Introduction
Methods
Search methods
Inclusion criteria | Exclusion criteria |
---|---|
English language articles | Studies where intervention is not clearly defined |
Studies recruiting individuals under the age of 18 years | Studies including individuals over the age of 18 years |
Evaluating technologies that can be used independently of a therapist | Non-interventional studies |
Participants reported to have ADHD diagnosis | Interventions that are led by anybody other than the child/YP with ADHD (e.g. clinician led interventions) |
Participants without reported ADHD diagnosis (e.g. parent or teacher reported) | |
Validated outcome measures assessing ADHD-related difficulties | Outcome measures that do not assess ADHD-related difficulties or are not validated |
Observational checklist for observations and recording behaviours | Conners parent scale (brief version) | Corsi Block Tapping Task (CBTT) |
Chart to track each students appropriate behaviour | Connors teacher rating scale | Digit span subtest from the Weschler Intelligence Scale for Children (WISC-III) |
Guided reading packet | 5 subtests from the Movement Assessment Battery for Children (MABC-2-NL) | Disruptive Behaviour Disorders Rating Scale (DBDRS; parent and teacher versions) |
X 2 outcome measures—multiple choice, fill in the blanks and short answer response | Behaviour Rating Inventory of Executive Function (BRIEF): plan/organise | Sensitivity to punishment and sensitivity to reward questionnaire for children (SPRSQ-C) |
Total time to complete reading | BRIEF: working memory subscale—parent | Paediatric quality of life inventory (PedsQL; parent and child versions) |
Sustained attention dots task version 02 k | Shape school | Counting span task |
Calculating time for distractions | BRIEF—inhibit | Connors Continuous Performance Test (CPT II) |
Time calculation | BRIEF—shift | WISC III |
Barkley School Situations Questionnaire | BRIEF—emotional | Social Skills Rating Scale (SRRS) self-control subscale |
Go/no-go task (not QbTest) | BRIEF—control initiate | SRRS total |
Time management questionnaire—parent and teacher completion | BRIEF—organisation of materials | ADHD VragenLijst (AVL) |
It’s About time Questionnaire (IATQ)—parent version | BRIEF—monitor | SSRS—teacher version |
Self efficacy questionnaire | BRIEF—metacognition index | Stop task |
Knox cubes LDT | Weshler Preschool and Primary Scale of Intelligence Revised translated in Dutch (WPPSI-R NL) | ADHD Rating Scale 1 (ADHD-RS-1) |
Action detector | Subscale of Cooperation of the SRRS (parent version) | Stroop (and day/night version) |
Duration of arbitrary standing | SRRS: subscales Responsibility | The home situations questionnaire (HSQ) |
Disruptive Behaviour Disorder Rating Scale (DBDRS) | SRRS: assertiveness subscale | Raven coloured progressive matrices (full and shortened version) |
Improvement index during training | Three subtests in Mandarin Literacy Assessment | ADHD Rating Scale (ARS-IV) |
Strengths and Difficulties Questionnaire (SDQ) | Trail Making Test (TMT) of the Delis-Kaplan Function System (D-KEFS) | Weshler Abbreviated Scale of Intelligence (WASI) |
South Australian Spelling Test (SAST) |
Quality Assessment
Data extraction
Outcome measurement assessment
Data synthesis
Appraisal of evidence
Level of evidence | Non-empirical | Group research | Outcome research | Single participant research |
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I | – | Randomised controlled trial | – | N-or-1 randomised controlled trial |
II | – | Non-randomised control trial Prospective cohort study with concurrent control group | Analytic survey | ABABA design Alternating treatments. Multiple baseline across participants |
III | – | Case–control study. Cohort study with historical control group | – | ABA design |
IV | Before and after case series without control group | – | AB design | |
V | Descriptive case series Anecdotes Expert opinion Theories Common sense | – | – |
Results
Search results
Quality assessment
Quality assessment of measurement scales
Authors, year, country, study design, level of evidence | Number recruited (N), final follow-up (n) overall and between groups | Gender, mean age (years), how ADHD diagnosis confirmed | Intervention and length/frequency/groups in study | Outcome measures used and ADHD-related difficulty domain assessed* | ADHD-related difficulty results and reported p values |
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Bamford, 2016, USA, single subject design (ABAB), level III [59] |
N = 4 | 2 males, 2 females, 16.5, medical diagnosis (N = 4) | iPad choice works app, 20 min (baseline observation), use app for 8 days, single participant group | Guided reading packet, multiple choice, observation checklist, education* | A trend towards improvements in on task behaviour was reported when participants used the iPad |
Pinna, 2015, USA, case series, level IV [60] |
N = 9 | 7 males, 2 females, 13, diagnosed by psychiatrist, psychologist or physician | Tablet-based reading app designed to help reading, answer questions about the text and record the answer. Participants read at same time on 2 separate days, day 1 reading a book, day 2 reading text on app, single participant group | Total time to complete reading, calculating time for distractions, time calculation, ADHD symptoms* | No significant differences were found in student’s ability to recall information from a story were observed when they read from the application or a book |
Ruiz-Manrique et al., 2016, Spain, case study, level V [58] |
N = 1 | Male, 10 years, DSM V criteria | App “ADHD Trainer”, every day at the same time, no more than 4 h daily for first month (average 1 h per day), at least 10 min per day for following month, single participant group | Conners parent Scale (brief version), Connors teacher rating scale, Barkley School Situations Questionnaire, ADHD symptoms* | ADHD symptoms improved following training. BSSQ was 70 pre and 66 post training. Conners scores were 19 for teachers and 20 for parents pre training, 15 for teachers and 16 for parents post training. Authors report that findings demonstrate that “cognitive computerised training” may improve some ADHD cognitive symptoms |
Weerdemeester et al., 2016, The Netherlands, 2 arm feasibility RCT, adventurous dreaming highflying dragon computer game (ADHD group), computer game without ADHD focussed training components (control group), level II [56] |
N(n) = 73(66), intervention; 37(32), control; 36(34) | 58 males, 15 females, 9, formal diagnosis (N = 39), elevated symptoms (no diagnosis or other diagnosis; (N = 26), comorbid disorder (N = 8) | Computer games: “Adventurous Dreaming Highflying Dragon” (intervention), comparable intervention without ADHD focussed training components (control), 6 15-min sessions over 3 weeks, intervention and control group | ADHD VragenLijst (AVL), Go/no-go task, MABC-2-NL, ADHD symptoms* and motor skills* | Total and hyperactivity sections of AVL and the Go/No-go outcomes demonstrated improvements (p ≤ 0.05). The impulsivity section of the AVL and the fine motor skills also showed improvements (p ≤ 0.10). Teacher-rated ADHD symptoms improved in the intervention compared to control group (p ≤ 0.05) |
Bul et al., 2016, The Netherlands, RCT crossover trial, serious game intervention (intervention), treatment as usual (control), level 1 [34] |
N(n) = 170(139), intervention; 88(68), control; 82(71) | 137 males, 33 females, 9, DSM IV criteria | Serious game intervention (programmed so can not play more than 65 min in 24-h period) called “Plan-It Commander”, or treatment as usual, 10 weeks, intervention and control crossover design | Time management questionnaire—parent and teacher completion, subscale Plan/Organise and working memory of BRIEF, Subscale of cooperation, responsibility, assertiveness, self control and total SRRS of SRRS, IATQ, SRRS teacher version, self efficacy questionnaire, social skills*, self efficacy* and executive function* | Group 1 participants significantly improved time management skills compared to group 2 (parent reported; p = .02). Parents and teachers reported total social skills improved within groups effects on total social skills and teacher reported planning/organising skills were non-significant between groups. Group 1 positive effects were maintained and improved in last 10 weeks of study |
Shih et al., 2014, Taiwan, before and after case series, level IV [61] |
N = 2 | 2 males, 8.5, diagnosed, details not reported | Wii remote controller and control system, used to detect activity in students and giving them reminders when they are standing (rather than sitting) in the classroom, 40-min sessions, 3–5 times per week, single participant group | Action detector and duration of arbitrary standing, ADHD symptoms* | Both participants improved hyperactive behaviour during intervention phase (p < 0.01). Effects maintained at maintenance phase (1 week later) |
van der Oord et al., 2014, The Netherlands, 2 arm RCT, Executive function training (intervention) or wait list (control), level I [57] |
N(n) = 43(40), treatment 21(18), wait list 22(22). | 33 males, 7 females, 9.75, DSM IV diagnosis (N = 77) | Computer game (macintosh computer installed in participant’s homes), EF training group consisted of 25 40 min over 5 weeks. Sessions covered inhibition, cognitive flexibility and working memory, intervention and wait-list conditions | All subscales of BRIEF, DBDRS, ADHD symptoms*, executive function* | Participants in the EF training showed improvements compared to those in wait-list condition on parent rated EF and ADHD behaviour in total sample and subsample (those treated with methylphenidate). Effects maintained at follow-up. Between group differences suggested for ODD subscale of DBDRS |
Dovis et al., 2015, The Netherlands, 4 arm RCT, full active condition (visuospatial WM, inhibition and cognitive flexibility trained), partially active condition (inhibition and cognitive flexibility trained), WM training task presented in placebo mode and a full placebo condition, level I [55] |
N(n) = 89(57), full active training 31(20), partially active training 28(21), placebo training 30(16) | 71 males, 18 females, 10, DSM IV diagnosis | Computer game “Braingame Brian”, 5 weeks, weekly phone calls from research team, four groups: “full active” (visuospatial WM, inhibition, cognitive flexibility training), “partially active” (inhibition and cognitive flexibility), WM training task presented in placebo mode and full placebo condition | Improvement index during training, Stop task Stroop, CBTT, WISC-III, TMT of D-KFES, Raven, DBDRS, BRIEF, SPRSQ-C, PedsQL, Home situations Questionnaire, executive function*, ADHD symptoms*, QoL*, social skills* | Improvements were observed in visual spatial STM and WM, inhibitory performance and interference control |
Lin et al., 2016, Taiwan, single case (ABA), level III [62] |
N = 2 | 2 males, 11, diagnosed, details not reported | App, Mobile Augmented Reality (MAR), data collected over 3 months, single participant group | Three subtests in Mandarin Literacy Assessment (MLA), education* | MLA scores increased during intervention and maintenance phases( p < 0.05) |
Rijo et al., 2015, Portugal, before and after case series, level III [63] | Study 1: N = 8, study 2: N = 12 (N = 6 ADHD, N = 6 not ADHD) | Study 1: 2 males, 2 females, 7, not diagnosed. Study 2:gender not reported, 7, N = 6 diagnosed, details not given | Computer serious game involving a treasure hunt find things like letters and words, 3 months, daily use monitored by the research team, two studies, single participant groups in each | CPT II, WISC III, ADHD symptoms*, executive function* | A trend towards improved CPT II and WISC III scores post intervention was reported |
Van Dongen-Boomsma et al., 2014, The Netherlands, randomised placebo control trial, level I [51] |
N(n) = 51(47), intervention; 27(26), control 24(21) | 34 males, 17 females, intervention; 6.5 ± 0.6, control; 6.6 ± 0.7, DSM IV criteria | CogMed Working Memory Training (CMWT; computer software). 25 sessions of 15 min, 5 days a week, sessions. Both conditions included 7 visuo spatial working memory tasks. In intervention group, software adjusted task difficulty based on child’s performance. Control group same as intervention, exec items to memorise did not exceed starting level, intervention and control | ADHD-RS-1, BRIEF (parent and teacher Dutch versions), BRIEF-P, Adapted didgit span from WISC-III, Knox cubes LDT, Sentences from WPPSI-RN, Shortened Ravens progressive matricies, Day night stroop task, Sustained attention dots task version 02 k, Shaoe school | Does not provide evidence in favour of CMWT. Significant improvement of active condition found on verbal working memory task (p = .041; adapted Digit Span WISC-III..No significant treatment effect on any other outcome measurements. No significant differences found in ADHD-RS and Behavior Rating Inventory of Executive Function |
Egeland et al., 2013, Norway, RCT, level I [52] |
N(n) = 75(67), intervention 38(33), control 37(34) | 49 males, 18 females, 10.4, ICD-10 criteria | CogMed roboMemo program performed daily at school for 5-7 weeks, 30–45 min in length, consists of 13 adaptice exercises, difficulty level altered based on child’s performance. Tasks taxed working memory capacity, these included tasks such as letter and digit span tasks. Two groups; intervention and control | ARS-IV ADHD rating scale, SDQ, BRIEF metacognition index and general executive composite | Significant training effect in psychomotor speed, but not to any other neuropsychological measures. No training induced changes in symptom rating scales at home or school |
Klingberg et al., 2005, Sweden, double blind RCT, Level I [54] |
N(n) = 53(46), intervention 27(20), control 26(24) | 36 males, 8 females, intervention 9.8, control 9.9, reports ADHD diagnosis confirmed | Working memory tasks in a computer program “RoboMemo® Cogmed Cognitive Medical systems AB”, provided on a CD, used by child on personal computer at home or school. Included visuo spatial working memory tasks. Children performed 90 trials on each day, around 40 min per day, difficulty level adjusted based on child’s performance | WAIS-RNR, Digit span from WISC III, Stroop interference, Raven’s coloured progressive matrices, Connors for parents and teachers | Significant effects for verbal WM; Digit span p = .01 post intervention/p = .03 at follow-up, Stroop (accuracy) p = .004 post intervention/p = .44 follow-up response inhibition, and complex reason in measures. Parent ratings showed significant reduction insymptoms of inattention (post intervention: p = .002; follow-up: p = .04) and hyperactivity/impulsivity (post intervention/follow-up: p = .03), both post intervention and at follow-up |
Johnstone et al., 2012, Australia, randomised waitlist control, Level I [53] |
N(n) 151(128), waitlist (WL) ADHD group n = 20, Software (SW) ADHD group n = 22, software with attention monitoring (SWAM)ADHD group n = 18, non ADHD WL n = 25, non ADHD SW group n = 23, non ADHD SWAM group n = 20. Drop out rate not reported therefore post training assessment n not available | 96 males, 55 females, ADHD WL 19 male, 1 female, SW ADHD group 19 males, 3 females, SWAM ADHD group 16 males, 2 females, non ADHD WL group 15 males, 10 females, non ADHD SW group 15 males, 8 females, non ADHD SW + AM group 12 males, 8 females | Three conditions; waitlist, working memory and inhibitory control with attention monitoring or working memory and inhibitory control without attention monitoring. Reported as ADHD diagnosis confirmed | WASI, South Australian Selling Test, Counting span task | Non-significant post training improvements in spatial working memory (p = .066), ignoring distracting stimuli, and sustained attention reported for children with ADHD and without. Improvements for both groups maintain 6-weeks after training. Results suggest combined training can result in improved behavioural control for children with and without ADHD |