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Playing smarter in the digital world (2)


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A presentation given by LearningWorks for Kids at a 2013 conference.

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Playing smarter in the digital world (2)

  1. 1. Playing Smarter in the Digital World: Games, Apps, Technology, and ADHD Randy Kulman, Ph.D
  2. 2. Disclaimer Randy Kulman is President of LearningWorks for Kids, Inc. and a Cogmed provider.
  3. 3. Take-Aways • Recognition of the extent of children’s involvement with digital media • What are kids with ADHD doing 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
  4. 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, go to Free version, tap free and then download • Android Phone/ Tablets: Go to Google Play, search Angry Birds goto Free version, tap free and then download
  5. 5. Does Technology Help with Learning? • Let us find out! • Take out your cell phones for texting. • Dial the following number: 22333 • Go to New Message line. • You will then respond in the messaging area with a series of codes based upon the following questions.
  6. 6. Poll
  7. 7. Poll
  8. 8. Poll
  9. 9. Poll
  10. 10. It’s Not Just Video Games Anymore • Screen-based technologies or digital-media use are more encompassing terms than video games. • 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.
  11. 11. 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.
  12. 12. (This is not a new question) 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
  13. 13. TV Music Computer Videogames Print Movies
  14. 14. Developmental Trends across Media
  15. 15. 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% Kaiser Study (2010)
  16. 16. Percent of Young People in Each Age Group Who Own a Cell Phone: Kaiser (2010)
  17. 17. How Much Do They Play? • Clinical and anecdotal observations too much! • No evidence of difference concerning frequency or duration of play between ADHD and typicallydeveloping children ages 10 to 12. • Similar enjoyment for the same types of games (Bioulac 2008). • South County Child and Family Consultants Data
  18. 18. Do children with ADHD play video games the same amount as their TD peers? • 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)
  19. 19. LW4K/SCCFC 2011 study of ADHD kids and parents on video game play • (Current sample of 105 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)
  20. 20. 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? •23% no time •46% less than 1 hour •27% 1-5 hours •4% 6+ hours
  21. 21. Children, parents, and video game play Do you play video games with your child? •25% Never •57% Sometimes •14% Often •3% 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
  22. 22. 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 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
  23. 23. How do children with ADHD perform on video games? • Cogmed data and observations on Wisconsin Card Sorting Test (Oznoff) • Persistence is dramatically increased with a computerized task, resulting in success, although • Sometimes requiring longer processing and more effort. • Improved performance on reading tasks (Clarfield and Stoner) • Improved on mathematics (Ota and DuPaul) 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.”
  24. 24. Problematic behavior in video-game play in children with ADHD • 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)
  25. 25. Do Video/Computer Games and Television Impact Attention Span? • • • • 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?
  26. 26. Do Video/Computer 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 slowpaced 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)
  27. 27. 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 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.
  28. 28. 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 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
  29. 29. Why use video games and digital media to help kids with ADHD? Kids with ADHD or Attention Difficulties Video Games and Digital Media May become easily bored and unable to sustain attention Good video games and digital media are often multi modal, requiring ever-changing skills and employing video, sounds, words, and actions that help keep kids interested and engaged. Often require immediate reinforcement or consequence to stay focused on a task. Video games provide clear and immediate feedback, constantly letting the player know what he is doing wrong, and what he is doing right. Often require that their body or mind to be actively engaged. Video games and digital media are extremely engaging and many require physical and cognitive involvement.
  30. 30. Why use video games and digital media to help kids with ADHD? Kids with ADHD or Attention Difficulties Video Games and Digital Media Usually have problems with following directions. Video games teach by trial and error or through guided discovery, requiring that the player understand the instructions in order to succeed. May struggle to learn new information and experience frustration or low self-esteem as a result. Most negative feed back from video games and other digital media occurs privately. This causes less embarrassment and frustration, while teaching the player how to handle these emotions
  31. 31. Why use video games and digital media to help children with ADHD? • • Video game play requires the use of executive functioning skills. 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 management. • Many games specifically tax working memory skills and attentional skills.
  32. 32. Games for practicing executive skills 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
  33. 33. Amazing Alex
  34. 34. 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 )
  35. 35. LearningWorks for Kids 2013 Study On a typical weekend or vacation, about how much time does your child spent with the following technologies and activities: 0 None 1 <30 2 30-60 3 60-120 4 >120 minutes
  36. 36. LearningWorks for Kids 2013 Study 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
  37. 37. LearningWorks for Kids 2013 Study 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?
  38. 38. 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 ) 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
  39. 39. Poll
  40. 40. Poll
  41. 41. Poll
  42. 42. Poll
  43. 43. Research-based Technological Recommendations • • • • • • • 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
  44. 44. Recommendations for Video Games and Technologies for Children with ADHD • 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
  45. 45. What makes a game or app a good teaching tool for children with ADHD? • 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.
  46. 46. Why do children with ADHD not become scholars after playing video games? • 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.
  47. 47. 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
  48. 48. 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
  49. 49. What can we do to make video games a more productive learning experience for children with ADHD? • 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 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
  50. 50. 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.
  51. 51. 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
  52. 52. Angry Birds • 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.
  53. 53. Angry Birds
  54. 54. ANGRY BIRDS • 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.
  55. 55. How Much Should Your Child with ADHD Play Video Games? Age 0 to 24 months 2 to 5 years Amount of Time not at all 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)
  56. 56. Why It Is Difficult to Set Limits on Game Play with Children with ADHD • 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
  57. 57. Strategies for Setting Effective Limits for Children with ADHD • Be firm, consistent, and engaged. • Have different limits on weekends, holidays, and when it serves your purpose • After homework is done • After exercise and vigorous activity • Create a regular time frame for video-game play • Not before bedtime
  58. 58. More Strategies for Setting Effective Limits for Children with ADHD • Use tools such as the screen limits on Kindle Freetime • Have direct control over Internet access via the router or the use of game timers • TV video game timers such as “Bob” that use coins • Provide “learning” game time • Have different limits on weekends, holidays, and when it serves your purpose
  59. 59. What Types of Games and Apps Should a Child with ADHD Use? • • • • 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 • 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 timemanagement skills
  60. 60. How Games and Apps can Help Support- External structure, scaffolding to help self regulation and learning Practice-Guided and regular rehearsal of new skills in an interesting manner Master- Owning the skill , knowing how, when, and where to use it
  61. 61. LiveScribe • 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
  62. 62. LiveScribe
  63. 63. Minecraft
  64. 64. Cogmed Working Memory training • 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 • 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
  65. 65. Cogmed Working Memory training
  66. 66. Wii Sports: Tennis • 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
  67. 67. Wii Sports: Tennis
  68. 68. Thank You Randy Kulman, Ph.D @lw4k on Twitter