BackgroundThe 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).ObjectiveThe 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.MethodsParticipants (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.ResultsAfter 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.ConclusionsPlan-It Commander offers an effective therapeutic approach as an adjunct intervention to traditional therapeutic ADHD approaches that improve functional outcomes in daily life.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV).

The need for engaging treatment approaches within mental health care has led to the application of gaming approaches to existing behavioral training programs (i.e., gamification). Because children with attention deficit/ hyperactivity disorder (ADHD) tend to have fewer problems with concentration and engagement when playing digital games, applying game technologies and design approaches to complement treatment may be a useful means to engage this population in their treatment. Unfortunately, gamified training programs currently available for ADHD have been limited in their ability to demonstrate in-game behavior skills that generalize to daily life situations. Therefore, we developed a new serious game (called ''Plan-It Commander'') that was specifically designed to promote behavioral learning and promotes strategy use in domains of daily life functioning such as time management, planning/organizing, and prosocial skills that are known to be problematic for children with ADHD. An interdisciplinary team contributed to the development of the game. The game's content and approach are based on psychological principles from the Self-Regulation Model, Social Cognitive Theory, and Learning Theory. In this article, game development and the scientific background of the behavioral approach are described, as well as results of a survey (n = 42) to gather user feedback on the first prototype of the game. The findings suggest that participants were satisfied with this game and provided the basis for further development and research to the game. Implications for developing serious games and applying user feedback in game development are discussed.

This study examined the relations between behavioral inhibition, Big Five personality traits, and anxiety disorder symptoms in non-clinical children (n = 147) and clinically anxious children (n = 45) aged 6–13 years. Parents completed the Behavioral Inhibition Questionnaire-Short Form, the Big Five Questionnaire for Children, and the Screen for Child Anxiety Related Emotional Disorders-Revised. Results indicated that, compared to parents of non-clinical children, parents of clinically anxious children rated their offspring higher on neuroticism and behavioral inhibition, but lower on extraversion, conscientiousness, and intellect/openness. Further, extraversion emerged as the strongest correlate of an inhibited temperament, and this appeared true for the clinically anxious as well as the non-clinical children. Finally, in both the clinical and non-clinical samples, higher levels of behavioral inhibition and neuroticism were unique and significant predictors of anxiety disorders symptoms.

The School Refusal Assessment Scale (SRAS) was developed to identify four factors that might maintain a youth's school attendance problem (SAP) and thus be targeted in treatment.There is still limited support for the 4-factor model inherent to the SRAS and its revision (SRAS-R). Recent studies indicate problems with the wording of 8 items added to the SRAS to form the SRAS-R. We examined the factorial validity of an adapted item set comprising 16 of the 24 SRAS-R items and 8 items developed for this study. The 8 items paralleled the content of the SRAS-R items being replaced but were less complex and ambiguous. Data