The Mightier Program
An alternative to medication management of ADHD has always involved occupational therapy as well as behavioral therapy, in addition to modification of the school and home environments to better accommodate the needs of the child. The problem with these modalities for ADHD is that it is often difficult to find a provider that participates in a family’s insurance and it can take months to see results.
Recently a parent informed me about Mightier , which was developed at Boston Children’s Hospital. It is an at home, biofeedback program that teaches children coping and calming skills that can yield tangible results in a matter of months. It is appropriate for children with ADHD, oppositional defiant disorder, and anxiety disorders. Children are provided with a gaming tablet and a heart rate monitor, worn on the arm, that records heart-rate. As described in the video the child plays video games while wearing the heart rate monitor. As the heart rate increases the difficulty of the games increases as well and when the heart rate reaches a certain level, the game is interrupted, and the child is taught a variety of coping skills from a cartoon character. Cognitive behavioral therapy teaches a child to identify and label thoughts and emotions, and utilize coping strategies to prevent or treat the consequences of these. In contrast, Mightier teaches children to implement coping strategies when they recognize the physiologic consequence of negative thoughts and emotions. ie an elevated heart rate, associated with “dysregulation.” An integrated award system reinforces the adoption of coping strategies and children look forward to participating in the program.
The technology behind Mightier has been tested in four trials, including two double-blind, randomized controlled trials.
The program was developed at Boston Children’s Hospital and has been commercialized. It has been used by thousands of children over 7 years and is quite affordable. It is $40 per month, with discounts offered for pre-payment. It is directed at children age 6 and to 12 and a child should commit to at least 45 minutes of play time a week to see results from the program.
BTW, my good friend, Dr. Mitch Frumkin appears as a ghost on my side of the screen throughout the video and asks some great questions of Emily Stone, who explained the system quite well.