Can video games fight ADHD?

Video games make parents nervous. They've been blamed for everything from promoting violence to creating a generation of kids with short attention spans. And for parents of kids diagnosed with attention deficit hyperactivity disorder - better known as ADHD - video games might seem like just another challenge to their kids' ability to focus. But not all video games are created equal. Researchers are now working to harness video games' potential to retrain the brain. Some say the alternative to drugs like Ritalin could even be in the form of a video game. 

Bruce Wexler, a psychiatric neuroscientist from Yale University has developed a video game that he believes has potential as a non-pharmaceutical ADHD intervention to improve focus and mental agility.  

This interview has been edited for clarity and length. 

Here's my assumption: when I think of video games, I think of them being a distraction, especially for a kid with ADHD. Am I wrong? 

There's a lot of evidence now that we can use computer-presented, engaging activities like video games to harness the brain's natural neuroplasticity for a variety of therapeutic purposes, including treating ADHD.- Bruce Wexler

Well "video game" is just a general term about the technology and pictures on the TV screen or the computer monitor but the content of it can vary widely. So all games are not the same. Certainly some games have one type of effect on the child and other games can have very different effects. There's a lot of evidence now that we can use computer-presented, engaging activities like video games to harness the brain's natural neuroplasticity for a variety of therapeutic purposes including treating ADHD.

OK We'll get into how that might work I just want to first play a clip from one of your video games take a listen.

Pirate Video game clip: I will tell you when to switch between grabbing blue jewels and red ones. But it will be coming from two places at once. Yarrr!! 

Bruce, explain to me what I'm seeing there.  

So what you're seeing is a level of one of our games where there's a shiny orb floating around the screen and sometimes it turns into a blue jewel, and sometimes it turns into a red jewel. The instructions at this particular level switch back and forth between whether you're looking for a blue jewel or for a red jewel. What this does is it exercises sustained attention, and also response inhibition because what was a target that you were supposed to click on seconds before, you now have to ignore. And finally it adds in cognitive flexibility as well. 

Explain these to me in layman's terms. Why are things like "response inhibition" valuable to kids with ADHD?

"Response inhibition" is another way of saying self-control, and it's part of the self-regulation that many of these children lack. It helps them to resist distractions that are coming in from anywhere; in the classroom or noise in the hallway. They have to resist or inhibit their tendency to respond to those things and they have to also inhibit their internal impulses. So these are executive functions that are essential for managing information and managing the self, and self-regulation response inhibition, or self-control, is one of the key dimensions of that. 

Don't all video games sort of do that, require those kinds of skills? Aren't those skills being employed by many many video games? 

Well those games create a high stimulation, high arousal arcade-like environment. In that situation with constant stimulation, ADHD kids can become engaged. In fact, I think those games actually engage the child's effort and attention by bypassing the executive control systems that are needed to sustain attention in a situation that's not so arousing and stimulating. 

So it's a right amount of stimulation, not too much stimulation. 

Exactly. For all of us it's harder to pay attention when the things we're looking for are coming infrequently. When they keep coming fast and get us aroused and stimulated we can stay more motivated and focused. And that is a particular challenge for the ADHD kids.

I've got to be honest with you Bruce. I've got young children and this game seems on the simple side compared to the games kids play these days. How do you compete for kids' attention when they're used to games that are so much more sophisticated? 

Well, I would not use the word "sophisticated". Our games are actually much more sophisticated in terms of what's going on behind the scenes. Now what you probably looked at were the initial levels of these games that become very difficult because there's hundreds of difficulty levels in them. But we have gone through multiple generations of the games and we actually work very closely with computer entertainment game designers to employ the latest features of game design that can help in gauging interest without producing that high activity arousal situation. 

You tested your games on hundreds of children who have ADHD. Do you see this as a potential alternative to medication, medication that is used to treat many many children with ADHD? 

Our data at this point indicates that about 25% of children with ADHD may show sufficient benefit to our program that they don't need medicine. So that would be over a million children in the United States in Canada. Another 25% show substantial benefit from our program that could add to the benefits they get from medication or make the medication dose be less.- Bruce Wexler

We definitely do. Our data at this point indicates that about 25% of children with ADHD may show sufficient benefit to our program that they don't need medicine. So that would be over a million children in the United States in Canada. Another 25% show substantial benefit from our program that could add to the benefits they get from medication or make the medication dose be less. 

And the other 50%? This doesn't seem to work for all kinds of kids with ADHD.

That's correct.

And why is that? 

That's one of the things that we and researchers in several other countries, experts in ADHD, are trying to understand better. ADHD, like all psychiatric diagnoses, is not a very precise term. It's a general category that includes children who have their attention problems for a variety of different reasons. And so our program is designed to target a certain part of the brain, certain neural systems that support executive functions in many children. But some children who have the behavioural manifestations that would lead to the diagnosis of ADHD actually have a different sort of problem. And our program isn't addressing that. So that's one reason. Another reason is the one you alluded to earlier. How can we engage all the children to do the program effectively? And so some of the children are getting engaged more effectively than others at this point. Those are design features of the program that we're working on hope that will increase the percentage of children who show benefit. 

Is there a kid from your research that stands out in your mind that you've seen him or her make great progress? 

A child came back after using the program in the summer and the teacher said, "What happened? This is like a different child."- Bruce Wexler

We have a lot of anecdotal reports. For example, a child came back after using the program in the summer and the teacher said "What happened? This is like a different child." We had children in kindergarten in a school in Harlem where all the children were in the special education class because of their attention problems. And the assistant principal told us that three of those ten children were now in the mainstream classrooms in first grade. She couldn't believe the difference in them, they were like different children again in their ability to engage with the material put forward to them. This is a key feature of how these programs can be helpful because children with ADHD, because of their attention problems, cannot engage with things that we have put into the curriculum in schools and into their lives that would help them further develop. If we can get them over that hurdle by giving them enough attention and self-regulation skills to participate effectively, they get all that benefit that they're missing out on now. 

So you're working on getting this into schools. Parents are often skeptical as video games as a learning or education tool. How skeptical are they about these video games?

Well, parents, teachers, principals, and superintendents should all be skeptical because there are some brain training programs and therapeutic programs that work and some don't. Some are based on their science principles. Some have sophisticated technology taking advantage of the potentials of computers; sophisticated technology behind the scenes that you cannot see just by looking at the surface of it. So it's very hard for parents and teachers to know which programs work and which don't. They have to look carefully at the evidence in the research behind them to make a decision.