A feasibility trial of digital game intervention in Chinese children vulnerable to ADHD

Abstract

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by persistent inattention, hyperactivity and impulsivity. Children with ADHD face challenges in multiple domains including emotion regulation, impulse control, organizational skills, academic achievement, and social interaction. In China, ADHD is often overlooked or underdiagnosed due to limited awareness among parents and educators, stigma associated with mental health problems, or inadequate diagnostic infrastructure, resulting in a significant gap between actual cases and patients receiving appropriate treatment. Traditional treatments such as medications and cognitive behavioral therapy have limitations such as side effects and high cost. In contrast, digital play interventions are an ideal alternative. However, digital interventions still have limitations, such as device accessibility issues, focus on a single ADHD problem, unappealing design, and unclear subclinical treatment effects. To address these limitations, this study developed a digital game, and explored the feasibility of the digital intervention for ADHD through an 8-week randomized controlled trial (RCT). A sample of 100 children aged 6-12 years with ADHD (74%) or subclinical ADHD (26%) was recruited. The study employed a 3 (within-subject, Test: baseline vs. 8-week post-test vs. 16-week post-test) × 2 (between-subject, Group: intervention vs. waitlist group) mixed-model design. The intervention and the waitlist groups received the intervention in the first and the second 8 weeks, respectively, during the study period. The intervention comprised 40 sessions (30 minutes each, 5 sessions per week) grounded in Executive Function Theory. The two groups demonstrated reduced symptoms measured by the Conners Abbreviated Symptom Questionnaire (C-ASQ), the Swanson, Nolan and Pelham scale (SNAP), and the Clinical Global Impression of Severity scale (CGI-S) after the intervention phase. Multivariate Analysis of Covariance (MANCOVA) revealed time-by-group interactions: C-ASQ (F = 69.89, η² = 0.419, p < 0.001), SNAP (F = 10.54, η² = 0.098, p < 0.001), and CGI-S (F = 5.67, η² = 0.063, p < 0.05) after controlling for training sessions. Simple effect comparison analysis showed that in the intervention group, significant reduction of ADHD symptoms were observed from the baseline to the 8-week post-test (C-ASQ: 16.54 ± 3.33 to 13.72 ± 3.02, p < 0.001; SNAP: 1.48 ± 0.20 to 1.37 ± 0.22, p < 0.001; CGI-S: 3.50 ± 1.31 to 3.26 ± 1.21, p > 0.05). In addition, symptom levels remained stable from the 8-week post-test to the 16-week post-test (C-ASQ: 13.72 ± 3.02 to 13.58 ± 3.09, p > 0.05; SNAP: 1.37 ± 0.22 to 1.33 ± 0.19, p > 0.05; CGI-S: 3.26 ± 1.21 to 3.08 ± 1.05, p > 0.05), a period during which no additional intervention was administered for the intervention group. In the waitlist group, C-ASQ scores showed minimal natural reduction from baseline to the 8-week post-test (C-ASQ: 16.10 ± 3.84 to 15.22 ± 4.05, p < 0.05; SNAP: 1.49 ± 0.23 to 1.44 ± 0.30, p > 0.05; CGI-S: 3.56 ± 1.26 to 3.30 ± 1.06, p > 0.05), and substantial reductions were observed from the 8-week post-test to the 16-week post-test (C-ASQ: 15.22 ± 4.05 to 9.96 ± 3.20, p < 0.001; SNAP: 1.44 ± 0.30 to 1.17 ± 0.20, p < 0.001; CGI-S: 3.30 ± 1.06 to 2.20 ± 0.64, p < 0.001), a period during which the waitlist group received the intervention. This study highlights the potential of this digital game as a low-cost, engaging tool for ADHD intervention. These results reveal that the digital intervention can reduce the patient’s symptoms and have a beneficial effect on children with clinical and subclinical ADHD. The successful implementation of the game also suggests that digital interventions have the potential to reduce stress in families, healthcare systems, and professional care facilities.