The Effectiveness of Serious Games as Digital Therapeutics for Enhancing the Abilities of Children with ADHD: A Systematic Literature Review (Preprint)

Abstract

BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often begins in childhood and requires long-term treatment and management. Given the potential adverse effects of medication in children, interest in alternative treatments has grown. Serious games have emerged as promising non-pharmacological interventions for children with ADHD among these alternatives. OBJECTIVE This review examines serious games from the past 14 years using Digital Therapeutics (DTx) criteria, assesses user engagement outcomes such as enjoyment and adherence, and analyzes the impact of these games on competencies including attention, social skills, motor skills, and executive functions in children with ADHD. METHODS This review was conducted by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search encompassed five databases: PubMed, Web of Science, Scopus, IEEE Xplore, and ACM Digital Library, covering January 2010 to January 2024. Studies focused on serious games as Digital Therapeutics to enhance the abilities of children with ADHD were selected. Each publication was evaluated and categorized based on key characteristics such as experiment type, targeted abilities, game software and hardware, publication area, duration, length, and frequency of use. Features from experimental and game designs were systematically tabulated, and the resulting data were analyzed and summarized narratively to assess therapeutic effects. RESULTS This review included a total of 29 studies. The review showed that serious gaming interventions might improve attention, social skills, and executive functions. Although findings related to motor skills were inconsistent, somatosensory games that use body movements or gestures as inputs demonstrated higher adherence rates. Additionally, serious games yielded favorable outcomes regarding player enjoyment. CONCLUSIONS This review indicates that employing serious games as Digital Therapeutics (DTx) can potentially support ADHD treatment in children by enhancing various competencies, enjoyment, and adherence. Future studies are expected to focus on integrating serious games more broadly into treatment protocols and standardizing research methods.