Efficacy of computer-assisted cognitive flexibility training and the moderating role of neuroticism in children with...

Cognitive flexibility (CF) deficits significantly impact academic and social functioning in individuals with Attention Deficit Hyperactivity Disorder (ADHD). This study aimed to evaluate the efficacy of an 8-week computer-assisted cognitive flexibility training (CFT) program and explore the moderating effect of neuroticism on intervention outcomes.

A total of 203 children with ADHD (152 boys, 51 girls; aged 6-12 years) were enrolled between December 2024 and April 2025 and randomly assigned to CFT arm (CFTA, n = 70), pharmacological treatment arm (PTA, Atomoxetine, n = 67), or wait-list control arm (WLCA, n = 66). Outcomes were measured at baseline, week 4, and week 8 using the Wisconsin Card Sorting Test for CF, the Weiss Functional Impairment Rating Scale-Parent Form for functional impairments, and the Swanson, Nolan, and Pelham, Version IV- Scale for ADHD symptom severity.

Compared to PTA and WLCA, CFT was associated with significant near-transfer gains in CF and parent-reported improvements in life skills and social activities. In contrast, PTA yielded larger gains for inattention, learning and school, and risky activities, while both active arms surpassed the wait-list in reducing hyperactivity-impulsivity. Lower baseline neuroticism predicted greater CFT-related cognitive gains.

Targeted CFT demonstrated near-transfer cognitive gains and was associated with parent-reported improvements in some functional domains. Given its distinct profile from pharmacotherapy, CFT may be a promising adjunct, rather than a standalone treatment, for children with ADHD, particularly those with lower neuroticism.