1. Playing Smarter in a Digital World:
Improving Attention and Executive
Functioning Through Technology
Randy Kulman, Ph.D
President LearningWorks for Kids
Gary Stoner, Ph.D.
University of Rhode Island

2. Disclaimer
Randy Kulman is President of LearningWorks for
Kids, Inc. and a Cogmed provider.

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. 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

5. Children with ADHD and academics, continued:
• As many as 80% of students with ADHD exhibit
academic difficulties, including lower than
expected work completion rates
• Approximately 20-30% are identified with
learning difficulties due to problems with
acquisition of academic skills
• Recent studies show literacy/reading skill
acquisition problems relative to matched peers
as early as Kindergarten
• These risks and outcomes suggest need for
effective educational interventions

6. ADHD in School Contexts: Reasons for Concern
• School success is both critical and potentially
elusive for students with ADHD
• Increasing numbers of children who are
“difficult-to-teach” and “difficult-to-manage”
• Need to expand the range of intervention
“agents” and strategies

7. Children with ADHD are at higher than average
risk for:
• As many as 80% of students with ADHD exhibit
academic difficulties, including lower than
expected work completion rates
• Approximately 20-30% are identified with
learning difficulties due to problems with
acquisition of academic skills
• Recent studies show literacy/reading skill
acquisition problems relative to matched peers
as early as Kindergarten
• These risks and outcomes suggest need for
effective educational interventions

8. How Much Do They Play?

9. • 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?

10. • 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?

11. 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

12. 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

13. 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)

14. • 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?

15. • 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

16. • 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?

17. • 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.

18. • 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:

19. • 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) :

20. 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.

21. • Point of performance interventions
• Immediacy of feedback
• Powerful and engaging feedback and
meaningful consequences
• Multimodal presentations and multiple
intervention agents
• Individualized to child’s capacities
• Strategic teaching principles including:
previewing, setting explicit goals,
partnering, metacognition, and
generalization strategies
What are the characteristics of interventions that
work best with children With ADHD?

22. Why use video games and digital media to
help children with ADHD?
• Both simple and complex video games
regularly use skills such as planning,
cognitive flexibility, self-control, and time
management.
• Many games specifically tax working
memory skills and attention skills.
• Video game play requires the use of executive functioning skills.
• Other skills such as organization and metacognitive skills are
required for success.

23. • 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?

24. • 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

25. 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

26. 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

27. Poor Executive Functions

28. • 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 ) 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) increase cognitive load teaching tool by
parents reduce ADHD signs in Preschoolers (Halperin, 2012)
• Dovis (2011) study on games to improve working memory
Research on Executive/Thinking Skills and
Video Games

29. What Tech Tools are Used to Teach Attention
and other Skills?
• Working memory training programs- Cogmed
• Neurofeedback/ biofeedback
• 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

30. 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

31. 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

32. 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

33. 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

34. • 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?

35. • 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!!!

36. 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

37. 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

38. 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

39. LearningWorks for Kids Prescription Model

40. • 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

41. • 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

42. Minecraft

43. Building a Home

44. 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

45. Amazing Alex

46. Evernote

47. • 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

48. LiveScribe

49. • 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

50. Cogmed Working Memory training

52. • 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

54. Thank You
• Randy Kulman, Ph.D
• randy@learningworksforkids.com
• @lw4k and @rkulman on Twitter
• www.pinterest.com/lw4k
• www.learningworksforkids.com
• Gary Stoner, Ph.D.
• Gstoner@uri.edu