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Cited by 28Educational Games and GamificationAttention Deficit Hyperactivity DisorderDigital Mental Health Interventions

Adaptive Tele-Therapies Based on Serious Games for Health for People with Time-Management and Organisational Problems: Preliminary Results

Open access
Frutos-Pascual, Maite, Zapirain, Begoña, Zorrilla, Amaia·2014·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph110100749PMC PMC3924472
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Abstract

Attention Deficit with Hyperactivity Disorder (ADHD) is one of the most prevalent disorders within the child population today. Inattention problems can lead to greater difficulties in completing assignments, as well as problems with time management and prioritisation of tasks. This article presents an intelligent tele-therapy tool based on Serious Games for Health, aimed at the improvement of time management skills and the prioritisation of tasks. This tele-system is based on the use of decision trees within Django, a high-level Python Web framework. The technologies and techniques used were selected so as to boost user involvement and to enable the system to be easily customised. This article shows the preliminary results of the pilot-phase in an experiment performed to evaluate the use of adaptive tele-therapies within a group of typically developing children and adolescents aged between 12 and 19 years old without ADHD. To do so, we relied on the collection of parameters and the conduct of surveys for assessing time management skills, as well as measuring system usability and availability. The results of a time management survey highlighted that the users involved in the trial did not use any specific or effective time management techniques, scoring 1.98 and 2.30 out of 5 points in this area for ages under 15 and over 16 years old, respectively. The final calculations based on the usability questionnaire resulted in an average score of 78.75 out of 100. The creation of a customisable tool capable of working with different skills, in conjunction with the replication of the current study, may help to understand these users’ needs, as well as boosting time management skills among teenagers with and without ADHD.

AI snapshot

Written from the paper’s full text.

TL;DR

This paper presents an online Serious Games for Health tele-therapy tool using Django decision trees to help children and adolescents prioritise tasks and improve time management, and reports preliminary pilot results with 17 typically developing Spanish adolescents aged 12–19 without ADHD. The pilot found low self-reported time-management technique scores and good usability (SUS mean 78.75/100), but the authors frame it as preliminary and call for larger, ADHD-inclusive, longitudinal replication.

Key findings

  • On the Time Management Behavior Questionnaire (TMBQ), participants reported low use of specific/effective time-management techniques: 1.98/5 for ages under 15 and 2.30/5 for ages 16+; across all four TMBQ areas scores were below 3.5/5, with the extremes being area F1 (goal setting) and area F2 (specific effective techniques).
  • System usability was rated 78.75/100 overall (SD 6.39); users under 15 scored 73.93/100 (SD 4.97) and users over 16 scored 82.5/100 (SD 4.68). Sixteen of the 17 initial participants completed the SUS.
  • The tool is an online platform built in Django with MySQL, JQuery/JavaScript/CSS, and Touch Punch; it uses a decision tree based on the ID3 algorithm and Shannon entropy to prioritise between two activities, and has three parts: training, consultation, and monitoring.

Methods

  • Design: development and preliminary pilot evaluation of an adaptive online tele-therapy tool based on Serious Games for Health, centred on task prioritisation and time management.
  • Sample: 17 randomly selected typically developing children/adolescents aged 12–19 (mean age 16.23; 7 women, 10 men), resident in the Basque Country, Spain, without ADHD and with Spanish as their mother tongue; parental approval was requested for those under 18.
  • Procedure and analysis: two independent online stages 1–3 weeks apart—first the TMBQ (34 items, four areas, Likert 1–5), then use of the online tool followed by the SUS (10 items, Likert 1–5); data were analysed in IBM SPSS, and a Mann-Whitney non-parametric test was applied and reported as significant (p < 0.05) for the 12–15 and 16–19 age groups.

Limitations

  • Stated by the paper: this is a preliminary pilot with a small sample; one participant under 15 left after the first questionnaire due to schedule issues, so SUS results are based on 16 users; the authors call for replication with more users, users with and without ADHD, age segmentation, a bilingual/trilingual tool, and a longitudinal study; they also state the tool should support rather than substitute traditional therapies.
  • Evident from the text: no participants with ADHD were included despite the target population, there was no control/comparison group, outcomes are short-term self-report usability and time-management surveys rather than clinical or behavioural time-management outcomes, and the age-group comparisons rest on very small subgroups.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/ijerph110100749

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 28 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    15 out of 17 participants used mobile devices to perform the activities proposed in this trial.

    “Results obtained in this study show that 15 out of 17 participants used mobile devices to perform the activities proposed in this trial.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The areas that make these extremes are those corresponding to the willingness of students to set specific goals (area 1; F1) and the use of specific effective techniques in time management (area 2; F2).

    “The areas that make these extremes are those corresponding to the willingness of students to set specific goals (area 1; corresponding to F1) and the use of specific effective techniques in time management (area 2; corresponding to F2).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants aged under 15 in the pilot trial scored 1.98 out of 5 on the time management survey area assessing use of specific effective time management techniques.

    “The results of a time management survey highlighted that the users involved in the trial did not use any specific or effective time management techniques, scoring 1.98 and 2.30 out of 5 points in this area for ages under 15 and over 16 years old, respectively.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Users under 15-years-old scored an average result of 73.93 out of 100, with a standard deviation of 4.97.

    “Users under 15-years-old scored an average result of 73.93 out of 100, with a standard deviation of 4.97”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants aged over 16 in the pilot trial scored 2.30 out of 5 on the time management survey area assessing use of specific effective time management techniques.

    “The results of a time management survey highlighted that the users involved in the trial did not use any specific or effective time management techniques, scoring 1.98 and 2.30 out of 5 points in this area for ages under 15 and over 16 years old, respectively.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 11
  • Classified as probably not a substantial claim. 19
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    The SUS mean overall score was 78.75 out of 100, with a standard deviation of 6.39.

    “The SUS mean overall score was 78.75 out of 100, with a standard deviation of 6.39.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The majority of the group chose to use their smartphones and only five participants decided to use other devices, such as a computer (two users) or a tablet (three users).

    “The majority of the group chose to use their smartphones and only five participants decided to use other devices, such as a computer (two users) or a tablet (three users).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The average rating per block varies between 2.98 and 1.92 points out of 5 for the group under 15 years old and between 3.44 and 2.30 for the group over 16 years old.

    “As shown in Figure 6a, the average rating per block varies between 2.98 and 1.92 points, out of a total of 5, for the group under 15 years old and between 3.44 and 2.30 for the group over 16 years old.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The Mann-Whitney non-parametric test was significant (p < 0.05) for the 12-15 year-old and the 16-19 year-old groups.

    “This test was significant (p < 0.05) for the 12–15 year-old and the 16–19 year-old groups.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The final calculations based on the usability questionnaire resulted in an average System Usability Scale score of 78.75 out of 100.

    “The final calculations based on the usability questionnaire resulted in an average score of 78.75 out of 100.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In addition to hyperactivity and inattention, organisational difficulties such as time management may occur in ADHD, especially in the school setting and in adulthood.

    “In addition to these hyperactivity and inattention problems, organisational difficulties such as time management may also occur, especially within the school setting [5], as well as in adulthood, in the individual’s professional life.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Houghton, 2011, Measuring temporal self-regulation in children with and without attention deficit hyperactivity disorder: Sense of time in everyday contexts, Eur. J. Psychol. Assess. source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    Very little work on time management skills has been done in the reviewed literature, which is mostly focused on attention problems.

    “By examining Table 1 it can be seen that very little work on time managment skills has been done, the analysed references being mostly focused on attention problems.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Participants were 17 users randomly selected from a group of volunteers.

    “Participants were 17 users randomly selected from a group of volunteers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    16 participants, seven women and 9 men, out of the 17 initial participants in the trial, answered the system usability questionnaire.

    “As far as the answers are concerned, 16 participants, seven women and 9 men, out of the 17 initial participants in the trial, answered the system usability questionnaire.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationown data

    The rise in the use of mobile devices, along with access to a permanent Internet connection, increases the demand for interactive online content, enabling the emergence of tools like the one presented in this article.

    “The rise in the use of these devices, along with access to a permanent Internet connection, increases the demand for interactive online content, enabling the emergence of tools like the one presented in this article.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The evaluation of participants' time management skills was done by using a Spanish validated version of the TMB Questionnaire.

    “The evaluation of participants’ time management skills was done by using a Spanish validated version of the TMB Questionnaire [66].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] 2012, Spanish version of the time management behavior questionnaire for university students, Span. J. Psychol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisecitation

    Serious games within interactive tools can help to improve specific skills through the use of gaming techniques and appealing and accessible content.

    “According to the literature mentioned in Section 1 and Section 2, serious games within these interactive tools can also help to improve specific skills through the use of gaming techniques and appealing and accessible content.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The Spanish version of the Time Management Behavior Questionnaire (TMBQ) used in the study was validated and accepted for measuring time management skills, especially for the selected age range.

    “This scale was chosen for its prestige and validity in the measurement of time management skills, especially for the age range selected in the test. The Spanish version was validated and accepted [66,67].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [66] 2012, Spanish version of the time management behavior questionnaire for university students, Span. J. Psychol. source

      Not checked in the free run.

    • cites [67] Aponte, 2013, Manejo del tiempo académico en jóvenes que inician estudios en la Universidad Simón Bolívar, Rev. Latinoamer. De Cienc. Sociales Niñez y Juventud

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    One participant left the testing after the completion of the first questionnaire due to schedule issues.

    “Due to schedule issues, one of the participants left the testing after the completion of the first questionnaire.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    In order to evaluate system usability, the SUS questionnaire was used, which consists of 10 items.

    “In order to evaluate system usability, the SUS questionnaire [69] was used, which consists of 10 items.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Brooke, 1996, SUS—A quick and dirty usability scale, Usability Eval. Ind.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Premisenone given

    Time management skills and task prioritisation capabilities need to be developed during childhood and adolescence, in order to prepare users for adult life and the management of their own time.

    “As explained in Section 1, time management skills and task prioritisation capabilities need to be developed during childhood and adolescence, in order to prepare users for adult life and the management of their own time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Time management skills and task prioritisation capabilities could also be key skills in obtaining good academic results.

    “Moreover, they could also be key skills in obtaining good academic results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The participant who left belonged to the group under 15-years old.

    “This user belonged to the group under 15-years old.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    These results suggest the need for the creation of new, efficient, and attractive content that provides guidance and effective techniques to work on time management skills.

    “These results suggest the need for the creation of new, efficient, and attractive content that provides guidance and effective techniques to work on time management skills.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The development of new online solutions could help to complement traditional therapies fostering their effects and helping to create efficient management and organisational skills.

    “The development of new online solutions could help to complement traditional therapies fostering their effects and helping to create efficient management and organisational skills.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    It is therefore necessary to create an accessible tool for time management habits and the prioritising of tasks for adolescents in general, and not only for those diagnosed with ADHD.

    “It is therefore necessary to create an accessible tool for time management habits and the prioritising of tasks for adolescents in general, and not only for those diagnosed with ADHD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    These new therapies included the use of new technologies such as virtual environments and computer-based therapies, thus providing users with a greater autonomy.

    “These new therapies included the use of new technologies such as virtual environments and computer-based therapies, thus providing users with a greater autonomy [52].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Bioulac, 2012, Impact of time on task on ADHD patient’s performances in a virtual classroom, Eur. J. Paediatr. Neurol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bioulac, Lallemand et al. proposed a virtual development that implied the first steps in the evolution of face-to-face therapies to more innovative interventions.

    “Bioulac, Lallemand et al. proposed a virtual development that implied the first steps in the evolution of face-to-face therapies to more innovative interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Bioulac, 2012, Impact of time on task on ADHD patient’s performances in a virtual classroom, Eur. J. Paediatr. Neurol. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The described system presented in this paper goes one step beyond, by including the use of online therapies which promote availability and convenience while using the tool.

    “The described system presented in this paper goes one step beyond, by including the use of online therapies which promote availability and convenience while using the tool.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationown data

    Key skills to be worked on lie not only in the field of the prioritisation of tasks, but also in the effective utilisation of specific techniques to that effect.

    “Key skills to be worked on lie not only in the field of the prioritisation of tasks, but also in the effective utilisation of specific techniques to that effect.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    As a conclusion to this study, it was confirmed that there is a need for new interactive content in order to work on time management skills in teenagers with and without ADHD.

    “As a conclusion to this study, it was confirmed that there is a need for new interactive content in order to work on time management skills in teenagers with and without ADHD.”
    Quote in the paperSubstantial claim
26 of 26

  • The paper relies on this without support.

    Organisational problems derived from poor planning of an academic course or subject lead to bad academic results and can end in school failure.

    “Organisational problems such as the ones derived from poor planning of an academic course or a subject, lead to bad academic results that can end in school failure in the most dramatic cases.”

  • The paper relies on this without support.

    Results from typically developing children and adolescents without ADHD can guide adaptation of the tool for users with and without ADHD.

    “This article shows the preliminary results of the pilot-phase in an experiment performed to evaluate the use of adaptive tele-therapies within a group of typically developing children and adolescents aged between 12 and 19 years old without ADHD.”
    “These tests are intended to serve as guidance for adapting the tool presented in this article to final users, helping them to evaluate whether it could be used on a daily basis with users with and without ADHD.”

  • The paper relies on this without support.

    The 17 participants are representative of teenagers with and without ADHD.

    “Participants were 17 users randomly selected from a group of volunteers.”

  • The paper relies on this without support.

    The described tool is effective in improving time management skills.

    “The described tool is focused on working on these activities, particularly on prioritising tasks.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting year for the Gureasko-Moore study

    Minor

    Table 2 dates the cited study to 2008, whereas the discussion dates it to 2006.

  • SUS response scale is reversed between methods and results

    Minor

    The methods section assigns 1 to agreement and 5 to disagreement, but the later description assigns 1 to disagreement and 5 to agreement. This affects how the reported usability scores should be interpreted and calculated.

  • Conflicting lowest TMBQ score for the younger group

    Minor

    The abstract reports 1.98 points for the younger group's use of time-management techniques, while the results identify that area as the group's lowest score and report it as 1.92 points.

3 of 3

Cites

Flagged first, then by citations

9 of the 72 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Van Dijk, D., Hunneman, R., and Wildlevuur, S. (, January October). Self City: Training Social Skills in a Game. Proceedings of Second European Conferences on Game-based Learning, Barcelona, Spain.
  2. Abikoff, 2003, Measuring and treating organizational, time management, and planning deficits in children with ADHD, J. Child Adolesc. Psychopharmacol., 13, 422

Cited by

Sorted by citations

Related

Authors
Frutos-Pascual, M., Zapirain, B., & Zorrilla, A.
Affiliations
  • Universidad de Deusto (ES)
  • DeustoTech Life (eVIDA), Faculty of Engineering, University of Deusto, Bilbao 48007, Spain
Corresponding author
Frutos-Pascual, Maite
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2014-01-07
Volume
11
Issue
1
Pages
749-772
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph110100749
PMC
PMC3924472
OpenAlex
W1969872231
Semantic Scholar
443491cbe07c6d9658d5ffcd36efff2c925807b9
Cited by
27
References
72
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 2
FWCI
5.47
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • BCU Open Access Repository (Birmingham City University) (acceptedVersion)
  • DeustoTeka (submittedVersion, cc-by-nc-nd)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Universidad de Deusto
Topics
  • Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
time management, task prioritization, attention deficit hyperactivity disorder, inattention, decision tree, adaptive learning systems, online intervention, usability evaluation, adolescents, children, typically developing children
MeSH terms
Adolescent, Attention Deficit Disorder with Hyperactivity, Decision Trees, Female, Humans, Male, Pilot Projects, Time Management, Video Games, Healthy Volunteers

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