Pills or pixels?
That's a question being asked more often than ever by those impacted by Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, anxiety, depression, and a range of executive functioning issues.
About 6.4 million children and roughly 8 million adults are thought to have attention disorders. Many of them face difficulties at school, at work, and in their daily lives.
The first-line treatments for ADD and ADHD are powerful stimulant drugs like Ritalin and Adderall.
But there's a new solution gaining traction: video games, with entirely novel user interfaces, that can, their producers say, help people retrain their brains.
A 9-year-old boy named Hayden lives near Newton, Mass. His mother Sandra, (who agreed to be interviewed on the condition that her and her son used only their first names), started noticing school and behavioral issues in Hayden when he was in kindergarten.
"When he’s watching TV he’s so superfocused that I ask him, what do you want for breakfast, and he doesn't hear me," she says. "He’s very distractible. He has impulses. He has trouble being able to sit and listen and follow directions."
Sandra was reluctant to put her son on a pill he could be dependent on for years. Instead, she jumped at the chance to enroll him in a trial of a new technological solution, Atentiv.
Atentiv has been under development since 2007, originally at Duke University. Kids strap on a Bluetooth headset to play a game that involves a runner crossing a landscape, something like what's done in Temple Run. When you focus, the runner speeds up; when you get distracted, he slows down.
"It's a simple applied EEG device that measures your levels of attention in real time," says founder Eric Gordon, whose background is in biotech. "We target the actual neural network in your frontal lobe to be able to understand and articulate what your impulse level is. We teach the child how to manage distractions and impulse control." Their trials show that 75% to 85% of kids improve their symptoms over time.
The field of "brain training" games is controversial.
Although many studies show these games build working memory, researchers disagree on whether the gains are applicable outside of the narrow context of the game. A meta-analysis of major studies on the topic published earlier this year concluded that playing the games did not lead to improvement on math, reading, or other intelligence tests.
Gordon claims that Atentiv's technology is both more advanced and more targeted than what's come before. One feature that seems to be different is that players aren't just passively building their attention, they're learning to be aware of when it is drifting and bring it back under conscious control.
"It’s not a general brain game," he says. "Our intellectual property is to be able to understand instantly your attention level. We can tell when they’re moving from 66% to 65% of attention, and in that instant, they can adjust, like when you're losing balance on a bike and you adjust the steering or push on the pedals."
Sandra saw "tremendous" improvements in her son after Hayden received several hours of Atentiv training through the clinical trial, three times a week for eight weeks. Hayden's teacher stopped calling with discipline issues. His homework was neat and on time. Handwriting improved. He had an easier time falling asleep at night. He fought less with his older sister and with friends. However, after the game stopped, the behavioral improvements faded. "I would definitely incorporate this into my son's life if I could," says Sandra.
For now Atentiv’s founders are not seeking FDA approval for their technology, which means they can’t make fact-based claims about ADHD. Instead they are launching in May of next year with a $259 consumer product aimed at parents seeking a drug-free solution for their kids' attention problems. CEO Eric Gordon is confident that the technology will eventually lead to clinical products for treating not just ADHD but memory and abstract reasoning, in children, adults and the elderly.
CogCubed is another video game in development aimed at the diagnosis and treatment of executive functioning disorders including ADD. This startup uses Sifteo Cubes, an interactive game system developed at MIT in 2011 that consists of a set of white cubes that resemble dice with touch screens, or mini iPhones. Move, stack or tap the cubes—they communicate wirelessly and the image on the screen changes in response. This system is known as a "tangible user interface," a coding cousin of "graphical user interface."
CogCubed cofounder Kurt Roots, along with his wife Monika Heller, a child psychiatrist, and engineer Jaideep Srivastava, also created a game called Groundskeeper that resembles the old arcade game Whack-a-Mole. Players must ignore distractions like tweeting birds or the image of a squirrel popping up in order to succeed.
The company's technology focuses on capturing and analyzing players' actions: are they rocking from side to side to soothe themselves? Can they inhibit the impulse to grab the wrong cube when it makes a noise? What is their reaction time? "We know that during gameplay, lots of microdecisions are made by the player," says Roots. "We’re not so much concerned with the response, as with the steps taken to get to the response. These are undetectable with traditional laptops or desktops."
In a pilot study at the University of Minnesota, the game demonstrated a surprising power to diagnose ADHD as people play. After 30 minutes, it could accurately detect the presence of the condition, as well as the subtype of the condition, 75% to 78% of the time, compared to 65% for other existing methods.
CogCubed is in Phase II clinical trials at Johns Hopkins. They are pursuing FDA approval as a medical device to diagnose not only attention disorders, but other conditions affecting executive functioning in the brain: anxiety, depression, autism spectrum disorders, traumatic brain injuries and Alzheimer’s, and even obesity, as it relates to the ability to self-regulate. CogCubed's creators are also piloting a version of the game at a private school to actually treat attention disorders, by gradually sensitizing students to exactly the kind of stimulus they find most distracting.
The science is clearly in early stages here, but the initial results are promising for moms like Sandra.
"For any parent it’s so comforting to show your child he’s not alone and we’re aware and trying to help him," she says. "I always use the metaphor with him that your brain is a muscle, like your heart, and you can make it stronger."