1. International Journal of Nursing Practice 2007; 13: 284–288
RESEARCH PAPER
Effect of computer game intervention on the
attention capacity of mentally retarded children
Akram Rezaiyan RN, MNSc
Clinical Nurse, Nursing Department, Medical Sciences Faculty, Tarbiat Modarres University, Tehran, Iran
Eesa Mohammadi RN, PhD
Lecturer, Nursing Department, Medical Sciences Faculty, Tarbiat Modarres University, Tehran, Iran
Parviz A Fallah PhD
Lecturer, Department of Psychology, Human Sciences Faculty, Tarbiat Modarres University, Tehran, Iran
Accepted for publication January 2007
Rezaiyan A, Mohammadi E, Fallah PA. International Journal of Nursing Practice 2007; 13: 284–288
Effect of computer game intervention on the attention capacity of mentally retarded children
The low rate of understanding and the limited domain of attention are two important and distinctive characteristics of
mental retardation. One of the important strategies to provide effective education for these subjects is to lessen the
backgrounds and impacts of these affective factors. The aim of this research was to find the effect of computer games
program on the amount of mentally retarded persons’ attention. Sixty educable male mentally retarded subjects were
selected from two 24-h care centres in Tehran. The Toulouse–Pieron Scale was used to determinate the subjects’ attention
at pre–post test. Members of the experimental group were subjected to 35 sets of computer games. After use of the sets
of computer games, the attention scores of the subjects were assessed immediately after the intervention and 5 weeks
later. The results showed that exactly after the intervention the average attention scores of the experimental group were
significantly higher than those of the control group. But, 5 weeks after the intervention, there was actually no significant
difference.
Key words: attention capacity, computer game, mental retardation.
INTRODUCTION of the society 25 times more than blindness does.2 Whally
Mental retardation is the most common disorder of and Wong reported the prevalence of mental retardation
growth,1 especially in the view of health, because of its as 3% while Kaplan and Sadock reported it as 1% of the
side-effects and vast prevalence. This disorder is seen >10 world population.3 In Iran, some 1200 000 people suffer
times of brain paralysis and >20 times of the spinal cord from mental retardation. More to its high prevalence, this
disorders such as Spina Bifida. It also affects the members disorder is followed by dysfunction in growth in diverse
physical, mental, social and educational aspects. Thus, it
can cause many problems to the patient and to his/her
Correspondence: Eesa Mohammadi, Nursing Department, Medical family.4 Depending on the severity of the disorder, the
Sciences Faculty, Tarbiat Modarres University, PO Box 14115-331, patient cannot do his own tasks––both individual and
Gisha Bridge, Tahran, Iran. Email: mohamade@modares.ac.ir; interpersonal––like other people of the same age;there-
emohamadus@yahoo.com fore, their families encounter problems in mental and
© 2007 The Authors
Journal compilation © 2007 Blackwell Publishing Asia Pty Ltd doi:10.1111/j.1440-172X.2007.00639.x

2. Computer game intervention on attention capacity 285
social health as well. All these necessitate the importance METHOD
of supporting programmes. Unfortunately, this is not The participants in the present study consisted of 60 men-
done except in some developed countries.5 tally retarded subjects from two boarding care centres in
The low rate of understanding and the limited domain Tehran. The subjects were drawn randomly and assigned
of attention, which start at ages <18 years, are two into experimental and control groups. All the subjects had
important and distinctive characteristics of mental retar- an IQ level of 50–70 with no physical disability—especially
dation.2 These two characteristics cause disorders in adap- in the upper organs.
tive behaviours, especially the latter, as the main factor of To determinate the attention capacity, the Toulouse–
understanding the inhabitant motivations affects consider- Pieron Scale was used. This scale is one of the widely used
ably the process of learning and understanding. standard tests for assessing attention.12 The reliability of
The prevalence of attention disorders among adults the scale, drawn from test–retest method, was 91. A
differs between 12% and 55%, depending on the selected demographic questionnaire was also used to extract infor-
scale, IQ of the patient, sex, age and adapting behaviours.6 mation about personal and social characteristics of sub-
The treatments have different aspects, including drug jects. Both the experimental and control groups took the
therapy, mental consultations, learning, behaviour Toulouse–Pieron Scale as pretest. How to fill out the scale
therapy, school-based interventions, family treatment and was individually explained to all the participants. Then the
social confidence training. Normally, the treatment chart experimental group experienced the computer game
consists of combination of referred interventions.7 The program intervention. The program consisted of 35 ses-
new strategy, taken for increasing the attention capacity, sions of game playing. The game was path-finding and
provides games, especially video games. These games proceeded from easy to hard. The desired time of each
cause the increase of basic metabolism and heart beat rate in session was 20–30 min depending on the subject’s incli-
children.8 In young men, playing video games causes a nation. During the intervention period, the control group
significant increase in systolic and diastolic blood pressure, received no treatment. Both groups were assessed
heart beat rate and use of oxygen.9 These are the same as the through the Toulouse–Pieron Scale immediately after the
increases caused by a normal level of physical activity. intervention and 5 weeks later.
These findings show that playing video games while making
internal motivation can be a source for increasing attention RESULTS
power. This increase of internal motivations is supported To find the demographic characteristics, factors like age,
by the magnification of homodynamic values. family structure, outcomes of retardation and literacy
The researchers of the present study have paid much were assessed. The groups were matched according to
attention to computer games among other video games these factors. The results showed that there is a significant
because of the growing influence of computers in our difference in the attention capacity between the two
lives, because of its simple usage and the diversity of its groups, in terms of their family structure. Also there was
games, and because it allows performance of interventions no significant relation between the age and the attention
during the games. Also, the cooperative aspect of com- scores of the two groups. The attention scores had no
puter games can make a desired natural environment to statistical relationship with the retardation reasons, the
examine the mutuality between attention and appliance. birth date or even the unknown reasons. The attention
Computer games provide an opportunity to work in multi scores of the literate subjects were significantly higher
keys, a complex and classified environment leading to (P < 0.01) (Table 1).
the improvement of internal motivation.10 Mallone has Table 2 and Figure 1 show the change of mean scores
examined >10 attractive features of computer games. of the subjects in two groups during the study (pre–post
Aspects like competing, laugh and curiosity are features test and after 5 weeks of follow up). Independent t-test
that can be attractive to children,11 and that this attraction did not indicate a significant difference between the atten-
can be a good source for paying attention. Some re- tion scores in the two groups at pretest. But the mean
search has shown that paying attention with awareness attention score after the intervention was 19.3 for the
and permanent checking of different data sources and experimental group and 9.09 for the control group. Inde-
also using the keys related to the game can be used as pendent t-test (t = 4.107, d.f. = 58, P < 0.01) showed a
a strategy to simplify the improvement of operating.10 significant difference between the mean attention scores
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3. 286 A Rezaiyan et al.
Table 1 Comparison between two groups based on literacy sta- up (t = -4.21, d.f. = 29, P < 0.01). No meaningful sta-
tistical attention scores tistical difference was observed between the average
attention scores of the control group members before and
Statistical summary Attention score d.f. t P after the intervention using paired t-test (t = -5.88,
d.f. = 29, P < 0.01), while the difference between the
Mean SD average attention scores of the experimental group sub-
jects before the intervention and after 5 weeks of follow
Literate 8.21 8.16 44.5 -3.485 0.01 up was significant.
Illiterate 3.35 2.39
DISCUSSION
The visual stimulus selective filtration––which is the
Table 2 Comparison of the mean attention scores before, after principle of doing permanent-action exams—can be
and 5 weeks after intervention influenced by the ages of people.13 On the other hand,
the attention quality and capacity differ in different
Group Pretest Post-test Follow up ages.14 Therefore, the age factor was matched in both
groups in the present study. Psychological factors are
Mean SD Mean SD Mean SD known to be effective on attention and can influence the
attention in different dimensions and amounts according
Experimental 7.67 8.62 19.33 11.8 12.95 7.88 to their kinds and powers.15 So, having a family and the
Control 7.29 7.06 9.09 6.88 10.32 7.75 opportunity to make contact with them were matched in
P-value 0.83 0.000 0.19 both groups. The obtained results showed a significant
difference between the attention of the literate and illite-
rate people. Literacy––even at low rates––can influence
20 one’s understanding skills. It can also increase the prob-
18 ability of their success in the selective filtration. Lee has
16 shown that any primary guidance increases the success in
14 the selective filtration task.16 Knowing how to read and
12
write can act like a pre-guide that can increase one’s
10
8
capabilities in analysing the lines and making connections
6 between them and increase one’s chance to succeed in
4 the permanent-functioning exam. Thus, being a literate
2 means having more capabilities to understand and learn.
0
Pretest Post-test Post 5 weeks
Also, the subjects of the experimental and control group
were matched accordingly.
Figure 1. Change of the mean attention scores during the study. Munir and et al. have shown that mental retardation
Experimental group; Control group. can influence attention in different aspects. Thus, the dis-
tribution of retardation reasons was also matched in both
of both groups after the intervention. Also the paired groups. In this research, the results showed that in 40% of
t-test (t = -6.95, d.f. = 29, P < 0.01) showed a signifi- the experimental group and in 36.7% of the control
cant difference between the mean attention scores of the group, retardation reasons occurred after birth, so the
experimental group before and after the intervention. most common retardation reason was the same in both
The mean attention scores after 5 weeks were 12.95 groups.17
for the experimental and 10.32 for the control group, but The final results of this research are summarized in
no significant difference between the attention scores of Table 2, showing that the intervention of computer
both groups was observed using independent t-test. games increased the attention of subjects, but the results
The paired t-test also shows a significant difference do not have a suitable consistency in the follow-up
between the average attention scores of the experimental assessments. Computer games have an accepted effect
group before the intervention and after 5 weeks of follow on increasing internal motivation and activity.18 This
© 2007 The Authors
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4. Computer game intervention on attention capacity 287
increase of internal motivation––supported by resonance Monno’s findings about the mutual effect of paying atten-
of homodynamic values––can be a good source in tion and movement harmony, the patients’ attempt to
increasing attention capabilities. On the other hand, the have movement harmonies leads to the improvement of
cooperative characteristic of computer games can be a concentration.26
natural suitable background to study the mutuality of Considering the mentioned features of computer
attention and action. Computer games provide an games, these games have had a positive effect on our
opportunity to find skill to work in a few-key, complex subjects’ attentions. But according to the findings, the
and classified environment, leading to the improvement effect of the games did not have a satisfactory consistency,
of internal motivation.19 Malone has examined >10 that is, after 5 weeks there was not any significant differ-
attractive features of computer games. Things like com- ence between the subjects of the experimental and control
peting, laugh and curiosity are features that can be so groups. This can be explained by the characteristics of a
attractive to children. It can also be used for improving mentally retarded person. A significant characteristic of a
the ability to pay attention.11 Subrahmanyama et al. have mentally retarded person is late understanding and soon
pointed out that the best way of showing a capability is forgetting; therefore, the most important point of teach-
its third form––the interstitial form––which is inevitable ing a skill is repeating it.28 Incapability to understand
in a great percentage of computer games.20 Since com- abstract meanings is the other characteristic of mentally
puter games are important for enhancing the capability retarded subjects, so these individuals need to be looked
to understand and use information on the screen, their after more, listened to more and touched more to under-
repetition (video and computer games) can improve the stand a new skill compared with normal people; thus, if
third selection skills.21 In many computer games, pic- the backgrounds are not provided, the obtained skill will
tures are much more important than words.22 The visual be forgotten.29
and symbolic presentation is inevitable for scientific and Mentally retarded individuals have limited internal
technical thinking.20 This point, just like the already motivation capacities and, unlike normal people, they are
mentioned characteristic, can play an important role in not curious and active. This characteristic can influence
the Toulouse–Pieron Scale. their attention and, thus, their success in achieving goals.30
Computer games make a critical background for the Considering the conditions of keeping mentally retarded
player in which overcoming it requires problem-solving individuals, it is clear that intervention of computer games
methods. Practising and repeating these processes lead to can influence their quality of attention as a new entertain-
the improvement of personal understanding skills, ing hobby.
whereas paying attention to an object or location influ- Mentally retarded subjects have low self-confidence
ences all of the nervous processes. Paying attention to an because of having experienced many losses. This charac-
object improves one’s perception of the object23 and teristic can influence their capabilities in learning new
allows one to follow the moving object and determine its skills.31 Considering this point, the other factor that can
position at different times and to have a conscious knowl- influence the quality of attention among these subjects is
edge of the facts.24 Considering the mutual relation taking part in research projects; the existence of the
between paying attention and understanding, as paying researcher inside the care centre, choosing certain indi-
attention can influence understanding functions, under- viduals to perform the research and paying close attention
standing improvement skills can improve attention func- to the subjects, could improve their self-confidence aside
tions.25 The harmony of the two moving hands and from making a situation to improve their internal motiva-
attentive functions in the central nervous system are con- tion. This characteristic can cause positive effects on the
nected.26 So moving timing and feeling attention influence attention quality and skills of learning new skills among
each other.27 In the current intervention, one of the the subjects. The researcher was not present in the mental
factors that led to the subject success was the trying to retardation centre at the end of the study. This led sub-
synchronize the hand and the mental movements and jects to discontinue playing computer games, causing
visual stimuli and also the moving organs. Whereas in the negative effects on their quality of attention. Therefore, it
game scenario, there were some designed situations that is necessary for subjects to repeat playing computer games
led to loss of points, so it was explained to the subject that in order to maintain and continually increase attention
facing them meant losing some points. According to capacity.
© 2007 The Authors
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5. 288 A Rezaiyan et al.
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© 2007 The Authors
Journal compilation © 2007 Blackwell Publishing Asia Pty Ltd