The study comprised three stages. In the first stage, normative data were obtained, in the second stage (concurrent validity) Chefmania scores were compared with those obtained in standardized tests and in the third stage (discriminant validity) the Chefmania scores of school children were compared with those of children diagnosed with attention deficit hyperactivity disorder (ADHD), a psychiatric disorder which encompasses inattention and impairment in executive functions (Dajani et al., 2016; Carter-Leno et al., 2018). The study was approved by the internal review board of participant institutions, informed assent and consent were obtained from the subjects and their parents.
A sample of 6–12 years old children was recruited from public and private primary schools of two cities in Mexico. Those children with a history of neurological or psychiatric disorders, severe visual impairment, academic failure, or who were over-aged for their grade level were excluded.
Chefmanía is a video game located in a restaurant setting. It consists of eight tasks aimed at exploring both cognitive (attention, memory, and executive functions) and basic academic skills (numeracy, space, time, proportionality, tracking instructions). Running the program is not complicated, only basic hardware (keyboard, mouse, screen) and basic computer skills are needed. The player can take the role of chef or waiter depending on the tasks, which are described as follows:
Table allocation: The waiter needs to direct the guests to the requested table, clicking on the table as appropriate (e.g. second table on the right) (Fig. 1a).
Orders: The waiter takes three orders selecting and dragging the food from several images, the second order will be set based on the first order, increasing or decreasing the number of dishes. The third order follows the same rules.
Cupcakes: A third customer orders cupcakes with toppings, the waiter will choose by clicking only on those that comply with the requested feature (Fig. 1b).
Committing an order to memory: The next order will be interrupted by another customer so the waiter will have to remember the order and perform the command after serving the customer with the urgent order.
Getting the bill: To deliver the bill the waiter will make a two-digit sum corresponding to the cost of the dishes and a multiplication depending on the number of guests. Later the customer will give a discount card (10%/20%/25%/50%) and the waiter should estimate the final amount.
Choosing ingredients: The chef has to identify whether the drawers contain food or not and click on the “yes” or “no” button as appropriate. The drawers show the ingredients and distractors in superimposed figures (Fig. 1c).
Chop: The chef player must quickly prepare a fruit salad, chopping everything except red fruits in the processor. There is a counter for the ingredients to be chopped as well as a time bar showing the remaining time (Fig. 1d).
Cooking: The chef should prepare three dishes considering that all must be finished at the same time and should not be under or overcooked.
The total test time is 20 min, but children can complete it earlier. Chefmania was designed based on standardized cognitive tests, the cognitive correlate, foundation, and scoring system of each task are shown in Table 1.
Chefmania also provides the following global scores: Time (total execution time), Global Hits (GH, total hits), Global Misses (GM, total misses), Efficacy (E, GH−GM) and the Impulsivity control index (ICI, obtained by the formula ICI = (E/(GH + GM)×100).
Child neuropsychological assessment (Evaluación Neuropsicológica Infantil, ENI)
The ENI is a comprehensive neuropsychological battery developed specifically for Spanish-speaking children which was created based on paper and pencil tests. It provides an assessment of several cognitive domains including constructional abilities, memory, perceptual abilities, oral language, metalinguistic awareness, spatial skills, attention, concept formation, and executive functions. Normative data were collected from 800 children in Mexico and Colombia, aged 5–16 years (Rosselli et al., 2010). In the present study the superimposed figures, mental calculation, and right–left orientation understanding subtests were used.
NEUROPSI attention and memory (NEUROPSI)
This neuropsychological battery was developed based on paper and pencil tests to assess a wide spectrum of cognitive functions including orientation, attention, memory, and executive functions. Normative data were collected from Spanish-speaking individuals, aged 6–85 years (Ostrosky-Solís et al., 2007). In the present study, the following subtests were used: wordlist, digit forward span, digit backward span, spatial forward span, visual search, digit detection, Stroop, word list (free recall, cued recall, recognition).
Battery for the assessment of executive functions and frontal lobes (BANFE)
This neuropsychological battery was developed based on paper and pencil tests to assess cognitive functions related to the prefrontal cortex, including planning, working memory, inhibition. Normative data were collected from Mexican Spanish-speaking individuals, aged 6–55 years (Flores and Ostrosky-Solís, 2008). In the present study, only the mazes subtest was used.
The study design is shown in Fig. 2. Subjects for the standardization were asked to play Chefmania. A subsample was then evaluated by trained psychologists for the obtention of concurrent validity data. For discriminant validity, a sample of children diagnosed with ADHD was recruited at a public mental health facility in Mexico City and asked to play chefmania.
Statistical analysis was carried out using the Statistical Package for Social Science (SPSS 21 for Windows). Only the data for those participants who completed all tasks were included. Performance measures were transformed into z scores for each age group and task. Subsequently, these were transformed into a scalar score according to the Wechsler Intelligence Scale standardized version for Mexico (Wechsler, 2003) with mean = 10 and standard deviation = 3, that is, a scalar score of 10 suggests an average performance within a specific age group, while scalar scores of 7 and 13 reflect a performance one standard deviation below and above the mean, respectively. To examine the effect of age on the performance we divided the sample into three groups (6–7, 8–9, and 10–12 years old) and performed an ANOVA. Pearson correlation tests were used for concurrent validity. Discriminant validity was obtained comparing the scores of children with ADHD vs. a paired sample from the standardization study using Student’s t-test, hypothesizing that the former group would show lower scores. Significance was set at p < 0.05 with 95% confidence intervals.