Doctor-prescribed videogame for ADHD
endeavorrx.comI've been on this for about a month and a half now.
The game itself isn't engaging at all. It was a struggle to get myself to actually play the game regularly, for the allotted time (30 minutes, 5 days a week). It feels like a pretty big flaw with the game - after all, one of the challenges that people with ADHD face is forcing themselves to do things they don't want to do. This game is a complete bore, and I can't imagine anyone over, idk, 10 feeling differently.
It's also an incredibly frustrating game, and for the first couple of weeks I was fairly irritated after each 30 minute session.
I haven't noticed any improvement yet.
Thanks for your perspective. I've known and lived with several people who have ADHD, and you've expressed exactly the perspective I expected to hear from them.
"Games as treatment" are a new frontier of "selling bullshit". This happened before in education, and it's now making its way into health care.
The problem, here, is that the users aren't any part of how these games are designed. Everything about them is just directed at making presentations to investors and licensing bodies.
In the real games industry, user testing is the apex of success: you know your users will enjoy and benefit from your design choices because your users have already enjoyed and benefited from your design choices. When this relationship doesn't hold, the game gets changed. Play testing is king.
This kind of thing is cynical, thoughtless, and testless. It shouldn't exist, and it's nothing more than the effort of some founders to gather funding from clueless agencies.
And let’s be honest they’re just torturing people with no positive outcome. The net effect is you have a poorer, more frustrated patient, who has this stupid game burned into their memories.
Here is their safety and warnings section disclosing that. It's really interesting because of how they're presumably required by law to make a CVS-receipt-length FDA medicine warning but all the dangers are for playing a video game. I think it's pretty cool to see how effective the FDA's procedures are at capturing your concerns, through forcing them to be transparent
# Indications: > EndeavorRx is a digital therapeutic indicated to improve attention function as measured by computer-based testing in children ages 8-17 years old with primarily inattentive or combined-type ADHD, who have a demonstrated attention issue. Patients who engage with EndeavorRx demonstrate improvements in a digitally assessed measure, Test of Variables of Attention (TOVA®), of sustained and selective attention and may not display benefits in typical behavioral symptoms, such as hyperactivity. EndeavorRx should be considered for use as part of a therapeutic program that may include clinician-directed therapy, medication, and/or educational programs, which further address symptoms of the disorder.
# Safety: > No serious adverse events were reported. Of 342 participants who received AKL-T01 in the two clinical trials supporting EndeavorRx authorization for age ranges 8-17, 17 participants (4.97%) experienced treatment-related adverse events (TE-ADE) (possible, probable, likely). TE-ADEs reported at greater than 1% across the studies include: frustration tolerance decreased (2.34%) and headache (1.17%). Other adverse events occurred less than 1% and included dizziness, emotional disorder, nausea, and aggression. All adverse events were transient and no events led to device discontinuation. Across other studies in children and adolescents with ADHD, rates of adverse events were similarly low (<10%) and no Serious Adverse Events have been reported. All reported adverse events across all clinical trials resolved at the end of treatment. Users should consider the totality of evidence presented along with their health care provider when considering incorporating AKL-T01 into their treatment plan.
# Cautions: > Rx only: Federal law restricts this device to sale by or on the order of a licensed health care provider. EndeavorRx should only be used by the patient for whom the prescription was written. For medical questions, please contact your child’s healthcare provider. If you are experiencing a medical emergency, please dial 911. EndeavorRx is not intended to be used as a stand-alone therapeutic and is not a substitution for your child’s medication.
> If your child experiences frustration, emotional reaction, dizziness, nausea, headache, eye-strain, or joint pain while playing EndeavorRx pause the treatment. If the problem persists contact your child’s healthcare provider. If your child experiences a seizure stop the treatment and contact your child’s healthcare provider.
> EndeavorRx may not be appropriate for patients with photo-sensitive epilepsy, color blindness, or physical limitations that restrict use of a mobile device; parents should consult with their child’s healthcare provider.
> Please follow all of your mobile device manufacturer’s instructions for the safe operation of your mobile device. For example, this may include appropriate volume settings, proper battery charging, not operating the device if damaged, and proper device disposal. Contact your mobile device manufacturer for any questions or concerns that pertain to your device.
I wish these texts were written with the intent to inform rather than cover their asses legally, it's barely readable to me.
I feel like playing a video game for 30 minutes a day is pretty far from torture.
ADHD is a weird disorder that's hard to explain to people who don't suffer from it. Understimulation is a physically painful experience, one that pain killers don't really work with. Before I got on a regimen that works well-enough for me I had to regularly leave social events and check out of work to lie down and sleep it off. And it's not really a boredom thing, I can be actively enjoying the thing I'm doing — hell I can want to be doing the thing and it still happens.
Forcing yourself through 30 minutes of a video game likely isn't much compared to their day-to-day painful experiences at work or school but given the high likelihood that it doesn't actually work it's unnecessary additional suffering likely imposed on them by a frustrated parent who wants them to "get better" for their own sake instead of the kid's.
> This game is a complete bore, and I can't imagine anyone over, idk, 10 feeling differently.
FWIW, from their FAQ (and several other places on the site):
> EndeavorRx is indicated only for children ages 8-12 years old with primarily inattentive or combined-type ADHD who have a demonstrated attention issue.
The FAQ does indeed say that it's for children ages 8-12 years old, but the main page says the following:
> EndeavorRx improves attention function in children 8‑17 with ADHD.
I went back to look at older versions of the site, and some of the references have changed from 12 to 17, but not others. I assume that they ran another study with a higher upper limit later, but didn't update their site everywhere.
so there's endeavorRX, which is aimed at kids, and then there's also endeavorOTC, which is 18+. my understanding is that both games are more or less the same, really the big difference is just that the child version requires a prescription.
there's an adult version, endeavorOTC. it's what I use - but it's really the same thing as the kids version. the gameplay is more or less identical.
I can barely get myself to play games I'm actually interested in, since there's always something slightly more interesting than that. I can imagine this would be not only a complete non-starter but also... how is this specific video game supposed to help?
My guess is that this is indeed what gaming would practic: prolonged focus on a single activity.
For me it seems like other games would also do, as long as they don't promote "scatterbrain".
Prolonged focus on a single activity isn't what people with ADHD have problems with. Rather, it's being able to control when they're focusing, and on what, and keeping that focus for any activity, not just the engaging ones.
Playing video games is thus usually a problem, not treatment - games are just more interesting in the moment than anything else you can or should be doing, so it's hard to stop playing. Ripping out everything that makes the game interesting and stimulating doesn't turn it into a therapeutic tool, it turns it into a bullshit chore that's done on a computer. In comparison, doing your taxes may seem more appealing, because while it's mind-dumbingly boring, it's at least not a make-believe time waster. Which I suppose could be of therapeutic value, if not for the fact that other videogames still exist.
(And so do books, TV shows, parties, substances, whatnot.)
Could it be that the boring part is part of the treatment?
If a game was exciting and engaging, wouldn't someone with ADHD be drawn in and be focused naturally, like that isn't different from any game. But the problem with ADHD is paying attention to things in life that are boring, so forcing someone to focus on a game for some 30min/day is training them to focus on boring?
IF it was a good game, then it would just be a game. So just go play other games. But the point is to focus on something boring?
Thanks for sharing.
Reading your comment though, did I understand correctly that the irritation faded over time? Wouldn't that be an improvement?
Not that I think that inability to focus on boring BS is something that needs to be fixed, but it still might be doing something positive.
> The game itself isn't engaging at all
> It's also an incredibly frustrating game
I'm curious, is that intentional? As in, progressively learn to deal with those two aspects that are instant triggers for an ADHD mind to run away?
I mean, otherwise literally any other actually engaging and satisfying game would do.
> As in, progressively learn to deal with those two aspects that are instant triggers for an ADHD mind to run away?
Regular life will do that to you anyway; not sure how a game is going to help.
If anything, particularly when aimed at kids, it's main effect is likely exhausting the video game time budget parents allotted to the kid, possibly souring the whole class of entertainment to them. Which I guess may look like a win to outsiders if the kid happens to use videogames to cope with ADHD. Not sure if it's a win for the kid.
Let's say you have an allergy to nuts, or shrimps, or some phobia. Life does throw a lot of this at you but it doesn't really help. What helps is following a protocol with controlled doses of exposure to make the body/mind unlearn "DANGER!!!1!11!!" and instead "oh actually this is safe".
Same difference as life making you lug objects/yourself around daily vs a workout plan. You start small and progressively build up to go from here to there. Also you don't stop all physical activity when following a workout plan, it's just that you have a framework to build up.
There may be a thousand ways to do these brain workouts, probably kids would not be too enticed to do meditation or read books so a videogame is more appealing on the surface.
Also I'm not saying this particular game is any good or not in that regard, I'm just saying maybe there's something to it, asking naive questions such as "was this actually intentional design?", and conducting some thought experiment.
Tangentially I'll be the old man yelling at clouds, but I've noticed that games these days are very much not frustrating, probably to cater for the widest audience: compare today's infinite respawn at magic checkpoints with automated difficulty adjustment and no mistake possible change-your-build-tree-anytime and deus-ex-machina health/ammo drops so that you never quite fall short to the likes of Megaman, Mario, Sonic, Gradius, Doom, Ikaruga, Baldur's Gate, Diablo... To be successful these days it seems like games must be pleasing with all frustrations removed, plowing like a demigod through hordes of prop opponents or gigantic bosses made of cheese. By endgame you can even max out all skill trees and be a warrior/wizard/necromancer/sharpshooter/thief all at once.
You can't make a mistake, you can't paint yourself in a corner, you can't lose, you never have to roll back to a savegame 10 hours back or live with your erroneous choice for the next 40+ hours, or, god forbid, start over.
My initial reaction is that it looks like a Super Mario Galaxy ripoff.
That looks like an extremely generous take
I was going to comment that the asinine gameplay and frustrating design elements may be "by design" and part of the treatment, but then I decided to comment about how this would be a perfect way to ask for the most money, develop it for the least, and handwave away all the bugs as "by design."
My gut-check says Zelda (especially the newer ones where you build things and have creative, problem-solving leeway) may be a better choice.
Heh Maybe reading a good physical book for the same time would work as well??
If you do find a book which manages to totally captivate you, then you’d just rather read that instead of returning to normal life. Not sure if this really counts as helping ADHD
The key is to find a hard, less captivating book and just power your way through it. Crime and Punishment may be this for some. You could also try learning X11 programming with the famous wall-o'-manuals that entails.
>The key is to find a hard, less captivating book and just power your way through it...
This is a lot like saying that the way to treat a broken leg is to just start running on it and not have it be broken anymore.
Unironically yes. Neuroplasticity means that that is exactly a way to improve brain function. Not perfect, not universal, not the only way, but absolutely a working approach.
(Obvious disclaimer: Not a doctor, not your doctor, this is not medical advice.)
The brain is plastic, but it does not respond well to being hit with a brick wall. It needs reinforcement in the direction you want it to go.
For example, you treat a phobia through gradual exposure to the source of fear, not through undergoing a sudden overwhelming experience. That usually creates a traumatic response that actually makes the phobia worse.
Likewise, if you want to learn how to read a long book, start with shorter books and work your way up. If you can't sit through a novella and so you try to force yourself to read Crime and Punishment, you will fail — and you risk actually making it harder to read books in the future by strengthening the neural association between reading and feeling bored/frustrated.
I think yjftsjthsd-h is correct.
These posts are arguing over 'scale' or degree. Everyone is agreeing on 'brain is plastic'.
Just arguing over starting with 'Crime and Punishment' or 'Snow Crash'.
I would just add, that it all depends on where the kid is at. This just jumped out at me because I did have one kid at young age, set a schedule and forced himself to read 'Crime and Punishment'. So it can be done.
But maybe for others, that is a huge step. Everyone is starting at some different levels of current skills, with different levels of drag. -- So any discussion here about 'where to start' will all be wrong.
Unironically wrong. That’s like saying the key to a kid being good at calculus is skipping the silly arithmetic and geometry topics and taking a calculus course.
As a mathematician, I say: if the kid is "somewhat mature" in mathematics, I wouldn't say this is necessarily a bad idea.
I honestly love to read mathematical textbooks that are quite above my current mathematical level and knowledge. It is brutal to go through and attempting to understand the material, but this is soooo rewarding.
This method of learning mathematics is clearly not for everyone, but if you are sufficiently motivated to go this way, and love the brutality innate to this method, I actually would recommend it.
As a middle-aged adult with ADD, "try harder, just do it" is absolutely not an effective overall treatment for ADD at any age.
Agreed. However, doing things that reinforce ADD are an anti-treatment.
Dunno why you're being downvoted. Practising reading is probably one of the best things I've done for my attention recently. I've gone from being so unable to sit still in a one hour reading session that I read only 4 pages, to mostly being able to sit still and read around 30 pages. And yeah I started with a book I was hyper-engaged in, then joined a book club and read what's assigned to me, and I'm working up to reading harder things. This is a much cheaper way to train your attention than an overpriced shitty videogame. Though playing super hard video games like Dark Souls type and forcing myself to persevere also can be a good excercise for me.
My productive habit is that every morning I wake up, eat a healthy breakfast, and pop a couple Atomoxetine
>The current cost for EndeavorRx is $99 for a 30 day prescription.
Why is everything subscription based nowadays? Even without a subscription $99 would seem a lot to me. I guess because something something server costs and update development? Or is it just plain greed?
PS: Programming is absolutely fantastic, too, when you have ADHD (an probably even if you don't have it). It also doesn't cost a dime and there is plenty of content available for free. Might give that one a shot! Works wonders for me
> 30 day prescription
> Why is everything subscription based nowadays?
It's a prescription (written note from the doctor) but this looks like a long term regimen so you could call it a subscription too. The reason is almost definitely profit. As a game there's no reason for it to be this expensive. As a medical treatment I doubt the R&D justifies the cost.
Oh woopsie, Thanks for the clarification.
Pretty amusing. They make more money when you're worse at treating your ADHD since you'll be unable to actually cancel the subscription.
Is it like possible that they thought it through to take advantage of individuals with conditions like ADHD?
It's meant for kids so parents would be the ones paying. Obviously they're trying to profit and it does seem a bit overpriced (though there are extra logistical costs for anything to be medically approved, so it's not comparable to a normal game). But I highly doubt there was any intent to take advantage of people here.
Yeah, merits of subscriptions in general aside, targeting subscriptions specifically to people with ADHD is a next level of underhanded business.
It's because it makes more money and is more stable than once time buy. And it's especially expensive because it's "medical": both because it is more expensive to have a medical stamps of approval (although I'm not sure here) and because people don't have many alternatives
everything is subscription based, because companies have a continuous income stream (as opposed to one time large payment). With an continuous income stream you can plan better.
Well, one time payment can be turned into an income stream by investing the amount in treasuries or a time deposit account. That is the whole purpose of existence of financial markets.
Yes, it is favored by companies for its ability to provide a steady flow of revenue. It makes financial planning and forecasting more reliable
Come on... plan better?
It's almost always the simplest answer: they can get richer like that. I don't get why people try to rationalize greed so much. It's just that: greed.
People do things for reasons other than greed.
People, yes. Corporations, no. It's literally their raison d'être.
Disagree. Profit is not the same as greed, and corporations regularly make decisions that are not profitably in the short or long term.
Look at the rise in DEI! As soon as rates went up, a lot of that started getting cut. That strongly suggests it was an unprofitable decision. So why was it made?
Because it was a good marketing stunt and they believed it would increase profits in the long term by hiring/keeping people that cared about that. Also, I wouldn't discount the fact that there's a lot of cargo cult induced decisions everywhere. But as soon as profits get hit, companies will correct course.
I don't think companies are perfect at optimizing for their profits (thankfully), but profit is and will always be their only driver for decisions.
A good example is how Google seemingly spoiled their employees with benefits and high pay. Their objective was to hoard talent so they could continue to grow their profits. It's not because they are thinking of the well being of their employees. As soon as they weren't growing as much, they had mass layoffs.
The only way a company isn't optimizing for profits is if it's smaller with owners that personally want to prioritize something else at the cost of profits. Which, in theory, means they will go out of business at some point because of being undercut by their competitors that don't care.
Companies are abstract entities that only serve one purpose: to make profit. Every single action is towards this goal. They are NOT people. Even the people behind them make decisions that they would never do individually but, behind the facade of a "company decision", they nevertheless do.
> Profit is not the same as greed
Greed is defined as:
For me that's basically the definition of a company's purpose. If companies only generated enough profits to survive, we wouldn't live in the world we live in today. Numbers must go up!An excessive desire to acquire or possess more than what one needs or deserves, especially with respect to material wealth
Yes like fear
Digital therapeutics often require ongoing development
>Why is everything subscription based nowadays
It makes more money for the people who peddle it, duh!
>PS: Programming is absolutely fantastic, too, when you have ADHD
Probably why I got into it (though Turbo Pascal / Delphi compile times were much more amenable to providing the dopamine rush than C++ even today).
That said, getting a diagnosis and access to medication [1] worked wonders for making other aspects of work much easier.
There's much more to software engineering than just programming, especially with larger projects and larger teams. And hyperfocusing on code to find yourself in the office at 3AM on the reg can end up being detrimental to one's ability to deliver consistent results on schedule, as well as setting and meeting expectations (...plus: being on time, completing the small tedious tasks, doing paperwork, filling forms, submitting reports, documenting, logging, planning, testing, avoiding feature creep, writing proposals and design docs, doing code reviews, being on call, ...).
The joy of programming does make all of this worth bearing. But stimulant meds take a significant chunk of pain out of it.
Imagine needing to submit a trip reimbursement report, deciding to do it between 5 and 5:30PM on Tuesday, and doing it then, without it being a monumental effort, even though the deadline is on Friday.
That's the superpower that meds give (...the superpower that non-ADHD people are unaware of having, it seems).
But yeah, a higher-than-average proportion of programmers are neurodivergent for a reason :)
Programming is not fantastic for ADHD. Especially when majority of people don’t have ADHD to begin with. They are looking for an excuse for their lack of ability to focus on a boring task.
It’s subscription and expensive because it’s another way to suck the money out of people who think they have ADHD.
We're sentient beings who have been co-opted into becoming part of an edit-run-debug cycle serving people who think they are changing the world. And if we opt out - we starve. Is it any wonder that some turn to drugs to cope with this reality?
Damn thats real.
Reminds me of a joke I heard from a comedian, cant remember who - "soon we will just become the part of our home entertainment system that eats and shits"
> Programming is not fantastic for ADHD. Especially when majority of people don’t have ADHD to begin with. They are looking for an excuse for their lack of ability to focus on a boring task.
An excuse, or an explanation?
I have ADHD and programming is and always has been fantastic for me, if the project is not boring.
> lack of ability to focus on a boring task.
Sounds somewhat like ADD alright.
Sounds like being a nornal human
A normal human with ADD.
No one is able to concentrate on something that bores them. Thats like, the definition of something being boring...
No, most people aren't able to enjoy boring things. They're still able to concentrate on them. ADD makes this an impossibility.
$99 a month subscription, because they're FDA or whatever approved.
Is there corruption with these kind of things, or did they just hit jackpot?
There is high corruption at every level of healthcare, from ambulance companies to prosthetists to local doctors to hospitals to pharmacies to insurance to government.
$99/month is pure corruption, and they get away with it because insurance can help cover it.
In healthcare, "Economies of scale don’t lower prices", and "prices rise to what the market will bear" - An American Sickness. Very much what you're seeing here for this price tag.
As a healthcare clinic owner:
ITS SO EASY TO MAKE MONEY!
Like, my wife with 0 business experience, is able to profit 6 figs off her workers and 6 figs off her labor. She completely failed to train new/bad people and multiple patients left her clinic because of the poor quality labor.
Doesnt matter, all those patients paid and she is slammed busy.
Limiting licenses is an excuse for quality. These doctors are so absurdly low quality and getting paid for treatment that doesnt work.
I propose a science based medical system as an alternative to the Authority based healthcare system. Never going to happen because clinic owners like myself lobby, but it would be better.
Well said.
This corruption costs Americans hundreds of billions of dollars every year.
FDA did not approve it, that is the highest level and requires proof that it is more effective than placebo I believe. The FDA only looked for adverse events in the data and granted authorization to market it as they determined it is very low risk for adverse events. But people will be mislead by the FDA-authorized status as some kind of FDA blessing that it works: https://www.fda.gov/news-events/press-announcements/fda-perm...
This is false. The FDA does not grant approval to market anything solely on the basis of "low risk for adverse events." The game makers had to run studies demonstrating that it improved ADHD measures. The link you provided says that as well:
"The FDA reviewed data from multiple studies in more than 600 children, including studies that evaluated, among other things, whether participants demonstrated improvements in attention function, as measured by the Test of Variables of Attention (TOVA), academic performance measures, and other assessment tools."
Fair enough, I think I came to that conclusion because reading the next statement was just that they determined there were no major adverse events. But I think it still stands that this is only a marketing authorization, the FDA isn't saying it works, so really the company shouldn't be mentioning the FDA at this point unless they go for a stronger classification.
"When the facts change, I don't change my opinion."
Which facts? I was wrong about the evidence needed for marketing authorization but, if I’m not mistaken, they would need that authorization in order to market the product in the first place so mentioning the FDA authorization would, in my opinion, potentially give people the wrong impression that the FDA has endorsed the product at a level (e.g. approval) which I don’t believe the FDA has done at this point.
They went through "De Novo" premarket review as their medical device was distinct from any previous devices. This is a higher standard than the normal "510(k)" process. Both tracks involve a lot of evidence, a lot of documents, and a lot of scrutiny from the FDA.
They went through the harder track of FDA approval for medical devices.
I have no idea why you seem to think the primary way for the FDA to approve of new treatments is somehow... not them approving of it?
The wording is really poor. "Pre-market authorization" is their approval process. As in, you don't get to tell anybody that your device has any medical benefit unless we've assessed it.
They have endorsed the product in the only way applicable. There are different processes for drugs and “medical devices” and this one falls under devices. https://www.fda.gov/consumers/consumer-updates/it-really-fda...
If it works, then that’s not a bad price at all. ADHD attentional issues will suck orders of magnitude more money out of your life if left untreated in some people.
If it works. If it doesn't, then that's just another $99/month money hole that people with ADHD have a particular difficulty digging themselves out of - subscriptions are like a kryptonite to them.
So long as cancellation is as easy signing up, I think they’ll be okay.
Not really - cancellation being objectively as easy as signing up is still much harder to actually do for people with ADHD.
Signing up is something exciting and fun and something such person may do impulsively in a moment of weakness. Cancelling is boring and scary (what if dark patterns?) and a chore you don't look forward to, but rather try to not forget. It's not positively rewarding, but merely stops a penalty.
This might seem like an exaggerated difference, but it actually hits the exact points that are affected by executive dysfunction.
Hence the studies? /sarcasm.
And, can't you cancel the subscription?
Most people can. People with ADHD usually can, eventually.
I guarantee they didn't invent anything new to gaming. It's just like all those studies that claim tetris helps with ptsd, stress, lazy eye, postpartum depression, etc. It's just a game. There's nothing that makes this game, or tetris specifically special.
Even though there were a lot of studies on other existing games helping "ptsd, stress, lazy eye, postpartum depression, etc.".
I wonder if they were to be used in some treatment, they would also need to be approved? So Tetris itself wouldn't cost, but the doctor administering treatment gets approval to use the game, and that overall treatment costs the money.
I'm little unsure if any joe blow psychologist is allowed to makeup treatments, or if they go through an approval process also.
Genius move, take a crappy mobile game, call it a medical device and sell it for a price not even the best AAA games would ever dream to ask.
Only the USA healthcare system could give life to such an abomination.
Nope, we have the same in Germany (and in the EU), called "digital health applications" (DiGA in German). These are smartphone apps with some medical claims, certified as medical devices and prescribed by doctors. They make about €120-€500 for 90 days.
In some cases, these apps might be useful. But I think there are quite a few cash grabs in there, too.
Germany is the first country, in 2019, to have introduced a pathway for DiGA to be prescribed and reimbursed by health insurance.
But in 2017 the FDA launched the Digital Health Innovation Action Plan. So arguably the concept was born in the USA.
On one hand, this isn’t a drug, so it would probably be much cheaper to test and verify.
On the other hand, the average cost for drug R&D, testing, and approval was $2.87 billion each… in 2016.
That’s going to take serious cash to break even on.
Getting any kind of drug or medical therapy approval is extremely risky and expensive.
Will insurance lower the cost in the case that this is a prescribed treatment?
Just saying there are heaps of free apps that monitor and manage insulin dosing without FDA approval.
I don't see why you need FDA approval for a video game, or even make medical claims about a video game.
Because you can buy it using FSA/HSA. There are very strict laws against what is considered purchasable on those plans.
Stimulant medication for ADHD has the highest effect size in all of psychiatry. ADHD is highly treatable, when people are properly treated. This just feels like something that somebody made for the parents who are pathologically drug averse at the expense of their children. Of course, the parents don’t realize that their kids don’t get that development time back, so the longer they wait, the harder things can get for their kids.
Nonstimulant medication is also very effective, but with the caveat that it takes longer to kick in. The second caveat is that it’s devoid of any recreational value during the startup period, which has an outsized effect on people’s perception of the medication “working”.
Stimulant medication tends to be favorably accepted at first (for entirely unsurprising reasons, even though some people don’t experience quite the same euphoria) but it actually has a high discontinuation rate. The number of people who start stimulants, think they’re the best thing ever, then slowly decline into generally disliking them is far higher than you’d ever imagine if you only ever read short anecdotes on Reddit from people writing glowing reviews after their first dose.
Obligatory: I’m not taking about everyone and I don’t need to hear 10 different anecdotes about people who still like their medications. I’m talking about macro level phenomenon. Stimulant prescriptions are a hot topic on TikTok right now and a lot of people who aren't really ADHD are getting into prescriptions without a full picture of what they’re signing up for.
I would be surprised if even 10% of people taking therapeutic doses of stimulant ADHD meds experience euphoria. IME the noticeable effect of taking 10mg of methylphenidate was that I could stand in my open plan office and not have every word of a dozen conversations invade my consciousness constantly. If I was working in an environment designed to allow people to focus on their work, I probably would not have noticed any effects at all.
I wouldn't call it euphoria, but the first 10mg of methylphenidate I took kept me running around the house at high gear for almost an entire day, doing all kinds of non-critical chores that ordinarily were too boring and/or difficult to get into. Subsequent doses did not have anywhere near as drastic effect :).
But, euphoria or not, on stimulants I can at least feel the change near-immediately. It's unlike pretty much any psychiatric drug out there, where in most cases you can spend months taking it and still have serious doubts if it's doing anything (same with therapy). Hell, I can't think of a non-psychiatric medication that works as fast and as clearly. Paracetamol and Ibuprofen come close when dealing with sharp pain.
Oxy does the same for pain, also stops working pretty quickly.
The problem with both stimulants and opiates is overdosing will kill you pretty effectively, and many will eventually overdose if they keep using them long enough, chasing the initial effect.
Modern medicine unfortunately seems focused on creating ever more addictive substances and treatments, creating subscribers I guess, which says a thing or two about how well profit driven healthcare works in practice.
I don't know how bad are opioid overdoses, though my understanding is that for at least some products, the opioid is mixed with paracetamol, specifically in order so you die from OD-ing on the paracetamol before you get high on the opioid.
As for stimulant medication, I haven't heard of this being a real danger - not at the doses that prescription drugs have. Hell, I personally know a person who ate two boxes (i.e. 60+ tablets) of methylphenidate in a suicide attempt, and all they got from it was couple hours of hyperactivity, followed by a big headache, after ER flushed their stomach; they got discharged less than 24 hours later. But sure, if you drop the pharmaceuticals and go for illegal drugs, where the doses can be 100x as high, I guess you can mess yourself up pretty bad and rather quickly.
Yeah, I know about the paracetamol; I took Oxy 24/7 for two months after a spine operation, and then got that crap instead. It's pure evil if you ask me.
I really don't think it's reasonable to mix addictive stimulants in general into a discussion about ADHD drugs. There's a difference between (for example) crack and ritalin. It's hard to even chase the initial ritalin effects - once you go past your useful dose, you just start getting similar symptoms as not taking it at all + side effects.
If it doesn't work well, you'll get lots of other options - they're just as much a part of the modern medicine. This is becoming a meme. Why repeat this rather than post information about alternatives, if you care about this issue?
I don't find that stimulants in general have enough differences to draw a line, not that I've tried all of them but many. Maybe Ritalin is different? I've seen plenty of people hooked to different kinds of stimulants though.
Look, we're experimenting on children who can't sit still long enough by giving them pretty serious drugs, for profit. We're still waiting on the long term consequences from that game.
I’m not saying the non-stimulant options do nothing, but on average the non-stimulant options have a lower effect size than the stimulants. There are many well designed studies that have covered this territory over and over.
Lots of people take these medications at the same dose for years and years.
I get that many people feel strongly about this topic in all kinds of ways and directions, but that fact by itself changes nothing.
The fun with averages! The thing that's often missed when discussing this is that the alternatives don't help the same group to a smaller degree. The groups are not fully overlapping. That means you may find some stimulants not working for you, but some non-stimulants working great. The biggest effect of stimulants is why they're tried first.
Could you share some sources on stimulants discontinuation?
High discontinuation rate around stimulants aligns with my observations but I was wondering if that was only because of limited medication options where I am (not only for stimulants but in general).
Yeah, I would be surprised if it were to do with "not liking them" and not "consistently getting them is highly difficult for a person with ADHD" due to their controlled status in most countries. In the US, from what I've heard, it's particularly draconian, where you're only allowed to get a new prescription on the day the last one runs out, and then have to take a paper prescription to a pharmacy where they often don't have stock, so you have to try many pharmacies, all the while being treated as a possible drug seeker by staff.
Maybe this is based off of outlier reports, but it doesn't sound easy for someone with ADHD to keep up a regular supply of medication in the US, and the slightest lapse in medication supply to an individual can worsen that difficulty with their symptoms reappearing almost immediately.
Here in the UK it's a bit more relaxed, but still more difficult and under way more scrutiny and dumb rules than, say, an SSRI medication, which are plentiful and under no scrutiny at all, despite the fact that I had a much worse time on those with worrying side effects and extreme withdrawal symptoms.
> In the US, from what I've heard, it's particularly draconian, where you're only allowed to get a new prescription on the day the last one runs out, and then have to take a paper prescription to a pharmacy where they often don't have stock, so you have to try many pharmacies, all the while being treated as a possible drug seeker by staff.
I live in the US and take Adderall, the only part of this that is even slightly true is that sometimes there are shortages on dosage. As in they’re back-ordered on the 20mg pills so my doctor writes me a prescription for 10mg and I double up for a week until I can get the 20mg pills.
My prescriptions are all digital, come to me at least a week before I run out, and nobody has ever even batted an eye when I fill it, which always happens at the same pharmacy.
It varies by state. In Ohio, I had to get physical paper with a physical signature from the doctor’s office. Every single month. I’m somewhat thankful I turned out to have been misdiagnosed in childhood and I’m actually bipolar. At least I can get my meds as a 90-day supply and have over a month of spare medication.
I don’t understand the hyper-regulation of adhd meds when they hand out benzos like candy. Unadulterated opioids are a bit more difficult but I’ve still have a month’s supply of those from a previous dental surgery.
Do you know if that’s a consequence of Ohio law, or your insurance provider?
> you're only allowed to get a new prescription on the day the last one runs out
I think it's more like a week before.
You might be right, it might be that the pharmacy won't accept the prescription until the last one has run out, rather than when the doctor will prescribe a new one. Regardless, it's a really common complaint in ADHD support groups I'm a member of with members based in the US - every month is a hectic hoop-jumping exercise that, if you didn't know better, almost seems designed to be difficult for people with ADHD.
3 days in Ohio
This is the problem with the internet. The post I’m replying to is a complete lie. Non-stimulant medication is basically useless.
There's lots of options and people have different issues. For me stimulants suck, but 2 out of 3 tested non-stimulants work great. So [citation needed] on your "basically useless".
Which non-stimulant medication do you have in mind?
Likely guanfacine: https://en.wikipedia.org/wiki/Guanfacine
Looks really promising for people who don't like stimulants or can't take them for other reasons, slowly gaining popularity as well. Unfortunately not yet approved for adults in Europe, or I would have tried it. I'm fine with stimulants, but I'm a little wary of the effects on heart health over decades and I would like my appetite back. I also dislike that with stimulants I don't have any attention span in the evening, guanfacine provides more of a steady effect from what I can tell.
I dunno about the EU, but guanfacine has been approved in Norway for a couple years now, and AFAIK our approval process is fairly tied to the EU one, though I can't speak to the details.
There's also clonidine which has roughly the same mechanism of action as guanfacine and has been used for ADHD for a long time.
Sorry I did mean in the EU, specifically Germany. It's available for children, but for adults it's considered "off label" so it's hard to convince a doctor to prescribe it, usually they only go off label for people who have contraindications for all of the approved medicines.
It could be that the EMA has approved it for everyone, but Germany is more restrictive. It's been my experience that Germany as a society is terrified of medicine, and takes forever to adopt new drugs. They also have an attitude towards ADHD in particular that it's just for children, until somewhat recently you couldn't even be diagnosed as an adult here. Even today if you get diagnosed as an adult many doctors will demand "documentation" showing you were affected by ADHD as a child, some even want to speak with your parents.
This stuff knocked me on my ass when I took it. I literally had to lie down on numerous occasions. I'm just an anecdotal case, but it unfortunately did not work for me at all.
Would you describe the effect as fatigue?
Something else?
Thanks.
My best guess is that my blood pressure dropped precipitously. I would get light headed if I stood up. It would happen roughly 15 minutes after taking the medication.
The effects ramp up over a number of days, but it works for me until the day after taking it - which is great.
Our stupid phobia of stimulants is a major blocker too.
Making it hard to get ADD drugs does nothing to address abuse of street drugs like meth. Unlike opiates there is no evidence they lead people toward street drugs.
I’m personally in favor of OTC availability of some kind of safe abuse resistant mild stimulant. Sure there are a few people who would try to get high with it but hard liquor and weed are legal.
Up until the 2000s, ephedrine and pseudoephedrine were sold over the counter at pretty much every truck stop, gas station, and convenience store. Usually at a big display rack at the checkout counter, where nowadays they might have things like '5 hour energy drink' stuff. Dirt cheap too.
And yes, people did use it recreationally. But it wasn't really a problem. If they took enough that their capillaries burst, they were the only ones getting hurt. And they could easily buy more for a few dollars at any store, so there was no crime associated with it.
Now it's illegal mainly because 'war on drugs' is fun for some people or something. Crime rates were dropping so they needed to invent new crimes.
>I’m personally in favor of OTC availability of some kind of safe abuse resistant mild stimulant. Sure there are a few people who would try to get high with it but hard liquor and weed are legal.
Like caffeine?
Caffeine builds physical dependence easier than amphetamine, AFAIK
Is caffeine strong enough to have any serious effect on ADHD? It barely touches my concentration difficulties.
Compared to actual medication, no. It can help though… and that’s how you may unintentionally develop a pretty high tolerance for caffeine (200mg caffeine pills and energy drinks every day at sunrise).
Turns out I had ADHD and I had been using caffeine my entire life as a crutch.
Diagnosed in my late thirties, and although finding the correct medication and dosage that works is an ordeal… once you are there you realize you’ve been swimming with a hand tied behind your back this entire time.
It’s not a magical cure motivation-in-a-pill though, it requires you to do the work. It simply enables you to try instead of completely failing to attempt anything.
I don't know if it actually helps, but for a while I was drinking so much coffee I gave myself ulcers.
I eventually got diagnosed ADHD in my 30s, and my doctor suggested that my coffee problem was a subconscious effort to self-medicate. I've been on stimulants for a few years and quit coffee easily (with some nasty headaches and such, but no real cravings)
I do still have coffee now and then, but only occasionally and only because I like the taste. I often stick to decaf when I do have it, too
It is quite effective for me, but I suspect that I am a slow metabolizer because even a small amount (less than a cup of coffee) can still have lingering effects the next day.
However, it does not affect me quite like it affects most people. I find that caffeine before bed helps me quiet my thoughts and fall asleep, for example.
Mind you, I have not been diagnosed with ADHD (I can't be bothered going through the process of diagnosis when I already have medication and techniques that work).
I took caffeine pills to self-medicate before I got diagnosed. It was better than nothing, but nothing compared to proper medication. Taking enough caffeine to concentrate properly also made me shake a little bit, so not super fun
It works great once or twice if you don't ever drink it normally. It's way too easy to get used to though and it just becomes the new baseline.
Yes, but you end up taking doses where the physical side effects are disruptive to your routine. If you have concentration difficulties, you should see a psychiatrist.
One of my friends works in the rehab field. Prescription stimulants are a common starting point for a lot of younger kids entering their programs right now.
One of the major problems is some primary care doctors and nurse practitioners have started prescribing stimulants to anyone who requests them. Even worse, some of these people are prescribing unreasonably high doses (some times 2/3rd of the maximum allowable dose are given to small teens as their starting dose, which is absolute insanity).
It’s not just pointless fear mongering. These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night.
>Prescription stimulants are a common starting point for a lot of younger kids entering their programs right now.
So is drinking water, I presume.
This has "weed is a gateway drug" written all over it.
>It’s not just pointless fear mongering
It is pointless fear mongering in the sense that the risks are very low for the people with the condition the stimulant is prescribed for.
If you wear prescription glasses for fun, you can screw up your vision easily.
If you take chemotherapy for fun, you will mess up your health.
Heck, wearing wrong size shoes for extended periods of time will destroy your feet.
So go figure, people who don't have ADHD and take meds for ADHD are messing up their health.
The big question is why protecting people who are abusing the medication is more important than making it available to people who need it.
Abusing the meds has adverse effects, sure.
Not having access to meds has much stronger adverse effects. Like not being able to function in this society (getting an education, holding a job, having a relationship), depression, and higher suicide rates.
The risks from abusing Adderall are, as far as I know, significantly smaller in comparison.
But somehow, increasing risk of death for ADHD folks is deemed acceptable in this society if it can be done under the pretense of reducing alcoholism (without much evidence that it actually addresses the problem).
>These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night.
So, we're talking about people who are already determined to get wasted on alcohol, and somehow, it's Adderall that is the problem here — not the alcohol, not the alcoholics, not the party culture, and not the fact that removing Adderall from the equation still leaves you with people who are determined to drink beyond what they know they can handle.
I'm without words.
Disclaimer: I have ADHD[1], and I have benefited tremendously from having access to medication[2] after getting a late diagnosis[3] at the age of 34.
[1] https://romankogan.net/adhd
>pathologically drug averse at the expense of their children
I'm sorry but this just comes off as so perverse to me. Giving amphetamines to children and forming a lifelong dependency on pharmaceuticals should be something to be apprehensive about. IMO it should be drastically less common than it is, the industry has every incentive to over-diagnose and act as glorified drug pushers. I'd rather take a closer look at the environmental factors for ADD than just let the pharma industry run wild on it.
is the idea this is used instead of medication or in addition to medication?
“More than one-third (36.6%) of adults with ADHD moved into the non-clinical, or normative, range (TOVA ACS score of >0)”- https://www.businesswire.com/news/home/20230503005295/en/Adu...
So about as effective as a placebo or sugar pill https://en.wikipedia.org/wiki/Placebo
Not to mention, TOVA scores are pure blocks that don't even claim to correlate with ADHD traits.
I'm extremely skeptical. I've yet to see a treatment for ADHD that is only effective on children 8-17. If their product actually worked, I'm sure they wouldn't want to exclude the massive market of adults with ADHD.
I'm also opposed to any medical device that uses a cell phone or requires a download from an app store. At that point you're handing over at least some amount of medical information to an ad company, using a device that's entirely controlled by that same ad company, who would be all to happy to use that information against you.
That said, Their privacy policy isn't too terrible. They do sell your data to third parties for advertising (including cross-context behavioral advertising) and they're handing data over to "service providers", some of which are also ad companies. A lot of their data collection does seem to be opt-in at the moment which is nice. They say that they "seek to link only to [social media] sites that share our high standards and respect for privacy", but because they link to facebook it makes their "standards and respect for privacy" seem very questionable.
Video games in general are already known to help people with ADHD focus, the problem is that while it can greatly improve the ability to focus on the game while it's being played the effect doesn't seem to hold up for very long after the game is turned off. I suspect that the very slight improvements their own research shows could be gained by playing many other games.
They do have the 'adult version' at https://www.endeavorotc.com/
Wait, how isnt that privacy policy terrible? No medical treatment should also be selling your behavior to advertisers.
Yeah, sad to see the standards are set so low
This game is "Endless Running And Jumping Game" clone, similar to those typically placed in YouTube Shorts to hold visual attention. But how one of these games - completely blank in terms of novelty and unreasonably expensive for its quality - could start being used as a cure is beyond me. It is an absolute discredit to both doctors and the FDA as a whole.
I think this is a snake oil, but since (as other commenters mentioned) it seems to bring benefits even though it’s mediocre game I have another question.
Would it be possible that ANY video game has a positive effect on ADHD?
I’m wondering because usually games reward focus and provide plethora of stimulus both visually and auditory.
>Would it be possible that ANY video game has a positive effect on ADHD?
Some have very detrimental effects. Games are inherently interesting. Usually much more interesting than homework and/or housework. So, you start playing video games and all of a sudden you can't switch your attention back to the homework or housework when you need to. This causes lots of friction between you and the other people in your life that expect things of you.
It's a fundamental difficulty of regulating attention, not staying focused. That means either keeping it on something when you need to OR switching it away from something when you need to.
In my experience an enormous class of problems stems from being unable to switch your attention away from something that has just absolutely grabbed a hold of you and that causing you to be scolded by those around you day in day out for not meeting expectations.
Base building, collectathons, grand strategy, delivery simulators there’s plenty out there to get ADHD kids into a flow state where their brains start wiring towards sustaining focus. While avoiding hyper focus through gameplay mechanics. This, at $99 a month being more expensive than anything else, doesn’t seem to do any of that.
> Kids are challenged to multitask and ignore distractions by navigating courses, collecting targets, and avoiding obstacles.
You could pick something like path of exile for free.
My daughter was prescribed an audio therapy that worked wonders.
An app plays something akin to channel surfing on steroids, at a high initial switching frequency. Patient is to watch their favorite Youtube vids, play a video game - for 30 min while this cacophony slams their ears. Then gradually, day after day, the frequency is lowered to "humane" levels.
Totally worked, no meds involved.
I think it simply flooded her CNS and trained it to focus, without conscious effort. Might only work in 8 year olds, I don't know.
A lot of sound therapy we saw initially tried the opposite, calm stuff like classical music - feels clear why this can't work on a ADHD brain that runs in circles.
Really fascinating. Do you remember the name of the app or the kind of sound therapy? Sounds like it might work wonders.
You know when they don't say actual numbers that it doesn't work much better than a placebo.
They include some clinical research info at the end of the usage instructions PDF[0].
One says results were not statistically significant and the other has a warning that it may be placebo effect since they didn’t have a “sham control group”.
(I don't have enough stats knowledge to know what any of this actually means though.)
0: https://www.endeavorrx.com/wp-content/uploads/2024/01/Endeav... (pdf)
As a person who did study statistics, they found absolutely nothing useful, for the most part, if what you say is correct.
(Basically, everything they found can be attributed to random chance, and there’s no proof their game is anything special compared to other games)
Did we read the same thing? "The primary endpoint was achieved, mean change from baseline on the TOVA API was 0.93 in the EndeavorRx group versus 0.03 in the control group (p=0.006). "
I couldn't find anything incredibly definitive on TOVA, but based on https://www.queensu.ca/rarc/sites/rarcwww/files/uploaded_fil... it does seem incredibly useless / statistically insignificant.
From their own description, it has absolutely nothing to do with ADHD.
As in: there's not even a claim it correlates with how strongly people experience ADHD symptoms.
I'm sorry, but have you looked at the TOVA API[1]?
I have.
Put simply, it's bullshit — and one that doesn't even purport to measure ADHD (which, indeed, is not something one could measure on a linear scale).
It has nothing to do with how we experience ADHD symptoms and traits.
It does, however, look like something one could train for by... playing videogames.
Surprise, playing videogames makes one statistically better at videogames! Now pay me.
Disclaimer: I have ADHD, and have written a small wiki about it, which quite a few folks with ADHD have found useful:
The same remains to be said of the product we're discussing.
You created that one? Thank you, it's amazing and painfully true.
Yup, made it when I was just learning about ADHD while figuring out how many traits are applicable to me.
100+ pages in, I figured it's time to get myself assessed [1].
Went through the assessment three times with different doctors just to be sure; unsurprisingly, they all had the same conclusion.
Life has been so much simpler since then. Adderall is a great asset to have in the toolbox, but probably 90% of life quality improvement came from stopping to expect my brain to work the same way a neurotypical brain does, and adjusting my environment / lifestyle / habits / the way I do things to how my brain works, rather than the other way around.
That ranges from little things like having a pair of scissors at all desks and places where I use them (instead of perpetually looking for them) and trusting my partner's time estimates over my brain's — to bigger things like using body doubling[2] to get things done.
On that note, the online body doubling community ADHD Actually[3] has provided a very strong effect when I needed it the most (e.g. chugging through a less-exciting work project), and I can highly recommend it.
I'm paying for it even when I'm not using it just because this needs to exist.
It's made for and by people who understand our experience, and is based on time-proven techniques that all the therapists recommend for ADHD people.
Technically, one doesn't need an online platform for that; we've organized similar sessions with friends on Zoom... But in practice, the accountability aspect is much harder to maintain (...as well as getting people to show up consistently and at the same time as you).
ADHD Actually solves this problem; and paying a small fee also adds extra motivation to make use of the service and show up.
And the impartiality of people in the group is a big plus.
[1] https://romankogan.net/adhd#Diagnosis
In their largest study, they found that 4 weeks of treatment improved ADHD scores by 1 standard deviation, and this was highly significant. That's the equivalent of going from the 5th percentile to the 35th - definitely a meaningful improvement.
What "ADHD scores" are we talking about?
There's no such thing as the "ADHD score".
Did they measure it in "how much you get yelled at"? That's my yardstick for how bad my symptoms are in any given week.
I played a game pretty similar to this when I was a kid. It was a Game and Watch style game with two buttons on a simple LCD screen. I got it for free with a happy meal. Bull.
In case anyone is curious, this is the actual study: https://www.nature.com/articles/s44184-024-00075-w.pdf
"AKL-T01 was linked with improvements on the Test of Variables of Attention (TOVA®) Attention Comparison Score (ACS) of 2.6 (95% CI: 2.02, 3.26; p < 0.0001) in adolescents and 6.5 in adults (95% CI: 5.35, 7.57; p < 0.0001)"
I would read that as: Focusing on this specific video game helps you to learn how to focus on things in general.
But "Mean overall compliance in the Efficacy Population was 72.4%", which kind of suggests that this game isn't that much fun to play. Or else, why would 1 out of 4 kids not play the mandatory 25 minutes per day?
What I find a bit shady, though is that https://www.endeavorrx.com/the-research/ says "There were no serious adverse events seen in any clinical trials of EndeavorRx" with a big 0% above it, but the study did have adverse events, like headache and nausea, they just didn't classify those as "serious".
"Nature" used to be well respected according to academics. However, Academia isnt science, its authority.
I've now seen 2 studies that should never have been published in Nature in the last year.
I am science based, so I never really cared about what organization published, look to the data. However, if you hang out with academics, they unanimously read the journal + abstract. Its so weird. I feel like there is some sort of Dunning Kruger where I'm the idiot... But really... I know the scientific method. I know the quality of the people I'm talking to.
Happy to see you didn't just accept it like my academia pals!
To acquire strategies to alleviate some problems, this might be helpful, similar to coaching and therapy.
I have, however, serious doubts that it can be a substitute for stimulants. ADHD affects so many parts of one's life such that attention sometimes seem a very small part of the disorder. Miraculously, at least for some people, stimulants create a kind of automatic improvement in other areas too. I hope that general discourse about ADHD moves towards easier access to those drugs, not replacing them.
Also, please don't speculate about ADHD, especially about people who suspect they might have it.
ADHD experience differ a lot among people and even in different situations for an individual. Because of this aspect, a lot of people have complicated relationships with their diagnoses.
Self-doubt, for various reasons, is a very common trait of people with ADHD. Strongly worded claims about ADHD might be very harmful to people who plan to seek help or struggle to follow their treatments.
I have ADHD-PI and am medicated. I too believe this cannot substitute medication in anything but less severe cases (if that even exists), but I cannot overstate the importance and usefulness of coping mechanisms and attention training. It really defines to some extent whether medication is necessary and in which form (only working hours, all waking hours, etc). Now, granted, for some even building habits and a routine is impossible (like me sometimes too), and then medication fixes some issues and one starts to almost automagically create habits and routines.
I've gone years unmedicated when I had a less demanding and more lax work environment and daily focus meditation has helped a great deal. If I'm not mistaken some video games have also vastly improved and kept alive quick reaction times and delayed reward mindset - stuff that this game seemingly also does - training being less impulsive and overriding other, negative habits.
It makes perfect sense - video games can release high amounts of dopamine on demand, while in our daily lives we lack release in key moments. Synaptic plasticity, learning and memory is dopamine dependent. In a dopamine deprived brain, if timed correctly, these sudden releases can be extremely habit-forming and beneficial.
I've read through their whole website and nowhere is mentioned that this is supposed to replace necessary medication. It's simply another tool in the toolbox, and as such should absolutely not be disregarded. I can 100% see this being extremely helpful and would love to try it out - unfortunately the apps are only available in US app stores.
Thank you for sharing your experience. I am also able to work without medications but doing it for a long period makes me miserable:) Glad to hear that it is possible with some right habits. I also didn't want to be dismissive about this game or coping mechanisms, sorry if I worded it like that. Even seemingly small changes can bring great improvements. There is a stigma around stimulants and I just wanted to highlight their benefits for people who are doubtful about them.
> please don't speculate about ADHD, especially about people who suspect they might have it.
Is this a joke? This is a discussion platform for speculating. Plus half the people on HN probably have ADD or ADHD
Love this comment. As someone with ADHD, I am drawn to technology and made a career out of it. I suspect many people here are the same, diagnosed or not.
By the way, the "ADD" diagnosis has been removed from the DSM, there's no longer a medical distinction between the two.
> Plus half the people on HN probably have ADD or ADHD
They've convinced themselves they have it. Please ignore the prevalence of obesity, lack of exercise, poor diet, and anti-social nature of tech workers plz. They are suffering from a natural affliction.
Here's a video of a doctor playing the game along with sort of an explanation of how it works and is meant to do.
I'd be curious to know how much this costs for patients. I'm guessing it's some type of a subscription model.
Watching the video, it's not really clear how this game is substantially different than a normal mobile game. What is the actual mechanism here for treating ADHD?
If the gameplay amounts to what's in the video, it seems to be based on a poor or at least vastly simplified understanding of what ADHD is, seems to be training some a simple kind of multimodal attention and context switching between simultaneous things, but pretty much any complex video game will do that. Being designed around that premise seems to be taking the name "attention deficit" a bit too literally given the wide array of symptoms that have little to do with that kind of skill. Anecdotally, as someone with ADHD, I seem to be naturally better at that kind of "doing 2 things at once" skill than my peers anyway. Perhaps we're just seeing a tiny slice of the game and there's a lot more to it, but my experience of healthcare software and startup culture makes me think no, that's probably the entirety of the game, dressed up in some technobabble and references to medical journals/papers without much actual evidence-based efficacy.
Placebo effect for parents who pay money for this, I assume.
Spend $99/mo on some meds instead. Much more effective.
FDA approves all sorts of software as a medical device that it doesn't rigorously test or understand.
Completely serious - I bet Tetris could be approved by the FDA for ADHD treatment if The Tetris Company were willing to put in the effort for all the paperwork and fees.
Tetris has been used to reduce PTSD:
“Can playing Tetris help prevent PTSD if you’ve witnessed something traumatic?”
https://theconversation.com/can-playing-tetris-help-prevent-...
You don't need to put in efforts, I offer with ADHOCON.COM a contract legal manufacturer, we do all the paperwork incl. clinical evaluation for the developer and register the product with our QMS and Documentation for you
equally seriously, if you ran proper scientific studies showing actual improvements with tetris because it's a very rules oriented game, vs something more abstract, like Stardew valley, isn't that actually a treatment?
If you ran them, and they did show actual improvement, and demonstrated the causal connection, then yes, it would be a treatment.
That is not what happened here, though.
I almost spit out my coffee when I saw this. The ADHD industrial complex steams on I guess. If doctors can "prescribe" video games, can prescribe time playing outside or away from technology? I suspect that doesn't get the user on a monthly subscription plan. Soon we'll have the government subsidizing video games in the name of "digital therapeutics". Nothing says mental well-being like playing video games.
I know this is for children, but anecdotally, the number of 30 somethings I know IRL who are now discovering they have "ADHD" is comically high. Social media has truly been a disaster for the human race.
I was just speaking to a parent who, several years ago, sent their (very ADHD) kids through biofeedback, and were really impressed by the results.
I mentioned it to the school psychologist, who told me that biofeedback is not considered legit, but that it does seem to work for some kids.
My first thoughts when trying to figure out how biofeedback works is that it could easily be turned onto a game, even a good game, and it would help at least those that it helps.
Is that right? Thoughts from those here with experience or domain knowledge?
video game 'prescription'? lol
The game doesn't look anything special to me, what are the key traits that make it suited as a treatment?
Or did they simply run a clinical trial and get FDA approval as a treatment because of that?
It seems to me many other games would also be effective, especially building games, Factorio, Minecraft, etc, and which don't require a $99/month 'prescription'.
doctor-prescribed
TFA’s title is to blame. This hyphen makes the title read correctly.
This is frustrating that it's marketed as FDA approved but people won't recognize that it is regulated as a medical device, which have to only show safety, rather than as a drug, which have to show safety *and* efficacy.
Cost for EndeavorRx
The current cost for EndeavorRx is $99 for a 30 day prescription. EndeavorRx is FSA/HSA eligible. You can pay for EndeavorRx by using your FSA/HSA card during checkout or by submitting the cost to your FSA/HSA after purchase.
as a treatment the product probably has some form of patent like protection, BUT as with all kind of games nothing keeps someone from just building a clone, and malet as „attention improving“ without the fda stamp.
They also offer an OTC version.
> EndeavorOTC is the only FDA-authorized digital therapeutic for ADHD available without a prescription.
I wish there was a comparison between the two - or is the age requirement (18+ for otc) the only difference?
Just yesterday I read about Interactive Metronome and thought how it could easily model to various games. I am now quite sure that many games, especially classic ones, could try to get some sort of certification.
The results footnoted on the web site are underwhelming. Kids report they can pay better attention? If you weren’t trying to sell a product you would make up a better metric.
Maybe the real papers are more legit.
ADHD and other neurodevelopmental disorders are all typically assessed based on self report (via standardised questionnaires).
$99 a month for a 30 day "prescription" of a game.
Really obscene. The healthcare industry is such a sickness in this country, I hope we get a populist one day who completely guts it.
Half-OT: I played Balatro.
It eats hours.
However!
It drastically cut down on my doom scrolling.
Would be cool to see if someone could design a game that was addictive, but also fade you out of this addiction natively.
Any plans for opening video game to Europe? I once wrote to you about availability for individuals to purchase it in Europe, but didn’t get any answer
$99 for a 30 month prescription.
So it's priced way higher than a full AAA game, but you only keep it for a month. So even worse than a digital purchase.
A shame there's only one doctor left :(
> 73% of children reported an improvement in their attention.
What kind of study outcome is this?
The kind of study outcome that tries to get people to buy the product.
the designer of the UX of the website needs to be freaking slapped with wet noodles...poor text contrast even by WWW3 own text contrast measuring tools.
This looks like something you could game jam with a 4 person crew in a couple days (being really generous). $99 a month, seriously?
I think it is a promising advancement in ADHD treatment
I wouldn't be at all surprised if this turned out to be some kind of exposé on FDA corruption and the farcical levels of blatant pisstaking within the US medical insurance system. Brilliant work.
Who knew all this time I was self-medicating
Not sure this even joking really.
ADHD people often self medicate with alcohol or coffee.
Video Games have definitely been in the mix for 'self-medicating'.
That is why I'm wondering why so many people in this thread say 'just play such and such game X'. Games can be addicting, to be addicted to a game isn't necessarily helping the person.
But games can also help. So there has to be some mechanism, some particular game play mechanism that is helping. That is what needs to be studied. Then we could pick the ones already on the market with that mechanism.
I'm on 40mg Vyvanse daily, so it was a self-depricating joke... but as for me, replace games with programming - like many here, I was fortunate enough to turn my hyper-hyper-focus in a paid career. I don't know how many people with ADHD are as lucky.
From the website, I’m not clear on how this is actually working. (On the assumption it’s working at all, I have not read the research)
The FAQ says “EndeavorRx uses sensory stimuli and simultaneous motor challenges designed to target areas of the brain that play a key role in attention function.”
So is it just meant to exercise those areas? “Uses sensory stimuli and simultaneous motor challenges” could describe a million other games.
Now I'm interested in a proper study that compares different popular video games across various genres, for treating ADHD.
Difficult to say for sure without the ability to try a demo (seriously??), but I'd bet there are at least fifty games on Steam that "address" ADHD along the same pathways as this one, with the added benefit of actually being fun.
Now I know for certain that all that N64 Star Fox has clinically helped me :)
To this day when I need to focus on an issue I often say “Location confirmed, sending supplies” or some other SF sentence.