The Dynamic Difficulty Adjustment of a Neurofeedback-Based Cognitive Game to Make a Help to Treatment of Attention Deficit Hyperactivity Disorder

Document Type : Original Articles

Authors

1 Department of Biomedical Engineering, School of Engineering, University of Isfahan, Isfahan, Iran

2 Assistant Professor, Department of Biomedical Engineering, School of Engineering, University of Isfahan, Isfahan, Iran

3 Associate Professor, Department of Biomedical Engineering, School of Engineering, University of Isfahan, Isfahan, Iran

4 Associate Professor, Department of Psychology of Children with Special Needs, School of Education and Psychology, University of Isfahan, Isfahan, Iran

5 Associate Professor, Department of Cognitive Neuroscience, School of Educational Sciences and psychology, University of Tabriz, Tabriz, Iran

10.22122/jrrs.v15i1.3445

Abstract

Introduction: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurological disorders among the children and adolescents. Neurofeedback-based exercises, as a new method in non-pharmacological treatments, can help to improve their performance by modifying existing abnormalities in some of the brain frequency bands of these children. The aim of the present study was to develop and design a computer game as a platform for neurofeedback exercises by employing dynamic difficulty adjustment in the game design.Materials and Methods: This study was carried out to evaluate the dynamic difficulty setting in the game and measuring the satisfaction of play with dynamic difficulty versus static difficulty in 4 sessions on 6 participants of 20 to 26 years. They graded their experience in each session from 1-10 depending on the amount of enjoyment. Then, 2 boys of 12 and 13 years with ADHD participated by playing the game for 10 sessions.Result: There was a significant difference between the participants’ satisfaction with dynamic difficulty versus static difficulty (P = 0.002). Moreover, the game had a positive impact on improving brain function in children with ADHD.Conclusion: The results showed that children were attracted and motivated to use the game for treatment. Adjusting the challenges based on the individual skills maintained the user's motivation from the beginning to the end of the game, and enhanced user’s enjoyment and motivation to continue the therapy.

Keywords

  1. Dawson P, Guare R. Executive Skills in children and adolescents: A practical guide to assessment and intervention. New York, NY: The Guilford Press; 2018.
  2. Zuberer A, Brandeis D, Drechsler R. Are treatment effects of neurofeedback training in children with ADHD related to the successful regulation of brain activity? A review on the learning of regulation of brain activity and a contribution to the discussion on specificity. Front Hum Neurosci 2015; 9: 135.
  3. Volkow ND, Wang GJ, Newcorn J, Fowler JS, Telang F, Solanto MV, et al. Brain dopamine transporter levels in treatment and drug naive adults with ADHD. Neuroimage 2007; 34(3): 1182-90.
  4. Jones SR, Gainetdinov RR, Wightman RM, Caron MG. Mechanisms of amphetamine action revealed in mice lacking the dopamine transporter. J Neurosci 1998; 18(6): 1979-86.
  5. Lubar JF, Shouse MN. EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR): A preliminary report. Biofeedback Self Regul 1976; 1(3): 293-306.
  6. Lubar J, Swartwood M, Swartwood J, Timmermann D. Quantitative EEG and Auditory Event-Related Potentials in the Evaluation of Attention Deficit/Hyperactivity Disorder: Effects of methylphenidate and implications for neurofeedback training. J Psychoeduc Assess 1994; 34: 143-60.
  7. Lubar JO, Lubar JF. Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting. Biofeedback Self Regul 1984; 9(1): 1-23.
  8. Lubar JF. Discourse on the development of EEG diagnostics and biofeedback for attention-deficit/hyperactivity disorders. Biofeedback Self Regul 1991; 16(3): 201-25.
  9. Clarke AR, Barry RJ, McCarthy R, Selikowitz M. EEG analysis in Attention-Deficit/Hyperactivity Disorder: Acomparative study of two subtypes. Psychiatry Res 1998; 81(1): 19-29.
  10. Demos JN. Getting started with Neurofeedback. New York, NY: W. W. Norton & Company; 2005.
  11. Van Doren J, Arns M, Heinrich H, Vollebregt MA, Strehl U, Loo K. Sustained effects of neurofeedback in ADHD: A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2019; 28(3): 293-305.
  12. Sterman MB, Wyrwicka W, Howe R. Behavioral and neurophysiological studies of the sensorimotor rhythm in the cat. Electroencephalogr Clin Neurophysiol 1969; 27(7): 678-9.
  13. Granic I, Lobel A, Engels RCME. The benefits of playing video games. Am Psychol 2014; 69(1): 66-78.
  14. Zohaib M. Dynamic Difficulty Adjustment (DDA) in computer games: A review. Advances in Human-Computer Interaction 2018; 2018: 5681652.
  15. Chen J. Flow in games (and everything else). Commun ACM 2007; 50: 31-4.
  16. Stein A, Yotam Y, Puzis R, Shani G, Taieb-Maimon M. EEG-triggered dynamic difficulty adjustment for multiplayer games. Entertain Comput 2018; 25: 14-25.
  17. Hunicke R. The case for dynamic difficulty adjustment in games. Proceedings of the International Conference on Advances in Computer Entertainment Technology (ACE 2005); 2005 Jun 15; Valencia, Spain. p. 429-33.
  18. van der Pal J, Roos C, Sewnath G. Exploring adaptive game-based learning using brain measures. In: Sampson D, Ifenthaler D, Spector JM, Isaias P, editors. Digital Technologies: Sustainable Innovations for Improving Teaching and Learning. Cham, Switzerland: Springer International Publishing; 2018. p. 161-71.
  19. Chowdhury MI, Katchabaw M. Bringing auto dynamic difficulty to commercial games: A reusable design pattern based approach. Proceedings of the18th International Conference on Computer Games: AI, Animation, Mobile, Interactive Multimedia, Educational and Serious Games (CGAMES); 2013 Jul 30-Aug 1; Louisville, KY, USA. p. 103-10.
  20. Csikszentmihalyi M. Creativity: Flow and the psychology of discovery and invention. New York, NY: Harper Collins; 1996.
  21. Shouse MN, Lubar JF. Physiological basis of hyperkinesis treated with methylphenidate. Pediatrics 1978; 62(3): 343-51.
  22. Monastra VJ, Lynn S, Linden M, Lubar JF, Gruzelier J, LaVaque TJ. Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback 2005; 30(2): 95-114.
  23. Vidal JJ. Real-time detection of brain events in EEG. Proceedings of the IEEE 1977; 65(5): 633-41.
  24. Jasper HH. Report of the committee on methods of clinical examination in electroencephalography. Electroencephalogr Clin Neurophysiol 1958; 10(2): 370-5.
  • Receive Date: 01 February 2020
  • Revise Date: 01 June 2022
  • Accept Date: 22 May 2022