This week, the FDA gave its go-ahead for the first prescription video game to treat ADHD. According to the FDA’s press release, the game is appropriate for kids between 8 and 12 years of age who have either inattentive or combined ADHD.
If you’re having some deja vu, that might be because last year I wrote about another FDA first: the first non-drug treatment for ADHD approved by the FDA.
As I mentioned back then, even though a treatment being “FDA-approved” sounds impressive, all it really means is this: from what we know so far, the potential benefits of the treatment appear to be greater than the potential risks.
It’s worth asking, then, what the evidence is for those benefits?
According to the website of Akili, the company that makes the new prescription video game, the game (called EndeavorRx) is “clinically proven to improve objective attention in children with ADHD ages 8-12.”
That claim might immediately set off your “overhyped marketing” radar for a couple reasons:
- Psychology studies generally don’t “prove” anything
- It’s not clear what “objective attention” is
For the curious, though, Akili does offer a link to the study their claim is based on, which was published this year in Lancet Digital Health.
In that study, 348 children received either the video game ADHD treatment or a placebo. Their attention performance was assessed before and after using a diagnostic tool called TOVA.
Many ADHDers who have been through the diagnostic process will be familiar with TOVA. It’s a task where you have to selectively respond to certain images or sounds while ignoring others, with the idea that certain patterns of mistakes are indicative of inattention or impulsivity.
TOVA is often used as a data point by clinicians, but it’s not sufficient to make a diagnosis itself because it only seems to identify about 80 percent of people with ADHD, and it also inconveniently misidentifies about 30 percent of non-ADHD children as having clinical attention problems.
So when Akili says that its new video game improves “objective attention” what they mean is that children who received their video game treatment subsequently performed better on TOVA.
Now, to put those results in context, it’s necessary to get into the details of how the new video game actually works. When you play the video game, you have to switch back and forth between two different tasks. Here’s how the paper from Akili describes one of those tasks:
a perceptual discrimination targeting task in which users respond to the instructed stimulus targets and ignore the stimulus distractors (similar to a Go–No-Go task)
As the paper says, this is what psychologists call a “go/no-go” task because you have to selectively respond to some stimuli (images, sounds, etc.) while ignoring others.
And you know what else is a go/no-go task? TOVA. In other words, what this study essentially shows is that by practicing a video game with a go/no-go task, children seem to improve their performance on a test based on a go/no-go task.
The big question, then, is whether that improvement in a relatively narrow type of task generalizes to fewer symptoms of attention and impulsivity in real life. Unfortunately, the evidence presented in the Lancet Digital Health paper isn’t especially promising in that regard: the group that received the video game treatment did not see a significant improvement on a rating scale of ADHD symptoms.
In other words, while an “FDA-approved” video game that is “clinically proven to improve objective attention” sounds like a big deal at first, you realize when you dig into the details that the jury is still out on whether this treatment offers any substantial benefits to ADHDers.
What the study did show that is important for purposes of FDA approval is that side effects from the “treatment” (that is, the video game) tend to be mild and relatively uncommon. Still, “it’s not going to kill you” is a relatively low bar for an ADHD treatment.
Despite my skeptical take on the existing evidence for this treatment, I’m rooting for the idea of a video game that helps with ADHD. There’s definitely a need to explore a wider range of ADHD treatments than we currently have, and this game looks like a good step in that direction.
I’d love to see more evidence come out showing that playing this video game really does lead to symptom improvements in real-world settings. But based on the trials that have been done so far, I’m going to wait until that evidence actually comes out and not get my hopes too high.
Image: Flickr/One Tonne Life