Playing Smarter in the Digital World:Games, Apps, Technology, and ADHD

Randy Kulman, Ph.D

Disclaimer

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

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

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

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.

Poll

Poll

Poll

Poll

It’s 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.

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.

(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, televisionTVs on 6 hours per day in homes

• 1980s: Cable, video game consoles, portable music players, computers, VCRsElementary schools kids watch 2.3 hours TV per

day

• 2010s: Internet, cell/ smart phones, DVRs, Tablets, handheld video games

TV Music Computer Videogames Print Movies

Developmental Trends across Media

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)

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

Kaiser (2010)

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)

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)

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

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

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

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.”

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)

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?

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)

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.

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

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.

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

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 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

Amazing Alex

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)

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

360-120

4>120 minutes

0None

230-60

1<30

LearningWorks for Kids 2013 Study

Time spent with technology on a typical weekend or vacationMean = 306.92, SD = 116.64Time spent with non-technological activities on a typical weekend or vacationMean = 228.31, SD = 96.87

LearningWorks for Kids 2013 StudyParenting 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?

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

Poll

Poll

Poll

Poll

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

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

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.

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.

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

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

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

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.

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

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.

Angry Birds

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.

How Much Should Your Child with ADHD Play Video Games?

Age Amount of Time

0 to 24 months not at all2 to 5 years 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)

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

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

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

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 time-management skills

How Games and Apps can Help

Practice-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

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

LiveScribe

Minecraft

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

Cogmed Working Memory training

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

Wii Sports: Tennis

Thank You

Randy Kulman, Ph.Drandy@learningworksforkids.com

@lw4k on Twitterwww.pinterest.com/lw4k

www.learningworksforkids.com