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Does Computerized Working Memory Training with Game Elements Enhance Motivation and Training Efficacy in Children with ADHD?
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This study examined the benefits of adding game elements to standard computerized working memory (WM) training. Specifically, it examined whether game elements would enhance motivation and training performance of children with ADHD, and whether it would improve training efficacy. A total of 51 children with ADHD aged between 7 and 12 years were randomly assigned to WM training in a gaming format or to regular WM training that was not in a gaming format. Both groups completed three weekly sessions of WM training. Children using the game version of the WM training showed greater motivation (i.e., more time training), better training performance (i.e., more sequences reproduced and fewer errors), and better WM (i.e., higher scores on a WM task) at post-training than children using the regular WM training. Results are discussed in terms of executive functions and reinforcement models of ADHD. It is concluded that WM training with game elements significantly improves the motivation, training performance, and working memory of children with ADHD. The findings of this study are encouraging and may have wide-reaching practical implications in terms of the role of game elements in the design and implementation of new intervention efforts for children with ADHD.
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... Recent studies have reported that motivational variables can influence the effects of cognitive training, acting as important predictors. In this context, incorporating game elements into training tasks effectively addresses modulating variables related to motivation, such as willingness and predisposition to participate in training sessions [10,65,66,67,68,69,70,71,72,73]. ...
... Specifically, Prins et al. [68] and Ninaus et al. [72] explored the effects of gamified working memory training versus standard working memory training, reporting that the game -based protocol led to benefits in performance and training motivation [68], as well as near transfer effects to untrained working memory skills [68,72]. Similarly, Dorrenbacher et al. [75] implemented a gamified stimulation program focused on task switching, reporting gains in motivation to participate in the intervention as well as improvements in untrained switching tasks compared to standard training. ...
... Specifically, Prins et al. [68] and Ninaus et al. [72] explored the effects of gamified working memory training versus standard working memory training, reporting that the game -based protocol led to benefits in performance and training motivation [68], as well as near transfer effects to untrained working memory skills [68,72]. Similarly, Dorrenbacher et al. [75] implemented a gamified stimulation program focused on task switching, reporting gains in motivation to participate in the intervention as well as improvements in untrained switching tasks compared to standard training. ...
Numerous studies explore the effect of cognitive stimulation programmes on reading skills in children and adolescents, with mixed results. Although several studies support that the relationships established between executive functions and reading skills are more robust at early ages, when the process of formal reading acquisition is being consolidated, there are few studies that evaluate the impact of this type of interventions at the beginning of primary school. For this reason, the present pilot study investigates the possible effects of executive functions training on letter identification and decoding, as well as word and pseudoword reading. A cognitive training was carried out using the CogniFit platform in 12 typically developing 6-year-old children, comparing their performance with a control group of 28 children of the same age and similar socioeconomic status. This protocol took place over 8 weeks, with a mean of 19 minutes of training per week. The results obtained indicate that the experimental group showed a higher reading speed in letter recognition than the control group. However, no effect was found in the rest of the reading skills. These promising results indicate that additional research is needed to clarify the lack of convergence reported in the current scientific literature.
... All of the studies cited above included game elements in computerized cognitive trainings. Game-based computerized CTs have found significant results in WM tasks [24,25]. Moreover, these studies have found more improvements in WM CTs with game elements than in the same CTs without them. ...
... As in previous studies [87], future studies should not only include neuropsychological tasks, but also behavioural rating scales to assess transfer to everyday behaviours. Additionally, in future studies it would be advisable to assess other variables associated to cognition (i.e., physical activity [88]), to mathematical skills (i.e., time spent on homework [89]) or to trainings based on games (i.e., motivation versus board games or time spent playing [25]). ...
Citation: Estrada-Plana, V.; Martínez-Escribano, A.; Ros-Morente, A.; Mayoral, M.; Castro-Quintas, A.; Vita-Barrull, N.; Terés-Lleida, N.; March-Llanes, J.; Badia-Bafalluy, A.; Moya-Higueras, J. Benefits of Playing at School: Filler Board Games Improve Visuospatial Memory and Mathematical Skills. Brain Sci. 2024, 14, 642. https://doi.org/10.3390/ brainsci14070642 Academic Editors: Bart Roelands and Špela Bogataj These authors contributed equally to this work. Abstract: The aim of the study was to test the effectiveness of cognitive interventions based on modern board games in school settings to improve memory outcomes and math skills. A parallel, quasi-experimental study was carried out with children (n = 234) into third and fourth grades (8-10 years old). School centres were allocated into a general domain intervention (playing memory board games), a specific domain intervention (playing mathematical board games) or a control group (regular classes without playing). Teachers carried out biweekly sessions during the last 30 min of mathematical lessons (8 weeks, 15 sessions). Before and after intervention, we individually measured verbal and visuospatial memory outcomes (short-term memory and working memory updating) and mathematical skills (number operations, number ranking, number production and problem solving). The results showed significant transfer effects of both memory and math trainings. In third grade, we found that playing math games showed medium-large effect sizes in visuospatial short-term memory and updating memory, number operations and number ranking compared to the control group. In fourth grade, we found that playing memory games showed significant small effect sizes in problem solving compared to the control group. Playing board games could be a methodology that enhances cognitive and mathematical development in children.
... These serious games offer activities aimed at enhancing attention, memory, spatial skills, processing speed, problem-solving, and more. They engage participants more to overcome their difficulties because they (i) offer more interactive experiences 28,29 (ii) provide positive reinforcement such as praise or encouragement 30,31 , (ii) allow participants to mitigate the impact of their difficulties and access literacy remediation 28,29 , and (iv) finally help them complete treatments sessions 32 . However, there are few digital interventions specifically designed for psychoeducational purposes for children and parents. ...
Background. Children with neurodevelopmental disorders (NDD) are impacted in their emotional, cognitive, social, and/or motor development. They, along with their relatives, confront multifaceted challenges. Psychoeducation as an evidence-based intervention providing support and education, would play a crucial role to facilitate their daily live and disorders’ progress. In the emerging digital world, online and gamified psychoeducation has gained increasing traction since they offer a better engagement and accessibility. However, there is a discrepancy between the number of digital psychoeducation programs and those with clinical evidence-basis. The present work aims at reviewing evidence-based interventions for neurodevelopmental disorders, targeting both children and/or parents. Methods. A systematic search of PubMed, Web of Science, and Cochrane was conducted with keywords related to “neurodevelopmental disorders”, “psychoeducation”, “online and digital interventions”, and no publication date restrictions. Inclusion criteria involved studies on psychoeducation for parents or children using online platforms or gamified designs. Results. Out of the initial 70 articles, only 8 met inclusion criteria. Limited number of the publications showed that psychoeducation is a recent area of research for neurodevelopmental disorders. Reported results converged to support that technology and gamification in psychoeducational interventions stimulate children’s interest and improve outcomes for children with neurodevelopmental disorders and their parents. Discussion. While digital psychoeducational interventions are promising for children and parents, the existing literature highlights the need of a scientific validation of such technology-enhanced interventions before being translated in real life practice. Furthermore, such research topic should account for behavioral and cognitive skills along with quality of life, to consider the NDD comorbidities.
... Among the studies analysing the impact of inhibitory control stimulation programs in typically developing children, Johann and Karbach [34] compared the effects of gamified executive function training versus standard training. These authors concluded that both types of training impact the performance in trained and untrained inhibitory control tasks similarly, consistent with previous evidence [197,209]. ...
The scientific evidence regarding the possibility of transferring benefits derived from cognitive training focused on working memory and inhibitory control to reading skills in children aged 6 to 12 is inconclusive. This study carries out a systematic review of recent published studies on this topic with the aim of analysing the specific role of various cognitive stimulation programs in the growth of executive functions and reading performance in children from ages 6 to 12. Here, we present the main results reported in the most recent literature, where the impact of intervention programs on working memory and inhibitory control in children with typical development are analysed. Even though the effectiveness of executive function training programs in terms of close transfer is conspicuous, there is still a lack of convergence in recently published articles, especially regarding the effects of far transfer in reading comprehension after cognitive stimulation programs are applied.
... Brian is a computerised training and consists of 25 training sessions of about 40 minutes. Each session contains two blocks (of about 15 minutes) of the three training tasks of working memory, inhibition, and cognitive flexibility in a fixed order [79][80][81]. The first training task is a working memory training task (consists of 5 variants increasing in working memory load), the second an inhibition training task, and the third a cognitive flexibility training task. ...
tAttention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT),mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.
BACKGROUND
Emotional regulation difficulties are often observed in children and adolescents with ADHD. Innovative complementary treatments, such as video games and virtual reality, have become increasingly appealing to patients. "The Secret Trail of Moon" (MOON) is a serious video game developed by a multidisciplinary team, featuring cognitive training exercises. In this second randomized clinical trial, we evaluated the impact of a 20-session treatment with MOON on emotional regulation, as measured by the Strengths and Difficulties Questionnaire (SDQ).
OBJECTIVE
We hypothesize that ADHD patients using MOON will show improvements in (1) emotional regulation, (2) core ADHD symptoms, (3) cognitive functioning, and (4) academic performance, compared to a control group. Additionally, we anticipate that (5) changing the platform (from face-to-face using virtual reality to web-based) will not affect emotional regulation outcomes; and (6) the video game will not cause any clinically significant side effects.
METHODS
This was a prospective, unicentric, randomized, unblinded, pre- and post-intervention study with block-randomized sequence masking. Participants included clinically diagnosed ADHD patients aged 7 to 18 years, under pharmacological treatment. They were randomized into two groups using an electronic case report form (eCRF): the MOON group, receiving standard pharmacological treatment plus personalized cognitive training via a serious video game; and the control group, receiving standard pharmacological treatment. Both groups were provided with psychoeducational support on ADHD. Analysis was conducted using Student's t-test and two-factor analysis of variance (ANOVA). Approval was granted by the Research Ethics Committee of Puerta de Hierro University Hospital on December 14, 2022, and by the Spanish Agency of Medicines and Health Products on February 14, 2023 (1061/22/EC-R). An independent monitor supervised the study.
RESULTS
A total of 76 ADHD patients participated in the trial, with an equal randomization (MOON=38; control=38) and a total dropout rate of 7. The primary hypothesis, a 3- or 4-point reduction in the global SDQ score, was not met. However, significant improvements were observed in material organization (p=0.03), working memory (p=0.04) and inhibition (p=0.05), particularly among patients more engaged with the MOON treatment.
CONCLUSIONS
Serious video games, when integrated into a multimodal treatment plan, can enhance outcomes for symptoms associated with ADHD.
CLINICALTRIAL
International Registered Report Identifier (IRRID): DERR1-10.2196/53191; ClinicalTrials.gov; NCT06006871; https://clinicaltrials.gov/study/NCT06006871
INTERNATIONAL REGISTERED REPORT
RR2-10.2196/53191
Background: Children with attention-deficit hyperactivity disorder (ADHD) struggle with impaired attention, leading to impaired executive function and behavioral symptoms. In this study, we aimed to evaluate the effect of attention training on executive functions and behavioral symptoms in children with ADHD, in a tele-cognitive-rehabilitation setting. Methods: Thirty children (mean age: 9.93 ± 1.68 years, 21 boys) with ADHD were randomly assigned to 2 equal groups of attention training and active control group. Attentive Rehabilitation and Improvement of Attention (ARIA) and a class of storytelling were used for intervention in two groups, in an online platform. Continuous performance test, one-back test, Wisconsin card sorting test (WCST), Conner's parent rating scale, and behavioral rating inventory of executive function (BRIEF) were used for assessment in three-baseline, postintervention, and follow-up sessions. Repeated measures analysis of variances were used for analysis. Results: ARIA leads to significant improvement in omission error (P < 0.001), commission error (P = 0.006), and response time (P = 0.005) of continuous performance test, cluster (P = 0.001), but not preservation error (P = 0.110) of WCST, accuracy of NBT (P = 0.004) and the score of Conner's parent rating scale (P < 0.001) and BRIEF (P < 0.001). These results indicate improved attention and executive functions, amelioration of ADHD symptoms, and improved behavioral performance. Conclusion: This study suggests that attention can be trained through tele-cognitive rehabilitation using a remediation program in children with ADHD. The effectiveness of this training can be confirmed by examining the transfer of training effects to other untrained cognitive domains, executive functions, symptoms of ADHD, and behavioral performance.
This article asks how good video and computer game designers manage to get new players to learn long, complex and difficult games. The short answer is that designers of good games have hit on excellent methods for getting people to learn and to enjoy learning. The longer answer is more complex. Integral to this answer are the good principles of learning built into successful games. The author discusses 13 such principles under the headings of ‘Empowered Learners’, ‘Problem Solving’ and ‘Understanding’ and concludes that the main impediment to implementing these principles in formal education is cost. This, however, is not only (or even so much) monetary cost. It is, importantly, the cost of changing minds about how and where learning is done and of changing one of our most profoundly change-resistant institutions: the school.
For many years investigators have worked toward achieving a better understanding of the causes of the impaired performance of children with Attention-Deficit/Hyperactivity Disorder (ADHD) on cognitive, information-processing, and neuropsychological tasks. These efforts have led to a recent emphasis on identifying the “core” or “primary” dysfunction responsible for ADHD children’s cognitive problems. In this chapter, I attempt an overview of the extensive and often confusing literature in this area, emphasizing findings that I believe must be encompassed in a working conceptualization of the cognitive deficits associated with ADHD. I also point to conceptual and statistical problems that I believe are impeding research progress on ADHD.
Recent years have seen tremendous advances in understanding and treating Attention-Deficit/Hyperactivity Disorder (ADHD). Now in a revised and expanded third edition, this authoritative handbook brings the field up to date with current, practical information on nearly every aspect of the disorder. Drawing on his own and others' ongoing, influential research - and the wisdom gleaned from decades of front-line clinical experience - Russell A. Barkley provides insights and tools for professionals working with children, adolescents, or adults. Part I presents foundational knowledge about the nature and developmental course of ADHD and its neurological, genetic, and environmental underpinnings. The symptoms and subtypes of the disorder are discussed, as are associated cognitive and developmental challenges and psychiatric comorbidities. In Parts II and III, Barkley is joined by other leading experts who offer state-of-the-art guidelines for clinical management. Assessment instruments and procedures are described in detail, with expanded coverage of adult assessment. Treatment chapters then review the full array of available approaches - parent training programs, family-focused intervention for teens, school- and classroom-based approaches, psychological counseling, and pharmacotherapy - integrating findings from hundreds of new studies. The volume also addresses such developments as once-daily sustained delivery systems for stimulant medications and a new medication, atomoxetine. Of special note, a new chapter has been added on combined therapies. Chapters in the third edition now conclude with user-friendly Key Clinical Points. This comprehensive volume is intended for a broad range of professionals, including child and adult clinical psychologists and psychiatrists, school psychologists, and pediatricians. It serves as a scholarly yet accessible text for graduate-level courses. Note: Practitioners wishing to implement the assessment and treatment recommendations in the Handbook are advised to purchase the companion Workbook, which contains a complete set of forms, questionnaires, and handouts, in a large-size format with permission to photocopy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(jacket)
Currently, children and adolescents with an excess of hyperactive, inattentive, and impulsive behavior are diagnosed as Attention-Deficit/ Hyperactivity Disorder (ADHD; see the Diagnostic and Statistical Manual of Mental Disorders {DSM-IV}, American Psychiatric Association, 1994, and chapter 1, this volume).