Efficacy of non-pharmacological interventions on executive functions in children and adolescents with ADHD: A systematic review and meta-analysis

Hui Qiu; Xiao Liang; Peng Wang; Hui Zhang; David H K Shum

doi:10.1016/j.ajp.2023.103692

Efficacy of non-pharmacological interventions on executive functions in children and adolescents with ADHD: A systematic review and meta-analysis

Asian J Psychiatr. 2023 Sep:87:103692. doi: 10.1016/j.ajp.2023.103692. Epub 2023 Jul 11.

Authors

Hui Qiu¹, Xiao Liang², Peng Wang³, Hui Zhang⁴, David H K Shum⁵

Affiliations

¹ Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
² Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China. Electronic address: shawn.liang@polyu.edu.hk.
³ Center for Lifestyle Medicine, Fuwai Hospital, Chinese Academy of Medical, Sciences & Peking Union Medical College, Beijing, China.
⁴ Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China; Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
⁵ Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.

PMID: 37450981
DOI: 10.1016/j.ajp.2023.103692

Abstract

Objective: Although front-line doctors recommend medications, this kind of treatment has limited efficacy in improving executive functions (EFs) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). This study explored the effects of non-pharmacological intervention on EFs in children and adolescents with ADHD.

Methods: In accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, we searched seven electronic databases: APA PsycINFO, CINAHL Complete, EMBASE, ERIC, Medline, Pubmed, and Web of Science, from inception to March 2022. Two authors independently screened studies for eligibility, extracted data, and assessed bias risk using the Physiotherapy Evidence Database scale. Our analyses included randomized controlled trials and non-randomized comparison studies of non-pharmacological interventions and assessed EFs through neurocognitive tasks in children and adolescents between 5 and 18 years.

Results: Sixty-seven studies with 3147 participants met the inclusion criteria. The final meta-analysis included 74 independent interventions categorized into six categories: cognitive training, EF-specific curriculum, game-based training, mindfulness practice, neurofeedback training, and physical exercise. Overall, non-pharmacological interventions (combined) produced significant moderate to large effects on overall EFs in children and adolescents with ADHD (g=0.673). Physical exercise had a large positive effect on domain-specific EFs, including inhibitory control (g=0.900) and cognitive flexibility (g=1.377). Cognitive training had a large training effect on working memory (g=0.907), and an EF-specific curriculum had a small to moderate beneficial effect on planning performance (g=0.532).

Conclusion: Non-pharmacological interventions, particularly physical exercise, cognitive training, and an EF-specific curriculum, appear to have beneficial effects on EFs in children and adolescents with ADHD.

Keywords: ADHD; Children and adolescents; Executive functions; Non-pharmacological interventions.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity* / therapy
Child
Executive Function*
Humans
Memory, Short-Term