ABS 089: Can a Video Game Targeting Cognitive Control Improve the Treatment of OCD in Children?

Chloe Samouhi ¹ ; Yu-Hsuan Chen, B.A. ² ; Marissa Caldera, B.S. ² ; Simone DiMatteo, B.S. ² ; Kate Fitzgerald, PhD ² ; David Pagliaccio, PhD ² ; Rachel Marsh, PhD ²

¹ Barnard College of Columbia University
² Department of Psychiatry, CUIMC, New York, NY

Van Wickle (2025) Volume 1, ABS 089

Introduction: Obsessive-Compulsive Disorder (OCD) affects 1-3% of the U.S. population and often onsets in childhood, during the brain’s transition from primarily concrete ways of thinking to more abstract and reason-based processes. While Cognitive Behavioral Therapy (CBT) coupled with Exposure and Response Prevention (EXRP) is the gold-standard treatment, about 40% of patients fail to remit, leading to poor self-regulation in adulthood. Successful treatment is contingent upon a patient’s level of cognitive control (CC) – or their ability to regulate and adapt their thoughts, memory, and attention – which patients of OCD show deficits in. This study investigates whether a video game-based CC training program, called Akili Interactive, enhances cognitive control and alleviates OCD symptoms in children ages 8-12. Participants undergo cognitive training (CT) with Akili Interactive for 25 minutes per day for four weeks. NIH Toolbox digital assessments are administered pre-, mid-, and post-game play to measure changes in cognitive control, and fMRI scans are taken pre- and post-game play to analyze changes in connectivity patterns between active and resting-state neural networks involved in OCD’s pathology. Upon completion of the study, participants are offered 12 free sessions of CBT with EXRP conducted by a psychiatrist in New York City. Preliminary NIH Toolbox data have identified a positive correlation between game play and cognitive control, while fMRI data have identified increased anticorrelation between task control (TC) networks and the default mode network (DMN) post-game-play. By establishing an engaging, scalable, and affordable method of augmenting the gold-standard treatment for pediatric OCD, this study hopes to improve remission rates earlier on in development and across various socioeconomic groups.

Methods: Participants (n = 60 children ages 8-12 with OCD) begin with screenings and clinical evaluations to determine study eligibility. Each participant completes four weeks of CT with Akili for 25 minutes/day with a lab-provided iPad. NIH Toolbox digital assessments are taken by participants pre-(Week 0), mid-(Week 2), and post-(Week 4) game play, and fMRI scans are taken pre-(Week 0) and post-(Week 4) game play. Surveys regarding OCD symptomology and enjoyability of Akili are administered to both participants and parents. Upon completion, participants are offered 12 free sessions of CBT coupled with EXRP.

Results: The study is currently in its initial stages. Still, pilot data from 6 children with anxiety (7-16 years old) saw improvements in NIH Toolbox digital assessment scores (testing for cognitive control) after completion of cognitive training (CT) with Akili Interactive. Additionally, preliminary fMRI data showed strengthened anticorrelation between the Default Mode Network (DMN) and task control (TC) networks post-CT with Akili Interactive. Data gathered from the study, thus far, similarly point to overall increases in NIH Toolbox scores.

Discussion: Establishing Akili Interactive as a significant augmenter of cognitive control strength amongst pediatric OCD patients would provide the OCD community with an affordable, highly-scalable, and enjoyable tool to increase remission rates from CBT and EXRP. Such results could eventually lead to Akili’s use as a preventative method against OCD development, saving individuals the time and money spent undergoing therapy later on. Determining the effects of cognitive training with Akili on the connectivity patterns between task control and Default Mode networks can improve our understanding of OCD’s physiology, as well as provide anatomical proof of cognitive control’s role in OCD symptomalogy.