REVIEW
URRENT
C
OPINION
Video game play, attention, and learning: how to
shape the development of attention and influence
learning?
Pedro Cardoso-Leite a and Daphne Bavelier a,b
Purpose of review
The notion that play may facilitate learning has long been touted. Here, we review how video game play
may be leveraged for enhancing attentional control, allowing greater cognitive flexibility and learning and
in turn new routes to better address developmental disorders.
Recent findings
Video games, initially developed for entertainment, appear to enhance the behavior in domains as varied
as perception, attention, task switching, or mental rotation. This surprisingly wide transfer may be mediated
by enhanced attentional control, allowing increased signal-to-noise ratio and thus more informed decisions.
Summary
The possibility of enhancing attentional control through targeted interventions, be it computerized training
or self-regulation techniques, is now well established. Embedding such training in video game play is
appealing, given the astounding amount of time spent by children and adults worldwide with this media. It
holds the promise of increasing compliance in patients and motivation in school children, and of enhancing
the use of positive impact games. Yet for all the promises, existing research indicates that not all games are
created equal: a better understanding of the game play elements that foster attention and learning as well
as of the strategies developed by the players is needed. Computational models from machine learning or
developmental robotics provide a rich theoretical framework to develop this work further and address its
impact on developmental disorders.
Keywords
attention, child development, computerized training, learning, learning disabilities, play, video games
INTRODUCTION
La plus utile règle de toute l’éducation ce n’est pas
de gagner du temps, c’est d’en perdre.
Jean-Jacques Rousseau, Émile ou De l’Éducation.
From ethologists to psychologists, it has long
been recognized that play time presents key opportunities for learning [1,2]. All mammals engage in
playful activities during which instinctive behaviors
seem to be shaped – as during rough-and-tumble
play – or new strategies developed – as during play
pretend. During play, the individual is typically
highly engaged, faced with complex sequences of
events, and challenged to respond appropriately, all
the while in a fail-safe environment, conducive to
exploration – setting ideal conditions to promoting
learning. In addition, play is typically social, adding
a key motivational component. As illustrated by the
computational approaches to learning, these are
ideal conditions to foster more flexible behaviors
and promote adaptability to new situations – a form
of learning to learn [3 ]. At the same time, play can
also be conceived of as a natural outcome of development that can then be leveraged to assess the performance in a more engaging and natural way [4].
Here, we focus on a very specific form of play:
that mediated through new media and, in particular, video games. We will consider the current
knowledge of these effects on behavior, with a
special emphasis on attention and learning. To this
&&
a
Faculty of Psychology and Educational Science, University of Geneva,
Geneva, Switzerland and bDepartment of Brain and Cognitive Sciences,
Meliora Hall, University of Rochester, Rochester, New York, USA
Correspondence to Pedro Cardoso-Leite, Faculty of Psychology and
Educational Science, University of Geneva, Boulevard du Pont d’Arve 40,
CH-1211 Geneva 4, Switzerland. Tel: +41 22 379 91 00; e-mail:
[email protected]
Curr Opin Neurol 2014, 27:185–191
DOI:10.1097/WCO.0000000000000077
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Developmental disorders
KEY POINTS
Action video game play improves top-down attention.
Top-down attention is seen to facilitate learning.
Not all video games promote learning and brain
plasticity.
Need to take into account the player: interventions
should not be applied blindly to any population.
aim, we will first review the developmental time
course of attention before considering the impact of
various forms of media use on attentional control.
We will discuss other interventions – in school and
after-school programs – that appear promising in
improving attentional control as well as the possible
consequences of this research on clinical populations.
At first sight, the focus on attentional control
may seem to be a departure from our central topic:
play and learning. Yet, one of the dominant assumptions – both in education and developmental
robotics – is that learning relies on a fundamental
skill: the ability to focus on task-relevant features,
while ignoring potential sources of distractions.
Increased signal-to-noise promotes not only processing efficiency but also learning as the nature of
the task at hand becomes easier to apprehend and
distractions are better ignored [5 ].
&
THE DEVELOPMENT OF ATTENTION:
VARIETIES OF ATTENTION AND
MILESTONES
Attention is critical to guide information processing,
given limited resources. It can be exogenous or
stimulus-driven, automatically capturing resources
for the immediate processing of salient or unpredicted stimuli, as when startled by a sudden alarm.
Alternatively, attention can be endogenous or top
down, engaged voluntarily and oriented toward a
desired goal as when reading on a crowded bus [6].
This form of attention can be expressed in the
temporal and spatial domains as well as toward
objects. For example, the temporal resolution of
attention can be assessed using the attentional blink
task, in which individuals are to report the presence
of target stimuli presented within a stream of mostly
nontarget stimuli. The attentional blink phenomenon refers to the observation that detecting a first
target reduces the ability to detect a subsequent
target if it is presented shortly thereafter, as if attention had blinked.
These different forms of attention rely on partially different neural networks and follow different
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developmental trajectories [7]. Orienting toward
abrupt onsets seems present at birth and mediated
by subcortical structures, whereas other forms of
exogenous attention are under cortical control and
reach adult levels only by ages 10–11 years [8].
Top-down attention on the other hand relies on
the development of a fronto-parietal network and
improves at least until adolescence, as exemplified by
the attentional blink task [9,10]. Top-down spatial
attention appears to mature faster, reaching asymptotic levels around age 7, when assessed with simple
tasks, but can be shown to mature beyond puberty
with more complex tasks. The developmental milestones of top-down attention are typically measured
through the visual modality; yet, an important
variant uses dichotic listening, whereby participants
listen to two simultaneously presented stories, one in
each ear. Through instructions, participants are told
which ear to attend to and are then questioned about
the stories. Importantly, while the stories are played,
target sounds are presented to either ear, making it
possible to assess the event-related potentials (ERPs)
to these irrelevant stimuli and how they are affected
by attention [11]. Using this paradigm, markers of
top-down attention could be characterized in children as early as preschool up to adulthood, tracking
separately not only enhancement of the to-beattended stream, but also suppression of the irrelevant, distracting stream.
When it comes to learning, two forms of attention are essential: top-down attention – because it
controls the allocation of processing resources to the
task at hand, a prerequisite for any form of declarative learning and a facilitator of most skilled learning, even if some learning is certainly possible
without attention [12] – and sustained attention,
the ability to hold focus from seconds to minutes
[13–15], a key skill for school and yet understudied,
especially when it comes to ways to enhance it. We
regroup below the mechanisms that subtend these
two forms of attention under the term ‘attentional
control’. These mechanisms are at play in attention
disorders [attention deficit disorder (ADD) and
attention deficit hyperactivity disorder (ADHD)],
with their compromise being associated with impulsivity and various forms of inattention.
VIDEO GAME PLAY AND ATTENTIONAL
CONTROL: COUNTER-INTUITIVE FINDINGS
How can attentional control be improved? Does
play have a special status when it comes to fostering
attentional control? Games can be used to develop
attention, a fact that the French psychologist Alfred
Binet exploited to help children acquire the attentional skills needed in school. In a telling example,
Binet documents the game of ‘statue’, in which
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Video game play, attention and learning Cardoso-Leite and Bavelier
children are to take a pose and hold it for as long as
possible. Although laughter and chatting initially
dominate the classroom, over time children get into
the game, trying their best to outperform their peers!
The use of such games, Binet [16] surmises, was key
in allowing students who had failed the school
system to catch up two academic years in one! More
recently, in another surprising twist, playing commercially fast paced, action packed such as first or
third shooter video games has been shown to
improve attentional control across many of its
manifestations [17] and has led to investigating
whether action video game play may positively
affect attention in the developing brain [10,18,19].
Dye and Bavelier [10] tested top-down attentional skills of 7–22 year olds focusing on top-down
attention in space (Visual Search), in time (attentional blink paradigm), or over objects as in the
multiple object tracking (MOT) paradigm, in which
participants are presented a set of identical objects
moving in space and asked to keep track of a subset
of them. For all of these tasks, children who reported
playing action video games systematically outperformed those who did not. This group difference
emerged between 7 and 10 years of age, and kept
increasing thereafter. Notably, action video gaming
children reached adult nonplayer levels of performance for attention in time (attentional blink) by ages
7–10 and for attention to objects (MOT) by ages 11–
13 years (see also [19]). Clearly, the developmental
time-course of attention is being modified by the
technology use. Here, we see it accelerated by a
certain type of video game play, but technology
use has certainly been associated with worse, rather
than better, attentional control, with many reporting an increase in ADD and ADHD and other wellbeing issues among pediatric populations [20,21].
The source of this rise remains an active topic
of studies.
Although video game play is often blamed, the
Test of Variables of Attention (TOVA) which focuses
on impulsivity and sustained attention – functions
typically hindered in ADD and ADHD – shows that
action video game play is not the culprit. When
tested on the TOVA, action video game players were
faster, but not less accurate, than nonaction game
players, suggesting a notable ability at making more
correct decisions per unit of time ([22], see Fig. 1).
Finally, it is important to note that various
components of attention are not all equally affected
by action video game play. Whereas attentional
control is seen to improve, exogenous attention
or the automatic pull on attention created by abrupt
onsets is unchanged by action video games [18,23–
25]. This is the case despite the profusion of abrupt
onsets that these video games contain. Such results
highlight the need to go beyond intuitive analyses
of the impact of technology use on the brain and call
for more controlled laboratory studies distinguishing among the many technology uses. Only by
doing so can we achieve the needed level of granularity to understand how various technology uses
affect brain and behavior.
In adults, many of the studies have gone
beyond contrasting groups based on their reported
action video game play experience (>5 h/week for
at least 6 weeks vs. <1 h per week). In training
studies, nonvideo game players asked to play
action video games for about 0.5–1 h per day,
5 days a week for
2–10 weeks, show improved
attentional abilities above and beyond a control
group asked to play other genres of commercial
video games [26–33], establishing a direct link
between action game play and attention enhancement. In children, because of the typical violence
in action video games, training studies would
be unethical, calling for the development of ageappropriate action video games.
This work should not be taken as an excuse
to binge on video games. Short daily sessions over
multiple weeks suffice to induce long-lasting
positive changes, in line with the importance of
distributed practice in learning. In some studies,
the effects of action video game training were still
visible months to years after the end of training. It
should be recognized that video game play affects
the brain at multiple time-scales. Some effects occur
after small amounts of training, whereas others
require extensive practice. The potential of video
game play to induce neuroplastic changes is highlighted by reports of changes in both gray [34] and
white matter [35] after only 2 h of playing an actionvideo car-racing game. Interestingly, these changes
were observed only when participants raced the
same track repeatedly, and thus could learn its
spatial layout, but not when the track changed
continuously, implying that in addition to the time
on task, the specific way in which a game is played
critically determines its effects on the brain.
The existing training studies in children have all
used specially designed computer software (e.g.,
[36–39]). For example, Rueda et al. [38] assigned 4
and 6 year olds to five sessions of either an attention
training game – originally designed by the National
Aeronautics and Space Administration (NASA) to
prepare monkeys for space travel – or of video
watching. Both groups were pretested and posttested on an attention task while recording ERPs.
In the game but not the movie-watch group, the
brain markers of attention after training resembled
those observed in the adult brain. Interestingly, no
effect was observed at the behavioral level (see also
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(c)
(a)
400
Sustained attention–Target infrequent
Time
(d)
6
NVGP (n = 10)
VGP (n = 9)
375
Don’t
respond
Don’t
respond
Respond
Don’t
respond
(b)
Impulsivity–Target frequent
Time
5
Accuracy (d')
Don’t
respond
Response time (ms)
350
325
300
275
250
4
3
225
Respond
Respond
Respond
Respond
Don’t
respond
200
Sustained Impulsivity
attention
2
Sustained Impulsivity
attention
FIGURE 1. The Test of Variables of Attention (TOVA) assesses impulsivity and sustained attention. In this test, participants are
seated in front of a computer screen and required to press a key as fast as possible in response to a target (black square in
upper position) and to withhold responding to nontarget stimuli (black square presented in lower position). (a) In one
condition, the targets are rare and the nontargets appear frequently. The extent to which participants are able to stay on task
and respond quickly to rare targets is a measure of sustained attention. (b) In a different set of trials, targets appeared
frequently, whereas nontargets were rare. The extent to which participants are able to withhold responding to nontargets is a
measure of impulsivity. Dye et al. [22] used the TOVA to assess differences in impulsivity and sustained attention between
young adults who were either nonvideo game players (NVGPs) or habitual action video game players (VGPs). (c) Their results
show that VGPs were overall faster than NVGPs and that held true in both the sustained attention and the impulsivity
condition. (d) This increased speed did not come at the expense of accuracy as both groups did not differ on this measure,
indicating overall enhanced attentional control in VGPs. Error bars are standard errors of the mean. Of note is the fact that the
TOVA software automatically considers response times shorter than 200 ms as anticipatory responses and classifies them as
incorrect. Because VGPs have many response times below 200 ms, VGPs would have been found to have worse attention than
NVGPs despite being correct on these trials. The plotted data did not use the 200-ms cutoff for anticipation. An important
lesson is the importance of revising clinical tests and their criteria for use as new generations may not match previous norms.
In this case, ample research documents faster response times in the users of technology. Reproduced with permission [22].
[39]). This observation fits well with the notion of
‘preparation for future learning’, which states that
games produce latent effects that facilitate future
learning [40 ]. Computerized games have also been
developed to train executive functions of preschool
children [41,42]. Although not directly targeting
attention, some of these studies reported transfer
effects from working memory training to attentional control tasks [43].
Top-down attention appears, therefore, highly
plastic, especially during development, making it
both vulnerable and also a powerful target for intervention.
&&
OTHER APPROACHES TO RETRAINING
ATTENTIONAL CONTROL
Other interventions exist in addition to computer
and video games. Contemplative training such
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as mindfulness meditation [44] or compassion
meditation [45,46] also improves the abilities to
regulate one’s behavior, be it through enhanced
attentional control or better emotional regulation
[47 ]. Yet, applications of these approaches on
children and adolescents remain limited, calling
for further studies [48].
Physical exercise, especially in sedentary individuals, results in both physical and cognitive improvements. After exercising regularly for several weeks,
older adults display not only improved physical
health, but also enhanced cognitive functions,
including faster reaction times, enhanced attentional
control, and executive processes, and spatial cognition [49]. Although exercise training studies on children are rare, the sharp rise in obesity and the all-too
common attention problems that affect this age
group, combined with the fact that exercise can easily
be gamified (as illustrated by the recent surge in
&
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Video game play, attention and learning Cardoso-Leite and Bavelier
exergames [50]), suggest that such interventions
might be especially promising [51,52].
The possibility of re-introducing within the
school system some of the best practices suggested
by the studies of attention and its underlying brain
systems has recently caught some traction. An
example is ‘Tools of the Mind’ – a program based
on Vygotsky’s insights on the factors that promote
learning, including use of aids and strategies to
facilitate focus, use of private speech to regulate
one’s thoughts as well as acting of short scenarios.
All these activities require self-regulation and concentration; in turn, such interventions markedly
improve executive functions and attentional control in school-age populations [53].
Finally, an often-forgotten catalyzer of cognitive
development is children’s home environment. In a
recent thought-provoking study, Neville et al. [54 ]
contrasted two forms of intervention: one focusing
mainly on child classroom training with reduced
parent-directed training, and the other both on
children’s attention and parent-directed training.
Increase in attentional control was assessed both
behaviorally and through ERP markers of selective
attention, demonstrating an enhancement of brain
responses to attended stimuli in the group who
received most parent training. This study is all
the more important in that it focused on children
from low socio-economic background, in which the
neural underpinnings of selective attention are
compromised. The key role of family members in
fostering positive conduct in children is receiving
more and more attention and has led to the development of family video games, specially designed for
children to play with adults [55]. Although this
game genre is developing fast, controlled studies
are needed to quantify their impact on cognition,
social, and affective skills.
&&
IMPLICATIONS FOR CLINICAL
POPULATIONS
The possibility of retraining attentional control and
stimulating learning makes this work particularly
relevant to children with learning disabilities and
attention disorders (ADD and ADHD). Yet not all
interventions that boost attention in normal children may apply to clinical populations. This point is
probably best illustrated by asking whether ADD
and ADHD individuals, who suffer from low attentional and executive control, should be advised
to play action video games. Probably not! First, a
number of studies point to the time spent playing
video games as a risk factor for ADD and ADHD and
pathological gaming, calling for caution [56,57].
Second, enhancing attentional control in individuals with intact regulatory brain systems is a
different proposition than doing so in individuals
in whom these systems are dysfunctional. Finally, to
appeal to a wide audience, video games allow for
many types of game play and thus strategies. This
means that the same game can be played not only
proactively – with the player seeking to predict next
moves and events – but also reactively, with the
player jumping in the middle of the action and
indiscriminately pushing the buttons. These two
types of game play are unlikely to have the same
effect on attention, and may explain the apparent
discrepancy between action video game playing
enhancing performance in TOVA (see Fig. 1),
whereas being a risk factor for ADD and ADHD.
In the ADD and ADHD population, a series of
mini-games targeting both attentional control and
executive functions have shown some promising
results [58]. Yet, at present, neurofeedback whereby
the patient is trained to control his or her brain
states appears one of the most promising technology-based interventions for attention disorders
[59,60 ,61]. Of course, neurofeedback could be
naturally integrated into video game play, facilitating treatment compliance [62].
Surprisingly, some commercial video games have
been found to positively impact health. Low vision
patients, such as amblyopic patients, can enhance
their visual acuity by playing the Sims, Tetris, or
Unreal Tournament. This was shown in adult amblyopes typically thought to be past the ‘critical period’
for visual plasticity and thus untreatable [63,64].
Children with language impairment often
exhibit attentional problems and seem to benefit
from retraining attentional control. In one study,
Italian dyslexic children played either action minigames or nonaction mini-games for 12 h over 9 days.
The action mini-game trainees exhibited increased
attentional skills and faster reading speed than
the nonaction trainees [65]. Of note, both forms of
mini-games were part of the same commercial video
game ‘Rayman’s Raving Rabbids’. Action mini-games
emphasized visuo-motor control, precise aiming, and
proper timing of action, as well as divided attention
and planning, whereas the control mini-games
emphasized very fast motor execution with little
need for control on behalf of the player. That different parts within a game can have such different
impact tellingly illustrates the key role of processing
demands inherent to the game play in shaping the
game impact, and call for further cognitive task
analyses of game play. And indeed, not all games
seem to equally foster performance improvement
and transfer, as shown by a large-scale study of ‘brain
games’ in adults which reported gains on the trained
mini-games, with little transfer to different assessments testing the same cognitive functions [66].
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Together, such studies suggest that enhanced
attentional control may be key in unlocking brain
plasticity and learning; however, a causal role for
attentional enhancement in rehabilitating language
or visual deficiencies remains to be firmly established.
CONCLUSION
Children are faced with incredibly complex learning
problems in open-ended environments that they
have to solve autonomously. In this context, human
play is thought to be an ingenious trick invented by
evolution to help solve those problems. Two major
insights in understanding human play have recently
emerged in machine learning and developmental
robotics [67 ]. First, gaining information is valuable
to the individual and might by itself be rewarding.
Play may, therefore, provide the right time windows
to express such intrinsically motivated actions.
Second, information or novelty seeking per se is
not sufficient to drive efficient learning in the multidimensional space faced by the learning child.
Indeed, completely unpredictable events, such as
white noise on a television screen, will forever
remain both novel and unlearnable; yet children
rarely get stuck trying to learn them. The dominant
view is that cognitive mechanisms, such as attentional control, are specifically designed to maximize
learning, which would explain the many positive
consequences of fostering the development of
attentional control. Combined together, these two
insights identify play as a key activity that can be
leveraged to better engage patients with their prescribed therapy, enhance treatment compliance
and its learning impact as well as to continuously
monitor performance in a seamless way facilitating
diagnosis and treatment titration to a patient’s
need. It is with these goals in sight that video game
play is seen as a promising avenue for the diagnosis
and treatment of developmental disorders at the
turn of the 21st century.
&&
Acknowledgements
This study was conducted with partial support by the
grants from the National Science Foundation (1227168)
and the Swiss National Foundation (100014_140676)
to D.B.
Conflicts of interest
D.B. has patents pending for action video-game-based
intervention to promote learning and brain plasticity in
the domains of mathematics and visual rehabilitation.
D.B. is a consultant for PureTech Ventures, a company
that develops approaches for various health areas,
including cognition.
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