A big bet on game-changing ADHD treatment

December 1, 2013

Were it not for the black headbands they were wearing, the two fourth-graders would have looked like any other kids playing video games on a break from class one recent morning at the Churchill School in Manhattan. But as a little bird bounced along a road on each computer screen, the boy and girl were doing something that seemed straight out of a magic show: making their characters move simply by paying attention.

The game is a prototype for a deluxe version that will be released commercially for 8- to 12-year-olds next summer by Waltham, Mass.-based startup Atentiv. Designed for children who have trouble paying attention, the digital learning device marks the first implementation of technology developed in Singapore that uses a brain-to-computer interface to strengthen focus, just as a treadmill works the heart and lungs.

That, at least, is the idea. The children, who play for 20 minutes three times a week, are part of an eight-week school-based study aimed at assessing the impact of the game on their schoolwork and home life. The Churchill School, on East 29th Street, is for students with learning disabilities.

A clinical study of the effects of the game, with a control group, is set to begin on the Upper West Side with children at the Hallowell Center, which specializes in treating attention disorders.

The game, which employs electroencephalography sensors in the headbands to transmit brain-wave activity to the computer via Bluetooth, may be just the beginning, as Atentiv joins a growing field of neuro-feedback applications. Its system is undergoing a clinical study in Singapore, with another planned for the U.S. next year that could lead to an advanced version being used by clinicians to treat attention-deficit/hyperactivity disorder without drugs.

That’s the dream of Atentiv founder and Chief Executive Eric Gordon, a serial entrepreneur in the biotech industry whose grown daughter has suffered all her life with problems related to ADHD.

“We have one parent saying, ‘For the first time, my daughter in ballet can hold a pose for 10 seconds,’ ” he said in an interview at the Churchill School, referring to a clinical study being conducted at the Hallowell Center’s Sudbury, Mass., location. “Being the parent of that child—because I was one—that takes the knees out from under you, because you have no idea how difficult [ADHD] is to live with day in, day out.”

The brain-workout market is a sprawling one, with a number of practitioners and companies offering games that also claim to improve attention. The governing concept behind all of them is neuroplasticity, the term for the brain’s ability to heal itself and learn new skills.

The distinction of the Atentiv system, according to Mr. Gordon, is the precision with which its technology calibrates each individual’s mental circuitry and then zeroes in on electrical activity related to attention, as opposed to memory, for instance, or critical thinking. A numerical indicator on the screen gives a real-time reading of the child’s attention level, the numbers fluctuating from zero to 100.

The goal of the game is to get a bird to move along a winding road and perform certain tasks that require tapping keys. But the bird speeds along, or slows down and stops, depending solely on the degree to which the user stays focused.

It’s not an easy task, as this reporter found when he tried on the headband. Willing oneself to “pay attention” can bring the bird figure to a stop. The user must ignore all distractions—including the mind saying, “Focus! Focus!”

Questions remain

“The breakthrough here is that no one’s ever been able to isolate, target and measure the exact cognitive signature for a unique neural circuit,” Mr. Gordon said. “Based upon the calibration, you’re exercising that exact ‘muscle.’ ”

The ultimate question will be whether children who exercise that muscle in the game will exercise it in life—that is, will they tune out distractions and finish their homework, sit through dinner and pay attention in class?

Studies initially done in Singapore—where the system was developed by government science agency the Institute for Infocomm Research and Dr. Ranga Krishnan, dean of Duke’s medical school in Singapore—showed a 40% reduction of symptoms such as inattention and impulsivity in children with moderate to mild ADHD after eight weeks of using the game.

Cumulatively, in all studies to date, “75% to 85% of children have shown significant improvement,” or roughly the same percentage who are helped by drugs, Mr. Gordon said.

The clinical study in Singapore is “registration quality”—as will be the one expected to begin in the U.S. next year—meaning it could help to gain clearance from the Food and Drug Administration for a different application of similar technology.

While brain games may be good exercises, some experts warn that their benefits have not been conclusively shown to extend beyond the games themselves.

“[Atentiv] sounds interesting,” said David Hambrick, a professor of psychology at Michigan State University, who has worked on studies that debunked claims of companies like Cogmed and Lumosity that their games improved memory or attention. (Cogmed and Lumosity maintain their exercises work.)

Spending on ADHD medication in the U.S. rose from $4 billion in 2007 to $9 billion in 2012.
Photo: Newscom

But beyond being interesting, Atentiv will have to prove through “rigorous study” that it’s effective, Mr. Hambrick added.

It also has to prove that it’s different, said one competitor. “There’s nothing new here,” said Peter Freer, founder of Asheville, N.C.-based Unique Logic and Technology, which produces an EEG-based game called Play Attention.

“Others may claim to do this,” responded Mr. Gordon, but their products “are using technology that is 20 years old, or older.”

Atentiv will face an especially high bar if it’s to be used by medical professionals in lieu of drugs such as Ritalin and Adderall, whose use is widespread and growing. Spending on ADHD medication in the U.S. rose from $4 billion in 2007 to $9 billion in 2012, according to research firm IMS Health, with the lion’s share of that medication being given to children and teenagers. About one in 10 children have been diagnosed with the disorder, according to the National Institutes of Health.

So far, EEG-based remedies have been “somewhat promising” but not convincing overall, said Dr. Jonathan Posner, assistant professor of clinical psychiatry at Columbia University.

“The medications we have for ADHD are among the most effective medications in all of psychiatry,” he added. If Atentiv can take their place, “that would be quite a substantial breakthrough.”

‘Huge market’

Investors in Atentiv say it will also be a good business.

The government of Singapore and angel investors in New York and Boston have so far put $20 million into the company. Mr. Gordon, who has also invested his own money, is now looking to raise between $10 million and $15 million to finance the commercial launch. He also hopes to persuade school systems, including New York City’s, to employ the Atentiv system.

“The market is huge, and I concluded there is nothing quite like this,” said Ernest Pomerantz, chairman of StoneWater Capital in Manhattan, adding that he consulted with neuroscientists and psychiatrists before investing in Atentiv. “It has the potential to be a high-margin business and do a lot of good.”

Particularly attractive to Mr. Pomerantz is the potential of Atentiv’s technology to target different mental functions and age groups, including adults and the elderly.

Games for improving attention for high-school students and pre-schoolers will be out late next year or in early 2015, following the company’s product debut next summer—all of them produced by San Francisco-based developer Mighty Play. The first game will be priced at $260.

Atentiv’s supporters say that even if the system proves as effective as they believe it will, there will continue to be a range of treatments for attention disorders.

“Physical exercise helps, meditation helps, medication, getting enough sleep, nutrition,” said Dr. Edward Hallowell, director of the Hallowell Center, who is also an investor in Atentiv. “But now this Atentiv system is another tool in the toolbox, and it may be the most powerful one of all.”

A version of this article appears in the December 2, 2013, print issue of Crain’s New York Business.

Article source: http://www.crainsnewyork.com/article/20131201/TECHNOLOGY/312019979


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