Around 14.5 million young people in the U.S. have ADHD, anxiety or depression, according to the CDC. And rates are only increasing.
While multiple treatments are effective at treating these conditions in young people, factors like clinician shortages can keep children from receiving care.
Gamification, a strategy that involves adding games or game-like elements to a task, could represent an accessible method to improve ADHD and depression symptoms among children and adolescents, according to a new meta-analysis published in Jama Pediatrics.
“Gamified [digital mental health interventions] (DMHIs) represent a novel way to deliver evidence-based mental health care in an accessible, scalable and engaging manner,” researchers wrote. “The findings suggest that gamified DMHIs may constitute a key piece of a comprehensive pediatric mental health treatment plan for youth with ADHD or depression.”
Other treatments have been demonstrated to be effective in treating or managing ADHD, including parent training, cognitive behavioral therapy (CBT) and stimulant and non-stimulant medications.
These treatments may not always be accessible, however. They are often limited to specialty clinics, and clinician shortages may lead to long wait times. Additionally, controlled substances may require regular in-person visits that could not be feasible for families.
DMHIs have demonstrated some efficacy, but still come with certain barriers. A teenager with low motivation or inattention may struggle to open an app, engage with digital content and then employ learned strategies in everyday life.
Gamification represents a novel method to improve engagement among adolescents with depression or ADHD.
Researchers analyzed 27 randomized clinical trials that tested the efficacy of gamified DMHIs to treat anxiety, depression and ADHD among children and adolescents. The 27 trials included a total of 2,911 participants across ADHD, depression and anxiety disorders.
The study found that gamified treatments resulted in modest effects for participants with ADHD and depression, and few clinical trials reported any adverse effects.
Effects for anxiety disorders were small and nonsignificant, though.
“Given that DMHIs show modest benefit for adults with anxiety, it is worth considering whether
gamified DMHIs use the optimal approach to delivering therapeutic components or whether therapists and other expert health care professionals are needed to deliver these therapeutic components (eg, exposure therapy),” the study’s authors wrote.
Delivery of the gamification strategies mattered. Using computers rather than modalities such as tablets or video games resulted in larger treatment effects. This could be because computers are stationary and placed in areas with limited distractions, according to researchers. Mobile options could be used in settings that have a higher likelihood of distractions, like the backseat of the car or doctor’s office waiting rooms.
Preset time limits for the duration of treatment also resulted in greater impacts.
To optimize outcomes, factors like setting and time limits should therefore be considered, according to the study.
Results differed based on patient demographics. Trials that included more male participants found that gamification was more impactful. Researchers specified that this distinction is not necessarily due to intrinsic differences between males and females.
“On one hand, this is consistent with literature identifying sex differences in the phenomenology, clinical presentation, and neurobiology of female individuals with ADHD,” the study’s authors wrote. “On the other hand, this finding may be less influenced by underlying neurobiological sex differences but rather the specific gamification approaches used in DMHIs to promote engagement.”
Some of the gamification strategies, including action and driving games, may not have appealed equally to males and females, researchers wrote.
The study did have limitations. Most of the analyzed trials relied on outcome measures reported by parents or children, which could create bias. Some factors, like digital literacy and social determinants, were not examined by all trials, and could influence treatment efficacy.