Games and Apps for Improving Executive Functions in Children with ADHDPresentation at CHADD 2013 Annual International Conference on ADHD

Randy Kulman, Ph.D.President, Learning Works for Kids

Disclaimer

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

Take-Aways• Brief review of Executive Functions (EFs) / Thinking

Skills• Why EFs are crucial, particularly to kids with ADHD• How EFs are used in video games and apps• Why we want to use technology to teach EFs for

ADHD• How games and apps can support, practice, and

help acquire EFs• Why games and apps are not enough• How to transfer game –based skills to real world

activities

Finding Angry Birds• 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 go to Free version, tap free and then download

What are Executive Functions?

• Cognitive capacities that enable independent, purposeful, goal-directed behavior

• The CEO or the conductor of the brain

• A collection of brain processes that guide thought and behavior

• Located primarily in the prefrontal cortex but involving other neural networks

Executive Functions Development

• Infancy; when a child can keep an object in mind while playing hide-and-seek

• Preschoolers; learning to inhibit behavior such as not touching a hot stove and developing basic social skills

• Adolescence; learning to develop planning, emotional regulation, and organizational skills

• EFs develop slowly in many psychiatric disorders, and in particular ADHD

• Teens, Tweens need EF “support”, scaffolding

Evernote

Evernote

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

Dawson and Guare Model of Executive/Thinking Skills

Focus Task PersistenceSustained attentionTask initiation

Self-Awareness MetacognitionSocial thinking

Self-Control Regulation of affectResponse inhibition

Working MemoryOrganizationPlanningFlexibilityTime Management

The Importance of Teaching Thinking and Executive Skills

• Preschoolers who learn EF’s perform better academically (Diamond, McClelland)

• Improving working memory enhances reading, reduces ADHD symptoms (Cogmed research)

• Self Control enhances future life success (Marshmallow test)

• Protects children from mental health issues

Executive/Thinking Skills in Daily Life

• Assembling a toy - planning and organization, focus

• Cleaning one’s room - focus, organization• Getting ready for school

in the morning: planning, time management

• Completing chores: focus, time management, working memory

Executive/Thinking Skills in School

• Doing homework - organization, planning, focus, time management

• Phonological awareness - working memory• Written language:

organization, focus, planning

• Math word problems: working memory, focus, planning

Train Your Brain for Success

Research on Thinking/Executive Skills and Video Games

• Games (non video) that increase cognitive load and used as a teaching tool by parents reduce ADHD symptoms in Preschoolers (Halperin, 2012)

• Combination of board and video games improve fluid reasoning and processing speed (Mackey, 2011)

• Working memory video games improve WM, fluid reasoning skills (Cogmed studies)

• Computer-based training improves executive attention in preschoolers (Rueda, 2005)

• LW4K pilot study

Research based technologies to improve executive skills

• Improves processing speed and time management (Green and Bevalier, 2009)

• Improves working memory (Klingberg, et al, 2007)

• Increases pro-social behaviors (Gentile et al, 2009)  

• Improves problem solving skills (Gee, 2007)• Enhances social involvement (Ferguson, 2010)

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

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.

Play Diet• Social Play, Active Play, Creative Play, and

Free Play.• Digital Play is just one part of a balanced

Play Diet.• Neglecting digital play is just

as bad as allowing too much digital play.

• Digital Play can be active, social, creative, and free.

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

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

How do games, apps, and digital media improve executive functions?

• Great variation in how they may or may not help, similar to physical exercise

• Effectiveness is determined in part by level of stimulation and engagement

• Support—provides external structure to help regulate or scaffold skills

• Practice—guided rehearsals in repeatedly using a new executive skill

• Master—the child “owns the skill” and is motivated and knowledgeable about where and when to apply it

How do digital technologies teach executive functions?

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

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• 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

Effective teaching with digital technologies:

• Goals need to be explicit and shared• "It's not about the game.”• Finding other teaching opportunities for

developing executive skills• Limiting video game-play• Getting peers, siblings, or other family

members involved• Noticing and reinforcing improvements in the

use of executive skills

Conditions in which “Brain Training” or Technology Work Effectively

(From the Sharpbrains Guide to Brain Fitness, assumes direct connection of brain training to skills)

• Training exercises core brain-based capacity• Training connects to real-life outcomes such as

executive functions or working memory• Training targets an area of weakness• Dosage is important, with a minimum of 15 hours

performed over 8 weeks or less• Intensity is important, as training must be adapted

to performance and requires increasing effort• Continued practice is necessary to see continued

benefits

Executive Skills Questionnaire

Prescription of Games, Technologies, and Recommendations

Quizzes and Assessments

Advice for Parents

Where’s My Water?

Where’s My Water?

Planning in Where’s My Water?

Planning skills are used when the player:•assesses the level.•thinks out steps before moving water.•considers different options for reaching the goal.•decides on a course of action.•carries out a course of action based on a predetermined plan.

Planning in LifePlanning skills are used when a child:•reads directions prior to starting a task.•determines the steps necessary to complete complex math problems.•engages in pre-writing tasks such as brainstorming, outlining, and using graphic organizers.•decides which materials to pack in a backpack.•prioritizes homework and extracurricular tasks.

Thank You

Randy Kulman, Ph.Drandy@learningworksforkids.com

@lw4k on Twitterwww.pinterest.com/lw4k

www.learningworksforkids.com