Earlier this spring, Tate fumed as he walked off a four square court at recess. The 9-year-old thought that the ball had bounced on the line, and he was still in the game. His classmates saw it differently, and ruled him out.
Tate was mad, but kept his temper in check.
“I don’t want to get in a big fight,” he recalled. “I just got back in line and I tried to take deep breaths.”
Tate has no formal behavioral diagnosis, but has struggled with frustration and tantrums at his school in Trumbull, Conn. Like some children, he has trouble navigating certain social situations and controlling his emotions.
“He just feels the big feels,” said his mother, Cathleen Dauenhauer, a yoga teacher who mostly works with children. “All of a sudden, he’ll go from zero to 11.”
Tate has taken anger management classes, but in September, his mother looked to technology for help.
She heard about a video game, called Mightier, that is designed to help children learn to handle stressful situations.
Developed and tested at Boston Children’s Hospital to help children who struggle with emotional and behavioral regulation, Mightier was commercially launched in November 2017 after three clinical studies.
The game is bioresponsive, meaning it changes according to the player’s reactions. Players wear a stretchy armband, which tracks their heart rate. As their heart rate increases, the games become harder. To succeed, players have to pause the game and take deep breaths to lower their heart rate. When they do, play can resume. They become calmer, almost without realizing it.
“It’s a very low-stakes way to practice your response to that anxiety,” said Dr. Jason Kahn, co-founder and chief scientific officer of Mightier. “That physiological response lines up quite nicely with any stressful situation, just happening in miniature.”
As diagnoses for attention-deficit hyperactivity disorder and autism become more common, the question of technology’s role in helping kids like Tate has sparked vigorous debate. Some specialists welcome video games as an opportunity to connect to children using their own language. Others view them as part of the problem, a distraction for children who already prefer screens to socializing.
“Real life alone is what teaches you self-regulation for real life,” said Dr. Erik von Hahn, a pediatrician at Tufts Medical Center who focuses on developmental-behavioral pediatrics. “On the computer, the way that the game works, you as the game player is still in control over what happens next. And in real life, you aren’t.”
In recent years, von Hahn has noticed that children who visit his clinic are more impatient, and attributes the change in large measure to the popularity of video games. He believes that screen-less socialization is the best way to help children learn to handle stressful encounters.
“Real life doesn’t happen as quickly as a computer game does, and can be very frustrating for a kid because real life doesn’t respond quickly,” von Hahn said.
Other clinicians harbor similar doubts about the use of video games as a clinical tool.
“The differences between educational technology and games ... is a blurred line for children,” said Nikki Magliaro, the clinical director of Puzzle Pieces, a private practice for children with emotional challenges. “I know there’s a lot of cool technology, but I am just hesitant to replace a relationship-based intervention.”
The team at Mightier built several physical games as prototypes, Kahn said. But pilot studies found that children responded best to video games.
“Video games are just a modern version of games,” said Trevor Stricker, vice president of technology for Mightier and a longtime video game designer. “This is where kids are nowadays.”
The game focuses on helping children understand how emotions feel, and create a muscle memory of calming techniques.
“You can sit there and talk to a kid until they’re blue in the face, that ‘you just have to take deep breaths and calm down,’ ” Stricker said. “But if calming themselves down is how they get better at the game, that’s a way in. You’re meeting them where they want to be.”
The program costs $249, a sum that includes six hourlong coaching sessions with a licensed social worker. After that, it costs $19 a month. More than 1,500 families have used the platform, the company said.
Some child psychologists also use video games to connect with troubled children. Dr. Lawrence Kelly, a clinical psychologist in Wakefield and an avid gamer, ends his sessions with five minutes of screen time, often playing a video game with the child.
“If I say, ‘Tell me about your feelings,’ they won’t come back. But if I say, ‘Let’s play a game, let’s be interactive,’ their emotions start pouring out,” Kelly said.
Dauenhauer also sees the game as a way to bond with her son and discuss his challenges.
“If I am saying, ‘Let’s do yoga with mom,’ he doesn’t want to do that,” she said. “But he’ll go play Mightier and that gives us a common vocabulary and platform, a place to meet and have some connection.”
Tate plays Mightier for about an hour a week. He has come a long way, his mother said.
“He just seems so much more at ease with himself, and so much more comfortable,” she said.
As with recess games, Tate said he isn’t as quick to anger when he fights with his brother or is having a hard time with his homework. His mother reminds him to take deep breaths, and he has started to do so on his own.
“Now, it’s my first reaction,” he said. “I don’t want to be annoyed. I hate being annoyed. So I stop.”