Games to Sharpen the Brain
Start-Ups Seek FDA Approval for Videogames as Treatment for ADHD
If two start-ups have their way, videogames might cure more than just boredom. They could also be used to treat attention-deficit hyperactivity disorder.
Akili Interactive Labs Inc. of Boston, formed by start-up-creating firm PureTech Ventures, and San Francisco company Brain Plasticity Inc. are seeking Food and Drug Administration approval for a videogame treatment they hope clinicians will turn to before prescribing medicines for ADHD.
The disorder, whose symptoms include difficulty paying attention and remaining focused, affects 9% of adolescents and 4.1% of adults in the U.S., according to the American Psychiatric Association.
The companies are building on research suggesting that action videogames can sharpen players' ability to concentrate, and may have other medical or health benefits. University of Toronto scientists said in April that action videogame play causes improvement in "visual attention," which is needed to drive a car or track changes on a computer display. In 2010, University of Rochester and University of Minnesota researchers found that action videogames can train people to make the right decisions faster.
If proven effective, doctor-prescribed videogames could treat neurological illnesses without exposing patients to the side effects seen with today's medications, including stimulant Ritalin, made by Novartis NOVN.VX +0.26% AG. Psychotherapy and medication can reduce ADHD symptoms, though side effects of stimulants, the most widely used medicines, can include decreased appetite, sleep problems, anxiety and irritability, according to the National Institute of Mental Health.
These companies face an uphill battle. The FDA has never approved a videogame as a medical therapy. And despite their side effects, today's ADHD medicines generally are well tolerated and effective, said Lenard A. Adler, professor of psychiatry and child and adolescent psychiatry at NYU Langone Medical Center.
"When we look for other therapies, we want to be sure they will work as well as the accepted therapies that we have," Dr. Adler said.
Akili co-founder Eddie Martucci said his company's research shows that people want choices other than today's powerful medicines. "We would aim to have efficacy and tolerability that outstrips any of the drugs," said Dr. Martucci, an associate at PureTech Ventures.
Dr. Martucci is part of a team of PureTech entrepreneurs that forms start-ups with new approaches to medical and research problems. About two years ago, they began looking for ways to treat neurological disease without drugs or invasive procedures. This led them to the field of videogame research, where scientists were finding correlations between videogame skill and cognitive functions.
The PureTech team was especially drawn to the work of Daphne Bavelier of the University of Rochester and Adam Gazzaley of the University of California, San Francisco, who were studying how the brain processes information that is relevant to a task and blocks out distractions.
Dr. Bavelier had found that players of fast-paced, action videogames outperform non-gamers in their visual-attention skills, or the ability to concentrate visually on an object while ignoring irrelevant information. Visual attention is important for things like driving or picking a friend's face out of a crowd.
With research increasingly suggesting that neurological benefits are a byproduct of recreational, action-game play, PureTech teamed up with Dr. Bavelier and Dr. Gazzaley to design videogames that stimulate parts of the brain in ways that could be medically useful. With Dr. Bavelier's and Dr. Gazzaley's guidance, and advice from videogame experts like Noah Falstein, formerly of videogame publisher LucasArts Entertainment Co., PureTech launched Akili in December.
Akili—which means "wisdom" in Swahili—hasn't disclosed how its game designed for smartphones and tablets is played, but Dr. Gazzaley said it is designed to affect the prefrontal cortex—an area involved in goal-directed behavior—and visual and motor parts of the brain to strengthen the ability to concentrate and to ignore distractions. Akili has a neural-imaging study underway with its current game in healthy individuals and its clinical-pilot studies will begin shortly.
Meanwhile, Brain Plasticity has launched clinical tests of computer-based exercises to treat schizophrenia and ADHD, said Henry Mahncke, chief operating officer of Brain Plasticity and chief executive of San Francisco-based Posit Science Corp.
Brain Plasticity was spun off from Posit, which built a profitable business selling software to improve the brain's ability to process and remember information it takes in through sound. Like Akili's game, Posit's flagship, Brain Fitness Program—which uses games to improve the ability to hear and recall speech—works through the principle of neuroplasticity, or the brain's ability to rewire itself in response to learning or new experiences.
Brain Plasticity, which pursues the medical potential of Posit's research, is testing its "ADHD suite," a set of 25 exercises designed to train the cognitive skills of alertness, attention, working memory, impulse control and suppression of distractions, according to Dr. Mahncke. One attention exercise asks the trainee to pick out a sound that is distinct from a series of repetitive sounds that are all the same, for example.
A potential problem for these companies is that action videogames seem to affect various types of attention differently, raising the question of whether an ADHD game or computer exercise can be made to trigger desirable effects only.
A study of 3,034 children and adolescents in Singapore, published in Psychology of Popular Media Culture, found videogame play to be associated with greater attention problems.
Noting Dr. Bavelier's and Dr. Green's research, the authors speculate that electronic media might improve visual attention but impair the ability to sustain attention on a hard or boring task. The latter type is what teachers need from students, according to co-author Douglas A. Gentile, a developmental psychologist at Iowa State University.
"The biggest problem is that we use the word 'attention' to mean many different things," Dr. Gentile wrote in an email. "Could games be designed to improve the kinds of attention that teachers need? I expect so, but given that games usually train the other types, it becomes a great design challenge."
Another challenge: designing video or computer games that make a lasting impact without taking too much time away from schoolwork, a job or other activities. Too much television, Internet and videogame exposure can be harmful to children, according to the American Academy of Pediatrics, which recommends that they have no more than two hours of "screen time" per day.
How much time patients would have to spend with their products is one of the questions that Akili and Brain Plasticity intend to answer. Akili expects its first product to be engaging, nonviolent, and able to enhance higher-order attention without decreasing other faculties, said Dr. Martucci. Akili also plans to use its game as a platform and to test it in other diseases.
Write to Brian Gormley at firstname.lastname@example.org