With an estimated 97 percent of adolescents playing video games in their free time, there is growing potential to design games as tools for attention-building instead of attention-busting.
A research team at the Center for Healthy Minds at the University of Wisconsin–Madison and the University of California, Irvine, designed a video game to improve mindfulness in middle schoolers and found that when young people played the game, they showed changes in areas of their brains that underlie attention.
“Most educational video games are focused on presenting declarative information: various facts about a particular subject, like biology or chemistry,” says Elena Patsenko, a research scientist at the Center for Healthy Minds and lead author on the recently published paper.
“Our aim is different. We want to actually change the cognitive or emotional processes – how people think or process information they’re trying to learn.”
The game, called “Tenacity,” was designed for middle schoolers and requires players to count their breaths by tapping a touch screen to advance.
It leads players through relaxing landscapes such as ancient Greek ruins and outer space.
Players tap once per breath while counting breaths for the first four breaths and then tap twice every fifth breath. Players earn more points and advance in the game by counting sequences of five breaths accurately.
This trains mindfulness, which is a state of awareness of the present moment, by encouraging players to focus on their breaths.
In the study, 95 middle school-aged youth were randomly assigned to one of two groups, either the Tenacity gameplay group or a control group that played the game “Fruit Ninja,” another attention-demanding game that does not teach breath counting or aspects of mindfulness.
Kids in each group were instructed to play their assigned game for 30 minutes per day for two weeks while researchers conducted brain scans with participants before and after the two-week period.
Researchers found that adolescents in the Tenacity group had changes in the connectivity between their left dorsolateral prefrontal cortex and the left inferior parietal cortex in the brain, which are two areas critical for attention.
“Tenacity” is a video game developed for research purposes by the Center for Healthy Minds at the University of Wisconsin–Madison and colleagues at the University of California, Irvine. Credit: UW–MADISON
These changes in the brain were associated with improvements on an attention task in the lab and were found only in the group playing Tenacity. Kids who played Fruit Ninja showed none of these changes.
“Training attention has been criticized in the scientific community because we often use a particular task to train attention and see improvement in that task alone, which doesn’t translate into other tasks or day-to-day activities,” says Patsenko.
“Here, we trained young people with Tenacity (a breath-counting game) and tested them with another unrelated attention task in the lab. We found that brain changes following two weeks of gameplay were associated with improvement in the performance on that unrelated attentional task.”
The public is increasingly interested in meditation and mindfulness training. There are several smart phone apps on the market that are predominantly geared toward adult populations, including programs developed by the Center for Healthy Minds. However, video games can be a tool to engage younger people in mindfulness training.
The capacity to voluntarily control attention and minimize distraction has been linked to people’s emotional health and is foundational to learning.
“This study illustrates that changes in objective measures of brain function and behavior are achievable with relatively short amounts of practice on a novel video game,” says Richard Davidson, co-author on the paper and the William James and Vilas Professor of Psychology and Psychiatry.
“Video games may be a powerful medium for training attention and other positive qualities in teenagers, and even small amounts of practice induce neuroplastic changes.”
The project reflects a larger trend toward developing games for the greater good, says Constance Steinkuehler, a professor of informatics at UCI, who led creation of the game while at UW–Madison.
“Games for impact have entered the mainstream, affecting both consumers and the industry,” she says. “Good designs and solid research move not only players but also future designers as well. This work lays a great foundation for wellness interventions for kids.”
The game, originally developed for research, is not supported for public use at this time.
Executive functions are psychological processes that enable us to plan and monitor our actions. They involve our ability to keep our thoughts, actions, and emotions under conscious control (Zelazo and Müller, 2011). Three components of EFs are commonly distinguished: inhibitory control, working memory, and cognitive flexibility (Diamond, 2013; Snyder et al., 2015; Bardikoff and Sabbagh, 2017).
Inhibitory control allows us to consciously direct our attention to stimuli that will enable us to conduct a task. This cognitive function permits us to avoid thoughts, behaviors, or emotions unsuited to the demands of a given situation (Friedman and Miyake, 2004; Diamond, 2013). Specifically, control of one’s emotions, thoughts, and affects has been labeled as cognitive inhibition, whereas control exerted over one’s actions is known as behavioral inhibition (Lampe et al., 2007).
Working memory means the ability to operate with mental representations, that is, to remember and use information simultaneously. It is a limited capacity that increases with age. Working memory is essential to establishing connections between prior knowledge and new information (Carriedo et al., 2016), generating non-evident associations, and understanding expressions of various types (Diamond, 2012, 2013).
Lastly, cognitive flexibility is an ability that enables us to adjust to the demands posed by the environment in an efficient manner (Miller and Cohen, 2001) by creating alternative ways of solving problems from multiple perspectives (Diamond, 2012), shifting our attention, or changing our strategies according to stimuli (McGowan et al., 2018). Cognitive flexibility is a relevant socio-affective component since it involves not only adopting divergent strategies to solve one’s problems but also understanding the approaches used by others. In brief, it is both an affective and a cognitive function that is closely linked to creativity (Diamond, 2014; Santa Cruz and Rosas, 2017).
Development of EFs
Executive functions involve a long developmental process that begins during the perinatal period, sharply increases in the preschool stage, and reaches its apex during adolescence (Shonkoff et al., 2011). This process is supported by the development of the prefrontal cortex (Lezak et al., 2012), a brain area that hosts higher psychological functions, which are key to achieving adequate social and cognitive functioning (Rueda et al., 2011; Wiebe et al., 2011; Posner, 2012).
Although the growth of EFs follows a common trend, it has been proposed that their components do not develop as a unit; rather, each individual EFs follows its own trajectory (Diamond, 2006). Yet authors have suggested that these trajectories operate in tandem, with certain factors forming the basis for the development of others. Inhibitory control has been described as laying the groundwork for the development of EFs, followed by working memory and cognitive flexibility (Anderson et al., 2001). Thus, the development of inhibitory control has been reported to make it possible for working memory to grow, with both enabling individuals to increase their cognitive flexibility skills.
It has been proposed that although all the components of EFs start developing in the first years of life, their individual development trajectories differ. Inhibitory control has been described as having a very steep developmental slope between 3 and 5 years of age, which becomes weaker from age 5 onward, sharply declines after age 8, and becomes stable around age 12. Working memory, for its part, has a more gradual development trajectory, with a linear increase being observed between 4 and 14 years of age and stabilization being reached in adolescence. Lastly, research suggests that cognitive flexibility also gradually develops in childhood and reaches its peak around age 15 (Best et al., 2009; Best and Miller, 2010).
The development of the components of EFs allows reasoning, problem-solving, and planning to manifest themselves (Diamond, 2013, 2016; Baggetta and Alexander, 2016). These higher psychological processes are essential when confronting the demands of school life and those that entail adult life.
Why Play Is Important for the Development of EFs at Preschool Age
As noted above, the components of EFs develop at a much faster rate in the preschool stage. It is precisely at this stage that children are first exposed to schooling, where environmental demands are key to promoting the early development of EFs (Rothbart and Posner, 2006; Garon et al., 2008), which in turn help improve school learning (Rimm-Kaufman et al., 2009).
Preschool education has been described as a space that makes it possible to strengthen the development of skills and knowledge that children require to adequately perform at later stages of school education (Pianta et al., 2009). At this stage, children are expected to develop the skills that lay the groundwork for the acquisition of reading and mathematical skills (Whitehurst and Lonigan, 1998; Espy and Cwik, 2004), which are modulated by the development of EFs. In addition, children are expected to improve their skills needed to develop adaptive behaviors that will enable them to meet the demands of the school system (Blair, 2002). These include self-regulation and social competence, both of which allow students to be motivated, focused, and persevering when dealing with tasks in order to complete them successfully (Kochanska et al., 2000). These skills are also grounded in the development of EFs, inasmuch as they allow thought and behavior to become organized while inhibiting automatic responses to attractive stimuli and privileging more self-regulated behaviors (Kochanska et al., 2001; Bierman et al., 2008).
However, not all educational environments promote the development of EFs equally. There is evidence that shows that stress and poor fitness negatively affect the functioning of the prefrontal cortex, and thus of EFs (Diamond and Lee, 2011). In this context, the educational programs that have proven to be most successful in developing EFs share two key characteristics: (1) they do not expect children to remain seated for long periods since this is not in line with their stage of development, generating tension between teachers and students and increasing children’s fear of school, and (2) they tend to reduce stress in the classroom, encouraging enjoyment, self-confidence, and the development of social ties.
Ludic environments could be spaces that foster the development of EFs if they take into account the needs of preschoolers and implement activities that promote the improvement of students’ physical condition. Play-based interventions have been shown to be effective when they increase the development of skills associated with divergent thinking, problem-solving, and life satisfaction (Moore and Russ, 2008).
Various types of games can support the development of EFs. There is evidence linking the use of video games designed to foster visual working memory skills (Thorell et al., 2009) and attention (Tahiroglu et al., 2010; Anderson and Bavelier, 2011) with better EFs development in preschoolers. In addition, authors have reported that EFs improve as a consequence of engaging in games based on aerobic exercises (Davis et al., 2011) and sports such as karate (Lakes and Hoyt, 2004). It has also been suggested that role-playing activities are tools that contribute to the development of emotional regulation and language, both of which are regarded as precursors of EFs (Fantuzzo et al., 2004). Other authors have reported that children’s performance improves when EFs are evaluated through play (Rosas et al., 2015).
Play makes it possible to reduce anxiety, which increases motivation and provides further chances to try out solutions and practice with no real consequences (Cadavid-Ruiz et al., 2014). Also, given that play is the predominant activity at the preschool stage, it can be regarded as a mediator that promotes children’s cognitive development (Vygotsky, 2001). In short, play is considered to be one of the key activities in children’s life at the preschool stage (Duncan and Tarulli, 2003).
Successful Play Intervention Programs for the Development of EFs in Preschoolers
The literature describes a variety of successful EFs training initiatives. Authors have also referred to the necessary conditions for EFs interventions to succeed.
Traverso et al. (2015) conducted an intervention focused on the development of working memory, inhibitory control, and cognitive flexibility with 75 children aged 5. Twelve play sessions lasting 30 min each were conducted for over 1 month at the educational center that these children attended. The children were divided into groups of five and performed tasks that required progressive levels of inhibitory control, working memory, and cognitive flexibility. The results indicate that the children who took part in the intervention performed better in tasks involving simple EFs as well as in others requiring complex EFs. To analyze the effectiveness of the intervention, the authors compared the students’ performance in the tasks presented. Significant differences were observed in most tasks, controlling for initial performance. The children in the experimental group performed significantly better in inhibition tasks (delay task, gift wrap task time, circle drawing task, preschool matching familiar figure task, arrow flanker task), working memory tasks (backward word span, keep track task), and cognitive flexibility tasks (point accuracy task). This suggests that the children who participated in the training sessions performed better than those in the control group.
Specifically for EFs, Diamond et al. (2007) noted that children trained with “Tools of the Mind”, which is a research-based model that implies the implementation of a preschool curriculum focused on the development of cognitive, social-emotional, self-regulatory and foundational academic skills of children, perform better than their untrained peers in overall EFs, with minor effects in tests with low EFs requirements and major effects in tests with greater EFs demands, which benefit from more inhibitory control.
In the same way, Goldin et al. (2014) assessed several aspects of EFs (working memory, inhibitory control, flexibility, and planning) and school grades (language and mathematics), comparing children who used a computer program aligned with the Argentinian school curriculum and designed to train these variables (7 h of training in total over 10 weeks). Children in the experimental group played three adaptive computer games focused on training EFs, and children in the control group played games that require similar motor responses but were less demanding cognitively. All children played during school time, one game per 15-min session. The authors presented evidence that showed that children who received this training exhibited improvements in working memory as measured by the Attention Network Test (Rueda and Posner, 2013) and in inhibition and cognitive flexibility as measured by the Hearts and Flowers task (Davidson et al., 2006).
Another example of a play-based intervention was reported by Hermida et al. (2015), who generated a program that involved a longer training period: twice a week for 16 weeks. These authors carefully designed an intervention in which each activity had to meet the following conditions: (a) must be based on an aspect of the official school curriculum of the city of Buenos Aires; (b) must be structured as a game; (c) must require an increasing level of executive functioning; (d) must have three chronological stages (i.e., teacher-provided planning, execution of the planned activity and discussion of the activity with the children, and integration, with the children evaluating the plan and the strategies needed to implement it); (e) must be novel and different from previously introduced games, and; (f) must target an EFs clearly identified by the teachers, who had to be aware of which specific part of the activity trained EFs selected. They assessed the children in a variety of cognitive tasks at the beginning and after finishing the intervention. Also, they collected the grades of the children of both groups the year after the intervention.
Results for cognitive variables show that only differences in favor of the experimental over the control group exist, in the general measure of the Attention Network Test (Rueda and Posner, 2013) and in the selection of four blocks in the Corsi block-tapping test (Kessels et al., 2010). However, since these represent only two dependent variables out of 20, the authors suggested that the results cannot be attributed to the intervention. However, the experimental group showed significantly better performance in both language and math grades one year after the intervention, when comparing the experimental and control groups. They also compared these results with an external control group with similar demographic characteristics (not part of the study) and found similar results, suggesting a lasting effect of the training over the general school outcomes of the children.
The authors noted that the rejection of the main hypothesis (posttest cognitive advantage for the intervention group) could be due to several factors: (1) the use of a test battery that might have been suboptimal for interventions of this type, (2) the time that the intervention lasted and the intensity of the activities (32 weeks, two games per week), and/or (3) the composition of the sample since ethical considerations demanded that an experimental design be avoided: the unit of analysis included whole classes (each with its own dynamics) participating in the intervention program, not individual participants.
Finally, although it is not totally based on play, the intervention program of Röthlisberger et al. (2011) is particularly relevant to the present work because of their strong similarities. The authors developed a small group intervention in EFs for a total of 33 prekindergarten and 30 kindergarten children, for 30 min in consecutive schooldays for a total of 6 weeks. A total of 19 tasks that would promote EFs were designed, specifically for working memory, interference control, and cognitive flexibility.
The tasks were presented 2 days a week by a research team member and the remaining 3 days by a regular teacher. Group sizes for both the intervention and the control groups varied between 3 and 11 children.
All the sessions, which lasted for about 30 min, included whole group activities, small group ones, and individual ones. Although not all tasks were games, all of them were highly motivating to the children.
The three EFs components were assessed separately: interference control, by an adaptation of the Simpler Flanker Task (Roebers and Kauer, 2009); working memory, by an adaptation of the Complex Span Task (Daneman and Carpenter, 1983); and flexibility by an adaptation of the Flanker Task from Diamond et al. (2007).
The results show significant training effects for working memory and flexibility in the prekindergarten group and for interference control only in the kindergarten group.
One important issue that arises from these studies is that they can all demonstrate significant effects over at least one of the EFs components. Nevertheless, none of them give a sound theoretically grounded explanation as to why their particular programs have a specific impact over only some of the EFs components. We believe that these results show that at preschool age, EFs are not so clearly differentiated and thus cannot be reliably measured separately. In the present project, we will therefore use only one global measure of EFs, although we will differentiate the EFs components to be trained in the intervention program.
A Framework for the Design of Successful EFs Enhancement Intervention Programs
Diamond and Ling (2016) analyzed several studies on interventions that successfully improved EFs development, drawing a number of conclusions about the characteristics of these initiatives. The following is a brief description of the authors’ conclusions.
(1) Although training appears to have a high degree of transference, it tends to be strongly associated with the cognitive function trained. For this reason, to avoid predictability, the authors suggest developing varied tasks that require the use of multiple cognitive skills.
(2) Practice time is important, as programs that include more weekly sessions and are applied over a longer period have better outcomes.
(3) The way in which the activity is presented and conducted can also influence the program’s outcomes: it has been observed that when a program is administered by more committed people, more benefits are observed.
(4) EFs must be constantly challenged.
(5) Individuals with lower levels of EFs development benefit more from programs of this type, with potential differences being due to age, socioeconomic status (SES), or the presence of disorders.
(6) The impact of programs fades over time.
(7) Differences that can be attributed to the impact of a program are often observed only in the most cognitively demanding tasks.
(8) Physical training without a cognitive component has little impact on EFs development.
(9) It is necessary to analyze the largest number of intervening factors possible to determine whether the results obtained are due to the program or to other factors related to it. For instance, benefits may be due to the type of mediation rather than to the cognitive tasks proposed; alternatively, gains could be mediated by the impact of the program on other factors such as stress reduction.
Also, extending the effects of interventions to other cognitive aspects, evidence shows that cognitive gains appear to be small initially, but longitudinal studies indicate that they increase as children grow up (Nix, 2003) and that effective interventions tend to be part of low-scale, high-quality programs (Schweinhart et al., 2005). Thus, program quality should be ensured, considering the aspects that have shown to be key: clarity regarding what the program provides, who its target audience is, and what wider educational, social, and economic contexts it encompasses (Barnett, 2004).
These three factors become especially relevant considering that low-quality programs do not produce good results and that significant long-term effects are observed only when programs protect their high quality (Barnett and Masse, 2007). In consequence, authors recommend that interventions be implemented in both developed and developing countries if good quality can be ensured (Barnett, 2011).
In brief, research suggests that intervention programs, both play-based and not play-based, aimed at promoting EFs development in preschoolers must meet certain requirements in order to succeed. The present study was designed considering the main findings derived from interventions that have successfully improved EFs development in preschoolers, based on play activities in a natural context.
Discussion
This study aimed to analyze the impact of a game-based intervention on the development of EFs in preschoolers. As described by other authors (Hermida et al., 2015; Traverso et al., 2015), the implementation of the program had a positive impact on the improvement of the participants’ EFs, which provides support for the use of such programs in preschool classrooms.
We will organize our discussion around some of the conclusions advanced by Diamond and Ling (2016) since we consider them to be essential for analyzing the causes of the program’s success.
First, regarding transference, we sought to align our program with the authors’ views: it includes a variety of games that, apart from involving physical activity, require the combined use of a number of cognitive skills.
For instance, ball war not only involves picking up and throwing balls around, as children must also make a cognitive effort to identify the facial expression drawn on each ball and then decide to either throw or keep it. The games used were varied and were repeated only three times at most.
This prevented the children from predicting their contents and putting less effort into them. In addition, the types of tasks used for evaluating EFs sharply differ from the games implemented in the intervention, which makes it possible to rule out the effect of direct or excessively specific training of EFs components.
One open question related to transference that was not addressed by our project is whether there can be design-specific EFs component interventions to specific EFs outcomes. As we only took a general measure of EFs, we cannot show any data in this direction, but future research should address the contradictory evidence from almost all of the studies reported regarding these issues.
Second, regarding duration, the present program attempted to greatly surpass the 32 sessions used in the study conducted by Hermida et al. (2015), who found this number to be insufficient. The participants played for 45 min per day over a 3-month period. This resulted in a total of 60 game sessions.
Compared with other programs (e.g., Traverso et al., 2015), this implementation time is long; however, it is shorter than that reported for curricular programs such as “Tools of the Mind.” Implementing a game-based program such as ours at the curriculum level could have a more lasting impact on students’ EFs development.
This should be tested in future studies that incorporate games over a longer period and that are able to conduct a longer longitudinal follow-up process.
It is interesting to note that a very similar intervention program designed by Röthlisberger et al. (2011) also generated significant training effects in 60 sessions of 30-min activities.
But in contrast to that experience, which was implemented in a small-group format, our intervention proved to be possible to implement in a totally natural classroom context, with groups with up to 30 children. This is a huge advantage of our design because it can possibly be transferred as a regular preschool activity, without the need to take groups of children apart.
Related to this, it should be noted that a program such as that proposed here, implemented during regular class hours, shows that it is more effective for EFs development than the “regular” classes attended by the control group.
And given the proven association between EFs and mathematics performance 10 months later, it is necessary to consider the importance of conducting activities to promote EFs in the preschool curriculum.
The fact must be highlighted that our interventions were always implemented with the entire class of approximately 35 children, that is, a full group intervention. Some of the games required dividing the class into subgroups, of course. But our methodology, in contrast to other successful programs (e.g., Traverso et al., 2015), is designed to make its implementation possible in natural school settings.
In any case, it is important to highlight that the work of Traverso et al. (2015) shows significant outcomes in many measures of EFs after only twelve 30-min training sessions in a controlled setting, with robust size effects in the majority of them. Although they did not report any long-term effects, it is necessary to investigate more exhaustively whether their results are a consequence of the type of training tasks employed, the training setting, or a combination of the two.
In the same direction, it is important to note, however, that the intervention program’s optimal duration remains an open question. Hermida et al. (2015) showed very weak results in EFs after 32 sessions, but very strong results in the long-term effects over math and language outcomes one year later. We obtained similar results in math outcomes, but not in language outcomes. And our program effects over EFs are modest but significant.
Third, this study expressly controlled for the program monitors’ commitment and motivation, as suggested by Diamond and Ling (2016). The monitors were part of the research team and took part in the design of the games and the program.
Therefore, they expected the program to have positive results and were committed to the success of the intervention. However, it is necessary to test the efficacy of the program in a more natural context, that is, where the implementation is in charge of the educators who work with the children.
Fourth, this program has a design that constantly challenges children’s EFs, at least for 45 min per day for over 3 months.
Organizing the sessions around mindfulness activities, games, and a cognitive closing phase in which the participants metacognitively reflect on the games can also allow the children to learn a more general way to approach tasks. In this regard, this program is consistent with others in which activities are designed to permanently challenge children’s EFs (Hermida et al., 2015) but extend the intervention compared with brief programs, whose longer-term effects are unknown (Traverso et al., 2015).
Fifth, our study is consistent with what Diamond and Ling (2016) report, as we observed that individuals with lower EFs development levels tend to benefit more from programs of this type.
Although research shows that the effect of these programs fades over time, 8 months after they are finished, our program displayed a better effect than immediately after it ended. This is a promising result since it suggests that game-based strategies promote a more lasting development of EFs.
This project yielded no information about the cognitive load of tasks and their greater influence in programs aimed at developing EFs (Diamond and Ling, 2016) since we only tested EFs with the gold standard for their overall evaluation: the Hearts and Flowers task devised by Wright and Diamond (2014).
Likewise, our program did not aim to generate evidence about whether physical activity by itself is a good way to foster EFs, as suggested by Hillman et al. (2018) in their response to Diamond and Ling’s (2016) criticism. Still, what we do consider relevant is to incorporate games with a major aerobic component since preschoolers are very open to and motivated by games of this type. Yet in all the games included, our program explicitly sought to develop a given EFs component; thus, we have no information that could shed light on the issue.
Lastly, it cannot be completely ruled out that our program was affected by intervening factors beyond our control. We believe that the main potential issue was that the experimental group had very motivated monitors with lengthy experience in classroom games with small children. In contrast, the control group attended to regular classes with their regular teachers.
Although we made sure to select only teachers with good scores on the CLASS Pre-K® scales (Pianta et al., 2008), the novelty and highly interactive nature of the games played by the experimental group could have a strong impact on the motivation of the children. Although this is a possibility, it does not negate the fact that the proposed program, after controlling for all the aspects listed by Diamond and Ling (2016), has a significant effect on the development of EFs in preschoolers, which was measured 8 months after the end of the intervention.
Also, the results of our intervention, despite its modest effect sizes, show that the suggestions laid out by Diamond and Ling (2016) give a good framework to the design and implementation of high-quality (Barnett, 2011) and replicable programs for the enhancement of EFs, with proven, lasting effects.
Future research interventions should include more variables, as IQ or sociodemographic factors that could have an impact over the program results.
