Digital games show promise for improving ADHD and depression in youth, but anxiety remains a challenge

By Pooja Toshniwal PahariaReviewed by Lily Ramsey, LLMSep 27 2024

New research highlights benefits of gamified mental health tools for pediatric ADHD and depression treatment.

Study: Efficacy of Gamified Digital Mental Health Interventions for Pediatric Mental Health Conditions. Image Credit: Prostock-studio/Shutterstock.com

In a recent study published in JAMA Pediatrics, researchers conducted a meta-analysis to determine the effectiveness and modifiers of game-based digital mental health interventions (DMHIs) in reducing depression, attention-deficit/hyperactivity disorder (ADHD), and anxiety among young individuals.

Background

Depression, anxiety, and ADHD are frequent mental health issues in children and teenagers. Excessive concern, poor mood, concentration issues, impulsivity, and hyperactivity are signs of mental disorders that cause significant damage in various aspects of life. Untreated, these disorders can result in adverse psychopathology and health-related consequences in adulthood.

Despite their effectiveness, evidence-based therapies for these illnesses are frequently unavailable due to a shortage of educated healthcare practitioners and the requirement for controlled drugs.

Pediatric primary care facilities function as intermediaries for mental healthcare services. However, novel approaches are required to satisfy the growing need for child and adolescent mental health treatment.

DMHIs have demonstrated some success in addressing mental health issues, although engaging with therapeutic information is difficult. Gamification, or adding games or game-like aspects to tasks, could increase children and adolescent engagement.

Previous research shows that gamified DMHIs can enhance youth involvement compared to traditional treatments, giving them an innovative method to offer evidence-based mental healthcare in an accessible, scalable, and engaging format.

About the study

In the present meta-analysis, researchers investigated whether gamified DMHIs are effective in treating pediatric depression, ADHD, and anxiety, given the challenges confronting the accessibility of pediatric mental healthcare. They also evaluated moderators of treatment effects from DMHIs.

The researchers searched the PubMed, Web of Science, and PsycInfo databases for studies published before 20 March 2024.

The analysis included randomized controlled trials (RCTs) evaluating the effectiveness of gamified digital mental health interventions in treating pediatric anxiety, depression, or ADHD. Exclusions were studies published in non-English languages that did not assess gamified DMHIs or provided insufficient data on treatment effect sizes.

Two independent researchers performed title abstract screening and extracted data from relevant records. Consulting a senior researcher resolved disagreements between the two.

The team extracted effectiveness information from anxiety, depression, and ADHD rating scales. Moderator variables extracted included characteristics related to participants, intervention, and trial design.

Participant characteristics included sex, age, and sample type (community-recruited or clinically significant). Intervention characteristics included the duration, delivery mode, time limit, public accessibility, and aesthetic sophistication. RCT design characteristics included sample size, publication year, outcome measure, control condition, and bias risk.

The primary study outcomes were changes in anxiety, depression, or ADHD severity among treatment recipients compared to non-recipients. Random-effects models and Hedges g values indicated treatment effects.

The second version of the Cochrane Risk Bias tool assessed bias risk in the included studies. I2 values and Q statistics assessed heterogeneity between the included studies. Funnel plots and Egger tests indicated publication bias. Inverse variance-weighted meta-regressions analyzed moderators.

Results

The literature search yielded 27 RCTs, including 2,911 individuals with anxiety, depression, or ADHD. The team noted modestly significant effect sizes for gamified digital mental health interventions in improving depression (g, 0.3) and ADHD (g, 0.3) but non-significant effects in lowering anxiety (g, 0.1).

The moderator analysis showed that DMHIs to improve ADHD delivered through computers were more effective (g, 0.4) than tablet-delivered ones (g, 0.1) and video-game consoles (g, 0.1). Trials including male-dominant populations reported larger treatment effect sizes. 

Gamified DMHIs to lower depression that used predetermined time limits (g, 0.5) showed higher efficacy than those without time limits (g, 0.1). I² values and Q statistics showed significant heterogeneity in treatment effects across studies for depression and ADHD (I²=54%, Q₈=17) but little heterogeneity (Q₁₁=6.3, I²=0%) concerning trials investigating anxiety-related outcomes.

Visually inspecting funnel plots and Egger tests did not indicate publication bias. Trials with low bias (g, 0.1) had smaller effect sizes than those with bias-related concerns (g, 0.7).

Conclusions

The study suggests that gamified DMHIs may benefit the pediatric population with depression or ADHD by providing innovative, effective, and accessible choices for addressing child and adolescent mental health.

However, issues persist since most commercially marketed DMHIs have not undergone evaluation in RCTs. It is necessary to develop reporting requirements for RCTs on DMHIs in youngsters.

Adverse effects from gamified DMHIs were largely unreported across RCTs, raising concerns about the potential adverse effects of screen time for youth. Additionally, there is minimal information about data safety and privacy policies for gamified DMHIs.

Future RCTs should report adverse effects, consider data safety or privacy policies, and monitor the efficacy, safety profile, and dose of DMHIs to understand their lasting impacts and adoption in clinical practice.