The promoting effects of digital targeted cognitive training in medication treatment for children with ADHD: a randomized controlled trial

Background: Attention deficit hyperactivity disorder (ADHD) is commonly managed with medication, yet improving cognitive functions alongside medication may enhance outcomes. This study investigated whether combining digitally targeted cognitive training (TCT) with medication improves ADHD core symptoms versus medication alone. Methods: Randomized parallel-group controlled trial with 124 children with ADHD completing 8 weeks: medication monotherapy (M; atomoxetine [ATX] or methylphenidate [MPH], n=64) versus TCT plus medication (TCT+M; TCT+ATX or TCT+MPH, n=60). Primary outcome: changes in ADHD Rating Scale (ADHD-RS). Secondary outcomes: parent-reported ecological executive functions (BRIEF), social functioning (WFIRS), and laboratory cognitive functions. Results: Overall, TCT+M was not superior to M for ADHD core symptoms, ecological executive functions, social functions, or lab cognitive functions. Post-hoc exploratory analyses: In the ATX subgroup, TCT+ATX showed greater improvement in ADHD-RS total, inattention, and hyperactivity/impulsivity than ATX alone, with similar advantages in ecological executive functions and significant correlations between executive function improvements and ADHD symptom changes. In the MPH subgroup, no between-group differences were observed. Conclusions: Compared to medication alone, TCT+M did not yield greater improvements in ADHD core symptoms or secondary outcomes. Targeted cognitive training may promote atomoxetine’s efficacy for alleviating ADHD core symptoms. Trial registration: ChiCTR2100043525. Keywords: ADHD, Medication treatment, Targeted cognitive training, Ecological executive functions.

Chen Dang, Yu Zhu, Xiangsheng Luo, Lu Liu, Yuan Feng, Guisen Wu, Shaogen Zhong, Xin Wang, Jianzhao Zhang, Yike Zhu, Siqi Liu, Ziqi Liu, Li Qin, Xiaohui Ma, Yufeng Wang, Xiaoyi Wang, Jian Yang, Changming Wang, Li Sun