Doctor-prescribed videogame for ADHD
endeavorrx.com
endeavorrx.com
The game itself isn't engaging at all. It was a struggle to get myself to actually play the game regularly, for the allotted time (30 minutes, 5 days a week). It feels like a pretty big flaw with the game - after all, one of the challenges that people with ADHD face is forcing themselves to do things they don't want to do. This game is a complete bore, and I can't imagine anyone over, idk, 10 feeling differently.
It's also an incredibly frustrating game, and for the first couple of weeks I was fairly irritated after each 30 minute session.
I haven't noticed any improvement yet.
"Games as treatment" are a new frontier of "selling bullshit". This happened before in education, and it's now making its way into health care.
The problem, here, is that the users aren't any part of how these games are designed. Everything about them is just directed at making presentations to investors and licensing bodies.
In the real games industry, user testing is the apex of success: you know your users will enjoy and benefit from your design choices because your users have already enjoyed and benefited from your design choices. When this relationship doesn't hold, the game gets changed. Play testing is king.
This kind of thing is cynical, thoughtless, and testless. It shouldn't exist, and it's nothing more than the effort of some founders to gather funding from clueless agencies.
# Indications: > EndeavorRx is a digital therapeutic indicated to improve attention function as measured by computer-based testing in children ages 8-17 years old with primarily inattentive or combined-type ADHD, who have a demonstrated attention issue. Patients who engage with EndeavorRx demonstrate improvements in a digitally assessed measure, Test of Variables of Attention (TOVA®), of sustained and selective attention and may not display benefits in typical behavioral symptoms, such as hyperactivity. EndeavorRx should be considered for use as part of a therapeutic program that may include clinician-directed therapy, medication, and/or educational programs, which further address symptoms of the disorder.
# Safety: > No serious adverse events were reported. Of 342 participants who received AKL-T01 in the two clinical trials supporting EndeavorRx authorization for age ranges 8-17, 17 participants (4.97%) experienced treatment-related adverse events (TE-ADE) (possible, probable, likely). TE-ADEs reported at greater than 1% across the studies include: frustration tolerance decreased (2.34%) and headache (1.17%). Other adverse events occurred less than 1% and included dizziness, emotional disorder, nausea, and aggression. All adverse events were transient and no events led to device discontinuation. Across other studies in children and adolescents with ADHD, rates of adverse events were similarly low (<10%) and no Serious Adverse Events have been reported. All reported adverse events across all clinical trials resolved at the end of treatment. Users should consider the totality of evidence presented along with their health care provider when considering incorporating AKL-T01 into their treatment plan.
# Cautions: > Rx only: Federal law restricts this device to sale by or on the order of a licensed health care provider. EndeavorRx should only be used by the patient for whom the prescription was written. For medical questions, please contact your child’s healthcare provider. If you are experiencing a medical emergency, please dial 911. EndeavorRx is not intended to be used as a stand-alone therapeutic and is not a substitution for your child’s medication.
> If your child experiences frustration, emotional reaction, dizziness, nausea, headache, eye-strain, or joint pain while playing EndeavorRx pause the treatment. If the problem persists contact your child’s healthcare provider. If your child experiences a seizure stop the treatment and contact your child’s healthcare provider.
> EndeavorRx may not be appropriate for patients with photo-sensitive epilepsy, color blindness, or physical limitations that restrict use of a mobile device; parents should consult with their child’s healthcare provider.
> Please follow all of your mobile device manufacturer’s instructions for the safe operation of your mobile device. For example, this may include appropriate volume settings, proper battery charging, not operating the device if damaged, and proper device disposal. Contact your mobile device manufacturer for any questions or concerns that pertain to your device.
Forcing yourself through 30 minutes of a video game likely isn't much compared to their day-to-day painful experiences at work or school but given the high likelihood that it doesn't actually work it's unnecessary additional suffering likely imposed on them by a frustrated parent who wants them to "get better" for their own sake instead of the kid's.
FWIW, from their FAQ (and several other places on the site):
> EndeavorRx is indicated only for children ages 8-12 years old with primarily inattentive or combined-type ADHD who have a demonstrated attention issue.
> EndeavorRx improves attention function in children 8‑17 with ADHD.
I went back to look at older versions of the site, and some of the references have changed from 12 to 17, but not others. I assume that they ran another study with a higher upper limit later, but didn't update their site everywhere.
For me it seems like other games would also do, as long as they don't promote "scatterbrain".
Playing video games is thus usually a problem, not treatment - games are just more interesting in the moment than anything else you can or should be doing, so it's hard to stop playing. Ripping out everything that makes the game interesting and stimulating doesn't turn it into a therapeutic tool, it turns it into a bullshit chore that's done on a computer. In comparison, doing your taxes may seem more appealing, because while it's mind-dumbingly boring, it's at least not a make-believe time waster. Which I suppose could be of therapeutic value, if not for the fact that other videogames still exist.
(And so do books, TV shows, parties, substances, whatnot.)
If a game was exciting and engaging, wouldn't someone with ADHD be drawn in and be focused naturally, like that isn't different from any game. But the problem with ADHD is paying attention to things in life that are boring, so forcing someone to focus on a game for some 30min/day is training them to focus on boring?
IF it was a good game, then it would just be a game. So just go play other games. But the point is to focus on something boring?
Reading your comment though, did I understand correctly that the irritation faded over time? Wouldn't that be an improvement?
Not that I think that inability to focus on boring BS is something that needs to be fixed, but it still might be doing something positive.
> It's also an incredibly frustrating game
I'm curious, is that intentional? As in, progressively learn to deal with those two aspects that are instant triggers for an ADHD mind to run away?
I mean, otherwise literally any other actually engaging and satisfying game would do.
Regular life will do that to you anyway; not sure how a game is going to help.
If anything, particularly when aimed at kids, it's main effect is likely exhausting the video game time budget parents allotted to the kid, possibly souring the whole class of entertainment to them. Which I guess may look like a win to outsiders if the kid happens to use videogames to cope with ADHD. Not sure if it's a win for the kid.
Same difference as life making you lug objects/yourself around daily vs a workout plan. You start small and progressively build up to go from here to there. Also you don't stop all physical activity when following a workout plan, it's just that you have a framework to build up.
There may be a thousand ways to do these brain workouts, probably kids would not be too enticed to do meditation or read books so a videogame is more appealing on the surface.
Also I'm not saying this particular game is any good or not in that regard, I'm just saying maybe there's something to it, asking naive questions such as "was this actually intentional design?", and conducting some thought experiment.
Tangentially I'll be the old man yelling at clouds, but I've noticed that games these days are very much not frustrating, probably to cater for the widest audience: compare today's infinite respawn at magic checkpoints with automated difficulty adjustment and no mistake possible change-your-build-tree-anytime and deus-ex-machina health/ammo drops so that you never quite fall short to the likes of Megaman, Mario, Sonic, Gradius, Doom, Ikaruga, Baldur's Gate, Diablo... To be successful these days it seems like games must be pleasing with all frustrations removed, plowing like a demigod through hordes of prop opponents or gigantic bosses made of cheese. By endgame you can even max out all skill trees and be a warrior/wizard/necromancer/sharpshooter/thief all at once.
You can't make a mistake, you can't paint yourself in a corner, you can't lose, you never have to roll back to a savegame 10 hours back or live with your erroneous choice for the next 40+ hours, or, god forbid, start over.
My gut-check says Zelda (especially the newer ones where you build things and have creative, problem-solving leeway) may be a better choice.
This is a lot like saying that the way to treat a broken leg is to just start running on it and not have it be broken anymore.
(Obvious disclaimer: Not a doctor, not your doctor, this is not medical advice.)
For example, you treat a phobia through gradual exposure to the source of fear, not through undergoing a sudden overwhelming experience. That usually creates a traumatic response that actually makes the phobia worse.
Likewise, if you want to learn how to read a long book, start with shorter books and work your way up. If you can't sit through a novella and so you try to force yourself to read Crime and Punishment, you will fail — and you risk actually making it harder to read books in the future by strengthening the neural association between reading and feeling bored/frustrated.
These posts are arguing over 'scale' or degree. Everyone is agreeing on 'brain is plastic'.
Just arguing over starting with 'Crime and Punishment' or 'Snow Crash'.
I would just add, that it all depends on where the kid is at. This just jumped out at me because I did have one kid at young age, set a schedule and forced himself to read 'Crime and Punishment'. So it can be done.
But maybe for others, that is a huge step. Everyone is starting at some different levels of current skills, with different levels of drag. -- So any discussion here about 'where to start' will all be wrong.
I honestly love to read mathematical textbooks that are quite above my current mathematical level and knowledge. It is brutal to go through and attempting to understand the material, but this is soooo rewarding.
This method of learning mathematics is clearly not for everyone, but if you are sufficiently motivated to go this way, and love the brutality innate to this method, I actually would recommend it.
Why is everything subscription based nowadays? Even without a subscription $99 would seem a lot to me. I guess because something something server costs and update development? Or is it just plain greed?
PS: Programming is absolutely fantastic, too, when you have ADHD (an probably even if you don't have it). It also doesn't cost a dime and there is plenty of content available for free. Might give that one a shot! Works wonders for me
> Why is everything subscription based nowadays?
It's a prescription (written note from the doctor) but this looks like a long term regimen so you could call it a subscription too. The reason is almost definitely profit. As a game there's no reason for it to be this expensive. As a medical treatment I doubt the R&D justifies the cost.
It's almost always the simplest answer: they can get richer like that. I don't get why people try to rationalize greed so much. It's just that: greed.
Look at the rise in DEI! As soon as rates went up, a lot of that started getting cut. That strongly suggests it was an unprofitable decision. So why was it made?
I don't think companies are perfect at optimizing for their profits (thankfully), but profit is and will always be their only driver for decisions.
A good example is how Google seemingly spoiled their employees with benefits and high pay. Their objective was to hoard talent so they could continue to grow their profits. It's not because they are thinking of the well being of their employees. As soon as they weren't growing as much, they had mass layoffs.
The only way a company isn't optimizing for profits is if it's smaller with owners that personally want to prioritize something else at the cost of profits. Which, in theory, means they will go out of business at some point because of being undercut by their competitors that don't care.
Companies are abstract entities that only serve one purpose: to make profit. Every single action is towards this goal. They are NOT people. Even the people behind them make decisions that they would never do individually but, behind the facade of a "company decision", they nevertheless do.
> Profit is not the same as greed
Greed is defined as:
An excessive desire to acquire or possess more than what one needs or deserves, especially with respect to material wealth
It makes more money for the people who peddle it, duh!
>PS: Programming is absolutely fantastic, too, when you have ADHD
Probably why I got into it (though Turbo Pascal / Delphi compile times were much more amenable to providing the dopamine rush than C++ even today).
That said, getting a diagnosis and access to medication [1] worked wonders for making other aspects of work much easier.
There's much more to software engineering than just programming, especially with larger projects and larger teams. And hyperfocusing on code to find yourself in the office at 3AM on the reg can end up being detrimental to one's ability to deliver consistent results on schedule, as well as setting and meeting expectations (...plus: being on time, completing the small tedious tasks, doing paperwork, filling forms, submitting reports, documenting, logging, planning, testing, avoiding feature creep, writing proposals and design docs, doing code reviews, being on call, ...).
The joy of programming does make all of this worth bearing. But stimulant meds take a significant chunk of pain out of it.
Imagine needing to submit a trip reimbursement report, deciding to do it between 5 and 5:30PM on Tuesday, and doing it then, without it being a monumental effort, even though the deadline is on Friday.
That's the superpower that meds give (...the superpower that non-ADHD people are unaware of having, it seems).
But yeah, a higher-than-average proportion of programmers are neurodivergent for a reason :)
It’s subscription and expensive because it’s another way to suck the money out of people who think they have ADHD.
Reminds me of a joke I heard from a comedian, cant remember who - "soon we will just become the part of our home entertainment system that eats and shits"
An excuse, or an explanation?
I have ADHD and programming is and always has been fantastic for me, if the project is not boring.
Sounds somewhat like ADD alright.
Is there corruption with these kind of things, or did they just hit jackpot?
$99/month is pure corruption, and they get away with it because insurance can help cover it.
In healthcare, "Economies of scale don’t lower prices", and "prices rise to what the market will bear" - An American Sickness. Very much what you're seeing here for this price tag.
ITS SO EASY TO MAKE MONEY!
Like, my wife with 0 business experience, is able to profit 6 figs off her workers and 6 figs off her labor. She completely failed to train new/bad people and multiple patients left her clinic because of the poor quality labor.
Doesnt matter, all those patients paid and she is slammed busy.
Limiting licenses is an excuse for quality. These doctors are so absurdly low quality and getting paid for treatment that doesnt work.
I propose a science based medical system as an alternative to the Authority based healthcare system. Never going to happen because clinic owners like myself lobby, but it would be better.
This corruption costs Americans hundreds of billions of dollars every year.
"The FDA reviewed data from multiple studies in more than 600 children, including studies that evaluated, among other things, whether participants demonstrated improvements in attention function, as measured by the Test of Variables of Attention (TOVA), academic performance measures, and other assessment tools."
They went through the harder track of FDA approval for medical devices.
I have no idea why you seem to think the primary way for the FDA to approve of new treatments is somehow... not them approving of it?
The wording is really poor. "Pre-market authorization" is their approval process. As in, you don't get to tell anybody that your device has any medical benefit unless we've assessed it.
Signing up is something exciting and fun and something such person may do impulsively in a moment of weakness. Cancelling is boring and scary (what if dark patterns?) and a chore you don't look forward to, but rather try to not forget. It's not positively rewarding, but merely stops a penalty.
This might seem like an exaggerated difference, but it actually hits the exact points that are affected by executive dysfunction.
And, can't you cancel the subscription?
I wonder if they were to be used in some treatment, they would also need to be approved? So Tetris itself wouldn't cost, but the doctor administering treatment gets approval to use the game, and that overall treatment costs the money.
I'm little unsure if any joe blow psychologist is allowed to makeup treatments, or if they go through an approval process also.
Only the USA healthcare system could give life to such an abomination.
In some cases, these apps might be useful. But I think there are quite a few cash grabs in there, too.
But in 2017 the FDA launched the Digital Health Innovation Action Plan. So arguably the concept was born in the USA.
On the other hand, the average cost for drug R&D, testing, and approval was $2.87 billion each… in 2016.
That’s going to take serious cash to break even on.
I don't see why you need FDA approval for a video game, or even make medical claims about a video game.
Stimulant medication tends to be favorably accepted at first (for entirely unsurprising reasons, even though some people don’t experience quite the same euphoria) but it actually has a high discontinuation rate. The number of people who start stimulants, think they’re the best thing ever, then slowly decline into generally disliking them is far higher than you’d ever imagine if you only ever read short anecdotes on Reddit from people writing glowing reviews after their first dose.
Obligatory: I’m not taking about everyone and I don’t need to hear 10 different anecdotes about people who still like their medications. I’m talking about macro level phenomenon. Stimulant prescriptions are a hot topic on TikTok right now and a lot of people who aren't really ADHD are getting into prescriptions without a full picture of what they’re signing up for.
But, euphoria or not, on stimulants I can at least feel the change near-immediately. It's unlike pretty much any psychiatric drug out there, where in most cases you can spend months taking it and still have serious doubts if it's doing anything (same with therapy). Hell, I can't think of a non-psychiatric medication that works as fast and as clearly. Paracetamol and Ibuprofen come close when dealing with sharp pain.
The problem with both stimulants and opiates is overdosing will kill you pretty effectively, and many will eventually overdose if they keep using them long enough, chasing the initial effect.
Modern medicine unfortunately seems focused on creating ever more addictive substances and treatments, creating subscribers I guess, which says a thing or two about how well profit driven healthcare works in practice.
As for stimulant medication, I haven't heard of this being a real danger - not at the doses that prescription drugs have. Hell, I personally know a person who ate two boxes (i.e. 60+ tablets) of methylphenidate in a suicide attempt, and all they got from it was couple hours of hyperactivity, followed by a big headache, after ER flushed their stomach; they got discharged less than 24 hours later. But sure, if you drop the pharmaceuticals and go for illegal drugs, where the doses can be 100x as high, I guess you can mess yourself up pretty bad and rather quickly.
If it doesn't work well, you'll get lots of other options - they're just as much a part of the modern medicine. This is becoming a meme. Why repeat this rather than post information about alternatives, if you care about this issue?
Look, we're experimenting on children who can't sit still long enough by giving them pretty serious drugs, for profit. We're still waiting on the long term consequences from that game.
Lots of people take these medications at the same dose for years and years.
I get that many people feel strongly about this topic in all kinds of ways and directions, but that fact by itself changes nothing.
High discontinuation rate around stimulants aligns with my observations but I was wondering if that was only because of limited medication options where I am (not only for stimulants but in general).
Maybe this is based off of outlier reports, but it doesn't sound easy for someone with ADHD to keep up a regular supply of medication in the US, and the slightest lapse in medication supply to an individual can worsen that difficulty with their symptoms reappearing almost immediately.
Here in the UK it's a bit more relaxed, but still more difficult and under way more scrutiny and dumb rules than, say, an SSRI medication, which are plentiful and under no scrutiny at all, despite the fact that I had a much worse time on those with worrying side effects and extreme withdrawal symptoms.
I live in the US and take Adderall, the only part of this that is even slightly true is that sometimes there are shortages on dosage. As in they’re back-ordered on the 20mg pills so my doctor writes me a prescription for 10mg and I double up for a week until I can get the 20mg pills.
My prescriptions are all digital, come to me at least a week before I run out, and nobody has ever even batted an eye when I fill it, which always happens at the same pharmacy.
I don’t understand the hyper-regulation of adhd meds when they hand out benzos like candy. Unadulterated opioids are a bit more difficult but I’ve still have a month’s supply of those from a previous dental surgery.
I think it's more like a week before.
Looks really promising for people who don't like stimulants or can't take them for other reasons, slowly gaining popularity as well. Unfortunately not yet approved for adults in Europe, or I would have tried it. I'm fine with stimulants, but I'm a little wary of the effects on heart health over decades and I would like my appetite back. I also dislike that with stimulants I don't have any attention span in the evening, guanfacine provides more of a steady effect from what I can tell.
There's also clonidine which has roughly the same mechanism of action as guanfacine and has been used for ADHD for a long time.
It could be that the EMA has approved it for everyone, but Germany is more restrictive. It's been my experience that Germany as a society is terrified of medicine, and takes forever to adopt new drugs. They also have an attitude towards ADHD in particular that it's just for children, until somewhat recently you couldn't even be diagnosed as an adult here. Even today if you get diagnosed as an adult many doctors will demand "documentation" showing you were affected by ADHD as a child, some even want to speak with your parents.
Something else?
Thanks.
Making it hard to get ADD drugs does nothing to address abuse of street drugs like meth. Unlike opiates there is no evidence they lead people toward street drugs.
I’m personally in favor of OTC availability of some kind of safe abuse resistant mild stimulant. Sure there are a few people who would try to get high with it but hard liquor and weed are legal.
And yes, people did use it recreationally. But it wasn't really a problem. If they took enough that their capillaries burst, they were the only ones getting hurt. And they could easily buy more for a few dollars at any store, so there was no crime associated with it.
Now it's illegal mainly because 'war on drugs' is fun for some people or something. Crime rates were dropping so they needed to invent new crimes.
Like caffeine?
Turns out I had ADHD and I had been using caffeine my entire life as a crutch.
Diagnosed in my late thirties, and although finding the correct medication and dosage that works is an ordeal… once you are there you realize you’ve been swimming with a hand tied behind your back this entire time.
It’s not a magical cure motivation-in-a-pill though, it requires you to do the work. It simply enables you to try instead of completely failing to attempt anything.
I eventually got diagnosed ADHD in my 30s, and my doctor suggested that my coffee problem was a subconscious effort to self-medicate. I've been on stimulants for a few years and quit coffee easily (with some nasty headaches and such, but no real cravings)
I do still have coffee now and then, but only occasionally and only because I like the taste. I often stick to decaf when I do have it, too
However, it does not affect me quite like it affects most people. I find that caffeine before bed helps me quiet my thoughts and fall asleep, for example.
Mind you, I have not been diagnosed with ADHD (I can't be bothered going through the process of diagnosis when I already have medication and techniques that work).
One of the major problems is some primary care doctors and nurse practitioners have started prescribing stimulants to anyone who requests them. Even worse, some of these people are prescribing unreasonably high doses (some times 2/3rd of the maximum allowable dose are given to small teens as their starting dose, which is absolute insanity).
It’s not just pointless fear mongering. These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night.
So is drinking water, I presume.
This has "weed is a gateway drug" written all over it.
>It’s not just pointless fear mongering
It is pointless fear mongering in the sense that the risks are very low for the people with the condition the stimulant is prescribed for.
If you wear prescription glasses for fun, you can screw up your vision easily.
If you take chemotherapy for fun, you will mess up your health.
Heck, wearing wrong size shoes for extended periods of time will destroy your feet.
So go figure, people who don't have ADHD and take meds for ADHD are messing up their health.
The big question is why protecting people who are abusing the medication is more important than making it available to people who need it.
Abusing the meds has adverse effects, sure.
Not having access to meds has much stronger adverse effects. Like not being able to function in this society (getting an education, holding a job, having a relationship), depression, and higher suicide rates.
The risks from abusing Adderall are, as far as I know, significantly smaller in comparison.
But somehow, increasing risk of death for ADHD folks is deemed acceptable in this society if it can be done under the pretense of reducing alcoholism (without much evidence that it actually addresses the problem).
>These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night.
So, we're talking about people who are already determined to get wasted on alcohol, and somehow, it's Adderall that is the problem here — not the alcohol, not the alcoholics, not the party culture, and not the fact that removing Adderall from the equation still leaves you with people who are determined to drink beyond what they know they can handle.
I'm without words.
Disclaimer: I have ADHD[1], and I have benefited tremendously from having access to medication[2] after getting a late diagnosis[3] at the age of 34.
[1] https://romankogan.net/adhd
I'm sorry but this just comes off as so perverse to me. Giving amphetamines to children and forming a lifelong dependency on pharmaceuticals should be something to be apprehensive about. IMO it should be drastically less common than it is, the industry has every incentive to over-diagnose and act as glorified drug pushers. I'd rather take a closer look at the environmental factors for ADD than just let the pharma industry run wild on it.
So about as effective as a placebo or sugar pill https://en.wikipedia.org/wiki/Placebo
I'm also opposed to any medical device that uses a cell phone or requires a download from an app store. At that point you're handing over at least some amount of medical information to an ad company, using a device that's entirely controlled by that same ad company, who would be all to happy to use that information against you.
That said, Their privacy policy isn't too terrible. They do sell your data to third parties for advertising (including cross-context behavioral advertising) and they're handing data over to "service providers", some of which are also ad companies. A lot of their data collection does seem to be opt-in at the moment which is nice. They say that they "seek to link only to [social media] sites that share our high standards and respect for privacy", but because they link to facebook it makes their "standards and respect for privacy" seem very questionable.
Video games in general are already known to help people with ADHD focus, the problem is that while it can greatly improve the ability to focus on the game while it's being played the effect doesn't seem to hold up for very long after the game is turned off. I suspect that the very slight improvements their own research shows could be gained by playing many other games.
Would it be possible that ANY video game has a positive effect on ADHD?
I’m wondering because usually games reward focus and provide plethora of stimulus both visually and auditory.
Some have very detrimental effects. Games are inherently interesting. Usually much more interesting than homework and/or housework. So, you start playing video games and all of a sudden you can't switch your attention back to the homework or housework when you need to. This causes lots of friction between you and the other people in your life that expect things of you.
It's a fundamental difficulty of regulating attention, not staying focused. That means either keeping it on something when you need to OR switching it away from something when you need to.
In my experience an enormous class of problems stems from being unable to switch your attention away from something that has just absolutely grabbed a hold of you and that causing you to be scolded by those around you day in day out for not meeting expectations.
You could pick something like path of exile for free.
An app plays something akin to channel surfing on steroids, at a high initial switching frequency. Patient is to watch their favorite Youtube vids, play a video game - for 30 min while this cacophony slams their ears. Then gradually, day after day, the frequency is lowered to "humane" levels.
Totally worked, no meds involved.
I think it simply flooded her CNS and trained it to focus, without conscious effort. Might only work in 8 year olds, I don't know.
A lot of sound therapy we saw initially tried the opposite, calm stuff like classical music - feels clear why this can't work on a ADHD brain that runs in circles.
One says results were not statistically significant and the other has a warning that it may be placebo effect since they didn’t have a “sham control group”.
(I don't have enough stats knowledge to know what any of this actually means though.)
0: https://www.endeavorrx.com/wp-content/uploads/2024/01/Endeav... (pdf)
(Basically, everything they found can be attributed to random chance, and there’s no proof their game is anything special compared to other games)
As in: there's not even a claim it correlates with how strongly people experience ADHD symptoms.
I have.
Put simply, it's bullshit — and one that doesn't even purport to measure ADHD (which, indeed, is not something one could measure on a linear scale).
It has nothing to do with how we experience ADHD symptoms and traits.
It does, however, look like something one could train for by... playing videogames.
Surprise, playing videogames makes one statistically better at videogames! Now pay me.
Disclaimer: I have ADHD, and have written a small wiki about it, which quite a few folks with ADHD have found useful:
The same remains to be said of the product we're discussing.
100+ pages in, I figured it's time to get myself assessed [1].
Went through the assessment three times with different doctors just to be sure; unsurprisingly, they all had the same conclusion.
Life has been so much simpler since then. Adderall is a great asset to have in the toolbox, but probably 90% of life quality improvement came from stopping to expect my brain to work the same way a neurotypical brain does, and adjusting my environment / lifestyle / habits / the way I do things to how my brain works, rather than the other way around.
That ranges from little things like having a pair of scissors at all desks and places where I use them (instead of perpetually looking for them) and trusting my partner's time estimates over my brain's — to bigger things like using body doubling[2] to get things done.
On that note, the online body doubling community ADHD Actually[3] has provided a very strong effect when I needed it the most (e.g. chugging through a less-exciting work project), and I can highly recommend it.
I'm paying for it even when I'm not using it just because this needs to exist.
It's made for and by people who understand our experience, and is based on time-proven techniques that all the therapists recommend for ADHD people.
Technically, one doesn't need an online platform for that; we've organized similar sessions with friends on Zoom... But in practice, the accountability aspect is much harder to maintain (...as well as getting people to show up consistently and at the same time as you).
ADHD Actually solves this problem; and paying a small fee also adds extra motivation to make use of the service and show up.
And the impartiality of people in the group is a big plus.
[1] https://romankogan.net/adhd#Diagnosis
There's no such thing as the "ADHD score".
"AKL-T01 was linked with improvements on the Test of Variables of Attention (TOVA®) Attention Comparison Score (ACS) of 2.6 (95% CI: 2.02, 3.26; p < 0.0001) in adolescents and 6.5 in adults (95% CI: 5.35, 7.57; p < 0.0001)"
I would read that as: Focusing on this specific video game helps you to learn how to focus on things in general.
But "Mean overall compliance in the Efficacy Population was 72.4%", which kind of suggests that this game isn't that much fun to play. Or else, why would 1 out of 4 kids not play the mandatory 25 minutes per day?
What I find a bit shady, though is that https://www.endeavorrx.com/the-research/ says "There were no serious adverse events seen in any clinical trials of EndeavorRx" with a big 0% above it, but the study did have adverse events, like headache and nausea, they just didn't classify those as "serious".
I've now seen 2 studies that should never have been published in Nature in the last year.
I am science based, so I never really cared about what organization published, look to the data. However, if you hang out with academics, they unanimously read the journal + abstract. Its so weird. I feel like there is some sort of Dunning Kruger where I'm the idiot... But really... I know the scientific method. I know the quality of the people I'm talking to.
Happy to see you didn't just accept it like my academia pals!
I have, however, serious doubts that it can be a substitute for stimulants. ADHD affects so many parts of one's life such that attention sometimes seem a very small part of the disorder. Miraculously, at least for some people, stimulants create a kind of automatic improvement in other areas too. I hope that general discourse about ADHD moves towards easier access to those drugs, not replacing them.
Also, please don't speculate about ADHD, especially about people who suspect they might have it.
ADHD experience differ a lot among people and even in different situations for an individual. Because of this aspect, a lot of people have complicated relationships with their diagnoses.
Self-doubt, for various reasons, is a very common trait of people with ADHD. Strongly worded claims about ADHD might be very harmful to people who plan to seek help or struggle to follow their treatments.
I've gone years unmedicated when I had a less demanding and more lax work environment and daily focus meditation has helped a great deal. If I'm not mistaken some video games have also vastly improved and kept alive quick reaction times and delayed reward mindset - stuff that this game seemingly also does - training being less impulsive and overriding other, negative habits.
It makes perfect sense - video games can release high amounts of dopamine on demand, while in our daily lives we lack release in key moments. Synaptic plasticity, learning and memory is dopamine dependent. In a dopamine deprived brain, if timed correctly, these sudden releases can be extremely habit-forming and beneficial.
I've read through their whole website and nowhere is mentioned that this is supposed to replace necessary medication. It's simply another tool in the toolbox, and as such should absolutely not be disregarded. I can 100% see this being extremely helpful and would love to try it out - unfortunately the apps are only available in US app stores.
Is this a joke? This is a discussion platform for speculating. Plus half the people on HN probably have ADD or ADHD
By the way, the "ADD" diagnosis has been removed from the DSM, there's no longer a medical distinction between the two.
They've convinced themselves they have it. Please ignore the prevalence of obesity, lack of exercise, poor diet, and anti-social nature of tech workers plz. They are suffering from a natural affliction.
I'd be curious to know how much this costs for patients. I'm guessing it's some type of a subscription model.
Completely serious - I bet Tetris could be approved by the FDA for ADHD treatment if The Tetris Company were willing to put in the effort for all the paperwork and fees.
“Can playing Tetris help prevent PTSD if you’ve witnessed something traumatic?”
https://theconversation.com/can-playing-tetris-help-prevent-...
That is not what happened here, though.
I know this is for children, but anecdotally, the number of 30 somethings I know IRL who are now discovering they have "ADHD" is comically high. Social media has truly been a disaster for the human race.
I mentioned it to the school psychologist, who told me that biofeedback is not considered legit, but that it does seem to work for some kids.
My first thoughts when trying to figure out how biofeedback works is that it could easily be turned onto a game, even a good game, and it would help at least those that it helps.
Is that right? Thoughts from those here with experience or domain knowledge?
The game doesn't look anything special to me, what are the key traits that make it suited as a treatment?
Or did they simply run a clinical trial and get FDA approval as a treatment because of that?
It seems to me many other games would also be effective, especially building games, Factorio, Minecraft, etc, and which don't require a $99/month 'prescription'.
TFA’s title is to blame. This hyphen makes the title read correctly.
The current cost for EndeavorRx is $99 for a 30 day prescription. EndeavorRx is FSA/HSA eligible. You can pay for EndeavorRx by using your FSA/HSA card during checkout or by submitting the cost to your FSA/HSA after purchase.
> EndeavorOTC is the only FDA-authorized digital therapeutic for ADHD available without a prescription.
I wish there was a comparison between the two - or is the age requirement (18+ for otc) the only difference?
Maybe the real papers are more legit.
Really obscene. The healthcare industry is such a sickness in this country, I hope we get a populist one day who completely guts it.
It eats hours.
However!
It drastically cut down on my doom scrolling.
Would be cool to see if someone could design a game that was addictive, but also fade you out of this addiction natively.
So it's priced way higher than a full AAA game, but you only keep it for a month. So even worse than a digital purchase.
What kind of study outcome is this?
ADHD people often self medicate with alcohol or coffee.
Video Games have definitely been in the mix for 'self-medicating'.
That is why I'm wondering why so many people in this thread say 'just play such and such game X'. Games can be addicting, to be addicted to a game isn't necessarily helping the person.
But games can also help. So there has to be some mechanism, some particular game play mechanism that is helping. That is what needs to be studied. Then we could pick the ones already on the market with that mechanism.
The FAQ says “EndeavorRx uses sensory stimuli and simultaneous motor challenges designed to target areas of the brain that play a key role in attention function.”
So is it just meant to exercise those areas? “Uses sensory stimuli and simultaneous motor challenges” could describe a million other games.
To this day when I need to focus on an issue I often say “Location confirmed, sending supplies” or some other SF sentence.