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?
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● 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
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