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Doctor's orders: Start playing video games

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Brain-altering screen time may combat Alzheimer's, ADHD


PHOTO COURTESY OF MELISSA VAN DER ZWAN - Computer games that could help children with attention deficit disorders have begun clinical trials that may lead to FDA approval. Many children with autism and Asperger syndrome, such as 13-year-old Damian, are more comfortable learning from a screen than face-to-face.Thirteen-year-old Damian loves his computers. If given the choice, he might play video games and look up information on Wikipedia all day long, says his mother, Melissa Van Der Zwan.

Damian, who has Asperger syndrome, but mostly functions very well, just seems to retain information better when it’s presented on a screen. In-person social interactions are hard for him. Damian won’t talk to some kids in school, but he’s happy to chat with them via Skype all afternoon.

“When they are face-to-face in a classroom, the teacher will say, ‘You’re not looking at me, so you’re not paying attention,’” Melissa Van Der Zwan says of Asperger kids. “They stop learning because they either have to focus on the eye contact or the listening and learning.”

Wouldn’t it be great, she says, if the therapy that might help Damian deal with his distractibility and inability to organize himself could be delivered through a video game?

That day is getting closer, says Dr. Adam Gazzaley, a University of California, San Francisco, neurologist who has begun producing video games that are showing positive results in scientifically structured clinical trials. Video games based on Dr. Gazzaley’s work might be available within two years to help elderly people fight off dementia. And it might help children with attention deficit hyperactivity disorder, and many Asperger kids, improve attention spans and memory, as well as deal with inhibitions.

Gazzaley is scheduled to speak in Portland Feb. 29 as part of Oregon Health & Science University’s Brain Awareness lecture series. Among other things, he will explain why the company he founded to develop therapeutic video games is seeking federal Food and Drug Administration approval to market the games as medical devices — with a physician’s prescription that would be covered by health insurance.

Despite decades of unsupported claims made by game manufacturers that promised to sharpen people’s intellect and give children a leg up on their classmates, Gazzaley is convinced that the games he’s been working on can truly alter the brains of children with ADHD. He’s thinking soon his software will be medicine.

“We’ve relied heavily on pharmaceuticals and traditional classroom-style education, and I think we can do better,” he says.

Improving seniors’ abilities

The early returns on Gazzaley’s work are impressive. He started with a game called NeuroRacer, intended first to measure cognitive decline in older adults, and later to help those adults improve their attention spans and what he calls “working memory.” Working memory allows the brain to use new information at the same time it accesses memories to learn, think and store new memories.

On the screen, NeuroRacer looks deceptively simple, and familiar. A player drives a car down a road. Every now and then a target appears on screen that demands the player either touch the target or ignore it, depending on its color. There’s a reward system — the game gets harder as players do better. “Better” is defined as more proficiency at both tasks — driving safely as the road becomes more difficult and touching the right targets at faster speeds.

The game forces players to multitask. When seniors were studied, improvements were measured not only by the computer, but by EEG testing that showed physical changes in their brains. Six months later, the participants who showed the most changes during EEG testing not only performed better on retesting, but also showed improved attention span and working memory.

According to a study published in the medical journal Nature, the seniors in Gazzaley’s trial ended up with the multitasking skills of 20-year-olds six months after they’d played NeuroRacer.

From oldsters to youngsters

That’s heady stuff for the team of UCSF researchers led by Gazzaley, a 47-year-old who grew up playing Space Invaders on his Atari and hacking and modifying its code because he was interested in how the game was created.

Later, Gazzaley says, he became inspired to consider video gaming more seriously, as studies showed first-person shooter games were improving some thinking skills in young adults. The UCSF team’s first work involved creating games to challenge participants and study their reactions. Only later, Gazzaley says, did the goal become improving brain function. And only after success with seniors did the idea of games for ADHD kids gain their attention.

Gazzaley founded Boston-based Akili Interactive to take his ideas out of the lab and potentially to the marketplace. But not just to the commercial marketplace — into the hands of pediatricians. FDA approval for Project: EVO, Akili’s ADHD game, is going to require clinical trials similar to those required for new medical devices. EVO is similar to NeuroRacer, but instead of driving a car, players ride a surfboard through an increasingly complex landscape while tapping the screen when the right-colored fish jumps out at them.

It sounds like an arcade game and it looks like one, too, since Akili hired a LucasArts designer to make sure the graphics were state of the art, the better for keeping kids engaged. All of which has Gazzaley optimistic, but well aware of where his work is heading.

“To actually consider a physician prescribing a game instead of a molecule for one of their patients is a leap,” he says.

PHOTO COURTESY OF UCSF - Seniors required to multitask while playing a video game were able to significantly improve attention spans and working memory in a University of California, San Francisco, lab.

Empty promises in past

Toward that end, Akili last month secured $30.5 million in financing and has started the clinical trials. Among the backers are a major pharmaceutical company and the nonprofit Autism Speaks. Akili officials say they hope to have FDA clearance for a launch in 2017.

If Akili succeeds in getting FDA approval for games, it would represent the first approval for software as medical therapy, Gazzaley says.

One of the researchers conducting a trial for EVO is Benjamin Yerys, a clinical psychologist at the Center for Autism Research in Philadelphia who studies children who are autistic and have ADHD. Yerys says he’s impressed by the initial trials on NeuroRacer, because they were conducted more scientifically than those he’s used to seeing

“When you look at the landscape of games, so far, there have been a lot of empty promises. The data has not lived up to what we hoped for,” Yerys says.

Brain-training program Lumosity has been fined by the Federal Trade Commission for unsupported claims. Cogmed, another program claiming to improve working memory, mostly trains players to improve on its own tests, and those improvements are not likely to translate to real-life gains, in Yerys’ opinion.

In his clinic, most kids working on such games generally get bored and lose motivation fairly quickly, Yerys says.

But EVO, in Yerys’ view, feels different. “It feels like a hard video game, not like doing homework,” he says. “The therapy is actually the fun part of the game.”

Yerys says he’s impressed by the initial study of NeuroRacer, and the improvements it produced for seniors six months after the trial. “You just don’t see that happening,” he says.

But that’s still a distance from convincing Yerys that the games have long-lasting impact. The trick now will be to measure if an 8-year-old is less impulsive after playing EVO, and there isn’t an easy scientific test for that.

Even with adults, Yerys says, the critical proof can’t be found in a researcher’s lab.

Real-world improvements needed

“What we don’t know is, in their day-to-day life, are they still doing better? Are they remembering to pick up the dry cleaning on the way home?” he says.

Only about half of autistic children who also suffer attention deficits respond to the drugs typically prescribed for ADHD, according to Yerys. And, he says, nearly one in five of those kids suffer significant side effects from the drugs. An alternative in the form of a video game would be especially welcome for those children, he says.

University of Oregon professor of cognitive science Ulrich Mayr is a little more skeptical about the claims being bandied about for Gazzaley’s products. Like Yerys, he wants tests to show that the games don’t just teach kids to become better at the games, but actually improve day-to-day life skills of players.

“All I want to see is the people who spend millions of dollars designing the games, spend 5 percent of that to do a real robust controlled study,” Mayr says.

Mayr also is concerned about a lack of scientific grounding — a theory that would explain why playing these games would permanently alter childrens’ brains. Other games, including Lumosity, require multitasking, he points out.

“All these people are doing is going by hunches,” he says.

Which is why it is critical that Gazzaley and others in the therapeutic gaming field approach their work and marketing with scientific rigor, says Jonathan Moreno, a University of Pennsylvania medical ethicist. Families caring for seniors experiencing memory loss and parents of children with attention deficits are not always the most discriminating consumers.

“Parents will do anything,” Moreno says. “If they have the means and resources, they will do anything for their kids. There’s a big moral burden on proponents and on the people who want to say that these things actually help.”


Find out more

What: Dr. Adam Gazzaley will speak on “Gaming And The Brain”

When: 7 p.m. Monday, Feb. 29

Where: Newmark Theater, 1111 S.W. Broadway, Portland

More: Tickets cost $17-$50 and can be purchased in person at the theater box office or by calling 1-800-273-1530.


Doctor has more therapeutic games on the horizon

The future is never far from Dr. Adam Gazzaley’s mind. The University of California, San Francisco, neurologist has passed off the research on his initial therapeutic video games to Akili Interactive, but he’s got other games in sight.

In “incubation,” he says, is a game called Meditrain. Inspired by the positive effects of meditation on brains, Gazzaley is working with a Buddhist teacher to develop a game that can help people regulate internal distractions and achieve a meditative state.

And then there’s Rhythmicity, a game Gazzaley’s team is working on that involves tapping increasingly complex rhythms on a personal tablet. The idea is to improve thinking skills which appear to be connected to parts of the brain involved with timing and anticipation.

A third working project is Body Brain Trainer, which has participants performing aerobic exercise while matching patterns on a screen — multitasking while jumping and waving.


Educational games see their share of false claims

There’s good reason for Akili Interactive to conduct clinical trials and seek FDA approval for their therapeutic video games: The field of educational games has had more than its share of false claims.

Last month, the Federal Trade Commission fined the creators and marketers of the Lumosity “brain-training” program $2 million. Lumosity, according to the FTC, deceived consumers with claims that their games could help users perform better at work and in school, and reduce or delay cognitive impairment associated with age.

“Lumosity preyed on consumers’ fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia and even Alzheimer’s disease,” says Jessica Rich, director of the FTC’s Bureau of Consumer Protection. “But Lumosity simply did not have the science to back up its ads.”