Cited by 272Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyCognitive Abilities and Testing

The DOI matches its Crossref record; 93 of the 96 references it cites were found in a registry or an index, and 1 are not checked yet; none of the 81 sources its claims cite is checked for support yet.

Improving Executive Functioning in Children with ADHD: Training Multiple Executive Functions within the Context of a Computer Game. A Randomized Double-Blind Placebo Controlled Trial

Open access
Dovis, Sebastiaan, Van der Oord, Saskia, Wiers, Reinout W., Prins, Pier J. M.·2015·PLOS ONE

Abstract

INTRODUCTION: Executive functions (EFs) training interventions aimed at ADHD-symptom reduction have yielded mixed results. Generally, these interventions focus on training a single cognitive domain (e.g., working memory [WM], inhibition, or cognitive-flexibility). However, evidence suggests that most children with ADHD show deficits on multiple EFs, and that these EFs are largely related to different brain regions. Therefore, training multiple EFs might be a potentially more effective strategy to reduce EF-related ADHD symptoms. METHODS: Eighty-nine children with a clinical diagnosis of ADHD (aged 8-12) were randomized to either a full-active-condition where visuospatial WM, inhibition and cognitive-flexibility were trained, a partially-active-condition where inhibition and cognitive-flexibility were trained and the WM-training task was presented in placebo-mode, or to a full placebo-condition. Short-term and long-term (3-months) effects of this gamified, 25-session, home-based computer-training were evaluated on multiple outcome domains. RESULTS: During training compliance was high (only 3% failed to meet compliance criteria). After training, only children in the full-active condition showed improvement on measures of visuospatial short-term-memory (STM) and WM. Inhibitory performance and interference control only improved in the full-active- and the partially-active condition. No Treatment-condition x Time interactions were found for cognitive-flexibility, verbal WM, complex-reasoning, nor for any parent-, teacher-, or child-rated ADHD behaviors, EF-behaviors, motivational behaviors, or general problem behaviors. Nonetheless, almost all measures showed main Time-effects, including the teacher-ratings. CONCLUSIONS: Improvements on inhibition and visuospatial STM and WM were specifically related to the type of treatment received. However, transfer to untrained EFs and behaviors was mostly nonspecific (i.e., only interference control improved exclusively in the two EF training conditions). As such, in this multiple EF-training, mainly nonspecific treatment factors - as opposed to the specific effects of training EFs-seem related to far transfer effects found on EF and behavior. TRIAL REGISTRATION: trialregister.nl NTR2728. Registry name: improving executive functioning in children with ADHD: training executive functions within the context of a computer game; registry number: NTR2728.

Checked 2026-10-06 · 1 reference not checked yet

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This randomized double-blind placebo-controlled trial tested a gamified, home-based multiple executive-function training (Braingame Brian) in 89 children aged 8–12 with ADHD combined-type. Only trained EF domains showed specific improvements, while far transfer to untrained EFs and behavior was mostly nonspecific, with broad time effects even in placebo.

Key findings

  • Compliance was high: 30/31 (96.7%) in full-active, 28/28 in partially-active, and 28/30 (93.3%) in placebo met the 25-session/5-week compliance criterion; overall only 3% failed to meet compliance criteria.
  • Only the full-active condition improved on visuospatial short-term memory and working memory: CBTT-forward showed a significant Treatment × Time interaction pre- to post-test after Bonferroni correction (p = .002); full-active vs placebo contrasts were F(1,59) = 11.03, p < .01, ηp² = .16 pre–post and F(1,59) = 8.35, p < .01, ηp² = .12 pre–follow-up.
  • Inhibitory performance and interference control improved only in the full-active and partially-active conditions: Stop task full-active vs placebo pre–post F(1,59) = 5.73, p < .05, ηp² = .09; partially-active vs placebo pre–post F(1,56) = 4.22, p < .05, ηp² = .07; Stroop full-active vs placebo pre–follow-up F(1,59) = 6.53, p < .05, ηp² = .10. After Bonferroni correction, only CBTT-forward remained significant.
  • No Treatment-condition × Time interactions were found for cognitive flexibility, verbal WM, complex reasoning, or any parent-, teacher-, or child-rated ADHD behaviors, EF behaviors, motivational behaviors, or general problem behaviors. Nonetheless, almost all measures showed main Time effects, including teacher ratings (e.g., parent DBDRS Inattention pre–post F(1,86) = 66.21, p < .001, ηp² = .44; teacher DBDRS Inattention pre–post F(1,86) = 19.27, p < .001, ηp² = .18).

Methods

  • Multicenter (14 sites), double-blind, placebo-controlled, multi-arm parallel-group trial in the Netherlands. Eighty-nine children aged 8–12 with DSM-IV-TR ADHD combined-type, clinical-range parent and teacher DBDRS scores, PDISC-IV ADHD combined-type, IQ ≥ 80, and no autism spectrum disorder or conduct disorder were randomized by minimization to full-active (WM, inhibition, cognitive flexibility trained), partially-active (inhibition and cognitive flexibility trained; WM in placebo mode), or full placebo.
  • Intervention: “Braingame Brian,” a gamified, home-based computerized EF training of 25 sessions over 5 weeks, with each session including WM, inhibition, and cognitive-flexibility tasks; training-mode adjusted difficulty, while placebo-mode did not.
  • Outcomes assessed at pre-test, post-test, and 3-month follow-up: performance measures (Stop task SSRT, Stroop, Corsi Block Tapping forward/backward, Digit span, Trail Making Test, Raven) and rating scales (DBDRS parent/teacher, BRIEF, SPSRQ-C, PedsQL, HSQ). Analyses used intent-to-treat with stochastic regression imputation, repeated-measures MANOVAs with Bonferroni corrections, simple contrasts, within-group paired t-tests, and reliable change indices for responders.

Limitations

  • Stated: no wait-list control condition was used, so the authors cannot determine the extent to which findings relate to multiple testing, passage of time, or nonspecific treatment factors. They also note that stochastic regression imputation can increase the probability of type I errors.
  • Stated: the study only investigated overall group differences, children were allocated irrespective of individual EF deficits, far-transfer domains were limited to direct performance measures and indirect behavior ratings, and no direct behavior measures were included; effects of inhibition versus cognitive-flexibility training were not separated.
  • Evident from the text: the placebo condition still required sustained attention and may have constituted some cognitive training; the cognitive-flexibility outcome (TMT global switch cost) may not match the trained local switch cost; and Bonferroni corrections with small subgroups may have reduced power to detect interactions.

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Integrity signals

Registry

Crossref · 10.1371/journal.pone.0121651

Cites

93 of 94 references verified0 citation errors · 0 not checkable

Statistics

Figures

Fig 1 The inhibition training task with the green colored time-frame (response window) in the upper-middle of the screen.
Fig 1 The inhibition training task with the green colored time-frame (response window) in the upper-middle of the screen.CC BY · PubMed Central
Fig 2 CONSORT flow diagram.
Fig 2 CONSORT flow diagram.CC BY · PubMed Central
Fig 3 Mean values and standard errors of the executive functioning tasks (A—F) and the Raven (G) on the pre-test, post-test and (3 month) follow-up of children in the three treatment groups. Note: SSRT = Stop Signal Reaction Time; CBTT = Corsi Block Tapping Task.
Fig 3 Mean values and standard errors of the executive functioning tasks (A—F) and the Raven (G) on the pre-test, post-test and (3 month) follow-up of children in the three treatment groups. Note: SSRT = Stop Signal Reaction Time; CBTT = Corsi Block Tapping Task.CC BY · PubMed Central
Fig 4 Mean values and standard errors of the mean scores on the Inattention and Hyperactivity/Impulsivity (Hyp/Imp) scales of the parent and the teacher versions of the Disruptive Behavior Disorder Rating Scale (DBDRS; H-K) on the pre-test, post-test and (3 months) follow-up of children in the three treatment groups.
Fig 4 Mean values and standard errors of the mean scores on the Inattention and Hyperactivity/Impulsivity (Hyp/Imp) scales of the parent and the teacher versions of the Disruptive Behavior Disorder Rating Scale (DBDRS; H-K) on the pre-test, post-test and (3 months) follow-up of children in the three treatment groups.CC BY · PubMed Central

Verification

Claims the paper makes

65 Own result · 42 Not checked yet · 24 Own method · 24 Own interpretation · 4 No basis given

Verify all 81 references — free account

Show all 88 claims

  • Probably not a substantial claim. 37
  • It may state two separate claims as one. 45
71 of 71
  • The paper relies on this without support.

    The placebo condition used in Klingberg et al. was considerably shorter in time than the training condition.

    “However, the placebo condition used in Klingberg et al. was considerably shorter in time than the training condition.”
  • The paper relies on this without support.

    Klingberg et al. did not include children with comorbid ODD.

    “Another notable feature of the study of Klingberg et al. is that they did not include children with comorbid ODD.”
  • The paper relies on this without support.

    Most previous studies also used an external reward system, a structured schedule for implementing the intervention, weekly contact with a coach, and performance feedback during training.

    “Since most previous studies also used an external reward system, a structured schedule for implementing the intervention, weekly contact with a coach, and performance feedback during training”
  • The authors state this as an assumption.

    The absence of comorbid ODD in the Klingberg et al. study is an unlikely explanation for their distinctive findings on parent-rated ADHD.

    “Therefore, the absence of comorbid ODD in the Klingberg et al. study seems an unlikely explanation for their distinctive findings on parent-rated ADHD. This assumption is further substantiated by the findings we presented in Table A”
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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(4) = 1.26reported p = .868 · recomputed p = .868

    “χ2(4) = 1.26, p = .868”

  • Consistentt(30) = -18.66reported p < .001 · recomputed p < .001

    “t (30) = -18.66, p < .001”

  • Consistentt(30) = -19.14reported p < .001 · recomputed p < .001

    “t (30) = -19.14, p < .001”

  • Consistentt(30) = -7.25reported p < .001 · recomputed p < .001

    “t (30) = -7.25, p < .001”

  • Consistentt(30) = -7.9reported p < .001 · recomputed p < .001

    “t (30) = -7.90, p < .001”

  • Consistentt(30) = -7.19reported p < .001 · recomputed p < .001

    “t (30) = -7.19, p < .001”

  • Consistentt(30) = -9.21reported p < .001 · recomputed p < .001

    “t (30) = -9.21, p < .001”

  • Consistentt(30) = -7.72reported p < .001 · recomputed p < .001

    “t (30) = -7.72, p < .001”

  • Consistentt(27) = -15.86reported p < .001 · recomputed p < .001

    “t (27) = -15.86, p < .001”

  • Consistentt(27) = -22.89reported p < .001 · recomputed p < .001

    “t (27) = -22.89, p < .001”

  • ConsistentF(14, 334) = 6.74reported p < .001 · recomputed p < .001

    “F (14,334) = 6.74, p < .001”

  • ConsistentF(14, 162) = 1.41reported p = .154 · recomputed p = .154

    “F (14,162) = 1.41, p = .154”

  • ConsistentF(28, 676) = 1.59reported p = .027 · recomputed p = .028

    “F (28,676) = 1.59, p = .027”

  • ConsistentF(8, 232) = 6.22reported p < .001 · recomputed p < .001

    “F (8,232) = 6.22, p < .001”

  • ConsistentF(4, 56) = 5.06reported p = .009 · recomputed p = .001

    “F (4,56) = 5.06, p = .009”

    The paper states a correction for multiple tests

  • ConsistentF(8, 232) = 3.9reported p < .001 · recomputed p < .001

    “F (8,232) = 3.90, p < .001”

  • ConsistentF(8, 220) = 3.49reported p = .001 · recomputed p < .001

    “F (8,220) = 3.49, p = .001”

  • ConsistentF(4, 53) = 1.44reported p = .235 · recomputed p = .234

    “F (4,53) = 1.44, p = .235”

  • ConsistentF(8, 220) = 1.07reported p = .388 · recomputed p = .385

    “F (8,220) = 1.07, p = .388”

  • ConsistentF(8, 224) = 9.79reported p < .001 · recomputed p < .001

    “F (8,224) = 9.79, p < .001”

  • ConsistentF(4, 54) = 1.76reported p = .151 · recomputed p = .150

    “F (4,54) = 1.76, p = .151”

  • ConsistentF(8, 224) = 2reported p = .048 · recomputed p = .048

    “F (8,224) = 2.00, p = .048”

  • ConsistentF(8, 340) = 13.32reported p < .001 · recomputed p < .001

    “F (8,340) = 13.32, p < .001”

  • ConsistentF(8, 166) = 0.33reported p = .953 · recomputed p = .954

    “F (8,166) = .33, p = .953”

  • ConsistentF(16, 688) = 0.77reported p = .718 · recomputed p = .721

    “F (16,688) = .77, p = .718”

  • ConsistentF(30, 318) = 4.91reported p < .001 · recomputed p < .001

    “F (30,318) = 4.91, p < .001”

  • ConsistentF(30, 146) = 1.08reported p = .368 · recomputed p = .369

    “F (30,146) = 1.08, p = .368”

  • ConsistentF(60, 644) = 0.72reported p = .942 · recomputed p = .944

    “F (60,644) = .72, p = .942”

  • ConsistentF(14, 334) = 5.15reported p < .001 · recomputed p < .001

    “F (14,334) = 5.15, p < .001”

  • ConsistentF(14, 162) = 1.83reported p = .038 · recomputed p = .038

    “F (14,162) = 1.83, p = .038”

  • ConsistentF(28, 676) = 1.1reported p = .337 · recomputed p = .331

    “F (28,676) = 1.10, p = .337”

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

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Citations

Cites

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Research works printed but not linked: 1

  1. RA Barkley, 1987, 3, 157

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Metadata

Authors
Dovis, S., Van der Oord, S., Wiers, R. W., & Prins, P. J. M.
Affiliations
University of Amsterdam (NL)
Corresponding author
Dovis, Sebastiaan
Venue
PLOS ONE
Published
2015-04-06
Volume
10
Issue
4
Pages
e0121651
ISSN
1932-6203 (ISSN-L)
OpenAlex
W2041411601
Cited by
272
References
96
Citations by year
2026: 27 · 2025: 33 · 2024: 18 · 2023: 26 · 2022: 27 · 2021: 20 · 2020: 31 · 2019: 28 · 2018: 20 · 2017: 26 · 2016: 12 · 2015: 2
FWCI
16.22
Type
journal article
Language
en
Open access
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
Janssen Pharmaceuticals
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
Keywords
attention deficit hyperactivity disorder, executive function training, visuospatial working memory, inhibition, cognitive flexibility, far transfer, children, home-based exercise
MeSH terms
Attention Deficit Disorder with Hyperactivity, Child, Computer-Assisted Instruction, Double-Blind Method, Female, Humans, Male, Patient Compliance, Treatment Outcome, Video Games, Executive Function

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