Using games to probe attention deficits

Hannah Kirk, a developmental neuroscientist at Australia’s Monash University, is paying close attention to attention. That is, she is particularly intrigued by the cognitive processes that enable us to concentrate, filter distractions, and switch focus when needed.

Attention plays an important role in human cognition, and is particularly crucial in childhood development, so Kirk is also interested in how attention processes differ in children with developmental disorders — such as autism spectrum disorder (ASD), Down syndrome, and attention deficit hyperactivity disorder (ADHD) — who often experience impairments in attention.

Moreover, by working closely with game developers, she and her colleagues have created a game-based attention training program to treat attention difficulties, and the results are quite promising.

So, what’s actually happening in the brain when we pay attention?

“We know there are three core attention networks within the brain,” says Kirk. “They are distinct, but overlap quite significantly.”

‘Selective attention’ relates to the ability to focus on important things in the environment whilst filtering out distractions, like ambient noise.

‘Sustained attention’ is the ability to fixate attention for a prolonged period of time.

“That’s really what we think of as our attention span,” says Kirk.

Last, but not least, is ‘attentional control’, which relates to the ability to switch attention from one task to another and control impulsive responses.

“These distinct processes develop throughout childhood and are really important for laying the foundation for what we know as attention and the ability to not be hyperactive, and to remain attentive in the classroom,” she says.

“But in children who have developmental disorders, often there are distinct areas of weakness in one or all of those processes.”

For example, children with Down syndrome have difficulties in both selective and sustained attention, whereas children with ASD tend to have problems with attentional control, she explains. Some children with ASD have very good selective attention, but research by Kirk and her colleagues shows this isn’t always the case.

Meanwhile, children with ADHD tend to have difficulties with attentional control and working memory, which is important for maintaining concentration.

Thus, while the outward inattentive behaviour may appear similar in these children, there are different underlying causes. One child may not be able to absorb the information being taught, another may have difficulty sustaining focus, whereas another may struggle with filtering out distractions.

“It’s really important for us to hone in treatments and interventions to individually support those children, because it’s really those cognitive aspects that should be the focus for interventions rather than the behavioural aspects,” says Kirk.

While drugs may help treat behavioural symptoms, they don’t address the underlying causes, she says.

With this in mind, Kirk and her colleagues teamed up with game developers to create TALI Train, the first non-pharmaceutical intervention for attention difficulties.

“It’s designed to train children’s ability to attend,” says Kirk. “It’s built on this concept that the brain is flexible and adaptive to change.”

The program comprises multiple exercises each lasting four minutes, the ‘sweet spot’ for how long a typical six year old child can maintain focus. The children are given a task, such as finding particular objects on a touch screen and the program quickly adapts to the child’s progress, adjusting the difficulty level – such as the addition of distractions – along the way.

Two double-blind randomised control trials (here and here) showed that children with developmental disorders who used the program five times a week for five weeks displayed improvements in focusing attention and filtering distractions, and maintained these improvements for three months after completion of training.

“We also saw improvements in numeracy skills,” says Kirk, adding that this was interesting because there is no numeracy training in the program.

“We know that attention, and in particular selective attention, is really important for numeracy development,” says Kirk, but this is one of the first demonstrations that improving attention can also improve numeracy.

Tali Train is now being used by a number of health professionals and schools around the country.  In addition to improvements in selective attention, Kirk says, “we’re getting feedback that individuals are improving in their general well being and their sense of achievement.”

“It’s very exciting.”

She and her colleagues are also investigating how the program improves attention in neurotypical children and expect to publish those results soon.