Peer-reviewed article

A Telerehabilitation-Based Fine Motor Training Program for Children With Inattentive Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

Zhu F, Sun Y, Kuang D, Zhu X, Bi X et al. · 23 Jul 2026

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 for these outcomes. Objective This study aims 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 waitlist 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 the 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 an exploratory mediation analysis was conducted using postintervention values at 12 weeks. Results Compared with the waitlist control group, the intervention group showed greater reductions in parent-reported inattention symptoms at 12 weeks (mean difference [MD]=-3.85, 95% CI -5.01 to -2.68; Hedges g=-1.13; P<.001) and 24 weeks (MD=-2.00, 95% CI -3.17 to -0.83; Hedges g=-0.59; P<.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=.006) and 24 weeks (MD=-8.88, 95% CI -17.04 to -0.72; Hedges g=-0.63; P=.03), 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=.02). 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=.001) and 24 weeks (MD=2.94, 95% CI 1.18 to 4.70; Hedges g=1.16; P=.001), and for hand-eye coordination at 12 weeks (MD=2.48, 95% CI 0.68 to 4.29; Hedges g=1.06; P=.007) and 24 weeks (MD=2.09, 95% CI 0.28 to 3.90; Hedges g=0.89; P=.02). Writing skills improved at 12 weeks but not at follow-up. An 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=.05). 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 waitlist control design, parent-reported symptom outcome, and exploratory mediation analysis. Trial registration Chinese Clinical Trial Registry ChiCTR2200065413; https://www.chictr.org.cn/showproj.html?proj=182412.