JMIR Publications

ABSTRACT

Background:

Children with inattentive attention-deficit/hyperactivity disorder (ADHD) often present with impairments in executive functions and fine motor skills in addition to core inattentive symptoms. However, the effects of structured remote fine motor training on these outcomes remain unclear.

Objective:

To examine the effects of a 12-week telerehabilitation-based fine motor training program on inattention symptoms, executive functions, and fine motor performance in children with inattentive ADHD.

Methods:

This assessor-blinded randomized controlled trial investigated a 12-week remote fine motor training program delivered via Tencent Meeting in children aged 6-10 years with inattentive ADHD. Sixty-six children were randomly assigned to either the intervention group (n=33) or a wait-list control group (n=33). The intervention was conducted 3 times per week, 60 minutes per session, for 12 weeks. Assessments were performed at baseline, immediately postintervention, and at 3-month follow-up. The outcomes were inattention symptoms, executive functions and fine motor skills. Linear mixed models were used for the main analysis, and mediation analysis was performed to examine whether executive functions explained changes in inattention.

Results:

Compared with the wait-list control group, the intervention group showed significantly greater reductions in inattention symptoms at 12 weeks (MD= −3.85, 95% CI: −5.01 to −2.68) and 3-month follow-up (MD= −2.00, 95% CI: −3.17 to −0.83). For executive functions, significant between-group differences were observed in inhibitory control, immediate memory, and cognitive flexibility at both time points (P<0.05), while delayed memory was significant at 12 weeks only (MD= −3.03, 95% CI: 0.57 to 5.49) and showed no significant between-group difference at follow-up (MD= 1.62, 95% CI: −0.84 to 4.08). For fine motor outcomes, significant between-group differences were found in manual dexterity and hand-eye coordination at both 12 weeks and 3-month follow-up (P<0.05), and in writing skills at 12 weeks (MD= −6.85, 95% CI: −13.38 to −0.32) but not at follow-up (MD= −2.18, 95% CI: −8.71 to 4.35). Subgroup analyses suggested age-related variation in treatment response, with younger children showing more evident gains in fine motor performance and older children showing more sustained improvements in inattention and selected executive function domains. Mediation analysis showed that inhibitory control partially mediated the effect of the intervention on inattention (indirect effect: β= −0.85, 95% CI: −1.85 to −0.08).

Conclusions:

A 12-week remote fine motor training program may be a feasible, safe, and effective nonpharmacological intervention for children with inattentive ADHD. The intervention improved inattention symptoms, executive functions, and fine motor performance, with inhibitory control emerging as a potential mechanism underlying symptom improvement. The subgroup findings further suggest that developmental stage may influence the pattern of response, which may help guide age-tailored intervention design in future practice. Clinical Trial: Chictr.org.cn ChiCTR2200065413; https://www.chictr.org.cn/showproj.html?proj=182412