A brain-computer interface (BCI)–based video gaming system improves attention in children with attention-deficit/hyperactivity disorder (ADHD) by rewiring abnormal brain networks that regulate attention, suggest preliminary findings of the first brain imaging study to test the system.
The ATENTIVmynd (Atentiv LLC) gaming system has been studied in eight clinical trials of children with ADHD.
"The previous studies have shown benefit in terms of reduction of ADHD symptoms and improvement in academic skills, such as reading, comprehension, math fluency, and completion of homework. This study now shows that there is rewiring of the brain, that there is an actual change in the brain that occurs associated with the ATENTIVmynd intervention," Jonathan Rubin, MD, the company's chief medical officer, told Medscape Medical News.
The study was published online August 10 in Translational Psychiatry.
The BCI-based attention training gaming system consists of a headband with mounted electroencephalography (EEG) sensors that transmit EEG readings to the computer through Bluetooth.
Players use their brain waves to control an avatar to complete a task, such as running around an island in the shortest time possible. The more attentive the player is, the faster the avatar runs. The player is presented with challenges that target, measure, and teach attention and inhibitory control skills.
The brain imaging study, part of a larger randomized, controlled study of 172 children with ADHD, included 18 boys (mean age, 9 years) who played the game for 20 minutes 3 days per week for 8 weeks and a matched wait-list control arm of 11 boys with ADHD who received no intervention.
At baseline and 8 weeks, the researchers obtained resting-state functional MRI scans and assessed ADHD symptoms using the ADHD Rating Scale–IV.
Compared with the wait-list control persons, the gamers showed higher efficiency within the salience/ventral attention network, which is involved in orienting attention; this was correlated with fewer inattentive symptoms (r = 0.39; P = .038), report first author Xing Qian, PhD, of Duke–National University of Singapore Medical School, and colleagues.
The gamers also showed evidence of increased communication between the executive control network involved in orientation to external stimuli and the default mode network involved in daydreaming and mind wandering.
The data suggest that the gaming intervention "makes the brain in ADHD children more similar to the brain of children who are developmentally normal without ADHD. So now we have both the clinical finding and also the physical manifestation of the clinical finding," said Rubin.
"This new imaging study provides provocative preliminary evidence that changes in attentional functioning in ADHD patients as a result of treatment with the ATENTIVmynd game is mediated through neuroplastic processes," Scott Kollins, PhD, professor of psychiatry and behavioral sciences at Duke University School of Medicine and director of the Duke ADHD Program, Durham, North Carolina, who was not involved in the research, said in a news release issued by the company.
"These findings are an important step toward better understanding the mechanisms underlying novel approaches to treating ADHD," he added.
Digital Therapies Gaining Traction
Commenting on the findings for Medscape Medical News, Stephen Faraone, PhD, distinguished professor of psychiatry and of neuroscience and physiology, SUNY Upstate Medical University, Syracuse, New York, said that digital therapies for ADHD are "gaining traction" and that the results of this study are "very promising."
"One caveat," said Faraone, "is that the nonintervention group is poorly described. My guess is that it might not have been an adequate control for placebo effects. Thus, effects on inattentive symptoms should be viewed with caution. The imaging results are less likely to show placebo effects, but it is still possible," said Faraone.
The ATENTIVmynd platform is not yet commercially available. The company has met with the US Food and Drug Administration and has agreed on the design of a pivotal clinical trial that would support approval, Rubin said.
He also noted that currently, game is designed for children aged 8 to 12 years with ADHD or with attention problems in general. The company has plans to design a game for younger and older children and adults.
The ATENTIVmynd gaming system was developed by the Institute for Infocomm Research in Singapore and by Atentiv, LLC. The study was funded by the National Medical Research Council, Singapore, and the Duke-NUS Medical School Signature Research Program, which is funded by Ministry of Health, Singapore. The authors have disclosed no relevant financial relationships.
Transl Psychiatry. Published online August 10, 2018. Full text
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Cite this: Video Game 'Rewires' ADHD Brain to Improve Attention - Medscape - Aug 21, 2018.