Game-Based Learning and Children with ADHD

A Dissertation

Submitted to the Faculty

of

Drexel University

by

Margaret Sullivan-Carr

in partial fulfillment of the

requirements for the degree

of

Doctor of Education

May 2016
 © Copyright 2016

Margaret Sullivan-Carr, All Right Reserved.

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Dedication

I dedicate this dissertation to my family-- My husband, Dan, who has held down the

home front during my many trips to Philadelphia and has shown his A+ proofreading skills; my

son, William, who is the inspiration for this work; my mother, Margaret “Twinkie” Sullivan,

whose wisdom encouraged me to try; and my late father, Neil Sullivan, for teaching me that

education is the most important “tool in life’s toolbox” for fulfillment, success and continuous

curiosity.

I would be remiss to not include Fr. Mark Cregan, C.S.C., Emeritus President of Stonehill

College, in this dedication. His challenge to pursue a doctorate degree set me on the path to this

work. He serves as a professional mentor and friend. I’m extremely lucky to have worked with

him.
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Acknowledgments

First and foremost, I’d like to acknowledge, Will Bailey, my research partner for this

work. His students are lucky to have a teacher that is willing to try new teaching approaches to

allow for a better understanding of math. I’m fortunate to have found a math teacher who is also

a “gamer” who appreciates the importance of this study.

Most importantly, I’d like to acknowledge my Dissertation Committee. I won the lottery

when Dr. Mary Jean Tecce DeCarlo agreed to Chair my Dissertation Committee. Her steadfast

support, practical advice and record-breaking edit turnaround times has made this process into a

fulfilling journey, not an ordeal. Dr. Albert Ritzhaupt’s expertise in game-based instruction

allowed for a more robust literature review. Dr. John Gould’s expertise in qualitative research

allowed for the development of a meaningful approach to this portion of the research.
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TABLE OF CONTENTS

LIST OF TABLES ......................................................................................................................... ix

LIST OF FIGURES ........................................................................................................................ x

ABSTRACT ................................................................................................................................... xi

CHAPTER 1: INTRODUCTION TO THE RESEARCH .............................................................. 1

Introduction to the Problem ............................................................................................................ 1

Statement of the Problem ................................................................................................................ 2

Purpose and Significance of the Problem ....................................................................................... 4

Research Questions ......................................................................................................................... 5

Researcher Stance and Experiential Base ....................................................................................... 6

Researcher’s Potential Bias............................................................................................................. 8

Conceptual Framework ................................................................................................................... 8

Definition of Terms....................................................................................................................... 10

Assumptions and Limitations ....................................................................................................... 11

Assumptions .............................................................................................................................. 11
Limitations ................................................................................................................................ 12

Study Delimitations ...................................................................................................................... 13

Summary ....................................................................................................................................... 14

CHAPTER 2: THE LITERATURE REVIEW ............................................................................. 16

ADHD in the Classroom ............................................................................................................... 17

ADHD and Educational Outcomes ............................................................................................... 18

Use of Video Games in Education ................................................................................................ 20

Game-based Learning and Children with ADHD ......................................................................... 28

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Game-Based Learning in Academics............................................................................................ 30

Conclusion and Future Study ........................................................................................................ 33

CHAPTER 3: RESEARCH METHODOLOGY .......................................................................... 35

Introduction ................................................................................................................................... 35

Research Design and Rationale .................................................................................................... 35

Flow of Research Design .............................................................................................................. 36

Research Questions and Related Methodology ............................................................................ 37

Method .......................................................................................................................................... 38

Site and Population ....................................................................................................................... 43

Site Description ......................................................................................................................... 43

Study Participants ......................................................................................................................... 44

Teacher Collaboration ................................................................................................................... 46

Data Collection ............................................................................................................................. 47

Pre- and Post-Tests .................................................................................................................... 47
Focus Group .............................................................................................................................. 48
Teacher Interviews .................................................................................................................... 48
Teacher Journal ......................................................................................................................... 48

Quantitative Research ................................................................................................................... 49

Pre- and Post-Tests .................................................................................................................... 49
Data Analysis ............................................................................................................................ 50

Qualitative Research ..................................................................................................................... 50

Focus Groups............................................................................................................................. 50
Algebra Teacher Interviews ...................................................................................................... 51
Interview Protocols ................................................................................................................... 51
Data Analysis ............................................................................................................................ 52

Timeline ........................................................................................................................................ 53

Ethical Considerations .................................................................................................................. 54

Study Specific Ethical Considerations .......................................................................................... 55

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Inclusion of Minors ................................................................................................................... 55

Role of Teacher ......................................................................................................................... 55
Data Collection .......................................................................................................................... 56
Data Security ............................................................................................................................. 56

Study Rigor ................................................................................................................................... 56

CHAPTER 4: FINDINGS AND RESULTS ................................................................................ 59

Introduction ................................................................................................................................... 59

Study Introduction ........................................................................................................................ 59

Qualitative Results ........................................................................................................................ 59

Pre-Intervention Teacher Interview .............................................................................................. 60

Student Post-Intervention Interview.......................................................................................... 64
Teacher Journal ......................................................................................................................... 67
Teacher Post-Intervention Interview ......................................................................................... 68
Axial Coding ............................................................................................................................. 71

Quantitative Data .......................................................................................................................... 75

Themes Related to Research Questions ........................................................................................ 76

Summary ....................................................................................................................................... 77

CHAPTER 5: INTERPRETATION, CONCLUSION, AND RECOMMENDATIONS ............. 79

Introduction ................................................................................................................................... 79

Conclusions ................................................................................................................................... 80

Lessons Learned............................................................................................................................ 81

Recommendations ......................................................................................................................... 83

Limitations and Future Research .................................................................................................. 87

Summary ....................................................................................................................................... 89

REFERENCES ............................................................................................................................. 90

APPENDIX A: SUMMARY OF ALGEBRA CHAMP VIDEO GAME .................................. 107

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APPENDIX B: PRE- AND POST-ASSESSMENTS ................................................................. 108

APPENDIX C: FOCUS GROUP QUESTIONS FOR STUDENTS .......................................... 112

APPENDIX D: RESEARCH QUESTIONS FOR TEACHER .................................................. 113

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List of Tables

1. Flow of Research Design ............................................................................................. 36

2. Questions and Related Methodology ........................................................................... 38
3. Study Timeline ............................................................................................................. 53
4. Themes of Pre-Intervention Teacher Interview ........................................................... 63
5. Themes of Post-Intervention Student Participant Focus Group .................................. 67
6. Themes of Post-Intervention Teacher Interview.......................................................... 70
7. Pre- and Post-Quiz Scores for Student Participants ..................................................... 76
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List of Figures

1. Conceptual Framework of Study .................................................................................... 9

2. Algebra Champ Game Set-Up ...................................................................................... 41
3. Algebra Champ Difficulty Level Set-Up ...................................................................... 42
4. Sample of Algebra Champ Equation ............................................................................ 42
5. Axial Coding of Game Design Category ...................................................................... 73
6. Axial Coding for Related Study Categories.................................................................. 74
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Abstract

Game-Based Learning and Children with ADHD

Margaret Sullivan-Carr, M.B.A.
Mary Jean Tecce DeCarlo, Ph.D.

Children with ADHD (Attention-Deficit Hyperactivity Disorder) Attention Deficit Hyperactivity

Disorder (ADHD) may exhibit behavioral and executive function issues that affect classroom

learning. Documented behaviors include inattention, disruptive behavior, and poor social

relationships (Gureasko-Moore, DuPaul, & White, 2006). Support for children with ADHD has

primarily focused on behavioral modifications and organizational skill enhancement. Computer-

assisted or game-based learning has shown promise with this population in small-scale studies

(Mautone, 2005; Ota, 2002). This case study research sought to investigate the use of game-

based learning and children with ADHD. The subjects were high-school aged children with the

primary diagnosis of ADHD who received a game-based intervention. This study shows game-

based learning has a positive effect on students with ADHDs’ engagement and interest in Math.

The analysis of the data from the qualitative portion of this study lends itself to a grounded

theory approach indicating game-based learning is an important consideration in curriculum

development for students with ADHD.

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CHAPTER 1: INTRODUCTION TO THE RESEARCH

Introduction to the Problem

According to the American Psychological Association, Attention-Deficit Hyperactivity

Disorder (ADHD) is a disability diagnosed in approximately 11% (6.4 million) of United States

children (CDC, 2015). This number is a 2.9-fold increase from 1990 (Sondik, Madans, &

Gentleman, 2011). Reasoning for these increases in diagnoses is debated amongst experts.

Some experts cite misdiagnosis of symptoms as a reason for the sharp increase (Nissen, 2006).

Others cite increased parent and teacher education on the signs and symptoms of ADHD leading

to greater and appropriate diagnosis (Biederman, 2006; CDC, 2015; Merrell & Tymms, 2001).

ADHD is a complex, chronic neurodevelopmental disorder with behavioral and cognitive

consequences that has attracted more attention during the past decade (Rapport, et al., 2009).

Most of these children remain in mainstream classroom settings, but require educational

accommodations to address the associated issues of ADHD.

Children with ADHD may exhibit behavioral issues that can impair learning in the

classroom. Documented behaviors include inattention, disruptive behavior and poor social

relationships (Gureasko-Moore, DuPaul, & White, 2006). Executive function is inhibited in

children with ADHD, leading to issues in the classroom that include problems with memory,

reasoning, and general cognitive ability (Daley & Birchwood, 2010). Without supportive

interventions, students with ADHD fall behind acceptable levels in subject areas, most notably

math and reading as they require a higher level of executive functioning (Zentall, Tom-Wright,

& Lee, 2013).

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Statement of the Problem

Academic modifications are necessary with the ADHD student population to allow for

individual success and classroom order for the entire class. Classroom interventions for students

with ADHD have focused on teacher-based contingency management strategies more than

enhancement of academically-focused assistance (Antshel, et al., 2011). Common classroom

modifications include removal of privileges, homework management programs, and material

rewards (DuPaul & Eckert, 1998; Fabiano & Pelham, 2003; Pfiffner et al., 2006). There is not a

specific strategy that provides consistent and long-term success (Fabiano & Pelham, 2003;

Pfiffner et al., 2006; DuPaul, Weyandt, & Janusis, 2011).

Several modifications appear to have promise, but few have been empirically tested.

Harrison et al. (2013) note:

Unfortunately, similar to the results of the Tindal and Fuchs (2000) review of the
evidence for the effectiveness of accommodations for all disabilities, we found that
experts in the field recommend many accommodations; yet few have scientific evidence
on the effectiveness. (p.582)

These include peer tutoring, strategies instruction, and computer-assisted instruction

(Barkley, 2008; DuPaul & Eckert, 1998). Game-based learning has drawn particular interest by

some researchers as it provides a tool to enhance focus for students with ADHD (Muñoz et al.,

2015). Game-based learning uses computer games developed and designed for use in an

educational setting. The games break material into smaller segments, which is a strategy often

used for students with ADHD. The underlying assumption is enhanced focus will lead to better

academic outcomes. It has shown promise in small-scale studies (DuPaul & Eckert, 1998; Ota &

DuPaul, 2002). These studies further explore the use of game-based learning with the ADHD

population to measure levels of focus and disruptive behavior.

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Game-based learning for children with ADHD shows promise, but requires additional

research to further test the hypothesis that it offers increased academic outcomes (Muñoz et al.,

2015; Reid et al., 2002). Previous research has been limited to small-scale studies with no more

than 6 participants (Mautone et al., 2005; Ota & DuPaul, 2002). There are still questions on the

efficacy and the role of this type of instruction. Furthermore, there is little research that

measures the combination of game-based learning with traditional classroom teaching and

children with ADHD (Fabio & Antonietti, 2014).

The relationship between ADHD and academic impairment has been well documented

(DuPaul & Stoner, 2003; Pfiffner, 1996; Zentall & Meyer, 1987). Academic issues include

frequent use of remedial services, lower grades, three times the rate of attrition and school drop-

out, and lower standardized test achievement (Zentall, Tom-Wright, & Lee, 2013). Test scores

for reading and math for children diagnosed with ADHD without remedial support also show

significant deficits (Bennedetto-Nash & Tannock, 1999).

School-aged children with ADHD are often placed in classrooms that employ teaching

methodologies not prescribed for children with ADHD (Ota & DuPaul, 2002). Studies have

shown smaller class sizes with fewer distractions support success for students with ADHD (Loe

& Feldman, 2006; Mautone et al., 2005; Raggi & Chronis, 2006). United States public schools

rarely have the opportunity to offer small-class settings due to overcrowding and strained

budgets (Armstrong, 1999; Biddle & Berliner, 2014). This results in a lower success rate for this

population as well as issues for classroom management (Barkley, 2008; Jitendra & DuPaul,

2007).
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Purpose and Significance of the Problem

The purpose of this study was to determine whether game-based learning provides an

effective accommodation for students with ADHD, thus leading to better academic outcomes.

The study reviews the academic indicators and measurements, i.e., test scores of students with

ADHD, who receive traditional classroom instruction coupled with a game-based intervention.

Qualitative measures included pre and post intervention teacher interviews about game-

based instruction in combination with traditional classroom instruction, a focus group interview

with students, and a journal written by the teacher throughout the intervention. The focus group

was comprised of students with ADHD who received the game-based intervention. These

students were asked questions to gain an understanding of their experience with, and opinion of,

game-based learning. The third dimension of the qualitative component of this study was an

analysis of the teacher’s journal notes transcribed during the study duration.

Game-based learning has shown promise for students with ADHD as it engages attention

and provides an alternative or complementary teaching technique for academic material.

Research results have shown the positive effects of videogame play on attention (Lawrence,

2002; Muñoz et al., 2015). Several studies have indicated promise in using video-game based

learning in children with ADHD (Mautone et al., 2005; Ota & DuPaul, 2002), but the studies are

small-scale and measure factors such as focus, attention, and engagement. They do not measure

academic outcomes.

Ota and DuPaul (2002) examined the effects of using game-based learning software to

improve math performance and attentiveness in a population of fourth to sixth graders diagnosed

with ADHD. The study was small scale (3 subjects), but supports other research (Mautone et al.,
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2005). The study did not measure academic outcomes of study participants. Other research

indicates game-based learning and students with ADHD enhances attention and engagement in

academic material leading to increased executive function and understanding of material

(Veenstra, 2012).

Game-based learning is a relatively new teaching model in K – 12 classrooms. Research

indicates promise for the use of this modality as it promotes experiential, active, and creative

learning (Admiraal et al., 2011; Martinussen et al., 2006). These attributes are of particular

interest to a student with ADHD. It provides teachers with new options to engage students with

technology that is familiar and interesting. Children with ADHD have difficulty focusing in the

classroom. Teachers have differing approaches with this population of students. Preliminary

research has shown that game-based learning may be advantageous for students with ADHD as it

fosters an active and vibrant environment for teaching and learning (Mautone et al., 2005).

Game-based learning holds great promise for students with ADHD, yet more research is needed

to understand if, how, and why it works.

The results of this study will provide information to teachers for use with students with

ADHD. If the hypothesis is supported, it provides evidence to support the use of another “tool”

to the “toolbox” of instruction for students with ADHD. It also provides game developers with

information on an untapped market segment.

Research Questions

There were two research questions for this study. The research was intended to measure

(a) the efficacy of the use of game-based learning for children with ADHD in terms of improving
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academic outcomes, and (b) to report on the perceptions of the teacher and students who

participated in this study. The research questions were:

1. What is the relationship between game-based learning and academic outcomes in

Algebra One for students with ADHD?

2. How do teachers and students perceive the influence of game-based instruction on the
academic performance of Algebra One students with ADHD?

This research was predicated on the hypothesis that game-based learning coupled with

traditional classroom instruction increases academic outcomes for children with ADHD. This

hypothesis was based on research that indicates game-based learning increases attention,

decreases disruptive behavior in the classroom, and leads to more meaningful academic

engagement (Admiraal et al., 2011; Fabio & Antonietti, 2014; Martinussen et al., 2006).

Researcher Stance and Experiential Base

The hypothesis for this study stemmed from the author’s personal experience and

observations of her fifteen-year old child who has ADHD. Her son was formally diagnosed with

ADHD in the third grade. The diagnosis came after several years of severe behavioral issues in

school. The issues involved inability to stay seated, inattention to teacher instruction, constant

interruption of peers and teachers, and lack of organizational skills. The diagnosis was

documented by an independent clinical psychologist specializing in neuropsychology after the

school did an initial evaluation that indicated a suspicion of ADHD. The child was also found to

have an exceptionally high IQ.

Once the ADHD was documented, the treatment plan included medication, behavior

modification, and a Section 504 plan (Section 504 of the Rehabilitation Act of 1973, as amended, 29

U.S.C. § 794) which mandated seating near model peers and assistance with organization of course
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materials and homework. Under Federal Law, the Section 504 plan is reviewed on an annual

basis (IDEA, 2004).

The author’s son continually struggled with organization, motivation, and attention in

school. The author has provided supplemental assistance to her son at home including the hiring

of an ADHD coach, and the provision of organizational tools including organization with course

materials, and homework calendars. These tools and additional support have resulted in minimal

change in organizational outcomes and grades.

The researcher has observed her son’s keen interest and success in subjects that involve a

combination of lecture and experiential learning. In contrast, subjects that are delivered primarily

through lecture format are very difficult for him to understand as his attention quickly dissolves

in the classroom. For example, science is a subject that provides engagement through lab

exercises and experimentation. Her son excels in this subject.

The author introduced her son to supplemental learning modalities for subjects that were

delivered primarily through lecture at school; i.e., mathematics. The supplemental materials

were game-based that provide another way for the student to learn subject matter that may not be

comprehended when delivered via lecture-based teaching.

These materials were introduced after the author initially observed her son’s long-

standing attention to non-academic video games. This prompted her to surmise academic-based

video games may offer a solution to overcome his claims of “boredom” in the classroom and

difficulty with comprehension. For example, while in middle school, the video game of

Minecraft engaged him for multiple hours. The lecture-style lesson delivery was less action-

based, used a linear instruction method, and was less captivating.

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Researcher’s Potential Bias

As noted earlier, the researcher had a vested interest in the research as she has a child

with ADHD. Given this connection, she took caution to not influence the study through her

actions, data analysis, or interactions with study participants.

To ensure validity of data analysis, an unbiased secondary person was asked to validate

all data presented in the findings section of this paper.

Conceptual Framework

The research sought to study and test several concepts discussed in the Literature Review

(Chapter Two) of this paper. Research streams included ADHD in the classroom, ADHD and

educational outcomes, use of video games in education, and game-based learning for children

with ADHD. The researcher also sought to understand a teacher’s and students’ perceptions of

the influence of game-based learning on academic outcomes.

The first stream of research, ADHD in the Classroom, reviews literature on the issues

confronted by students with ADHD and their teachers in the classroom. It reveals the disruptive

tendencies, inattention, and fidgety behavior of students with ADHD. The second stream

discusses the impact of these behaviors and overall lower academic outcomes (measured by

graduation rate, the achievement of passing grades, and test scores) found in children with

ADHD compared to normally developed children. The third research stream reviews literature

on the relatively new introduction of game-based learning in the classroom. A discussion on the

benefits of the instructional tool is presented and its impact on academic outcomes is explored.

The final area reviews literature on the use of game-based learning with students with ADHD
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measuring areas of focus and engagement. Figure 1 outlines the conceptual framework for this

study.

Small-scale studies that have tested the hypothesis of this study have been conducted and

indicate promising results for use of game-based learning and children with ADHD (Annetta,

2009; Ota & DuPaul, 2002). This study replicates elements of these studies with the addition of

a qualitative component (see Chapter 3) to understand the teacher’s and students’ perceptions of

the additional instructional delivery.

Figure 1. Conceptual Framework of Study

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Definition of Terms

Several terms are key to the understanding of this study:

504 Plan -- Section 504 is part of the Rehabilitation Act of 1973, a civil rights statute

aimed at ending disability-based discrimination in schools (Zirkel, 2009). A 504 Plan is

developed by teachers, parents/guardians, and students to provide accommodations and services

to eligible students to support learning and outcomes in a mainstream classroom.

Academic Outcomes – The measurement of lesson comprehension in an academic setting

(Harford College, 2013, July 10).

ADHD - a chronic condition that affects millions of children and often persists into

adulthood. ADHD includes a combination of problems, such as difficulty sustaining attention,

hyperactivity, and impulsive behavior (Mayo Clinic, 2013).

Case Study – “An in-depth exploration of a bounded system (e.g., activity, event, process

or individuals) based on extensive data collection” (Creswell, 2012, p. 465).

Game-Based Learning – Game-based learning broadly refers to the use of video games to

support teaching and learning (Ott et al., 2013; Perrotta et al., 2013). Also commonly referred to

as serious games, Kim and Bae provide further explanation, “Serious games can be defined in

various aspects that have elements of fun games. In serious games, functionality and

entertainment are not mutually exclusive concepts. Serious games are differentiated from

entertainment games in aspect that they don’t only pursuit fun in process and from edu-contents

in aspect that they don’t focus only on learning effects as results. Specific purposes and fun

elements of games combine and have great synergy effects” (2014, p. 209).
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Math Anxiety—“A feeling of tension and anxiety that interferes with the manipulation of

numbers and the solving of mathematical problems in ordinary life and academic situations”

(Hopko et al., 2003, p. 648).

Multiple Intelligences- A theory developed by Howard Gardner which states humans

possess intelligence in various capacities. “Using biological and cultural research, he developed a

list of the following intelligences: (1) logical-mathematical intelligence; (2) linguistic

intelligence; (3) spatial intelligence; (4) musical intelligence; (5) bodily-kinesthetic intelligence;

(6) interpersonal intelligence; and (7) intrapersonal intelligence. Gardner asserts that the

intelligences seldom operate independently; they are used concurrently and complement each

other” (as cited in Brualdi, 1998, p. 26).

Traditional Classroom Instruction –Based in a school location that primarily uses face-

to-face communication as a means for instruction (Bernard et al., 2004).

Assumptions and Limitations

This section provides a summary of the underlying assumptions woven into this study. It

also provides the acknowledged study limitations.

Assumptions

The researcher came to this study with several assumptions on ADHD and its impact on

academic performance. These assumptions extended to the classroom. It is believed the results

of this study will be of great interest to educators who have students with ADHD in the

classroom.
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The following list summarizes the assumptions for this study:

1. Children with ADHD learn differently.

2. Teachers are open to game-based learning in classrooms.
3. Students have computers available to them for game play in the school setting.
4. Teachers are interested in new teaching techniques for the ADHD population of students.
5. Study participants will have the same interest in game-based learning as the researcher’s
son.

Limitations

This study had several limitations due to the number of participants, site selection, length

of study, and assumed computer literacy of teachers and students. Due to the setting within a

private school focused on students with learning differences, study results may be considered

school-specific rather than applicable to classrooms in all schools. The following list

summarizes the study limitations:

Study size. This study was limited to the number of students with ADHD enrolled in the

two Algebra 1 course sections of School X (the school is assigned the pseudonym of School X

for this paper to insure confidentiality of the site and population). The school estimated that 30%

of the student population had ADHD as a primary diagnosis. Given the average class size is 15,

30% of this population equals 4-5 students per class. If 100% participation was received, this

equated to 8 – 10 study participants who have ADHD.

Despite the teacher’s exemplary efforts, only three students’ parents chose to sign the

permission form allowing their child to participate in this study. This situation changed the

original study design from a mixed method that would have reviewed data from pre- and post-

test assessments (quantitative portion) and the qualitative data elements included in the final

study. The researcher concluded that quantitative data from three study participants would not

provide information that was meaningful to the study results and discussion. Therefore, the
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original study design was changed to a case study methodology to provide an in-depth analysis

of the students’ and teacher’s perceptions and attitudes on the use of game-based learning as a

complementary teaching strategy in Algebra One.

School Curriculum. School X teaches all classes on the basis of Gardner’s Multiple

Intelligences Theory. Given this, teachers utilize a variety of methods including art, linguistic,

and spatial representations to instruct students. Assessments of learning content are relatively

subjective compared to a mainstream school environment. Given the difference in teaching

methodology between the research site and most public schools, results may not be considered

applicable by public and mainstream school administrators.

Length of study. The duration of the study is three months. The duration is determined

by the researcher’s time limitation due to Ed.D. program requirements. It was also dictated by

the access granted to the researcher. School X agreed to host the research for one semester.

Ideally, this study would have had a longer duration to provide a longitudinal review of the

game-based intervention.

Study Delimitations

This study has several delimitations as a result of the researcher’s decision on research

design and site choice.

Computer Game Choice. The computer game Algebra Champ was used in this study. It

is a single player game. Although a multi-player game would have offered additional research

opportunities, school IT issues prevented its use. The game “provides introductory level algebra

skills practice with timed rounds, high scores, and a cage fight theme” (West, AppFindzUS,
 14

2015). The game was chosen based on a literature review and colleague recommendations. The

colleague provided an overview of Algebra Champ, “If she really wants a drill-style game that is

clearly classroom math, but just adds some game elements (like time limits and levels), she could

always do something like this: https://itunes.apple.com/us/app/algebra-

champ/id398873050?mt=8” (personal communication, C. Williams, April 24, 2015).

The game was synergistic with lesson plans. The researcher did not find any information

to determine which educational computer games are considered “best in the market”, therefore,

the choice of Algebra Champ may or may not have been the best choice.

Site Selection. The study site was in a school with students with a high degree of

computer literacy; results may not duplicate to school settings of students with less computer

access and/or aptitude. In addition, the intervention will be difficult to replicate in schools with

no or limited access to computers for students and resources to purchase an appropriate game.

Summary

Students with ADHD learn differently. Educators have long struggled to find a teaching

resource that fits with the factors of inattention and executive function deficits associated with

students with ADHD (DuPaul et al., 2006). Traditional classroom strategies show success with

behavioral management, but do not provide enhancement for students’ learning (Martinussen et

al., 2006).

Research shows students with ADHD respond positively to action based video games as

irrelevant information is filtered out and attention is drawn to factors influencing success

(Bavelier et al., 2012). Small scale studies of game-based learning and children with ADHD

show promising results for use in education (Mautone, 2005; Ota, 2002). These studies review
 15

attention and behavioral measures, but do not assess academic outcomes or teachers’ response to

the newly introduced teaching modality. This study furthers the research of Ota and Mautone

while focusing on academic outcomes of students’ and a teacher’s observations and reactions to

the use of game-based learning complemented by traditional classroom instruction.

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CHAPTER 2: THE LITERATURE REVIEW

The purpose of this literature review was to investigate the use of game-based learning

and children with Attention-Deficit Hyperactivity Disorder (ADHD). In order to understand the

use of game-based learning and the learning deficits of children with ADHD, research was

compiled to better comprehend the components within the research questions.

The interest of this research was the use of video game-based learning and children with

Attention-Deficit Hyperactivity Disorder. The examination studied the use of games to deliver

course content to complement traditional classroom learning in United States schools.

Measurements were taken to ascertain if increased academic outcomes are achieved with video

game-based learning integrated with traditional classroom teaching for children with ADHD.

ADHD is complex, chronic neuro- developmental disorder with behavioral and cognitive

consequences (Rapport et al., 2009) that has attracted more attention during the past decade.

Diagnosed cases have increased to 6.4 million United States children between the ages of 3 and

17 in 2014 (CDC, 2015). This number is a 2.9-fold increase from 1990 (Sondik, Madans, &

Gentleman, 2011). Males are more likely to be affected with ADHD than females (Purdie et al.,

2002). It is estimated that one out of five United States school aged children have ADHD.

(Fabiano et al., 2003).

Students with ADHD also struggle within normal social frameworks of friendships as

their behaviors may hinder the formation of positive relationships with other children (Duhaney,

2003). Researchers have also observed less intimacy and reciprocity in children with ADHD

(Normand et al., 2011).

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The following sections provide an overview of ADHD and its implication on academic

performance. The sections further break the research question down into smaller subjects; i.e.,

game-based learning, effects of ADHD on academic performance. The first section provides

information on children with ADHD in the classroom. The next section offers information on

academic outcomes of children with ADHD. Literature suggests the negative effects that ADHD

can have on academic outcomes (Zentall, Tom-Wright, & Lee, 2013). The next section discusses

the use of game-based learning in the mainstream classroom citing the proponents and opponents

of use. The following section describes the use of game-based learning with children with

ADHD. The last section concludes the literature review and calls for further research on the use

of game-based learning with children with ADHD.

ADHD in the Classroom

This section discusses the implications of ADHD students in mainstream classroom

settings. These students require specialized support and consideration. Educators are called upon

to develop instructional methods to address the issues of ADHD students.

ADHD is an issue that is prevalent in general education classrooms, as most students

with ADHD do not qualify for special education programs (Nowack & Mamlin, 2007).

Academic modifications are necessary with the ADHD student population to allow for individual

success and classroom order for the entire class. Common modifications include removal of

privileges, homework management programs, and providing material rewards (DuPaul & Eckert,

1998; Fabiano et al., 2003). Several modifications appear to have promise, but have not been

empirically tested. These include peer tutoring, strategies instruction, and computer-assisted

instruction (DuPaul & Eckert, 1998; DuPaul et al., 2006).

 18

Nowacek and Mamlin’s (2007) research indicates teachers’ general understanding of the

characteristics of students with ADHD. Despite the teachers’ understanding of issues related to

ADHD, inconsistent classroom modifications are offered. Generally accepted classroom

modifications for children with ADHD are a necessary element in today’s schools (Evans et al.,

2013). Martinussen and colleagues (2006) stress the importance of academic interventions

designed especially for the ADHD population. They emphasize the high rate of success found

with interventions where “students are more engaged when there are more opportunities to

respond” (Martinussen et al., 2006, p. 116). Game-based learning provides this type of

opportunity. Teachers, school administrators, and support staff must recognize and support

students with ADHD. This population has specific learning requirements that need to be

addressed to fully support successful academic outcomes.

This literature suggests the need for additional instructional strategies for students with

ADHD. Although several modifications are commonly used in the classroom, none have been

proven to lead to increased focus and academic outcomes. The purpose of this research study is

the exploration of game-based learning as a teaching strategy that may positively affect focus

and academic outcomes for students with ADHD.

ADHD and Educational Outcomes

This section provides information on the effect of ADHD on academic aptitude and

outcomes. Numerous studies have been conducted to document the nuances and issues in the

classrooms of ADHD students.

The relationship between ADHD and academic impairment has been well documented

(Jitendra & DuPaul, 2007; Rapport et al., 1999; Zentall & Meyer, 1987). Academic issues
 19

include frequent use of remedial services, lower grades, three times the rate of school drop-out,

and lower standardized test achievement (Zentall et al., 2010). As noted earlier, ADHD affects a

student’s ability to complete tasks that require a high degree of executive functioning, attention,

and reflection. Children with ADHD have a short duration of attention compared to typically

developing children (Rapport et. al, 2009). Deficits are especially found in math and reading as

both subjects require a higher demand for focus and executive function (Zentall, Tom-Wright, &

Lee, 2012). Antshel and associates note, “…we found that 25% of children with ADHD showed

skills deficits in reading/language, 15% showed skills deficits in mathematics, and 22% showed

skills deficits in written language” (Antshel et al., 2011, p. 220).

Research has found reading comprehension to be lower within an ADHD population

compared with control groups (Beike & Zentall, 2010; Jacobson et al., 2011). Reading

comprehension is the “who,” “what,” and “when” of a piece of literature; not the translation of

symbols or sounds into words. Slower rates of reading have also been reported in children with

ADHD. This can be related to the deficits in reading comprehension as passages may be re-read

to ascertain meaning. Specifically, Jacobson and associates found that the deficits in working

memory and processing speed in students with ADHD effected oral reading fluency and reading

comprehension (Jacobson et al., 2011).

Poor performance in math scores has been reported in children with ADHD. Scores in

timed addition fact efficiency (the amount of addition problems completed correctly) and

subtraction fact accuracy show low performance compared to control groups of students

(Bennedetto-Nash & Tannock, 1999). Fuchs and associates (2005) found that attention and

working memory were also predictors of math achievement. Deficits in these areas led to lower

scores compared to peers who had normally developed attention and working memory.
 20

Research has shown interventions that add color, active response (reading problems out

loud and then writing answers versus just writing), or manipulation of objects (i.e., a stress ball

or toy) while solving problems lead to differential gains for students with ADHD (Zentall, Tom-

Wright, & Lee, 2013). These gains have been recorded in math and reading subjects.

Current literature and research validates the deficits of ADHD students’ function and

outcomes in academic subjects; specifically in reading and math (Bennedetto-Nash & Tannock,

1999; Fuchs et al., 2005; Jacobson et al., 2011; Zentall, Tom-Wright, & Lee, 2013). However,

there is limited research that looks at alternative instruction methods that may better suit this

population (Mautone et al., 2005; Ota 2002; Evans et al., 2013).

This action oriented study sought to test the use of game-based learning with an ADHD

population of high school students to see if this instruction method leads to increased academic

outcomes. Study information may inform future classroom practice for this population of

students.

Use of Video Games in Education

This section discusses the introduction of video games as an instructional tool in the

classroom. This shift from traditional teaching to a new paradigm of instruction has attracted

many researchers to study the use of this teaching method.

The advent of computer gaming in the classroom has introduced teachers and students to

new methods of instruction, learning and assessment. The academic computer gaming industry

has grown exponentially in the past 5 years – predicted to reach a $8,958,490 mark by 2017. This

is a 18% increase from $3,912,000 in 2012 (Vargus et al., 2014).

 21

The popularity and exposure of video games has become an everyday part of children’s

lives. Video games have become ingrained in American culture with 58% of households owning

a gaming console in 2011 (Nielson, 2012). Classrooms have not been immune to this culture

shift with the introduction of gaming as a learning tool (Squire, 2003).

Video games as classroom tools have been in existence for years, but have become more

integrated and developed in recent years (Heick, 2012; Ribeiro et al., 2013). Heick explains,

“Educational games have been a commonplace part of the K-12 experience since the beginning

of the 1980s (and in some places well before that), with early titles introducing students to

fundamental math, history, and problem solving concepts just as games do today” (Heick, 2012,

para. 1). Video games have gained more attention as a valid means for instruction as they have

become more interactive and emphasized cognitive thinking development.

Further research has shown that gaming in an educational setting leads to increased

student motivation, as learning is seen as fun and interactive (Baltra, 1990; Ke, 2008; Ott et al,

2014; Pange, 2003). Student engagement in learning content delivered via game-based learning

scores higher than traditional classroom instruction (Alan, 2011; Annetta, 2009; Ribeiro et al,

2013). Studies have also shown the use of action video games provides students with a long-term

higher intensity of attention (Bavelier, 2012). Teachers also report enhanced methods for student

assessment as progress is instantly tabulated as games are played (Alan, 2011).

Rizhaupt, Higgins and Allred (2011) studied the effect of modern educational games on

student attitudes towards mathematics. They found that educational game play showed

“significant and positive changes” (p. 277) in students’ attitudes towards mathematics.

However, no significant gains in mathematics achievement were conveyed.

 22

Ke (2008) also examined the potential of use of game-based learning. The results indicate

students’ increased positive “disposition” (p. 539) towards mathematics after computer games

were introduced into the classroom.

Bourgonjon and colleagues’ (2013) research indicates the necessity for teachers to

understand the benefits of video games in the classroom. Teachers are hesitant to adopt the

game-based learning into classrooms before they understand the specifics of the game and the

complement to traditional classroom teaching.

Ritzhaupt, Higgins and Allred (2010) found that teachers are open to adoption of video

games into the classroom, but successful integration is dependent on ongoing technical support

and information on game usage. Furthermore, as found in Bourgonjon and colleagues’ research,

teachers must receive training on the game and its benefits prior to classroom integration

(Bourgonjon et al., 2010). Ribeiro and colleagues caution the introduction of games in a

classroom may come with technical difficulties which can be overcome with proper training and

support (Ribeiro et al, 2014). They caution teachers to practice the game prior to introduction so

as not to overshadow the positive effects of the game by student frustration.

Teachers use video games to deliver course content in creative ways. Some video games

were originally introduced to the market for entertainment purposes, but have been accepted as

educational tools. Educational games require strategizing, hypothesis testing, or problem-

solving, usually with higher order thinking rather than simple memorization or comprehension

(Dondlinger, 2007; Kebritchi & Hirumi, 2008).

Games such as SimCity, Civilization, Tropico, Minecraft, DimensionM and SimEarth

have been used in and out of classrooms to teach the subjects of Science, Math and Government
 23

(Hays, 2005; Kebritchi & Hirumi, 2008; Squire, 2002). SimCity allows players to develop cities

while learning about geography (Squire, 2002). Civilization provides players with an opportunity

to run an entire civilization (Squire, 2002). Tropico affords players the tools to govern computer-

based nations, while SimEarth opens the door for players to investigate complex systems like the

Earth’s chemical and life cycles (Squire, 2002). DimensionM is an immersive 3-D game to teach

Algebra (Kebritchi & Hirumi, 2008). All of these games develop collaborative decision-making

and communication (Paraskeva, Mysirlaki, & Papagianni, 2010; Williamson Shafer et al., 2005).

The use of computer-based learning can complement traditional classroom instruction to

deliver a learning environment that is engaging, fun and motivational for students (Williamson

Shafer et al, 2005). Research on the comparison between learning outcomes on game-based

learning vs. the traditional classroom instruction has delivered mixed results (Hainey &

Connolly, 2010; Halverson, 2012; O’Neil et al., 2005). Hainey and Connolly (2010) compared

the delivery of education using game-based and traditional classroom instruction. They found

neither delivered better results. Furthermore, they note the need for gaming software engineers

to collaborate with educators in the development of game-based learning approaches (Hainey &

Connolly, 2010). They stress the need for both teaching mechanisms to be deployed in today’s

classrooms.

Halverson looked at games in the classroom as an intervention worthy of its own

objective research. The author calls for action based research that examines how students

“navigate education” through the use of games (Halverson, 2012, p. 445). The author also calls

for new teaching practices to be developed using “new technologies of teaching and learning”

that will “allow for innovation, exploration and experimentation” (Halverson, 2012, p. 445).
 24

Halverson hypothesizes that game-based learning may be the answer to this new teaching

practice.

Kebritchi, Hirumi and Bai (2010) looked at the effect of modern computer games on

mathematics achievement and class motivation. They found no significant achievement in a

comparison of game-users vs. non game-users. However, they found greater motivation in

students who played the games in the classroom and at home (Kebrichi, Hirumi, & Bai, 2010).

Learning outcomes can be linked to computer games for many subjects (Hays, 2005).

O’Neil and associates’ (2005) research on the delivery of education using video games and the

effect on learning outcomes shows a positive impact on students’ abilities to apply earlier

learning to more complex tasks as new levels are reached in the games. These findings also

show an increase in problem-solving capabilities in students that utilized video game-based

learning. The problem-solving skills are honed in games as no solution is delivered; the student

must use cognitive processing to arrive at an answer.

The research of Gillispie, Martin and Parker (2010) used the video game, Dimension-M,

as an intervention to determine whether it positively influenced math achievement and attitude in

math. Their findings imply the game does have a positive impact. This study calls for further

research on a multi-player game scenario as well as a focus on students’ cognitive processes

while playing the game.

Bavelier and colleagues (2012) reviewed the aspects of attention enhanced in action

video games to understand the changes in neural behavior between children who played video

games (gamers) and those who did not (non-gamers). Their research measured aspects of brain

activity and found a startling contrast between the two groups. The gamers showed “better
 25

selection attention over space” and “enhanced selective attention to objects” (Bavelier et al.,

2012, p. 132). They concluded that gamers hold a stronger ability to “either limit or recover

faster from the distracting effect of abrupt onsets” (Bavelier,et al., 2012, p.133). In other words,

they have developed an ability to keep on-task.

Other research has also shown evidence in the promise of video games as a positive

effect on attention abilities (Boot et al., 2008; Green & Bavelier, 2012). Boot and associates

(2008) studied the use of video games amongst players who played on a regular basis; i.e. expert

gamers, and non-gamers (those that didn’t play at all). They concluded that the expert gamers

manifested better attention among other positive attributes that support successful learning

outcomes (Boot et al., 2008). Green and Bavelier (2012) provide evidence that video games

provide a means for practicing attention skills that is transferable to an academic setting. They

report action video games call upon the gamer to stay on-task and suppress irrelevant

information. This skill enables gamers to adapt more swiftly to new environments or learn new

skills quickly (Green & Bavelier, 2012).

Further research conducted by Admiraal and associates (2011) also concludes that game-

based learning leads to better academic outcomes as students are engaged in learning content

longer in more meaningful ways. This research also indicates students retain the course material

for a longer amount of time due to the active learning environment it is delivered in (Admiraal et

al., 2011). Cagiltay (2007) also notes that delivery of academic lessons utilizing computer-based

games creates a more interesting delivery of information leading to longer-term engagement of

students.
 26

The use of technology in the classroom does not come without its detractors (Bennett,

Maton, & Kervin, 2008; Frank, 2012). In a journal article dated 2008, Bennett, Maton and

Kervin discuss the claim that technology is a necessity in the classroom due to students’ status as

“digital natives.” A digital native is defined as the generation born between 1980 and 1994

described as living lives “immersed in technology” (Bennett, Maton, & Kervin, 2008, p.776).

These students possess sophisticated knowledge of technology. The authors state that digital

natives prefer education delivery via technology versus the traditional classroom. The authors

further explain that this generation of students is reliant on technology for information,

communication and socializing, but not for education. Bennett and colleagues (2008) contend

that technology is embedded in the classroom; however, students’ and teachers’ use is not

uniform, therefore it cannot be used as the only means of education.

Other studies have outlined some cautions in using game-based learning with children.

They point to the propensity for some personality-types to become addicted to video games, later

leading to gambling and internet addictions (Boyle et al., 2011; Chou & Chou, 1997). This is

particularly concerning for persons with narcissistic and aggressive personality traits. The

authors also note that the addiction can lead to diminished friendships and loss of control over

time regulation.

Studies have been conducted to assess how computer games are played in education

(Chou & Chou, 1997; Frank, 2012; Hays 2005). Frank (2012) conducted a study that measured

gamers’ use of video games intended for education. They found players to become more focused

on winning the game than reaching educational objectives. They labeled this state as “gamer-

mode” whereas players become fiercely competitive looking at the achievement of “winning” as

the end goal versus the obtainment of education (Frank, 2012).

 27

Hays notes educational games are not always used in ways intended by game developers.

He emphasizes the need for instructors to embed video games feedback into learning materials to

ascertain the players’ understanding of learning objectives (Hays, 2005). Chou and Chou call for

careful integration into education with attention to “instructional design principals” (Chou &

Chou, 1997, p. 1334).

Other researchers point out the benefits of computer game play (Durkin & Barber, 2002;

Piper et al, 2006). Durkin and Barber (2002) measure the effect of video game play on

adolescent development. The study measures levels of aggression, leisure time and self-

confidence. Results show no measurable effects on aggressiveness. This finding conflicts with

other non-empirical papers that suggest video game play can lead to aggressive behavior (Do

violent video games lead to Aggression?, 2006). Study participants led active social lives, albeit

some of the socialization occurred online. Online friendships included children from the

participants’ locale as well as locations far away. In measurements of self-concept, player

participants viewed themselves higher in intelligence than non-players (Durkin & Barber, 2002).

Other researchers have noted the benefits of game-based learning in education, but

caution that they cannot stand alone as an instructional method (Hwang et al., 2012; Williamson

Shafer et al., 2005). Hwang and colleagues (2012) stress the importance of personalized lesson

plans to address students’ individual learning needs. Williamson Shafter and colleagues (2005)

stress the potential of video games "to move our system of education beyond the traditional

academic disciplines-derived from medieval scholarship and constituted within schools

developed in the Industrial Revolution-and toward a new model of learning through meaningful

activity in virtual worlds." (Williamson Shaffer et al., 2005, p. 111).

 28

Game-based Learning and Children with ADHD

Game-based learning and children with ADHD is a subject this has garnered limited

attention in research. This section provides information on the studies that have been conducted

to assess the value of game-based learning with the ADHD population.

Game-based learning for children with ADHD has been recently introduced as an

academic intervention that enhances this population’s abilities (Jitendra & DuPaul, 2007). Game-

based learning addresses the issues of attention-span, engagement and disruptive behavior found

in the ADHD student population (Fabio & Antonietti, 2014; Houghton et al., 2004; Jitendra &

DuPaul, 2007; Shaw, 2005).

Research results have shown the positive effects of videogame play on children’s

attention-spans (Fabio & Antonietti, 2014; Lawrence, 2002). These findings show promise for

educators working with students with ADHD, in large part because of their deficiencies in

attention and executive function. Educators strive to introduce tools and methodology that

provide a successful learning environment for students with ADHD. Game-based learning is a

tool worth considering for this population as it enhances lengthened learning engagement,

attention span effectiveness and social benefits which are issues that have been cited as obstacles

to successful academic outcomes (Zentall, Tom-Wright, & Lee, 2013).

Other research has focused on the use of computer games and children with ADHD to

measure inhibition and attention. Houghton and colleagues (2004) conducted a study to assess

video game play in non-medicated ADHD boys and normally developed boys. Study results

indicate quicker response rates by ADHD boys and better results for games that require a high

working memory load (a high degree of executive function). The authors concluded, “Computer
 29

technology in the classroom may afford children with ADHD increased opportunities to be more

successful, both academically and socially, and to improve their interactions with peers”

(Houghton et al., 2004, p. 31-32).

Shaw (2005) conducted a small-scale study to review the engagement of children with

ADHD when using commercially available video games. Specific measures were taken to assess

executive function and attention. Results of the study revealed stronger attention of the ADHD

group compared to the control group. The ADHD group of children also showed a significant

decrease in impulsive response compared to the control group (Shaw, 2005).

Both of the above studies do not measure the effectiveness of video game use in an

academic setting, but do provide results on measurements of attention, executive function and

working memory. These issue deficits are known to affect academic success in children with

ADHD (Daley & Birchwood, 2009; Loe & Feldman, 2007; Rapport et al, 2009).

The use of video games and children with ADHD comes with some caution. Weiss and

colleagues (2011) conducted a literature review on the correlation between use of video games

and its impact on children with ADHD. The authors warn of the propensity of people with

ADHD to have “addictive” (p. 331) personalities. They cite literature that indicates “internet

addiction” and off-line video game addition as a disorder that makes children with ADHD more

vulnerable. Citing this risk factor, they recommend time limitations on video-game play for

children with ADHD.

This research study furthers the research of proponents of game-based learning in the

classroom using a case study methodology to assess the impact of its use in a math classroom

with children with ADHD. Research has shown the positive effect of video game play with
 30

children with ADHD in terms of focus, attention and engagement; however limited research has

been conducted on the use of game-based learning with children with ADHD.

Game-Based Learning in Academics

Game-based learning with students with ADHD is a subject that has shown promising

outcomes. This section provides information on the benefits of this instructional method. The

use of technology in an academic setting with children with ADHD has also proven successful.

McClanahan (May/June 2012) shares the results of an academic intervention used with a

child with ADHD. The child was tutored in reading using an iPad. Previous attempts at

teaching the child to read at grade-level had been unsuccessful. Upon introduction of reading

lessons using the iPad, the child became more engaged and on-task. The student was reading at

grade level by the end of the school year (McClanahan, May/June 2012). The author calls for

further research on the use of technology with ADHD students.

Other studies have indicated promise in using video-game based learning in children with

ADHD (Mautone et al., 2005; Ota & DuPaul, 2002). Ota and DuPaul examined the effects of

using game-based learning software to improve math performance and attention in a population

of fourth to sixth graders diagnosed with ADHD. The researchers found the use of a game-based

learning format showed increased in "active engaged time and decreased in off-task behaviors"

(Ota & DuPaul, 2002, p. 254). The study did not measure whether the game-based intervention

correlated to academic performance.

Mautone and colleagues’ (2005) study provided similar results in relation to off-task

behavior and engagement. This study is limited as it has three participants identified from a

larger group of children “participating in a study funded by the National Institute of Mental
 31

Health (NIMH) aimed at improving academic performance of children with ADHD.” (Mautone

et al, 2005. P. 3030). The study participants ranged in age 8 -9 and were in the second, third and

fourth grades. The study utilized the software package Math Blasters 6-9 in the study.

Both studies indicate a strong improvement in engagement and decreases in off-task

behavior. However, improved learning outcomes were not demonstrated by all study

participants. Both papers suggest the promise for game-based learning with the ADHD

population, but acknowledge the preliminary findings of their studies due to size of number of

participants.

Raggi and Chronis (2006) compared the use of computer assisted tutoring using software

using games and non-games. They found higher response rates and engagement with the game

format with children with ADHD. The study focused on behavioral factors, but the authors

surmised the benefits of computer-assisted instruction using games on academic outcomes. The

authors call for further research.

Veenstra and associates (2012) conducted an exploratory multiple case study to examine

how a computer game focused on improving “ineffective learning behavior” (p. 27) in children

diagnosed with ADHD and or both ADHD and Autistic Spectrum Disorder (ASD) (Veenstra et

al., 2012). They measured rate of mouse clicks to assess executive function of study

participants. The study concluded a direct correlation between increased executive function in

children with ADHD and use of action computer games. Study authors call for further research

on the use of action video games developed for academic use.

Xu and colleagues completed a review of empirical studies that have “assessed the

efficacy of technology as a tool for students with ADHD”. (Xu, Reid, & Steckelberg, 2002, p.
 32

225). This paper reviews literature on the use of technology with children with ADHD in five

categories: computer-assisted instruction (CAI), computer-based cognitive training, biofeedback

training, assessment, and behavior modification. In terms of CAI, the authors noted two studies

(Ford, Poe, & Cox, 1993; Kleiman, Humphrey, & Lindsay, 1981) that reported promising results

for CAI with children with ADHD. The study results are limited due to research methodology

and setting.

Fabio and Antonietti (2014) conducted research using “hypermedia tools” with students

with ADHD. They compared results to a control group of normally developed students.

Hypermedia tools are defined as “images, photos, diagrams, motion pictures, sounds, and texts

are simultaneously available to activate learner’s verbal/auditory and visual channels at the same

time” (p. 8). They found that these tools led to increased levels of retention of knowledge in the

long-term for students with ADHD. They performed at the same level as the control group.

Research to assess the effect of game-based learning on students with ADHD's on-task

behavior, engagement and behavior is relatively abundant compared to studies on the academic

outcomes for the same population. There is agreement in the literature that game-based learning

does improve ADHD students' engagement, on-task behavior and behavior in the classroom

(Ford, Poe, & Cox, 1993; Kleiman, Humphrey, & Lindsay, 1981; Raggi & Chronis, 2006; Xu,

Reid, & Steckelberg, 2002). These factors are a known construct to successful academic

outcomes. Preliminary studies have shown game-based learning as a promising instruction mode

for the ADHD population (Mautone et al., 2005; Ota & DuPaul, 2002). These initial results call

for further research to assess the academic outcomes in children with ADHD using game-based

learning instruction.
 33

Conclusion and Future Study

Game-based learning offers educators an opportunity to strongly engage children with

ADHD in their own learning. Introducing this methodology paired with traditional classroom

teaching provides these students with tools that enhance their ability to succeed in academic

settings. Game-based learning affords a learning tool that increases executive function and focus

while reducing hyperactivity and inattention (Houghton et al., 2004). This combination places

these students at a higher rate of success in academics.

Studies indicate game-based learning in children with ADHD for math is particularly

promising (Annetta, 2009; Ota, 2002). This teaching technique has shown successful behavioral

outcomes. Reductions in off-task behavior and hyperactivity have been found with the

introduction of game-based learning. Increases in active engagement and focus are also found.

More research is needed to assess the effect on academic outcomes when game-based learning is

introduced into the curriculum for children with ADHD.

Another important aspect of the use of game-based learning for children with ADHD is

the acceptance of this pedagogy by the academic community. Bourgonjon (2010) concludes the

necessity for educators and video game creators to collaborate on the development of video

games for education is essential to overall acceptance and use. Bavelier and associates (2010)

further emphasize this importance as they stress the need for appropriate content integration into

action video games developed for education. Game-based learning tools must be organized to

incorporate content that triggers learning in order for suitable classroom use. Kirriemuir and

McFarlane (2004) also stress this point in their call for partnerships between academic and
 34

industry game developers. If this collaboration does not take place, academic standards and

requirements may be missed in the development of video games targeted for education.

Further research to assess the academic outcomes for children with ADHD when they

engage game-based learning must be performed to answer questions pertaining to improvement

in academic outcomes. This study enrolled participants to test the research questions noted at the

beginning of this chapter

 35

CHAPTER 3: RESEARCH METHODOLOGY

Introduction

Chapter Three describes research design, rationale, site, population, data collection

timeline, and ethical considerations of this study. The focus of the research was the use of video

game-based learning and children with ADHD. The study was predicated on the hypothesis

that game-based learning coupled with traditional classroom instruction increases academic

outcomes for children with ADHD. This hypothesis was based on research that indicates game-

based learning increases attention, decreases disruptive behavior in the classroom and leads to

more meaningful academic engagement (Admiraal et al., 2011; Fabio & Antonietti, 2014;

Martinussen et al., 2006).

The research questions for this study were:

What is the relationship between game-based learning and academic outcomes in Algebra
One for students with ADHD?

How do teachers and students perceive the influence of game-based instruction on the
academic performance of Algebra One students with ADHD?

Research Design and Rationale

This section discusses the research approach and design. This case study provides results

to inform educators on a game-based intervention to teach math to children with ADHD.

Creswell describes a case study as “An in-depth exploration of a bounded system (e.g., activity,

event, process or individuals) based on extensive data collection” (Creswell, 2012, p. 465). The

case study methodology consisted of a bounded system of 3 study participants and their Algebra

One teacher.
 36

One of the anticipated outcomes of this research was the use of the study information to

further inform the teaching of students with ADHD in the classroom. Results will be shared with

educators in the hopes that the game-based intervention will be used with students with ADHD.

Flow of Research Design

Table 1 depicts the flow of the research design for this study. Step One shows the

identification of the study participants. Step Two was an interview with the teacher to

understand his thoughts on the use of game-based learning. Step Three measured the pre-test

results of all study participants before intervention is introduced. Step Four was the introduction

of the game-based intervention and the teacher’s journaling while the intervention took place in

his classroom. Step Five shows the post-test of study participants. Step Six identified the focus

group with study participants and an interview with the classroom teacher who taught the lesson

to study participants in her classroom.

Table 1. Flow of Research Design

Step One •Enroll Study Participants

Step Two •Teacher interview (pre-intervention)

Step Three •Pre-test

•Game-based intervention
Step Four •Teacher journal
Step Five •Post-test
•Focus group with study participants
Step Six •Teacher interview (post-intervention)

The design incorporated a quantitative analysis of academic outcomes measured by test

results. The school’s existing curriculum and assessments, i.e., tests, were used. This allowed

for uniformity in testing as the students and teacher were familiar with the format. The
 37

qualitative portion of the research gathered information from a variety of sources. It included a

focus group with students in the study. The data was further tri-angulated with two interviews

(pre- and post-intervention) of the teacher in the classroom. Another data set was information

from a journal that the teacher wrote to capture his thoughts as the intervention was used in the

classroom.

The quantitative approach was chosen to allow for comparison of test results before and

after a game-based learning intervention is introduced to students with ADHD. Results indicated

the effect of the game-based intervention on math achievement of study participants. This

portion of the study is included as a basis to further inform the discussion. The assessment

results cannot be considered statistically valid as the sample size is too small. This is discussed

further in the Recommendations section of Chapter 5.

A qualitative component of the study assessed feedback received in a focus group with

students who participate in the study. The focus group with student study participants who

receive the intervention assessed their experiences with game-based learning. The teacher’s

perceptions of game-based learning is explored to further understand the practicality of use in the

classroom through pre- and post-test interviews as well as his journal kept throughout the

intervention.

Research Questions and Related Methodology

Table 2 outlines the research questions and the corresponding research methodology

employed to gather appropriate data.

 38

Table 2. Questions and Related Methodology

Research Questions Approach Methodology Data Analysis

What is the Quantitative Math factorization Gain score analysis

relationship between
game-based learning
and academic
outcomes in Algebra
One for students with
ADHD?

How do teachers and Qualitative Focus group with Deductive coding,

students perceive the study participants, Axial coding
influence of game- Teacher interviews,
based instruction on Teacher’s journal
the academic
performance of
Algebra One students
with ADHD?

The researcher established a goal to review whether there is a causal relationship between

game-based learning and academic outcomes in children with ADHD. Previous small-scale

studies have indicated this instruction method shows promise in children with ADHD (Mautone,

2005; Ota, 2002). Both the Mautone and Ota studies had 3 participants each. Neither study

included academic assessments as a part of the research design.

Method

This author further explored the findings from the Ota and DuPaul, and Mautone, DuPaul

and Jitendra studies. The researcher also considered Hess and Gunter’s (2013) study that

compared academic outcomes and learning experiences of students who used game-based

learning in an online course with those who were instructed in the classroom (Hess & Gunter,
 39

2013). Study authors used a mixed methods triangulation convergence model (Creswell et al.,

2003) where quantitative analysis of academic outcomes was conducted with a qualitative study

of teachers’ and students’ motivation and engagement in the instruction methods. Neither study

measured whether game-based learning as a complement to traditional classroom teaching led to

better academic outcomes for students with ADHD.

Hess and Gunter used the Self-Determination Learning Theory (SDT) social theory as a

basis for their research (Hess & Gunter, 2013). Deci and Ryan (2000) describe this model as the

belief that humans have an innate need for growth and motivation who “strive to master ongoing

challenges and to integrate their experiences into a coherent sense of self” (p. 68). Active

learning is an expression of this theory. Game-based learning is considered active learning as it

calls upon players, i.e., students, to engage in learning by continuous decision-making,

collaboration, and scaffolding of knowledge to achieve higher levels. Hess and Gunter contend

“In educational settings, the goal of the theory is to enhance those intrinsically motivated

behaviors while addressing innate student psychological needs” (p. 375). Byman and Kansanem

(2008) note the theory will be successful if students are placed in an academic setting that

motivates and interests.

The Hess and Gunter study “informs instructional designers, teachers, education

stakeholders and educational game designers by providing research-based evidence related to the

learning experiences and outcomes of the serious game-based online course” (Hess and Gunter,

2013, p. 372). The research methodology for this study provided information on the learning

experiences of students (qualitative) while measuring the learning outcomes of the students

(quantitative). Although Hess and Gunter’s study did not focus on the ADHD population of
 40

students, it does provide a statistically significant (184 study participants) review of game-based

learning and academic outcomes.

This study also took into account the research of Ke in which a mixed methods study

delivered results that show the specific type of game affects students’ motivation and

engagement in game-based learning. In Ke’s study, a summer cohort of 4th and 5th graders used

game-based math programs to facilitate cognitive math achievement (Ke, 2008). The study

highlights the value of learning activities within a game-based program. Results show an

increase motivation, but no significant increase in cognitive achievement in math.

Ke’s study underscores the importance of game-based program choice for this study. A

game proven to engage students while providing a challenging scaffolding lesson environment is

imperative. Kebritch and Hirumi analyzed modern games that are in the education market. They

note, “…little has been done to synthesize information on how established learning theories and

instructional strategies are being applied to design educational games to guide research and

practice” (Kebritch & Hirumi, 2008, p. 1729 -1730).

Due to the research site’s IT firewall system, an individual player game was deemed the

most appropriate solution for this study. The school’s Information Technology Department did

not allow for firewall access due to the stress of a multiplayer game on the bandwidth and the

potential security threats from a multiplayer game. This threat has been documented in literature

including Sinha, Mitchell and Medhi’s article which states multiplayer games “pose a great

challenge to the existing network infrastructure in order to satiate its requirements” (2005, p. 71).

Reviewing the literature, which included online reviews of various Algebra apps, and

conferring with colleagues led to the choice of Algebra Champ as the most appropriate game.
 41

The game is described as providing “practice in solving equations in an entertaining, game-like

format. Student may reinforce their algebraic thinking skills by solving one, two and multi-step

equations and becoming the “Champ” (Apps for Algebra, 2015). Appendix A provides an

overview of the game outlining the benefits and constraints. Given the site and population for

this study, the game was deemed to be a reasonable tool for use in this study. The game is free of

charge and is accessible via iTunes.

Algebra Champ is a game that “offers introductory algebra skills practice” with “timed

rounds, high scores, and a caged fight theme” (West, 2016). The game allows players to choose

their “fighter” (Figure 2) and difficulty level (Figure 3) to solve basic Algebra equations while a

timer streams at the top of the screen (Figure 4). It is a game that provides practice for basic

Algebra concepts.

Figure 2. Algebra Champ Game Set-Up (West, 2016).

 42

Figure 3. Algebra Champ Difficulty Level Set-Up (West, 2016).

Figure 4. Sample of Algebra Champ Equation (West, 2016).

This study employed one Algebra One class at a private school focused on students with

learning differences. The school utilizes Gardner’s Theory of Multiple Intelligences as a basis

for instruction and curriculum design. For example, students in the Algebra One sections

demonstrate their understanding of the Order of Operations through a modality of choice, e. i.,

music, drawing or writing.

 43

Students identified as ADHD as a primary diagnosis by medical and/or

neuropsychological testing were recruited as potential study participants. The determination of a

diagnosis of ADHD by an outside medical or mental health provider is school policy.

Pre- and Post-test results were compared to assess whether game-based learning had a

positive impact on learning. Copies of the pre- and post-assessments are found in Appendix B.

Site and Population

Site Description

The site for this study was a private nonsectarian co-educational college-preparatory high

school in a suburb of Boston, MA that specializes in teaching students with learning differences.

The school website describes the teaching approach as:

“Our multiple intelligences approach to teaching, along with support seamlessly

integrated into the classroom, creates a transformational learning experience for
students” (school name not cited to protect confidentiality, 2015).
School X has a 2015-2016 total enrollment of 175 students. The enrollment was 55%

boys and 45% girls. There was a 1:5 faculty to student ratio. The school was comprised of 55%

day students with the remaining 45% boarding. The 2015-2016 school year tuition was $39,200

for day students and $53,750 for boarding students. The school describes itself as respecting

“ethnic, cultural, and intellectual diversity, we teach and live in an atmosphere of mutual respect

for differences” (school reference not cited to protect confidentiality, 2015). The enrollment had

25% international students from 12 different countries. Thirty percent of the students were

categorized as “students of color.” Approximately 30% of the students had ADHD as their

primary diagnosis of learning difference. Classes were 75 minutes in length allowing for a

“deeper learning environment”.

 44

The site was chosen due to the author’s knowledge of the schools’ specialty for teaching

students with learning differences. The school prides itself on its “creative approach to teaching

and learning” (school viewbook, 2015). Upon initial inquiry the researcher was directed to the

schools’ Program Director of the 9th and 10th grades. He expressed interest in the study and

secured participation of the Algebra teacher. The school requested an in-service of research

results to the faculty once the study is finished.

The school had a higher than average population (30%) of students with ADHD

compared to the average public school (11%) (CDC, 2015). Prior to the study, the researcher’s

stance included a belief that if the study hypothesis was proven correct, results may provide

teachers with new instructional methods for the ADHD population of students. This enhanced

the students’ learning and created a new platform for successful academic outcomes.

The study was limited to the subject of math allowing for a systematic and pragmatic

approach. There were five math teachers at the school across four grades (School Web Site,

name redacted to protect for confidentiality, 2015). One of the teachers of Algebra One agreed

to participate in the study. He taught two sections of Algebra One. All students had iPads as a

school requirement. iPads were used as teaching tools across subject areas. The game-based

intervention for this study was a web-based application. It could be accessed by all study

participants via their personal iPads. There was no charge to access the game.

Study Participants

Prospective research participants were identified by School X’s administration. The

school facilitated the communication with parents/guardians. The teacher coded test results with

a unique identifying number to protect student confidentiality. School administration predicted

 45

4-5 student study participants with ADHD as a primary diagnosis in each Algebra One class.

Students’ secondary diagnoses, if existing, were not tracked.

Study participants were recruited using a purposeful sampling method. Creswell (2013)

defines purposeful sampling as, “intentionally selecting individuals or sites to learn or

understand a central phenomenon” (p. 206). Further, Harsh (2011) states, “The logic and power

of purposeful sampling lie in selecting information-rich cases for study in depth. Information-

rich cases are those from which one can learn a great deal about issues of central importance to

the purpose of the inquiry…” (p. 63).

All students enrolled in Algebra One of the participating teacher’s classes were eligible to

use the game-based intervention. Although non-traditional in research methodology, this format

had been requested by the school administration to minimize classroom disruption that could be

caused by differential teaching methodologies, specifically, one group of students using game-

based learning vs. those that do not. The teacher only shared data for the students that had

ADHD as a primary diagnosis who consented to participate in the study.

Letters were emailed home by the school to parents/guardians of students with ADHD as

a primary diagnosis; requesting permission for their student to participate in the study. Email is

the preferred delivery system as many prospective participants were international students and

regular mail could have added weeks to the study protocol. Parents/Guardians were asked to

complete a consent form and return it to the researcher within two weeks of receipt. A secondary

reminder email was sent after ten days of the initial communication.
 46

Questions pertaining to the study were directed to the researcher. The informed consent

provided information on the study methodology and included the access for all study participants

to game-based learning after the pre- and post-tests have been completed.

Parents/guardians were asked to discuss study participation with their students. The study

protocol was shared with the teacher and students. Once permission was received from

parents/guardians of the student, the teacher approached students whose parents/guardians had

granted permission to discuss the research study. The teacher obtained student assent to

participate in the study. They were reassured that they had the right to withdraw from the study

at any time.

Pre- and post-test results were shared with the researcher. Students were identified by

number to protect confidentiality. This allowed for data to be analyzed without the concern of

specific student outcomes known by the researcher.

Teacher Collaboration

An important component of this study was the collaboration of the School X Math

teacher. This teacher assisted in the facilitation of the study through the introduction of the

game-based intervention as well as the facilitation of game-based learning time in the classroom.

His participation added credibility to the study as it is seen as an endorsement of the

importance of the information that is reported at the conclusion of the study. The teacher has

access to study results. The teacher was viewed as a partner in research for this study as he

facilitated the classroom, gave the tests, graded the tests, and shared test results with the

researcher.
 47

This teacher’s participation in the interview framed the results of the qualitative portion

of the study. His observations and thoughts shaped this portion of the study by providing

constructive feedback on students’ usage of game-based learning tools as well as his reflection

on the value of the instruction tool. Appendix D provides the list of questions for the interviews.

Data Collection

This section provides a description of the quantitative and qualitative data collection tools

used for the study. Both data sets were used to draw conclusions on the use of game-based

learning and students with ADHD.

Pre- and Post-Tests

This study collected data from pre- and post-tests. These tests provided a baseline of

students’ knowledge and a measurement of gains. It provided two data points used for

comparison and review.

The tests were ten questions presented in a paper format. They were administered at the

beginning of the class period. They consisted of single variable problems which tested concepts

found in the Algebra Champ game. There were no test time restrictions, but all students

completed it within 30 minutes.

School X had class periods of 75 minutes during which experimental learning was often

included into instruction. Fifteen minutes at the end of each class for a period of three weeks

were designated for game-based learning. The teacher was the lead educator in the classroom.

He delivered the traditional Math lesson and facilitated the game-based learning.
 48

Focus Group

The researcher requested a mutually agreeable time for a focus group with study

participants. Refreshments were offered as a small incentive for focus group participation. Use

of designated school space was requested to provide the most comfortable setting for this larger

meeting.

Teacher Interviews

Two interviews were conducted with the teacher. The first was conducted prior to the

intervention. Questions were focused on the teacher’s pre-intervention perception of game-based

learning. They also assessed his anticipated outcomes of the intervention. The questions were

carefully worded so as to not create a “reactive effect” (Schmitz, 2006) to the study. A reactive

effect is created when pre-test or pre-intervention questions may lead a study participant to

conclude the results of the research before it has been completed. In doing so, the study

participant may behave differently in the research.

A second interview was conducted with the teacher to understand his observations of the

game-based intervention in his classroom. The quantitative study results served as a basis for

discussion in the interview.

Teacher Journal

The teacher kept a daily journal to capture his thoughts throughout the time of the

intervention. This allowed for real-time perceptions, observations, and thoughts to be

documented, thus diminishing the necessity to recall such events during the post-intervention
 49

interview. The journal entries served as a discussion topic during the post-intervention teacher

interview.

Quantitative Research

Pre- and Post-Tests

The quantitative portion of the study consisted of a pre- and post-test to compare

students’ understanding of lessons before and after the intervention. These tests were

administered by the classroom teacher utilizing the Math XL® tool. The specific tests were a part

of the current assessment method at the school.

The school did not follow a specific curriculum for math. The researcher’s school

contact noted, “As an independent school, we do not use prescriptive or standardized curricula

and our teachers have more leverage to adjust curriculum than in a public school” (N. Cronin,

personal communication, July 23, 2014). Due to the situation, there were no test validity scores

available. Another classroom teacher from the school described the lesson assessments as, “One

is ‘formal’, meaning on paper with a pencil, be quiet and show me your work. One is generally

collaborative, meaning a team game, work with a partner or interact with me or another student

to demonstrate understanding. One part is either creative or introspective, meaning find an

alternate way to show me you understand the concept (picture, artwork, analogy, photography

etc.) or include a written portion trying to assess your own skill, confidence and/or accuracy.”

(K. Sokolow, personal communication, August 8, 2014).

The school used an online math curriculum enhancement tool, Math XL®. Math XL®’s

website described the tool as:

 50

“MathXL® for School is the essential online addition to any core curriculum that provides
personalized instruction and practice for middle and high school students of all levels.
Tied directly to more than 300 Pearson mathematics and statistics texts, teachers can
easily create, edit, and assign homework and tests.” (Math XL, 2014).
MathXL® is a Pearson product that incorporates quizzes which allow the teacher to

further assess students’ understanding of course material. The teacher offered to adjust his

curriculum to integrate Math XL® quizzes at the beginning and end of the timeframe of the

research study to provide pre- and post-test data.

All study participants were administered a pre- and a post-test to compare results of the

intervention. Results were compared to assess whether the study participants had academic gains

after the intervention.

Data Analysis

Analysis of pre- and post-test results were done using a simple math equation to assess

the comparisons of scores between pre- and post-intervention tests. The sample size was too

small to allow for further analysis.

Qualitative Research
Focus Groups

A qualitative portion of this study was conducted using a focus group. Maxwell (2013)

notes the importance of focus groups in terms of in-depth information that can be garnered

through the approach. The focus group invited all study participants to share their thoughts on

the use of game-based learning in conjunction with traditional classroom teaching. The pros and

cons of game-based learning was assessed. Appendix C provides a list of questions for the
 51

Student Focus Group. The questions were open-ended to capture respondents’ initial thoughts

while allowing for follow-up questions.

Algebra Teacher Interviews

Two interviews were conducted with the Algebra teacher who hosted the research. He

was questioned on his perceptions of the game-based learning before and after the intervention.

He was also questioned on the engagement, motivation and interest of students during the

intervention.

Interview Protocols

The focus group and the teacher interviews were recorded to allow for later transcription.

All participants were advised of the recording devices. All information was used solely for this

research study and not shared with anyone other than the study author, dissertation committee or

Drexel University IRB (if necessary).

Interviews were held during a time that was convenient for the teacher and students. A

lunch time was suggested to eliminate the teacher and students committing extra time before or

after school. Separate interviews were scheduled with the teacher and the student study

participant group.

An iPhone device was used to record the interviews. The iPhone recording was used to

transcribe the interviews. Immediately after the interview, the iPhone was transported to the

researcher’s home office. Upon arrival, the file was transferred to the password protected laptop

dedicated to the researcher’s school work. Once the files were downloaded, it was deleted from

the iPhone to protect for privacy. The files were sent to an external company for transcription.
 52

The researcher also took notes throughout the process to capture participants’ body

language and expressions. The notes were matched up to the transcription to create a richer

interpretation of the data.

Study participants were asked to contribute their thoughts and observations on their use

of game-based learning. Although the entire class received the game-based intervention,

Question 2 for this research focused on the perceptions of the group identified as students with

ADHD.

An interview with the participant teacher was held pre- and post-intervention to assess his

perceptions of the effect on students. Appendix D outlines the questions for his interviews. The

answers help to shape the conclusions drawn for Question 2.

Data Analysis

Data analysis of the focus groups followed Creswell’s advice on the Case Study

Methodology (Creswell, 2013). Once the transcription was complete, it was read and notes were

written in the margins. The process of open coding was followed (Merriam, 2009). These

notations reflected bits of data found in the interview that was relevant to the research questions.

The data was then color coded to reveal the initial themes found in the dialogue. Once the

color coding was finished, the themes visually emerged by reviewing the amount of highlights

by color. The strongest themes received the most highlights and the less important themes

received smaller amounts. The themes were then grouped into categories to allow for patterns to

inform the answer to Question 2 of the study (Merriam, 2009).

 53

The teacher’s journal was also analyzed using an open coding methodology. A similar

color coding system was used to look for themes of his thoughts and observations during the

intervention period.

The data was then axial coded to allow for categories to be grouped together to analyze

for streams of events and theories.

Timeline

Table 3 shows the timeline of this study. This study initially began in December of 2014,

but was postponed due to technical difficulties between the school’s firewall and the original

game choice. The study was started again in October of 2015 with a newly recruited group of

students. It provided a three-month timeframe for the game-based intervention to be introduced

and assimilated into classroom teaching.

Table 3. Study Timeline

Date Action Steps Responsible Party

May 2014 Contact School X Principal M. Carr

to discuss study

May 2014 Submit research to School M. Carr

Administration for approval

Fall 2014 Drexel Proposal Review M. Carr and Committee

Fall 2014 Submit research to Drexel M. Carr

University Institutional
Review Board (IRB) for
approval following proposal
approval

November 2014 Pass IRB proposal hearing M. Carr

Solicit School X Math M. Carr and School X

teacher collaboration
 54

May 2015 Revised IRB approval M. Carr

September 2015 Work with School X to M. Carr and School X

identify potential study
participants

October 2015 Solicit study participants M. Carr and School X

through mailing to
parents/guardians.

November 2015 Assess response to initial M. Carr

mailing; send out reminder if
necessary

November 2015 Conduct pre-intervention School X

teacher interview

December 2015 Conduct pre-lesson test M. Carr and School X

December 2015 Classroom and game-based School X

instruction proceeds

December 2015 Post-lesson test administered M. Carr and School X

December 2015 Focus groups with game- M. Carr

based learning students and
teacher interview

Ethical Considerations

The researcher sought Institutional Review Board (IRB) approval from Drexel

University. The principals of The Belmont Report were followed. The Report was published in

1978 by The National Commission to Protect Human Subjects of Biomedical and Behavioral

Research (The National Commission) to provide moral principles on the ethical considerations of

behavioral and biomedical research (Beauchamp, 2008). This study fits within the parameters of

the covenants of the report.

The three guiding ethical principles of the Belmont report are respect for persons,

beneficence, and justice (National Commission for the Protection of Human Subjects of
 55

Biomedical and Behavioral Research, 1978). In following these principles, the researcher did

seek informed consent from all participants. They were fully informed on the study protocol,

risks and benefits. Study participants were informed of their right to withdraw from the study at

any time.

Study Specific Ethical Considerations

There are several ethical considerations for this study. The considerations include the

researcher’s personal interest in the research, the various instructional methods of the study, the

inclusion of minors in the study, and role of the teachers in the study.

Inclusion of Minors

Special consideration was given to the informed consent and study participants’ rights

throughout the study. The informed consent document stressed the protocols followed to protect

the anonymity of minors (see sections on Data Collection and Data Security).

Role of Teacher

Another ethical consideration was the central role of the teacher in the study. The role of

teacher was twofold. The teacher had the responsibility of pre- and post-test administration. He

was asked not to share his opinion on the different instructional delivery throughout the study to

avoid study influence.

The teacher also had an active role in the interviews and journal. His opinions shaped the

outcome of the qualitative portion of the study. This information is important in study results

and may inform future instruction in School X as well as others schools who use this research.
 56

Data Collection

All quantitative data were protected and only shared between the school and the

researcher. Test results were reported to the researcher by the teacher. Students were assigned a

number by the teacher to protect confidentiality. The researcher reported results by student

number.

Qualitative results from the focus groups were reported as themes. Specific comments

are not attributed to speakers by name. Focus group participants were notified of this plan at the

beginning of each session.

Data Security

All data and recordings were stored on the researcher’s laptop which is stored in a home

office. Data was password protected for further security. The files were also saved on a flash

drive which is locked in a safe at the researcher’s home. Data will be saved for seven years after

the study has finalized.

The data on test results were scrubbed for identifying student characteristics by School X

before submission to the researcher. Students were identified by number. This further protected

students’ confidentiality.

Study Rigor

The design of this case study research took into account the suggested frameworks from

noted qualitative researchers (Creswell, 2012; Maxwell, 2013). The research has the inclusion of

several data elements including a student focus group, pre- and post-intervention teacher
 57

interviews, a teacher’s journal and data from pre- and post-intervention assessments (Oliver,

2011).

The research design is connected to the theoretical framework outlined in Figure 1 in that

it seeks to further understand the effect of a game-based intervention on a population of students

with ADHD in a classroom setting. All of the streams of research outlined in Figure 1 are

investigated using qualitative research methodologies. The use of differential measures further

adds to the rigor of this study.

The four elements of trustworthiness were considered during the evaluation of rigor.

Billups discusses the four elements of trustworthiness as: “credibility (truth), dependability

(consistency), transferability (applicability), and confirmability (neutrality).” (Billups, 2014, p.

10).

The element of “credibility” was triangulated through the use of the teacher interviews

and journal; and the focus group to collect data on the experience of using game-based

technology in the classroom. Although the teacher and students offered differing perspectives,

they corroborated several findings.

Dependability was validated through several sources to conduct an external audit. The

researcher’s Dissertation Chairperson reviewed the study on numerous occasions. The

remaining Dissertation Committee Members also reviewed the manuscript at two points. The

manuscript was further reviewed by the researcher’s colleague who has a Ph.D. in Special

Education.

All of these reviewers reviewed the research procedure and findings to assess for

consistency of the research process and validation of the findings. They further reviewed the
 58

manuscript to ensure the data was reported in a manner which provided a description of the

events of the study using sufficient detail.

The transferability of the findings was considered throughout the study, but most notably

during the post-test teacher interview and during the student focus group. The teacher expressed

concern that the specific classroom technology of the school in this study may not be duplicated

in other school settings. He noted that the school has a one to one iPad program; whereas other

schools may not have the same technology. The uniqueness of the school’s teaching

methodology also led to deliberation when considering transferability. This is discussed in the

Chapter 5 in the Study Limitations section.

A clear audit trail is available for this study strengthening the confirmability of data.

The researcher has recordings of the focus groups and teacher interviews as well as the

transcribed notes. The teacher’s journal, and pre- and post-test results are also clearly

documented.

This study included strategies to support the “trustworthiness” of this case study research

(Billups, 2014, p. 12). These strategies strengthen the rigor of this study as a whole, not

individually.
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CHAPTER 4: FINDINGS AND RESULTS

Introduction

Chapter Four presents the findings, results, and interpretations of data from this study.

The first section discusses the findings from the qualitative components of the study. The second

section reports the results of the quantitative portion of the study. The third section discusses the

interpretations of both sets of data.

Study Introduction

The study intervention was introduced to the entire class so as not to disrupt the class by

providing just the students with ADHD the opportunity to play the game. The comments and

data in this paper pertain only to the three study participants who are students identified with

ADHD.

The game intervention was introduced by the teacher and students were asked to play the

game for 10 minutes in each math class period over a three-week duration. The class met three

times a week. The teacher used the first class during the study duration to introduce the study.

The students did not play the game during this class. The total study duration amounted to eight

class periods or a timeframe of 80 minutes total.

Qualitative Results

This section discusses the findings of the qualitative portion of the study. Data points

include pre- and post-intervention teacher interviews, a student participant post-intervention

focus group and an assessment of a journal kept by the teacher during the intervention.
 60

Pre-Intervention Teacher Interview

A one-hour interview was conducted using the questions listed in Appendix D. The

meeting took place one week prior to the introduction of the game-based intervention in the

classroom. The teacher had verbally explained the research study to the study participants and

gauged their interest. Permission slips had been distributed to parents/guardians. He had also

spent time playing the game used in the intervention to become acclimated with the operations of

the game.

The following discusses the teacher’s answers to questions found in Appendix D and

summarizes the emergent themes from the interview.

He was asked to discuss and provide examples of measures he uses to teach students with

ADHD. Specifically, he was asked to share of examples of what has worked and what has not

worked.

The teacher relies on numerous class transitions to continuously engage his students with

ADHD. He uses different modalities to deliver lessons. For example, he transitions from a

“lecture approach to a hand-on approach to group work”. He works with students to develop

strategies for time management as they transition from one class component to the next. He

introduces “different perspectives” which allows for interesting ways to deliver a lesson. Each

75-minute class block is “an amalgamation of different approaches”.

The teacher noted “kinetic lessons” seem to have a high success rate for students with

ADHD. A recent example was an assignment to measure a lounge area of the school to teach

graphing. The students were asked to work in groups to measure the space and graph it. They

were given meter sticks and graph paper as tools. In doing so, the students were moving around,
 61

drawing and working as a group. One noted drawback was the distractions that took place due to

the social aspect of the setting.

The teacher noted the “iPad adoption” of the school has been beneficial for students with

ADHD as it provides another mechanism for lesson delivery and information. However, he noted

it can also serve as a distraction if the student goes “off topic” with things other than schoolwork.

If he finds a student using the iPad for non-coursework, he re-engages them through

questioning on the lesson. This gives them reason to pay attention and keeps their focus on the

math lesson. He finds that this brief change is a built in “unofficial break” for the student.

The teacher cited word problems as one of the hardest material for students with ADHD

to grasp. He said they can be “very overwhelming.” He does not assign more than two or three

at a time. He finds the students struggle with “translating English into Math” and it “plays into

all their weaknesses.” Word problems also require a lot of focus.

The teacher stressed the importance of connecting math lessons to “real world

applications.” Students lose focus if they do not understand how the math can be used in the

“real world setting” and are hesitant to learn unless they see how it will be used outside of the

classroom.

He said students need to have a direct connection between the classroom work and the

outside world to make it “worth their effort.” If this is not clearly defined, they lose the

motivation to learn and “don’t see the point.” He said the “practicality of it needs to be

transparent.” The more abstract the process, the harder it is for them to focus.
 62

The teacher was then asked to shift his focus to the study. He was asked to consider the

inclusion of game-based learning into his math curriculum; and share his feelings about the

introduction to his class. This teacher spent time “trying out” the game prior to the interview. He

noted some students may have “difficulty doing the mental math.” He decided he needed to

work to make sure the students select the appropriate level of the game so as they aren’t under-

or over-challenged. The level needs to meet their ability. He viewed one of his roles to encourage

the students to choose the right level.

He further emphasized the need for the “appropriate level” to allow for realistic feedback

from the students. If a student chooses a level that is too easy, they won’t show any

improvements. However, if a student chooses a level that is too hard, they may become

frustrated and stop playing.

He said the students were very enthusiastic about trying the game. The students showed

a lot of curiosity and looked forward to beginning the study. He said the fact that they were

engaged and eager to start is a great step with his students with ADHD.

The teacher expressed disappointment that more parents had not consented to the study

(there were 8 prospective students). He hoped that the findings are beneficial. He also noted the

study limitation of not having a control group as it may be difficult to discern between the

benefits of game-based learning and the classroom learning.

The teacher expressed confidence that games will enhance the students’ ability to engage

more in math. He knew game-based learning will make the subject “fun” and may offer another

tool for students to “absorb” the material. He emphasized their “baseline will be drastically
 63

improved” through this type of learning. He noted it may be of particular use for students with

“math anxiety” because it makes math fun and relaxing.

Themes. There are three major themes that emerged from this interview. The first theme

is concern about the study design. The second theme is game-based learning as an additional

tool for teaching students with ADHD. The third theme is differential learning styles of students

with ADHD.

Themes were categorized utilizing Merriam’s data analysis methodology (Merriam,

2009). A deductive coding methodology was used. Recordings and transcripts were color coded

to count the number of times categories were mentioned in the interview. Categories with the

highest number of counts were identified as themes. Table 4 provides a count of the themes.

Table 4. Themes of Pre-Intervention Teacher Interview

Category # of References
Study Design 12
Game-based Learning as Teaching Tool 10
Differential Learning Styles of Students with 7
ADHD

The first theme that emerged was the study design. As noted in the question summary,

the teacher expressed disappointment that several parents had not granted permission for their

child to participate in the study. There were eight potential study participants. After receiving

the initial study introduction letter, the teacher reached out to them to discuss the study. Despite

a commitment to return the letter, the parents did not follow through; thus the study number of

three participants. The teacher expressed concern that the low student participation would affect

the study design.

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The researcher explained this study limitation would be discussed in the paper and the

study would be considered a precursor to future research.

The second theme centered on the teacher’s anticipation of the use of game-based

learning with students with ADHD. During the interview, he expressed the typical modifications

he makes in his teaching for students with ADHD. Given their differential learning styles, he

expressed curiosity on the use of game-based learning as he thought it would be beneficial.

The third emergent theme was the differential learning styles of students with ADHD.

The teacher provided specific examples of strategies used to maintain focus, continuous

engagement and motivation for his students with ADHD.

Student Post-Intervention Interview

Study participants were interviewed following the game intervention. Two students self-

identified as “gamers” and the third stated games, either educational or recreational, were not a

big part of her life.

The following is provides a summary of students’ answers to the questions listed in

Appendix C. This is followed by the themes of the interview.

The students indicated an optimistic outlook on the use of game-based learning in

addition to classroom instruction. One student noted, “I think having different approaches to

learning, like trying to find different ways to help students is a good thing. Not just paper and

pencil.” They appreciated the creative approach to learning and teaching. Two out of the three

had used games in the classroom prior to this study.

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The students initially answered the question regarding game-based learning and the effect

on focus with complaints about the game itself, Algebra Champ. They discussed the game

design and noted the single player function. They would have preferred a multi-player game.

The group commented on the lack of “cool graphics” and the timer feature built into the game.

The timer was of particular issue as it “made it very stressful”. They stated the teacher told them

the time did not affect their scores or game outcome, but it was an overall distraction.

The researcher asked the students to set aside their feelings on the game design and to

focus on the use of a game as an addition to regular instruction. Once the question was

positioned in this way, the students said the game was a tremendous help in terms of “recall” and

“fun”. One student provided the analogy, “It’s like taking a long walk with a friend. You’re

having fun talking and you don’t realize you’re getting the benefit of exercise too. Game based

learning is having fun while you’re learning too. It provides a great distraction.”

Another student noted the benefit to those students who “have math anxiety”. When

questioned about the term “math anxiety”, the student reported having a reaction to math that

caused severe physical symptoms including headaches and stomach aches. This prevented her

from “doing math” or gaining the confidence to complete assignments or assessments to show

her understanding of the subject. She said the game provided an easy and interesting way to

“practice math” that wasn’t stressful. It also allowed her to get engaged in the game and not

focus “other things.” The students said the game was a good support to what they had learned via

conventional classroom instruction. They did not feel they learned “anything new” using the

game. However, they stressed it was very useful to help with the material “recall” and to gain a

better understanding of the “process.” Overall, the students felt it was a good complement to

classroom instruction.
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One student shared that she had transferred from a school that had relied heavily on

game-based learning. She said each student was “matched” to games that were best suited for

their “learning issues” and abilities. In her experience, this was a great way to use game-based

learning as it provided an individualized learning plan that was best suited for the student. In this

case, she was motivated to play the game and she felt it helped in her understanding of the

subject.

All of the students supported the use of game-based learning as a regular part of math

curriculum. However, they continued to stress their dislike of the game used in this intervention,

Algebra Champ. Of particular note was the students’ frustration with the game set-up;

particularly the lack of playing level choice at start-up and the continuous timer which they

found distracting and anxiety provoking.

The students said game-based learning would make math “more fun” and “interesting.”

It also allowed for another way to “focus” on the material. They stressed the importance of game

choice noting the game should be “a good fit for where you are in math” and “not boring”.

They also noted their teacher was “cool” for introducing game-based learning into their

classroom. They voiced appreciation that he had been willing to try something new to make

“learning fun”.

Themes. Two themes emerged from the focus group with the students. The first theme

centered on the game design. The second theme showcased the students’ desire to have a

complementary teaching tool that is “fun” and beneficial in terms of focus and recollection of

material.
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Table 5 shows the two themes that emerged after completion of deductive coding of
transcripts.

Table 5. Themes of Post-Intervention Student Participant Focus Group

Category # of References
Game Design 21
Teaching tool 35

As noted, the students were disappointed in the game design of Algebra Champ. They

found the game “boring” and “not challenging”. Given this situation, the researcher asked the

students to think about game-based learning in a broader context. This led to a discussion on the

overall use of game-based learning and the benefits it may bring. Students cited examples from

their own experience.

The students did note that the game provided benefits in terms of practice of existing

course knowledge and recall. Those with experience stressed the importance of game choice.

The second theme that emerged was the benefit of game-based learning in terms of

“making learning fun.” The students felt game-based learning is a creative way to join education

and fun in a way that is beneficial to students. They also noted the way in which games engage

and make them stay “more in tune” with the subject matter.

Teacher Journal

The teacher kept a journal throughout the duration of the study. He provided descriptions

of students’ reactions, frustrations and a description of the operations of the classroom. The

journal provides insight into the students’ feelings pre- post and during the intervention. The

teacher also shared his feelings throughout the intervention. Upon completion of the

intervention, he sent it to the researcher. The journal was color coded by theme.
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The themes that emerged from the teacher’s journal reflected those that arose in the

student post-intervention focus group. The teacher reported student feelings of being “nervous”

due to the timer component of the game. The teacher reported that he assured the students the

timer did not affect their game score and it was not an indicator of their math skills.

One of the major themes found in the teacher’s journal was the students’ negative

feelings about Algebra Champ. He reported that within three days of the intervention the

students “grumbled” that they had to continue to play the game. However, they did ask for a

different game. He noted, “A couple of them expressed an interest in finding another game.” He

stated that at the end of the intervention (day 8), the students “seemed bored” with the game.

Of particular note is the teacher’s note that “most everyone seemed to have put forth

earnest effort in playing Algebra Champ …”. The game choice will be discussed as a study

limitation in Chapter 5.

Teacher Post-Intervention Interview

A post-intervention interview was conducted with the teacher. It occurred one week after

the classroom intervention had finished. The student post-intervention focus group had been

conducted.

The interview questions can be found in Appendix D. Following is a discussion of the

teacher’s answers. The themes are discussed at the end.

The teacher was questioned on his future plans for game-based learning after the

completion of the intervention. The teacher noted his plan for the inclusion of game-based

learning into his curriculum. He noted the benefits of using a game to create a “more relaxed
 69

and receptive” environment for learning. He added that the addition of a game made it “easier

for them to learn.”

The teacher also emphasized the game choice was a challenge in terms of keeping the

students engaged due to its “simplicity.” Several students referred to the game as “corny.”

However, he noted that they still “couldn’t help themselves by to get involved and became

competitive.”

He suggested a game without a timer feature would be more beneficial as students

became hyper-focused on the timer vs. playing the game and using math skills. He noted this was

especially concerning for those students with math anxiety.

The teacher noted it was hard to comment specifically on student engagement due to the

students’ unhappiness with the game format. He said “it will depend greatly on the game format

and how individual reacts to that in determining if it’s going to increase engagement or

discourage engagement”. However, he noted that the use of a game was helpful for study

participants as they “couldn’t help but get sucked into” the game play and didn’t focus on the

game goal of learning. They looked at it as a way to have fun. Game choice is discussed in

Chapter 5 as a study limitation.

The teacher noted the ongoing challenge of keeping students with ADHD engaged and

on-task during a lesson plan. He observed the study participants remained on-task and

“involved” in the game compared to other methods he’s used in class.

The teacher summarized that providing students with ADHD an opportunity to focus on

something that is “constructive and applicable to the curriculum” is a benefit. It provides a

conduit to have students focus on the “right material and actually progress in the curriculum.”
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The teacher was asked to comment on game-based learning in terms of academic

achievement and learning. There was an improvement between the pre- and post-test quizzes.

The teacher noted his relief to see these results. He suggested the improvement came from a

combination of classroom teaching and the activity of playing the game.

The teacher was asked to comment on how this study will help educators and students

with ADHD. He noted the boundaries that may be in place in schools in terms of funding for

game apps, computers devices and classroom time. However, he noted, “I believe that

incorporating game-play into a Math curriculum, whether it be a computer game or a physical

game, any kind of game, I think it is beneficial to help learning.”

He stressed the benefit for students with ADHD as it’s an important way to engage them

in the learning process. He shared his plan for his class next year where he will add a game-

based app to the supply list for each of his classes. He noted that the related cost can be afforded

by all of his students due to the one-to-one computer and the family demographics.

Themes. Four themes emerged from the post-intervention teacher interview. The most

prevalent theme was student engagement. The second theme was math anxiety. The third theme

was fun in a learning environment. The fourth theme was game design.

Table 6 shows the themes and number of times mentioned in the interview.

Table 6. Themes of Post-Intervention Teacher Interview

Theme # of References
Student engagement 14
Math anxiety 4
Fun in a learning environment 4
Game design 3
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The theme of student engagement carried throughout the interview. The teacher

continuously cited the connection with student learning and engagement with the use of game-

based learning in his classroom. He provided specific examples of his students and their

increased attention during the study intervention. He stressed the potential benefits of using a

game that could advance learning in a fun and interactive way.

The theme of math anxiety was woven into the teacher’s commentary on the way the

study intervention was seen by students. Due to the game design incorporating a timer into play,

some students experienced increased anxiety. Once they understood the timer did not affect

score outcomes, the anxiety decreased, but was still exhibited. However, the teacher observed a

more relaxed approach to math with some students as they viewed the game as a fun way to learn

math.

As noted above, fun in a learning environment was a theme that emerged from the post-

intervention teacher interview. The teacher stressed the benefit of introducing game-play to his

curriculum as it created a fun and healthy competitive environment.

The fourth theme that emerged was the design of the game. As noted in the student focus

group, the students did not care for the game design. It became a strong factor in student game

play. The teacher felt this could have hindered their game engagement and would look to another

game if he permanently introduced game-play into his curriculum.

Axial Coding

Once the open coding was analyzed, an axial coding process occurred. Bloomberg and

Volpe (2008) describe axial coding as a means “to generate theory from the data or modify or

extend existing theory” (p. 33). They state,

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“Study participants would have experienced the process, and the development of theory
might explain practice, or provide a framework for further research. A core component is
that theory development is generated by or “grounded” in data from the field –especially
in actions, interactions, and social processes.” (Bloomberg and Volpe, 2008, p. 33).
Further, Kendall (1999) describes axial coding as a means to formulate a theory from the

categories identified. Kendall states:

“Whereas open coding fractures the data into categories, axial coding puts the
data back together by making connections between the categories and subcategories.
Axial coding focuses on the conditions that give rise to a category
(phenomenon), the context (specific set of properties) in which it is
embedded, the action/interactional strategies by which the processes are carried
out, and the consequences of the strategies” (p. 793).
This process allowed for a systematic organization of the themes presented from the

student focus group; and teacher’s journal and interviews. Four identified open coding themes

were axial coded to further understand the phenomena found. The themes include: student

engagement, game design, teaching tool and learning fun. The themes were further grouped into

related categories to “further refine the category theme” (Merriam, 2009, p. 200).

One category, Game Design, stood alone as it brought forth negative connotations for

study participants. Their comments are noted in the earlier discussion of this study. Figure 5

shows the axial coding for this category.

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Figure 5. Axial Coding of Game Design Category

Figure 5 shows the causal conditions created by the game company that designed Algebra

Champ. The game designers chose to add the timer element and did not allow for the “gamer” to

choose the appropriate level of challenge at the beginning of the game. At game introduction,

these game elements created stress and boredom in study participants. This is labeled as the

context in the figure.

Continuing along the stream of the causal condition created by the timer element of the

game, it becomes clear that it invoked math anxiety for some study participants. Study

participants with self-described “math anxiety” found the condition exacerbated by these game
 74

elements. The teacher employed strategies to lessen these conditions through reminders and

prompting during game play. Despite the teacher’s attempt to reduce anxiety, the consequence is

the students’ request for a different game.

A similar stream is found in the context of study participants’ labeling of the game as

“boring.” The teacher tried to encourage them to re-engage in game play, but the final

consequence also led to the students’ request for a different game.

This analysis provides evidence that game choice is an important element in game-based

learning as students may have limited engagement if the game is not considered entertaining or

has design elements that have negative consequences. The choice of Algebra Champ for this

study is discussed in chapter five as a study limitation. The importance of game choice is also

discussed in Chapter 5.

Figure 6 shows the interconnectivity of the remaining categories found through the open

coding exercise.

Figure 6. Axial Coding for Related Study Categories

•Complement to •Increase in math

classroom focus
instruction

Teaching Student
Tool Engagement

Game Learning
Design Fun

•Video games add

animation and
new challenge to
math

Increased math focus and confidence in math

skills
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Figure 6 shows the connection between the remaining three categories found in the open

coding. Using game-based learning as a teaching tool influences student engagement and

learning fun. Students reported an increase in focus on math when game-based learning was

used. The teacher commented on the benefit of “making math fun” when adding game-based

learning to his classroom.

The students also commented on the effect of game-based learning and “fun” in math and

in the classroom. They also commented on their increased focus using game-based learning.

This is of particular note with students with ADHD as focus and attention span are particularly

challenging and can effect academic outcomes (Zentall et. al, 2009).

The axial coding lends itself to a grounded theory approach as supported by Charmaz

(2006). The formation of the categories emerges from that actions observed, data collected and

analysis of codes. Whereas, the theory is the outcome of the analysis of the aforementioned

combined data.

Quantitative Data

This section discusses the quantitative portion of the study.

The study participants were given a pre- and post-intervention quizzes to assess their

knowledge of specific algebra equations. Each quiz consisted of ten questions worth one point

each. The quiz questions were 10 single variable equations which paralleled those introduced as

practice problems in the Algebra Champ game. The questions were not the same, but assessed

the students’ understanding of the same concepts.

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The relationship between game-based learning and academic outcomes for students with

ADHD is examined in this study of N=3 students. Pre- and post-intervention quiz scores, as well

as the difference, were recorded for the three students and are shown in Table 7.

Table 7. Pre- and Post-Quiz Scores for Student Participants

Pre-Intervention Quiz Post-Intervention Difference

Quiz

Student #1 8 9 1

Student #2 8 9 1

Student #3 5 10 5

Students scored higher on the post quiz than the pre quiz.

Themes Related to Research Questions

This section organizes the emergent themes in relation to the research questions.

Question 1. What is the relationship between game-based learning and academic

outcomes in Algebra One for students with ADHD?

The first question is best answered with quantitative data, but as noted earlier, the N for

this study did not allow for sufficient analysis to provide statistical analysis of collected data.

This study does not provide any qualitative data to support this question. Therefore, there are not

any themes that emerged to answer this question.

Question 2. How do teachers and students perceive the influence of game-based

instruction on the academic performance of Algebra One students with
ADHD?
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Themes that emerged in relation to this question include the use of game-based learning

as a teaching tool to complement traditional classroom learning; game-based learning as a means

to make learning fun; and increased student engagement due to game-based learning. These

themes were reported by all study participants—the teacher and the three students.

All participants reported positive attitudes of game-based learning in relation to Algebra

One teaching and learning. However, these attitudes were overshadowed by the game choice for

this study. The students’ answers focused on the benefit of game-based learning in terms of it

being something new and interesting compared to regular classroom teaching and assessments.

The teacher viewed game-based learning as a modality to support classroom teaching; not as a

replacement.

Summary

This chapter discussed the information gathered through the qualitative and quantitative

methodology outlined in Table 2. The data was gathered from one classroom teacher and three

study participants.

There were four methods used to collect data for the qualitative portion of the study.

These included pre- and post-intervention teacher interviews, analysis of the teacher’s journal

kept during the intervention and the post-intervention student focus group.

The quantitative data was points were taken from pre- and post-intervention quizzes

taken by the study participants. The quizzes measured the students’ understanding of specific

algebraic expressions that were taught using direct instruction and through the Algebra Champ

game (study intervention).

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The qualitative portion of the study indicates students with ADHD are more engaged and

motivated in Algebra when game-based learning is used as a complementary teaching platform.

This is supported through the teacher’s post-intervention interview and journal. It is further

supported through the post-intervention focus group with the study participants. The axial coding

further confirms this theory.

The quantitative portion of the study is statistically inclusive as the N in the data

calculation is too small to allow for statistically significant results. However, the raw data

indicates there was an increase in academic outcomes after the study intervention.
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CHAPTER 5: INTERPRETATION, CONCLUSION, AND RECOMMENDATIONS

Introduction

The purpose of this study was to determine the relationship between game-based learning

and academic outcomes in Algebra One for students with ADHD. This case study sought to

further the research of Ota and DuPaul which measured the academic engagement of students

with ADHD when game-based learning was introduced (Ota & DuPaul, 2002); and of Mautone,

DuPaul and Jitendra which used a case study to research the effects of computer-assisted

instruction on children with ADHD.

This case study found similar results to those of Ota and DuPaul in terms of an increase

in academic outcomes and on-task behavior of study participants. Like the Ota and DuPaul

study which also had a small number of participants, the findings are worthy of further research.

Although this study used different measures for academic outcomes and focus, results were

similar in terms of positive effects on study participants.

This study further corroborated the research of Gardner, Kolb, and Houge Mackenzie, et

colleagues which indicates students identified with different learning styles; i.e. multiple

intelligence, benefit from a learning environment that matches their learning style (Gardner,

1999; Houge Mackenzie et al., 2014; Kolb, 1984). All of these researchers discuss the

importance of carefully aligning selected teaching modalities with a students’ specific

intelligence strength to actively engage in the learning process.

The study participants in this study explicitly stressed the importance of teaching

modalities that supported their individual learning styles. Although none used the academic
 80

terminology of “multiple intelligence”, they did describe the need for making learning “fun” and

“interesting” while considering their individual learning needs.

They also expressed appreciation of their teacher’s willingness to try a new concept to

“try a new thing”. One student noted, “I think having different approaches to learning, like

trying to find different ways that help students is a good thing, not just pencil, paper, here’s a

test”.

The quantitative component of this research sought to measure the academic outcomes of

study participants by comparing pre- and post-intervention quiz scores. The raw data shown in

Table 7 from the pre- and post-assessment indicated an increase in scores; however, it was

statistically insignificant due to the low number of study participants.

Conclusions

The research questions posed for this case study sought to test the researcher’s hypothesis

that game-based learning coupled with traditional classroom instruction increases academic

outcomes for children with ADHD. The research questions are noted below:

Question 1. What is the relationship between game-based learning and academic

outcomes in Algebra One for students with ADHD?

The answer to this question was inconclusive due to the low number of study

participants. This is discussed in more detail in the Recommendations section in this chapter.

This number was lower than expected after study recruitment was finalized.

Overall, as shown in Table 7 students scored higher on the post assessment than the pre

assessment. One student increased her results by 5 points and two increased by one point. The
 81

raw data indicates a relationship between game-based learning and academic outcomes for

Algebra One students with ADHD. However, this difference was not statistically significant.

Question 2. How do teachers and students perceive the influence of game-based

instruction on the academic performance of Algebra One students with
ADHD?

The study participants and teacher indicated a positive attitude towards game-based

learning and math. This was measured through a student focus group, the teacher’s journal, and

pre- and post-intervention teacher interviews.

The teacher reported an increased level of engagement with math when the students used

game-based learning to practice math concepts taught in class. As a result of this study, the

teacher plans to include game-based learning into his curriculum for next year.

Study participants also indicated a positive perception of game-based learning associated

with math. They reported a higher level of engagement and interest in math when game-based

learning complemented traditional classroom teaching. They projected that their interest in

game-based learning would lead to better academic outcomes as they would be more engaged in

math “practice”.

Lessons Learned

This research process provided several lessons to the researcher. These lessons will shape

future research and should be considered in future study designs. These lessons may lead to

greater amounts of data and a richer study.

The first lesson involves the recruitment of study participants. This researcher assumed

all parents/guardians who were approached would consent to the study. The teacher assumed the
 82

same. As it turned out, only three out of eight student’s parents consented. This small number

influenced the findings for question 1 of the research questions; leaving the researcher with little

data to consider. Future research will seek to invite a larger number of study participants to allow

for greater amounts of data.

The teacher asked to lead the recruitment efforts for this study due to his familiarity with

the students’ parents. However, results may have differed had the researcher done follow-up

communication to the teacher’s initial email to parents. The teacher had other responsibilities

that superseded study recruitment; therefore the process was not consistent with the study design

in terms of timing between the initial study introduction and the reminder email.

The second lesson reflects on the qualitative components of the study design. The focus

group with students allowed for a greater understanding of their attitudes, experience and

opinions on game-based learning. However, a deeper understanding may have been gained

through individual interviews with each student.

Individual interviews may have allowed students to expand on their initial thoughts and

allowed the interviewer to ask questions focusing on the student’s unique experience. The

interviews would have also allowed the quieter students to have an equal amount of time to

express their opinions; whereas they may have felt overshadowed by more outgoing students in a

group focus group setting.

The third lesson involves game choice. As noted, the game choice was limited to a single

player game due to the school’s firewall system. The choice of Algebra Champ was made after

an informal poll to colleagues and online research. However, additional research to other school

districts may have identified another game that may have provided a better experience for the
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study participants. Time limitations of the study and researcher prevented this step from taking

place.

Recommendations

This study informs future research on the connection between game-based learning and

academic outcomes in children with ADHD. In doing so, researchers need to consider the

limitations of this research along with the key findings.

The following recommendations should be considered during the design phase of future

research. In doing so, future studies may lead to findings that are more informative to educators

and the research community.

Sample size: In a methodological review of on the comparison of research on training

simulators in Emergency Medicine, Lineberry and associates discuss the issue of duplicative

studies using small sample sizes in quantitative research. The authors suggest, “…rather than

having many underpowered and uncoordinated studies, it would be preferable for researchers to

collaborate and conduct coordinated experiments across multiple sites” (Lineberry et al., 2013).

Given the small sample size (N=3), it is recommended that future studies involve greater

sample sizes (N>30) in order to increase statistical power. However, a larger sample size may be

difficult to obtain due to the specificity of the population and the necessity to keep other

variables consistent.

Other studies have overcome this obstacle through recruitment of study participants at a

number of schools within a district, state or geography. Evans et al., had 107 participants from 3

schools in Virginia (2015). The study measured game-based learning in math and student
 84

engagement. The researchers were able to achieve the larger number of participants through

recruitment at more than one school.

Houge Mackenzie and associates discuss the issue of small sample sizes in studies on

experiential education by noting:

“…Gillis, Gass, and Russell (2008) highlight the dearth of quantitative, longitudinal, and
randomized controlled studies in EE (experiential education). Ewert and Sibthorp (2009)
argue that self-selection (rather than randomly assigned treatment and control groups),
small sample sizes, and a range of confounding variables hinder the development of
evidence-based practice, empirically validated models of experience, and the holistic
understanding of underlying psychological processes” (2014, pp. 77-8).
The issue of statistical significance has long been discussed in relation to psychological

and education research (Harrison, Thompson, & Vannest, 2009; Kehle et al., 2007; Thompson,

2004). Harrison, Thompson and Vannest’s continued use of null hypothesis statistical

significance testing (NHSST) can lead researchers to easily reject a null hypothesis as the results

are not reported objectively.

In addition, in educational research interventions cannot be easily replicated under the

same conditions; i.e., teaching styles, student relations. Therefore the rejection of a null

hypothesis may not be consequential for educators.

In juxtaposition, Borg and Gall note the benefit of a small sample size in qualitative

research:

“In many educational research projects, small samples are more

appropriate than large samples. This is often true of studies in
which role-playing, in-depth interviews, projective measures, and
other such time consuming techniques are employed.... A study that
probes deeply into the characteristics of a small sample often
provides more knowledge than a study that attacks the same problem
by collecting only shallow information on a large sample.”
(1989, 236-237).
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Borg and Gall’s discussion supports the qualitative work done in this study. The data

gathered through the student focus group, teacher interviews and journal, is informative towards

the conclusions. The accompanying data coding and analysis is time consuming and impractical

for a large scale study, but was informative in this study.

Game Choice: The choice of the game-based intervention is an important component in

this study design. As noted earlier, the researcher was limited to single-player games as the

school’s firewall did not provide access for web-based multi-player games.

Ribeiro et al. outline the issue of multi-player game integration in school settings due to

firewalls (Ribeiro et al., 2013). They note, “Don’t underestimate the technical challenges…” (p.

432) associated with specific game designs.

The study intervention game, Algebra Champ, did not receive positive reviews from the

study participants due to the game design. The students found some design elements including

the timer to be a distraction. Despite their negativity towards the game design, the students did

report a positive experience using game-based learning in their Algebra One class.

Bourgonjon and colleagues stress the importance of “ease of use” for games to be

successful in the classroom. They state:

“Students like games better when the level of sophistication is high (Vivou, Katsionis &
Matsos, 2008). Games that are too easy or too hard will put students off. This stresses the
need to consider ease of use as a critical variable when studying video game acceptance in
a learning context” (2010, p. 1147).

The choice of game is the foundation for success with game-based learning and children

with ADHD. Bavelier and associates note the game must be engaging, challenging and full of
 86

action to increase focus and filter out irrelevant information for children with ADHD (Bavelier et

al., 2011). The game must be appealing to the users to meet the intended objectives of the

educational process.

Ribeiro and associates discuss the use of game-based learning with students with

different learning styles (students with ADHD falling into this category). They note:

“Some of the main reasons outlined to explain this increase applied to learning contexts
are the actions rather than explanations, the creation of personal motivation and
satisfaction, the accommodation of multiple learning styles and abilities, the fostering of
decision-making and problem-solving activities in a virtual setting.” (Ribeiro, et al.,
2013, p. 427).

The game must be carefully reviewed to assess effectiveness for learning in a meaningful

context. There needs to be a relation between the computer game and the classroom curriculum.

The teacher must also assess the game for its age appropriateness and game design. Bourgonjon,

et al. note this is “an important predictor of student success” (Bourjongon et al., 2010).

Teacher Acceptance. Teacher acceptance is of paramount importance when game-based

learning is introduced to a classroom. The teacher must be accepting of the concept of game-

based learning and knowledgeable about the game design. Ketelhut and Schifter note the

importance of teachers’ efficacy prior to classroom introduction:

“From our research, care needs to be given to supporting teachers as they develop
efficacy in using the innovation. Suggestions include giving teachers time to develop
personal comfort with and ownership over the technological intervention, and provide
teachers with models of successful implementation, as well as just-in-time support.
Further, researchers and designers need to take care to understand and engage the school
community” (2011, p. 545).
In this research, the classroom teacher was accepting and had familiarity with game-

based learning in association with Math. However, he had not used Algebra Champ prior to this
 87

study. His pre-acceptance was an important component that assisted in the positive introduction

to the study participants.

Ritzhaupt, Higgins and Allred (2010) stress the importance of a disciplined and careful

introduction of game-based learning in a classroom. Teachers must have professional

development support prior to the integration of game-based learning into a classroom for it to

provide intended benefits to students. Teachers must be trained on the proper “curriculum

integration strategies” (2010, p. 198) to ensure success in the classroom.

The teacher in this study confirmed this during the post-intervention interview when he

discussed his plan to integrate game-based learning into his curriculum design for next year. He

noted the need to “further explore” game options that would properly align to his lesson plans

and learning goals.

School Information Technology Infrastructure. The study site’s information

technology infrastructure should be considered during a study design. As in this study, if a

school has a firewall that does not allow for a multi-player game; choice is limited. If the study

site does not have these restrictions, additional games are available for use in the study (Ahmad

et al., 2010). This may provide a different experience other than reported in this study.

Limitations and Future Research

There are a number of limitations to this study. Firstly, the number of study participants

did not provide enough information for a statistically analysis to provide useful data. This has

created a limitation of data for Question 1. Secondly, the game choice was limited due to the

school’s firewall system. Thirdly, the study results may not be applicable to all schools due the
 88

study setting of an independent school. Fourthly, the study results may not be applicable to

students in all age ranges.

One of the most influential study limitations is the low number of study participants. As

discussed, this led to insufficient data for a strong statistical analysis to be performed. Future

research studies on this topic should include a recruitment mechanism with a higher number of

study participants (<30).

The game choice is a variable that is highly influential in this study. The students’

negativity associated with the game design affected the qualitative portion of this study as they

dedicated a large portion of the focus group to their game design complaints. Future research

should include a game that has been pilot tested in terms of game design. This is of particular

importance in a study with students with ADHD as negative feelings related to game design can

become distracting and influence the study outcomes.

As noted in Chapter 3, Ke (2008) stresses the importance of appropriate game choice in

study design. The game must be engaging and aligned with students’ abilities to be a good fit.

A game choice that is not aligned can create a distraction and de-motivate students from playing.

The third study limitation is the applicability of this study’s findings to a broader

population of schools. This study was performed at an independent school with resources that

allow for a one-to-one computer device initiative. This is not the situation in every other United

States high school. Therefore, this limits the broader application of game-based learning in all

school settings.
 89

The fourth study limitation is the age range of study participants. The setting is a high

school, thus the study participants are high school aged. The findings from this study may not be

applicable to school aged students in lower grades.

Summary

This study shows game-based learning has a positive effect on students with ADHDs’

engagement and interest in Math. This further supports the work of Ota and DuPaul (2002) and

Mautone, DuPaul and Jitendra (2005). The analysis of the data from the qualitative portion of

this study lends itself to a grounded theory approach indicating game-based learning is an

important consideration in curriculum development for students with ADHD.

Further research must be done to further explore the connection between game-based

learning and children with ADHD and academic outcomes. This preliminary research indicates

promise, but must be implemented on a larger scale to further test the hypothesis presented.

Although small in scale, this study will contribute to the literature on students with ADHD and

game-based learning.
 90

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APPENDIX A: SUMMARY OF ALGEBRA CHAMP VIDEO GAME

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APPENDIX B: PRE- AND POST-ASSESSMENTS

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APPENDIX C: FOCUS GROUP QUESTIONS FOR STUDENTS

1. What are your thoughts on using game-based learning as a complement to your teacher’s
instruction?
2. Do you think game-based learning helped you focus more on the math curriculum?
a. If so, how?
b. Did you feel you were actively involved in decision-making during this game?
Can you give an example?
3. Do you think game-based learning helped you to better understand the material?
a. If so, how?
b. Were you more or less motivated by the game-based learning? Why do think that
was?
4. Should game-based learning be a regular part of your math learning? Why or why not?
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APPENDIX D: RESEARCH QUESTIONS FOR TEACHER

Pre-Intervention

1. Research has shown students with ADHD fall behind acceptable levels in subject areas;
most notably math and reading. Supportive interventions can assist students with
struggles with executive function. What types of measures have you seen work? What
hasn’t worked?
2. What are the greatest difficulties in dealing with academic motivation for students with
ADHD?
3. Describe your feelings about the inclusion of game-based learning into your math
curriculum?
a. Are you hesitant to introduce it? Why or why not?
b. Are you excited to introduce it? Why or why not?
4. Do you think game-based learning will be helpful for your students with ADHD in terms
of academic achievement and learning?
Post Intervention

1. Now that the intervention has taken place, describe your feelings about the inclusion of
game-based learning into your math curriculum?
a. Did you find it a good tool? Why or why not?
b. Were you excited to introduce it? Why?
2. Did you find it helpful for your students with ADHD in terms of engagement?
3. Did you find it helpful for your students with ADHD in terms of on-task behavior?
4. Did you find it helpful for your students with ADHD in terms of academic achievement
and learning?
5. Did you find this particular game, Algebra Champ, a good tool? Why or why not?
6. How will this research help the ADHD population and educators?