A Game-Changing Treatment for ADHD

Evidence suggests that old-fashioned childhood games — simple family play — can improve executive function, working memory, and self-control in kids with attention deficit.

Mother presenting hand puppet show to ADHD daughter

The researchers have kept the families' focus on fun and flexibility, to keep parents busy as well as to keep their children engaged.

   
 

Play with Purpose

Ready to try the TEAMS program at home? Psychologist Jeffrey Halperin and his colleagues recommend that parents and kids play for at least half an hour a day, six days a week. The games should be fun and mildly competitive. Here are three of Halperin's favorites:

Puppet Says

What it does: improves self-control What to do: Parents and children take turns holding two puppets, which give instructions for physical tasks. For instance, "Puppet says: Put your hands on your head!" or "Puppet says: Jump up and down!" The trick is that you need to ignore one puppet — the one that neglects to say "puppet says" — and listen to the other. You can increase the difficulty by using the same voice for both puppets (this is harder, because it requires you to look as well as listen) or by speeding up commands.

Remember the Treasure

What it does: enhances working memory What to do: The parent and child take turns placing several upside-down cups in a random arrangement on a table, with a "treasure" (a jelly bean, a stick of sugarless gum, or a dime) underneath each one. The child turns over one cup at a time to retrieve the treasure, replacing each cup before the next turn, until all the remaining treasures have been found. The trick is to try not to upend an empty cup while looking for another treasure. If you do, you have to return a treasure, placing it under the upended cup. The child will have to remember where the treasure is during his next turn.

Ping-Pong Balance

What it does: sharpens motor control What to do: This is a non-messy version of balancing eggs. You take turns trying to balance a ping-pong ball on top of a spoon while you walk across the room. Use only one hand to hold the spoon. Make things more challenging by speeding up the pace at which you walk.

 
   

Four-year-old Lola often annoyed her mother and nursery-school classmates. She didn't sit still in circle time, wouldn't follow instructions, and invaded other kids' "personal space." In other words, Lola seemed eligible for a diagnosis of ADHD. That's why her mother, Molly Barbalat, signed her up for a study testing a new, non-pharmaceutical intervention for preschoolers with ADHD.

During the next several weeks, Molly and Lola learned to play games together, mostly updated versions of old-fashioned staples, like Simon Says and Freeze Tag. Lola loved it so much that now, one year later, she still asks her mom to play the games. And Barbalat saw that when Lola was happy and engaged, her attention span improved.

"She has so much fun that she doesn't realize how much she is learning," Barbalat says.

More Than Just Games

That's actually what the doctor — or the psychologist, in this case — ordered. In an intriguing report, published in the Journal of Attention Disorders, the Queens College psychologist, Jeffrey M. Halperin, Ph.D., and his colleagues say that they have gathered evidence to show that a program focused on playing nursery games helps young children improve a range of "executive functions," including working memory and self-control. EFs are more important than IQ for academic success.

The Queens project contributes to other research suggesting that non-computerized learning games should be included in early interventions for ADHD. Such high-intensity focus on a child's daily experience — including happiness, a sense of mastery, and improved relationships — may have longer-lasting benefits than medication, the effects of which disappear if the pills aren't taken.

"This is an exciting study and the kind of work the field really needs," wrote Duke University associate research professor David Rabiner, in a recent edition of his online newsletter, Attention Research Update.

In the small, "proof of concept" study, performed without a control group, Halperin and his colleagues recruited and selected 29 boys and girls, aged four and five, who met the criteria for ADHD but who weren't taking medication. They met with the children and their parents in small groups, once a week, for five or more weeks of 90-minute sessions, teaching and practicing games and discussing the problems that came up. The families learned to play variations of several exercises that Halperin says tend to develop key cognitive skills and motor control, including games with balls, finding treats hidden under cups, and verbal exercises, such as making shopping lists for a picnic. The parents promised to spend half an hour a day, six days a week, on the games, at home, while also having their child do aerobic exercises, such as jumping jacks and twirling a hula hoop, and to practice relaxation techniques.

Three months after the treatment sessions ended, parents and teachers reported significant reductions in inattentive, hyperactive, and impulsive behavior. Teachers also reported that the children seemed less impaired by their ADHD.

Equally important, both parents and children said they enjoyed the program, Halperin said, which, he felt, offered hope that they'd continue to play the games. The key, he said, is that the games be intrinsically rewarding — meaning that the kids are having fun rather than being bribed to play games. The researchers have kept the families' focus on fun and flexibility, to keep parents busy as well as to keep their children engaged.

The need for more civilizing experiences for preschoolers with and without diagnoses of mental disorders has grown in recent years. In multiple surveys, teachers complain that kindergartners come to school with less self-control than ever before. Yet one of the unanswered questions in the Queens study is to know which of the program's many components contributed the most to improving behavior.

Halperin suspects that the game-playing was most influential, but says he's zeroing in on that question in an expanded, double-blind clinical trial that is underway, in which some families will play games while others will only get education and support. Both studies have been funded by the National Institute of Mental Health.

Getting the TEAMS Spirit

Halperin's approach is called TEAMS, for Training Executive, Attention and Motor Skills. He developed it after more than two decades of doing longitudinal research involving children with ADHD. His research suggests that kids who were able to develop their brains over time, with social play, for instance, have better outcomes. "The idea that we work with is not that EF deficits cause ADHD, but that improving them may help the kids compensate," he says.

The TEAMS study isn't the first to look at the brain benefits of play. In 2007, Adele Diamond, Ph.D., a professor of developmental cognitive neuroscience at the University of British Columbia, wrote a paper on a program for preschoolers called Tools of the Mind. The program, developed in Colorado by two early-childhood experts, Deborah Leong, Ph.D., and Elena Bodrova, Ph.D., uses a system of simple games and exercises to help develop skills in four- and five-year-olds.

The common theme that connects all of these scholars is the shared idea that a child's experience and behavior can be dramatically changed by relationships. Of course, so can that of the parents, and this presents the question of whether the parents in Halperin's study were having so much fun with their previously annoying children that they came to overlook what might have been formerly labeled "bad behavior."

As Barbalat says of her daughter, Lola: "I still get impatient with her sometimes, but I realize now that a lot of her behavior is beyond her control." She believes that improving a child's ADHD symptoms is "mostly about the parent. You can't ask a small child to change. You have to change the way you view it and deal with it, and that's a big commitment."

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This article appears in the Winter 2012 issue of ADDitude.
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To share suggestions for ADHD-friendly games, visit the ADHD Alternative Treatments support group on ADDConnect.


 

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