1. Literature Review
1.1 Literation Overview
In the past decade, the way of providing health care has revolutionised technology. Patients were equipped with the means to access information on wellbeing, control their medical attention and connect on a remote basis through smartphones, tablatures, personalised computers and machine devices (Dimitri, 2019). Historically, creativity and technology in infant welfare has developed in a comparatively emerging and formally poorly coordinated fashion (Gordon & Catalini, 2018). The goal is to step away from the conventional model of repurpose adult technology to provide the development of anatomically, physiologically and developmentally relevant, flexible, and planned for children and youths, a broad-based and organised approach to the development of specific health technology for children (Hussien et al., 2019). ADHD is a chronic disease which affects millions of children and often continually affects adulthood and is associated with care deficiency and hyperactivity (Sayal et al., 2018). ADHD comprises a group of persistent disorders such as concentration maintenance difficulties, hyperactivity and impulsive behaviour. In the next five years, the overarching dynamics will shape the landscape of games and interactive media in general and increase the interference of conventional media, irrespective of their situation (Hussien et al., 2019). This is a unique summary of six business, technology and market developments, which together make a revolution. Along with Android the common options for digital gaming platforms are iPhone and Windows.
Concept of Digital gaming history
Digital gaming is a modern phenomenon, having first appeared about two decades ago. Since indoor sports, it was around; shifting just its shape (Reinhardt, 2017). Over the years, digital gaming has developed into an independent sector of tremendous artistic and technical potential. Along with Android the common options for digital gaming platforms are iPhone and Windows. Future opportunities for growth are at an all-explosive pace. Soon Virtual reality and 3D gaming and numerous innovative emerging innovations to act as peripherals for the improvement of interactive gaming experience shall penetrate the mass industry (Singh, 2019).
1.2 Investigation of History of Digital Gaming Along With That of Children with ADHD
Origins of Digital Gaming (1940 – 1960)
The history of video games dates from attempts to create artificial intelligence Video games have experienced steady development along with hardware and software upgrades from the day when the first ENIAC was developed to the latest microprocessors. This is the reason it is impossible to determine precisely when the first video game was released, in this day and age, because it is interconnected and dependent on everything that came before it (Dillon, 2020). Any variety of puzzles, arcade and card sports, and also the first video games, may have disappeared from human experience in the far past.
Nascent Phase (1960 – 1990)
In 1960, Steve Russell, MIT employee, created ‘Spacewar,’ a widespread, highly influent video game. Atari, Inc. was founded in 1972 and ushered in the commercialization of the gaming industry’s digital era. Within a short time, the innovative ‘Pong’ was published. Several American game development companies declared bankruptcy because of the 1983 recession and a flood of home computers and video game consoles. Video games such as ‘Space Invaders’ caused a large upheaval in the gaming industry in the 1980s which established popular games appeared on the scene during the evolving age of video games such as ‘Donkey Kong’ and ‘Pac-Man’.
Golden Age (1990- 2010)
While the demand for video games started in the early 1990s, the leading companies like EA, Atari, and Nintendo and other giants, such as Nintendo, remained underground until around. 1990 saw the release of Super Nintendo. Sega created its own ‘Sonic the Hedgehog’ using the same 16-bit technology PC games began to become more common after the turn of the century. ID Software launched the network multi-player feature in the genus of FPS in 1996 with the first person shooter ‘Quake.’
In 1996, Nintendo released the 64-bit Nintendo. With the PlayStation in the late 1990’s, Sony influenced the entire industry, point out Reinhardt (2017). Microsoft entered the Xbox video game at about the same time. At the same time, mobile phones have become popular with video game consoles. Children aged 9 to 12 are becoming more competitive. This means they can play multiplayer games or games where they play on the same or online platform against others.
Concept of ADHD and Children
ADHD is a chronic disease which affects millions of children and often continually affects adulthood and is associated with care deficiency and hyperactivity (Sayal et al., 2018). ADHD is the most common psychiatric illness in children, with an estimated prevalence of 5.3 percent worldwide. ADHD comprises a group of persistent disorders such as concentration maintenance difficulties, hyperactivity and impulsive behaviour. Children with ADHD may have difficulty with low self-esteem and disturbed relationships and bad academic success. Sometimes with age, symptoms are diminishing. Some people cannot overcome their signs of ADHD fully. But tactics to succeed can be learned. Via therapy ADHD cannot heal, but signs can be very helpful. Medicines and behavioural therapies usually provide treatment (Bélanger et al., 2018). The results can be greatly altered by early diagnostic and medication. Most children will not be tested for ADHD until they are in school, but children as young as four may be diagnosed as per the American Academy of Paediatrics guidelines (AAP). Many children are active and impulsive at that age. Early recognition and efficient management will greatly enhance people with ADHD and their families’ ability to work normally and their overall quality of life.
1.3 History of children of ADHD
Meaning of ADHD
ADHD is a general neurodiversity most often seen in young children. The CDC (2020) says that the average age at which parents discover that their child has autism is 7 years of age. There are twice as many boys with ADD/ADHD diagnosed than girls. Since adults can have symptoms, they can be identified and diagnosed, too.
Peasgood et al. (2016) suggest that Attention Deficit Hyperactivity Disorder (ADHD) was only officially classified as a disease when the APA did so in the late 1960s. Learn more about ADHD, such as when it was first recognised as a real condition, how it was defined, how it is currently diagnosed, and the cause, in order to find answers for the timeline.
First half of 1990s
ADHD was first recorded in an article published in a paper in 1902. Doctor Still mentioned the “malfunctioned deficits” in children. She noted that a group of the affected children’s conduct was beyond the control of normal, but were still intelligent (Peasgood et al. (2016).
Changes in Medical Definition
In 1980, the APA issued the DSM (DSM-III) for the third edition. The name of the condition was changed from hyperkinetic to attention deficit disorder (ADD). Hyperactivity is not thought to be a typical symptom of the condition by scientists. This list created two subtypes of ADD: hyperactive ADD and hyperactivity-free ADD.
In 1987, the APA published a revised DSM-III edition. It eliminated the difference between hyperactivity and changed the name to a hyperactivity condition for attention (ADHD), as per the findings of Feldman, Charach & Bélanger (2018). Three signs (inattention, impulsiveness, and hyperactivity) were grouped into a common type and no subtypes of the disease could be identified.
In the fourth edition the three subtypes of ADHD used by medical practitioners today were determined:
- ADHD-type combination
- Intense ADHD form primarily
- Hyperactive-pulmonary ADHD forms primarily (Jarrett et al., 2016).
Rise in the number of cases
In the 1990s cases of ADHD started to grow markedly. The increase in diagnosis may be due to a few factors:
- Physicians have become more effective in diagnosing ADHD
- more ADHD parents register signs to their children
- more kids developed ADHD directly
As the number of ADHD cases increased, more and more drugs became available to treat the condition. The medicines were even more effective in the treatment of ADHD.
Researchers aim to classify the origins of ADHD and alternative therapies. Research shows that the genetic correlation is very deep. It is most likely to be seen in children who have parents or siblings with the condition.
Vajawat, Varshney & Banerjee (2020) opine that the role played by environmental factors in deciding the development of ADHD is currently not clear. The root cause of an illness is to be found by researchers. They are aimed at improving therapies and helping people find care.
1.4 Impact of Digital Gaming and Internet Access on the children with ADHD
Some important questions to be discussed in this study about digital gaming and its relationship with children with ADHD are as follows-
- Why do children with ADHD appear so attracted to video games?
- Can ADHD signs such as inattention be triggered or exacerbated by playing digital games?
- How is the video game related to ADHD?
To start with, no proof exists that ADHD is caused by video games (Balfe, 2019). And one major Norwegian study that traced children’s gaming patterns for many years beginning at the age of 6 showed that people with more signs of ADHD appear to play more as they get older. But the total amount of time on the television was not worse.
Researchers have various reasons why video games could pull certain children and young people with ADHD so strongly.
Stimulation: Immediate prizes are provided by video games, usually high tempo, and visually entertaining. Games could provide the kid with a way to master his own skills, to avoid life, and to feel better.
Social Interactions: Children with ADHD also have difficulties building relationships. Online games allow them to make friends and hold them.
Hyper focus: This is the opportunity to concentrate super on pleasant or fascinating material. In certain people, it may be a distinctive ADHD symptom. Your child might be so attached to the game that they can’t hear your name crying.
Benefits of Video Games
Online gaming can be more than recreational for children with ADHD. It is suggested by Prax & Rajkowska (2018), the games will help them develop key skills such as:
- Spatial-visual skills
- Hand-eye coordination
- Strategy and solution of problems
- Plan, sequence and prioritise
- Coordination and collaboration
- Control of time
If a child is playing, the games should be ensured according to their age. Certain games intended for older children or adults can be too aggressive. The classification ranges from “E” which stands for “Everyone” to “AO” for “adults only — 18 years and over.”
Gameplay that requires material to create simulated shelters or carts and other traffic control to take characters to their destinations may well be included. Children may improve their preparation, sharpen their memory and acquire additional useful skills they may lack.
The first prescription computer game was approved as ADHD therapy by the FDA in 2020. EndeavorRx is available for young people between 8 and 12 years old. It takes players across various environments, like a river of lava and an eclipsing winter land. Children tap the button to collect goals. The game helped increase attention by a study sponsored by EndeavorRx’s founder, reveal Zajac, Ginley & Chang (2020).
Some children with ADHD may spend too long in video games. Parents should guide the children as to how much or where s/he should play. They should be ensure that video games does not become the replacement of other experiences for children, such as social contact, family time, physical exercise, etc.
The given list includes signs that a child must be restrained from excessive gaming:
- Fits or tangles if s/he is asked to stop playing
- Explosive fits after loss
- Stay overnight or play really late
- Lies about how long it takes to play (Prax & Rajkowska, 2018)
Gaming produces dopamine, which is the same brain chemistry you would use to get stuff like alcohol or other drugs.
If it is found that a child is a difficult game, a paediatrician or mental health practitioner should be consulted by parents.
1.5 The Impact Internet Assess on Short-Long Term Effect on the behaviour of children with ADHD
Internet connectivity is an advantage for those with attention deficit hyperactivity disorder. Many individuals with ADHD have difficulty with time control, planning, finishing assignments, and paying attention to small information. It is impossible to remain focused in school or the workplace while this occurs. Internet content will help people with ADHD remain on task, achieve their goals, and resist diversion.
Warnings on the phone or in advance may help the workers arrive on time or maintain their schedules. Diverting attention from a particular work activity for too long, which results in the person getting less done in total (Andersson et al., 2018).
Online technologies will help people with ADHD get organised, boost morale, and make them more mindful of their job deadlines.
Hindrances caused by Internet Access
The level of ADHD symptoms and the seriousness of Internet addiction among children were observed in a study of 535 primary school students. Singh (2018) state that the research indicates a significant risk factor for internet addiction could be the existence of ADHD signs, whether they be carelessness or hyperactivity/impulsive.
The use of technology calls for harmony and self-monitoring. The use of available tools to improve efficiency, but also to reduce distraction and hyperfocus can be helpful.
1.6 Role of Government to Help Children in School and Parents to Help the Children of ADHD
The UK government has not only established various policies to help children with ADHD to receive special care and attention, but has provided articulate guidelines to help the school authorities and the parents to deal with children diagnosed with ADHD. Some of the important steps to be followed by the schools, as per the governmental instructions will be mentioned ahead. According to Robinson (2017), the characteristics that are required to become an ADHD friendly adult have been identified by the Government. The ADHD-friendly adult:
- is conscious of the life of the kid with ADHD
- it caring and intelligent
- is ready for flexibility
- has an advanced sense of humour
- Cooperates with parents closely.
Among the various strategies mentioned by the government, a few of the important ones are-
- Using headphones to enable children detect environmental stimuli to help them focus on their jobs
- Traffic signals are used as basic visual noise level management scheme. The professor sets the arrow for the job at hand at an acceptable amount of noise, i.e. red would stand for silence, amber for whispering, and green for free speech. This will help a child with ADHD when it visually recalls a verbal command.
- Visual schedule / chunking for multisensory alerts to keep them in mind
- Attention preparation with the introduction of brain gym and stress toys
- Implementing ICT to increase the variety and scope of curriculums and the teaching process
- Time Circle Children with ADHD provide them and all children with an outstanding forum to learn to take turns, to listen, to feel comfortable and to make smart choices.
Much instructions have been provided to the parents as well. Given below will be some of the most important and easily followable ones, as pointed out by Robinson (2017)-
- Setting aside a day when the kid will have their undivided attention.
- clearly and calmly describing the state
- to help answer any questions the child may have” Befriend your kid and emphasise that they are not unintelligent
- Not using ADHD as an excuse, since it does not justify the behaviour.
- Reiterating that they bear responsibility and accountability for their own actions. Where necessary, attempting to tell the kid that having ADHD isn’t shameful.
- supporting a child in coming to terms with their problem and in communicating it
- Emphasizing the child’s talents and assets.
- correcting the unbalance by listening to the other children’s fears and complaints
From the above literature review, it can be observed that digital gaming and internet access do not just exacerbate the condition of children with ADHD, rather they may also be of immense value in terms of enhancing their attention, concentration and perception. Against the conventional belief that technology can only negatively affect a child with ADHD, fresh research suggests just the opposite. It is also important to note that excessive usage of these items can lead to a worsening of the mental state: and this is true not just in the people with AHD, but also the general masses. Therefore the aim of this study is to conduct an inquiry into the impact of various kinds of digital games on children affected with ADHD.
The following discussion has been conducted on the basis of the research survey undertaken on the parents and practitioners who have experienced children with ADHD and application for digital gaming for their recovery.
The aim of the discussion is to determine the perception of using or applying Digital Gaming for the treatment of children with ADHD, basis of parent and practitioners’ beliefs. The survey was a part of the “Investigation into the Impact of Digital Gaming on Children with ADHD.” The researcher has conducted a survey comprising mixed questionnaires (both quantitative and qualitative). The questionnaires contain eleven (11) different questions of two categories: demographic (two) and topic-based (9). The survey population were 20 parents and practitioners who are encouraged to provide their valuable opinions on their own consent.
2.1 Findings Analysis
The results obtained from the research survey have been outlined and discussed below.
Q1: What is the Age of the child for whom you have diagnosed or arrange diagnosis of ADHD?
As per the survey respondents, various distinct results have been obtained. Interpreting the results, 5% or 1 of the respondents experienced 3 months old children with ADHD; another 5% or 1 of the respondents has experienced children of 3-6 months old with ADHD; 10% or 2 of the respondents have found ADHD in 6 months old; again another 5% of respondents have seen 6-8 months old with ADHD; also children of 8 months old have been found with ADHD by 5% of the respondents; again another 10% or 2 of the respondents has found children of 8-10 months old with ADHD. There were also 20% respondents who have diagnosed children of 10 months old with ADHD and another 10% of them have seen ADHD in 10-12 months old children. Therefore, distinct 6 segments of 5% respondents each has experienced children with ADHD in respectively 12 months, 1-4 years, 4-6 years, 6-9 years and more than 9 years old. The result indicates that there is no certain minimum restriction of age for children to be affected by ADHD. The survey showed that children from 3 months to more than 9 years can be found with ADHD. More broad survey will reveal in-depth and vast data to know the high bar of children to be found with ADHD.
Q2: What was the gender of children you have found with ADHD?
According to the respondents, two categories of gender have been come up as results. 80% of the respondents have seen male children with ADHD and rest 20% have found female children with ADHD. This result can indicate the male children are mostly affected by the ADHD, but since the survey was restricted to only 20 people, this result can not considered as the most viable information.
Q3: As a parent or practitioner, do you think Digital Gemming affect children with ADHD?
As per the survey results, people have different perspective about the effect of digital gaming on children with ADHD. The results showed that 65% respondents believed that Digital Gaming affects children with ADHD, other 10% respondents experienced no effect of digital gaming on children with ADHD. And, 25% of respondents were confused about the fact and answered “maybe.” The confused people probably have not applied digital gaming for the treatment of ADHD. But, overall most cases were found positive about the effect of digital gaming on children with ADHD.
Q4: As a parent or practitioner, do you think digital gaming impacts children with ADHD behaviour?
While asking about the impact of digital gaming on ADHD behaviour of children, 80% respondents agreed by saying “yes” that digital gaming actually impacts the ADHD behaviour for children. Another 5% respondents have answered negatively about the fact and they have found no impact of digital gaming implementation on the ADHD behaviour of children. There were also 15% people in the survey, who were unsure about the impact, because of not practically implemented digital gaming for ADHD treatment or have experienced very least significance.
Q5: As a parent or practitioner, do you think playing video games actually causes ADHD? Does it make it worst?
This question was asked to know the individual opinion of the respondents of the impact of digital gaming on ADHD of children. Respondents have been provided a blank space instead of pre-specified options for writing their personal opinion and perspective. As seen in the image above, there are 15 responses among which 11 are distinct from each other. Two answers were generally “yes” which means they believed that digital gaming causes ADHD, and two of the responses were “no” which means digital gaming neither cause ADHD nor make it worse. Other responses were mostly positive for digital gaming, meaning that generally it does not cause ADHD, but it can enhance the ADHD symptoms if used rigorously. Also some people were believer of the expert thoughts that digital gaming does not cause or worsen ADHD, rather it helps to treat ADHD. Following the contradictory responses, Digital Gaming can be considered both positively and negatively impacting ADHD behaviour, which is truly dependent on cases’ distinction.
Q6: As a parent or practitioner, do you think playing video games benefits children with (ADHD)?
As per the survey respondents, the benefit of Digital Gaming on ADHD suffering children were diversely answered. 20% of the respondents have answered “Yes” that they found benefit of implementing Digital Gaming on children with ADHD, whereas 45% people have negatively revealed their opinion by saying “No” that they never experienced a positive benefit of applied Digital Gaming on ADHD behaviour of children. Though, 35% people among the respondents were unsure about the benefit of Digital gaming on ADHD. The results indicate that Digital Gaming not actually always prove being advantageous in ADHD treatment.
Q7: As a parent or practitioner does you thinks that children with (ADHD) are safe online without any supervision?
As per the survey responses, parents and practitioners do not really trust Digital Gaming to be used by children (with ADHD) individually without any supervision. 85% of the respondents denied that fact that children with ADHD should use digital gaming only on their own without any control of seniors. Though 5% of the respondents wanted their children to be self-dependent and learn to use the Digital gaming with a positive impact, so that they agreed for their children (with ADHD) to use Digital Gaming without any supervision. There were also 10% respondent who are confused about the control, measure, because perhaps they have not yet implemented digital gaming as treatment of ADHD.
Q8: Do you believe that children with ADHD by playing video games can improve their self-esteem?
It is a contradictory fact that although less respondents found possibility of benefit in applying Digital Gaming for children with ADHD, 35% of the respondents believed that playing Digital Games can improve their children’s (with ADHD) self-esteem. Other 35% of the respondents answered “No” to the fact that playing video games would improve self-esteem of children with ADHD. Other, 30% people were confused about the fact due to their lack of experience of minimal improvement observed. It can therefore be stated that Digital Gaming has been found both on improvement or neutral effect for Children’s esteem.
Q9: As a parent or practitioner, do you think there is enough awareness for parental control in digital gaming?
As per the response of survey population, 75% of the respondents belief that parents in recent days are not sufficiently aware of the parental control in digital gaming. In comparison, 15% of the respondents agreed that people are aware of the parental control regarding the use of digital gaming. Though, 10% of the respondents were unsure about the fact. The result implied that the awareness of parental control is less among people, so digital gaming can adversely affect ADHD behaviour of children. Parents and practitioners must be acquired proper awareness about how to help their children (with ADHD) to play digital games properly (Zajac, Ginley & Chang, 2020).
Q10: Do you believe that digital games are age-appreciate?
Digital Gaming’s application for ADHD treatment of children has emerged a great concern of age-appreciation (Sayal et al., 2018). That is why survey respondents were asked about this fact. 70% of the respondents have answered like Digital Gaming are not age-appreciated. Comparatively, 15% people answered that digital gaming is age appreciated. Another 15% respondents were unsure about the fact, probably because of their inexperience about using digital gaming for ADHD of children. The age-appreciation perspective is purely based on the user experience, a user’s dissatisfaction does not imply that another user is also dissatisfied. Not all digital gaming is age-restricted (Sayal et al., 2018), parents or practitioners must check the game before applying it to the treatment of children with ADHD.
Q11: As a parent or practitioner, do you think that children are aware of the risk when playing online at a young age?
It is evident that you aged people are not properly educated and aware of the use of gaming and technology (Reinhardt, 2017). That is what reflected in the survey results. 89.5% respondents have said that young children are not aware of the risk while playing online. Also, 5.5% people have said that children are aware of the risks, probably because they could have taught their children about the risks. There were also 5% people confused about the fact. The results implied that children are mostly unaware about the risk of the Digital Gaming usage.
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