JMIR Publications

ABSTRACT

Background:

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition in children and adolescents, for which conventional treatments present certain limitations. While digital therapeutics (DTx) have developed rapidly, the relative efficacy of different DTx modalities for this population remains to be established.

Objective:

To systematically compare the efficacy of four digital therapeutics (DTx) modalities (single-task, cognitive-motor dual-task, AI-integrated single-task, and AI-integrated cognitive-motor dual-task) on core symptoms and executive functions in children and adolescents with ADHD within the dual framework of task design and AI empowerment.

Methods:

We systematically searched PubMed/MEDLINE, PsycINFO, Web of Science, EMBASE, Scopus, ProQuest Dissertations and Theses, the Cochrane Library, and grey literature from ClinicalTrials.gov for randomized controlled trials published from January 2000 to February 2026, without language restrictions. A snowballing method was also employed. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Data were analyzed using Bayesian network meta-analysis in R software (version 4.2.3). Heterogeneity was assessed using I² statistics, and publication bias was evaluated using Egger's test. Subgroup analyses, meta-regression, and sensitivity analyses were performed to explore sources of heterogeneity.

Results:

A total of 32 studies involving 2,819 patients were included. Network meta-analysis showed that AI-integrated cognitive-motor dual-task DTx appeared to be the most effective modality for improving core symptoms and executive functions, demonstrating the highest probability of being the best treatment on the Attention Deficit/Hyperactivity Disorder-Rating Scale (ADHD-RS) [Surface Under the Cumulative Ranking Curve (SUCRA): 57.5%; Mean Difference (MD): -3.03, 95% Confidence Interval (95% CI): -5.59 to -0.47], the Swanson, Nolan, and Pelham Rating Scale, Version IV - Inattention subscale (SNAP-IV-PI) [SUCRA: 58%; MD: -5.58, 95% CI: -8.76 to -2.39], the Swanson, Nolan, and Pelham Rating Scale, Version IV - Hyperactivity-Impulsivity subscale (SNAP-IV-PHI) [SUCRA: 81.6%; MD: -6.84, 95% CI: -10.37 to -3.31], and the Behavior Rating Inventory of Executive Function (BRIEF) [SUCRA: 67.4%; MD: -7.75, 95% CI: -10.06 to -5.43]. Moreover, this modality significantly outperformed conventional pharmacotherapy across all outcomes. Subgroup analyses revealed that intervention duration emerged as a potential source of heterogeneity for the SNAP-IV (both PI and PHI subscales) and BRIEF, while mean participant age was identified as a potential source of heterogeneity for the SNAP-IV-PI and BRIEF (all P < 0.05). Sensitivity analyses indicated that individual studies influenced heterogeneity. Of note, all outcome measures reported were based on parent versions of the scales.

Conclusions:

AI-integrated cognitive-motor dual-task DTx may be the most effective intervention for improving core symptoms and executive functions in children and adolescents with ADHD. Subgroup analyses suggested that Intervention duration and age emerged as moderators of treatment outcomes, warranting consideration in clinical practice. Clinical Trial: CRD420261304236