Not screens but their context of use impact cognitive development: a commentary on Yang et al. (2023).

There have been extensive debates about the impact of the digital transformation on human development. A recent study by Yang and colleagues highlights the importance of considering context of use, beyond amount of use. In their study, children from parents who reported having TV-on during family meals when they were 2 years old showed poorer cognitive development at age 3.5 as compared to those with TV-off during family meals. This highlights the importance of considering the context of use when studying effect of screen use. While Yang et al. discuss the distracting effects of TV-on sensory processing, we propose an alternative - and not mutually exclusive - interpretation based on TV induced deprivation of family interactions. On a more practical note, this should encourage to preserve screen-free time, especially during structured time such as family meals, in order to maintain family interactions known to be critical to development.

Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial.

BACKGROUND: Adolescence is a critical period for the onset and maintenance of anxiety disorders, which raises the importance of intervening early; one possibility of doing so is via digital interventions. Within that research field, at least two important research paths have been explored in the past years. On the one hand, the anxiolytic effect of casual video games has been tested as such gaming activity may distract away from anxious thoughts through the induction of flow and redirection of attention toward the game and thus away of anxious thoughts. On the other hand, the bidirectional link between weak attentional control and higher anxiety has led to the design of interventions aiming at improving attentional control such as working memory training studies. Taking stock that another genre of gaming, action video games, improves attentional control, game-based interventions that combines cognitive training and action-like game features would seem relevant. This three-arm randomized controlled trial aims to evaluate the feasibility and the efficacy of two video game interventions to document how each may potentially alleviate adolescent anxiety-related symptoms when deployed fully on-line. METHODS: The study aims to recruit 150 individuals, 12 to 14 years of age, with high levels of anxiety as reported by the parents' online form of the Screen for Child Anxiety Related Disorders questionnaire. This trial contrasts a child-friendly, "action-like" video game designed to improve attentional control abilities in a progressive and stepwise manner (Eco-Rescue), a casual puzzle video game selected to act as a positive distraction tool (Bejeweled) and finally a control group with no assigned training intervention to control for possible test-retest effects (No-training). Participants will be assigned randomly to one of the three study arms. They will be assessed for main (anxiety) and secondary outcomes (attentional control, affective working memory) at three time points, before training (T1), one week after the 6-week training (T2) and four months after completing the training (T3). DISCUSSION: The results will provide evidence for the feasibility and the efficacy of two online video game interventions at improving mental health and emotional well-being in adolescents with high levels of anxiety. This project will contribute unique knowledge to the field, as few studies have examined the effects of video game play in the context of digital mental health interventions for adolescents. TRIAL REGISTRATION: The trial is registered on ClinicalTrials.gov (NCT05923944, June 20, 2023).

Going beyond video game consumption when considering Internet Gaming Disorder.

BACKGROUND: Recognizing the crucial importance of understanding the impact of video games on health in today's gaming-dominated world, our study aimed to investigate the relationship between gaming time and Internet Gaming Disorder (IGD). Despite the widespread assumption that a connection exists between both, previous studies have revealed highly variable associations, highlighting significant weaknesses in establishing a robust link. METHODS: To unravel this complex relationship, we recruited two independent samples of League of Legends players. We combined the collection of self-reported and actual gameplay data, together with assessments of mental health, personality traits, and cognitive abilities. RESULTS: Surprisingly, none of the gaming variables demonstrated a robust and stable association with IGD, regardless of whether players spent less than or more than 30 hours per week gaming-a threshold suggested by the American Psychiatric Association as a potential indicator of disordered gaming. Notably, mental health factors, such as anxiety, depression and ADHD, emerged as the most influential predictors of IGD. CONCLUSION: These findings, replicated across two independent samples, challenge the prevailing belief that limiting screen time alone effectively combats IGD. Instead, mental health factors play a crucial role in mitigating risks associated with gaming. Policies focusing solely on restricting screen time are insufficient in reducing the prevalence or symptoms of IGD. Rather, a comprehensive approach that considers mental health and key personality traits must be adopted to safeguard the well-being of individuals engaged in gaming.

[Screens and adolescence: what issues for the Z generation?] / Écrans et adolescence : quels enjeux pour la Génération Z ?

Digital media and screens are ubiquitous in the daily lives of adolescents. The screen-addicted portrait of young people has gained public attention, and health professionals are often consulted about the impact of screen use on teenagers' physical and mental health. Scientific evidence suggests that screen use is associated with risks and benefits that need to be weighed up in a nuanced way. This paper takes a critical look at the issue of screen time and at the models for understanding a problematic screen use. These considerations underline the importance of adopting a contextual understanding of screen use in adolescence.

Les médias numériques sont omniprésents dans la vie quotidienne des adolescent-es. La figure de l'adolescent-e « addict-e ¼ aux écrans est devenue un sujet de préoccupation dans l'opinion publique et il est fréquent que les professionnel-les de la santé soient sollicité-es pour répondre aux interrogations sur l'impact de l'utilisation des écrans sur la santé mentale et physique des jeunes. Les données scientifiques indiquent que l'usage des écrans est associé à des risques et des bénéfices qu'il s'agit d'évaluer de manière nuancée. Dans cet article, nous discutons en particulier et de façon critique du temps d'écran et des modèles de compréhension de l'usage problématique de celui-ci. Ces réflexions nous amènent à souligner l'importance d'adopter une compréhension contextualisée de cet usage à l'adolescence.

Attentional modulation as a mechanism for enhanced facial emotion discrimination: The case of action video game players.

Action video game players (AVGPs) outperform nonvideo game players (NVGPs) on a wide variety of attentional tasks, mediating benefits to perceptual and cognitive decision processes. A key issue in the literature is the extent to which such benefits transfer beyond cognition. Using steady-state visual evoked potentials (SSVEP) as a neural measure of attentional resource allocation, we investigated whether the attentional benefit of AVGPs generalizes to the processing of rapidly presented facial emotions. AVGPs (n = 36) and NVGPs (n = 32) performed a novel, attention-demanding emotion discrimination task, requiring the identification of a target emotion in one of two laterally presented streams of emotional faces. The emotional faces flickered at either 2.0 Hz or 2.5 Hz. AVGPs outperformed NVGPs at detecting the target emotions regardless of the type of emotion. Correspondingly, attentional modulation of the SSVEP at parieto-occipital recording sites was larger in AVGPs compared with NVGPs. This difference appeared to be driven by a larger response to attended information, as opposed to a reduced response to irrelevant distractor information. Exploratory analyses confirmed that this novel paradigm elicited the expected pattern of event-related potentials associated with target detection and error processing. These components did not, however, differ between groups. Overall, the results indicate enhanced discrimination of facial emotions in AVGPs arising from enhanced attentional processing of emotional information. This presents evidence for the attentional advantage of AVGPs to extend beyond perceptual and cognitive processes.

Examining the synergistic effects of a cognitive control video game and a home-based, self-administered non-invasive brain stimulation on alleviating depression: the DiSCoVeR trial protocol.

Enhanced behavioral interventions are gaining increasing interest as innovative treatment strategies for major depressive disorder (MDD). In this study protocol, we propose to examine the synergistic effects of a self-administered home-treatment, encompassing transcranial direct current stimulation (tDCS) along with a video game based training of attentional control. The study is designed as a two-arm, double-blind, randomized and placebo-controlled multi-center trial (ClinicalTrials.gov: NCT04953208). At three study sites (Israel, Latvia, and Germany), 114 patients with a primary diagnosis of MDD undergo 6 weeks of intervention (30 × 30 min sessions). Patients assigned to the intervention group receive active tDCS (anode F3 and cathode F4; 2 mA intensity) and an action-like video game, while those assigned to the control group receive sham tDCS along with a control video game. An electrode-positioning algorithm is used to standardize tDCS electrode positioning. Participants perform their designated treatment at the clinical center (sessions 1-5) and continue treatment at home under remote supervision (sessions 6-30). The endpoints are feasibility (primary) and safety, treatment efficacy (secondary, i.e., change of Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week six from baseline, clinical response and remission, measures of social, occupational, and psychological functioning, quality of life, and cognitive control (tertiary). Demonstrating the feasibility, safety, and efficacy of this novel combined intervention could expand the range of available treatments for MDD to neuromodulation enhanced interventions providing cost-effective, easily accessible, and low-risk treatment options.ClinicalTrials.gov: NCT04953208.

Stereoptic serious games as a visual rehabilitation tool for individuals with a residual amblyopia (AMBER trial): a protocol for a crossover randomized controlled trial.

BACKGROUND: Amblyopia is the most common developmental vision disorder in children. The initial treatment consists of refractive correction. When insufficient, occlusion therapy may further improve visual acuity. However, the challenges and compliance issues associated with occlusion therapy may result in treatment failure and residual amblyopia. Virtual reality (VR) games developed to improve visual function have shown positive preliminary results. The aim of this study is to determine the efficacy of these games to improve vision, attention, and motor skills in patients with residual amblyopia and identify brain-related changes. We hypothesize that a VR-based training with the suggested ingredients (3D cues and rich feedback), combined with increasing the difficulty level and the use of various games in a home-based environment is crucial for treatment efficacy of vision recovery, and may be particularly effective in children. METHODS: The AMBER study is a randomized, cross-over, controlled trial designed to assess the effect of binocular stimulation (VR-based stereoptic serious games) in individuals with residual amblyopia (n = 30, 6-35 years of age), compared to refractive correction on vision, selective attention and motor control skills. Additionally, they will be compared to a control group of age-matched healthy individuals (n = 30) to account for the unique benefit of VR-based serious games. All participants will play serious games 30 min per day, 5 days per week, for 8 weeks. The games are delivered with the Vivid Vision Home software. The amblyopic cohort will receive both treatments in a randomized order according to the type of amblyopia, while the control group will only receive the VR-based stereoscopic serious games. The primary outcome is visual acuity in the amblyopic eye. Secondary outcomes include stereoacuity, functional vision, cortical visual responses, selective attention, and motor control. The outcomes will be measured before and after each treatment with 8-week follow-up. DISCUSSION: The VR-based games used in this study have been conceived to deliver binocular visual stimulation tailored to the individual visual needs of the patient, which will potentially result in improved basic and functional vision skills as well as visual attention and motor control skills. TRIAL REGISTRATION: This protocol is registered on ClinicalTrials.gov (identifier: NCT05114252) and in the Swiss National Clinical Trials Portal (identifier: SNCTP000005024).

A video-game-based method to induce states of high and low flow.

Flow has been defined as a state of full immersion that may emerge when the skills of a person match the challenge of an activity. It is a special case of being on task, as during flow, keeping focused on the task feels effortless. Most experimental investigations of the neural or physiological correlates of flow contrast conditions with different levels of challenge. Yet comparing different levels of challenge that are too distant may trigger states where the participant is off task, such as boredom or frustration. Thus, it remains unclear whether previously observed differences ascribed to flow may rather reflect differences in how much participants were on task-trying their best-across the contrasted conditions. To remedy this, we introduce a method to manipulate flow by contrasting two video game play conditions at personalized levels of difficulty calibrated such that participants similarly tried their best in both conditions. Across three experiments (> 90 participants), higher flow was robustly reported in our high-flow than in our low-flow condition (mean effect size d = 1.31). Cardiac, respiratory, and skin conductance measures confirmed the known difference between a period of rest and the two on-task conditions of high and low flow, but failed to distinguish between these latter two. In light of the conflicting findings regarding the physiological correlates of flow, we discuss the importance of ensuring a low-flow baseline condition that maintains participants on task, and propose that the present method provides a methodological advance toward that goal.

Prior Reward Conditioning Dampens Hippocampal and Striatal Responses during an Associative Memory Task.

Offering reward during encoding typically leads to better memory [Adcock, R. A., Thangavel, A., Whitfield-Gabrieli, S.,Knutson, B., & Gabrieli, J. D. E. Reward-motivated learning: Mesolimbic activation precedes memory formation. Neuron, 50, 507-517, 2006]. Whether such memory benefit persists when tested in a different task context remains, however, largely understudied [Wimmer, G. E., & Buechel, C. Reactivation of reward-related patterns from single past episodes supports memory-based decision making. Journal of Neuroscience, 36, 2868-2880, 2016]. Here, we ask whether reward at encoding leads to a generalized advantage across learning episodes, a question of high importance for any everyday life applications, from education to patient rehabilitation. Although we confirmed that offering monetary reward increased responses in the ventral striatum and pleasantness judgments for pictures used as stimuli, this immediate beneficial effect of reward did not carry over to a subsequent and different picture-location association memory task during which no reward was delivered. If anything, a trend for impaired memory accuracy was observed for the initially high-rewarded pictures as compared to low-rewarded ones. In line with this trend in behavioral performance, fMRI activity in reward (i.e., ventral striatum) and in memory (i.e., hippocampus) circuits was reduced during the encoding of new associations using previously highly rewarded pictures (compared to low-reward pictures). These neural effects extended to new pictures from same, previously highly rewarded semantic category. Twenty-four hours later, delayed recall of associations involving originally highly rewarded items was accompanied by decreased functional connectivity between the hippocampus and two brain regions implicated in value-based learning, the ventral striatum and the ventromedial PFC. We conclude that acquired reward value elicits a downward value-adjustment signal in the human reward circuit when reactivated in a novel nonrewarded context, with a parallel disengagement of memory-reward (hippocampal-striatal) networks, likely to undermine new associative learning. Although reward is known to promote learning, here we show how it may subsequently hinder hippocampal and striatal responses during new associative memory formation.

Brain plasticity through the life span: learning to learn and action video games.

The ability of the human brain to learn is exceptional. Yet, learning is typically quite specific to the exact task used during training, a limiting factor for practical applications such as rehabilitation, workforce training, or education. The possibility of identifying training regimens that have a broad enough impact to transfer to a variety of tasks is thus highly appealing. This work reviews how complex training environments such as action video game play may actually foster brain plasticity and learning. This enhanced learning capacity, termed learning to learn, is considered in light of its computational requirements and putative neural mechanisms.

Individual differences in the acquisition of non-linguistic audio-visual associations in 5 year olds.

Audio-visual associative learning - at least when linguistic stimuli are employed - is known to rely on core linguistic skills such as phonological awareness. Here we ask whether this would also be the case in a task that does not manipulate linguistic information. Another question of interest is whether executive skills, often found to support learning, may play a larger role in a non-linguistic audio-visual associative task compared to a linguistic one. We present a new task that measures learning when having to associate non-linguistic auditory signals with novel visual shapes. Importantly, our novel task shares with linguistic processes such as reading acquisition the need to associate sounds with arbitrary shapes. Yet, rather than phonemes or syllables, it uses novel environmental sounds - therefore limiting direct reliance on linguistic abilities. Five-year-old French-speaking children (N = 76, 39 girls) were assessed individually in our novel audio-visual associative task, as well as in a number of other cognitive tasks evaluating linguistic abilities and executive functions. We found phonological awareness and language comprehension to be related to scores in the audio-visual associative task, while no correlation with executive functions was observed. These results underscore a key relation between foundational language competencies and audio-visual associative learning, even in the absence of linguistic input in the associative task.

Neural Correlates of Enhanced Visual Attentional Control in Action Video Game Players: An Event-Related Potential Study.

Action video game players (AVGPs) outperform non-action video game players (NAVGPs) on a range of perceptual and attentional tasks. Although several studies have reported neuroplastic changes within the frontoparietal networks of attention in AVGPs, little is known about possible changes in attentional modulation in low-level visual areas. To assess the contribution of these different levels of neural processing to the perceptual and attentional enhancements noted in AVGPs, visual event-related potentials (ERPs) were recorded from 14 AVGPs and 14 NAVGPs during a target discrimination task that required participants to attend to rapid sequences of Gabor patches under either focused or divided attention conditions. AVGPs responded faster to target Gabors in the focused attention condition compared with the NAVGPs. Correspondingly, ERPs to standard Gabors revealed a more pronounced negativity in the time range of the parietally generated anterior N1 component in AVGPs compared with NAVGPs during focused attention. In addition, the P2 component of the visual ERP was more pronounced in AVGPs than in NAVGPs over the hemisphere contralateral to the stimulus position in response to standard Gabors. Contrary to predictions, however, attention-modulated occipital components generated in the low-level extrastriate visual pathways, including the P1 and posterior N1, showed no significant group differences. Thus, the main neural signature of enhanced perceptual and attentional control functions in AVGPs appears linked to an attention-dependent parietal process, indexed by the anterior N1 component, and possibly to more efficient higher-order perceptual processing, indexed by the P2 component.

The prevalence and diagnosis of 'stereoblindness' in adults less than 60 years of age: a best evidence synthesis.

PURPOSE: Stereoscopic vision (or stereopsis) is the ability to perceive depth from binocular disparity - the difference of viewpoints between the two eyes. Interestingly, there are large individual differences as to how well one can appreciate depth from such a cue. The total absence of stereoscopic vision, called 'stereoblindness', has been associated with negative behavioural outcomes such as poor distance estimation. Surprisingly, the prevalence of stereoblindness remains unclear, as it appears highly dependent on the way in which stereopsis is measured. RECENT FINDINGS: This review highlights the fact that stereopsis is not a unitary construct, but rather implies different systems. The optimal conditions for measuring these varieties of stereoscopic information processing are discussed given the goal of detecting stereoblindness, using either psychophysical or clinical stereotests. In that light, we then discuss the estimates of stereoblindness prevalence of past studies. SUMMARY: We identify four different approaches that all converge toward a prevalence of stereoblindness of 7% (median approach: 7%; unambiguous-stereoblindness-criteria approach: 7%; visual-defect-included approach: 7%; multiple-criteria approach: 7%). We note that these estimates were derived considering adults of age <60 years old. Older adults may have a higher prevalence. Finally, we make recommendations for a new ecological definition of stereoblindness and for efficient clinical methods for determining stereoblindness by adapting existing tools.

Neural systems supporting linguistic structure, linguistic experience, and symbolic communication in sign language and gesture.

Sign languages used by deaf communities around the world possess the same structural and organizational properties as spoken languages: In particular, they are richly expressive and also tightly grammatically constrained. They therefore offer the opportunity to investigate the extent to which the neural organization for language is modality independent, as well as to identify ways in which modality influences this organization. The fact that sign languages share the visual-manual modality with a nonlinguistic symbolic communicative system-gesture-further allows us to investigate where the boundaries lie between language and symbolic communication more generally. In the present study, we had three goals: to investigate the neural processing of linguistic structure in American Sign Language (using verbs of motion classifier constructions, which may lie at the boundary between language and gesture); to determine whether we could dissociate the brain systems involved in deriving meaning from symbolic communication (including both language and gesture) from those specifically engaged by linguistically structured content (sign language); and to assess whether sign language experience influences the neural systems used for understanding nonlinguistic gesture. The results demonstrated that even sign language constructions that appear on the surface to be similar to gesture are processed within the left-lateralized frontal-temporal network used for spoken languages-supporting claims that these constructions are linguistically structured. Moreover, although nonsigners engage regions involved in human action perception to process communicative, symbolic gestures, signers instead engage parts of the language-processing network-demonstrating an influence of experience on the perception of nonlinguistic stimuli.

Action video game play facilitates the development of better perceptual templates.

The field of perceptual learning has identified changes in perceptual templates as a powerful mechanism mediating the learning of statistical regularities in our environment. By measuring threshold-vs.-contrast curves using an orientation identification task under varying levels of external noise, the perceptual template model (PTM) allows one to disentangle various sources of signal-to-noise changes that can alter performance. We use the PTM approach to elucidate the mechanism that underlies the wide range of improvements noted after action video game play. We show that action video game players make use of improved perceptual templates compared with nonvideo game players, and we confirm a causal role for action video game play in inducing such improvements through a 50-h training study. Then, by adapting a recent neural model to this task, we demonstrate how such improved perceptual templates can arise from reweighting the connectivity between visual areas. Finally, we establish that action gamers do not enter the perceptual task with improved perceptual templates. Instead, although performance in action gamers is initially indistinguishable from that of nongamers, action gamers more rapidly learn the proper template as they experience the task. Taken together, our results establish for the first time to our knowledge the development of enhanced perceptual templates following action game play. Because such an improvement can facilitate the inference of the proper generative model for the task at hand, unlike perceptual learning that is quite specific, it thus elucidates a general learning mechanism that can account for the various behavioral benefits noted after action game play.

Brains on video games.

The popular press is replete with stories about the effects of video and computer games on the brain. Sensationalist headlines claiming that video games 'damage the brain' or 'boost brain power' do not do justice to the complexities and limitations of the studies involved, and create a confusing overall picture about the effects of gaming on the brain. Here, six experts in the field shed light on our current understanding of the positive and negative ways in which playing video games can affect cognition and behaviour, and explain how this knowledge can be harnessed for educational and rehabilitation purposes. As research in this area is still in its early days, the contributors of this Viewpoint also discuss several issues and challenges that should be addressed to move the field forward.

The absolute disparity anomaly and the mechanism of relative disparities.

There has been a long-standing debate about the mechanisms underlying the perception of stereoscopic depth and the computation of the relative disparities that it relies on. Relative disparities between visual objects could be computed in two ways: (a) using the difference in the object's absolute disparities (Hypothesis 1) or (b) using relative disparities based on the differences in the monocular separations between objects (Hypothesis 2). To differentiate between these hypotheses, we measured stereoscopic discrimination thresholds for lines with different absolute and relative disparities. Participants were asked to judge the depth of two lines presented at the same distance from the fixation plane (absolute disparity) or the depth between two lines presented at different distances (relative disparity). We used a single stimulus method involving a unique memory component for both conditions, and no extraneous references were available. We also measured vergence noise using Nonius lines. Stereo thresholds were substantially worse for absolute disparities than for relative disparities, and the difference could not be explained by vergence noise. We attribute this difference to an absence of conscious readout of absolute disparities, termed the absolute disparity anomaly. We further show that the pattern of correlations between vergence noise and absolute and relative disparity acuities can be explained jointly by the existence of the absolute disparity anomaly and by the assumption that relative disparity information is computed from absolute disparities (Hypothesis 1).

Video game play, attention, and learning: how to shape the development of attention and influence learning?

PURPOSE OF REVIEW: The notion that play may facilitate learning has long been touted. Here, we review how video game play may be leveraged for enhancing attentional control, allowing greater cognitive flexibility and learning and in turn new routes to better address developmental disorders. RECENT FINDINGS: Video games, initially developed for entertainment, appear to enhance the behavior in domains as varied as perception, attention, task switching, or mental rotation. This surprisingly wide transfer may be mediated by enhanced attentional control, allowing increased signal-to-noise ratio and thus more informed decisions. SUMMARY: The possibility of enhancing attentional control through targeted interventions, be it computerized training or self-regulation techniques, is now well established. Embedding such training in video game play is appealing, given the astounding amount of time spent by children and adults worldwide with this media. It holds the promise of increasing compliance in patients and motivation in school children, and of enhancing the use of positive impact games. Yet for all the promises, existing research indicates that not all games are created equal: a better understanding of the game play elements that foster attention and learning as well as of the strategies developed by the players is needed. Computational models from machine learning or developmental robotics provide a rich theoretical framework to develop this work further and address its impact on developmental disorders.