New Digital Therapeutics for ADHD in Children

 New Digital Therapeutics for ADHD in Children : video : AVAILABLE IN YOUTUBE

https://www.additudemag.com/webinar/neurotechnology-options-adhd-treatment-children/

Dr. Randy Kulman is the founder of LearningWorks for Kids, an educational technology company that specializes in using video games to teach executive functioning and academic skills. He conducts neuropsychological evaluations of children with executive functioning and attention difficulties at South County Child and Family Consultants. His latest project is LW4K LIVE, a live, online, small-group executive function tutoring program that uses games such as Minecraft and Roblox to practice and improve executive functions. Dr. Kulman is the author of numerous essays, chapters, and books on the use of digital technologies for improving executive functioning skills in children, including Train Your Brain for Success: A Teenager’s Guide to Executive Functions, Playing Smarter in a Digital World, and the recently published The Gaming Overload Workbook for Teens.

Take-Aways

 Recognition of the extent that children with ADHD are engaged in video games and other technologies

 ● Understanding the impact of screen-based technologies and commercial video games on kids with ADHD ● Analyze how video games, XR, and neurotechnologies might be used to help kids with ADHD 

● Describe innovative digital therapeutics, digital medicines, and apps designed for kids with ADHD T

Reasons to Use Video Game, VR, XR, and Tech to Help Kids with ADHD

Analyze how video games, XR, and neurotechnologies might be used to help kids with ADHD ● Describe innovative digital therapeutics, digital medicines, and apps designed for kids with ADHD

What Are Video Games, VR, AR, XR, AI, and the Metaverse?

Video Games: An electronic game where players control images on a video screen ● VR (Virtual Reality): Computer-generated environment, making user feel immersed in surroundings ● AR (Augmented Reality): Integration of digital information with the environment in real time (Yellow lines on TV football/Pokémon Go) ● XR (Extended Reality): Catch-all term describing VR and AR ● AI (Artificial Intelligence): Machines that mimic human intelligence and improve themselves based upon information collected ● Metaverse: A VR space where users interact with a computergenerated environment and other users W

What Are the Characteristics of Interventions That Work Best for Children with ADHD?

Point of performance interventions ● Immediacy of feedback ● Powerful and engaging feedback and meaningful consequences ●Multimodal presentations and multiple intervention agents ●Individualized to child’s capacities ●Strategic teaching principles, including: previewing, setting explicit goals, partnering, metacognition, and generalization strategies

Reasons to Use Video Games and Technology to Help Kids with ADHD

ADHD kids often… — Have problems following directions, and video games require the user to understand instructions to succeed — Experience frustration and low self-esteem with learning, and negative feedback with video games is private which eliminates embarrassment — Are easily bored and struggle to sustain attention, and video games are multimodal with different engagement techniques to keep kids interested, attentive, and engaged — Benefit from reinforcement, and video games provide clear and immediate feedback, like sharing their experiences with others; technology is a way to connect — Search for a “dopamine rush” that they can receive from technologies.

Reasons to Use Video Games and Technology to Help Kids with ADHD

Excitement, fun, and cognitive engagement. At LW4K, we call it “engamement” ● Attentive, immersed, sustained focus, persistent, willing to overcome frustration ● Multimodal, immediate feedback, cognitively and physically interactive ● Negative feedback is private and teaches skills ● Kids feel like they are learning, creating, and improving

What Do We Know?

Parent, clinician, anecdotal observations… too much! ● More game play in ADHD kids (2.05 hours) vs. community control (1.44 hours) (Masi et al., 2021) ● Increased screen time throughout childhood associated with more ADHD symptoms at age 22 (Soares et al., 2021) ● Association of higher digital media use and subsequent symptoms of ADHD in 15- to 16-year-olds (Ra, et al., 2018) ● ADHD and non-ADHD 10-year-olds similar: > 2 hours/day playing video games ● ADHD kids have higher rate of compulsive video game use vs. controls (37.5% vs 11.8%) (Kietglaiwansiri & Chonchaiya, 2018)

Digital Therapeutics: 

Medical interventions using evidencebased, prescriptive, clinically evaluated software. Often seek government approval (FDA in U.S.)

 ● Digital Medicine: The use of technologies as tools for measurement and intervention that support the practice of medicine broadly ● Digital Health: Refers to the use of information and communication technologies (apps, brain training) to manage illnesses and to promote wellness ● Apps and Games: Consumer-directed, popular games and apps used as tools to help with learning, skill development, problem solving, and personal growth 

What Are Digital Therapeutics, Digital Medicine, Neurotechnologies, and Apps for ADHD?

 SLIDESMANIA.COM ADHD expert webinars additu.de/webinar Copyright © 2022 by ADDitude Sponsored by: SLIDESMANIA.COM ADHD expert webinars additu.de/webinar Copyright © 2022 by ADDitude Sponsored by: ● Evidence-based approaches and research ● Directly targets specific brain functions, skills, self-regulatory capacities, behaviors ● Built-in algorithms, adaptable ● A tool in the toolbox, adjunctive, used in combination with other interventions Characteristics of Video 

Problematic Behavior with Video Game Play in Children with ADHD

More than 1 hour/day is associated with short-term, increased signs of inattention (Taharoglu) ● Increased difficulty in transitioning and stopping video game play, resulting in more oppositionality ● More video game time is associated with increasing signs of inattention (Mazurek & Engelhardt, 2013) ● Video game play can be associated with video game addiction related to dopamine release in the brain (Han & colleagues, 2009) ● Total time spent with screen media is positively associated with attention problems (Swing, Gentile, et al., 2010) 

Research on Executive Function Skills and Positive Effects of Video Games

Increasing Processing Speed (Green & Bavelier 2009) ● Improving Working Memory (Klinberg et al., 2007) ● Increasing Pro-Social Behavior in Children (Gentile et al., 2009) ● Improving Social Involvement (Ferguson, 2010) ● Improving Executive-Functioning with Video Games (Kulman, Slobuski, & Seitsinger, 2014)

Evidence-based approaches and research

 ● Directly targets specific brain functions, skills, self-regulatory capacities, behaviors ● Built-in algorithms, adaptable ● A tool in the toolbox, adjunctive, used in combination with other interventions

What Is Mightier? 

A video game-based program, with more than 30 engaging games designed to help kids build emotional regulation skills. ● Age Range: 8 to 12 ● Target Diagnoses or Symptoms: Frustration, anger, oppositional behavior, anxiety, emotional regulation, inattentiveness, and hyperactivity ● Cost: Monthly subscription $40, Annual $336 ● Length of Use: Ongoing; Suggested use 3 times per week, 15 minutes per day

How Does It Work? 

Direct instruction in breathing and relaxation techniques and sustained practice of these skills via their heart rate monitor that controls game play. —Kids wear a wireless heart rate monitor on their arm while playing Mightier games —A graphic within the game shows them their heart rate —Players observe that if their heart rate rises due to excitement or anxiety, the games become harder —Using various calming skills taught within the gameplay, they learn how to bring their heart rate down. These same skills can then be applied in real-world situations of frustration, anger, or loss of control.

What Is Play Attention? 

A customized computer-based program that integrates feedback technology, attention training, executive function training, and behavior shaping. Player wears an armband that monitors neuro signals. These signals provide real-time feedback that demonstrates how inattention and distracted behaviors interfere with performance. ● Age Range: Children and adults ● Target Diagnoses or Symptoms: Sustained attention, directed attention, and executive functions ● Cost: Professional and home systems available ● Length of Use: 40 hours recommended. Lifetime membership

How Does It Work? 

—Uses a Body Wave armband that monitors brain activity indicative of attention —Provides direct feedback to user about their focus —Coaches initially assess attention and executive functions, then set up an individualized program —Targets specific skills such as time on task, attention stamina, short-term memory, working memory, and auditory processing —Individuals generally do their Play Attention exercises at home or in a professional setting for 1 hour per week

What Is XR Health?

A telehealth clinic where live online therapists guide patients in the use of virtual reality (VR) treatment. ADHD applications include boxing-like game in which players need to choose what stimuli to punch, what to avoid, and what distractions to ignore. ● How Does It Work? Virtual reality for ADHD uses a go/no-go task that practices selective attention and avoidance of distraction. VR increases willingness to practice. ● Age Range: 10 to 17 for ADHD, Adult applications as well ● Target Diagnoses or Symptoms: Concentration, attention, and hyperactivity ● Cost: May be covered by insurance. 3 levels for self-pay, $276 to $476 per month ● Length of Use: 3 to 6 months, 1 to 2 times per week

What Is DeepWell DTx? 

Video games and VR that use enhanced game mechanics and target neurological reward centers. Game play alone is the mechanism of action. ● How Does It Work? Intends to “balance visuospatial interference with vagus nerve stimulation” ● Age Range: Children and adults ● Target Diagnoses or Symptoms: Moderate symptoms of stress, anxiety, ADHD, and depression ● Cost: TBD ● Length of Use: Ongoing

● What Is L4WK.com?

 An educational platform using live and self-guided online classes that leverage popular video games as teaching tools. It uses games such as Minecraft, Roblox, and Pokémon to identify, practice, and apply executive functioning and social-emotional learning (SEL) skills. ● How Does It Work? Uses games that require the use of executive functioning skills such as time management, organization, planning, task initiation, and flexibility in their gameplay. Classes help children identify, think about, and apply executive functions by teaching them the skills that improve their game play and their real-world abilities to solve problems. ● Age Range: 6 to 13 ● Target Diagnoses or Symptoms: Executive function and SEL skills ● Cost: $5 per class or $19 monthly subscriptions ● Length of Use: Ongoing L

What Is Joon? 

A mobile game that turns daily tasks into a fun adventure for neurodivergent children. ● How Does It Work? Parents input their child’s daily routine and select from a list of ageappropriate habits they want their child to practice. Children earn coins and experience points by completing parent-assigned tasks. They use these points to take care of their online pet, explore Joon, and unlock new items. Joon ● Ages: 6 to 12 ● Target Diagnoses or Symptoms: Task initiation, motivation, focusing, task persistence ● Cost: Monthly $18.99, Yearly $89.99 ● Length of Use: Ongoing

 What Is EndeavorRX? 

An engaging video game in which players chase mystic creatures, race through different worlds, and problemsolve. It presents difficult challenges and adapts to the players’ skill levels. ● How Does It Work? A proprietary platform that engages cognitive networks. It is prescribed by a physician and then downloaded onto a mobile device. ● Age Range: 8 to 12 ● Target Diagnoses or Symptoms: Inattentive and combined-type ADHD, selective and sustained attention ● Cost: Insurance may pay for some patients; $99 maximum per month for a 3-month subscription ● Length of Use: 25 minutes per day, 5 days per week for 4 or 8 weeks E

Well-constructed studies that resulted in an FDA-authorized Class II software as a medical device STARS study (Software Treatment for Actively Reducing the Severity of ADHD) ● Randomized Controlled Trial — 348 subjects: 180 in experimental group, 168 in control — No medication for either group — 4 weeks of treatment, 25 minutes per day, 5 days per week — Experimental group improvements on the TOVA and parent-rated ADHD improvement ● STARS Adjunct Trial, open label study — 130 kids (ages 8 to 14, ADHD combined or inattentive) on meds, 76 no meds — 4 weeks on, 4 weeks off, 4 weeks on — Improvements on a variety of measures including the ADHD Rating Scale E

Additional Tools to Find Games for Kids with ADHD

● Learningworksforkids.com ● Lw4k.com ● ADDitude magazine ● Digital Therapeutics Alliance ● CHADD A

Playing Smarter in a Digital World: A Guide to Choosing and Using Video Games and Apps to Improve Executive Functioning in Children and Teens

“The book’s clearly articulated strategies help parents use digital media in a more effective manner and, at the same time, set effective limits and implement a healthy ‘play diet’ for their children. A section devoted to exploring specific strategies for using digital media with children in specific populations—such as children affected by ADHD, autism spectrum and learning disorders, and other mental health and educational issues—is also featured, as is a list of specific games, apps, and tools to make game-based learning most effective.

The Gaming Overload Workbook: A Teen’s Guide to Balancing Screen Time, Video Games, and Real Life

“A workbook for teenagers that embraces their love of video games and technology while helping them understand the impact of screen time on their lives. This was written so that teenagers feel understood but challenged to find balance between screen time and daily activities.”

Credits to : Randy Kulman, Ph.D