1. Prescribing Video Games (not Medication) for ADHD: How to
Make it Work Randy Kulman, Ph.D. [email protected]
@rkulman In Collaboration With Gary Stoner, Ph.D. Ashley Alves Lara
Goodrich, M.A. LearningWorks for kids Games for
Healthwww.learningworksforkids.com June 12-1, 2013 Boston, MA
@lw4k
2. What Im PlayingGardens of Wheres 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 parentsinvolvement with kids video game
playHow many hours per week do you (parents)spend observing or
interacting with your childwhen they play video games? 30% no time
49% less than 1 hour 19% 1-5 hours 2% 10+ hoursDo you play video
games with your child? 56% Sometimes 25% Never 12% Often 3%
Always
9. Concerns and benefits regarding video game playDescribe the
level of concern that you have about yourchilds video game play
leading to video game addiction. 70% Not at all concerned 14%
Mildly concerned 6% Concerned 4% Somewhat concerned 4% Extremely
concernedHow much do you believe that video games can help
yourchild 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 childrens 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
DifficultiesMay 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 feedbackreinforcement or consequence Constantly let
player know what he is to stay focused on a task. doing wrong and
rightOften 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 digitalfrustration 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 SkillsFocus
Task Persistence Sustained attention Task initiationSelf-Awareness
Metacognition Social thinkingSelf-Control Regulation of affect
Response inhibitionWorking
MemoryOrganizationPlanningFlexibilityTime 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 ones room - focus, organization
19. The Importance of Teaching Thinking Skills Preschoolers who
learn EFs 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 gamewithout guidance or purposewill 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. BUTgames 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 childs 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 "Its 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.
[email protected] @rkulman LearningWorks for kids
Games for Healthwww.learningworksforkids.com June 12-1, 2013
Boston, MA @lw4k