Computer games for user engagement in attention deficit hyperactivity disorder (ADHD) monitoring and therapy

State-of-the-art computer games and psychological tests for symptom monitoring and therapy in Attention Deficit Hyperactivity Disorder (ADHD) are explored and reviewed. Three foci for research studies are identified: task (human performance) focus; educational focus; medical/clinical focus. It is found that game designs in the literature include a variety of tests of cognition mostly dependent on attention and executive functions (inhibitory motor control, working memory, interference suppression) which involve reactions to stimuli on computer (or mobile phone) screens. In addition, based on the measurement of neural pathways that can be accessed by Brain Computer Interfaces, there are several applications of games that employ biofeedback and demand the user to control aspects of their brain activity to play them, with the aim of improving function. A number of games have been used in clinical studies for self-monitoring and therapy, some of these controlled with comparators such as treatment as usual or cognitive therapies, or with the individual as their own control, where efficacy is evaluated by measuring behavioural and functional outcomes on measurement instruments such as ADHD or behavioural trait questionnaires or other cognitive tests. Other applications of games include education and raising awareness of mental health conditions to reduce stigma. The paper then presents and proposes designs of new games that are based on psychological tests or tasks that aim to monitor or improve attention, inhibitory and/or motor activity including Continuous Performance Tests, Go/No-go and Stop-signal tasks

Computer games for user engagement in attention deficit hyperactivity disorder (ADHD) monitoring and therapy

State-of-the-art computer games and psychological tests for symptom monitoring and therapy in Attention Deficit Hyperactivity Disorder (ADHD) are explored and reviewed. Three foci for research studies are identified: task (human performance) focus; educational focus; medical/clinical focus. It is found that game designs in the literature include a variety of tests of cognition mostly dependent on attention and executive functions (inhibitory motor control, working memory, interference suppression) which involve reactions to stimuli on computer (or mobile phone) screens. In addition, based on the measurement of neural pathways that can be accessed by Brain Computer Interfaces, there are several applications of games that employ biofeedback and demand the user to control aspects of their brain activity to play them, with the aim of improving function. A number of games have been used in clinical studies for self-monitoring and therapy, some of these controlled with comparators such as treatment as usual or cognitive therapies, or with the individual as their own control, where efficacy is evaluated by measuring behavioural and functional outcomes on measurement instruments such as ADHD or behavioural trait questionnaires or other cognitive tests. Other applications of games include education and raising awareness of mental health conditions to reduce stigma. The paper then presents and proposes designs of new games that are based on psychological tests or tasks that aim to monitor or improve attention, inhibitory and/or motor activity including Continuous Performance Tests, Go/No-go and Stop-signal tasks

Early intervention combined with targeted treatment promotes cognitive and behavioral improvements in young children with fragile x syndrome.

Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability due to an expansion in the full mutation range (>200 CGG repeats) of the promoter region of the FMR1 gene leading to gene silencing. Lack of FMRP, a critical protein for dendritic spine formation and maturation, will cause FXS. Early environmental enrichment combined with pharmacological intervention has been proven to rescue dendritic spine abnormalities in the animal model of FXS. Here we report on 2 young children with FXS who were treated early with a combination of targeted treatment and intensive educational interventions leading to improvement in their cognition and behavior and a normal IQ

Influence of a specific aquatic program on social and gross motor skills in adolescents with Autism Spectrum Disorders: Three case reports

Swimming pool activities revealed to be efficacious to train psychomotor skills and increase adaptive behaviors in children with Autism Spectrum Disorders (ASD). Therefore, the purpose of this study was to investigate the efficacy of a specific multi-systemic aquatic therapy (CI-MAT) on gross motor and social skills in three adolescents with Autism Spectrum Disorders (ASD). Methods: three adolescents with ASD of which two boys (M1 with a chronological age of 10.3 years and a mental age of 4.7 years; M2 with a chronological age of 14.6 and a mental age inferior to 4 years) and one girl (chronological age of 14.0 and a mental age inferior to 4 years). The study was divided into three phases: baseline, 12-week CI-MAT program and Post-Test. Participants were administered a battery of tests incorporating anthropometric measurements, gross motor development test and a social skills questionnaire before and after a 12-week MAT-CI program. Results: Subjects improved locomotors and object control skills following the CI-MAT program in a different way. Concerning social behaviors, the higher proportion of gains was observed in the sensitivity of other's presence and eye contact, for the contact domain, and in the comply turn for the relationship domain. Conclusions: The results of this study showed that the CI-MAT program was effective for the development of gross-motor skills and social behaviors in subjects with ASD. Moreover there is an urge to carry out a whole psychological assessment targeting both motor and adaptive development suitable to provide educational and vocational plans of exercises for people with ASD

The effects of hippotherapy in children and adolescents with autism : a systematic review

The purpose of this systematic review was to investigate the effectiveness of hippotherapy, also known as horse- or equine-assisted therapy, for improving the socialization and communication behaviors of children diagnosed with Autism Spectrum Disorders (ASD). The PubMed research database was used to search for relevant studies. Six studies were evaluated and demonstrated overall mixed findings for the use of hippotherapy as an effective treatment technique for communication and socialization skills. To further analyze the strength of these findings, the selected studies were evaluated for limitations related to outcome measure selected and treatment design. The present analysis revealed four main limitations: 1) lack of established treatment protocol led to differences with how hippotherapy was delivered; 2) most assessment measures were based on parent report; 3) small sample sizes; and 4) multiple treatment interference. While these limitations do not detract from the information gleaned from the treatment and research, implementing a standard protocol would make the replicability easier for future clinicians.Communication Sciences and Disorder

Therapeutic use of serious games in mental health: scoping review.

BACKGROUND: There has been an increase in the development and application of serious games to support management of mental ill health, but their full impact is unclear. AIMS: Evaluation of the current evidence of acceptability and effectiveness of serious games in improving mental health disorders. METHOD: A PRISMA-guided scoping review was conducted, using a predefined criteria and a relevant word combination on three databases: EMBASE, Medline and PsycINFO. Each included study was examined for game format, study type, number of participants, basic demographics, disorder targeted, recruitment, setting, control conditions, duration and follow-up, study attrition, primary outcomes and their results. Each study was given a Grading of Recommendations, Assessment, Development and Evaluations rating for quality. RESULTS: Fourteen out of 513 studies met the inclusion criteria. The serious games focused on symptoms of anxiety (n = 4), attention-deficit hyperactivity disorder (n = 3), depression (n = 2), schizophrenia (n = 2), alcohol use disorder (n = 2) and bipolar disorder (n = 1). There were multiple significant outcomes favouring serious games across conditions covered in the review. Study quality varied, with studies rated high (n = 3), moderate (n = 6), low (n = 3) and very low (n = 2). CONCLUSIONS: The available evidence suggests that serious games could be an effective format for an intervention to reduce mental health symptoms and improve outcomes of individuals. Better designed studies would further develop confidence in this area. This is a potential vehicle of change to deliver some of the much-needed psychiatric support to both economically developed and developing regions in a resource-utilitarian manner. Partnerships between the gaming industry, researchers and health services may benefit patients

Occupational Therapist Perceptions on How Eye Movement Therapy Supports Working Memory in Children Diagnosed with Attention Deficit/Hyperactivity Disorder

Previous research reports that children with attention-deficit/hyperactivity disorder (ADHD) show a deficit in their working memory. Working memory is the ability to temporarily manipulate, store, and retrieve information during cognitive tasks. Working memory is considered a critical deficiency in individuals diagnosed with ADHD. Working memory has been shown to be a mechanism for symptoms of disorganization and inattention in individuals diagnosed with ADHD. This qualitative research study reviewed occupational therapists’ perceptions on their role working with children, aged six to 10 years old, diagnosed with ADHD and low working memory, who have had eye movement therapy. The occupational therapists’ perceptions of the effects of eye movement therapy on working memory, conduct, and academic ability were investigated. ADHD and low working memory have been reported and characterized in two formats. First, children diagnosed with ADHD with hyperactive-impulsive subtype exhibit advanced levels of impulsive behavior, while those diagnosed with ADHD without hyperactive-impulsive subtype show a significant decrease in working memory to reduced reaction times. This research explored the effects of eye therapy treatment on the cognition of children diagnosed with ADHD from an occupational therapist professional perspective. Previous research has shown that eye therapy has improved working memory in children diagnosed with ADHD. Overall, during this study, occupational therapists discovered that integrating EMT with other interventions, such as cognitive-behavioral and sensory integration therapies, with children diagnosed with ADHD resulted in improvements in their working memories, attention, and academic performances

The Effect of Interactive Music Therapy on Joint Attention Skills in Preschool Children with Autism Spectrum Disorder

The purpose of this study was to investigate the effect of interactive music sessions on joint attention behaviors in preschool children with Autism Spectrum Disorders (ASD). Joint attention, the ability to share attention to a stimulus with another person, is a key deficit in children with ASD. Lack of joint attention behaviors contributes to the limited social and verbal skills that characterize ASD; joint attention behaviors are the primary component of the early screening for ASD advocated by the American Academy of Pediatrics. Participants (N=6; 5 male, 1 female) were between 36 and 64 months old at the time of the study, and were recruited from the child development program at a large Midwestern university. All children were enrolled in classrooms with curricula designed specifically for children with ASD. A multiple treatment (within-subject) design was used, with three treatment conditions: interactive music therapy, non-music interactive play, and independent play. Participants experienced each condition six times for a total of 18 ten-minute sessions over a five-week period. Session order was randomized to control for order effect. Behavioral observation of videotaped sessions was used to determine both interaction (responding to a bid for joint attention) and requesting behavior (initiating joint attention). Visual analysis of data graphs and statistical analysis were used to determine treatment effect. Interaction behaviors were most frequent in the interactive music therapy sessions, with less interaction in non-music interactive play sessions, and much less interaction during independent play. Although the difference between was less significant for the two children with the best interaction skills prior to the study, overall, the between-subject ANOVA revealed a significant difference in interaction among all three conditions (F [2, 105] = 62.028, p < 0.001; Bonferroni p < 0.01 between all conditions). Requesting behavior was highly variable across sessions, regardless of treatment condition, although requesting was generally higher in the interactive conditions than in the independent play sessions. Implications, limitations, and opportunities for further research are discussed

Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs

BackgroundThe New Forest Parenting Package' (NFPP), an 8-week home-based intervention for parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD), fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control. Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short- and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior [Helping the Noncompliant Child' (HNC)] in young children with ADHD. MethodsA randomized controlled trial with three parallel arms was the design for this study. A total of 164 3-4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N=67), HNC (N=63), or wait-list control (WL, N=34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: ). ResultsIn both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC. ConclusionsThe results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across nontargeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects

A pilot study to assess the usability of a novel psychotherapeutic interactive gaming application as a tool to measure facial emotion recognition in patients with schizophrenia

This work presents the development and the assessment of Feeling Master, a novel psychotherapeutic interactive gaming application that uses cartoon stimuli to measure facial emotion recognition in schizophrenic patients. A pilot study among 24 patients with schizophrenia (PS) and 17 healthy control (HC) subjects was conducted to assess the usability of Feeling Master as a tool to measure facial emotion recognition ability in schizophrenic patients. The usability assessment of the application was based on three criteria: adaptability, effectiveness, and efficiency of the tool (Nielsen, 1994; Schwebel, McClure, & Severson, 2014). The study also attempted to determine whether people with schizophrenia would show emotion recognition deficits and if such deficits would vary among the basic emotions described by Ekman and Friesen (1971). Moreover, our team aimed to relate the results of facial emotion recognition within the schizophrenia group to clinical variables such as the Personal and Situational Attribution Questionnaire (IPSAQ). Descriptive data reveal that Feeling Master is a useful tool for measuring facial emotion recognition in patients with schizophrenia. Schizophrenia patients showed impairments in the emotions recognition. PS subjects remained slower than HC (Average time: F(1.38) = 15.1, p = 0.000). On the other hand, we did not find significant values for the overall emotion discrimination (average accuracy: F(1.38) = 0.733, p>0.05), but we found significant error rates for discrimination in fear: F=(1.38)=8.2, p < 0.007) ) using Fisher¿s exact test to compare errors between PS and HC groups. Using the Feeling Master tool, the performances of patients with schizophrenia were compared to those of healthy control volunteers on computerized tasks of emotion recognition, and the Personal and Situational Attribution Questionnaire (IPSAQ) was administered to determine whether emotion processing deficits were correlated with the attributional style. The correlations between correct response on the Feeling Master and Personal and Situational Attribution Questionnaire (IPSAQ) were not significant, but they showed interesting relations: Sad vs. External Situational Negative, Rho= 0.346, p=0.106; Sad vs. External Situational Positive, Rho=0.320, p=0.136. Finally, the Technology Acceptance Model (TAM) was used to study the acceptance among professionals of the Feeling Master as a tool to measure facial emotion recognition in rehabilitation psychiatric units. The TAM study was conducted among 66 experienced mental health professionals. Except for Perceived Ease of Use (PEOU), which has a high value, the other TAM construct values (i.e., Perceived usefulness (PU), Attitude Toward Using (ATU), Enjoyment (E), and Behavioral Intention (BI)) should be improved. In conclusion, the study puts forward the usability of a novel, psychotherapeutic interactive gaming tool used in Facial Emotion Recognition for people with schizophrenia. These findings lend support to the notion that difficulties in emotion recognition are associated with key cognitive deficits among individuals with schizophrenia. These findings were consistent with previous studies.Este trabajo presenta el desarrollo y la evaluación de Feeling Master, un novedoso videojuego psicoterapéutico que utiliza ilustraciones faciales como estímulos para medir el reconocimiento de emociones en pacientes esquizofrénicos. Se realizó un estudio piloto a 24 pacientes con diagnostico de esquizofrenia (PS) y 17 controles voluntarios (HC) para evaluar la usabilidad de Feeling Master como herramienta para la medición del reconocimiento de emociones faciales en pacientes esquizofrénicos. La evaluación de la usabilidad de Feeling Master se baso en tres criterios: la adaptabilidad, la eficacia y la eficiencia de la herramienta (Nielsen, 1994; Schwebel et al., 2014). Conjuntamente, se intentó determinar si las personas enfermas de esquizofrenia muestran déficits en el reconocimiento de las emociones faciales y si tales déficits varían entre las distintas emociones básicas descritas por Ekman y Friesen (1971). Además, se relacionaron los resultados del reconocimiento de emociones faciales del grupo de personas enfermas de esquizofrenia con variables clínicas como el cuestionario de atribuciones internas, personales y situacionales (IPSAQ). Los resultados obtenidos en este estudio revelan que Feeling Master es una herramienta efectiva para la medición del reconocimiento de emociones faciales en personas enfermas de esquizofrenia. Los pacientes con diagnostico de esquizofrenia mostraron un déficit de reconocimiento de las emociones faciales. El grupo PS necesitó mas tiempo que el grupo HC para el reconocimiento de las emociones (tiempo medio: F (1,38) = 15,1, p = 0,000). El estudio no evidenció valores significativos para la discriminación en general de emociones faciales (precisión media: F (1,38) = 0.733, p> 0,05). Por otra parte, se encontró una tasa de error significativo para la discriminación en el miedo: F = (1 , 38) = 8,2, p <0.007)) con la prueba exacta de Fisher para comparar errores entre los grupos PS y HC. Los resultados del reconocimiento de emociones faciales del grupo PS obtenidos con el Feeling Master, se relacionaron con el IPSAQ para determinar si existen correlaciones entre el déficit de reconocimiento de las emociones y el estilo atribucional. Las correlaciones entre los resultados obtenidos por el Feeling Master y el IPSAQ no fueron significativas, pero se encontraron las siguientes relaciones interesantes: tristeza vs. externa situacional negativa, Rho = 0,346, p = 0,106; tristeza vs. externa situacional positiva, Rho = 0,320, p = 0,136. Por último, se utilizo el modelo de aceptación de la tecnología (TAM) para estudiar la adopción de Feeling Master como herramienta para el reconocimiento de emociones faciales en unidades psiquiátricas de rehabilitación. El estudio TAM se realizó a 66 profesionales experimentados de la salud mental. Excepto por la facilidad de uso percibida, que ha obtenido un alto valor, el resto de los constructos del TAM (utilidad percibida , actitud hacia el uso, placer de uso y la intención hacia el uso) deben mejorar sus valores. hacia el uso) deben mejorar sus valores. Como conclusión podemos afirmar que, este trabajo demuestra la correcta usabilidad de Feeling Master como herramienta para la medición del reconocimiento de emociones faciales en personas enfermas de esquizofrenia. Conjuntamente, los resultados de nuestra investigación confirman la existencia de un déficit de reconocimiento de las emociones faciales en las personas enfermas de esquizofrenia. Estos resultados son consistentes con el resto de la literatura científica. de la salud mental. Excepto por la facilidad de uso percibida, que ha obtenido un alto valor, el resto de los constructos del TAM (utilidad percibida , actitud hacia el uso, placer de uso y la intención hacia el uso) deben mejorar sus valores.Postprint (published version