This document discusses the development of an attention-deficit hyperactivity disorder (ADHD) awareness game called "Attention Grabber" and its testing on public screens. The game aimed to educate the public about ADHD through gamification of a continuous performance test used clinically to assess ADHD symptoms. Initial results found over 500 plays across 4 locations, with varying levels of ADHD awareness and knowledge gained depending on the demographic of each location. While engagement with the game and educational film was good, ethical concerns remain around balancing increased awareness and potential health anxiety. Further evaluation is needed on gamifying clinical ADHD assessments for public education.

1. ITAG 2014, Nottingham, 17/10/2013
From SnappyApp to Screens in the Wild: Gamifying an Attention Deficit Hyperactivity Disorder continuous performance test for public engagement and awareness
NIHR MindTech Healthcare Technology Co-operative
Michael Craven, Zoe Young, Lucy Simons, Holger Schnädelbach, Alinda Gillott
University of Nottingham:
Institute of Mental Health
+Faculty of Engineering
+School of Computer Science & IT
Nottinghamshire Healthcare NHS Trust
Intellectual and Developmental Disabilities Service

2. 2
Nottingham MindTech: Mental Health & Dementia
Sheffield: Devices for Dignity
Cambridge: Brain Injury
Bart’s: Gastrointestinal Disease
Guy’s: Cardiovascular Disease
Leeds: Colorectal Therapies
Bradford: Wound Care
Birmingham: Trauma Management
•A catalyst for the development of new technologies
•Focusing on 8 areas of high unmet clinical need
•Working with NHS, service users, academia &industry
NIHR Healthcare Technology Co-operatives

3. Contents
1.Motivations: Public awareness of mental health
2.Attention Deficit Hyperactivity Disorder in Adults
3.Screens in the Wild public screen network
4.SnappyApp – ADHD App
5.Attention Grabber design
6.Initial results
7.Conclusions
3

4. Public awareness of Mental Health
•Motivations
–Address stigma
–Provide information for the public
–Align with MindTech domain interests
–Neurodevelopmental disorders – (Adult) ADHD
–Use new technologies
–Explore gamification
4

5. What is Attention Deficit Hyperactivity Disorder?
•ADHD is a common neurodevelopmental condition
•ADHD affects around 3-5% of the general population
•Approximately two-thirds of children with ADHD will continue to experience symptoms in adulthood (2.5% adult population; Simon et al., 2009)
•Many adults with ADHD have never been formally diagnosed
•Frequent co-morbidities, substance misuse, offending (Xenitidis, Maltezos & Pitts, 2011); wide social & economic impact
•Diagnosis can have a significant positive impact for the individual and help to direct appropriate treatment and support

6. Core Characteristics of ADHD
Inattention
Difficultly concentrating/completing tasks, forgetful, disorganised, easily distracted, unable to listen
Hyperactivity
Fidgety, unable to sit still, talks excessively, always on the go, inner restlessness
Impulsivity
Acting quickly without thinking, interrupting other people, difficulty waiting turn

7. Why is it important to raise public awareness about ADHD in adults?
Despite advancements in research validating the condition, ADHD remains controversial
‘ADHD doesn’t exist’
‘its an excuse for bad behaviour’
‘its an excuse for poor parenting’
‘you grow out of ADHD’
‘its invented by the pharmaceutical industry to sell medication’

8. What are the consequences of this?
•Research has found public uncertainty about the validity of ADHD as a diagnosis and scepticism towards ADHD treatment (Mueller et al, 2012)
•Could need to negative response in disclosing an ADHD diagnosis (isolation)
•Significant implications for access & engagement with appropriate diagnosis and treatment

9. A film about living with ADHD
•Developed with 5 service users from local adult ADHD clinic
•Describe their experiences of living with ADHD as a child and now
•Used in the clinic as post- diagnostic support tool & training resource

10. 10

11. Very few examples of games for public mental health awareness
–Flash game: Talk Out Loud Mental Health Stigma Programme
–Depression Quest: narrative-based adventure game
–Few evaluations of mental awareness campaigns
11
C. Henderson and G. Thornicroft, “Evaluation of the Time to Change programme in England 2008-2011,” British Journal of Psychiatry, vol. 202, suppl. 55, pp. s45-s48, 2013.

12. Screens in the Wild Network
12
Application server
Video link
24/7
Management
Maintenance
CCTV IP Cam
Content Scheduling
www.screensinthewild.org

13. 13
SITW continues during 2014
UoN supports network for 12 months from January 2014
Outreach work:
•Promoting science and scientific outcomes
•Supporting 3rd party non-profit organisations
Commercialisation:
•Sponsored experiences
•Technical test bed for corporations
•Sale of network / copies of the network

14. ADHD Continuous Performance Tests (CPT)
Computer based task widely used to objectively measure attention and impulsivity and response to medication
Requires the detection of low probability targets and inhibit response to non-targets
A-X task highly specific – ADHD and controls
clearly differentiated (van Leeuwen et al., 1998)
Methylphenidate can improve performance on CPT (Klorman et al., 1981)
One CPT (QbTest) includes measurement of motor activity - activity higher in ADHD children and adults and co-varied with cognitive performance (Lis et al., 2010) – QbTest

15. Snappy App
A CPT on a smartphone
Objective measure of attention, impulsivity and activity
Capture of movement data during the test
Early stages of development
Objective
Establish whether a new smartphone application
combining the cued CPT with a physical activity
measure could be appropriate for monitoring
symptoms in a clinical population.

16. SnappyApp video
16

17. 17
→
→
+
Evolution of ‘Attention Grabber’
•Fruit instead of letters
•Simpler ‘test’
•Add score and hi-score
•Encouraging messages
•Include ADHD film
•Share hi-scores
•Player video-streams
•Pose questions

18. 18
Evaluation questionnaire
Question
Rating scale
Q1. Did playing the game make you think about your own attention span?
A lot
Some
A little
Not at All
Q2. How much do you know about ADHD?
A lot
Some
A little
None at All
Q3. How aware are you that ADHD affects adults?
A lot
Some
A little
Not at All
Q4. How much has the film increased your knowledge of ADHD?
A lot
Some
A little
Not at All

19. 19
Initial results
•4 sites (BW, WA, LE, NA)
•Official launch 4th Sept
•520 plays by 1st Oct:
– 156 (BW), 183 (WA), 134 (LE), 47 (NA)
•47% played game until end (answered Q1)
•18% watched film until end (answered Q4)

20. 20
Results (LE)
•Leytonstone Library (LE)
•134 plays
•47(Q1), 47(Q2), 47(Q3), 34(Q4)
Question
Rating scale
Q1. Did playing the game make you think about your own attention span?
A lot
2
Some
3
A little
24
Not at all
18
Q2. How much do you know about ADHD?
A lot
4
Some
15
A little
5
None at all
21
Q3. How aware are you that ADHD affects adults?
A lot
7
Some
0
A little
13
Not at all
25
Q4. How much has the film increased your knowledge of ADHD?
A lot
11
Some
9
A little
12
Not at all
3

21. 21
Results (BW)
•Broadway Cinema (BW)
•156 plays
•71(Q1), 70(Q2), 63(Q3), 58(Q4)
Question
Rating scale
Q1. Did playing the game make you think about your own attention span?
A lot
9
Some
16
A little
29
Not at all
17
Q2. How much do you know about ADHD?
A lot
43
Some
10
A little
13
None at all
4
Q3. How aware are you that ADHD affects adults?
A lot
25
Some
17
A little
7
Not at all
8
Q4. How much has the film increased your knowledge of ADHD?
A lot
39
Some
12
A little
7
Not at all
0

22. Conclusions
•Evidence of good engagement with the game and film
•However, different ADHD awareness at different screen locations – demographics?
•Ethical issues – health anxiety vs. benefits of awareness (e.g. K. A. Robb, A. Miles, J. Campbell, P. Evans, and J. Wardle, “Can cancer risk information raise awareness without increasing anxiety? A randomized trial,” Preventative Medicine, vol. 43, no. 3, pp. 187-190, 2006.)
•Gamifying the original ADHD App?
22

23. Dr. Michael Craven, NIHR MindTech Healthcare Technology Co-operative
Senior Research Fellow (Technology), University of Nottingham, United Kingdom
michael.craven@nottingham.ac.uk
www.mindtech.org.uk
@NIHR_MindTech
Thank you
23