Gamified ability tests may feel more engaging, enjoyable for the test-taker. However, does this come at a cost in terms of data validity and standardization? Gamified behavior and cognitive tests aren’t always accurate. They reward superficial metrics like speed, streaks, or points rather than genuine psychological accuracy or competence.
Let’s explore how gamification may affect ADHD test performance, so you can choose a test that best fits your needs.
What does gamification mean in ADHD testing?
In many performance-based digital ADHD tests, patients complete a short task, and their results are compared with normative data. A gamified ADHD test adapts this format by adding perverse incentives including elements commonly found in video games. These may include background music and visuals, rewards such as points, performance feedback, storylines or competitive elements.
Why are some ADHD tests gamified?
A 2021 review examined why game elements had been incorporated into attention-based tests. In 40/74 studies, gamification was added to potentially increase participant engagement and enjoyment, while 22/40 studies cited a desire to “improve motivation and engagement.”
Gamification may make an ADHD test feel more engaging or enjoyable. However, these qualities are superficial and can lead to fairness and relevance issues. Alone, they do not demonstrate clinical value. In ADHD assessment, objectivity, validity, reliability, and standardization are key for accuracy.
A user-friendly testing experience is important, but a test does not need to be gamified to achieve this.
How can gamification affect ADHD test performance?
If any part of an ADHD evaluation does not accurately reflect a patient’s performance, it could compromise the validity of data you use to support diagnosis and treatment decisions.
We reviewed recent evidence to identify the potential risks of using gamification in ADHD assessment.
Challenges of gamified ADHD tests
“Recent research suggests that gamification may not be the best approach for assessment.”
Wiley et al., 2021
Gamification leads to a temporary dopamine rush
Game elements like rewards, music, storylines, and feedback change the ADHD test-taking experience by giving the brain signals of a quick rush of interest or focus. These features may also affect patient performance and even “hinder the assessment properties of a task.”
Features such as rewards and feedback are designed to influence motivation, and this may affect attention, task performance, and response-time measures.
Game elements may also incentivize certain behaviors in the test-taker. A study found that where points were awarded for quicker correct responses, participants responded with greater speed but reduced accuracy.
“The use of games to measure cognitive processes related to attention poses unique issues. Through their use of graphics, stimuli, and visual feedback, games inherently manipulate the player’s attention, which has been shown to be problematic when using games for assessment.”
Wiley et al., 2021
Patients may respond differently to gamified ADHD tests
There is also evidence to suggest that gamification may affect test performance differently according to factors including age, ADHD symptom levels, and responsiveness to rewards.
“Game features were related to enhanced attention in those with more ADHD symptoms and higher reward responsivity, as well as in younger individuals.”
Gallen et al., 2023
In the same study, older participants and those reporting fewer ADHD symptoms tended to perform better on the traditional task. Meaningful ADHD test results depend on a consistent, standardized testing experience. If game features affect patients differently, this variation can make results harder to compare and interpret with confidence
Gamification may affect patient confidence in a cognitive test
Adding game elements to a cognitive test may affect how patients view its validity. A study of a game-based cognitive assessment used in recruitment found that some users struggled to see how the games related to the abilities being assessed. In a healthcare setting such as ADHD assessment, similar concerns could affect how credible a gamified test feels to patients.
In a Reddit discussion about one such test (Creyos ADHD), one user felt that a gamified task did not seem to capture the daily challenges they faced and worried that it affected their results. While this experience does not indicate that gamification influenced the outcome, it illustrates how game-based tasks may affect patient confidence in a test.
Gamified ADHD tests may have a less established evidence base
Some established digital ADHD tests are supported by decades of research and clinical use, giving researchers confidence in a test’s validity, reliability, and ability to measure what it claims. For example, QB testing has been used in ADHD assessment for over 1 million patients, and is backed by decades of research and studies. By comparison, the evidence base for gamified ADHD tests is generally less established.
Clinicians should look for this evidence before adopting a gamified ADHD test.
Alongside the strength of the evidence, clinicians should consider exactly what a test has been validated to measure. Some gamified tests focus on cognitive functions linked to ADHD, such as planning and working memory. A review of 83 studies found that people with ADHD performed less well in these areas on average, but these weaknesses were not found in everyone with ADHD and could not explain the condition on their own.
These tests therefore provide objective data on cognitive performance, rather than an objective measure of ADHD itself.
Common questions clinicians have about gamified assessments
Understanding how gamified assessments perform across patients and over time is important. Here are some questions clinicians frequently inquire about when it comes to game elements in an ADHD assessment –
Can video game experience influence ADHD test results?
Another consideration is whether previous video game experience could influence performance in a gamified ADHD assessment. People who play action video games have demonstrated advantages in visual search. This could become relevant when attention is measured through a game-based task. Conversely, older adults and people with less gaming experience may be less familiar with the gaming conventions and controls used in a gamified ADHD assessment.
Can results from a gamified ADHD test be compared over time and used in treatment monitoring?
To be used for long-term treatment monitoring, clinicians would need confidence that a gamified ADHD test can reliably distinguish treatment-related changes from improvements associated with repeated gameplay. A study of gamified cognitive assessment tasks found that performance on some more difficult games improved over repeated sessions. The authors suggested that greater motivation may have helped participants learn and improve at the games.
Clinicians therefore need evidence that any change in scores reflects treatment effects rather than practice or learning.
Some digital ADHD tests can support treatment monitoring as part of ongoing patient care. Sanyal et al. have demonstrated the use of QbCheck to “facilitate treatment monitoring and dosage titration” by comparing baseline test results with those after starting medication.
What to consider before adopting an ADHD test
When choosing a new ADHD test, it can help to review the test’s specification, evidence base, and fit with your clinic.
1. What does the ADHD test measure?
Consider whether a test measures attention, activity, and impulsivity together, as many tools do not cover all three core ADHD symptom domains, especially hyperactivity.
2. Could ADHD test features or design affect performance?
Before adopting a test using rewards, feedback, storylines, sound, or animations, review evidence that the effect of these features on patient responses has been sufficiently investigated. You should also consider if any gamified elements are likely to enhance or impede the performance of any specific patient populations.
3. Is the ADHD test clinically validated?
To add confidence that a new ADHD test is valid, reliable, and fit for purpose, look for evidence that the test:
- Measures what it claims
- Is supported by peer-reviewed evidence, including independent research
- Meets relevant regulatory standards
- Is validated for use with your patient populations
4. How will a new test complement your existing ADHD workflow?
A new test should fit into your existing assessment process and meet your clinic’s standards. Gamification may make a test more engaging or enjoyable, but does it provide the clinical evidence you need to reach confident diagnostic decisions?
How to choose the right ADHD test for your practice: A clinician’s guide
How QB testing approaches ADHD care delivery
QB testing uses a standardized, non-gamified task methodology. There are no rewards, levels, or performance feedback during testing.
Additionally, QB testing:
- Is FDA-cleared and CE-marked, demonstrating compliance with applicable regulatory requirements
- Measures attention, impulsivity, and activity simultaneously
- Compares results with age- and sex-at-birth normative data to aid clinical decision-making
- Presents results visually to support clinical interpretation and support better conversations with patients
- Can be repeated over time to facilitate treatment monitoring during long-term care
- Supports remote testing using a compatible computer and webcam at home
- Supports rather than replaces clinical judgment
Find out more: Understanding QbCheck: A complete guide to digital ADHD testing
Finding the right role for gamification in ADHD care
While gamification creates potential concerns in ADHD evaluations, it may still have a place in after-diagnosis care. Recent research suggests that game-based training may help improve cognitive function, including forward and backward working memory.
The fact that game elements can influence responses and behavior, is a concern during diagnosis, it can become a strength when the goal is treatment or psychoeducation.
An ADHD assessment, needs to measure behavior rather than change it. Using an objective, non-gamified test during ADHD assessment helps maintain a consistent, standardized approach that supports clinical decision-making.
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