Youth with attention-deficit/hyperactivity disorder (ADHD) may experience persistent barriers to engagement in individual psychotherapy despite adequate pharmacologic treatment and evidence-based therapeutic content. Existing gamified approaches often rely on fixed protocols, specialized materials, or group-based formats to address interfering symptoms such as distractibility, low frustration tolerance, and difficulty sustaining mental effort, with mixed feasibility and clinical outcomes. This case describes a novel, individualized gamified intervention designed to address limitations of existing approaches and support ADHD treatment engagement. An otherwise healthy 11-year-old male with ADHD, combined type, was referred for outpatient psychotherapy to address difficulties with organization and emotional self-regulation while receiving methylphenidate extended-release 18 mg daily. Early sessions used established approaches, including gamified interventions, but were marked by distractibility, fidgeting, and disengagement. Treatment was reorganized into a structured, therapist-led, quest-based gamified framework delivered across 21 completed 60-minute sessions over approximately 24 weeks. ChatGPT-4o was used to assist with narrative creation and maintenance and to support integration of therapist-selected psycho-education, behavioral skills training, cognitive-behavioral strategies, mindfulness, and parent management principles into a tabletop role-playing structure. Over time, the patient demonstrated progressively improved engagement, emotional awareness, organization, and coping skills, corroborated by parent-informed improvements on the “Hyperactive/Impulsive” and “Conduct” items of the National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale, third edition. This case illustrates how therapist-led gamification may function as a pragmatic delivery framework for evidence-based individual psychotherapy in youth with ADHD when engagement is a primary treatment barrier. The intervention emphasized therapist-guided skills coaching, flexibility, narrative reinforcement, and repeated practice. A large language model was used to make the intervention feasible, primarily as a preparatory narrative support tool under full therapist oversight. Further study is needed to evaluate the feasibility, acceptability, and generalizability of individualized gamified psychotherapy frameworks in outpatient ADHD treatment.
Montoya et al. (Wed,) studied this question.
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