Novel AI-Assisted Quest-Based Therapeutic Framework for Enhancing Engagement and Executive Functioning in...

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.