Tele-treatments

Attention deficit & hyperactivity disorder

Evidence reviewed as of before 20-05-2021

Author(s): Ogourtsova, T. (PhD OT), Osman, G. (MSc OT student), & Dunn, T. (MSc student)

Introduction

For attention deficit & hyperactivity disorder (ADHD), we found 8 studies on tele-treatments. Three of them are high quality randomized clinical trials (RCTs), two are fair quality RCTs, and 3 are non-RCTs.

These tele-treatments were provided by psychologists, a multidisciplinary team of professionals, and paraprofessional coaches. Some of the tele-interventions did not involve a clinician in delivering the treatment and focused on health education (e.g., targeting life skills). Some tele-treatments (37.5% of studies) targeted to improve both, parent- and child-related outcomes, 37.5% targeted only child-related outcomes, and 25% targeted parent-related outcomes. For instance, interventions focused on improving the mental health of persons with ADHD, child behavior, life skills, parent engagement, distress, and self-efficacy. Interventions were provided through videoconferencing only in 25% of studies and clinicians were actively involved in sessions (37.5% of studies).

Thirty-nine (n=39) different outcomes were studied, and 82.1% of them emerged from RCTs. Telerehabilitation was found to be more effective (vs. no treatment) in improving 68.4% of outcomes and more effective (vs. another intervention such as usual care or face-to-face treatment) in improving 23.1% of outcomes.

Proceed to the Clinician information section to find out more.

Clinician information

In this section, you will find a list of outcomes that were examined in the selected studies; whether telerehabilitation was more or as effective (for RCTs) or effective/not effective (for non-RCTs); the comparison intervention (e.g., usual care, if present); and the level of evidence. Find out more about the levels of evidence here.
Heath education
Results Table
For attention deficit & hyperactivity disorder (ADHD),  one study focused on interventions without specifying the professional. This study was a high quality RCT.

The focus of these tele-interventions was to improve child’s life skills, including time management, planning, organization., and cooperation skills.

Nine (n=9) different outcomes were studied and all emerge from RCTs.

Expand on the outcomes below to find out more.
Sense of responsibilityMore effective vs. Usual care1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on sense of responsibility among children with attention deficit hyperactivity disorder (ADHD). This high quality RCT assigned participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Responsibility was measured by the parent-reported Social Skills Rating System (SSRS: Responsibility subscale) at post-treatment (10 weeks). A significant between-group difference was found, favouring Plan-It Commander vs. usual care.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning, and organizing, cooperation skills) is more effective than the comparison intervention (usual care) in improving sense of responsibility among children with ADHD.
Working MemoryMore effective vs. Usual care1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on working memory among children with attention deficit hyperactivity disorder (ADHD). This high quality RCT assigned participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Working memory was measured by the parent- and teacher-reported Behavior Rating Inventory of Executive Function (BRIEF: Working memory subscale) at post-treatment (10 weeks). A significant between-group difference was found on the parent-reported measure only, favouring Plan-It Commander vs. usual care.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills) is more effective than the comparison intervention (usual care) in improving working memory among children with ADHD.
AssertivenessAs effective vs. Usual care 1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on assertiveness among children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Assertiveness was measured by the parent-reported Social Skills Rating System (SSRS: Assertiveness subscale) at post-treatment (10 weeks). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills) is as effective as the comparison intervention (usual care) in improving assertiveness among children with ADHD.
CooperationAs effective vs. Usual care 1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on cooperation among children with attention deficit hyperactivity disorder (ADHD). This RCT study assigned participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Cooperation was measured by the parent-reported Social Skills Rating System (SSRS: Cooperation scale) at post-treatment (10 weeks). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills) is as effective as the comparison intervention (usual care) in improving cooperation among parents of children with ADHD.
Planning and organization skills As effective vs. Usual care 1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on planning and organization skills among children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Planning and organization skills were measured by the parent and teacher-reported Behaviour Rating Inventory of Executive Function (BRIEF: Plan/Organize subscale) and parent-reported It's About Time Questionnaire at post-treatment (10 weeks). No significant between-group differences were found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills) is as effective as the comparison intervention (usual care) in improving planning and organization skills among children with ADHD.
Self-ControlAs effective vs. Usual care 1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on self-control among children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Self-control was measured by the parent-reported Social Skills Rating System (SSRS: Self-control subscale) at post-treatment (10 weeks). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills) is as effective as the comparison intervention (usual care) in improving self-control among children with ADHD.
Self EfficacyAs effective vs. Usual care 1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on self-efficacy among children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Self-efficacy was measured by self-report at post-treatment (10 weeks). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills) is as effective as the comparison intervention (usual care) in improving self-efficacy among children with ADHD.
Social skillsAs effective vs. Usual care 1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on total social skills among children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Social skills were measured by the parent and teacher-reported Total Social Skills Rating System (SSRS) at post-treatment (10 weeks). No significant between-group differences were found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills) is as effective as the comparison intervention (usual care) in improving social skills among children with ADHD.
Time managementAs effective vs. Usual care 1b
One high quality RCT (Bul et al., 2016) investigated the effect of telerehabilitation on time management among children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Plan-It Commander targeting life skills of time management, planning, organizing, and cooperation skills in 65 minutes sessions, 3 sessions a week for 10 weeks) vs. usual care. Time management was measured by the parent and teacher-reported Time Management questionnaire at post-treatment (10 weeks). Significant between-group differences were found on both reports, favouring Plan-It Commander vs. usual care.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Plan-It Commander targeting life skills of time management, planning and organizing, cooperation skills) is as effective as the comparison intervention (usual care) in improving time management among children with ADHD.
Multidisciplinary team
Results Table
For attention deficit & hyperactivity disorder (ADHD), we found 2 studies on tele-treatments provided by a multidisciplinary team. Both studies are non-RCTs.

The focus of the tele-interventions provided by the multidisciplinary team was to improve the mental health of persons with ADHD (self-esteem, quality of life, anxiety, and depression) and caregivers’ sense of burden.

Seven (n=7) different outcomes were studied, and all of them emerge from non-RCTs.

Expand on the outcomes below to find out more.
Quality of lifeEffective5
Two non-RCT studies from one project (Wentz et al., 2012; Soderqvist et al., 2017) investigated the effect of telerehabilitation on quality of life among youth with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Asperger’s syndrome (AS), or pervasive developmental disorder not otherwise specified (PDD-NOS). These non-RCT studies assigned participants (youth and parent) to receive telerehabilitation (Internet-Based Support and Coaching [IBSC] targeting self-esteem, anxiety, quality of life, and depression in two 30–60-minute sessions a week for 8 weeks). Quality of life was measured by the Manchester Short Assessment of Quality of Life at post-treatment (8 weeks) and follow-up (6 months). A significant improvement was found at follow-up.

Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (IBSC targeting self-esteem, anxiety, quality of life, and depression) on quality of life among youth with ADHD, ASD, AS, and/or PDD-NOS. However, two non-RCT studies found improvements following telerehabilitation.
Self-esteemEffective5
Two non-RCT studies from one project (Wentz et al., 2012; Soderqvist et al., 2017) investigated the effect of telerehabilitation on self-esteem among youth with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Asperger’s syndrome (AS), or pervasive developmental disorder not otherwise specified (PDD-NOS). These non-RCT studies assigned participants (youth and parent) to receive telerehabilitation (Internet-Based Support and Coaching [IBSC] targeting self-esteem, anxiety, quality of life, and depression in two 30–60-minute sessions a week for 8 weeks). Self-esteem was measured by Rosenberg Self-Esteem Scale at post-treatment (8 weeks) and follow-up (6 months). A significant improvement was found at follow-up.

Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (IBSC targeting self-esteem, anxiety, quality of life, and depression) on self-esteem in youth with ADHD, ASD, AS, and/or PDD-NOS. However, two non-RCT studies from one project found improvements following telerehabilitation.
Sense of coherenceEffective5
Two non-RCT studies from one project (Wentz et al., 2012; Soderqvist et al., 2017) investigated the effect of telerehabilitation on sense of coherence among youth with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Asperger’s syndrome (AS), or pervasive developmental disorder not otherwise specified (PDD-NOS). These non-RCT studies assigned participants (youth and parent) to receive telerehabilitation (Internet-Based Support and Coaching [IBSC] targeting self-esteem, anxiety, quality of life, and depression in two 30–60-minute sessions a week for 8 weeks). Sense of coherence was measured by the Sense of Coherence questionnaire at post-treatment (8 weeks) and follow-up (6 months). A significant improvement was found at follow-up.

Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (IBSC targeting self-esteem, anxiety, quality of life, and depression) on sense of coherence among youth with ADHD, ASD, AS, and/or PDD-NOS. However, two non-RCT studies from one project found improvements following telerehabilitation.
Assistance with activities of daily livingNot effective 5
Two non-RCT studies from one project (Wentz et al., 2012; Soderqvist et al., 2017) investigated the effect of telerehabilitation on assistance with activities of daily living (ADL) among youth with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Asperger’s syndrome (AS), or pervasive developmental disorder not otherwise specified (PDD-NOS). These non-RCT studies assigned participants (youth and parent) to receive telerehabilitation (Internet-Based Support and Coaching [IBSC] targeting self-esteem, anxiety, quality of life, and depression in two 30–60-minute sessions a week for 8 weeks). Assistance with ADLs was measured by questionnaire at post-treatment (8 weeks) and follow-up (6 months). No significant improvements were found.

Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (IBSC targeting self-esteem, anxiety, quality of life, and depression) on assistance with ADLs among youth with ADHD, ASD, AS, and/or PDD-NOS.
Mood and affectNot effective 5
Two non-RCT studies from one project (Wentz et al., 2012; Soderqvist et al., 2017) investigated the effect of telerehabilitation on mood and affect among youth with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Asperger’s syndrome (AS), or pervasive developmental disorder not otherwise specified (PDD-NOS). These non-RCT studies assigned participants (youth and parent) to receive telerehabilitation (Internet-Based Support and Coaching [IBSC] targeting self-esteem, anxiety, quality of life, and depression in two 30-60 minute sessions a week for 8 weeks). Mood and affect were measured by Hospital Anxiety and Depression Scale (HAD) and the Montgomery Åsberg Depression Rating Scale (MADRS) at post-treatment (8 weeks) and follow-up (6 months). No significant improvements were found.

Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (IBSC targeting self-esteem, anxiety, quality of life, and depression) on mood and affect among youth with ADHD, ASD, AS, and/or PDD-NOS.
Relationship with youthNot effective 5
Two non-RCT studies from one project (Wentz et al., 2012; Soderqvist et al., 2017) investigated the effect of telerehabilitation on relationship with youth among youth with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Asperger’s syndrome (AS), or pervasive developmental disorder not otherwise specified (PDD-NOS). These non-RCT studies assigned participants (youth and parent) to receive telerehabilitation (Internet-Based Support and Coaching [IBSC] targeting self-esteem, anxiety, quality of life, and depression in two 30–60-minute sessions a week for 8 weeks). Relationship with youth was measured by questionnaire at post-treatment (8 weeks) and follow-up (6 months). No significant improvements were found.

Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (IBSC targeting self-esteem, anxiety, quality of life, and depression) on relationship with youth among youth with ADHD, ASD, AS, and/or PDD-NOS.
Sense of worryNot effective 5
Two non-RCT studies from one project (Wentz et al., 2012; Soderqvist et al., 2017) investigated the effect of telerehabilitation on sense of worry among youth with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Asperger’s syndrome (AS), or pervasive developmental disorder not otherwise specified (PDD-NOS). These non-RCT studies assigned participants (youth and parent) to receive telerehabilitation (Internet-Based Support and Coaching [IBSC] targeting self-esteem, anxiety, quality of life, and depression in two 30–60-minute sessions a week for 8 weeks). Sense of worry was measured by questionnaire at post-treatment (8 weeks) and follow-up (6 months). No significant improvements were found.

Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (IBSC targeting self-esteem, anxiety, quality of life, and depression) on sense of worry among youth with ADHD, ASD, AS, and/or PDD-NOS.
Paraprofessional coaching
Results Table
For attention deficit & hyperactivity disorder (ADHD), we found 1 study on tele-treatments provided by a paraprofessional coach. This study is a high quality RCT.

The focus of the tele-interventions provided by the paraprofessional coach was to improve insomnia outcomes.

Two (n=2) different outcomes were studied.

Expand on the outcomes below to find out more.
Challenging behaviorsMore effective vs. Waitlist1b
One high quality RCT (Corkum et al., 2016) investigated the effect of telerehabilitation on challenging behaviours among children with attention deficit hyperactivity disorder (ADHD) and sleep difficulties. This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Better Nights/Better Days targeting insomnia in 30–45-minute sessions, 5 sessions a week for 8 weeks) vs. waitlist. Challenging behaviours were measured by the Child Behaviour Checklist (CBCL) at post-treatment (2 months) and follow-up (6 months). Significant between-group differences were found at post-treatment, favouring Better Nights/Better Days vs waitlist.

Conclusion: There is moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (Better Nights/Better Days targeting insomnia) is more effective than a comparison intervention (waitlist) in improving challenging behaviours among children with ADHD and sleep difficulties.
Sleep outcomesMore effective vs. Waitlist1b
One high quality RCT (Corkum et al., 2016) investigated the effect of telerehabilitation on sleep outcomes among children with attention deficit hyperactivity disorder (ADHD) and sleep difficulties. This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Better Nights/Better Days targeting insomnia in 30–45-minute sessions, 5 sessions a week for 8 weeks) vs. waitlist. Sleep outcomes were measured by the parent-reported Children’s Sleep Habits Questionnaire (CSHQ: Bedtime resistance subscale; Sleep duration subscale; Total sleep disturbance subscale), and actigraphy measurements (speed onset latency; sleep duration) at post-treatment (2 months) and follow-up (6 months). Significant between-group differences were found at both timepoints on all measures except actigraphy sleep duration measurement, favouring Better Nights/Better Days vs. waitlist.

Conclusion: There is moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (Better Nights/Better Days targeting insomnia) is more effective than the comparison intervention (waitlist) in improving sleep outcomes among children with ADHD and sleep difficulties.
Psychology
Results Table
For attention deficit & hyperactivity disorder (ADHD), we found 4 studies on tele-treatments provided by psychologists. Out of those studies, one is a high quality randomized clinical trials (RCTs), 2 are fair quality RCTs, and 1 is a non-RCT.

The focus of the tele-interventions provided by psychologists was to improve child’s behavior and parent engagement, stress, resiliency, and self-efficacy.

Twenty-one (n=21) different outcomes were studied.

Expand on the outcomes below to find out more.
Executive functionsMore effective vs. Unspecified training1b
One high quality RCT (Simone et al., 2018) investigated the effect of telerehabilitation on executive functions (concentration, attention, processing speed, working memory and cognitive flexibility) in children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Specific Training targeting neuropsychological performance in 1-hour sessions, 2 sessions a week for 3 months) vs. unspecified training. Executive functions were measured by the Symbol Digit Modalities Test and Trail Making Tests A/B at post-treatment (3 months). A significant between-group difference was found on one measure (SDMT), favouring specific vs. unspecified training.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Specific Training targeting neuropsychological performance) is more effective than the comparison intervention (unspecified training) in improving executive functions in children with ADHD.
Visuo-spatial learning and delayed recallMore effective vs. Unspecified training1b
One high quality RCT (Simone et al., 2018) investigated the effect of telerehabilitation on visuo-spatial learning and delayed recall in children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Specific Training targeting neuropsychological performance in 1-hour sessions, 2 sessions a week for 3 months) vs. unspecified training. Visuo-spatial learning and delayed recall were measured by the Spatial Recall Tests (SRST: Standard; Delayed) at post-treatment (3 months). A significant between-group difference was found in one measure (SRST: Delayed recall), favouring specific vs. unspecified training.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Specific Training targeting neuropsychological performance) is more effective than the comparison intervention (unspecified training) in improving visuo-spatial learning and delayed recall in children with ADHD.
Expressive languageAs effective vs. Unspecified training 1b
One high quality RCT (Simone et al., 2018) investigated the effect of telerehabilitation on expressive language in children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Specific Training targeting neuropsychological performance in 1-hour sessions, 2 sessions a week for 3 months) vs. unspecified training. Expressive language was measured by the Semantic Verbal Fluency Test at post-treatment (3 months). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Specific Training targeting neuropsychological performance) is as effective as the comparison intervention (unspecified training) in improving expressive language in children with ADHD.
Global neuropsychological performance As effective vs. Unspecified training 1b
One high quality RCT (Simone et al., 2018) investigated the effect of telerehabilitation on global neuropsychological performance in children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Specific Training targeting neuropsychological performance in 1-hour sessions, 2 sessions a week for 3 months) vs. unspecified training. Global neuropsychological performance was measured by the Cognitive Impairment Index at post-treatment (3 months). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Specific Training targeting neuropsychological performance) is as effective as the comparison intervention (unspecified training) in improving global neuropsychological performance in children with ADHD.
Mood and affect (child) As effective vs. Unspecified training1b
One high quality RCT (Simone et al., 2018) and one fair quality RCT (DuPaul et al., 2018) investigated the effect of telerehabilitation on mood and affect among children at risk for attention deficit hyperactivity disorder (ADHD).

The high quality RCT (Simone et al., 2018) investigated the effect of telerehabilitation on mood and affect in children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Specific Training targeting neuropsychological performance in 1-hour sessions, 2 sessions a week for 3 months) vs. unspecified training. Mood and affect were measured by the Children’s Depression Inventory (self-assessed) and Kiddie Schedule for Affective Disorder and Schizophrenia at post-treatment (3 months). No significant between-group differences were found.

The fair quality RCT (DuPaul et al., 2018) randomized participants (parent alone) to receive telerehabilitation (online Behavioural Parent Training [BPT] targeting parent engagement, program acceptability, parent stress, and child behaviour for 1 session a week for 10 sessions), face-to-face BPT or waitlist. Child’s mood and affect were measured by Conners Early Childhood Rating Scale (CERS: Mood/Affect scale) at post-treatment (10 weeks). A significant between-group difference was found, favouring online BPT vs. waitlist.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Specific Training targeting neuropsychological performance) is as effective as the comparison intervention (unspecified training) in improving mood and affect in children with ADHD.
PlanningAs effective vs. Unspecified training 1b
One high quality RCT (Simone et al., 2018) investigated the effect of telerehabilitation on planning in children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Specific Training targeting neuropsychological performance in 1-hour sessions, 2 sessions a week for 3 months) vs. unspecified training. Planning was measured by the Tower of London Test at post-treatment (3 months). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Specific Training targeting neuropsychological performances) is as effective as the comparison intervention (unspecified training) in improving planning in children with inattention (ADHD).
Verbal learning and delayed recallAs effective vs. Unspecified training 1b
One high quality RCT (Simone et al., 2018) investigated the effect of telerehabilitation on verbal learning and delayed recall in children with attention deficit hyperactivity disorder (ADHD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (Specific Training targeting neuropsychological performance in 1-hour sessions, 2 sessions a week for 3 months) vs. unspecified. Verbal learning and delayed recall were measured by the Selective Reminding Tests (SRT: Standard; Delayed) at post-treatment (3 months). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (Specific Training targeting neuropsychological performance) is as effective as the comparison intervention (unspecified training) in improving verbal learning and delayed recall in children with ADHD.
Awareness and knowledgeMore effective vs. Waitlist2a
One fair quality RCT (DuPaul et al., 2018) investigated the effect of telerehabilitation on awareness and knowledge of behavioural techniques and ADHD information among parents of children at risk for attention deficit hyperactivity disorder (ADHD). This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (Online Behavioural Parent Training [BPT] targeting parent engagement, program acceptability, parent stress, and child behaviour for 10 sessions; 1 session a week for 10 weeks), face-to-face BPT or waitlist. Awareness and knowledge of behavioural techniques and ADHD information was measured by a pre-post assessment of knowledge at post-treatment (10 weeks). A significant between-group difference was found, favouring online BPT vs. waitlist.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (online BPT targeting parent engagement, program acceptability, parent stress, and child behaviour) is more effective than the comparison intervention (waitlist) in improving awareness and knowledge of behavioural techniques and ADHD information among parents of children at risk for ADHD.
BehaviourMore effective vs. Waitlist2a
One fair quality RCT (DuPaul et al., 2018) investigated the effect of telerehabilitation on behaviour in children at risk for attention deficit hyperactivity disorder (ADHD). This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (Online Behavioural Parent Training [BPT] targeting parent engagement, program acceptability, parent stress, and child behaviour for 1 session a week for 10 sessions), face-to-face BPT or waitlist. Behaviour was measured by the Conners Early Childhood Rating Scale (CERS: Global Index Total) at post-treatment (10 weeks). A significant improvement was found, favouring online BPT vs. waitlist.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (online BPT targeting parent engagement, program acceptability, parent stress, and child behaviour) is more effective than the comparison intervention (waitlist) in improving behaviour among children at risk for ADHD.
EmpathyMore effective vs. Waitlist2a
One fair quality RCT (Park et al., 2020) investigated the effect of telerehabilitation on empathy among children with learning and attentional disabilities. This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (Stress Management and Resiliency Training – Relaxation Response Resiliency Program [SMART-3RP] targeting parental distress, resiliency, and stress coping in 90-minute sessions, 1 session a week for 9 weeks) vs. waitlist. Empathy was measured by the Interpersonal Reactivity Index at post-treatment (9 weeks). A significant between-group difference was found, favouring SMART-3RP vs. waitlist.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (SMART-3RP targeting parental distress, resiliency, and stress coping) is more effective than the comparison intervention (waitlist) in improving empathy among children with learning and attentional disabilities.
MindfulnessMore effective vs. Waitlist2a
One fair quality RCT (Park et al., 2020) investigated the effect of telerehabilitation on mindfulness among parents of children with learning and attentional disabilities. This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (Stress Management and Resiliency Training – Relaxation Response Resiliency Program [SMART-3RP] targeting parental distress, resiliency, and stress coping in 90-minute sessions, 1 session a week for 9 weeks) vs. waitlist. Mindfulness was measured by The Cognitive and Affective Mindfulness Scale Revised at post-treatment (9 weeks). A significant between-group difference was found, favouring SMART-3RP vs. waitlist.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (SMART-3RP targeting parental distress, resiliency, and stress coping) is more effective than the comparison intervention (waitlist) in improving mindfulness among parents of children with learning and attentional disabilities.
Mood and affect (parent)More effective vs. Waitlist2a
One fair quality RCT (Park et al., 2020) and one case series study (Reese et al., 2012) investigated the effect of telerehabilitation on mood and affect among parents of children with learning and attentional disabilities.

The fair quality RCT (Park et al., 2020) randomized participants (parent alone) to receive telerehabilitation (Stress Management and Resiliency Training – Relaxation Response Resiliency Program [SMART-3RP] targeting parental distress, resiliency, and stress coping in 90-minute sessions, 1 session a week for 9 weeks) vs. waitlist. Mood and affect were measured by the Patient Health Questionnaire (PHQ) and the Positive/Negative Affect Schedule (PNAS: Positive subscale) at post-treatment (9 weeks). A significant between-group difference was found in one measure (PHQ), favoring SMART-3RP vs. waitlist.

The case series study (Reese et al., 2012) assigned participants (parent alone) to receive telerehabilitation (Group Triple P [Positive Parenting Program] targeting challenging behaviors and parental self-efficacy for 8 sessions) vs. no training. Mood and affect were measured by the Depression Anxiety Stress Scales-21 (DASS-21) at post-treatment (at 8 sessions). A significant improvement was found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (SMART-3RP targeting parental distress, resiliency, and stress coping) is more effective than the comparison intervention (waitlist) in improving mood and affect among parents of children with learning and attentional disabilities. One non-RCT study also found improvements following telerehabilitation.
ResilienceMore effective vs. Waitlist2a
One fair quality RCT (Park et al., 2020) investigated the effect of telerehabilitation on resilience among parents of children with learning and attentional disabilities. This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (Stress Management and Resiliency Training – Relaxation Response Resiliency Program [SMART-3RP] targeting parental distress, resiliency, and stress coping in 90-minute sessions, 1 session a week for 9 weeks) vs. waitlist. Resilience was measured by the Current Experience Scale at post-treatment (9 weeks). A significant between-group difference was found, favouring SMART-3RP vs. waitlist.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (SMART-3RP targeting parental distress, resiliency, and stress coping) is more effective than the comparison intervention (waitlist) in improving resilience among parents of children with learning and attentional disabilities.
Restlessness and impulsivityMore effective vs. Waitlist2a
One fair quality RCT (DuPaul et al., 2018) investigated the effect of telerehabilitation on restlessness and impulsiveness among children at risk for attention deficit hyperactivity disorder (ADHD). This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (online Behavioural Parent Training [BPT] targeting parent engagement, program acceptability, parent stress, and child behaviour for 1 session a week for 10 sessions), face-to-face BPT or waitlist. Restlessness and impulsiveness were measured by Conners Early Childhood Rating Scale (CERS: Global Index Restlessness/Impulsive scale) at post-treatment (10 weeks). A significant between-group difference was found, favouring online BPT vs. waitlist.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (online BPT targeting parent engagement, program acceptability, parent stress, and child behaviour) is more effective than the comparison intervention (waitlist) in improving restlessness and impulsiveness among children at risk for ADHD.
Social supportMore effective vs. Waitlist2a
One fair quality RCT (Park et al., 2020) investigated the effect of telerehabilitation on social support among parents of children with learning and attentional disabilities. This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (Stress Management and Resiliency Training – Relaxation Response Resiliency Program [SMART-3RP] targeting parental distress, resiliency, and stress coping in 90-minute sessions, 1 session a week for 9 weeks) vs. waitlist. Social support was measured by the Medical Outcomes Study (MOS: Social Support survey) at post-treatment (9 weeks). A significant between-group difference was found, favouring SMART-3RP vs. waitlist.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (SMART-3RP targeting parental distress, resiliency, and stress coping) is more effective than the comparison intervention (waitlist) in improving social support among parents of children with learning and attentional disabilities.
Treatment acceptabilityMore effective vs. Waitlist2a
One fair quality RCT (DuPaul et al., 2018) investigated the effect of telerehabilitation on treatment acceptability among children at risk for attention deficit hyperactivity disorder (ADHD). This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (online Behavioural Parent Training [BPT] targeting parent engagement, program acceptability, parent stress, and child behaviour for 1 session a week for 10 sessions), face-to-face BPT, or waitlist. Treatment acceptability was measured by Intervention Rating Profile-15 at post-treatment (10 weeks). A significant between-group difference was found, favouring online vs. face-to-face BPT.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (online BPT targeting parent engagement, program acceptability, parent stress, and child behaviour) is more effective than the comparison intervention (face-to-face BPT) in improving treatment acceptability among children at risk for ADHD.
Treatment fidelityMore effective vs. Waitlist2a
One fair quality RCT (DuPaul et al., 2018) investigated the effect of telerehabilitation on treatment fidelity among children at risk for attention deficit hyperactivity disorder (ADHD). This fair quality RCT study randomized participants (parent alone) to receive telerehabilitation (Online Behavioural Parent Training [BPT] targeting parent engagement, program acceptability, parent stress, and child behaviour for 1 session a week for 10 sessions), face-to-face BPT, or waitlist. Treatment fidelity was measured by pre-post assessment at post-treatment (10 weeks). A significant between-group difference was found, favouring BPT vs. waitlist.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (BPT targeting parent engagement, program acceptability, parent stress, and child behaviour) is more effective than the comparison intervention (waitlist) in improving treatment fidelity among children at risk for ADHD.
Challenging behavioursAs effective vs. Waitlist2a
One fair quality RCT (DuPaul et al., 2018) and one case series study (Reese et al., 2012) investigated the effect of telerehabilitation on challenging behaviours among children at risk for attention deficit hyperactivity disorder (ADHD).

The fair quality RCT (DuPaul et al., 2018) randomized participants (parent alone) to receive telerehabilitation (Online Behavioural Parent Training [BPT] targeting parent engagement, program acceptability, parent stress, and child behaviour for 1 session a week for 10 sessions), face-to-face BPT or waitlist. Challenging behaviours were measured by Conners Early Childhood Rating Scale (CERS: Defiant/Aggressive Scale) at post-treatment (10 weeks). No significant between-group differences were found.

The case series study (Reese et al., 2012) assigned participants (parent alone) to receive telerehabilitation (Group Triple P [Positive Parenting Program] targeting challenging behaviours and parental self-efficacy for 8 sessions) vs. no training. Challenging behaviours were measured by the Child Behaviour Checklist at post-treatment (at 8 sessions). A significant improvement was found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (online BPT targeting parent engagement, program acceptability, parent stress, and child behaviour) is as effective as the comparison intervention (waitlist; face-to-face BPT) in improving challenging behaviours among children at risk for ADHD. However, one non-RCT study found improvements following telerehabilitation.
Inattention and overactivityAs effective vs. Waitlist2a
One fair quality RCT (DuPaul et al., 2018) investigated the effect of telerehabilitation on inattention and overactivity among children at risk for attention deficit hyperactivity disorder (ADHD). This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (Online Behavioural Parent Training [BPT] targeting parent engagement, program acceptability, parent stress, and child behaviour for 1 session a week for 10 sessions), face-to-face BPT or waitlist. Inattention and overactivity were measured by Conners Early Childhood Rating Scale (CERS: Inattention/Overactivity scale) at post-treatment (10 weeks). No significant between-group difference was found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (online BPT targeting parent engagement, program acceptability, parent stress, and child behaviour) is as effective as the comparison interventions (waitlist; face-to-face BPT) in improving inattention and overactivity among parents of children at risk for ADHD.
Sense of worryAs effective vs. Waitlist 2a
One fair quality RCT (Park et al., 2020) investigated the effect of telerehabilitation on sense of worry among parents of children with learning and attentional disabilities. This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (Stress Management and Resiliency Training – Relaxation Response Resiliency Program [SMART-3RP] targeting parental distress, resiliency, and stress coping in 90-minute sessions, 1 session a week for 9 weeks) vs. waitlist. Sense of worry was measured by the Penn State Worry Questionnaire at post-treatment (9 weeks). No significant between-group differences were found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (SMART-3RP targeting parental distress, resiliency, and stress coping) is as effective as the comparison intervention (waitlist) in improving sense of worry among parents of children with learning and attentional disabilities.
StressConflicting vs. Waitlist4
Two fair quality RCTs (DuPaul et al., 2018; Park et al., 2020) investigated the effect of telerehabilitation on stress among parents of children with or at risk for attention deficit hyperactivity disorder (ADHD).

The first fair quality RCT (DuPaul et al., 2018) randomized participants (parent alone) to receive telerehabilitation (online Behavioural Parent Training [BPT] targeting parent engagement and program acceptability; parent stress; and child behaviour for 1 session a week for 10 sessions), face-to-face BPT or waitlist. Stress was measured by Parent Stress Index—Short Form at post-treatment (10 weeks). No significant between-group differences were found.

The second fair quality RCT (Park et al., 2020) randomized participants (parent alone) to receive telerehabilitation (Stress Management and Resiliency Training – Relaxation Response Resiliency Program [SMART-3RP] targeting parental distress, resiliency, and stress coping in 90-minute sessions, 1 session a week, for 9 weeks) vs. waitlist. Stress reactivity, coping, and distress were measured by Measure of Current Status and Visual Analogue Scale at post-treatment (9 weeks). A significant between-group difference was found in both measures, favouring SMART-3RP vs. waitlist.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of telerehabilitation on stress among parents of children with or at risk for ADHD. While one fair quality RCT found no significant improvements following telerehabilitation, another fair quality RCT found that telerehabilitation (SMART-3RP targeting parental distress, resiliency, and stress coping) was more effective than waitlist in improving stress among parents of children with ADHD. Note: The receiving client and target of the interventions (parent only vs. parent + child) might have contributed to differences in findings.
References
Bul, K.C., et al., Behavioral Outcome Effects of Serious Gaming as an Adjunct to Treatment for Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial. Journal of medical Internet research, 2016. 18(2): p. e26.

Corkum, P., et al., Better Nights/Better Days-Distance Intervention for Insomnia in School-Aged Children With/Without ADHD: A Randomized Controlled Trial. Journal of pediatric psychology, 2016. 41(6): p. 701-713.

DuPaul, G.J., et al., Face-to-Face Versus Online Behavioral Parent Training for Young Children at Risk for ADHD: Treatment Engagement and Outcomes. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 2018. 47(Supplement1): p. S369-S383.

Park, E.R., et al., A Virtual Resiliency Intervention Promoting Resiliency for Parents of Children with Learning and Attentional Disabilities: A Randomized Pilot Trial. Maternal and child health journal, 2020. 24(1): p. 39-53.

Reese, R.J., et al., Telehealth for underserved families: an evidence-based parenting program. Psychol Serv, 2012. 9(3): p. 320-322.

Simone, M., et al., Computer-assisted rehabilitation of attention in pediatric multiple sclerosis and ADHD patients: a pilot trial. BMC Neurology, 2018. 18(1): p. 82.

Soderqvist, H., et al., The caregivers' perspectives of burden before and after an internet-based intervention of young persons with ADHD or autism spectrum disorder. Scandinavian journal of occupational therapy, 2017. 24(5): p. 383-392.

Wentz, E., A. Nyden, and B. Krevers, Development of an internet-based support and coaching model for adolescents and young adults with ADHD and autism spectrum disorders: a pilot study. Eur Child Adolesc Psychiatry, 2012. 21(11): p. 611-22.

Patient and family information

Summary for Patients/Families
What research is available?
There are 8 studies on different available telerehab-treatments.
How strong is the research behind these treatments?
While there are 5 studies of high and moderate research quality, 3 studies are of low research quality. Telerehabilitation is an emerging and a rapidly growing field. More high-quality research is on its way.

We are dedicated to update the available information with the most recent findings.
Who provides these treatments?
These telerehab-treatments are provided by different specialists including:

• Psychologists
• Multidisciplinary teams of different professionals (e.g., occupational therapists and speech language pathologists)
• Paraprofessional coaches
What is the involvement of the clinician in these treatments?
Clinicians are mainly actively involved in these telerehab-treatments. In other words, they are present and engaged with you and/or the child in every therapy session.
How are these treatments provided?
In a number of cases, telerehab-treatments are provided through videoconferencing by using different platforms (e.g., Skype, Zoom, or other video calls options). Other methods included the use of the web with phone calls.
Who receives these treatments?
Most telerehab-treatments are provided directly to parents of children with ADHD. Fewer treatments involve parents together with their child. No treatments engaged the child alone in their approach.
What are the goals of these treatments?
Most of these telerehab-treatments focus on improving both child and parent-related outcomes including:

• Parent’s…
• Sense of burden
• Engagement
• Stress levels and coping
• Resiliency (i.e., ability to withstand challenges)
• Self-efficacy

Child’s…
• Mental health
• Challenging behaviors
• Cognitive functions (e.g., memory, attention)
• Life skills (e.g., time management, planning, organization, cooperation).
Does it work?
Yes! Telerehab-treatments are shown to work for children and youth with ADHD and their families.

For instance, telerehab was shown to be more effective or as effective in improving numerous skills and abilities among parents and children than when the family receives:

• No treatment
• Usual care
• Face-to-face comparable treatment

It is important to note that no studies showed that the telerehab-treatments were less effective (than other interventions) or detrimental.
Are there any side effects/risks?
If your medical and rehabilitation team have cleared you and/or your child to engage in telerehabilitation, there are no specific associated risks or side effects. Your rehabilitation professional will help you and your child to perform the therapy safely and effectively.

However, it is important to relay any concerns and/or questions to your rehabilitation professional because telerehabilitation is a relatively new approach and it is different from the traditional face-to-face method. For instance, sometimes, technical issues (e.g., access to suitable technology such as a computer or a smart phone, internet connection, the platform that is used) might come up. We encourage you to discuss these and other issues with your rehabilitation specialist to promote best results and optimize your therapy sessions.
How many treatments are necessary to make progress?
On average, improvements were noted following telerehab-treatments that were provided for 30-60 minutes, 1-2 times per week, for about 9 weeks.

However, every child’s needs and progress journeys, as well as parents’ resources, preferences, and availabilities are different.

In collaboration with your rehabilitation professional, you can determine the duration and frequency of tele-treatments that are most optimal and suitable for you and your child.
Is this appropriate for me and my child?
Telerehab could be a great option for certain interventions that are feasible to be delivered and received virtually.

Children with ADHD aged anywhere from about 3 to 22 years old, and their families, can benefit from telerehab. However, every child’s needs, family’s resources, and progress journeys are different. We encourage that you discuss the appropriateness of telerehabilitation with your health professional.
Where can I access more detailed information (e.g., that I can share with my child’s health provider)?
More detailed information is available here. We are encouraging you to share this resource with your rehabilitation professional.

The scientific publication that synthesizes the aforementioned research findings can be found here.