November 23, 2022 – You might not think that children with attention deficit hyperactivity disorder, or ADHD, have much in common with older adults.
Children find it difficult to sit still and concentrate on a task. Older adults are good at sitting still, but they often struggle to follow the conversation at a holiday dinner.
In both cases, the problem is one of attention.
Yes, it is obvious to someone who has been diagnosed with ADHD. It’s right there in the name. With ADHD, the brain is constantly looking for new and interesting ways to distract itself.
But old people are not looking for distractions. They simply cannot ignore the distractions that find them.
“Focusing has two sides: focusing and ignoring,” says Adam Gazzaley, MD, PhD, professor of neuroscience at the University of California, San Francisco. “It’s filtering out irrelevant information that diminishes with age.”
That’s why Gazzaley invented EndeavorRx, a therapeutic video game you may have heard of, especially if your child has ADHD. In 2020, FDA Approved EndeavorRx to treat children with ADHD between the ages of 8 and 12, making it the first digital therapy to get the green light for any condition.
What you might not know is that the game was originally used to help the elderly. Or that therapeutic games are now being developed and tested for a wide range of conditions and populations.
Gazzaley calls it “experimental medicine” and says it has one major advantage over traditional medicine: it adapts to you. As the patient learns to play the game, the game learns to work with the patient.
How video games work as exercises for your brain
This adaptive quality is the key to EndeavorRx and what differentiates it from commercial video games. Gazzaley calls it an “adaptive closed-loop algorithm”.
Simply put, the game adapts to the player. Better players encounter tougher challenges, while those with less skill can still work through the game’s levels and unlock its rewards.
Your brain, in turn, adapts to challenges with structural changes, much like the adaptations your body makes when you exercise.
Just as your muscles respond to strength training by getting bigger and stronger, your brain adapts to challenges by forming new connections between and within neural networks. It works the same for all ages, whether you’re an older adult who’s never played a video game or a youngster who may have played too much. (worth noting too) lots of play can harm your mental health.)
The ability of the brain to adapt to new information, circumstances or demands is called neuroplasticity, and it is the main advantage of experiential medicine over drug treatments. The changes in the brain not only result in actual improvements in attention, but they also remain intact after the patient completes the prescribed time with the game.
“It sticks, which is incredibly different from how drugs work now,” Gazzaley says.
The treatment of children with ADHD is just one of many potential applications.
“The game has no specificity towards a particular pathology or age group,” says Gazzaley. “It challenges the brain in such a way that it leads to this sustained attention advantage in all the populations we tested.”
Case in point: He and his colleagues at UCSF have now tested closed-loop games with people with depression, multiple sclerosis, and lupus, all of which can affect ability to concentrate.
But it all started with a very specific population.
How video games became therapy
In the early 2000s, Gazzaley worked with elderly patients who had problems with thinking skills for the first time.
“They often told me they were distracted,” he says. “They just couldn’t hold their attention.”
This led to a series of studies on the source of the problem. In a study published in 2005for example, his research team found that older adults could focus on a task as well as 20-year-olds.
“What they weren’t doing was ignoring,” he explains. “There is so much irrelevant information that needs to be filtered out. That’s what caused the deficiency.
A later study which was published in 2008 found that the impairment was made worse by a slowing in the processing speed of the brain. It took longer for older adults to decide whether an interruption actually required their attention, which meant that each distraction was more disruptive than it would have been for younger themselves.
For seniors, these challenges are especially apparent when trying to multitask, when you quickly redirect your attention from one thing to another. The ability to multitask typically peaks around your 20th birthday and declines throughout life.
That was the goal of Gazzaley and his game development team at UCSF when they released their first results in a landmark study in 2013.
After playing a game called NeuroRacer (the precursor to EndeavorRx), seniors got a lot better at multitasking – improvements that they maintained at a follow-up 6 months later.
And that was not all. The people in the study also improved their thinking skills in areas that weren’t targeted: sustained attention and working memory. This was the first evidence of the potential of therapeutic video games to target and enhance these abilities. But it wouldn’t be the last.
Which brings us back to children with ADHD.
Is there a therapeutic video game in your future?
working memory – the ability to retain information long enough to use it – is the key to success in school, at work and in everyday life. Like the ability to focus one’s attention, this is a higher-level executive function, which means the two processes share some of the same neural networks in the same parts of the brain. It is no coincidence that working memory deficits are one of the hallmarks of ADHD.
But it’s the same play video games, according to a recently published study. 9- and 10-year-olds who played commercial video games for several hours a day had better working memory and response inhibition – stop before allowing a distraction to remove them from the task – than children who have never played.
Luckily, kids don’t need to play multiple hours a day to get benefits.
“We found linear effects in just about everything we looked at,” says Bader Chaarani, PhDassistant professor of psychiatry at the University of Vermont and lead author of the study.
“Light gamers who played an average of 1 hour per day showed the same improvements in cognition, response inhibition, and working memory, compared to those who never played video games,” he said. “These effects were intermediate between non-video gamers and heavy video gamers.”
This helps explain why video games are getting so much attention in neurological, medical, and psychological research.
In addition to EndeavorRx, Gazzaley and his team have developed several others for different populations and preferences.
MediTrain, for example, uses digital technology to helping young adults master meditationthe timeless practice of stillness and presence.
Rhythmicity, a musical game designed to help seniors improve their short-term memory, has also helps them remember faces. (Grateful Dead drummer Mickey Hart helped develop the game.)
Body-Brain Trainer, another game created for seniors, combines cognitive training with exercise, using the closed-loop algorithm to adjust both interventions to the user’s ability. Those who used the game for 8 weeks improved in two fitness measures (blood pressure and balance) as well as in their ability to sustain attention.
Gazzaley plans to explain in a future study how games with such different mechanics and tempos — from obstacle-dodging racing to drumming to slow-paced meditation — lead to similar improvements in attention.
Again, this is similar to exercise, where almost any type of workout will lead to improvements in heart health, which in turn will reduce the risk of premature death from any cause.
Because there are so many ways to get to the same destination, you can find effective exercise programs to suit almost any combination of abilities and preferences. You can also progress through a fitness program at your own pace.
Perhaps this is how we use therapeutic video games as the category grows.
“Now that we have so many game types and so many populations, we have a better understanding of how you can push and pull these systems to get these results,” Gazzaley says. “That’s what makes me so excited for the future.”
Games as medicine? Seems worthy of attention.