a specialist. (usually BUP) The specialist can be a part of BUP or is employed by a different public or private institution All factors combined: Is it likely to be ADHD? Couple therapy for parents of children with ADHD. If yes: patient is referred to a specialist. Medication can only be prescribed if diagnosis is made by a specialist in child & youth psychiatry, paediatrics, psychiatry or neurology or by GP together with medical specialist “Norsk med tegnstøtte” Beneficial Methods in the schools system What is it? Objective Talking both with oral messages and hand gestures Stimulating more senses to increase focus. “Double messaging” knowing what comes minimizes the amount of emotions produced To create tasks that are manageable/foreseeable Take away the stigma of forgetting books Music removes all other distractions, makes it easier to focus on the task at hand. Increase mastering situations, and therefore motivate to learn more. e.g. always starting class at the same time Splitting larger tasks into several smaller ones One set of books at home, one set of books at school Students are allowed to listen to music on their headsets in class Figure out how students learn best; physically, auditively, visually, etc. Strict Routines Dividing tasks Double set of books Listening to music while working Correct and individual learning methods Sees if symptoms can be related to ADHD Asks patient and/or parents what they think the problem is Considers severity and impact of symptoms on daily life. Medical history given by patient or parents Physical check-up incl. blood tests (Drug test for grown-ups) Retrieves information from school, psychologist and other ext. Institutions Return patient responsibility to GP Assist GP in further treatment Perform annual check-up The long term side effects are uncertain -- Increased risk of developing Parkinson disease 30% of Ritalin users get sleeping disorders and are put on sleep medication. --Ritalin leads to appetite reduction and from that to growth reduction --Apathy --Sleep deprivation Unable to concentrate Feeling stupid “difficult child” Begin treatment Ritalin YES Ritalin has an effect NO Ritalin has no effect Continue on medication, sometimes up to adulthood Stop/change treatment and/or medication Side effects Digital training Hard to make friends Child 4-5 (Behavioral treatment) 6-11(Behavioral treatment, possible medication) Confused and afraid about being sick PPT work together with schools. Implemetation of different methodologies to work around learning disabilities. Waiting time for the diagnosis of their child Parents fill out a form that describes the child’s behaviour Adult 12-18 (Medication and behavioral treatment) Sometimes schools have to ask for a budget to their municipality and therefore they calculate the quantity of children they will have with learning disabilities before the semester starts. Screening for other clinical conditions Might be temporary condition and not ADHD --Parents divorcing. --Maybe children that have a neurological condition Treatments In some cases the children are refered to BUP (Barne- og ungdompsykiatrien). This institution has specialists who can perform a diagnosis. Unnatural context. Patient rarely observed in real life. Taking medication tends to give a label to children, in other words they feel stigmatized. “There was a case where a child was peeling off the lable of the drug, in order to hide that he had ADHD.” ADHDPATIENTRELATIVESSCHOOLGeneralPracticionerAuxilliarinstitutions ADHD PATIENT JOURNEY ALTERNATIVE TREATMENTS DIAGNOSIS AND THEIR SYMPTOMS sis under the umbrella term: Executive dysfunction. HD as a case of study. However, the different diagnosis ed with the ADHD symptoms, specially those under the ecutive dysfunctions. In other words, by improving some e ADHD patient, we can also have an impact on other diagnosis. Cerebral Palsy Epilepsy Tourettes Dyslexia Prematurely born chiledren Chronic Tic disorder Learning disabilities medicine. Hewroteaboutbehavioural problemsinchildrenwithnormal intelligence. 1950´s Clinicaldefinition: ADHD 1952 DSM-1waspublished. Definitionsofmentaldisorders Researchonritalinas treatment(metylphenidate) 1976 Clinicaldefinition: ADHD 2010 Childandadolescent psychiatryincreasedin Norway 2011 Projectstart CharlotteLundeandgames astreatmentforADHD. Alternative Treatments (Active) Regular Treatment (Passive) POSSIBLE CAUSES PRESENCE OF SYMPTOMS TESTING FOR ADHD EVALUATION TREATMENT OUTCOME IT IS ADHD! IS THIS ADHD? The chance of getting an ADHD diagnosis is about 6-7% of children when diagnosed via the DSM-IV criteria (American System) and 1-2% when diagnosed via the ICD-10 criteria (European System). Could one of the reasons for this be that the economical healthcare system in the USA is supported in big parts by drug companies? NEUROPLASTICITY AND ITS EFFECT ON ADHD The Rafael center is a center that offers counselling, treatment and therapy to people of all ages. They have a program directed towards children with ADHD in collaboration with the schools and the parents. The program is based on physical exercises, therapy sessions, drawing as a therapy, and close collaboration with parents and teachers. The results from the program have been very good. All of the children who completed the program, experienced better social skills and higher life quality. The Arrowsmith school was funded by Barbara Arrowsmith, also known as ”The woman who changed her brain”. She has developed a series of exercises that help develop the executive functions. The school says they can help people with ADHD, dyslexia and other types of learning disabilities. The aim of the school is to help children who are experiencing difficulties with regular education by offering specialized education for a given period of time, so that they can return to school after a while in the special program. Miss Arrowsmith says that if all schools implemented her methods in their everyday school day, then we wouldn´t have children with special needs anymore since their symptoms would be helped. ? Physical by combin exercises w otenti Self part by letting t the game, ownership continues. Sending by giving a sign messa increase th Self corr by allowing strengthen feeling of s Collabor the social a it is collabo important t dialogue b P utive function in clinical practice dhd/guide/adhd-causes ntion-Deficit/Hyperactivity Disorder: A Meta-Analytic Review Rafael centeret (Denmark) Arrowsmith school (Canada and USA) Teachers fill out a form that describes the child’s behaviour Special Licence to prescribe Ritalin is needed. Straterra = Atomoxetim It is not a Narcotic, therefore some prescribe it, instead of Ritalin, since license is not needed. Ritalin= Methylphemidat This inhibits the reuptake of dopamine. Meaning that the enzymes degrade less dopamine after the transmition. There- fore Ritalin is consider a Narcotic and license is needed to prescribe it. Evaluate treatment and/or medication during the first year Berit Killingbergtrø Havåg berithavaag@gmail.com +47 906 30 780 Valeria Gaitan vpgaitan@gmail.com +47 405 77 993 Sven Håkon Voldum shvoldum@gmail.com +47 916 11 629

9. 9 ADHD 1950s ADHDappearsasaclinical definition,andreseachon Ritalin(metylphenidate)asa treatmentbegins. 1952 DSM-1ispublished,with definitionsofmentaldisorders. 2010 Childandadolescentpsychiatry increasedinNorway. We also started building an “ADHD Patient Journey”, which show an overview of all potential involved parts before, in the process off and after a diagnosis is given. During this research it became clear to us that there are many personal variations when it comes to symptoms, diagnosing and the process of finding the proper diagnosis. We also saw that many of the symptoms are highly related to social issues; Both as a cause and result of the diagnosis. Prior to our first workshop with Charlotte, and to start off our project, we began gathering all the information we could find on ADHD as a diagnosis. To get some perspective on the issues at hand, we researched the history of it and created a timeline based on that, which is shown below. Initial research

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11. 11 ADHD possible ways to aid them, and also to gain more insight on the process of diagnosing and medicating ADHD. We learned that ADHD is one of many diagnoses under the umbrella term executive dysfunctions. These are all related to challenges in the frontal lobe of the brain, and the majority of the symptoms related to ADHD can be connected to one or multiple other diagnoses. We also learned that nearly half of those diagnosed with epilepsia has ADHD as well. After this workshop we decided to include most of the diagnoses related to executive dysfunctions in our research, and we looked into the overlapping of symptoms to get an overview of where we could create the biggest impact. After the first round of research on ADHD, we had a workshop with Charlotte to share and add to our findings. In preparation to this, we had researched the diagnosis, made a timeline of the history of these kinds of behavioural problems, and made a patient journey for children suspected of having ADHD. We were keen to learn more about the various symptoms and Workshop with Charlotte

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13. 13 Executive functions and dysfunctions Executive functions is an umbrella term for the management of cognitive processes like: - Organizing - Planning - Paying attention - Remembering details - Task switching flexibility - Inhibition - Managing time and space - Logic Executive functions are the brain’s ability to organize and perform everyday tasks. The executive functions help us in keeping focused on a task for a period of time, organize our time, remembering faces, listening and reading, and managing complexity. Directly corresponding to this, executive dysfunctions are related to challenges with these abilities. Executive dysfunctions refers to problems in the executive functions and covers several different diagnoses: - ADHD - Asperger - Autism - Cerebral palsy - Epilepsy - Tourettes - Dyslexia - Prematurely born children - Chronic tic disorder - Other learning disabilities

14. 14 Hyperactivity Trouble maker Constant motion Working memory problems Not following instructions Attention Impulsivity Daydreaming ADHD Asperger Autism Epilepsy Dyslexia Learning disabilities Impatient Distraction Not seeming to listen Not completing tasks Losing things No organization Problems processing information Inappropriate comments Talk nonstop Constant interruption ADHD PATIENT Difficulty regulating behaviors and emotions Sudden Rage Poor social skills Anxiety Mania (exessive happines/ euphoria) Depression Impetuos behaviour. Overreacting or acting out Difficulties using and understanding language Poor coordination Tourettes

15. 15 Diagnosis We compared symptoms of these diagnoses and made this overview over all the ones overlapping with ADHD. The differences between the diagnoses are unclear in many cases and the symptoms are similar in many of them. Having learned about executive functions and dysfunctions, we started gathering information on diagnoses related to this as well as their symptoms. We divided all of the symptoms into four categories according to what they were related to; Body, brain, emotions and speach. In other words, by focusing on some of the ADHD related symptoms we can also have an impact on other diagnoses Overlapping of symptoms

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17. 17 Brain functions represents for the development of our project. This was not only a possibility to gather insight, but also a chance to validate the information we had already found together with the expert. During this session we learnt about neurons and We interviewed Dr. Abhilash D. Pandya, who just finished his PHD on molecular, cellular and organ related changes in inflammatory disease. The objective was to understand how the brain works, how the information is transmitted between the neurons and what the term “neuroplasticity” their functions, hormones, neuroplasticity, as well as processes that enhance learning. We even got to see the screening of a mouse brain, in order to visualize how the connections between the neurons work. Meeting with Dr. Abhilash D. Pandya at Ullevål Sykehus

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19. 19 To learn more about the role of the educational institutions in the diagnosis of ADHD, we had a workshop together with kindergarden teacher Ylva and special education teacher Siw. From this we learned about the role of Pedagogisk Psykologisk Tjeneste (PPT) and Barne- og Ungdomspsykiatrien (BUP). When the school or kindergarden suspects special needs of a child, they are reported to PPT and BUP, who then assess the child and develop a treatment plan for it and the school or kindergarden. PPT and BUP are locally based external agencies, to avoid conflicts of interest with the school system. ADHD-journey Educational institution

20. 20 GOOD OK BAD BREAKDANCE NEW TEACHER EQ UAL PUPIL EQ UAL PUPIL 10years 12.5years Jacob is one of five boys in his class that are considered “more trouble- some” than average. Might have a bit more challenges than average learning, but does well socially. Jacob gets a new “old-school” teacher who immediately points him out as different and worse than the rest. Jacob looses contact with his friends as a result of being frozen out by the teacher. The teacher contacts PPT and dictates a report saying that Jacob has ADHD, dyslexia and epilepsia. The school and Jaboc’s parents agrees to work on his math at home so that he can stay in class all the time. Things have improved significantly, Jacob is doing better at school and has a group of new friends. The teachers at the new school considers Jacob a more-or-less normal boy, but due to problems with math he is withdrawn from class together with one pupil with tourettes and another with a brain injury. Fear- ing he’ll be considered different again, this solution doesn’t help.

21. 21 ADHD-journey downward spiral both socially and educationally when PPT was dictated by the teacher in how to deal with his behaviour. Singled out as a problem, he was soon losing friends at school as well as struggling to keep up with the curriculum. After he was transferred to a new school, things began to improve, although he is still behind in some subjects. We met with Lisbeth, the mother of a boy in the process of being evaluated for many diagnoses. Living in a small place near Lillestrøm, they experienced first hand how problematic things can get when the system is faulty. Her son’s new teacher and the local PPT had close connections, which led to a This meeting emphasized our notion that ADHD is very much a social issue, and not merely a clinical diagnosis. Parental point of view

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23. 23 Digital tools interesting findings she has had is how self-driven children often are when it comes to the use of these tools. With very few guidelines, kids will easily divide tasks, share knowledge and work towards the objective of the game. Another interesting discovery from this is that children who need additional resources and support in specific areas, can use the digital tools to work on their challenges. This is of course provided that the Referred to us by Charlotte, Cathrine Darre is the pedagogical manager in Myrertoppen kindergarden. She has been studying the implementation and use of digital tools at kindergarden level, with the focus on “learning-through-play.” Through testing various games and applications, mainly on iPads, she has gained insight in how these can be beneficial and also what works and what doesn’t. One of the most quality of the application is good, and that the possibility to adapt them to personal requirements are present. Cathrine also explained how the iPad-games were used to enhance the social position of children with special needs. They had extra playtime with the games and became good at them. That way they could teach the other children about the game. iPad in kindergarden image source: http://myrertoppenbarnehage.blogspot.no/2012/12/digitale-fortellinger-kreativitet.html game displayed on iPad: ToonTastic

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25. 25 Preventive work in getting to know their new pupils. When necessary, this would also include PPT and BUP, allowing them to develop a plan for the individuals at an earlier stage than what is normal today. Since the parents are involved in this communication process as well, it creates a feeling of security for them (as well), knowing that their children’s needs are shared and taken We found out that the design office LiveWork recently finished a pilot project to improve healthservices and -systems related to children. The main objective of the project was to create a way of communication between kindergarden and school. By doing so, experience could be shared between the two institutions in order to give the school faculty a head start seriously. The project also creates a lower threshold for the arenas if they want to contact the different institution, having met representatives face to face and been given their contact information from day one. The project focuses on the qualities of the children as well as achievements and creating a sense of mastering. Bridge-building between kindergarden and school

26. 26 COGNIFIT MEMORY GYM BRAIN FITNESS JUNGLE MEMORY COGMED LUMOSITY COMPLETE MEMORY TRAINING BRAIN METRIX Memory Visual & Spacial Memory Short-Term Memory Concentration Focus Creativity Stretching Speed Flexibility Attention Problem- Solving Perception Will Power IQ Working Memory 3D 3D 3D 3D 3D 3D

27. 27 Methods that are meant for casual gaming instead of clinical use/training though. One of the most promising of these commercial games is called Lumosity, and looking at the various tasks offered by them shows that they also make use of what is considered to be working methods for stimulating brain functions. All of the games we found consist of a bunch of individual tasks rather than a continuous gameplay with integrated methods. In the brain training game Charlotte is developing, she is making use of methods found in competitor Cogmed’s game RoboMemo. This is a game with documented results within cognitive training, but it requires the player to be coached by a trained person and is by many considered to be rather boring. We looked into RoboMemo to learn more about the methods applied, but also found other games that claim to be beneficial for the brain. Most of these are commercial games We only found two other digital tools with a clinical background; NeuroRacer and Interactive Metronome. Respectively, these are focusing on multitasking and the timing/coordination of the brain. In addition Interactive Metronome is the only game that actually includes physical activity. Mindgames

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29. 29 Methods each child. They also have a bottom-up way of approaching challenges, meaning that they start with making sure that the basic senses are in order before focusing on more complex issues. In their treatment they also focus a lot on the importance of both physical and cognitive stimulation. We visited the center as well as a few of their specialized therapists in Copenhagen, and were guided through their approach and applied In a TV-documentary called “I hate ADHD,” we saw 12 children at a primary school in Denmark go through treatment by Rafael Centeret. These 12 children all had attention challenges of some sort, and Rafael Centeret is a center for alternative treatment not only for ADHD-diagnoses, but any kind of behavioural challenges. Various methods are applied depending on the need of the child in question, but they are always focused around the individual differences of methods. It was a very inspiring visit, and a nice contrast to the empirically based medical environment we had researched so far. Seeing the positive results from their treatment inspired us to further investigate the possibility to integrate physical elements and/or activites in our work. Rafaelcenteret, DK

30. 30 for improving this, and thus an important focus for us in this project. With two main areas in place, social impact and working memory training, we began narrowing down which methods to apply in order to create an intervention with the best possible impact. We looked at methods used by Rafael Centeret, Klingberg Lab and Lumosity among others, and narrowed down the most important ones. Throughout the research phase we found several indications that social challenges were present both before and after diagnose was set. Difficulties at home or at school could disturb the behaviour of a child, causing it to perform irrational actions not considered normal. This again could lead to changes in how the surroundings relate to them, further confusing the child. We also found examples of behaviour and learning abilities improving when the social challenges were improved. Based on these findings we concluded that our intervention should be stimulating for the social life of those suspected of an ADHD diagnose. Looking at diagnoses related to executive functions, it quickly became clear that working memory problems were an important area. Being closely related to everyday tasks like paying attention, maintaining a conversation and organizing time, it is crucial to have a well functioning working memory. Luckily cognitive training is particularly beneficial

31. 31 Research summary At the Rafael Center in Denmark we learned many ways to improve symptoms related to executive dysfunctions. Many of them were physical exercises that could be translated into different tasks in a gaming experience. Some of the most interesting of these were: - Spinning around - Mirroring shapes - Touch stimulation - Eye coordination The tasks in Lumosity uses many of the same methods as those found in RoboMemo, but these are generally wrapped in a more pleasing package. With less focus on proven results, their tasks are still proper brain training and also the source of these methods that we’ve chosen to continue working with: - Mirrored visuo-spatial - Auditive sequence memory Cogmed’s methods used in their game RoboMemo, were developed by Klingberg Lab. Their main focus was the part of our brain taking care of our working memory, which is a part of the executive functions. From their methods, these were the ones we found to have the most potential: - Visual orientation - Sequence memory - Visuo-spatial recollection Methods Rafael Centeret Klingberg Lab Lumosity

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33. 33 MAPPING

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35. 35 information that we could look more deeply into. The information gathered during the first iteration was used as a starting point for our research. We looked into the principal causes of ADHD, general information about the patient journey and both different ways to treat the diagnoses: Ritalin vs. digital/ analog training. The goal of this mapping was to have an overview, but also have a tool where we could get the right information from our partner Charlotte Lunde, MA. In our first meeting with Charlotte, we brought a map with some information on it from the first mapping, but we also deliberately left a lot of white space for her to fill in information. Because we didn´t include too much of the information from our first map, she met us with a fresh mind and we got new directions around the area of Executive Functions. We learned that many diagnoses are covered by this umbrella term, meaning that a lot of the diagnoses have many symptoms in commom with ADHD. At the beginning of the semester we had a presentation from the potential partners in our course System Oriented Design. We listened to their weak points, strengths, procedures, type of work, employees and other things included in the brief. So we took notes and did a short research on the Internet about each of the partners. After this we began to map out what we called a “first draft of the system”. Each person from the class wrote down on a brown paper the information they got from their sources about each partner, then we got an overview of the cluster of Start Mapping

36. 36 Asperger and ADHD have some symptoms in common. Different diagnosis and their relation to ADHD

37. 37 2. Explore Travel through an unknown area to learn about it. For example, regarding the previous example I can choose to go through the different diagnoses that are related to ADHD. They might have areas in common, like symptoms. Different diagnoses were listed with their respective symptoms. There was no order, just selection of colours: Purple for the diagnosis and orange for the symptoms. 3. Reconfigurate To rearrange the elements or setting in many possible ways in order to start finding patterns. In this case, lines were drawn to connect symptoms to their respective diagnoses. The goal was to find common or overlapping symptoms among the diagnoses. 1. Select To find the most suitable information that might be beneficial to start the exploration of the topic. For example, the topic: Neuroplasticity and its effect on ADHD. After briefly reading about the topic, the potential type of information could be: what is neuroplasticity? What is ADHD? How is the brain affected by ADHD? Are there any other diagnoses related to ADHD? Existing treatments and alternative treatments? etc. Categories of interaction with visualization within this System ADHD and its relation to other diagnoses Here we deployed some of the interactions we had with the visualization within this system. The next categories are based on a publication called “Toward a Deeper Understanding of the Role of Interaction in Information Visualization”. These are organized around the user’s interaction with a system. These categories can act as a framework to help discuss and evaluate interaction techniques and lay an initial foundation toward a deeper understanding of the system. Diagnoses Symptoms

38. 38 Calssification of symtoms Categories of symptoms according diagnoses

39. 39 5. Abstract/Elaborate To consider the important points of the information to create organizational parameters. Here is where we started abstracting or taking the most important information from the table, in other words we started to use it as a tool for our own research. Here we noticed that one of the areas where we should have an impact on with our design is in "Working Memory", since this is a common denominator in most of the diagnoses under the umbrella of "Executive Dysfunctions". Furthermore, we can also see that the overlapping of symptoms of all these diagnoses is more evident than in the previous graphic, something that helped us for the argumentations of our final design decision. 4. Encode To convert the information in a way that can be understood by the brain. In this image it is possible to see the beginning of this process. The diagnoses were displayed with their symptoms around them. But it didn't give any meaning until colors and categories were assigned to divide the symptoms. However, the disorganization of the previous visualization didn't allow us to find that much, therefore we decided to make a table out of this information (See image on the left). Here you can see how this table is starting to become a tool. We took the categories from the previous visualization and arranged them under 4 main categories. Just by listing them, it was easier to understand the overview of the diagnoses and how they affect the patient.

40. 40 Categories of symptoms according diagnoses

41. 41 7. Connect This is where the discovery happens. When you make a logical or causal relation that can lead to finding valuable knowledge that will impact the system. Our project wants to look at the impact of neuroplasticity principles on ADHD and other diagnoses under the umbrella term of executive dysfunctions. Therefore the visualization of the symptoms are circles with different sizes, meaning the bigger it is the more diagnoses we can impact in a positive way with our design. This was a discovery relating to a small part of our research but it proved to be valuable for us when arguing why our design is beneficial. 6. Filter A pattern through which data is passed. Only data that matches the pattern is allowed to pass through the filter. In other words, it is the way information is displayed regarding the parameters mentioned before. This is how we interpret the information and how it is displayed to communicate the right message to the right audience. In this image, the overlapping of the different diagnoses from their symptoms is more visual and evident. However, we decided just to focus on displaying the symptoms of ADHD and not the rest of the symptoms from the other diagnoses.

42. 42 The neurotransmitters are chemicals that transmit signals from a neuron cell through the axon terminal to a neighbouring cell. This connection is called a synapse Some of the neurotransmitors are degraded by enzymes, and some of them are carried back inside the presynaptic neuron. AXON SOMA TERMINAL TERMINAL BUTTON (LIPID LAYER) MYELIN SHEATH DENDRITE NEUROTRANSMITTERS like dopamine or serotonin etc The brain What makes brain cells,orneurons, so special, is the Terminal they use to transmit their signals The brain h asapproximately 100 billion neurons

43. 43 what the term “neuroplasticity” means for the development of our project. We want to highlight that the interview wasn’t just an opportunity to gather insights, but to map the information together with the expert. So we decided to display the information that we had already, using some diagrams we had made beforehand, to grasp briefly the functioning of the brain. We had different interviews with professionals to gather information so we could get an overview of the topic “neuroplasticity and ADHD”. Among many experts we interviewed was the Dr. Abhilash D. Pandya, just finished with his PHD on Molecular, cellular and organ related changes in inflammatory disease. The objective was to understand how the brain works, how the information is transmitted between the neurons and This methodology helped us to have a faster understanding, but specifically it helped the doctor to convey the information to us in an easier way. During this session we learned about neurons and its functions, hormones, neuroplasticity and processes that enhance learning, among others. Mapping while Researching

44. 44 “Norsk med Tegnstøtte” Strict Routines Dividing tasks Double set of books Listening to music while working Correct and individual learning methods Talking both with oral messages and hand gestures. E.g. always starting class at the same time Splitting larger tasks into several smaller ones One set of books at home, one set of books at school Pupils are allowed to listen to music on their headsets in class Figure out how pupils learn best: physically, auditively, visually, etc. Stimulating more senses to increase focus. “Double messaging”. Knowing what comes minimizes the amount of emotions produced. To create tasks that are manageable/foreseeable. Take away the stigma of forgetting books. Music removes all other distractions, and therefore motivates them to learn more. Increase mastering situations, and therefore motivate to learn more. Beneficial Methods in the schools system How it works Objective

45. 45 learning disabilities in high- school, Siw Risøy. We look into the different institutions linked to the schools like PPT (Pedagogisk- psykologisk Tjeneste) and also BUP (Barne- og ungdomspsykiatrisk). In this part of the mapping we found different weak points where our solution could be implemented, especially when we related it to our patient journey. We were searching for information about possible methodologies to treat the symptoms of ADHD based on the principles of Neuroplasticity. However, after many iterations on the map related to this type of information, we decided on going to one of the roots, the school system. We wanted to know how they treat these children and if there is any method that is working already. So we had a meeting with a teacher for kinder-garden Ylva B. and with a counselor for Mapping the school system in Norway

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47. 47 The scenarios were simple sketches presented almost like flashcards, the purpose of this is that these cards allowed us to move them around together with Charlotte to add or subtract elements from our journey in a forth iteration. The fifth iteration we had when we interviewed the mother of a child (Lisbeth) with suspected ADHD. She completed our journey adding different emotions that opened a door for us to really understand the situation of uncertainty that the family and the child have, when the diagnose is just a suspicion. We started researching the patient journey in order to find weak points that our solution should improve. We had 5 iterations, one that we built up briefly in out first meeting with our partner, Charlotte Lunde. A second iteration together as a group, where we added different actors. A third iteration after the meeting with the teachers, where we added different institutions influencing system in schools and the way children with learning disabilities are treated. When we got all this information, we decided to illustrate the scenarios to have a better overview of the things happening along the timeline. Mapping patient Journey

48. 48 Neuroplasticity research Game research ADHD as a case The Brief

49. 49 First iteration of the complete system ADHD patient journey Potential areas to address witn Neuroplasticity Alternative Treatments

50. 50 Klingberg Lab research Torkel Klingberg Bavelier Lab research Daphne Bavelier Lumosity Human Cognition ProjectRafael Centre

51. 51 We evaluated the possibility of translating them into a game or activity, either digitally or in an analog way. We added source location so we could track them back to the research distributed in the map and, last but not least, we added some arrows to emphasize the relation between the different areas affected. Here we discovered that by improving Working Memory and Social skills in the patient, most of the other symptoms will be improved. This is what we can call a positive spiraling effect. After a thorough research in the methods that could be used in our design, we started looking at the way of displaying them, not just to communicate them, but as a tool to find the most efficient ones and the ones that will have more impact on the children. We started categorizing them in relation to the areas affected in the patient, for example, the ones related to executive functions, to the emotional symptoms, the language symptoms, among others. After categorizing them, we wrote briefly how, and in what area they were going to affect the patient in a positive way. Reliable methods

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53. 53 skills, etc. We analized the concepts and decided to stop two of the concepts. As you can see in the graph, non of the concepts is covering all the areas, but our aim is to develope two of them further, inasmuch as with those we can cover the two most important areas, which are Working Memory and the Social Skills, besides beig easy to implement and distribute in the existet patient journey. On the map, we displayed our concepts, in order to translate the methods into opportunities of desgin. We re-evaluated our ideas comparing them with the methods for cognitive and physical training, among others. By using a “spider chart diagram”, we highlighted the most important areas covered by the methods, e.g. Working Memory, the vestibular sense, logic, social Evaluation of the design concepts

54. 54 Parents sometimes labelled “bad parents” because of unruly children School School suspects ADHD Many lack the tools for observing when it comes to ADHD or similar problems Feeling of helplessness “Normal”methods for disciplining the child can have opposite effect Sometimes schools have to ask the municipality for a budget and therefore they calculate the quantity of children they will have with learning disabilities before the semester starts. Relatives

55. 55 Implementation of the design solution The mapping of the user journey helped us analyze the root of the problem and how frustrating and painful the journey can be, not just for the child, but for the parents as well. Visualizing the scenarios and writing briefly in bullet points the action of different actors, helped us in the decision- making to determine where the best place for our design solution to be utlized is.

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57. 57 emotional development and the last part of the stem the cognitive skills. From this visualization we discovered that Rafael Center focuses more on the root, whereas Klingberg focuses on the cognitive training. We found a missing spot where those training are not being combined as we will do with out design solutions. When we were at the Rafael Center, they showed us a type type of visualization they use to identify the areas they are impacting with their methods to improve the child’s life. This visualization shows a tree from the roots to the leaves, the roots represent the primary senses, the reflects, reactions and other basic motor skills; the stem represents the Mapping Rafael Centeret

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59. 59 So we decided to map out each of the conferences and their focus point. This mapping we did it on a workshop together with Mosse. For our surprise we discovered that the way the researchers were approaching their research was touching several of the areas we are focusing on in our Design solutions. I addition we decided to take some of the methods and argumentations mentioned by the neuro scientist Dahpne Daphne Bavelier during the conference During the semester we researched on how the brain and its neurons work, and other topics related to the function of the cognitive system. However, we felt that we were lacking information about current research on neuroplasticity. Our supervisors Mosse Sjaastad and Charlotte Lunde informed us about a recent conference that took place in USA, where many of the most recognized neuro-scientists around the world gathered to talk about their research and possible methods to be implemented. Mapping research on Neuroplasticity

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61. 61 Map last iteration We will call it “Last iteration” for now, it can still be many opportunities to modify the map, but for now this is the most realistic and useful way to distribute the research and the findings. Thus, in our last iteration we had a serious paper prototyping, we cut the previous 4 m long map and started shuffling the parts around until the distribution of those made sense. We took information away, as well as we added. This was one of the most important paper prototyping processes we had. This is due to the knowledge gained during the process to arrange the information in different ways so we could get the big picture of the system.

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63. 63 Mapping research and result

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65. 65 "Converting to a graphic form and searching visually for patterns and anomalies is an effective way of prompt scientific insight" (DiBiase, MacEachren, Krygier, & Reeves, 1992). Visual System thinking, besides being a tool to gather insights and for researching, it is also a powerful tool to communicate the cause and effect in context of the solution given. The examples we mentioned before, about the symptoms and methods related to ADHD and Neuroplasticity, are just the result of some of the "zoom" areas of our map. The map consists of many parts that are all inter-related. Visualization has facilitated the process of researching and the proper communication of those relations and patterns to the right audience. “The purpose of visualization is insight, not pictures. A visualization’s function is to facilitate understanding. This does not mean that aesthetics are not important - they are. Some researchers have detected correlations between the aesthetic qualities of a visualization and how well it is understood” (Data Flow 2, 2010) Therefore every vizualization within a system is an interpretation that can lead to different and more appropiate solutions. In our opinion, Systems thinking requires the use of both visual thinking and visual communication. This is because when one uses visualization for rapid learning, fancy infographics are not required, rather technical visualizations to find relations that can lead to a discovery. However, in some cases, when the system thinker starts communicating the discovery in better visual ways, he or she can also find other challenges, problems or even solutions to the system. Mapping summary

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67. 67 PRODUCTION

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69. 69 Early sketching After our initial research phase, we had a creative session based on all the methods we had learned that were benefitial. We sketched out ideas and presented them to each other as we went along. After that, we grouped the sketches into themes and saw that they could be devided into four main areas where we saw potential for further development. The four potential areas to be addressed with Neuroplasticity are: Active participation and self-correction: By allowing the child to correct him/herself, we strengthen their confidence, responsibility and feeling of self worth. Collaboration: The social aspect of a game is important. Whether it is collaboration with a friend or with a parent, it is important to improve social skills and to encourage dialogue between players. Physical activity: By combining physical exercises with mental exercises we emphasize the effect of the task. Stimulation of multiple senses: By giving audio messages, visual messages and sign messages, we stimulate more senses and increase the complexity of the tasks.

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71. 71 Creative workshop After these sessions, we gave a workshop where we presented the main theme: “Methods to enhance learning and social skills” and gave each group one of our potential areas. The goal of the workshop was to get more ideas or directions for our solutions. Therefore we provided them with material and trigger cards with content related to our previous research. Each group had a different methodology to solve the brief, this last one was also provided by us. It consisted on visual triggers for physical activities or materials to build up models related to the topic “stimulation of different senses”, among others. From these four areas, the participants came up with many ideas, which after the workshop were utilized as directions to be taken into consideration. After that, we sketched out more ideas while we revised the ideas from the workshop and adjusted them to fit our project. In the end, we had five different directions we could go in.

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73. 73 Concepts Colour changing ball The colour changing ball, as its name describes it, is a ball that changes colour whenever it is caught or dropped to the ground. One way of playing with it is to assign the players different colours and when the ball lights up in their colour, the person holding it needs to remember who the colour belongs to and throw the ball to that person. This activity requires abstract thinking, working memory, and fast decision-making. The complexity of the game will be increased if the players change colour often or if they have to increase the speed of playing it. The therapists at the Rafael center were very excited about this ball since they always use balls in their training and this ball makes the gameplay more exciting as well as providing many ways of playing and training. Variation is an mportant factor for keeping up motivation Strengths: • Working memory • Abstract thinking • Speed • Focus Weaknesses: • Needs monitoring • Limited cognitive training Opportunities: • Simple • commercial • cheap

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75. 75 Concepts Physical controls The physical controls is a concept for exchanging regular controls like buttons and switches with something more tangible, bigger and more flexible. Rapid task switching (also known as mutitasking) and managing different objects stimulates more than just the finger tips. Having objects spaced out that need to be pressed, pulled, moved or pushed, trains hand eye coordination, stimulates the sense of touch and makes for more stimulating challenges when it comes to game controls in specific. Using bigger movements than just your fingers, like you do in regular games, stimulates parts of the brain that are normally not used when playing regular computer- or video games. Physical controls can also be used to strengthen our mirroring concept at a later stage. The therapists at the Rafael center thought this was a good idea. This is because they aways try to use as many senses in their training as possible. The feeling sense is an important base for cognitive development. Strengths: • Multitasking • Hand-eye coordination • Stimulation of different senses • Physical training • Impulse control Weaknesses: • Needs increased diversity • Expensive components Opportunities: • React to sounds • Body-tracking • Commercial opportunity • Added complexity

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77. 77 Concepts Kinect The vestibular sense is what controls our balance and registers the body´s movement. It also plays an important role in children not being able to sit still. An overactive vestibular sense gives them a feeling of seasickness when they are not moving. At the same time, a vestibular sense that is too weak makes the child feel uneasy when it is in activity and both situations affect the social skills very much. In order to stimulate the vestibular sense so that it can work better, big movements are required, such as spinning or rocking. This is difficult to do without a coach but it can be done by utilizing the kinect sensor from Microsoft, which is a controller that registers your body movement. As a next step, we would like to investigate how we can use the kinect in a game that is fun and also training the vestibular sense by using spinning, hand-eye coordination exercises, and other training methods where the whole body is utilized. However, for this training to work, the user needs a kinect and a big sized screen. In other words, the implementation of this type of training would require more engagement and economical resources from the family of the child. That is the main reason why we chose not to take this concept further for now Strengths: • Hand-eye coordination • Trains the vestibular sense • Physical training • Impulse control • Body-tracking Weaknesses: • Expensive components Opportunities: • Sounds • Added working memory training • Commercial opportunity • Added complexity All info about the vestibular sense from the Rafael center in Copenhagen

78. 78 Drag buildings to match the reflections. Once they match, a new world will unfold! Mirrors UnfoldMirrors Unfold Bring me safely to theportal by the time thenext world unfolds! Tap on either side of your hero to make him jump in that direction! Reality Reflection

79. 79 Concepts iPad game In the early sketches for the iPad game, we knew we wanted to implement mirroring as an important game mechanic, and we sketched a lot to see how that could be. Mirroring tasks enhance the visuo-spatial intelligence, which impacts the working memory and also our ability to read and to orient ourselves in space. These types of tasks already exist (i.e. robomemo and lumosity), but not as these specific mirror tasks. Klingberg lab has written about the importance of visuo- spatial tasks but have mainly sequence tasks in their game Robomemo. When training with Robomemo, it often feels like tedious training because the child jumps from task to task. In our game we want to hide the tasks behind a fun story in an immersive game so that the children playing it will not get tired so easily, even when the tasks are difficult. Cogmed recommends training with their computer training Robomemo for 30-40 minutes a week. After training with Robomemo, the children can choose to play an action videogame afterwards as a reward. To us this seems a bit backwards and we want the game itself to feel like a reward. Strengths: • Spatial orientation • Visualization • Abstract thinking Weaknesses: • Can be boring without a goal. Opportunities: • Added complexity • Added visuals and contrast Might need a bigger story

80. 80 First sketch of sequence task Last iteration of sequence task

81. 81 We were so lucky to get in contact with a programmer who could make our ideas into a game. The development was in collaboration with the game programmer Øyvind Byhring, and it went from being simple tasks to being an actual playable game. During this process we also managed to implement sequence memory, which is an important tool for training working memory. By combining mirroring training and sequence recall in an iPadgame, we hope to enhance the effect of both types of training. Getting to test the play of the mirror game was very good for our process. One thing we learned was that we had underestimated how difficult it would be to mirror the objects on the screen. The sequence part started out with being objects that you needed to move so they mirrored the original. We added a sequence to it so that you needed to place them both in the right place and in the right order. This was a challenge, but it was also a bit confusing and we couldn´t get it to make sence. In the final iteration the placement of the objects is taken away and now it is just a sequence that you need to remember. In this last iteration you press the stones after seing the sequence blinking in the water. This forces you to translate colours and shapes from one place to another. Sequence recall Production of the iPad game.

82. 82 DIFFICULTY PROGRESS LEVEL 2 LEVEL 1 GAME PROGRESS Mirrored path EXAMPLESOF INTEGRATEDMETHODSGAME

83. 83 LEVEL 3 One of the most important reasons for using a digital training tool is that the computer can adjust the difficulty level to your skill level as you play so that the tasks are always difficult enough to provide efficient training, and easy enough for the child not to lose motivation. This is an illustration of our overall structure. The yellow squares show the different worlds you come to that provide added complexity and the blue line shows the individual ajdustmen of difficulty level as you progress in the game. Overall structure Production of the iPad game. Coloured sequences

84. 84 First sketch of mirror task Last sketch of sequence task

85. 85 Production of the iPad game. The mirror tracing was a game where you saw the original trace and should try to mirror it on the bottom half of the screen. It started out almost like a musical task where each level of lines represented one tone and as you moved you heard music that helped you remember where the original trace had been. After the first iteration, we decided to make the environment into a magical forest where the first part is a magical map that shows the path you should follow but shows it upside down. Since it is magical, it can also show you the path mirrored in different directions as the difficulty indreases. Trying the game as it progressed was an important part for our further development. We also got to test the game on children in different age groups including some with relevant diagnoses. These tests showed us how the game would actually be played and we discovered many things we needed to fix in order for the training part of the game to work. One of the things we saw was that in the magical world, the children saw where the glowing mushrooms were instead of looking at the upside down map. That meant that we needed to make the world darker so that the kids didn´t see where to go without the map. Mirror trace

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87. 87 The experience With this iPad-game we wanted to create an immersive experience for the children to want to play. We wanted to distance ourselves from the more clinical training form that Robomemo is. In that training you get the tasks one by one and at the end of some of them the “coach” actually says “it is good to be done with it”. Our game is also a low threshold game. We don´t aim towards clinical proof that our training works but we do feel that it can be tested afterwards in a clinical setting the way Klingberg lab has done it. Only in the first six months of 2013, Norwegians bought 500.000 tablets. And the sales are increasing. This means that games on tablets are very accessible for many children. Those who do not have tablets can also play on smartphones. The training effect will be almost as good as with a tablet. The magical world was chosen partly because we wanted to have a setting that was suitable for both boys and girls. It was also a way of distancing ourselves from Robomemo where there are robots and a space environment. The magical world was also chosen because it makesit easier to explain all the strange things that happen to the map; why it is first upside down and later gets flipped n different mirrored directions.

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89. 89 Concepts Tangible memory Playing an ordinary memory game trains your working memory. With “The Tactile Memory” we wanted to enhance the original game by including more senses. The person, whos turn it is, feels inside the box and has to visualize what he/she is feeling. This stimulates the sense of touch and the envisioning skills. He or she also has to describe what he or she is feeling so that the other players will have a chance of finding the matching piece. Describing the textures and shapes stimulates the verbal skills and provides a different challenge than we usually meet in everyday life. The other players have to pay attention to the person describing the objects inside the boxes. Because they have to listen in order to play, it is social training in the form of respecting others and letting them finish what they are saying without being interrupted. They have to guess what is inside the boxes only by listening, which stimulates the hearing and the way the brain interprets audiosignals. It also enhances the ability to envision things and triggers the imagination. The therapists at the Rafael center were especially positive to this concept due to the benefitial effects the feeling sense can have on children with cognitive challenges. Strengths: • Multitasking • Hand-eye coordination • Stimulation of different senses • Physical training • Impulse control Weaknesses: • Needs increased diversity • Expensive components Opportunities: • React to sounds • Body-tracking • Commercial opportunity • Added complexity

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91. 91 Production of Tangible memory The initial idea for our tangible memory game was that the children should feel the texture inside the gameboxes and then describe what they were feeling to the rest of the children playing. Early in the process, we made some mockups in order to test the game in play. The initial test went very well, and we saw that it was a strong game concept. It just needed some tweeking in size and design. We took the game with us to the Rafael center in Copenhagen and tested it with the therapists who work with children in the user group every day. They loved the game concept and they came with suggestions as to how we could adapt the game to children who might have difficulties with verbal communication. They suggested that the child could draw on the blackboard, for instance, to show what they felt inside the box. We have had three tests with children in different age groups and each time the children were eager to describe what they were feeling while the others paid close attention. There were also attempts at cheating by kneeling down to look inside or to lie about what they were feeling, but those are minor problems that we chose not to look at since it is something each and every gameplayer needs to address when it occurs.

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93. 93 Production of Tangible memory After the visit to Copenhagen we decided to add picture cards to the game. These pictures showed what was inside the boxes and they allowed for different ways of playing the game. The child can point to the picture to show what they see and can also read what the material is called. When testing the game, we saw that the cards made the game easier to play for all children but it should be used with care since it is very tempting to use the cards instead of your words when the cards are introduced in the game. On the back of the cards, we put descriptions of what was inside to allow for even more ways of playing the game. We saw that these cards had some words on them that we often use in our daily speech to describe texture but that these words were new to the children. They asked what the words meant and that way they learnt a new word by actually feeling the texture it describes. The descriptions also allow for a new way of playing the game. You read the descriptions and try to find the boxes that fit them. Afterwards you flip the card around to see if you were right. This is also a good way to play with different age groups. Bigger kids can use the word side of it while smaller kids can use the picture side

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95. 95 The experience One of the most important aspects of this game is the social training. The fact that the children have to pay attention and respect the other player´s input improves social skills The game is suitable for all ages and can easily be played with both adults and kids. Either as a regular memory game or with the cards as adjustments of difficulty level. The game is also very flexible because of the different ways of playing. This is good to create variation in for instance a training situation with a teacher or other adults. We wanted to go for the toy- feel more than training feel, again to escape the stigma that comes from the child using a training tool which only emphasizes that the child is different. Because we are designing it as a regular game, we can give the child an opportunity to train and be good at a game that other children will want to play. Showing that he or she can be better at something is an important part of strengthening self confidence and the feeling of self worth. The game can be used both at school and in a home environment. Since it is a game that the children would want to play, it doesn´t feel like training. This takes away stigma and adds motivation

96. 96 After going through reliable methods and other sources of information, interviews with professionals, interviews with institutions and relatives of children with suspected ADHD. We decided that our solutions should be inplemented at the beggining of the patient journey, when parents and teachers meet for the first time with the question “Does my child has ADHD?” Why? Because being uncertain about the diagnosis of a child is one of the worst situations parents and engaged teachers can have. Our games will cover different aspects (graph above), that will help parents and teachers feel they are doing something active towards a possible diagnosis, even though they don’t know the results. In addition, these games provide information about the benefits not just in children with a diagnose, but in any child. We hope that by implementing these games at the start of the patient journey, it can also

97. 97 Production summary be an aid that will support the patient with the other different treatments. The distribution in different schools can be a task done by PPT or BUP. We want to take advantage of this, since they are the intitutions in charge of the curriculum and administration of education in Norway. Besides of being the ones in charge of testing for learning disabilities. Our final concepts are suggestions to how a solution could be. They are low threshold solutions that aim at reaching as many children as possible rather than being clinically proven and that way being very efficient to a select few. An iPad game that can be downloaded in the app store and can be used on an iPad or a smartphone, is avaiable to many children and parents. A tangible memory game that can be given to schools or taken home for those who want it is low threshold and doesn´t take up any more space than a regular board game. As interaction designers we always aim to create good experiences. User testing is very valuable for us and is not so much a process to validate our concepts but a way of seeing how people will actually experience the design. That is why prototyping has been an important part of our project. Seeing and feeling how things work also triggers new ideas in our process.

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99. 99 REFLECTIONS & REFERENCES

100. 100 Already by this stage we were struggling to make sense of all the information we had gathered, not to mention linking related findings from different areas to one another. We found that mapping out each field independently was straightforward enough, but trying to link the various areas to each other was a lot more challenging. With all of the areas we had researched placed and linked together in our GIGA-map, we started looking for interesting areas for design interventions. Our map includes facts on brain functions, symptoms and diagnosis, stakeholders and patient journeys, as well as traditional and alternative treatments. To find a suitable context, we analyzed the patient journey and findings related to the system involved During the course of System Oriented Design, we have been learning the methodology of GIGA-mapping as a tool for researching within a system in order to find more adequate solutions to real problems or to find opportunities of design in order to improve the functioning of the whole system. At the beginning of the semester we were introduced to possible partner collaborators for our course. We chose Charlotte Lunde as our partner, a researcher on cognitive training for children with ADHD. The topic for our project was Neuroplasticity, more specifically how the principles of Neuroplasticity can be beneficial for children with ADHD. Working with such broad fields, we quickly found ourselves in a bit of a dilemma; When do we draw the line when following a lead? Working in a group of three, we had the advantage of being able to investigate several directions simultaneously, and then combine our findings and discuss which areas needed more investigation and which were sufficiently explored. This, on the other hand, also meant that we had three different views on what was interesting, which again meant that we spent a lot of time debating on what to research. After a long period of research, meetings, workshops and even an excursion to Denmark, we generated a GIGA-map (4x1m) of it all in order to see the big picture and find connections that might not have been discovered otherwise.

101. 101 Project reflections in this. By doing so, we revealed gaps for many of the involved parts, and identified the need for a low threshold intervention in the early phases of diagnosis assessment. With the context in place, we continued to study findings within treatments and beneficial methods for the symptoms we had mapped out. Based on these studies we chalked up five directions, all related to cognitive, physical and/or social training, in which we wanted to focus our design. After several evaluations of our concepts we decided to develop just two of the concepts, but left a starting point to continue with a third direction that can offer more areas of exploration to have a better impact on the patient. At the end of the semester we had researched and mapped to our four design directions, and then began adding other relevant connections to areas all over. Simply by doing this, it felt like all the pieces of the puzzle fell into place, and the argumentation we knew we had became real. It wasn’t about being able to point to a line between two parts to prove the connection, but rather a proof for ourselves. Seeing the connections between our work and our research not only strengthened our belief in our concepts, it also allowed us to better identify the strong and weak areas within them. out complex fields related to neuroplasticity and ADHD. We had linked all relevant findings with one another, used the insight that we have gained to develop four guidelines for our design work, and started to develop concepts. With work on our concepts well on the way, we found that we had to take a step back and re-do the GIGA- map once again to clarify the basis for our ideas. We found that we needed to link the research to the design directions in order to find the argumentation that we needed to justify our concepts. Even though we knew where the basis for our concepts came from and were sure of their credibility, we found it hard to argue for them without proper documentation in the map. We set about linking the concepts

102. 102 Articles: Arnheim, R. (1969). Visual Thinking, Berkeley, University of California Press. Parsons, P., & Sedig, K. (2014). Common Visualizations: Their Cognitive Utility. In W. Huang (Ed.), Handbook of Human Centric Visualization (pp. 671–691). Springer New York. Retrieved from http://link.springer.com/chapter/10.1007/978-1-4614-7485-2_27 Yi, J. S., Kang, Y. ah, Stasko, J. T., & Jacko, J. A. (2007). Toward a Deeper Understanding of the Role of Interaction in Information Visualization. IEEE Transactions on Visualization and Computer Graphics, 13(6), 1224–1231. doi:10.1109/TVCG.2007.70515 Fougnie, D., Vanderbilt University (2008). The Relationship between Attention and Working Memory, Chapter 1 from New Research on Short-Term Memory. Johansen, N. B. (Ed.). Klingberg, T., Karolinska Institutet (2011). Dopamine, Working Memory and Training Induced Plasticity: Implications for Developmental Research. Klingberg, T.; Fernell, E.; Olesen, P. J.; Johnson, M.; Gustafsson, P.; Dahlström, K.; Gillberg, C. G.; Forssberg, H.; Westerberg, H. (2005), Computerized Training of Working Memory in Children With ADHD - A Randomized, Controlled Trial. Söderqvist, S.; Nutley, S. B.; Ottersen, J.; Grill, K. M.; Klingberg, T. (2012), Computerized training of non-verbal reasoning and working memory in children with intellectual disability. Schubert, T. (Ed.). Olesen, P. J.; Macoveanu. J.; Tegnér. J.; Klingberg. T. (2006), Brain Activity Related to Working Memory and Distraction in Children and Adults. Nutley, S. B.; Söderqvist, S.; Bryde, S.; Thorell, L. B.; Humphreys, K.; Klingberg. T. (2011), Gains in fluid intelligence after training non-verbal reasoning in 4-year-old children: a controlled, randomized study. Jepsen, J., Rafael Centeret (2011), Projektafhandling: Interventionsprojekt Lindevangskolen, Frederiksberg, 01.05.2011-01.12.2011, Ny og gennemgribende indsats til børn med specifikke vanskeligheder i perioden 01.07.2011-01.11.2011. Stephenson, S. (2006), ADHD and Montessori A Case Study. Ph. d. applicant Helle-Valle, A., Restless children: who are they, how can they best be met, and what could be the contribution of music therapy? Bavelier, D.; Davidson, R. J. (2013), Vol. 494 Nature magazine, Games to do you good. Totland, K. (2001), article in STÅ PÅ Nr 1 2001, AD/HD illustrert ved «liknelser». Germinario, E. A. P.; Arcieri, R.; Bonati, M.; Zuddas, A.; Masi, G.; Vella, S.; Chiarotti, F.; Panei, P.; Italian ADHD Regional Reference Centers (2013), Journal of Child and Adolescent Psychopharmacology, Volume 23, Number 7, 2013, Attention-Deficit/Hyperactivity Disorder Drugs and Growth: An Italian Prospective Observational Study.

103. 103 References Valdersnes, A. K., LiveWork Nordic AS (2013), God skolestart: En historie om hvordan helsetjenester kan formes. Erhardt, R. P. (2006), Sensorimotor Stimulation Activities for Preschool Children with Significant Visual Impairments. Modern technology is changing the way our brains work, says neuroscientist. (n.d.). Mail Online. Retrieved November 22, 2013, from http://www. dailymail.co.uk/sciencetech/article-565207/Modern-technology-changing-way-brains-work-says-neuroscientist.html Greenfield, S. (n.d.). Under the Microscope: When the brain goes down the drain. The Independent. Retrieved October 27, 2013, from http://www. independent.co.uk/arts-entertainment/under-the-microscope-when-the-brain-goes-down-the-drain-1354092.html Interviews: Lene Knudsen (Psychomotor competence, Rafael Centeret) Pia Schackinger Christensen (Optometrist, sight- and motor skills competence, Rafael Centeret) Birte Glud (Psychotherapist, Rafael Centeret) Jonna Jepsen (Manager and consultant, Rafael Centeret) Siw Risøy (Counselor for learning disabilities in high school) Ylva B. (Kindergarden teacher) Lisbeth (Mother of a child with suspected ADHD) Cathrine Darre (Pedagog with experience in digital tools for children in kindergarden) Espen Bergå Johansen (Researching behaviour in hyperactive rats) Abhilash D. Pandya (Neuro-scientist) Visit to a school in Denmark where the methods from Rafael Centeret were implemented (TV-documentary “Jeg hader ADHD”) User testing at the school of SSE (Avdeling for kompleks epilepsi) Øyvind Byhring (Game programmer)

104. 104 One of the biggest problems with the way ADHD is viewed today is the fact that many children are being diagnosed or over-diagnosed and prescribed narcotics (Ritalin) to treat ADHD. This affects their lives negatively, and the long term effects are uncertain. We want to address the problem by finding an alternative method to treat ADHD by exploring the executive functions and the way they can be developed with Neuroplasticity.