Digital Therapies Targeting Neural Markers Beneficial for Children With ADHD

Courtney L. Gallen, PhD

A video game-based therapeutic targeting a specific neural marker could help improve attention symptoms in pediatric patients with attention deficit/hyperactivity disorder (ADHD).

A team, led by Courtney L. Gallen, PhD, Department of Neurology, University of California, assessed a group of children with ADHD on neural, behavioral, and clinical metrics of attention before and after a 4 week at-home intervention on an iPad targeting a critical neural marker for attention.

Attention Issues

ADHD is often related to diminished attentional control, which are related to negative consequences in real-life functioning both during development and into adulthood. However, recent research suggests modulating the underlying neural circuits related to attention can assist in improving behavior and brain function in pediatric patients with ADHD.

“Individuals with ADHD exhibit persistent patterns of diminished attentional control–the capacity to appropriately allocate attention resources and monitor the environment for new sources of information, ultimately enabling optimal processing of task-relevant information,” the authors wrote. “Attentional control is a key component of general cognitive control abilities that are critical for goal-directed behavior.”

Currently, treatment for ADHD can include both pharmacological and behavioral therapies that reduce ADHD symptoms, but also have several limitations because pharmacological treatments can induce side effects including reduced appetite. There are also barriers to obtaining non-pharmacological interventions.

Using Digital Therapeutics

The investigators previously discovered that game-based digital therapeutics targeting a crucial neural marker of attention called the midline front theta (MFT) can have positive effects on attentional control in different populations.

However, these studies have not yet included children with ADHD, but no other comorbidities.

In the study, the investigators assessed 25 pediatric patients with ADHD between 8-12 years using a game-based digital therapeutic called AKL-T01.

The investigators initially showed training on a custom-designed multi-tasking video game called NeuroRacer remediated age-related neural deficits in the MFT. The video game also had positive effects on related objective behavioral metrics of attention and other cognitive control abilities in healthy older adults.

The team then extended the work to children with attention difficulties with NeuroRacer, a video game experience built on the digital therapeutic, AKL-T01.

Each participant in the study performed a perceptual discrimination task that assessed selective attention abilities with concurrent electroencephalography (EEG) recording. The task was a go/no-go task which each patient was instructed to respond to specific green stimuli presented on a computer monitor while ignoring other color and shape combinations.

The investigators also assessed concurrent changes in task performance and quantified changes in response time and response time variability.

Finally, they assessed changes on a visual continuous performance task to further index improvements in attentional control.

Each participant completed 5 missions at least 5 days per week for 4 weeks. There was approximately 25 minutes of gameplay per day.

Positive Results

Overall, participants showed enhancements on a neural measure of attention (MFT power) and on objective behavioral measures of attention. They also showed improvements based on parental reports of clinical ADHD symptoms.

Particularly important was the relationship between the neural and behavioral cognitive improvements, which shows that patients who had the largest intervention-related neural gains were also the patients that improved the most on the behavioral tasks indexing attention.

The 25 participants that completed the study had normal performance on the Wechsler Intelligence Scale for Children, while also showing excellent adherence with the AKL-T01 intervention.

There was also an improvement in response time (mean ± SE gain = 39.67 ± 11.86 ms; t(1,24) = 3.35; P = 0.003; d = 0.62) for perceptual discrimination tasks, which suggests that users performed faster following AKL-T01.

There was not an improvement found on the response time variability (RTV; t(1,24) = -0.76; P = 0.45; d = 0.12).

There was also no improvements on response time or response time variable for sustained attention task t(1,23) = 0.35; P = 0.73; d = 0.09 and t(1,23) = 0.14; P = 0.89; d = 0.03, respectively).

Overall, the video game increases MFT broadly following post-stimulus presentation in this patient population, which suggests the user is better able to engage control functions and monitor ongoing cognitive processes to support attention-centric performance.

The investigators also found neural changes were most pronounced in the early and late stages of the perceptual discrimination task trials.

“The present findings contribute to the recent burst of empirical work aiming to demonstrate the efficacy of various digital health technologies,” the authors wrote. “Here, we provide supporting evidence for the efficacy of one such digital therapeutic in remediating attentional control difficulties in children with ADHD.”

The study, “Enhancing neural markers of attention in children with ADHD using a digital therapeutic,” was published online in PLOS One.