A presentation given by LearningWorks for Kids at a 2013 conference.

1. Playing Smarter
in the Digital World:
Games, Apps, Technology, and ADHD
Randy Kulman, Ph.D

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

3. Take-Aways
• Recognition of the extent of children’s involvement with
digital media
• What are kids with ADHD doing with digital media
• Understanding the research on the impact of games, apps,
technology on kids with ADHD
• Concerns and cautions about digital media and ADHD
• What makes digital media so powerful for kids with ADHD
• Real world strategies for video games and kids with ADHD
• Generalization strategies to make popular games and apps
into teaching tools for executive and academic skills

4. Finding Angry Birds and Amazing Alex
• How to find Angry Birds on your device:
• iPhone, iPad: Go to App store, search on
bottom of screen, type Angry Birds, go to Free
version, tap free and then download
• Android Phone/ Tablets:
Go to
Google Play, search
Angry Birds goto
Free version, tap free and then
download

5. Does Technology Help with Learning?
• Let us find out!
• Take out your cell phones for
texting.
• Dial the following number: 22333
• Go to New Message line.
• You will then respond in the
messaging area with a series of
codes based upon the following
questions.

6. Poll

7. Poll

8. Poll

9. Poll

10. It’s Not Just Video Games Anymore
• Screen-based technologies or digital-media use are more
encompassing terms than video games.
• Games, apps, software,
and websites are
merging.
• Access, particularly
mobile and tablet-based,
requires a new type of
monitoring and
understanding.
• Academic and classroom
are increasing requiring
games and technology.

11. Do Parents, Educators, and Healthcare
Professionals Have a Choice?
•
Many homework and supplementary
programs are available only on websites.
•
Libraries are still for research (but only if
you use the Internet to search).
•
Everybody else is playing.
•
21st century skills require digital literacy.
•
Communication requires digital
technology.

12. (This is not a new question)
Media Use Across Decades
• 1930s: Movies, print, radio.
 Children 9-12; 2-3 hours per day listening to radio
• 1960s: Movies, print, radio, television
TVs on 6 hours per day in homes
• 1980s: Cable, video game consoles, portable music
players, computers, VCRs
Elementary schools kids watch 2.3 hours TV per
day
• 2010s: Internet, cell/ smart phones, DVRs, Tablets,
handheld video games

13. TV
Music
Computer Videogames
Print Movies

15. Developmental Trends across Media

16. Percentage of 8-18 Year Olds
Who Own Each Item:
Among All
8-10
11-14
15-18
Ipod/mp3 player 76%
61%
80%
83%
Cell phone
66%
31%
69%
85%
Handheld video
game player
59%
65%
69%
41%
Laptop
29%
17%
27%
38%
Portable
CD/tape player
16%
9%
16%
20%
Kaiser Study (2010)

17. Percent of Young People in Each
Age Group Who Own a Cell Phone:
Kaiser (2010)

18. How Much Do They Play?
• Clinical and anecdotal observations too much!
• No evidence of difference concerning
frequency or duration of play
between ADHD and typicallydeveloping children ages 10 to 12.
• Similar enjoyment for the same types
of games (Bioulac 2008).
• South County Child and Family
Consultants Data

19. Do children with ADHD play video games the
same amount as their TD peers?
• 10- to 12-year-olds in France are
exactly like their peers (Bioulac
2008)
• Milwaukee study of teens, same
amounts with more variability
(Fischer and Barkley 2006)
• More video-game play than music,
in contrast to peers (LearningWorks
for Kids 2011)
• 90% of ADHD rather than 80% of
TD kids spend more than one hour
a day on computer (Linginerni,
2012)

20. LW4K/SCCFC 2011 study of ADHD kids
and parents on video game play
• (Current sample of 105 children with a primary ADHD
diagnosis based upon a full neuropsychological evaluation)
• Survey asks parents to describe their own media usage to
see if it is correlated to attitudes regarding video games
• Also asks them to describe their concerns and hopes for
benefits of video games and other digital media
• Digital media use of ADHD kids- Most time television,
video games, music (different from what is seen in
national studies of typically developing kids)

21. Children, parents, and video game play
How many hours a week does your child spend playing
video games?
•34% Less than 1 hour per
•32% 2-4 hours
•20% 5-7 hours
•13% 8+ hours
How many hours per week do you spend observing or
interacting with your child when they play video games?
•23% no time
•46% less than 1 hour
•27% 1-5 hours
•4% 6+ hours

22. Children, parents, and video game play
Do you play video games with your child?
•25% Never
•57% Sometimes
•14% Often
•3% Always
How much do you believe that video games can help your
child with problem solving?
•34% Somewhat
•25% Quite a bit
•19% A little bit
•13% A great deal
•8% Not at all

23. How do children with ADHD perform on video games?
May not always perform as well as their typically-developing peers
(Lawrence, et al 2002)
May process information somewhat slowly on video games.
(Lawrence et al. 2002, 2004).
Perform as well as their peers in simple games but problems applying
executive and problem-solving skills to complex video games
(Lawrence et al. 2004).
Less success when navigating challenges, developing novel
problem-solving (Lawrence 2004)
•Perform poorly in neuropsychologically-based game mechanics such
•as working-memory and cognitive-flexibility tasks

24. How do children with ADHD perform on video
games?
• Cogmed data and observations on Wisconsin Card Sorting Test
(Oznoff)
• Persistence is dramatically increased with a computerized task,
resulting in success, although
• Sometimes requiring longer processing and more effort.
• Improved performance on reading tasks (Clarfield and Stoner)
• Improved on mathematics (Ota and DuPaul)
No difference in inhibitory performance of children with ADHD and TD
Kids with Crash Bandicoot and Frogger (Shaw 2005).The similarity
of performance in this study suggested that “enjoyable video
games provide a context in which their performance is
enhanced.”

25. Problematic behavior in video-game play in children
with ADHD
• More than one hour a day is associated with short term
increased signs of inattention (Taharoglu)
• Increased difficulty in transitioning and stopping video-game
play, resulting in more oppositionalism
• More video-game time is associated with increasing signs of
inattention (Mazurek and Engelhardt 2013 study)
• Video-game play can be associated with video-game addiction
related to Dopamine release in the brain (Han and colleagues
2009)

26. Do Video/Computer Games and Television
Impact Attention Span?
•
•
•
•
Total time spent with screen media is positively associated with
attention problems (Swing, Gentile, et al. 2010).
Four-year-olds watching Spongebob can have an immediate
negative effect on children’s executive-functioning skills (Lillard
2011).
Television/Video-game use along with exposure to violent
content not predictive of attention problems or grade point
average (Ferguson 2010)
Is digital media the cause of increasing rates of ADHD?

27. Do Video/Computer Games and
Television Impact Attention Span?
• Improves capacity to rapidly filter visual
distractions, but may negatively effect focus
on slow streams of information (Bavelier)
• Leads to listlessness and discontent in slowpaced and less stimulating academic, work,
and social environments (Merzenich)
• Attention skills improved by video games
(detecting differences and orienting attention)
are liabilities in classroom resulting in
distractibility (Gentile)

28. Cautions
Solutions
Children with ADHD or attention problems
may become “hyper-focused” on video games
and other digital media, neglecting other
important responsibilities.
Require that your child complete all of her
homework, chores, or other responsibilities
before being allowed some digital play time. By
making him put-off these fun activities until
after her work is done, he won’t be able to use
digital play as a means of procrastination.
Kids with ADHD or attention problems often
become so absorbed with activities they find
interesting, that they may lose track of how
much time they have spent on their digital
play.
Use a timer if you need to limit your child with
ADHD. Time management and having a sense
of time are often significant deficits for children
with attention problems. You can use online
timers such as TabTimer.com or even an
everyday kitchen timer to keep your child on
track.
Kids with ADHD or attention problems may
choose to engage with digital play instead of
the physical activities that are part of a
healthy treatment process.
Exercise has been shown to improve Focus and
learning in children with attentional problems.
Tell your child to go out and run around before
playing video games, and to play active games
such as Wii Tennis or Kinect Adventures.

29. What are the characteristics of interventions that
work best with children With ADHD?
• Point of performance interventions
• Immediacy of feedback
• Powerful and engaging feedback and
meaningful consequences
• Multimodal presentations and multiple
intervention agents
• Individualized to child’s capacities
• Strategic teaching principles including:
previewing, setting explicit goals,
partnering, metacognition, and
generalization strategies

30. Why use video games and digital media to help
kids with ADHD?
Kids with ADHD or Attention
Difficulties
Video Games and Digital Media
May become easily bored and unable
to sustain attention
Good video games and digital media are often
multi modal, requiring ever-changing skills and
employing video, sounds, words, and actions that
help keep kids interested and engaged.
Often require immediate
reinforcement or consequence to
stay focused on a task.
Video games provide clear and immediate
feedback, constantly letting the player know
what he is doing wrong, and what he is doing
right.
Often require that their body or mind
to be actively engaged.
Video games and digital media are extremely
engaging and many require physical and cognitive
involvement.

31. Why use video games and digital media to help
kids with ADHD?
Kids with ADHD or Attention Difficulties
Video Games and Digital Media
Usually have problems with following
directions.
Video games teach by trial and error or
through guided discovery, requiring that the
player understand the instructions in order to
succeed.
May struggle to learn new information and
experience frustration or low self-esteem as a
result.
Most negative feed back from video games
and other digital media occurs privately. This
causes less embarrassment and frustration,
while teaching the player how to handle
these emotions

32. Why use video games and digital media to help children
with ADHD?
•
•
Video game play requires the use of executive functioning skills.
Other skills such as organization and metacognitive skills are required for
success.
•
Both simple and complex video games
regularly use skills such as planning,
cognitive flexibility, self-control, and time
management.
•
Many games specifically tax working
memory skills and attentional skills.

33. Games for practicing executive skills
Amazing Alex
– Physics-based puzzle game
where players create chain
reactions using everyday
items
– Skills of planning, flexibility,
and focus
– Foresight and working
memory in order to succeed
– Attention to detail is
important in order to obtain
perfect score across many
levels

34. Amazing Alex

35. LearningWorks for Kids 2013 Study
How often does your child show signs of ADHD such as loss of focus, fidgeting, and
disorganization while: (Scale 0 to 9 with 0 meaning never, 9 always )

36. LearningWorks for Kids 2013 Study
On a typical weekend or vacation, about how much time does
your child spent with the following technologies and activities:
0
None
1
<30
2
30-60
3
60-120
4
>120 minutes

37. LearningWorks for Kids 2013 Study
Time spent with technology on a
typical weekend or vacation
Mean = 306.92, SD = 116.64
Time spent with non-technological
activities on a typical weekend or
vacation
Mean = 228.31, SD = 96.87

38. LearningWorks for Kids 2013 Study
Parenting strategies with children with ADHD:
1. Do you monitor the length of time your child plays with video games and is on the
computer?
Never
Sometimes
Often
Always
6.2%
18.8%
28.1%
46.9%
2. What best describes your approach to setting limits for your child with digital media?

39. Research on Executive/Thinking Skills and
Video Games
• LWK pilot research on differentiated instruction, targeting
areas of EF weakness with video games
• Combination of board and video games improve fluid
reasoning and processing speed (Mackey, 2011)
• Working memory video games improve WM, fluid reasoning
skills (Cogmed ) Intensity/duration
• Computer-based training improves executive attention in
preschoolers (Rueda, 2005)
• Video game like math and reading programs improves
learning, reduces attention symptoms
• Games (non video) increase cognitive load teaching tool by
parents reduce ADHD signs in Preschoolers (Halperin, 2012)
• Dovis (2011) study on games to improve working memory

42. Poll

43. Poll

44. Poll

45. Poll

46. Research-based Technological Recommendations
•
•
•
•
•
•
•
Cogmed Working Memory Training
Action video games for improving
selective attention (Green and
Bevalier)
DDR and Improved reading
Headsprout and ADHD kids
Computer -based math programs and
ADHD
Other studies, eg Interactive
metronome, Play Attention, Brain
Train Products, Lumosity, Posit
Science’s BrainHQ
LWK research on EFS

47. Recommendations for Video Games and
Technologies for Children with ADHD
• Apps and Video Games “made”
for ADHD
• Tend to be psychoeducational or
simply not fun
• Select technologies based upon a
child’s individual needs
• Engagement which increases
attention and persistence to the
task is important
• Technologies with near transfer
or direct connections to a skill are
best
• Practice, intensity, and limitations
are important

48. What makes a game or app a good
teaching tool for children with ADHD?
• It is engaging and sustains attention.
• It practices a specific skill the child needs to improve such as
focus, planning, or time management.
• It promotes persistence of effort and a willingness to
overcome obstacles.
• It is complex and interesting enough to result in duration and
intensity of game play.
• Generalization of game-based skills can be applied to the real
world.

49. Why do children with ADHD not become scholars after
playing video games?
•
Existing games are generally not designed
to promote skills in children with ADHD.
•
Existing games focus on other things, while
using important thinking skills.
•
Metacognitive skills are not built into
existing video games.
•
Generalization and strategic teaching skills
are not built into existing game.

50. How well do game based skills
transfer to the real world?
• Game play alone results in modest improvements
in real-world executive skills
• Children with learning and attention problems
have problems in generalizing strategies
• Kids like to talk about playing video games and
may be willing to learn from that
• Games prompt partnering and motivation to learn
executive skills
• Practice and rehearsal of executive skills

51. BUT…games are not enough!!!
• The key to success is effective teaching or
mediation (can be done in the game)
• Teachers (including peers, parents, and
imbedded instruction) make the connection
between game-based learning and real-world
skills
• Actual learning requires knowledge of the
skill, understanding how and when to use it,
and practice across many situations

52. What can we do to make video games a more productive
learning experience for children with ADHD?
•
Utilize a differentiated instructional model that identifies the specific skills
that a child with ADHD needs to improve
•
•
•
Teach skills and then practice them in game and technology play
Talk about gameplay and skills, metacognitive approaches
Build generalization strategies, practice skills
outside of the game
•
Consider duration and intensity of game play
to practice skills
•
Mediated learning, including parents,
psychologists, educators, and peers

53. Play Together
• Talk before, during, and after gameplay.
Choose gameplay goals with your child.
• Have fun playing the game with your child!
• Reflect on gameplay, emphasizing the use of
the targeted thinking or academic skills.
• Direct your discussion to how these same
skills are useful in daily activities.

54. Make it Work
• Explain the benefits of digital play, and
introduce the skills being exercised in the
game.
• Encourage non-digital activities that use the
same skills.
• Regularly connect game-based skills to things
your child is struggling with in the real-world.
• Try different games and skills

55. Angry Birds
• Birds are used as projectiles
to hit pigs that are protected
by structures.
• Players plan out each shot
and predict the
consequences of his shot.
• Each level is set out uniquely
so the player to flexibly
change strategies.

56. Angry Birds

57. ANGRY BIRDS
• Birds are used as projectiles
to hit pigs that are protected
by structures.
• Players plan out each shot
and predict the
consequences of his shot.
• Each level is set out uniquely
so the player to flexibly
change strategies.

58. How Much Should Your Child with
ADHD Play Video Games?
Age
0 to 24 months
2 to 5 years
Amount of Time
not at all
30 to 60 minutes a day (joint
media engagement the rule)
6 to 9 years
30 to 60 minutes a day
(parents select games)
10 to 13 years
30 to 60 minutes a day (parents
monitor game selection)
14 years old older
30 to 90 minutes a day
(emphasize social gaming)

59. Why It Is Difficult to Set Limits on
Game Play with Children with ADHD
• Concerns regarding time management and time blindness
• Difficulty with shifting and transitions from one activity to another
• Tendency to become overly focused on video-game play
• Oppositional tendencies
seen with children with
ADHD
• Child’s sense of success
and reward in playing
video games
• Parent’s sense of peace
and reduction of conflict

60. Strategies for Setting Effective Limits
for Children with ADHD
• Be firm, consistent, and engaged.
• Have different limits on weekends, holidays, and when it
serves your purpose
• After homework is done
• After exercise and
vigorous activity
• Create a regular time
frame for video-game
play
• Not before bedtime

61. More Strategies for Setting Effective
Limits for Children with ADHD
• Use tools such as the screen limits on Kindle Freetime
• Have direct control over Internet access via the router or the
use of game timers
• TV video game timers
such as “Bob” that use
coins
• Provide “learning”
game time
• Have different limits on
weekends, holidays,
and when it serves your
purpose

62. What Types of Games and Apps Should
a Child with ADHD Use?
•
•
•
•
Developmentally rather than chronologically age-appropriate
Genres rather than specific games
Active games, the more active and vigorous movement the better
Puzzle games- Help with time management and focus
• Working-memory games, both
formal training and casual games
• Planning games that require
setting long- and short-term
goals
• Apps that help with
organizational and timemanagement skills

63. How Games and Apps can Help
Support- External structure, scaffolding to help self
regulation and learning
Practice-Guided and
regular rehearsal of new
skills in an interesting
manner
Master- Owning the skill ,
knowing how, when, and
where to use it

64. LiveScribe
• A smartpen that records voice notes that is connected to
written notes
• Child takes notes on digitally-equipped paper and when going
over those notes can listen to
• Recordings of lectures
• Helps with children who
struggle with working
memory
• Very helpful for children who
process information or have
slow clerical motor speed

65. LiveScribe

66. Minecraft

67. Cogmed Working Memory training
• Research-based, clinically-proven computer program to
improve working-memory capacities of
• Targeted regimented exercises
• Demonstrated to promote structural changes in the brain
based upon principles of neuroplasticity
• 50+ peer review studies demonstrated to improve
reading, math, and sustained
attention
• Generalization is improved by
using additional tools and
strategies in conjunction with
Cogmed

68. Cogmed Working Memory training

69. Wii Sports: Tennis
• Players use tennis rackets and can get vigorous
exercise
• Self-control and flexibility required while
playing the game
• Primarily the game is good
for children with ADHD,
as it promotes vigorous
exercise using complex
body movements when
done properly

70. Wii Sports: Tennis

71. Thank You
Randy Kulman, Ph.D
randy@learningworksforkids.com
@lw4k on Twitter
www.pinterest.com/lw4k
www.learningworksforkids.com