Effectiveness of an attention enhancement task on executive function in children with attention deficit-hyperactivity disorder: A systematic review and meta-analysis

Background Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder diagnosed in childhood. Untreated ADHD can impair development and increase the likelihood of psychopathology due to executive dysfunctions.Aim This review examined the effect of attention training on executive functions in children with ADHD.Methods A literature search was conducted in Scopus, PubMed, CINAHL, Cochrane, and Embase databases from January 2004 to May 2024, following PRISMA guidelines. Randomised clinical trials (RCTs) involving children with ADHD (younger than 17 years) that included attention training alone or alongside standard treatments (such as medication) with executive functions as primary outcomes were included. Review Manager (RevMan), Version 5.4.1 and the Cochrane Collaboration, 2011, was used to evaluate study quality. The random effects model was used, and heterogeneity was measured via the I2 statistic.Results Five studies (N = 289) were included in the systematic review and three in the meta-analysis. The analysis revealed a significant effect of attention training on the global executive composite (SMD = 1.17, 95% CI:-2.11 to -0.23, p = 0.010), the behavioural regulation index (SMD = -0.34, 95% CI: -0.68 to -0.01, p = 0.040), and the metacognitive index (SMD = -0.70, 95% CI:-1.11 to -0.29, p < 0.001). Thus, attention training can enhance the behavioural and metacognitive functions of children with ADHD.Conclusion This review revealed that attention training may improve executive functions in children with ADHD. However, due to a few studies and heterogeneity, the findings must be interpreted cautiously.