from snappyapp to screens in the wild: gamifying an attention hyperactivity deficit disorder...
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From SnappyApp to Screens in the Wild: Gamifying an Attention Hyperactivity Deficit Disorder continuous performance test for public engagement and awareness Michael P. Craven, Zoe Young, Lucy Simons, Holger Schnädelbach and Alinda Gillott Interactive Technologies and Games (ITAG) Conference 2014 Health, Disability and Education Dates: Thursday 16 October 2014 - Friday 17 October 2014 Location: The Council House, NG1 2DT, Nottingham, UKTRANSCRIPT
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
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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
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
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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
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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
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
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’
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
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
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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
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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.
Screens in the Wild Network
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Application server
Video link
24/7
Management
Maintenance
CCTV IP Cam
Content Scheduling
www.screensinthewild.org
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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
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
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.
SnappyApp video
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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
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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
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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)
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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
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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
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?
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Dr. Michael Craven, NIHR MindTech Healthcare Technology Co-operative
Senior Research Fellow (Technology), University of Nottingham, United Kingdom
www.mindtech.org.uk
@NIHR_MindTech
Thank you
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