Educational Research

Play Attention and ADD / ADHD Students – Field Study

Abstract
The Play Attention® software and data collection device is an educational software system designed to be a primary component in the home and school for individuals diagnosed with attention difficulties. A primary objective in the testing of Play Attention is to determine whether and to what extent it can reduce the levels of symptoms of hyperkinesis and learning disabilities associated with low attention.

Testing of Play Attention® was conducted at ID (name withheld) Elementary School from September 17 to December 21, 1996.


Background
The National Institute of Health estimates that Attention Deficit Disorder and Hyperactivity Disorder (ADD/HD) affects 5 – 10% of all school age children and 3 – 7% of all adults. Currently, educational intervention is highly limited to behavior modification plans, books, videotapes, and counseling.

Educators are very interested in reducing discipline problems, increasing classroom participation, and increasing the focus/concentration of ADD/HD students. The amount of disciplinary effort in a classroom is greatly increased by the addition of even one ADD/HD student because these students seldom are able to accommodate the conditions of the traditional classroom.

Play Attention is the first educational intervention that allows the teacher to introduce an environment of success and learning particularly suited for the ADD/HD student. Play Attention, an electroencephalograph (EEG) device, allows the user to control screen characters by attention alone. Play Attention monitors brainwaves indicative of focus (theta) and cognitive processing (beta). For over twenty–five years, feedback training, often termed "bio" or "neuro" feedback has been used by the military, NASA, and universities worldwide to increase attention. Training, usually clinical, has produced positive results (Shouse, Lubar 1994).

Play Attention is a concerted effort to remove feedback training from the clinical realm and provide educational applications.


Method
Research was conducted under the auspices of the City School System under the guidance and recommendation of Dr. Sam Dempsey, Executive Director of Exceptional Children's Programs.

Principal Robert McGrattan selected seven children from the general population in conjunction with classroom teachers and special education teachers. All seven participants had been previously medically diagnosed with severe ADHD. All seven were on medication for ADD/HD. All had signed parent permission to participate in the study. Parents were encouraged to attend at least one session to understand the process. One participant had a compounding issue (Fetal Alcohol Syndrome).

Participants were administered Play Attention training in a sound attenuated room solely devoted for this purpose. The room had no distracting features, i.e., nothing except painted walls, a desk, a computer, and two chairs.

Participants were scheduled for a minimum of two sessions per week and a maximum of three. The sessions lasted for approximately 35 to 45 minutes.

Students were removed from regular classes or participated after school.


Assessment
The Conners Continuous Performance Test (CPT) was the primary assessment instrument. Developed at Duke University by Dr. Keith Conners, the CPT indicates the subject's impulsivity and distractibility associated with attention disorders. The CPT was administered to the subjects as pre– and post evaluation of the Play Attention® software.

The CPT is a computerized test of attention stamina, impulsivity, and prudence. The CPT administers the protocol directly to the subject, using the computer screen, keyboard or mouse. An optional tutorial prepares the patient for the task. The subject is instructed to press the spacebar (or mouse button) immediately following the presentation of specific letters on screen. A proprietary standard mode of presentation, developed by Dr. Conners, is administered. The standard mode controls for the number of trials, target letters presented, varied inter–stimulus intervals between letters, and more. It normally takes 14 minutes to administer. The User Manual presents data on nearly 2000 new cases and the clinical sample consists of more than 600 cases of varying diagnoses and includes new ADHD normative data. The data is broken down into groups by age levels for comparison purposes.

The CPT User's Manual presents data, using the "standard" mode, on more than 500 community–based norms and 670 clinical patients. The data is broken into groups by age and gender for comparison purposes. In addition, the CPT Manual documents the development, research and clinical use of the CPT. Also included with this Manual is a complete literature overview of the use of the CPT in clinical populations, a comprehensive annotated bibliography and case examples.


Summary
The following is a summary of the evaluation processes beginning with the Conners' CPT. The CPT determines a subject's degree of attention deficit through an interactive computer program. Three measures, Reaction Time, Omission Errors, and Commission Errors provide the basis for analysis. These measures are divided into component elements that are designated as Typical, Atypical, Markedly Atypical, or Atypically slow. The subsequent classification of these elements is then related to an overall index and synthesized to render general comments.


The mean overall index for the test group prior to the use of Play Attention® was 15.298. The mean overall index for the test group after the use of Play Attention was 4.559 indicating significant positive change in reaction time, omission errors, and commission errors.

An index of 15.00 prompts the Conners' CPT to render the comment, "Numerous indices from the Conners' Continuous Performance Test suggest that [subject] has attention problems. There is strong evidence from the Conners' CPT to suggest attention difficulties."

An index of 5.00 prompts the Conners' CPT to render the comment, "This type of response pattern alone does NOT strongly suggest an attention problem, but further observations and testing of this individual would be advisable.

The Conners' CPT also advises in both the pre– and post usage,

The comments in this report are based on general patterns apparent in the responses of [subject]. Always examine the graphs and information provided carefully to refine (and add to) the interpretations given.

To better interpret the data, an analysis of the component elements was performed. These included Hits, Number of Omissions, Number of Commissions, Hit Reaction Time, Hit Reaction Time Standard Error, Attentiveness, and Risk Taking. The test subjects' responses were categorized from Average to Markedly Atypical. The post evaluations indicated significant positive response changes in four categories; Average, Mildly Atypical (MI AT), Markedly Atypical (MA AT), and Good.



As the above data indicate, statistically significant results are indicated when Mildly Atypical responses decreased from 13 occurrences in the pretest application to only 4 posttest. Good responses increased from 1 to 11. Average responses increased from 21 to 56. But, perhaps most significantly, Markedly Atypical responses decreased from 46 occurrences to 14.

The positive changes indicated by this data demonstrate a higher degree of attention in post evaluation through lessening atypical response patterns and increasing positive response patterns.

To reiterate, the most significant data to be extrapolated from this test group is the reduction of the mean overall index. This index for the test group prior to the use of Play Attention® was 15.298 indicating significant attention problems for the group. The mean overall index for the test group after the use of Play Attention was 4.559 indicating significant positive change in reaction time, omission errors, and commission errors. The reduction in the mean overall index demonstrates clearly that Play Attention improved attention, reduced attention fatigue, reduced impulsivity, and increased prudence over time.