Scientific Research

Goals:
Two primary goals were identified:

• To determine if Play Attention significantly increases attention
• To determine if the increases transfer to a classroom environment

Theory:
Play Attention is a unique learning system that utilizes Edufeedback™ – the integration of real–time feedback with specific skill training of learning process components. Current research demonstrates the brain is always changing due to learning and our environment. The possibilities for neurological change are quite high. The ability of the brain to make changes is termed neuroplasticity. Due to the brain's ability to form new neural pathways during the learning process, impairments such as attention difficulties can be overcome, or at the very least, managed with correct training. Play Attention facilitates this reshaping for success in the classroom and life.

Recent advances in the human genome project also demonstrate neuroplasticity. Changes occur on the genetic level during the learning process specifically on chromosomes 2 and 16 (genes that are central to memory and learning). Known as CREB (cyclic AMP response element binding protein) system in the brain, the changes indicate that every time a person learns something, some of these genes must switch on in order to lay down new connections between neurons (brain cells).

Administration:
The clinical case studies utilizing Play Attention were performed by Dr. Jerry Coffey of Sylva Clinical Associates, P.A. in psychology, psychiatry, and education over the course of 1999 through mid 2000. No other interventions were used.

Environment:
The actual use of Play Attention was performed in a sound attenuated office located apart from Dr. Coffey's main office. Both subjects used Play Attention at least twice weekly. If any appointment were missed, concerted effort was made to insure that the subject attended the very next day available. No adaptive procedures or augmentations to the Play Attention software were made. This practice was continued until both subjects had reached forty (+) hours of training.

Subjects:
The subjects of the study were two males, one 6 ½ year old and one 10 year old. They were given a full battery of tests to determine levels of attention difficulties. Behavioral ratings scales were included to determine transfer/generalization to social and classroom settings.

Assessment:
Increases in attention and response control were assessed using the IVA (Integrated Visual & Auditory)Continuous Performance Test (CPT) pre and post Play Attention training. The IVA is marketed by BrainTrain and founded and developed by Dr. Joseph A. Sanford, Ph.D., and Dr. Ann Turner, M.D. The IVA is one of the two major objective ADD/HD assessments available to clinicians and medical practitioners.

This test presents a person with a series of numbers, either "1" or "2", presented either visually or auditorally. The person must respond if a "1" is presented (the "target"), and withhold responding if a "2" is presented (the "distracter"). This main task lasts approximately thirteen minutes and presents 500 trials of "1"s and "2"s in a pseudo–random pattern requiring the shifting of sets between the visual and auditory modalities. During some segments, the "1"s are more common than the "2"s creating a response set which "pulls" for errors of commission or impulsivity. During alternate segments of the test, the "1"s occur rarely: this invites more errors of omission or inattention since the subject must remain vigilant while awaiting a "1" to occur.

The fundamental data recorded is the reaction time for correct responses (RT), and accuracy/error rates. When the stimulus is "1", the percent of responses is the "hit" rate. The percent of non-responses is the "miss" rate. When the stimulus is "2" the percent of responses is the "false alarm" rate, and the percent of non–responses is the "correct rejection" rate.

Three research papers document the usefulness of the IVA instrument. First there is a normative study, which collected data on several hundred normal people to establish baseline data. Second, there is a reliability study, which looked at the consistency of a normal person's performance across two tests with no intervening treatment or training. To be reliable a test must give essentially the same score each time it is used on the same person. This lets us know that a change is due to our intervening program, and not just to chance fluctuations. Third, there is a validity study, which determines whether the test results agree with other known methods of assessing ADHD.

IVA's normative group (N=1700) is divided by gender, and grouped by age as follows: 6,7,8,9,10,11,12,13,14,15,16, 17-18, 19-21, 22-24,25-29,30-34, 35-39, 40-44, 45-54, 55-65, 66-96. The database is gathered from all areas of the United States, and all races and socioeconomic groups are well represented. The normative group is comprised only of individuals without known attention, learning, neurological, or psychological problems. Because of this, the IVA's hit rate in correctly identifying ADHD children was 92%, which is quite high. The "correct rejection" rate (identifying non–ADHD correctly) was 90%, also quite high. The miss rate was 8% (100 – 92), and the false alarm rate was 10% (100 – 90). These figures indicate that the IVA discriminates ADHD from non–ADHD children quite well.

The IVA scores are normalized identically to the familiar Intelligence Quotient (IQ). The IVA regards a standard deviation as fifteen points. All of IVA's scores are presented both as raw scores and as quotient scores. Applying these familiar interpretive guidelines makes it easy to interpret test results.

IVA's scores are divided into two categories: Attention and Response Control.

The Full Scale Response Control Quotient is based on separate Auditory and Visual Response Control Quotient scores. These Response Control Quotient scores are derived from visual and auditory Prudence, Consistency and Stamina scores.

Prudence is a measure of impulsivity and response inhibition as evidenced by three different types of errors of commission.

Consistency measures the general reliability and variability of response times and is used to help measure the ability to stay on–task.

Stamina compares the mean reaction times of correct responses during the first 200 trials to the last 200 trials. This score is used to identify problems related to sustaining attention and effort over time.

The Full Scale Attention Quotient is derived from separate Auditory and Visual Attention Quotients. The Attention Quotient scores are based on equal measures of visual and auditory Vigilance, Focus, and Speed.

Vigilance is a measure of inattention as evidenced by two different types of errors of omission.

Focus reflects the total variability of mental processing speed for all correct responses.

Speed reflects the average reaction time for all correct responses throughout the test and helps identify attention–processing problems related to slow discriminatory mental processing.

Summary:
The IVA was administered within 45 days of competing the Play Attention training. This was done to insure that results of the training did not diminish over time.

Two primary goals were identified: (1) to determine if Play Attention significantly increases attention and (2) to determine if the increases transfer to a classroom environment. Play Attention clearly increased attention and improved impulsivity. This is clearly evident in the statistical data obtained from the IVA. A more detailed analysis follows.

The 6 ½ year old scored 92 on the Response Control Quotient (pre) and 99 post Play Attention. He also scored 64 on the Attention Quotient pre Play Attention and 107 post Play Attention. Play Attention helped increase RCQ (lower impulsivity, faster reaction times) of the 6 ½ year old by 7 points. Play Attention helped increase the Attention Quotient (increased attention, attention stamina) by 43 points or nearly three standard deviations.




The 10–year–old scored 81 on the Response Control Quotient (pre) and 114 post Play Attention. He also scored 103 on the Attention Quotient pre Play Attention and 121 post Play Attention. Play Attention helped increase RCQ (lower impulsivity, faster reaction times) of the 10 year old by 33 points (over two standard deviations). Play Attention helped increase the Attention Quotient (increased attention, attention stamina) by 18 points or over a full standard deviation.




The aforementioned data demonstrate significant statistical increases in attention and response controls. Increases of two and three standard deviations indicate tremendous positive learning and growth promoted by the Play Attention learning system. The data also represent dramatic positive change in the area of behavioral outcomes.

Socially and academically changes were documented by parent/teach rating scales and anecdotal records.

Rating scales offer the ability to monitor changes in behaviors. They are reliable instruments typically used as a partial assessment of ADD/HD by a clinician. They rely upon either the parent, teacher, or other significant adult to assess the frequency of positive and negative behaviors. Behavior rating scales utilize a sliding scale, the number zero meaning that the parent or teacher does not see the behavior manifesting in the subject, the number one indicating the behavior manifests very little, the number two signifying that the behavior manifests often, and the number three signifying that the behavior manifests all the time.

The behavioral rating scales were initiated before Play Attention training and after. Both parents and teachers reported significant differences. These include:

• increased grades at school
• parental reports of less argument
• homework being finished within an acceptable period of time
• better use of instructional time
• less fidgeting
• less calling out in class
• subjects were generally more happy about themselves (increased self–esteem

Dr. Coffey was able to wean one of the males off medication completely after training. He was able to decrease the other subject's medication greatly and planned to possibly wean him from medication entirely. These are perhaps the most significant results of Play Attention training.