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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→ →

+

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

michael.craven@nottingham.ac.uk

www.mindtech.org.uk

@NIHR_MindTech

Thank you

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