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Cited by 158Attention Deficit Hyperactivity DisorderEducational Games and GamificationChild Therapy and Development

Behavioral Outcome Effects of Serious Gaming as an Adjunct to Treatment for Children with Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

Open access
Bul, Kim CM, Kato, Pamela M, Van der Oord, Saskia, Danckaerts, Marina, Vreeke, Leonie J, Willems, Annik, van Oers, Helga JJ, Van Den Heuvel, Ria +4 more·2016·Journal of Medical Internet Research
DOI 10.2196/jmir.5173PMC PMC4773597
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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. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV).

AI snapshot

Written from the paper’s full text.

TL;DR

In a 20-week multisite randomized controlled crossover open-label trial (N=170 children aged 8-12 with ADHD), adding the Internet-based serious game Plan-It Commander to treatment as usual improved parent-reported time management, responsibility, and working memory at 10 weeks compared with treatment-as-usual crossover controls. Effects were small to medium and maintained or further improved at 10-week follow-up for the initial game group, while the delayed group improved after crossing over.

Key findings

  • At 10 weeks, group 1 showed significantly greater improvements than group 2 on parent-reported time management (P=.004; Cohen’s d=0.39), parent-reported responsibility (P=.04), parent-reported working memory (P=.02; d=0.51), and teacher-reported time management (P=.001; d=0.41).
  • Between-group effects were nonsignificant for parent-reported planning/organizing (P=.07), cooperation (P=.13), total social skills (P=.10), self-efficacy (P=.09), teacher-reported planning/organizing (P=.13), teacher-reported total social skills (P=.48), and teacher-reported working memory (P=.05).
  • Within group 1, effects were maintained or further improved from 10 weeks to 10-week follow-up, e.g., parent-reported time management (P<.001; d=0.39) and parent-reported working memory (P=.03; d=0.21). Group 2 improved after crossing over to the game, e.g., parent-reported time management (P<.001; d=0.43) and parent-reported working memory (P<.001; d=0.61).
  • Parents and children reported moderate to high satisfaction with the game (parent mean 6.96, SD 1.40; child mean 7.33, SD 1.87); 10 mild/moderate adverse events were reported, with no serious adverse events.

Methods

  • A 20-week multisite randomized controlled crossover open-label trial randomized 170 children aged 8-12 with DSM-IV-TR ADHD to group 1 (n=88; serious game plus treatment as usual for first 10 weeks, then treatment as usual) or group 2 (n=82; treatment as usual first 10 weeks, then crossed over to serious game plus treatment as usual). Most participants (91.8%, 156/170) were on medication.
  • Primary outcomes were parent-reported time management, BRIEF Plan/Organize, and SSRS Cooperation; secondary outcomes included parent, teacher, and child self-report measures at baseline, 10 weeks, and 10-week follow-up.
  • Between-group baseline-to-10-week change scores were compared with ANCOVAs adjusting for baseline score, gender, and site; within-group changes used paired samples t tests; intention-to-treat analyses used linear trend imputation, with Hochberg adjustment for primary outcomes and Cohen’s d effect sizes.

Limitations

  • The paper states that group 2 received treatment as usual rather than a nontherapeutic placebo game, so placebo effects could not be controlled; parents were not rater-blinded and teacher blinding could not be fully guaranteed; and the time management and self-efficacy questionnaires were developed for this study and need further psychometric evaluation.
  • The text also makes evident that dropout was higher in group 1 at 10 weeks (χ²₁=8.0, P=.01), and children who dropped out had higher ADHD severity scores than completers (mean 45.06, SD 15.79 vs mean 39.07, SD 14.16; P=.04), limiting generalizability to children with less severe ADHD symptoms.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/jmir.5173

Cites

62 of 62 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 59 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    On the secondary outcome It's About Time, the group 1 versus group 2 difference was not statistically significant (P=.09).

    “| | | It’s about time | 2.74 (0.73) | 1.30, 4.17 | 1.18 (0.76) | –0.32, 2.68 | 2.98 | .09 | 0.20 |”
    Quote in the paperNot a substantial claim
  • Findingown data

    Both parents (mean 6.96, SD 1.40) and participants (mean 7.33, SD 1.87) reported moderate to high satisfaction with receiving the serious game intervention.

    “Both parents (mean 6.96, SD 1.40) and participants (mean 7.33, SD 1.87) reported moderate to high satisfaction with receiving the serious game intervention.”
    Quote in the paperNot a substantial claim
  • Findingown data

    After 10 weeks, participants in group 1 compared with group 2 achieved significantly greater improvements on the primary outcome of parent-reported time management skills (P=.004).

    “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)”
    • Also stated in: § Between-Group Differences (Group 1 Versus Group 2) · plain
      “On the primary outcome measures, group 1 showed significantly greater improvements in parent-rated time management skills compared to participants in group 2.”
    Quote in the paperSubstantial claim
  • Findingown data

    Within group 1, positive effects were maintained or further improved in the last 10 weeks of the study.

    “Within group 1, positive effects were maintained or further improved in the last 10 weeks of the study.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Between-group effects on total social skills were nonsignificant.

    “whereas effects on total social skills and teacher-reported planning/organizing skills were nonsignificant between groups.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 25

  • May combine two claims.

    Findingown data

    Group 1 showed more improvement in parent-reported planning/organizing skills compared to group 2, but this did not meet statistical significance (P=.07).

    “Group 1 also showed more improvement in parent-reported planning/organizing skills compared to group 2, although this did not meet statistical significance (P=.07).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Group 1 showed greater improvements in self-efficacy compared to group 2, but this did not meet statistical significance (P=.09).

    “Finally, the same accounted for participants’ self-efficacy in which participants in group 1 showed greater improvements as compared to group 2 (P=.09), but it did not meet statistical significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No differences were found on teacher-rated total social skills or planning/organizing skills.

    “No differences were found on parent-rated total social skills (with subscales assertiveness and self-control) and teacher-rated total social skills and planning/organizing skills.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No differences were found on parent-rated total social skills, assertiveness, or self-control.

    “No differences were found on parent-rated total social skills (with subscales assertiveness and self-control) and teacher-rated total social skills and planning/organizing skills.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Plan-It Commander demonstrated improvement of total social skills over time, but had nonsignificant between-group effects as reported by parents and teachers.

    “Plan-It Commander demonstrated improvement of total social skills over time, but had nonsignificant between-group effects as reported by parents and teachers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Teachers reported greater improvements in group 1 than group 2 on working memory, but this did not meet statistical significance (P=.05).

    “Teachers reported greater improvements in group 1 than group 2 on the measure of time management and working memory, although this latter effect did not meet statistical significance (P=.05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Group 1 showed greater improvements in time perception compared to group 2, but this did not meet statistical significance (P=.09).

    “Participants in group 1 showed greater improvements in participants’ time perception compared to group 2, although this did not meet statistical significance (P=.09).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Results demonstrated that parents as well as children were satisfied with their treatment.

    “Results demonstrated that parents as well as children were satisfied with their treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There were no differences between the 2 groups in number of days playing the mission-guided game.

    “There were no differences between the 2 groups with regard to the number of days playing the mission-guided game.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Compared to children without the disorder, children with ADHD have more difficulties at school making schedules to finish assignments on time, executing complex planning tasks, organizing material needed for assignments, remembering task instructions, and setting priorities.

    “Compared to children without the disorder, children with ADHD have more difficulties at school making schedules to finish assignments on time, executing complex planning tasks, organizing material needed for assignments, remembering task instructions, and setting priorities [6,7].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] source

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    • cites [7] source

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    Study design and conductreasoning

    It was not possible to blind participants to their treatment allocation.

    “It was not possible to blind participants to their treatment allocation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Group assignment was performed online using the next available number on the randomization list corresponding to the site and gender of the participant.

    “Group assignment was performed online using the next available number on the randomization list corresponding to the site and gender of the participant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Participants who dropped out during the study did not differ from completers on age, gender, ADHD subtype, or intelligence.

    “Participants who dropped out during the study period did not differ according to age (t 168 =–1.34, P=.18), gender (χ2 1=2.2, P=.13), ADHD subtype (χ2 2=2.5, P=.29), or intelligence (t 168 =–1.66, P=.10) compared to participants who did not drop out”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The significance level for primary outcome measures was adjusted on the basis of the Hochberg procedure.

    “The significance level for primary outcome measures was adjusted on the basis of the Hochberg procedure [56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Hochberg, Y, 1990, Stat Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Participants played the mission-guided game for a mean 19.04 (SD 9.61) days and the closed social community for a mean 11.20 (SD 8.55) days.

    “Participants played for a mean 19.04 (SD 9.61) days in the mission-guided game and a mean 11.20 (SD 8.55) days in the closed social community.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    At 10 weeks, 152 of 170 participants (89.4%) completed the study, and 139 of 170 (81.8%) completed at the 10-week follow-up.

    “At 10 weeks (T1), 152 of 170 participants (89.4%) completed the study and 139 of 170 (81.8%) completed at the 10-week follow-up (T2).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The sample size was determined in advance by power calculations on the basis of previous pilot study descriptive results on primary outcome measures, indicating that 78 participants per group would give 87% power to detect differences of a medium effect size (at least 0.5) between groups (α=.05; 2-sided).

    “The sample size was determined in advance by power calculations on the basis of previous pilot study descriptive results (mean, SD) on primary outcome measures, which indicated that 78 participants per group would give 87% power to detect differences of a medium effect size (at least 0.5) between groups (α=.05; 2-sided).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The difference between group 1 (mean 13.53, SD 6.25) and group 2 (mean 11.53, SD 7.25) in amount of time playing the mission-guided game did not meet statistical significance (t155=1.81, P=.07).

    “A difference was seen between group 1 (mean 13.53, SD 6.25) and group 2 (mean 11.53, SD 7.25) with regard to the amount of time playing the mission-guided game (t 155=1.81, P=.07) but it did not meet statistical significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Children with ADHD show impairments in social functioning, are rejected more often by peers, and have more conflicts with other children and adults compared to children without ADHD.

    “Children with ADHD also show impairments in social functioning. They are rejected more often by their peers and have more conflicts with other children and adults compared to their counterparts who do not have ADHD [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] source

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  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Inclusion required a DSM-IV-TR diagnosis of ADHD confirmed by the Kiddie Schedule for Affective Disorders and Schizophrenia-Lifetime version (K-SADS).

    “Inclusion criteria were (1) a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis of ADHD (confirmed by the Kiddie Schedule for Affective Disorders and Schizophrenia-Lifetime version [K-SADS] [44,45])”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [44] Puig-Antich, J, 1978, The Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS)

      Not checked in the free run.

    • cites [45] Reichart, C, 2000, Dutch Translation of the Kiddie-SADS

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Allocation was stratified by study site and gender and arranged in permutated blocks.

    “Allocation was stratified by study site and gender and arranged in permutated blocks.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Randomization was carried out on a 1:1 ratio and based on a prespecified computer-generated randomization list.

    “Randomization was carried out on a 1:1 ratio and based on a prespecified computer-generated randomization list.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Participants played the mission-guided game for a total duration of mean 12.56 (SD 6.57) hours and engaged with the closed social community for mean 54.27 (SD 70.00) minutes.

    “Additionally, participants played the mission-guided game for a total duration of a mean12.56 (SD 6.57) hours and engaged with the closed social community for a mean 54.27 (SD 70.00) minutes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Children with ADHD are more likely to show academic underachievement, poor academic performance, and educational problems compared to children without the diagnosis.

    “Thus, it is not surprising that children with ADHD are more likely to show academic underachievement, poor academic performance, and educational problems compared to their counterparts without the diagnosis [8].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Intention-to-treat analyses were used and included all randomized participants.

    “Intention-to-treat analyses were used and included all randomized participants.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Impaired social functioning in children with ADHD has serious long-term consequences for the development of conduct disorder and even some substance use disorders.

    “Although understudied, impaired social functioning in children with ADHD has serious long-term consequences for the development of conduct disorder and even some substance use disorders [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Greene, RW, 1997, J Consult Clin Psychol source

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  • May combine two claims.

    Study design and conductown data

    Mean scores for primary and secondary outcome measures and characteristics of groups 1 and 2 did not differ significantly at baseline.

    “Mean scores for primary and secondary outcome measures and characteristics of groups 1 and 2 did not differ significantly at baseline (see Table 2).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The difference between group 1 (mean 1.04, SD 1.16) and group 2 (mean 0.44, SD 1.02) in amount of time playing in the closed social community was not statistically significant (t156=1.82, P=.07).

    “With regard to the amount of time playing in the closed social community, there was a difference between group 1 (mean 1.04, SD 1.16) and group 2 (mean 0.44, SD 1.02; t 156=1.82, P=.07), although this was not statistically significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Stimulant medication reduces ADHD core symptoms among children with ADHD, but effects are limited with regard to children's behavioral, social, and cognitive functioning in daily life.

    “Although stimulant medication has been shown to reduce ADHD core symptoms among children with ADHD, effects are limited with regard to children’s behavioral, social, and cognitive functioning in daily life [15].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Well-developed social responsibility skills in children contribute to academic success and an optimal learning environment.

    “This finding is important given that well-developed social responsibility skills in children contribute to academic success and an optimal learning environment [52,53].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [52] Gresham, M, 2008, Rating Scales Manual. SSIS Social Skills Improvement System

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    • cites [53] source

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  • Classified as probably not a substantial claim.

    Premisecitation

    Serious gaming is a novel and promising approach to support the treatment of clinical symptoms and improvement of adaptive functioning among diverse patient groups.

    “Serious gaming (ie, [digital] games used for purposes other than purely entertainment) is a novel and promising approach to support the treatment of clinical symptoms and improvement of adaptive functioning among diverse patient groups [31-35].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [31] Merry, S, 2012, BMJ source

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    • cites [32] source

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    • cites [33] Griffiths, M, 2002, Educ Health

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    • cites [34] source

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    • cites [35] source

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  • May combine two claims.

    Premisecitation

    Computerized training programs for ADHD show some evidence for short-term effects on targeted working memory outcomes as measured by neurocognitive tests similar to the ones practiced in the games, but have not shown compelling evidence that these effects generalize beyond neurocognitive outcomes to important domains of daily life functioning.

    “Although these programs show some evidence for short-term effects on targeted working memory outcomes as measured by neurocognitive tests similar to the ones practiced in the games, they have not shown compelling evidence that these effects generalize beyond neurocognitive outcomes to important domains of functioning in the daily lives of children with ADHD (so-called “far-transfer effects”) [27-”
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    • cites [27] source

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  • May combine two claims.

    Interpretationown data

    Improvements in time management and working memory were reported by parents at home and teachers at school, supporting the claim that positive behavioral adaptations generalized across different settings.

    “It should be noted that the improvements in time management and working memory were reported by parents at home and teachers at school supporting the claim that positive behavioral adaptations resulting from use of the serious game generalized across different settings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Most effects maintained or even further improved at 10-week follow-up.

    “This implies that most effects maintained or even further improved at 10-week follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Dysfunctional time management is one of the core problems in ADHD, affecting social and executive domains of daily life functioning.

    “Of particular interest is the clear effect seen on time management skills because dysfunctional time management is one of the core problems in ADHD, affecting social and executive domains of daily life functioning [4,37].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Sonuga-Barke, E, 2010, J Am Acad Child Adolesc Psychiatry

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    • cites [37] source

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  • May combine two claims.

    Premisecitation

    Behavioral interventions developed to improve functional outcomes are effective but often time-consuming, costly, and not easily accessible to all children who might benefit.

    “Behavioral interventions developed to improve these children’s functional outcomes, although effective [7,14,16], are often time-consuming, costly, and not easily accessible to all children who might benefit from them [17-19].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [7] source

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    • cites [14] source

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  • May combine two claims.

    Interpretationreasoning

    This approach provides sustainable therapeutic effects by improving behavioral strategies that can be applied in daily life.

    “As such, this approach provides sustainable therapeutic effects by improving behavioral strategies that can be applied in daily life.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Serious games are characterized by high-intensity immediate reinforcement, which appears to improve task performance, especially within ADHD populations.

    “These games are characterized by a high-intensity immediate reinforcement and this appears to improve task performance, especially within ADHD populations [39,40].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [39] source

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    • cites [40] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    No additional rewards were given and no prompts to play the game regularly were explicitly provided outside the game.

    “Furthermore, no additional rewards were given and no prompts to play the game regularly were explicitly provided outside the game.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The findings contribute to scientific knowledge about the impact of serious game interventions on behavioral outcomes, Internet-based interventions for mental health, and innovative approaches to treating people coping with chronic mental health conditions.

    “The findings contribute to scientific knowledge about the impact of serious game interventions on behavioral outcomes, Internet-based interventions for mental health that are consistent with the Chronic Care Model of Health, and innovative approaches to treating people coping with chronic mental health conditions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study could be controlled for changes in time and effects of repeated measurements, but not for placebo effects.

    “Therefore, this study could be controlled for changes in time and effects of repeated measurements, but not for placebo effects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    It is a unique contribution to the literature on serious games because it showed that a serious game for ADHD, as an adjunct to treatment as usual, improves functional outcomes of time management as well as working memory and social responsibility.

    “It is a unique contribution to the literature on serious games because it showed that a serious game for ADHD, as an adjunct to treatment as usual, improves functional outcomes of time management as well as working memory and social responsibility.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The time management questionnaire was developed because of a lack of instruments for this age group.

    “The time management questionnaire was developed because of a lack of instruments for this age group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Group 2 followed treatment as usual and did not use a nontherapeutic placebo game.

    “Group 2 followed treatment as usual and did not use a nontherapeutic “placebo game.””
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Both instruments show good reliability.

    “Both instruments show good reliability.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Previous studies have emphasized the need for efforts to treat impairments outside the therapy context and provide patients with greater autonomy.

    “ADHD is a chronic health problem and previous studies have emphasized the need for efforts to treat impairments outside the therapy context and provide patients with greater autonomy [22,23,63].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22] source

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    • cites [23] 2013, Mental Health Action Plan 2013-2020

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    • cites [63] source

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  • May combine two claims.

    Interpretationown data

    Overall, this study introduces serious gaming as an effective and attractive behavioral intervention for children with ADHD, especially for time management with evidence for effects on certain social skills and self-efficacy.

    “Overall, this study introduces serious gaming as an effective and attractive behavioral intervention for children with ADHD, especially for time management with evidence for effects on certain social skills and self-efficacy as well.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    This questionnaire was used previously in a randomized controlled pilot study.

    “This questionnaire was used previously in a randomized controlled pilot study (KCMB, unpublished data, 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (KCMB, unpublished data, 2016)

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Questionnaires to assess time management and self-efficacy were designed on theoretical basis and guidelines by Bandura.

    “Questionnaires to assess time management and self-efficacy were designed on theoretical basis and guidelines by Bandura [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Bandura, A, 2006, Self-Efficacy Beliefs of Adolescents

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Increased self-efficacy has been shown to correlate significantly with self-esteem and adaptive behaviors such as persistence in reaching goals in daily life.

    “It may be important that further development of serious gaming addresses aspects of the concept of self-efficacy (eg, modeling behavior) more thoroughly because increased self-efficacy has been shown to correlate significantly with self-esteem and adaptive behaviors such as persistence in reaching goals in daily life [60-62].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [60] source

      Not checked in the free run.

    • cites [61] source

      Not checked in the free run.

    • cites [62] Lieberman, D, 1997, Health Promotion and Interactive Technology: Theoretical Applications and Future Directions

      Not checked in the free run.

50 of 50

  • The paper relies on this without support.

    A serious game designed to enhance behavior strategies for children with ADHD to improve their daily life functioning has not been scientifically evaluated in the literature.

    “To our knowledge, a serious game designed to enhance behavior strategies for children with ADHD to improve their daily life functioning has not been scientifically evaluated in the literature.”

  • The paper relies on this without support.

    Young patients with ADHD have engagement and motivation issues in general.

    “Given that young patients with ADHD have engagement and motivation issues in general, easy accessible interventions such as serious games can stimulate them to comanage their health care processes as part of the Chronic Care Model of Child Health and the World Health Organization Mental Health Action Plan 2013-2020 [22,23,64].”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Serious game interventions have been found to improve time management and planning/organization and reduce hyperactivity symptoms in students with ADHD.

    “Those authors found improvements in time management and planning/organization, and a reduction in hyperactivity symptoms in a group of students with ADHD who received an SG intervention.”

    From Serious Games and Their Effect Improving Attention in Students with Learning Disabilities (2019) · cites this paper as [14]

  • The current results are consistent with previous research stating that playing videogames can increase concentration and other cognitive variables, such as processing speed or visual discrimination.

    “These results are in line with previous research stating that playing videogames can increase concentration and other cognitive variables, such as processing speed or visual discrimination [12,13,14,15,16].”

    From Serious Games and Their Effect Improving Attention in Students with Learning Disabilities (2019) · cites this paper as [14]

  • Bul et al. [14] found positive effects of serious games on attention in a 10-week SG intervention ('Plan-It Commander') in a sample of ADHD students aged 8-12.

    “The same authors found positive effects of SGs on attention in previous research [14] when they analyzed the effect of a 10-week SG intervention (called “Plan-It Commander”) in a sample of ADHD students aged 8–12.”

    From Serious Games and Their Effect Improving Attention in Students with Learning Disabilities (2019) · cites this paper as [14]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Adverse event both did and did not cause discontinuation

    Minor

    The adverse-events section says the reported events were no reason to discontinue participation, then says an adverse event caused one participant to discontinue.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 13

  1. 2013, Diagnostic and Statistical Manual of Mental Disorders. 5th ed
  2. Sonuga-Barke, E, 2010, J Am Acad Child Adolesc Psychiatry, 49, 345
  3. Conners, C, 2003, Adv Stud Med, 3, S442
  4. 2013, Mental Health Action Plan 2013-2020
  5. Griffiths, M, 2002, Educ Health, 20, 47
  6. Puig-Antich, J, 1978, The Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS)
  7. Reichart, C, 2000, Dutch Translation of the Kiddie-SADS
  8. Oosterlaan, J, 2000, Vragenlijst voor Gedragsproblemen bij Kinderen (VvGK) [Dutch translation of the DBD Rating Scale]
  9. Wechsler, D, 1991, Wechsler Intelligence Scale for Children. 3rd ed
  10. Gioia, G, 2000, Behavior Rating Inventory of Executive Function, Manual
  11. Smidts, D, 2009, Dutch Translation of Behavior Rating Inventory of Executive Function, Manual
  12. Gresham, M, 2008, Rating Scales Manual. SSIS Social Skills Improvement System
  13. Lieberman, D, 1997, Health Promotion and Interactive Technology: Theoretical Applications and Future Directions, 103

Cited by

Sorted by citations

Related

Authors
Bul, K. C., Kato, P. M., Van der Oord, S., Danckaerts, M., Vreeke, L. J., Willems, A., van Oers, H. J., Van Den Heuvel, R., Birnie, D., Van Amelsvoort, T. A., Franken, I. H., & Maras, A.
Affiliations
  • Yulius (NL)
  • Coventry (United Kingdom) (GB)
  • KU Leuven (BE)
  • Janssen (Belgium) (BE)
  • Erasmus University Rotterdam (NL)
Corresponding author
Bul, Kim CM
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2016-02-16
Volume
18
Issue
2
Pages
e26
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.5173
PMC
PMC4773597
OpenAlex
W2286694224
Semantic Scholar
2d63f0279771daa3cfecd43229836b8eccb11089
Cited by
158
References
62
Citations by year
2026: 13 · 2025: 20 · 2024: 19 · 2023: 19 · 2022: 25 · 2021: 15 · 2020: 15 · 2019: 16 · 2018: 6 · 2017: 8 · 2016: 2
FWCI
9.48
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure (Coventry University) (publishedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
  • Lirias (KU Leuven) (submittedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion, cc-by)
  • UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Coventry University Open Collections (Coventry university) (submittedVersion)
  • The Open Collections (Coventry University) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • Vlaamse regering
  • Janssen Pharmaceuticals
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
  • Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
Keywords
attention deficit hyperactivity disorder, serious games, online intervention, adjunct treatment, children, time management, daily living skills, social skills, responsibility, working memory, planning and organization, parent-reported outcomes, child self-report, medication adherence, treatment engagement, treatment discontinuation
MeSH terms
Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Male, Social Behavior, Video Games, Internet

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

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