Enhancing attention in children using an integrated cognitive-physical videogame: A pilot study

Abstract

Inattention can negatively impact several aspects of a child's life, including at home and school. Cognitive and physical interventions are two promising non-pharmaceutical approaches used to enhance attention abilities, with combined approaches often being marketed to teachers, therapists, and parents typically without research validation. Here, we assessed the feasibility of incorporating an integrated, cognitive-physical, closed-loop video game (body-brain trainer or 'BBT') as an after-school program, and also evaluated if there were attention benefits following its use. Twenty-two children (7-12 years of age) with a range of attention abilities were recruited to participate in this proof of concept, single-arm, longitudinal study (24 sessions over 8 weeks, ~30 min/day). We interrogated attention abilities through a parent survey of their child's behaviors, in addition to objective performance-based and neural measures of attention. Here we observed 95% compliance as well as, significant improvements on the parent-based reports of inattention and on cognitive tests and neural measures of attention that were comparable in scale to previous work. Exploratory measures of other cognitive control abilities and physical fitness also showed similar improvement, with exploratory evaluation of retained benefits on the primary attention-related outcomes being present 1-year later. Lastly, there was no correlation between the baseline parent-rated inattention score and the improvement on the primary task-based measures of attention, suggesting that intervention-based benefits were not solely attained by those who stood the most to gain. These pilot findings warrant future research to replicate and extend these findings.

Fig. 1. BBT platform.

a Image of participant playing BBT. Highlighted is the use of a heart rate monitor (green circle; used to assess and adapt the physical intensity of game play in real-time) and the Microsoft Kinect™ motion capture technology (yellow circle; used to collect responses with one’s hands and/or feet based on the cognitive task presented on the monitor and adapt the cognitive difficulty of each game in real-time). b Image of the three modules in BBT, with the top panel showing the visual search module, the middle panel showing the task switch module, and the lower panel showing the working memory module. A video of BBT in action can be viewed at https://youtu.be/vvR5WhSzQU4. c An overview of the study timeline with outcome measures collected at each timepoint listed. Abbreviations - CPT: Continuous Performance Task. ITC of CPT: Inter-Trial Coherence of the Continuous Performance Task. WM: Working Memory Task. BRT: Basic Response Time Task.

Fig. 2. CONSORT diagram.

Illustration depicting the number of participants at different stages of the study, from consent to enrollment and 1-year follow-up. The embedded table reflects the number of participants with datasets for each of the primary measures of interest at each time point, as well as the number of individuals with data at each paired timepoint. For the CPT task, missing data was due to participants not being able to stay to the end of their testing session due to other outside obligations those days. For the EEG recordings, missing data points reflect a hardware error where photodiodes used to time lock the onset of targets were not functioning properly, preventing the analysis of event-related activity.

Fig. 3. Parent report of inattention and CPT task over time.

a Parent report of inattention (Vanderbilt) over time illustrating the group mean at each time point. b Scatterplot illustrating trending correlation between the change on the Vanderbilt inattention measures versus overall change in accuracy collapsed across BBT training modules (r = 0.42, p = 0.05). c CPT (sustained condition) response time variability over time illustrating the group mean at each time point. d CPT (impulsive condition) response time variability over time illustrating the group mean at each time point. *p < 0.05. Error bars represent s.e.m.

Fig. 4. Neural correlates of each CPT task over time.

a Midline frontal theta inter-trial coherence (ITC) for the sustained condition of the CPT over time. b Correlation between the change in sustained ITC and the change in Vanderbilt inattention measure. c Midline frontal ITC for the impulsive condition of the CPT over time. d Correlation between the change in impulsive ITC and the change in impulsive RTV. The dashed circle on the topographic plot illustrates the electrodes where statistical analyses took place. *p < 0.05. Error bars represent s.e.m.

Fig. 5. Comparison of primary outcomes to Anguera et al. (2017).

a Change on Vanderbilt Inattention Measure for BBT cohort and participants from Anguera et al. (2017). b Change on CPT task on the Sustained Condition for BBT cohort and participants from Anguera et al. (2017). SPD + IA = Children with Sensory Processing Disorder and ADHD comorbidity. TDC Typically Developing Children. Error bars represent s.e.m. *p < 0.05, **p < 0.01.