The impact of a board game as parent guidance strategy to reinforce Cognitive Control Therapy in the home environment

Abstract

In this study the impact of a board game as parent guidance strategy to reinforce Cognitive Control Therapy (CCT) in the home environment of a child with ADHD was explored. The influence of such a board game, based on the principles of CCT, on multiple contexts of the child’s existence - therapeutic and family contexts - was also investigated. There were two reasons for involving the parents in therapy. Firstly, children with an attention problem are situated within contexts and the effect of ADHD can permeate to the home and school environments. Secondly, for Cognitive Control Therapy (CCT) to be successful, it needs to be sustained by frequent repetition. It was hypothesized that sustainability of the effect of CCT should rise substantially after introduction of the board game, as the child and the parent can reinforce the principles of CCT by using it, even without being able to attend a session. The board game was designed by using the principles for game development as articulated by Dodge. A case study was then conducted by using a mixed methods approach, where quantitative and qualitative data were obtained. Data collection strategies consisted of quantitative methods in the form of the Cognitive Control battery (pre and post test), and the Copeland Symptoms checklist. Qualitative strategies included parental feedback, qualitative data during therapy sessions (observations and therapeutic notes) and a semi-structured interview with the mother. Data was collected before, after and during the intervention. The intervention consisted of individual therapy with the participant, parent guidance and parallel implementation of the designed board game by the parents with the child-participant. The quantitative data (from the CCB and the Copeland Symptoms Checklist) from the post test indicated that sensitivity towards distractions remains a concern, and that parental implementation of a board game (incorporating elements of CCT) with a child can possibly have a slightly negative effect on cognitive control functioning. However, the scope of this case study does not allow direct correlations to be drawn between the parental input and the child’s cognitive control functioning. It does point to the possibility of heeding caution when implementing a board game to reinforce CCT principles by a parent. Conversely, the findings from the study also indicated that family relations improved. Five qualitative insights emerged: i) increased ability to distinguish between relevant versus irrelevant information in the participant; ii) increase in organizational thought in the therapeutic situation and at home; iii) improved communication between parent and child, resulting in improved skills to maintain discipline; iv) improved interaction among family members; and v) transfer of skills to the mother. The study found that the greatest contribution of the board game appears to be the improvement experienced in the family context – probably as a result of increased interaction among family members and attention focused on the problem.