One day—and it might not be that far off—doctors could be prescribing what seems an unlikely treatment for ADHD: Play a video game over and over.
That’s the aim of Akili Interactive Labs, a Boston-based firm that hopes to become the first company to have a game approved by the FDA as a medical device to treat the condition.
It’s not just any game, of course, but one that’s been designed specifically to stimulate neural pathways in the prefrontal cortex, the part of the brain tied to a person’s ability to sustain attention and control impulsivity. And that, according to Akili co-founder and CEO Eddie Martucci, makes it more of a medical “delivery system” than a game, although it clearly feels like the latter.
As scientists have come to better understand how the brain works and how experiences can change that function, Martucci says, “The possibility for a novel digital approach to treat neurological disorders became real.” For several years now, he and his team have been exploring how to best use algorithms to create gameplay that focuses brain activity to get therapeutic results.
Recent research suggests Akili may be on the right track. A study involving 348 children between the ages of eight and 12 found that those who played Akili’s game on a tablet five days a week for four weeks had “statistically significant improvement” in metrics reflecting their attention and impulse control, compared to kids using a placebo, which in this case was another action video game.
Martucci is reluctant to describe his game in great detail because clinical trials are ongoing, but it’s designed to have players steer through an increasingly complex course, an activity that, he notes, “forces patients to make rapid decisions and prioritize multiple stimuli in a challenging environment.” Another feature: the experience can be adjusted to meet the personal needs of a patient. Some kids might need a lot of stimulation, others less.
None of the children in the study were taking medications for ADHD, since the goal was to see how effective the game could be on its own. Each game session lasted about half an hour, and according to Martucci, there were few adverse side effects—11 “treatment-related events,” primarily headaches and simple frustration.
What’s not known yet is how long the benefits of the treatment last, and what kind of effect it can have on a child’s ability to focus on a very different type of task, such as studying math. Additional research is expected to explore the game’s broader potential impact.
Will doctors prescribe it?
If the Akili game ultimately passes muster as an approved ADHD treatment, it no doubt will face some challenges. How will parents feel about daily game-playing as therapy? Will doctors prescribe it? Will insurers pay for it?
Martucci is confident that FDA approval is key, that once the game is validated as safe and effective, doctors will come to view it as a treatment option. He’s also realistic. “We know it will be hard work to get there,” he says, “but any new medicine is worth the work to get broad access to all patients.” The plan is to apply to the FDA sometime next year.
One thing in Akili’s favor is that this comes at a time when the federal agency is quickly expanding its view on what qualifies as a medical device. In the past few months, it has approved an app to treat substance abuse, a band for the Apple Watch that does EKG readings, and a “digital pill” that tracks when a person has taken a medication.
The prospect of a digital treatment for ADHD has generally prompted a positive response from other experts, although some feel more research needs to be done. Alan Schroeder, associate chief of research at Lucile Packard Children’s Hospital at Stanford, notes, for instance, that no comparisons in the study were made with children receiving other types of ADHD treatment, only with those playing the other game.
“From the perspective of a pediatrician who is quite concerned about excessive medication exposure to the U.S. pediatric population as a whole, I am enthusiastic about many non-pharmacologic interventions,” Schroeder says. But he adds, “While this approach to ADHD appears to have some promise, I think we have to be cautious, given that the study has yet to be peer-reviewed and that the comparator group is another video game. So, it remains to be determined how this intervention will measure up against current standards of care.”
Martucci says a more extensive analysis of the data is underway and will be presented in peer-reviewed publications and medical meetings in the coming months.
No matter how the process plays out, he says his company is committed to applying this kind of digital technology to treatment of other conditions, from adult depression to high-functioning autism to multiple sclerosis.
In fact, Martucci believes the general public is now more receptive to the idea of using games or other digital experiences to affect brain function.
“At the patient level, the world is starting to understand that not all screen time is created equal, or is bad,” he says. “Our aim is to continue to show not just benefits, but therapeutic benefits, of our specific type of medicine that comes through a screen.”