DESCRIPTION
Attention-deficit/hyperactivity disorder (ADHD) is characterized by symptoms of hyperactivity, impulsivity, and inattention that are considered excessive for an individual’s age. Established treatments for ADHD include medication, as well as educational, psychological, and behavioral interventions. Digital therapy in the form of computer games (e.g., EndeavorRx) is also being proposed to improve attention in children with ADHD.
POLICY
Prescription digital therapy for the treatment of attention-deficit/hyperactivity disorders is considered investigational.
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g., statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the medical policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
ADDITIONAL INFORMATION
The clinical significance of an improvement in a computerized test of attention without a detectable improvement in behavior by parents and clinicians is uncertain. Several questions remain concerning the efficacy of this treatment, and additional studies to assess the effect of the digital therapy in adolescents and in children on stimulant medication are ongoing or have recently been completed. At this time, the digital therapy cannot be recommended as an alternative or adjunct to established treatments. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
SOURCES
American Academy of Pediatrics. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Retrieved April 11, 2023 from https://publications.aap.org/.
Anguera, J.A., Boccanfuso, J., Rintoul, J.L., Al-Hashimi, O., Faraji, F., Janowich, J., et al. (2013). Video game training enhances cognitive control in older adults. Nature, 501 (7465), 97-101. (Level 5 evidence)
BlueCross BlueShield Association. Evidence Positioning System. (8.2022). Digital Health Therapies for Attention Deficit/Hyperactivity Disorders (3.03.03). Retrieved April 11, 2023 from www.bcbsaoca.com/eps/. (10 articles and/or guidelines reviewed)
Kollins, S H., DeLoss, D J., Canadas, E., Lutz, J., Findling, R L., Keefe, R. S E., et al. (2020). A novel digital intervention for actively reducing severity of paediatric adhd (STARS-ADHD): a randomized controlled trial. The Lancet, Digital Health, 2 (4), e168-e178. (Level 2 evidence)
Society for Developmental and Behavioral Pediatrics. (2020, March). Society for developmental and behavioral pediatrics clinical practice guideline for the assessment and treatment of children and adolescents with complex attention-deficit/hyperactivity disorder. Retrieved April 11, 2023 from https://journals.lww.com/jrnldbp/Fulltext/2020/03001/Society_for_Developmental_and_Behavioral.3.aspx.
U.S. Food and Drug Administration. (2020, June). Center for Devices and Radiological Health, De Novo classification request for EndeavorRx. DEN200026. Retrieved April 11, 2023 from https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?ID=DEN200026.
Winifred S. Hayes, INC. Evolving Evidence Review. (2023, January). EndeavorRx (Akili Interactive Labs Inc.) for treatment of attention-deficit/hyperactivity disorder in children. Retrieved April 11, 2023 from www.Hayesinc.com/subscribers. (37 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 8/30/2023
MOST RECENT REVIEW DATE: 8/30/2023
ID_BA
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