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A full body game for children with attention deficit hyperactivity disorder: adventurous dreaming high-flying dragon

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A full body game for children with attention deficit hyperactivity disorder: adventurous dreaming high-flying dragon

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A FULL BODY GAME FOR CHILDREN WITH ATTENTION DEFICIT
HYPERACTIVITY DISORDER:

ADVENTUROUS DREAMING HIGH-FLYING DRAGON

by

Yasaman Hashemian

A Thesis Presented to the

FACULTY OF THE USC SCHOOL OF CINEMATIC ARTS
UNIVERSITY OF SOUTHERN CALIFORNIA

In Partial Fulfillment of the
Requirements for the Degree
MASTER OF FINE ARTS
(INTERACTIVE MEDIA)

May 2013

Copyright 2012 Yasaman Hashemian

ii

ACKNOWLEDGMENTS

No one can walk alone on the journey of life. I was blessed that I had so
many wonderful people who joined me, walked beside me, inspired me, and
helped me along the way. So, perhaps this page will be seen as a "thanks" to
those of you who have helped make my life what it is today.

I would like to express my special thanks of gratitude to my thesis chair,
Marientina Gotsis. She is not only my mentor, but I would also consider her my
older sister who supported me, believed in me, and encouraged me in many
different ways. She gave me the golden opportunity to work at her new research
lab, the Creative Media & Behavioral Health Center, while I was attending the
University of Southern California. Much of what I have learned over the past
three years came as a result of being a research assistant at CM&BHC.
Working at her lab and participating in many different, wonderful projects
opened my eyes to a completely new perspective and helped me in doing a lot
of research. I also came to know about so many new things. I cannot say thank
you enough for her tremendous support and help, as she makes me feel
motivated and encourages me every time I talk to her and ask for advice.

In addition, I have a deep appreciation for my committee member,
Andreas Kratky, for his useful comments and endless encouragement through
the design process of this master thesis. Furthermore, I would like to thank my

iii

outside advisors, Dr. David Baron, Dr. Attila Ceranoglu, and Dr. Erica
Shoemaker, for introducing me to the medical aspects of this project and who
willingly shared their precious time and provided necessary expertise. I am
grateful for their constant support and help.

This research project would not have been possible without the support
of many people. First, I would like to thank Scott Easley for giving me the
opportunity to develop my project as one of his class projects. The success of
this project depends largely on the efforts of all of my team members who
walked besides me on and off on this project; it would not have been possible
without you. I would like to extend my sincere thanks to all of them: my producer,
Dai Yun; my programmer team, Rasik Srinath Ramish, Sunil Venkatraman,
Cheng-Yin Wu; my art team, Katie Dicus, Maitrayee Borah, Marcus Bydlowski;
and my music and sound team, Lance Trevino, Caleb Miller, Dashiel Reed,
Tony Hsieh. Thank you.

Special thanks to all the little angels who played my game and helped me
in the processes of design in their own ways. Their enthusiasm and energy
always motivated me to work harder to have a better game: Thank you -
Doreen, Delara, Darya, Baran, Ally, Vincent, Jerry, Leon, Amaya, Emma, Parker,
Maelee.

iv

Finally, I would also like to thank my family and friends who helped me a
lot, believed in me, and supported me in many different ways throughout this
process.

v

TABLE OF CONTENTS
Acknowledgments…………………………………………………………..……ii
List of Figures……………………………………………………………………vi
List of Tables……………………………………………………………………vii
Abstract……..…………………………………………………………………..viii
Introduction…..…………………………………………………………………..1
Part I: Research…………………………………………………………………4
Part II: Design…………………………………………………………………...9
Design Objective………………………………………………………...9
Prior Art…..…………….……………………………………………….11
Pre-Design Research…………………………………………………..15
Game Design Process / Game Flow………………………………....19
Mini-game # 1 “Catchy”..…….………………………………....19
Mini-game # 2 “Shaver”..…………………………………..……21
Mini-game # 3 “Cracks”..….…………………………..……..…23
Reward System………………………………………………....25
Part III: Playtests..…..…………………………………………………………..26
Conclusion / Future Plans..…………………………………………….28
References…..……………………..…………………………………………...29

vi

LIST OF FIGURES

Figure 1. Game environment concept art for virtual world 3
Figure 2. Main character concept art (2D left, 3D right) 3
Figure 3. “Lumosity” mini-game 12
Figure 4. Another example of “Lumosity” mini-games 13
Figure 5. Catchy mini-game prototype 20

Figure 6. Shaver mini-game prototype 22

Figure 7. Cracks mini-game prototype 23

vii

LIST OF TABLES

Table 1.1. Symptoms of Hyperactivity 5
Table 1.2. Symptoms of Impulsivity 5
Table 1.3. Symptoms of Inattention 5
Table 2. Why use of video games can help kids with ADHD? 16
Table 3.1. Positive influence of this project on Hyperactivity 17
Table 3.2. Positive influence of this project on Impulsivity 18
Table 3.2. Positive influence of this project on Inattention 18
Table 4. Age/Gender distribution of players by session 26

viii

ABSTRACT

Adventurous Dreaming High-flying Dragon is a full-body, interactive
experience for children, ages 6-8, that engages players in activities that improve
brain activity by encouraging goal planning and dedication. This project
incorporates from scientific studies that show that physical exercise can help
children better cope with the symptoms of Attention Deficit Hyperactivity Disorder
(ADHD).

This project is composed of a series of mini-games, each of which can
teach generalizable life skills to help players manage their ADHD symptoms.
Players repeat each of these games several times to gain mastery over real-life
skills as they follow the story of a young dragon character. Each game is focused
on a specific strength or weakness prevalent in children with ADHD, and the
games are categorized by ADHD diagnosis categories, including specific
hyperactivity, impulsivity and inattention.

1

INTRODUCTION

Attention is a major determining factor in how children experience the world.
Internal feelings, thoughts, and emotions—as well as external sights, sounds, and
sensations—compete for their subconscious and conscious attention. The Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV-TR), includes a statement by the
American Psychiatric Association that 3-7% of school-aged children have ADHD.
1

This project seeks to provide structured, interactive training and evaluation to assist
these children in combating the symptoms of ADHD without the need and expense of
constant supervision by a child psychiatrist.

Hallowell, in an interview for the Montessori Society, proclaimed that “the
cognitive style of children with ADHD is qualitatively different from most of their
peers”. The style needs patience, reinforcement and encouragement, which are just a
few things that video games are good at.
2
This is what this project is hoping to
contribute with its different experiences.

In order to help children with ADHD, this project builds a structure to break
tasks down into smaller tasks and make multiple mini-games from it. Once this is
done, children are asked to keep playing it and repeat it to be able to achieve
mastery. I hope that through this project, those children would be able to start doing

1

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders:
DSM-IV-TR. Washington: American Psychiatric Association, 2000.

2

Peters, D. L. It Really Is All about the Child: An Interview with Dr. Edward Hallowell.
Montessori Life: A Publication of the American Montessori Society, 24, 4 ( 2012), 12-17.

2

things in their life that they had never been able to do before.
In my conversations with clinical experts, I was told that many of ADHD
children lack certain social competencies because of various neurodevelopmental
deficits. Therefore, they are often not popular among their peers, which may
contribute to lack of self-confidence and depression in adulthood. This project tries to
incorporate the goal of trying to make these children feel good about themselves.

The game takes place in a charming, happy, playful, and a bit mysterious little
floating dragon island as shown in Figure 1. Players play as the main character in the
game, The Dragon as shown in Figure 2, who is not a hero from the beginning, but
who can eventually become one based on the performance and skills of the players.
Each mini-game has its own scenario to engage children and takes place at different
location on the island to provide more variety and prevent boredom. Overall, all the
mini-games are tied into the main narrative of the game, which is the part of the story
of an adventurous dreaming highflying Dragon (adhD).

3

Figure 1. Game environment concept art for virtual world

Figure 2. Main character concept art (2D left, 3D right)

4

Part I: Research

Studies on Attention Deficit Hyperactivity Disorder:
A Behavioral disorder not a cognitive disorder

ADHD is characterized by core symptoms of hyperactivity, impulsivity, and
inattention. The symptom of hyperactivity is diagnosed by observing inappropriate
behaviors such as climbing furniture, untimely departure from the classroom, and just
a lot of activity in general. Impulsivity has a real impact on turn taking, whether it
occurs in something simple like playing games, or even in cutting people off in front of
a line, which has a larger social cost. For school age kids, being fair and following the
rules is very important, therefore misbehavior can contribute to being ostracized by
one’s peers. Lastly, with inattention, which mostly affects older kids, the brain is
unable to prioritize what to ignore and what to pay attention to. For example, in class
when the teacher is teaching and there is a sound of a high-heeled shoe from outside
of the classroom, the brain has difficulty choosing which sound to ignore.

These symptoms often present the following behaviors, as shown in the tables
below, which can interfere with normal functioning.
3

3

“INTUNIV (guanfacine) Extended-Release Tablets.” Accessed February 27, 2013. http://www.intuniv.com/.

5

Table 1.1. Symptoms of Hyperactivity
1. Fidgeting with hands or feet or squirming when seated
2. Leaving his or her seat in the classroom or in other places where it is
inappropriate
3. Running around or climbing excessively in situations in which it is
inappropriate
4. Difficulty playing or quietly engaging in leisure activities
5. Excessive talking
6. Acts as if "on the go"

Table 1.2. Symptoms of Impulsivity
1. Blurting out answers before questions have been completed
2. Having difficulty awaiting his or her turn
3. Interrupting or intruding on others

Table 1.3. Symptoms of Inattention
1. Inability to pay close attention to details or makes careless mistakes in
schoolwork or other activities
2. Difficulty paying attention during tasks or play activities
3. Inability to listen when spoken to directly
4. Inability to follow through on instructions and failure to finish schoolwork

6

or chores
5. Difficulty organizing tasks and activities
6. Avoidance, dislike, or unwillingness to do things that involve continuous
mental effort, such as schoolwork or homework
7. Loss of things needed for tasks or activities, such as toys, school
assignments, pencils, or books
8. Easily distracted by noises or objects
9. Forgetfulness in daily activities

There are common issues and struggles among all three categories, such as
easily being disoriented. Easily distracted by things around them, children with ADHD
have a great tendency to lose things or not notice them, even if they are right in front
of them. Because of their distractions, their priorities might be different from other
children around them, which results in having difficulty with finding a starting point.
Even with a set of instructions for a task, they might forget doing it or not know how to
follow instructions.

For example, some of the common behavior problems are as follows:
 Interpersonal conflicts / Applying rules: Some children may routinely respond
aggressively, even if they understand the rules that govern a social situation,
such as “I shouldn’t hit others” or “I should listen to my teacher who warned
me about hitting other children,” because of problems with rule use.

7

 Fail to plan: Some children may routinely act aggressively because they fail to
plan and anticipate the negative consequences of their own aggressive
behavior. For instance, they may fail to realize that if they hit another child, the
other child will hit them back, which could provoke an all-out fight.

 Difficulty Evaluating: Some children may routinely respond aggressively
because they have difficulty evaluating the effects of their behavior and
learning from feedback: for example “the last time I hit someone, he hit me
back, and we both got in trouble.”

 Combination of reasons: Some children may respond aggressively because of
many of the above reasons combined. Thinking about executive function might
help parents and caregivers consider that behavior problems might not be due
to children simply having strong aggressive tendencies or intentionally acting
out, but rather, these children may have problems associated with the control
processes that are tied to executive function.
4

4

Evidence-Based Diagnosis and Treatment for Specific Learning Disabilities Involving
Impairments in Written and/or Oral Language, Berninger, Virginia W.; May, Maggie O'Malley.
Journal of Learning Disabilities, v44 n2 p167-183 Mar-Apr 2011.

Executive Dysfunction among Children with Reading Comprehension Deficits, Locascio,
Gianna; Mahone, E. Mark; Eason, Sarah H.. Journal of Learning Disabilities, v43 n5 p441-
454 Sep 2010.

Executive Functions as Predictors of Math Learning Disabilities, Toll, Sylke W. M.; Van der
Ven, Sanne H. G.; Kroesbergen, Evelyn H., Journal of Learning Disabilities, v44 n6 p521-532
Nov-Dec 2011.

Neuropsychological Aspects for Evaluating Learning Disabilities, Semrud-Clikeman, Margaret.
Communication Disorders Quarterly, v26 n4 p242-247 Sum 2005.

8

The research part of this project helped me to understand this disorder better,
to identify my plan, try the best design, and evaluate it with a play test. I designed
each mini-game of this project through consideration of the aforementioned common
behavioral problems. I blended a small portion of instruction with activities that
strengthen working memory, inhibition, and attention control. Procedural learning was
the main aim in this project.

What are executive functions? (2011). Center on the DevelopingChild at Harvard University,
www.developingchild.harvard.edu

Zelazo, P.D. (2011). Multi-part series on the topic of executive function.
www.aboutkidshealth.ca

9

Part II : Design

Design Objective:

The objective for all games in this project is to demand focused attention while
players use different body gestures to control the main character in the game. This
process is not only fun but also aims to teach children to pay attention for longer
periods of time. As with anything else, mastering this game takes practice, so players
can play for as long as they want. As they master required in-game skills, the levels
become more difficult so players can build up “brain” power incrementally.

Studies consistently show that playing video games improves hand-eye
coordination and increases humans’ visuospatial skills. These increases in brain
function are tied not only to game play but also to several other real-world scenarios.
When the brain encounters new visual and auditory stimulation, or new and different
ways of processing information, it can change and grow in the most remarkable
ways.
5
That is how neuroplasticity works. In fact, this improvement may naturally
register as a part of the behavior and then be incorporated into daily life.
6
This is the
process that I am hoping to foster with this project.

5

Bavelier, D., Green, C. S., Han, D. H., Renshaw, P. F., Merzenich, M. M. and Gentile, D. A.
Brains on video games. Nature Reviews Neuroscience, 12, 12 ( 2011), 763-768.

Boot, W. R., Kramer, A. F., Simons, D. J., Fabiani, M. and Gratton, G. The effects of video
game playing on attention, memory, and executive control Acta Psychol. (Amst), 129, 3 (Nov
2008), 387-398. DOI=10.1016/j.actpsy.2008.09.005.

6
Halperin, Bédard, and Curchack-Lichtin, “Preventive Interventions for ADHD.”

10

It is commonly reported that children who are placed in front of therapeutic or
educational programs suffer test anxiety. The feeling that they are attached to
multiple devices and are being monitored while the slightest mistake can be observed
can destroy the essence of creativity, motivation, and enthusiasm for these children.

To solve this problem, it is better to provide an environment in which children
can play with complete freedom, setting their own pace, and enjoying the game play
without knowing the training structure in the background of the game. The beautiful,
interesting, and imaginative world of games for children can create a new level of
interest and immersion for the children and help them forget about the therapeutic or
educational aspect of it.
7

7

Ferguson, B. The Emergence of Games for Health. GAMES FOR HEALTH: Research,
Development, and Clinical Applications, ( 2012).

Ferguson, C. J. A further plea for caution against medical professionals overstating video
game violence effects. In Anonymous Mayo Clinic Proceedings. (). Mayo Foundation, , 2011,
820.

Olson, C. K. Children’s motivations for video game play in the context of normal development.
Review of General Psychology, 14, 2 ( 2010), 180-187.

11

Prior Art:

I have always been impressed by the power, capabilities, and potential of the
human brain. It is the converging point of all human feelings, behaviors, and
experiences, as well as the repository of memory and regulator of self-awareness.
Many products have emerged in the market claiming effectiveness toward brain
improvement. While I was researching for my project, I discovered Lumosity.com and
spent a couple of months practicing it to understand its success.

According to Lumosity.com, “Lumosity is based on the science of
neuroplasticity – your brain’s ability to strengthen and grow. Just 10 hours of
Lumosity training can create drastic improvements. Track your own amazing
progress with our sophisticated tools.” According to the LA Times, “Lumosity presents
a wide range of exercises that target different mental processes that decline with age,
including working memory, speed of processing and attention.”

I agree with the quote above that Lumosity has multiple mini-games, which
give players the opportunity to improve their capacities in multiple ways—memory,
attention, problem solving, speed, and flexibility improvement—but it is hard to
understand how this generalizes to daily activities.

12

Figure 3. Lumosity mini-game

For example, a mini-game in Lumosity challenges players to use the arrow
keys and submit the direction of the odd bird in the bird flock as shown in Figure 3.
This practice might be challenging for many people who have attention problems, but
it mostly works on eye-finger coordination.

I personally find it hard to be engaged in any of Lumosity’s mini-games. Maybe
the lack of narrative was one of personal reasons, but I also had difficulty seeing
results from improvements in these mini-games in real life. There was no connection
between what I practiced in the mini-games and my real life routines. As an adult, I
was able to force myself to remain in the program but after couple of months, I gave
up. Moreover, the scoring system was less meaningful than I expected it to be. I
learned a valuable lesson from practicing these brain exercises: since I was dealing
with children for my thesis, I needed to have a stronger “hook” for my game to
engage children to keep on playing it. Strong narrative in the content of the game and
an innovative way to present it to the audience can be very helpful for bonding

13

children with the game. Also, I believe that the scoring system has to be tied in the
narrative of the game to engage the players to look forward the next level.

I learned different aspects of how to use tricks to recover the attention of
players. I also learned how to use different orientations on the screen to capture the
players’ foci on a specific portion of the game.

Figure 4. Lumosity mini-games

The screen captures in Figure 4 are from two different mini-games at
Lumosity.com. There is enough information on the left image to understand the game
play. For the right image, the objective of the game is to memorize the location of the
colored tiles. The game will show the image of the location of tiles for a few seconds
and then wipe them off. By clicking on tiles, players must guess the right location
based on the previous image.

14

Overall, this program and most similar versions have the same design problem:
they lack context of skills situated within daily routines. My thesis project uses
Microsoft Kinect® as a game controller, which can track full body movement in 3D to
enable a gesture-based play experience. Physically active learning can increases
performance
8
, and this technology can provide this capacity for any therapeutic or
educational applications.

8

Flohr et al., “Effects of Physical Activity on Academic Performance and Behavior in Children
with ADHD.”

Farrace-Di Zinno et al., “Body Movements of Boys with Attention Deficit Hyperactivity
Disorder (ADHD) During Computer Video Game Play.”

15

Pre - Design Research:

Previously in WHICH CHAPTER, I explained that studies consistently show that
playing video games can improve hand-eye coordination visuospatial navigation skills.
These skills were found to generalize in real-world scenarios. This project hopes to
foster generalization of these skills into daily life.
9
Using video games as a tool in
psychotherapy for children could facilitate the needed engagement in treatment.
Multiple studies show that patients attend therapy sessions more regularly when
video games are involved in the therapeutic process in comparison with traditional
approaches for therapy.
10
Kulman and Stoner, in CHADD annual conference 2012,
classified the reasons of why video games and digital media can help kids with ADHD.
(See Table 2.)

9

Bavelier, D., Green, C. S., Han, D. H., Renshaw, P. F., Merzenich, M. M. and Gentile, D. A.
Brains on video games. Nature Reviews Neuroscience, 12, 12 ( 2011), 763-768.

Boot, W. R., Kramer, A. F., Simons, D. J., Fabiani, M. and Gratton, G. The effects of video
game playing on attention, memory, and executive control Acta Psychol. (Amst), 129, 3 (Nov
2008), 387-398. DOI=10.1016/j.actpsy.2008.09.005.

10

Clarke, B. and Schoech, D. A video-assisted therapeutic game for adolescents: Initial
development and comments. Videos in Human Services, 1, 2( 1994), 121-140.

16

Table 2. Why use of video games can help kids with ADHD?

Kids with ADHD or Attention Difficulties Video games and digital media
May become easily bored and unable to
sustain attention
• Require ever-changing skills
• Employ video, sounds, words,
and actions.
• Multi-modal
Often require immediate reinforcement
or consequence to stay focused on a
task.
• Provide clear and immediate
feedback
• Constantly let player know he is
doing wrong and right
Often requires that their body or mind to
be actively engaged.
• Extremely engaging
• Many require physical and
cognitive involvement

Ceranoglu and others report several barriers against use of video games in
psychotherapy process, such as thematic content of video games, style of play they
require, access to video games, or general attitudes toward video games. General
public attitudes toward video games also may lead therapists to avoid video games in
their offices. The common negative reception to video games, particularly because of
belief in a possible association between intensive play and aggressive behavior,
school failure, and obesity, makes it difficult for clinicians to display these tools in
offices.
11

This thesis project requires full body engagement to help against combat
attitudes against
video-game induced “laziness” and to avoid contributing to

11
Ceranoglu, T. A. Video games in psychotherapy. Review of General Psychology, 14, 2
(2010), 141-146.

17

sedentary behavior, which is linked to obesity. Moreover, this project aspires to
provide a happy and cheerful environment and avoids any themes of violence or
destruction. It provides encouraging support for players to help engage them and
bring back their self-confidence, which can help with their social competencies. As
mentioned on Tables 3.1, 3.2 and 3.3 the thematic content of this project specially
designed for children and all game mechanics target specific neurodevelopmental
needs of children with ADHD.

Therapeutically-oriented games, such as this thesis project, provide an
environment in which children can play with complete freedom, at their own pace,
and enjoy the game play without knowing the training structure behind the game.
Beautiful, interesting, and imaginative worlds of games for children can create a new
level of interest and immersion and help children forget about therapeutic or
educational goals.
12

Table 3.1. Hypothesized positive influence of adhD game on Hyperactivity

Hyperactivity

Video
games

Full
body

experience
with

technology
of

Kinect

Detecting
body

movement
and

providing

immediate

reflection

Comparing
past
and

present
playtests
and

detecting

improvement

Improving
real
life

executive
function

skills

Helping
to
release
extra

energy

Narrative,
art
and

audio
feedback
in

games

12

Ferguson, C. J. A further plea for caution against medical professionals overstating video
game violence effects. In Anonymous Mayo Clinic Proceedings. (). Mayo Foundation, , 2011,
820.

18

Table 3.2. Hypothesized positive influence of adhD game on Impulsivity

Impulsivity

Video
games
Asking
for
patience

based
on
the
nature

of
the
game

Avoiding

inappropriate

interrupting
or

intruding

Full
body

experience
with

technology
of

Kinect

Increasing
capacity

for
spatial

recognition

Narrative,
art
and

audio
feedback
in

games

Allowing
for

immediate

reinforcement

Preventing
boredom

Table 3.3. Hypothesized positive influence of adhD game on Inattention

Inattention

Video
games
Improving
the

ability
to
make
a

plan
and
follow

through
with
it

Increasing
the
ability

to
stay
focused
by

presenting
the

consequences

Increasing
the
ability

to
follow
the
given

instruction

Repeating
practice
to

accomplish
mastery

Full
body

experience
with

technology
of

Kinect

Narrative,
art
and

audio
feedback
in

games

Increasing
capacity

for
visual
attention

Preventing
distraction

from
the
experience

Allowing
for
an

engaging
experience

19

Game Design Process / Game flow:

Mini-game #1 Catchy:

Objective:
The Catchy (See Figure 5) mini-game increases the ability to focus and
remember specific visual prompts. Sustaining visual concentration in these types of
endeavor can increases the potential for learning. The objective of this game is to
memorize a specific sequence and apply it in the game environment.

Previous prototypes and lessons learned:
In the first version of this mini-game, there was a rainfall of objects that players
collected based on the visual cue they received at the beginning of the game. This
version tested multiple times to understand the complexity of spatial movement.

Understanding the exact location of each object was not easy for players to
recognize. The depth perception was also another difficulty I noticed in play tests.
Another issue was accidental collecting, which generated the idea of shield protection.
In the next prototype, the objects that fell down casted shadows to make it a little bit
easier for players to recognize the place. Still, the issue of depth perception remained
unresolved. Then, the idea of providing fixed column of objects was implemented.
This has improved navigation, but my team is exploring a better solution for spatial
cueing.

20

Figure 5. Catchy mini-game prototype

Current version:
In the beginning of each level, the screen shows a visual prompt, which is a
sequence of an object in different colors. The objective of the game is to memorize
the sequence and to carry it out. The more successful the player is, the longer and
more complex the sequences become. There are more shapes and more colors in
the higher level memorization sequences.

After memorizing the prompt, the game starts. Players find themselves in the
middle of a room with beam of colors around them. Each beam has one color and
different objects falls down from it. In the beginning levels there are only two color
beams and only one type of object falling down to decrease the complexity, since
memorizing complex prompts for children with attention deficit is very hard. Players
have to walk toward each beam and collect objects in the correct sequence. Each
mistake resets the stack of collected objects and asks the player to start from the
beginning.

21

In the higher levels, the number of beams will increase, which might cause
accidental collection while walking around the space to reach to the certain beam. In
that case, the game provides players a shield to cover themselves from this
accidental collection. There will be a specific gesture to activate shield protection.

With this mini-game, players can train their visual ability, focus, and body-eye
coordination, and learn valuable stimulus discrimination skills. The latter skills help
children pay attention to only what they want to, while ignoring other things that might
normally be distracting.

Mini-game #2 Shaver:

Objective:
The Shaver (See Figure 6) mini-game aims to strengthen hand-eye
coordination. In terms of practical application, this can help improve real world skills,
such as handwriting, sports, keyboarding, and any activity requiring fine motor skills.
Children with ADHD often have poor hand-eye coordination. With practice, the brain
can learn to focus on what the hand is doing. With repeated play, the brain can
become more accurate and more aware of the focus required for complete control of
the body.

22

The objective of this mini-game is to collect as many jewels as possible. The
jewels are hidden between rocks, and players have to break them carefully to not
harm the jewels and pick them up.

Previous prototypes and lessons learned:
In the early version of this game, a golden egg was hidden in the middle of a
rock. Players had to carve the rock to be able to reach the golden egg. On the right
hand side of the screen there was a red ball, which helped the players to reach the
top of the rock. I was looking for more involvement of other body parts in this mini-
game since players were not moving around the space. Standing at one place was
not very helpful for kids with hyperactivity. Because of this, the game control
incorporated two virtual pads on the floor that players had to step on to be able to
rotate the rock along the X- or Y-axis. This works very well and stepping on each pad
seems very satisfying to players.

When the model of Dragon eventually came along, a new challenge emerged
because the dragon character covered most of the rock with their body.

Image 6. Shaver mini-game prototype

23

Current version:
In the beginning of the game, players are told there is a fragile and valuable
object in the middle of the rock that needs to be set free without harm. With every
touch, pieces of the rock break away and disappear, and players get closer to the
valuable object in the center. The location of the valuable object is not predictable,
therefore the task requires more attention and accuracy for each movement by the
player. There are two virtual “pads” on the floor that players can tap with their leg to
rotate the rock on two different axes in order to make every segment of the rock more
accessible.

Mini-game #3 Cracks:
Objective:
The Cracks (See Figure 7) mini-game aims to develop the ability to hold the
body still in a pose. The goal is to gradually increase pose complexity to and to
increase the time required to hold the pose. Children with hyperactivity are usually
diagnosed with ADHD because of their restlessness and fidgeting. This mini-game
can help them overcome this issue by maintaining control over their movements.

Image 7. Cracks mini-game prototype

24

Current version:
In the beginning levels, the game starts with couple of cracks on a wall.
Players are asked to place any part of their body over the cracks to avoid further
expansion of cracks and to hold the pose for few seconds so the cracks can heal..
Eventually, the game generates more cracks on the wall, which necessitates more
body parts to cover them. This mini-game has the potential to be very fun and
exciting for children to play. Most of the time, childrens’ poses turn into goofy and silly
gestures that can be very engaging and exciting for children while playing.

25

Reward system:

Kids with ADHD are often good with video games, or at least as good as their
peers, because video games are very good at giving small, constant rewards for
persistence of engagement. Games can reinforce patterns of behavior, which may
increase inattention, impulsivity, or quick changes in attention. Activities with
appropriate reward systems can help sustain attention and encourage players to hold
back their impulses and control their hyperactivity. Persistent reward, stimulation, and
mastery can engage children to play without the perception of being in “therapy”. The
reward system of adhD is different than many popular video games. The system uses
audio feedback to cheer players based on their performance as part of the increase
in complexity as a reward in itself.

26

Part III: Play-testing Studies

In this experiment, the data collection was performed only for the purpose of
design. Because of the informal nature of the observations, there was no official
video recording, and results are based on my personal observations and notes. Data
collection consisted of observing the children’s interactions with the game, including
the players’ body gestures, facial and verbal expressions.

The data for this paper consisted of three different playtest sessions, which
included the combination of ADHD and non-ADHD children, ages 5-8, with diagnosis
self-reported by the parents. (See Table 4)

Table 4. Age/Gender distribution of players by session
Age 5 Age 6 Age 7 Age 8
Female 1 3
SESSION 1
Male
Female 1
SESSION 2
Male 1 1 1
Female 3
SESSION 3
Male 1

These particular sessions involved four children who took turns to play the
game while others were watching. Since each playtest session took place as a group
meeting, all players had a chance to talk and interact with each other while playing
the game. It is interesting to note that in the Catchy mini-game, children with ADHD
had more difficulty in sustaining their attention and following the prompts than non-

27

ADHD children. Where the children with ADHD were encouraged by their peers, they
were more motivated to keep trying. This inspired me to include more audio feedback
in the game to keep the children engaged and motivated to play.

In the case of the other two mini-games, the simple mechanic of Cracks
provided a big opportunity for both ADHD and non-ADHD children to enjoy the game.
The playful nature of the poses and the childrens’ tendency to choose the most
exciting pose provided fun for everyone. One of the players verbally expressed his
this feeling: “This is cool, I can do anything I want.”

The sense of anticipation felt while searching for the valuable object in the
middle of the rock kept children engaged during gameplay. All the children faced
some initial difficulty in controlling their actions, but eventually they managed to figure
it out. At one of the playtest sessions, one child had difficulty accomplishing the goal,
but she kept motivating herself by saying, “I really want to get the golden box.”

After each playtest session, I made some changes to the game based on my
observation and scheduled another playtest session to observe the changes.
Because the three groups of players played three different version of the game, it
would be impossible to combine all the data coherently in a single transcript. The
scope of each version of the game are simply too different, as I only mentioned a few
examples of each mini-game from different sessions independently.

28

Conclusion / Future Plans:

This project is still in development with temporary art assets. Even without
polished visual effects and audio feedback, children found a way to enjoy playing the
game. This project would have to be developed enough to understand what the
appropriate depth and length of play would be for improvement in measurable skills
through psychometric testing, and in real-life. I plan to develop an integrated beta
version with adequate story elements and enough level depth to provide “replaybility”
toward a preliminary evaluation than could assess the potential for short-term skill
“generalizability”.

29

References:

Materials taken and adapted from:

Books:

• The gift of ADHD activity book; 101 ways to turn your child’s problem into strengths by
Lara Honos-Webb, PhD
• Your defiant child by Russel A. Barkley, PhD and Christine M. Benton
• Taking Charge of ADHD by Russel A. Barkley, PhD
• Attention GAMES by Barbara Sher
• The Healing Power of Emotion by Diana Fosha, Daniel J. Siegel, Marion F. Solomon
• Psychophysiology of self awareness by Alan Fogel
• The intimate act of Choreography by Lynne Anne Blom, L.Tarin Chaplin
• Trauma and the body by Pat Ogden, Kekuni Minton, Clare Pain
• The Survival Guide for kids with ADD or ADHD by John F.Taylor, PhD

Websites:
• www.webmd.com
• www.focusing.org
• www.allpsych.com
• www.addadhdadvances.com
• http://psych.wisc.edu/postlab/readings/Westerberg2007PhysBehav.pdf
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is-remembered/
• http://adhd.kids.tripod.com/rabinerst.html
• http://www.additudemag.com/adhd/article/3577.html
• http://www.additudemag.com/adhd/article/798.html
• http://www.chadd.org/
• http://www.playattention.com/
• http://www.lumosity.com/
• http://developingchild.harvard.edu/

30

• http://www.deltraining.com/courses/Executive_Function/content-frame.htm
• http://developingchild.harvard.edu/library/reports_and_working_papers/

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• INTUNIV (guanfacine) Extended-Release Tablets.” Accessed February 27, 2013.
http://www.intuniv.com/.

• Evidence-Based Diagnosis and Treatment for Specific Learning Disabilities Involving
Impairments in Written and/or Oral Language, Berninger, Virginia W.; May, Maggie
O'Malley. Journal of Learning Disabilities, v44 n2 p167-183 Mar-Apr 2011.

• Executive Dysfunction among Children with Reading Comprehension Deficits,
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• Neuropsychological Aspects for Evaluating Learning Disabilities, Semrud-Clikeman,
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Asset Metadata

Creator Hashemian, Yasaman (author)

Core Title A full body game for children with attention deficit hyperactivity disorder: adventurous dreaming high-flying dragon

School School of Cinematic Arts

Degree Master of Fine Arts

Degree Program Interactive Media

Publication Date 04/26/2013

Defense Date 03/09/2013

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag ADHD/ADD,attention,executive function,game,kinect,motor skills,OAI-PMH Harvest,prototype

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Gotsis, Marientina (committee chair), Baron, David (committee member), Kratky, Andreas (committee member)

Creator Email yasaman.hashemian@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-243476

Unique identifier UC11287998

Identifier etd-HashemianY-1591.pdf (filename),usctheses-c3-243476 (legacy record id)

Legacy Identifier etd-HashemianY-1591-0.pdf

Dmrecord 243476

Document Type Thesis

Rights Hashemian, Yasaman

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA