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The need for accessible and motivating treatment approaches within mental health has led to the development of an Internet-based serious game intervention (called “Plan-It Commander”) as an adjunct to treatment as usual for children with attention-deficit/hyperactivity disorder (ADHD).
The aim was to determine the effects of Plan-It Commander on daily life skills of children with ADHD in a multisite randomized controlled crossover open-label trial.
Participants (N=170) in this 20-week trial had a diagnosis of ADHD and ranged in age from 8 to 12 years (male: 80.6%, 137/170; female: 19.4%, 33/170). They were randomized to a serious game intervention group (group 1; n=88) or a treatment-as-usual crossover group (group 2; n=82). Participants randomized to group 1 received a serious game intervention in addition to treatment as usual for the first 10 weeks and then received treatment as usual for the next 10 weeks. Participants randomized to group 2 received treatment as usual for the first 10 weeks and crossed over to the serious game intervention in addition to treatment as usual for the subsequent 10 weeks. Primary (parent report) and secondary (parent, teacher, and child self-report) outcome measures were administered at baseline, 10 weeks, and 10-week follow-up.
After 10 weeks, participants in group 1 compared to group 2 achieved significantly greater improvements on the primary outcome of time management skills (parent-reported;
Plan-It Commander offers an effective therapeutic approach as an adjunct intervention to traditional therapeutic ADHD approaches that improve functional outcomes in daily life.
International Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV).
Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder with young patients experiencing functional impairments in different areas of daily life [
Although stimulant medication has been shown to reduce ADHD core symptoms among children with ADHD, effects are limited with regard to children’s behavioral, social, and cognitive functioning in daily life [
A growing number of computerized training programs for ADHD have been designed to improve working memory and executive functioning, thereby addressing specific neurocognitive deficits and ADHD core symptoms [
Serious gaming (ie, [digital] games used for purposes other than purely entertainment) is a novel and promising approach to support the treatment of clinical symptoms and improvement of adaptive functioning among diverse patient groups [
To our knowledge, a serious game designed to enhance behavior strategies for children with ADHD to improve their daily life functioning has not been scientifically evaluated in the literature. We developed a serious game intervention for children with ADHD to teach and reinforce daily life skills, such as time management, planning/organizing, and cooperation skills [
A total of 182 participants were recruited from January to March 2013 across 4 outpatient mental health care clinics and institutions in the Netherlands and Belgium. Eligible parents and children were informed by their clinician about this study. In other cases, the patient organization provided information about the study to their members; these parents directly applied for the study. Once the clinician identified eligible parents and children, they received detailed written and verbal information about the study from the researcher. After signing informed consent, they were invited for a screening visit (performed by trained research assistants with MA in psychology) to verify inclusion and exclusion criteria. This resulted in a sample of 170 participants. Inclusion criteria were (1) a
This study used a 20-week multisite randomized controlled crossover open-label trial design (see
Study design with both groups.
Randomization was carried out on a 1:1 ratio and based on a prespecified computer-generated randomization list. Allocation was stratified by study site and gender and arranged in permutated blocks. Group assignment was performed online using the next available number on the randomization list corresponding to the site and gender of the participant. It was not possible to blind participants to their treatment allocation. After screening and baseline assessment, parents received an email with the notification to which group (group 1 vs group 2) their child was allocated. Although all efforts were made to keep the investigator blind during baseline assessments, full blinding of researchers and teachers at the other assessment points could not be guaranteed because participants could spontaneously talk about the game during the study.
The serious game is an online adventure game (called Plan-It Commander) developed by health care professionals, researchers, and game experts in collaboration with parents and children with ADHD. In collaboration with a focus group of parents, the multidisciplinary game development team agreed on the game’s learning goals and play frequency/time. After each prototype build, usability tests were iteratively performed to examine whether children liked the game and understood how to use it and navigate within the game. User data were evaluated and incorporated in the design process for the final game format, which was examined in this study. Plan-It Commander was designed to improve domains of daily life functioning with a primary focus on time management, planning/organizing, and cooperation skills in children with ADHD. Unifying their knowledge and expertise resulted in a unique online learning environment in which principles of behavior therapy and game-based learning were combined [
Plan-It Commander is a mission-guided game divided into 10 different missions and several side missions (
Screenshot of Plan-It Commander game world.
Screenshot of game social community (called “Space Club”).
Multi-informant (parent, teacher, and self-report) measures were administered at baseline (T0), at 10 weeks (T1), and at 10-week follow-up (T2). Parent and teacher reports were administered through online questionnaires. Questionnaires were administered to the children during face-to-face appointments at each assessment time point. At baseline, demographic information and children’s game experience were collected through parent reports. The parent reported on the game experience of their child as starter, amateur, experienced, or expert. For the primary outcomes, parents filled in the following questionnaires during the 3 assessment time points: (1) a time management questionnaire (
Description of primary and secondary outcome measures.
Measuresa | Respondent | Description | Cronbach alphab | |
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Time management questionnaire | Parent and teacher report | This 11-item scale is a measure of children’s time management behavior. Parents were asked to rate this behavior on a 10-point Likert scale (ranging from true to not true). The total score ranges from 11 to 110. Higher scores indicate better time management skills. | .83/.90 |
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BRIEF (subscale Plan/Organize) | Parent and teacher reportc | A measure of executive functioning in home situations in children aged 5-18 years. For this study, the subscale Plan/Organize, consisting of 12 items, was used to measure children’s planning and organizing skills. The answers are scored on a 3-point Likert scale (never—sometimes—often). The total score ranges from 12 to 36. Higher scores indicate better planning skills. | .81/.80 |
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SSRS (subscale Cooperation) | Parent and teacher reportd | A measure of social functioning in children aged 8- 12 years. This questionnaire consists of 4 subscales (ie, Cooperation, Responsibility, Assertiveness, Self-Control) of 10 items each. The answers are scored on a 3-point Likert scale (never—sometimes—often). Two items load on 2 subscales; therefore, the total scale consists of 38 items and has a possible range from 0 to 80. Higher scores indicate better social skills. | .70/.84 |
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IATQ | Parent report | A measure of children’s skills in time perception and organization. It consists of 25 items scored on a 3-point Likert scale ranging from 0 “rarely” to 3 “almost always.” The total score ranges from 0 to 75. Higher scores indicate better time-oriented behavior. | .74 |
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Self-efficacy | Self-report | A measure of one’s confidence in his/her ability to carry out specific behaviors related to time management, planning, and social functioning. This measure was constructed in accordance with the standard method for designing self-efficacy scales [ |
.88 |
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Satisfaction | Parent and self-report | Satisfaction was indicated on a 10-point Likert scale in which both children and parents were asked: “What grade would you give to this game?” | N/A |
a BRIEF: Behavior Rating Inventory of Executive Functioning; SSRS: Social Skills Rating System; IATQ: It’s About Time Questionnaire.
b Cronbach alpha is an indication of construct validity. Coefficients were calculated from baseline data in this sample.
c The subscale Working Memory (10 items) from the BRIEF was used as a secondary measure for parents (Cronbach alpha=.83) and teachers (Cronbach alpha=.85).
d The subscales Assertiveness, Responsibility, and Self-Control and the Total Score were used as secondary outcome measures for parents and teachers (except for the subscale Responsibility).
The sample size was determined in advance by power calculations on the basis of previous pilot study descriptive results (mean, SD) on primary outcome measures, which indicated that 78 participants per group would give 87% power to detect differences of a medium effect size (at least 0.5) between groups (α=.05; 2-sided). In the current study, differences in baseline characteristics were tested with an independent samples
A total of 170 participants met the inclusion criteria and participated in the study. Mean scores for primary and secondary outcome measures and characteristics of groups 1 and 2 did not differ significantly at baseline (see
Demographic information of the sample at baseline.
Baseline characteristics | Total |
Group 1 |
Group 2 |
Group comparison | |||
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χ2 ( |
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0.1 (1) | .72 | |
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Male | 137 (80.6) | 70 (79.5) | 67 (81.7) |
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Female | 33 (19.4) | 18 (20.5) | 15 (18.3) |
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Age (years), mean (SD) | 9.85 (1.26) | 9.89 (1.28) | 9.82 (1.24) | –0.36 |
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.79 | |
Total IQ,a mean (SD) | 106.18 (14.79) | 105.40 (14.46) | 107.02 (15.18) | 0.72 |
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.55 | |
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3.2 (2) | .21 | |
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Combined | 126 (74.1) | 66 (75.0) | 60 (73.2) |
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Inattentive | 38 (22.4) | 17 (19.3) | 21 (25.6) |
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Hyperactive-Impulsive | 6 (3.5) | 5 (5.7) | 1 (1.2) |
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1.6 (1) | .21 | |
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Normal | 62 (36.5) | 36 (40.9) | 26 (31.7) |
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(Sub)clinical | 108 (63.5) | 52 (59.1) | 56 (68.3) |
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1.9 (1) | .17 | |
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Normal | 84 (49.4) | 39 (44.3) | 45 (54.9) |
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(Sub)clinical | 86 (50.6) | 49 (55.7) | 37 (45.1) |
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2.1 (1) | .14 | |
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Normal | 149 (87.6) | 74 (84.1) | 75 (91.5) |
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(Sub)clinical | 21 (12.4) | 14 (15.9) | 7 (8.5) |
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4.3 (3) | .23 | |
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Starter | 29 (17.1) | 13 (14.7) | 16 (19.5) |
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Amateur | 55 (32.4) | 29 (33.0) | 26 (31.7) |
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Experienced | 82 (48.2) | 42 (47.7) | 40 (48.8) |
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Expert | 4 (2.4) | 4 (4.5) | 0 (0) |
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Special education? (yes), n (%) | 25 (14.7) | 14 (15.9) | 11 (13.4) |
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0.2 (1) | .65 | |
Medication use? (yes), n (%) | 156 (91.8) | 80 (90.9) | 76 (92.7) |
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0.2 (1) | .67 | |
Psychoeducation for parents? (yes), n (%) | 9 (5.3) | 5 (5.7) | 4 (4.9) |
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0.1 (1) | .82 |
a IQ: Intelligence Quotient.
b ADHD and ODD severity are based on clinical and subclinical scores on the parent version of the DBDRS.
At 10 weeks (T1), 152 of 170 participants (89.4%) completed the study and 139 of 170 (81.8%) completed at the 10-week follow-up (T2). At 10 weeks (T1), the dropout rate was higher in group 1 compared to group 2 (χ2
1=8.0,
Participants played for a mean 19.04 (SD 9.61) days in the mission-guided game and a mean 11.20 (SD 8.55) days in the closed social community. Additionally, participants played the mission-guided game for a total duration of a mean12.56 (SD 6.57) hours and engaged with the closed social community for a mean 54.27 (SD 70.00) minutes. A difference was seen between group 1 (mean 13.53, SD 6.25) and group 2 (mean 11.53, SD 7.25) with regard to the amount of time playing the mission-guided game (
Study flow diagram.
To test the hypothesis that participants playing the serious game would improve on primary and secondary outcome measures, differences between group 1 and group 2 from baseline to 10 weeks (T1; posttest) were evaluated with ANCOVAs (see
Univariate analyses of covariance comparing group 1 and group 2 on primary and secondary outcome measures during first 10 weeks.
Measuresa | Group 1 (n=88) | Group 2 (n=82) | ANCOVA | ||||||
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Least square mean (SE) | 95% CI | Least square mean (SE) | 95% CI |
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Cohen’s |
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Time management | 10.66 (1.64) | 7.42, 13.89 | 4.68 (1.72) | 1.29, 8.07 | 8.56 | .004c | 0.39 |
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BRIEF (subscale Plan/Organize) | 1.47 (0.36) | 0.75, 2.18 | 0.64 (0.38) | –0.11, 1.39 | 3.32 | .07c | 0.35 |
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SSRS (subscale Cooperation) | 1.10 (0.34) | 0.43, 1.78 | 0.46 (0.36) | –0.25, 1.16 | 2.32 | .13c | 0.16 |
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It’s about time | 2.74 (0.73) | 1.30, 4.17 | 1.18 (0.76) | –0.32, 2.68 | 2.98 | .09 | 0.20 |
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BRIEF (subscale Working Memory) | 0.75 (0.32) | 0.11, 1.38 | –0.17 (0.33) | –0.83, 0.49 | 5.16 | .02 | 0.51 |
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SSRS (Total) | 2.24 (0.81) | 0.64, 3.83 | 0.58 (0.85) | –1.09, 2.26 | 2.68 | .10 | 0.05 |
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SSRS (subscale Assertiveness) | 0.32 (0.27) | –0.22, 0.85 | –0.06 (0.28) | –0.62, 0.49 | 1.28 | .26 | 0.04 |
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SSRS (subscale Responsibility) | 0.75 (0.25) | 0.27, 1.23 | 0.11 (0.26) | –0.39, 0.62 | 4.28 | .04 | 0.04 |
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SSRS (subscale Self-Control) | 0.24 (0.29) | –0.34, 0.81 | 0.22 (0.31) | –0.38, 0.83 | 0 | .97 | 0.07 |
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Time management | 5.30 (1.32) | 2.70, 7.90 | –0.16 (1.38) | –2.88, 2.56 | 11.05 | .001 | 0.41 | |
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BRIEF (subscale Plan/Organize) | 0.78 (0.34) | 0.11, 1.44 | 0.14 (0.35) | –0.55, 0.84 | 2.30 | .13 | 0.18 | |
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BRIEF (subscale Working Memory) | 1.32 (0.34) | 0.65, 2.00 | 0.50 (0.36) | –0.20, 1.20 | 3.79 | .05 | 0.22 | |
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SSRS (Total) | 2.95 (0.67) | 1.64, 4.27 | 2.36 (0.70) | 0.98, 3.74 | 0.51 | .48 | 0 | |
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Self-efficacy | 3.06 (2.42) | –0.73, 7.84 | –2.13 (2.55) | –7.16, 2.90 | 2.95 | .09 | 0.26 |
a BRIEF: Behavior Rating Inventory of Executive Function; SSRS: Social Skills Rating Scale.
b Pillai’s Trace.
c Adjusted
Regarding the secondary outcome measures, group 1 also improved significantly more than the group 2 on measures of parent-reported working memory and responsibility skills. Participants in group 1 showed greater improvements in participants’ time perception compared to group 2, although this did not meet statistical significance (
Within-group differences for group 2 were evaluated (see
Group 2 results of paired samples
Outcomes | Assessment, mean (SD) | T0 vs T1 | T1 vs T2 | ||||||||
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Baseline (T0) | 10 weeks (T1) | 20 weeks (T2) |
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Cohen’s |
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Cohen’s |
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Time management | 48.88 (15.25) | 52.95 (18.17) | 60.00 (14.71) | 2.80 | .006 | 0.24 | 4.36 | <.001 | 0.43 |
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BRIEF (subscale Plan/Organize)a | 20.41 (4.61) | 20.76 (4.54) | 22.01 (4.27) | 1.07 | .29 | 0.08 | 3.29 | .001 | 0.28 |
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SSRS (Cooperation) | 8.73 (3.68) | 8.90 (3.46) | 9.86 (3.16) | 0.55 | .58 | 0.05 | 2.85 | .006 | 0.29 |
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It’s about time | 30.88 (7.82) | 31.61 (7.58) | 33.89 (7.15) | 1.05 | .30 | 0.09 | 3.05 | .003 | 0.31 |
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BRIEF (subscale Working Memory) | 14.23 (3.29) | 14.42 (3.13) | 16.39 (3.36) | 0.63 | .53 | 0.06 | 5.36 | <.001 | 0.61 |
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SSRS (subscale Assertiveness) | 14.52 (3.81) | 14.35 (3.73) | 15.18 (2.65) | –0.67 | .50 | 0.05 | 2.91 | .005 | 0.26 |
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SSRS (subscale Responsibility) | 13.63 (3.16) | 13.41 (2.92) | 13.97 (2.61) | –0.95 | .35 | 0.07 | 1.97 | .05 | 0.20 |
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SSRS (subscale Self-Control) | 10.06 (3.78) | 10.19 (3.95) | 10.74 (3.15) | 0.50 | .62 | 0.03 | 1.50 | .14 | 0.20 |
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SSRS (subscale Total) | 44.24 (10.50) | 44.08 (10.67) | 46.83 (8.84) | –0.23 | .82 | 0.02 | 2.96 | .004 | 0.28 |
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Time management | 65.04 (16.37) | 64.68 (14.78) | 70.20 (10.46) | –0.27 | .79 | 0.02 | 4.09 | <.001 | 0.43 | |
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BRIEF (subscale Plan/Organize) | 20.17 (3.96) | 20.16 (3.77) | 20.92 (3.18) | –0.05 | .96 | 0 | 2.40 | .02 | 0.22 | |
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BRIEF (subscale Working Memory) | 18.57 (3.73) | 18.97 (3.87) | 20.42 (3.18) | 1.19 | .24 | 0.11 | 4.11 | <.001 | 0.41 | |
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SSRS (Total) | 34.87 (7.62) | 36.76 (7.21) | 38.37 (6.33) | 2.74 | .01 | 0.25 | 2.52 | .01 | 0.24 | |
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Self-efficacy | 87.35 (23.63) | 86.12 (25.55) | 90.87 (22.32) | –0.48 | .64 | 0.05 | 2.08 | .04 | 0.20 |
a BRIEF: Behavior Rating Inventory of Executive Function; SSRS: Social Skills Rating Scale.
Within-group differences for group 1 were then evaluated (see
Group 1 results of paired samples
Outcomes | Assessment, mean (SD) | T0 vs T1 | T1 vs T2 | ||||||||
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Baseline (T0) | 10 weeks (T1) | 20 weeks (T2) |
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Cohen’s |
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Cohen’s |
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Time management | 49.73 (16.41) | 59.45 (15.28) | 64.70 (11.32) | 5.82 | <.001 | 0.61 | 4.66 | <.001 | 0.39 |
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BRIEF (subscale Plan/Organize)a | 21.32 (4.21) | 22.19 (3.70) | 22.58 (3.63) | 2.18 | .03 | 0.22 | 1.25 | .22 | 0.11 |
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SSRS (Cooperation) | 8.53 (2.71) | 9.45 (3.24) | 10.29 (2.27) | 2.62 | .01 | 0.31 | 3.12 | <.01 | 0.30 |
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It’s about time | 30.62 (7.21) | 33.04 (6.55) | 35.08 (6.36) | 3.02 | .003 | 0.35 | 3.48 | .001 | 0.32 |
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BRIEF (subscale Working Memory) | 15.50 (3.52) | 16.06 (3.32) | 16.78 (3.48) | 1.61 | .11 | 0.16 | 2.29 | .03 | 0.21 |
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SSRS (subscale Assertiveness) | 14.14 (3.33) | 14.48 (2.69) | 14.63 (3.04) | 1.24 | .22 | 0.11 | 0.62 | .54 | 0.05 |
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SSRS (subscale Responsibility) | 12.83 (2.88) | 13.53 (2.69) | 14.06 (2.54) | 2.83 | .006 | 0.25 | 2.55 | .01 | 0.20 |
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SSRS (subscale Self-Control) | 9.66 (3.51) | 9.93 (3.03) | 10.82 (3.05) | 0.94 | .35 | 0.08 | 3.58 | .001 | 0.29 |
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SSRS (subscale Total) | 42.57 (8.81) | 44.58 (8.50) | 46.85 (8.69) | 2.46 | .02 | 0.23 | 3.93 | <.001 | 0.26 |
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Time management | 65.31 (16.12) | 70.31 (12.43) | 73.92 (10.07) | 3.45 | .001 | 0.35 | 2.95 | .004 | 0.32 | |
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BRIEF (subscale Plan/Organize) | 20.30 (3.81) | 20.87 (2.97) | 21.38 (2.39) | 1.54 | .13 | 0.17 | 1.79 | .08 | 0.19 | |
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BRIEF (subscale Working Memory) | 18.49 (3.65) | 19.75 (3.33) | 20.62 (2.47) | 3.87 | <.001 | 0.36 | 2.55 | .01 | 0.30 | |
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SSRS (Total) | 33.73 (9.42) | 36.75 (6.92) | 36.38 (7.04) | 4.03 | <.001 | 0.37 | –0.52 | .60 | –0.05 | |
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Self-efficacy | 89.39 (25.03) | 92.33 (22.01) | 94.09 (20.66) | 1.29 | .20 | 0.12 | 1.62 | .29 | 0.08 |
a BRIEF: Behavior Rating Inventory of Executive Function; SSRS: Social Skills Rating Scale.
While playing the serious game, adverse events were registered by the researcher and checked by a health care professional. Overall, there were 10 adverse events that could be related to the intervention that were reported by parents, teachers, or participants themselves. All adverse events were of mild (n=5) or moderate (n
The findings of this 20-week multisite randomized controlled crossover open-label trial demonstrate the efficacy of an Internet-based serious game specifically developed for children with ADHD. Participants who played the serious game during the first 10 weeks significantly improved in their daily life functioning across domains of time management, social skills (eg, responsibility) and working memory compared to participants in group 2. These effects were small to medium and were maintained or even further improved at the 10-week follow-up for group 1. Children from group 2, who played the serious game during the second period of the study (weeks 10 to 20), improved on comparable domains of daily life functioning over time. In contrast to previous studies that typically demonstrate that computerized neurocognitive interventions for ADHD improve working memory skills but do not have a strong impact on daily life functioning (“far-transfer effects”) [
Of particular interest is the clear effect seen on time management skills because dysfunctional time management is one of the core problems in ADHD, affecting social and executive domains of daily life functioning [
Plan-It Commander demonstrated improvement of total social skills over time, but had nonsignificant between-group effects as reported by parents and teachers. Multiplayer and cooperative game play could be more explicitly integrated to improve social benefits of the current game format. Improvements in social responsibility among players was observed. This was expected given that game elements, such as a mentor figure or nonplayable characters and peers with ADHD with whom they could interact (eg, asking for help, being polite, and dealing with compliments in a good way), enabled players to practice socially responsible behaviors in the game that could be practiced in the “real world” as well. This finding is important given that well-developed social responsibility skills in children contribute to academic success and an optimal learning environment [
Another goal of Plan-It Commander was to improve children’s self-efficacy. Children were more confident in self-control with regard to their time management and planning skills and engagement in positive social interactions. However, the between-group effect on self-efficacy did not meet statistical significance. It may be important that further development of serious gaming addresses aspects of the concept of self-efficacy (eg, modeling behavior) more thoroughly because increased self-efficacy has been shown to correlate significantly with self-esteem and adaptive behaviors such as persistence in reaching goals in daily life [
ADHD is a chronic health problem and previous studies have emphasized the need for efforts to treat impairments outside the therapy context and provide patients with greater autonomy [
The current intervention is unique in its contribution to the adjunctive ADHD treatment repertoire because it differs from existing computerized neurocognitive training formats. Instead of requiring the repetition of executive function tasks normally presented in neurocognitive training format for children with ADHD, Plan-It Commander offers behavioral strategies (e.g., reinforcement, immediate performance feedback from a mentor, goal setting through missions, modeling, social support, and comparison) that increase functional outcomes within a relatively short period of time. Even more important is the fact that participants labeled as “clinically stable” by their clinicians still showed significant improvements in daily functioning. It is encouraging that significant results were obtained over and above medication effects. Future research could examine the effects of this serious game in a nonmedicated sample to disentangle its effects. Notably, participants with higher severity scores on ADHD symptoms were more likely to drop out from the study, which implies that we can only generalize our results to children with less severe ADHD symptoms, but this remains speculative because symptoms were within the normal range. Furthermore, future research should consider family factors (eg, social support network, socioeconomic status, parental ADHD) as well in contributing to study dropout.
The results of this study must be considered in the light of several limitations. Group 2 followed treatment as usual and did not use a nontherapeutic “placebo game.” Therefore, this study could be controlled for changes in time and effects of repeated measurements, but not for placebo effects. Further, parents were not rater-blinded and rater-blindness of teachers could not fully be guaranteed because children were free to report game experiences. Questionnaires to assess time management and self-efficacy were designed on theoretical basis and guidelines by Bandura [
The current randomized controlled study demonstrated that Plan-It Commander is an effective adjunctive Internet-based behavioral intervention for children with ADHD. It is a unique contribution to the literature on serious games because it showed that a serious game for ADHD, as an adjunct to treatment as usual, improves functional outcomes of time management as well as working memory and social responsibility. It fits the current interest in nonmedical treatment options for ADHD and stimulates young children to manage their impairments by offering an easy, accessible home treatment intervention. The findings contribute to scientific knowledge about the impact of serious game interventions on behavioral outcomes, Internet-based interventions for mental health that are consistent with the Chronic Care Model of Health, and innovative approaches to treating people coping with chronic mental health conditions.
CONSORT-EHEALTH checklist V1.6.2 [
Time management questionnaire.
Self-efficacy questionnaire.
attention-deficit/hyperactivity disorder
Behavior Rating Inventory of Executive Functioning
Disruptive Behavior Disorders Rating Scale
It’s About Time Questionnaire
intelligence quotient
Kiddie Schedule for Affective Disorders and Schizophrenia-Lifetime
Social Skills Rating System
Wechsler Intelligence Scale for Children III
We thank the statistical study experts Luc Janssens (MSc), who works for the Research and Development Department of Janssen Pharmaceuticals in Beerse (Belgium), and Franky de Cooman (MSc), who works for Art Decoo, for their statistical work and advice. We thank all the parents and children for their participation. The study was conducted in collaboration with the following partners: Parent Association Centre ZitStil (Belgium), Focuz Treatment Centre for Children and Youth in Rotterdam, Mental Health Care Organization Mondriaan in Heerlen, and the University Hospital Gasthuisberg (Belgium). Johnson & Johnson was the funding source for game development and consultancy with regard to the design of the study. Flanders’ Care provided funding to perform the study (DEM2012-02-07) at the University Hospital Gasthuisberg (Belgium).
Kim Bul has been paid by Janssen Pharmaceuticals for consultancy and lectures (fees were paid to the institution), but was not paid by Janssen Pharmaceuticals to perform the pilot study. Pamela Kato has been paid by Janssen Pharmaceuticals for consultancy during the development, but did not receive any fees for her work on this research evaluation. Leonie Vreeke, Ria van den Heuvel, Thérèse Van Amelsvoort, and Ingmar Franken declare no competing financial interests exist. Saskia Van der Oord has been involved in the development, implementation, and trialing of “Braingame Brian,” an executive functioning game training for children with ADHD, and Zelf Plannen (Plan my Life) and Zelf Oplossingen bedenken (Solution focused treatment), 2 cognitive behavioral planning interventions for adolescents with ADHD. She has no financial interests in either of these interventions. She has been a paid consultant for designing a RCT of Plan-It Commander (Janssen Pharmaceuticals) and has received speaker’s fees from MEDICE and Shire. Marina Danckaerts has received personal fees from Shire, MEDICE, Novartis, Janssen-Cilag, and Neurotech Solutions outside the submitted work. Helga van Oers and Annik Willems are employees of Janssen Pharmaceuticals. Athanasios Maras has been paid by Janssen Pharmaceuticals for consultancy and has been a consultant to, a member of an advisory board of, and/or speaker for Janssen Pharmaceuticals, Eli Lilly, Eurocept, and Neurim Pharmaceuticals in the past 2 years, but is not an employee or a stock shareholder of any of these companies.