title: Behavioral Outcome Effects of Serious Gaming as an Adjunct to Treatment for Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial.
abstract: BACKGROUND
  The need for accessible and motivating treatment approaches within mental health has led to the development of an Internet-based serious game intervention (called "Plan-It Commander") as an adjunct to treatment as usual for children with attention-deficit/hyperactivity disorder (ADHD).
  
  
  OBJECTIVE
  The aim was to determine the effects of Plan-It Commander on daily life skills of children with ADHD in a multisite randomized controlled crossover open-label trial.
  
  
  METHODS
  Participants (N=170) in this 20-week trial had a diagnosis of ADHD and ranged in age from 8 to 12 years (male: 80.6%, 137/170; female: 19.4%, 33/170). They were randomized to a serious game intervention group (group 1; n=88) or a treatment-as-usual crossover group (group 2; n=82). Participants randomized to group 1 received a serious game intervention in addition to treatment as usual for the first 10 weeks and then received treatment as usual for the next 10 weeks. Participants randomized to group 2 received treatment as usual for the first 10 weeks and crossed over to the serious game intervention in addition to treatment as usual for the subsequent 10 weeks. Primary (parent report) and secondary (parent, teacher, and child self-report) outcome measures were administered at baseline, 10 weeks, and 10-week follow-up.
  
  
  RESULTS
  After 10 weeks, participants in group 1 compared to group 2 achieved significantly greater improvements on the primary outcome of time management skills (parent-reported; P=.004) and on secondary outcomes of the social skill of responsibility (parent-reported; P=.04), and working memory (parent-reported; P=.02). Parents and teachers reported that total social skills improved over time within groups, whereas effects on total social skills and teacher-reported planning/organizing skills were nonsignificant between groups. Within group 1, positive effects were maintained or further improved in the last 10 weeks of the study. Participants in group 2, who played the serious game during the second period of the study (weeks 10 to 20), improved on comparable domains of daily life functioning over time.
  
  
  CONCLUSIONS
  Plan-It Commander offers an effective therapeutic approach as an adjunct intervention to traditional therapeutic ADHD approaches that improve functional outcomes in daily life.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV).
authors.affiliation: Yulius Academy, Yulius Mental Health Care Organization, Barendrecht, Netherlands. k.bul@yulius.nl.
authors.forename: Kim C M
authors.identifier: http://orcid.org/0000-0001-8984-9921
authors.initials: KC
authors.lastname: Bul
authors.forename: Pamela M
authors.identifier: http://orcid.org/0000-0002-4755-5009
authors.initials: PM
authors.lastname: Kato
authors.forename: Saskia
authors.identifier: http://orcid.org/0000-0003-2771-0187
authors.initials: S
authors.lastname: Van der Oord
authors.forename: Marina
authors.identifier: http://orcid.org/0000-0002-7168-963X
authors.initials: M
authors.lastname: Danckaerts
authors.forename: Leonie J
authors.identifier: http://orcid.org/0000-0003-0532-2343
authors.initials: LJ
authors.lastname: Vreeke
authors.forename: Annik
authors.identifier: http://orcid.org/0000-0002-5247-5863
authors.initials: A
authors.lastname: Willems
authors.forename: Helga J J
authors.identifier: http://orcid.org/0000-0003-2015-2733
authors.initials: HJ
authors.lastname: van Oers
authors.forename: Ria
authors.identifier: http://orcid.org/0000-0002-3655-8941
authors.initials: R
authors.lastname: Van Den Heuvel
authors.forename: Derk
authors.identifier: http://orcid.org/0000-0001-9214-1553
authors.initials: D
authors.lastname: Birnie
authors.forename: Thérèse A M J
authors.identifier: http://orcid.org/0000-0003-1135-5133
authors.initials: TA
authors.lastname: Van Amelsvoort
authors.forename: Ingmar H A
authors.identifier: http://orcid.org/0000-0002-7853-2694
authors.initials: IH
authors.lastname: Franken
authors.forename: Athanasios
authors.identifier: http://orcid.org/0000-0001-9361-1414
authors.initials: A
authors.lastname: Maras
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D012919:Social Behavior; D018910:Video Games / Q000523:psychology*
keywords: ADHD; Internet; attention deficit-hyperactivity disorder; children; randomized controlled trial; serious game; treatment