Digital Intervention for ADHD
A recent study published in The Lancet Digital Health suggests that a digital intervention for pediatric attention deficit hyperactivity disorder (ADHD) could potentially improve inattention in children aged 8-12 years with minimal adverse effects. While further analysis is needed to confirm the clinical significance of these findings, the digital nature of the intervention could enhance accessibility for patients.
Replacing conventional care with digital alternatives
ADHD is a childhood-onset disorder that affects approximately 5% of the global population. It is characterized by persistent impaired attention, hyperactivity, or impulsivity. Current treatments for ADHD include medication and evidence-based behavior therapy, but both have limitations. Limited availability of trained pediatric mental health specialists and services often restricts access to behavioral interventions. Additionally, some patients may not be suitable candidates for medication due to caregiver preferences or concerns about misuse and abuse.
While medication is highly effective in treating ADHD symptoms, it may not adequately address the day-to-day cognitive and functional impairments experienced by patients. Children with ADHD often struggle with social and academic functioning, which require complex skill acquisition over time. Treatment options that solely target symptom relief may not directly improve these difficulties. Digital alternatives to conventional care have shown promise in addressing these issues.
Video game-like intervention
In this study, researchers investigated whether a video game-like intervention designed to target attention and cognitive control could improve a validated score related to engagement (Test of Variables of Attention (TOVA) Attention Performance Index (API)). A total of 348 children aged 8-12 years were randomly assigned to either undergo the digital therapy (n=180) or a control therapy (n=168), which was designed to be a challenging and engaging digital word game.
Prior to the intervention or control, patients discontinued any medication for three days to establish a baseline attention score. Throughout the trial, participants did not take their ADHD medication. The intervention or control therapy was administered for 25 minutes daily, five days a week. Compliance was monitored electronically, and parents were notified via email if patients did not engage with the intervention for 48 hours.
Professor Scott Kollins of Duke University Medical Centre in the USA stated, “Our trial is one of the few randomized controlled investigations into digital interventions for children with ADHD. The improvement observed in attentional functioning among patients who received the active intervention was remarkable. However, further studies are needed to determine the full clinical significance of these findings. It is still uncertain whether this intervention should be considered an alternative to current treatments.”
On average, patients in the intervention group completed 83 out of 100 sessions over the four-week period, while the control group completed 96 out of 100 sessions. More patients in the intervention group showed significant improvement in their attention scores. Both the treatment and control groups demonstrated improvement in secondary outcomes, such as symptom ratings, but there were no significant differences between them.
No severe adverse events or discontinuations occurred during the trial. Only 12 children in the intervention group and three in the control group experienced treatment-related adverse events, with the most common being frustration and headaches.
The authors selected the TOVA API attention score as the primary endpoint in this trial, specifically targeting cognitive control and attention. This differs from traditional primary outcomes used in pharmacological treatment studies of ADHD, which rely on symptom rating scales. In this study, symptom rating scales were used as secondary outcomes, but no significant differences were found between the intervention and control groups.
A reliable and easy-to-access intervention
Co-author Dr. Elena Cañadas from Akili Interactive Labs in the USA stated, “These findings support the evidence that digital therapy is a reliable and easily accessible intervention that can address treatment delivery issues for many patients with ADHD. Further research should explore different scheduling and time requirements for treatment sessions, as well as long-term benefits.”
The authors acknowledge several limitations of the study. The four-week treatment duration is relatively short, and future research should investigate longer interventions and different video game-like therapy regimens. The results may not be applicable to the entire population of children with ADHD, as milder cases and those with significant psychiatric comorbidities were not included. Additionally, the trial did not allow children to take their regular medication, which may limit the generalizability of the findings to medicated individuals.
The study did not collect EEG data, which could have provided insights into the underlying mechanisms of the observed effects. Future research should also explore secondary outcomes related to behavioral improvements and further investigate the