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

Abstract Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder often managed with medication. Improving cognitive functions alongside medication treatment is crucial for better outcomes. This study aimed to investigate the therapeutic effects of combining digitally targeted cognitive training with methylphenidate or atomoxetine, compared to medication monotherapy, on ADHD core symptoms and executive function. We hypothesized that cognitive training could enhance treatment efficacy when combined with medication, potentially by improving cognitive functions. A total of 124 children with ADHD were assessed at baseline and followed up for eight weeks, with 60 receiving cognitive training combined with medication, and 64 receiving medication treatment alone. The results indicated that inattentive and hyperactivity/impulsivity symptoms decreased more in the cognitive training and atomoxetine combination group than in the atomoxetine monotherapy group. Similar between-group differences were observed in executive functions. Executive functions improvements, mainly working memory improvements, were significantly correlated with changes in ADHD core symptoms. However, no such differences or correlations were observed between the two intervention groups for children treated with methylphenidate. These findings suggested a more significant amelioration in symptoms in the atomoxetine combination group, possibly due to a significant improvement in ecological executive function with add-on targeted cognitive training. This study provided preliminary evidence of enhanced therapeutic efficacy in combining cognitive training and atomoxetine compared to medication monotherapy, which contributed to development of personalized treatments, such as combining targeted cognitive training with atomoxetine for ADHD children who are unsuitable to take methylphenidate. (This study was pre-registered at Chinese Clinical Trial Registry: ChiCTR2100043525)