Evaluating the evidence: a systematic review of reviews of the effectiveness and safety of digital interventions for ADHD

Background Attention-Deficit/Hyperactivity Disorder (ADHD) impacts academics, work and social relationships. Digital 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 digital 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 analyzed 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.