A pilot study testing a multi-tasking game in children with autism and ADHD demonstrated feasibility, acceptability, and non-significant efficacy.
Benjamin Yerys, PhD
A pilot study has found that a video game designed to treat autism spectrum disorder (ASD) and co-occurring attention/deficit-hyperactivity disorder (ADHD) is acceptable to kids and parents and feasible. While not statistically significant, investigators did report an improvement in measures of attention for children who played with the multi-tasking game.
The game, Project Evo, has been previously studied in children with ADHD, but without co-occurring ASD. Investigators led by Benjamin Yerys, PhD, a child psychologist at the Center for Autism Research at Children’s Hospital of Philadelphia, wanted to test the digital medicine tool with this unique population of children with both diagnoses.
“How feasible is it to use a digital treatment for kids with autism?” asked Yerys in an interview with MD Magazine®. “There are very few such treatments that are out there—there are none that are FDA-approved.”
The question is particularly important because typical medications for ADHD, including methylphenidate, guanfacine, and atomoxetine, aren’t as successful at treating children with autism in addition to ADHD, Yerys added.
The Project Evo game requires children to multi-task by switching between a memory-based task and a visuomotor task. The first requires players to tap the screen to choose a target from a few options, for example, a blue fish as the target with red and yellow fish as distractions, according to the paper. The second task consists of steering a hovercraft along a river. The game’s difficulty increases as the child progresses.
The educational game that children in the control group were given tasked them with generating ever-longer words from a pool of letters.
Children assigned to either group demonstrated high engagement with the games, indicating feasibility of the treatment. Acceptability was measured by questions answered by children and their parents. Most children believed the games improved their attention (72.7% of multi- tasking group answered “yes” or “unsure,” as did 62.5% of educational group). Parents responded that they would want their child to continue playing with the game after the study (90.9% of the multi-tasking group said “yes” or “maybe,” as did 62.5% of the educational group).
Despite the study’s small sample size—just 19 children—the CHOP team also measured promising trends in attention scores for the patients assigned to the multi-tasking game compared to those in the control group.
“While it is extremely early, we did see things moving in the direction that has been seen in other studies,” said Yerys. “The performance on the measure of attention of sustained attention seemed to be in the direction of improving for kids in the active treatment group versus the kids in the control treatment group.”
The multi-tasking treatment group showed non-significant improvement as measured by the Attention Performance Index (API) score from the Test of Variables of Attention (TOVA), while the educational group showed non-significant losses on the API from TOVA. The multi-tasking group had a positive effect size (Hedges’ g = .72; 95% CI, − 2.68 - .98; P = .12) about twice that of the educational group’s negative effect (Hedges’ g = -.35; 95% CI, − 1.73, 3.08; P = .55).
“This treatment may be doing what we think it’s doing, which is to improve a certain aspect of cognitive function which can help reduce the negative effects of ADHD,” said Yerys, though he emphasized that with just 11 children participating in the active treatment group these results are not statistically significant.
Akili Interactive Labs, the company that designed the game, made minor modifications to the Project Evo game to better suit children with autism as well as ADHD. The study included a pilot phase a week before beginning where the children had access to the games and shared feedback with the investigators.
“One of the most critical things that we changed was in the learning rate,” said Yerys. “That learning rate is a critical piece because you want it to improve fast enough that the game is a challenge, because if the treatment isn't a challenge, then it's not actually pushing the system that they want to push with that treatment.”
Yerys indicated that the team is currently pursuing federal funding to continue this research.
"Based on the promising study results, we look forward to continuing to evaluate the potential for Project: Evo as a new treatment option for children with ASD and ADHD," Yerys said in a statement.
The paper, “Brief Report: Pilot Study of a Novel Interactive Digital Treatment to Improve Cognitive Control in Children with Autism Spectrum Disorder and Co-occurring ADHD Symptoms” was published in the Journal of Autism and Developmental Disorders.