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ADHD & Digital Medicine (Apps & Games)

Here I discuss the new field of digital medicine for treating ADHD. This is just a fancy relabeling of the use of games and other apps for treating symptoms of ADHD. While there are more than 300 such apps having some relevance to ADHD, the ones most likely to appear in the trade media recently are the Endeavor video games (Endeavor Rx for children, and EndeavorOTC for adults). I discuss the two studies that have been published on this particular app to illustrate the issues with determining if such apps work to treat ADHD in real life settings. Most such apps have no evidence at all. To date the evidence available for this form of digital medicine (Endeavor) is thin and not especially compelling when one looks closely at the details of the studies. The problem here is similar the earlier app, CogMed, that was marketed to improve working memory in ADHD and thus inattention. And that is the problem of showing near vs. far transfer of treatment effects. It is much easier with these games to show that there is some benefit on a lab task or test that is similar to the game. It is far more difficult to show that there is far transfer to improved behavior in natural settings, which CogMed failed to convincingly do. And the same is true for Endeavor and other apps at this time. At this time, my advice is buyer beware. The prevailing evidence base is thin to nonexistent for digital therapeutics for ADHD. References: Shuman, A. J. (2023) Mobile mental health apps: Should we recommend them? Contemporary pediatrics, 40 (8). https://www.contemporarypediatrics.co... Kollins, S. et al. (2020). A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. Lancet Digital Health, 2(4), e168-e178. doi: 10.1016/S2589-7500(20)30017-0 Kollins, S. et al. (2021). Effectiveness of a digital therapeutic as adjunct to treatment with medication in pediatric ADHD. NPJ Digital Therapeutics, 4(1), 58. doi: 10.1038/s41746-021-00429-0.