A User’s Guide to Digital Therapeutics for ADHD

Virtual reality games with stimuli to punch or avoid. Video games requiring problem-solving strategies to save the galaxy from a meteor storm. A to-do app designed to help kids follow routines. These are some of the new technology-based tools — some of which are considered digital therapeutics — that promise to help patients with attention deficit hyperactivity disorder (ADHD) and related conditions like anxiety and depression.

Most emerging digital therapy companies emphasize the power of technology to engage patients and maintain treatment compliance. This is particularly true for technologies that use video game-like interfaces, including wearable technologies and virtual reality (VR), as a mode of delivery. Industry leaders say digital therapeutics should be seen as “a tool in the toolbox,” along with clinician visits, ADHD medication, and psychoeducation, to maximize impact.

Some of these interventions require a prescription and are monitored by physicians or other clinicians. Read on to learn about the most promising tools to date.

NOTE: All product/service names, models, prices, links, and specifications were accurate at the time of this article's publication.

Akili Interactive touts its product, EndeavorRx, as “the only doctor-prescribed video game treatment for kids with ADHD” that has received FDA authorization. In a company-funded study published in 2020, data showed that the video game improved ADHD symptoms in children when used at home for four weeks.

EndeavorRx is prescribed by a physician and then downloaded onto a mobile device. Within the game, players chase mystical creatures through different worlds, and they must problem‑solve to unlock new characters and build their own universe. It is fast-moving and designed to present increasingly difficult challenges. Players must multitask and avoid distractions and obstacles to advance through all the levels of the game.

• Age Range: 8-12
• Targets: Inattentive and combined subtypes, selective and sustained attention
• How it works: Children play a game that requires them to use problem-solving skills to advance and maintain focus to avoid obstacles. Real-time algorithms adjust the difficulty based on the player’s performance.
• Cost: $99 for a three-month subscription. Some insurance plans may cover the cost.
• Length of use: 25 minutes per day, 5 days per week, for 4 or more weeks
• Website: www.endeavorrx.com

[Read: Video Games Can Help Kids with ADHD – If You Choose Wisely]

XRHealth is a VR telehealth clinic offering physical, occupational, speech-language, and mental-health therapy; cognitive training; and support groups for a variety of conditions. Patients begin by meeting with a therapist, who conducts an assessment, determines the safety of VR for the individual, and develops a treatment plan. VR allows the therapist to measure how the patient reacts and adjust as needed. Applications for kids with ADHD include a boxing-like game in which players choose which stimuli to punch, which to avoid, and what distractions to ignore.

• Age Range: 10-17 for kids with ADHD; adult applications as well
• Targets: Concentration, attention, and hyperactivity
• How it works: Virtual reality presents a go/no-go task that allows users to practice selective attention and distraction avoidance. The immersive nature increases attention and willingness to practice.
• Cost: Three levels of care for $276, $356, or $476 per month, including online therapy sessions that vary in length. Some insurance plans may cover the cost.
• Length of use: Once or twice per week for 3 to 6 months
• Website: www.xr.health

Joon is a downloadable app that’s designed to make tasks, or “quests,” fun for kids to complete. Parents and kids both need access to a mobile device where they can keep track of their quests. First, parents choose from a small list of recommended quests (i.e., chores, homework) for their child. Then the child chooses a virtual pet that requires their care. As they complete their parent-assigned tasks, the child can level up their pet and explore new worlds within the game. Joon says it can help kids complete tasks more efficiently and without the nagging that often accompanies homework and chores.

• Age Range: 8-12
• Targets: Task initiation, motivation, focusing, task persistence
• How it works: Joon rewards children with coins and points to motivate them to complete routine chores and develop new skills. Parents can modify expectations and rewards.
• Cost: $89.99 per year, or $18.99 month-to-month
• Length of use: Ongoing
• Website: www.joonapp.io

[Read: 10 Behavior Chart Rewards to Motivate Your Child]

Calmsie has developed a video game that includes real-time elements of cognitive behavioral therapy (CBT) to help with anxiety, depression, and emotional challenges. Avatars guide kids through conversational CBT sessions designed to help them gain better control of their thoughts, emotions, and actions. The players must use these skills to “save the galaxy from a meteor storm.”

The game is seen as a complement to the medical and therapeutic treatment of anxiety and depression.

• Age Range: 8-12
• Targets: Depression, anxiety, and emotional challenges
• How it works: Calmsie uses a daily CBT session with a videobot. Through real-time conversations, the child learns effective ways to cope with challenging emotions.
• Cost: Not yet available
• Length of use: 17 to 25 minutes per day for 28 consecutive days
• Website: calmsie.ai

Mightier offers more than 30 engaging video games designed to help kids build emotional regulation skills. The patient wears a wireless heart rate monitor on their arm and can see their heart rate in a box on the screen while they play. When a child’s heart rate rises due to excitement or anxiety, the games become harder. The player must then bring their heart rate down using various calming exercises taught within the gameplay. The idea is that these skills can then be applied in real-world situations.

• Age Range: 8-12
• Targets: Frustration, anger, oppositional behavior, anxiety, emotional dysregulation, inattention, and hyperactivity
• How it works: The games offer direct instruction in breathing and relaxation techniques. The system encourages sustained practice of the skills and monitors their effectiveness via the heart rate monitor.
• Cost: $336 per year, or $40 month-to-month
• Length of use: Ongoing; suggested use 15 minutes per day, three times per week.
• Website: www.mightier.com

Revibe Technologies released Revibe Connect, a wearable watch-like device, in 2018. The device sends vibration reminders to redirect children to stay on task or get back to work. Parents and teachers set the initial schedule of alerts (could be 15 minutes of work time with reminders every 5 minutes). They can also program custom text messages to display at designated times, such as “write down your homework assignment.” Revibe Connect was designed to track attention span, focus rate, motor activity, and fidgeting, and generate reports on a child’s progress.

The company announced in 2022 that it was discontinuing sales of Revibe Connect to focus on newer products, including “FokusRx,” an investigational SaMD (software as a medical device) for ADHD still in early development.

Digital Therapeutics for ADHD: Next Steps

• Free Download: Brain-Boosting Video Games
• Read: 10 Best Brain Training Programs for Children with ADHD
• Read: 7 Ways to Maximize the Impact of Brain Training

Randy Kulman, Ph.D., is the founder and president of LearningWorks for Kids, an educational technology company that specializes in using video games and interactive digital media to teach executive-functioning and academic skills.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.