Using Video Games for Teaching Executive Functions in a Clinical Setting: A Description of Pilot Studies at LearningWorks for Kids

Video games are powerful tools for learning, and it is widely accepted that video games are helpful teachers of academic skills. But they can also be powerful tools for learning problem-solving skills and executive functions. Clinicians who observe or talk to children about their video-game play recognize that popular video games require far more than fast reaction times and a killer instinct. Instead, they rely on skills such as planning, flexibility, time management, and persistence, executive-functioning skills that are vital to success in the 21st century. However, there are many legitimate questions about whether this type of game-based learning generalizes to real-world skills.

The basic premise of using popular video games for the training of executive functions is that children are easily engaged, highly attentive, and, as a result, receptive learners while playing. By capturing children when they are in this highly receptive state, we amplify the opportunity for learning executive-functioning skills.

At this point, very few popular games have embedded strategies that assist children in taking game-based skills and applying them directly to the real world. However, there are a few games in which feedback and questions may be asked that might stimulate children to think about real-world applications (The Sims, Fallout Shelter). While we hope that game publishers will choose to add these innovations in the future, the primary approach that has been used across our studies has been to use video games as a teaching tool. We have developed strategies for clinicians, parents, teachers, and kids to take what they are doing in a video game and apply those skills to the real world.

Strategic Teaching Strategies in These Studies

A number of strategic teaching skills are at the core of this model. Again, while these strategic thinking skills are being applied externally to the game by teachers, parents, and/or learning modules, they can be embedded into games without changing the nature of the games (i.e., making the games into onerous “learning” games). A brief review of these strategies follows:

  • Making the learning goals explicit
  • Developing a partnership with children for learning executive skills that are in the game
  • Encouraging children to practice these skills in an interesting and reinforcing manner (playing the video games)
  • Previewing strategies to help children recognize how they will use these executive-functioning skills in game play
  • Prompting metacognitive strategies that encourage children to reflect on their use of executive-functioning skills in a game and possible uses in their daily activities
  • Employing generalization and point-of-performance strategies that link executive functions used with digital technologies to real-world experience

These strategic thinking skills are employed through a series of online “Playbooks” that provide parents and teachers with an understanding of the executive-functioning skills that are used in the game. They include talking points to discuss how the skills help children in the game and a section called “Making It Real,” which helps parents and teachers find ways for children to connect game-based skills to the real world.

In our latest studies, the children were also presented with e-learning modules called “PrePlays” and “RePlays” that helped them learn about game-based executive functions and how these functions might apply in the real world. The e-learning modules help the children to go through a three-step process, which we refer to as “detect, reflect, and connect.” This three-step process helps them to identify when they are using an executive skill in a game, reflect on how the executive skill helped them in the game, and consider places where they could potentially connect that skill in their daily routines. Here are the results of the pilot test and discussion.

Brain Training Study

Our first study used a pair of traditional “brain-training” games, along with our parent training program, to teach real-world executive skills. Six children participated in this pilot study, in which neuropsychological data were collected before and after the completion of the study. The children were assigned a highly structured, intensive program of game play over the course of six weeks. Fifteen mini-games (including Pathfinder, Sound Bites, Missing Link, Coin-parison, Matchmaker, and Calculations x 20 ) were chosen from platforms Brain Age and Big Brain Academy to practice executive functions of planning, working memory, sustained attention, and time management/processing speed. The children were required to play each of these mini-games three times a day, four days a week. The intensity of the practice of playing these games as a prerequisite for real-world improvement is seen in a series of studies conducted using video-game based working-memory training (Klingberg, 2005, 2007).

In addition to the game play, parents were provided with “Playbooks” that assisted them in using the child’s game play as a teaching tool. The Playbooks contained a set of discussion points to help parents talk with their children specifically about executive functions used in game play.  The Playbooks were designed to help children identify when they use executive skills in a game, reflect on how these skills assist them in beating the game, and connect these executive skills to the real world. Parents also had the “Making It Real” section of their Playbooks, which provided them with practice opportunities to reinforce the use of game-based executive skills in the child’s day-to-day activities.

Only three of the original six participants completed the study. This appeared to be a reflection of the intensity and duration of the game play.  Parents of children who did not complete the study reported that their children did not sustain their interest in repeatedly playing the game over the course of six weeks.

While the sample size was small, the resulting data that indicated children’s improvement were compelling. Most notable was improvement in time-management and processing-speed strategies. Children displayed improvement on the Process Assessment of the Learner-II (PALS-II) Writing Test, a measure of writing speed, and significant improvement on the Test of Word Reading Efficiency (TOWRE) Sight Word Subtest, which measures how quickly children can read a set of words. Improvement was also seen in their capacity to do math minutes, that is, to complete grade-appropriate math problems accurately and quickly.  

Parents’ qualitative reports of observed changes in their children were even more encouraging. One parent described her son as displaying much improvement in school, to the point where he had received some grades of 100% on tests and quizzes in contrast to never having received these types of grades before. Improved planning skills were also noted with this child, as he independently packed his backpack for a Boy Scout camping trip, which he had never been able to do previously. Increased persistence in practicing the piano and taking his papers to and from school was also observed. Another parent described her child as “flying through” math minutes at school and displaying enhanced persistence and responsibility at home. She attributed this to her child having developed a sense of success in practicing and playing video games that he initially found to be frustrating and, with encouragement, being able to see gains he had made in the course of the study.

Significant improvement was also found on the Stroop Color-Word Inhibition Subtest t(2)= 7.77, p= 0.16, and the Sight Word Efficiency Subtest of the Test for Word Reading Efficiency (TOWER-SWE) was also significantly improved t(2)= -5.89, p= .028. The Math Calculation Subtest was also significant, at the p<.o5 level (t(2)= -6.047, p= 026). Children also showed improvement on the Continuous Performance Test (CPT), which measures sustained and selective attention and impulsivity. The Copying Task B Subtest of the Process Assessment of the Learner (PAL) also showed significant change t(2)= -4.88, p= .039.

Together, these results from a small sample of children suggest that children who are difficult to teach and have problems with self-regulation experienced improvement in laboratory-based tasks of attention, working memory, and processing speed as a function of structured play with video games. More importantly, they also demonstrated improvement in real-world skills, including mathematics, reading, organization, and overall school performance.

TIP Study

In a second study the group’s work took a different approach to the use of popular games to improve executive-functioning skills. This study, titled the “Tailored Intervention Program (TIP),” used neuropsychological pre-testing to determine the areas in which participants displayed executive-functioning weaknesses. A set of individualized prescriptions using specific Internet and console games that practice areas of executive functioning weakness was given to each child, along with parent Playbooks for each of the skills. In addition, parents were given psycho-educational instructional materials such as readings about executive functions, along with some basic training in the theory of executive functions. As in the previous study, parent Playbooks provided them with specific talking points to help their children identify and reflect on their use of executive skills in game play and a Making It Real section that helped them to connect and practice game-based skills in the real world.

Ten children participated in the TIP study. Parents again reported that there was some difficulty in getting the children to sustain their effort over the course of the study. Of the ten children who participated, seven were able to play the games and to record their participation at an acceptable level.  The children appeared to be more likely to sustain their participation in the study as we relied more on Internet-based games and Nintendo DS games such as Harvest Moon and Animal Crossing that changed for each child over the course of the six-week participation.

Results of this study again supported a conclusion that using video games can improve executive-functioning skills. An important outcome of this work was that the analysis of the data indicated that significantly more improvement was seen in the executive-functioning skills that were practiced by the participants than those that were not practiced. In other words, we saw more improvement in game-based executive skills that were targeted in our prescriptions than we did in executive skills that were not targeted. In addition, the improvement of these skills from pretest to post-test was clinically significant. These results suggest that specific targeting of executive-functioning skills can be responsive to targeted instruction using video games.

An additional study and a pilot program have also been implemented by the same research team. A school-based curriculum using popular video games to teach executive-functioning skills was piloted at Mount Pleasant Academy in Providence, Rhode Island across six classroom settings during November and December 2009. This study was qualitative and developmental in nature. In this study, teachers served as coaches in their use of Playbooks to help children transfer game-based executive-functioning skills into the real world, including classroom-based activities and demands. This study also included supplementary online and paper-and-pencil materials for the students to complete in order to learn about executive functions, set goals for improvement of their executive skills, and assist them in making the connection between game-based skills and the real world.

Interviews with teachers and students indicated that the children were extremely excited and active participants in the program, and the teachers found the skills being practiced to be relevant to classroom learning for their students. There were many reports of children talking about their use of executive skills. In this case, curricula were used to improve executive functions of sustained attention, working memory, and planning. Some teachers reported improvement in classroom behavior and/or academic performance. Difficulties included problems in reading for many of the younger children and the difficulty some of these children had in understanding these concepts. The results of this study show that video-game based learning can be made relevant and useful for teachers and students in school/classroom settings.

A fourth study was an interview study conducted with the parents of 17 children with attention and learning difficulties. Here the focus was to explore how parents interact with their children related to the children’s use of video games. The findings were consistent with previous reports such as from the Pew Internet studies (2007) that indicated that approximately 30% of parents play video games with their children. However, our data were particularly interesting, in that parents consistently reported they did not know how to implement teaching strategies with video games as they might with common daily activities involving parents and children such as how to deal with playing and/or losing a game or discussion of the need to practice to get better at playing a musical instrument. These results suggested the need to develop materials and strategies for parents that could help guide their parenting interactions about video games to produce intentional learning outcomes.


Overall, these initial studies suggest that:

(a) children can learn executive functions through video-game play

(b) targeted skills that are specifically taught are likely to improve more than skills practiced in the game but not specifically taught

(c) video-game based teaching of executive functions can result in improvement in school-related skills

(d) teaching through the use of video games is judged by teachers and students to be a reasonable in-school activity

(e) parents could/would benefit from explicit instruction and materials on how to engage in parenting around children’s use of video games, especially when it involves trying to teach and strengthen specific skills that are embedded in the games.

While each of these conclusions would benefit from further evidence through controlled research, these initial findings provide the impetus for further work embedding parent- and teacher-facilitated teaching into the context of children’s video-game play.

Our pilot research has helped us to clarify the directions for our next set of studies. We will be exploring the issue of generalizability of game-based learning to the real world through the use of video and non-video game controls, with and without parent and teacher participation. An assessment of similar strategies with a normative population rather than an ADHD/LD population will be important. Further assessment of the use of differentiated instructional or targeted strategies for youngsters as compared to a one-size-fits-all strategy would also be useful. Clearly, the need for a far greater number of subjects in our studies will be important, along with comparison of game-based to traditional interventions for teaching executive skills for children with ADHD and learning disabilities.

Our research leads us to the following points:

  • Brain-training video games have promise for developing decision-making and executive functioning skills, particularly if they are played repetitively and for an adequate duration.
  • Targeting particular areas of problem-solving or executive functioning weaknesses with video games that practice these skills can result in measurable improvements in these areas.
  • Using video games to teach these skills to youngsters with learning and attention problems can be effective. This suggests that applying the same practices to a population of normative learners would have an even greater chance for success.
  • Parents and teachers need to be educated about how to use popular video games to enhance ethical decision-making and executive-functioning skills in children.

We have learned that it is possible to use the popular video games that children are already playing to help them in developing real-world decision-making and problem-solving skills. For children, real-world decision making and problem solving in academic and social situations constitutes the building blocks of ethical decision making applied to various situations they may encounter. Although the data are limited as to the generalizability of game-based executive-functioning skills to the real world, our research suggests that using popular video games as teaching tools for these skills can succeed in transferring game-based skills to daily activities. We need to do more than simply identify those popular games that practice executive-functioning skills by developing strategies to connect those game-based skills to the real world and to children’s day-to-day experiences and learning. In order to do this, we will need to educate parents, teachers, and game publishers about the potential for using the games that kids are already playing to help them learn.

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