Serious Video Games: Angels or Demons in Patients With Attention-Deficit Hyperactivity Disorder? A Quasi-Systematic Review

Enhancing effects of exercise and neurofeedback: A systematic review and meta-analysis of computer game-based interventions for pediatric ADHD

OBJECTIVE

While numerous reviews examine digital interventions, including computer game-based, evidence regarding their effectiveness for ADHD symptoms remains mixed. Focusing on computer game-based interventions, this study aims to identify specific intervention features and trial-related factors that influence outcomes in pediatric ADHD symptoms through a systematic review and meta-analysis of randomized controlled trials.

METHODS

Comprehensive literature searches were conducted in Web of Science, PubMed and PsycINFO. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Seventeen studies were included. Beyond common game characteristics, some interventions incorporated additional elements-such as neurofeedback, physical exercise via virtual reality (VR) and social components-allowing subgroup analyses. The neurofeedback subgroup showed the largest effect size (standardized mean difference (SMD)=-0.51, 95 % confidence interval (CI) [-0.88, -0.15], heterogeneity index (I2)=45.85 %, p < 0.05, very low certainty of evidence), followed by the physical exercise/VR subgroup (SMD=-0.40, 95 %CI [-0.76, -0.04], I2=0.00 %, p < 0.05, very low certainty of evidence). Other subgroups, including those with social components or without additional elements, did not show significant effect sizes. The physical exercise/VR subgroup demonstrated small-to-medium effect sizes in both inattention and hyperactivity/impulsivity subscales, whereas the neurofeedback subgroup showed similar effects only in inattention. Trial-level factors, including participant demographics and intervention duration, showed no significant relationship with SMD in meta-regression.

CONCLUSION

Although inconclusive, synergizing with game dynamics, neurofeedback and physical exercise/VR may enhance effectiveness of computer game-based interventions in addressing pediatric ADHD symptoms. Particularly, interventions with physical exercise/VR have potential to address both inattention and hyperactivity/impulsivity.

Discriminative Power of the Serious Game Attention Slackline in Children and Adolescents With and Without Attention-Deficit/Hyperactivity Disorder: Validation Study

Background

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity, significantly impacting the psychological, social, and academic well-being of affected children and adolescents. Traditional ADHD diagnostic methods often rely on subjective reports, which can be biased. Recent advancements in serious games offer the potential for objective assessment tools.

Objective

This study aimed to evaluate the discriminative power and concurrent validity of the serious game Attention Slackline in distinguishing children and adolescents with ADHD from those without the condition and in correlating game performance with standardized ADHD assessment scales.

Methods

A sample of 32 children and adolescents diagnosed with ADHD and 39 healthy controls participated in the study. Participants were divided into 2 age groups: children (aged 6-11 years) and adolescents (aged 12-17 years). The serious game Attention Slackline was administered alongside established ADHD assessment scales, including the Child and Adolescent Assessment System and the ADHD Rating Scale IV. Group differences were analyzed using multivariate analysis of covariance, and effect sizes were reported using Cohen d. Correlations between game performance and ADHD symptoms were calculated using Pearson r.

Results

Children with ADHD demonstrated significantly worse performance in Attention Slackline than the controls (t65=-2.26; P=.03; |d|=0.901), whereas no significant differences were observed in adolescents (t65=0.75; P=.73; |d|=0.191). Task performance was negatively correlated with family-reported hyperactivity/impulsivity symptoms in children across both tests (r=-0.43 and r=-0.51), but no significant correlations were observed in adolescents.

Conclusions

The findings support the validity of Attention Slackline for assessing hyperactivity/impulsivity symptoms in children with ADHD. However, its efficacy decreases in adolescents, potentially due to developmental factors, such as compensatory strategies and ceiling effects in task performance. The gamified nature of the tool enhances engagement, which is crucial for young populations, while maintaining its diagnostic utility in measuring impulsivity. The age-dependent validity aligns with previous research indicating that continuous performance test paradigms are less effective in older populations due to developmental maturation. Attention Slackline shows potential as a complementary tool for ADHD diagnosis in children, offering an engaging and objective assessment of hyperactivity/impulsivity. Future research should aim to establish clinical cutoff points and refine the task's complexity to align with individual characteristics.

Effects of virtual reality technology on attention deficit in children with ADHD: A systematic review and Meta-analysis

BACKGROUND

Virtual reality (VR) technology is increasingly utilized in the medical field, including interventions for attention deficit hyperactivity disorder (ADHD) in children. However, evidence on the efficacy of VR-based interventions in improving attention remains limited and inconclusive.

OBJECTIVE

This systematic review synthesizes evidence from randomized controlled trials (RCTs) to evaluate the effectiveness of VR-based interventions in addressing attention deficits in children with ADHD and identifies key methodological insights.

METHODS

Six databases were searched for English-language RCTs involving children aged 6-12 years with ADHD receiving VR interventions. The Cochrane bias risk assessment tool was used to assess methodological quality. Statistical analyses included meta-analysis for effect size estimation and publication bias testing.

RESULTS

Eleven RCTs involving 640 participants were included. Meta-analysis revealed a moderate reduction in attention deficit symptoms (SMD = -0.33, 95%CI [-0.58, -0.09], p = 0.008). No significant publication bias was detected.

CONCLUSION

VR-based interventions show potential in alleviating attention deficits in children with ADHD. However, study heterogeneity and limited long-term data warrant caution. Future research should focus on large-scale, standardized trials with extended follow-ups to validate these findings.

Evaluating the evidence: a systematic review of reviews of the effectiveness and safety of digital interventions for ADHD

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) impacts academics, work and social relationships. Digital interventions, such as virtual reality, games, app and other, offer accessible therapeutic options, yet understanding their efficacy and potential adverse effects is crucial for safe use. The objective of this study is to identify and analyze the efficacy and adverse effects reported in systematic reviews of digital interventions for ADHD.

METHODS

We conducted a systematic review of systematic reviews to assess the reported efficacy and safety of digital interventions for ADHD. We searched for relevant publications in Scopus, PubMed, PsycINFO and Cochrane Library. Both study selection and data extraction were performed in duplicate to ensure accuracy and reduce bias. This review followed PRISMA 2020 guidelines, PRISMA-harms checklist, and we used AMSTAR-2 to assess the quality and risk of bias of the included reviews.

RESULTS

A total of 26 systematic reviews on digital interventions for ADHD were included. These reviews collectively involved 34,442 participants, with the majority focusing on children and adolescents. The digital interventions analyzed included video games, computerized cognitive training, virtual reality, apps, and others. The outcomes reported various positive effects, such as improvements in inattention and executive function, though evidence was generally low quality. Adverse effects were reported in 8 of the 26 included reviews (30,1%), and included physical discomfort, emotional reactions, and behavioral issues, such as video game addiction.

CONCLUSIONS

This systematic review of systematic reviews indicates that while digital interventions for ADHD show potential benefits, their effectiveness remains inconclusive due to low evidence quality. Adverse effects, particularly from video games, have been reported but are inconsistently documented. Future research should focus on rigorous safety assessments, standardized reporting, and long-term effectiveness.

TRIAL REGISTRATION

This systematic review is registered in Prospero: CRD42024521084.

Decreased impulsiveness and MEG normalization after AI-digital therapy in ADHD children: a RCT

Attention-deficit/hyperactivity disorder (ADHD) presents with symptoms like impulsiveness, inattention, and hyperactivity, often affecting children's academic and social functioning. Non-pharmacological interventions, such as digital cognitive therapy, are emerging as complementary treatments for ADHD. The randomized controlled trial explored the impact of an AI-driven digital cognitive program on impulsiveness, inattentiveness, and neurophysiological markers in 41 children aged 8-12 with ADHD. Participants received either 12 weeks of AI-driven therapy or a placebo intervention. Assessments were conducted pre- and post-intervention and magnetoencephalography (MEG) analyzed brain activity. Results showed significant reductions in impulsiveness and inattentiveness scores in the treatment group, associated with normalized MEG spectral profiles, indicating neuromaturation. Notably, improvements in inhibitory control correlated with spectral profile normalization in the parieto-temporal cortex. Improvements in inhibitory control, linked to normalized spectral profiles, suggest AI-driven digital cognitive therapy can reduce impulsiveness in ADHD children by enhancing neurophysiological efficiency. This emphasizes personalized, technology-driven ADHD treatment, using neurophysiological markers for assessing efficacy.

Dementia and Video Games: Systematic and Bibliographic Review

BACKGROUND/OBJECTIVES

This systematic and bibliographic review examines publications in the field of dementia and video game research from 2004 to 2023. The main objective is to assess developments and trends in video game technology for dementia care and detection.

METHODS

The PubMed database was the primary source for publications. PRISMA guidelines were applied to structure this review. Ten variables were defined, investigated, and split into three main categories: bibliographic, medical, and technical.

RESULTS

The results were synthesized using a quantitative approach to reduce bias through interpretation. Of 209 initial results, 77 publications have been included in the investigation. More studies focus on rehabilitation over assessment and detection of dementia. Clinical trials are typically conducted with limited participants. The most populated trials rarely enrol over 300 subjects. On average, around 38 subjects were enrolled in the trials. These studies are commonly supervised by a trainer or technology specialist, suggesting a technology gap in familiarity in the trial demographic.

CONCLUSIONS

Most interventions assessed were custom-designed applications with a specific outcome, focusing on physical activity and cognitive exercises. As the first of its kind, this publication focuses on the technical aspects of applied technologies and development methods. Using video games to treat and detect patients with cognitive impairments like dementia can benefit healthcare professionals, caretakers, and patients.

Improved attentional abilities after playing five weeks of active video games in children with and without developmental coordination disorder

BACKGROUND

Besides motor coordination problems, attentional impairments are reported in children with developmental coordination disorder (DCD), but the connection or trainability is still unclear.

AIM

To test changes on attentional abilities after playing active video games (AVG) in children with DCD and their peers (TD), to evaluate near transfer and the relationship between omissions in attentional and motor tests.

METHODS

Seventy children (35 DCD; 35 TD), 7-12 years old, were assessed on three types of attention: distractibility (DIS); divided-attention (DA); sustained-attention (SA) and on the Wii Fit test pre- and post-training.

RESULTS

A significant decrease of errors in attentional tasks was found after training, independent of group (TD/DCD) and console (Wii Fit/Xbox) with medium-strong effect sizes (DIS η2p =.42; DA η2p =.51; SA η2p =.41). The groups responded similarly to the training but the DCD children scored poorer on the DA. A positive transfer-effect to the non-trained Wii Fit test was found in accuracy (missed gates), while speed proved console-specific. A medium/strong relation was found between omissions in attentional tasks and the missed gates (Wii Fit test).

CONCLUSION

More accurate responses on attentional tasks were found after AVG-training in both groups. A clear relationship between attentional abilities and motor performance was found.

Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review

BACKGROUND

Effective health care services that meet the diverse needs of children and adolescents with cancer are required to alleviate their physical, psychological, and social challenges and improve their quality of life. Previous studies showed that serious games help promote people's health. However, the potential for serious games to be used for successful cancer control for children and adolescents has received less attention.

OBJECTIVE

This scoping review aimed to map the use of serious games in cancer prevention and cancer care for children and adolescents, and provide future directions for serious games' development and implementation within the context of cancer control for children and adolescents.

METHODS

This study followed a combination of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) framework for the conduct of scoping reviews. PubMed, CINAHL Plus Full Text, Scopus, Web of Science Core Collection, and American Psychological Association (APA) PsycINFO databases were used for the search.

RESULTS

From the initial 2750 search results, 63 papers were included in the review, with 28 quantitative, 14 qualitative, and 21 mixed method studies. Most of the studies were cancer care serious game papers (55/63, 87%) and a small number of studies were cancer prevention serious game papers (8/63, 13%). The majority of the included studies were published between 2019 and 2023 (cancer prevention: 5/8, 63%; cancer care: 35/55, 64%). The majority of the studies were conducted in Europe (cancer prevention: 3/8, 38%; cancer care: 24/55, 44%) and North America (cancer prevention: 4/8, 50%; cancer care: 17/55, 31%). Adolescents were the most represented age group in the studies' participants (cancer prevention: 8/8, 100%; cancer care: 46/55, 84%). All (8/8, 100%) cancer prevention serious game papers included healthy people as participants, and 45 out of 55 (82%) cancer care serious game papers included patients with cancer. The majority of cancer prevention serious game papers addressed game preference as a target outcome (4/8, 50%). The majority of cancer care serious game papers addressed symptom management as a target outcome (28/55, 51%). Of the cancer care studies examining serious games for symptom management, the majority of the studies were conducted to treat psychological (13/55, 24%) and physical symptoms (10/55, 18%).

CONCLUSIONS

This review shows both the growth of interest in the use of serious games for cancer control among children and adolescents and the potential for bias in the relevant literature. The diverse characteristics of the included papers suggest that serious games can be used in various ways for cancer control among children and adolescents while highlighting the need to develop and implement serious games in underrepresented areas.

A mobile device-based game prototype for ADHD: development and preliminary feasibility testing

This research aimed to devise and assess a mobile game therapy software for children with Attention-Deficit/Hyperactivity Disorder (ADHD), as well as evaluating its suitability and effectiveness in improving the cognitive ability of typically developing children. The study encompassed 55 children diagnosed with ADHD and 55 neurotypical children. Initial assessments involved ADHD-related scales, computerized tests for information processing, and physiological-psychological evaluations. After a 4-week home-based game intervention, participants underwent re-evaluation using baseline measures and provided feedback on treatment satisfaction. Considering the small proportion of study participants who dropped out, data was analyzed using both the Intention-to-Treat (ITT) analysis and the Per-protocol (PP) analysis. The trial was registered at ClinicalTrials.gov (NCT06181747). In ITT analysis, post-intervention analysis using linear mixed models indicated that the ADHD group improved significantly more than the neurotypical group particularly in Continuous Performance Test (CPT) accuracy (B = -23.92, p < 0.001) and reaction time (B = 86.08, p < 0.01), along with enhancements in anti-saccade (B = -10.65, p < 0.05) and delayed-saccade tasks (B = 0.34, p < 0.05). A reduction in parent-rated SNAP-IV scores was also observed (B = 0.43, p < 0.01). In PP analysis, paired-sample t-tests suggested that the ADHD group had significant changes pre- and post-intervention, in terms of CPT Accuracy (t = -7.62, p < 0.01), Anti-saccade task Correct Rate (t = -3.90, p < 0.01) and SNAP-IV scores (t = -4,64, p < 0.01). However, no significant changes post-intervention were observed in the neurotypical group. Survey feedback highlighted a strong interest in the games across both groups, though ADHD participants found the game more challenging. Parents of ADHD children reported perceived benefits and a willingness to continue the game therapy, unlike the neurotypical group's parents. The findings advocated for the integration of serious video games as a complementary tool in ADHD treatment strategies, demonstrating the potential to augment attentional abilities and alleviate clinical symptoms. However, a randomized controlled trial (RCT) is needed to further verify its efficacy.

Attitudes of patients and mental health professionals towards hypothetical use of serious games in psychotherapy

Serious games are increasingly being applied within healthcare, but their integration in psychotherapeutic settings is less documented.

OBJECTIVES

The present study sought to identify the attitudes of psychotherapists and patients towards the hypothetical use of serious games in psychotherapy in the South African context.

METHODS

Online surveys assessed acceptance, experience, and requirements for the utilisation of serious games in therapeutic contexts. Clients utilising mental health services (n = 209) and psychotherapists delivering mental health services (n = 156) in South Africa completed the online survey.

RESULTS

Knowledge about serious games is limited with only 15% of clients and 16% of therapists reporting knowledge of the existence and application of serious games. Use of serious games is even more infrequent with only 1% of therapists and 6% of clients currently using serious games as an intervention. Despite this, our findings highlight an apparent demand for their use, with 71% of therapists indicating that serious games would be a suitable adjunct treatment modality for their patients. Our results show a general openness toward the use of serious games in psychotherapy.

CONCLUSION

The use of serious games as an e-mental health treatment modality is conceivable for both patients and therapists, particularly as a complementary strategy to traditional face-to-face psychotherapy.

Measuring attention of ADHD patients by means of a computer game featuring biometrical data gathering

ADHD is a neurodevelopmental disorder diagnosed mainly in children, marked by inattention and hyperactivity-impulsivity. The symptoms are highly variable, such as different ages of onset and potential comorbidities, contributing to frequent misdiagnoses. Professionals note a gap in modern diagnostic tools, making accurate identification challenging. To address this, recent studies recommend gamification for better ADHD diagnosis and treatment, though further research is essential to confirm its efficacy. This work aims to create a serious game, namely "Attention Slackline", to assess attention levels. The game, designed with expert input, requires players to concentrate on a specific point to recognize specific patterns while managing distractions. A controlled experiment tested its precision, and results were compared with established attention tests by a correlation analysis. Statistical analysis confirmed the game's validity, especially in tracking attention through correct responses and errors. Preliminary evidence suggests that "Attention Slackline" may serve as a credible instrument for the assessment of attentional capacities in individuals with ADHD, given that its outcomes have been empirically shown to correlate with those derived from a well-established attention assessment methodology.

Effectiveness of a Serious Video Game (MOON) for Attention Deficit Hyperactivity Disorder: Protocol for a Randomized Clinical Trial

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood and adolescence, with a prevalence of 5% and associated difficulties and worse prognosis if undetected. Multimodal treatment is the treatment of choice. However, sometimes treatment can be insufficient or have drawbacks.

OBJECTIVE

This study protocol aims to demonstrate the effectiveness of cognitive training through the serious video game The Secret Trail of Moon (MOON) in improving emotional regulation in people with ADHD.

METHODS

This is a prospective, unicenter, randomized, unblinded, pre- and postintervention study. The groups will be randomized (MOON vs control) via an electronic case report form. The MOON intervention will be performed 2 times per week for 10 weeks (30 minutes per session). The first 5 weeks (10 sessions) will be conducted face-to-face at the Puerta de Hierro University Hospital, and the remaining weeks will be conducted via the internet at the participants' homes. The total sample consists of 152 patients aged between 7 and 18 years. All participants have a clinical diagnosis of ADHD under pharmacological treatment. Data collection will be used to obtain demographic and clinical data. The data will be recorded using REDCap. Measures will be made through clinical scales for parents and objective tests of cognitive functioning in patients. Additional information on academic performance will be collected. The study has a power greater than 80% to detect differences. Student t test, 2-factor analysis of variance (ANOVA), and Mann-Whitney analyses will be performed according to each variable's characteristics.

RESULTS

The study was approved by the Research Ethics Committee of the Puerta de Hierro University Hospital on December 14, 2022. As of September 26, 2023, we have enrolled 62 participants, and 31 participants have completed the study. This clinical trial was funded by the Comunidad de Madrid (IND2020/BMD-17544). The approximate completion date is March 2024.

CONCLUSIONS

Serious video games such as MOON can be motivational tools that complement multimodal treatment for ADHD.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT06006871; https://clinicaltrials.gov/study/NCT06006871.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53191.

Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study

BACKGROUND

The opioid crisis continues to worsen across the United States, affecting people of all demographics. Few evidence-based interventions exist for educating families, particularly those with adolescents, about opioid prescription safety. Serious games have demonstrated impacts in improving medication-related outcomes for various health conditions. The characterizing goal of this serious game is to improve opioid safety knowledge and awareness among adolescents and their families.

OBJECTIVE

This study evaluated the impact of a serious game, MedSMARxT: Adventures in PharmaCity, designed to foster opioid safety awareness among adolescents and their parents.

METHODS

A national sample of parents and their adolescent children was recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Eligible participants were adolescents aged between 12 and 18 years and their parents. Study participants were required to reside in the United States; speak, read, and understand English; and have access to a computer with a webcam. Parent-child dyads completed pregame and postgame surveys and participated in gameplay for up to 30 minutes. Primary outcome scales have been previously evaluated by the study team.

RESULTS

A total of 60 adolescent participants and 68 parent participants met full attention criteria for inclusion in this study. Statistical analysis confirmed that both adolescents' and parents' concept scores improved from baseline regarding opioid safety self-efficacy (adolescent: mean 0.35, SD 0.60; P<.001; parent: mean 0.28, SD 0.42; P<.001), perceived knowledge (adolescent: mean 1.08, SD 1.04; P<.001; parent: mean 0.56, SD 0.55; P<.001), behavioral intent (adolescent: mean 0.26, SD 0.39; P<.001; parent: mean 0.25, SD 0.32; P<.001), safe storage (adolescent: mean 0.12, SD 0.27; P<.001; parent: mean 0.03, SD 0.11; P=.03), disposal knowledge (adolescent: mean 0.10, SD 0.27; P=.006; parent: mean 0.07, SD 0.16; P<.001), and knowledge about misuse behavior (adolescent: mean 0.05, SD 0.14; P=.002; parent: mean 0.04, SD 0.10; P<.001). Participant groups, stratified by who completed and who did not complete gameplay, improved their knowledge and awareness, with no significant differences between subgroups.

CONCLUSIONS

The use of this serious game to improve opioid prescription safety practices among parents and adolescents was supported by the study findings. MedSMARxT: Adventures in PharmaCity is an intervention with the capability of teaching parents and adolescents about safe opioid prescription practices. Further studies and game refinement are needed to demonstrate the effectiveness of a game-based intervention in clinical settings and community pharmacies.

An Overview of the CRoME Lab's MedSMA℞T Families Intervention for Promoting Opioid Medication Safety among Adolescents and Parents

As the opioid epidemic unrelentingly places profound weight on pharmacists, youth, parents, and the nation at large, innovative interventions are critical to prevent potential misuse and untimely death. Adolescents are especially vulnerable to misuse behaviors due to knowledge, attitudinal, and social influences. To best resonate with adolescents, appropriate tools and technologies must be developed and deployed. Few educational tools are more ubiquitous to adolescents than video games. Video games, specifically serious games, have the potential to connect with adolescents and impart critical knowledge related to opioid safety. Engaging youth, parents, and pharmacists in the design, refinement, and evaluation of a serious game is novel and necessary for building a robust, efficacious game. This commentary describes the conceptualization, inception, development, and evaluation of a novel opioid medication safety intervention, MedSMA℞T Families. This two-part intervention is comprised of an adolescent-tailored serious game entitled MedSMA℞T: Adventures in PharmaCity, and a family-focused tool named the personalized Family Medication Safety Plan. This intervention is the first theory-based, family-focused opioid medication safety toolkit co-designed by an interdisciplinary team of researchers, game developers, behavioral health scientists, pharmacists, student pharmacists, addiction medicine physician, adolescent health physician, parents, and teens. Responses from key stakeholders (pharmacists, parents, and teens) have demonstrated positive attitudes and impressions towards both components of the MedSMA℞T Families intervention. Empirical evidence of efficacy from two separate studies denotes improvement in key concepts related to safe behavior in adolescents. Findings to date support the widespread use, implementation, and dissemination of this efficacious intervention to supporting safe opioid prescription practices in families with adolescents. In this paper, we outline and summarize our process of intervention development and use of longitudinal data to validate each step of our process. Future directions include mobile compatibility, refinement based on key stakeholder feedback, and dissemination in various clinical settings where opioid medications are prescribed and dispensed such as emergency departments, pharmacies, hospitals, and clinics.

Adherence, frequency, and long-term follow-up of video game-based treatments in patients with attention-deficit/hyperactivity disorder: A systematic review

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adolescents. Recent studies show that video games have great potential for the treatment and rehabilitation of ADHD patients. The aim of the present review is to systematically review the scientific literature on the relationship between video games and ADHD, focusing on adherence to treatment, frequency of the intervention, and the long-term follow-up of video games in children and adolescents with ADHD.

METHODS

The preferred reporting items for systematic reviews and meta-analyses guidelines were adopted. The review protocol was registered in PROSPERO database. We searched in three databases, PubMed, Medline, and Web of Science to identify studies examining the association between video game interventions in ADHD patients.

RESULTS

A total of 18 empirical studies met the established inclusion criteria. The results showed that video games-based interventions can be used to improve ADHD symptoms and display high adherence to treatment. In addition, in the studies reviewed, the most common intervention frequency is 30 min three to five times per week. However, there is little evidence from studies with video games showing long-term effects in patients with ADHD.

CONCLUSION

Video games are useful and effective interventions that can complement traditional treatments in patients with ADHD.

Screen Time and Its Health Consequences in Children and Adolescents

Nowadays, children and adolescents are exposed to digital media (DM) from an early age. Therefore, specific guidelines have been published by the World Health Organization, whose aim is to limit daily screen time (ST) viewing. However, during the COVID-19 pandemic, a rise in DM use, and consequently ST viewing, was observed. More and more aspects of modern life are thought to be affected by excessive ST viewing. Accordingly, the aim of this review is to document the health effects of excessive ST viewing on children and adolescents. A narrative review was performed in searchable databases. In total, 43 original articles were considered. Excessive ST viewing was correlated with increased risk for obesity and other cardiometabolic risk factors, mental health, unhealthy dietary habits and eating disorders, and problems in development and child-parent relationships. Sleep, physical activity, eyesight, headaches, and the musculoskeletal system were negatively affected as well. However, the effect of ST was weighted by the type of media used and the way types of media were used. Other confounding factors were reported. There is evidence to suggest a negative correlation between excessive ST and youth health exists. Nevertheless, more research is needed if this correlation is to be established.

Problematic online behaviors and psychopathology in Australia

This study aimed to ascertain frequency rates and predictors of six problematic online behaviors (POBs) in an Australian sample. Participants (N = 1626) completed instruments measuring problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, problematic online gambling, anxiety, depression and attention deficit/hyperactivity disorder (ADHD). Each POB was presumed to be present based on the cut-off score on the corresponding instrument and at least one indicator of interference with functioning. Generalized linear model analyses were used to determine socio-demographic and psychopathological predictors of each POB. The most common POB was problematic online shopping (12.2%), followed by problematic online gambling (11.4%), problematic use of social networking sites (6.0%), problematic cybersex (5.3%), problematic online gaming (5.2%) and cyberchondria (4.6%). Age group 27-36 had the highest rates of POBs. The intensity of ADHD symptoms predicted all POBs, whereas younger age predicted all POBs except for problematic cybersex and online gambling. Female gender predicted lower scores on the measures of problematic online gaming and cybersex. These findings have implications for age- and gender-adapted education, prevention and treatment efforts and suggest that specific POBs should be investigated separately instead of lumping them together under the umbrella terms such as "Internet addiction".

Immersive virtual reality for improving cognitive deficits in children with ADHD: a systematic review and meta-analysis

Virtual reality (VR) shows great potential in treating and managing various mental health conditions. This includes using VR for training or rehabilitation purposes. For example, VR is being used to improve cognitive functioning (e.g. attention) among children with attention/deficit-hyperactivity disorder (ADHD). The aim of the current review and meta-analysis is to evaluate the effectiveness of immersive VR-based interventions for improving cognitive deficits in children with ADHD, to investigate potential moderators of the effect size and assess treatment adherence and safety. The meta-analysis included seven randomised controlled trials (RCTs) of children with ADHD comparing immersive VR-based interventions with controls (e.g. waiting list, medication, psychotherapy, cognitive training, neurofeedback and hemoencephalographic biofeedback) on measures of cognition. Results indicated large effect sizes in favour of VR-based interventions on outcomes of global cognitive functioning, attention, and memory. Neither intervention length nor participant age moderated the effect size of global cognitive functioning. Control group type (active vs passive control group), ADHD diagnostic status (formal vs. informal) and novelty of VR technology were not significant moderators of the effect size of global cognitive functioning. Treatment adherence was similar across groups and there were no adverse effects. Results should be cautiously interpreted given the poor quality of included studies and small sample.

IAmHero: Preliminary Findings of an Experimental Study to Evaluate the Statistical Significance of an Intervention for ADHD Conducted through the Use of Serious Games in Virtual Reality

The use of new technologies, such as virtual reality (VR), represents a promising strategy in the rehabilitation of subjects with attention-deficit/hyperactivity disorder (ADHD). We present the results obtained by administering the IAmHero tool through VR to a cohort of subjects with ADHD between 5 and 12 years of age. The trial time was approximately 6 months. In order to assess the beneficial effects of the treatment, standardised tests assessing both ADHD symptoms and executive functions (e.g., Conners-3 scales) were administered both before and at the end of the sessions. Improvements were observed at the end of treatment in both ADHD symptoms (especially in the hyperactivity/impulsivity domain) and executive functions. One of the strengths of the VR approach is related above all to the acceptability of this tool and its flexibility. Unfortunately, to date, there are still few studies on this topic; therefore, future studies are essential to expand our knowledge on the utility and benefits of these technologies in the rehabilitation field.

Lack of educational impact of video game addiction in children and adolescents diagnosed with ADHD: A cross-sectional study

Introduction

The use of video games has become widespread worldwide. Excessive use of video games is increasingly becoming a matter of concern, particularly in patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Currently, internet gaming disorder (IGD) is not included within the DSM-5-chapter Disorders related to substances and addictive disorders.

Methods

This is a post-hoc descriptive naturalistic study comparing children and adolescents diagnosed with ADHD with and without IGD. We used the 85% cut-off point of the test ADITEC-V for video game addiction to split our sample of ADHD patients into those with IGD (>=85%) and those without IGD (<85%).

Results

13 (25%) out of the 51 children and adolescents with ADHD included in our study had an IGD. Patients with IGD had a first contact with internet, smartphones, and videogames at a very early age (5.67 ± 3.31, 6.33 ± 4.60, and 7.50 ± 2.61, respectively). However, only age at first contact with the internet was statistically significantly different when comparing ADHD patients with and without IGD (8.68 ± 2.71 vs. 5.67 ± 3.31, t = 3.166, df = 47, p = 0.01). Different neurodevelopmental, clinical, and neuropsychological measures converging in impulsivity is a risk factor for IGD. Unexpectedly, we found no association between IGD and poor academic achievement.

Discussion

Future studies may include randomized controlled trials for treating IGD, the study of social adjustment as a protective factor against developing an IGD, and the role of serious and non-serious video games in the development of an IGD, among others. Additional research is clearly needed on IGD.

ADHD-Gaming Disorder Comorbidity in Children and Adolescents: A Narrative Review

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurobiological condition characterized by developmentally inadequate levels of inattention, hyperactivity, and impulsivity, and a neurobiological disruption in brain neurotransmitters and circuitry causing abnormal responses to rewards. Playing electronic games generates a biological response that activates the neuronal circuits linked to pleasure and reward, and there is a growing attention to this type of activity, which can also turn into a mental health condition. The existence and the boundaries between the functional and the dysfunctional are still a source of debate, with the recognition of 'Internet Gaming Disorder' (IGD) as a condition belonging to the broader area of addiction requiring more in-depth study with respect to the DSM-5, while 'Gaming Disorder' (GD) was officially recognized as a new diagnosis by the World Health Organization (WHO) in the updated revision of the International Classification of Diseases (ICD-11). Notwithstanding, the suggested criteria for the diagnosis of Gaming Disorder are still debated. Since ADHD has been reported as a risk factor for developing addictions, this narrative review aims to provide the current state-of-the art of the knowledge about the comorbidity between ADHD and Gaming Disorder. For this aim, a literature search was conducted using a combination of specific keywords and the results are discussed within the R-Do-C framework and dimensions, and implications for treatment are considered.

Effectivity of Saffron Extract (Saffr’Activ) on Treatment for Children and Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD): A Clinical Effectivity Study

Attention Deficit/Hyperactivity Disorder is the most prevalent neurodevelopmental disorder worldwide. Choice treatment includes psychostimulants, but parents tend to be reluctant to administer them due to side effects, and alternatives are needed. Saffron extract is a natural stimulant that has been proven safe and effective for treating a variety of mental disorders. This study compares the efficacy of saffron and the usual treatment with methylphenidate, using objective and pen-and-paper tests. We performed a non-randomized clinical trial with two groups, methylphenidate (n = 27) and saffron (n = 36), in children and adolescents aged 7 to 17. Results show that the efficacy of saffron is comparable to that of methylphenidate. Saffron is more effective for treating hyperactivity symptoms, while methylphenidate is more effective for inattention symptoms.

Developing Serious Video Games to Treat Attention Deficit Hyperactivity Disorder: Tutorial Guide

Video game–based therapeutic interventions have demonstrated some effectiveness in decreasing the symptoms of attention deficit hyperactivity disorder (ADHD). Compared with more traditional strategies within the multimodal treatment of ADHD, video games have certain advantages such as being comfortable, flexible, and cost-efficient. However, establishing the most appropriate type(s) of video games that should be used for this treatment remains a matter of debate, including the commercial existing video games or serious video games that are specifically constructed to target specific disorders. This guide represents a starting point for developing serious video games aimed at treating ADHD. We summarize the key points that need to be addressed to generate an effective and motivating game-based treatment. Following recommendations from the literature to create game-based treatments, we describe the development stages of a serious video game for treating ADHD. Game design should consider the interests of future users; game mechanics should be based on cognitive exercises; and therapeutic mechanisms must include the control of difficulty, engagement, motivation, time constraints, and reinforcement. To elaborate upon this guide, we performed a narrative review focused on the use of video games for the treatment of ADHD, and were inspired by our own experience during the development of the game “The Secret Trail of Moon.”