Can Gamified Digital Interventions Alleviate ADHD Symptoms in Children?

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition in children, traditionally managed through pharmacotherapy and behavioral interventions. Recently, nonpharmacologic approaches such as digital and exercise-based therapies have emerged as promising adjuncts to improve both physical and psychological health outcomes in children with ADHD. However, the combined effects of digital and exercise interventions have not been fully explored.

This study aimed to assess the efficacy of BrainFit, a novel digital program that integrates gamified cognitive and exercise training, in reducing ADHD symptoms and improving executive function (EF) in school-aged children diagnosed with ADHD.

Researchers designed a 4-week prospective randomized controlled trial involving 90 children, aged 6-12 years, who were diagnosed with ADHD and attended an outpatient ADHD clinic. Participants were randomly assigned (1:1) to either the BrainFit intervention group (n = 44) or a waitlist control group (n = 46) between March and August 2022.

The intervention consisted of 12 sessions delivered via an iPad, scheduled three times a week (Monday, Wednesday, and Friday) over a 4-week period. Each 30-minute session was conducted under the supervision of trained staff. The primary outcomes included parent-rated ADHD symptoms measured using the Swanson, Nolan, and Pelham questionnaire (SNAP-IV), and executive function skills assessed with the Behavior Rating Inventory of Executive Function (BRIEF) scale. Pre- and post-intervention assessments were conducted, and intention-to-treat analysis was applied to the data from 80 children after accounting for attrition. A nonparametric permutation test was used to analyze the intervention’s effects.

Out of 145 children who met the study's inclusion criteria, 90 consented to participate and were randomized, with 80 (88.9%) completing the study. The predominant ADHD subtype was hyperactive/impulsive (68%), and 29% exhibited severe ADHD symptoms. At the study's conclusion, the BrainFit intervention group demonstrated significantly greater reductions in total ADHD symptoms compared to the control group, as measured by the SNAP-IV total score (β=-12.203, 95% CI -17.882 to -6.523; P < .001). Significant improvements were also observed in specific symptom subscales, including Inattention (β=-3.966, 95% CI -6.285 to -1.647; P < .001), Hyperactivity/Impulsivity (β=-5.735, 95% CI -8.334 to -3.137; P < .001), and Oppositional Defiant Disorder (β=-2.995, 95% CI -4.857 to -1.132; P=.002). Additionally, the intervention was associated with significant improvements in executive function, including reductions in the BRIEF Metacognition Index (β=-6.312, 95% CI -10.973 to -1.650; P = .006) and Global Executive Composite (β=-5.952, 95% CI -10.214 to -1.690; P = .003).

The study has several limitations, including its short duration and a relatively small sample size, which may affect the generalizability of the findings. Additionally, the reliance on parent-reported outcomes introduces potential bias, and the lack of a long-term follow-up prevents assessment of the durability of treatment effects. The absence of blinding and the use of a waitlist control group also may limit the validity of the results. 

This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD,” the authors concluded. “A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects.”

Reference

Zhao L, Agazzi H, Du Y, et al. A digital cognitive-physical intervention for attention-deficit/hyperactivity disorder. J Med Internet Res. Published online Oct 5, 2024. doi:10.2196/55569.