From Snappy App to Screens in the Wild: Gamifying an Attention Deficit Hyperactivity Disorder Continuous Performance Test for Public Engagement and Awareness

Abstract

Abstract-Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is characterised by three core behaviours: inattention, hyperactivity and impulsivity. It is typically thought that around 3-5% of school aged children have ADHD, with lifetime persistence for the majority.A psychometric Continuous Performance Test (CPT) had recently been incorporated into an interactive smartphone application (App), SnappyApp, to allow the measurement of the three ADHD symptom domains. SnappyApp presents a sequence of letters of the alphabet in a pseudo-random manner with responses via the device's touch screen. Following a pilot test in the general population where the CPT showed sensitivity to ADHD-related symptoms (self-reported impulsive behaviour related to CPT measures), a new project was begun to convert the App into a game Attention Grabber based on the functionality of the test, focussing on the attention and impulsivity domains.The Screens in the Wild (SITW) platform is in the process of being employed for public engagement in awareness about ADHD through interactive technology. SITW has deployed a network of four public touch-screens in urban places. Each of the four nodes has a large (46 inch) display, a camera, a microphone and a speaker. The SnappyApp web-app was translated for presentation on to the SITW platform. The browser-based App was redesigned, with the input of a commercial graphics design company, based on an initial proof-of-concept whereby the original App was reprogrammed to present sequences of graphical objects (fruit) and to introduce further engagement features including animations. A shortened video about Adult ADHD and a brief questionnaire were incorporated to form a stand-alone edutainment package.The earlier design and user testing of SnappyApp is briefly described and details are then provided of the process of gamification to produce Attention Grabber. An evaluation process is described whereby awareness of ADHD and its related symptoms are to be probed. In general, finding out whether and how people engage with interactive screen technology can help in the design of future public engagement and health promotion activities. Ethical considerations are discussed, since public access to this kind of game could potentially raise health anxiety related to self-interpretation of game performance. This risk is balanced with the need to provide health information.

Classification of Attention Deficit Hyperactivity Disorder (ADHD) Considering Diagnosis and Treatment

“…Different types of applications are designed with various electronic devices including computer and mobiles. Among many SanppyApp is the application designed for ADHD children and adults, and shows how to balance risk in addition providing health information [44] . Table 8 gives the Summary of ADHD Applications.…”

Computer Games for User Engagement in Attention Deficit Hyperactivity Disorder (ADHD) Monitoring and Therapy

“…Task focus  Abilities of game players (action video games, puzzle games) [4,[10][11][12][13] Education/Training/Health Awareness focus  Cyber-therapy classroom [14]  Intelligences [15]  Health awareness [16,17]  Cognitive (working memory) training [18] Medical/clinical focus  CBT (cognitive behavioural therapy) [19]  Cognitive tests: CPT (continuous performance test) [7,20,21]; Stop-signal or Go/No-go [22,23]  Working memory [24][25][26][27]  Eye-gaze [28][29][30]  Neurofeedback/Brain Computer Interfaces: EEG (electroencephalogram) theta/beta [31,32]; SCP (slow cortical potentials) [33,34]  Other biofeedback [9] It can be seen that most examples of games in the above list are concerned either with tasks to assess the effect of game playing on human performance or are for therapy, and a number of these are based on cognitive tests used more generally. One CPT game devised by the authors and other colleagues, SnappyApp, was intended for monitoring only [21] (see later), while another, QbTest, has been developed to aid diagnosis and monitoring [7].…”

“…Another simpler variant of the test (CPT-X), suited to young children, was gamified to use fruit instead of letters, with bananas replacing the X stimulus, and also introduced scores. The CPT-X with bananas was subsequently adapted for a public awareness raising application Attention Grabber on deployed on large touch screens in urban areas [17], representing another potential output for games in ADHD. Later, some of the gaming elements were removed to avoid some of the distraction and a test analogous to CPT-AX, with bananas as the stimuli to be selected after cherries, was used in a school study with young people, as seen in the last image of Fig.…”

Evaluating a Public Display Installation with Game and Video to Raise Awareness of Attention Deficit Hyperactivity Disorder

“…In the video, patients who had been treated by the Trust speak about their experiences of living with ADHD and the benefit of having a diagnosis. The game 'Attention Grabber' was developed from an initial proof-of-concept by the authors [3], then a commercial graphics design company and web designer were contracted to implement a polished version with attractive graphics and animations (Fig. 2).…”

“…Further work by the project team was carried out to fully integrate the game with the SitW platform. Examples of awareness initiatives for mental health that use game elements are few [3], but where these have been implemented these have not been evaluated explicitly. In order to integrate evaluation into this application, four questions were embedded in the application: three questions (on a 4 point scale) before the video and one after.…”