Designing Games for ADHD Neurofeedback Training

ADHD neurofeedback training aims to present impulsivity and hyperactivity features measured in the brain activity in real time to a child suffering from Attention Deficit Hyperactivity Disorder (ADHD) for him/her to learn how to self-regulate them. As was discussed in previous posts this technique has turned out to be a good complement to medication inducing enduring effects. Obviously one of the key points of neurofeedback training is the calculation of robust reliable attention and impulsivity features that will be trained by the child. The other important aspect is the game itself, that is nothing less than the means by which the child interacts with the neurofeedback application.

The design of a non-stimulating albeit engaging game for children suffering from ADHD is a challenging problem that we had to address while developing Neurosurfer. Thanks to the feedback provided by ADHD experts both in the clinical and research fields we could finally draw the main lines of what a game for ADHD training should consist of. Through this post I will try to present what a video-game for ADHD children shall consist of according to our opinion.
We can never forget that these children suffer from an attentional impulsivity disorder, and so we must avoid stimulating games. While the child is playing he will try to increase his concentration while inhibiting his impulsivity. Games have to be as plain and simple as possible to help the child to accomplish this task, and we can’t forget that the game is not intended to amuse the child. Neurofeedback is part of the ADHD treatment and the game must be designed in order to help the child to improve his focus and attention. On the other hand, the game has to be attractive enough to achieve a certain level of engagement in the child or they’ll just get bored.  It seems obvious but the game has to be appropriate for the child’s age, so its contents and graphics must be adapted depending on whether the child under treatment is 6 or 14 years old.


In general neurofeedback games only have two degrees of freedom. In our case it will depend on whether the measured impulsivity/attention levels are below or above the limits defined for the training session. The interaction with the game shall be simple enough so the child has clear feedback on whether he is performing well or not. This leads to a very simple interaction with the game’s character, for example if the child is doing fine the character will go upwards or run faster, otherwise it will do the opposite. Of course the delay between measured levels and game commanding has to be as low as possible so the child has the feeling the game is reacting to his behavior. In order for the child not to be so bored different 
The main feedback the child receives is the behavior of the game character he/she is controlling. Nevertheless it shall not be the only feedback. We have to take into account that the training session may last for 45 minutes and so it is good idea to have other ‘feedback sources’ so in case the child gets tired he/she may focus his attention on other things besides the game’s character. According to this it is good to have more visual feedback sources such as progress bar showing the current performance or auditory feedback. Auditory feedback is an excellent complement for the graphical game that definitely helps the child to accomplish the attentional task he/she has been requested. Imagine for example an aerostatic balloon that the child is asked to fly as high as possible, the sound of the engine (on/off) helps the child to know if he has attention/hyperactivity levels under the desired threshold. Also it is convenient to have several games with a similar interaction, so the child don’t gets too bored of playing for so long with the same avatar.
The doctor’s office can be a hostile place for children. It would be ideal to completely isolate the child from the room where the neurofeedback treatment is taking place. The use of immersive 3D virtual reality goggles such as Oculus Rift is a perfect solution to do so. Also using immersive virtual 3D scenarios helps to isolate the child from other distractions present in the office, forcing him/her to focus just on the game and the attentional task he/she was asked to carry out.

To finish I would like to highlight that we all are a bit competitive….  children aren’t an exception. It is very convenient to have a points system that the child earns depending on his/her performance. The objective would be to earn as many points as possible during each sessions in order to beat another child or last week’s best score. The practitioner can use these points to motivate the children and it will be a simple way for the children to understand if the session went well or not compared to previous ones.

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