After exclusion of physical diseases and confirmed classification of the ADHD disorder picture or its subtypes according to ICD-10 (or DSM-IV) are to be used according to valid scientific standard as treatment modules:
- Behavioral therapy of the child
- Parenting and training
- In case of inadequate effects of 1. and 2. a drug treatment with Ritalin® or similar drugs.
The majority of the neurobiological research efforts show numerous peculiarities of brain metabolism and brain structures in individuals with ADHD behaviors. However, it has not yet been clarified whether these characteristics existed primarily. It is to be assumed that the so-called neuroplasticity also changes the brain of ADHD children in the course of the learning experience. Recently, it has been emphatically pointed out by renowned neurobiological researchers that the importance of neuroplastic processes for ADHD development must be given more space. A diagnostic instrument to be required, which certainly could make ADHD behavior recognizable on the basis of a brain defect function, has not yet been developed. The rating method used in the international standard using the known 18 items (ICD-10 or DSM-IV) can not meet this requirement. On the other hand, neuropsychological research has already done pioneering work in this area by showing the extent to which attention in children with ADHD can become motivation-dependent and also without stimulant use.
II. Starting point
The newly developed PC game TAIL requires the children to deal with so-called NON-GO tasks, which are used in the diagnosis of attention as a test of a specific function of the frontal brain: mastering impulses; Waiting before any action. TAIL motivates the children to an adventurous treasure hunt. It links a series of NON-GO tasks on eight levels with increasing difficulty. The game is designed in such a way that the children want to lead the character with maximum motivation through the game, the treasure hunt. The children start the training game with an exercise time of 10 minutes; From session to session the game time is increased by 5 min.
TAIL differs from conventional jump-and-run games by consistently requesting impulse control: only waiting for the player to get closer to the treasure to be found. Encouraged by practical experience, the pilot study focused on the training of ADHD primary schoolchildren, who did not belong to the practice clientele. The learning progress achieved was compared with that of a clinically inconspicuous group.
III. Sample and methodology of the study
The children were subjected to training with TAIL over 4 weeks. In two sessions a week the training was increased from 10 to 50 minutes. After each session, each child was reported optically / graphically. Immediately after completion of the training, the parents received information about the developments of the training effects in a debriefing session. In this session, the parents were
A) with regard to the ADHD-typical characteristics and b) of the possibly changed everyday behavior of their children over the past 4 weeks explored. Three months after completion of the training, the ADHD volunteers were invited again to check the sustainability of the learning effects.
IV. Statistical results
1. Indicators for attention, hyperactivity and impulsivity in the two groups
The calculated mean values of the characteristics describe clinically significant disturbance patterns in the ADHD group.
(There are no significant differences between the mean values of attention, activity, and impulsiveness within the group, and no significant differences between the mean values of the characteristics were calculated in the comparison group.)
In the comparison group, all values marked indisputable characteristic expressions. The mean value comparisons between the groups are significant. Thus, it must be shown that a clinically inconspicuous comparison group was found by means of the ICD-10 rating with regard to its characteristics.
2. Changes during and after the workout
All children were indifferent from the training with TAIL.
All children were indifferent from the training with TAIL.
The progress after 50 training minutes is significant in both groups.
3. Stability of the training progress
The performance of the ADHD group about 3 months after the last training session (with a predominantly exercise-free interval) does not differ significantly from the performance of the last training session.
V. Quantitative change
In the follow-up, the children reported directly after the four-week training session in varying degrees and not always in the following behavioral changes:
A) in the family
- Increase in willingness to comply with the demands of parents
- Recognition of the borders and rules as well as the own area of responsibility
- Communication willingness of the child to communicate linguistically about rules and limits
- Insight in violation of rules
- Facilitated educational situation
- Relaxation of the affective climate in family life
- Increase of "good mood" and independence
- Higher willingness to start the school tasks and to keep them up to their full performance
- Improved font and reduced error in spelling (both confirmed by the school)
- Increased interest in dealing with the written language (increased reading performance).
- In the clinically inconspicuous children from the comparison group such effects were not described.
The study showed that if the ratings of attention, hyperactivity, and impulsiveness, according to ICD-10 in the ADHD group before and after the training, remain unchanged, the learning software used will lead to a significant training effect, To make decisions that can reduce impulsivity in children - not only in ADHD children; Provided the game is played over a sufficiently long period of time.
Conclusion: All children under study have benefited from the playful training.
The behavioral changes of the ADHD-children in family and school life, which were presented under v. (S.o.), were reported spontaneously by the parents. These qualitative features are surprising in that they describe behavioral changes, which also include the ratings of attention, hyperactivity and impulsiveness. ICD-10 after training. However, this is not the case.
All of the qualitative changes in behavior can be interpreted without difficulty as the effect of improved impulse control. The improved performance in dealing with the written language is understandable because playing with the learning software trains and improves the differentiated visual perception as well as the control of the fine motor skills demands and increases.
The childlike behavioral changes experienced by parents and teachers show a favorable effect on the affective climate in the family. The increased self-efficacy registered by the children improves their mood and increases their sense of independence.
These encouraging results from the pilot study are now being verified by a larger sample of ADHD children.