November 23, 2022 – You may not think that children with Attention Deficit Hyperactivity Disorder or ADHD have much in common with older adults.
Children have trouble sitting still and concentrating on a task. The older adults are good at sitting still, but they often find it difficult to follow the conversation at a holiday dinner.
In both cases the problem is one of attention.
Yes, that’s obvious for someone diagnosed with ADHD. That’s already in the name. With ADHD, the brain is constantly looking for new and interesting ways to distract itself.
But older adults don’t look for distractions. They just can’t ignore the distractions they find.
“There are two sides to focusing attention: focusing and ignoring,” he 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. 2020, EndeavorRx has been approved by the FDA to treat children with ADHD between the ages of 8 and 12, making it the first digital therapy to get the green light for every condition.
What you may not know is that the game was originally designed to help seniors. Or that therapeutic games are now being developed and tested for a wide range of diseases and population groups.
Gazzaley calls it “experiential 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 like a workout for your brain
This adaptive quality is key to EndeavorRx and sets it apart from commercial video games. Gazzaley calls it an “adaptive closed-loop algorithm”.
Put simply, the game adapts to the player. Better players will face tougher challenges, while those with less skills can still progress through the game’s levels and unlock its rewards.
Your brain, in turn, adapts to the challenges with structural changes, similar to the adaptations your body makes when you exercise.
Just as your muscles respond to resistance training by growing 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 has never played a video game or a young person who may have played too many. (That’s also worth noting play a lot may harm your mental health.)
The brain’s ability to adapt to new information, circumstances, or demands is called neuroplasticity and is the key advantage experimental medicine has over drug treatments. Changes in the brain not only lead to improvements in real-life attention, but also remain intact after the patient has completed the prescribed amount of time playing the game.
“It just sticks, which is incredibly different from how drugs work,” says Gazzaley.
Treating children with ADHD is just one of many possible applications.
“The game isn’t specific to any particular pathology or age group,” says Gazzaley. “It challenges the brain in such a way that it leads to this sustained attention benefit in every population we’ve ever tested.”
Case in point: He and his colleagues at UCSF have now tested closed-loop games with people suffering from depression, multiple sclerosis and lupus, all of which can impair the ability to focus.
But it all started with a very specific population.
How video games became therapy
In the early 2000s, Gazzaley worked with elderly patients who were having trouble thinking 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 into the cause of the problem. in the a study published in 2005For example, his research team found that older adults were just as good at concentrating on a task as 20-year-olds.
“What they failed to do was ignore,” he explains. “There is so much irrelevant information that needs to be filtered out. That caused the impairment.”
A follow-up study which was published in 2008, found that the impairment was made worse by slowing down the processing speed of the brain. Older adults took longer to decide if an interruption actually required their attention, meaning any distraction was more disruptive than it would have been to their younger selves.
For seniors, these challenges are particularly evident when trying to multitask when you quickly shift your attention from one thing to another. Multitasking ability typically peaks around age 20 and declines throughout life.
That was the focus for Gazzaley and his game development team at UCSF when they published their first results in a landmark study In 2013.
After playing a game called NeuroRacer (the precursor to EndeavorRx), seniors became much better at multitasking – Improvements they retained at a follow-up visit 6 months later.
And that’s not all. Study participants also improved their thinking skills in areas not addressed: sustained attention and working memory. It was the first evidence of the potential of therapeutic video games to address and enhance these skills. 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 a key to success at school, at work and in everyday life. Like the ability to focus attention, it is an overarching executive function, meaning the two processes share some of the same neural networks in the same parts of the brain. Working memory deficits are no coincidence one of the hallmarks of ADHD.
Medication can certainly help.
But it does playing video games, according to a recently published study. Nine- and 10-year-olds who played commercial video games several hours a day had better working memory and reaction inhibition – Pause before you let a distraction distract you – as children who never played.
Luckily, kids don’t have to play for several hours a day to get benefits.
“We’ve seen linear effects in pretty much everything we’ve looked at,” he 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, responsiveness and working memory compared to those who never played video games,” he says. “These effects ranged between non-video gamers and heavy video gamers.”
This explains why video games receive so much attention in neurological, medical, and psychological research.
In addition to EndeavorRx, Gazzaley and his team have developed several others for different demographics and preferences.
MediTrain, for example, uses digital technology for this Help young adults master meditationthe timeless practice of stillness and presence.
Rhythmicity, a musical game designed to help seniors improve short-term memory helps them remember faces. (Grateful Dead drummer Mickey Hart helped develop the game.)
Body-Brain Trainer, another game designed for seniors, combines cognitive training with movement, using the closed-loop algorithm to adapt both interventions to the user’s abilities. Those who have used the game for 8 weeks improved in two fitness measures (blood pressure and balance) and in their ability to sustain attention.
Gazzaley plans to explain in a future study how games with such different mechanics and tempos — from a run that avoids obstacles to drumming to slow meditation — lead to similar improvements in attention.
Again, this is similar to exercise, where almost any type of exercise leads to an improvement in heart health, which in turn reduces the risk of premature death from any cause.
Because there are so many ways to achieve the same goal, you can find effective exercise programs that fit almost any combination of skills and preferences. You can also complete a fitness program at your own pace.
So we may use therapeutic video games as the category evolves.
“Now that we have so many types of games and so many populations, we’re getting a better understanding of how you can push and pull those systems to get those results,” says Gazzaley. “It makes me so excited about the future.”
Games as medicine? Seems worth paying attention to.