Doctors’ orders: "Play Your Medicine?" Promising results for a Digitalized Medicine to reduce ADHD symptoms
ADHD is very common among children on the autism spectrum, with researchers estimating as many as 50 percent of children with ASD have some ADHD symptoms, and roughly 30 percent receiving a co-occurring ADHD diagnosis. Unfortunately, fewer autistic children have a positive response to ADHD medications, and researchers have been seeking effective alternatives.
Researchers at CHOP, in collaboration with Boston tech company Akili Interactive and colleagues at Children’s National Health System/Georgetown University and UC-San Francisco/Cortica, have completed a pilot study of a “digital treatment” for ADHD in children with ASD. Akili’s “Project: EVO is a digital cognitive remediation treatment that can be accessed on an iPad or other mobile device. EVO targets players’ “cognitive control” abilities- or the way the mind is able to override impulses in order to make decisions based on an end-goal, rather than on habits or momentary reactions.
“This treatment provides each user repeated opportunities to improve their ability to control the interference that comes from distracting information and to stay focused. This ability to control interference by ignoring distractions may be a critical ability affected by co-occurring ADHD symptoms. We know that children who have co-occurring autism and ADHD diagnoses are having more difficulty with functioning in everyday life, and are less likely to respond to ADHD medications as children with ADHD and no autism. Our hope is that these attention skills will generalize to life outside of the treatment,” explains Benjamin Yerys, PhD, Principal Investigator for the study at CAR.
The study, which included 19 children aged 9-13 diagnosed with ASD and co-occurring ADHD symptoms, evaluated the feasibility and acceptability of the video-game based treatment. Participants were divided into two groups and given either the Project: EVO treatment or an educational activity involving pattern recognition. Their ability to focus and concentrate were assessed using the Test of Variable Attention (TOVA), an FDA-cleared objective measure of attention, both at the start of the study and again at its conclusion.
Dr. Yerys and his team found that children in the treatment group engaged with the EVO protocol for 95 percent or more of the treatment sessions. According to both the parents and children, attention improved and they viewed the treatment as worthwhile. Attention on the TOVA showed a trend towards improvement after using Project: EVO and, based on parent reports, general ADHD symptoms showed improvement as well. While the study’s sample size was small, the results are encouraging. Parents and children found Project: EVO a feasible and acceptable treatment option for co-occurring ADHD and ASD, and study results point to potentially therapeutic effects.
Dr. Yerys and his collaborators are planning a larger follow-up study to continue to evaluate both the underlying brain mechanism and the potential efficacy of EVO as a treatment option for children with ASD and co-occurring ADHD. “At the Center for Autism Research, we are dedicated to matching the right treatments with the right child at an age where they are best able to benefit from it. This includes developing and evaluating new treatments that can be made available to people in the clinic and in their community. EVO is one such treatment that has such potential because it would be accessible by a mobile device and in the comfort of one’s home. Future work is needed to figure out who is the right child to benefit from EVO, and how it may be packaged with other treatments (behavior or medication) to achieve optimal treatment responses."
This study was sponsored by Akili Interactive, which provided financial support to Dr. Yerys and co-author Jennifer Bertollo. All other authors were advisers to Akili and participated in study design, data interpretation and manuscript preparation. Co-author Robert Schultz holds stock options for consulting work to Akili, and is also a member of the Scientific Advisory Board of Akili. Co-author Geraldine Dawson is on the Scientific Advisory Board of Akili. Akili participated in the study design but did not participate in the data analysis, manuscript preparation or decision to publish.
** Please note, CAR uses identity-first language as recent research has demonstrated that this is the preferred term in the autism community (Kenny et al., 2016, "Which terms should be used to describe autism? Perspectives from the UK autism community" Autism).