Effectiveness of different digital interventions on symptoms for children and adolescents with...

Attention-deficit/hyperactivity disorder (ADHD) in children and adolescents is often treated effectively with medication, though this approach requires careful monitoring for side effects and long-term use. Consequently, digital interventions are emerging as a convenient and acceptable supplementary or alternative treatment option.

The present study aims to systematically compare the efficacy of various digital interventions on core symptoms in children and adolescents diagnosed with ADHD through a network meta-analysis.

A comprehensive literature search was performed in the following databases: PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science-from their inception to August 21, 2025. Outcome measures comprise three continuous variables: inattentive symptoms, hyperactive-impulsive symptoms, and executive function. These measures are assessed through subjective behavioral ratings or objective neuropsychological testing. Literature screening was conducted using EndNote 21 software. The quality of the included studies was assessed with the Cochrane Risk of Bias Assessment Tool, and the network meta-analysis was performed using Stata 17.0 software. Effect sizes were pooled using the standardized mean difference (SMDs) with 95% confidence intervals (CIs). Given the diversity of digital interventions, the age range of study participants, and the complexity of the control groups, it was determined that random-effects models would be employed for all analyses.

Traditional meta-analyses a total of 37 randomized controlled trials involving 2,922 participants. results indicate that digital interventions yield significant improvements in inattention [SMD = -0.44, 95% CI (-0.62, -0.26)] and hyperactivity-impulsivity [SMD = -0.26, 95% CI (-0.41, -0.12)] compared to control conditions. Although digital interventions showed a trend toward improvement in executive function, this effect did not reach statistical significance [SMD = -0.41, 95% CI (-0.85, 0.02)]. Subgroup analysis revealed that, compared to the control group, significant improvements in inattention were observed in subgroups involving computer-based cognitive tasks, virtual reality technology, neurofeedback, subjective behavioral scoring, and objective neuropsychological testing (all P < 0.05). For hyperactive and impulsive behaviors, significant improvements were observed across all subgroups: computer-based cognitive tasks, mobile gaming, mobile video viewing, and subjective behavioral ratings (all P values < 0.05). Regarding executive function, a significant improvement was found in the mobile gaming subgroup (P < 0.05). The network meta-analysis based on subjective behavior assessment scales included 32 randomized controlled trials involving 2,726 participants. The results indicate that neurofeedback achieved the highest relative SUCRA value (79.4%) for improving inattentive symptoms. Computer-based cognitive tasks yielded the highest relative SUCRA value (76.1%) for improving hyperactive/impulsive behaviors. Mobile gaming applications demonstrated the highest relative SUCRA value (72.9%) for enhancing executive function.

This systematic review and network meta-analysis found that multiple digital interventions demonstrate positive effects in improving core symptoms of ADHD in children and adolescents. Cumulative Rank Probability Results from a Network Meta-Analysis of Subjective Measurement Tools, neurofeedback demonstrated the most pronounced advantage in ameliorating attention deficit symptoms, computerized cognitive tasks showed the greatest potential for alleviating hyperactivity-impulsivity symptoms, while mobile gaming exhibited the strongest potential for enhancing executive function. Given methodological heterogeneity among existing studies and the limited number of relevant publications included in the analysis, these conclusions warrant cautious interpretation.

https://www.crd.york.ac.uk/, identifier CRD420251126367.