Earlier this month, facing an increasingly precarious situation, the US Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) joined forces to address the ongoing Adderall shortage. Technically, neither organization has the power to compel pharmaceutical companies to produce mixed amphetamine salts, but in the face of skyrocketing diagnoses for attention deficit hyperactivity disorder (ADHD) in the pandemic era of telemedicine, they wanted to reassure the public that they were looking into potential alternatives to stimulant medications. One suggestion: video games.
In a joint statement, the agencies acknowledged that while they were actively working with the pharmaceutical industry to address the shortages, the FDA did approve a "game based digital therapeutic" to address ADHD symptoms in children back in 2020. While it’s unclear whether digital therapeutics can replace stimulants entirely (they probably can’t), it is clear that people want options beyond amphetamines. And this summer, digital medicine company Akili Interactive dropped the first “over-the-counter” digital therapeutic for managing ADHD symptoms in adults, using the same technology underlying their previously FDA-approved prescription video game for kids.
Having a doctor prescribe a video game sounds unusual, but prescription digital tools aren’t totally new. Nearly six years ago, the FDA cleared reSET, a mobile app designed to help people during outpatient therapy for substance use disorders. The idea that video games can boost cognition isn’t new, either. Despite widespread mid-aughts panic that video games would poison young minds, scientists like Randy Kulman have studied their potential benefits for decades. Kulman is the founder and president of LearningWorks for Kids, an online platform that teaches parents how to help their children practice executive functioning skills while playing regular video games. He is a firm believer that, when approached mindfully, the games on popular platforms like Minecraft and Roblox can help kids strengthen their problem-solving, self-control, and planning. “I call it making them digitally nutritious,” he says.
It’s possible to turn Minecraft into a well-balanced digital meal, but it would be easier if the game were designed to target the cognitive skills a kid was struggling with most. Kulman says the difference between a regular video game and a specially-designed therapeutic video game is like the difference between decaf and espresso: “If you have seven cups of decaf coffee, you’ll have some caffeine. But if you have a little cup of espresso, you’ll get a whole lot of caffeine all at once.” To get such a nutrient-dense game, Kulman says, its missions should challenge specific elements of brain function, like attention, and they should be individualized to each user.
Adam Gazzaley, a neuroscientist at the University of California, San Francisco, and Akili Interactive’s chief scientific advisor, agrees. “Video games can be abused, and you could use them excessively,” he says. “Or, they could be intentionally delivered in a limited time course and used to improve brain function.”
On the surface, Akili Interactive’s prescription pediatric digital therapeutic, EndeavorRx, looks a lot like a regular video game. Like Mario Kart, the game involves steering a hovercraft through whimsical race tracks. (When I tried the demo, it also involved a lot of cursing.) There are two main goals: drive over as many power-ups as possible, and catch specific creatures as they fly toward you, while avoiding others.