Psychologists, physicians, parents, and educators have attempted a variety of strategies to treat ADHD. Treatment strategies include varying combinations of behavioral, educational, social, and medication therapy, the last of which is considered the frontline treatment for ADHD. However, there are legitimate concerns about the side effects of ADHD medications and the short-term nature of their benefits. But what if medications weren’t the only FDA-approved treatment for ADHD? What if there was a video game to treat ADHD? A prescription video game?
Over the last decade, the use of digital media to treat the symptoms of ADHD has emerged. Dozens of games, apps, and neurotechnologies have been developed that can help children and adults with ADHD. Some of these tools were created specifically as ADHD therapy, while others happen to target skills that are problem areas for kids with ADHD.
Because ADHD is a disorder of executive functions, any game or app that can improve or support focus, organization, time management, planning, and other executive skills may be helpful for kids with ADHD. There is evidence that puzzle and problem-solving games and apps can improve working-memory skills, first-person shooters can improve selective attention, and certain action games can improve processing speed.
LearningWorks for Kids has long recommended the use of video games and technologies such as these as part of ADHD therapy. But never before has a video game received the approval of the FDA as a proven treatment specifically for ADHD. Boston-based Akili Interactive Labs is working to change that with their flagship product, Project: EVO; a medical device built to appear like an action video game. Akili recently presented data at the American Academy of Child and Adolescent Psychiatry from a pilot study indicating that playing Project: EVO improved attention, working memory, and inhibitory control, three of the major areas used to diagnose and assess ADHD.
The study was reflective of the role that technology will be assuming in the treatment of ADHD and other mental health issues. It was designed with future FDA interaction in mind, meaning that it was structured like a pharmaceutical study rather than a psychological study and used widely known and accepted assessment tools (TOVA, BRIEF, and CANTAB) to collect pre- and post-data.
The results of the study are extremely informative. Forty children previously diagnosed with ADHD participated in the study, and not one dropped out during it, a rarity. I suspect that’s because the participants found the video- game treatment to be immersive and engaging.
The improvements that were observed were consistent with what we already know about video games. Gains made in memory were specifically visual-spatial, an area to which we know adaptive video games (those that get increasingly challenging) are uniquely suited. These working-memory improvements were seen in parent report data as well as in neuropsychological testing.
Participants also demonstrated improvement in their reaction times and the variability of their responsiveness, both subtle but key measures of attention and the capacity for response inhibition. Overall, 32% of the kids diagnosed with ADHD moved into the “neurotypical” (average, non ADHD) range on the Attention Performance Index of the TOVA. Essentially, this means that by the end of the 9-hour intervention that took place over 4 weeks, 32% of the kids previously diagnosed with ADHD did not exhibit one of the major characteristics of ADHD.
As a preliminary study this is very promising. The fact that Project Evo is home-based, easily administered, and well-tolerated by kids is important. It is highly conceivable that a lengthier, more varied, ongoing administration of this therapy would produce even stronger results. As is the case with many technological interventions, however, we need to consider how well these results transfer (generalize) to the real world and how effectively they are maintained. The research and knowledge of the use video games and other technologies to treat ADHD, autism, learning disabilities, and other executive-functioning issues is moving from its infancy into toddlerhood. Well-controlled research such as this study will be helpful in determining key factors in gaming and technology that can improve symptoms and build skills that translate to the real world.
While this study is promising, it is important to note that the developers of Project: EVO do not describe it as a cure-all, very clearly stating that medication is the frontline treatment for children with ADHD. However, as many of us who treat ADHD recognize, a multimodal approach to ADHD works best. Medication alone is often insufficient, and non-medication techniques have always been the preferred method of treating kids with modest ADHD symptoms. In fact, new research suggests that behavioral interventions should be attempted before medication is prescribed. Engaging and easy-to-apply neurotechnological treatments such as Project: EVO hold great promise for the future of ADHD treatment.