ADHD, Long Covid, and the Future of Prescription Video Games


On the freezing planet of Frigidus, a virtual world full of icy caverns and treacherous waterfalls, your mission is to race down a track and target the animals flying towards you. It’s not exactly easy: bumping into walls – you’re navigating via your phone or tablet – can slow your avatar down, and there are other characters out there to distract you from your goal. Still, the idea is that through all of these challenges, the freezing terrain of Frigidus can give you something other video games don’t: medical treatment.

Frigidius is just one part of the EndeavorRx universe, a video game designed to treat ADHD in children ages 8-12. The game, which was cleared by the Food and Drug Administration in 2020, is designed to engage the parts of the brain we use to focus our attention. Now the company that created it, Akili Interactive, hopes to expand its games to all sorts of other conditions, including Covid depression and brain fog. The goal is to create a new kind of medicine, using technology to deliver a treatment that requires no in-person supervision or risks serious side effects.

The idea of ​​a prescription video game seems far-fetched and perhaps counterintuitive if you read the headlines warning of rising video game addiction. Still, games like EndeavorRx are appealing because they raise the possibility that an extremely fun activity could also serve as potential therapy. This approach promises to make treatment delivery much more affordable and suggests that we can turn the phones, tablets and computers we already own into medical devices, simply by downloading an app. The challenge is that the impact of these games – which are still relatively new – is up for debate, even as companies like Akili go public and try to tackle more conditions. This means that these platforms currently run the risk of over-promising and under-delivering.

EndeavorRx has some scientific backing. After analyzing the results of five clinical trials with more than 600 children, the FDA found that the game may facilitate “general improvement in attention” and also appeared to improve other ADHD symptoms. Although EndeavorRx is not designed to replace any medication, it is only available to people who have a prescription. Patients with a prescription are given an access code that they can use to download the game. The list price for the game is $450 per month for people covered by insurance, but people who don’t have insurance pay a discounted $99 per month, although still expensive. These are just a few of the reasons Akili executives say EndeavorRx isn’t just a spin on Mario Kart or a bloated version of the brain-training app Luminosity.

For all the “I’m not like other video games” energy, playing EndeavorRx feels familiar. You navigate the virtual galaxy as a cartoonish avatar, which you can dress up in various outfits, including an equestrian outfit and a Frozen– ice queen dress. In the larger EndeavorRx game, you can visit different worlds, where you can select different tasks that challenge you to concentrate. Completing these tasks earns you prized mystical creatures that you are meant to collect, and the game gets harder or easier depending on your performance. The hope is that between smashing targets and gliding through power zones, the technology can essentially train patients to stay focused.

The EndeavorRX game is designed to help children with ADHD.
Courtesy of Akili

“Under the hood are these really complex and beautiful sets of algorithms that create stimuli and closed feedback loops to activate a very specific part of the brain,” said Matt Omernick, co-founder and chief creative officer of Akili at Recode. “That engine underneath is what really produces lasting effects in the brain, and the beautiful skin, or the wrapper, or the vessel, is the style, look, and feel of the video game.”

Although Akili’s product was the first of its kind to gain FDA clearance, it’s far from the first example of video games being used in medicine. Veterans have used video games to alleviate symptoms of post-traumatic stress disorder, and therapists have increasingly turned to online games to work with people suffering from depression, schizophrenia and anxiety, especially during the pandemic. Some experts think these games could do even more with the take-off of virtual reality.

But promoters can get ahead of themselves. When the FDA approved EndeavorRx in 2020, the agency cleared it through a low-risk medical device marketing process. EndeavorRx isn’t yet hugely popular either: fewer than 1,000 prescriptions were written for the game in the second quarter of this year, and only 3% were reimbursed by insurance companies. Some critics have also expressed concern that the game only teaches children how to get better at games, which is a payoff that doesn’t really translate into everyday life. Attrition could also make these types of games less effective, as pointed out in an August study that analyzed people using Akili, as well as other platforms.

“Let’s say you want to expand it to 1 million ADHD children,” says P. Murali Doraiswamy, co-author of the study and director of the Neurocognitive Disorders Program at Duke Medical School. “They have to be motivated to do it.”

These drawbacks did not dampen Akili’s aspirations. The company is already working on a game for adults with depression, and recent research has indicated that its platform could help people with lupus. Of course, the company hopes that developing games for all of these conditions could become big business. Akili has raised more than $160 million after going public through a SPAC, or special purpose acquisition company, earlier this year. The company recently teamed up with kids’ gaming platform Roblox, a sign that it’s happy to blur the line between medical and traditional video games.

“I’ve always found that the more interesting and fun the activity, the more likely someone is to come. Just like a medicine, the better it tastes, the more likely someone is to take it,” says Josué Cardona, who runs a nonprofit organization focused on video games, Geek Therapy.

It’s all part of a larger effort to reinvent what video games are and what they can do. It’s already clear that our virtual worlds will become more sophisticated as technologies like 5G and the metaverse take off. Now there’s a race to make them as useful as possible for our daily lives, whether that’s using them to treat mental health issues, practice for job interviews or learn a language.

EndeavorRx’s progress so far suggests that this race continues, but we’re still in the early days. For now, it is not yet clear what impact this new approach to health care could have. Still, it seems fair to say that at least some of the help kids get from the company’s game is real, even if the planet of Frigidus isn’t.

This story was first published in the Recode newsletter. register here so as not to miss the next one!

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