J Med Internet Res. 2026 Jun 18. doi: 10.2196/97365. Online ahead of print.
ABSTRACT
BACKGROUND: Children with inattentive attention-deficit/hyperactivity disorder (ADHD) often present with impairments in executive functions and fine motor skills in addition to core inattentive symptoms. However, evidence remains limited regarding structured telerehabilitation-based fine motor training on these outcomes.
OBJECTIVE: To examine the effects of a 12-week telerehabilitation-based fine motor training program on inattention symptoms, executive functions, and fine motor skills in children with inattentive ADHD.
METHODS: This randomized controlled trial included 66 children aged 6 to 10 years with inattentive ADHD. Participants were randomly assigned to a telerehabilitation-based fine motor training group (n=33) or a wait-list control group (n=33). The intervention was delivered live online 3 times per week, 60 minutes per session, for 12 weeks. Assessments were conducted at baseline, immediately after the intervention, and at 3-month follow-up. Outcomes included parent-reported inattention symptoms, executive functions, and fine motor skills. Linear mixed-effects models were used for the primary analysis, and exploratory mediation analysis was conducted using postintervention values at 12 weeks.
RESULTS: Compared with the wait-list control group, the intervention group showed greater reductions in parent-reported inattention symptoms at 12 weeks (MD=-3.85, 95% CI: -5.01 to -2.68; Hedges' g=-1.13; P<0.001) and 24 weeks (MD=-2.00, 95% CI: -3.17 to -0.83; Hedges' g=-0.59; P<0.001). For executive functions, between-group differences favored the intervention group for inhibitory control at 12 weeks (MD=-11.62, 95% CI: -19.78 to -3.46; Hedges' g=-0.83; P=0.006) and 24 weeks (MD=-8.88, 95% CI: -17.04 to -0.72; Hedges' g=-0.63; P=0.033), immediate memory at both time points, and cognitive flexibility at both time points. Delayed memory showed a significant between-group difference only at 12 weeks (MD=3.03, 95% CI: 0.57 to 5.49; Hedges' g=0.65; P=0.016). For fine motor skills, between-group differences favored the intervention group for manual dexterity at 12 weeks (MD=2.97, 95% CI: 1.12 to 4.73; Hedges' g=1.17; P=0.001) and 24 weeks (MD=2.94, 95% CI: 1.18 to 4.70; Hedges' g=1.16; P=0.001), and for hand-eye coordination at 12 weeks (MD=2.48, 95% CI: 0.68 to 4.29; Hedges' g=1.06; P=0.007) and 24 weeks (MD=2.09, 95% CI: 0.28 to 3.90; Hedges' g=0.89; P=0.024). Writing skills improved at 12 weeks but not at follow-up. Exploratory mediation analysis using week-12 postintervention values suggested a statistical indirect association through inhibitory control (β=-0.85, 95% CI: -1.85 to -0.08; P=0.046). However, post hoc lagged exploratory mediation analyses did not support longitudinal indirect effects through inhibitory control or other executive function outcomes.
CONCLUSIONS: A 12-week telerehabilitation-based fine motor training program may be a feasible and potentially beneficial adjunctive intervention for children with inattentive ADHD. The findings suggest potential benefits for parent-reported inattention symptoms, selected executive function outcomes, and fine motor skills, but should be interpreted cautiously given the wait-list control design, parent-reported symptom outcome, and exploratory mediation analysis.
CLINICALTRIAL: Chictr.org.cn ChiCTR2200065413; https://www.chictr.org.cn/showproj.html?proj=182412.
PMID:42321154 | DOI:10.2196/97365