Background Attention-deficit/hyperactivity disorder (ADHD) affects between 4% and 8% of children worldwide. The treatment of choice is multimodal treatment. Multimodal interventions for ADHD may be improved by incorporating new treatments, such as treatment via serious video games. The Secret Trail of Moon (TSTM) is a virtual reality serious video game that was designed for cognitive training related to core ADHD symptoms and executive dysfunction. Objective We aimed to describe the development and usability of TSTM. Methods The usability study included 37 children and adolescents who tested TSTM during the early usability stage (preinclusion) of a randomized controlled clinical trial for testing the effectiveness of TSTM. Chi-square tests were performed to compare patients with ADHD (ADHD combined subtype vs inattentive subtype) and to compare frequent and infrequent video game players in the second study. We used SPSS version 20 for Macintosh (IBM Corporation). Results A total of 31/37 (86%) and 30/37 (83%) of participants liked playing TSTM and wanted to continue playing TSTM, respectively. Further, 5/37 (14%) of participants reported that they experienced either perceived dizziness or virtual reality motion sickness. We found no statistically significant differences after comparing the ADHD combined subtype to the inattentive subtype and frequent video game players to infrequent video game players. Conclusions Serious video games, such as TSTM, may complement the current multimodal approach for treating ADHD. Trial Registration ClinicalTrials.gov NCT04355065; https://clinicaltrials.gov/ct2/show/NCT04355065

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BACKGROUND Attention-Deficit/Hyperactivity Disorder (ADHD) affects between 4% and 8% of children worldwide. The treatment of choice is multimodal treatment. Unfortunately, multimodal treatment is usually insufficient to fully correct ADHD. Accordingly, the incorporation of new treatments such as serious video games may be a good strategy. Here, we present a Virtual Reality (VR) chess-based serious video game (“The Secret Trail of Moon”, TSTM), which was specifically designed to treat core ADHD symptoms and executive dysfunction. OBJECTIVE This study aims to describe the development, proof of concept and usability of TSTM. METHODS We included information about: 1) a brief market study (n=56) over the potential interest of professionals in using a serious video game such as TSTM, and 2) a proof-of-concept and usability study including 37 children and adolescents who tested the initial versions of TSTM during an ongoing randomized controlled clinical trial testing the effectiveness of TSTM. RESULTS Eighty-six percent and 83% of participants liked and would like to continue playing TSTM, respectively. Thirteen and nine-tenths percent were reported to have either perceived dizziness or VR motion sickness. We found no statistically significant differences after comparing either ADHD combined vs. inattentive subtypes or frequent vs. infrequent video game players. Furthermore, wearing glasses did not affect our results. CONCLUSIONS Serious video games such as TSTM may help educational and medical professionals to either diagnose or treat ADHD. TSTM, a VR chess gamified serious video game was well-tolerated and most participants liked and wanted to continue playing TSTM. CLINICALTRIAL ClinicalTrials.gov NCT04355065; https://clinicaltrials.gov/ct2/show/NCT04355065

IntroductionThe use of video games has become widespread worldwide. Excessive use of video games is increasingly becoming a matter of concern, particularly in patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Currently, internet gaming disorder (IGD) is not included within the DSM-5-chapter Disorders related to substances and addictive disorders.MethodsThis is a post-hoc descriptive naturalistic study comparing children and adolescents diagnosed with ADHD with and without IGD. We used the 85% cut-off point of the test ADITEC-V for video game addiction to split our sample of ADHD patients into those with IGD (>=85%) and those without IGD (<85%).Results13 (25%) out of the 51 children and adolescents with ADHD included in our study had an IGD. Patients with IGD had a first contact with internet, smartphones, and videogames at a very early age (5.67 ± 3.31, 6.33 ± 4.60, and 7.50 ± 2.61, respectively). However, only age at first contact with the internet was statistically significantly different when comparing ADHD patients with and without IGD (8.68 ± 2.71 vs. 5.67 ± 3.31, t = 3.166, df = 47, p = 0.01). Different neurodevelopmental, clinical, and neuropsychological measures converging in impulsivity is a risk factor for IGD. Unexpectedly, we found no association between IGD and poor academic achievement.DiscussionFuture studies may include randomized controlled trials for treating IGD, the study of social adjustment as a protective factor against developing an IGD, and the role of serious and non-serious video games in the development of an IGD, among others. Additional research is clearly needed on IGD.