Prescribe a Video Game for Children with ADHD?by Natasha Tracy - November 2nd, 2020
Most of us know a child with attention deficit hyperactivity disorder (ADHD), as about 3-7% of children have ADHD. And while medication has traditionally been useful in treating this, now, is it possible that video games could be a prescription for childhood ADHD? Read on to learn about ADHD in children and how a video game can now be prescribed to treat children with ADHD.
Understanding About a Prescribed Video Game for Childhood Attention Deficit Hyperactivity Disorder
According to a survey of 184 adults, 42.9% of respondents know a child diagnosed with ADHD and 31.5% know more than one. This makes understanding ADHD in children critical for the vast majority of people. In this survey, 30.4% of respondents were parents to one or more children with ADHD.
When it comes to treating ADHD in children, only 12.5% of respondents felt that Food and Drug Administration (FDA)-approved medication was “very effective.” Of the respondents, 75.0% felt it was “somewhat effective,” while 12.5% felt it was “not effective.” When it came to treating childhood ADHD with therapy and education, 42.9% felt that was “very effective,” while 50.5% felt it was “somewhat effective,” and 6.5% felt it was “not effective.”
Of the respondents, 23.9% had heard of a video game being used to treat ADHD in children. When asked if an FDA-approved video game was used to treat childhood ADHD, 27.1% thought it would be “very effective,” while 64.1% thought it would be “somewhat effective” and 8.7% thought it would be “not effective.”
Given the option, 15.8% of respondents would try medication to treat ADHD in children first, while 66.9% of people would choose therapy and education first, and 17.4% would choose an FDA-approved video game first.
What Is Childhood Attention Deficit Hyperactivity Disorder?
Childhood attention deficit hyperactivity disorder (ADHD), previously more commonly known as attention deficit disorder (ADD), is also referred to as pediatric ADHD. Childhood ADHD is a disorder that is characterized by inattention and distractibility with or without hyperactivity. Specifically, children with ADHD have trouble focusing their attention on desired stimuli while inhibiting their attention to nonrelevant stimuli. Those with childhood ADHD also tend to focus on one thing to the exclusion of all others. So, in one case, children with ADHD can’t focus on anything, and in the other case, they can only focus on one thing.
In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), three types of pediatric ADHD are described. The following are the ADHD types and their diagnostic criteria:
1. Predominantly inattentive – This must include at least six of the following symptoms of inattention that must have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• Often has difficulty sustaining attention in tasks or play activities
• Often does not seem to listen to what is being said
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• Often has difficulties organizing tasks and activities
• Often avoids or strongly dislikes tasks (such as schoolwork or homework) that require sustained mental effort
• Often loses things necessary for tasks or activities (school assignments, pencils, books, tools, or toys)
• Often is easily distracted by extraneous stimuli
• Often forgetful in daily activities
2. Predominantly hyperactive/impulsive – This must include at least six of the following symptoms of hyperactivity-impulsivity that must have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
• Fidgeting with or tapping hands or feet, squirming in seat
• Leaving seat in classroom or in other situations in which remaining seated is expected
• Running about or climbing excessively in situations where this behavior is inappropriate (in adolescents, this may be limited to subjective feelings of restlessness)
• Difficulty playing or engaging in leisure activities quietly
• Unable to be or uncomfortable being still for extended periods of time (may be experienced by others as “on the go” or difficult to keep up with)
• Excessive talking
• Blurting out answers to questions before the questions have been completed
• Difficulty waiting in lines or awaiting turn in games or group situations
• Interrupting or intruding on others (for adolescents, this may intrude into or take over what others are doing)
3. Combined – This is when enough symptoms of both of the above types have been present for at least six months.
Other diagnostic criteria include:
• Onset is no later than age 12 years
• Symptoms must be present in two or more situations, such as school, work, or home
• The disturbance causes clinically significant distress or impairment in social, academic, or occupational functioning
• Disorder does not occur exclusively during the course of schizophrenia or other psychotic disorder and is not better accounted for by mood, anxiety, dissociative, personality disorder or substance intoxication or withdrawal
These symptoms tend to create issues in what is known as executive functioning. According to the Merriam-Webster dictionary, executive function includes the group of complex mental processes and cognitive abilities that control the skills required for goal-directed behavior.
According to Medscape, in the case of childhood ADHD, the six major tasks negatively impacted are:
1. Shifting from one mindset or strategy to another (also known as flexibility)
2. Organization (such as anticipating both needs and problems)
3. Planning (such as goal setting)
4. Working memory (i.e., receiving, storing, then retrieving information within short-term memory)
5. Separating affect from cognition (in other words detaching one's emotions from one's reason)
6. Inhibiting and regulating verbal and motoric action (such as jumping to conclusions too quickly, difficulty waiting in line in an appropriate fashion)
Standard Treatments for Children with ADHD
To no one’s surprise, video games have not traditionally been prescribed for childhood ADHD. Medication is the standard treatment for children with ADHD. Stimulant medications such as methylphenidate agents and amphetamine/mixed amphetamine salts agents are most common. Atomoxetine (Strattera) and guanfacine (Intuniv) are also options for childhood ADHD.
Educational therapies can also be useful in helping to improve academic work habits, organizational skills and approaches taken to school assignments.
In spite of the beliefs held by the survey respondents, unfortunately, behavioral and psychotherapeutic treatments have not been shown effective in treating the core symptoms of childhood ADHD. That said, many children with ADHD also have oppositional behaviors, parent-child problems, and social/peer problems and behavioral and psychotherapeutic treatments may help with these additional concerns.
Using an FDA-Approve Video Game to Treat Childhood Attention Deficit Hyperactivity Disorder
For the first time, the FDA has approved a video game for treatment of any condition – in this case, pediatric ADHD. This video game is for childhood ADHD of the inattentive or combined type. This game, EndeavorRx, is available by prescription only and is designed for children with ADHD ages 8-12. It’s designed to be used for 25 minutes, five days a week as a monthly treatment, to be used as long as a doctor sees fit.
According to Medical Daily,
“While playing the game, children will be given the task to control an avatar that they will then steer through a course that’s dotted with multiple obstacles, all while collecting targets to earn rewards.”
According to the study, “A Novel Digital Intervention for Actively Reducing Severity of Paediatric ADHD (STARS-ADHD): A Randomised Controlled Trial,” the video game for children with ADHD “significantly improved” performance on an objective measure of attention when compared with the control group (the group that did not use the ADHD video game). Additional symptoms of mean reaction time during infrequent target stimuli and response time variability showed “significantly greater improvements” when compared with the control group. However, when parents and clinicians rated childhood ADHD symptoms before and after video game usage, there was not a significant improvement when compared with the control group.
It is also important to note that EndeavorRx is not designed to be used as a standalone treatment or as a replacement for ADHD medication. This FDA-approved video game for childhood ADHD treatment should be used in a therapeutic program that may include therapy, medication and/or educational programs.
How Perceptions Meet Reality in Childhood ADHD Video Games
Unfortunately, even an FDA-approved video game for children with ADHD doesn’t produce the positive effects that parents and clinicians would want. While scientifically, there are significant gains that may help in the long run, parents and clinicians aren’t observing them. That means that even after using the video game for children with ADHD as prescribed, parents may not be satisfied with the outcome. This means that even though adults may not like it, medication remains the standard treatment for children with ADHD. That said, this FDA-approved video game may provide an additive benefit.
1. Wilkes, M., Pediatric Attention Deficit Hyperactivity Disorder (ADHD). Medscape, Updated Nov. 20, 2018.
2. Canadian Pharmacy King, Video Games, Kids and ADHD. SurveyMonkey, Sep. 30, 2020.
3. Merriam-Webster, Executive Function. Merriam-Webster.com, Accessed Oct. 19, 2020.
4. Medscape, Atomoxetine. Accessed Oct. 19. 2020.
5. Medscape, Guanfacine. Accessed Oct. 19, 2020.
6. Kollins, S. et al, “A Novel Digital Intervention for Actively Reducing Severity of Paediatric ADHD (STARS-ADHD): A Randomised Controlled Trial.” The Lancet, April 1, 2020.
7. Cortes, J., “FDA Reveals Video Game Prescribed Specifically For Kids With ADHD.” Medical Daily, Jun. 17, 2020.
8. Akili, “Akili Announces FDA Clearance of EndeavorRx™ for Children with ADHD, the First Prescription Treatment Delivered Through a Video Game.” Akili Interactive Labs, Jun. 15, 2020.