ADHD & Digital Medicine (Apps & Games)

Summary

In this video, Dr. Russ Barkley discusses the role of digital medicine, particularly the Endeavor video game, in managing ADHD. He highlights the limited evidence base for such apps and games, cautioning against their use as a primary treatment. Barkley critiques the FDA's lower standards for approving digital devices compared to drugs and emphasizes the need for independent research to validate claims of effectiveness. He concludes that while digital medicine shows promise, it is not yet ready for prime time as an evidence-based treatment for ADHD.

Takeaways

• 😀 Digital medicine, including apps and video games like Endeavor, is being used for ADHD management, but the evidence for their effectiveness is limited.
• 📱 Companies have created games and apps for smartphones that claim to improve attention, impulse control, and working memory through practice.
• 💡 Some websites offer a variety of cognitive games for a monthly fee, but they cannot claim to treat diagnosed mental or medical disorders, only to improve cognitive abilities that might be impaired.
• 🚫 The FDA approval for a device like a digital medicine app is not as stringent as for a drug, focusing more on safety than efficacy.
• 🔍 A review found that there are hundreds of apps for ADHD or related cognitive deficits, but most lack research to support their claims.
• 🎮 Endeavor is a video game designed to improve ADHD symptoms, with a version called Endeavor RX that has FDA approval and another called Endeavor OTC.
• 📊 A 2020 study on Endeavor RX showed improvement in lab tests measuring attention but did not demonstrate real-world behavioral changes.
• 🤔 The concept of 'near transfer' refers to improvement in lab measures similar to the game practice, which is not as important as 'far transfer' that extends into real life.
• 🧐 A subsequent trial of Endeavor showed improvement in impairment ratings but lacked a placebo control and did not convincingly demonstrate far transfer.
• 💡 The speaker does not recommend apps or games for ADHD as first-line treatments due to the weak evidence base and suggests buyer beware.
• 👎 The speaker expresses concern about relabeling games as digital therapeutics, as it may be misleading and implies medical treatment without sufficient evidence.

Q & A

What is the main topic of the video by Russ Barkley?

The main topic is the role of digital medicine, particularly focusing on the Endeavor video game's effectiveness for the management of ADHD.

What has been the trend since the invention of smartphones in relation to mental health apps?

Since the invention of smartphones, companies have been creating apps, usually games, that individuals can practice on, with the belief that this practice leads to improved attention, impulse control, and working memory.

What is the difference between the claims websites like lumosity.com can make and those they are not allowed to make?

Websites like lumosity.com are not allowed to claim that they treat mental health disorders or medical disorders. However, they can claim to improve cognitive abilities that might be impaired in various diagnosed mental or medical disorders.

What is the FDA's stance on approving apps for mental health treatment?

The FDA has a less strict set of standards for approving devices like apps compared to drugs. The main concern is safety, and there must be some evidence of efficacy.

What is the current evidence base for apps and games designed for ADHD?

The evidence base is extremely limited, with almost no research on most of these apps. The few that have research are often funded by the companies that manufacture and market the apps.

What is the Endeavor RX and how does it differ from Endeavor OTC?

Endeavor RX is a version of the video game that requires a prescription and is FDA approved. Endeavor OTC, on the other hand, is over-the-counter and does not require a prescription.

What is the primary concern Russ Barkley has about the Endeavor RX study published in 2020?

The primary concern is that the study relies on a lab test (TOVA) for measuring attention and inhibition, which may not correlate significantly with real-world behavior changes in ADHD symptoms.

What is meant by 'near transfer' and 'far transfer' in the context of digital medicine?

Near transfer refers to improvements on lab measures similar to what is practiced in the game. Far transfer refers to whether the results of the treatment extend into real-life settings, such as home, school, work, and social functioning.

What does Russ Barkley suggest about the evidence for the Endeavor program's effectiveness in real life?

Russ Barkley suggests that the evidence for the Endeavor program's effectiveness in real life is thin and not convincing, as the studies lack rigorous examination of far transfer using randomized trials with placebo controls.

What is the general recommendation from Russ Barkley regarding the use of digital medicine apps for ADHD?

Russ Barkley does not recommend digital medicine apps or games as frontline treatments for ADHD due to the weak evidence base and suggests caution, advising consumers to 'buyer beware' until more independent research is available.

What is the issue with relabeling a game as a digital therapeutic according to Russ Barkley?

Relabeling a game as a digital therapeutic can be misleading and deceptive to patients, as it implies a medical or digital treatment of the disorder without sufficient evidence to support such claims.