Comparative Effects of BCI-Based Attention Training, Methylphenidate, and Citicoline on Attention and Executive Function in School-Age Children: A Quasi-Experimental Study

<i>Background and Objectives</i>: Attention-Deficit Hyperactivity Disorder (ADHD) is a neurological condition characterized by cognitive task difficulty, impulsivity, hyperactivity and loss of attention. This study compared four approaches for improving attention and related skills in school-age children: COGO Brain-Computer Interface (BCI)-based attention training, methylphenidate, citicoline, and their combined use. <i>Materials and Methods</i>: A quasi-experimental pre-post design was used with four groups: COGO + methylphenidate (<i>n</i> = 44), COGO + citicoline (<i>n</i> = 44), COGO-only (<i>n</i> = 44), and citicoline-only (<i>n</i> = 42). Children completed baseline and post-treatment assessments, including the CPT-3 and several behavioral and emotional rating scales. Analyses included paired <i>t</i>-tests, ANCOVA, and repeated-measures ANOVA, adjusting for age. <i>Results</i>: The strongest improvements appeared in the COGO + methylphenidate group, especially in measures of sustained attention and reaction time consistency. The COGO + citicoline group showed clearer gains in inhibitory control (fewer commission errors) and reductions in anxiety/emotional symptoms. The COGO-only and citicoline-only groups showed little to no measurable change. Despite these within-group patterns, there were no significant differences between groups on CPT-3 outcomes or behavioral/emotional scales. <i>Conclusions</i>: This trial showed that combining COGO-based attention training with medication is both feasible and well-tolerated in children with attention and executive function difficulties. Moreover, the integrated approach produced measurable improvements across attentional performance and behavioral regulation domains.