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Cited by 106Attention Deficit Hyperactivity DisorderAutism Spectrum Disorder ResearchDevelopmental and Educational Neuropsychology

Proof-of-concept study of an at-home, engaging, digital intervention for pediatric ADHD

Open access
Davis, Naomi O., Bower, Jeffrey, Kollins, Scott H.·2018·PLOS ONE
DOI 10.1371/journal.pone.0189749PMC PMC5764249
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Abstract

OBJECTIVE: Pharmacological and behavioral therapies have limited impact on the distinct neurocognitive impairments associated with ADHD, and existing cognitive training programs have shown limited efficacy. This proof-of-concept study assessed treatment acceptability and explored outcomes for a novel digital treatment targeting cognitive processes implicated in ADHD. METHOD: Participants included 40 children with ADHD and 40 children without ADHD. Following psychiatric screening, ADHD ratings, and baseline neuropsychological measures, participants completed 28-days of at-home treatment. Neuropsychological assessment was repeated at end-of-study along with treatment satisfaction measures. RESULTS: Eighty-four percent of treatment sessions were completed and ratings showed strong intervention appeal. Significant improvements were observed on a computerized attention task for the ADHD group and a highly impaired ADHD High Severity subgroup. There was no change for the non-ADHD group. Spatial working memory also improved for the ADHD group and the ADHD High Severity subgroup. CONCLUSION: Findings provide preliminary support that this treatment may improve attention, working memory, and inhibition in children with ADHD. Future research requires larger-scale randomized controlled trials that also evaluate treatment impact on functional impairments. TRIAL REGISTRATION: ClinicalTrials.gov NCT01943539.

AI snapshot

Written from the paper’s full text.

TL;DR

This open-label proof-of-concept study tested an at-home digital intervention (Project: EVO) in 40 children with ADHD and 40 without ADHD over 28 days, finding high compliance and acceptability. Preliminary cognitive improvements were observed in ADHD, especially a high-severity subgroup, but the design cannot establish efficacy.

Key findings

  • Compliance and acceptability were high: 84% of prescribed in-home sessions were completed overall (≈10.9 hours per child); ADHD completed 81%, ADHD High Severity 86%, and non-ADHD 87%. There were no ADHD dropouts, 9 adverse events reported, and none judged related to EVO; child enjoyment averaged 6.9/10.
  • Attention improved on the TOVA Attention Performance Index for the ADHD group (N=40, t=2.21, p=0.033, d=0.35) and more strongly for the ADHD High Severity subgroup (N=22, t=3.33, p=0.003, d=0.71); the non-ADHD group showed no change (p=0.30).
  • Spatial working memory improved for the ADHD group and ADHD High Severity subgroup on 8 of 12 CANTAB SWM variables each; BRIEF Working Memory improved significantly in the High Severity subgroup (p=0.014) and Inhibition improved significantly there (p=0.027), while the full ADHD group showed only a trend for Working Memory (p=0.07).
  • Non-ADHD participants improved on 6 of 10 CANTAB Rapid Visual Processing variables and 9 of 16 Delayed Match to Sample variables, whereas ADHD improved on 3 of 10 RVP and 0 of 16 DMS variables.

Methods

  • Open-label proof-of-concept study at 3 U.S. sites (January–August 2014) with 40 children with confirmed DSM-IV ADHD (M=10.3 years) and 40 age-matched non-ADHD children (M=10.5 years), ages 8–12; ADHD eligibility required ADHD-RS-IV ≥24 and being off ADHD medication for ≥1 week, while non-ADHD required ADHD-RS-IV ≤13.
  • Participants completed 28 days of at-home Project: EVO, prescribed 30–45 minutes/day, 5 days/week (7 sessions/day), with screening and Day 28 post-intervention assessments; compliance was monitored electronically.
  • Pre-post within-group analyses used paired t-tests or Wilcoxon tests, with Bonferroni corrections within statistical families; a post-hoc cut-point analysis defined the ADHD High Severity subgroup as ADHD-RS ≥30 and TOVA API ≤−1.8 (N=22).

Limitations

  • The paper states that the open-label design may have allowed parent expectations to influence parent-report improvements, that real-world functional outcomes were not measured, that the sample may not represent all children with ADHD (e.g., unmedicated, no significant comorbid psychiatric disorders), and that exploratory multiple comparisons raise Type I error concerns despite Bonferroni corrections.
  • Evident from the text: there was no randomization or blinded control group, analyses were per-protocol rather than intent-to-treat, noncompliant non-ADHD participants were dropped and replaced, the sample was small, and the High Severity subgroup was defined post-hoc.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0189749

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 57 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the ADHD High Severity subgroup, Reaction Time Variability (Variance) Standard Score improved significantly from pre- to post-intervention.

    “Reaction Time Variability (Variance) Standard Score (T-Test; N = 22, t = 2.89, p = 0.009, Effect Size (d) = 0.62, mean of differences = -26.42, 95%CI-Lower = -45.42 95%CI-Upper = -7.43).”
    Quote in the paperSubstantial claim
  • Findingown data

    The ADHD High Severity subgroup showed significant improvement on 8 of 12 variables within the CANTAB SWM test.

    “The ADHD High Severity subgroup showed significant improvement (p < 0.05) on 8 of 12 variables within the SWM, 0 of 10 variables within the RVP, and 1 of 16 within the DMS.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no change in API scores for the non-ADHD group (t=1.04, p=0.30, d=0.17, mean diff -0.39, 95% CI -1.16 to 0.37).

    “There was no change in API scores for the non-ADHD group (T-Test; N = 40, t = 1.04, p = 0.30, Effect Size (d) = 0.17, mean of differences = -0.39, 95%CI-Lower = -1.16, 95%CI-Upper = 0.37).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The non-ADHD group provides a valid comparison for practice effects on the TOVA API.
  • Findingown data

    A total of 40 ADHD and 40 non-ADHD participants completed the study.

    “A total of 40 ADHD and 40 non-ADHD participants completed the study.”
    Quote in the paperNot a substantial claim
  • Findingown data

    D-prime remained relatively constant in the ADHD High Severity subgroup.

    “D-prime, a measure of signal detection sensitivity, remained relatively constant in both the ADHD group (p = 0.718) and the ADHD High Severity subgroup (p = 0.406).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 25
  • May combine two claims. 28
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    A total of 87 participants were screened and 3 were screen fails.

    “A total of 87 participants were screened for the study and a total of 3 participants were screen fails.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were only 4 participants who dropped out of the study, and none of these participants were in the ADHD cohort.

    “Additionally, there were only 4 participants who dropped out of the study, and none of these participants were in the ADHD cohort.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Compliance rates did not differ significantly between ADHD and non-ADHD groups, ADHD and ADHD High Severity subgroup, or non-ADHD and ADHD High Severity subgroup.

    “There were no significant differences found between the ADHD and non-ADHD groups (p = 0.20), the ADHD and ADHD High Severity subgroup (p = 0.38), or the non-ADHD and the ADHD High Severity subgroup (p = 0.30).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All ADHD group participants were compliant with the intervention and none were replaced.

    “All of the ADHD group participants were compliant with the intervention and none of these participants were replaced during the study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Four participants from the non-ADHD group were dropped for poor compliance, representing a replacement rate of 5% of the total study final sample size.

    “Four participants from the non-ADHD group were dropped from the study for poor compliance, which represents a replacement rate of 5% of the total study final sample size.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The full ADHD group did not show significant improvement on Reaction Time Mean Standard Score or Reaction Time Variability (Variance) Standard Score.

    “The ADHD High Severity subgroup, but not the full ADHD group, showed significant improvements on two indicators of ADHD severity”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Spatial working memory also improved for the ADHD group and the ADHD High Severity subgroup.

    “Spatial working memory also improved for the ADHD group and the ADHD High Severity subgroup.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Four participants from the non-ADHD group were dropped for non-compliance and were replaced.

    “During the intervention period, four participants from the non-ADHD group were dropped from the study for non-compliance with the at-home intervention use. These participants were replaced by recruiting additional participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A total of 9 adverse events were reported over all study phases; none were judged by PIs and site staff as related to EVO.

    “A total of 9 adverse events were reported over all study phases; however, none of those adverse events were judged by the PIs and site staff as related to EVO (Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The ADHD group completed an average of 81% of required at-home sessions, the ADHD High Severity subgroup 86%, and the non-ADHD group 87%.

    “The ADHD group completed an average of 81% (10.8 hours of intervention), the ADHD High Severity subgroup completed an average of 86% (11.1 hours of intervention), while the non-ADHD group completed an average of 87% (11.5 hours of intervention) of the required at-home sessions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The ADHD High Severity subgroup was selected via post-hoc statistical analyses and demonstrated a greater response to the intervention.

    “A subset of participants from the ADHD group was subsequently selected via post-hoc statistical analyses to comprise the ADHD High Severity group. As described further below and characterized in Table 1, this subset of participants demonstrated a greater response to the intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the ADHD group, Working Memory percentile scores improved non-significantly but showed a trend-level effect.

    “On the Working Memory subscale, percentile scores for the ADHD group improved non-significantly but a trend-level effect was observed (Wilcoxon; N = 40, z = 1.81, p = 0.07, Effect Size (r) = 0.29, mean of differences = 2.48, 95%CI-Lower = 0.0, 95%CI-Upper = 5.5) (Table 4).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Only participants who completed the at-home period and final assessments were included in the analysis, therefore no missing data was present.

    “Only participants who completed the at-home period and completed the final assessments were included in the analysis, therefore no missing data was present.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study was open-label; participants and study staff were not blinded to study condition.

    “Given the open-label design, participants and study staff were not blinded to study condition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The MINI-KID has demonstrated concordance to other structured psychiatric interviews and can be implemented using parent report.

    “It has demonstrated concordance to other structured psychiatric interviews and can be implemented using parent report.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] DV Sheehan, 2010, Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), Journal of Clinical Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The sample size was chosen to be sufficiently large to detect significant within-subject effects of at least 0.45 (Cohen's D) for a 2-tailed test, at alpha 0.05 with 80% power.

    “Given the exploratory nature of the study, the sample size was chosen to be sufficiently large to detect significant within subject effects of at least 0.45 (Cohen’s D) for a 2-Tailed test, at anlpha-0.05 with a power of 80%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Equivocal findings from meta-analyses of cognitive training programs have been reported, such as inadequate generalizability of effects outside of training and limitations of addressing cognitive processes versus core symptoms.

    “equivocal findings from meta-analyses have been reported, such as inadequate generalizability of effects outside of training and the limitations of addressing cognitive processes versus core symptoms [18–20].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [18] M van Dongen-Boomsma, 2014, Working memory training in young children with ADHD: a randomized placebo-controlled trial, Journal of Child Psychology and Psychiatry and Allied Disciplines source

      Not checked in the free run.

    • cites [19] S Cortese, 2015, Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials, Journal of the American Academy of Child and Adolescent Psychiatry source

      Not checked in the free run.

    • cites [20] MD Rapport, 2013, Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes, Clinical Psychology Review source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The ADHD-RS is an 18-item validated scale completed via semi-structured interview with the parent to assess symptom severity.

    “The ADHD-RS is an 18-item validated scale that is completed via semi-structured interview with the participant’s parent to assess symptom severity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] G DuPaul, 1998, ADHD Rating Scale-IV: Checklist, norms, and clinical interpretation

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The TOVA is a computerized continuous performance test that objectively measures attention and impulsivity.

    “The TOVA is a computerized continuous performance test that objectively measures attention and impulsivity”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] LM Greenberg, 2007, Test of Variables of Attention Clinical Manual

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The C-SSRS has been well-validated for use in clinical trials.

    “It has been well-validated for use in clinical trials.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] K Posner, 2011, The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults, American Journal of Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    After completing the Neuroracer regimen, changes in EEG signals occurred at neurological loci associated with cognitive control.

    “they showed that changes in EEG signals occurred at neurological loci associated with cognitive control after completing the prescribed therapeutic regimen.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] JA Anguera, 2013, Video game training enhances cognitive control in older adults, Nature source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In older adults, Neuroracer reduced interference susceptibility and cognitive benefits transferred to untrained tests of attention, impulsivity, and multitasking.

    “Results of the study indicated that interference susceptibility was reduced and demonstrated that cognitive benefits transferred to performance on untrained tests of attention, impulsivity, and multitasking [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] JA Anguera, 2013, Video game training enhances cognitive control in older adults, Nature source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was reviewed and approved by the Copernicus Group IRB on 8/28/2013.

    “This study was reviewed and approved by the Copernicus Group IRB on 8/28/2013 (IRB Tracking #: AKI1-13-296).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The ADHD High Severity sub-sample had 22 participants (mean age = 10.2, 14 males and 8 females) and did not differ in terms of age or gender.

    “This sub-sample had 22 participants (mean age = 10.2, 14 males and 8 females), and did not differ in terms of age or gender.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Improvements in multi-tasking were maintained in the Neuroracer treatment group after 6 months of no treatment, and this maintenance correlated with EEG-based neurological changes.

    “Improvements in multi-tasking were maintained in the treatment group after 6 months of no treatment, and this maintenance effect also correlated with the same EEG-based neurological changes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] JA Anguera, 2013, Video game training enhances cognitive control in older adults, Nature source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Written consent was obtained from parents/caregivers of all participants prior to completing study procedures.

    “Written consent was obtained from parents/caregivers of all participants prior to completing study procedures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductnone given

    For each variable and group, the normality assumption for T-Tests was verified using a Shapiro-Wilks test.

    “For each variable and group, the normality assumption for T-Tests was verified using a Shapiro-Wilks test.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Medication management has a very significant effect on core symptoms of ADHD but only equivocal effects on specific executive functions.

    “medication management, the mostly commonly utilized treatment for ADHD, has a very significant effect on core symptoms of ADHD but only equivocal effects on specific executive functions [38–40].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [38] P Hammerness, 2014, Assessment of cognitive domains during treatment with OROS methylphenidate in adolescents with ADHD, Child Neuropsychology source

      Not checked in the free run.

    • cites [39] J Swanson, 2011, Understanding the effects of stimulant medications on cognition in individuals with attention-deficit hyperactivity disorder: a decade of progress, Neuropsychopharmacology source

      Not checked in the free run.

    • cites [40] SS Gau, 2010, Improvement of executive functions in boys with attention deficit hyperactivity disorder: an open-label follow-up study with once-daily atomoxetine, International Journal of Neuropsychopharmacology source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Deficits observed on the CANTAB among individuals with ADHD improve in the context of stimulant treatment.

    “Similarly, deficits observed on the CANTAB among individuals with ADHD improve in the context of stimulant treatment, suggesting these are key targets for other novel interventions for this disorder [38].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] P Hammerness, 2014, Assessment of cognitive domains during treatment with OROS methylphenidate in adolescents with ADHD, Child Neuropsychology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    If the Shapiro-Wilks test indicated that the distribution of scores did not meet normality, a Wilcoxon rank sum test was performed instead.

    “If the Shapiro-Wilks test indicated that the distribution of scores did not meet normality, a Wilcoxon rank sum test was performed instead.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The current study reports Bonferroni corrected significance values to address the concern of Type I error.

    “The current study reports Bonferroni corrected significance values to address this concern; however, future studies will need to replicate the current findings with a priori hypotheses to confirm these exploratory findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Statistical significance for some outcomes was determined after a Bonferroni correction of 0.05/5 = 0.01.

    “** indicates statistical significance after a Bonferroni correction of 0.05/5 = 0.01.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Study participants with ADHD represented a subset of the pediatric general population, but may not be representative of the entire general population of children with ADHD (e.g., not on medication, no significant co-morbid psychiatric disorders).

    “In addition, study participants with ADHD represented a subset of the pediatric general population, but may not be representative of the entire general population of children with ADHD (e.g., not on medication, no significant co-morbid psychiatric disorders) which may affect the generalizability of these preliminary findings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The ADHD groups' improved Attention Performance index and maintenance of D-prime, despite a decrease in the omission error standard score, may imply attentional improvements that accompany and are not compromised by a shift to a more cautious/withholding response profile.

    “Interestingly, the ADHD groups’ improved Attention Performance index and maintenance of D-prime, despite a decrease in the omission error standard score, may imply attentional improvements that accompany and are not compromised by a shift to a more cautious/withholding response profile.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Overall, the results suggest improvement in Spatial Working Memory (SWM) for the ADHD and ADHD High Severity subgroups, and improvements for the non-ADHD group on Rapid Visual Processing (RVP) and Delayed Match to Sample (DMS).

    “Overall, the results suggest an improvement for Spatial Working Memory (SWM) for the ADHD and ADHD High Severity subgroup and well as improvements for the non-ADHD group on Rapid Visual Processing (RVP) and Delayed Match to Sample (DMS).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Delivery of a digital treatment intervention on a mobile device may increase compliance by making the treatment enjoyable and comfortable for use in an at-home setting.

    “Delivery of a digital treatment intervention on a mobile device may increase access to treatment, reduce cost of care, and increase compliance by making the treatment enjoyable and comfortable for use in an at-home setting.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Delivery of a digital treatment intervention on a mobile device may reduce cost of care.

    “Delivery of a digital treatment intervention on a mobile device may increase access to treatment, reduce cost of care, and increase compliance by making the treatment enjoyable and comfortable for use in an at-home setting.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Parent acceptability of ADHD treatment is influenced by multiple factors.

    “consistent with prior research that parent acceptability of ADHD treatment is influenced by multiple factors [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] NK Schatz, 2015, Systematic Review of Patients&apos; and Parents&apos; Preferences for ADHD Treatment Options and Processes of Care, Patient source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The BRIEF parent-report has been correlated with both neuroanatomy and performance on working memory measures.

    “For example, the BRIEF parent-report provides important clinical information about functional deficits associated with ADHD, and has been correlated with both neuroanatomy and performance on working memory measures [44, 45].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [44] ME Toplak, 2009, Executive functions: performance-based measures and the behavior rating inventory of executive function (BRIEF) in adolescents with attention deficit/hyperactivity disorder (ADHD), Child Neuropsychology source

      Not checked in the free run.

    • cites [45] N Faridi, 2015, Neuroanatomical correlates of behavioral rating versus performance measures of working memory in typically developing children and adolescents, Neuropsychology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Delivery of a digital treatment intervention on a mobile device may increase access to treatment.

    “Delivery of a digital treatment intervention on a mobile device may increase access to treatment, reduce cost of care, and increase compliance by making the treatment enjoyable and comfortable for use in an at-home setting.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Other computerized cognitive training programs have demonstrated positive outcomes on executive tasks similar to trained tasks but limited generalization to other tasks.

    “Results of the study build upon those reported for other computerized cognitive training programs that have demonstrated positive outcomes on executive tasks that are similar to trained tasks but have shown limited generalization to other tasks [35, 36].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [35] T Klingberg, 2010, Training and plasticity of working memory, Trends in Cognitive Sciences source

      Not checked in the free run.

    • cites [36] S Dovis, 2015, 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, PLoS One source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Findings from the current study provide preliminary support that this digital therapy intervention may be effective for improving attention, working memory, and inhibition in pediatric ADHD, especially among children with greater symptom severity and impaired attention.

    “Findings from the current study provide preliminary support that this digital therapy intervention may be effective for improving attention, working memory, and inhibition in pediatric ADHD, especially among children with greater symptom severity and impaired attention.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    It is possible that any improvements observed via parent report were influenced by parent expectations of benefit.

    “In addition, because the current study was an open-label, proof-of-concept trial, it is possible that any improvements observed via parent report were influenced by parent expectations of benefit that would be received from the intervention.”
    Quote in the paperSubstantial claim
43 of 43

  • The paper relies on this without support.

    Improvements in the ADHD group are attributable to the EVO intervention rather than practice effects, regression to the mean, or other nonspecific factors.

    “Significant improvements were observed on the TOVA primary composite measure, the Attention Performance Index (API) in the ADHD group (T-Test; N = 40, t = 2.21, p = 0.033, Effect Size (d) = 0.35, mean of differences = -1.43, 95%CI-Lower = -2.75, 95%CI-Upper = -0.12).”

  • The paper relies on this without support.

    The ADHD High Severity subgroup's greater response is not due to regression to the mean or selection artifact.

    “In addition, a larger effect of the intervention was observed for the subset of ADHD participants with greater functional deficits and lower attentional performance (T-Test; N = 22, t = 3.33, p = 0.003, Effect Size (d) = 0.71, mean of differences = -3.05, 95%CI-Lower = -4.96, 95%CI-Upper = -1.15).”

  • The paper relies on this without support.

    The 84% completion rate and appeal ratings indicate acceptable treatment acceptability.

    “Across all participants, 84% of all prescribed in-home sessions were completed.”

  • The paper relies on this without support.

    The non-ADHD group provides a valid comparison for practice effects on the TOVA API.

    “There was no change in API scores for the non-ADHD group (T-Test; N = 40, t = 1.04, p = 0.30, Effect Size (d) = 0.17, mean of differences = -0.39, 95%CI-Lower = -1.16, 95%CI-Upper = 0.37).”

  • The paper relies on this without support.

    Prior work with Neuroracer showed that participants who received the digital intervention demonstrated improvements in attentional functioning and spatial working memory as measured by accepted computerized tests over a one-month intervention period.

    “As shown in prior work with Neuroracer, the platform upon which Project: EVO was developed, participants who received the digital intervention demonstrated improvements in attentional functioning and spatial working memory as measured by accepted computerized tests over the one-month intervention period.”

  • The paper relies on this without support.

    Medication is the front line treatment for children with ADHD.

    “Although medication is the front line treatment for children with ADHD, there remains a need for the development of alternative intervention modalities to optimize care for these patients.”

  • The paper relies on this without support.

    The ExGaussian Tau may be a sensitive metric for attentional challenges.

    “Analyses of the ExGaussian Tau, an experimental measure derived from the TOVA that may be a sensitive metric for attentional challenges, indicated significant improvement for both the ADHD group (T-Test; N = 40, t = 2.14, p = 0.039, Effect Size (d) = 0.34, mean of differences = 30.56, 95%CI-Lower = 1.7, 95%CI-Upper = 59.43)”
7 of 7

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.

  • Consistentz = 2.39reported p = .016 · recomputed p = .017

    “z = 2.39, p = .016”

    The paper states an exact rank test

  • Consistentz = 2.05reported p = .04 · recomputed p = .040

    “z = 2.05, p = .040”

  • Consistentz = 1.81reported p = .07 · recomputed p = .070

    “z = 1.81, p = .07”

  • Consistentz = 2.4reported p = .014 · recomputed p = .016

    “z = 2.40, p = .014”

    The paper states an exact rank test

  • Consistentz = 2.19reported p = .027 · recomputed p = .029

    “z = 2.19, p = .027”

    The paper states an exact rank test

5 of 5

Self-check

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.

  • Overall intervention hours do not match the two group averages

    Minor

    The ADHD and non-ADHD groups each had 40 participants, so their reported averages of 10.8 and 11.5 hours imply an overall average of 11.15 hours, not approximately 10.9 hours.

    Reported 10.9 · recomputed 11.15

  • Working-memory result is marked significant after a correction it does not pass

    Minor

    The ADHD High Severity subgroup's working-memory result has p = 0.014 and is marked with **, but the table defines ** as significance after correction to a threshold of 0.01. Since 0.014 exceeds 0.01, the corrected-significance marker is inconsistent with the reported p-value.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. CANTAB [Cognitive assessment software]. Cambridge Cognition; 2016.

Cited by

Sorted by citations

Related

Authors
Davis, N. O., Bower, J., & Kollins, S. H.
Affiliations
Duke University (US)
Corresponding author
Davis, Naomi O.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2018-01-11
Volume
13
Issue
1
Pages
e0189749
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0189749
PMC
PMC5764249
OpenAlex
W2782909961
Cited by
106
References
44
Citations by year
2026: 9 · 2025: 12 · 2024: 16 · 2023: 12 · 2022: 19 · 2021: 18 · 2020: 13 · 2019: 5 · 2018: 2
FWCI
7.42
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
Akili Interactive Labs
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
Keywords
children with ADHD, digital interventions, home treatment, cognitive training, attention, spatial working memory, inhibition, treatment acceptability, neurocognitive impairment, children
MeSH terms
Attention, Attention Deficit Disorder with Hyperactivity, Child, Cognition, Female, Humans, Male, Memory, Short-Term, United States, Case-Control Studies, Executive Function

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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