A General Information

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Elfrieda Banks
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Call for Interdisciplinary Projects Sevres 2014 Project title A General Information Can videogames with neurofeedback be used as a complementary treatment for children diagnosed with Attention

1 Call for Interdisciplinary Projects Sevres 2014 Project title A General Information Can videogames with neurofeedback be used as a complementary treatment for children diagnosed with Attention Deficit Disorder (ADD)? Acronym NEUROGAME Keywords (5) Attention Deficit Disorder, Neurofeedback, Video Games Team members Names Fields of interest THEFFO Alexis Pedagogy, Education HOBEIKA Lise Cognitive Sciences, Social Neurosciences PARIA Anne Medicine RUBANOVA Natalia Bioinformatics, Systems Biology GOUJET Raphael Computer Science, Video Games, Education, Biology Abstract (200 words max) In most of the western countries including the US, many children are diagnosed with Attention Deficit Disorder (ADD). The usual treatment is Ritalin, which is a psychotrope with many adverse side effects. In this project, we propose to find a less invasive treatment based on behavioral techniques. Our team needs first to list characteristic symptoms of ADD to find a pool of affected children. Then, a quantification tool will be built using electroencephalogram (EEG) and analysis of brain waves. Based on this, an application will be developed that gives real-time feedback to users about their current attention to test whether they can increase their attention level. Then, the efficiency of attention consolidation by games with neurofeedback will be tested on healthy children, then on ADD-affected children. Finally, we intend on following up kids on a 6-month period to get feedback from parents and psychiatrists on the evolution of ADD symptoms. 1

2 B Description of the project (1 page max) B-1 General Introduction Attention Deficit Disorder without Hyperactivity (ADD) is a behavioral condition that makes focusing on everyday requests and routines challenging (American Psychology Association). First clinically described in 1980, it is often put in the same category as Attention Deficit Disorder with or without Hyperactivity (ADHD). Up to 7% of children aged 6-12 have ADHD and boys are affected four times as much as girls (APA). ADD is due to a lack of a certain type of neurotransmitters, but the fundamental causes are still unknown. It is assumed to be at least partly genetic. Some research have pointed to food additives, but there is no consensus. The treatment proposed by psychiatry is either Ritalin or behavioral therapies sometimes implying harsh lifestyle changes. Ritalin is a psychotrope with many adverse side effects such as sleep troubles, nervousness, headaches, appetite troubles, and emotional instability among others. But it is efficient, especially when combined with counseling. The mechanism of how Ritalin works are still unknown. It is even paradoxical that two opposite diseases, hyperactivity and narcolepsy, can be treated with this same drug, Ritalin. On the other hand, video games have been proven to increase attention of adults [1] and to be useful in various therapies, such as Post Traumatic Stress Disorder prevention [2]. That's why we propose to use video games as a complementary therapeutic tool for ADD. [1] Video game training enhances cognitive control in older adults, Anguera et al., Nature, Sept 2013 [2] Can Playing the Computer Game Tetris Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science, Holmes et al., PLoS ONE, January 2009 B-2 Objectives and specific aims 1 - Identify, characterize, quantify children ADD. 2 - Create a video game that integrates neurofeedback in order to have children improve their concentration ability. 3 - Assert that concentration can be improved in adult subjects by using a video game. 4 - Assert that a video game with attention feedback is better than a video game alone to improve focusing ability. 5 - Set up a clinical study in order to evaluate the effects of the game by comparing it to a regular video game. 2

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4 C Detailed description of the project (2 pages (max) + figures and references. The main scientific idea and aim should be developed, put into general context, and some details should be provided on the different phases and methodological approaches. Alternative routes should be proposed in the case of setbacks in the proposed plan. Ethical and/or safety aspects of the proposed research should also be discussed when identified) Experiment 1 : Identification of ADD, differentiation of ADD from similar behavioral problems. ADD is a widespread diagnosis nowadays. From 1 to 10 % of children can be diagnosed with ADD depending on the diagnosing schemes. However some studies show that ADD could be over diagnosed and mixed up with similar behavioral problems. There are also doubts that this disorder exists. To identify a potential group of patients we will perform patient profiling. We will use data from: - psychologists: medical history, diagnosis details, EEG - parents survey: heredity, lifestyle, diet - genetics: genes associated with ADD We will perform patients profiling using clustering algorithms. As a result we expect to identify a group of patients with ADD and exclude patients with similar behavioral problems. Experiment 2 : Quantification and evaluation of ADD. We are going to design a tool to quantify ADD. Human brain produces waves at different frequencies. These waves are measured using EEG with a special helmet. It has been shown already that alpha and theta waves are associated with attention, focus and relaxation. We will analyze EEGs from our group of patients using pattern recognition (classification algorithms). We expect to find patterns of brain activity specific to ADD patients. We will build a model to quantify ADD based on brain waves activity. We will also compare brain activity of normal children and children with ADD and possibly we could find some insight into ADD mechanism. Experiment 3: Evaluate on adults the presence of feedback during attention training The importance of feedback during learning has been often studied. It is considered as an essential part of education and training programs, as a tool to identify which action must be taken to improve performances. The aim of this experiment is to understand how neurofeedback can help the training of attention ability. Protocol: Using the machine decoder that we created in the experiment 2, we will be able to decode and quantify the level of attention of a subject in real time. The subject will be performing a simple task (like reading). The level of attention will be recorded and marked on the screen by a color scale. A control group will do the same experiment, but without any feedback. The attention ability of the subjects will be evaluated at the beginning and at the end of the training session, by the EEG decoder and by behavioral data. We expect a larger improvement of subjects on the reading task and on the attention ability on the feedback condition. Subjects will be followed for one week, with a one hour session per day. The subjects will be divided in two groups of 30 people each, group with feedback and group without feedback. The subjects will receive a financial compensation for their entire participation on the experiment. 4

5 Experiment 4: Evaluation on children of the impact of feedback during attention training with video games A ludic activity is the best way to capture children interest. To have non-attentive children practice their cognitive skills, it is important to propose to them an amusing activity. We propose to create a therapeutic video game as behavioral remediation. During this experiment, we will develop a video game using the same neurofeedback as in the experiment 3. The game will be a race, in which the child embodies a bird. The more concentrated the kid is, the faster the bird flies. To succeed in a level of the game, the children will need to be focused long enough. The difficulty of the levels will increase, so that the child will need to focus longer and longer. To record EEG, the children will wear an EEG helmet that is connected to the computer on which he plays the game. Subjects will be followed for two weeks, with a half hour session per day. The subjects will be divided in two groups of 30 people each, group with feedback and group without feedback. The subjects won't receive any financial compensation as it is forbidden to pay children to participate in an experiment. Experience 5 : Evaluation of the feedback on the attention on ADD children. The aim of this experience would be to compare video games with and without feedback on ADD children. It would be like the 4th experience but with ADD children. In the first time, the aim will be to evaluate if the concentration is improving during the game, and if there is a short-time effect. To do that, we plan to recruit about 30 children with the diagnosis of ADD. They will come at the center and play half an hour a day during 7 days. The evaluation of the concentration will be divided in 2 parts: evaluation with the EEG helmet during the game give a control task to the child at the end of the week Experience 6 : Long-time follow up. In this experience, the child has the video game at home and plays half an hour 3 days a week. Using the doubleblind method, two groups will be made. One will use our video game, the other will use another video game. We will evaluate if the concentration of the child improves 6 months later. The follow-up will be divided in 3 parts : recorded EEG in the game feedback from the parents and the teacher at school changes in the life style 5

6 D Scientific Interest in the project of all the participants and beyond (200 words max. What are your motivations to participate to this project? Why should other scientists, society and general public be interested?) THEFFO Alexis Conception of the project, working with children and scientists of different areas HOBEIKA Lise Studying and evaluating neurological disease. PARIA Anne Following children after experiment, evaluating influence of the videogames on children health RUBANOVA Natalia Modeling and applying machine learning to neurological data GOUJET Raphael Developing videogame with therapeutic effect 6

7 E BUDGET (1 million euro max for 3 years including salaries, equipment, consumables, etc.) Scientists Salaries: 5 PhD students for 3 years x 5 = The scientist team is : a neuroscientist, a Pedo-Psychiatrist, a data-analyst and modeling specialist, a game developer, a pedagogy specialist Game development team : Sound engineer : Graphist : Game Designer : Equipment : EEG helmets : renting of high quality helmets for precise experiments x 3 experiments = EEG helmets: bought for home experiments x 30 models = Computer equipment : x 6 models = Tablets for home experiments 200 x 30 models = Softwares licenses for 3 years : Adult subjects gratification 100 x 60 subjects = Consumables : TOTAL =

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