Prescription-Based Video Games for Therapy, Learning, and Development

Akili and the University of San Francisco’s Neuroscape lab are creating a mobile game called Project: EVO. It is potentially the first prescription-based video game, designed to help treat children with ADHD.

In my very first blog post on Gamasutra, I wrote about using video games as serious social tools, and touched somewhat on the use of video games as therapy. I wanted to revisit that topic more in-depth, beyond the allegorical links between Dark Souls, suicide, and depression, and beyond the University of Barcelona “full body ownership illusion” study.

I’ve since read about a collaborative effort between a company called Akili and the University of San Francisco’s Neuroscape lab to create a mobile game called Project: EVO. What’s so special about this game? Project: EVO is potentially the first prescription-based video game, designed to help treat children with ADHD.

Brain Games and Funny Business

Akili is in for an uphill battle from the get-go. Brain-training games, and, most popularly, brain training service provider Lumosity, have been under fire since late 2014, after a group of 69 prestigious scientists signed and published an open letter refuting the validity of these programs and services. While a response was drafted shortly thereafter by another group of scientists reminding that not all “brain training” is the same and that the blanket disapproval of an entire category represents flawed thinking and methods, the negative perception toward brain training still persists.

As such, Akili is legitimizing their efforts in a way that no other brain-training company ever has before; they are seeking FDA approval, the same type that any other drug or medical device has to go through. They’re currently in phase III clinical trials, and, if successful, will be the first prescription-based video game in the US — and could lead to a surge of other companies and developers trying to get in on “digital medicine.”

Other Efforts in Therapeutic Video Games

While Akili is the only company that I’ve read about currently seeking FDA approval, it’s definitely not the only company pursuing and advocating video games as therapy. Checkpoint is a non-profit that, according to their website copy, “acts to connect mental health resources with video games and technology.”

I first read about Checkpoint on Gizmodo Australia, who explained that the former is involved in presenting mental health information about gamers and gaming and provides guidance on how to treat mental health in video game narratives. In the author’s own words:

As an advocate for games as therapy, Checkpoint makes the very good point that they're cheaper than traditional medication and therapy, they're familiar for a large audience, and they're often fun. The organisation wants to see more games with potential therapeutic applications developed, and it says the best way forward is to gather data — from you — on how people feel when they're playing, what kind of games they play, and how they play them.”

While Checkpoint isn’t necessarily seeking out FDA approval, they are still trying to bring light to the study of video games as therapy for adults and kids alike. The rest of the field, however, seems intent on bringing this therapy to kids and kids alone.

This may be because children are at developmental stages, and any type of stimulation in these areas (from video games, or otherwise) is bound to form the impetus of developmental growth. If true, that would mean that the scientists criticizing brain-training would likely be right in one sense — that “pretty much any activity–learning a language, navigating a motor skill, playing a game–can change neural systems that make learning easier, and it’s not clear that playing brain games works better than anything else,” to quote Sarah Kessler writing for FastCompany. However, this doesn’t invalidate video games’ use as therapeutic tools, or even learning tools, Instead, it shows that many activities could be considered “therapeutic” and/or “developmental,” including video games, if done right.

Taunya Banta, expert in child development with a master’s degree in teaching and 15 years of experience is no stranger to channeling play into learning experiences. In her post, “Why Do Some Kids Love Games That Go Bang-Bang?” Banta argues that “fascination with weapon play is normal for many boys—and some girls, too—but it can also be really distressing for parents, who may worry that this kind of play can lead to violent behaviors later.” She lists four different ways that a parent can channel pretend-gunplay into a developmental learning experience, and I can’t help but see how these could absolutely be presented in video games:

  1. Explore good and bad. Banta suggests asking who your child is pretending to be. Chances are, they’re the good guy, providing you an opportunity to talk about what good guys do and connect them to your familial and cultural values. This is also often explored in typical Campbellian story arcs in video games, and parents can draw on game situations to explore good and evil, presuming they are familiar with the content already.

  2. Give her real-life chances to save the day. Real-life chances to save the day include helping set the table, watching a little sister, or helping grandma with groceries. Video games, on the other hand, give us that opportunity all of the time.

  3. Let her shoot off social skills. We live in an increasingly social world, and kids should play pretend together. Why make them pretend, though? With a VR headset and the internet, your kid (and you too!) can have an interactive time without ever leaving the house.

  4. Open up the imagination beyond violence. Banta here is simply suggesting giving your children toys that don’t always involve guns or action. Once again, video games have been captivating children without violence for decades.

Is AR and VR’s Physicality a Necessary Component?

The above stems from a child running around with a stick, playing “bang-bang” with friends, and there’s a marked difference in the way we connote feelings with that type of play, vs. the inactive, seated gamer who is sitting playing what some might call “violence and murder simulators”. It makes me wonder if there’s a difference in the way we perceive video games that present themselves as therapy based on physicality, or, more appropriately, whether or not they use some type of virtual reality (VR) or augmented reality (AR) interface.

Let’s take the most obvious example in my mind: games that aren’t based in any type of virtual world at all vs. games that are. It’s long been accepted that sports can help improve students' social and cognitive abilities, as evidenced by the tenure or core sports such as football, basketball, and other high school sanctioned sports. Yet, it hasn’t been until the last four or five years that gaming as a pastime and eSports have begun to be taken seriously. Nevertheless, I think that as eSports become more mainstream, we’ll inevitably see sports and video games reach a symbiotic climax in evolution.

Another driver for AR and VR therapy will likely come from eLearning based in VR, such as this CPR simulator. Not only that, but we’ve already seen VR and physicality components in Akili’s models, which might end up being the first form of prescribed digital therapy. However, I think it’s extremely important that we don’t cast these other forms of emotional and mental therapy aside.

ADDitude Magazine has a report on a series of video games designed by Boston Children’s Hospital to teach emotional and anxiety control, while FastCompany ran a story on a Cognitive Behavioral Therapy-based game called gNats Island designed to help children with mental health issues.

The lesson to take away here is that video games are finally being recognized as therapeutic and even developmental tools. We must not pigeonhole them in one way or another — there is no proof that physicality makes for better therapy, nor is there proof that “brain training” is the “best” way to achieve deeper learning. We must instead be open to new things, and I personally am excited for the day that we see effective prescription-based video game therapies.

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