Roughly 6 million kids between the ages of 4 and 17 are diagnosed with ADHD, according to the Centers for Disease Control. Of that 6 million, about half are misdiagnosed, says Kurt Roots, co-founder and CEO of CogCubed. Roots has teamed up with his wife, Dr. Monika Roots (co-founder and chief medical officer at CogCubed), to create games that model player behavior by leveraging new digital devices. The goal of CogCubed’s games is to help clinicians more accurately and objectively diagnose ADHD.
This week we spent a little time picking their brains about the challenges of diagnosing ADHD and the promise CogCubed holds for accurately diagnosing patients. If you have more questions for the power couple, join them this week on the MedTech Boston Talk forum.
Q: CogCubed… How did you come up with that as a name? What does that mean to you?
Dr. Monika Roots: It’s the intersection between mental health and cognition and technology. “Cog” obviously meaning cognition, and “cubed” meaning the cubes we currently use. The cubes were created at MIT. They are tangible blocks that look like mini-iPhones that interact with each other. We’re using new technology to assess cognition.
Q: What problem are you trying to solve with CogCubed?
MR: We’re trying to bring objectivity to an inherently subjective field. Mental health and behavioral health diagnoses currently are being done by a clinician who asks questions and does a checklist. It’s unusual for them to do objective testing. We’re trying to bring numerical and objective answers to help a clinician make a diagnosis.
Q: How specifically does this game make a difference for the patients you’re trying to help?
MR: If someone says the word “test” to me, I either have a mental freeze or I don’t want to do it. What we want is to have a test that, in some ways, is disguised as a game to encourage the engagement between the clinician and the patient. We want patients to be motivated to engage and complete the game – and be honest in their “play” or their behavior while they’re doing it. Of course, we created the game so that it’s just “boring enough” so we’re able to capture the people with ADHD.
Q: Without CogCubed, how would patients and physicians handle these issues?
MR: Clinicians are looking for answers, but adoption in the healthcare field is typically slow. On top of that, clinicians are always looking for publications and evidence in order to adopt new technologies.
ADHD is known to not just be a problem of patients’ responses and being right or wrong. But it’s actually a problem of not being consistent with their answers. The Continued Performance Test, an objective test that we typically use in the office and in research, is able to capture response variability, meaning: Did they get it right or did they get it wrong and are they consistent with that?
CogCubed’s tool has been able to pick up on the motor variability. For example, how much are they moving between responses and how is that varying? That is crucial, because it helps us differentiate between ADHD and anxiety and depression. Clinicians really get that fact, and they’re very interested to see how it plays out.
Q: What age ranges are we talking about here? It sounds pretty broad.
MR: The new Diagnostic and Statistical Manual of Mental Disorders says that we can diagnose ADHD as of the age of 3. That’s extremely hard, obviously, and has treatment implications. Currently, we have focused our clinical research on ages 6 to 17; also, we’ve recently extended up to the age of 25. These are the individuals who are most frequently assessed for ADHD and attention disorders.
Q: How are these games different from those you’d buy on Amazon.com, at Best Buy or on your iPad?
Kurt Roots: The device that we’re using is manipulative. It has four wireless sensors that are an inch-and-a-half by an inch-and-a-half by an inch-and-a-half high. They have LCD screens, and they’re high resolution. The gaming experience with something like this is very different from what you’d see with a mobile device or a tablet device. How you interact with that is very different as well. With a tablet device, you might have it on a table. With a mobile device, you might be holding on to it. But that doesn’t allow for the spatial component, which we’ve used in assessing attention.
Like Monika said, our games are “just boring enough” that they’re a little repetitive. There are 16 levels with our games, one of which is called Groundskeeper. The number of distractions and the way that the objects move around in the game are things you might see from level one to level 16, for example.
Q: How are patients responding to this so far?
MR: I’m the world’s biggest pessimist about new tests. When we first created this and started to have patients – especially young patients – using this, I was fascinated at how interested and willing they were to engage with it. One of my biggest jobs as a child and adolescent psychiatrist is to get the child to speak to me, get them engaged, get them to do something so that I can actually analyze what they’re doing. Patients have been very willing to play the game – and that alone is a victory. Parents welcome any information you can provide that will help their children. They’re very open to a numerical explanation of how their kid’s doing.
Q: How are investors responding?
MR: Investors seem to be extremely interested in the momentum created by the biotech field. They frequently ask if we have a mobile app or if we have a mobile version of our games. Our technology is different, and the design of our games makes it possible to capture some of the data we need to diagnose patients properly. Investors are interested in our new technology and they’re asking the important questions about how we’re going to get this out to clinicians. They seem to be interested and open to this idea that it’s a new way of objectively identifying these disorders, which they realize are a problem.
In addition to that, given that our game is really building on some of the limitations of previous tests, there are existing billing codes. Because of that, some of the obstacles that high-tech startups have, we don’t have.
Aine (“ONya”) Cryts is an on-staff contributing writer for MedTech Boston. She's a political scientist by education, a writer and marketer by trade. She has written for various healthcare technology publications and also served as marketing director at several healthcare software companies in the Boston area. Cryts is an avid volunteer, pet lover and long-distance runner. Story ideas are always welcome.
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