Gabarron et al.

BMC Psychiatry (2025) 25:414 BMC Psychiatry

https://doi.org/10.1186/s12888-025-06825-0

SYSTEMATIC REVIEW Open Access

Evaluating the evidence: a systematic review

of reviews of the effectiveness and safety
of digital interventions for ADHD
Elia Gabarron1*†, Kerstin Denecke2† and Guillermo Lopez‑Campos3†

Abstract
Background Attention-Deficit/Hyperactivity Disorder (ADHD) impacts academics, work and social relationships. Digi-
tal interventions, such as virtual reality, games, app and other, offer accessible therapeutic options, yet understanding
their efficacy and potential adverse effects is crucial for safe use. The objective of this study is to identify and analyze
the efficacy and adverse effects reported in systematic reviews of digital interventions for ADHD.
Methods We conducted a systematic review of systematic reviews to assess the reported efficacy and safety of digi-
tal interventions for ADHD. We searched for relevant publications in Scopus, PubMed, PsycINFO and Cochrane Library.
Both study selection and data extraction were performed in duplicate to ensure accuracy and reduce bias. This review
followed PRISMA 2020 guidelines, PRISMA-harms checklist, and we used AMSTAR-2 to assess the quality and risk
of bias of the included reviews.
Results A total of 26 systematic reviews on digital interventions for ADHD were included. These reviews collectively
involved 34,442 participants, with the majority focusing on children and adolescents. The digital interventions ana-
lyzed included video games, computerized cognitive training, virtual reality, apps, and others. The outcomes reported
various positive effects, such as improvements in inattention and executive function, though evidence was generally
low quality. Adverse effects were reported in 8 of the 26 included reviews (30,1%), and included physical discomfort,
emotional reactions, and behavioral issues, such as video game addiction.
Conclusions This systematic review of systematic reviews indicates that while digital interventions for ADHD show
potential benefits, their effectiveness remains inconclusive due to low evidence quality. Adverse effects, particularly
from video games, have been reported but are inconsistently documented. Future research should focus on rigorous
safety assessments, standardized reporting, and long-term effectiveness.
Trial registration This systematic review is registered in Prospero: CRD42024521084.
Keywords ADHD, Attention-Deficit/Hyperactivity Disorder, Systematic Review, Digital Health, Adverse effects

†
Elia Gabarron, Kerstin Denecke and Guillermo Lopez-Campos contributed
equally to this work.
*Correspondence:
Elia Gabarron
[email protected]
Full list of author information is available at the end of the article

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0
International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long
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Gabarron et al. BMC Psychiatry (2025) 25:414 Page 2 of 18

Background in publications related to digital mental interventions

Attention-Deficit/Hyperactivity Disorder (ADHD) is a [19–21].
neurodevelopmental disorder characterized by persis- With the exponential growth of research on digital
tent patterns of inattention, hyperactivity, and impulsiv- interventions for health [22], particularly related to men-
ity that interfere with functioning or development [1]. tal health [23–25], and the increasing number of sys-
It affects approximately 5–11% of children worldwide tematic reviews synthesizing these studies, a systematic
[2], with symptoms often continuing into adulthood [3], review focusing not only on the effectiveness but also on
where the prevalence of adult ADHD is 6,76% [4]. ADHD the safety of these interventions for ADHD is highly rel-
significantly impacts individuals by impairing academic evant. The research question guiding this study is: What
performance [5], occupational success [6], and social is the effectiveness and safety of digital interventions for
relationships [6], and it is associated with higher risks ADHD, as reported in systematic reviews? Understand-
of comorbid health conditions [7, 8]. At society level, ing the potential risks associated with digital interven-
ADHD contributes to increased healthcare costs, educa- tions helps clinicians make informed decisions, ensuring
tional support needs, and productivity losses, underscor- that these tools are implemented safely and effectively in
ing the importance of effective interventions and support clinical settings. For researchers, identifying effectiveness
systems. as well as common adverse effects and events can high-
Digital interventions offer solutions for addressing light areas that require further investigation, driving the
challenges in current healthcare systems (i.e., account- development of safer and more effective interventions for
ability, coverage; accessibility of health facilities; availabil- individuals with ADHD. From a policy perspective, com-
ity of human resources, commodities, and equipment; prehensive knowledge of the effectiveness and safety can
contact and continuous coverage; effective coverage; and inform regulations and guidelines, ensuring that digital
financial coverage) [9]. Digital interventions are already interventions for ADHD are held to high safety stand-
being used for treating individuals with ADHD [10–13]. ards, ultimately improving patient outcomes.
Digital interventions include a range of technologies,
such as mobile apps, computer programs, video games, Objective
virtual reality, or robotics. These technologies have the The objective of this study is to identify and analyze the
potential to be personalized, scalable, and accessible with effectiveness and safety reported in systematic reviews of
options for integration into daily life to treat ADHD or digital interventions for ADHD.
as a complement to other interventions, as well as to
improve adherence and engage younger populations who Methods
are often more receptive to digital tools [14, 15]. We have performed a systematic review of systematic
In the evaluations of digital interventions, it is cru- reviews to capture the current evidence on the reported
cial not only to assess their efficacy but also to under- effectiveness and safety associated with digital interven-
stand their safety and potential adverse effects or events. tions for ADHD.
Adverse effects (i.e., adverse outcome that can linked to This review followed the Preferred Reporting Items
the intervention) [16] and adverse events (i.e., adverse for Systematic Reviews and Meta-Analyses (PRISMA
outcome that occurs during an intervention, but is not 2020 Statement) [26], the PRISMA harms checklist
directly caused by it, or may not be linked to it at all) [16] [27] to identify the minimal set of items to be reported
are a critical aspect of any intervention, as they provide when reviewing harms; and the MeaSurement Tool to
a comprehensive view of the potential risks involved in Assess systematic Reviews (AMSTAR- 2) guidelines
using these technologies. This information is essential for [28]. This systematic review is registered in Prospero:
informed decision-making by both clinicians and users CRD42024521084.
of these technologies, as it helps to weigh the benefits
against the possible risks. Moreover, understanding safety Search strategy and information sources
can guide the development of safer and more effective This review is part of a larger project in which we
interventions, ensuring that they do not unintentionally are examining the safety of any type of intervention
harm users [17]. Focusing on these aspects contributes to addressed to individuals with ADHD, as reported in sys-
a more holistic evaluation, ultimately aiming to enhance tematic reviews with or without meta-analysis. With the
the quality and safety of digital mental health solutions. objective of identifying the reported effectiveness and
In the field of mental health, some research indicates that safety associated with any type of intervention for ADHD
there is little risk of harm associated with certain digital documented in systematic reviews, an electronic search
interventions (e.g., chatbots) [18], while other studies was carried out on March 4 th, 2024. Additionally, a sec-
suggest that there may be a gap in the reporting of safety ond search was conducted on March 6 th, 2025, covering
Gabarron et al. BMC Psychiatry (2025) 25:414 Page 3 of 18

the period from 2024 to 2025. These searches were car- assessed in full text by two reviewers. Discrepancies were
ried out by the first author. The searches covered pub- solved through discussion until reaching agreement. All
lished studies comprising the terms related to ADHD in selected articles were included in qualitative synthesis.
title or abstract “ADHD” or “Attention Deficit Disorder The following data were extracted into an ad hoc docu-
with Hyperactivity” or “Attention Deficit Disorder” or ment: publication year, population (age, gender, ethnic-
“Attention Deficit Hyperactivity Disorder” or “Attention ity, and comorbidities), intervention (type and duration),
Deficit Hyperactivity Disorders” or “Hyperkinetic Syn- comparator/control, and reported outcomes (effective-
drome” in combination with terms related to systematic ness and safety). The data extraction was also performed
review in the title “Systematic review” or “Meta-analysis” in duplicate, with all selected articles from the full-text
or “Metaanalysis” and indexed in the following databases: screening divided among the three reviewers, ensuring
Scopus, PubMed, PsycINFO, and the Cochrane Library. that each article had data extracted by two independent
No year or language limitations were used. The full reviewers. No additional attempts were made to retrieve
search strategy is presented in Appendix 1. relevant data from the authors of included studies. Data
In this article, we specifically present data correspond- extraction files were merged, and discrepancies were dis-
ing to systematic reviews on digital interventions for cussed between all authors until consensus was achieved.
ADHD, which refer to the use of any digital technology to
deliver the intervention, such as apps, computers, video Data items and synthesis of data
games, virtual reality, robots, artificial intelligence, and Following the PRISMA guidelines [26], we performed a
others. narrative synthesis of the results and present tables and
figures summarizing the outcomes (effectiveness and
Eligibility criteria, selection process and data extraction safety) reported in the systematic reviews. These were
Publications were included in the review if they fulfilled categorized according to the type of intervention, over
following criteria: time, and according to the quality of evidence of the sys-
Inclusion Criteria: tematic review. Additionally, we have summarized the
systematic reviews that have not reported safety data.
1) Systematic reviews specifically focusing on individu- These findings were also categorized according to the
als with ADHD (of any age group, gender, ethnicity, type of intervention, over time, and according to the
and existence of comorbidity); and quality of evidence provided in the systematic review. All
2) Systematic reviews covering any digital intervention coauthors have been involved in the data synthesis.
and published in any language.
Quality evidence assessment and risk of bias
Exclusion Criteria: We have used the critical appraisal tool for systematic
reviews that include randomized or non-randomized
1) Systematic reviews that do not specifically focus on studies of healthcare interventions, known as AMSTAR-
individuals with ADHD; 2 [28] to evaluate the quality of the evidence of the
2) Systematic reviews that do not address digital inter- included reviews. This tool helps to rate the studies as
ventions; having high, moderate, low, or critically low quality based
3) Protocols of systematic reviews; on the assessment of 16 domains, such as the inclusion of
4) Editorials, letters to the editor, errata, corrigenda, PICO questions and criteria; existence of prior published
corrections, comments, retracted articles, responses, review protocol; explained inclusion criteria; use of com-
or similar materials about systematic reviews or prehensive literature search strategy; performed dupli-
meta-analyses. cate study selection; performed duplicate data extraction;
or list of excluded studies with justifications of their
All references captured by the search engine were exclusion, among others. Each included study was inde-
uploaded to EndNote 20 and Rayyan. Duplicates were pendently evaluated by two authors.
identified and removed. In order to assess eligibility, in a
first step, all titles and abstracts were reviewed in dupli- Results
cate: one reviewer (EG) screened all references, while two Study selection
other reviewers (KD and GLC) independently screened A total of 5,565 records were identified in the data search.
half of the references each. In a second step, the full text After removing duplicates, 3,088 titles and abstracts were
of the selected studies was reviewed in duplicate; two- screened, and of those 540 were sought for retrieval. Of
thirds of the references were assigned to each of the three those, 40 additional articles were excluded due to lack
reviewers, ensuring that each article was independently of access to their full text, being retracted articles or
Gabarron et al. BMC Psychiatry (2025) 25:414 Page 4 of 18

duplicates (most of which resulted from overlap in the the accuracy of the automated translation with Google
second search). The full texts of 500 systematic reviews Translate Documents could not be confidently relied
on interventions for ADHD were obtained, and from upon.
these, a total of 26 systematic reviews addressing any Studies classified as low or critically low mainly failed
type of digital intervention were included in this review to report a list of excluded studies with reasons for exclu-
[29–54]. Figure 1 presents the flowchart of the selection sion (a critical domain in AMSTAR- 2), and because the
procedure for both search engines. authors did not address how the risk of bias might have
The list of the 474 articles systematic reviews on inter- impacted the interpretation of their results.
ventions for ADHD that do not specifically address any
type of digital intervention and were therefore excluded
from this review is presented in Appendix 2. Description of participants, interventions and comparators
A summary of the 26 included systematic reviews is pre-
Risk of bias sented in Table 1. The included articles were published
The methodological quality and risk of bias of the between 2018 and 2025 and reported the inclusion of a
included systematic reviews are presented in Fig. 2. Three total of 575 articles in their reviews. The source of fund-
reviews were classified as high quality [41, 46, 54], one ing of the included reviews is reported in Appendix 3.
as moderate quality [50], ten as low quality [29–31, 33, The systematic reviews included in this review collec-
34, 38–40, 44, 48, 49, 52, 53], and eleven were classified tively involved a total of 34,442 study participants across
as critically low [29–31, 33, 34, 38–40, 44, 48, 51] using intervention and control groups. The smallest review
AMSTAR- 2 [28]. The risk of bias for one of the included included 39 participants [39], while the largest included
articles could not be assessed [37], as it was published 11,969 participants [42]. Most of the studies focused on
in a language not known to the authors (Slovenian) and children and adolescents (ages 3 to 18), though seven

Fig. 1 Flowchart of the selection procedure for both search engines

Gabarron et al. BMC Psychiatry (2025) 25:414 Page 5 of 18

Fig. 2 Risk of bias of the systematic reviews evaluated with AMSTAR- 2 [28]. * AMSTAR- 2 Critical domain. H: High (No or one non-critical weakness);
M: Moderate (More than one non-critical weakness); L: Low (One critical flaw with or without non-critical weaknesses); CL: Critically low (More
than one critical flaw with or without non-critical weaknesses). Yes; No; Unclear; Ø: Not applicable
Table 1 Summary of the systematic reviews included (n = 26)
Reference Articles Participants included the Intervention type and Use of control groups Outcomes-Effectiveness Outcomes-Safety
included in reviews and their ages durations (D)
review

Powell et al, 2018 [41] 14 N = 743 Several digital interventions Control groups: Technology has potential Not reported
6,6 to 16,5 years (self-help devices, video - No intervention in pediatric ADHD manage-
games, internet, software, ment, but current research
Gabarron et al. BMC Psychiatry

social media, apps…) lacks robustness

for facilitating the self-
management of ADHD
associated difficulties
D: 2 days to 3 months
Gudka et al., 2025 [54] 19 N = 26,518 to 77 years Several digital tools (web- Control groups: Limited evidence of effec- Not reported
(2025) 25:414

base, apps and chatbots) - No intervention (only used tiveness was found,
for providing psychoeduca- in 9/19 included articles) except for psychoeduca-
tion; symptom monitoring; tion DHIs which may be
practical interventions; effective in reducing ADHD
healthcare and self-manage- symptoms
ment information
D: Not reported
Westwood et al, 2023 [46] 42 N = 2234 Computerized cognitive Control groups: No effect of computer- Not reported
6 to 65 years training for supporting - Treatment as usual ized cognitive training
clinical, neuropsychological - Waiting list interventions on ADHD
and academic outcomes - Medication total or hyperactivity/
D: Not reported - No intervention impulsivity symptoms; small
improvement in inattention
symptoms
Liu et al., 2024 [50] 25 N = 1780 Several digital tools (com- Control groups: The digital interventions Not reported
5 to 38,9 years puters, internet, chatbot, - Wait list proved beneficial for individ-
games) for delivering CBT, - Placebo pill uals with ADHD by alleviat-
cognitive or attention ing symptoms of ADHD,
training, neurofeedback, inattention, and hyperactiv-
and relaxation training ity/impulsivity
D: 4 to 25 weeks
Elbe et al, 2023 [35] 9 N = 285 Computerized cognitive Control groups: Computerized cognitive Not reported
21,1 to 39,5 years training for supporting cog- - Active intervention training showed a slight
nitive outcomes and symp- (1-back) improvement in overall
tom severity - Wait-list cognition, with no signifi-
D: 4 to 12 weeks cant changes in symptom
severity or specific cognitive
skills
Yu et al., 2024 [52] 9 N = 370 Virtual reality (games, cogni- Control groups: Both immersive and non- Not reported
8 to 18 years tive training, and neural - Methylphenidate immersive virtual reality
feedback training) for sup- - Conventional therapy/ interventions significantly
porting attention and motor feedback training improved attention
ability - No intervention
D: 2 to 12 weeks
Page 6 of 18
Table 1 (continued)
Reference Articles Participants included the Intervention type and Use of control groups Outcomes-Effectiveness Outcomes-Safety
included in reviews and their ages durations (D)
review

Avion, 2024 [49] 9 N = 370 Computerized-cognitive Control groups: Computerized-cognitive Not reported
6 to 17 years training for supporting - Waiting list training interventions did
attention, working memory, - Sham not provide enough data
Gabarron et al. BMC Psychiatry

and/or combined aspects - Active control to determine their impact

of cognitive function - Stimulant medication on executive and adaptive
D: 5 to 8 weeks - Combined treatment functioning
Caselles-Pina et al, 2023 [32] 18 N = 1479 Video-games as cognitive Control group only men- Video games-based Headache (3 studies)
7,8 to 15,6 years training tioned for one study (Tetris) interventions can be used Pain in the fingers (1 study)
D: 1 to 20 weeks to improve ADHD symptoms Irritability (1 study)
(2025) 25:414

and display high adherence Frustration (1 study)

to treatment
Zhang et al., 2024 [53] 10 N = 683 Virtual reality-based sports Control group: Virtual reality motor games Not reported
6 to 17 years games (computer-based - No intervention significantly improved
training; motor games, the executive and cogni-
and virtual reality training) tive functions of children
for improving executive with ADHD
and cognitive functions
D: 4 to 20 weeks
He et al, 2023 [36] 31 N = 2169 Several digital interventions Control groups: Digital interventions Video game therapy lead
4 to 17 years (RoboMemo; Cogmed work- - No intervention improved inattention to headache, dizziness, agita-
ing memory training; Xbox - Traditional cognitive symptoms, reduced reaction tion, and other adverse effects
Kinect; Focus iCON mobile intervention time on the continuous ADHD patients are at higher
application; and other) - Standard care performance task, slightly risk for video game and inter-
as digital therapeutics decreased impulsive net addiction
D: Not reported hyperactivity, and enhanced
executive function
Rodrigo-Yaguas et al., 2022 128 N = 11,969 Video games as cognitive Control groups: Video games can be Playing video games
[42] 10 months to 36 years rehabilitative tools - No intervention used to ameliorate ADHD for over 1 h daily may worsen
D: 2 weeks to 2 years - Different interventions symptoms while improving ADHD symptoms
- Usual treatment adherence to treatment Playing video games may
- Other comparators increase attention problems
The presence of electronic
devices can cause sleep
problems
Vitija et al, 2022 [45] 4 N = 502 Several digital interventions Control groups: Digital interventions bridge Not reported
2 to 18 years (mobile app; Telemental - Treatment as usual gaps between patients
Health service; digital and healthcare profession-
appointments with coun- als, enabling more frequent
serllors…) for promoting monitoring and communi-
communication cation
D: 5 to 12 weeks
Page 7 of 18
Table 1 (continued)
Reference Articles Participants included the Intervention type and Use of control groups Outcomes-Effectiveness Outcomes-Safety
included in reviews and their ages durations (D)
review

Romero-Ayuso et al., 2021 6 N = 311 Virtual reality for supporting Control groups: Virtual reality interven- Children struggle to distin-
[43] 7 to 12 years cognitive deficits - Non VR tions led to improvements guish real memories from VR
D: 2 to 8 weeks - Placebo psychotherapy in attentional vigilance, memories
Gabarron et al. BMC Psychiatry

training with more correct responses

- Long-lasting methylphena- and fewer omission errors,
mide but no change in impulsivity
Wilkes-Gillian et al., 2021 [47] 15 N = 106 Video-modelling for improv- Some studies have controls Evidence suggests video Not reported
5 to 16 years ing skills and behaviours modeling may effectively
D: 15 min to 18 months enhance social skills
(2025) 25:414

and behaviors in individuals

with ADHD when combined
with other interventions
Black et al, 2020 [31] 32 Not reported Several digital interven- Not reported Mixed conclusions Not reported
tions (wearables, mobile on the effectiveness of utiliz-
apps and computer based) ing these technologies
as school performance sup- as an aid of ADHD
port tools
D: Not reported
Păsărelu et al, 2020 [39] 1 N = 39 App for improving medica- Control groups: Further research is needed Not reported
6 to 16 years tion adherence - Treatment as usual (no to determine the safety
D: Not reported app) and efficacy of available
ADHD apps
Andreou et al., 2024 [29] 15 N = 310 Several digital interventions Some studies have controls Educational software Not reported
6 to 16 years (iPad, software, Lexia SOS, and computer games can
augmented reality app, aid children with ADHD
etc.….) for enhancing the in native language learning,
academic achievements supporting skills like read-
D: 1 lesson to 6 months ing, spelling, and descriptive
writing
Bernanalizadeh et al., 2024 12 N = 708 Several digital interventions Control groups: Significant effect on inat- Not reported
[30] 5 to 17 years (computer-based training; - No intervention tention/cognitive function,
online behavioural parent - Waitlist hyperactivity/impulsivity,
training; virtual reality…) - Other comparators and oppositional behaviours
for supporting symptom
domains
D: 4 to 22 weeks
Cervantes et al., 2023 [33] 36 N = 1219 Social robots and video Control groups (not speci- Social robots and video Issues related with device
3 to 35 years (social robots) games for supporting cogni- fied) games interventions have ergonomics
and 5 to 40 (games) tive or behavioral rehabilita- the potential to support
tion therapies non-pharmacological
D: Not reported treatments of people living
with ADHD
Page 8 of 18
Table 1 (continued)
Reference Articles Participants included the Intervention type and Use of control groups Outcomes-Effectiveness Outcomes-Safety
included in reviews and their ages durations (D)
review

Corrigan et al., 2023 [34] 7 N = 321 Virtual reality for improving Control groups: Virtual reality interven- “My head become heavy” (full-
7 to 18 years cognitive deficits - Computer monitor tions lead to large effect ness of head)
D: 2 to 10 weeks - No intervention sizes in favor of VR-based
Gabarron et al. BMC Psychiatry

- Traditional training interventions on outcomes

- Flash games of global cognitive function-
- Medication ing, attention, and memory
Oh et al, 2023 [38] 20 N = 1402 Serious games as digital Control groups: Game-based interven- No serious side effects
6 to 17 years therapeutics - Other type of games tions improved inatten- Minimal side effects
D: Not reported - Wait list control tion and hyperactivity
(2025) 25:414

- Medication more than the control,

while medication was more
effective than game-based
interventions
Wong et al, 2023 [48] 19 N = 1843 Several digital interventions Control groups: Small and significant Not reported
7 to 12 years (computer-assisted interven- - Not receiving training effect sizes in inattention,
tions, exergame training, - Treatment as usual overall executive function,
virtual classrooms, web- - Other comparators disruptive behavior disorder,
based training and other) and computer-rated visual
for regulating the behaviors attention
and cognitive functions
D: 4 weeks to 6 months
Peñuelas-Calvo et al, 2022 22 N = 1473 Video games as digital Control groups: Effective in improving cogni- Not reported
[40] 8,6 to 14,7 years therapeutics - No intervention tion and reducing ADHD
D: 3 to 24 weeks symptoms
Shou et al, 2022 [44] 6 N = 261 Online interventions (includ- Control groups: Online interventions Not reported
3 to 12 years ing Cognitive Behavioural - Waiting list were more effective
adults mean age 38,9 years Therapy; Behavioural Parent than the waiting list
Training; Online web Learn- in improving attention
ing: Internet-based Cogni- deficit and social function-
tive Behavioural Therapy, ing in adults and children
and other) for reducing with ADHD
ADHD related cognitive
and social disorders
D: 6 to 16 weeks
Page 9 of 18
 Gabarron et al. BMC Psychiatry

Table 1 (continued)
Reference Articles Participants included the Intervention type and Use of control groups Outcomes-Effectiveness Outcomes-Safety
included in reviews and their ages durations (D)
review
(2025) 25:414

Ramos-Galarza et al, 2024 40 Not reported Several technologies (seri- Not reported Increase in the patient’s Not reported
[51] ous games; mobile apps; motivation for the treatment
monitoring devices; robots; process and their interest
internet-based platforms; in performing the different
voice assistants) as digital exercises to improve their
therapeutics attention and self-control
D: Not reported
Mičič et al, 2021 [37] 25 N = 1214 Computerized cognitive Control groups: Computerized cognitive Impulsiveness
5 to 17 years training for supporting - Placebo training shows a positive
functional deficits (attention - Passive effect on the cognitive abili-
deficit, impulsivity, lack - Later inclussion ties of children with ADHD.
of behavioural inhibition, - Partially active + placebo Some studies have
planning, and organisation) - Later inclusion + active also shown a positive effect
D: 4 weeks to 4 months on reducing dysfunctional
and impulsive behavior
Page 10 of 18
Gabarron et al. BMC Psychiatry (2025) 25:414 Page 11 of 18

reviews also included studies with adult participants [33, cognition, and promote high adherence to treatment [32,
35, 42, 44, 46, 50, 54]. 40, 42].
Regarding the interventions, 10 systematic reviews Five low or critically low quality reviews (AMSTAR-
addressed various types of digital interventions [29–31, 2) found that video modeling may improve social skills
36, 41, 45, 48, 50, 51, 54]; 4 on computerized cognitive [47], ADHD apps require further research [39], serious
training [35, 37, 46, 49]; 4 on virtual reality-based inter- games improved inattention and hyperactivity but were
ventions [34, 43, 52, 53]; 3 specifically focused on video less effective than medication [38], online interventions
games [32, 40, 42]; 1 on video modeling [47]; 1 on apps outperformed waiting list interventions in improving
[39]; 1 on serious games [38]; 1 on online interventions attention and social functioning [44], and social robots
[44]; and 1 on both social robots and video games [33]. and video games may support non-drug treatments for
The reviews reported varied intervention durations, ADHD [33].
with the shortest being from 15 min [47] and the longest Only 8 of the 26 included systematic reviews explicitly
lasting up to 2 years [42]. Eight reviews did not report the reported any adverse effects associated with digital inter-
duration of the analyzed interventions [31, 33, 36, 38, 39, ventions [32–34, 36–38, 42, 43]. The reported adverse
46, 51, 54]. effects of digital interventions could be considered under
All systematic reviews, except two [31, 51], reported falling into several broad categories, such as physical dis-
that their included studies used control groups or com- comfort (including symptoms like headache, dizziness,
parators, with waitlist and no intervention being the fullness of head, pain in the fingers, and issues related to
most commonly reported types of controls. device ergonomics) [32–34]; mental and emotional reac-
tions, such as irritability, frustration, agitation, hangover,
Description of the outcomes: effectiveness and safety impulsiveness and hyperactivity [32, 33, 36, 37]; Confu-
Several reviews analyzed the effectiveness of various digi- sion is noted in cases where children struggle to distin-
tal interventions. The high-quality reviews focusing on guish real memories from VR experiences [43]; Sleep and
various digital interventions reached different conclu- attention issues arise from media use, with electronic
sions: one found that current research lacks robustness devices linked to sleep problems, and both video gam-
[41], while the other found limited evidence of effec- ing and TV potentially worsening attention, especially in
tiveness, except for psychoeducation DHIs, which may ADHD patients [42]. Additionally, behavioral and addic-
help reduce ADHD symptoms [54]. The moderate qual- tion risks are highlighted, with individuals with ADHD
ity evidence review found that the digital interventions being more prone to video game and internet addiction
proved beneficial for individuals with ADHD by alleviat- [36], and extended video game use potentially worsening
ing symptoms of ADHD, inattention, and hyperactivity/ ADHD symptoms [42]. One review reported minimal or
impulsivity [50]. Reviews considered of low and critically no serious side effects [38].
low evidence according to AMSTAR- 2 showed signifi- A comprehensive overview of the main reported out-
cant effects on attention, executive functions, behaviour, comes regarding effectiveness and safety associated with
and learning in children with ADHD linked to the use of various digital interventions for ADHD, categorized by
various digital interventions [29–31, 36, 45, 48, 51]. the overall confidence in the review results, is provided
Regarding the computerized cognitive training, the in Table 2.
high-quality review found no effect on ADHD total
or hyperactivity/impulsivity symptoms, with a small Discussion
improvement in inattention symptoms [46]. In reviews Summary of findings
ranked of lower quality evidence computerized cogni- This systematic review includes 26 systematic reviews on
tive training showed some cognitive benefits but limited digital interventions for ADHD, published between 2018
impact on ADHD symptoms and executive functioning and 2025, and covering more than 34,000 patients, most
[35, 37, 49]. of which focus on children and adolescents. The technol-
Four low or critically low-quality reviews (AMSTAR- 2) ogies tested in the studies concern digital interventions,
found that virtual reality interventions improved cogni- interactive and immersive technologies, cognitive and
tive functioning, attention, and memory [34]; enhanced behavioral training technologies as well as robotics and
attentional vigilance but not impulsivity [43]; improved hybrid technologies including video games.
executive and cognitive functions [53]; and significantly The studies showed that there is some low-quality
enhanced attention in both immersive and nonimmersive evidence (as assessed by AMSTAR- 2) that digital inter-
formats [52]. ventions improve single symptoms of ADHD, such as
Additionally, low-quality reviews suggested that inattention, impulsivity, and hyperactivity. Beside that
video games may improve ADHD symptoms, enhance they can have an effect on the treatment adherence and
Gabarron et al. BMC Psychiatry (2025) 25:414 Page 12 of 18

Table 2 Overview of the main reported outcomes associated with the digital interventions for ADHD
Analyzed digital interventions for Positive effects of interventions Neutral or marginal effects of Adverse effects of interventions
ADHD interventions

Computerized cognitive training High evidence

(to improve clinical, cognitive, aca- • Small improvement in inattention • No effects on hyperactivity symp-
demic, and functional outcomes) symptoms [46] toms [46]
• No effects on impulsivity symp-
toms [46]
Low evidence
• Improvement in overall cognition • No significant changes in symptom
[35] severity or specific cognitive skills
[35]
• Lack of data to determine impact
on executive and adaptive function-
ing [49]
Critically low evidence
• Improved overall cognition [37] • Impulsiveness [37]
• Reduced dysfunctional behavior
[37]
• Reduced impulsive behavior [37]
Several digital interventions High evidence
(to provide psychoeducation, symp- • Psychoeducation delivered • Current research lacks robustness
tom monitoring, self-management, through digital interventions may [41]
CBT, training, and academic support) help reduce ADHD symptoms [54] • Limited evidence of effectiveness
[54]
Moderate evidence
• Alleviated symptoms of ADHD,
inattention, and hyperactivity/impul-
sivity [50]
Low evidence
• Improved inattention symptoms
[36]
• Enhanced executive function [36]
• Reduced reaction time on continu-
ous performance tasks [36]
• Decreased impulsive hyperactiv-
ity [36]
• More frequent monitoring
and communication with healthcare
professionals [45]
Critically low evidence
• Aid in language learning [29] • Mixed conclusions on the effec-
• Improved inattention symptoms tiveness of utilizing technologies
[30, 48] as an aid of ADHD [31]
• Improved visual attention [48]
• Improved cognitive function [30]
• Enhanced executive function [48]
• Improved disruptive behaviour
[30, 48]
• Decreased impulsive hyperactiv-
ity [30]
• Increased motivation for the treat-
ment [51]
Virtual reality Low evidence
(to support and improve attention, • Improved attentional vigilance [43] • No changes in impulsivity [43] • Children struggle to distinguish
motor ability, and cognitive func- • Improved executive and cognitive real memories from VR memories
tions) functions [53] [43]
• Significantly enhanced attention
[52]
Gabarron et al. BMC Psychiatry (2025) 25:414 Page 13 of 18

Table 2 (continued)
Analyzed digital interventions for Positive effects of interventions Neutral or marginal effects of Adverse effects of interventions
ADHD interventions

Critically low evidence

• Improved global cognitive func-
tioning [34]
• Improved attention [34]
• Improved memory [34]
Video games Low evidence • Headache [32]
(for supporting cognitive training, • Reduced ADHD symptoms [32, 42] • Pain in fingers [32]
rehabilitation, and as digital thera- • Higher adherence to treatment • Irritability [32]
peutics) [32, 42] • Frustration [32]
• Worsening ADHD symptoms
when playing > 1 h/day [42]
• Increased attention problems
[42]
• Sleep disturbances [42]
Critically low evidence
• Reduced ADHD symptoms [40]
• Improved cognition [40]
• Potential to support non-pharma-
cological interventions [33]
Video modelling Low evidence
(for improving skills and behaviours) • Enhanced social skills [47]
Serious games Critically low evidence
(as digital therapeutics) • Improved inattention [38] • Medication more effective • Minimal side effects [38]
• Improved hyperactivity [38] than serious games [38]
Social robots Critically low evidence
(for supporting cognitive or behavio- • Potential to support non-pharma- • Ergonomics [33]
ral rehabilitation therapies) cological interventions [33]
Online interventions Critically low evidence
(for reducing ADHD related cognitive • Improved attention deficit [44]
and social disorders) • Improved social functioning [44]
Apps Critically low evidence
(for improving medication adher- • Inconclusive safety and efficacy
ence) of ADHD apps [39]

the monitoring and communication behavior of health- are analyzed in further detail it is possible to identify
care professionals. differences in the effectiveness and the associated level
The overall findings from 8 from the 26 reviews sug- of evidence of the reviews. Three of the studies consid-
gest that digital interventions can have a range of ered [31, 39, 41] did not clearly identify any positive or
adverse effects, spanning physical, mental, and behavio- negative outcomes associated with the use of the digital
ral domains. They are related to the interaction with the interventions (i.e., apps and several digital solutions).
technology itself (e.g. video games), the device ergonom- These reviews are the oldest considered in our analyses,
ics (e.g. in social robots) respectively such as physical dis- published between 2018 and 2020, and showed mixed
comfort. Some worsening of typical ADHD symptoms conclusions regarding the effectiveness of the interven-
namely attention loss, mental and emotional reactions or tions and highlighted the need of generating further evi-
behavioral and addiction risks were also mentioned. dence. These results could fit a scenario where the body
of research in this domain was still under development.
Are digital interventions for ADHD effective and safe? Most of the reviews showed some evidence of positive
All the included systematic reviews examined the effec- outcomes associated with the use of digital interventions
tiveness of using digital health interventions in ADHD, in ADHD populations. However, it is important to notice
but only twelve addressed safety, with only eight report- that the level of evidence for those reviews was mostly
ing any adverse effects. This could indicate a potential low or critically low, limiting the strength of these find-
oversight or underreporting of safety concerns in the lit- ings. Only two reviews showed high evidence of positive
erature, highlighting a gap in comprehensive evaluations outcomes related to the use of various digital interven-
of both effectiveness and safety. When these findings tions to deliver psychoeducation, which was found to be
Gabarron et al. BMC Psychiatry (2025) 25:414 Page 14 of 18

beneficial to reduce ADHD symptoms [54]; and comput- transitions such as adulthood [63], where demands and
erized cognitive training was linked to “a small improve- responsibilities increase. This highlights the potential
ment in inattention symptoms” [46] while it also showed need for more structured, facilitated interventions for
moderate evidence of no impact on hyperactivity or adults, rather than relying on self-directed approaches.
impulsivity symptoms [46]. These findings highlight the Further evaluations focusing on adults with ADHD,
variability in the strength of evidence across reviews and especially during key life transitions, would be valuable
suggest that while some positive effects are observed, in addressing this gap in the literature.
they are generally based on low-quality evidence. Safety is an important component of any heath inter-
When we consider the technologies used for deliver- vention, however in the majority (18/26) of the studies
ing the interventions, it is possible to identify a similar included in our analyses no safety data was reported. Pre-
landscape in the field of digital interventions for mental vious research had already highlighted the poor reporting
health to the one described above, where many studies of harms in primary studies related to diverse interven-
on digital technologies show low or critically low evi- tion types [27], and this issue appears to be reflected in
dence level [55–58]. The studies considered covered a systematic reviews as well. It is not clear whether this is
broad range of tools and technologies used in the differ- due to a lack of focus in considering the safety aspects
ent interventions. However, the continuous advancement or because the interventions completely safe and free
in the use of novel technologies particularly the recent of adverse effects or adverse events. However, when the
use of generative artificial intelligence solutions based on different digital interventions are analyzed in detail, it
the use of large language models represents an opportu- can be seen that for 5 out of the 8 types of intervention
nity to develop new digital interventions tailored for indi- considered (see Table 2) at least one adverse effect could
viduals with ADHD. In most cases, these solutions might be associated with them. In particular, the studies that
have not been fully addressed in this work due to their looked at the use of video game interventions [32, 42],
novelty. where the ones were this information was more detailed
Overall, our findings show that despite there have been and presented. On the other side, neither online inter-
advances in the development and use of digital health ventions nor video-modelling [44, 47] presented informa-
interventions for ADHD their effectiveness remains tion related to potential adverse effects. Focusing on the
arguable as the vast majority of the systematic reviews effectiveness of digital interventions is a strong attrac-
supporting their effectiveness are considered to have low tion given the pressures and needs to support individu-
or critically low evidence. However, this does not imply als with ADHD. Providing novel therapies to replace or
that the original articles included in these reviews were complement pharmacological interventions, while ensur-
of low quality. Even more, our results showed mixed and ing widespread accessibility, is a mayor challenge. Digi-
even contradictory outcomes regarding the effective- tal technologies offer promising solutions by adapting
ness of the analyzed interventions, for example the use of and translating existing tools, such as cognitive behav-
computerized cognitive training has been associated to ioral therapy [64]. However, many of these interventions
having no effect on impulsivity symptoms according to a focus primarily on achieving a like-for-like replacement
review with moderate evidence [46], and also positively of existing approaches with digital platforms. While
associated with reduced impulsive behavior or even with this approach is common, it risks overlooking poten-
adverse effects related impulsiveness by a review graded tial adverse effects and risks associated with the transi-
as having critically low evidence [37]. tion to digital platforms. Such considerations should
The majority of the original studies included in the be addressed more systematically to ensure safety and
systematic reviews that we have analyzed focused on efficacy [17]. Specifically, the increasing use of artificial
children/adolescent population (17/26) with a few stud- intelligence and large language models in the develop-
ies (7/26) that reported a broad range of ages span- ment of digital health interventions necessitates rigorous
ning from childhood to adult hood [33, 35, 42, 44, 46, criteria for algorithmovigilance [65, 66].
50, 54] and two that did not report the ages [31, 51]. These criteria must be integrated at every stage of
It has been observed before that the severity of the design, implementation, and analysis to safeguard against
ADHD-related symptomatology can decrease in some unforeseen consequences. In the context of ADHD and
individuals during adolescence [59, 60], thus it is pos- the safe use of digital health interventions, it is worth
sible that this phenotypic variability could impact the noting that the CONSORT-EHEALTH [67] checklist for
different outcomes observed and the low level of evi- reporting digital health clinical trials includes a section
dence reported across the studies. However, evidence on “Harms.” While this section encourages reporting on
suggests that ADHD traits can become more challeng- potential adverse effects, its inclusion is currently only
ing for women later in life [61, 62], particularly during recommended rather than mandatory. Strengthening
Gabarron et al. BMC Psychiatry (2025) 25:414 Page 15 of 18

these requirements could play a critical role in ensuring Although the reporting of side effects on digital plat-
the safe and effective deployment of digital interventions. forms may lack structure, and its credibility can be ques-
To our knowledge, no comprehensive study has been tionable, it could serve as warning for potential safety
published that specifically examines the safety of any type concerns. This underscores the need for more research
of interventions for ADHD. However, we are currently on the unintended consequences of digital interventions
conducting a larger project that systematically investi- [74], as well as the establishment of standardized proto-
gates the safety of all intervention types for individuals cols for reporting adverse effects that enable comprehen-
with ADHD, based on evidence from systematic reviews sive safety assessments for all stakeholders [69]. Advances
with or without meta-analysis. This ongoing work is reg- in technology, including artificial intelligence, have the
istered in PROSPERO (CRD42024521084). potential to revolutionize the identification and synthe-
sis of safety information for ADHD digital interventions
Managing the evidence on digital interventions safety by processing vast amounts of data from diverse sources,
for ADHD including unstructured data posted on social media.
Research on digital interventions for mental health has
experienced exponential growth [23–25], and the vol- Strengths and limitations
ume of scientific publications on ADHD has similarly In this paper, we focused on a specific condition ADHD
expanded significantly over the past decade [68]. This and digital interventions addressing it. The aggregated
growing volume of literature can make it challenging evidence as reported in this paper was not previously
for clinicians, educators, and other professionals work- available, yet crucial to recognize current limitations of
ing with individuals with ADHD to stay up-to-date and digital interventions for ADHD and determine poten-
recommend the most effective and safest interventions. tial for future improvements, in particular regarding
Systematic reviews and meta-analyses are considered safety. We used the broad scope of digital technologies
the gold standard for synthesizing evidence that can pro- without focusing on specific technologies which pro-
vide professionals with crucial information to fully assess vides an excellent overview on the current landscape in
interventions, both in terms of effectiveness and safety. this field and which allows us to judge the differences
In this review, however, we identified that only 8 of the in effectiveness and safety of the different types of tech-
26 included systematic reviews reported on the adverse nologies. However, our search was limited to only four
effects of digital interventions for ADHD [32–34, 36–38, databases, and we limited our search keywords to titles
42, 43], therefore leaving a critical knowledge gap for cli- and abstracts, which may have resulted in the exclusion
nicians, educators, policymakers or others who rely on of relevant studies. We also did not search for grey litera-
systematic reviews to make informed decisions. Publica- ture, potentially limiting the breath of our findings.
tion bias and underreported negative outcomes in origi- Although we found adverse effects reported, their
nal research may contribute to the limited reporting of amount was limited. It is unclear whether no further
adverse effects in systematic reviews. adverse effects occurred or whether there is a gap in
When systematic reviews cannot be relied upon to reporting. Reviews included were mainly of low or
provide comprehensive reporting, especially regard- critically low quality, with many failing to report a list
ing safety, identifying sources of information on pos- of excluded studies (a critical domain in AMSTAR- 2).
sible adverse effects of digital interventions for ADHD While journal restrictions on word count or page lim-
becomes crucial. Other sources that might include safety its may pose challenges, authors still have the option to
data related to interventions are clinical trial registries upload these lists to repositories to enhance transpar-
(e.g., ClinicalTrials.gov), case reports, or observational ency and reproducibility. Since AMSTAR- 2 considers
studies. However, the current lack of standardization in this a critical reporting requirement, we did not contact
reporting adverse effects of digital interventions [17, 69] the authors to obtain these lists, as this information
makes it difficult to aggregate and interpret data effec- should have been included in their published reviews.
tively. Furthermore, clinicians working with digital inter- The absence of this information limits the ability to fully
ventions for ADHD may observe side effects that are not assess the rigor of the included reviews. Further, the
documented or shared with the scientific community. number of papers considered was small, at least when
Further, individuals with ADHD and their caregivers may considering the different technologies. We relied upon
report adverse effects of digital interventions through the information in the included systematic reviews
informal or non-traditional channels, such as social and did not collect the information from the original
media platforms or app store reviews. Reporting of side sources of the single reviews. It might be, that the data
effects related to interventions for mental health in digi- aggregated in the included reviews is incomplete. In
tal platforms has been previously reported [21, 70–73]. fact, we had to acknowledge that the information in the
Gabarron et al. BMC Psychiatry (2025) 25:414 Page 16 of 18

papers was incomplete or even contradictory, and one Data availability

The data used to support the findings of this study are included within the
of the included articles could not be evaluated for its article.
risk assessment due to our lack of knowledge in which
the language was written, and the accuracy of the auto- Declarations
mated translation could not be reliably confirmed.
Additionally, our review focused on previously pub- Ethics approval and consent to participate
This article is a systematic review of systematic reviews and does not involve
lished reviews, so newer digital interventions, includ- human participants or primary data collection. Therefore, ethical approval and
ing those using generative artificial intelligence or other Consent to Participate declarations are not applicable.
recent technological advancements, may not have been
Consent for publication
fully addressed. Not applicable.

Competing interests
The authors declare no competing interests.
Conclusions
This review of systematic reviews on digital interven- Author details
1
tions for ADHD highlights that while there is some Department of Education, ICT and Learning, Østfold University College,
Halden, Norway. 2 Institute for Patient‑Centered Digital Health, Bern University
evidence suggesting potential benefits, the overall effec- of Applied Sciences, Bern, Switzerland. 3 Wellcome‑Wolfson Institute for Experi-
tiveness of these interventions remains inconclusive, mental Medicine, Queens University Belfast, Belfast, Northern Ireland, UK.
with most systematic reviews presenting low or criti-
Received: 27 December 2024 Accepted: 7 April 2025
cally low levels of evidence. While digital interventions
may improve symptoms such as inattention, adherence
to treatment, and communication with healthcare pro-
fessionals, the findings are inconsistent, and the safety
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