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

Kim Bul, Pamela Kato, Saskia Van der Oord, Marina Danckaerts , Leonie Vreeke, Annik Willems, Helga van Oers, Ria van den Heuvel, Derk Birnie, Therese van Amelsvoort, Ingmar Franken, Athanasios Maras

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    Background: The need for accessible and motivating treatment approaches within mentalhealth has led to the development of an Internet-based serious game intervention (called Plan-ItCommander) as an adjunct to treatment as usual for children with attention-deficit/hyperactivitydisorder (ADHD).Objectives: To determine the effects of Plan-It Commander on daily life skills of children withADHD 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 inage from 8 to 12 years (male: 80.6%, 137/170; female: 19.4%, 33/170). They were randomizedto 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 inaddition to treatment as usual for the first 10 weeks and then received treatment as usual for thenext 10 weeks. Participants randomized to group 2 received treatment as usual for the first 10weeks and crossed over to the serious game intervention in addition to treatment as usual forthe subsequent 10 weeks. Primary (parent report) and secondary (parent, teacher, and childself-report) outcome measures were administered at baseline, 10 weeks, and 10-week followup.Results: After 10 weeks, participants in group 1 group compared to group 2 achievedsignificantly greater improvements on the primary outcome of time management skills (parentreported; P=.004) and on secondary outcomes of time management (teacher reported; P=.09),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 werenonsignificant between groups. Within group 1, positive effects were maintained or furtherimproved in the last 10 weeks of the study. Participants in group 2, who played the seriousgame during the second period of the study (weeks 10 to 20), improved on comparable domainsof daily life functioning over time.Conclusions: Plan-It Commander offers an effective therapeutic approach as an adjunctintervention to traditional therapeutic ADHD approaches that improve functional outcomes indaily life.TrialRegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 62056259; (Archived by WebCite® at

    Publisher Statement: This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
    Original languageEnglish
    Article numbere26
    Number of pages19
    JournalJournal of Medical Internet Research
    Issue number2
    Publication statusPublished - 16 Feb 2016


    • Attention Deficit-Hyperactivity Disorder
    • Randomized Controlled Trial
    • Treatment
    • Children
    • Internet
    • Serious Game


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