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Effects of game-based digital therapeutics on attention deficit hyperactivity disorder in children and adolescents as assessed by parents or teachers: a systematic review and meta-analysis

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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset disorder characterized by pharmacological and non-pharmacological interventions. Despite the available treatment options and prevention measures, conventional treatments have several limitations. Digital therapeutics (DTx) like EndeavorRx® is an emerging alternative to overcome these limitations. EndeavorRx® is the first FDA-approved, game-based DTx approved for the treatment of pediatric ADHD. We investigated the effects of game-based DTx in randomised controlled trials (RCTs) on children and adolescents with ADHD. In this systematic review and meta-analysis, we searched PubMed, Embase, and PsycINFO databases up to January 2022. The protocol was registered (CRD42022299866). The assessor was defined as parents and teachers. The primary outcome was differences in inattention reported by the assessor, and the secondary outcome was differences in hyperactivity and hyperactivity/impulsivity reported by the assessor and the relative comparisons between game-based DTx, medicine, and control with indirect meta-analysis. Game-based DTx improved inattention more than the control upon assessment by assessors (standard mean difference (SMD) 0.28, 95% confidence interval (CI) 0.14–0.41; SMD 0.21, 95% CI 0.03–0.39, respectively), while medication improved inattention more than game-based DTx (SMD − 0·62, 95% CI − 1·04 to − 0·20) upon assessment by the teacher. Game-based DTx improved hyperactivity/impulsivity than the control upon assessment by assessors (SMD 0.28, 95% CI 0.03–0.53; SMD 0.30, 95% CI 0.05–0.55, respectively), and medication improved hyperactivity/impulsivity significantly than game-based DTx upon assessment by the teacher. Hyperactivity has not been reported extensively. As a result, game-based DTx had a more significant effect than the control, however medication was more effective.

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Funding

This research was supported by a grant from the National Research Foundation of Korea (NRF), funded by the Korean government (Ministry of Science and ICT, MICT)(NRF2021R1F1A1062044), and by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (grant number 2021R1A6A1A03044296), which had no further role in the study design, data collection, analysis, and interpretation, the writing of the report, or in the decision to submit the paper for publication.

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  1. Data Science, Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea

    SuA Oh & EunYoung Kim

  2. College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea

    Jina Choi & EunYoung Kim

  3. Department of Psychiatry, College of Medicine, Chung Ang University Hospital, Seoul, 06974, Republic of Korea

    Doug Hyun Han

  4. Regulatory Science, Pharmaceutical Industry, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea

    EunYoung Kim

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EY contributed to the conceptualisation, methodology, project, administration, supervision, and writing (review and editing). SA contributed to the conceptualisation, data curation, methodology, project administration, visualisation, and writing (original draft, review, and editing). JN, DH assessed the study eligibility and quality. All the authors contributed to the interpretation and subsequent editing of the manuscript.

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Oh, S., Choi, J., Han, D.H. et al. Effects of game-based digital therapeutics on attention deficit hyperactivity disorder in children and adolescents as assessed by parents or teachers: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 33, 481–493 (2024). https://doi.org/10.1007/s00787-023-02174-z

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