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If you want your child with ADHD to sit still, stay on task, and pay close attention, put him in front of a screen, preferably playing a video game.
In previous posts, we explored how kids show far fewer symptoms of ADHD (loss of focus, fidgeting, and disorganization) while engaged in screen-based technologies. But can playing video games improve ADHD? It’s logical that kids pay better attention to desirable activities such as video games — and, interestingly while playing with Legos or action figures — than to less desirable activities such as doing homework, having a conversation with family members, or doing chores. At the most basic level, the data indicate that technologies engage children in a way where inattention is less problematic.
This suggests that when done properly, online video game-like learning programs may be powerful for teaching kids with ADHD. This is supported by research dating back nearly two decades describing how computer programs such as Math Blaster and an online reading program called HeadSprout were more effective than teacher instruction for kids with ADHD. More recent findings support the use of computer-assisted technologies in video games to teach academic skills to children with ADHD. The recent announcement of Endeavor, an FDA-approved video game for the treatment of ADHD, by the digital medicine company Akili changes our way of thinking about the use of technology to help kids with ADHD and other neurodevelopmental disorders. We can now consider how video games can improve ADHD.
The recent study by Scott Kollins et al. in The Lancet found that kids with ADHD who played Endeavor for 25 minutes per day, five days per week for a month displayed significant improvement on a composite score of attention on the TOVA (Test of Variables of Attention), a commonly used neuropsychological test.
This well-designed, double-blind study of 348 children with ADHD is the largest study ever conducted in the area of digital mental health. The control group also played a cognitively challenging word game that maintained children’s focus but did not improve attention. However, there were no significant differences between the Endeavor and the control groups on parent-report measures of inattention, hyperactivity, working memory, or metacognition. Interestingly, an improvement on many of the parent-report measures was reported for both groups, perhaps reflective of the potential of other well-constructed video games for training academic or executive skills. This does not suggest that the gains in attention from using Endeavor are not meaningful but that the digital treatment of ADHD requires a multifaceted approach that builds on generalization opportunities to apply improved attention to real-world settings.
One of the main reasons to be optimistic about Endeavor as an effective ADHD treatment is that it was built on a video game platform. The developers recognized the need to have an engaging video-game experience comparable to that of popular video games that kids are already playing and chose to use an action genre — focused on gameplay, missions, rewards, and adventure to engage kids. Endeavor was built like most action video games to be adaptive and become more challenging as players succeed at different levels. This adaptive mechanism allows the game to be personalized, so while some players may progress more quickly than others, they still need to achieve a certain level of competence to go on to the following levels.
Previous research on the impact of playing popular video games on kids with ADHD has been mixed. Some studies suggest that playing for more than one hour increases inattention, while others demonstrate that kids with ADHD have more difficulty transitioning and stopping video gameplay than their non-ADHD peers. Parents routinely report that kids with ADHD often display irritable behavior after gameplay. However, those same parents readily acknowledge that symptoms of ADHD magically disappear when their children are engaged with popular video games. They also report that kids with ADHD are highly attentive and persistent in gameplay, displaying skills such as working memory, metacognition, planning, time management, and other executive skills. However, for the most part, there is not much evidence that using these skills in gameplay transfers them to real-world activities.
The scientists at Akili describe how Endeavor’s video game-like platform (named the Selective Stimulus Management Engine, or SSME) facilitates a type of attention that is able to be generalized to other situations requiring focus and sustained attention. SSME was “designed for the targeted activation of specific neural systems in the brain to treat diseases with associated cognitive dysfunction and presents specific sensory stimuli and simultaneous motor challenges designed to target and activate the neural systems that play a key role in attention function.” Endeavor is described as training “interference management” and requiring sustained focus and the ability to ignore distraction. This appears to be a sophisticated “go/no go” task.
The strongest previous evidence for video game-like tools to improve attention span comes from two distinct categories. The first has been a series of studies investigating go/no go tasks that often connect this type of training to improvements in inhibitory capacities and working memory. The second line of research describes how action video games can improve a variety of attention skills, including selective attention and processing speed. These are the video game mechanics that have been built into Endeavor.
Over the past decade, many brain training programs and digital medicine technologies have been criticized for overhyping the effectiveness of their products. All too often, these types of brain training and attention programs have produced modest effects on neuropsychological measures that assess a targeted skill but not in real-world improvement of the skill.
Treating a multi-faceted, complex disorder such as ADHD requires far more than a single intervention. At the same time, requirements for conducting well-designed research with a single independent variable often result in interventions that have a narrow scope and limited real-world applicability. Combining Endeavor with educational, executive-functioning, and behavioral interventions will be needed to see the most beneficial effects of this new digital medicine.
Akili will offer mobile behavior tracking to show treatment progress. Hopefully, strategies will follow that promote the transfer and generalizability of the skills practiced in Endeavor, perhaps in the form of “sister” digital medicine games, virtual reality modes, or making it more ecologically valid, will eventually describe its success as a treatment for ADHD.
