The Use and Impact of Video Games and Digital Media for Children with ADHD
The Use and Impact of Video
Games and Digital Media for
Children with ADHD
Randy Kulman, Ph.D.
Gary Stoner, Ph. D.
CHADD annual conference 2012
LearningWorks for kids
Presenter Information and
Randy Kulman, Ph.D. commercial interests:
• President, Majority Stockholder, LearningWorks for
• Cogmed Working Memory provider
Gary Stoner, Ph. D.
• Research Consultant LearningWorks for Kids
• Professor, Dept. of Psychology, University of Rhode
• What do we know about children with ADHD and
• Why use video games and digital media to help
children with ADHD?
• What are the characteristics of interventions proven to
work with children with ADHD?
• Why do children with ADHD not become scholars
after playing video games?
• What can we do to make video games a more
productive learning tool for children with ADHD?
Consider the Following Questions:
• How much time do children with ADHD spend playing
video games, per day? Adolescents with ADHD?
• In what ways might video games and digital media be
helpful for children with ADHD?
• What are the characteristics of video games and
digital media that may facilitate learning in children
• My child with ADHD plays video games; why is s/he
not earning all A’s in school?
• How can video games become more effective
learning tools for children with ADHD?
Signs of ADHD may include:
• difficulty in following through on instructions
• problems organizing tasks and activities
• difficulty sustaining attention in tasks
• restlessness and excessive movement
• high levels of activity and always being on the go
• physical and verbal impulsivity
• executive functioning issues
• 3 major forms of ADHD
Demographics of ADHD
• 5-9 % of Population Diagnosed with
• 20-50% have Learning Disabilities
• 30-40% Oppositional Defiant Disorder
• 20-30 Anxiety Disorder
• 2.7 million kids taking meds (66% of
those diagnosed) CDC 2007
• Major treatments educational, behavioral
• High percentage of EDF, mild ADHD;
kids who are struggling with traditional
What do we know about ADHD kids
and video games?
• Clinical and anecdotal
observations - too much and
often too intensely! (but this is
exactly why we need to use this
• No research evidence of
difference concerning frequency
or duration of play between
ADHD and typically-developing
children ages 10 to 12.
• Similar enjoyment for the same
types of games (Bioulac 2008).
• South County Child and Family
How do children with ADHD perform on
• May not always perform as well as their typically-
developing peers (Lawrence, et al 2002)
• May process information somewhat slowly on
video games. (Lawrence et al. 2002, 2004).
• Perform as well as their peers in simple games
but not as well in complex games. (Lawrence et
• No difference in inhibitory performance of children
with ADHD and TD Kids with Crash Bandicoot
and Frogger (Shaw 2005).
• The similarity of performance in this study
suggested that “enjoyable video games provide a
context in which their performance is enhanced.”
Do Video/Computer Games and
Television Impact Attention Span?
• Short-term effects suggest that more than an hour of
computer-game play a day is correlated to poor
scores for ADHD, Inattentive Type (Taharoglu
• Total time spent with screen media is positively
associated with attention problems (Swing, Gentile,
et al. 2010).
• Four-year-olds watching Spongebob can have an
immediate negative effect on children’s executive-
functioning skills (Lillard 2011).
• Television/Video-game use along with exposure to
violent content not predictive of attention problems
or grade point average (Ferguson 2010)
• Is digital media the cause of increasing rates of
Do Video Games and Television
Impact Attention Span?
• Improves capacity to rapidly filter visual
distractions, but may negatively effect
focus on slow streams of information
• Leads to listlessness and discontent in
slow-paced and less stimulating
academic, work, and social environments
• Attention skills improved by video games
(detecting differences and orienting
attention) are liabilities in classroom
resulting in distractibility (Gentile)
LWK study of ADHD kids and
parents on video game play
• (Current sample of 105 children with a
primary ADHD diagnosis based upon a full
• Survey asks parents to describe their own
media usage to see if it is correlated to
attitudes regarding video games
• Also asks them to describe their concerns
and hopes for benefits of video games and
other digital media
• Digital media use of ADHD kids- Most time
television, video games, music (different from
what is seen in national studies of typically
*Children, parents, and video game play
How many hours a week does your child spend
playing video games?
• 34% Less than 1 hour per
• 32% 2-4 hours
• 20% 5-7 hours
• 13% 8+ hours
How many hours per week do you spend
observing or interacting with your child when they
play video games?
• 27% no time
• 39% less than 1 hour
• 31% 1-5 hours
• 3% 6+ hours
Children, parents, and video game play
Do you play video games with your child?
• 32% Never
• 55% Sometimes
• 10% Often
• 2% Always
How much do you believe that video games can
help your child with problem solving?
• 34% Somewhat
• 25% Quite a bit
• 19% A little bit
• 13% A great deal
• 8% Not at all
**Why use video games and digital media to
help children with ADHD?
• Video game play requires the use of executive
• Other skills such as organization and metacognitive
skills are required for success.
• Both simple and complex video
games regularly use skills such
as planning, cognitive flexibility,
self-control, and time
• Many games specifically tax
working memory skills and
Why use video games and digital
media to help kids with ADHD?
Kids with ADHD or Video Games and Digital Media
May become easily bored and • Require ever-changing skills
unable to sustain attention • Employ video, sounds, words, and
Often require immediate • Provide clear and immediate feedback
reinforcement or consequence • Constantly let player know what he is
to stay focused on a task. doing wrong and right
Often require that their body or • Extremely engaging
mind to be actively engaged. • Many require physical and cognitive
Why use video games and digital
media to help kids with ADHD?
Kids with ADHD or Attention Video Games and Digital Media
Usually have problems with • Teach by trial and error or
following directions. guided discovery
• Require that the player
understand the instructions in
order to succeed
May struggle to learn new • Most negative feed back from
information and experience video games and other digital
frustration or low self-esteem as a media occurs privately.
result. • Causes less embarrassment
• Teaches the player how to
handle these emotions
What are the characteristics of interventions
that work best with children With ADHD?
• Point of performance interventions
• Immediacy of feedback
• Powerful and engaging feedback and
• Multimodal, movement, and
multiple intervention agents
• Individualized to child’s
• Above list are all basic video
• Strategic teaching principles
including: previewing, setting
explicit goals, partnering,
strategies- The LW4K approach
**My child with ADHD plays video games; why
is s/he not earning all A’s in school?
• Existing games are generally not designed to promote
skills in children with ADHD.
• Existing games focus on
other things, while using
important thinking skills.
• Metacognitive skills are not
built into existing video
• Generalization and strategic
teaching skills are not built
into existing game.
Research on Executive/Thinking
Skills and Video Games
• LWK pilot research on differentiated instruction,
targeting areas of EF weakness with video
• Combination of board and video games improve
fluid reasoning and processing speed (Mackey,
• Working memory video games improve WM, fluid
reasoning skills (Cogmed ) Intensity/duration
• Computer-based training improves executive
attention in preschoolers (Rueda, 2005)
• Video game like math and reading programs
improves learning, reduces attention symptoms
• Games (non video) that increase cognitive load
and used as a teaching tool by parents reduce
ADHD symptoms in Preschoolers (Halperin,
How well do game based skills
transfer to the real world?
• Game play alone results in modest
improvements in real-world executive
• Children with learning and attention
problems have problems in
• Kids like to talk about playing video
games and may be willing to learn
• Games prompt partnering and
motivation to learn executive skills
• Practice and rehearsal of executive
BUT…games are not enough!!!
• The key to success is effective teaching or
mediation (can be done in the game)
• Teachers (including peers, parents, and
imbedded instruction) make the connection
between game-based learning and real-world
• Actual learning requires knowledge of the skill,
understanding how and when to use it, and
practice across many situations
• Video games are like soccer, checkers, card
games and can and should be used as a
teaching tool by parents and educators
What can we do to make video games a more
productive learning experience for children with
• Utilize a differentiated instructional model that identifies
the specific skills that a child with ADHD needs to
• Teach skills and then practice them in game and
• Talk about gameplay and skills, metacognitive
• Build generalization strategies,
practice skills outside of the
• Consider duration and intensity
of game play to practice skills
• Mediated learning, including
educators, and peers
• Talk before, during, and after
gameplay. Choose gameplay goals
with your child.
• Have fun playing the game with your
• Reflect on gameplay, emphasizing the
use of the targeted thinking or
• Direct your discussion to how these
same skills are useful in daily
Make it Work
• Explain the benefits of digital play,
and introduce the skills being
exercised in the game.
• Encourage non-digital activities that
use the same skills.
• Regularly connect game-based
skills to things your child is
struggling with in the real-world.
• Try different games and skills
Randy Kulman, Ph.D.
Gary Stoner, Ph.D.
LearningWorks for kids
Takeaway 1. Characteristics of video games share many features with effective tools for teaching children with ADHD2. Play=Learning, Video game play is digital play3. Video games require the EF skills such as planning , WM, Flexibility4. Playing video games alone is not enough 5. Games are a teaching tool requiring metcognitive and generalization strategies ----- Meeting Notes (11/10/12 12:58) -----Gary to reemphasize points
----- Meeting Notes (11/10/12 12:58) ----- Gay to Ask to write down some answers
----- Meeting Notes (11/10/12 12:58) -----Gary
Does a fast-paced video game (or for that matter movie, lifestyle, or presentation) make others less engaging in comparision. Does something need to be going on all the time. Look at kids and adults who are always checking their phone, looking for the next thing to do, easily boredMerzenich-founder Posit Science also argues that time spent playing games takes away from other school, social , and outdoor related activities that also offer cognitive gains.Gentile suggests that video game attention to the periphery is counterproductive to focusing on only one thing.
How much time do children with ADHD spend playing video games, per day? Adolescents with ADHD?- Meeting Notes (11/8/12 14:24) -----
Kaiser Foundation data"halo" effect of parents, social desirability ordifferences in data collection, a daily diary vs, an estimate Parents who reported themselves as more active participants in their child’s video game -greater belief that video games could help their child with planning, time management, understanding themselves/others, and overall performance in school Addiction-15% are at least somewhat concerned about video game addiction
47% believe that video games cannot help their children at all in school85% believe that video games can at least somewhat improve memory skills86% believe that video cans can a little bit to very much improve focusing skills72% believe video games can a little bit to very much improve planning skills61% believe that video games can a little bit to very much improve self control skills…more on cognitive than behavioral skills
General strategies that work with ADHD children… something to do, to be able to move, to be able to talk , or to be able to fidget when concentratingResearch on ADHD and vigorous exercise (Verret et al 2010, Ratey in Spark)…what about exergames as a tool for increasing focusing skillsBest (2011) Exergaming immediately enhance EFs
LWK pilot research (N=10) that targeted areas of specific EF weakness resulted in gains in these areas, not in others, similar to what Mackey found where they targeted solely by the games played,rather than by child’s needs and games/playbooks selectedTools of the mind study- game play leads to improved EFsOther studies (Cogmed) support targeted approaches, the use of mediators, the importance of intensity and duration (5-6 weeks 40 minutes per day)Halperin- trained parents to play board and other games with preschoolers
----- Meeting Notes (11/10/12 11:04) -----Generalization is difficultDenckla suggested using embedded experiences as opportunities for improving brain plasticity,. If video game play is an everyday experience, should we use parents and teachers to work with kids on this
Gary starts upGames as a teaching tool,Can be an enduring, continuous support to deal with a chronic conditionBuilding metacognition and generalization into processTargeting skills individuallyHot vs. cold Efs, games seem to be better for cognitive than self control skills ( eg planning, cognitive flexibility, organization, time management, task initiation…than regulation of affect, response inhibition)----- Meeting Notes (11/10/12 13:08) -----
Thinking and Executive Skills Test..Well researched, presented data at CHADD
Mediation, metacognition, goal setting, FUN!This is about parenting and teaching with tools kids love.----- Meeting Notes (11/10/12 13:11) -----Gary to start
Far transfer and metacognitionPractice across settingsExpand the skill sets to other similar skills