Another Video Game That Treats ADHD

A well-designed randomized trial puts a tablet-based game to the test

STUDY: Lee S et al, npj Digital Medicine 2026 (Article in Press)

STUDY TYPE: Randomized, single-blind, sham-controlled trial

FUNDING: Korea Medical Device Development Fund (Korean government)

Background

On June 15, 202, the FDA cleared the first video game for ADHD (ages 8-17), EndeavorRx, challenging the perception that video games are bad for mental health. The game plays a bit like MarioCart, requiring you to touch some objects and avoid others as you sail down a rocky river. What sets it apart, however, is this feature: It shuts off after 25 minutes of play per day.

Now comes Star Ruckus, a similar game recently approved in South Korea for child and adolescent ADHD in South Korea. Both games feature adaptive algorithms that scale the game’s difficulty in real time based on the player’s performance to target areas of the brain responsible for attention and multitasking. Star Ruckus gamifies the N-back working memory task, made famous in 2008 after a controversial study found that practicing the test added 3-4 points to a person’s IQ.

This study tested Star Ruckus, and though the game is not available in the US it has implications for other digital therapeutics like EndeavorRx. The company is planning a US edition in the future.

The Study

• 122 children ages 6–12 with ADHD; about half were on stable medication at enrollment.
• Randomized to STAR RUCKUS or a sham app (identical driving game, no N-back task) for 4 weeks, five sessions per day.
• Primary outcome: clinician-rated ADHD symptom scale (K-ARS), rated by psychiatrists blinded to group assignment.

Results

At 4 weeks, STAR RUCKUS produced a 7.5-point drop on the K-ARS versus 4.0 points with sham (statistically significant). Both inattention and hyperactivity/impulsivity subscales favored the game. Clinician global ratings (CGI-I) also favored the active group. Twice as many game players hit the 30% response threshold compared to sham (44% vs 21%).

Neurocognitive tests (attention, inhibitory control) trended better in the game group but didn’t survive correction for multiple comparisons.

The sham control here is better designed than most digital therapeutic trials, with the same interface, same session length, blinded raters.

Side Effects

Two children (3.6%) on STAR RUCKUS reported mild, transient drowsiness. No serious adverse events in either group.

Limitations

Single-blind design; study coordinators distributing devices knew group assignments. Recruited from university clinics in Korea, limiting generalizability. Only 4 weeks of follow-up; durability of gains is unknown. Industry employees co-authored the paper.

Practice Implications

1. Tasks that require us to adjust our actions based on feedback in the environment are generally good for the brain, which is likely why most dexterity games improve cognition, from table tennis to videogames.
2. The brain also needs variety. Musicians know not to practice too long, and gamers can take a lesson from the auto-shut off feature on these apps (learn more ways to curb video game addiction).
3. On the other hand, maybe these games offer more than table tennis? I respect the 10 years of research that went into developing these unique games and the growing clinical evidence behind them. Team sports also have an advantage in ADHD, combining exercise with social and frontal-lobe training.
4. EndeavorRx is available by prescription or over-the-counter ($130/year). Star Ruckus is available in South Korea by prescription.