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    Finnish Doctors Are Prescribing Video Games for ADHD

    Written by

    Anna Leach

    A physiotherapy patient using a Kinect-based game in treatment. Photo courtesy Serious Games Finland

    There’s a problem with the drugs used in mental health care: You have to be on them for them to work. Even then, they can be expensive and have detrimental side effects.  

    Ville Tapio had an idea to do it better. He runs a private psychiatry center in Helsinki, and psychiatrists had told him they were reluctant in particular to hand out drugs for patients with attention deficit hyperactivity disorder (ADHD). ADHD drugs are psychostimulants, they are frequently abused, and kids can be prescribed them young and kept on a regimen for years.

    Tapio's alternative? Getting people with mental health concerns to play video games. They're special video games, of course—ones that can change how your brain works, with a technique loosely termed gameified neuroplasticity therapy

    The idea isn’t totally out of the blue. The University of Helsinki is well known for its neuroscience, with researchers already investigating how brain activity changes when people do different things. Scientists there have already tinkered around with game play, checking out local Helsinki production Angry Birds to test why the game was so addictive, and it's all part of a push by Finnish developers to build games that do good.

    But using games to change people’s brains for health reasons is an ambitious and relatively new concept. Still, Helsinki has the scientists and the gaming companies—Angry Birds developer Rovio is just one—to give the idea a proper look. Now, researchers also have cash: Tapio's company Mental Capital Care received 790,000 euro in funding from Finnish investment board Tekes last year to test out a game designed to cure the symptoms of ADHD

    The new interest in gaming in treatment is fueled partly because brain wave scanning headsets have come down in cost, making it a more realistic option outside the lab. Neurogames work with EEG headsets, which place small electrodes directly on your scalp to measure brain waves. While EEG technology has been around in medicine for ages, only recently have cheaper commercial versions of EEG caps come on the market.

    One such EEG cap is the Emotiv, which has become popular with researchers looking to move beyond the restrictions of fMRI brain studies. For one, it's hard to study the brain's reactions to natural stimuli when a person is inside an MRI machine. A brain cap, on the other hand, is mobile enough for users to utilize in their daily lives, an advantage researchers hope will help users hack their brains.

    Emotiv's brain-controlled headset was originally designed for regular gaming, but has since found fans in neuro researchers.

    Thinking in different ways changes the signal the headset receives and sends different signals to a computer, which means you can control a game with your mind. Researchers at the University of Helsinki put together a lab test with 50 ADHD sufferers and 40 sessions of a game where they had to lift an on-screen ball with their thoughts. Different types of thinking do different things to the ball. The goal is to exercise specific sectors of the brain.

    “We start the gaming treatment by analyzing the person’s brains, and defining the areas of the brain which are too active or not active enough,” said Tapio. “And then we create a gaming plan that will stimulate those areas of the brain.”

    The game is tuned to make the tasks accomplishable by thinking in a certain way—a desirable way, from the doctor's point of view. But it’s more than just concentrating.

    “It’s not only the activity in brain areas we are trying to affect but also the kind of activity: the different wavelengths, the different types of electromagnetic action—it can’t be too high or too low. We set a goal which will be optimal for the patient,” Tapio said. “And after we have created an optimal profile for the patient, he will start the gaming and get his brain active to the optimal levels.”

    It’s not an alternative to therapy, Tapio explained, but this type of symptom control may be an alternative to drugs. The concept of neuroplasticity suggests that your brain changes according to what you do. In other words, if you spend an hour a day thinking the right way, you could train your brain to think that way more. At the very least, you might teach gamers to recognize how their brains work and get them to practice controlling them.

    The early results show that everyone improved at the game, and there were positive early indications that it had an impact outside the game. The results are to be published in several months.

    This video from the early development of EEG gaming shows how simple tasks can be controlled by thought. Tapio's work is designed to create specific tasks to train the brain in specific behaviors.

    If the idea turns out to have potential, it could have enormous impact. In the US alone, $143 billion was spent on ADHD treatments, Tapio said. Add in treatments for anxiety, depression, PTSD—which Tapio believes neuroplastic treatment can also help alleviate—and you’re looking at an enormous market.

    It’s a big idea. But then we’re still far from swapping the Ritalin for a computer session.

    Currently, gaming is just a complementary therapy. Does it genuinely give you better concentration, or does it just make you better at playing the game? Do the effects last a few hours, or can balancing a ball on a computer screen actually affect behavior months and years in the future? How can the effect of the game be quantified in a way that meets the requirement for medical evidence?

    “Brain plasticity as a theme is an extremely broad issue. We have long-term funding channeled into multiple ways how to affect it," said Pekka Kahri, director of Tekes. "There are initiatives around stroke rehabilitation, dementia [and] learning difficulties—even in areas where mastering high amounts of pressure is needed, like the military.”

    Technology has allowed for much greater and cheaper self-measurement or self-quantification over the past few years—including your footsteps, pulse, and skin temperature—and Pekka is interested in people finding ways to wrestle that into useful applications.

    “For several years now we’ve had measurement devices where you can measure your own physical state with different types of approaches. That’s been a hot trend," he said. "The question so far has been so what? It needs to link into the social context of people."

    “How does this measurement information help behavior change?" he added. "How does it help rehabilitation of people after an accident, how does it support people handling stressful and difficult situations in life?”

    Pekka mentioned that his firm is also funding a project involving sensors and the social web. Designed to look at stress management techniques, the project uses sensors to pick up stress indicators like heart rate, skin temperature and sweat. Reading those measurements real-time it determines how social networks can improve or aggravate people in a state of stress.

    But though using games to change your brain is still an emerging avenue of research, games have already found traction in other areas of medicine. Finisher developer Janne Niittymäki and his firm Serious Games Finland make games that use feedback loops to improve physical health.

    For example, stroke patients expecting a session with a hospital physiotherapist instead found themselves rigged up to a Kinect and tasked with playing a flying game created by Serious. According to Niittymäki, the game got wheelchair-bound patients moving “like maniacs” as they flew over a city collecting gold coins. 

    “It started as a trial project. Is it possible to do good-looking and entertaining video games out of such a serious disease? And it turned out to be really suitable," he said. "It’s in use at the local healthcare trust and the reaction from customers has been really really good. People don’t expect to have fun when they go to the hospital.”

    “At first people say, ‘Okay, I don’t play games. This is not for me.’ Then they start and they're moving like maniacs."

    The game was developed in collaboration with physiotherapists, who prescribed what kind of movements were important; patients control it with their upper body and hands. It’s also been run for elderly people and chronic pain patients.

    “At first people say, ‘Okay, I don’t play games. This is not for me.’ Then they start and they're moving like maniacs,” Niittymäki said.

    “You’re looking at the patient like ‘oh my god can he actually do that?’ But yes he can, if the motivation is strong," he added. “In that time, for two minutes they are not focusing even for one second on their pain. They are focusing on collecting those gold coins. As simple as it is, I think it’s a really remarkable thing.”

    After delivering its first game to a hospital in Helsinki, Serious Games Finland is working on another physiotherapy-based game that's due in 2015. The trick, Niittymäki said, is partnering with someone who does know about physiotherapy, or education or ADHD.

    “Because we are game developers we know how to make people behave, how to make something attractive and how to keep them focused hour after hour, looking at a screen," he said. “We don’t know that much about physiotherapy or education. If we do something in those areas we need a good partner that knows existing best practices. Then we think about how can game technology feed into that."

    Niittymäki's ultimate goal is to figure out how games can best be applied to make people's lives better, whether it's physically or mentally. If that also pushes back against the conception that games are just guns and violence, that's all the better.

    “Games do affect people and they do have an impact on how they think, because they spend so much time in that game," Niittymäki said. "If we switch it around, and make the game give good feedback and still have the same fun inside the game, the result will be positive.”

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