Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition, yet its diagnosis typically relies on subjective clinical interviews, questionnaires, and informant reports, leading to potential bias and variability. Concerns about overdiagnosis and the demand for objective measures have spurred interest in tools that offer more objective insights such as digital cognitive tests.
Gamified versions of these tests are particularly promising, using game elements like real-time feedback, scores, and timers to boost patient engagement while maintaining scientific validity. This article explores common questions about gamified computerized tests in ADHD diagnosis, focusing on the Creyos Health ADHD assessment and the science supporting its design and use.
How accurate and useful are computerized cognitive tests for ADHD?
Computerized cognitive tests like Creyos Health's ADHD assessment enhance traditional diagnostic methods by providing objective, quantifiable data about cognitive markers such as sustained attention, response inhibition, and impulsivity. These tools complement subjective measures by delivering standardized and scientifically validated insights that are critical to confirming or clarifying an ADHD diagnoses.
How cognitive tests complement traditional methods
Traditional ADHD evaluations rely on subjective reporting, which can vary due to biases or inconsistencies. Cognitive tests address this by objectively measuring cognitive deficits linked to ADHD, such as lapses in sustained attention or impulsive behavior. For example, while parents or teachers might observe difficulties in a child, a Creyos assessment can confirm these behaviors with performance data, ensuring a more rigorous and accurate evaluation. However, it’s important to note that cognitive testing alone cannot diagnose ADHD. It must be interpreted alongside clinical interviews, observations, and questionnaires as part of a comprehensive diagnostic process.
Benefits of gamified assessments
Gamification enhances digital cognitive testing by increasing patient engagement. Feedback, scores, and timers motivate patients, especially children, to complete tasks, which minimizes misunderstandings and improves data quality. Research supports that when carefully designed, these gamified elements increase accessibility and engagement without compromising scientific validity (Cheng & Ebrahimi, 2023). Additionally, digital tests can be conducted remotely or in-person on multiple devices, allowing clinicians to reach a broader range of patients, while gamification elements help maintain the same level of engagement across contexts.
One of the greatest strengths of computerized cognitive tools is their ability to provide data that go beyond subjective impressions. Objective measures of inattention, impulsivity, and response variability help confirm suspected diagnoses and improve overall diagnostic confidence. These data can differentiate ADHD from conditions with similar symptoms (e.g., mood disorders) and reveal context-dependent symptoms (e.g., ability to focus on engaging tasks vs. monotonous ones), guiding severity assessment and treatment.
Creyos further enhances this process by combining questionnaires, engaging gamified tasks, and non-gamified (or “boring”) tasks to build a full picture of patient health. The variety helps clinicians capture accurate results to support a formal diagnosis while providing detail on the specific symptoms for a given patient. ADHD is a heterogeneous condition, and clinician-patient relationships are enhanced when the patient’s unique set of symptoms is acknowledged.
Scientifically validated tools
The Creyos computerized cognitive tests are grounded in decades of research. Numerous studies support the validity of using task-based measures to distinguish individuals with ADHD from neurotypical individuals. For example, one review found that gamified tools were often as reliable as traditional tools in capturing core ADHD symptoms (Peñuelas-Calvo et al., 2022).
Similarly, the Creyos tests correlate strongly with their non-gamified counterparts, showing consistent validity while adding the advantage of increased accessibility and engagement (Thienel et al., 2024). While cognitive testing is part of a broader diagnostic process and must always be interpreted in the context of other data, it provides a critical layer of objectivity when used alongside clinical interviews, observational reports, and subjective questionnaires.
Are Creyos cognitive tests gamified? How would you define gamification in this context?
Creyos Health’s cognitive tasks incorporate some gamified elements, but they are not games in the traditional sense. Rather than being designed purely for entertainment, they are scientifically validated neuropsychological assessments that strategically borrow specific design features from games. For example, tasks use elements like progress feedback and a timer to ensure engagement, focus, and task understanding.
To fully assess ADHD symptoms, it’s important to find a balance between engaging and tedious tasks in order to evaluate a patient’s performance under multiple conditions. Context dependence, or how attention and focus shift based on the nature of a task, is a hallmark of ADHD. Engaging tasks with gamification features test cognitive performance in stimulating environments, while non-gamified tasks evaluate sustained attention in less stimulating situations. This approach ensures data is collected across contexts, enabling clinicians to assess broader attention and focus deficits.
Creyos Health’s tests can be categorized as “serious games,” a growing domain of gamified tools designed for practical purposes such as medical assessment, education, or training. Serious games incorporate aspects of game design without prioritizing entertainment, focusing instead on delivering specific outcomes (Laamarti et al., 2014).
However, Creyos tasks remain less gamified than most serious games on the market. Their design is abstract and culture-neutral, avoiding fantasy-themed graphics, characters, or flashy sound effects that could detract from the validity of the cognitive tasks. This keeps the focus on collecting objective data, rooted in decades of neuropsychological research, with user-centered refinement to reduce barriers to task completion.
What does research say about whether gamified cognitive tests for ADHD alter patient performance?
Research consistently shows that carefully designed gamified cognitive tests provide reliable data on ADHD-related deficits and correlate well with traditional diagnostic tools. Gamification helps capture data from patients who might struggle with conventional assessments, and digital tasks like those from Creyos encourage participation and minimize frustration that could compromise data. Importantly, individuals with ADHD perform differently on the cognitive markers measured by Creyos tasks compared to neurotypical individuals, revealing significant differences in sustained attention, impulsivity, and executive functions.
A 2022 review found that even serious games can effectively identify ADHD symptoms (Peñuelas-Calvo et al., 2022). They show performance differences between ADHD and control groups, align with traditional assessments, and achieve high diagnostic accuracy, suggesting these tools enhance traditional evaluations.
Creyos leverages these gamification elements without compromising data accuracy. The ADHD protocol includes four tasks with gamified features to measure performance during engaging activities, a non-gamified continuous performance task called the Sustained Attention to Response Task (SART), and an optional age-appropriate ADHD questionnaire. This combination provides reliable data across multiple contexts for a fuller picture of attentional challenges.
Do gamification elements compromise scientific validity?
A common concern is that game elements might make tasks too engaging, masking ADHD symptoms. While researchers have noted the potential for digital games in the assessment of ADHD, they also emphasize the importance of user-centered design, integration with clinical workflow, and scientific validation (Wiley et al., 2021, Cibrian et al., 2024).
For example, one study found that adding simple gamification (a points system) increased engagement in a go-no-go task without altering performance, whereas extreme gamification (a cowboy theme) hindered task clarity and performance (Lumsden et al., 2016).
Creyos offered some of the first computerized cognitive tasks, adding gamification elements as early as the 1980s to gain data quickly and capture deficits associated with disruptions to the brain. This experience, backed by decades of research, allows for careful implementation of gamification elements that enhance accessibility and administration speed without affecting the core validity. Creyos also offers accessible user-centered design features to make it easy for patients, clinicians, and caregivers, while integrating seamlessly with clinical workflows.
Can gamified tests miss signs of ADHD in patients with attentional deficits (false negatives)?
The concern that enjoyable tasks might lead to missed diagnoses (false negatives) is generally unfounded. Performance differences between individuals with and without ADHD persist even on gamified tasks (Ruiz-Robledillo et al., 2025).
However, some patients, particularly those with milder ADHD, might perform well initially on engaging tasks but show deficits as testing progresses or tasks become less engaging. For example, children with ADHD tend to decline in performance as the duration of testing increases, due to deficits in both executive functioning and motivation (Dekkers et al., 2017). Clinicians must interpret results contextually, as these patterns themselves provide objective data on symptom nature and severity.
Creyos's combination of engaging and unengaging tasks alongside subjective reports casts a wide net, capturing deficits across different types of attention and executive function, minimizing the risk of false negatives.
What are the key characteristics of the ADHD assessment in Creyos?
The Creyos ADHD assessment uses gamified design elements to ensure accurate and engaging testing. Features such as sound effects, timers, feedback, and a “health bar” help users understand instructions, stay focused, and complete tasks. For clinicians, this provides reliable and usable data even in cases where traditional tests might be incomplete or abandoned, whether tests are performed in person or remotely.
Each patient’s performance is compared to a comprehensive normative database segmented by age, making the assessment appropriate for children and adults. These comparisons identify when ADHD-linked markers such as error rates, interference ratios, and consistency of reaction times are outside of the typical ranges in the normative database.
Rather than oversimplifying results into a single score, Creyos provides detailed, multi-dimensional reports that reflect the complexity of each patient’s cognitive profile. It avoids shortcuts or overly automated outputs, emphasizing data richness to support meaningful clinical decision-making. By combining scientifically validated markers with user-centered design, Creyos delivers accurate, actionable insights that align with the nuanced needs of ADHD diagnosis.
Conclusion
While there are valid concerns about gamified testing, research shows that thoughtfully designed tasks reliably measure cognitive markers of ADHD without compromising validity. These tools provide valuable insights into a patient’s cognitive abilities in contexts where traditional assessments might fail, particularly by increasing engagement and accessibility.
The Creyos ADHD assessment demonstrates how combining gamified and non-gamified tasks with subjective questionnaires provides a comprehensive and nuanced view of ADHD symptoms. By evaluating performance across both stimulating and unstimulating tasks, the assessment enables clinicians to make precise, evidence-based diagnostic decisions tailored to individual patient needs.
Reviewed by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.