Groundskeeper: a new game for ADHD diagnosis in children and adolescents

A recent study aimed to characterise the diagnostic accuracy of Groundskeeper, a novel interactive game that captures ADHD symptoms and associated behaviours,* relative to Conners’ parent-rating of ADHD symptoms and patient performance on Conners’ Continuous Performance Test II (CPTII). The results indicated that Groundskeeper had similar diagnostic accuracy to the Conners’ inattention scale in the inattention domain, and predicted ADHD diagnosis more accurately than CPTII.

In this study, children/adolescents (n=113; aged 6–17 years) recruited from two outpatient psychiatric clinics participated. Participants were included if they were positively diagnosed with ADHD or other psychiatric morbidities, and were assigned to two groups, the ADHD group (n=66) and the non-ADHD group (n=47). Parents completed the Conners’ Brief Rating Scale, Parent Version, which provided information relating to the child’s hyperactivity/impulsivity, inattention, learning problems, aggression and executive function. Enrolled children played the Groundskeeper game, then completed the CPTII after 1 week. For those participants who were receiving stimulant medication, treatment was discontinued on the days of testing.

Based on the area under the curve (AUC) statistic from receiver operating characteristic analysis, the diagnostic accuracy of Groundskeeper was comparable to that of the Conners’ parent-rating of inattention (0.79 and 0.76, respectively; p=0.8), and higher than that of CPTII (0.62; p=0.03). The three tests used in combination generated an AUC of 0.87, and correlations among the three measures were small and mostly not significant.

A limitation of this study was that a medicated, psychiatric control group was included, which was assumed to be relatively difficult to differentiate from the ADHD group, and as such diagnostic accuracy statistics were underestimated. In addition, youths with conduct disorder and tics were excluded, which undermines the generalisability of the results. However, the authors believe that if a healthy control group was used, the discriminative ability of Groundskeeper would be much improved.

*Motor coordination, reaction time variability, impaired temporal processing and impaired decision-making

Based on the Kiddie-Schedule of Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL), Version 19

Major depressive disorder, dysthymia, generalised anxiety disorder, anxiety disorder not otherwise specified, social phobia, oppositional defiant disorder, panic disorder or eating disorders

Read more about Groundskeeper instructions, sensitivity and specificity here


Date of preparation: November 2016; Job code: INTSP/C-ANPROM/NBU/16/0002i



View references

  1. Faraone SV, Newcorn JH, Antshel KM, et al. The Groundskeeper gaming platform as a diagnostic tool for attention-deficit/hyperactivity disorder: sensitivity, specificity, and relation to other measures. J Child Adolesc Psychopharmacol 2016; 26: 672-685.

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