Meet Akili, the company treating ADHD with games

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Chief creative officer Matthew Omernick tells us how an unlikely alliance of software developers and neuroscientists could have created a new kind of medicine.

For as long as video games have been around, there have been those saying that the medium isn't a force for good.

Whether it was the moral crusade against violent games like Doom and Mortal Kombat in the 1990s or more modern concerns about their business models and potentially addictive qualities, there's been no shortage of people lining up to talk about the negative impact of video games.

But there have also been those out there who were considering the unthinkable: could video games be good for you?

Back in 2003, highly-respected neuroscientist Dr Daphne Bavelier published a study showing that first-person shooters – Medal of Honor: Allied Assault in this instance – improved visual attention skills in players by between 30% and 50%. The scientific community’s interest didn’t end there, of course. In 2009, Dr Adam Gazzaley put together a study at the University of California, San Francisco, to design a game that could detect differences in people’s cognitive abilities.

The title was called NeuroRacer and was developed in collaboration with some staff from development studio LucasArts, including Matthew Omernick, whom Gazzaley had met socially before. The NeuroRacer study ended up making the front cover of scientific journal Nature in September 2013 and found that the game improved the cognitive abilities of those who took part. 

By the time this study had been published, Gazzaley and Omernick had set up their own company called Akili. Founded in 2011 with CEO Eddie Martucci, the venture had a lofty goals of creating a new kind of medicine.

“The full vision of the company was to use technology to not only achieve a greater understanding of cognition in the brain but also to deeply impact cognitive impairments and disease,” Omnerick, Akili’s chief creative officer, explains.

Paying Attention

The company’s first project is EndeavorRx, a title that aims to help improve concentration in children with Attention Deficit Hyperactive Disorder (ADHD). Omnerick says that it was a “natural fit,” given that video games are good at keeping the player’s focus – something those with ADHD struggle with in normal life. 

EndeavourRx is played on smartphones and tablets and sees kids navigating a course by tilting their mobile device, collecting items and avoiding obstacles along the way. From the start, Akili had aspirations to release it as a way of actually treating ADHD in real life. As a result, making EndeavorRx was rather different to other games the team had made.

“Development was highly iterative,” Omnerick explains.

“Much more so than you would imagine with a regular game studio. We were working directly with the science and the regulatory side of things. We were constantly checking back and forth to make sure that we're enabling the desired results and that we're improving the experience whenever we add new features. We also needed to make sure that the balance of challenge to reward was just right.”

Part of the problem that people with ADHD face is called ‘interference processing’. In short, they’re unable to filter out information or stimuli, so they struggle to focus on one specific thing at a time. The goal with EndeavorRx was to help train players’ attention.

“What the game does when you first play is dials in to what the players strengths and weaknesses are,” Omnerick says. “It builds the experience out based on you as an individual. No person who plays a game will have the same reward loops or the same experience in general, because it's finely tuned to what each player needs to work on.

“Then what it does – like a good game or like a good personal trainer – is constantly push you and reward you as you improve. There's a list of 100 reasons why a video game is a great mechanism to deliver this kind of medicine. That back and forth of great challenge mixed with great reward is one of the most important ones.”

Testing, Testing

From the start, Akili was looking to market EndeavorRx as a treatment for ADHD, but to do so the studio would need to receive approval from the United States’ Food and Drug Administration (FDA).

This was far from a quick and easy route to release. In order to get the nod from the federal organisation, Akili had to do a wealth of clinical trials. This process is not cheap, which is probably the largest reason why EndeavorRx became the first game to be given FDA approval in June of this year.

“This is a new kind of medicine that's directly affecting the brain,” Omnerick says.

“We realised early on that we had to truly legitimise not just Akili, the game and the medicine, but frankly the industry. We went headlong into this knowing that this was the mountain that we wanted to climb; not just for us, but for this industry in general. Taking the FDA path was long and expensive, thanks to the huge randomised clinical trials you need to do, but it was the right path to make it clear that this new kind of medicine is unquestionably effective and safe.”

Despite helping with some of the problems that those with ADHD face, EndeavorRx isn’t intended as a replacement for existing treatments. It’s simply another tool in the kit, alongside drugs and other therapies, that can be used to treat this cognitive disorder.

“It's a very different kind of medicine than than pharmaceuticals,” Omnerick explains.

We ran a really interesting study recently that compared EndeavorRx’s effects on kids taking ADHD medication to those who weren’t. What's really fascinating is that both groups saw the same impact. I’m simplifying a complex study, but this is cool because it shows that the game is working on a different part of the brain to pharmaceuticals.

“Drugs work really well for a lot of people to help with things like hyperactivity, but they really are just toning down symptoms. What we are trying to do here is more changing the neural network of the brain at a ground level.”

Games for Good

At the time of writing, EndeavorRx is soon to be made available for doctors to prescribe to patients. Despite its focus on ADHD with its first project, Omnerick is keen to explain that Akili isn’t “the ADHD company.” In fact, it’s not even a games company but a broader technology firm that is trying to come up with ways to help people. As well as EndeavorRx, the company is building products to help parents and medical professionals track symptoms and behaviours.

Many in the industry will be familiar with – and sick of – the term ‘gamification,’ the notion that you can add elements from video games such as reward loops into an experience in order to achieve a desired result. Most of the time, this kind of design philosophy is about keeping users engaged with something and encouraging them to spend more time with an app or product.

The phrase has come to have some pretty negative connotations, so much so that Omnerick has grown to dislike it. But overall, Akili shows that it is possible to use gamification for good.

“It's got a couple of associations that I don't like,” he admits. “One is what you just described; sometimes gamification is used for evil. One of the key pillars when we founded the company was about the quality of experience. We built a true internal game company within Akili to be able to deliver experiences that are high quality and are at the same kind of level as you’d see from proper video games. We really know – both from the neuroscience and from the world outside – that experiences have a major impact on who we are in our in our brain and video games are an incredible way to deliver something really immersive.”

He concludes: “A lot of what we do at Akili do is look at the way things work in medicine and medical practice in general and ask whether it has to be that way.”

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