How Therapeutic Video Games Are Becoming Prescription Medicine for Mental Health

 Once the subject of concern and debate with respect to their impact on well-being, video games are increasingly being redeemed in research and developed for the express purpose of addressing and improving mental health. In this News and Perspectives article, JMIR Correspondent Benedette Cuffari reports on the state of serious games.

Key Takeaways:

• Serious video games use evidence-based psychological methods to support the development of emotional, cognitive, and behavioral skills.
• Therapeutic video games range from US Food and Drug Administration (FDA)–authorized treatments for attention-deficit/hyperactivity disorder (ADHD) to commercial games that may support emotional well-being and resilience.

Most mental health disorders emerge during adolescence, with peak onset at just over 14 years of age. The adolescent brain is characterized by a high degree of neuroplasticity—the brain’s ability to adapt and form new connections—suggesting that adolescence may also be an ideal period of life for improving and promoting positive mental health through innovative approaches.

But stigma, high costs, and inequitable access to mental health services often prevent adolescents with mental health disorders from receiving treatment, with only half of American adolescents, for example, receiving needed mental health support. If left untreated, these individuals are more likely to drop out of school, experience behavioral difficulties, abuse drugs, and die by suicide; the need for more effective alternatives to conventional treatments is urgent.

What Are Serious Games?

Serious games have emerged as a promising strategy to address mental health concerns, particularly for adolescents, by combining entertainment with validated therapeutic approaches. Compared to traditional video games developed primarily for recreational purposes, serious games are designed by using established principles from cognitive behavioral therapy or acceptance and commitment therapyhttps://my.clevelandclinic.org/health/treatments/acceptance-and-commitment-therapy-act-therapyto support cognitive and emotional skills.

Like conventional video games, serious games can immerse users in fictional worlds through a combination of auditory, visual, and tactile stimuli that then help engage them in therapeutic cognitive, behavioral, or emotional learning processes. Typically, they incorporate an overarching storyline, accompanied by player dialogues, in-game feedback, mini-games or quizzes, and other gaming elements to simulate real-life situations. These games can be designed to prevent or treat mental health conditions, including anxiety, depression, posttraumatic stress disorder, autism, and attention-deficit/hyperactivity disorder (ADHD), and to supplement existing therapies, emotional development education, and standardized academic evaluations.

How Video Games Became Prescription Medicine

For practicing clinicians, therapeutic video games connect evidence-based strategies with patient engagement. “Video games create a safe environment where clients can explore complex emotional themes and practice real-life coping mechanisms,” notes Megan Connell, PsyD, ABPP—a board-certified clinical psychologist specializing in neurodivergent care for women and girls. “Games offer a diverse range of experiences where patients can process challenges through an interactive medium.”

Now, one of them can even be prescribed: EndeavorRx, the first and only video game to be approved by the US Food and Drug Administration (FDA) for children between 8 and 17 years of age with primarily inattentive or combined-type ADHD. The basis of EndeavorRx is for users to guide alien avatars traveling on flying saucers through dynamic worlds with changing landscapes and moving obstacles.

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It’s designed to challenge users’ ability to pay attention to multiple things at once, improving their ability to focus and filter out distractions. Powered by a proprietary adaptive algorithm, EndeavorRx continuously adjusts its difficulty to personalize the treatment experience for each patient, which maintains engagement by encouraging them to perform better during each game. With a prescription of up to 25 minutes of play, 5 days a week, for at least 4 consecutive weeks, EndeavorRx has been shown to improve attention capacity in 73% of children.

EndeavorRx should not, however, be considered a stand-alone treatment for ADHD or a replacement for standard medication. Rather, it should be incorporated as one component of a broader treatment plan that may include medication, educational programs, and/or therapy.

From Serious Games to Commercial Games With Serious Impact

Beyond FDA-authorized software, commercial off-the-shelf video games—not explicitly built for therapeutic purposes—are nonetheless increasingly being evaluated as low-cost and accessible mental health interventions. “We utilize indie games like Gris quite a bit,” says Connell, referring to a video game where users guide the main character as she processes a deeply emotional loss. “Each level explores a different aspect of grief, finding yourself, and discovering your own purpose while confronting challenges.”

Eudaimonic video games, like Gris, aren’t designed as mental health treatments but can evoke meaning and improve mood through self-growth experiences that directly address emotional states. In addition to enhancing resiliency to stress, frustration, or sadness through meaningful and reflective scenarios, these video games could function as therapeutic tools for promoting relaxation and emotional well-being.

Even video games like Dark Souls, which was originally created for entertainment purposes alone, may have eudaimonic effects. This combat-focused action role-playing game is incredibly challenging, even for experienced players, and requires characters to die repeatedly as part of the core experience. Yet, research examining the themes present in an online forum dedicated to the game suggests that individuals respond favorably to this dynamic and view it as useful for coping with difficult emotional experiences, like depression. By forcing players to sit with frustration, Dark Souls teaches players to practice perseverance, even when their depression tells them to give up, through frequent failures accompanied by rewarding moments of achievement and victory, while also prompting existential reflection and providing community.

Like EndeavorRx, Dark Souls, Gris, and other nonprescription video games can complement established treatment approaches for their respective indications rather than serve as a replacement for standard treatment. This caveat is particularly important for users who turn to these games to escape from or avoid negative moods, as their overuse can contribute to problematic or excessive gaming rather than help players develop and apply real-world coping skills.

The Future of Serious Games

Many existing serious games are limited by a one-size-fits-all design that requires all players to interact under the same rules, with minimal adaptation to individual differences. To overcome this limitation, AI tools are being explored for their potential to create personalized and realistic environments that adapt, in real time, to changes in the players’ behavior during gaming. Additional customizations can be based on the players’ learning styles, personal strengths, and challenges to make the gaming experience more personalized and engaging.

Virtual gaming experiences can also be enhanced with immersive technologies like virtual reality, which blurs the lines between reality and the digital world to create a more realistic experience that allows players to focus their attention on targeted stimuli. For example, the PainWaive game combines a brain-monitoring headset with the game application to help users learn how to consciously regulate brain activity linked to chronic nerve pain. PainWaive and similar digital therapeutics offer a nonpharmacological alternative that can reduce reliance on addictive prescription opioids.

Incorporating physiological sensors to monitor heart rate, skin conductance, or brain activity also adds a useful layer—providing feedback to users and feeding back into game parameters. As these tools evolve, clinicians emphasize that their integration into the clinic must remain thoughtful. “Any intervention can be helpful or harmful; it depends on how you want to wield it and use it,” Connell concludes.

Children should be given more opportunities for independence before adolescence

As thousands of children start secondary school, experts have called for children to be given more opportunities for independence before they hit adolescence.

New research, from the Outdoor Play Research Centre based at the University of Exeter, of almost 9,000 children and young people across England found that greater independence was not automatically associated with better wellbeing. Among adolescents, the context in which that independence was experienced mattered: for those who felt unsafe to travel within their neighbourhood, greater independence was associated with lower wellbeing.

The findings come against a backdrop of a substantial generational decline in children’s freedom. Previous research has shown that the proportion of primary-school children in England allowed to walk to school alone fell from 86 per cent in 1971 to 25 per cent in 2010, while children are now typically granted greater independence at around the age they move to secondary school at 11 years old.

The researchers, led by Outdoor Play Research Centre deputy director Dr Paul McCrorie, suggest that the findings raise important questions about whether children are being given enough opportunities to gradually develop the skills, confidence and familiarity with their neighbourhoods that may help prepare them for greater independence in adolescence.

Dr McCrorie of the University of Exeter said: “There is a compelling argument that children need more freedom and opportunities to do things independently.

“Our findings don’t contradict that. What they suggest is that simply giving children independence isn’t enough.

“We need to think about the conditions in which that independence happens. Asking a young person to navigate their neighbourhood independently when they don’t feel safe doing so may be a very different experience from giving them freedom in an environment where they feel confident, secure and supported.

“The goal shouldn’t therefore just be to give children more freedom. It should be to create communities where children feel able and ready to use that freedom.”

The Outdoor Play Research Centre has called on policy makers to respond to their research by moving beyond simply encouraging children’s independence towards creating the conditions that make it possible. This requires coordinated action across transport, urban planning and communities, alongside support for parents to progressively give children greater freedom. They have called for more zebra crossings, investment in crossing patrol staff - lollipop men and women – and help to establish walking buses.

The Department for Transport unveiled an active travel plan in June, pledging £4.5 billion for walking, wheeling and cycling routes and promising 10,000 safer crossings over the next five years.

Please find the full report here.

ENDS 

Kids’ brains are built for distraction. Sometimes that’s a good thing.

 Parents often learn the hard way that to make it anywhere on time, they should calculate how much time they think they need to get ready — and double it.

It’s hard enough for adults with deep-rooted mental checklists to make it out the door. For young children, such lists give way to treasure maps.

Everything from clothing choices to snacks and toys for the car require diplomatic negotiations that can’t be rushed without risking a meltdown. The clock is ticking, but your child is blissfully unaware and is suddenly more interested in staying home.

Whereas adults rely on streamlined internal mind maps to carry out their daily routines, young children’s brains appear to be wired for distraction. According to a review paper published recently in Trends in Cognitive Sciences, what might look and feel like pure chaos — or worse, obstinance — is an important window into how growing minds think and learn through exploration.

In the paper, lead author Vladimir Sloutsky, a professor of psychology at The Ohio State University, revisits research his lab previously reported in the Journal of Experimental Psychology: General, and notes that “children tend to explore broadly, and, despite its costs, exploration confers important benefits, especially early in development, when they know little.”

In other words, Sloutsky said, “they are humans learning to be human.”

When choosing between trying something new (exploration) or repeating actions that have already proven successful (exploitation), learners of all ages encounter what researchers call the “exploration-exploitation dilemma.” Trying new things might prove to be a waste of time and energy, but repeating familiar actions could prevent someone from acquiring new skills or knowledge.

Adults are typically more exploitative, preferring to repeat actions that have previously led to successful, rewarding outcomes, while children are less selective about where they direct their attention. Sloutsky and his co-authors wanted to find out more about what is driving this exploratory behavior, particularly in children between the ages of 3 and 8 years old.

For decades, the prevailing theory was that children explore simply because they are naturally curious — or, possibly, because their decision-making is more random. Sloutsky’s work offers a different explanation: Early exploration is driven by the immaturity of a child’s working memory system.

A mature working memory helps adults hold onto a plan and selectively filter out distractions, while an immature working memory, by contrast, is set to “distributed attention,” meaning young children are prone to spreading their attention broadly. To test this, Sloutsky’s team overloaded adults’ working memory by asking them to complete a decision-making game while also reporting whenever two consecutive odd numbers appeared in a stream of continuous numbers. When their working memories were taxed, adults in the study abandoned their strategic choices and explored more broadly, exhibiting attentional patterns nearly identical to 5-year-olds.

While children’s lack of focus might make leaving the house a test of patience, it serves a crucial evolutionary purpose, ensuring that young learners absorb as much information as possible about the world. “Because they don’t have a fully developed working memory system, children will explore and resample, especially in less familiar situations. An adult will quickly decide that something is worthy of attention and other things are not. Children do not make those selective decisions as quickly,” Sloutsky said.

For example, let’s say you’ve researched nearby gas stations and found a couple with lower prices. You might start to frequent those stations without continuing to search for better options. Meanwhile, other stations are dropping their prices and becoming more competitive, but you won’t benefit because you are certain that your initial choices are the best ones.

“Because children explore, they may not immediately optimize the benefit of the best option, but they also won’t lose out if something in the environment changes,” Sloutsky explained. “That is where exploratory behavior becomes very beneficial, guarding them against being entrapped by their own knowledge early in development.”

Sloutsky hopes studies like this help remind parents that kids “are annoying and destructive for a reason: They need to acquire a lot of knowledge in a relatively short period of time. We need to provide them with things that are OK to break, because exploring and breaking things is how they learn about the world.”

If you plot immaturity — measured by the onset of the first molar in mammals or the age of sexual maturity — against brain size, you will find an almost perfect dependence: the greater the brain size, the longer the period of immaturity, he noted.

“Children are almost completely immobile for the first year of life, disorganized for the next three, extreme risk-takers for the next 15 and self-insufficient for the first 22 years,” Sloutsky said. “It is extraordinarily costly, and that cost is mainly borne by caregivers. But it is necessary given how much kids need to learn. Organisms with bigger brains have longer periods of immaturity to allow them the flexibility to learn all that.”

Visual aids help school-aged children with ADHD recount stories

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Graphical illustration with two silhouetted children, one reading from a book, with a squiggly line between them.

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Credit: Adrian Skov (OIST)

Whether you’re sharing a funny story told by another friend or recounting the details of a text for a school exam, accurate storytelling and retelling are an integral part of everyday communication and children’s education alike.

A new study from the Okinawa Institute of Science and Technology (OIST) has found that children aged 8-12 with attention deficit hyperactivity disorder (ADHD) retell less complete and coherent stories than their neurotypical counterparts, potentially putting them at a disadvantage in social and educational settings. Visual aids helped reduce the gap. Their findings, published in Research on Child and Adolescent Psychopathology, pave the way for creating more inclusive learning and social environments for school-aged children.

Dr. Hend Samniya from the Human Developmental Neurobiology Unit (Professor Gail Tripp) at OIST explains: “Previous research on story retelling has focused on a narrow range of variables, leaving a significant gap in our understanding of its role in communication and learning of children with ADHD. It occupies a larger role in communication than we might imagine — sharing experiences, memories, or feelings is important socially and for children’s development.”

Visual aids improve storytelling, but do not remove performance gaps

In the study, English-speaking children aged 8-12, with and without ADHD, were told two short stories from Aesop’s fables with and without visual aids. Transcripts of the retellings were then coded by researchers to capture the narrative structure, fluency, and linguistic accuracy of each participant.

The researchers found clear differences in narrative ability between children with and without ADHD. They also confirmed that visual aids helped participants with ADHD retell stories better to a much greater extent than their peers, likely because neurotypical children already performed well without visual support. However, even with visuals, their performance did not match their peers. “It’s important to note that even though we could see the general differences between participant groups, each child experienced the challenges differently — there is no one-size-fits-all intervention,” adds Samniya.

Recognizing ADHD-related challenges beyond diagnosis

ADHD is a common neurodevelopmental condition, affecting an estimated 8% of children and 3% of adults worldwide.  While the lived experiences of every person with ADHD differ, the condition generally complicates participation in social settings, particularly those that carry a high expectation of rote performance and repetition. This especially impacts school-aged children, whose challenges with ADHD are known to impact learning performance and social relationships in classroom settings. Samniya summarizes:

“It’s encouraging to see ADHD receiving more attention in recent years. I hope that our study can help increase awareness about the diverse challenges faced by people with ADHD, and help educators, clinicians, and carers in recognizing potential language and communication difficulties early to create supportive spaces for children with ADHD.” 

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Journal

Research on Child and Adolescent Psychopathology

DOI

10.1007/s10802-026-01494-3 

New book: case studies where university journalism programs provide, publish news

 The United States has lost more than 3,000 newspapers in the last 20 years. In most cases, those outlets are simply gone. 

A new book co-written by a University of Kansas professor of journalism examines what happens when universities step in to serve news deserts and what it means when “universities own the news,” according to the authors.

“News Desert U” by Teri Finneman, professor of journalism at KU, and Pamela Walck of Duquesne University details six case studies of universities that started publications to provide service to communities that no longer had their own newspaper.

There are many partnerships across the country in which journalism students provide news coverage of a given community to an existing company that oversees operations of the outlet. Those detailed in “News Desert U” are different.

“There is a group of faculty across the country seeing this problem of a need for more local news and knowing something must be done. Action must be taken,” Finneman said. “These faculty want to put their research and knowledge to use.”

As a result, a handful of them either started local news outlets themselves or helped save newspapers from closing. They now collaborate with students to keep local news alive.

The book, published by Bloomsbury, details six such operations in Georgia, Iowa, Kansas, Massachusetts, Nevada and Ohio. All six were unique in their formation, operation and structure, but all have lessons they can provide for the pros and cons of a university-operated news outlet.

Among the positives, the authors point out that journalism faculty have industry experience and knowledge as well as experience researching journalism and academic insight they can lend to the operations. Universities also have a renewable supply of students to provide coverage as well as multimedia equipment and often physical space for staff to meet, all of which allows them to provide operations at a fraction of the cost.

Significant challenges remain, however, and the authors point out that in cases where working for the outlet is part of a one-semester class, turnover presents difficulty in maintaining consistency or continuity in coverage. Further, universities often do not recognize the amount of time and work required of a faculty member to serve as a publisher and all the attendant roles, including generating revenue and serving as a community liaison, the authors wrote.

Each chapter details the unique work of university partnerships to address news deserts. In Iowa, the partnership saved two existing newspapers. In Kansas, students produce “Good Morning Indian Country,” a broadcast program to serve Indigenous communities. In Ohio, the academic news partnership ultimately was unable to continue.

In the conclusion of “News Desert U,” Finneman, who serves as publisher of the Eudora Times, another Kansas project, and co-author Walck argue there are many benefits a university community news partnership can provide. Furthermore, there are lessons that existing partnerships can provide, namely that universities would do well to support faculty members who take on the role. The book not only provides lessons learned but also questions a university should ask itself before taking on such an arrangement.

Finneman and Walck will host a “News Desert U” virtual conference Sept. 14 with faculty featured in the book discussing the structure of their publications, finances, student and community impact, and related topics. Registration is available online.

Eating disorders more common in teens from low socioeconomic backgrounds

Teenagers who come from households with a lower income and lower level of education are more likely to have an eating disorder, finds a new study co-led by UCL researchers.

The study, published in International Journal of Eating Disorders and in collaboration with researchers at Copenhagen University Hospital, reviewed data from 51 studies involving 26,174 adolescents from Western countries across North America, Europe and Australia.

It found that, contrary to common stereotypes, eating disorders don’t just affect wealthy and well-educated families, and that this assumption can lead adolescents from lower-income backgrounds to be overlooked, under-screened, or not recognised as at risk.

Senior author, Dr Nora Trompeter (UCL Great Ormond Street Institute of Child Health), said: “Eating disorders are often stereotyped as a problem of affluence but this review shows that this is not the full picture.

“Our review has found that teenagers from lower-income, lower-education households are actually more likely to show signs of disordered eating, not less.

“This tells us that disordered eating is a concern across the socioeconomic spectrum, and prevention and treatment efforts need to reach families facing financial and social disadvantage, who may currently be overlooked.”

Alongside diagnosed anorexia, bulimia and binge eating disorders, the review also included early warning symptoms of disordered eating, such as restricting food, fasting, poor body image and feeling a pressure to become thinner.

Family income showed the strongest and most consistent correlation. About two-thirds of the studies found that teenagers from lower-income families were more likely to have eating disorder symptoms, and no studies found the opposite.

The analysis also found that teenagers whose parents had more education were less likely to have symptoms of an eating disorder.

For example, teenagers whose parents didn’t attend university were around 25% more likely to report eating disorder symptoms than teenagers whose parents did go to university*.

However, other measures of social and economic background, such as how deprived a neighbourhood is, parents' jobs, financial difficulties, or receiving government benefits, gave much more mixed and inconsistent results.

Dr Trompeter said: “Eating disorders don’t discriminate by income or education. If anything, the evidence points the other way, and treating them as a ‘privileged’ condition risks leaving adolescents most in need of support undiagnosed and untreated.”

As a result of their findings, the researchers are now calling for clinicians, healthcare professionals, and school counsellors to broaden their assumptions about who is at risk of an eating disorder, to improve early identification.

Dr Trompeter added: “Challenging outdated stereotypes could help reduce missed diagnoses and ensure that those young people who are most in need receive timely treatment.”

The study was supported by grants from UK Research and Innovation and the Novo Nordisk Foundation.

Study limitations

Most studies involved mainly White adolescents from Western countries. The studies that were analysed also used different ways of measuring family socioeconomic status, making it difficult to draw firm conclusions.

*Education was measured in different ways across studies but broadly maps onto whether parents had a university-level education or not.

U.S. Students Above OECD Average in Science, Reading, and Computational Problem Solving

 

The National Center for Education Statistics (NCES) today released the U.S. results from the 2025 Program for International Student Assessment (PISA), an international study of how 15-year-olds around the world apply their knowledge and skills to real-world challenges. Administered by the Organization for Economic Co-operation and Development (OECD), PISA assesses student performance in science, mathematics, and reading. In 2025, 91 education systems participated, including 38 OECD member countries. U.S. students scored above the OECD average in science and reading, while the U.S. mathematics score was not significantly different from the OECD average. Average U.S. scores in science and mathematics were not measurably different from those in 2022, while the reading score was significantly lower than in 2022. PISA 2025 also introduced Learning in the Digital World, a new assessment that measures how students build knowledge and solve problems using digital tools. U.S. students scored above the OECD average in computational problem solving, one of the two reporting subscales of this new assessment. The report also examines longer-term trends across PISA cycles. The 2025 cycle was the largest in PISA's history, with more than 760,000 students participating across 91 education systems. PISA 2025 was the ninth cycle of the assessment, which was first administered in 2000. View the full report on the PISA 2025 U.S. Results page. Learn more about PISA.