How’s this for medicine?
Freah Lewis sits on the sofa at her Port Richey home, a tablet in her small hands. On the screen, her avatar rides a small hovercraft over rivers and valleys. She controls the craft’s direction by tilting the tablet left or right. Every few seconds, the 10-year-old earns points by swatting shifting targets on-screen with her thumbs.
After about 25 minutes, the craft runs out of fuel, the signal for “game over.”
That’s her therapy for the day. No spoonful of sugar necessary.
Freah has struggled with attention-deficit/hyperactivity disorder, or ADHD, since she was 4, said her mother, Amanda Lewis. In preschool, she wouldn’t sit for circle time and hid under tables to escape the classroom hubbub. She found it difficult to focus on activities and was kicked out of two preschools whose staff said they didn’t know how to help her.
Her formal diagnosis at age 6 was the start of a search to find the right medication and dosage. Some worked for a while until she outgrew them. Others helped but would typically wear off by late afternoon, her mother said.
A breakthrough came in December when Freah was prescribed not another pill but a video game.
Known as EndeavorRx, it was approved by the Food and Drug Administration in 2020 to be marketed as ADHD therapy for children ages 8 to 12. Freah uses the game in conjunction with medication.
The improvement in her daughter wasn’t immediate, Lewis said, but after two weeks they noticed that Freah was sitting on her own working on her homeschool lessons. Previously, she needed constant monitoring and prompting.
“I didn’t know if it would be effective,” Lewis said. “Then things started to be really noticeable.”
ADHD is a common neurodevelopmental disorder that typically begins in childhood and affects more than 6 million U.S. children. Symptoms include difficulty staying focused and controlling behavior and very high levels of activity.
It is frequently treated with stimulant medications such as Adderall.
Freah’s video game was prescribed by Katharine Quinn, a nurse practitioner at Pediatric Epilepsy and Neurology Specialists in Tampa.
Quinn first learned about the game after patients began to request it. She reviewed data from several clinical trials that showed significant improvements in children’s attention.
Almost half of children who used the game five days a week over two, four-week treatment periods showed improved attention, according to the 2020 STARS-ADHD study. Almost 70% of parents reported improvements in their child’s ADHD when they used the game along with medication, another study found. Game manufacturer Akili Interactive funded both studies.
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The game helps stimulate a child’s prefrontal cortex, Quinn said. The player must maintain concentration to steer the craft while also dealing with the “interruption” of objects flying past that must be quickly assessed to see if they can be turned into points.
The code that drives the game includes an algorithm that is constantly monitoring the child’s response levels in real time. As their performance improves, it ups the difficulty level to continue to push them.
Quinn typically recommends children use the game five days per week over a two-month period. She uses the therapy to compliment medication but she knows of cases where it has helped children who could not be on medication or whose parents did not want to use drugs.
“It is a great option for patients that have struggled with medication side effects or that may have a desire to reduce reliance on prescription medication,” she said.
The game is only available to patients with a prescription and is obtained from specialty pharmacies, which provide a copy that can be downloaded onto a smartphone, tablet or computer. It can be a struggle to get insurance to pay for the therapy, Quinn said. The game’s manufacturer offers a discounted rate of $99 for parents who have to pay out of pocket. The full cost is $450 per month.
All four of Lewis’ children have been diagnosed with ADHD, which scientists believe is linked to genetics but not to a single gene.
Her oldest son is prescribed Adderall but has not been able to get his medication due to a national shortage of the drug.
Lewis is hoping that the game therapy will soon be available for her older children. Akili announced in January that it will apply for a U.S. Food and Drug Administration label expansion for use in teens 13 to 17 years old based on new studies that showed the game brought about higher attention improvements than those seen in younger children.
“It’s important to find solutions other than medication,” Lewis said. “You want your children to live their dream and function in the real world. Medications don’t work for the whole day.”