Works in Progress

Can custom-made video games help kids with attention deficit disorder?

By Karen Wright|Thursday, March 01, 2001

For children with attention deficit hyperactivity disorder, life can feel like a nonstop video game. They are wired: restless, impulsive, and easily distracted. Their minds never stop fracturing the present into competing realms of awareness and opportunity. They'd make better action heroes than they would honor students, and their grades often show it.

The easy answer so far has been Ritalin, a rapid-acting stimulant for adults that has the opposite effect in children, calming the jitters associated with the disorder. About 3 percent of American schoolchildren take stimulants like Ritalin regularly. But new research suggests a surprising strategy: video games linked to brain-wave biofeedback that help kids with attention deficit train their minds to tune in and settle down.

"Biofeedback has been around for three decades, but it's still considered by some as a kind of fringe treatment," says Olafur Palsson, a clinical psychologist who conducted trials of the new approach last year at the Eastern Virginia Medical School in Norfolk. Biofeedback teaches patients to control normally involuntary body functions such as heart rate by providing real-time monitors of those responses. It can relieve maladies ranging from headaches to hypertension. More than 15 years of studies show that with the aid of a computer display and an EEG sensor attached to the scalp, attention-deficit patients can learn to modulate brain waves associated with focusing. Increasing the strength of high-frequency beta waves and decreasing the strength of low-frequency theta waves, for example, creates a more attentive state of mind. With enough training, changes become automatic and lead to improvements in grades, sociability, and organizational skills.

"This is a brain-based disorder, so we're trying to change the substrate that's causing the problems rather than just treating the symptoms," says Joel Lubar, a professor of psychology at the University of Tennessee in Knoxville.

Despite success, the technique hasn't entered the mainstream for several good reasons. First, unlike drug therapy, a typical course of treatment takes 40 hour-long sessions spread out over several months before benefits become apparent. Second, it's more expensive than drugs— $3,000 to $4,000 for treatments— so insurance companies tend to pick the cheaper way. And finally, biofeedback training requires the very kind of prolonged concentration that patients with attention deficit struggle to attain. To motivate patients, biofeedback clinics use incentives such as prizes for showing up and playful imagery such as faces that smile to indicate desired changes in brain waves.

Alan Pope, a behavioral scientist at NASA Langley Research Center in Hampton, Virginia, came up with a more engaging approach through working with NASA flight simulators. He was trying to see what degree of interaction with cockpit controls was necessary to help pilots stay attentive during routine flights. In an experiment, he linked the level of automation in the cockpit to the pilots' brain-wave signals, so that some controls switched from autopilot to manual when the pilot got bored. He realized that with practice the pilots could begin to adjust the controls to the level of automation that felt most comfortable by regulating their own brain waves.

Pope thought he could use a similar principle to help attention-deficit kids stay focused by rewarding an attentive state of mind. And he knew the simple displays that were already part of biofeedback treatment wouldn't hold the interest of restless youngsters. So, in consultation with Palsson, he chose several off-the-shelf video games and linked the biofeedback signal from the player's brain waves to the handheld controller that guides the games' action. Brain waves became part of the game: In one auto-racing game, for example, a car's maximum speed increases if the player's ratio of beta to theta waves improves.The same sort of feedback can also control steering.

In their trial, Pope and Palsson selected half a dozen Sony PlayStation games and tested 22 girls and boys between the ages of 9 and 13 who had attention deficit disorder. Half the group got traditional biofeedback training; the other half played the modified video games. After 40 one-hour sessions, both groups showed substantial improvements in everyday brain-wave patterns as well as in tests of attention span, impulsiveness, and hyperactivity. Parents in both groups also reported that their children were doing better in school. The difference between the two groups, says Pope, was motivation.

"In the video-game group, there were fewer no-shows and no dropouts," he says. Parents and kids alike enjoyed the video-game biofeedback more; parents were more satisfied with the results of the training, and the kids were just having more fun.

Because children are more motivated in video-game biofeedback, says Palsson, they won't need one-on-one coach- ing to master the technique. That means the cost of the treatment should come down and maybe even permit do-it-yourself biofeedback. NASA has begun licensing the technology. A Richmond, Virginia, company called East3, for example, plans to release an $899 system this year that puts the monitor in a wireless headset. But Palsson cautions that such portable systems aren't identical to the NASA prototype and may not produce the same results. For that reason, he says, such commercial devices are still best used with a doctor's supervision, at least initially.

And parents shouldn't expect regular video games to help their kids, Lubar says. The wrong kinds of video games, adds Palsson, might actually hurt children with attention disorders. "Games where you are just a lone ranger fighting everybody else probably have a negative effect on children who already have a tendency toward short attention and impulsivity," he says.

Lubar also warns that brain-wave biofeedback shouldn't be seen as a substitute for drug therapy, because its long-term effects have yet to be proven in large-scale studies. Instead, the two treatments have complementary traits that make them effective as adjuncts. A single dose of Ritalin, for example, acts quickly but only for a few hours, and most patients take it only on school days. Brain-wave regulation takes a long time to learn but has the potential for longer-lasting action.

Lynda Thompson, director of the ADD Centre in Toronto, advocates an approach that combines nutrition, sleep, exercise, and learning strategies as well as biofeedback and drug therapy. Her hopes are highest for brain-wave biofeedback, she says, because its methods could last a lifetime. "Increasingly, people are realizing that this is not something you outgrow," she says. "It's so powerful for a child to learn how to self-regulate, to learn what it feels like to concentrate— that's where the real change happens."

For information about the availability of this experimental treatment for attention deficit hyperactivity disorder, visit

Information about Southeastern Biofeedback and Neurobehavioral Institute, a center founded by biofeedback pioneer Joel Lubar, can be found at

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