[Paper Review] A Review on Serious Games for ADHD

Yuanyuan Zheng, Rongyang Li+4 more|arXiv (Cornell University)|Mar 31, 2021

Attention Deficit Hyperactivity Disorder51 references18 citations

TL;DR

This paper reviews serious games for ADHD (SGADs), categorizing them by platform—console, computer, and mobile—while analyzing their roles in diagnosis and treatment. It highlights how gamified, interactive, and immersive environments enhance engagement and clinical accuracy, with BCI integration enabling neurofeedback training, ultimately improving attention, impulse control, and executive functions in children with ADHD.

ABSTRACT

Attention deficit and hyperactivity disorder (ADHD) have two main characteristics: inattention and impulsivity.It has many obstacles to the normal development of children and is very common among children.As an intervention, Serious games for ADHD(SGADs) have shown great potential and are very effective for these ADHD patients.Although many serious games have been developed for ADHD patients, but a review paper that summarizes and generalizes the topic of video games has not yet appeared.In this article, we first classified serious games about ADHD according to different platforms developed by video games, and then we conducted a systematic review of video games that can help children with ADHD diagnose and treat. Finally, we discussed and made suggestions based on the current development of SGADs.

Motivation & Objective

• To systematically review serious games for ADHD (SGADs) across different platforms, including console, computer, and mobile games.
• To analyze the technological components and mechanisms of SGADs in improving attention, impulse control, and executive functions in children with ADHD.
• To evaluate the effectiveness of SGADs in both diagnostic and therapeutic applications, particularly in reducing reliance on medication.
• To identify key challenges such as game addiction, symptom misclassification, and lack of standardized evaluation criteria in game-based assessment.
• To provide actionable recommendations for future SGAD development, including adapting commercial games and improving diagnostic granularity.

Proposed method

• Classified SGADs into three platform-based categories: console, computer, and mobile games, based on hardware and interaction modalities.
• Conducted a systematic review of SGADs focusing on diagnostic and therapeutic applications, analyzing game mechanics, user interaction, and clinical outcomes.
• Evaluated the integration of brain-computer interface (BCI) and neurofeedback technologies in computer-based SGADs to monitor EEG and train attention.
• Assessed the use of gamified evaluation to replace or supplement traditional questionnaires, improving participant engagement and diagnostic reliability.
• Proposed a development framework for BCI-based serious games to reduce technical complexity and improve accessibility.
• Reviewed existing game design principles to minimize addiction risks, such as avoiding overly stimulating visuals and emphasizing focus and impulse control in gameplay.

Experimental results

Research questions

• RQ1 How do different platforms (console, computer, mobile) influence the design, engagement, and effectiveness of serious games for ADHD?
• RQ2 To what extent can serious games improve diagnostic accuracy for ADHD compared to traditional clinical assessments?
• RQ3 What role do BCI and neurofeedback technologies play in enhancing attention and impulse control in SGADs?
• RQ4 How can serious games be adapted to address the distinct behavioral profiles of ADHD subtypes (inattentive, hyperactive, combined)?
• RQ5 What design and evaluation challenges exist in SGADs, and how can they be mitigated to ensure clinical utility and long-term safety?

Key findings

• Serious games significantly improve engagement and participation among children with ADHD compared to traditional assessment and treatment methods.
• BCI-integrated computer games enable real-time neurofeedback, effectively training attention and impulse control through EEG monitoring.
• Gamified diagnostic tools reduce dropout rates and improve reliability by minimizing subjective bias and enhancing naturalistic behavior observation.
• Mobile and console-based SGADs offer portability and physical engagement, supporting motor coordination and sustained attention through interactive gameplay.
• Current SGADs often fail to distinguish between ADHD subtypes, indicating a need for more granular diagnostic game design.
• There is a lack of standardized evaluation criteria for game-based assessments, suggesting a need to adapt or revalidate existing clinical scales for digital environments.