Gamified Interventions for ADHD: Wearables, Digital Therapeutics

Individuals with ADHD are uniquely impacted by video games, screen time, and technology, which we know can fragment attention, increase distraction, and potentially worsen social isolation. But can digital technology be harnessed to expand working memory, increase concentration, and improve ADHD symptoms in children, adolescents, and adults? That is a key research question today.

As this exciting new area of research and clinical development gains speed, my practice in St. Louis has been exploring more than a half-dozen digital technologies and measuring their impact on patients with certain mental health conditions, including ADHD and depression. We are encouraged by what we, and other practitioners and researchers, are seeing.

Editor’s Note: The American Academy of Pediatrics (AAP) recommends treating ADHD in children and adolescents with FDA-approved medications, plus parent training in behavior modification and behavioral classroom interventions. Research confirms that “stimulant medications are most effective, and combined medication and psychosocial treatment is the most beneficial treatment option for most adult patients with ADHD.”¹

Digital Technology: Benefits & Research

In a recent meta-analysis of 31 studies spanning more than 2,000 participants, digital interventions were found to significantly improve attention, executive function, and working memory in children ages 4 to 17 who had been diagnosed with ADHD. According to the analysis, published in 2023 by Frontiers in Psychiatry, digital therapeutics had a larger effect on inattentive symptoms than on hyperactive-impulsive symptoms.²

Here’s a glimpse into a few interventions, some of which I’ve been involved in developing, that have recently come to market or are being explored. Some of these interventions are supplements to ADHD medication therapy, and some are used to predict, diagnose, or monitor other health conditions.

[eBook: The ADDitude Guide to Brain Training for ADHD]

NeuroTrainer

This “mental fitness system,” which utilizes the Meta Quest virtual reality platform, was designed to improve focus, decision speed, and situational awareness. It was initially developed to help improve performance in athletes and is currently used by professional sports leagues including the NBA, NHL, and MLB, as well as the NCAA and elite athletes. This technology is also being explored to improve concentration, focus, and academic performance in academically at-risk high school and middle school students, including a clinical trial funded by the National Institutes of Health (NIH) and University of California (UC) Davis.

Revibe Technologies’ Wearable Reminder System

As a school psychologist, Rich Brancaccio saw firsthand the benefit of subtle reminders and cues to help improve attention and on-task performance for children with ADHD. What followed was his “light bulb” moment of utilizing wearable technology to offer digital cues and coaching reminders. Brancaccio founded Revibe Technologies, a digital therapeutics company that is exploring smartwatch technology that measures on-task behavior, concentration, focus and distractibility.

[ADDitude Directory: Find an ADHD Clinic]

This adaptive technology sends coaching reminders and cues during off-task behavior to help a child regain focus and, thus, bolster academic achievement. An initial study of 706 children with ADHD, ages 7 to 18, found a more than 25-minute increase in attention span and a 19 percent increase in on-task/focus behaviors after three weeks of using the Revibe watch. ^{3, 4} Two small open-label studies published in 2023 followed children ages 8 to 12 and found improvements in functional domains including attention, school learning, academic performance, working memory, initiation, and self-monitoring. ^{5, 6} A larger study is in development to gauge and measure similar improvements in children with ADHD throughout their school day.

Brain Training Programs by Lumos Labs

To help improve cognitive performance through digital interventions, this San Francisco-based lab is leveraging a massive data set of more than 100 million members who have played several billion gamified cognitive tasks on the lab’s Lumosity platform. The lab is also harnessing this large database of participants to develop digital biomarkers to predict, diagnose, or monitor cognitive challenges stemming from ADHD, multiple sclerosis, and other conditions.^{7, 8}

The lab’s first adult ADHD trial evaluated a series of cognitive-enhancing games to improve measures of attention on a continuous performance test, and assessed improvement in executive function and overall functional capacity in participants not receiving medication treatment. A second ADHD study is currently evaluating whether its technology can improve ADHD symptoms, cognitive performance, and quality of life in adults who are being treated with stimulant or non-stimulant medication. Pending the outcome of clinical trials, the lab plans to seek FDA approval to offer a digital therapeutic tailored to adults with ADHD as prescription digital medicine, said Bob Schafer, Ph.D., Chief Executive Officer of Lumos Labs, in a 2023 press release.

Akilli’s EndeavorRx for Children

This FDA-authorized video game, available by prescription for children ages 8 to 17 with ADHD, is meant to be played for 25 minutes, five days per week, for four consecutive weeks. In clinical studies involving more than 600 children with ADHD, EndeavorRx improved objective measures of attention, focus, and distractibility.⁹ In a 2021 study involving 206 children with ADHD ages 8 to 14, more than tw0-thirds of parents reported improvements in ADHD-related impairments after two months of treatment.¹⁰ No adverse side effects were reported.

EndeavorOTC for Adults

EndeavorOTC uses the EndeavorRx technology modified for adults with ADHD, and it does not require a prescription. A study of 220 adults using EndeavorOTC found improvements in ADHD-related symptoms, functional difficulties, and quality of life, the company said.^{11, 12, 13}

Many doctors, scientists, and researchers agree that these exciting new developments using technology to improve mental health are only the tip of the iceberg of what is to come. Harnessing digital therapeutics to expand working memory, and improve focus and concentration, is at the forefront of clinical development and research.

Digital Therapeutics for ADHD: Next Steps

• Download: Learn the Facts About Neurofeedback
• Read: A User’s Guide to Digital Therapeutics for ADHD
• Read: How to Leverage Video Game Psychology to Improve Your Child’s Behavior

Greg Mattingly, M.D., is an associate clinical professor at Washington University School of Medicine. He serves on the Scientific Advisory Board at Revibe and has been a principal investigator in trials for Akilli, Lumos Labs, and other digital therapeutics.

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