EndeavorRx: A fun intervention to improve attention in children with ADHD
By Stephanie Barcan
Bachelor of Arts Student in (Honours) Psychology, McGill University, Canada | November 2023
Reviewed by Alexandre Lemyre, Ph.D.
Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder starting before age 12 and potentially lasting into adulthood. ADHD is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that impair daily functioning. According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), ADHD symptoms fall into two subtypes: inattentive and hyperactive-impulsive. Inattentiveness may be displayed through difficulty sustaining attention or poor organization. Hyperactivity/impulsivity may manifest through restlessness or frequent interruptions of others. ADHD symptoms can have significant impacts on daily functioning, which, in youth, may lead to lower academic performance and impaired social functioning.
ADHD is a relatively common disorder in children. The Centers for Disease Control and Prevention (CDC) report that an estimated 6 million (9.8%) US children between 3 and 17 years of age have been diagnosed with ADHD. Two main types of treatment are recommended: medication (for children over 6 years old) and behavior therapy. Overall, in 2016, 77% of children 2-17 years of age diagnosed with ADHD received treatment. Of these, 32% received combined treatment, 30% used medication alone, and 15% received behavior therapy alone. Additionally, in 2014, 90% of children with ADHD between 4 and 17 years received educational support in the form of school accommodations or support in the classroom.
EndeavorRx, developed by Akili Interactive Labs, is a novel digital therapeutic game designed to address ADHD in children between 8 and 12 years. This is the first video game to be authorized by the U.S. Food and Drug Administration (FDA) as an intervention for ADHD. The therapeutic game (designed for iOS and Android mobile devices and tablets) works by engaging the child in challenges that train their attention and working memory. Underlying the game are algorithms which continually adjust the difficulty level to match the child’s skill and attention level, promoting sustained engagement. Importantly, EndeavorRx is only available for U.S. residents and requires a prescription by a healthcare professional, meant as a complement to the child’s treatment.
According to the company’s website, FDA-authorization was received for EndeavorRx based on the findings of 5 clinical trials done with over 600 children diagnosed with ADHD. However, when searching in the scientific literature, we were only able to find the results of two trials. Before addressing these results, it is worth considering that both studies were conducted by researchers affiliated to Akili Interactive Labs and/or were sponsored by the company, which may have biased the presentation of the results to some extent. It is also possible that the decision not to publish the results of some studies was motivated by a desire to keep unfavorable results out of public view.
The first study compared EndeovorRX (intervention group) to the use of a digital word game that did not target cognitive domains primarily associated with ADHD (control group). The participants from each group used their respective digital game for five sessions per day, five days per week, for four weeks. In a computerized task measuring attention (the TOVA test), a greater proportion of participants in the intervention group (47%) displayed an improvement compared with the control group (32%). There was also a small difference in the proportion of parents who reported a subjective improvement in children’s attention (56% in the intervention group vs. 44% in the control group). However, there was no significant difference between the intervention group and the control group on several other variables, including inattention symptoms and hyperactivity symptoms (measured with the two subscales from the ADHD Rating Scale-IV), overall improvement in ADHD symptoms, and impairments associated with ADHD (e.g., in social relationships and academic progress). In the second study, after four weeks using EndeavorRx, there was an overall improvement in ADHD symptoms and a reduction in impairments related to ADHD, both in participants treated with medication and in those off medication. However, because this study did not include a control group, it does not inform on whether EndeavorRX can produce better results than regular digital games requiring sustained attention.
The company’s website reports evidence for the safety of EndeavorRX, with only minor side effects such as headaches or frustration being present in some participants (1.3% and 6.1%, respectively). However, it is worth noting that neither of the above-mentioned studies discussed the potential risk of videogame addiction presented by this type of intervention. This would be important, especially since individuals with ADHD are at increased risk for video-game addiction.
Overall, EndeavorRx may be considered as a potentially engaging complement to extant ADHD treatments.
The content of this article was last updated on November 1, 2023
