JMIR Publications

ABSTRACT

Background:

For a large number of children with clinical and subclinical attention-deficit hyperactivity disorder (ADHD), access to appropriate and timely care remains lacking due to limited resources and long waiting times. Self-administered digital interventions that provide supportive and accessible options without drug-related side effects can help alleviate ADHD symptoms while waiting. However, existing digital interventions are limited by poor accessibility, narrow scope, unappealing design, and unclear efficacy for subclinical cases.

Objective:

This study aimed to evaluate the efficacy of a game-based digital intervention, grounded in Executive Function Theory, for reducing core ADHD symptoms in children with both clinical and subclinical diagnoses.

Methods:

This study developed a digital game and tested its feasibility in an 8-week randomized controlled trial. One hundred children (Mage = 8.87 years; 65% boys; 74% ADHD) were randomly assigned to an immediate intervention group or a waitlist group. The study employed a 3 (within-subject, Test: baseline vs. 8-week post-test vs. 16-week post-test) × 2 (between-subject, Group: intervention vs. waitlist group) mixed-model design. The intervention comprised 40 sessions (30 min/day, 5 days/week) grounded in Executive Function Theory. The two groups demonstrated reduced symptoms measured by the Conners Abbreviated Symptom Questionnaire (C-ASQ), the Swanson, Nolan and Pelham scale (SNAP), and the Clinical Global Impression of Severity scale (CGI-S).

Results:

Multivariate Analysis of Covariance (MANCOVA) revealed time-by-group interactions (F = 13.709, η² = 0.222, p < 0.001) after controlling for training sessions. Significant interaction effects were also found for C-ASQ (F = 69.89, η² = 0.419, p < 0.001), SNAP (F = 10.54, η² = 0.098, p < 0.001), and CGI-S scores (F = 5.67, η² = 0.063, p < 0.05). Simple effect comparison analysis showed that in the intervention group, significant reduction of ADHD symptoms were observed from the baseline to the 8-week post-test (C-ASQ: 16.54 ± 3.33 to 13.72 ± 3.02, p < 0.001; SNAP: 1.48 ± 0.20 to 1.37 ± 0.22, p < 0.001; CGI-S: 3.50 ± 1.31 to 3.26 ± 1.21, p > 0.05). In addition, symptom levels remained stable from the 8-week post-test to the 16-week post-test (C-ASQ: 13.72 ± 3.02 to 13.58 ± 3.09, p > 0.05; SNAP: 1.37 ± 0.22 to 1.33 ± 0.19, p > 0.05; CGI-S: 3.26 ± 1.21 to 3.08 ± 1.05, p > 0.05), a period during which no additional intervention was administered for the intervention group. In the waitlist group, C-ASQ scores showed minimal natural reduction from baseline to the 8-week post-test (C-ASQ: 16.10 ± 3.84 to 15.22 ± 4.05, p < 0.05; SNAP: 1.49 ± 0.23 to 1.44 ± 0.30, p > 0.05; CGI-S: 3.56 ± 1.26 to 3.30 ± 1.06, p > 0.05), and substantial reductions were observed from the 8-week post-test to the 16-week post-test (C-ASQ: 15.22 ± 4.05 to 9.96 ± 3.20, p < 0.001; SNAP: 1.44 ± 0.30 to 1.17 ± 0.20, p < 0.001; CGI-S: 3.30 ± 1.06 to 2.20 ± 0.64, p < 0.001), a period during which the waitlist group received the intervention.

Conclusions:

The results demonstrate that the 8-week, executive function-based digital game intervention is efficacious in reducing core ADHD symptoms in children. The intervention showed a beneficial effect for both clinical and subclinical populations, supporting its potential as an accessible, non-pharmacological support tool while awaiting conventional care.