Akili Chief Medical Officer Dr. Scott Kollins Talks EndeavorOTC App, Treating ADHD With Tech In Interview

The team at Akili describes its ethos on its website as “establishing a new era of cognitive medicine.” The company writes it “[believes] effective medicine can also be fun and engaging [by] creating a new class of digital medicines for people living with cognitive impairments, delivered through captivating video game experiences.” On its leadership page, Akili says its employees—colloquially known as Akilians—are “committed to challenging the status quo of medicine to help people living with cognitive impairment,” adding the company is “passionate about bringing together top science and entertainment with great user experience to forever change how medicine is designed and delivered.”

Akili’s marquee product is EndeavorRx, which they describe as a “first-of-its-kind attention treatment for children with ADHD, delivered through an action video game experience.” EndeavorRx is built on proprietary technology developed in-house by Akili, who claims the product “[improves] attention function as measured by computer-based testing in children ages 8–12 years old with primarily inattentive or combined-type ADHD, who have a demonstrated attention issue.”

Building on EndeavorRx’s foundational Selective Stimulus Management Engine technology (SSME), Akili in September released EndeavorOTC. The app, available on iOS and Android, is being billed as a video game app which “clinically designed to treat and improve ADHD symptoms for adults, anytime, anywhere.” On the app’s website, a clinical study conducted with EndeavorOTC found nearly three-quarters, or 73%, of participants reporting seeing quality of life improvements using the software. Among the study’s highlights, the site notes 53% of people were able to successfully manage multiple tasks at once, while 54% said they were able to better track everyday items such as keys and wallets and 60% were able to complete projects in a more timely manner.

SSME has been validated in over a dozen clinical trials involving conditions which impact cognition. They include depression, multiple sclerosis, autism spectrum disorder, and even Long COVID.

“EndeavorOTC is a specifically designed digital therapeutic to improve attentional control,” Dr. Scott Kollins, Akili’s chief medical officer, said to me recently in an interview over email. “It is delivered in the form of an immersive mobile video game that is clinically proven to improve attention and focus, specifically in adults with ADHD. EndeavorOTC is built on the same technology as Akili’s EndeavorRx, the first and only FDA-authorized video game to treat ADHD in children aged 8–12.”

Our conversation coincided with ADHD Awareness Month in October.

Dr. Kollins, himself a licensed clinical psychologist who spent more than two decades part of the faculty of the Department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine, explained that research has shown video games “can be highly effective for treating cognitive conditions, including inattention. EndeavorOTC” provided the software is carefully designed as medical treatment by clinicians and neuroscientists. EndeavorOTC, he said, is purposely designed to ”target and stimulate parts of the brain that control cognitive functions like attention.” Dr. Kollins added that when someone plays the game, they’re asked to complete certain tasks while filtering away distractions; the cumulative effect of which is to train one’s brain to generalize this behavior in real life. The game, he said, adapts to a player’s abilities in real time, thereby optimizing the challenge to keep a person engaged and improve their focus.

“We developed the game [and] rigorously tested it in a study of more than 200 adults with ADHD, and subsequently made it available under the FDA’s enforcement discretion because we recognized an urgent need to introduce new, non-medication treatments for ADHD. Right now, the standard for treatment is medication, which works well for a lot of people but doesn’t work for everyone,” Dr. Kollins said. “Many people struggle with the side effects, they can’t mix it with other medications, or they’re having trouble accessing their medications in light of the ongoing stimulant shortage. Combined with a shortage of mental health professionals, we realized that there was a major gap in care demanded and treatments available. Patients simply needed more options.”

He added: “By completing tasks while simultaneously filtering out distractions, the treatment [EndeavorOTC] targets areas of the brain responsible for cognitive functions including focus, which helps improve attention and day-to-day functioning. Algorithms adapt to each user in real time, delivering a personalized experience and challenging the user at an optimized level to improve the targeted cognitive function.”

When asked about societal awareness of ADHD, Dr. Kollins told me it’s a disability that is less understood in adults compared to that in children. He said ADHD in adults is prevalent, noting 1.1 million people in the United States have it yet often goes undiagnosed and untreated. There are signs that diagnosis and impairment rates have increased in the last several years, especially coincident with the pandemic, according to Dr. Kollins. Living with ADHD undiagnosed, he said, can have “devastating impact across many aspects of a person’s life” spanning one’s career, interpersonal relationships, mental health, and more. Moreover, Dr. Kollins said there’s a big shift happening, with a “spike in adults” seeking out care for ADHD symptoms. As ever, there’s more work to be done.

The advent of EndeavorOTC is noteworthy because, as Dr. Kollins told me, treatment methodologies for ADHD haven’t meaningfully changed since the 1970s. Medication delivery hasn’t changed and patient outcomes haven’t changed either. A tool like EndeavorOTC, then, “could change a lot of lives.” Dr. Kollins said he’s “excited about the opportunity to spread awareness and help patients think innovatively about how they’re managing care,” adding that the opportunity for education and awareness is something he’s “really passionate” about evangelizing.

Feedback on EndeavorOTC has been positive. Dr. Kollins said many patients have shared they feel EndeavorOTC has helped them regain control of their lives, on both personal and professional levels. He called the feedback “especially profound” in context of the ongoing shortages of stimulant medications, as well as challenges in accessing therapy. Many adults, Dr. Kollins said, struggle with ADHD symptoms, and are “relieved” to discover alternative treatments like EndeavorOTC that can be used independently or in conjunction with medication and more.

Furthermore, Dr. Kollins cited a slew of statistics from Akili’s study including the numbers I mentioned earlier in this piece. Of the numbers, he said the clinical study’s results “speak for themselves.”

More detailed information on the outcomes are available online.