Spending 25 minutes a day with a video game-like intervention improved symptoms among adolescents with attention deficit-hyperactivity disorder (ADHD), a randomized control trial found. Among 348 adolescents, those assigned to the intervention — which involved a gaming therapy designed to improve attention and multitasking — had small but significant […]
Among 348 adolescents, those assigned to the intervention — which involved a gaming therapy designed to improve attention and multitasking — had small but significant improvements in Test of Variables of Attention-Attention Performance Index (TOVA-API) scores at 4 weeks compared with a control group that played a similar game targeting other, non-ADHD-related cognitive domains (0.88 vs 0.93, P=0.006), reported Scott Kollins, PhD, of Duke University in Durham, North Carolina, and colleagues.
However, patients in the intervention arm did not show significantly improved scores on parent and clinician ratings of ADHD symptoms and functional impairment versus the control group, they wrote in the Lancet Digital Health.
“Digital therapeutics have the potential to transform the way we provide healthcare [because] they are inherently safe and easy to access,” Kollins told MedPage Today. “Particularly with mental health, access to care is a huge issue and that is especially true for nonpharmacologic interventions like behavioral therapy.”
Moreover, efficacy was not assessed in all forms of ADHD, they noted.
“Some might argue that efficacy of digital health interventions should be shown on patients with all subtypes of ADHD, and analyses of effects on subtypes (e.g., predominantly inattentive ADHD) might be considered secondary,” the editorialists wrote.
Catalá-López and Hutton argued that “the study was unable to address a major challenge in treatment of children with ADHD”: The long-term efficacy of interventions on functional outcomes like school performance-social functioning.
“Thus, further research is needed to examine ways of sustaining treatment effects over the long term, in the broader population of children with ADHD including those who have comorbidities and receive evidence-based therapies,” they said.
But Kollins told MedPage Today the treatment, called AKL-T01, was specifically designed to target attention in children with ADHD, and shouldn’t be expected to affect other aspects such as hyperactivity-impulsivity.
“It made sense to measure in as rigorous a way as possible something that captures attention,” he said.
“That’s related to why I think we did not find as much effect on secondary measures, which are more traditional measures but are not as targeted,” Kollins said. He added that most secondary outcomes did show trends toward beneficial effects.
For the trial, children with baseline ADHD Rating Scale-IV (ADHD-RS-IV) scores of 28 or more, TOVA-API scores of -1.8 and below, and IQ scores of 80 or more were enrolled.
Eligible patients were randomized to either the attention-focused intervention or a word-matching game with a similar engagement level. After a 10-minute training session at one of 20 research institutions, participants performed the rest of the intervention at home, completing five sessions per day (for a total of about 25 minutes), five days per week.
Participants in both arms averaged about age 9.5, with mean baseline Clinical Global Impressions-Severity scores of about 4.5, ADHD-RS-IV scores of about 38, and Impairment Rating Scale scores of about -5.0.
In a stratified analysis, adolescents with a recent history of pharmacological intervention showed significantly higher symptom improvement in the intervention arm, which “could be related to biological factors associated with recent pharmacologic intervention, or psychological factors such as parents being more attuned to symptom changes in children recently treated with medication,” the authors noted.
In post-hoc analyses of various TOVA components, the intervention moved significantly more patients into the normative range in at least one measure (36% vs 21%, P=0.0027), Kollins’ group reported. Impairment Rating Scale (IRS) scores were also significantly higher compared with the control arm (48% vs 37%, P=0.49).
Finally, a small proportion of patients in the intervention and control groups reported adverse events across the study period (7% and 2%, respectively), the most common of which were frustration (3%) and headache (2%).
Study limitations included the substantial number of children with ADHD diagnoses excluded from the trial and the short-term intervention. Also, EEG data were not collected so the underlying mechanisms behind the findings warrant further study, the authors stated.