Assessing Executive Functions through Gaming: Development and pilot evaluation of an innovative diagnostic tool for children and adolescents with ADHD and cognitive control problems

This project aims to develop an innovative diagnostic tool based on gamification to assess Executive Functioning deficits in children with Attention Deficit-Hyperactivity Disorder (ADHD). Although ADHD is diagnosed on the basis of behavioral symptoms of inattention and/or hyperactivity-impulsivity, both theory and empirical research emphasize a number of cognitive and motivational processes underlying these symptoms. In the cognitive domain, there is a strong interest in executive functions (EFs), such as working memory and inhibition which are needed for the maintenance of goal-directed behaviors. In the motivational domain, the decreased activity of the reward system is emphasized and related to the underperformance of children with ADHD. An emerging research literature evaluates the degree to which cognition and motivation may interact, and a growing number of studies provides evidence that motivational processes may influence, or moderate, cognitive processing in ADHD. Several recent studies indicate for example that reinforcement markedly improves EF-performance in children with ADHD. Generally, children with ADHD underperform when reinforcement is low frequent, low intensive, or delayed. Assessing EFs with performance-based tasks typically is low stimulating and not highly reinforcing. Children with ADHD are unable to muster the required motivation to perform optimally on these EF-tasks, which results in underperformance and therefore in unreliable and invalid EF-scores. By raising motivation through gamification of the EF tasks, i.e. adding game-elements to the EF-tasks, we expect that, through controlling for the motivational factor, more valid EF scores will be collected, which is important for future research on the specific role of EFs in various childhood disorders as well as clinical applications that aim to improve EFs.