A recent review by a team from Johns Hopkins Children’s Center finds that certain video games designed for mental health can be helpful, though modest, tools for improving the well-being of children and teens with anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD). The findings were published on September 23 in JAMA Pediatrics.
In the U.S., around 20% of children and teenagers aged 3 to 17 suffer from mental, emotional, developmental, or behavioral disorders. Additionally, a report from the Agency for Healthcare Research and Quality shows that suicidal behaviors among high school students increased by over 40% in the decade leading up to 2019. Disruptions caused by the COVID-19 pandemic have further exacerbated these issues. Despite parents increasingly seeking mental health care for their children, wait times for appointments have also risen.
Barry Bryant, a resident in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine, and the first author of the study, stated, “We found literature that suggests that even doubling the number of pediatric mental health providers still wouldn’t meet the need.”
To assess the effectiveness of “gamified digital mental health interventions,” or video games aimed at treating mental health conditions, the research team analyzed randomized clinical trials involving children and adolescents. They identified 27 trials from the U.S. and abroad, which included 2,911 participants, roughly evenly split between boys and girls aged 6 to 17.
The interventions varied in content but all targeted ADHD, depression, and anxiety. For instance, games for ADHD involved tasks requiring players to split their attention, while those for depression and anxiety taught psychotherapy concepts through gameplay. These interventions were accessible on various platforms, including computers, tablets, consoles, and smartphones. Some games were available online, while others required access through specific research teams.
The studies measured outcomes differently. However, the Johns Hopkins team standardized effect sizes using a random-effects model to gauge effectiveness compared to control conditions. They used Hedges’ g statistic to quantify treatment effects.
Their analysis revealed that video games targeting ADHD and depression resulted in a modest reduction in symptoms, with both showing an effect size of 0.28. This indicates slight improvements in sustaining attention and decreased feelings of sadness, based on feedback from participants and families. In-person interventions usually produce moderate to large effect sizes, between 0.50 and 0.80. Conversely, games aimed at alleviating anxiety showed minimal benefits, with an effect size of only 0.07.
The research team also explored factors that could enhance the effectiveness of these digital interventions. Specific delivery methods, like using computers and setting time limits, as well as participant demographics, such as involving more boys, positively influenced therapeutic outcomes. These findings highlight potential areas for improvement in the efficacy of these interventions.
“While the benefits are still modest, our research shows that we have some novel tools to help improve children’s mental health—particularly for ADHD and depression—that can be relatively accessible to families,” said Joseph McGuire, an associate professor of psychiatry and behavioral sciences. He added that gamified interventions could serve as a helpful first step for pediatric patients awaiting individual therapy.
However, the team noted that their review did not clarify why some video game interventions were more effective than others. They acknowledged that some trials relied on parent- or child-reported measures rather than standardized clinician ratings, and the studies varied in examining engagement and social factors, which may have affected outcomes. Accessibility remains a concern, as some video games studied are not widely available or are behind paywalls.
The researchers emphasized that while video game addiction and excessive screen time are valid concerns, children who participated in structured, time-limited gaming sessions showed the best results. Bryant explained, “If a child has a video game problem, they are often playing for several hours a day, as opposed to a gamified mental health intervention that might last 20 to 45 minutes, three times a week.”
McGuire concluded, “I think having many tools in the toolbox can be helpful to confront the increasing demand for child mental health care.”
Morgan Sisk from the University of Alabama at Birmingham also contributed to the study, which was funded by generous donations and Johns Hopkins Medicine.
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