Can We Play with ADHD? An Alternative Game-Based Treatment for Inattentive Symptoms in Attention-Deficit/Hyperactivity Disorder

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder presenting in early childhood with persistent, pervasive and impairing symptoms. It is also associated with other problematic mental health issues and negative outcomes, such as aggression, difficulties forming relationships and academic and occupational problems. Current standard treatments for ADHD include pharmacological treatments with stimulants and other medications, psychosocial interventions such as behavioural modifications, or a combination of both approaches (multi-modal approach consisting of parent education, medication and behaviour management for the child). There is interest in understanding effective non-pharmacological treatments for ADHD, given the temporary effects of medication and recent controversies on over-medicating children with ADHD. The use of neurofeedback treatment and cognitive training offers a promising new area for clinicians. We present a brain–computer interface (BCI)-based neurofeedback and cognitive training programme targeting the inattentive symptoms of ADHD in this chapter. The concept of an individualized model of attention is one of the features of the BCI training system. Incorporating this attention model into an innovative game targeted at ADHD children is another unique feature of this system. Recognizing the importance of validating serious games for the use of therapy, we have conducted several trials testing out the validity and playability of the BCI game, including a pilot phase and a larger randomized controlled trial. Currently, the future of this BCI-based treatment for ADHD is promising and we hope that, through our research efforts, it may prove to be an effective and viable treatment option that also appeals to the game-playing nature of children.

Annex 1

1.1 DSM-5

• A. Either (1) or (2):

• 1. Inattention:

Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least 5 symptoms are required.

• (a) Often fails to give close attention to details or makes careless mistakes in schoolwork, at work or during other activities (e.g. overlooks or misses details, work is inaccurate).

• (b) Often has difficulty sustaining attention in tasks or play activities (e.g. has difficulty remaining focused during lectures, conversations or lengthy reading).

• (c) Often does not seem to listen when spoken to directly (e.g. mind seems elsewhere, even in the absence of any obvious distraction).

• (d) Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (e.g. starts tasks but quickly loses focus and is easily sidetracked).

• (e) Often has difficulty organizing tasks and activities (e.g. difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

• (f) Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (e.g. schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

• (g) Often loses things necessary for tasks or activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

• (h) Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

• (i) Is often forgetful in daily activities (e.g. doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

• 2. Hyperactivity and impulsivity:

Six (or more) of the following symptoms of hyperactivity–impulsivity have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least 5 symptoms are required.

• (a) Often fidgets with or taps hands or feet or squirms in seat.

• (b) Often leaves seat in situations when remaining seated is expected (e.g. leaves his or her place in the classroom, in the office or other workplace or in other situations that require remaining in place).

• (c) Often runs about or climbs in situations where it is inappropriate (Note: in adolescents or adults, may be limited to feeling restless).

• (d) Unable to play or engage in leisure activities quietly.

• (e) Is often ‘on the go’, acting as if ‘driven by a motor’ (e.g. is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

• (f) Often talks excessively.

• (g) Often blurts out an answer before a question has been completed (e.g. completes other people’s sentences; cannot wait for turn in conversation).

• (h) Often has difficulty waiting his or her turn (e.g. while waiting in line).

• (i) Often interrupts or intrudes on others (e.g. butts into conversations, games or activities; may start using other people’s things without asking or receiving permission; for adolescents or adults, may intrude into or take over what others are doing).

• A. Several inattentive or hyperactive–impulsive symptoms were present prior to age 12.

• B. Several inattentive or hyperactive–impulsive symptoms are present in two or more settings (e.g. at home, school or work; with friends or relatives; in other activities).

• C. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic or occupational functioning.

• D. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Specify whether:

• 314.01 (F90.2) Combined Presentation: If both Criteria A1 and A2 are met for the past 6 months

• 314.00 (F90.0) Predominantly Inattentive Presentation: If Criterion A1 is met, but Criterion A2 is not met for the past 6 months

• 314.01 (F90.1) Predominantly Hyperactive–Impulsive Presentation: If Criterion A2 is met, but Criterion A1 is not met for the past 6 months.