Will, a 13-year-old from Wisconsin, lives with high-functioning Asperger’s and faces difficulties recognizing and managing his emotions. He doesn’t like to talk about emotions he perceives as negative, and becomes upset when he doesn’t meet the high standards he sets for himself. These oachhallenges have made it difficult for Will to thrive in social situations.
Karen immediately began researching strategies, as many as she could find, to help Will manage his emotions. She found a Social Thinking program, as well as ABA therapy, both of them important opportunities for Will to increase his “social batting average,” as Karen puts it.
However, Will soon became resistant to using the strategies offered by these programs. Cues to calm down through deep breathing, for example, tended to create more frustration and anger and did not decrease his swearing, frustration or oppositional behaviors. Despite his ongoing work with an ABA therapist and the Social Thinking program, his academics started to suffer and he sometimes had to leave the classroom. “He would miss class, and then miss homework, and it would circle out of control,” says Karen.
Video game therapy?
Karen’s research eventually led her to Mighteor, developed by a team at Boston Children’s Hospital and Harvard Medical School. Mighteor helps children and teens develop emotional regulation skills, including kids with anxiety, ADHD and oppositional defiant disorder (a formal diagnosis is not required to play) through through video games with biofeedback. Games like these:
In a small trial of an early pilot version of the platform, children scored 62 percent lower on the Modified Overt Aggression Scale and 40 percent lower on the Disruptive Behavior Disorder Rating Scale after the intervention, as rated by blinded clinicians. (The study, still pending publication, was presented at the American Academy of Child and Adolescent Psychiatry conference in 2015.)
Karen was skeptical at first. “Mighteor sounded too good to be true. Play video games and you’ll be able to self-regulate?” She was hesitant to use another approach, given Will’s difficulty with previous efforts. Nonetheless, she signed up and soon received an invitation for Will to join Mighteor’s three-month Foundation Program.
Will, unlike Karen, expressed nearly instant interest and quickly integrated Mighteor into his daily life. “Will bought into the platform immediately because of his interest in video games – which he plays all the time anyway,” Karen says.
Will received a tablet with an assortment of games, challenging players to quickly slice vegetables, serve up ice cream scoops, etc. As Will played the games each week, he wore a heart rate monitor on his arm that controlled the games’ difficulty. This helped him develop awareness of changes in his heart rate based on external stressors.
As he developed this awareness, Will made significant, positive changes in regulating his emotions. Mighteor reinforced skills he had been taught before, such as deep breathing, and he was able to apply them in real-life situations that previously would have caused outbursts. Will’s community, including his mom, ABA therapist and school district, observed the same improvements.
On-going use of the Mighteor platform (at least 45 minutes per week for at least three months is recommended) increased Will’s progress. Throughout the program, Karen received tips and coaching from Erina White, PhD, Mighteor’s director of clinical, during bi-weekly phone calls.
Will began to provide critical feedback, which Karen relayed to the Mighteor team. He even found a glitch in one of the games, and a narrated a video demonstrating the issue; it was forwarded to Trevor Stricker, co-founder of Mighteor and VP of technology.
Mighteor stems back to 2008. Originally called Regulate and Gain Emotional Control (RAGE Control), it’s the brainchild of Joseph Gonzalez-Heydrich, MD, chief of the psychopharmacology program at Boston Children’s Hospital, and developmental psychologist Jason Kahn. They wanted to find a way to help children control anger and aggression without medications.
Will bought into the platform immediately because of his interest in video games – which he plays all the time anyway. The earliest version of RAGE Control used a pulse oximeter on the player’s finger and the old game Space Invaders. It was first tested in 18 youth (age 9 to 17) in Boston Children’s inpatient psychiatry unit, in conjunction with cognitive-behavioral therapy (CBT). The results, published in the journal Adolescent Psychiatry in 2012, showed reductions in anger scores in the games when compared with 19 youth “treated as usual.”
The study presented in 2015 showed the importance of biofeedback. It randomized 40 adolescents with anger or aggression problems to 10 cognitive behavioral therapy sessions and videogame therapy — either with biofeedback on heart rates, or without. Reductions in aggression and opposition (but not anger) were greater when the games were played with biofeedback.
Kahn received an innovation grant from Boston Children’s in 2011 to advance the project, followed by software-development resources in 2016 when Kahn was selected as a recipient of the Accelerator Grant. The hospital’s Innovation and Digital Health Accelerator then helped Kahn form a company, Neuromotion Labs, and connected him with entrepreneur Craig Lund as CEO.
The venture-backed startup received $1 million-plus in seed funding, became a MassChallenge Finalist and began making the games (including a tablet and wireless watchband) commercially available in June under the name Mighteor. The games are coupled with coaching and support from trained staff.
From games to real life
After using Mighteor, Will no longer missed significant periods of his classes at school. Karen is now able to have conversations with Will about emotional regulation strategies, like deep-breathing, and no longer needs to miss as many hours of work driving Will to appointments.
Will recently went to watch 4th of July fireworks with Karen, his mother. It was crowded, and during the course of the evening, Will became increasingly stressed out.
“I suggested he take a break,” says Karen. “And he stood up, took a walk, and did deep breathing. He came back, and he was relaxed. Mighteor taught him that.”
But Karen also credits Will’s other interventions, which taught similar calming strategies. “I think Mighteor, combined with ABA therapy and school support, all worked together to help Will improve his emotional regulation.”