1. The Use and Impact of VideoGames and Digital Media for Children with ADHD Randy Kulman, Ph.D. Gary Stoner, Ph. D.CHADD annual conference 2012 LearningWorks for kids www.learningworksforkids.com @lw4k

2. Presenter Information and DisclosureRandy Kulman, Ph.D. commercial interests: President, Majority Stockholder, LearningWorks for Kids, Inc. Cogmed Working Memory providerGary Stoner, Ph. D. Research Consultant LearningWorks for Kids Professor, Dept. of Psychology, University of Rhode Island

3. Overview What do we know about children with ADHD and video games? Why use video games and digital media to help children with ADHD? What are the characteristics of interventions proven to work with children with ADHD? Why do children with ADHD not become scholars after playing video games? What can we do to make video games a more productive learning tool for children with ADHD?

4. Consider the Following Questions: How much time do children with ADHD spend playing video games, per day? Adolescents with ADHD? In what ways might video games and digital media be helpful for children with ADHD? What are the characteristics of video games and digital media that may facilitate learning in children with ADHD? My child with ADHD plays video games; why is s/he not earning all As in school? How can video games become more effective learning tools for children with ADHD?

5. 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

6. 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

7. 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

8. 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.

9. 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?

10. 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)

11. LWK 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)

12. *Children, parents, and video game playHow many hours a week does your child spendplaying video games? 34% Less than 1 hour per 32% 2-4 hours 20% 5-7 hours 13% 8+ hoursHow many hours per week do you spendobserving or interacting with your child when theyplay video games? 27% no time 39% less than 1 hour 31% 1-5 hours 3% 6+ hours

13. Children, parents, and video game play Do you play video games with your child? 32% Never 55% Sometimes 10% Often 2% 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

14. **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 attention skills.

15. 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

16. 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

17. 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, movement, and multiple intervention agents Individualized to childs capacities Above list are all basic video game mechanics Strategic teaching principles including: previewing, setting explicit goals, partnering, metacognition, generalization strategies- The LW4K approach

18. **My child with ADHD plays video games; why is s/he not earning all As in school? 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.

19. 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) that increase cognitive load and used as a teaching tool by parents reduce ADHD symptoms in Preschoolers (Halperin, 2012)

20. 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

21. 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 Video games are like soccer, checkers, card games and can and should be used as a teaching tool by parents and educators

22. What can we do to make video games a moreproductive 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

23. Executive Skills Questionnaire

24. Prescription of Games, Technologies, and Recommendations

25. Gardens of Time PlayBook

26. Gardens of Time: Video PlayBook

27. myHomework for ADHD

28. Advice for Parents

29. Quizzes and Assessments

30. 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.

31. 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

32. Thank You! Randy Kulman, Ph.D. randy@learningworksforkids.com @rkulman Gary Stoner, Ph.D. gstoner@uri.edu LearningWorks for kidswww.learningworksforkids.com @lw4k