Effect of Digital Technology–Based Interventions on Core Symptoms and Cognitive Function in Children With Attention-Deficit/Hyperactivity Disorder: Systematic Review and Meta-Analysis
Journal of Medical Internet Research ·
Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children, characterized by core symptoms of hyperactivity, impulsivity, and inattention, in addition to cognitive impairments that compromise physical and psychological development. Digital technology–based interventions have emerged as a promising approach for ameliorating both core symptoms and cognitive impairments. However, a comprehensive evidence base supporting their efficacy is lacking. Objective: This study aimed to systematically evaluate the effects of digital interventions on core symptoms and cognitive impairments in children with ADHD. Methods: Web of Science, PubMed, EBSCOhost, and ProQuest were systematically searched using predefined inclusion and exclusion criteria. The risk of bias of the included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Effect sizes were pooled under a random-effects model, and heterogeneity across studies was evaluated using the ² statistic. Publication bias was assessed using Egger regression and Begg rank correlation tests. Subgroup analyses were performed to explore sources of heterogeneity across intervention type, age, intervention dosage, control group type, and outcome measurement tools. Sensitivity analyses were performed by switching from a random-effects model to a fixed-effects model to confirm the results’ robustness. Results: Thirty-seven randomized controlled trials were included, encompassing 4 types of digital interventions: computer-based interventions, serious video games, exergames, and virtual reality. Digital interventions significantly alleviated core symptoms and cognitive impairments, with improvements in the former primarily attributable to serious video games (=.02) and those in the latter mainly attributable to computer-based interventions (=.04) and serious video games (=.02). Subgroup analyses revealed that effects were stronger in younger children (<10 years) and with short-to-moderate intervention duration (≤8 weeks) and were influenced by control group type and assessment modality. Conclusions: Digital interventions may relieve core symptoms and cognitive deficits in children with ADHD, with highly variable efficacy shaped by intervention type, age, dosage, and assessment methods. Serious games produce superior improvements in core symptoms, whereas computer-based training better enhances cognitive function. Future trials should optimize design and implement stratified analyses (eg, by symptom subtype and age) to clarify tailored intervention effects for better clinical application. Trial Registration: PROSPERO CRD420261399517; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261399517
Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children, characterized by core symptoms of hyperactivity, impulsivity, and inattention, in addition to cognitive impairments that compromise physical and psychological development. Digital technology–based interventions have emerged as a promising approach for ameliorating both core symptoms and cognitive impairments. However, a comprehensive evidence base supporting their efficacy is lacking. Objective: This study aimed to systematically evaluate the effects of digital interventions on core symptoms and cognitive impairments in children with ADHD. Methods: Web of Science, PubMed, EBSCOhost, and ProQuest were systematically searched using predefined inclusion and exclusion criteria. The risk of bias of the included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Effect sizes were pooled under a random-effects model, and heterogeneity across studies was evaluated using the ² statistic. Publication bias was assessed using Egger regression and Begg rank correlation tests. Subgroup analyses were performed to explore sources of heterogeneity across intervention type, age, intervention dosage, control group type, and outcome measurement tools. Sensitivity analyses were performed by switching from a random-effects model to a fixed-effects model to confirm the results’ robustness. Results: Thirty-seven randomized controlled trials were included, encompassing 4 types of digital interventions: computer-based interventions, serious video games, exergames, and virtual reality. Digital interventions significantly alleviated core symptoms and cognitive impairments, with improvements in the former primarily attributable to serious video games (=.02) and those in the latter mainly attributable to computer-based interventions (=.04) and serious video games (=.02). Subgroup analyses revealed that effects were stronger in younger children (<10 years) and with short-to-moderate intervention duration (≤8 weeks) and were influenced by control group type and assessment modality. Conclusions: Digital interventions may relieve core symptoms and cognitive deficits in children with ADHD, with highly variable efficacy shaped by intervention type, age, dosage, and assessment methods. Serious games produce superior improvements in core symptoms, whereas computer-based training better enhances cognitive function. Future trials should optimize design and implement stratified analyses (eg, by symptom subtype and age) to clarify tailored intervention effects for better clinical application. Trial Registration: PROSPERO CRD420261399517; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261399517