ArticlePDF Available

Abstract

In recent years, there has been an increase in the incidence of ADHD in children and adolescents. Many learning and behavioral problems are associated with this disorder as a result of difficulties in cognitive and metacognitive functions. According to Drigas et al. (2021), only when individuals develop these functions can they be integrated in the social environment. Skills such as self-awareness, self-regulation and self-control through inner attention can help children develop alternative strategies to manage their cognitive deficits and adapt in many different environments. With the rapid development of science, several medical and psychological methods have been proposed for the treatment of ADHD, which have contributed significantly to the control of symptoms. In the present work, alternative forms of intervention are investigated, such as video games, with virtual or augmented reality environments that aim to improve the quality of life of these children.
A new decade
for social changes
9 772668 779000
ISSN 2668-7798
www.techniumscience.com
Vol. 28, 2022
Electronic, VR & Augmented Reality Games for Intervention
in ADHD
Aikaterini Doulou, Athanasios Drigas
Net Media Lab Mind - Brain R&D ΙΙΤ - N.C.S.R. "Demokritos", Athens, Greece
katerina.doulou@gmail.com, dr@iit.demokritos.gr
Abstract. In recent years, there has been an increase in the incidence of ADHD in children and
adolescents. Many learning and behavioral problems are associated with this disorder as a result
of difficulties in cognitive and metacognitive functions. According to Drigas et al. (2021), only
when individuals develop these functions can they be integrated in the social environment. Skills
such as self-awareness, self-regulation and self-control through inner attention can help children
develop alternative strategies to manage their cognitive deficits and adapt in many different
environments. With the rapid development of science, several medical and psychological
methods have been proposed for the treatment of ADHD, which have contributed significantly
to the control of symptoms. In the present work, alternative forms of intervention are
investigated, such as video games, with virtual or augmented reality environments that aim to
improve the quality of life of these children.
Keywords. Attention Deficit Hyperactivity Disorder (ADHD), Social/Emotional Development,
ICTs, Metacognition, Video Games, Virtual Reality, Augmented Reality
1. Introduction
According to Drigas & Driga (2019), Attention Deficit Hyperactivity Disorder (ADHD)
is a complex neurological disorder, which still lacks scientific data concerning its nature and
treatment methods. Some factors, such as the family's socioeconomic status, the existence of a
psychiatric disorder in the mother, or smoking and alcohol consumption during pregnancy, have
been proved to play an important role. The main symptoms of ADHD are lack of attention and
impulsivity, resulting from a malfunction in areas of the brain that control executive functions.
These functions, such as memory and attention, lay the foundation for an individual's
organizational skills, their ability to focus on tasks, control of emotions, and the ability to self-
evaluate.
In order to control the symptoms of ADHD, a therapy based on the development of
cognitive and metacognitive skills is required. According to Drigas et al. (2021), cognitive and
metacognitive skills evolve progressively via an individual’s self-awareness of their strengths
and weaknesses, their self-observation, self-regulation, adaptation and flexibility in diverse
areas (cognitive, emotional, and behavioral), recognition, discernment and mindfulness. People
with high social and emotional intelligence are capable of better self-monitoring, a skill that is
necessary to control behavior in children with ADHD (Drigas & Papoutsi 2018). Emotional
159
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
intelligence focuses also on the individual's character and aspects of self-control, such as
regulating impulses, which is one of the predominant difficulties of these children (Matthews
et al., 2004). According to the 9-level model (pyramid) of emotional intelligence of Drigas &
Papoutsi (2018), a person must go through the following stages to reach the highest level of
Emotional Intelligence, which is Emotional Unity:
1) Emotional Stimuli (coding of emotional senses, attention)
2) Emotions’ Recognition, Perception/Expression of Emotions (memory, perception,
recognition, emotions’ identification)
3) Self-knowledge (self-perception, awareness, self-observation)
4) Self-management (self-regulation, flexibility, self-control)
5) Social Awareness, Empathy, Emotion Discernment (awareness, monitoring, social
recognition & flexibility)
6) Social skills, Specialization in Emotions (reflection, management of social problems)
7) Universality of Emotions, Self-actualization (self-perfection, self-completion)
8) Transcendence (self-reflection, transcendental knowledge)
9) Emotional Unity (pure consciousness & fullness)
The seventh level, "self-actualization", is at the top of Maslow's hierarchy of needs. In
order to achieve this condition of becoming, it is necessary to meet needs at lower levels of the
pyramid, such as the need for survival, security, social acceptance, and self-esteem (Maslow
1943, 1987). Only when people with ADHD meet their needs, develop their emotional
intelligence and improve their metacognitive skills will they be able to master the appropriate
cognitive and socio-emotional skills that will allow them to integrate into the social
environment (Drigas & Mitsea 2020; Drigas & Mitsea 2021). Medication is considered a first-
choice treatment to reduce the symptoms. However, it has several disadvantages due to the side
effects caused and the risk of addiction. On the other hand, intervention tools such as new
technologies have proved to be just as effective.
2. 2D Video Games
Hakimirad et al. (2019) investigated the effectiveness of the EmoGalaxy video game on
the social skills of children with ADHD. The concerned study was conducted in two groups
(experiment and control), and the study population included children with ADHD. Specifically,
20 boys aged 7 to 12 years were selected and randomly divided into the experimental group (10
children) and the control group (10 children). The experimental group did fifteen (15) 45-minute
long intervention sessions using EmoGalaxy, while the control group did not receive any
specific intervention. The students' social skills were assessed via the Gresham & Elliot (1990)
Social Skills Assessment Scale before and after the intervention.
In the EmoGalaxy video game the player must travel between four planets. Each planet
refers to one of the primary emotions: happiness, sadness, fear, and anger. In each part of the
planet, the player can play different games. The game is designed to intervene in three areas of
emotional capacity, i.e. emotion recognition, emotion expression, and emotion regulation. For
example, on the "frowning" planet anger-related abilities are being exercised. In order to access
any game, the player has to show and express the feeling of anger. Through the front camera
the game captures the users’ faces and recognizes their emotional expression. If the player
cannot express the right emotion, the game asks him to recognize an angry face among the
characters in the game. In other words, it evaluates a rather basic level of emotional capacity,
i.e. recognition. Players receive a score after completing each game. When a player's score
160
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
reaches a certain level, they collect enough fuel for their spaceship and can travel to the next
planet that corresponds to another emotion (Hakimirad et al., 2019).
EmoGalaxy can be played on Android smartphones and tablets with operating systems
4.4 and above, iPhone 5 or later models, and on PCs. The game is two-dimensional and was
developed through the Unity 5 application. The results showed a significant difference in the
social skills test scores before and after the intervention. EmoGalaxy increased the level of
collaboration by 0.46, assertiveness by 0.59, responsibility by 0.25, and self-control by 0.47.
The overall social skills were affected by 0.73. According to the results of this study,
EmoGalaxy, as a cognitive video game, had a positive effect on all components of social skills
of children with ADHD (Hakimirad et al., 2019).
Prins et al., (2013) developed the game "Braingame Brian" to improve the executive
functions in children with ADHD. "Braingame Brian", named after the main character Brian,
consists of 25 activities lasting 40 to 50 minutes and has seven different worlds: The area around
Brian's parents' house, the village, the uninhabited island, the backlands, the beach, the swamp,
and the basement workshop. All characters that live in these worlds have a problem. Brian helps
them solve these problems by completing cognitive exercises.
An external support system is used to enhance the child's motivation to complete the
training. Data from each training session are sent to a central database. Based on this data,
educators receive online feedback on the child's progress. The study included 40 children
diagnosed with ADHD (8-12 years old) who were divided into two groups, the experimental
group that received intervention through "Braingame Brian" (n = 18) and the control group
which didn’t receive any form of intervention (n = 22). Questionnaires were given to parents
and teachers to assess the difficulties in executive functions, the symptoms of ADHD, and any
disruptive behavior problems, before and after the intervention. The results showed that children
improved significantly their executive functions (Gioia et al., 2000) and ADHD symptoms
(Inattention and Hyperactive-Impulsivity subscale of the Disruptive Behavior Problem Scale)
(Pelham et al., 1992). This pilot study shows much promising evidence on the effectiveness of
this program. However, "Braingame Brian" should not be considered an autonomous form of
treatment but should complement or be integrated in existing ADHD interventions, such as
pharmacotherapy and behavioral therapy, in order to deliver therapeutic results (Prins et al.,
2013). Wrońska et al. (2015) introduced a new interactive game designed to improve reading
and comprehension skills in children with ADHD. The LyC (Lectura y Comprensión) game
was developed for the iPad and is based on techniques used in health-promoting serious games.
That research was conducted in a control group of six children (two boys and four girls) of
typical development and aged 8 to 12 years, who were not diagnosed with ADHD. The game
was developed using an Apple iPad 2 running on iOS 7.2, the XCode 5 programming platform,
and the SQLite and MySQL databases. Its content was based on attention-catching exercises
during reading and image observing, which are available on the website (Programa de
Entrenamiento de Instrucciones Escritas Nivel Medio, 2013). Specifically, the application
consists of nine interactive exercises of different levels of difficulty, and the game includes
three stages. First, the player must read the text that contains critical information. Then, he must
comprehend and process the information. Finally, the player must select the correct answer
among the multiple given answers. The answer is selected by dragging and dropping a button
from the toolbox to the correct image.
The evaluation of the game consists of two parts. First, the evaluation of data that
contain the scores of the children who played the game, and second, the evaluation of the
161
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
system's usability based on the SUS questionnaire. Two parameters were recorded during each
child’s assessment: the time they took to complete each exercise and the overall score of
answers (for every wrong response, the corresponding score was 0). These results were sent to
the SQLite database, which stored them on the device. Immediately after completing the game,
the children were asked to complete the SUS questionnaire to evaluate the game’s usability.
The questionnaire consisted of ten sentences, each of which had to be graded using the Likert
scale that ranges from 1 (strongly disagree) to 5 (strongly agree) (Wrońska et al. 2015).
The outcome showed that the game is user-friendly and easy to complete, as confirmed
by the SUS questionnaire’s score. The study's main findings were that in the first stage of the
game, the participants explored how to play, and the rules were not very clear to them. Also,
age and gender differences were not as significant as the game evolved (Wrońska et al. 2015).
3. Virtual Reality (VR) Games
Yanguas et al. (2021) designed a video game using virtual reality (VR), which included
a gamified chess version called "The Secret Trail of Moon" (TSTM). Chess is a game based on
simple rules but requires a high cognitive level that includes among others attention, executive
functions, and memory (Song et al., 2020; Langner et al., 2019). TSTM aimed to create an
innovative and motivating tool for the cognitive therapy of patients diagnosed with ADHD.
This video game consists of 6 work areas. Each area is designed to improve a different area of
disability in patients with ADHD: attention, working memory, planning, spatial capacity,
impulse control, and reasoning. The video game’s innovative approach is the usage of chess as
a main feature. In TSTM, chess appears in three different forms: A) As a work area, which
consists of chess lessons and exercises B) As a central theme of the work area, where the
elements of the chessboard and its pieces are used for cognitive exercises, not needing however
to know the rules of chess. For example, in the "Smasher" game the player must pay attention
to press the X button on the game controller whenever the "pawn-horse" sequence appears. C)
As part of the video game plot. For example, the player is in a forest with chess elements who
narrate the history of this particular world. During his journey, along with the animals that
accompany him, he will unlock information about the relationship between the forest and chess.
The ultimate test of the video game is to play a game of chess against the enemy.
The initial design of the video game has been revised following a user-oriented model
(Fullerton, 2014). During the usability study, the researchers received feedback from patients
who tried different video game versions. This feedback allowed them to make improvements in
the game's layout, according to the needs and preferences of the patients. The Unity Game
Engine and Sony PlayStation VR were used to develop the video game. The study involved 105
patients diagnosed with ADHD and on regular medication who were randomly divided into 1)
Control team, 2) Online chess therapy team, and 3) TSTM team. All patients and their parents
were assessed before and after the intervention. The training lasted 12 weeks. The central
hypothesis was that the patients trained in TSTM or in online chess would improve their
executive functions compared to the patients who do not participate in any intervention (control
group) (Yanguas et al., 2021).
The results showed that TSTM was fun, understandable, easy to use, and with appealing
graphics, resulting in adequate participation of most players. Also, the patients in the TSTM
intervention group improved their executive functions more and had fewer undesirable
behaviors than those in the online chess intervention group or in the control group (Yanguas et
al., 2021).
162
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
Yang-Kun et al. (2020) used virtual reality games as means of intervention for attention,
abstract reasoning, and complex information processing in children with ADHD. This study
includes two stages: In the first stage, semi-structured interviews were conducted with
psychotherapists and physiotherapists in order to understand the treatment methods for children
with ADHD and to evaluate the difficulties so as to develop guidelines for what games to select.
In the second stage, the virtual reality game console HTC VIVE (HTC, Taiwan) was used to
develop a 3-month, three-times-per-week training program for children with ADHD. The study
involved three children aged 8-12 years, diagnosed with ADHD but without any other illnesses
or disorders and who had not previously received any VR-based training.
During the sessions each child's parents were present in the room but did not participate
in the game. The experiment consisted of three designed games, which focused on exercising
the visual-motor coordination ability of the participants and had different levels of difficulty.
Participants were assessed through four tests, before and after each session: 1) Non-verbal
intelligence assessment (fourth edition) TONI-4 (Mungkhetklang et al. 2016), 2) Attention test
for primary school children (ATESC), a scale developed in Taiwan by Lin and Chou (2010), 3)
Wisconsin Card Classification Test (WCST) (Heaton 1981), 4) The Chinese version of the
revised Swanson, Nolan, and Pelham (SNAP-IV) (Swanson et al. 1992).
Within each 3-week cycle, the difficulty level increased from beginner to advanced. In
the final three weeks, each child decided for himself/herself which game it would play during
the sessions. The researchers compared the children's attention, abstract reasoning, logic, and
complex information processing before and after this program. The results revealed that the
children with ADHD improved their attention span, hyperactivity/impulsivity, and decreased
provocative behaviors. More specifically, in terms of performance regarding intelligence,
cognitive function, and critical thinking, the results of the TONI-4 assessment revealed that
participant A increased his score from 78 to 87, participant B maintained his score of 84, and
participant C achieved the highest progress in his score (from 65 to 83). In total, participants'
scores improved after the experiment. The ATESC results showed that the participants' scores
in the five attention exercises improved particularly after the experiment. One participant
improved his abstract reasoning and information processing, while the other two showed
reduced performance. Participant A made fewer persistence errors, while participants B and C
did not improve their performance in this area (Yang-Kun et al., 2020).
Bland'on Diego et al. (2016) used in their research the virtual reality 3D video game
Harvest Challenge to assess and train attention and self-regulation in children with ADHD.
Attention levels were mapped from 0 to 100 percent, using a Brain-Computer Interface system
(MindWaveBCI) by placing an electrode on the frontal lobe. In addition, EEG signals were
recorded in the state of resting. Neurofeedback therapies and interactive games are
therapeutically ideal; they improve the disorder's symptoms due to the high motivation they
create (Drigas & Bravou, 2012).
Two intervention sessions were performed in a specialized local institution (Instituto de
Audiolog'ıa Integrated-IdeAI) with the participation of nine children aged 5 to 12 years and
diagnosed with ADHD. The 30-minute sessions were divided into two phases, the first lasting
5 minutes and the second lasting 25 minutes. In the first phase, the child listened to soothing
music while being monitored using the MindWave device that recorded their EEG signals
through the OpenViBE open-source software. In the second phase, three different stages of
interaction were developed:
1) Equipment: The game starts with adventure sports in an ecological farm. The first goal
for the player is to collect the equipment needed for a safe ride, which requires an
163
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
increase in attention levels (more than 50%) and following of rules. Players must
effectively choose a helmet, a pair of gloves, a rope, and sneakers through the visual
stimuli they see on the screen.
2) Path repair: The player must reach the top of a mountain to get the rope. For this reason,
a series of wooden stairs were placed on a long path where some disasters occurred.
Therefore, players will need to increase their level of attention to repair the track.
3) Carrot Harvest: At this point players interact with virtual objects. The user is placed in
a big field of carrot harvest and is equipped with a basket to collect as many carrots as
possible, raising and maintaining his/her attention levels until the vegetables are
collected. If players reduce their attention levels, the carrots hide under the ground, thus
not being collectable. The video game ends after time is up (30 minutes) (Bland'on
Diego et al., 2016).
The results showed that by playing the video game Harvest Challenge, the children
improved their performance, which reflects an enhanced ability to maintain continuous
attention and self-regulation (Bland'on Diego et al. 2016). The results also showed a higher
activity in alpha and beta waves that are widely associated with hyperactivity (Lansbergen et
al., 2011).
4. Augmented Reality Games (AR)
Barba et al. (2019) created the program BRAVO (Beyond the tReatment of Attention
loss hyperactiVity disOrder). This virtual and augmented reality environment applies
rehabilitation exercises in the form of serious games for children with ADHD and supports
therapists in managing the rehabilitation program.
The child is the main user of the system. Once the child is in front of the treatment room,
an automatic face recognition procedure activates the system’s authentication process, and the
child meets with his/her personal virtual avatar. The avatar will always be friendly disposed
towards the child's psychological profile so that they always feel welcomed by a familiar face.
In addition to being displayed on a screen at the entrance and exit of the treatment room, the
avatar also accompanies the child during the entire treatment process in the form of a digital
hologram (displayed via Microsoft Hololens) (Barba et al. 2019).
The BRAVO platform collects data via sensors (EEG helmet and bracelet to detect
pressure levels and performance during the game), processes the user's emotional state, and
exchanges data with other system components facilitating game adjustments in real-time. It also
contains a therapist’s toolkit, which can be used to monitor treatment and to obtain suggestions
regarding the game and recommended difficulty levels (Barba et al., 2019).
The BRAVO environment consists of three serious games that will be aiming to enable
compliance with rules and to improve attention, prediction of outcomes of actions and social
skills.
1) Topological Categories: The game is designed to be played via an HTC Vive and a
controller, allowing the user to move in a virtual environment just as they would in a
real one. In the game, users will explore three different environments (a classroom, a
bedroom, and a garden), where they will be asked to complete particular tasks.
2) Infinite Runner: This is an 8-level game, aiming to educate on respecting the rules,
active listening, and awareness of the player's limits. The game will be played using a
Kinect device that allows the game avatar to move simply by using the human body: in
fact, the player's movements are decoded without the need of wearing any additional
equipment. Inside the game, the user is placed in a virtual environment that depicts a
164
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
country or a city street, where he is asked to follow a path while running. As the game
progresses, the player must maneuver in the right directions to avoid various obstacles
or to collect any requested item.
3) Space Travel Trainer: This is a 7-level game with the educational goal of teaching
patients to plan their actions and manage their social relationships. The game is
controlled via the Kinect device, which allows the detection of the player's hands
movements. In the game, the player acts as an astronaut who aims to direct the spaceship
to the planet of his friends. During his/her journey, he/she has to face various challenges:
he/she needs to learn how to solve complex problems, how to make the right decision
at the right time (improving his decision-making skills), but above all, how to interact
with the members of his/her team (in order to defeat the enemy) (Barba at al. 2019).
The final stage of BRAVO will run for 27 weeks to evaluate the benefits. For this
purpose, 60 new patients will participate, divided into the following age groups: 1) 3-6 years,
2) 6-9 years, and 3) 9-12 years. Each age group will be randomly divided into two other equally
sized groups. The first group will serve as a control group undergoing traditional treatment,
while the second will be the test group, receiving the new treatment in the augmented and virtual
game environment. During the administration of treatments both groups will be assessed in
three phases: before, during and after the intervention. In order to assess the real impact of the
BRAVO system, usability and effectiveness tests will be applied (Barba et al., 2019).
Alqithami et al. (2019) aimed to design and simulate a cognitive model that can be used
as an alternative intervention to traditional CBT (Cognitive Behavioral Therapy). This model
takes advantage of current augmented reality developments to engage patients both in real and
virtual game-based environments. Augmented reality combines real and three-dimensional
virtual content through an interactive environment (Azuma, 1997). Compared to virtual reality
that portrays the real world in 3D graphics on a computer screen (Burdea & Coiffet, 2003),
augmented reality optimizes interactions with 3D objects in a real environment (Billinghurst et
al., 2015).
The augmented reality game of Alqithami et al. (2019) was designed using the
Microsoft-HoloLens emulator and the Unity application, and was tested in a case study. This
game simulates two 3D balls: one is the target ball, while the other is not. The player must
follow the instructions and hit the target ball in a specified time period to be counted as
successful hit. If he fails doing so, his attempt will be added to the sum of unsuccessful hits as
an omission or error. The child may play several rounds of the game during one therapy session.
The number of rounds played depends on their performance during the game and their overall
skill level. Each game consists of 10 one-minute trials. In each trial the "target" and "non-target"
balls will appear to the child. During the trial the child will be directed to catch the target ball
so to drop it during the trial interval. The time elapsed from the beginning of the trial to hitting
the target is the response time. If the response time decreases, this indicates that the child's
performance has improved. If the child is not able to catch any of the balls, this omission error
may indicate inattention. If the child catches the non-target ball, this error indicates impulsivity
(Alqithami et al., 2019).
This study was divided into two parts. The first part, examined the effect of successful
and unsuccessful attempts on the performance index, while the second part assessed the effect
of the child's involvement. The results showed an improvement in the child's attention to select
the desired object, which added positively to his performance index. Alqithami et al. (2019)
argue that through augmented reality games, every child can develop traits such as adaptability,
smartness, responsiveness, and accuracy. They also consider that using AR environments is
165
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
more appropriate than VR environments, as it allows children to observe their current position
while a game is introduced in their space.
Avila et al. (2018) aimed to improve attention in children with ADHD using Augmented
Reality Serious Games (ARSG). Through a prototype game called ATHYNOS, they tried to
emphasize the therapeutic benefits of using an AR environment. The purpose of ATHYNOS is
to develop cognitive skills such as visual-motor coordination, feedback, interactivity, problem-
solving, and selective and focused attention. Unity 3D in combination with Software
Development Kit (SDK) and Vuforia Engine was used to develop the game. Regarding the
game’s graphics, Adobe Illustrator was used to develop the images (characters, scenes, scripts,
and environments), Adobe After Effects for animation, and Adobe Premiere Pro for
professional video editing. Finally, listening tools such as Ableton Live and Adobe Audition
were used to create a music sequence.
At the beginning of the game, the therapist explains the procedure. Then, in order to
start the game, each child must log on via one of the six avatars. After that, a main menu of
scenes appears, containing two types of treatments (Missing Character, and Shape and Match)
with three levels of difficulty, depending on the child's abilities. Shape and Match, for example,
contains basic arithmetic operations, geometric shapes, sequences, and mathematical reasoning.
The aim for the child is to match objects on the left side of a scene with those on the right and
move them together to the center of the screen. In the end, the results are displayed (Avila et
al., 2018).
The research was conducted with 11 children with ADHD (9 boys and 2 girls), aged
between 7-10 years. There were 8 sessions per participant. In each session, the time for
completing the activities was recorded. The descriptive statistical analysis that followed
confirmed that the participants who played ATHYNOS during the eight sessions managed to
improve significantly their time management and social skills in their daily life. The findings
showed also that the players’ attention meliorated, improving in turn their ability to handle
frustration and reducing significantly the time needed to complete the game. It was also
observed that the children’s times and successes were homogeneous in both cases, thus showing
that all the children had similar abilities. Avila et al. (2018) argue that this game promotes
voluntary participation and requires a constant interest in problem-solving, contributing this
way to the improvement of learning. In addition, according to the therapist's feedback, almost
all children showed a great interest and motivation, a fact that made him feel highly satisfied.
5. Discussion
Playing a video game requires using executive, organizational and metacognitive skills.
The most important utilized skills during games are memory and attention skills (Kulman,
2010). There is an interrelationship between memory and attention when performing a task.
Their role is crucial to the cognitive functions of individuals with ADHD, since the higher the
working memory level is, the longer is the attention span. Children with ADHD are more likely
to have working memory deficits. (Angelopoulou & Drigas, 2021). Serious games, creating
virtual and augmented reality (AR) environments through the use of new technologies, are ready
to play a significant role in therapeutic interventions, especially in treating ADHD symptoms.
In their study on the effects of hypnosis via virtual reality on children with disabilities, Drigas
& Mitsea (2021) concluded that virtual reality (VR) environments could eliminate the
symptoms of inattention, distraction, and hyperactivity. Furthermore, VR environments make
participants' reactions faster and more accurate, cultivate many aspects of executive functions,
and enhance emotional regulation.
166
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
Because children with ADHD get bored quickly, it is essential to attract their attention
on a continuous basis. Video games make this possible because they require the child to remain
focused and busy the entire time, and furthermore having all senses alert, which makes these
games even more interesting for the user (Kulman, 2010). The findings of the present
bibliographic research conclude that serious games with the use of ICTs have a positive effect
on all components of social skills in children with ADHD (Hakimirad et al., 2019). Children
improve significantly their executive functions and ADHD symptoms (Prins et al., 2013) and
also exhibit less adverse behaviors (Yanguas et al., 2021). Furthermore, the research of Yang-
Kun et al. (2020) revealed that through serious games children with ADHD improve their
performance in attention, hyperactivity/impulsivity, critical thinking, abstract reasoning, and
information processing.
Alqithami et al. (2019) argue that, through games in augmented reality environments,
every child can develop traits such as adaptability, smartness, responsiveness, and accuracy.
They assert also that AR environments are more appropriate than VR environments, as they
allow children to be aware of their current position while a game is being introduced in their
space. Participants who played their program improved significantly their time management
and social skills in their daily lives, and improved also their attention, their ability to handle
frustration, and reduced notably their time for completing gaming activities.
The discussion around the causes of ADHD and corresponding rehabilitation methods
is a reflection of the fluidity of our knowledge in these areas. Further research is needed to
develop alternative therapies with the use of serious games in virtual and augmented reality
environments, to improve these children's cognitive and metacognitive skills and enable them
to integrate into the social environment.
References
[1] Alqithami Saad, Alzahrani Musaad, Alzahrani Abdulkareem & Ahmed Mustafa (2019).
AR-Therapist: Design and Simulation of an AR-Game Environment as a CBT for Patients with
ADHD. Healthcare, 7, 146, doi:10.3390/healthcare7040146
[2] Avila-Pesantez Diego, Vaca-Cardenas Leticia, Rivera Luis A., Aguayo Stteffano & Zuñiga
Lourdes (2018). Towards the Improvement of ADHD Children throughAugmented Reality
Serious Games: Preliminary Results. Conference: Global Engineering Education Conference
(EDUCON). DOI:10.1109/EDUCON.2018.8363318
[3] Azuma, R.T. (1997). A Survey of Augmented Reality. Presence: Teleoperators Virtual
Environ., 6, 355385. doi:10.1162/pres.1997.6.4.355.
[4] Barba Maria Cristina , Covino Attilio , De Luca Valerio , De Paolis Lucio Tommaso ,
D’Errico Giovanni , Di Bitonto Pierpaolo , Di Gestore Simona , Magliaro Serena , Nunnari
Fabrizio , Paladini Giovanna Ilenia , Potenza Ada & Schena Annamaria (2019). BRAVO: A
Gaming Environment for the Treatment of ADHD. International Conference on Augmented
Reality, Virtual Reality and Computer Graphics, pp 394-407.
[5] Bashiri A., Ghazisaeedi M., Shahmoradi L. (2017). The opportunities of virtual reality in
the rehabilitation of children with attention deficit hyperactivity disorder: A literature review.
Korean J. Pediatr., 60, 337 343.
[6] Billinghurst M., Clark A. & Lee G. (2015) A Survey of Augmented Reality. Found. Trends
Hum. Comput. Interact., 8, 73272.
[7] Bland´on Diego Zamora, Munoz John Edison, Lopez David Sebastian & Gallo Oscar Henao
(2016). Influence of a BCI neurofeedback videogame in children with ADHD. Quantifying the
167
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
brain activity through an EEG signal processing dedicated toolbox. Conference: IEEE 11th
Colombian Computing Conference (CCC). DOI:10.1109/ColumbianCC.2016.7750788
[8] Burdea, G.C. & Coiffet, P. (2003) Virtual Reality Technology. John Wiley & Sons.
[9] Colombo V., Baldassini D., Mottura S., Sacco M., Crepaldi M., Antonietti A. (2017).
Antonyms: A serious game for enhancing inhibition mechanisms in children with Attention
Deficit/Hyperactivity Disorder (ADHD). In Proceedings of the International Conference on
Virtual Rehabilitation (ICVR), Montreal, QC, Canada, 19 22 June, pp. 12.
[10] Drigas, A. S. & Papoutsi C. (2018). A New Layered Model on Emotional Intelligence.
Behav Sci (Basel), 8(5): 45. doi: 10.3390/bs8050045.
[11] Drigas, A.S., Driga, M. A. (2019). ADHD in the Early Years: Pre-Natal and Early Causes
and Alternative Ways of Dealing. International Journal of Emerging Technologies in Learning
(iJET). 15(13):95-102, 2019. DOI: 10.3991/ijoe.v15i13.11203
[12] Drigas, A.S., Mitsea, E. (2020). The 8 Pillars of Metacognition. International Journal of
Emerging Technologies in Learning (iJET). Vol.15, n.21, p.162-178.
DOI: 10.3991/ijet.v15i21.14907
[13] Drigas A. S. & Mitsea E. (2021). Metacognition, Stress Relaxation Balance & Related
Hormones. International Journal of Recent Contributions from Engineering Science & IT
(iJES), 9(1):4-15. DOI: 10.3991/ijes.v9i1.19623
[14] Drigas A. S. & Mitsea E. (2021). 8 Pillars X 8 Layers Model of Metacognition Educational
Strategies, Exercises &Trainings. International Journal of Online and Biomedical Engineering
(iJOE), 17(8):115-134. DOI: 10.3991/ijoe.v17i08.23563
[15] Drigas Athanasios & Bravou Vasiliki (2021). BCI-based games and ADHD. Research
Society and Development 10(4):1-6, DOI:10.33448/rsd-v10i4.13942
[16] Drigas Athanasios, Angelopoulou Effrosyni & Karabatzaki Zoi (2021). Assessing working
memory in general education students for ADHD detection. Research Society and
Development, 10(10):e138101018766, DOI:10.33448/rsd-v10i10.18766
[17] Drigas Athanasios, Mitsea Eleni & Skianis Charalabos (2021). The Role of Clinical
Hypnosis & VR in Special Education. International Journal of Recent Contributions from
Engineering Science & IT (iJES) 9(4):4-17, DOI:10.3991/ijes.v9i4.26147
[18] Fullerton T. (2014). Game Design Workshop, 3rd Edition: A Playcentric Approach to
Creating Innovative Games.AK Peters/CRC Press.
[19] Gioia G.A., Isquith P.K., Guy S.C., Kenworthy L. (2000) Behavior rating inventory of
executive functions. Child Neuropsychol, 6:235238.
[20] Gresham F. M and Elliott S. N. (1990). Social Skills Rating System Manual. Circle Pines,
MN: American Guidance Services. Inc. Publishers building.
[21] Hakimirad Elham, Kashani-Vahid Leila, Hosseini Marzieh Sadat & Moradi Hadi (2019)
in IEEE Conference on International Serious Games Symposium (ISGS), Tehran, Iran, 26-26
Dec. 2019.
[22] Heaton RK (1981) Wisconsin card sorting test manual. Psychological Assessment
Resource Inc, Odessa
[23] Kulman, I., Stoner, G., Ruffolo, L., Marshall, S., Slater, J., Dyl, A., and Cheng, A. (2010).
Teaching executive functions, self-management, and values through popular video-game play.
In Schrier, K. and Gibson, D. (Eds), Designing games for ethics: Models, techniques and
frameworks. Hershey PA: IGI Global.
[24] Langner R., Eickhoff S.B. & Bilalić M. (2019). A network view on brain regions involved
in experts’ object and pattern recognition: Implications for the neural mechanisms of skilled
visual perception. Brain Cogn., 131:74-86.
168
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
[25] Lansbergen M. M., Arns M., Van Dongen-Boomsma M., D. & Buitelaar J. K. (2011). The
increase in theta/beta ratio on resting-state eeg in boys with attention-decit/hyperactivity
disorder is mediated by slow alpha peak frequency. Progress in Neuro-Psychopharmacology
and Biological Psychiatry, vol. 35, no. 1, pp. 4752.
[26] Lin HY, Chou TJ (2010) The development of attention test for elementary school children.
Bull Spec Educ 35(2):2953
[27] Marzocchi G.M., Re A.M., Cornoldi C. (2010). BIA Batteria Italiana per l’ADHID per la
Valutazione dei Bambini con Deficit di Attenzione-Iperattività. Con DVD e CD-ROM,
Edizioni Erickson: Trento, Italy.
[28] Maslow, A. H. (1987). Motivation and personality (3rd ed.). Boston, MA: Addison-Wesley
[29] Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50, 370
396.
[30] Mungkhetklang C, Crewther SG, Bavin EL et al (2016) Comparison of measures of ability
in adolescents with intellectual disability. Front Psychol 7:683
[31] Pelham W.E., Gnagny E.M., Greenslade K.E., Milich R. (1992). Teacher ratings of DSM-
III-R symptoms for disruptive behaviour disorder. J Am Acad Child Adolesc Psychiatry, 31:
210218.
[32] Prins Pier J.M., Ten Brink, Esther, Dovis Sebastiaan, Ponsioen Albert, Geurts Hilde M.,
Vries Marieke, and Van der Oord Saskia (2013). ‘‘Braingame Brian’’: Toward an Executive
Function Training Program with Game Elements for Children with ADHD and Cognitive
Control Problems. GAMES FOR HEALTH JOURNAL: Research, Development, and Clinical
Applications, Volume 2, Number 1, DOI: 10.1089/g4h.2013.0004
[33] Programa de Entrenamiento de Instrucciones Escritas Nivel Medio, 2013. Available
online: http://www.orientacionandujar.es/2013/05/23/programa-de-entrenamiento-de-
intruccionesescritasnivel-medio/ (accessed on 20 May 2014).
[34] Song L., Peng Q., Liu S. & Wang J. (2020). Changed hub and functional connectivity
patterns of the posterior fusiform gyrus in chess experts. Brain Imaging Behav., 14(3):797805.
[35] Swanson JM, Nolan W, Pelham WE (1992) School-based assessment and interventions for
ADD students. K. C. Publishing, Irvine
[36] Thurstone L. & Yela (2012). CARAS-R-Percepción de diferencias [FACES-Perception of
differences]. Madrid: TEA Ediciones.
[37] Van der Oord S., Ponsioen A.J.G.B., Geurts H.M., et al. (2012) A pilot study of the efficacy
of a computerized EF remediation training with game elements for children with ADHD in an
outpatient setting: Outcome on parent- and teacher-rated executive functioning and ADHD
behavior. J Atten Disord, [Epub ahead of print]. doi: 10.1177/ 1087054712453167.
[38] Wrońska Natalia , Zapirain Begoña García, Mendez-Zorrilla Amaia (2015). An iPad-Based
Tool for Improving the Skills of Children with Attention Deficit Disorder. International Journal
of Environmental Research and Public Health 12(6):6261-6280,
DOI:10.3390/ijerph120606261
[39] Yang-Kun Ou, Yu-Lin Wang, Hua-Cheng Chang, Shih-Yin Yen, Yu-Hua Zheng,
Bih-O. Lee (2020). Development of virtual reality rehabilitation games for children
with attention-deficit hyperactivity disorder. Journal of Ambient Intelligence and Humanized
Computing, 11:57135720, https://doi.org/10.1007/s12652-020-01945-9
[40] Yanguas Rodrigo, M., Moratinos Martin, M., Tardon Gonzalez, C., Fontecilla Blasco, H.
(2021). A Virtual Reality Game (The Secret Trail of Moon) for Treating Attention-
Deficit/Hyperactivity Disorder: Development and Usability Study. JMIR Serious Games;
9(3):e26824, doi:10.2196/26824
169
Technium Social Sciences Journal
Vol. 28, 159-169, February, 2022
ISSN: 2668-7798
www.techniumscience.com
... When completing a task, memory and attention are combined Karyotaki, 2019;Galitskaya;Kefalis et al., 2020;Kulman et al., 2010). Longer attention spans are crucial for the cognitive functioning of people with ADHD because they are associated with higher levels of working memory (Angelopoulou et al., 2021;Doulou;. ...
... Thanks to VR settings made possible by new technology, serious games are set to play a big part in treatments, particularly in the monitoring and treatment of ADHD symptoms (Doulou;. According to 13 affects youngsters with disabilities. ...
Article
Full-text available
According to recent data, many communities worldwide are multicultural nowadays. Culture is believed to significantly impact the creation of therapy materials, practice models, assessment instruments, and client collaboration. Also, recent works address the interaction between a therapist and a client and the need to understand a child's social needs. Even with significant advancements in the development and delivery of efficient treatments for children with ADHD, ethnic minority youths and teens continue to lag behind their non-minority peers in terms of diagnosis and treatment rates. Various learning and behavioral obstacles are linked to this disorder because of cognitive and metacognitive functioning difficulties. Individuals can only fully integrate into society if these functions have been acquired. Children can acquire alternate strategies to manage their cognitive deficits and adapt to different circumstances by using internal attention to build self-awareness, self-regulation, and self-control. The quick progress of research has led to the development of several medicinal and psychological strategies for treating ADHD, which significantly help with symptom management. The goal of the current study is to gain an understanding of the various therapeutic approaches used to help children from racial and ethnic minorities who are suffering from ADHD. These approaches include games using augmented reality (AR) environments.
... Introducing this paragraph, we emphasize the significance of all digital technologies in the field of education and in ADHD training, which is highly effective and productive and facilitates and improves assessment, intervention, and educational procedures via mobile devices that bring educational activities everywhere [55][56][57][58], various ICTs applications that are the main supporters of education [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73], and AI, STEM, Games and ROBOTICS that raise educational procedures to new performance levers [74][75][76][77][78][79][80][81][82]. Additionally, the development and integration of ICTs with theories and models of metacognition, mindfulness, meditation, and the cultivation of emotional intelligence , accelerates and improves more the educational practices and results, especially in children with ADHD, treating domain and its practices. ...
Article
Full-text available
Students with learning disabilities are a heterogeneous group and exhibit particularities in the areas of perception, language, memory, attention and concentration, metacognition, self-regulation, motivation, behavior, social skills and emotional development. It is therefore important to identify these difficulties as early as possible, so that students can be helped in time by adapting teaching to their own needs. New technologies, already promising in a variety of fields, seem to be able to be used for the necessary differentiation of teaching, materials and assessment of students with learning difficulties such as dyslexia and ADHD.
... Concluding, we emphasize the significance of all digital technologies in the field of education and in DOWN syndrome training, which is highly effective and productive, facilitates and improves assessment, intervention, and educational procedures via mobile devices that bring educational activities everywhere [51][52][53][54], various ICTs applications that are the main supporters of education , and AI, STEM, GAMES, and ROBOTICS that raise educational procedures to new performance levers [78][79][80][81][82][83][84][85][86]. Additionally, the development and integration of ICTs with theories and models of metacognition, mindfulness, meditation, and the cultivation of emotional intelligence , accelerates and improves more the educational practices and results, especially in children with DOWN syndrome, treating domain and its practices like assessment and intervention. ...
Article
Full-text available
In the case of special education and specifically the education of people with mental disabilities and down syndrome, the presence of attractive tools and methodologies in the learning process is a basic request. Educational goals for students with intellectual disabilities and down syndrome may differ from educational goals and methods in formal education settings. At the same time, for each person with intellectual disability and down syndrome, a personalized training method is required according to their needs and capabilities. Despite the differences, the main goal remains the improvement of adaptability and autonomy, through the cultivation of the maximum potential of the individual. Digital gaming is a key and important means of achieving these goals.
... In the case of individuals with depression and anxiety, cognitive deficits are often observed in areas such as attention, memory, executive functions, and decision-making. 51 NRT interventions aim to address these deficits by engaging individuals in a variety of exercises and activities specifically designed to target these cognitive areas 40 as shown in Figure 2. For example, memory exercises may include tasks that improve working memory and recall, while attentional control may be enhanced through activities focused on sustained attention and cognitive flexibility. ...
Article
Full-text available
Depression and anxiety are pervasive mental health issues, affecting millions globally and often accompanied by cognitive impairments with significant repercussions in daily life and professions, particularly in safety-critical roles like community-living pilots. This exploration assesses Neurocognitive Remediation Therapy (NRT) as an innovative solution for addressing cognitive deficits linked to depression and anxiety in these pilots. Theoretical underpinnings of NRT draw from cognitive rehabilitation, neuropsychology, and neuroplasticity principles. Depression and anxiety often manifest as cognitive deficits, impacting attention, memory, executive functions, and decision-making. NRT interventions aim to address these impairments by enhancing cognitive flexibility, attentional control, and memory through training exercises and cognitive restructuring, empowering individuals to regain cognitive functionality and adaptability. Empirical evidence supports NRT’s efficacy in enhancing cognitive functioning, showing significant improvements in attention, memory, and executive functions. This review focuses on NRT’s potential to improve cognition in community pilots, demonstrating its effectiveness in reducing cognitive deficits and enhancing job performance, even in high-pressure environments like aviation. The practical implications of NRT for pilots are profound. Tailored programs can address specific cognitive challenges, such as maintaining vigilance and decision-making under stress. Integrating NRT into training regimens enhances skill sets and mental resilience, contributing to safety and success. Additionally, NRT positively impacts emotional well-being, reducing stress and improving overall quality of life. In Conclusion, NRT emerges as a promising intervention for enhancing cognitive functioning in community-living pilots with depression and anxiety. Evidence suggests its potential to improve performance, job satisfaction, and overall well-being. Further research and implementation are crucial to fully realize its benefits and ensure pilots’ safety and success.
... By connecting this relationship responsibly, entrepreneurs can play a role (Markwick,2018) (Li & als,2022). Finally we have to underline the important role of Ai, Robotics and Games in the education procedure in order to support sensitive social groups, to foster their personal growth, as well as their participation in the economic procedures and local development [28][29][30][31][32][33][34][35] ...
Article
Full-text available
The period of the Italian Occupation was an important chapter in the traditions and cultural heritage of the Dodecanese, as it led to the development of a particular culture. The effects of this period are still felt today. This paper briefly studies Italian architecture in the Dodecanese and, specifically, in Kos during the Italian occupation (1912-1943). Reference is made to the main monuments/buildings of the period and their use then and now. The aim of this paper is to highlight the cultural heritage of the Italians on the island of Kos and to examine the possibilities of its exploitation in the context of cultural entrepreneurship.
... Acting as a facilitator, ICTs nowadays enhance and foster educational procedures and practices in every domain of education, as well as in literature understanding and film promotion. Social media and Network applications, Mobile applications and Games, [35][36][37][38][39][40][41] speedup the distribution of knowledge globally through improving education, and even more enhance the literature availability and films promotion, fostering the penetration for literature and film knowledge into the global citizens. ...
Article
Full-text available
The aim of this study is to investigate the various dimensions of the phenomenon, modern, film tourism and its contribution to the local development of cities with the arrival of cinema tourists. For the needs of the study, a quantitative survey was carried out in the form of questionnaires, which were distributed in cinemas and in a central metro station in the Athens area.
... In conclusion, we emphasize the importance of all digital technologies in the field of culture, education, and training. These technologies are highly effective and productive in facilitating and improving assessment, intervention, and educational-cultural procedures through mobile devices that bring educational-cultural activities anywhere [22][23][24][25], various ICT applications that are the main supporters of culture and education , and AI, STEM, and ROBOTICS [48][49][50][51][52][53][54][55] that raise educational procedures and culture to new performance levels. In addition, the development and integration of ICTs with theories and models of metacognition, mindfulness, meditation, and the development of emotional intelligence , accelerates and improves educational-cultural practices and results. ...
Article
Full-text available
This paper deals with the position and role played by wine in the case of an important text of ancient Greek literature, the Odyssey. Reading the Homeric epic reveals its importance, as it is revealed by the multitude of references to wine in the work. Through the detailed description of the various verses and episodes, the multiple roles of wine in the epic are demonstrated. With the methodology of text analysis, it is proven that wine is a daily habit of the life of the lords, either at meals or at special moments, considering it an important asset. It also played an important role in the religious life of that time, both because mortals offered it to the gods, and because the latter treated it as they saw fit. Also, the familiarity with wine becomes evident from its use as a means, either to achieve one's goal, or to advance the plot.
... Last but not least, we emphasize the significance of digital technologies in the educational domain and math comprehension, which are very productive and successful, and how they facilitate and improve assessment, intervention, and educational procedures via mobile devices that bring educational activities everywhere [37][38][39][40], various ICTs applications that are the main supporters of education [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56], and AI, STEM, Games and ROBOTICS that raise educational procedures to new performance levers [57][58][59][60][61][62][63][64]. Additionally, ICTs are being improved and combined with theories and models for cultivating emotional intelligence, mindfulness, and metacognition , accelerates and improves more the educational practices and results, especially in children with Math problems, treating domain and its practices like assessment and intervention. ...
Article
Full-text available
In the current study, we dealt with Dyscalculia, Mathematics Anxiety and Low Intelligence Quotient as factors that contribute to low performance in Mathematics. We investigated the relative effect of Dyscalculia and Mathematics Anxiety on students' performance. Also, we examined how technology helps the educational intervention in cases of Low Intelligence Quotient. We first present the main characteristics of the three factors and we continue with studies which indicate the way they affect performance in Mathematics. Through the current study we found that Mathematics Anxiety affects more negatively the students' performance than Dyscalculia does, as Mathematics Anxiety is a broader psychosocial factor that is more difficult to locate and handle. With regards to Low Intelligence Quotient, we concluded that those people can best be educated through technology and specifically through applications that support learning basic Mathematic skills.
Article
Full-text available
The educational area of primary education is faced with most issues and problems due to the linguistic, religious, and cultural diversity of students, which is constantly growing numerically. Suddenly, elementary schools have become places where students speak different languages with each other, bring different cultures and cultural elements due to their various countries of origin, and have special educational needs. Regardless of what the reasons are for a newly formed multicultural social reality, education as an essential institution of society in global, European, and local contexts is called upon to think about and find appropriate solutions, to initiate and implement actions to update itself, to change the educational philosophy, the general principles, its targeting by subject, the methodological-educational/teaching approaches, the educational material, printed and digital, and accordingly to train its teachers. The heterogeneity of the student population in terms of language, religion, or ethnicity is an indisputable fact for educational systems. During the educational process, we teachers are called to educate our students equally and equally, regardless of their country of origin and any of their differences, and this constitutes the pedagogical contract of morals and universal values for us. The goal of the current study is to gain an understanding of terms such as "identity," "stereotypes," and "prejudices," as well as therapeutic approaches used to help children from racial and ethnic minorities who are suffering from ADHD. These approaches include games using Computers.
Article
Full-text available
The Aim of this Article is to propose an innovative system that combines augmented reality technology with actor training methodologies to enhance actors' skills, emotional depth, and adaptability. By integrating immersive experiences, real-time feedback, and interactive simulations, this approach aims to revolutionize the field of actor education in the evolving landscape of performing arts. AR technology can transform actor education by providing immersive experiences, immediate feedback, and interactive simulations. Augmented reality (AR) technology superimposes virtual information onto the physical environment, creating a dynamic and immersive experience. It enables prompt assessment of performance, augmenting capabilities and tactics. Augmented reality (AR) interactive simulations can improve actor training by fully engaging performers in intricate situations, promoting flexibility and profound emotional expression. The conventional techniques employed in actor training are constrained by various factors, including the absence of fully immersive experiences, constraints on time and financial resources, and the absence of prompt feedback. Integrating augmented reality (AR) and virtual reality (VR) technologies into actor training enhances the training experience by introducing greater dynamism and variety, enhancing overall performance. This novel method of actor education provides fresh prospects for enhancing skills and performance.
Article
Full-text available
Clinical hypnosis is becoming increasingly recognized as a valuable clinical intervention for a wide range of psychological and medical problems. The current review paper seeks to determine the role of clinical hypnosis in learning difficulties, emotional or behavioral problems and physical disabilities. In addition, we co-examine the effectiveness of virtual/augmented reality hypnosis. Finally, we discuss the possible uses of clinical hypnosis within the educational settings. The results showed that hypnosis may hold the keys for new types of metacognitive strategies based on non-verbal pathways of effortless self-regulation. We are on the eve of a new philosophy in special education, open to groundbreaking intervention strategies that recognize the fundamental role of subconsciousness in the treatment of learning and other disabilities. Clinical hypnosis seems to be a promising strategy with high potential to be applied in the educational settings.
Article
Full-text available
Metacognition is one of the foremost cardinal factors of achievement in the 21st century. Despite extensive research, there is still the need to build a unique model based on multidisciplinary research illuminating questions as regards the real nature of metacognition and the methods to develop metacognitive abilities. The current study presents a new layered model of metacognition based on well-established theories derived from cognitive science, psychology, physical and computer sciences, environmental and other sciences, even from philosophy. We describe in detail the cognitive and metacognitive processes involved at each layer, while particular emphasis is placed on the relation between the control processes as well as the special role of attention. According to our model, each layer of metacognition describes a higher-order control system which operates under the rule of a series of attention processes at an ever more refined, abstract and united level. The same applies to the cognitive processes and abilities such as attention , memory, perception, pattern recognition. At each higher level, they display more advanced attributes and functions responding to the necessity of creating more abstract mental representations and upper class motivations, thoughts and emotions. In addition, we recommend a number of strategies that support the metacognitive development at each level of the hierarchy. The multi-layered model of metacognition targets at enriching our understanding of how metacogni-tion evolves and it has the potential to guide the development of more effective strategies in educational system. 1 Introduction Many researchers have attempted to develop theories and models of metacognition. Flavell [1] recognized that metacognition consisted of both monitoring and regulating aspects. He proposed a model of metacognitive monitoring which includes the following components: metacognitive knowledge, metacognitive experiences, tasks or goals and strategies.
Article
Full-text available
The involvement of deficient working memory in ADHD symptomatology has attracted intense research interest and has been scientifically substantiated. This fact provided an impetus for this study, which aims to investigate the role of working memory assessment in detecting ADHD elements in general education students in classroom settings. Therefore, 67 classroom teachers rated 130 Greek general education primary school students on the Greek-WMRS. The research findings indicated statistically significant differences in the overall score of the Greek-WMRS and in the separate score of its 20 descriptions of classroom behaviors between children clinically diagnosed with ADHD and those without. In conclusion, students’ working memory assessment in classroom settings can significantly contribute to detection of ADHD behaviors so that such classroom behaviors to be extensively assessed for an effective diagnosis.
Article
Full-text available
Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition characterized by cognitive task difficulty, impulsivity, hyperactivity and loss of attention. It can persist into adulthood with negative academic and socio-professional outcomes. Neurofeedback treatments have been shown as effective for training the attention ability in children with ADHD. It has been found that interactive multi-player games are ideal from a therapeutic and long-term usage point of view due to their higher social motivation and cooperation among children with ADHD. In this study we conducted a semi-systematic review, with the goal of gathering findings from empirical and theoretical works in order to deepen our understanding about the use of Brain Computer Interface (BCI)-based for children and adults with ADHD, as a method to ameliorate the symptoms of their disorder.
Article
Full-text available
This paper examines the interaction between metacognition and stress response. Specifically, the main purpose of this study is to trace the interaction between metacognition, sympathetic-parasympathetic nervous system and the basic stress-related hormones/neurotransmitters. To achieve this aim, the research seeks to address the following questions: Can metacognition regulate the stress-related hormones and the sympathetic nervous system hyperactiv-ity? How can it contribute to the regulation of uncontrollable stress? What is the role of executive functions? Can metacognition stop the cells and neurons from degeneration and the brain from shrinking? The evidence support the hypothesis that there is a deep relationship between metacognition, stress-related hormones and autonomic nervous system. Therefore, the above finding paves the way for the design of new stress management strategies, which could implemented in family, in school and in workplace. Uncontrollable stress constitutes the "health epidemic" of our century. Mental and mood disorders, premature ageing, cogni-tive impairments, learning disabilities are some of the stress-related threats. There is an urgent need to focus on resilience in order to cope with stress and to stay in balance.
Article
Full-text available
Metacognition constitutes the dominant competence of the 21st century. Despite the indisputable scientific interest, there are various unan-swered questions concerning the identity of metacognition, its fundamental mechanisms and its limits. In this study, a holistic and multidisciplinary approach is attempted by collecting and utilizing data from sciences such as cog-nitive psychology and neuropsychology, and philosophy. The research has led us to the 8 pillars that underpin metacognition. These pillars follow the model of the hierarchical organization of knowledge. According to this approach, cog-nitive and metacognitive skills evolve progressively depending on the effort an individual exerts. It is worth noting that some cognitive functions such as attention and working memory seem to surpass the rest, since they operate simultaneously as cognitive and metacognitive abilities, affecting the functioning of the pillars, other cognitive functions, and in particular the higher mental abilities. Among the conclusions of greatest importance, we can cite that the metacogni-tion pillars are, like reality itself, a field of multiple readings. They contribute to the proper functioning of the cognitive and psychophysiological mechanism, the melioration of intelligence in all fields (physical, intellectual, emotional and spiritual), the emergence of consciousness and self-knowledge. In practical terms, the pillars of metacognition are the most valuable tool of self-learning, self-development, self-treatment and self-knowledge. Metacognition, also, constitutes a key factor in effective leadership, in medical and health professions. Lastly, the pillars of metacognition should be the cornerstone of general, special , vocational and academic education so as to promote holistic learning.
Article
Full-text available
Balance and coordination exercises improve the attention of children with attention-deficit hyperactivity disorder (ADHD), and exercise-based game treatments are effective in training children’s balance control and coordination and improving their cognition and intelligence. This study used immersive virtual reality exercise games as an intervention in rehabilitation to improve the attention, cognitive ability, abstract reasoning, and complex information processing of children with ADHD. This study is comprised of two stages: In the first stage, we interviewed experts in rehabilitation, made observations of rehabilitation sessions for children with ADHD, and developed three games focusing on training body coordination. In the second stage, we used the HTC VIVE (HTC, Taiwan), a virtual reality game console, in a 3-month training program developed for children with ADHD. We compared children’s attention, cognitive ability, abstract reasoning, and complex information processing before and after this program. The results revealed that children with ADHD improved their performance in attention, hyperactivity/impulsivity, and oppositional defiance. Our results may serve as a reference for the clinical use of technological assistive devices in rehabilitation as well as for families, schools, and rehabilitation institutes in implementing daily training and rehabilitation programs for children with ADHD.
Article
Full-text available
Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurological disorder with a lack of an official scientific understanding of its genetic nature and the potential causes. However, there are practical research data that points to certain directions. In this paper, we examine the possible external causes of the disorder and specifically ones whose influence is related to pregnancy and (early) childhood years. Children born prematurely and/or with low birth weight are at high risk of developing ADHD. Maternal smoking, alcohol consumption and psychological disorders during pregnancy were proven to play a part as well. Some special social and economic situations raised the risk of appearance in the minors experiencing them. Electronics are a factor of distraction to children and were found to exacerbate symptoms. Most importantly , parenting choices can be determinant for a child with the disorder. A solution often proposed for symptoms of this nature is medication. Nonetheless, there were many defects and risks found within the psychostimulants used for the disorder. Alternative treatments are proposed before reaching for medication , two very effective ones being brain training and meditation.
Article
Full-text available
The hubs of the brain network play a key role in integrating and transferring information between different functional modules. However, the effects of long-term practice on functional network hubs in chess experts are largely undefined. Here, we investigated whether alterations of hubs can be detected in chess experts using resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory methods. We first mapped the whole-brain voxel-wise functional connectivity and calculated the functional connectivity strength (FCS) map in each of the 28 chess players and 27 gender- and age-matched healthy novice players. Whole-brain resting-state functional connectivity analyses for the changed hub areas were conducted to further elucidate the corresponding changes of functional connectivity patterns in chess players. The hub analysis revealed increased FCS in the right posterior fusiform gyrus of the chess players, which was supported by analyses of this area’s regional homogeneity (ReHo), amplitude of low frequency fluctuations (ALFF), and fractional amplitude of low frequency fluctuations (fALFF). The following functional connectivity analyses revealed increased functional connectivities between the right posterior fusiform gyrus and the visuospatial attention and motor networks in chess players. These findings demonstrate that cognitive expertise has a positive influence on the functions of the brain regions associated with the chess expertise and that increased functional connections might in turn facilitate within and between networks communication for expert behavior to get superior performance.
Article
Skilled visual object and pattern recognition form the basis of many everyday behaviours. The game of chess has often been used as a model case for studying how long-term experience aides in perceiving objects and their spatio-functional interrelations. Earlier research revealed two brain regions, posterior middle temporal gyrus (pMTG) and collateral sulcus (CoS), to be linked to chess experts’ superior object and pattern recognition, respectively. Here we elucidated the brain networks these two expertise-related regions are embedded in, employing resting-state functional connectivity analysis and meta-analytic connectivity modelling with the BrainMap database. pMTG was preferentially connected with dorsal visual stream areas and a parieto-prefrontal network for action planning, while CoS was preferentially connected with posterior medial cortex and hippocampus, linked to scene perception, perspective-taking and navigation. Functional profiling using BrainMap meta-data revealed that pMTG was linked to semantic processing as well as inhibition and attention, while CoS was linked to face and shape perception as well as passive viewing. Our findings suggest that pMTG subserves skilled object recognition by mediating the link between object identity and object affordances, while CoS subserves skilled pattern recognition by linking the position of individual objects with typical spatio-functional layouts of their environment stored in memory.