Do video game interventions improve motor outcomes in children with developmental coordination disorder? A systematic review using the ICF framework

Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework

OBJECTIVE

This scoping review aims to explore published literature testing Virtual Reality (VR) interventions for improving upper limb motor performance in children and adolescents with Developmental Coordination Disorder (DCD). Our primary focus was on the types of VR systems used and the measurement tools employed within the International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) domains in these studies.

METHODS

A comprehensive search of six electronic databases up to 11th January 2024 was conducted using predefined terms. Inclusion and exclusion criteria were applied to determine study eligibility, with two authors independently assessing titles, abstracts, and full-text articles.

RESULTS

Out of 788 potential studies, 14 met the eligibility criteria. Studies predominantly utilized non-immersive VR (nVR) systems, for example, commercial platforms such as Nintendo Wii. Most interventions targeted general motor coordination or balance, with only four studies specifically focusing on upper limb motor performance. The Movement Assessment Battery for Children-2 was the predominant assessment tool. However, the use of game scores and trial durations raised concerns about the accuracy of assessments. The majority of studies reported no significant improvement in upper limb motor performance following VR interventions, though some noted improvements in specific tasks or overall outcomes.

CONCLUSION

The findings suggest that, while nVR interventions are being explored for paediatric motor rehabilitation, their impact on enhancing upper limb motor performance in children with DCD is unclear. The variability in intervention designs, outcome measures, and the predominant focus on general motor skills rather than specific upper limb improvements highlight the need for more targeted research in this area.

IMPACT

This review underscores the importance of developing precise and clinically relevant measurement tools in a broader range of VR technologies to optimize the use of VR in therapy for children with DCD. Future research should aim for more rigorous study designs and emerging immersive technologies to maximize therapeutic benefits.

Short- and Long-Term Changes in Balance After Active Video Game Training in Children With and Without Developmental Coordination Disorder: A Randomized Controlled Trial

Active video games (AVG) have been used as training tools and are known to ameliorate balance performance in children with Developmental Coordination Disorder (DCD). Our aim was to evaluate balance using clinical tests and by measuring body sway using a force plate with a mixed design of vision (eyes open/eyes closed), surface (rigid/soft), and support (stance/semitandem) before, and after, training and 4 months later (follow-up). Thirty-six DCD children and 40 typically developing children participated in the study, of which 50 children (26 DCD; 24 typically developing) were retested after 4 months. Balance improved on the clinical measures after the training, which was independent of type of AVG (Wii-Fit and Xbox Kinect) used, and this effect was still present after 4 months. The AVG training did not influence general sway behavior, but only sway in the eyes-open condition, corresponding with task demands of the training and indicating a training-specific effect. Overall, DCD children and typically developing children responded comparably to the AVG training, thereby maintaining the gap in performance between the two groups. The changes in postural sway are interpreted as a sign of more confidence and less freezing of the joints, enabling greater flexibility of movements and balance strategies as supported by the improved performance on balance tests in the DCD children. This is the first study that showed long-term effects of AVG training on balance performance. However, these follow-up results should be interpreted with caution given that 35% of the children were lost in follow-up.

Effectiveness of digital games promoting young people's mental health: A review of reviews

Objectives

Digital games are a popular form of entertainment for youth. They are often used as a therapy for psychological problems, a mental health promotion intervention, and a preventative measure. Systematic reviews and meta-analyses have been conducted to assess the effectiveness of mental health-related digital games. However, a synthesis considering all evaluation results to inform their development is missing.

Methods

We performed a review of reviews to synthetize results of previous research to describe the impact of digital games on the mental health of young people aged <30 years old. We considered systematic reviews and meta-analyses published between 2012 and 2022. Searches were conducted in Scopus, Google Scholar, Pubmed, and Cochrane library systematic reviews (CENTRAL) during October 2023.

Results

Our final selection included 10 systematic reviews and meta-analyses on interventions targeting youth of both sexes aged 2-29 years old across the world. In total, 218 interventions were identified. Selected articles reported different types of games, e.g., active and non-active video games, virtual reality games, serious games. Not all digital games were conscientiously evaluated, but, in general, their impact on mental health was positive. Regarding the quality, 5 studies were of high quality, 3 of moderate quality and 2 of low quality.

Conclusions

Overall, elements of gamification were well-accepted, but they lacked assessment through rigorous experimental conditions. Digital games for mental health are promising, but in order to be consistently effective in promoting young people's mental health and prevent psychological diseases, they should present specific features.

A Home-Based Exercise Program With Active Video Games for Balance, Motor Proficiency, Foot and Ankle Ability, and Intrinsic Motivation in Children With Chronic Ankle Instability: Feasibility Randomized Controlled Trial

Background

Children with chronic ankle instability (CAI) frequently experience ankle unsteadiness, causing trips, falls, and ankle sprain injuries resulting in poor quality of life. A specific exercise program focused on physical and psychological purposes in children with CAI is needed.

Objective

The purpose of this study was to investigate the feasibility of a 4-week home-based exercise training program using active video games (AVGs) for balance, motor proficiency, foot and ankle ability, and intrinsic motivation in children with CAI.

Methods

Sixty children with CAI (mean age 10, SD 2 years) were randomly assigned to an experimental group (AVG group; n=30) or a control group (CG; n=30). The AVG group played 2 selected video games, Catching Fish and Russian Block, while the CG received the traditional exercise program for CAI. Both programs were scheduled for 30 minutes per day, 3 times per week, for 4 weeks at home. The single-leg stance test was used to assess static balance. The walking forward on a line and standing long jump tests were used to assess motor proficiency. The Foot and Ankle Ability Measure (FAAM) and the Intrinsic Motivation Inventory questionnaire were used to assess foot and ankle ability and intrinsic motivation, respectively. Assessments were conducted at baseline and after 4 weeks.

Results

In the AVG group, the single-leg stand test (eyes open; on floor and on foam conditions), the FAAM (activities of daily living subscale), and intrinsic motivation (interest/enjoyment, pressure/tension, and value/usefulness dimensions) were improved compared with the CG (all P<.05). Motor proficiency did not differ between the 2 groups at the end of the 4-week program (P=.31 for the walking forward on a line, P=.34 for the standing long jump test).

Conclusions

A 4-week home-based exercise training program using AVGs can be beneficial and may be an effective approach for improving balance, foot and ankle ability, and enhancing positive motivation by increasing the interest/enjoyment and value/usefulness dimensions and lowering the pressure/tension dimension in children with CAI that require long-term rehabilitation sessions.

A Clinical Practice Guide to Enhance Physical Activity Participation for Children with Developmental Coordination Disorder in Canada

Purpose

This clinical practice guide (CPG) aims to provide evidence-based recommendations for promoting and enhancing the participation and integration of children with developmental coordination disorder (DCD) into physical activities that take place in the home, school, community, or rehabilitation clinic contexts.

Methods

A panel of key stakeholders relevant to these contexts (parents, instructors, rehabilitation professionals) developed evidence-based recommendations using a consensus methodology after reviewing results from a recent systematic review of relevant literature. The quality of the evidence on which the recommendations were based was evaluated (2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence scale) as was the strength of the final CPG recommendations (American Society of Plastic Surgeons Grade Recommendation Scale).

Results

Recommendations (n = 50; 36% supported by robust, empirically derived evidence) for the different stakeholder groups fell into three categories: 1) Choose an appropriate activity for your child, 2) Harmonize the activity with the child's interests and abilities, and 3) Help the child learn new movements prior to the activity.

Conclusions

This comprehensive CPG provides concrete recommendations, based on the currently available evidence, that can be used by stakeholders to address the physical activity participation and integration needs of children with DCD in a variety of contexts.

Task-specificity and transfer of skills in school-aged children with and without developmental coordination disorder

AIM

To compare the effects of two Active Video Game (AVG) protocols on transfer of learning in children with and without Developmental Coordination Disorder (DCD).

METHODS

Fifty children, aged 6-10 years were randomly allocated to either group A or B. Children in group A participated in a set of Nintendo Wii ball games whereas group B played agility games (8 DCD and 17 typically developing children (TD) per group). Participants in each group practiced Wii games for 20 min twice a week for 10 weeks. All children also practiced ball and agility games in real-world settings, once per week.

RESULTS

Both protocols yielded positive effects with the largest effect sizes shown on agility and balance items of the PERF-FIT and KTK tests. No interaction was found on learning real-world games and the virtual protocol, except for a Ping-Pong game. A significant interaction of time by protocol group indicated that the Ball group improved more on BOT-2-Upper-Limb Coordination than the Agility group. Importantly, children with DCD improved comparably with TD peers in virtual and real-world games.

CONCLUSION

Independent of training protocol, both children with DCD and TD children performed better on trained and non-trained ball, balance and agility tasks after 10 weeks of training.

[Formula: see text]Is active video gaming associated with improvements in social behaviors in children with neurodevelopmental disorders: a systematic review

Active video gaming (AVG) is a way that children with neurodevelopmental disorders can participate in social play and could be associated with improvements in social behaviors. However, limited research has investigated if AVG is associated with improvements in social behaviors in children and adolescents with neurodevelopmental disorders. A systematic literature search was conducted in Medline, Embase, Psycinfo, Cinahl, and Eric, Web of Science, and Scopus. Three main concepts were searched: exergaming, neurodevelopmental disorders, and social behaviors. Keywords and subject headings were used for each concept. 3080 articles were identified in the initial search in 2019; in January 2021, 167 additional articles were identified. Of these, 8 studies with 242 children with autism spectrum disorder, cerebral palsy, or developmental coordination disorder were included in this review. Six studies reported that participation in AVG was associated with improved social functioning, social interaction, emotional well-being, and social/emotional skills in children with ASD, CP, and DCD. In contrast, two studies that included children diagnosed with ASD did not find any association between AVG participation and social behaviors. The findings of this systematic review suggest that participation in an AVG intervention may be associated with improved social behaviors in children and adolescents with ASD, CP, and DCD. However, due to the limited number of studies included, this finding must be interpreted with caution. Future research is needed that examines the treatment fidelity of AVG in improving social behavior skills in children with neurodevelopmental disorders and the generalizability of these skills to real-life social situations.

Type of active video-games training does not impact the effect on balance and agility in children with and without developmental coordination disorder: A randomized comparator-controlled trial

AIM

To compare the effect of the Nintendo Wii-Fit and Xbox Kinect on motor performance and to assess differential effects in children with Developmental Coordination Disorder (DCD) and typical development (TD).

METHOD

In an assessor-blinded randomized comparator-controlled design, 68 participants (34 DCD and 34 TD) aged 7-10 years, were randomly assigned to train on one of two devices (34 Wii-Fit; 34 Xbox Kinect).

RESULTS

Repeated measure ANOVA revealed a significant main effect of time on balance and agility variables (MABC-2, Wii Yoga stance, PERF-FIT side-hop, PERF-FIT ladder-stepping; all p ≤ 0.02), but not on running variables (BOT2-sprint, 10 × 5 m sprint and PERF-FIT ladder running; p > 0.05). No significant interactions were observed, indicating similar changes on both devices. Overall, 35% of the TD children and 76% of the children with DCD improved on one or more of the outcomes beyond the smallest detectable difference. However, at the individual level, larger differences in improvement were found in the Kinect group compared to the Wii between TD and DCD groups.

CONCLUSION

Both Wii-Fit and Kinect devices can be used to train with similar results on motor performance. An important percentage (76%) of children with DCD improved on at least one motor task after training.

Effect of Wii Fit training on visual perception and executive function in boys with developmental coordination disorders: A randomized controlled trial

BACKGROUND

This paper elucidated the influence of Wii Fit training on visual perception and executive function in boys with developmental coordination disorders (DCD).

METHODS

50 school boy with DCD (Mean Age = 9.55 ± 2.24) were randomly assigned to one of two groups, Wii Fit training (intervention; n = 25) or usual school program (control; n = 25). Visual perception and executive function were measured pre-, post- (8 weeks, 3 sessions per week, 30 minute per session), using Cognitive Assessment System (CAS) and Test of Visual-Perceptual Skills-Revised (TVPS-R), respectively. Pre- and post-test changes in executive function and visual perception were calculated using one-way ANCOVA, with pre-test values as covariate and post-test values as dependent variables.

RESULTS

The findings show that the rates of change in total score of visual perception from pre to post were significantly different between groups (F(1, 47) = 660.76, P = 0.024). Similarly, intervention group showed significantly different rates of change in total score of executive function from pre to post (F (1, 47) = 26.15, P = 0.013).

CONCLUSION

Findings support that when developing interventions for the improvement or management of visual perception and executive function in children with DCD, key stakeholders should include the Wii Fit training programs.

Programs Using Stimulation-Regulating Technologies to Promote Physical Activity in People With Intellectual and Multiple Disabilities: Scoping Review

Background

People with intellectual and multiple disabilities tend to engage in very low levels of physical activity.

Objective

This review paper aims to provide a comprehensive picture of intervention programs using stimulation-regulating technologies to promote forms of physical activity in people with intellectual and multiple disabilities.

Methods

Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, a scoping review was conducted to identify and provide a synthesis of eligible studies published in English between 2010 and 2021. Studies were identified by searching PubMed, Web of Science, PsycINFO, ERIC, and CINAHL as well as by using Google Scholar and manual searches. Studies were included if they involved individuals with intellectual or multiple disabilities, used stimulation-regulating technology systems to help participants engage in physical activity, and reported data on the impact of the intervention.

Results

A total of 42 studies met the inclusion criteria. These studies were divided into 2 groups based on whether they pursued the increase in physical activity through technology-aided delivery of brief periods of preferred stimulation contingent on specific responses or the use of video games (exergames) and related auditory and visual stimulation. Subsequently, a narrative synthesis of the studies was provided.

Conclusions

The evidence reported by the 2 groups of studies is encouraging. However, further research is needed to compare the overall applicability and impact of the intervention strategies proposed by these groups of studies.

Effects of COVID-19 on Physical Activity and Its Relationship With Mental Health in a US Community Sample: Cross-sectional, Convenience Sampling-based Online Survey

Background

COVID-19 restrictions may make it difficult for people to engage in the recommended amounts of physical activity (PA).

Objective

The influence of the COVID-19 pandemic on PA, as well as the links between PA and mental health, was investigated in this study.

Methods

Participants were recruited using convenience sampling and responded to an online survey between April 15 and July 1, 2021, with ages ranging from 18 to 24 years (n=156, 40.9% of the sample) to ≥55 years (n=28, 7.4% of the sample). To assess general psychological distress, depression, anxiety, and pandemic anxiety, a battery of mental health assessments was used. The International Physical Activity Questionnaire - Short Form was used to collect PA data from participants, who were then classified as inactive, minimally active, or highly active. Participants also indicated the locations where they performed PA before and during COVID-19.

Results

A sample of 381 individuals was included in this research. The logistic regression analysis results were interpreted as odds ratios (ORs), where an OR higher than 1 indicated a greater chance of an event occurring and an OR less than 1 implied a lower likelihood of an event occurring. Logistic regression results revealed that inactive individuals were more likely to develop psychological distress (OR 2.17, 95% CI 1.27-3.69, P=.004), depression (OR 3.81, 95% CI 1.92-7.57, P<.001), and anxiety (OR 1.86, 95% CI 0.99-3.47, P=.05) as compared to highly active individuals. Furthermore, when compared to highly active people, those who were only minimally active had a higher risk of depression (OR 2.14, 95% CI 1.05-4.33, P=.04). Wilcoxon signed-rank tests revealed that COVID-19 has a greater impact on reducing the chances of less active individuals engaging in PA outside and in public spaces. Highly active people's physical exercise locations had changed less, and their exercise frequency at home increased.

Conclusions

Programmatic and policy interventions geared particularly toward enhancing PA among those less active may be a helpful strategy for addressing the worldwide pandemic’s mental health crisis.

Large-scale network dysfunction in youths with Internet gaming disorder: a meta-analysis of resting-state functional connectivity studies

Internet gaming disorder (IGD) has been defined as a specific behavioral disorder, associated with abnormal interactions among large-scale brain networks. Researchers have sought to identify the network dysfunction in IGD using resting-state functional connectivity (rsFC). However, results across studies have not reached an agreement yet and the mechanism remains unclear. The present research aimed to investigate network dysfunction in IGD through a meta-analysis of rsFC studies. Twenty-two seed-based voxel-wise rsFC studies from 25 publications (594 individuals with IGD and 496 healthy controls) were included. By categorizing seeds into seed-networks based on their location within a prior functional network parcellations, we performed a Multilevel kernel density analysis (MKDA) within each seed-network to identify which brain systems showed abnormal interaction with particular seed-network in individuals with IGD. Compared to healthy control groups, individuals with IGD exhibited significant hypoconnectivity within the default mode network, and enhanced connectivity between the default mode network and insula within the ventral attention network. IGD was also associated with increased connectivity between the ventral attention network and somatomotor regions. Furthermore, the IGD groups showed hyperconnectivity between the limbic network and regions of the frontoparietal network. The results suggest that individuals with IGD show large-scale functional network alteration which underpins their core symptoms including poor emotional competence, cue-reactivity and craving, habitual addictive behaviors and impaired executive control. Whether the compensation mechanism exists in IGD is discussed, and further research is needed. The findings provide a neurocognitive network model of IGD, which may serve as functional biomarkers for IGD and have potentials for development of effective diagnosis and therapeutic interventions.

Effects of Graded Exergames on Fitness Performance in Elementary School Children With Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) is a common childhood disorder affecting movement and coordination skills, fitness, and academic performance. Increased physical fitness may have a positive influence on physical and mental health outcomes in children with DCD. Yet, little has been done to develop interventions to improve fitness performance in this group. The purpose of this study was to determine the effects of graded exergames in 7 to 12-year-old children with DCD and typically developing (TD) peers. Participants (32 DCD and 28 TD children) received a 30-min training session twice weekly for 10 weeks. Performance on motor coordination (MABC-2 test), balance, aerobic, and anaerobic fitness tests were assessed at the beginning and end of training. In addition, enjoyment and perception of exertion were measured for each participant during the training period. Both children with DCD and TD children significantly improved on motor coordination, balance, aerobic, and anaerobic fitness at the end of the training. A significant Group by Time interaction was observed on the MABC-2 total [F (1, 55) = 13.19; p < 0.001] and balance scores [F (1, 55) = 26.83; p < 0.0001], with the DCD group demonstrating larger improvements than the TD children. Both groups enjoyed the program throughout the training period even though they rated the training to be of high intensity. These findings indicate that graded exergames may serve as potential treatment for impaired fitness in children with DCD. Regular participation in graded exergames in school settings may be needed to enhance and maintain fitness performance in young children with and without DCD.

Active Video Games for Improving Mental Health and Physical Fitness-An Alternative for Children and Adolescents during Social Isolation: An Overview

The aim of this study was to synthesize the evidence on the effects of active video games (AVGs) on mental health, physical fitness and body composition of children and adolescents. A search was conducted in the following databases: PubMed; MEDLINE (by Ovid); SportDiscus, Cochrane library systematic reviews (CENTRAL) and EMBASE with no language restrictions during October 2020. Reviews on the use of AVGs were included in the study. We use the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) scale to analyze the methodological quality of the studies. Seventeen systematic reviews and meta-analyzes were included on the effects of AVGs with 30 to 4728 children and adolescents of both sexes with ages ranging from 6 to 19 years. In five studies, the population was overweight or obese. Regarding the quality, 12 studies were of moderate quality, two had high quality, two had low quality and one showed very low quality. The analyzed data indicate that the use of AVGs with a frequency of 1 to 3 times a week with durations of between 10 and 90 min per day shows positive effects on mental health and physical functioning. There was moderate quality evidence that AVGs can result in benefits for self-esteem, increased energy expenditure, physical activity and reduced body mass index in children and adolescents who used AVGs in the home environment. Further research is needed on this tool to help in the process of social isolation and consequently in promoting health and well-being.

Effects of virtual reality training intervention on predictive motor control of children with DCD - A randomized controlled trial

It has been hypothesised that deficits in the functions of predictive motor control and internal modeling may contribute to motor control issues of children with Developmental Coordination Disorder (DCD). Virtual reality (VR) technologies have great potential to provide opportunity for Motor observation and motor imagery (MI) which could enhance learning and development of motor skills in children with DCD. Thus, the present study aimed to investigate the benefits of a VR training intervention to improve predictive motor control functions of children with DCD. Forty female children with DCD (aged 7-10) were randomly assigned to VR and control groups. In this study, an experimental pre-post and follow-up design was used, and Predictive motor control functions were measured before and after the VR intervention and two-months later. Predictive motor control was evaluated using MI (by hand rotation task), action planning (by sword placement task), and rapid and online control (by rotational tracking task) tests. VR intervention consisted of a selection of Xbox 360 Kinect games that were performed for sixteen 30-min sessions over 8 weeks. Compared to the control group, the VR group improved significantly on measures of MI, motor planning, and rapid and online control scores from pre- to post-test and retained their performance to follow-up. Overall, it seems that virtual reality training program may be used as an appropriate intervention approach for developing the ability of MI and predictive motor control functions in DCD children.

Motor skill learning in children with and without Developmental Coordination Disorder

OBJECTIVE

The question whether children with DCD have motor learning deficits is difficult to answer based on the current body of knowledge. The aim of this study was to examine the impact of practice on motor skill acquisition, retention and transfer in children with and without DCD using a variety of games in a virtual environment.

METHOD

Performance on a criterion task (Wii ski game) and MABC-2 balance subscore was compared between children with DCD (n = 33) and TD children (n = 28) following 10 weeks of playing active video games. Repeated measures ANOVA was used to compare changes in the two groups.

RESULTS

The children with DCD demonstrated lower performance on the criterion task than the TD group (p = 0.031). A time by group interaction indicated that the difference in performance on the criterion task became larger over time (p = 0.039). No differences were found in retention between groups. Large improvement (Cohen d 1.11) was observed for the children with DCD on the MABC-2 balance subscore.

CONCLUSION

Based on the criterion task results, typically developing children seem more proficient in learning new skills compared to children with DCD. More research is needed to confirm that children with DCD have a problem to transfer skills to other contexts.

Movement-based interventions for preschool-age children with, or at risk of, motor impairment: a systematic review

AIM

To explore the efficacy of movement-based interventions to improve motor skills in preschool-age children with, or at risk of, motor impairment, including those with a diagnosis of cerebral palsy, autism spectrum disorder, and developmental coordination disorder.

METHOD

Relevant electronic databases were searched for randomized or quasi-randomized controlled trials. Outcomes were classified using domains of the International Classification of Functioning, Disability and Health: Children & Youth version. Quality was assessed using the Physiotherapy Evidence Database scale. Risk of bias was assessed using the Cochrane Risk of Bias tool. Effect sizes were calculated using Cohen's d.

RESULTS

Seventeen articles exploring a heterogeneity of intervention types, population groups, and outcome measures met the inclusion criteria. Movement-based interventions did not significantly improve outcomes in either the body structure and function or activity domains in most studies. No studies used a participation outcome measure.

INTERPRETATION

There is a paucity of evidence exploring movement-based interventions in the preschool-age group. Although movement-based interventions showed potential for improving body structure and function and activity outcomes for children with motor impairment, results were mostly not significant. Small sample sizes, variable study quality, and risk of bias limit confidence in the results.

WHAT THIS PAPER ADDS

The evidence is inconclusive to support movement-based interventions in this group. No studies used outcome measures assessing participation. Variability in intervention type and study quality limit confidence in results.

Manual Dexterity is not Related to Media Viewing but is Related to Perceptual Bias in School-Age Children

Although the media can have both negative and positive effects on children’s cognitive and motor functions, its influence on their perceptual bias and manual dexterity is unclear. Thus, we investigated the association between media viewing time, media preference level, perceptual bias, and manual dexterity in 100 school-aged children. Questionnaires completed by children and their parents were used to ascertain media viewing time and preference levels. Perceptual bias and manual dexterity were measured using the visual-tactile temporal order judgment task and Movement Assessment Battery for Children—2nd edition, respectively. There were significant positive correlations between age and media viewing time and between media viewing time and media preference level. There was also a significant negative correlation between visual bias and manual dexterity. Hierarchical multiple regression analysis revealed that increasing visual bias was a significant predictor of decreasing manual dexterity. Further, children with low manual dexterity showed significant visual bias compared to those with high manual dexterity, when matched for age and gender. The present results demonstrated that, in school-aged children, although viewing media was not associated with perceptual bias and manual dexterity, there was a significant association between perceptual bias and manual dexterity.

Comparison of Behavioral Changes and Brain Activity between Adolescents with Internet Gaming Disorder and Student Pro-Gamers

While pro-gamers play according to defined living habits and planned schedules, adolescents with internet gaming disorder (IGD) exhibit irregular lifestyles and unregulated impulsive gaming behavior. Fourteen IGD adolescents and 12 pro-gaming students participated in this study. At baseline and after one year, demographic data, the Child Behavior Check List (CBCL), depressed mood, anxiety, and resting-state functional magnetic resonance imaging were assessed. Over the year, IGD adolescents played games as per their usual schedule, while pro-gamer students played according to their school’s team schedule. After one year, the pro-gamers’ scores had decreased in the CBCL-total (total problematic behaviors), CBCL-externalizing (under-controlled behavior, like impulsivity and aggression), and CBCL-internalizing (over-controlled behavior like depression and anxiety) compared to those of the IGD adolescents. Both groups displayed increased brain activity in the parietal lobe (a component of the attention network) over the years. Compared to pro-gamers, IGD adolescents showed higher brain activity within the left orbitofrontal cortex. Brain activity within the orbitofrontal cortex was associated with CBCL-externalizing scores. These results suggest that gaming had increased the attention network’s brain activity, but a well-organized support system could lead to different results, in terms of improved behaviors and suppressing brain activity within the orbitofrontal cortex.

Therapeutic and Preventive Use of Video Games in Child and Adolescent Psychiatry: A Systematic Review

BACKGROUND

Over the past decade, the use of commercial video games and serious games has developed in child and adolescent psychiatry. These games may become relevant alternatives or adjuncts to traditional psychotherapy, providing that their effectiveness is properly established. The purpose of this literature review was to evaluate the effectiveness of serious games and commercial video games in the treatment or prevention of psychiatric disorders in children and adolescents.

METHODS

Medline's database was used to search articles published between January 2012 and July 2019. The following keywords were used for this search: "Video games" OR "Active video game" OR "serious gaming" OR "Serious game" OR "Exergame" AND "Child mental disorder" OR "Adolescent" OR "Child" AND "Therapy" OR "Prevention". Only comparative studies which targeted interventions on children and adolescents suffering from psychiatric disorders were included.

RESULTS

Twenty-two studies, focusing on a wide range of psychiatric conditions, met our inclusion criteria's: 14 evaluated serious games and 8 commercial games. All studies were randomized controlled trials but only two studies compared the intervention game to psychotherapeutic gold standard; other studies used a no-intervention control group or an alternative game as the control group. Eighteen studies reported significant improvements on the symptoms and test scores targeted.

CONCLUSION

Serious games and commercially available video games can be an effective trajectory for psychotherapy in child and adolescent psychiatry. However, there is a lack of longitudinal studies which assess the sustained effects of these games, and standards for proper evaluation of their effectiveness are missing.