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Should Children with ADHD Play
Minecraft? The Pros and Cons of
Technology Use for Children
with ADHD
CHADD Annual Internat...
Disclaimer
Randy Kulman is President of LearningWorks for
Kids, Inc. and a Cogmed provider.
Introduction
• Terminology- Games, Apps, Digital media,
screen time, technologies- interchangeable
• Making the best of te...
Take-Aways
• Recognition of the extent of children’s involvement with
digital media
• Understanding the research on the im...
Finding Angry Birds and Amazing Alex
• How to find Angry Birds on your device:
• iPhone, iPad: Go to App store, search on
...
Minecraft
Why Do Kids Love Minecraft?
• Gratification in building something
• Constant feedback and discovery
• Creative engagement
...
Why Do Kids Choose To Play Minecraft?
• It's easy to enter, do not need to use to use complex moves
to start
• Simple as b...
It’s Not Just Video Games Anymore
• Games, apps, software,
and websites are
merging.
• Access, particularly
mobile and tab...
Do Parents, Educators, and Healthcare
Professionals Have a Choice?
• Many homework and supplementary
programs are availabl...
Media Use Across Decades
• 1930s: Movies, print, radio.
 Children 9-12; 2-3 hours per day listening to radio
• 1960s: Mov...
Developmental Trends across
Media
Percentage of 8-18 Year Olds
Who Own Each Item:
Among All 8-10 11-14 15-18
Ipod/mp3 player 76% 61% 80% 83%
Cell phone 66% ...
Percent of Young People in Each
Age Group Who Own a Cell Phone:
Recent scholarly perspectives on the potential benefits of
playing video games, as well as video games and children
with A...
• Identify and discuss potential benefits of playing
video games in 4 areas of functioning:
• Cognition
• Motivation
• Soc...
• “A small but significant body of research has begun to
emerge, mostly in the last five years, documenting these
benefits...
There is empirical evidence documenting positive
effects of video game play on cognition,
including:
– Spatial skills
– Pr...
• The design of many video games, seems
perfectly suited for promoting and teaching an
effortful, persistent, approach to ...
• “In summary, although playing games is often
considered a frivolous pastime, gaming environments
may actually cultivate ...
• “… among the top reasons individuals cite for using
diverse forms of media are to manage their moods
and to enhance thei...
• “experiencing positive emotions may help broaden the
number of behaviors one perceives as both possible and
motivating a...
• …In these virtual social communities, decisions need
to be made on the fly about whom to trust, whom to
reject, and how ...
• “Social skills are also manifested in forms of civic
engagement: the ability to organize groups and lead
likeminded peop...
WHAT’S KNOWN ON THIS SUBJECT: Children with autism
spectrum disorder (ASD) and those with ADHD are at risk for
problematic...
• METHODS: Participants included parents of boys (aged 8–
18) with ASD (n = 56), ADHD (n = 44), or TD (n = 41).
Questionna...
• WHAT’S KNOWN ON THIS SUBJECT: Concerns as well as
hopes regarding electronic games have led researchers to
study the inf...
• METHODS: A large sample of children and adolescents aged 10 to
15 years completed assessments of psychosocial adjustment...
• “Electronic games might best be thought of as a new
variety of toys offering a range of distinct play
experiences and no...
• ABSTRACT. Young people with developmental disorders
experience difficulties with many cognitive and perceptual
tasks, an...
• Why should videogames appeal to children with disorders,
who often struggle with many other tasks?
• Even if the games d...
• Exploiting videogames to support and extend the development of
young people with disorders, and to enhance their leisure...
• Clinical and anecdotal observations -
too much!
• No evidence of difference concerning
frequency or duration of play bet...
• 10- to 12-year-olds in France are
exactly like their peers (Bioulac
2008)
• Milwaukee study of teens, same
amounts with ...
Activity Mean (N = 65) Standard Deviation
Watching TV 2.8 .96
Reading or doing homework 1.37 .96
Playing outdoors or sport...
Activity Mean SD
1. Playing video games 1.59, N = 64 1.87
2. Doing homework 5.89, N = 64 2.24
3. Having a conversation wit...
• Time spent with technology on a typical weekend
or vacation
 Mean = 306.92, SD = 116.64
• Time spent with non-technolog...
Approach Percentage
1. No access to games or the Internet 3.1
2. Only on weekends and vacations 10.9
3. After homework is ...
• May not always perform as well as their typically-developing
peers (Lawrence, et al 2002)
• May process information some...
• More than one hour a day is associated with short term
increased signs of inattention (Taharoglu)
• Increased difficulty...
• Total time spent with screen media is positively associated
with attention problems (Swing, Gentile, et al. 2010).
• Fou...
Cautions Solutions
Children with ADHD or attention problems
may become “hyper-focused” on video games
and other digital me...
Angry Birds
• Birds are used as
projectiles to hit pigs that
are protected by
structures.
• Players plan out each shot
and predict the...
• Cogmed Working Memory Training
• Action video games for improving
selective attention (Green and
Bevalier)
• DDR and Imp...
• Apps and Video Games
“made” for ADHD
• Tend to be psychoeducational
or simply not fun
• Select technologies based
upon a...
• It is engaging and sustains attention.
• It practices a specific skill the child needs to improve such
as focus, plannin...
Strategies for Improving Executive
Functioning Skills and Attention
• Traditional behavioral, classroom, and cognitive str...
What Skills Can You Learn from Video
Games and Technology?
• Focus and attention
• Knowledge acquisition
• Social awarenes...
What Tech Tools are Used to Teach Attention
and other Skills?
• Working memory training programs- Cogmed
• Neurofeedback/ ...
How Popular Games and Apps Improve
Executive Functions
• Support, primarily apps where a
skill is scaffold it by the
funct...
Why Use Popular Games, Apps and Technologies
to Improve Executive Functions
• Engagement, fun, attention, and persistence
...
Limitations of using popular games and
technologies to prove executive functions
• Lack of peer-reviewed research
• Diffic...
Improving Generalization by Building it into the
Games
• New games such as IF (If You Can)
o For improving social awarenes...
Strategies for using popular games and apps
to improve executive functioning skills
• Typically requires more than game pl...
Strategies for using popular games and apps to
improve executive functioning skills- 2
• Dosage and intensity -needs to be...
Implementing a game and app
prescription
• Assess the executive functioning skills
• Choose a variety of games that practi...
LearningWorks for Kids Prescription Model
• Existing games are generally not designed
to promote skills in children with ADHD.
• Existing games focus on other thing...
• Game play alone results in modest improvements in real-
world executive skills
• Children with learning and attention pr...
• The key to success is effective teaching or mediation
(can be done in the game)
• Teachers (including peers, parents, an...
What can we do to make video games a
more productive learning experience for
children with ADHD?
• Build generalization st...
• Talk before, during, and after gameplay. Choose
gameplay goals with your child.
• Have fun playing the game with your ch...
Building a Home
• Explain the benefits of digital play, and introduce
the skills being exercised in the game.
• Encourage non-digital acti...
Amazing Alex
– Physics-based puzzle game
where players create chain
reactions using everyday
items
– Skills of planning, f...
Amazing Alex
Age Amount of Time
0 to 24 months not at all
2 to 5 years 30 to 60 minutes a day (joint
media engagement the rule)
6 to 9 ...
• Concerns regarding time management and time blindness
• Difficulty with shifting and transitions from one activity to
an...
• Be firm, consistent, and engaged.
• Be flexible when it serves your purpose
• Consider schedules
• Curation
• Consider t...
• Control the controller
• Limit access to content such as violence or
sexual themes
• No access during the school week
• ...
• Include large doses of physical, social, creative, and
unstructured play
• Make other forms of play more attractive
• Mo...
Make a Schedule
• An hour a day
• After homework is done
• Only on weekends and vacations
• Anytime and anywhere
• Never
•...
• Only educational games
• Differentiation based upon an individual child’s
characteristics
• Level of digital nutrition a...
• Play games together both at home or online
• Follow your own sensibilities about violence or
other inappropriate content...
• Maturity rather than age-based
• Children under the age of five need ongoing supervision
• Elementary school children-so...
• Working-memory games, both
formal training and casual games
• Planning games that require
setting long- and short-term
g...
• Practice-Guided and
regular rehearsal of new
skills in an interesting
manner
• Master- Owning the skill
, knowing how, w...
Evernote
• A smartpen that records voice notes that is connected to
written notes
• Child takes notes on digitally-equipped paper a...
LiveScribe
• 50+ peer review studies -
demonstrated to improve
reading, math, and sustained
attention
• Generalization is improved
by...
Cogmed Working Memory training
• Players use tennis rackets and can get vigorous
exercise
• Self-control and flexibility required while playing
the game
...
Wii Sports: Tennis
Thank You
• Randy Kulman, Ph.D
• randy@learningworksforkids.com
• @lw4k on Twitter
• www.pinterest.com/lw4k
• www.learning...
CHADD 2014 Should Children with ADHD Play Minecraft?
CHADD 2014 Should Children with ADHD Play Minecraft?
CHADD 2014 Should Children with ADHD Play Minecraft?
CHADD 2014 Should Children with ADHD Play Minecraft?
CHADD 2014 Should Children with ADHD Play Minecraft?
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CHADD 2014 Should Children with ADHD Play Minecraft?

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Strategies for using video games such as Minecraft to improve executive functions in children.

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CHADD 2014 Should Children with ADHD Play Minecraft?

  1. 1. Should Children with ADHD Play Minecraft? The Pros and Cons of Technology Use for Children with ADHD CHADD Annual International Conference on ADHD Randy Kulman, Ph.D. President, Learning Works for Kids Gary Stoner, Ph. D. University of Rhode Island
  2. 2. Disclaimer Randy Kulman is President of LearningWorks for Kids, Inc. and a Cogmed provider.
  3. 3. Introduction • Terminology- Games, Apps, Digital media, screen time, technologies- interchangeable • Making the best of technology--with concern • Research-based, practical approaches • Games, Tech, media are forms of digital play- and play=learning for children • We want you to have fun and learn today
  4. 4. Take-Aways • Recognition of the extent of children’s involvement with digital media • Understanding the research on the impact of games, apps, technology on kids with ADHD • Concerns and cautions about digital media and ADHD • What makes digital media so powerful for kids with ADHD • Real world strategies for video games and kids with ADHD • Generalization strategies to make popular games and apps into teaching tools for executive and academic skills
  5. 5. Finding Angry Birds and Amazing Alex • How to find Angry Birds on your device: • iPhone, iPad: Go to App store, search on bottom of screen, type Angry Birds on top of screen, go to Free version, tap and download • Android Phone/ Tablets: Go to Google Play, search Angry Birds go to Free version, tap free and then download • Do the same for Amazing Alex
  6. 6. Minecraft
  7. 7. Why Do Kids Love Minecraft? • Gratification in building something • Constant feedback and discovery • Creative engagement • Taking something from imagination and making it into reality • Incredible opportunities for expansion (achievement) via mods, videos, and programming (effort)
  8. 8. Why Do Kids Choose To Play Minecraft? • It's easy to enter, do not need to use to use complex moves to start • Simple as block by block but the complexity increases with more knowledge • Opportunities for planning and vision • Easy in the way the Legos is easy anybody can build a house but challenges increase incrementally • So much to learn from others, kids love to watch Minecraft videos
  9. 9. It’s Not Just Video Games Anymore • Games, apps, software, and websites are merging. • Access, particularly mobile and tablet-based, requires a new type of monitoring and understanding. • Academic and classroom are increasing requiring games and technology. • Screen-based technologies or digital-media use are more encompassing terms than video games.
  10. 10. Do Parents, Educators, and Healthcare Professionals Have a Choice? • Many homework and supplementary programs are available only on websites. • Libraries are still for research (but only if you use the Internet to search). • Everybody else is playing. • 21st century skills require digital literacy. • Communication requires digital technology.
  11. 11. Media Use Across Decades • 1930s: Movies, print, radio.  Children 9-12; 2-3 hours per day listening to radio • 1960s: Movies, print, radio, television TVs on 6 hours per day in homes • 1980s: Cable, video game consoles, portable music players, computers, VCRs Elementary schools kids watch 2.3 hours TV per day • 2010s: Internet, cell/ smart phones, DVRs, Tablets, handheld video games
  12. 12. Developmental Trends across Media
  13. 13. Percentage of 8-18 Year Olds Who Own Each Item: Among All 8-10 11-14 15-18 Ipod/mp3 player 76% 61% 80% 83% Cell phone 66% 31% 69% 85% Handheld video game player 59% 65% 69% 41% Laptop 29% 17% 27% 38% Portable CD/tape player 16% 9% 16% 20%
  14. 14. Percent of Young People in Each Age Group Who Own a Cell Phone:
  15. 15. Recent scholarly perspectives on the potential benefits of playing video games, as well as video games and children with ADHD.
  16. 16. • Identify and discuss potential benefits of playing video games in 4 areas of functioning: • Cognition • Motivation • Social behavior • Emotion regulation Granic, I., Lobel, A., and Engels, R. C. M. E. (2014). The benefits of playing video games. American Psychologist, 69 (1), 66-78.
  17. 17. • “A small but significant body of research has begun to emerge, mostly in the last five years, documenting these benefits. … these findings suggest that video games provide youth with immersive and compelling social, cognitive, and emotional experiences. Further, these experiences may have the potential to enhance mental health and well-being in children and adolescents… Whereas adolescents and adults often use self-disclosure and direct discussion with close friends to resolve emotional issues, children use play to work them out through pretend-based narratives enacted either alone or with others. Links between children’s propensity to play and their development of cooperative skills, social competence, and peer acceptance have also been empirically established” Why might video game play be beneficial?
  18. 18. There is empirical evidence documenting positive effects of video game play on cognition, including: – Spatial skills – Problem solving skills – Creativity Cognition
  19. 19. • The design of many video games, seems perfectly suited for promoting and teaching an effortful, persistent, approach to problem solving (e.g., motivation) and task completion Motivation
  20. 20. • “In summary, although playing games is often considered a frivolous pastime, gaming environments may actually cultivate a persistent, optimistic motivational style. This motivational style, in turn, may generalize to school and work contexts. … certain types of games will more likely foster these healthy motivational styles, while others may not…Game designers are wizards of engagement. They have mastered the art of pulling people of all ages into virtual environments, having them work toward meaningful goals, persevere in the face of multiple failures, and celebrate the rare moments of triumph after successfully completing challenging tasks” Motivation (cont.)
  21. 21. • “… among the top reasons individuals cite for using diverse forms of media are to manage their moods and to enhance their emotional states. Gaming may be among the most efficient and effective means by which children and youth generate positive feelings. Several studies have shown a causal relation between playing preferred video games and improved mood or increases in positive emotion” Emotional benefits of gaming:
  22. 22. • “experiencing positive emotions may help broaden the number of behaviors one perceives as both possible and motivating and may build social relationships that provide support for goal pursuit and coping with failure. …Games do not elicit only positive emotions; video games also trigger a range of negative ones, including frustration, anger, anxiety, and sadness. But…. the pretend context of video games may be real enough to make the accomplishment of goals matter but also safe enough to practice controlling, or modulating negative emotions in the service of those goals. Adaptive regulation strategies such as acceptance, problem solving, and reappraisal have repeatedly been linked to less negative affect, more social support, and lower levels of depressive symptoms… These same adaptive regulation strategies seem to be rewarded in gaming contexts because their use is concretely and clearly linked to goal achievement” Emotion regulation (cont.)
  23. 23. • …In these virtual social communities, decisions need to be made on the fly about whom to trust, whom to reject, and how to most effectively lead a group. Given these immersive social contexts, we propose that gamers are rapidly learning social skills and prosocial behavior that might generalize to their peer and family relations outside the gaming environment • Players seem to acquire important prosocial skills when they play games that are specifically designed to reward effective cooperation, support, and helping behaviors Social Behavior Enhancement:
  24. 24. • “Social skills are also manifested in forms of civic engagement: the ability to organize groups and lead likeminded people in social causes. A number of studies have focused on the link between civic engagement and gaming. For example, one large- scale, representative U.S. study (Lenhart et al., 2008) showed that adolescents who played games with civic experiences (e.g., Guild Wars 2, an MMORPG, or massive multiplayer online role-playing game) were more likely to be engaged in social and civic movements in their everyday lives (e.g., raising money for charity, volunteering, and persuading others to vote).” Social behavior (cont.)
  25. 25. WHAT’S KNOWN ON THIS SUBJECT: Children with autism spectrum disorder (ASD) and those with ADHD are at risk for problematic video game use. However, group differences in media use or in the factors associated with problematic video game use have not been studied. WHAT THIS STUDY ADDS: Boys with ASD and ADHD demonstrated greater problematic video game use than did boys with typical development. Inattention was uniquely associated with problematic use for both groups, and role-playing game genre was associated with problematic use among the ASD group only. Mazurek, M. O., & Engelhardt, C. R. (2013). Video game use in boys with Autism Spectrum Disorder, ADHD, or typical development. Pediatrics, 132(2), 260-266.
  26. 26. • METHODS: Participants included parents of boys (aged 8– 18) with ASD (n = 56), ADHD (n = 44), or TD (n = 41). Questionnaires assessed daily hours of video game use, in- room video game access, video game genres, problematic video game use, ASD symptoms, and ADHD symptoms. • RESULTS: Boys with ASD spent more time than did boys with TD playing video games (2.1 vs 1.2 h/d). Both the ASD and ADHD groups had greater in-room video game access and greater problematic video game use than the TD group. Multivariate models showed that inattentive symptoms predicted problematic game use for both the ASD and ADHD groups; and preferences for role-playing games predicted problematic game use in the ASD group only. Mazurek (cont.)
  27. 27. • WHAT’S KNOWN ON THIS SUBJECT: Concerns as well as hopes regarding electronic games have led researchers to study the influence of games on children, yet studies to date have largely examined potential positive and negative effects in isolation and using samples of convenience. • WHAT THIS STUDY ADDS: Results from this nationally representative study of children 10 to 15 years indicated low levels of regular daily play related to better psychosocial adjustment, compared with no play, whereas the opposite was true for those engaging in high daily play. Przybylski, A. K. (2014). Electronic gaming and psychosocial adjustment. Pediatrics, 134 (3), 716-722.
  28. 28. • METHODS: A large sample of children and adolescents aged 10 to 15 years completed assessments of psychosocial adjustment and reported typical daily hours spent playing electronic games. Relations between different levels of engagement and indicators of positive and negative psychosocial adjustment were examined, controlling for participant age and gender and weighted for population representativeness. • RESULTS: Low levels (less than 1 hour daily) as well as high levels (more than 3 hours daily) of game engagement was linked to key indicators of psychosocial adjustment. Low engagement was associated with higher life satisfaction and pro-social behavior and lower externalizing and internalizing problems, whereas the opposite was found for high levels of play. No effects were observed for moderate play levels when compared with non-players. Przybylski (Cont.)
  29. 29. • “Electronic games might best be thought of as a new variety of toys offering a range of distinct play experiences and not a new embodiment of traditional media entertainment. Other aspects of gaming, such as children’s motivations for play and the structural affordances of different kinds of gaming contexts, must be investigated to further our understanding of how exactly they impact on children’s well-being and behavior and inform improved evidence based guidelines for electronic play.” Przybylski (Cont.)
  30. 30. • ABSTRACT. Young people with developmental disorders experience difficulties with many cognitive and perceptual tasks, and often suffer social impairments. Yet, like typical youth, many appear to enjoy playing videogames. … Durkin, K. (2010). Videogames and young people with developmental disorders, Review of General Psychology, 14(2), 122-140.
  31. 31. • Why should videogames appeal to children with disorders, who often struggle with many other tasks? • Even if the games do have attractions for these individuals, how do their conditions affect their abilities to engage with them? • What is the nature of their uses and experiences with the medium? • Can their interactions with games help us to learn more about their disorders, needs and potentialities? • Is game playing advantageous to them or harmful? • Could their interests be built upon for developmental, cognitive, educational, social, or therapeutic benefit? Durkin (Continued); Questions posed:
  32. 32. • Exploiting videogames to support and extend the development of young people with disorders, and to enhance their leisure time, is an attractive prospect not least because it affords means of delivering or supplementing interventions and of stimulating play in a relatively cost-efficient manner. It is not a substitute for other forms of support, nor is it likely to prove a panacea for all the difficulties that these children face. Overall, considerable evidence indicates that videogames can be as engaging for children with disorders as they are for other players, and several studies indicate benefits in respect of cognitive or social functioning. There is little evidence to indicate that children with developmental disorders are harmed by playing videogames, though a cautious interpretation could be that this is partly because the question has not been addressed extensively. Durkin (Continued) :
  33. 33. • Clinical and anecdotal observations - too much! • No 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 Consultants Data How Much Do They Play?
  34. 34. • 10- to 12-year-olds in France are exactly like their peers (Bioulac 2008) • Milwaukee study of teens, same amounts with more variability (Fischer and Barkley 2006) • More video-game play than music, in contrast to peers (LearningWorks for Kids 2011) • 90% of ADHD rather than 80% of TD kids spend more than one hour a day on computer (Linginerni, 2012) Do children with ADHD play video games the same amount as their TD peers?
  35. 35. Activity Mean (N = 65) Standard Deviation Watching TV 2.8 .96 Reading or doing homework 1.37 .96 Playing outdoors or sports 2.31 1.34 Talking/texting on cell phone .63 1.10 Doing homework on the computer .51 .83 Listening to music 1.86 1.26 Using the Internet 1.49 1.31 Playinng organized sports 1.05 1.32 Playing video games 2.05 1.27 Playing with toys/board games 2.14 1.40 On a typical weekend or vacation, about how much time does your child spent with the following technologies and activities: LearningWorks for Kids 2013 Study 0 None 1 <30 2 30-60 3 60-120 4 >120 minutes
  36. 36. Activity Mean SD 1. Playing video games 1.59, N = 64 1.87 2. Doing homework 5.89, N = 64 2.24 3. Having a conversation with you or other 4.14, N = 64 2.16 4. Doing chores 5.51, N = 64 2.42 5. Watching TV 2.32, N = 64 1.96 6. Reading 3.67, N = 64 2.34 7. Playing with Legos or blocks 2.23, N = 62 2.12 8. Playing with action figures/dolls 2.30, N = 63 2.16 9. Playing on the Internet/computer 1.94, N = 64 1.76 LearningWorks for Kids 2013 Study How often does your child show signs of ADHD such as loss of focus, fidgeting, and disorganization while: (Scale 0 to 9 with 0 meaning never, 9 always)
  37. 37. • Time spent with technology on a typical weekend or vacation  Mean = 306.92, SD = 116.64 • Time spent with non-technological activities on a typical weekend or vacation  Mean = 228.31, SD = 96.87 LearningWorks for Kids 2013 Study
  38. 38. Approach Percentage 1. No access to games or the Internet 3.1 2. Only on weekends and vacations 10.9 3. After homework is completed 40.6 4. Limited number of hours a day 14.1 5. Do well in school and play games 14.1 6. No specific rules 17.2 Parenting strategies with children with ADHD: 1. Do you monitor the length of time your child plays with video games and is on the computer? Never Sometimes Often Always 6.2% 18.8% 28.1% 46.9% 2. What best describes your approach to setting limits for your child with digital media? LearningWorks for Kids 2013 Study
  39. 39. • 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 problems applying executive and problem-solving skills to complex video games (Lawrence et al. 2004). • Less success when navigating challenges, developing novel problem-solving (Lawrence 2004) • Perform poorly in neuropsychologically-based game mechanics such as working-memory and cognitive-flexibility tasks How do children with ADHD perform on video games?
  40. 40. • More than one hour a day is associated with short term increased signs of inattention (Taharoglu) • Increased difficulty in transitioning and stopping video- game play, resulting in more oppositionalism • More video-game time is associated with increasing signs of inattention (Mazurek and Engelhardt 2013 study) • Video-game play can be associated with video-game addiction related to Dopamine release in the brain (Han and colleagues 2009) Problematic behavior in video-game play in children with ADHD
  41. 41. • 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) • Are digital media the cause of increasing rates of ADHD? Do Video/Computer Games and Television Impact Attention Span?
  42. 42. Cautions Solutions Children with ADHD or attention problems may become “hyper-focused” on video games and other digital media, neglecting other important responsibilities. Require that your child complete all of her homework, chores, or other responsibilities before being allowed some digital play time. By making him put-off these fun activities until after her work is done, he won’t be able to use digital play as a means of procrastination. Kids with ADHD or attention problems often become so absorbed with activities they find interesting, that they may lose track of how much time they have spent on their digital play. Use a timer if you need to limit your child with ADHD. Time management and having a sense of time are often significant deficits for children with attention problems. You can use online timers such as TabTimer.com or even an everyday kitchen timer to keep your child on track. Kids with ADHD or attention problems may choose to engage with digital play instead of the physical activities that are part of a healthy treatment process. Exercise has been shown to improve Focus and learning in children with attentional problems. Tell your child to go out and run around before playing video games, and to play active games such as Wii Tennis or Kinect Adventures.
  43. 43. Angry Birds
  44. 44. • Birds are used as projectiles to hit pigs that are protected by structures. • Players plan out each shot and predict the consequences of his shot. • Each level is set out uniquely so the player to flexibly change strategies. Angry Birds
  45. 45. • Cogmed Working Memory Training • Action video games for improving selective attention (Green and Bevalier) • DDR and Improved reading • Headsprout and ADHD kids • Computer -based math programs and ADHD • Other studies, eg Interactive metronome, Play Attention, Brain Train Products, Lumosity, Posit Science’s BrainHQ • LWK research on EFS Research-based Technological Recommendations
  46. 46. • Apps and Video Games “made” for ADHD • Tend to be psychoeducational or simply not fun • Select technologies based upon a child’s individual needs • Engagement which increases attention and persistence to the task is important • Technologies with near transfer or direct connections to a skill are best • Practice, intensity, and limitations are important Recommendations for Video Games and Technologies for Children with ADHD
  47. 47. • It is engaging and sustains attention. • It practices a specific skill the child needs to improve such as focus, planning, or time management. • It promotes persistence of effort and a willingness to overcome obstacles. • It is complex and interesting enough to result in duration and intensity of game play. • Generalization of game-based skills can be applied to the real world. What makes a game or app a good teaching tool for children with ADHD?
  48. 48. Strategies for Improving Executive Functioning Skills and Attention • Traditional behavioral, classroom, and cognitive strategies • Medication and brain-based strategies • Organizational, study skills, and executive function coaching approaches • Meditation, mindfulness training, yoga • Physical exercise • Technology-based interventions
  49. 49. What Skills Can You Learn from Video Games and Technology? • Focus and attention • Knowledge acquisition • Social awareness • Spatial reasoning skills • Fluid reasoning skills • Executive functions and executive control
  50. 50. What Tech Tools are Used to Teach Attention and other Skills? • Working memory training programs- Cogmed • Neurofeedback/ biofeedback • Action-based video games • Attention trainers- Akilli, Play Attention • Brain Training suites such as Lumosity and Fit Brains • Apps and games designed for special needs kids with Autism ADHD, LD • Popular games, apps, and technologies
  51. 51. How Popular Games and Apps Improve Executive Functions • Support, primarily apps where a skill is scaffold it by the functionality • Practice – primarily with games with the scale is used repeatedly in order to achieve goals • Mastery, primarily apps and games that built in generalizability and practice
  52. 52. Why Use Popular Games, Apps and Technologies to Improve Executive Functions • Engagement, fun, attention, and persistence • Many games use the same types of activities and exercises that are used in brain training games • Game mechanics- adaptive, challenges adapt to mastery level • Variability- an opportunity to practice similar, but complementary skills with different games • Quality and depth of many of the games • Low-cost and accessibility
  53. 53. Limitations of using popular games and technologies to prove executive functions • Lack of peer-reviewed research • Difficulty in tracking engagement and progress in the game and relating it to real world skills and improvement • Skills that are practiced may be less focused or lack intensity and duration • Extraneous information and objectives that occur within the game • Focuses on fun and not skill development • Attitude of educators and researcher is often negative and skeptical • No evidence of generalizability
  54. 54. Improving Generalization by Building it into the Games • New games such as IF (If You Can) o For improving social awareness and self-control skills • Innovations in technology to create brain change such as a Akili and other potential tools • Cogmed working memory training • Luminosity/ other brain training tools • Still very limited and the critics of brain training tools are quite vocal
  55. 55. Strategies for using popular games and apps to improve executive functioning skills • Typically requires more than game play alone • Modeled after the SharpBrains method of effective brain training • Training engages a specific brain-based skill such as speed of processing or working memory • Training targets an area of weakness, assessed by tools such as the TEAS (Test of Executive and Academic Skills) • Adaptive- games and prescriptions increase the demands on cognitive resources
  56. 56. Strategies for using popular games and apps to improve executive functioning skills- 2 • Dosage and intensity -needs to be sufficient minimum dose of (Approx 15 hours per target area over eight weeks) • Choose games that target slightly different aspects of the same skill, similar to doing a variety of exercises to build biceps • Continued long-term practice is necessary to maintain benefits • Additional training outside of the game using metacognition and practice opportunities improves generalization
  57. 57. Implementing a game and app prescription • Assess the executive functioning skills • Choose a variety of games that practice targeted skills, or apps to support the skills • Create a prescription of games and apps that is age appropriate, adaptable, enduring, and intense • Provide specific instructions on how much to play • Use generalization and metacognitive strategies proven to be successful in the classroom to promote real world learning • Identify a variety of sub skills that can build on the initial prescriptions • Detect, Reflect, and Connect
  58. 58. LearningWorks for Kids Prescription Model
  59. 59. • 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 games. • Generalization and strategic teaching skills are not built into existing game. Why do children with ADHD not become scholars after playing video games?
  60. 60. • Game play alone results in modest improvements in real- world executive skills • Children with learning and attention problems have problems in generalizing strategies • Kids like to talk about playing video games and may be willing to learn from that • Games prompt partnering and motivation to learn executive skills • Practice and rehearsal of executive skills How well do game based skills transfer to the real world?
  61. 61. • 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 skills • Actual learning requires knowledge of the skill, understanding how and when to use it, and practice across many situations BUT…games are not enough!!!
  62. 62. What can we do to make video games a more productive learning experience for children with ADHD? • Build generalization strategies, practice skills outside of the game • Consider duration and intensity of game play to practice skills • Mediated learning, including parents, psychologists, educators, and peers • Utilize a differentiated instructional model that identifies the specific skills that a child with ADHD needs to improve • Teach skills and then practice them in game and technology play • Talk about gameplay and skills, metacognitive approaches
  63. 63. • Talk before, during, and after gameplay. Choose gameplay goals with your child. • Have fun playing the game with your child! • Reflect on gameplay, emphasizing the use of the targeted thinking or academic skills. • Direct your discussion to how these same skills are useful in daily activities. Play Together
  64. 64. Building a Home
  65. 65. • 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 Make it Work
  66. 66. Amazing Alex – Physics-based puzzle game where players create chain reactions using everyday items – Skills of planning, flexibility, and focus – Foresight and working memory in order to succeed – Attention to detail is important in order to obtain perfect score across many levels Games for practicing executive skills
  67. 67. Amazing Alex
  68. 68. Age Amount of Time 0 to 24 months not at all 2 to 5 years 30 to 60 minutes a day (joint media engagement the rule) 6 to 9 years 30 to 60 minutes a day (parents select games) 10 to 13 years 30 to 60 minutes a day (parents monitor game selection) 14 years old older 30 to 90 minutes a day (emphasize social gaming) How Much Should Your Child with ADHD Play Video Games?
  69. 69. • Concerns regarding time management and time blindness • Difficulty with shifting and transitions from one activity to another • Tendency to become overly focused on video-game play • Oppositional tendencies seen with children with ADHD • Child’s sense of success and reward in playing video games • Parent’s sense of peace and reduction of conflict Why It Is Difficult to Set Limits on Game Play with Children with ADHD
  70. 70. • Be firm, consistent, and engaged. • Be flexible when it serves your purpose • Consider schedules • Curation • Consider the Individual and Developmental level • Be in control of the tech • Be sensible, look at your own media use • Start with a “Play Diet” Strategies for Setting Effective Limits for Children with ADHD
  71. 71. • Control the controller • Limit access to content such as violence or sexual themes • No access during the school week • Parents own the technology • Time limiting tools such as timers, screen managers • Strategies best for younger children, kids with addictive tendencies, and inappropriate use Limit Setting-Parental Control of Access
  72. 72. • Include large doses of physical, social, creative, and unstructured play • Make other forms of play more attractive • Model a balanced play diet • Screen based technologies should not be the “to go” activity • Keep your kids very busy with other activities • Foster the development of alternative long-term interests • Strategy is preferred method as it focuses on overall health Create a Healthy Play Diet
  73. 73. Make a Schedule • An hour a day • After homework is done • Only on weekends and vacations • Anytime and anywhere • Never • Good for kids who struggle with school or find screen-based time too rewarding
  74. 74. • Only educational games • Differentiation based upon an individual child’s characteristics • Level of digital nutrition as judged by the parent • Choose games and apps suggested by your kids • Best for kids who can’t choose appropriately or those with specific academic needs Curation of Content
  75. 75. • Play games together both at home or online • Follow your own sensibilities about violence or other inappropriate content • Choose games to foster shared family interests such as sports or classic board games • Model appropriate amounts of screen-based activities • Good for families who use technology with their kids Family Sensibilities, Modeling, and Playing with Your Child
  76. 76. • Maturity rather than age-based • Children under the age of five need ongoing supervision • Elementary school children-some independence but not owners of technology • Tweens may choose own technology but need supervision from parents • Teens-Autonomy requires taking responsibility and good decision making • Teens need more access to digital and social media • Important approach for all kids Developmental Considerations
  77. 77. • Working-memory games, both formal training and casual games • Planning games that require setting long- and short-term goals • Apps that help with organizational and time- management skills • Developmentally rather than chronologically age-appropriate • Genres rather than specific games • Active games, the more active and vigorous movement the better • Puzzle games- Help with time management and focus What Types of Games and Apps Should a Child with ADHD Use?
  78. 78. • Practice-Guided and regular rehearsal of new skills in an interesting manner • Master- Owning the skill , knowing how, when, and where to use it • Support- External structure, scaffolding to help self regulation and learning How Games and Apps can Help
  79. 79. Evernote
  80. 80. • A smartpen that records voice notes that is connected to written notes • Child takes notes on digitally-equipped paper and when going over those notes can listen to • Recordings of lectures • Helps with children who struggle with working memory • Very helpful for children who process information or have slow clerical motor speed LiveScribe
  81. 81. LiveScribe
  82. 82. • 50+ peer review studies - demonstrated to improve reading, math, and sustained attention • Generalization is improved by using additional tools and strategies in conjunction with Cogmed • Research-based, clinically-proven computer program to improve working-memory capacities of • Targeted regimented exercises • Demonstrated to promote structural changes in the brain based upon principles of neuroplasticity Cogmed Working Memory training
  83. 83. Cogmed Working Memory training
  84. 84. • Players use tennis rackets and can get vigorous exercise • Self-control and flexibility required while playing the game • Primarily the game is good for children with ADHD, as it promotes vigorous exercise using complex body movements when done properly Wii Sports: Tennis
  85. 85. Wii Sports: Tennis
  86. 86. Thank You • Randy Kulman, Ph.D • randy@learningworksforkids.com • @lw4k on Twitter • www.pinterest.com/lw4k • www.learningworksforkids.com • Gary Stoner, Ph.D. • Gstoner@uri.edu

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