PowerPoint Presentation

A Clinicians Primer to Video Game and Digital media use in ChildrenRandy Kulman, Ph.DJeff Brusini, LMHC, JD

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DisclaimerRandy Kulman is President of LearningWorks for Kids, Inc. and a Cogmed provider.

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Take-AwaysWhat do clinicians need to know about the extent of childrens involvement with digital mediaWhat are kids with emotional and learning concerns doing with digital mediaUnderstanding the research on the impact of games, apps, technology on kids with emotional and learning concerns Concerns and cautions about digital media What makes digital media so powerful for kids with ADHDWhy clinicians need to understand and embrace technology in their workCybertherapy- cannedStrategies for tools and diagnoses

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Recognize their own sensibilities

Take a balanced but realistic view

Learn about their child's involvement with digital media

Understand the research on violence, cyber bullying, addiction, learning, and 21st century skills

Understand appropriate games for children, ESRB ratings, and the need for supervision

Do not make parents feel guilty for occasional use of technology as a babysitter

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Finding Angry Birds and Amazing AlexHow 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 downloadAndroid Phone/ Tablets: Go to Google Play, search Angry Birds goto Free version, tap free and then download

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Does Technology Help with Learning?Let us find out!Take out your cell phones for texting.Dial the following number: 22333Go to New Message line. You will then respond in the messaging area with a series of codes based upon the following questions.

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Poll

According to the Kaiser Foundation, the average child between the ages of 8 and 18 spends how many hours a day with digital media?

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Poll

What was the best-selling video game of 2012?

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Poll

What types of video games have been linked to improving reading fluency and speed of processing?

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Poll

What types of video games have been linked to improving reading fluency and speed of processing?

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Its Not Just Video Games Anymore

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.

Screen-based technologies or digital-media use are more encompassing terms than video games.

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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.

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(This is not a new question)Media Use Across Decades1930s: Movies, print, radio. Children 9-12; 2-3 hours per day listening to radio1960s: Movies, print, radio, televisionTVs on 6 hours per day in homes1980s: Cable, video game consoles, portable music players, computers, VCRsElementary schools kids watch 2.3 hours TV per day2010s: Internet, cell/ smart phones, DVRs, Tablets, handheld video games

ALWAYS CONNECTED REPORT COONEY FOUNDATION 2011More Choices, More Time on Media........More Information, More Access, More Opportunities for learning and Inappropriate materialsMore Mobile (2010 20% of media consumption on mobile devices), More on-Demand (25 minutes less regularly scheduled TV programming, You tube, Hulu) , More for Younger Children, More Social Connections, More and faster Internet access

TV Music Computer Videogames Print Movies

Total Media Use: 7 hours 38 minutes per day for 8-18 year oldsMultitasking proportion: 29%o f the time they are using 2 media at a time, much of it while watching TVTotal Media Exposure: 10:45 per dayLess reading of newspapers magazines, same amount of time for book .....More time with media, lower grades , less personal contentment, especially for heavy users (16 hours per day!) vs Moderate and Light users

From Kaiser (2010) reportTV increase mostly from watching on mobile or DVR, on demand

Developmental Trends across Media

Does not include telephone calls or textingDevelopmental changes, teens less TV, more musicBig jump for tweens, early teens

Percentage of 8-18 Year Olds Who Own Each Item:Among All8-1011-1415-18Ipod/mp3 player76%61%80%83%Cell phone66%31%69%85%Handheld video game player59%65%69%41%Laptop29%17%27%38%Portable CD/tape player16%9%16%20%

Kaiser Study (2010)

Data taken from p. 10 of report in case you need to reference it IS THERE A DIGITAL DVIDE?You better own a cell phone if you are a teenWho needs a portable CD player anymoreHomes 99% TV, 93% computers 87% Video game console, 84% Internet Access

Percent of Young People in Each Age Group Who Own a Cell Phone:

Kaiser (2010)

Light blue 2004 studyDark Blue 2010 study (data collected 2009)Newer data, shows even higher figures for young childrenPew internet 2013 TEENS- 78% own cell 37% own smartphone

What do we know about kids with clinical issues and technologyADD data

How Much Do They Play?

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

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)

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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 gamesAlso asks them to describe their concerns and hopes for benefits of video games and other digital mediaDigital media use of ADHD kids- Most time television, video games, music (different from what is seen in national studies of typically developing kids)

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Children, parents, and video game playHow many hours a week does your child spend playing video games?34% Less than 1 hour per 32% 2-4 hours20% 5-7 hours13% 8+ hours

How many hours per week do you spend observing or interacting with your child when they play video games?23% no time46% less than 1 hour27% 1-5 hours4% 6+ hours

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Children, parents, and video game playDo you play video games with your child?25% Never57% Sometimes14% Often3% Always

How much do you believe that video games can help your child with problem solving?34% Somewhat25% Quite a bit19% A little bit13% A great deal8% Not at all

Parents who reported themselves as more active participants in their childs video game play reported a greater belief that video games could help their child with planning, time management, understanding themselves/others, and overall performance in school.

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

Lawrence 2004 Study indicated that children with ADHD completed fewer challenges in a video game and had fewer items named correctly on the STROOP Color-Word Test. Results: There were no group differences in executive function on the Stroop or zoo tasks, but the ADHD group exhibited deficits in set-shifting as assessed by the WCST (perseverative errors and responses) and videogame play (fewer challenges completed).Also, the ADHD group showed slowed processing speed on the Stroop (slower color naming) and zoo activity (longer time to complete task), as well as a slower rate of acquisition of the sorting rule on the WCST (more trials to complete first category).

A second study that used Crash Bandicoot and Frogger investigated inhibitory performance of children with ADHD, and no difference was found between ADHD and typically- developing children (Shaw 2005).

Comparing computer as opposed to analog technologies on neuropsychological testing -compared typically-developing children with atypically-developing children on theWisconsin Card Sorting Test computerized version versus deck of cards, and there was a smaller difference on the computerized version (Oznoff 1995).26

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, althoughSometimes 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.

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Problematic behavior in video-game play in children with ADHDMore 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 oppositionalismMore 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)

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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 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?

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 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)

Does a fast-paced video game (or for that matter movie, lifestyle, or presentation) make others less engaging in comparision. Does something need to be going on all the time. Look at kids and adults who are always checking their phone, looking for the next thing to do, easily bored

Merzenich also argues that time spent playing games takes away from other school, social , and outdoor related activities that also offer cognitive gains.

Gentile suggests that video game attention to the periphery is counterproductive to focusing on only one thing.

CautionsSolutionsChildren 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 wont 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.

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What are the characteristics of interventions that work best with children With ADHD?Point of performance interventionsImmediacy of feedbackPowerful and engaging feedback and meaningful consequencesMultimodal presentations and multiple intervention agentsIndividualized to childs capacitiesStrategic teaching principles including: previewing, setting explicit goals, partnering, metacognition, and generalization strategies

General strategies that work with ADHD childrensomething to do, to be able to move, to be able to talk , or to be able to fidget when concentrating

Research on ADHD and vigorous exercise (Verret et al 2010, Ratey in Spark)what about exergames as a tool for increasing focusing skillsBest (2011) Exergaming immediately enhance EFs

Why use video games and digital media to help kids with ADHD?Kids with ADHD or Attention DifficultiesVideo Games and Digital Media

May become easily bored and unable to sustain attentionGood 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.

Why use video games and digital media to help kids with ADHD?Kids with ADHD or Attention DifficultiesVideo 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

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.

Games for practicing executive skillsAmazing Alex Physics-based puzzle game where players create chain reactions using everyday itemsSkills of planning, flexibility, and focusForesight and working memory in order to succeedAttention to detail is important in order to obtain perfect score across many levels

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Amazing Alex

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LearningWorks for Kids 2013 StudyHow 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)

ActivityMeanSD1. Playing video games1.59, N = 641.872. Doing homework5.89, N = 642.243. Having a conversation with you or other4.14, N = 642.164. Doing chores5.51, N = 642.425. Watching TV2.32, N = 641.966. Reading3.67, N = 642.347. Playing with Legos or blocks2.23, N = 622.128. Playing with action figures/dolls2.30, N = 632.169. Playing on the Internet/computer1.94, N = 641.76

LearningWorks for Kids 2013 StudyOn a typical weekend or vacation, about how much time does your child spent with the following technologies and activities:

360-1204>120 minutes

0None230-601

The average child between the ages of 8 and 18 spends how many hours a day with digital media?

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Poll

The best-selling video game of 2012 was?

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Poll

Which statement is the most accurate about video-game play?

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Poll

Which video game genre has been linked to improving reading fluency and speed of processing?

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Research-based Technological Recommendations

Cogmed Working Memory TrainingAction video games for improving selective attention (Green and Bevalier)DDR and Improved reading Headsprout and ADHD kidsComputer -based math programs and ADHDOther studies, eg Interactive metronome, Play Attention, Brain Train Products, Lumosity, Posit Sciences BrainHQLWK research on EFS

Recommendations for Video Games and Technologies for Children with ADHDApps and Video Games made for ADHDTend to be psychoeducational or simply not funSelect technologies based upon a childs individual needsEngagement which increases attention and persistence to the task is importantTechnologies with near transfer or direct connections to a skill are bestPractice, intensity, and limitations are important

Give examples of psychoeducational games-

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.

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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.

Simple, rhetorical questionIf kids with ADHD are so into games and they are so good for teaching, why do they still have ADHD?Lots of kids play gamesLots 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.

How well do game based skills transfer to the real world?Game play alone results in modest improvements in real-world executive skillsChildren with learning and attention problems have problems in generalizing strategiesKids like to talk about playing video games and may be willing to learn from thatGames prompt partnering and motivation to learn executive skillsPractice and rehearsal of executive skills

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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 skillsActual learning requires knowledge of the skill, understanding how and when to use it, and practice across many situations

Games as a teaching tool,

Building metacognition and generalization into processTargeting skills individuallyHot vs. cold Efs, games seem to be better for cognitive than self control skills ( eg planning, cognitive flexibility, organization, time management, task initiationthan regulation of affect, response inhibition)

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 improveTeach skills and then practice them in game and technology playTalk about gameplay and skills, metacognitive approaches

Build generalization strategies, practice skills outside of the gameConsider duration and intensity of game play to practice skillsMediated learning, including parents, psychologists, educators, and peers

The LearningWorks for Kids model:Games as a vehicle for "engaging the gears" of a child's brainOpportunities for children to practice an executive skill in a fun and engaging fashionA teaching opportunity for parents, teachers, and cliniciansAn opportunity to detect, reflect, and connect on the use of executive skillsA "new literacy," an understanding of ways of doing, thinking, and valuing things in the context of relationships and school practices (James Paul Gee)

Play TogetherTalk 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.

Mediation, metacognition, goal setting, FUN!

Make it WorkExplain 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

Far transfer and metacognitionPractice across settingsExpand the skill sets to other similar skills

Angry BirdsBirds 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.

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Angry Birds

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ANGRY BIRDSBirds 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.

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How Much Should Your Child with ADHD Play Video Games?AgeAmount of Time

0 to 24 monthsnot at all2 to 5 years30 to 60 minutes a day (joint media engagement the rule)6 to 9 years30 to 60 minutes a day (parents select games)10 to 13 years30 to 60 minutes a day (parents monitor game selection)14 years old older30 to 90 minutes a day (emphasize social gaming)

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Why It Is Difficult to Set Limits on Game Play with Children with ADHDConcerns regarding time management and time blindnessDifficulty with shifting and transitions from one activity to anotherTendency to become overly focused on video-game play

Oppositional tendencies seen with children with ADHDChilds sense of success and reward in playing video gamesParents sense of peace and reduction of conflict

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Strategies for Setting Effective Limits for Children with ADHDBe firm, consistent, and engaged.Have different limits on weekends, holidays, and when it serves your purpose

After homework is doneAfter exercise and vigorous activityCreate a regular time frame for video-game playNot before bedtime

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More Strategies for Setting Effective Limits for Children with ADHDUse tools such as the screen limits on Kindle FreetimeHave direct control over Internet access via the router or the use of game timersTV video game timers such as Bob that use coinsProvide learning game timeHave different limits on weekends, holidays, and when it serves your purpose

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What Types of Games and Apps Should a Child with ADHD Use?Developmentally rather than chronologically age-appropriateGenres rather than specific gamesActive games, the more active and vigorous movement the betterPuzzle games- Help with time management and focus

Working-memory games, both formal training and casual gamesPlanning games that require setting long- and short-term goalsApps that help with organizational and time-management skills

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How Games and Apps can HelpPractice-Guided and regular rehearsal of new skills in an interesting mannerMaster- Owning the skill , knowing how, when, and where to use it

Support- External structure, scaffolding to help self regulation and learning

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LiveScribeA smartpen that records voice notes that is connected to written notesChild takes notes on digitally-equipped paper and when going over those notes can listen toRecordings of lecturesHelps with children who struggle with working memoryVery helpful for children who process information or have slow clerical motor speed

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LiveScribe

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Minecraft

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Cogmed Working Memory training Research-based, clinically-proven computer program to improve working-memory capacities ofTargeted regimented exercisesDemonstrated to promote structural changes in the brain based upon principles of neuroplasticity

50+ peer review studies - demonstrated to improve reading, math, and sustained attentionGeneralization is improved by using additional tools and strategies in conjunction with Cogmed

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Cogmed Working Memory training

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Wii Sports: TennisPlayers use tennis rackets and can get vigorous exerciseSelf-control and flexibility required while playing the gamePrimarily the game is good for children with ADHD, as it promotes vigorous exercise using complex body movements when done properly

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Wii Sports: Tennis

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Thank You

Randy Kulman, Ph.Drandy@learningworksforkids.com@lw4k on Twitterwww.pinterest.com/lw4kwww.learningworksforkids.com

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