Virtual reality and tablet cognitive training improve attention and academic skills without dose effects

We evaluated the effects of a closed-loop video game intervention on cognitive and academic outcomes delivered in virtual reality (VR) and tablet formats at two different dosages in a school-based setting. This randomized controlled trial included 158 children aged 8–9 years who completed 30 training sessions over 10 weeks. Compared with an expectancy-matched active control group, both VR and tablet training improved objective measures of attention, including performance-based attention and eye-tracking outcomes. Teacher-rated inattention showed nominal improvement relative to the control group but did not remain statistically significant following correction for multiple comparisons. However, the intervention did not significantly surpass the active control condition for reading or math fluency improvements, indicating no between-group academic advantage. Both VR and tablet versions of the intervention produced comparable outcomes across most measures, with a platform-specific advantage for VR observed only on the performance-based attention measure. Intervention dose did not significantly moderate outcomes, suggesting that efficacy may depend more on achieving sufficient engagement than on total duration. These findings support the use of digital cognitive training to enhance objective measures of attention in school settings, while highlighting the importance of cautious interpretation of academic outcomes in the presence of an active control. (Trial registration: ISRCTN75915439; https://doi.org/10.1186/ISRCTN75915439 ).