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Does Computerized Working Memory Training with Game Elements Enhance Motivation and Training Efficacy in Children with ADHD?
Abstract and Figures
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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... In addition, young people are usually difficult to engage in interventions, and video games are often not perceived as an imposition by parents or professionals, which may be more interesting and enjoyable for them (Bussing et al., 2012;Tatla et al., 2014). Video games can also increase the participation and motivation (Granic et al., 2014;Prins et al., 2011). This is relevant as research suggests that children with ADHD with motivational problems may have a decrease in the beneficial effects of executive function training (Prins et al., 2011). ...
... Video games can also increase the participation and motivation (Granic et al., 2014;Prins et al., 2011). This is relevant as research suggests that children with ADHD with motivational problems may have a decrease in the beneficial effects of executive function training (Prins et al., 2011). ...
Background
Attention‐deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adolescents. Recent studies show that video games have great potential for the treatment and rehabilitation of ADHD patients.
The aim of the present review is to systematically review the scientific literature on the relationship between video games and ADHD, focusing on adherence to treatment, frequency of the intervention, and the long‐term follow‐up of video games in children and adolescents with ADHD.
Methods
The preferred reporting items for systematic reviews and meta‐analyses guidelines were adopted. The review protocol was registered in PROSPERO database. We searched in three databases, PubMed, Medline, and Web of Science to identify studies examining the association between video game interventions in ADHD patients.
Results
A total of 18 empirical studies met the established inclusion criteria. The results showed that video games‐based interventions can be used to improve ADHD symptoms and display high adherence to treatment. In addition, in the studies reviewed, the most common intervention frequency is 30 min three to five times per week. However, there is little evidence from studies with video games showing long‐term effects in patients with ADHD.
Conclusion
Video games are useful and effective interventions that can complement traditional treatments in patients with ADHD.
... Ambos grupos mejoraron progresivamente en atención selectiva a medida que avanzaba el tratamiento, y a partir de la novena sesión la mejora del grupo experimental (formato SG) fue más pronunciada que la del grupo control. Los programas en formato SG han mostrado su eficacia para mejorar la atención selectiva en niños con TDAH (Abad-Mas, et al., 2013;Prins et al., 2011); sin embargo, diversos estudios muestran discrepancias respecto al número y duración de las sesiones necesarias para mejorar esta función; mientras algunos autores señalan mejoras a partir de la octava sesión con periodos de entrenamiento de 45 minutos (Tucha, et al., 2011), otros han advertido mejoras a partir de la octava sesión con sesiones de entrenamiento de entre 30 y 60 minutos (Kerns et al., 1999;Semrud-Clikeman et al., 1999;Tamm et al., 2010), o a partir de la décima sesión (Vernon, 2005). Gevensleben et al., (2010) indican la necesidad de sesiones de más de 30 minutos para mejorar la atención y el autocontrol. ...
... En el TDAH la impulsividad, en combinación con déficits de autorregulación, se ha asociado tanto con el abandono como con resultados adversos del tratamiento(Nazar et al., 2016;Tourian et al., 2015). Al mismo tiempo, algunas investigaciones han demostrado que el uso de SG podría mejorar la motivación y adherencia al tratamiento(Dovis et al., 2012;Prins et al., 2011); dado algunos aspectos positivos que ofrecen como su capacidad de retener a los usuarios y la baja resistencia para su utilización, y su valoración como una experiencia divertida(Sim Et al., 2006; Wrońskaet al., 2015). El aspecto lúdico de los juegos, las imágenes, el entorno atractivo y dinámico, la movilidad dentro del juego puede reclamar la atención de sujetos con diagnóstico de TDAH; así mismo, la retroalimentación inmediata que reciben continuamente fortalece su autoeficacia y sentimiento de capacidad, componentes que no suelen vivenciar. ...
Antecedentes: el déficit de atención con hiperactividad (TDAH) es uno de los trastornos más prevalentes en la población infantil. En la última década ha surgido un creciente interés en investigar la aplicación de Serious Games en el tratamiento del TDAH. Objetivo: desarrollar y poner a prueba un programa de tratamiento en formato Serious Games para mejorar la atención en niños con TDAH y compararlo con un tratamiento tradicional en formato lápiz y papel. Metodología: se aplicó un análisis de varianza (ANOVA) de dos factores con medidas repetidas en un factor para analizar los resultados obtenidos en las diferentes pruebas aplicadas a una cohorte de 30 niños entre 8 y 10 años con TDAH. A 15 niños se les aplicó el programa de 16 sesiones de entre 30-45 minutos, en formato Serious Games (grupo experimental) y a 15 niños en formato lápiz y papel (grupo control). Para evaluar la mejoría en la atención se evaluaron variables atencionales mediante los tests CSAT-R, de CARAS-R y MFFT-20. Las pruebas se aplicaron al inicio, en la novena sesión y al finalizar el tratamiento. Resultados: ambos grupos mejoran en el índice de sensibilidad del CSAT-R (p<0,001), en atención selectiva evaluada mediante el test de CARAS-R (p<0,001), y en la impulsividad e ineficiencia evaluada mediante el MFFT-20 (ambas p<0,001). Asimismo, el grupo Serious Games (experimental) presenta una mejoría más acentuada en el test de CARAS-R y en el MFFT-20 (tanto para las puntuaciones de impulsividad como de ineficiencia) que el grupo control.
... - Dentz, et al., 2020;Prins, et al., 2011) . ...
... - Barkley (2015, 363), Dentz, et al. (2020, 78), Gray, et al. (2016, Lambez, et al. (2020, 40), Prins, et al. (2011, 115), Rapport, et al. (2015, 661), Re, et al. (2015, 2), Van der Donk, et al. (2013, 2), Van (Aksayli, et al. 2019;Chacko, et al., 2014;Delavarian, et al., 2015;Dentz, et al. 2020;Gray, et al., 2012;Heishman, 2015;Klingberg, et al., 2002, Klingberg et al., 2005Melby-Lervåg& Hulme, 2013;Morrison& Chein, 2011;Nelwan, et al., 2018;Nelwan & Kroesbergen, 2016;Orsolini, et al., 2019;Peijnenborgh, et al., 2015;Prins, et al., 2011;Randall & Tyldesley, 2016;Rapport, et al., 2013;Redick, et al., 2015;Spencer-Smith& Klingberg, 2015 - ...
... This overview could be helpful for different purposes: (a) it is found that there is no difference between addicted and nonaddicted players in terms of gaming motivation. It is known that motivation is the most important key in treatment, and clinical researcher could use these information to use videogames as a way to promote a healthy lifestyles, to reduce stress [144], to increase physical activity in sedentary people [145,146], for educational purposes by learning useful information [147,148], or for therapy with children with special educational needs, ADHD, or neurodevelopmental disorder [149,150]. As stated, motivation is strictly related to age and gender; thus, this systematic review could help in identifying which games with which characteristics could be helpful for the target population. ...
... It is similar to the experience of flow [37,54]. 15 Coping: using games to help coping with real problems (stress, aggression, and anxiety) and managing unpleasant moods and unwanted impulses [22]; playing for stress- 150 Human Behavior and Emerging Technologies reduction and mood enhancement [28]. 16 Completion: interest in performing every possible action in a game or collecting every in-game item [34]. ...
Nowadays, video games are part of our everyday life, and the number of players is increasing each day passing by. Thus, understanding what motivations drive people to play video games is becoming a very important topic for researchers. That is why this systematic review had the objective to summarize the existing literature about gaming motivation by including papers that used a validated tool to do so while excluding those that did address just the psychopathological aspect of gaming. The systematic review was carried out through the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRSIMA). A total of 53 papers were included in this systematic review, and the findings revealed that nonaddicted players and addicted players seem both to play for social, achievement, and competition motivations. Male players appeared more oriented to play to compete with others, while female players seemed to use games for relationship and social reasons. Gaming motivation was stronger in younger people.
... For one, non-commitment and a lack of persistence can have substantial effects on the interpretation of research trials studying the treatment's efficacy and effectiveness (Jaeggi et al., 2014;Katz, Jaeggi, et al., 2018). The field of cognitive training has employed several strategies to overcome issues of attrition, such as adding a layer of gamification to the cognitive training paradigm (Deveau et al., 2014(Deveau et al., , 2015Green & Seitz, 2015;Mohammed et al., 2017;Prins et al., 2010), personalized coaching (Chacko et al., 2010;Nelwan et al., 2018), and positively framing the context of the intervention (Harrell et al., 2021). While most research has focused on developing methods to improve persistence and reduce attrition and dropout, research aimed at identifying individual difference factors that predict and explain commitment to and persistence with treatment, are sparse, inconsistent, and restricted to specific populations. ...
Consistent with research across several domains, intervention adherence is associated with desired outcomes. Our study investigates adherence, defined by participants’ commitment to, persistence with, and compliance with an intervention’s regimen, as a key mechanism underlying cognitive training effectiveness. We examine this relationship in a large and diverse sample comprising 4,775 adults between the ages of 18 and 93. We test the predictive validity of individual difference factors, such as age, gender, cognitive capability (i.e., fluid reasoning and working memory), grit, ambition, personality, self-perceived cognitive failures, socioeconomic status, exercise, and education on commitment to and persistence with a 20-session cognitive training regimen, as measured by the number of sessions completed. Additionally, we test the relationship between compliance measures: (i) spacing between training sessions, as measured by the average time between training sessions, and (ii) consistency in the training schedule, as measured by the variance in time between training sessions, with performance trajectories on the training task. Our data suggest that none of these factors reliably predict commitment to, persistence with, or compliance with cognitive training. Nevertheless, the lack of evidence from the large and representative sample extends the knowledge from previous research exploring limited, heterogenous samples, characterized by older adult populations. The absence of reliable predictors for commitment, persistence, and compliance in cognitive training suggests that nomothetic factors may affect program adherence. Future research will be well served to examine diverse approaches to increasing motivation in cognitive training to improve program evaluation and reconcile the inconsistency in findings across the field.
... The total sample included 3147 children and adolescents with ADHD (75.98% boys aged 5-18 years). Forty-eight effect sizes utilized cognitive training in 15 interventions (Ackermann et al., 2018;Bigorra et al., 2016;Chacko et al., 2014;Egeland et al., 2013;Green et al., 2012;Kazemi and Mohammadi, 2019;Klingberg et al., 2005Klingberg et al., , 2002Lee et al., 2021;Muris et al., 2018;Sperafico et al., 2021;Steeger et al., 2016;Tucha et al., 2011;van der Donk et al., 2015;Van Dongen-Boomsma et al., 2014); 45 used EF-specific curriculum in 16 interventions (Gerber et al., 2012;Hannesdottir et al., 2017;Janmohammadi et al., 2019;Lan et al., 2020;Lloyd et al., 2010;Menezes et al., 2015;Miranda et al., 2013Miranda et al., , 2002Moreno-García et al., 2019;Qian et al., 2017;Smith et al., 2019;Steeger et al., 2016;Tamm et al., 2013;Vanzin et al., 2020;Wexler et al., 2021); 44 tested game-based training in 12 interventions (Azami et al., 2016;Bikic et al., 2018Bikic et al., , 2017Dovis et al., 2015;Estrada-Plana et al., 2019;Johnstone et al., 2017Johnstone et al., , 2010Jones et al., 2020;Kermani et al., 2016;Lan et al., 2020;Meyer et al., 2020;Prins et al., 2011); 24 used neurofeedback training in 13 studies (Alegria et al., 2017;Bakhshayesh et al., 2011;Dobrakowski and Łebecka, 2020;Drechsler et al., 2007;Geladé et al., 2017;Heinrich et al., 2004;Janssen et al., 2016;Lévesque et al., 2006;Maurizio et al., 2014;Moreno-García et al., 2019;Rezaei et al., 2018;Shereena et al., 2019;Wang, 2017); 26 measured physical exercise in 17 studies (Benzing and Schmidt, 2019;Bustamante et al., 2016;Chang et al., 2014;Choi et al., 2015;Faramarzi et al., 2016;Geladé et al., 2017;Janssen et al., 2016;Kadri et al., 2019;Lee et al., 2017;Memarmoghaddam et al., 2016;Pan et al., 2019Pan et al., , 2016Rezaei et al., 2018;Silva et al., 2020;Verret et al., 2012;Ziereis and Jansen, 2015); only one study (Kiani et al., 2017) focused on mindfulness practices. Intervention frequency ranged from 1 to 5 times per week, sessions lasted 8.5-120 min, number of intervention sessions ranged from 3 to 64, and total duration ranged from 105 to 7200 min. ...
Objective:
Although front-line doctors recommend medications, this kind of treatment has limited efficacy in improving executive functions (EFs) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). This study explored the effects of non-pharmacological intervention on EFs in children and adolescents with ADHD.
Methods:
In accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, we searched seven electronic databases: APA PsycINFO, CINAHL Complete, EMBASE, ERIC, Medline, Pubmed, and Web of Science, from inception to March 2022. Two authors independently screened studies for eligibility, extracted data, and assessed bias risk using the Physiotherapy Evidence Database scale. Our analyses included randomized controlled trials and non-randomized comparison studies of non-pharmacological interventions and assessed EFs through neurocognitive tasks in children and adolescents between 5 and 18 years.
Results:
Sixty-seven studies with 3147 participants met the inclusion criteria. The final meta-analysis included 74 independent interventions categorized into six categories: cognitive training, EF-specific curriculum, game-based training, mindfulness practice, neurofeedback training, and physical exercise. Overall, non-pharmacological interventions (combined) produced significant moderate to large effects on overall EFs in children and adolescents with ADHD (g=0.673). Physical exercise had a large positive effect on domain-specific EFs, including inhibitory control (g=0.900) and cognitive flexibility (g=1.377). Cognitive training had a large training effect on working memory (g=0.907), and an EF-specific curriculum had a small to moderate beneficial effect on planning performance (g=0.532).
Conclusion:
Non-pharmacological interventions, particularly physical exercise, cognitive training, and an EF-specific curriculum, appear to have beneficial effects on EFs in children and adolescents with ADHD.
... Together, the lack of perseverative responding and shortened reward latencies suggest that the highly motivational quality of the liquid reward was sufficient to overcome the effects of moderate PAE. Interestingly, enhancing motivational state has been shown to improve cognitive performance in rodents (Avlar et al., 2015) and humans (Nieto-Márquez et al., 2021) and has provided a framework for using intrinsic motivation states to improve cognitive abilities in neurodegenerative (Braver et al., 2014;Manera et al., 2017;Ruiz-González et al., 2021), neurodevelopmental (Prins et al., 2011;Demurie et al., 2012), and neuropsychiatric disorders (Choi and Medalia, 2010). The current data suggest that the motivational state may be a target for enhancing therapeutic efficacy in FASD. ...
Introduction:
Fetal Alcohol Spectrum Disorders (FASD) are the leading cause of preventable developmental disability and are commonly characterized by alterations in executive function. Reversal learning tasks are reliable, cross-species methods for testing a frequently impaired aspect of executive control, behavioral flexibility. Pre-clinical studies commonly require the use of reinforcers to motivate animals to learn and perform the task. While there are several reinforcers available, the most commonly employed are solid (food pellets) and liquid (sweetened milk) rewards. Previous studies have examined the effects of different solid rewards or liquid dietary content on learning in instrumental responding and found that rodents on liquid reward with higher caloric content performed better with increased response and task acquisition rate. The influence of reinforcer type on reversal learning and how this interacts with developmental insults such as prenatal alcohol exposure (PAE) has not been explored.
Methods:
We tested whether reinforcer type during learning or reversal would impact an established deficit in PAE mice.
Results:
We found that all male and female mice on liquid reward, regardless of prenatal exposure were better motivated to learn task behaviors during pre-training. Consistent with previous findings, both male and female PAE mice and Saccharine control mice were able to learn the initial stimulus reward associations irrespective of the reinforcer type. During the initial reversal phase, male PAE mice that received pellet rewards exhibited maladaptive perseverative responding whereas male mice that received liquid rewards performed comparable to their control counterparts. Female PAE mice that received either reinforcer types did not exhibit any deficits on behavioral flexibility. Female saccharine control mice that received liquid, but not pellet, rewards showed increased perseverative responding during the early reversal phase.
Discussion:
These data suggest that reinforcer type can have a major impact on motivation, and therefore performance, during reversal learning. Highly motivating rewards may mask behavioral deficits seen with more moderately sought rewards and gestational exposure to the non-caloric sweetener, saccharine, can impact behavior motivated by those reinforcers in a sex-dependent manner.
Children with ADHD struggle with impaired time management, indicating premature and temporally inadequate behavioral style. This study aimed to evaluate the impact of time perception remediation on hot and cold executive functions (EFs) and behavioral symptoms in children with ADHD. In this pilot study, an RCT design was employed to investigate the effects of the intervention on children with ADHD. The participants were assigned to either the control group (n = 15) or the intervention group (n = 13). The intervention group receive 10-12 sessions of program for attentive remediation of time perception (PART). Time perception, N-back, Wisconsin card sorting, Go/No-Go, balloon analog risk, Iowa gambling tasks, and Conner's parental rating scale were used for the assessment in three baseline, post-intervention, and follow-up sessions. Repeated measures ANOVAs were used for analysis. The results suggest improved time perception and risky decision making in intervention group. Working memory, inhibitory control, and cognitive flexibility did not improve after intervention. The behavioral symptoms ameliorated after intervention. Time perception is trainable in children with ADHD. This training effect transfers to hot EFs and behavioral symptoms, but not cold EFs. A cognitive model has been proposed based on the results of this studies and other cognitive training studies.
Background:
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that commonly occurs in childhood. The aim of this meta-analysis was to summarize the available evidence for the efficacy of digital therapeutics in children and adolescents with ADHD.
Methods:
We searched the MEDLINE, EMBASE, Cochrane Library (Cochrane Database of Systematic Reviews), and Web of Science (science and social science citation index) databases for relevant studies and used Stata 15.0 software to carry out the meta-analysis.
Results:
A total of 31 studies involving 2169 participants (1665 boys and 504 girls) aged 4-17 years old were included in the final analysis. The meta-analysis results showed that digital interventions improved the symptoms of inattention with an effect value of -0.20 (95% confidence interval [CI] -0.36, -0.04) and decreased the continuous performance task (CPT) reaction time (effect, -0.40, 95% CI -0.73, -0.07) in ADHD patients. The score for impulsive hyperactivity was slightly decreased (effect, -0.07, 95% CI -0.23, 0.09). Moreover, executive function was improved (effect, 0.71, 95% CI 0.37, 1.04). The capability of working memory appeared to be increased (effect, 0.48, 95% CI 0.21, 0.76) between the two groups. Visual appraisal of the sensitivity analysis suggested the absence of heterogeneity, and no obvious publication bias was detected.
Discussion:
Based on the existing literature evidence, we conclude that digital therapy can be a promising therapeutic strategy for ADHD patients.
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).