This is a review of a computerized training program for those with ADHD using neuro-bio-feedback in a game-like format.

1. Visual Performance Today 61 Volume 2 | Issue 1
Play Attention is a computerized train­
ing program for those 5 years of age or old-
er who have been diagnosed with attention
deficit hyperactivity disorder. This program
uses task-based neurofeedback (NF) that
reinforces correct responses to various stim-
uli in game-like format. This results in train-
ing attention and working memory while
simultaneously decreasing impulsivity. Inter-
ventions of NF have been found to improve
working memory and decrease parent- and
teacher-rated symptoms of ADHD.1
You must supply the computer, but they
provide all other software, a manual, and
equipment, including the Body Wave device
that fits on your arm or leg. There are six
games that are included: Attention Stamina,
Visual Tracking, Time on Task, Discriminatory
Processing, Short Term Memory, and
Finishing Tasks. The program notes what the
player has achieved and then sets the next goal
level automatically, or if you prefer, you can do
this manually.
(Before I begin this review I should note
that I had an opportunity to actually use this
program and that my review is based on
that use and current research involving its
application. Philip Brotman, PhD of Biofeedback
Instrument Corporation was kind enough to
send me a unit so that I could experience it
in a personal manner. I did not use this with
any patients, but rather on myself. I have no
personal financial interest in Biofeedback
Instrumentation Corporation or in the Play
Attention system).
The Games
In Attention Stamina you control a compu­
ter avatar’s dive depth in the ocean by your
concentration and attention. At the beginning
of the game you can choose who will represent
you: a diver, dolphin, whale, or submarine. When
you maintain attention, your avatar swims in a
straight line at a certain depth. When you lose
attention, the avatar rises. The goal is to avoid
fish and other objects and to finish the dive in
an appropriate manner. I personally used this
multiple times. This is not an easy task even
for an adult with a relatively normal level of
attention, but if mastered will give the desired
result. The initial goal is to pay attention for at
least 2% of the time and to pick up gold coins
Play Attention: A Computerized
Training Program for ADHD
Dominick M. Maino, OD, MEd • Illinois College of Optometry • Chicago, Illinois

2. Visual Performance Today 62 Volume 2 | Issue 1
along the way. Your task is to
improve upon this over time.
In Visual Tracking you begin by
seeing 25 blocks arranged in a square
five blocks tall by five blocks wide where
random blocks will light up and beep in
quick succession. The patient’s task is to click
on these blocks using the computer mouse
as they light up and beep.
Time on Task trains the patient on how
to start and finish an assignment on time.
The game starts with a warehouse scene.
There is a truck, a stack of wooden crates,
and a man on a yellow fork­lift. The task is to
load twelve crates onto the truck bed in five
minutes or less using sustained attention on
the task.
Discriminatory Processing teaches the
patient to filter out unwanted distractions
and attend to the task at hand. At the
beginner level you are in a spaceship
cockpit. The only way to move the spaceship
is to attend appropriately. You also must
protect yourself against various asteroids
along the way by hitting the space bar.
Timing is important because if the space
bar is hit too early, the protective shields will
go back down before the asteroid makes
contact. If the space bar is hit too late, the
ship takes damage. If you lose attention, the
ship will stop moving, and the patient hears,
“Focus to refuel.” As the patient gets better
in concentration and attention, the tasks
become more varied and difficult.
Short Term Memory teaches you how
to process visual and auditory information
and hold that information in short term
memory so you can recall it later when
needed. The first part is similar to the game
Simon. Sustained attention is required to
activate the game.
Finishing Tasks monitors your attention
when you’re doing an actual task (your
homework for example). The Attention Monitor
shows you how much attention you’re paying
to the task. If the patient becomes distracted,
the program will tell the patient to attend to the
chosen task.
A video that reviews Play Attention is
available here.
Add on Games
There are several additional games you can
purchase that include auditory processing,
hand-eye coordination, spatial memory, social
skills, working memory, and motor skills. Play
Attention will even customize a game for you
as well.
Other Important Things to Know
What You Will Receive
Play Attention includes the software, the
BodyWave® armband, interface box, Bluetooth
dongle, user manual, behavior shaping charts,
and all behavioral management materials.
You will also receive free and unlimited
technical and educational support, a phone call
supported introductory tutorial, an interactive
manual with audio and video clips, and an
unlimited user-license.
The Cost
The cost can be as little as $100 per month
for home use, but there is a variety of flexible

3. Visual Performance Today 64 Volume 2 | Issue 1
I usually read all instruc­
tions before start­ing a new
computer program or using new
instrumentation, but for the first part
of this review, I wanted not only to
evaluate the program for effectiveness,
but intuitiveness as well. I started Attention
Stamina without reading the instructions.
It took me about 20 minutes to figure
out what I needed to do and to accomplish
the task. I also learned that it is important
to read the instructions before using this
program to reduce any initial frustrations
that might otherwise occur!
After reading the instruc­tions, I then
worked on the other “games.” With a clear
idea of how to accomplish the tasks set
before me (I read the instructions this time),
I managed to complete the beginner levels
for all the games. With effort and a bit of
self-coaching, I found all the tasks doable. As
Play Attention and current research notes,
this is not a quick fix, but requires both a
serious fiscal and time commitment.
There are many things to like about
this program and a few that require a
deeper understanding of neuro-feedback
and patient manage­ment. Like vision
therapy, there must be a total commitment
by the doctors, staff, families, and patients
involved. All should understand the fiscal
and personal commitments needed to be
successful.
I suggest that if you are going to
incorporate this into your practice, that
you do it separately from your regular vision
therapy program. You may want to consider
using Play Attention’s iLab program to facilitate
this therapy as an at-home program. I would
also suggest, though, that if you do this the
first few sessions be conducted in-office. In this
way you can make sure your patient and their
family understand how to do the program to
maximize the individual’s chance of success.
Final Recommendation
This is a research supported tool to improve
attention and other attention-related areas
when deficits in attention are diagnosed. If
used in combination with optometric vision
therapy, not only should attention improve,
but all symptoms associated with learning
related vision problems can be eliminated as
well. Using the Play Attention “Finishing Tasks”
program while simultaneously conducting
active therapy should also improve vision
therapy outcomes. A combined program of Play
Attention and optometric vision therapy may
help us all improve the academic outcomes and
quality of life of our patients.
As a private practitioner (Lyons Family
Eye Care), I am going to seriously consider
this adjunct intervention as a part of the
many services I provide for my patients. As an
academic, I can see multiple Play Attention and
vision therapy research projects already being
considered in the future. I would suggest that
all who are reading this review take a moment
to consider using this within your patient care
regimen for attention anomalies as well.