Residential care is among the most intensive forms of treatment in youth care. It serves youths with severe behavioral problems and is primarily focused on targeting externalizing problems. Despite bestefforts, effect sizes remain moderate, which may be due to the disregarding of internalizing symptoms – in particular anxiety and to limitations regarding the delivery model of interventions. This initial randomized controlled trial (n= 41) aimed to examine the effectiveness of a biofeedback videogame intervention (Dojo) for youths with and without intellectual disability (ID )in residential care with clinical levels of anxiety and externalizing problems.Dojo targets both anxiety and externalizing problems, and incorporates the principles of conventional treatment, while addressing its limitations.Youths were randomly assigned to playDojo(eight 30-minute gameplay sessions) or to treatment asusual (TAU). Measurements of anxiety and externalizing problems were conducted at baseline,posttreatment, and four-month follow-up through youths’self-report and mentor-report. Intention-to-treat analyses revealed decreases in self-reported anxiety at posttreatment (p= .056) and self-reported externalizing problems at follow-up (p= .031), and mentor-reported anxiety at both posttreatment(p=.017) and follow-up (p= .005) for participants in the Dojo condition compared to the control condition. These findings show that Dojois a promising, innovative intervention that engages high-risk youths.