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Bos E, Preller KH, Kaur G, Malhotra P, Kharawala S, Motti D. Challenges With the Use of Digital Sham: Systematic Review and Recommendations. J Med Internet Res 2023; 25:e44764. [PMID: 37874638 PMCID: PMC10630857 DOI: 10.2196/44764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Digital therapeutics (DTx) are software-based products that prevent, manage, or treat a medical condition and are delivered through a smartphone app, web application, or wearable device. Clinical trials assessing DTx pose challenges, foremost among which is designing appropriate digital shams (or digital placebos), which should ideally mimic DTx (in terms of design, components, and duration of treatment) while omitting the active principle or component. OBJECTIVE The objective of our review was to understand how digital shams are being used in clinical research on DTx in neuroscience, which is the most common therapy area for DTx. METHODS We conducted a systematic literature review of DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) with a focus on controlled clinical trials involving digital shams. Studies were identified from trial registries (ClinicalTrials.gov, the European Union Clinical Trials Register, and Trial Trove) and through structured searches in MEDLINE and Embase (both via the Embase website) and were limited to articles in English published from 2010 onward. These were supplemented by keyword-based searches in PubMed, Google, and Google Scholar and bibliographic searches. Studies assessing DTx in neuroscience (including neurodevelopmental, neurodegenerative, and psychiatric disorders) were included. Details related to the publication, DTx, comparator, patient population, and outcomes were extracted and analyzed. RESULTS Our search criteria identified 461 neuroscience studies involving 213 unique DTx. Most DTx were extended reality based (86/213, 40.4%) or mobile device based (56/213, 26.3%); 313 were comparative, of which 68 (21.7%) used shams. The most common therapeutic areas assessed in these studies were stroke (42/213, 19.7%), depression (32/213, 15%), and anxiety (24/213, 11.3%). The most common treatments were cognitive behavioral therapy or behavioral therapy (67/213, 32.4%), physical rehabilitation (60/213, 28.2%), and cognitive training (41/213, 19.2%). We identified the following important issues related to the use of digital shams in neuroscience: shams were not validated before use in studies, they varied widely in design (from being nearly identical to the DTx to using different software programs altogether), and the level of patient engagement or satisfaction with the sham and the impact of the sham on study outcomes were infrequently reported. CONCLUSIONS Digital shams are critical for the clinical development of DTx in neuroscience. Given the importance of sham controls in evaluating DTx efficacy, we provide recommendations on the key information that should be reported in a well-designed DTx trial and propose an algorithm to allow the correct interpretation of DTx study results. Sham-controlled studies should be routinely used in DTx trials-in early-phase studies-to help identify DTx active components and-in late-phase studies-to confirm the efficacy of DTx. The use of shams early in development will ensure that the appropriate sham control is used in later confirmatory trials.
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Affiliation(s)
- Ernst Bos
- F Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Gavneet Kaur
- Bridge Medical Consulting Limited, London, United Kingdom
| | - Pooja Malhotra
- Bridge Medical Consulting Limited, London, United Kingdom
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Gallardo Montes CDP, Rodríguez Fuentes A, Caurcel Cara MJ. ICT training for educators of Granada for working with people with autism. Heliyon 2023; 9:e13924. [PMID: 36915522 PMCID: PMC10006459 DOI: 10.1016/j.heliyon.2023.e13924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Background Innovative methodologies based on Information and Communication Technology (ICT) are a tested and motivating option for working with people with autism. Their use, however, should not be indiscriminatory and arbitrary, but didactic and appropriate. Objective We aimed to discover the training in ICT they had, its frequency of use, and the types of digital resources that they used. Methods We administered the questionnaire, "Demands and Potentials of ICT and Apps for Assisting People with Autism" to 310 educators in the city of Granada (Spain). The participants belonged to schools and associations that worked with people with autism. Adopting a quantitative-type study, we carried out descriptive analyses (frequencies, mean, mode, and standard deviation). Having confirmed that the data did not follow a normal distribution (Kolmogorov-Smirnov test for samples of >50 participants), we carried out non-parametric inferential and intrafactorial correlation analyses. We also calculated the effect size. Results The educators revealed that they had ICT training for working with people with autism, but not enough. This suggests that there is still a need to improve the digital competence of these professionals. Strong, direct and significant correlations were found between ICT training and the frequency with which they were used. There were also statistically significant differences according to sex, gender, age, type of institution, and type of educator. The educators who worked as Therapeutic Pedagogy teachers and those who worked in Special Education schools were shown to be more competent than the rest in educational technology applied to people with autism. Conclusions The results, which were not wholly positive since ICT training should be better and have achieved higher scores, revealed that there is a foundation in ICT education but it needs to be heightened and improved with greater knowledge and more practical experience.
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Affiliation(s)
| | - Antonio Rodríguez Fuentes
- Department of Didactic and School Organization, Faculty of Education Sciences, University of Granada, Spain
- Corresponding author.
| | - María Jesús Caurcel Cara
- Department of Developmental and Educational Psychology, Faculty of Education Sciences, University of Granada, Spain
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3
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Features and effects of computer-based games on cognitive impairments in children with autism spectrum disorder: an evidence-based systematic literature review. BMC Psychiatry 2023; 23:2. [PMID: 36597046 PMCID: PMC9809031 DOI: 10.1186/s12888-022-04501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Children with Autism Spectrum Disorder (ASD) have different cognitive and intelligence profiles than typical developing individuals. Some of these children need cognitive rehabilitation. This study's main purpose is to provide a systematic review about applying computerized cognitive games for autistic children and to determine the effectiveness of such interventions. MATERIAL AND METHODS A thorough search of the ISI Web of Science, Medline (through PubMed), Scopus, IEEE Xplore, and APA PsycInfo databases was performed for articles published from inception to May 17, 2022. RESULTS Of 1746 papers, 28 studies were found to be eligible in this systematic review. Fifteen studies (53.57%) compared a Control Group (CG) with Experimental Groups (EGs), while 13 papers (46.42%) evaluated only the impact of the applied intervention in an experimental group. Major domains of cognitive functions are divided into five main categories: 1. Executive functions, 2. Social cognition/emotions, 3. Attention/concentration, 4. Learning and memory, and 5. Language. In 42.85% (12 studies) of the screened papers, social cognition and emotions were assessed after cognitive rehabilitation. The highest rate of effects reported by studies were related to social cognition enhancement. Of the total number of included studies, 17 studies reported a positive effect at all scales, of which nine were quasi-experimental, and seven were fully experimental. CONCLUSION Using suitable computerized game-based solutions could enhance cognition indexes in autistic children. Hence, further investigation is needed to determine the real effectiveness of these novel technologies.
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Ono T, Sakurai T, Kasuno S, Murai T. Novel 3-D action video game mechanics reveal differentiable cognitive constructs in young players, but not in old. Sci Rep 2022; 12:11751. [PMID: 35864114 PMCID: PMC9304325 DOI: 10.1038/s41598-022-15679-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Video game research predominantly uses a “one game-one function” approach—researchers deploy a constellation of task-like minigames to span multiple domains or consider a complex video game to essentially represent one cognitive construct. To profile cognitive functioning in a more ecologically valid setting, we developed a novel 3-D action shooter video game explicitly designed to engage multiple cognitive domains. We compared gameplay data with results from a web-based cognitive battery (WebCNP) for 158 participants (aged 18–74). There were significant negative main effects on game performance from age and gender, even when controlling for prior video game exposure. Among younger players, game mechanics displayed significant and unique correlations to cognitive constructs such as aim accuracy with attention and stealth with abstract thinking within the same session. Among older players the relation between game components and cognitive domains was unclear. Findings suggest that while game mechanics within a single game can be deconstructed to correspond to existing cognitive metrics, how game mechanics are understood and utilized likely differs between the young and old. We argue that while complex games can be utilized to measure distinct cognitive functions, the translation scheme of gameplay to cognitive function should not be one-size-fits-all across all demographics.
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Affiliation(s)
- Tomihiro Ono
- Department of Psychiatry, Kyoto University Hospital, Yoshida konoe cho, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan. .,BonBon Inc., Kyoto, Japan.
| | - Takeshi Sakurai
- BonBon Inc., Kyoto, Japan.,Department of Drug Discovery Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Functionality of Apps for People with Autism: Comparison between Educators from Florence and Granada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127019. [PMID: 35742268 PMCID: PMC9222948 DOI: 10.3390/ijerph19127019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies on the potential of smartphone apps for people with autism are currently increasing in number, given the large digital supply available and the benefits they offer. We analyzed the opinion of educators from Florence (Italy) and Granada (Spain) regarding the benefits and applicability of apps, frequency of their use, and the type of apps used for people with autism. METHODS The study involved 1261 professionals, of whom 286 worked with apps, using a non-experimental quantitative design, descriptive and frequency statistics, parametric inferential analyses (Student's t and one-factor ANOVA), and calculation of the effect size (Cohen's d and eta squared) and intrafactorial correlations. RESULTS Statistically significant differences were observed in respect of city, sex, age, years of experience, place of work, and type of teacher. The teachers from Granada found more benefits and applicability in apps, and revealed a slightly higher usage than those from Florence. CONCLUSIONS It is an arduous but worthy task for professionals from schools and associations that work with people with autism to acquire the necessary knowledge to apply methodologies based on information and communication technology (ICT), as this will help achieve the integrated development of people with different capabilities.
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Edmunds SR, MacNaughton GA, Rueda MR, Combita LM, Faja S. Beyond group differences: Exploring the preliminary signals of target engagement of an executive function training for autistic children. Autism Res 2022; 15:1261-1273. [PMID: 35481725 PMCID: PMC9322009 DOI: 10.1002/aur.2735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/24/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022]
Abstract
Understanding both for whom and how interventions work is a crucial next step in providing personalized care to children with autism spectrum disorder (ASD). Autistic children present with heterogeneity both within core ASD criteria and with respect to co‐occurring mental health challenges, which may affect their ability to benefit from intervention. In a secondary data analysis of a randomized control trial evaluating an executive function (EF) training with 70 7‐ to 11‐year‐old autistic children, we explored: (1) whether co‐occurring attention‐deficit/hyperactivity disorder (ADHD) features or anxiety features at baseline moderated the extent to which children benefited from the EF training. In other words, we asked, “For whom is training effective?” We also explored: (2) the extent to which changes in a brain‐based measure of target engagement predicted the clinical outcomes of the EF training. This is a step towards asking, “How is training effective?” We found that EF training improved behavioral inhibition only for children with clinically significant co‐occurring ADHD features. Anxiety features, while prevalent, did not moderate EF training efficacy. Finally, for the EF training group only, there was a significant correlation between pre‐to‐post change in an EEG‐based measure of target engagement, N2 incongruent amplitude during a flanker task, and change in repetitive behaviors, a behavioral outcome that was reported in the parent RCT to have improved with training compared to waitlist control. This study provides preliminary evidence that EF training may differentially affect subgroups of autistic children and that changes at the neural level may precede changes in behavior.
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Affiliation(s)
- Sarah R Edmunds
- Department of Psychology, St. Barnwell College, Columbia, South Carolina, USA.,Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Brookline, Massachusetts, USA
| | - Gabrielle A MacNaughton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - M Rosario Rueda
- Mind, Brain and Behavior Research Center (CIMCYC), Universidad de Granada, Campus Universitario de Cartuja, Granada, Spain
| | - Lina M Combita
- Mind, Brain and Behavior Research Center (CIMCYC), Universidad de Granada, Campus Universitario de Cartuja, Granada, Spain
| | - Susan Faja
- Department of Psychology, St. Barnwell College, Columbia, South Carolina, USA.,Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Brookline, Massachusetts, USA
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Stevanovic D, Wentz E, Nasic S, Knez R. ASD with ADHD vs. ASD and ADHD alone: a study of the QbTest performance and single-dose methylphenidate responding in children and adolescents. BMC Psychiatry 2022; 22:282. [PMID: 35448977 PMCID: PMC9022263 DOI: 10.1186/s12888-022-03878-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The continuous performance task (CPT) may help identify coexistent attention deficit hyperactivity disorder (ADHD) in autism spectrum disorder (ASD). The Quantified behavior Test (QbTest) combines a CPT and motion-tracking data to assess ADHD symptoms. This study aimed to evaluate the QbTest performance of children and adolescents with ASD plus ADHD, including estimating the effects of single-dose methylphenidate (MPH). To achieve these aims, (1) the QbTest performances were evaluated in ASD alone, ASD plus ADHD, and ADHD alone, and (2) the effects on the QbTest performance of single-dose MPH before and after intake were estimated across the groups. It was assumed that the ASD plus ADHD performance, including the MPH response, would preferably resemble the performance in ADHD alone, rather than ASD alone. METHODS Retrospective data were analyzed for 482 children and adolescents: 69 with ASD alone, 142 with ASD plus ADHD (ASD/ADHD), and 271 with ADHD alone. For 343 subjects, the QbTest was performed before and up to four hours after a single-dose MPH intake. A summary index of the CPT and motion-capture data was provided for QbTest cardinal parameters. RESULTS Of 12 QbTest parameters assessed before given MPH, the ASD/ADHD group had scores in line with the ASD group regarding four parameters and the ADHD group regarding nine parameters. Significant differences between groups were seen with respect to QbInattention (p > 0.05); the lowest scores in ASD and the highest in ADHD. Those with ASD/ADHD and ADHD had similar QbActivity and QbImpulsivity scores, but significantly higher than those with ASD. After MPH intake, scores for QbActivity decreased similarly in ASD/ADHD and ADHD, as well as scores for QbImpulsivity. QbImpulsivity increased in ASD. QbInattention scores decreased similarly in all groups after MPH intake. CONCLUSIONS Children and adolescents with ASD plus ADHD exhibited more atypical QbTest performances than those with ASD alone, while most of their performances were similar to those observed in ADHD alone. In addition, a single dose of MPH mitigated attention deficits and decreased hyperactivity while improved impulsivity in these children. Prospective studies should further clarify the role of the QbTest in the diagnostic and therapeutic interventions in ASD with ADHD.
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Affiliation(s)
- Dejan Stevanovic
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530 Göteborg, Sweden ,Psychiatry Department, Clinic for Neurology and Psychiatry for Children and Youth, Dr Subotic 6a, 11000 Belgrade, Serbia
| | - Elisabet Wentz
- grid.8761.80000 0000 9919 9582Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530 Göteborg, Sweden
| | - Salmir Nasic
- grid.416029.80000 0004 0624 0275Research & Development Centre, Skaraborgs Hospital, Lövängsvägen, 541 42 Skövde, Sweden ,grid.8761.80000 0000 9919 9582Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530 Göteborg, Sweden
| | - Rajna Knez
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530, Göteborg, Sweden. .,Department of Pediatrics, Skaraborgs Hospital, Skövde, Sweden.
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Faja S, Clarkson T, Gilbert R, Vaidyanathan A, Greco G, Rueda MR, Combita LM, Driscoll K. A preliminary randomized, controlled trial of executive function training for children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:346-360. [PMID: 34474598 PMCID: PMC8813874 DOI: 10.1177/13623613211014990] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
LAY ABSTRACT Executive function, which is a set of thinking skills that includes stopping unwanted responses, being flexible, and remembering information needed to solve problems, is a challenge for many children on the autism spectrum. This study tested whether executive function could be improved with a computerized executive function training program under the guidance of a coach who reinforced the use of executive function skills. Seventy children with autism spectrum disorder from age 7 to 11 years of age participated in the study. They were randomly assigned to receive training or to a waiting group. The tests most likely to determine whether the training may be effective were chosen from a larger battery before the study started and included one task measuring brain responses, two measures of executive function in the lab, and a parent questionnaire. Changes in social functioning and repetitive behaviors were also explored. All children assigned to training completed the program and families generally reported the experience was positive. Brain responses of the training group changed following training, but not within the waiting group during a similar time period. Children who received training did not exhibit behavioral changes during the two the lab-based tasks. Parent report on questionnaires indicated that neither group showed a significant change in their broad use of executive function in other settings. Yet, children who received training were reported to have fewer restricted and repetitive behaviors following training. These initial findings suggest that short executive function training activities are feasible and may improve some functioning of school-aged children on the autism spectrum.
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Affiliation(s)
- Susan Faja
- Boston Children's Hospital, USA.,Harvard Medical School, USA
| | | | - Rachel Gilbert
- Boston Children's Hospital, USA.,University of Florida, USA
| | | | - Gabriella Greco
- Boston Children's Hospital, USA.,University of Washington, USA
| | | | | | - Kate Driscoll
- Boston Children's Hospital, USA.,Harvard Medical School, USA
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Choi E, Yoon EH, Park MH. Game-based digital therapeutics for children and adolescents: Their therapeutic effects on mental health problems, the sustainability of the therapeutic effects and the transfer of cognitive functions. Front Psychiatry 2022; 13:986687. [PMID: 36523871 PMCID: PMC9744939 DOI: 10.3389/fpsyt.2022.986687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/20/2022] [Indexed: 11/30/2022] Open
Abstract
Mental health problems in childhood and adolescence (e. g., attention deficits, problems in emotional understanding and subclinical levels of anxiety) are reported to develop further in adulthood and/or to increase the risk of developing mental health disorders in adulthood. Although it is important to provide treatment or prevention interventions for children and adolescents in order to reduce the risk of the further development of mental health problems, the pharmacological and behavioral treatments for this age group have limitations (e.g., limited access, unsustainable treatment effects and the lack of engagement in intervention). In order to overcome the limitations of conventional treatments, the use of digital technology, especially video games for this age group, is suggested. In order to be accepted as clinical interventions, objective evidence for the therapeutic effects of digital therapeutic that used video games to treat or prevent targeted mental health problems are required. Thus, this review aims to explore whether game-based digital therapeutics (DTx) for children and adolescents showed therapeutic effects on targeted mental health problems. As game-based DTx are suggested to show sustained therapeutic effects and the transfer of cognitive functions, it also reviews the maintenance of the therapeutic effects of DTx and the extent of the transfer of cognitive functions. Game-based DTx that are developed to treat or prevent mental health problems (e.g., attention deficit, depression) in children and adolescents are found to show therapeutic effects on targeted mental health problems despite the limitations (e.g., small sample size, limited investigation of the sustainability). This review would contribute to the understanding of whether there is objective evidence of the therapeutic effects of digital therapeutics using video games that deliver treatment or prevention interventions for mental health problems in children and adolescents.
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Affiliation(s)
- Eunhye Choi
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Eun-Ha Yoon
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Min-Hyeon Park
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
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Jiang H, Natarajan R, Shuy YK, Rong L, Zhang MW, Vallabhajosyula R. The Use of Mobile Games in the Management of Patients With Attention Deficit Hyperactive Disorder: A Scoping Review. Front Psychiatry 2022; 13:792402. [PMID: 35308884 PMCID: PMC8931195 DOI: 10.3389/fpsyt.2022.792402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/17/2022] [Indexed: 12/03/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with significant morbidity. Current treatment approaches consist of a mixture of pharmacological and psychological approaches. The emergence of digital technology, and mobile gaming applications, represents a promising novel method in potentially augmenting existing interventions for ADHD. In this review, we will map out the use of mobile gaming applications in the management of ADHD and evaluate the effectiveness of these technologies and any areas for future research. Four electronic databases were searched for relevant articles. All articles were screened for abstract and full text by two independent reviewers, and data extracted onto a common data extraction sheet. The data was narratively synthesized and reported in line with the PRISMA-ScR guidelines. A total of 19 studies were included. Studies mostly evaluated the effectiveness of games on male children with ADHD. Most games were focused on the treatment of ADHD, while a minority were focused on the diagnosis and monitoring of ADHD. Some of the common gaming mechanisms employed in games included having participants responding to cures, remembering details, and making associations between different entities. The studies generally showed an improvement in performance of children as they played the games, but evidence for the effectiveness of these modalities remains scarce and mixed. While it is exciting that there is such a wide variety of games available currently in the diagnosis, treatment, and monitoring of ADHD, many of the games lack clinical evidence to prove their effectiveness. Furthermore, most studies contain several limitations including small sample size, limited ages of participants, lack of control group, and lack of comprehensive outcomes. To promote the application of these games to clinical practice, robust clinical trials, collaboration between stakeholders and using a comprehensive set of outcome measurements is essential.
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Affiliation(s)
- Haowen Jiang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rohit Natarajan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lim Rong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Melvyn Weibin Zhang
- Family Medicine and Primary Care, Lee Kong Chain School of Medicine, Nanyang Technological University, Singapore, Singapore
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Peñuelas-Calvo I, Jiang-Lin LK, Girela-Serrano B, Delgado-Gomez D, Navarro-Jimenez R, Baca-Garcia E, Porras-Segovia A. Video games for the assessment and treatment of attention-deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry 2022; 31:5-20. [PMID: 32424511 DOI: 10.1007/s00787-020-01557-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and serious disorder among children. Video games have shown potential for aiding in child healthcare. Video games could contribute to the assessment and management of ADHD, but there are no previous reviews on this topic. Here, we systematically review the evidence about video game-based assessment tools and interventions for children diagnosed with ADHD. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered in PROSPERO database. We searched four databases-PubMed, PsycInfo, Embase and clinicaltrials.gov-to identify original studies exploring either video game-based interventions or video game-based assessment tools in children with ADHD. After initial screening, full text revision and study selection, 22 articles were finally included in the review. Most studies used PC as platform, with a minority using a video console, pad, or 3D device. Video game-based assessment tools were generally effective in discriminating ADHD cases from controls, and in discriminating between ADHD subtypes. Video game-based therapeutic interventions were well accepted and generally effective in improving cognitive areas and decreasing ADHD symptoms. Gamification and cognitive training could be the main mechanisms underlying the usefulness and effectiveness of video game-based assessment tools and interventions. Software optimization and greater collaboration between developers and healthcare professionals are some of the priorities for future research in this area.
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Affiliation(s)
- Inmaculada Peñuelas-Calvo
- Department of Child and Adolescent Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain. .,Translational Psychiatry Research Group, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain. .,Department of Psychology, Universidad Complutense de Madrid, Madrid, Spain.
| | - Lin Ke Jiang-Lin
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Braulio Girela-Serrano
- Mood Instability Research Group, Centre for Psychiatry, Imperial College London, London, UK
| | | | - Rocio Navarro-Jimenez
- Translational Psychiatry Research Group, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Enrique Baca-Garcia
- Department of Child and Adolescent Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Translational Psychiatry Research Group, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.,CIBERSAM, Madrid, Spain.,Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain.,Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain.,Department of Psychiatry, Universidad Católica del Maule, Talca, Chile
| | - Alejandro Porras-Segovia
- Translational Psychiatry Research Group, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
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12
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Vaidya CJ, Klein C. Comorbidity of Attention-Deficit Hyperactivity Disorder and Autism Spectrum Disorders: Current Status and Promising Directions. Curr Top Behav Neurosci 2022; 57:159-177. [PMID: 35397063 DOI: 10.1007/7854_2022_334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
High rates of co-occurring Attention-Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD) suggest common causal pathways, which await elucidation. What is well-established, however, is the negative impact of comorbid ADHD and ASD on outcomes for everyday living, particularly in social interaction and communication and on broader psychopathology. Neurocognitive approaches suggest correlates of comorbidity are rooted in functional connectivity networks associated with executive control. There is support for familial origins, with molecular-genetic studies suggesting a causal role of pleiotropic genes. Further investigation is needed to elucidate fully how genetic risk for ADHD and ASD affects neurodevelopment and to identify structural and functional neural correlates and their behavioral sequelae. Identification of intermediate phenotypes is necessary to advance understanding, which requires studies that include the full spectrum of ASD and ADHD symptom severity, use longitudinal designs and multivariate methods to probe broad constructs, such as executive and social function, and consider other sources of heterogeneity, such as age, sex, and other psychopathology. Randomized efficacy trials targeting comorbid symptomatology are needed to mitigate negative developmental outcomes.
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Affiliation(s)
- Chandan J Vaidya
- Department of Psychology, Georgetown University, Washington, DC, USA.
- Children's Research Institute, Children's National Health System, Washington, DC, USA.
| | - Christoph Klein
- Clinic for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
- Psychiatry Department, National and Kapodistrian University of Athens, Medical School, University General Hospital "ATTIKON", Athens, Greece
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13
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Penev Y, Dunlap K, Husic A, Hou C, Washington P, Leblanc E, Kline A, Kent J, Ng-Thow-Hing A, Liu B, Harjadi C, Tsou M, Desai M, Wall DP. A Mobile Game Platform for Improving Social Communication in Children with Autism: A Feasibility Study. Appl Clin Inform 2021; 12:1030-1040. [PMID: 34788890 PMCID: PMC8598393 DOI: 10.1055/s-0041-1736626] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background
Many children with autism cannot receive timely in-person diagnosis and therapy, especially in situations where access is limited by geography, socioeconomics, or global health concerns such as the current COVD-19 pandemic. Mobile solutions that work outside of traditional clinical environments can safeguard against gaps in access to quality care.
Objective
The aim of the study is to examine the engagement level and therapeutic feasibility of a mobile game platform for children with autism.
Methods
We designed a mobile application,
GuessWhat
, which, in its current form, delivers game-based therapy to children aged 3 to 12 in home settings through a smartphone. The phone, held by a caregiver on their forehead, displays one of a range of appropriate and therapeutically relevant prompts (e.g., a surprised face) that the child must recognize and mimic sufficiently to allow the caregiver to guess what is being imitated and proceed to the next prompt. Each game runs for 90 seconds to create a robust social exchange between the child and the caregiver.
Results
We examined the therapeutic feasibility of
GuessWhat
in 72 children (75% male, average age 8 years 2 months) with autism who were asked to play the game for three 90-second sessions per day, 3 days per week, for a total of 4 weeks. The group showed significant improvements in Social Responsiveness Score-2 (SRS-2) total (3.97,
p
<0.001) and Vineland Adaptive Behavior Scales-II (VABS-II) socialization standard (5.27,
p
= 0.002) scores.
Conclusion
The results support that the
GuessWhat
mobile game is a viable approach for efficacious treatment of autism and further support the possibility that the game can be used in natural settings to increase access to treatment when barriers to care exist.
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Affiliation(s)
- Yordan Penev
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Kaitlyn Dunlap
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Arman Husic
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Cathy Hou
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Peter Washington
- Department of Bioengineering, Stanford University, Stanford, California, United States
| | - Emilie Leblanc
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Aaron Kline
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - John Kent
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Anthony Ng-Thow-Hing
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Bennett Liu
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Christopher Harjadi
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Meagan Tsou
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Manisha Desai
- Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Dennis P Wall
- Department of Pediatrics (Systems Medicine), Stanford University, Stanford, California, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
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14
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Silva GM, Souto JJDS, Fernandes TP, Bolis I, Santos NA. Interventions with Serious Games and Entertainment Games in Autism Spectrum Disorder: A Systematic Review. Dev Neuropsychol 2021; 46:463-485. [PMID: 34595981 DOI: 10.1080/87565641.2021.1981905] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The use of serious games and entertainment games was compared as adjuvant tools for intervention in Autism Spectrum Disorder (ASD). A comprehensive search was performed in the MEDLINE, PsycINFO, Scopus, and Web of Science databases. From 295 studies, 53 studies were selected and included in this review. Overall, studies showed improvement after intervention, regardless of the type of video games, mostly for social skills and behavior. However, these changes should be regarded with caution, as they are limited to the tests applied. Furthermore, neither the entertainment nor the serious approach had a therapeutic impact on emotional resilience, representing the current gap in the field. Thus, even considering the limitations, our study is important because it shows that both categories have strengths.
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Affiliation(s)
- Gabriella Medeiros Silva
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil.,Perception, Neuroscience and Behaviour Laboratory, Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil
| | - Jandirlly Julianna de Souza Souto
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil.,Perception, Neuroscience and Behaviour Laboratory, Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil
| | - Thiago P Fernandes
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil.,Perception, Neuroscience and Behaviour Laboratory, Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil
| | - Ivan Bolis
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil
| | - Natanael A Santos
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil.,Perception, Neuroscience and Behaviour Laboratory, Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil
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15
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Pasqualotto A, Mazzoni N, Bentenuto A, Mulè A, Benso F, Venuti P. Effects of Cognitive Training Programs on Executive Function in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review. Brain Sci 2021; 11:1280. [PMID: 34679345 PMCID: PMC8534174 DOI: 10.3390/brainsci11101280] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Autism Spectrum Disorder is often associated with deficits in executive functions (EFs), which is contributing significantly to individuals with ASD's difficulties in conducting an independent life, particularly considering social skills. Technologies offer promising opportunities to structure EF intervention programs for children on the autistic spectrum. METHODS This study aimed to review the effectiveness of randomized controlled trials or quasi-experimental studies of EF interventions delivered to children and young people (up to 23 years old) with a diagnosis of ASD. A special focus was dedicated to document the effectiveness of computerized and non-computerized cognitive training on (1) EFs and on (2) ASD symptomatology and social skills. Of 2601 studies retrieved, 19 fulfilled the inclusion criteria. RESULTS Most of the interventions identified were effective in enhancing EFs and reducing symptoms in children and young people with ASD. Limited evidence is available on their generalization to untrained skills (i.e., social abilities) as well as long-term effects. CONCLUSIONS There is growing evidence for overall effectiveness of EF training, particularly when computerized. However, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and a small samples of included studies.
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Affiliation(s)
- Angela Pasqualotto
- Laboratory of Observational, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (N.M.); (A.B.); (A.M.); (F.B.); (P.V.)
- Faculty of Psychology and Educational Sciences, University of Geneva, 1205 Geneva, Switzerland
| | - Noemi Mazzoni
- Laboratory of Observational, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (N.M.); (A.B.); (A.M.); (F.B.); (P.V.)
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems, Istituto Italiano di Tecnologia, 38068 Rovereto, Italy
| | - Arianna Bentenuto
- Laboratory of Observational, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (N.M.); (A.B.); (A.M.); (F.B.); (P.V.)
| | - Anna Mulè
- Laboratory of Observational, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (N.M.); (A.B.); (A.M.); (F.B.); (P.V.)
| | - Francesco Benso
- Laboratory of Observational, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (N.M.); (A.B.); (A.M.); (F.B.); (P.V.)
| | - Paola Venuti
- Laboratory of Observational, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (N.M.); (A.B.); (A.M.); (F.B.); (P.V.)
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16
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Brief Report: Feasibility of the Probabilistic Reversal Learning Task as an Outcome Measure in an Intervention Trial for Individuals with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:4191-4199. [PMID: 34557984 PMCID: PMC8459822 DOI: 10.1007/s10803-021-05288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/25/2022]
Abstract
Cognitive flexibility deficits are a hallmark feature of autism spectrum disorder (ASD), but few evidence-based behavioral interventions have successfully addressed this treatment target. Outcome measurement selection may help account for previous findings. The probabilistic reversal learning task (PRL) is a measure of cognitive flexibility previously validated for use in ASD, but its use as an outcome measure has not yet been assessed. The current study examined the feasibility, reproducibility, and sensitivity of PRL in a within-subjects trial of Regulating Together, a group-based intervention targeting emotion regulation. We demonstrated the PRL is highly feasible, showed test–retest reproducibility, and is sensitive to detect change following the intervention. Our findings demonstrate the PRL task may be a useful outcome measure of cognitive flexibility in future intervention trials in ASD.
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17
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:857-883. [PMID: 33884535 PMCID: PMC8411365 DOI: 10.1007/s10488-021-01133-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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18
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Spaniol MM, Mevorach C, Shalev L, Teixeira MCTV, Lowenthal R, de Paula CS. Attention training in children with autism spectrum disorder improves academic performance: A double-blind pilot application of the computerized progressive attentional training program. Autism Res 2021; 14:1769-1776. [PMID: 34227246 DOI: 10.1002/aur.2566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 04/10/2021] [Accepted: 04/21/2021] [Indexed: 01/22/2023]
Abstract
Atypical attention has been reported in individuals with autism spectrum disorder (ASD) with studies pointing to an increase in attention deficit and hyperactivity disorder-like symptomatology. Individuals with ASD may also present academic difficulties and it is possible that they face a double-barrier for academic attainment from both core ASD symptomatology and from attention atypicalities, which are directly linked to academic performance. This raises the possibility that academic difficulties in ASD may benefit from cognitive training targeting attention. To test this possibility, we used the computerized progressive attentional training (CPAT) intervention in a double-blind, active control with follow-up intervention study in Brazil. The CPAT is a computerized attention training program that was recently piloted with schoolchildren with ASD in the UK. Twenty-six participants (8-14 years) with ASD in the São Paulo's ASD Reference Unit were assigned to either the CPAT (n = 14) or active control group (n = 12), which were matched at baseline. Two 45-min intervention sessions per week were conducted over a 2-month period. School performance, attention, fluid intelligence, and behavior were assessed before, immediately after and 3 months following the intervention. Significant group by time interactions show improvements in math, reading, writing and attention that were maintained at follow-up for the CPAT (but not the active control) group, while parents of children from both groups tended to report behavioral improvements. We conclude that attention training has the potential to reduce obstacles for academic attainment in ASD. Combined with the previous pilot study, the current results point to the generality of the approach, which leads to similar outcomes in different cultural and social contexts. LAY ABSTRACT: Attention difficulties tend to occur in ASD and are linked to academic performance. In this study, we demonstrate that school performance in math, reading and writing in children with ASD can improve following an intervention that trains basic attention skills (the CPAT intervention). The improvements we report are stable and were maintained 3-months following the intervention. This study, which was conducted in a public-health setting in Brazil, extends previous research in schools in the UK pointing to the cross-cultural and cross-settings efficacy of the intervention.
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Affiliation(s)
- Mayra Muller Spaniol
- Developmental Disorders Program, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Carmel Mevorach
- School of Psychology and the Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Lilach Shalev
- School of Education and the Sagol School of Neuroscience, Tel-Aviv University, Israel
| | | | - Rosane Lowenthal
- Mental Health Department, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Cristiane Silvestre de Paula
- Developmental Disorders Program, Mackenzie Presbyterian University, São Paulo, Brazil.,Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
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19
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:884-908. [PMID: 34196884 DOI: 10.1007/s10488-021-01144-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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20
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Sosnowski DW, Stough CO, Weiss MJ, Cessna T, Casale A, Foran A, Erwinski M, Wilson J, Farber SA, Farber MA. Brief Report: A Novel Digital Therapeutic that Combines Applied Behavior Analysis with Gaze-Contingent Eye Tracking to Improve Emotion Recognition in Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:2357-2366. [PMID: 34060003 DOI: 10.1007/s10803-021-05101-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
This study examined the feasibility, acceptability, and efficacy of a video game-based digital therapeutic combining applied behavior analysis techniques and gaze-contingent eye tracking to target emotion recognition in youth with autism spectrum disorder (ASD). Children aged 4-14 years with ASD were randomized to complete Lookware™ (n = 25) or a control video game (n = 29). Results from a 2 × 2 mixed ANOVA revealed that children in the intervention condition demonstrated significant improvements in emotion recognition from pre- to post-intervention compared to children in the control condition, F(1,52) = 17.48, p < 0.001. Children and staff perceived high feasibility and acceptability of Lookware™. Study results demonstrated the feasibility, acceptability, and preliminary efficacy of Lookware™.
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Affiliation(s)
- David W Sosnowski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Tahra Cessna
- Positive Behavior Supports Corporation, Stuart, FL, USA
| | - Amy Casale
- Nashoba Learning Group, Inc., Bedford, MA, USA
| | | | | | | | - Steven A Farber
- Department of Embryology, Carnegie Institution for Science, Baltimore, MD, USA
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21
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Legault MCB, Liu HZ, Balodis IM. Neuropsychological Constructs in Gaming Disorders: a Systematic Review. Curr Behav Neurosci Rep 2021. [DOI: 10.1007/s40473-021-00230-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Fitzgerald KD, Schroder HS, Marsh R. Cognitive Control in Pediatric Obsessive-Compulsive and Anxiety Disorders: Brain-Behavioral Targets for Early Intervention. Biol Psychiatry 2021; 89:697-706. [PMID: 33454049 PMCID: PMC8353584 DOI: 10.1016/j.biopsych.2020.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
The DSM provides distinct criteria for obsessive-compulsive disorder (OCD) and various types of anxiety disorders, but phenomenological overlap, high rates of comorbidity, and early onset suggest common underlying mechanisms. This notion is further supported by use of the same treatments-cognitive behavioral therapy and serotonin reuptake inhibitor medication-for managing both OCD and non-OCD anxiety disorders in clinical settings. While early intervention with these gold standard treatments is recommended for pediatric OCD and anxiety disorders, young patients often remain symptomatic even after treatment. To guide the development of novel, mechanistically targeted treatments to better resolve OCD and anxiety symptoms, the identification of neural circuits underlying psychological constructs with relevance across disorders has been recommended. One construct that may be relevant for understanding pediatric OCD and anxiety disorders is cognitive control, given the difficulty that young patients experience in dismissing obsessions, compulsions, and worry despite recognition that these symptoms are excessive and unreasonable. In this review, we examine findings from a growing body of literature implicating brain-behavioral markers of cognitive control in pediatric OCD and anxiety disorders, including before and after treatment. We conclude by suggesting that interventions designed to enhance the functioning of the task control circuits underlying cognitive control may facilitate brain maturation to help affected youth overcome symptoms.
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Affiliation(s)
- Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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23
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Anguera JA, Schachtner JN, Simon AJ, Volponi J, Javed S, Gallen CL, Gazzaley A. Long-term maintenance of multitasking abilities following video game training in older adults. Neurobiol Aging 2021; 103:22-30. [PMID: 33789209 DOI: 10.1016/j.neurobiolaging.2021.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Abstract
The use of cognitive interventions to remediate deficient cognitive functions, or to enhance or preserve intact cognitive abilities, has been explored for some time, especially in older adults. However, few studies have investigated the long-term persistence of any positive benefits, with none examining whether changes in functional brain activity persist several years later. Here, we assessed whether enhanced cognitive abilities and potential underlying neural changes attained via the use of a custom-made video game (NeuroRacer) played by older adults (60-85 years old) continued to be elevated beyond control participants 6 years later. The NeuroRacer group continued to show reduced multitasking costs beyond control participants, with a neural signature of cognitive control, midline frontal theta power, also continuing to show heightened activity. However, previously evidenced performance benefits that had extended to untrained cognitive control abilities (i.e., enhanced sustained attention and working memory) did not persist, highlighting sustainability limitations. These findings continue to demonstrate the robust plasticity of the prefrontal cognitive control system in the aging brain, a potential neural mechanism underlying enhanced performance over time, and the possible long-term impact that digital therapeutics can have.
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Affiliation(s)
- Joaquin A Anguera
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA.
| | - Jessica N Schachtner
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Alexander J Simon
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Joshua Volponi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Samirah Javed
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Courtney L Gallen
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA
| | - Adam Gazzaley
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA; Neuroscape Center, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Physiology, University of California, San Francisco, CA, USA
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24
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Jurigova BG, Gerdes MR, Anguera JA, Marco EJ. Sustained benefits of cognitive training in children with inattention, three-year follow-up. PLoS One 2021; 16:e0246449. [PMID: 33539468 PMCID: PMC7861383 DOI: 10.1371/journal.pone.0246449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
The goal of this study was to test for long-term benefits three years after the completion of a cognitive training intervention (Project: EVO™) in a subset of children with Sensory Processing Dysfunction (SPD). Our initial findings revealed that children with SPD who also met research criteria for Attention Deficit Hyperactivity Disorder (SPD+IA) showed a significant decrease in parent-observed inattentive behaviors, which remained stable in a nine-month follow-up assessment. Forty nine caregivers of participants who completed the Project: EVO™ training were contacted to be included in this follow up study. Each was emailed an invitation to complete the Vanderbilt ADHD Diagnostic Parent Rating Scale, which yielded a completion rate of 39/49 (80%). A Generalized Estimating Equations analysis was used to assess changes in symptoms over time, specifically to determine whether the initial improvements were retained. The SPD+IA cohort continued to show sustained benefits on their parent-reported scores of inattention, with 54% of SPD+IA individuals no longer meeting criteria for ADHD three years following intervention. These findings provide initial insights into the potential long-term benefits of a digital health intervention for children with attention-based issues.
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Affiliation(s)
- Barbora G. Jurigova
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California, United States of America
| | - Molly R. Gerdes
- Research Division, Cortica Healthcare, San Rafael, California, United States of America
| | - Joaquin A. Anguera
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
| | - Elysa J. Marco
- Research Division, Cortica Healthcare, San Rafael, California, United States of America
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25
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Hsu WY, Rowles W, Anguera J, Zhao C, Anderson A, Alexander A, Sacco S, Henry R, Gazzaley A, Bove R. Application of an Adaptive, Digital, Game-Based Approach for Cognitive Assessment in Multiple Sclerosis: Observational Study. J Med Internet Res 2021; 23:e24356. [PMID: 33470940 PMCID: PMC7840186 DOI: 10.2196/24356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 01/19/2023] Open
Abstract
Background Cognitive impairment is one of the most debilitating manifestations of multiple sclerosis. Currently, the assessment of cognition relies on a time-consuming and extensive neuropsychological examination, which is only available in some centers. Objective To enable simpler, more accessible cognitive screening, we sought to determine the feasibility and potential assessment sensitivity of an unsupervised, adaptive, video game–based digital therapeutic to assess cognition in multiple sclerosis. Methods A total of 100 people with multiple sclerosis (33 with cognitive impairment and 67 without cognitive impairment) and 24 adults without multiple sclerosis were tested with the tablet game (EVO Monitor) and standard measures, including the Brief International Cognitive Assessment for Multiple Sclerosis (which included the Symbol Digit Modalities Test [SDMT]) and Multiple Sclerosis Functional Composite 4 (which included the Timed 25-Foot Walk test). Patients with multiple sclerosis also underwent neurological evaluations and contributed recent structural magnetic resonance imaging scans. Group differences in EVO Monitor performance and the association between EVO Monitor performance and standard measures were investigated. Results Participants with multiple sclerosis and cognitive impairment showed worse performance in EVO Monitor compared with participants without multiple sclerosis (P=.01) and participants with multiple sclerosis without cognitive impairment (all P<.002). Regression analyses indicated that participants with a lower SDMT score showed lower performance in EVO Monitor (r=0.52, P<.001). Further exploratory analyses revealed associations between performance in EVO Monitor and walking speed (r=–0.45, P<.001) as well as brain volumetric data (left thalamic volume: r=0.47, P<.001; right thalamic volume: r=0.39, P=.002; left rostral middle frontal volume: r=0.28, P=.03; right rostral middle frontal volume: r=0.27, P=.03). Conclusions These findings suggest that EVO Monitor, an unsupervised, video game–based digital program integrated with adaptive mechanics, is a clinically valuable approach to measuring cognitive performance in patients with multiple sclerosis. Trial Registration ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - William Rowles
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Joaquin Anguera
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Chao Zhao
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Annika Anderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Amber Alexander
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Simone Sacco
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Roland Henry
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Adam Gazzaley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Neuroscape, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Department of Physiology, University of California, San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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26
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van der Ham IJM, van der Vaart R, Miedema A, Visser-Meily JMA, van der Kuil MNA. Healthcare Professionals' Acceptance of Digital Cognitive Rehabilitation. Front Psychol 2020; 11:617886. [PMID: 33324309 PMCID: PMC7725711 DOI: 10.3389/fpsyg.2020.617886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
With technological possibilities in healthcare steadily increasing, more tools for digital cognitive rehabilitation become available. Acceptance of such technological advances is crucial for successful implementation. Therefore, we examined technology acceptance specifically for this form of rehabilitation in a sample of healthcare providers involved in cognitive rehabilitation. An adjusted version of the Technology Acceptance Model (TAM) questionnaire was used, including the subscales for perceived usefulness, perceived ease of use, subjective norm (toward use), and intention to use, which all contribute to actual use of a specific technology. Results indicate a generally favorable attitude toward the use of digital cognitive rehabilitation and positive responses toward the TAM constructs. Only for subjective norm, a neutral mean response was found, indicating that this could pose a potential obstacle toward implementation. Potential differences between subgroups of different age, gender, and professional background were assessed. Age and gender did not affect the attitude toward digital cognitive rehabilitation. Occupational therapists showed lower scores than healthcare psychologists and physiatrists with regard to perceived usefulness, possibly linked to a difference in operational and managerial tasks. The findings of his study stimulate further implementation of digital cognitive rehabilitation, where the role of subjective norms should be specifically considered.
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Affiliation(s)
- Ineke J M van der Ham
- Department of Health, Medical, and Neuropsychology, Leiden University, Leiden, Netherlands
| | - Rosalie van der Vaart
- Department of Health, Medical, and Neuropsychology, Leiden University, Leiden, Netherlands
| | - Anouk Miedema
- Department of Health, Medical, and Neuropsychology, Leiden University, Leiden, Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.,Center of Excellence in Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Milan N A van der Kuil
- Department of Health, Medical, and Neuropsychology, Leiden University, Leiden, Netherlands
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27
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Patel NA, Butte AJ. Characteristics and challenges of the clinical pipeline of digital therapeutics. NPJ Digit Med 2020; 3:159. [PMID: 33311567 PMCID: PMC7733514 DOI: 10.1038/s41746-020-00370-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
In this Comment, we characterize the current pipeline of digital therapeutics and offer a clinical perspective into the advantages, challenges, and barriers to implementation of this treatment modality for patient care, which we hope will inform future regulatory policy, prescribing decisions, and scope of real-world evidence collection.
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Affiliation(s)
- Nisarg A Patel
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, USA.
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA.
| | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
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28
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Hays R, Henson P, Wisniewski H, Hendel V, Vaidyam A, Torous J. Assessing Cognition Outside of the Clinic: Smartphones and Sensors for Cognitive Assessment Across Diverse Psychiatric Disorders. Psychiatr Clin North Am 2019; 42:611-625. [PMID: 31672211 PMCID: PMC7299150 DOI: 10.1016/j.psc.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Traditionally, the assessment of cognition and the administration of cognitive therapies has been performed in the clinic, but with modern technology, this clinic-centric view is changing. This article explores the landscape of digital devices used to measure cognition in settings outside the clinic. These devices range in mobility from user-friendly mobile devices to setting-specific devices able to provide powerful, robust cognitive therapy and living assistance in the comfort of a patient's home. Although these methods remain in early stages of developmental, initial studies suggest they may prove useful in treating patients with serious mental illnesses in a widespread clinical setting.
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Affiliation(s)
| | | | | | | | | | - John Torous
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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29
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Uhlhaas P, Torous J. Digital tools for youth mental health. NPJ Digit Med 2019; 2:104. [PMID: 31646184 PMCID: PMC6802195 DOI: 10.1038/s41746-019-0181-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Peter Uhlhaas
- 1Institute of Neuroscience and Psychology, University of Glasgow, 58 Hillhead Street, Glasgow, G12 8QB Scotland UK.,2Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02446 USA
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30
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Engelhard MM, Kollins SH. The Many Channels of Screen Media Technology in ADHD: a Paradigm for Quantifying Distinct Risks and Potential Benefits. Curr Psychiatry Rep 2019; 21:90. [PMID: 31410653 DOI: 10.1007/s11920-019-1077-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Individuals with attention-deficit hyperactivity disorder (ADHD) may be unusually sensitive to screen media technology (SMT), from television to mobile devices. Although an association between ADHD and SMT use has been confirmed, its importance is uncertain partly due to variability in the way SMT has been conceptualized and measured. Here, we identify distinct, quantifiable dimensions of SMT use and review possible links to ADHD to facilitate more precise, reproducible investigation. RECENT FINDINGS Display characteristics, media multitasking, device notifications, SMT addiction, and media content all may uniquely impact the ADHD phenotype. Each can be investigated with a digital health approach and counteracted with device-based interventions. Novel digital therapeutics for ADHD demonstrate that specific forms of SMT can also have positive effects. Further study should quantify how distinct dimensions of SMT use relate to ADHD. SMT devices themselves can serve as a self-monitoring study platform and deliver digital interventions.
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Affiliation(s)
- Matthew M Engelhard
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Lakeview Pavilion, Suite 300, 2608 Erwin Rd, Durham, NC, 27705, USA.
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Lakeview Pavilion, Suite 300, 2608 Erwin Rd, Durham, NC, 27705, USA
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