November 23, 2022 – You might not think that children with attention deficit hyperactivity disorder, or ADHD, have much in common with older adults.
Children struggle to sit still and focus on a task. Seniors are great at sitting still, but often find it difficult to follow a conversation at a holiday dinner.
In both cases, the problem is attention.
Yes, that’s obvious for someone diagnosed with ADHD. It’s in the name. With ADHD, the brain is constantly looking for new and interesting ways to distract itself.
But older adults aren’t looking for distractions. They simply cannot ignore distractions.
“Focusing attention has two sides: focusing and ignoring,” he says Adam Gazzaley, MD, PhD, Professor of Neuroscience at the University of California, San Francisco. “It’s the act of filtering out irrelevant information that declines with age.”
That’s why Gazzaley invented it 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 be given the go-ahead for any condition.
What you may 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 “experiential medicine” and says it has one big advantage over traditional medicine: It adapts to you. While the patient learns to play the game, the game learns to work with the patient.
How video games act like exercise for your brain
This customizable quality is the key to EndeavorRx and what makes it different from commercial video games. Gazzaley calls it an “adaptive closed-loop algorithm.”
Simply put, the game adapts to the player. Better players face tougher challenges, while those with less skill can still progress through the game’s levels and unlock its rewards.
Your brain, in turn, adapts to challenges through structural changes, similar to 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 equally well for all ages, whether you are an older person who has never played a video game or a young person who may have played too much. (It is also worth noting that lots of playing can harm your mental health.)
The brain’s ability to adapt to new information, circumstances or demands is called neuroplasticity, and it is a key advantage that experiential medicine has over drug treatment. The changes in the brain not only translate into improvements in attention in real life, but also remain intact after the patient completes the prescribed amount of time with the game.
“It just sticks, which is incredibly different from how drugs work now,” Gazzaley says.
Treating children with ADHD is just one of many potential applications.
“The game is not specific to a particular pathology or age group,” says Gazzaley. “It challenges the brain in such a way that it leads to this benefit in sustaining attention in any population we’ve ever tested.”
Case in point: He and his colleagues at UCSF have now tested closed-loop games with people who have depression, multiple sclerosis and lupus, all of which can affect the ability to focus.
But it all started with one very specific population.
How video games became therapy
In the early 2000s, Gazzaley worked with elderly patients who were experiencing problems with their thinking skills for the first time.
“They would often tell me that they were distracted,” he says. “They just couldn’t keep their attention.”
This led to a series of studies on the source of the problem. IN study published in 2005for example, his research team found that older adults could focus on a task just as well as 20-year-olds.
“What they failed to do was ignore it,” he explains. “There is so much irrelevant information that needs to be filtered out. That is what caused the damage.”
Follow-up study which was published in 2008 found that the damage was exacerbated by a slowing of the brain’s processing speed. Older adults took longer to decide whether the interruption really required their attention, which meant that each distraction was more distracting than it would have been for younger adults.
For older people, these challenges are especially evident when they try to multitask, when you quickly shift your attention from one thing to another. The ability to multitask usually peaks around your 20th birthday and declines throughout life.
That was the focus of Gazzaley and his game development team at UCSF when they published their initial findings in the significant study in 2013
After playing NeuroRacer (a precursor to EndeavorRx), seniors became much better at multitasking – they maintained the improvements at follow-up 6 months later.
And that wasn’t all. People in the study also improved their thinking skills in areas that weren’t targeted: sustained attention and working memory. It was the first demonstration of the potential of therapeutic video games to target and improve these abilities. But she 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 be used – is the key to success in school, work and everyday life. Like the ability to focus attention, it is a higher-level executive function, meaning that the two processes share some of the same neural networks in the same parts of the brain. Not coincidentally, working memory deficits are one of the hallmarks of ADHD.
Medicines can certainly help.
But also playing video games, according to a recently published study. Nine- and ten-year-olds who played commercial video games for several hours a day had better working memory and response inhibition – stopping before they let a distraction take them off task – but children who have never played.
Fortunately, children do not need to play for hours a day to reap the benefits.
“We saw linear effects in almost everything we looked at,” he says Bader Chaarani, Ph.Dassistant professor of psychiatry at the University of Vermont and lead author of the study.
“Light gamers who played an average of 1 hour a day showed the same improvements in cognition, response inhibition, and working memory, compared to those who never played video games,” he says. “These effects were mediated between non-video game players and heavy video game players.”
This helps explain why video games are receiving 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 help young people master meditationa timeless practice of silence and presence.
Rhythmicity, a music game designed to help seniors improve their short-term memory as well helps them remember faces. (Grateful Dead drummer Mickey Hart helped develop the game.)
Body-Brain Trainer, another game created for the elderly, combines cognitive training with exercise, using a closed-loop algorithm to adapt both interventions to the user’s abilities. Those who used the game for 8 weeks they improved in two measures of fitness (blood pressure and balance), as well as in their ability to sustain attention.
In a future study, Gazzaley plans to explain how games with such different mechanics and pacing—from dodgeball to drumming to slow meditation—lead to similar improvements in attention.
Again, this is similar to exercise, where almost any type of exercise will lead to improved heart health, which in turn reduces 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 the fitness program at your own pace.
This may be how we use therapeutic video games as the category evolves.
“Now that we have so many types of games and so many populations, we have a better understanding of how you can push and pull those systems to get these results,” Gazzaley says. “That’s what makes me so excited about the future.”
Games as medicine? It seems worthy of attention.