Videogame could be an important ally in ADHD treatment

Researchers in Brazil have developed a game to train inhibitory control, the brain’s ability to halt inappropriate responses to environmental stimuli.

By Karina Toledo

Agência FAPESP – Specialists who treat youth with Attention Deficit Hyperactivity Disorder (ADHD) could soon gain a new ally: a videogame.

Researchers in the Psychobiology Department at Universidade Federal de São Paulo (Unifesp), in partnership with the Department of Molecular Medicine at Universidade Federal de Minas Gerais (UFMG) and Duke University, are developing a game whose main objective is to train inhibitory control – the brain’s ability to halt inappropriate responses to environmental stimuli – in players. People with ADHD normally have a faulty inhibitory response.

“When inhibitory control is not developed, many problems can occur, such as substance abuse, unprotected sex, fights, and accidents,” explained neuropsychologist Thiago Strahler Rivero, author of a FAPESP-funded doctoral study, who was advised by Orlando Francisco Amodeo Bueno, a lecturer at Unifesp’s Psychobiology Department.

According to Rivero, training inhibitory control is particularly important in adolescence, a phase in which impulsiveness is naturally exacerbated and the statistics for involvement in risky situations linked to ADHD are most alarming.

“Making an adolescent adhere to treatment and keeping them motivated is one of the greatest difficulties in the clinic. That’s why we opted for a videogame,” explained Rivero.

The game, known as Project Neumann, is divided into four parts. Each part represents a different kingdom and is directly linked to symptoms involved in the lack of impulse control. Heroes help the player in the battle against the main enemy: ADHD.

“The four other secondary heroes represent some of the most prevalent characteristics of the disorder: difficulty in paying attention, difficulty controlling motor impulses, difficulty ignoring distractions, and difficulty controlling planning, which is the inability to mold the actions of the present by thinking about future consequences,” explained the researcher.

However, training these capacities in players is not the only objective of the Neumann Project, explained Rivero. “We also want to test whether the game can be a tool to evaluate these abilities. For this reason, we are comparing it with the evaluation scales considered to be the gold standard in literature. These scales help in the diagnosis and in monitoring treatment,” he explained.

The third goal of the researcher is psychoeducation. The idea is that by playing the game, people with ADHD learn about the disease, gain awareness, and recognize strategies to overcome it.

“Studies show that training the brain in isolated ways offers few results. Isolated psychotherapy helps build an understanding symptoms and their impacts, but studies show that in the long term, the efficacy is not that significant. Treatment solely with medication could be effective, but it may not teach important abilities for adult life. For these reasons, the consensus is that treatment of ADHD should be multimodal,” affirmed Rivero.

According to Rivero, the development of characters and a storyline was based on psychological, neuropsychological, and neuroscientific theories.

“With our partners in UFMG’s Laboratory of Neuropsychological Investigation who are specialists in the study of impulsivity in Brazil, particularly my adviser Leandro Maloy-Diniz, we outlined the regions of the brain that, according to the literature, must be stimulated to improve inhibitory control,” affirmed the researcher. “So we created tasks to be followed by players based on these theories.”

At the end of every phase, the system allows users to generate graphs and performance reports developed to help monitor the players’ evolution. The game is currently being refined and validated.

“We have performed three rounds of tests with volunteers. Initially, they helped to evaluate characteristics such as how fun the game was, its ability to involve the player in the storyline, and the playability. In the last round, we collected some data, and now we are comparing the data with the gold standard of evaluation scales to see if there is a correlation and performing statistical validation,” explained Rivero.

International partners

Another means of evaluating whether each game stimulates the proposed ability is through functional magnetic resonance imaging. “We intend to put volunteer players inside the equipment to see if the regions of the brain that are stimulated in the exam are the ones that we want to stimulate. To do so, we are partnering with the University of Southern California in the United States.” The team also involves collaborators from the design area and game development area.

Rivero presented the preliminary results during the World Congress on Brain, Behavior and Emotion, held at the end of June in São Paulo. The study was also presented at E3, the world’s leading game fair, after the group took third place in the Indies Crash competition for independent games, where 677 games from around the world were in the running.

“Although the game was focused on ADHD treatment, our idea was to create a method that could later be applied to autism, bipolar disorder, and other psychiatric problems,” affirmed Rivero.