“Do not keep children to their studies by compulsion but by play.”


Managing a successful clinical trial depends on a number of factors. However, nothing is more important than understanding the unique needs of your patients.  This is perhaps even more true when the trial involves children. Clinical trials involving young patients are inherently more complex due to the developmental transitions that occur throughout childhood and adolescence. Not only are children going through a number of physical changes, but they are also experiencing a host of emotional, social, and cognitive changes that can all impact recruitment and retention efforts.  In addition to this are parents’ concerns for the well-being of their children. Convincing a parent to enroll their child in a clinical trial that may involve painful treatments, have negative side effects, and that holds no promise of guaranteed improvement can be an incredibly challenging task.

One of the biggest concerns when conducting a clinical trial with children is non-adherence, which can be as high as 50% among young patients with chronic conditions.1-3  Children are not ‘little adults’ and as a healthcare consulting firm, it’s our job to take into consideration the unique factors contributing to children’s motivation and compliance in order to maintain high rates of retention.

So the question becomes, how do we keep children and adolescents actively motivated?  Anyone who has ever been around young children, or has children of their own, will know that they often do not like being told what to do.  Therefore, simply telling a child to take their medication because “I say so” is likely to be met with resistance and ultimately, poor adherence.

One solution to this problem is to make a child’s involvement in the trial a fun experience, by offering them something they enjoy – games! The concept of gamification, or using online/computer games to contribute to improved patient outcomes, is rapidly developing within the healthcare industry.  Initial research surrounding children and gaming focused predominately on negative consequences, such as increases in addiction, aggression, and anti-social behaviour. More recently, however, games have been recognized as a powerful form of engagement and motivation and have been associated with significant increases in the following health-related areas4:

  • Disease self-management
  • Health education
  • Physical activity
  • Psychological therapy outcomes
  • Physical therapy outcomes

Within a gaming environment, children have the ability to be who they want to be and to live a life outside of their illness. Through competition and reward, children gain self-management and self-efficacy (the belief in one’s ability to achieve a specific goal), which are both very helpful when it comes to adherence to medical regimens. Games also provide children a safe and fun environment to learn about their illness, including the importance (and consequences) of self-management strategies.

At AXON we work hard to provide our clients with bold, innovative strategies, and if that means letting down our hair to connect with our inner child, we are up for the challenge!

Dr Jenny Eastabrook


1. Drotar, D. (2000).  Handbook of Research in Pediatric and Clinical Child Psychology: Practical Strategies and Methods. Kluwer Academic/Plenum Publishers.

2. Rapoff, M. A. (2010).  Adherence to Pediatric Medical Regimens, Second Edition. New York, NY, Springer Publishing.

3. Rapoff, M. A., & Barnard, M. U. (1991). Compliance with pediatric medical regimens. In J. A. Cramer & B. Spilker (Eds.). Patient compliance in medical practice and clinical trials (73-98). New York: Raven Press.

4. Primack, B. A., Carroll, M. V., McNamara, M., Klem, M. L., King, B., Rich, M., Chan, C. W., et al. (2012). Role of video games in improving health-related outcomes. American Journal of Preventive Medicine, 42, 630-638.