SINGAPORE: A child with a band strapped to his head is moving the character through a maze in a game called CogoLand. The goal is to complete as many laps as possible in ten minutes.
As you watch him, you realise that he’s not using his fingers to move the character across the tablet screen. He’s using his brainwaves which are processed with the help of the headband to do so. Focusing on the character, moves it forward. Losing focus results in the character slowing down or standing still.
“This game is controlled by analysing the child’s brainwaves to detect their attention level. The higher their attention (or concentration), the faster the avatar moves,” said Dr Lim Choon Guan, senior consultant and deputy chief in the Department of Developmental Psychiatry at the Institute of Mental Health (IMH).
The game encourages concentration because it is designed for children with attention deficit hyperactivity disorder (ADHD) a neuro-developmental disorder which is characterised by hyperactive behaviour, impulsivity and inattentiveness.
PILOT RUN AT HOME
It is part of a pilot programme that was launched last month for 20 children aged six to 12 who are receiving treatment for ADHD at IMH. Dr Lim said that the programme would help evaluate if Brain-Computer Interface (BCI) technology used in the game could alleviate ADHD symptoms. The trial is expected to last at least a year.
The use of CogoLand to complement ADHD treatment is the result of a collaboration among IMH, Duke-NUS Medical School and A*STAR’s Institute for Infocomm Research. Neeuro, an A*STAR spin-off, is the current sole licensee of the technology.
The game was developed through a decade’s worth of extensive research, the agencies said. They added that the unique selling point of the technology is that children with ADHD can take part in the programme in the comfort of their homes.
The pilot comes after a large-scale randomised clinical trial for the game involving 172 children with ADHD in Singapore, showed results that were “very promising and robust”, according to principal investigator Associate Professor Lee Tih Shih from Duke-NUS Medical School.
A separate analysis of a subset of the children led by Duke-NUS also showed positive post-training effects observed in brain areas associated with attention and task-orientation.
Scientific advisor to Neeuro, Professor Guan Cuntai, explained that the technology can accurately quantify a person’s attention level in real-time and develop a personalised training programme.
“We hope it (the programme) can benefit many children with ADHD in the future,” Assoc Prof Lee said.
PREVALENCE OF ADHD AMONG CHILDREN
Dr Lim said that ADHD is one of the most prevalent developmental conditions in children, and ranks as one of the conditions with the highest impact - usually quantified by the number of years lost due to disease - among youths in Singapore below 14 years old.
Since 2014, there have been about 500 new patients diagnosed with ADHD each year at the IMH Child Guidance Clinics, he added.
While it is not known how many people in Singapore have ADHD, its prevalence internationally is estimated to be 5 per cent of the population, said Dr Lim, who is also adjunct assistant professor.
ADHD symptoms are usually observable in childhood and remain persistent across time and pervasive across situations, although there is tendency for them to gradually improve years later, he added.
Up to 80 per cent of children with ADHD continue into young adulthood.
“We know that inattentive symptoms tend to be more persistent, and this is the reason why we wanted to pursue research into an alternative method of treatment,” he said.
Despite the "promising" results, psychiatrist at Gleneagles Hospital Dr Lim Boon Leng, who has also seen children with ADHD, said that internationally, results from similar efforts have been poor.
He said that the correlation between brainwaves and concentration may be tenuous, and questioned if improvements seen based on playing can be applied to the rest of the child’s life, and whether such changes are sustainable.
MANAGING THE CONDITION
IMH’s Dr Lim said that a multidisciplinary approach is most effective, which includes psychological and psycho-social intervention, and medication in the case of children with more severe ADHD.
Having a routine is essential to manage ADHD, he said.
Parents may make use of concrete reminders, such as lists, schedules and alarm clocks to help break down homework activities into small steps, Dr Lim said. Use of small, frequent and constantly repeated incentives and feedback increases children’s awareness of what they are doing.
As children with ADHD often feel they can do nothing right or well, helping them experience success by discovering what they are good at will foster their confidence and competence.
However, Gleneagles’ Dr Lim said that from his experience, it is difficult for parents to make such efforts consistently in order to create change in behaviour, given that they could be both working. In school, it is difficult for teachers to implement strategies for individual children, Dr Lim added.
“It is not that behavioural therapy doesn’t work, but parents are often too busy,” he said. They may therefore rely more on medication that can fit into a daily schedule better, he said.
Dr Lim Choon Guan said that medicine changes the brain chemistry that could allow it to function in a more orderly manner.
“As a child’s concentration improves and hyperactivity lessens, the child will find life more manageable and satisfying,” he said.