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"Playing Your Medicine” - The First Prescription Video Game for Kids With ADHD

I call her my little hummingbird. Since she was a small child, my oldest daughter was constantly in motion. Her brain would be humming from the time she woke up until sundown. 

It was amusing mostly, frustrating at times, but overall, just the way my “little bird” was.  I learned how to better “read” my child, and she basked in the glow of performing for her mama.

Things went smoothly until the 5th grade. Unable to sit still, she started experiencing some social consequences of not paying attention and sitting still.

Luckily, with the help of a well-functioning school support team, I was able to secure a diagnosis of “Attention Deficit Hyperactivity Disorder”, or ADHD. 

“Birdie” was started on a stimulant medication and I began to notice a difference in her behavior. 

Unfortunately, she also noticed side effects of the medication. She was finally able to sit still but felt “all swirly angry-like a bumblebee” after her second dosage.

I wondered what our other options were, what else I could use in our toolbox of coping skills.

New Therapy in the Form of a Video Game

The Food and Drug Administration (FDA) announced marketing authorization of Akili Interactive’s EndeavorRx™ on June 15, 2020.  EndeavorRx™ is the only “prescription video game therapy” authorized on the market right now. Authorization was granted via a new premarket review pathway for low- to moderate-risk devices that are new. What does this mean for parents of kids with ADHD? Keep reading to learn more about EndeavorRx™.

What is ADHD? 

Attention Deficit and Hyperactivity Disorder (ADHD) is a common “neurodevelopmental”, meaning it affects brain development, disorder that affects approximately 400 million children ages 6-11. Main symptoms include high levels of activity, difficulty controlling behavior, and difficulty staying focused. 

Diagnosis of ADHD requires help of a trained health care professional and follows a comprehensive evaluation of symptoms or patterns of symptoms that affect your child’s overall quality of life. Healthcare providers use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, 5th edition (DSM-5) to diagnose ADHD. 

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

  1. 1. Combined-type presentation
  2. 2. Predominately inattentive presentation
  3. 3. Predominately hyperactive-impulsive presentation

How Does EndeavorRx™ Work?

The Endeavor™ treatment is known as a digital therapeutic. It is “indicated to improve attention function as measured by computer-based testing in children ages 8-12 years old with primarily inattentive or combined-type ADHD who have a demonstrated attention issue.”

It is designed to be used in conjunction with other therapeutic options in management of your child’s ADHD. The manufacturer clearly states that this is not a substitute for medication or other behavioral modification strategies that are already in place for your child.

Endeavor is not appropriate for use in children outside of the FDA approved use and is not available for them at this time. Parents and/or caregivers should consult with their child’s healthcare provider before using Endeavor treatment. It is also a required acknowledgement when registering for Endeavor treatment, 

The EndeavorRx™ Program Requires Users:

  1. 1) To interact with the game 30 min per day, five days per week over the course of a one-month treatment cycle
  2. 2) It does require a full month-long commitment to see the full benefit
  3. 3) After a month, your child is re-evaluated. If needed, therapy can be repeated one more month (after a four-week break)

Technical Aspects of EndeavorRx™

  • • Users access the program by downloading an app from their mobile devices’ app store
    • o There is no extra software needed
    • o Currently there is a wait list to sign-up for access to Endeavor™ which can be done here
    • • The game is designed to only let your child complete that day’s activities. Users cannot work ahead
    • • Parents track their child’s progress through a summary screen or download a separate app call ADHD Insight™

What Do the Studies About EndeavorRx™ Show?

EndeavorRx™ has been studied across five clinical trials in more than 600 children with ADHD. The most notable trial found that after four weeks of therapy, one third of children “no longer had a measurable attention deficit on at least one measure of objective attention.  Further, about half of parents saw a clinically meaningful change in their child’s day-to-day impairments after one month of treatment.”

You can read more about it here.

What is the Current Recommended Therapy for ADHD?

There are many therapeutic options for ADHD. Sometimes it takes some experimentation to find the right treatment for the individual child and family. Yes, you read that correctly, parents are involved in this too.

The two most common therapy options are:

1) medications 

2) behavior therapy

Some children find the side effects of medications undesirable. Parents can work with a pharmacist or prescriber to minimize these effects. EndeavorRx™ would provide another “non-drug’ therapy option for children with ADHD. It can also be used in combination with medication and behavior therapy.

What About Safety? Are there Any Side Effects?

Some children (less than 10%) experienced side effects such as frustration, headache, aggression, or dizziness. Parents are instructed to discontinue therapy and contact the child’s prescriber if this does occur. Effects are expected to be temporary and lessen with time. The manufacturer does caution against use if children have a history of epilepsy or seizures.

Parents may wonder about the increase in “screen time” while receiving this therapy. Akili follows the guidelines on media usage recommended by the American Academy of Pediatrics. The time it takes to complete therapy falls within this recommended range.

References:

Akili Interactive Labs, Inc. Endeavor ™Instructions for Use. Akili Interactive website.  Accessed June 25, 2020. https://my.akili.care/endeavor/IFU/Endeavor_IFU_1_3_0.pdf

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.

Centers for Disease Control and Prevention (CDC). ADHD Facts. CDC website. Accessed June 25, 2020. https://www.cdc.gov/ncbddd/adhd/facts.html

Centers for Disease Control and Prevention (CDC). Treatment of ADHD.CDC website. October 18, 2019. Accessed June 25, 2020. https://www.cdc.gov/ncbddd/adhd/treatment.html

Constance, Lilly. FDA OKs ADHD Video Game Therapy for Emergency Release During the Pandemic. ADDitude Magazine website. April 24, 2020. Accessed June 25, 2020.https://www.additudemag.com/akili-adhd-video-game-treatment-release-pandemic/

Endeavor Frequently Asked Questions. Akili Inc. website. Accessed June 25, 2020. https://my.akili.care/akiliassist/endeavor-faqs

Hollister, Sean. The FDA just approved the first prescription video game — it’s for kids with ADHD. The Verge website. June 15, 2020. Accessed June 24, 2020. https://www.theverge.com/2020/6/15/21292267/fda-adhd-video-game-prescription-endeavor-rx-akl-t01-project-evo 

 Kollins SH, DeLoss DJ, Cañadas E, et al. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial,The Lancet Digital Health,Volume 2, Issue 4,

2020,Pages e168-e178,ISSN 2589-7500,https://doi.org/10.1016/S2589-7500(20)30017-0.

U.S. Food and Drug Administration (FDA). FDA Permits Marketing of First Game-Based Digital Therapeutic to Improve Attention Function in Children with ADHD. FDA website. June 15, 2020. Accessed June 24, 2020. 

https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-game-based-digital-therapeutic-improve-attention-function-children-adhd

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