Executive Function and Behavior Improvement: An 8-Week Observational Study of a Gamified Reward System for Children

Introduction: Provider shortages, lengthy waitlists, and a variety of other challenges associated with implementing traditional evidence-based strategies to reduce parent stress and improve childhood outcomes have resulted in the development of digital solutions intended to overcome many of these challenges. Unfortunately, provider uptake of many of these digital approaches remains low. The current study examines parent perceptions of usability and changes in their child’s behavior, executive functioning, and impairment following eight weeks of use of a digital contingency management system that overcomes limitations of past approaches and integrates a parent application with a child video game. Method: Ninety children between the ages of 6 and 12 were enrolled in this observational study. Parents were asked to use the digital application for eight weeks and complete the Disruptive Behavior Disorders Rating Scale - Modified (DBD-Modified), Child Executive Function Inventory (CHEXI), and Impairment Rating Scale (IRS) every two weeks. Multilevel models (MLM) were used with repeated observations (Level-1) nested within individual parents (Level-2) to examine changes on these outcomes over time. Results: Small to moderate magnitude improvements in behavior (Cohen’s d = 0.57), executive functioning (Cohen’s d = 0.50), and impairment (Cohen’s d = 0.43) following eight weeks of use were observed. Additionally, most parents found the application easy to use (88.7%), would recommend it to a friend (90.4%) and perceived it as reducing stress (59.7%) and arguments with their child (72.6%). Discussion: This study provides preliminary evidence for the potential benefits of a parent-child digital application leveraging gamification for youth with behavioral and executive functioning challenges.