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.
"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.
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.
> 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.
For me it seems like other games would also do, as long as they don't promote "scatterbrain".
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?
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.
> 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.
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.
My gut-check says Zelda (especially the newer ones where you build things and have creative, problem-solving leeway) may be a better choice.
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
> 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.
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.
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 :)
It’s subscription and expensive because it’s another way to suck the money out of people who think they have ADHD.
An excuse, or an explanation?
I have ADHD and programming is and always has been fantastic for me, if the project is not boring.
Sounds somewhat like ADD alright.
Is there corruption with these kind of things, or did they just hit jackpot?
$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.
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.
This corruption costs Americans hundreds of billions of dollars every year.
"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."
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.
Only the USA healthcare system could give life to such an abomination.
In some cases, these apps might be useful. But I think there are quite a few cash grabs in there, too.
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.
I don't see why you need FDA approval for a video game, or even make medical claims about a video game.
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.
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.
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).
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.
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.
Like caffeine?
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.
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.
So about as effective as a placebo or sugar pill https://en.wikipedia.org/wiki/Placebo
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.
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.
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.
You could pick something like path of exile for free.
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.
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)
(Basically, everything they found can be attributed to random chance, and there’s no proof their game is anything special compared to other games)
"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".
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!
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'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.
Is this a joke? This is a discussion platform for speculating. Plus half the people on HN probably have ADD or ADHD
By the way, the "ADD" diagnosis has been removed from the DSM, there's no longer a medical distinction between the two.
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.
I'd be curious to know how much this costs for patients. I'm guessing it's some type of a subscription model.
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.
“Can playing Tetris help prevent PTSD if you’ve witnessed something traumatic?”
https://theconversation.com/can-playing-tetris-help-prevent-...
That is not what happened here, though.
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 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?
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'.
TFA’s title is to blame. This hyphen makes the title read correctly.
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.
> 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?
Maybe the real papers are more legit.
Really obscene. The healthcare industry is such a sickness in this country, I hope we get a populist one day who completely guts it.
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.
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.
What kind of study outcome is this?
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.
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.
To this day when I need to focus on an issue I often say “Location confirmed, sending supplies” or some other SF sentence.
