CogCubed Diagnoses ADHD with Video Games

When Kurt Roots sat down to dinner with his wife, Monika Heller, two years ago, he didn’t imagine that showing her a TED video would push them toward a way of fighting the crisis. The video featured Sifteo, a wireless, interactive game system developed at MIT that challenges players to manipulate a handful of digital, cube-shaped devices to play games. While Sifteo’s creators market it primarily as a gaming platform, Heller saw more potential in the cubes as a diagnostic tool. 

“When Kurt showed this to me I thought, why don’t we create a game where someone could play and we could hopefully assess whether someone had ADHD?” Heller says. For Heller, a practicing child and adolescent psychiatrist in Minneapolis, the low number of available adolescent psychiatrists has created a burden on untrained individuals, like parents and teachers, to identify children who may have ADHD. There are rating scales that parents and teachers can fill out, but the issue is that they aren’t properly trained. There are also computer-based assessments, but Heller says they are so dull that children will often quit them, leading to a wrongful diagnosis. 

“There are 7000 [child and adolescent psychiatrists] in the nation and, unfortunately, we are not the front lines of diagnosis,” Heller says. “The pediatricians and family care physicians are, and sometimes they might only have 15 minutes to make an adequate diagnosis. It’s a very difficult job and very hard to adequately assess someone.” 

Roots and Heller founded CogCubed with the goal to create a new kind of ADHD assessment tool using tangible gaming, one that will engage and properly monitor children, but also be simple enough that a non-psychiatrist can properly run it. The Sifteo cubes, with their ability to sense shaking, orientation (tilting and shifting), pressing, and whether they are next to each other, make them the perfect platform. “The wireless Sifteo cubes had the most potential because they had the most sensors and interaction with a person,” explains Roots, a computer scientist who has studied systems engineering and game design, With Heller’s help, Roots was able to use machine learning and predictive modeling to quantify the behavior of an ADHD patient into data that could be measured by the cubes. 

“We know that response patterns is an important thing to look at, so we added that.

We know that reading and math disorders are often comorbid with ADHD, so we made sure those features were not there. We also know that usually it’s the behavior in between the responses that was so crucial, and that’s where the Sifteo cubes have been so helpful because we can see the behavior that leads up to that response,” Heller adds. “All of those components are really part of decision making, and we can see how it’s breaking down, which is important for not only accurate diagnosis but also treatment.”

CogCubed’s flagship game is a take on Whack-A-Mole called Groundskeeper. The player takes on the role of a groundskeeper and must hit a gopher with a cube designated as a mallet without hitting any of the other distracter cubes. This requires the player to be able to quickly shift the cubes around and touch them against one another. As the levels progress, the gopher appears at more random intervals and the distracters become more visually, aurally, and spatially complex. 

Heller describes it as a game that’s “just boring enough”—good enough to keep children engaged but not so stimulating that it doesn’t provide accurate measurements. “Kids with ADHD can play video games for hours, and it’s likely because they are so engrossing,” Heller says. “That engrossing piece releases endorphins, dopamine, and norepinephrine, which is really actually a treatment for ADHD, so it’s no wonder they can pay attention all day. You can’t really see the facilities of behavior until we make it a game that is boring enough.”

An FDA-monitored phase I clinical trial of CogCubed’s games has shown they are 15% more accurate than what is currently available on the market for diagnosing ADHD. CogCubed is currently ramping up for phase II trials under FDA supervision and hopes to achieve 510(k) approval for its diagnostic game software in the next two years. Once this is complete, Roots and Heller hope to expand CogCubed to other populations and into other disorders. “The baby Boomer population has a need for understanding things around early stage dementia and Alzheimer’s,” Roots says. “We believe that games could be helpful in understanding what those conditions look like. We are first focusing on ADHD and building from there.” 

-Chris Wiltz, Associate Editor, MD+DI
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