A Systematic Review and Content Analysis of Serious Video Games for Children with ADHD

Our systematic review and content analysis of ADHD games was published (open access) today in Frontiers in Psychiatry. Link here.

We believe this study provides the most comprehensive overview to date of how therapeutic video games are being used to support children and adolescents with attention-deficit/hyperactivity disorder (ADHD). We systematically reviewed published studies and analyzed the content of the games to understand what features they use, how they are designed to improve attention or behavior, and how effective they appear to be in reducing ADHD symptoms in real-world settings.

Our review identified 37 studies published between 2005 and 2021 that evaluated 22 distinct serious video games targeting ADHD. These games were created for therapeutic purposes—often aiming to improve cognitive functions such as working memory, attention, and impulse control. More than half of the games relied on cognitive training paradigms similar to laboratory tasks like go/no-go or continuous performance tests, which challenge players to focus and inhibit responses. About 18 percent used EEG-based neurofeedback, where players learn to control brainwave patterns (specifically the theta/beta ratio) associated with attention. The remaining games employed more novel or mixed approaches, such as physical activity, gaze training, or combinations of multiple therapeutic strategies.

When we examined treatment outcomes, we focused especially on “far transfer” effects—improvements that extend beyond the game to real-world symptoms, as measured by parent ratings. Across studies, these effects varied widely, with reported effect sizes ranging from roughly d = –0.55 to d = 1.26. Importantly, no single type of game content was consistently linked to greater improvement. Cognitive training games did not outperform neurofeedback or other designs in any systematic way. Studies that showed the largest gains often had higher risk of bias, such as small samples or less rigorous controls, suggesting that some of the most optimistic results may be inflated.

Overall, the findings highlight both the limitations of serious video games as interventions for ADHD. While many studies show that such games can be engaging and produce measurable benefits, there is still no clear evidence that any particular game feature or therapeutic mechanism is reliably effective in improving everyday ADHD symptoms. The review also underscores the heterogeneity of this research area: studies differ widely in design, duration, outcome measures, and methodological rigor, making comparisons difficult.

In short, the field is still in an early developmental stage. Future research should focus on improving study quality, using more consistent outcome measures, and exploring innovative game designs that integrate proven psychosocial elements. By strengthening methodological standards and testing for real-world behavioral change, researchers may be able to better determine which features of serious games truly help children with ADHD—and why.