Effect of Video Games or Virtual Reality in Reducing Symptoms of Cognitive Deficits in Children and Adolescents with ADHD: A Systematic Review

Introduction: Attention-deficit hyperactivity disorder (ADHD) is one of the most frequent neurodevelopmental diseases affecting children and adolescents worldwide. Standard treatments often include a combination of pharmacotherapy and cognitive interventions. In the last decade, the effects of video game- and virtual reality (VR)-based treatments have been investigated as viable additional strategies to tackle ADHD symptoms. Methods: A systematic literature review was conducted to identify studies that compared video game or VR-based interventions with standard care in children and adolescents affected by ADHD, evaluating cognitive, motor, and behavioral outcomes. The RoB-2 and MINORS tools were utilized to assess the risk of bias in included studies. Results: Five studies published between 2001 and 2021 were included (437 patients, mean age: 10.74). Four studies investigated a video game-based intervention, and the remaining study employed VR. Collectively, the studies showed little to no effects on investigated outcomes. However, most of them were also affected by severe methodological issues carrying a moderate-to-high risk of bias. Discussion: ADHD is a complex disorder often needing a multi-dimensional, individualized therapeutical approach. Video games and VR carry substantial advantages, such as higher patient involvement, cost-effectiveness, and subtle improvements in cognitive and behavioral outcomes. However, additional well-designed clinical trials are needed to prove their efficacy in pediatric patients with ADHD.