This presentation explores ways to utilize video games as powerful tools for kids with ADHD in order to improve their executive functioning skills.

1. Prescribing Video Games (not
Medication) for ADHD:
How to Make it Work
Randy Kulman, Ph.D.
randy@learningworksforkids.com
@rkulman
In Collaboration With
Gary Stoner, Ph.D.
Ashley Alves
Lara Goodrich, M.A.
LearningWorks for kids Games for Health
www.learningworksforkids.com June 12-1, 2013 Boston, MA
@lw4k

2. What I’m Playing
Gardens of Where’s my Cut the
Time Water? Rope

3. Overview
• Diagnosis, demographics, associated
Executive Functions (EF), and treatment of
ADHD
• What do we know about ADHD kids
involvement with video games and digital
media, impact of digital media on attention
• Characteristics of video games that makes
them a powerful tool with kids with ADHD
• The importance of Efs in video games and
daily activities
• How differentiated instruction, generalization,
and strategic approaches make video games
teaching tools
• LearningWorks for Kids Strategies

4. 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

5. Demographics of ADHD
• 5-9 % of Population Diagnosed with
ADHD
• 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
education

6. 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
behavior)
• 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
Consultants Data

7. LWK study of ADHD kids and
parents on video game play
• (Current sample of 49 children with a primary
ADHD diagnosis based upon a full
neuropsychological evaluation)
• 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
developing kids)

8. Time per week for parents
involvement with kids video game play
How many hours per week do you (parents)
spend observing or interacting with your child
when they play video games?
• 30% no time
• 49% less than 1 hour
• 19% 1-5 hours
• 2% 10+ hours
Do you play video games with your child?
• 56% Sometimes
• 25% Never
• 12% Often
• 3% Always

9. Concerns and benefits regarding
video game play
Describe the level of concern that you have about your
child’s video game play leading to video game addiction.
• 70% Not at all concerned
• 14% Mildly concerned
• 6% Concerned
• 4% Somewhat concerned
• 4% Extremely concerned
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

10. How do children with ADHD perform on
video games?
• 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
al. 2004).
• 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.”

11. 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
2010).
• 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
ADHD?

12. 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
(Bavelier)
• Leads to listlessness and discontent in
slow-paced and less stimulating
academic, work, and social environments
(Merzenich)
• Attention skills improved by video games
(detecting differences and orienting
attention) are liabilities in classroom
resulting in distractibility (Gentile)

13. Why use video games and digital
media to help kids with ADHD?
Kids with ADHD or Video Games and Digital Media
Attention Difficulties
May become easily bored and • Require ever-changing skills
unable to sustain attention • Employ video, sounds, words, and
actions
• Multi-modal
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
involvement

14. Why use video games and digital
media to help kids with ADHD?
Kids with ADHD or Attention Video Games and Digital Media
Difficulties
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
and frustration
• Teaches the player how to
handle these emotions

15. Summary of why to use video
games with kids with ADHD
• Love, interest, flow, attention and
engamement are potentials for
learning (especially in contrast to
traditional learning)
• ADHD kids require repeated practice
and strategic thinking for which video
games are good teaching tools
• Many games practice the executive
skills such as planning, working
memory, cognitive flexibility,
organization, and time management
that define ADHD

16. What are Executive Functions?
• A construct of cognitive capacities that
enable independent, purposeful, goal-
directed behavior
• The CEO or the conductor of the brain
• A collection of brain processes that
guide thought and behavior
• Located primarily in the prefrontal
cortex but involving other neural
networks
• Skills, not fixed capacities

17. Dawson and Guare Model of
Executive/Thinking Skills
Focus Task Persistence
Sustained attention
Task initiation
Self-Awareness Metacognition
Social thinking
Self-Control Regulation of affect
Response inhibition
Working Memory
Organization
Planning
Flexibility
Time Management

18. Executive/Thinking Skills in
School and Home
• Doing homework - organization,
planning, focus, time management
• Phonological awareness - working
memory
• Written language - organization,
focus, planning
• Assembling a toy - planning and
organization, focus
• Cleaning one’s room - focus,
organization

19. The Importance of Teaching
Thinking Skills
• Preschoolers who learn EF’s perform
better academically (Diamond,
McClelland)
• Improving working memory enhances
reading, reduces ADHD symptoms
(Cogmed research)
• Self Control enhances future life
success (Marshmallow test)
• Protects children from mental health
issues

20. Research on Executive/Thinking
Skills and Video Games
• LWK pilot research on differentiated instruction,
targeting areas of EF weakness with video
games
• Combination of board and video games improve
fluid reasoning and processing speed (Mackey,
2011)
• Working memory video games improve WM, fluid
reasoning skills (Cogmed studies)
• 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,
2012)

21. And yet….
• Lots of kids play games
• Lots of kids have difficulty with
planning.
• We can observe that sitting a child
in front of a video game—without
guidance or purpose—will not
translate into noticeable
improvements in cognitive
functioning or academic success.

22. How well do game based skills
transfer to the real world?
• 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

23. 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 skills
• Actual learning requires knowledge of
the skill, understanding how and when
to use it, and practice across many
situations

24. How do digital technologies teach
executive functions?
The LearningWorks for Kids model:
• Games as a vehicle for "engaging the gears"
of a child's brain
• Opportunities for children to practice an
executive skill in a fun and engaging fashion
• A teaching opportunity for parents, teachers,
and clinicians
• An opportunity to detect, reflect, and connect
on the use of executive skills
• A "new literacy," an understanding of ways of
doing, thinking, and valuing things in the
context of relationships and school practices
(James Paul Gee)

25. Effective teaching with digital
technologies:
• Goals need to be explicit and shared
• "It's not about the game.”
• Finding other teaching opportunities
for developing executive skills
• Limiting video game-play
• Getting peers, siblings, or other family
members involved
• Noticing and reinforcing improvements
in the use of executive skills

26. Play Together
• 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.

27. 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.

28. Executive skills Questionnaire

29. Prescription of Games, Technologies,
and Recommendations

30. Gardens of Time PlayBook

31. Gardens of Time: Video
PlayBook

32. Beyond Games: myHomework

33. Beyond Games: Evernote

34. Thank You!
Randy Kulman, Ph.D.
randy@learningworksforkids.com
@rkulman
LearningWorks for kids Games for Health
www.learningworksforkids.com June 12-1, 2013 Boston, MA
@lw4k