Neuroscience and Biobehavioral Reviews 137 (2022) 104633

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Neuroscience and Biobehavioral Reviews

journal homepage: www.elsevier.com/locate/neubiorev

Popular interventions to enhance sustained attention in children and

adolescents: A critical systematic review☆
Eadaoin J. Slattery a, b, *, 1, Eoin O’Callaghan c, Patrick Ryan b, Donal G. Fortune b,
Laura P. McAvinue d
a
Centre for Assessment Research, Policy and Practice in Education, Institute of Education, Dublin City University, Ireland
b
Dept. of Psychology, University of Limerick, Ireland
c
Independent Researcher, Dublin, Ireland
d
School of Education, University College Dublin, Ireland

A R T I C L E I N F O A B S T R A C T

Keywords: There are a myriad of interventions promoting activities designed to help enhance sustained attention in children
Attention and adolescents. In this systematic review, we critically evaluate the evidence behind three popular sustained
Intervention attention training approaches – cognitive attention training, meditation, and physical activity. Seven databases
Children
were searched in addition to secondary searches. Cognitive attention training, meditation training or physical
Adolescence
activity intervention studies aimed at improving sustained attention (randomised-controlled or non-randomised-
controlled designs) in samples of children and adolescents (3–18 years) were included. We screened 3437 unique
articles. Thirty-seven studies satisfied inclusion criteria. In general, cognitive attention training (n = 14) did not
reliably improve sustained attention. Physical activity (n = 15) and meditation interventions (n = 8) demon­
strated somewhat more potential in enhancing sustained attention, but these effects should be considered pre­
liminary and need to be replicated with greater methodological rigour. Cognitive attention training
demonstrated very limited transfer to other aspects of attention. Notably, mindfulness training had rather
consistent positive effects on selective attention. Across all three intervention types, there was very weak evi­
dence for transfer to other aspects of cognition, behaviour, and academic achievement. The paper concludes with
methodological recommendations for future studies to strengthen the evidence base.

1. Introduction enhance sustained attention and other cognitive functions in children

have bourgeoned. In this paper, we review the evidence for three
Attention is a cognitive process that is fundamental to learning and common intervention approaches (cognitive attention training, physical
functioning (e.g., Lundervold et al., 2017; Slattery et al., 2022). It activity, and meditation training) for improving sustained attention in
comprises multiple independent but related components (Raz and children and adolescents and provide a systematic review of the studies
Buhle, 2006). Sustained attention (commonly referred to as ‘concen­ in this field.
tration’ or ‘focus’ in everyday life) refers to the ability to continuously
maintain focus on goal-directed activity over time (Sturm and Willmes,
1.1. Sustained attention
2001). From reading a book to listening to a talk, sustained attention is
an elementary cognitive function that underlies more complex forms of
Sustained attention refers to the ability to maintain focus and
attention, such as divided or selective attention, and other cognitive
engagement to task goals over time, particularly in conditions of
domains, such as memory and learning (Sarter et al., 2001). In the last
monotony and repetition (Unsworth and Robison, 2020). Robertson and
few years, studies of interventions promoting activities designed to
colleagues (1997) defined sustained attention as “the ability to

This research has been funded by the Irish Research Council under the Government of Ireland Postgraduate Programme (GOIPG/2018/796).
☆

* Correspondence to: Centre for Assessment Research, Policy and Practice in Education, Institute of Education, St. Patrick’s Campus, Dublin City University,
Drumcondra, Dublin 9, Ireland.
E-mail address: eadaoin.slattery@dcu.ie (E.J. Slattery).
1
https://orcid.org/0000-0002-5513-8635

https://doi.org/10.1016/j.neubiorev.2022.104633
Received 23 January 2022; Received in revised form 15 March 2022; Accepted 17 March 2022
Available online 23 March 2022
0149-7634/© 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
E.J. Slattery et al.
self-sustain mindful, conscious processing of stimuli whose repetitive,
non-arousing qualities, would otherwise lead to habituation” (p. 747).
An important characteristic of sustained attention is that performance
tends to decline over time (called the ‘vigilance decrement’; Parasura­
man, 1979). These time-on-task effects have been demonstrated over
both long durations (e.g., Mackworth, 1948) and short durations (e.g.,
Gillberg and Åkerstedt, 1998). Another important aspect of sustained
attention is that attention fluctuates from moment-to-moment. Sus­
taining an appropriate amount of attention is critical for task perfor­
mance, but our ability waxes and wanes. Sustained attention fluctuates
between ‘in the zone’ periods of low response variability and higher
accuracy and ‘out of the zone’ periods of higher response variability and
lower accuracy (Esterman et al., 2013, 2014). At any given moment, our
capacity to sustain attention is determined by a dynamic interplay be­
tween cognitive factors, motivation factors, emotional factors, and
arousal factors (McAvinue et al., 2015). Lapses in sustained attention
can occur from a deficit in any one or a combination of these factors,
which cause the individual to disengage from the task at hand.
A number of separate neural and neurophysiological networks have
been linked to sustained attention. These include the default network,
the frontoparietal network, the salience network, and the locus coeru­
leus norepinephrine system (Buckner and DiNicola, 2019; Langner and
Eickhoff, 2013; Petersen and Posner, 2012; Sridharan et al., 2008). The
default mode network is a large-scale brain system, which includes the
medial prefrontal cortex, precuneus and posterior cingulate, lateral
temporoparietal cortex and medial temporal lobe. This system tends to
be active during periods of rest and/or periods of internally-directed
thought (e.g., mind wandering) and ‘deactivated’ during
externally-oriented sustained attention tasks (Buckner and DiNicola,
2019). The right frontoparietal network plays an important role in the
cognitive control of sustained attention (Petersen and Posner, 2012).
This network demonstrates increased activity during externally-directed
sustained attention tasks and decreased activity with time on task (Coull
et al., 1996; Paus et al., 1997). Thus, when sustained attention is
externally directed, the frontoparietal network is typically activated,
while the default mode network is typically deactivated. The salience
network, which includes the insula, amygdala, dorsal anterior cingulate
and the frontal poles detects salient information (e.g., information
related to emotion and reward; Seeley et al., 2007) and maintains the
focus of attention on relevant stimuli for further processing by regu­
lating activity within other networks (Sridharan et al., 2008). It is
thought that the salience network engages the frontoparietal network to
focus on goal-directed activity (Sridharan et al., 2008). In addition to
these neural networks, the locus coeruleus norepinephrine system plays
a critical role in sustained attention, subserving arousal. The system has
widespread connections to the frontoparietal and salience networks
(Unsworth and Robison, 2017). Optimal locus coeruleus norepinephrine
activity is thought to reduce background noise and increase
signal-to-noise ratios, ensuring greater processing of target stimuli
(Esterman and Rothlein, 2019). This is consistent with the Yerkes
Dodson Law, which proposes that any task will have an optimal level of
arousal below and beyond which performance will decrease (i.e., there
is an inverted-U relationship between arousal and task performance;
Yerkes and Dodson, 1908).
Sustained attention develops through childhood and into adulthood
with a period of accelerated development occurring in early and middle
childhood (approximately 6–9 years; Betts et al., 2006; Lewis et al.,
2017; Lin et al., 1999; McAvinue et al., 2012; Yan et al., 2018). The
ability to sustain attention is a key factor influencing children’s aca­
demic achievements (e.g., Steinmayr et al., 2010). However, poor sus­
tained attention is a relatively common problem in childhood (Döpfner
et al., 2008) and certain neurodevelopmental disorders and learning
disorders are characterised by deficits in sustained attention. Attention
problems at school entry (age 5–6 years) have been shown to predict
success in reading and mathematics at the end of primary school (age
11–12; Duncan et al., 2007) and at the end of formal schooling (age 17;
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Neuroscience and Biobehavioral Reviews 137 (2022) 104633
Breslau et al., 2009). Moreover, problems with attention have been
shown to undermine traditional academic interventions (e.g., tutoring;
Rabiner and Malone, 2004) and early attention problems have even
been shown to predict graduation from high school (Pingault et al.,
2011). Given the importance of sustained attention in childhood, the
possibility of training sustained attention (i.e., improving the ability to
pay attention in typically developing children and ameliorating sus­
tained attention deficits in children with neurodevelopmental condi­
tions) has received considerable interest and several training methods
have been employed. Currently, there are a myriad of attention training
interventions promoting activities designed to help enhance sustained
attention.
1.2. Approaches for improving sustained attention
Two broad approaches for improving attention have been identified:
cognitive attention training and state training (Tang and Posner, 2009).
Cognitive attention training involves the repetitive practice of a cogni­
tive task thought to exercise neural networks related to attention (Pos­
ner et al., 2015). This type of training is often called attention training,
cognitive training, network training or brain training. Cognitive atten­
tion training focusses on improving the cognitive control aspect of sus­
tained attention involving the frontoparietal network with the practice
of tasks designed to exercise this system. The alternative approach, state
training, involves practice designed to develop a brain state that is
thought to influence attention and other networks (Posner et al., 2015).
This type of training may also involve networks but does not include
cognitive tasks designed to specifically train an attentional network
(Posner et al., 2015). A range of methods have been suggested for
training a brain state that promotes attention; physical activity and
meditation are two examples of state training approaches (Posner et al.,
2015; Tang and Posner, 2009). State training methods likely put the
brain and body into an optimal state for sustaining attention. Physical
activity likely primarily targets sustained attention via physiological
arousal though may also target cognitive control when the kind of ex­
ercise involves a requirement for continued focus on goal-directed
stimuli. Meditation training likely targets both physiological and
cortical arousal. It may also work through the salience network, calming
the emotions and enabling a reappraisal of what should be attended to,
and the frontoparietal network, maintaining focus on certain stimuli
while excluding others. In practice and school settings, cognitive
attention training, meditation and physical activity are among the most
popular intervention approaches for enhancing ‘concentration’ or
‘focus’. A recent commentary on behavioural interventions for cognitive
enhancement highlighted the need for well-defined and precise termi­
nology to describe interventions and intervention outcomes (Green
et al., 2019). To date, the lack of precision in the literature precludes a
definitive conclusion on whether cognitive attention training, medita­
tion and physical activity enhance sustained attention capacity. The
current review provides a fine-grained critical analysis of these sus­
tained attention training interventions and attempts to answer that
question.
1.3. Cognitive attention training
In recent years, cognitive attention training has been a common
intervention approach for targeting children’s sustained attention (e.g.,
Rapport et al., 2013). The premise of training is that the repetitive
practice of a specific task leads to improvements in the underlying
neural network linked to the task (i.e., the frontoparietal network),
which enhances the cognitive function(s) underpinned by the targeted
neural network (Kerns et al., 1999; Tamm et al., 2013). The objective is
that these improvements would be sustained on a long-term basis. It is
posited that if one’s sustained attention capacity increases, then per­
formance in other cognitive or behavioural domains that are related to
sustained attention should also increase (Peng and Miller, 2016). Several
E.J. Slattery et al.
cognitive attention training programmes claim to train sustained
attention in children (e.g., Pay Attention!, Aixtent, Attention Process
Training), including some commercialised programmes (e.g., Tali Train,
BrainTrain). Typically, training requires children to practice
videogame-like attention tasks (among other tasks) delivered via com­
puters or tablets with adaptive procedures (training task difficulty is
automatically adapted to an individual’s level of performance) and
reward systems to encourage motivation. It is widely accepted that
practice on any cognitive task leads to improved performance on those
same activities (Katz et al., 2018), but the extent to which those im­
provements matter for other untrained tasks (e.g., academic achieve­
ment) is a matter of ongoing debate (Shipstead et al., 2012).
In a selective meta-analysis, Peng and Miller (2016) investigated the
effects of cognitive attention training programmes on attention and
other cognitive outcomes (all non-trained academic and cognitive
measures) in populations of ADHD, learning difficulties and typically
developing individuals. The results indicated that training improved
performance on attention measures (objective and subjective combined)
compared to controls with a medium effect size (Hedges’ g =.25) and
transferred to measures of far transfer (Hedges’ g =.24). The findings led
the authors to conclude that “attention is a malleable construct” (p. 83).
However, the term ‘attention’ is a broad category and has limited
descriptive value. This is because attention is not a unitary construct but
rather comprises several distinct components (Raz and Buhle, 2006).
Thus, training may generate different effects on the various components
of attention (e.g., sustained attention, selective attention, divided
attention). The pertinent question is then: What aspect or aspects of
attention are amenable to cognitive attention training? Notably, these
findings are in direct contrast with an earlier review by Rapport et al.
(2013) which found no significant effects of training targeting attention
on attention outcome measures in children and adolescents with ADHD
(i.e., no evidence of near transfer) though only 6 attention training
studies were included.
1.4. Meditation
Another widespread approach for enhancing sustained attention in
children is meditation, particularly mindfulness meditation (e.g., Posner
et al., 2015). Mindfulness has been defined as “the awareness that
emerges through paying attention on purpose, in the present moment,
and nonjudgmentally to the unfolding of experience moment by
moment” (Kabat-Zinn, 2003, p. 145). During mindfulness practice
meditators typically select a point of focus (e.g., the breath) and direct
their attention to that point over time (Bishop et al., 2004). If one’s mind
wanders from the point of focus, thoughts or sensations are acknowl­
edged and further processing is inhibited as attention is directed back to
the point of focus (Bishop et al., 2004). Mindfulness training may
improve children’s self-regulation as it targets both top-down
(controlled) and bottom-up (automatic) processes (Zelazo and Lyons,
2012). That is, the effortful regulation of attention that is key to mind­
fulness practice trains children’s cognitive control (e.g., sustained
attention is required to maintain awareness of the present moment)
while simultaneously modulating potential bottom-up influences on
self-regulation (e.g., arousal and motivation). These bottom-up in­
fluences interact with top-down pathways in complex ways to facilitate
the recruitment of top-down processes (Zelazo and Lyons, 2012).
Recently, Mak et al. (2018) reviewed the efficacy of mindfulness-based
interventions for improving attention and executive function in children
and adolescents aged 5–18 years. The studies recruited child­
ren/adolescents that were typically developing, diagnosed with ADHD,
orphans, in correctional schools/institutions or had reading difficulties.
The authors found that out of 13 studies, 5 studies demonstrated a sig­
nificant positive effect of training on at least one measure of attention or
executive function; however, only one study found a positive effect of
mindfulness on sustained attention (assessed using the Test of Variables
of Attention).
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1.5. Physical activity
Physical activity is another popular approach for enhancing sus­
tained attention in children (e.g., Posner et al., 2015). Empirical and
meta-analytic studies have shown broad effects of chronic physical ac­
tivity on children’s cognition, including attention (e.g., Vazou et al.,
2019). Several mechanisms have been proposed to explain the effects of
physical activity on cognition. From a neurophysiological perspective, it
is posited that exercise stimulates the synthesis and release of neuro­
transmitters such as norepinephrine, dopamine and serotonin which
may improve cognitive functioning (Best, 2010; Moreau and Conway,
2013). The synthesis and release of norepinephrine is particularly
important for sustained attention as it regulates the arousal factors that
are required for maintaining optimal sustained attention (Sarter et al.,
2001). The positive effects of exercise on sustained attention may also be
attributed to increases in neuro-trophins such as brain-derived neuro­
tropic factor (Cotman et al., 2007; Hillman et al., 2008), which play a
critical role in hippocampus functioning, synaptic plasticity, neuro­
genesis, and neuroprotection (Cotman et al., 2007). However, recently,
some researchers (e.g., Diamond and Ling, 2016) have argued that
cognitively engaging physical activity (e.g., physical activity that re­
quires the allocation of attention and cognitive effort) is more beneficial
for cognition than ‘mindless’ or ‘simple’ physical activity (e.g., physical
activity without a cognitive component). Physical activity that is
cognitively engaging (e.g., basketball, which requires children to focus
their attention, scan the environment, anticipate the behaviour of
teammates/opponents and so on) may have more of an effect on
attention than physical activity with low cognitive engagement (e.g.,
running). This is because physical activity with a cognitive component is
assumed to activate multiple mechanisms simultaneously (Best, 2010).
Thus, this type of physical activity may impact arousal factors and
top-down systems of attentional control underlying sustained attention.
In a recent meta-analytic review, de Greeff et al. (2018) investigated
the effects of long-term physical activity on multiple cognitive domains,
including attention (selective, divided and sustained attention), execu­
tive functions (inhibition, working memory, cognitive flexibility and
planning), and academic performance (mathematics, spelling and
reading) in children aged 6–12 years. However, only one study exam­
ined the effect of long-term physical activity on attention, which used a
measure of selective attention and found a large positive effect (Hedges’
g = 0.90). Notably, no studies focused on sustained attention or divided
attention. Overall, there were small-to-moderate positive effects on
several cognitive domains as well as on academic performance but there
was no significant effect for each subdomain of academic performance
(mathematics, reading and spelling). The authors noted larger effects for
cognitively engaging physical activity compared to aerobic physical
activity.
1.6. Criteria for evaluating approaches for improving sustained attention
Unfortunately, various methodological issues are prevalent in the
literature evaluating the impact of behavioural interventions for
cognitive enhancement (Green et al., 2019). In an excellent review, Si­
mons et al. (2016) found insufficient evidence for the benefits of
cognitive training on real-world cognition after finding major method­
ological shortcomings in published studies. The authors recommend a
set of best practices for cognitive training interventions and use these
standards to evaluate intervention studies cited on the websites of
various cognitive training companies. These standards included
adequate sample sizes, pre-registration, active control groups, matched
groups at baseline, random assignment, outcome measures fully re­
ported and analysed, outcome measures different to the trained task and
blind assessors when using subjective outcomes (for more detail, see
Simons et al., 2016). While Simons et al. (2016) focused specifically on
cognitive training studies, these criteria are relevant for any interven­
tion study aiming to enhance cognitive capacity. In this review, we
E.J. Slattery et al.
evaluate the quality of scientific evidence for each intervention study for
enhancing sustained attention using these standards.
1.7. The current review
The current review updates and expands previous reviews by
examining popular intervention approaches (cognitive attention
training, physical activity, meditation) for specifically improving sus­
tained attention in a single paper. We focused on two main questions:
1) Do interventions designed to enhance sustained attention improve
performance on sustained attention tasks? If so, what intervention
methods are most effective?
2) Do interventions designed to enhance sustained attention improve
performance on other cognitive tasks (e.g., executive functions, ac­
ademic outcomes) and behavioural measures (e.g., ADHD
symptoms)?
Question 1 addresses whether attention training interventions are
effective in improving performance on sustained attention tasks.
Examining whether cognitive attention training, exercise and medita­
tion improves performance on measures of sustained attention is of
theoretical importance because it provides insight into whether sus­
tained attention is malleable. Question 2 addresses transfer to other
cognitive, academic and behavioural domains. This question is partic­
ularly relevant for practitioners, teachers, and applied researchers
designing interventions targeting real-world outcomes/clinically rele­
vant outcomes. To answer these questions, we synthesise studies of
cognitive attention training, physical activity and meditation that aim to
improve sustained attention in children and adolescents. We then
discuss evidence for improvements in sustained attention and other as­
pects of cognition/behaviour from these attention training approaches
and identify whether sustained attention and other cognitive/behav­
ioural skills can be enhanced. Lastly, we make recommendations for
future research.
2. Method
The protocol for this review was registered with PROSPERO:
CRD42020193922.
2.1. Search strategy
The following bibliographic databases were systematically searched
on June 19, 2020: EMBASE (via Elsevier), Medline (via Ovid), Medline
(via EBSCO), APA PsychInfo (via EBSCO), The Cochrane Library (via
Cochrane Library), Web of Science Core Collection (via ISI), and
PubMed (via National Library of Medicine). The search strategy took the
following form: (terms for physical activity) or (terms for meditation) or
(terms for cognitive attention training) and (terms for sustained atten­
tion) and (terms for training). No time restrictions were placed on the
search strategy. Supplementary searches were also performed. A grey
literature search was conducted via Open Grey and the references of
included studies/relevant systematic reviews were hand searched for
studies. Where possible, authors of registered trials, protocol papers,
conference proceedings were contacted to identify any unpublished
studies. Searches were updated on June 5, 2021, using the same search
strategy as the original search. The reproducible searches for all data­
base searches are available at https://osf.io/8m2nh/. All identified
studies were loaded into EndNote.
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2.2. Eligibility criteria
Studies meeting the following criteria were included: a) randomised
or non-randomised studies that compared an intervention group and at
least one control group, b) intervention designs with a stand-alone
cognitive attention training / physical activity / meditation pro­
gramme aiming to enhance sustained attention capacity (studies had to
describe a specific aim to improve attention or sustained attention), c)
samples of children or adolescents aged 3–18 years (this age range was
chosen to broadly capture the years characterised by development of
sustained attention capacity), including typically developing children
and children with neurological conditions / neurodevelopmental dis­
orders / learning difficulties, d) the intervention was delivered over
more than one session, e) employed at least one cognitive measure of
sustained attention. Multi-domain training programmes (e.g., in­
terventions training sustained, selective and divided attention) could
also be included. Multiple papers based on the same study were
compiled and included. For example, if multiple manuscripts reported
data from the same trial, they were compiled and included for full
evaluation. Studies were excluded when: a) samples comprised psychi­
atric patients (psychiatric groups can have sustained attention diffi­
culties for a variety of reasons other than weaknesses in the cognitive
systems underpinning sustained attention and, thus, were excluded from
the review to make the groups more comparable), b) pre- and post- data
for sustained attention was not reported or different measures of sus­
tained attention were used at pre- and post-test, c) they were written in a
language other than English, d) training effectiveness in enhancing
sustained attention capacity could not be established due to explicit
multicomponent interventions (this is because their design does not
permit determining the effect of each stand-alone intervention, exam­
ples of such interventions were cognitive attention training + physical
activity or cognitive attention training + strategy-based training or
mindfulness training + parent training) or e) they examined the atten­
tion training technique (used for treating repetitive negative thinking)
or attention bias modification training (used to modify attention bias to
threat).
2.3. Screening
Following de-duplication in EndNote, the titles and abstracts of all
studies were screened. Screening was conducted using Rayyan software.
An initial sample of 10% were independently screened by two reviewers
(ES, EOC) to ensure consistency in the screening process (n = 260).
Inter-rater reliability was high (Cohen’s Kappa = 0.86). The remaining
studies were single screened by ES. Where the title and abstract met the
criteria (or if this was unclear), the full text article was retrieved and
screened. Full-text screening was undertaken by ES and a random
sample of articles (10%) was checked by another reviewer (EOC). Any
disagreements between the reviewers regarding study eligibility were
resolved through discussion and consensus. A second reviewer (EOC)
was consulted if study eligibility was unclear at any stage. The screening
process is graphically represented in Fig. 1.
2.4. Data extraction
Data from the included studies were extracted by ES and entered into
an Excel spreadsheet. Under the following headings: publication details,
methods, number of participants, participant characteristics, interven­
tion, comparator, setting, statistical analyses, outcomes, results and
other.
E.J. Slattery et al.
Fig. 1. Prisma flow.
2.5. Quality assessment
The PEDro scale was used to assess the quality of all included full text
studies. ES completed quality assessment. The scale is widely used to
rate the methodological quality of clinical trials included in systematic
reviews across health and medical research (Cashin and McAuley,
2019). This scale was chosen because it can be used to evaluate many
different types of study designs (e.g., RCT, cluster RCT, crossover RCT).
It comprises 11 items assessing external validity (item 1), internal val­
idity (items 2–9) and statistical reporting (items 10–11). Items are rated
yes (1) or no (0). A total score is computed by adding the ratings of items
2–11. Scores range from 0 to 10 with higher scores indicating greater
methodological quality. Total PEDro scores are included in Table 3 (see
Appendix A for each study’s ratings on individual items).
3. Review and discussion
In this section, we summarise the results of studies evaluating three
popular intervention approaches (cognitive attention training, medita­
tion, physical activity) for enhancing sustained attention and discuss
whether certain methodological concerns apply. The evaluation of
methodology is based on criteria outlined by Simons et al. (2016), which
is described in the section ‘Criteria for Evaluating Approaches for
Improving Sustained Attention’ (see Introduction). Table 1 provides the
details of the 37 studies included in the review and Table 2 lists the
relevant measures included in each study. Table 3 indicates the extent of
positive effects on sustained attention and other cognitive/behaviour­
al/academic outcome measures. In the table, we use colours to represent
whether the intervention yielded 1) positive effects with few methodo­
logical concerns (dark blue), 2) positive effects with significant meth­
odological concerns (striped blue), 3) no effects with few
methodological concerns (dark yellow) or 4) no effects with significant
methodological concerns (striped yellow).
3.1. Summary of intervention study results
An overview of each study can be found in Appendix B.
3.1.1. Cognitive attention training studies
In total, fourteen studies examined cognitive attention training in
children and adolescents. Eight of these studies (1, 3, 4, 6, 7, 10, 13, 14)
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Neuroscience and Biobehavioral Reviews 137 (2022) 104633
reported at least one positive near transfer effect to a measure of sus­
tained attention; however, of these, five studies (1, 7, 10, 13, 14) had
serious methodological limitations. Six studies (2, 5, 8, 9, 11, 12) found
no statistically significant effects of training on sustained attention.
Three studies with few methodological limitations (3, 4, 6) reported
statistically significant improvements in sustained attention following
training. Study 3 found that the AKL-T01 programme designed to train
attention and cognitive control led to improvements in sustained
attention, assessed using the TOVA Attention Performance Index, in a
sample of children with ADHD (N = 348; Kollins et al., 2020). This study
has many strengths (e.g., randomised design, large sample size, active
control, prospective registration, participants with deficits in cognitive
attention, between group statistical comparisons) and provides the
strongest evidence for an improvement in sustained attention following
cognitive attention training. Study 4 reported that the Tali Train atten­
tion training group demonstrated greater improvements in sustained
attention from baseline to follow up compared to the passive control
group (Kirk et al., 2019). In this study, typically developing children
(N = 107) were cluster randomised to the training group, active control,
or passive control. The Tali Train group completed adaptive game-based
exercises designed to train sustained, selective, and executive attention.
The active control completed non-adaptive game-based exercises that
required minimal attention skills. Notably, there was no improvements
in sustained attention in the intervention group relative to the active
control group. That is, the active control who received no cognitive
attention training demonstrated improvements in sustained attention.
Thus, this study provides limited evidence that cognitive attention
training is effective in improving sustained attention. Study 6 found that
participants (N = 129) who received NeuroTracker training demon­
strated improvements in sustained attention, assessed using d prime
scores from the Conners’ Continuous Performance Test 3, compared to
participants in both the active and passive control groups (Tullo et al.,
2018). However, it is worth noting that an improvement was reported
on only one outcome (d prime) out of several possible outcome variables
on the CPT-3. Therefore, considering the inconsistent findings and
methodological weaknesses of the studies evaluating cognitive attention
training, the evidence supporting cognitive attention training for
improving sustained attention is sparse.
Seven studies (1, 4, 5, 8, 11, 13, 14) examined near transfer effects to
other measures of attention (e.g., selective attention, divided attention).
Four of these studies (1, 4, 8, 14) found evidence for such effects on
 E.J. Slattery et al.
Table 1
Characteristics of intervention studies.
ID First Year Sample (N) Age % Place Design Intervention (n) Setting Duration (minutes) Comparator (n) Follow up
Author (years) Male

Cognitive Attention Training

1 Nejati 2021 ADHD 8–14 53% Iran RCT (2) Program for Attention Rehabilitation Hospital 600–750 min (12–15 1. Passive control (n = 15)
(N = 30) & Strengthening (PARS; n = 15): sessions over 4–5
Adaptive, non-computerised tasks weeks)
targeting sustained attention,
selective attention and shifting
attention.
2 Slattery 2021 Typically 9–11 50% Ireland Cluster Keeping Score! (n = 18): Training School 270 min (18 sessions 1. Active control (n = 18): Same 6 weeks
developing RCT (2) was based on sustained updating and over 6 weeks) as the training group except the
(N = 36) required participants to silently keep score was called out by the
score while playing table tennis. researcher as each point was
won.
3 Kollins 2020 ADHD 8–12 71% United RCT (2) AKL-T01 (n = 180): Adaptive, video Home 500 min (20 sessions 1. Active control (n = 168):
(N = 348) States game-based exercises designed to over 4 weeks) Online activities that required
train to attention and cognitive participants to spell as many
control administered via a tablet. words as possible, by
connecting letters in a game-
like grid.
4 Kirk 2019 Typically 5–9 61% Australia Cluster Tali Train (n = 39): Adaptive, tablet- School 500 min (25 sessions 1. Active control (n = 35): Non- 6 months
developing RCT (3) based exercises designed to train over 5 weeks) adaptive, tablet-based exercises
(N = 107) sustained, selective, and executive that required minimal
attention. attention.
2. Passive control (n = 33)
5 Bikic 2018 ADHD 6–13 84% Denmark RCT (2) ACTIVATE™ Cognitive Training Home 1920 min (48 1. Passive control (n = 35) 24 weeks
(N = 70) (n = 35): Computerised exercises sessions over 8
6

designed to train multiple cognitive weeks)

functions.
6 Tullo 2018 Neurodev 6–18 71% Canada RCT (3) 3D Multiple Object-Tracking School 105 min (15 sessions 1. Active control (n = 43):
disorders Paradigm, NeuroTracker (n = 43): over 5 weeks) Computer game 2048.
(N = 129) Adaptive training designed to train 2. Passive control (n = 43)
visual attention including sustained
and selective attention.
7 Bikic 2017 ADHD 15.6 75% Denmark RCT (2) Scientific Brain Training (n = 9): Home 1050 min (35 1. Active control (n = 9): Non-
(N = 18) (0.99) Adaptive computerised programme sessions over 7 adaptive version of Tetris.
designed to train multiple cognitive weeks)
functions.

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8 Kirk 2016 IDD and 4–11 60% Australia RCT (2) Tali Train (n = 38): See study 1 for Home 500 min (25 sessions 1. Active control (n = 38): See 3 months
attentional description. over 5 weeks) study 1 for description.
difficulties
(N = 76)
9 Mishra 2016 ADHD 12 (1.9) 93% India RCT (2) Online Neuroplasticity Targeted Home 1800 min (60 1. Active control (n = 10):
(N = 31) Remediation of Attention Deficits in sessions over 6 Played the Hoyle puzzle game
Children (ONTRAC; n = 21): Online months) online.
adaptive exercises that either focused
on attended-signal training or
distractor-suppression training.
Exercises trained sustained attention,
working memory and response
inhibition.
10 Sarzyńska 2017 Typically 8 43% Poland CT (2) Adaptive computerised tasks NR 300 min (10 sessions) 1. Active control (n = 24): 3 months
developing designed to train multiple attentional Adaptive computerised tasks (intervention
(N = 54) functions (n = 30) that targeted problem solving group only)
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 E.J. Slattery et al.
Table 1 (continued )
ID First Year Sample (N) Age % Place Design Intervention (n) Setting Duration (minutes) Comparator (n) Follow up
Author (years) Male

and perceptual skills and

required minimal attention.
11 Schrieff- 2017 Low SES 7–13 80% South CT (3) Pay Attention! (n = 5): Non- School 900 min (20 sessions 1. Active control (n = 5). –
Elson (N = 15) Africa computerised tasks designed to train over 10 weeks) Played physical games like
sustained, selective, alternating, and hopscotch.
divided attention. 2. Passive control (n = 5)
12 Rueda 2012 Typically 64.7 54% Spain RCT (2) Adaptive computerised exercises School 450 min (10 sessions 1. Active control (n = 18). 2 months
developing (3.2) designed to train tracking, over 5 weeks) Watched cartoons.
(N = 37) months discrimination, conflict resolution,
inhibition, and sustained attention
(n = 19).
13 Tucha 2011 ADHD 10.9 69% Germany RCT (2) Aixtent (n = 16): Adaptive NR 360 min (8 sessions 1. Active control (n = 16) –
(N = 32) computerised programme designed to over 4 weeks) Adaptive non-computerised
trained sustained, selective, and visual perception training.
divided attention.
14 Kerns 1999 ADHD 7–11 57% Canada CT (2) Pay Attention! (n = 7): Adaptive, School or 480 min (16 sessions 1. Active control (n = 7): –
(N = 14) non-computerised exercises targeting lab over 8 weeks) Played computer games.
sustained, selective, alternating, and
divided attention.
Meditation Training
15 Bauer 2020 Typically 11.76 30% United RCT (2) Aimed to target focused attention and School 1440 min (32 1. Active control (n = 16): –
developing (.40) States change students’ mindsets about their sessions over 8 Computerised coding
(n = 40) stress and beliefs using mindfulness weeks) programme.
exercises requiring participants to
attend to the present moment and re-
focus their attention (n = 15).
7

16 Mishra 2020 History of 10–18 60% India Cluster Internal attention intervention After 900 min (30 sessions 1. External attention 1 year (for
neglect RCT (3) (n = 15): Practiced attending to the school over 6 weeks) intervention (n = 15): Adaptive behaviour and
(N = 45) sensations of their breath using the group computerised exercises from academic
Meditrain app. brainhq.com targeting focused measures)
attention, divided attention,
selective attention and working
memory.
2. Passive control (n = 15)
17 Tarrasch 2018 Typically 8–11 50% Israel CT (2) MBSR (n = 58): Exercises aimed to School 450 min (10 sessions Passive control (n = 43) –
developing raise children’s awareness of physical over 10 weeks)
(N = 101) processes, feelings, and thoughts.

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18 Kiani 2017 Females with 13–15 0% Iran RCT (2) Mindfulness meditation training NR 720 min (8 sessions Passive control (n = 15) –
ADHD (n = 15): Sessions focused on over 8 weeks)
symptoms attention and the five senses.
(N = 30)
19 Wimmer 2016 Typically 10.80 47% Germany CT (3) MBSR method (n = 16): Sitting School Approx. 2700 min 1. Active control (n = 8): –
developing (0.53) meditation and body scan formed the (25 sessions over 18 Concentration skills training
(N = 34) core the training programme. weeks) 2. Passive control (n = 10)
20 Ricarte 2015 Typically 6–13 54% Spain RCT (2) Mindfulness Emotional Intelligence School 450 min (30 sessions 1. Passive control (n = 45) –
developing years Training (n = 45): Exercises included over 6 weeks)
(N = 90) breathing meditation, synchronised
breathing meditation, mandala
meditation, present moment
meditation on sounds and body scan.
21 Leonard 2013 Imprisoned 16–18 100% United Cluster Power Source cognitive behavioural/ Prison 750 min (Approx. 10 1. Active control (n = 117): –
youth years States RCT (2) mindfulness meditation (n = 147): sessions over 3–5 Cognitive perception training
(N = 264) Combined aspects of cognitive weeks)
behavioural therapy with the
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 E.J. Slattery et al.
Table 1 (continued )
ID First Year Sample (N) Age % Place Design Intervention (n) Setting Duration (minutes) Comparator (n) Follow up
Author (years) Male

attentional and response modification

elements of mindfulness meditation.
22 Napoli 2005 Typically 1st-3rd 53% United RCT (2) Attention Academy (n = 114): School 540 min (12 sessions 1. Active control (n = 144) –
developing graders States Exercises included paying attention to over 24 weeks) completed “reading and other
(N = 228) (age NR) breath, movement activities and quiet activities”.
sensory stimulating activities.
Physical Activity
23 Meijer 2021 Typically 9.2 49% Netherlands Cluster 1. Aerobic exercise (n = 221): School 1680 min (56 1. Passive control (n = 430) –
developing RCT (3) Activities designed to target sessions over 14
children moderate-to-vigorous intensity while weeks)
(N = 891) avoiding high cognitive demands.
The focus was on highly repetitive
and automated exercises (e.g.,
running, squats).
2. Cognitively demanding exercise
(n = 240): Team games or exercises
that required complex movement,
strategic play, cooperation between
children, anticipating behaviour and
dealing with changing task demands.
24 Cherriere 2020 Diagnosis of 7–12 22% Canada CT (2) 1. Dance (n = 5): Various dance forms NR 1200 min (20 1. Passive control (n = 4) –
Charcot-Marie- years (African-contemporary, jazz, break sessions over 10
Tooth disease dance, and tap) with the goal of weeks)
(N = 9) addressing the specific clinical needs
of the children. Dance forms were
chosen for their particular emphasis
8

on musical rhythm and their inclusion

of complex motor movements.
25 Duarte 2020 Typically 12–14 NR NR Cluster 1. Qigong (n = 22): Qigong integrates School 40 min (8 sessions 1. Active control: Performed a –
developing years RCT (3) movement and breathing exercises + home over 4 weeks) sham Qigong (n = 22).
children that require and induce a special kind 2. Passive control (n = 22)
(N = 66) of mental state of ‘awareness’ or
‘attention’. This group performed the
White Ball Qigong exercise, according
to the Heidelberg Model of
Traditional Chinese Medicine.
26 García- 2020 Typically 8–10 57% Chile Cluster Active Start Intervention (n = 100): School 1200 min (40 1. Passive control (n = 70) –

Neuroscience and Biobehavioral Reviews 137 (2022) 104633

Hermoso developing years RCT (2) Physical games that focused on group sessions over 8
(N = 170) cooperation. weeks)
27 Hedayatjoo 2020 Hearing 7–12 44% Iran RCT (2) Balance training (n = 18): Completed School 540 min (12 sessions 1. Passive control (n = 18) –
deficits years various balance exercises. + home over 4 weeks)
(N = 36) practice
28 Månsson 2019 ADHD and 10–14 85% Denmark CT (2) Target shooting (n = 64) Shooting NR (sessions were 1. Passive control (n = 66) –
ADHD years range approx. 60 min; 1
symptoms session per week for 6
(N = 130) months)
29 Buchele 2018 Typically 4–5th 49% United Cluster Coordinated-bilateral physical School 120 min (20 sessions 1. Fitness tracker only group –
Harris developing graders States CT (3) activity (n = 31): Exercises involved over 4 weeks) (n = 29)
(N = 116) (age NR) bilateral body movement and 2. Passive control (n = 56)
participants wore fitness trackers.
30 Rezaei 2018 ADHD 7–14 NR Iran RCT (3) Yoga (n = 7): Yoga and relaxation NR 1080 min (24 1. Neurofeedback intervention –
(N = 21) years exercises. sessions over 8 (n = 7) 2. Passive control
weeks) (n = 7)
31 Chou 2017 78% Taiwan CT (2) 1. Passive control (n = 25) –
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 E.J. Slattery et al.
Table 1 (continued )
ID First Year Sample (N) Age % Place Design Intervention (n) Setting Duration (minutes) Comparator (n) Follow up
Author (years) Male

ADHD 10.50 Yoga (n = 25). Yoga exercises and After 640 min (16 sessions
(N = 50) (1.05) attention / breath / body awareness. school over 8 weeks)
group -
dance
studio
32 Sabel 2017 Childhood 7–16 46% Sweden Cross- Active video gaming (Nintendo Wii) Home 1500–1800 min (5 1. Passive control –
brain tumour years over sessions over 10–12
survivors RCT (2) weeks)
(N = 13)
33 Gallotta 2015 Normal weight 8–11 NR Italy Cluster 1. Coordinative physical activity School NR (2 1 hour sessions 1. Passive control (n = 69) –
and obese years RCT (3) (n = 83): Focused on improving per week over 5
children coordination and dexterity of months)
(N = 230) participants.
2. Traditional physical activity
(n = 78): Focused on endurance,
strength, flexibility exercises and
9

circuit training for cardiovascular

health.
34 Zach 2015 Typically 4–5 years 51% Israel Cluster 1. Orienteering (n = 44) School NR (9 weekly 1. Passive control (n = 39) –
developing CT (3) 2. Dance (n = 40) sessions)
(N = 123)
35 Spitzer 2013 Typically 12.72 63% Germany Cluster Activities like basketball, soccer, and School 1080 min (36 1. Passive control (n = 20) –
Study 1 developing CT (2) dance (n = 24). sessions over 4
(N = 44) months)
36 Spitzer 2013 Typically 12.36 61% Germany Cluster Games that could be played with 3–4 School 900 min (30 sessions 1. Passive control (n = 33) –
Study 2 developing CT (2) members on each team (n = 55). over 3 months)
(N = 148)

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37 Verret 2012 ADHD 7–12 90% Canada CT (2) Activities such as basketball, soccer, School 1350 min (30 1. Passive control (n = 11) –
(N = 21) years and tag (n = 10). sessions over 10
weeks)

Note. RCT = randomised controlled trial, CT = controlled trial, Neurodev = neurodevelopmental, IDD = intellectual and developmental disabilities, NR = not reported, MBSR = mindfulness-based stress reduction.
E.J. Slattery et al. Neuroscience and Biobehavioral Reviews 137 (2022) 104633

Table 2 Table 2 (continued )

Relevant measures assessed in each intervention study. ID First Author Year Objective Outcomes Subjective Outcomes
ID First Author Year Objective Outcomes Subjective Outcomes
(CANTAB; 3 measures) measures)
Cognitive attention training 2. Attention Switching 2. Executive function
1 Nejati 2021 1. Sustained attention: (CANTAB; 2 measures) behaviour: BRIEF
Persian Attention 3. Spatial Working (parent/teacher; 22
Registration Test (3 Memory (CANTAB; 1 measures)
measures) measure) 3. Functional behaviour:
2. Selective attention: 4. Spatial planning: Weiss Function
Stroop Test (4 measures) Stockings of Cambridge Impairment scale
3. Attention shifting: (CANTAB; 2 measures) (parent; 1 measure)
Trail Making Test (2 5. Movement/visual/
measures) comprehension
4. Inhibitory control: difficulties: Motor
Go/No-Go Test (3 Screening Task
measures) (CANTAB; 1 measure)
5. Working memory: 1- 6. Rule acquisition/
Back Task (2 measures) flexibility: Intra-Extra
2 Slattery 2021 1. Sustained attention: 1. Executive function: Dimensional Set Shift
Vigil, Cerberus and BRIEF (parent; 4 (CANTAB; 1 measure)
Sustained Attention to measures) 7. Response inhibition:
Response Task subtests Stop Signal Task
(TEA-Ch2; 3 measures) (CANTAB; 2 measures)
2. Short-term memory: 8. Reaction Time
Forward Span subtest (CANTAB; 2 measures)
WISC-V (1 measure) 6 Tullo 2018 1. Inattentiveness/
3. Working memory: inhibition: Conners’ CPT
Digit Span Backward (1 measure)
subtest WISC-V and the 7 Bikic 2017 1. Sustained attention: 1. ADHD symptoms:
Operation Span and Rapid Visual ADHD Rating Scale
Symmetry Span subtests Information Processing (parent/teacher/
of the Adaptive (CANTAB; 2 measures) participant; 3 measures)
Composite Complex 2. Speed accuracy:
Span (3 measures) Match to Sample Visual
3 Kollins 2020 1. Sustained attention: 1. Functional Search (CANTAB; 1
TOVA (1 measure) impairment: measures)
2. Working memory: Impairment Rating 3. Visual Memory:
CANTAB-Spatial Scale (parent; 1 Delayed Matching to
Working Memory test (8 measure) Sample (CANTAB; 1
measures) 2. ADHD symptoms: measure)
3. Inhibitory function: ADHD Rating Scale IV (3 4. Short-term memory:
TOVA (1 measure) measures) Spatial Span (CANTAB; 1
3. Clinical Global measure)
Impressions- 5. Spatial working
Improvement (clinician; memory: Spatial
measured at post working memory
intervention only) (CANTAB; 2 measures)
4. Executive function: 6. Spatial planning
BRIEF (parent; 3 ability: Stocking of
measures) Cambridge (CANTAB; 1
4 Kirk 2019 1. Sustained attention: 1. Inattention/ measure)
Simple reaction time hyperactivity: SWAN 7. Rule acquisition/
(TEA-Ch; 1 measure) (parent/teacher; 4 flexibility: Intra-Extra
2. Executive attention: measures) Dimensional Set Shift
SART (TEA-Ch; 1 (CANTAB; 1 measure)
measure) 8 Kirk 2016 1. Sustained attention: 1. ADHD symptoms:
3. Visual selective Vigilan task (2 measures; SWAN (parent/teacher;
attention: Balloon Hunt WATT) 2 measures)
+ Hide & Seek Visual 2. Selective attention: 2. Executive function:
(TEA-Ch; 2 measures) Visearch task (2 BRIEF (parent; 9
3. Auditory selective measures; WATT) measures)
attention: Hide & Seek 3. Attentional control: 3. Working memory:
Auditory (TEA-Ch; 1 Visearch task (1 WMRS (teacher; 1
measure) measure; WATT) measure)
4. Verbal working 4. Cardinality: Give-a- 4. Behavioural
memory: Backward Digit Number protocol (1 difficulties: DBC
Span (AWMA; 1 measure) (parent; 6 measures)
measure) 5. Informal/ formal
5. Visuospatial working numerical concepts:
memory: Odd One Out TEMA-3 (1 measure)
(AWMA; 1 measure) 6. Receptive vocabulary:
6. Numeracy: Test of PPVT-4 (1 measure)
Early Mathematics 7. Phonological abilities:
Ability (1 measure) Letter Knowledge and
5 Bikic 2018 1. Sustained attention: 1. ADHD symptoms: Rhyme Detection (PAT;
Rapid Visual ADHD Rating Scale IV 1 measure)
Information Processing (parent/teacher; 8 9 Mishra 2016 1. Sustained attention: 1. ADHD symptoms:
TOVA (1 measure) ADHD Rating Scale
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Table 2 (continued ) Table 2 (continued )

ID First Author Year Objective Outcomes Subjective Outcomes ID First Author Year Objective Outcomes Subjective Outcomes

2. Response inhibition: (parent; 1 measure) WISC-III (1 measure)

TOVA (1 measure) 2. Illness severity: and Coding subtest
3. Short-term memory: Clinical Global WISC-III (1 measure)
Spatial Capacity Task (1 Impression of Severity 5. Impulsivity/executive
measure), Verbal of Illness Scale function: Matching
Capacity Task (1 (clinician; 1 measure) Familiar Figures Test (2
measure) measures)
4. Executive function: 6. Inhibition/executive
Stroop Colour and Word function/selective
Interference Test (1 attention: Day-Night
measure) Stroop Test (1 measure)
10 Sarzyńska 2017 1. Attention: d2 7. Academic efficacy:
Attention test (7 Age- and grade-
measures) appropriate arithmetic
2. Intelligence: Raven’s problems (1 measure)
Progressive Matrices (1 8. Visual-spatial ability:
measure) Hooper Visual
11 Schrieff- 2017 1. Sustained attention: Organisation Test (1
Elson Score! (TEA-Ch; 1 measure)
measure) and Numbers Meditation Training
Forward (CMS; 1 15 Bauer 2020 1. Sustained attention:
measure) SART (1 measure)
2. Selective attention: 2. Response inhibition:
Sky Search (TEA-Ch; 3 SART (1 measure)
measures) 3. Seed of response:
3. Attentional control: SART (2 measures)
Opposite Worlds and 16 Mishra 2020 1. Sustained attention: 1. ADHD symptoms:
Creature Counting (TEA- Test of Variables of ADHD-RS IV (caregiver;
Ch; 3 measures) Attention (1 measure) 2 measures)
4. Divided attention: Sky 2. Interference 2. Academic
Search DT (TEA-Ch; 1 resolution: Flanker Test performance: APRS
measure) (1 measure) (teacher; 1 measure)
5. Inhibition/Switching: 17 Tarrasch 2018 1. Sustained attention:
Inhibition NEPSY-II (1 CPT (3 measures)
measure) and switching 2. Selective attention:
NEPSY-II (1 measure) Conjunctive Search task
6. Working memory: (6 measures)
Numbers Backwards 18 Kiani 2017 1. Sustained attention:
(CMS; 1 measure) CPT (1 measure)
12 Rueda 2012 1. Attention: ANT (3 2. Impulsivity: CPT (1
measure) measure)
2. Delay gratification: 3. Working memory:
Delay of gratification Digit Span and Letter-
task (4 measures) Number Sequencing
3. Decision making: subtests of the WISC-V (5
Children gambling task measures)
(2 measures) 4. Inhibition: Stroop-
4. Intelligence: K-BIT (2 Word-Colour
measures) Interference Test (1
13 Tucha 2011 1. Tonic alertness (TAP; measure)
2 measures) 5. Planning: Tower of
2. Phasic alertness (TAP; London Test (1 measure)
2 measures) 19 Wimmer 2016 1. Sustained attention:
3. Vigilance (TAP; 3 Vigilance test (3
measures) measures)
4. Selective attention 2. Cognitive flexibility:
(TAP; 3 measures) Reversible Figures task
5. Divided attention and WCST-64 (2
(TAP; 3 measures) measures)
6. Flexibility (TAP; 2 3. Inhibition: Stroop
measures) Color Word Interference
14 Kerns 1999 1. Auditory sustained Inattention/impulsivity: Test (2 measures)
attention: Attention ADDES (parent/ 4. Information
Capacity Test (1 teacher; 2 measures) processing: Recognition
measure) task and Visual Search
2. Visual sustained task (7 measures)
attention: Underlying 20 Ricarte 2015 1. Sustained attention/
Task subtest 14 (1 eye-hand coordination
measure) and Children’s speed: TMT Part A (1
CPT (2 measures) measure)
3. Selective attention: 2. Mental flexibility:
Underlying Task subtest TMT Part B (1 measure)
2 and 4 (1 measure) 3. Focused attention:
4. Planning/attention: Perception of Differences
Mazes subtests WISC-III Test-Faces (1 measure)
(1 measure), Digit Span 4. Memory span/
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Table 2 (continued ) Table 2 (continued )

ID First Author Year Objective Outcomes Subjective Outcomes ID First Author Year Objective Outcomes Subjective Outcomes

sustained attention/ R; 1 measure)

working memory: Digit 3. Short-term memory/
Span (WISC-III; 3 attention: Letter Number
measures) Sequencing Test (WISC-
21 Leonard 2013 1. Attentional networks R; 1 measure)
(alerting, orienting, 4. Short-term memory/
conflict monitoring): attention/hand-eye
ANT (9 measures) coordination: Coding
22 Napoli 2005 1. Sustained attention: 1. ADHD symptoms: Test (WISC-R; 1
Score! subtest, Walk ADD-H Comprehensive measure)
Don’t Walk subtest and Teacher Rating Scale (4 31 Chou 2017 1. Sustained attention/
Code Transmission measures) selective attention:
subtest (TEA-Ch; 1 Visual Pursuit Test (2
measure) measures)
2. Selective attention: 2. Discrimination:
Sky Search and Map Determination Test (2
Mission (TEA-Ch; 1 measures)
measure) 32 Sabel 2017 1. Sustained attention: 1. Execution of
Physical Activity Conners’ CPT II (1 Activities of Daily
23 Meijera 2021 1. Attention/sustained measure) Living: AMPS (clinician;
attention: ANT (5 2. Disinhibition: 2 measures)
measures) Conners’ CPT II (1
2. Verbal short-term/ measure)
working memory: Digit 3. Mean reaction time:
Span Task (2 measures) Conners’ CPT II (1
3. Visuospatial short- measure).
term/working memory: 4. Selective attention:
Grid Task (2 measures) Map Mission (1 measure)
4. Inhibition: Stop Signal 5. Visual attention:
Task (1 measure) Visual Scanning (D-
24 Cherriere 2020 1. Sustained attention: KEFS; 1 measure)
Score! subtest (1 6. General working
measure) and Score DT memory: Digit Span
subtest (1 measure; TEA- WISC-IV (1 measure)
Ch) 7. Verbal working
2. Short-term memory/ memory: Auditory
working memory: Digit Consonant Trigrams (1
Span subtest (WISC-IV; 1 measure)
measure) 8. Immediate memory:
RAVLT (1 measure)
25 Duarte 2020 1. Attention/ 9. Complex word span:
concentration: d2 Test of RAVLT (1 measure)
Attention (5 measures) 10. Simple span: Spatial
26 García- 2020 1. Concentration: d2 Test span (WNV; 1 measure)
Hermoso (1 measure) 11. Complex spatial
2. Selective attention: d2 span: Spatial span (WNV;
Test (1 measure) 1 measure)
3. Academic grades: 12. General spatial
Mathematics working memory:
performance (1 Spatial span (WNV; 1
measure) and language measure)
performance (1 13. Verbal learning:
measure) RAVLT (1 measure)
27 Hedayatjoo 2020 1. Attention/sustained 14. Immediate recall:
attention: Persian Form RAVLT (1 measure)
of the CPT (1 measure) 15. Delayed recall:
28 Månsson 2019 1. Inattention/ 1. ADHD symptoms: RAVLT (1 measure)
hyperactivity/ ADHD Rating Scale 16. Information: WISC-
impulsiveness: Qb Test (parent/teacher; 2 IV (1 measure)
(4 measures) measures) 17. Copying capacity:
2. Behavioural Rey Complex Figure Test
Problems: SDQ (parent/ (1 measure)
teacher; 2 measures) 18. Copying time: Rey
3. Quality of Life: Complex Figure Test (1
Kidscreen-27 (self- measure)
report; 1 measure) 19. Immediate recall:
29 Buchele 2018 1. Sustained attention/ Rey Complex Figure Test
Harris selective attention/ (1 measure)
concentration: d2 Test of 20. Delayed recall: Rey
Attention (5 measures) Complex Figure Test (1
30 Rezaei 2018 1. Sustained attention/ measure)
impulsivity: CPT (4 21. Recognition: Rey
measures) Complex Figure Test (1
2. Attention/ measure)
concentration/maths: 22. Psychomotor
Arithmetic Test (WISC- processing speed/
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E.J. Slattery et al. Neuroscience and Biobehavioral Reviews 137 (2022) 104633

a
Table 2 (continued ) Principal components analysis was performed on all measures to derive
composite scores. Six components were extracted: 1) information processing and
ID First Author Year Objective Outcomes Subjective Outcomes
control (information processing speed, lapses of attention and motor inhibition),
implicit learning: Coding 2) interference control (speed and accuracy of interference control), 3) attention
(WISC-IV; 1 measure) accuracy (accuracy of alerting attention and spatial orientation), 4) visuospatial
23. Verbal phonemic
working memory (visuospatial working memory and visuospatial short-term
fluency: COWAT (1
memory), 5) verbal working memory (verbal working memory and verbal
measure)
24. Verbal sematic short-term memory), and 6) attention efficiency (speed of alerting attention and
fluency: COWAT (1 spatial attention to information).
measure)
25. Interference: Stroop
task (1 measure)
26. TMT (1 measure) selective attention, though two of these studies (1, 14) had serious
27. Picture arrangement methodological limitations. Study 4 and Study 8 examined the efficacy
(WNS; 1 measure) of the Tali Train programme in typically developing children (4) and
28. IQ: WISC-IV (1 children with IDD (8). Study 4 reported that the passive control group
measure)
33 Gallotta 2015 1. Sustained attention/
made greater gains in auditory selective attention (assessed using the
concentration: d2-R test Hide and Seek Auditory subtest from the TEA-Ch) from baseline to post-
of attention (3 measures) training compared to the intervention group (Kirk et al., 2019). In
34 Zach 2015 1. Attention: MOXO contrast, Study 8 reported that the intervention group showed signifi­
Continuous Performance
cantly greater improvements in selective attention (assessed using the
Test (4 measures;
sustained attention, Visearch task from the Wilding Attention Battery) from baseline to
timing, impulsivity, and post-training and from baseline to 3-month follow up compared to the
hyperactivity) active control group (Kirk et al., 2016). These contradictory findings
2. Spatial perception: highlight the influence of the task used to assess study outcomes (i.e.,
Reproduction of Patterns
(CMB; 4 measures)
intervention effects may depend on the task used rather than on
35 Spitzer 2013 1. Sustained attention: 1. Study behaviour: enhanced capacity). Moreover, it also highlights that potential inter­
Study 1 d2 test of attention (4 Teacher’s List for Social vention effects may depend on the sample of participants selected (i.e.,
measures) and Studying behaviour enhancing capacity in children with developmental cognitive deficits vs
2. Academic (10 measures)
improving capacity in typically developing children). Two other studies
performance: German,
Math & English (tests not reported improvements in other aspects of attention. Study 13 reported
reported) improvements in divided attention and alternating flexibility following
36 Spitzer 2013 1. Sustained attention: 1. Study behaviour: training though this study had methodological limitations, including a
Study 2 d2 test of attention (4 Teacher’s List for Social small sample size and no correction for multiple comparisons despite a
measures) and Studying Behaviour
2. Academic (10 measures)
large number of pairwise comparisons (Tucha et al., 2011). Study 11
performance: German, reported improvements in the intervention group in attentional control;
Math & English (tests not however, the group comprised five participants (Schrieff-Elson et al.,
reported) 2017). Considered collectively, these studies at best provide limited
37 Verret 2012 1. Auditory sustained 1. Behavioural
evidence for the efficacy of cognitive attention training in improving
attention: Score (TEA- problems: CBCL (parent
Ch; 1 measure) and teacher; 22 other aspects of attention.
2. Visual search: Sky measures) Twelve studies (1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 14) examined far
search (TEA-Ch;1 1 transfer effects (i.e., any other cognitive, academic, or behavioural
measure) measure). Eight studies report far transfer; effects varied considerably
3. Divided attention: Sky
Search (TEA-Ch; 1
across studies. Studies reported improvements in working memory (1),
measure) planning (5, 14), IQ (12), decision making (12), ADHD symptoms (4, 9),
4. Response inhibition: interference (9), inhibition (1, 9, 11, 14), numeracy (8) and academic
Walk/Don’t Walk (TEA- efficacy (14). Some studies reported far transfer effects in the absence of
Ch; 1 measure)
reliable near transfer (e.g., 4). These effects are difficult to explain in the
Note. TEA-Ch = Test of Everyday Attention for Children, BRIEF = Behavioural absence of improvements in the trained cognitive abilities. That is, ef­
Rating Inventory of Executive Function, SART = Sustained Attention to fects of training on measures of far transfer are typically seen as
Response Task, WISC = Wechsler Intelligence Scale for Children, TOVA = Test of dependent on increases in cognitive capacity. Thus, in these studies, far
Variables of Attention, SWAN = Strengths and Weaknesses of ADHD Symptoms transfer effects are likely not attributable to the training component of
and Normal Behaviour, AWMA = Automated Working Memory Assessment,
the intervention and may be due to non-specific factors or factors un­
CANTAB = Cambridge Neuropsychological Test Automated Battery, CPT =
related to the intervention. Alternatively, a theoretical account of why/
Continuous Performance Test, WATT = Wilding Attention Battery, TEMA = Test
how cognitive attention training improves performance on measures of
of Early Mathematics Ability, PPVT = Peabody Picture Vocabulary Task, PAT =
Phonological Abilities Test, WMRS = Working Memory Rating Scale, DBC = far transfer in the absence of near transfer is required to explain these
Developmental Behaviour Checklist, CMS = Children’s Memory Scale, NEPSY = findings.
Developmental Neuropsychological Assessment, ANT = Attention Network Test,
K-BIT = Kaufman Brief Intelligence Test, TAP = Test Battery for Attentional 3.1.2. Meditation studies
Performance, ADDES = Attention Deficit Disorder Evaluation Scale, APRS = Eight studies examined meditation training in children and adoles­
Academic Performance Rating Scale, WCST = Wisconsin Card Sorting Test, TMT cents. All of these studies investigated mindfulness-based interventions.
= Trail Making Test, SDQ = Strengths and Difficulties Questionnaire, D-KEFS = Five studies (15, 16, 17, 19, 21) reported positive intervention effects on
Delis-Kaplan Executive Function System, RAVLT = Rey Auditory Verbal at least one measure of sustained attention. Though these results are
Learning Test, WNV = Wechsler Nonverbal Scale of Ability, COWAT =
encouraging, all meditations studies had methodological/statistical is­
Controlled Oral Word Association Test; AMPS = Assessment of Motor and Pro­
sues (e.g., small sample sizes, non-randomised designs, no correction for
cess Skills, CMB = Cognitive Modifiability Battery, CBCL = Child Behaviour
Checklist.
multiple comparisons, no long-term follow up). Out of the 8 meditation
studies, five studies (17, 19, 20, 21, 22) examined the impact of training

13
E.J. Slattery et al. Neuroscience and Biobehavioral Reviews 137 (2022) 104633

Table 3
Intervention effects and methodological characteristics.

Note. WM = Working Memory, EFs = Executive Functions, IN/HY = Inattention/Hyperactive-Impulsive behaviour. Dark blue = positive effects with few methodo­
logical concerns; striped blue = positive effects with significant methodological concerns; dark yellow = no effects with few methodological concerns; striped yellow =
no effects with significant methodological concerns; blank = not tested.
a
Results are split across Kirk et al. (2016) and Kirk et al. (2017) and also reported in Kirk et al. (2020).
b
Results of this study are also reported in Lange et al. (2012).
c
Principal components analysis was performed on all measures to derive composite scores. Some composite scores could not be categorised according to the above
table. The results indicated no statistically significant differences between the two intervention groups and the control group for any of the components.
d
Studies with less than 20 participants in each group were categorised as having significant methodological concerns despite having a high Pedro score. This is because
the Pedro scale does not account for the number of participants in each group.

on other measures of attention. Four of these studies reported positive
effects on other aspects of attention / other indices of attention,
including overall attention performance (ANT % correct; 21), selective
attention (conjunctive visual search task; 17; visual search task; 19; TEA-
Ch; 22). These findings suggest that mindfulness training may be
particularly helpful for improving selective attention. Five studies
examined other outcomes (16, 18, 19, 20, 22), out of which four studies
reported positive effects on aspects of cognition and/or behaviour
(ratings of attention or hyperactivity; 16, 18, 20, 22). However, it is
difficult to ascertain far transfer effects due to the small number of far
transfer measures employed in studies and these measures varied across
studies. Overall, these studies provide some promising evidence for the
efficacy of mindfulness in improving attention.
3.1.3. Physical activity studies
Fifteen studies examined the impact of a physical activity interven­
tion. Physical activity interventions included yoga, target shooting,
Nintendo Wii, coordinated-bilateral physical activity, and traditional
physical activity. Eleven of these studies reported improvements in
sustained attention following physical activity interventions (24, 25, 27,
28, 29, 30, 31, 33, 34, 36, 37). One of the most promising of these was
Study 33, which used a cluster-randomised parallel group design to
examine the impact of traditional physical activity, coordinative phys­
ical activity, and a passive control on sustained attention (d2-R test;

14
E.J. Slattery et al.
Gallotta et al., 2015). Improvements between groups were analysed by
comparing pre-to-post absolute difference and percentage difference. A
main effect of group was found on three measures. Post hoc tests indi­
cated that traditional physical activity led to an improvement in pro­
cessing speed compared to the coordinative group, while coordinative
physical activity led to improvements in concentration and % error
scores relative to both the traditional physical activity and control group
(exact p values not reported just p < .05). The other ten studies had
several limitations including non-randomised designs (e.g., 24, 28, 29,
31, 32, 34, 35, 36, 37), significant differences between the groups at
baseline on some outcome measures that were not controlled for (e.g.,
28, 29), passive controls only (e.g., 27, 30, 31, 34) and small sample
sizes (e.g., 24, 27, 30, 37), which complicate the interpretation of
intervention effects. Overall, while exercise-based interventions
demonstrate some potential, further, more rigorous research is required
to definitively determine the efficacy of physical activity in improving
sustained attention.
3.2. Issues that impact the comparison of studies
Many methodological factors complicate the comparison of study
results. In this section, we summarise these factors and explain the
impact of these issues on findings. Across studies there was large vari­
ability in study types and designs (randomised vs non-randomised
studies, active vs passive control groups), sample characteristics,
training characteristics, experimental protocols, construct measure­
ment, and statistical analyses and reporting. It is our hope that this
analysis will result in better methodology and reporting in future
attention training research.
3.2.1. Study types and designs
It is possible to differentiate between four broad types of intervention
studies for cognitive enhancement: 1) feasibility studies (identify the
feasibility of an intervention), 2) mechanistic studies (demonstrate an
intervention’s mechanisms of action), 3) efficacy studies (determine
whether the intervention results in the desired effect under controlled
circumstances) and 4) effectiveness studies (determine whether an
intervention results in the desired effect under real-world settings/
clinical practice; Gartlehner et al., 2006; Green et al., 2019). Each type
of study is characterised by different goals, which impacts the meth­
odological approaches employed and the conclusions that can or should
be drawn from the study (for detailed review, see Green et al., 2019).
Note, in practice studies may not neatly fall into these categories or may
overlap multiple categories. Many studies in this review seemed to
identify as either an efficacy study (2, 3, 4, 5, 6, 8, 14, 16, 21, 33) or
effectiveness study (13, 17, 18, 30); six studies clearly identified as a
feasibility or pilot study (7, 9, 19, 24, 32, 37). Notably, in most instances
the precise type of study being conducted was not clear (e.g., 1, 10, 20,
22, 25, 26, 31). This was particularly the case for meditation and
physical activity studies. As such, we would like to echo the call of Green
et al. (2019) for more precise terminology at the outset of a paper so that
studies can clearly be distinguished, and the methodology employed
evaluated relative to the type of study being conducted.
An important consideration in the design of any intervention study is
the selection of a control group or groups. The adequacy of a control
group depends on the type of intervention study being conducted and its
underlying research question. In an efficacy study, an appropriate con­
trol is identical to the intervention group except for the “active” ingre­
dient (i.e., an active control group; Simons et al., 2016). If an efficacy
study does not employ an active control, then differences between the
intervention and control group could account for any observed
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Neuroscience and Biobehavioral Reviews 137 (2022) 104633
improvements (Simons et al., 2016). In an effectiveness study, a passive
control (no-contact control or treatment-as-usual) may be more appro­
priate to align with the study’s aims (i.e., measure the extent of
improvement under real-world conditions; Green et al., 2019). Partici­
pants in these control groups simply complete pre- and
post-assessments. In a feasibility study, a passive control may be
appropriate as the aim of this study, as the name suggests, is to
demonstrate feasibility (Green et al., 2019). However, of the six feasi­
bility or pilot studies, three studies also aimed to evaluate the efficacy of
their respective interventions (7, 9, 32). Thus, it is important to consider
the study goals when evaluating the control groups. From the ten studies
that seemed to identify as efficacy studies in this review, seven studies
included active control groups (2, 3, 4, 6, 8, 14, 21). Two of these studies
included both an active and passive control group (4, 6). The inclusion of
both an active and passive control group can aid in the interpretation of
study results (Green et al., 2019). From the four studies that seemed to
identify as effectiveness studies, three studies included passive control
groups (17, 18, 30). Three out of six feasibility / pilot studies included
active controls (7, 9, 19; Study 19 included both an active and passive
control group). Notably, in several studies there were some differences
between the intervention and control groups on outcome measures prior
to the intervention (e.g., 17, 28, 29) which complicates the interpreta­
tion of intervention effects. Additionally, some studies did not randomly
allocate participants to groups (e.g., 17, 28, 31). Group differences on
variables other than those of interest might drive or suppress any effects
seen in these studies (Simons et al., 2016).
3.2.2. Sample size
Many studies had small sample sizes, which make the results less
reliable. Some intervention groups consisted of 15 or fewer participants
(e.g., 1, 7, 11, 16, 24, 30). This is problematic as a study with a small
sample size is likely to produce an exaggerated effect size, mis­
representing the strength of an intervention (Button et al., 2013). Large
sample sizes provide stronger and more reliable evidence about the ef­
ficacy of an intervention (Redick et al., 2015). It has been recommended
that intervention studies should include pre-test and post-test data for a
minimum of 20 participants per group (Redick et al., 2015; Simmons
et al., 2011). Twenty studies satisfied this criterion (out of 37 studies).
The type of intervention study being conducted may also influence de­
cisions around optimal sample size. For example, it has been suggested
that efficacy and effectiveness studies require larger sample sizes than
feasibility studies (Green et al., 2019). Further sample size consider­
ations may include practicalities or factors that may limit sample size
such as whether a study requires costly neuroimaging outcomes in
addition to behavioural outcomes.
3.2.3. Construct measurement
Studies used a wide range of tasks to measure sustained attention.
Common tasks included the Conners’ Continuous Performance Test, the
Test of Everyday Attention for Children, the d2 Test of Attention and the
Attention Network Test. Typically, multiple variables were extracted
from each task such as errors of omission, errors of commission, reaction
time and reaction time variability. Some studies used questionable
sustained attention tasks, which heavily rely on other cognitive pro­
cesses. For example, Study 20 used the Trail Making Test Part A to assess
sustained attention (Ricarte et al., 2015). This test is typically regarded
to be a test of visual search and motor speed skills (Bowie and Harvey,
2006; Crowe, 1998). The majority of studies measured changes in sus­
tained attention based on only one task, rather than using multiple
measures. Performance on any task reflects variance specific to 1) the
task, 2) its method of administration, and 3) the construct it is intended
E.J. Slattery et al.
to measure (Redick et al., 2015). Moreover, single tasks can be very
sensitive to similarities with training regimens and impacted by a
component of the intervention despite no change in the underlying
ability (Moreau, 2021). A more convincing demonstration of interven­
tion effects is achieved by using multiple different measures of the target
construct, which can be used to create a composite score or latent var­
iable for analysis (Moreau et al., 2016). However, while this may be
aspirational, it is important to recognise that the use of multiple mea­
sures may not always be possible to achieve in a given study or may
prove problematic if, for example, differences in the psychometric
properties of the measures makes their combination dubious. It is also
important to note that when interventions include multiple outcome
measures of an underlying construct, and report only one significant
effect, claims of improvement are much more ambiguous (Moreau et al.,
2021).
3.2.4. Statistical issues
Studies typically included multiple outcomes and tested multiple
comparisons. A considerable implication of multiple statistical tests in
one study is that the significance level of the study may need to be
adjusted to control for the family-wise error rate (Bender and Lange,
2001). For example, in a study when two outcomes are analysed inde­
pendently at α = .05, the probability of finding at least one false positive
significant result increases to 0.098 (Vickerstaff et al., 2019). Many
studies did not correct for multiple comparisons / correct p values for
multiple outcomes (e.g., 8, 13, 14). Reporting results without correcting
for multiple comparisons can inflate the rate of false-positive results,
introducing erroneous results into the literature (Simons et al., 2016). It
is likely that some of these intervention effects would not have been
statistically significant had p-values been corrected for multiple com­
parisons. However, there is a lack of consensus in the literature about
when it is appropriate to correct for multiple comparisons (e.g., Li et al.,
2017; Parker and Weir, 2020). The decision to correct for multiple
comparisons may be influenced by the type of study being conducted (e.
g., exploratory vs confirmatory studies). That is, the cost of a false
positive result in a confirmatory study is much greater than an explor­
atory study, which occurs at the initial phase of development and will be
tested in further studies (Li et al., 2017; Parker and Weir, 2020). A
second weakness identified within the group of studies reviewed related
to the inferential statistics used. Some studies (e.g., 19) reported sig­
nificant improvements in the intervention group but failed to adequately
compare improvement in the intervention group to improvement in the
control group. A difference in significance between the intervention and
control group (i.e., the training group shows significant improvement
with p < .05 and the control group does not with p > .05) is not the same
as a significant difference in the extent of the improvement (Vater et al.,
2021). Therefore, studies that report statistically significant improve­
ments within the intervention group in this manner provide very weak
evidence for transfer effects. Lastly, in some instances it was not clear
what analyses were performed (e.g., 22).
3.2.5. Different interventions and durations
Many different types of interventions were employed across studies
within each attention training category. In the case of cognitive atten­
tion training studies, 10 different interventions were evaluated across 14
studies, with only two interventions being evaluated twice; Tali Train
and Pay Attention!. Training programmes trained an array of attentional/
cognitive functions (though all aimed to train sustained attention). Some
primarily targeted attention functions (e.g., Tali Train, AixTent, Pay
Attention!), while others targeted attention and other cognitive func­
tions (e.g., ACTIVATE™, Scientific Brain Training). This variability was
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Neuroscience and Biobehavioral Reviews 137 (2022) 104633
evident for meditation studies; all studies examined mindfulness
training, but studies employed different mindfulness-based in­
terventions. This was also true for physical activity interventions
studies, which investigated a range of interventions such as target
shooting, dance and yoga. Interventions varied on many other di­
mensions (computerised vs in-person, type of instructions, training du­
rations, settings, etc.). In relation to training duration, studies used a
highly disparate amount of training durations. For example, cognitive
attention training studies varied from 105 to 1920min. Some training
durations were spaced across time (e.g., 6 months), while others took
place within a short time frame (e.g., 4 weeks). Thus, many factors may
influence whether one benefits from an intervention; however, these
characteristics are often not examined. Moreover, very few researchers
endeavour to replicate a training study. To really understand the
effectiveness of an intervention, replications must be done.
3.2.6. Sample characteristics
There was some variability in study populations within and across
intervention types. It is possible that intervention effects may vary
across populations, for example, due to differences in baseline sustained
attention performance. That is, some research suggests those with poor
baseline performance may benefit the most from training (compensation
effects), while other research suggests that those with high baseline
performance benefit the most (magnification effects; for review see, Katz
et al., 2021). In the cognitive attention training studies reviewed, seven
studies (1, 3, 5, 7, 9, 13, 14) examined the impact of training in child­
ren/adolescents with ADHD, five studies (2, 4, 10, 11, 12) had typically
developing participants and two other studies looked at child­
ren/adolescents with other neurodevelopmental conditions (6, 8). The
two most promising cognitive attention training studies (3, 6) included
neurodevelopmental samples. Study 3 examined the impact of training
in participants with ADHD and Study 6 examined the impact of training
in participants with various neurodevelopmental disorders. Notably,
Study 3 specifically included a sample of participants with deficits in
cognitive attention. All meditation studies included participants that
could be categorised as typically developing (note, Study 16 included
participants with a history of childhood neglect). Most physical activity
studies included typically developing participants (23, 25, 26, 29, 33,
34, 35, 36); four studies had ADHD samples (28, 30, 31, 37), while three
studies had other samples (i.e., Charcot-Marie-Tooth disease, hearing
deficits and childhood brain tumour survivors). The studies reporting
the positive effects of physical activity on sustained attention included
typically developing samples (25, 29, 33, 34, 36), ADHD samples (28,
30, 31, 37) and samples of children with Charcot-Marie-Tooth disease
(24) and hearing deficits (27). However, in the current review, it is
difficult to ascertain the potential effects of study populations on
meditation and physical activity intervention effects due to methodo­
logical limitations evident across studies.
Age is another important factor that may influence the impact of
each intervention (Katz et al., 2021). This is because childhood and
adolescence is a critical period for sustained attention development and
cognitive maturation. Many studies included in this review had a wide
age range (16 out of 37 studies had an age range ≥ 5 years), which
spanned more than one period of development across childhood and
adolescence. Note, 13 studies did not report an age range. Across all
intervention types, most studies examined participants in middle
childhood and early adolescence (7–14 years; cognitive attention
training 8 out of 14, meditation training 4 out of 8, and physical activity
13 out of 15). Intervention effects may differ across and within studies
due to age, but this is difficult to examine here due to the wide and
overlapping age ranges. Taken together, it is possible that attention
E.J. Slattery et al.
training interventions targeting sustained attention may work differ­
ently at different ages or with different populations; however, these
factors were too variable among the studies included in this review to be
analysed systematically.
3.2.7. Pre-registration and data analysis plans
In recent years, there has been an increasing emphasis on the pre-
registration of study protocols and data analysis plans in psychology.
However, very few recent studies were prospectively registered. Of the
29 studies published since 2015, 13 studies were registered but only 5 of
these studies were registered prior to data collection. Prospective pre­
registration is essential for research transparency and credibility.
4. Overall discussion
The present review provides a fine-grained critical analysis of pop­
ular attention training interventions specifically targeting sustained
attention in children and adolescents. Findings varied within and across
the different intervention approaches. The current evidence indicates
that cognitive attention training does not reliably improve the capacity
to sustain attention in children and adolescents. In contrast, the evi­
dence for mindfulness training and physical activity (with a cognitive
component) is somewhat more promising though these effects should be
considered preliminary and need to be replicated with greater meth­
odological rigour (i.e., pre-registration, larger samples, randomised
designs, active control groups and multiple measures of sustained
attention).
For other measures of attention, cognitive attention training
demonstrated very limited transfer. Physical activity studies rarely
assessed such measures. Notably, mindfulness training had rather
consistent positive effects on selective attention. Across all three inter­
vention types, there was weak evidence for transfer to other aspects of
cognition, behaviour, and academic achievement. A number of positive
effects of cognitive attention training on far transfer measures were re­
ported (e.g., ADHD symptoms); however, some of these effects were
found in the absence of near transfer, which is theoretically challenging
to explain. In the case of mindfulness and physical activity, it is difficult
to ascertain transfer to other cognitive, academic and behavioural
measures due to the small number of such measures employed in these
studies and the measures employed varied considerably across studies.
The primary focus of research in this area has been whether these
interventions work rather than why they might work. The mechanisms
of improvement are hypothesised to be different across each interven­
tion type reviewed here. Cognitive attention training focusses on
improving the cognitive control aspect of sustained attention using the
repetitive practice of a cognitive task designed to exercise the fronto­
parietal network. Physical activity likely targets sustained attention via
physiological arousal factors but may also target cognitive control when
the activity requires focus to be continuously maintained on goal-
directed stimuli. Finally, mindfulness training likely targets arousal
factors (cortical and physiological arousal), emotional factors (calming
the emotions and enabling a reappraisal of what should be attended to),
and cognitive factors (maintaining continuous focus on certain stimuli
over time) implicated in sustained attention. Thus, in theory, physical
activity and mindfulness training offer the most potential for enhancing
sustained attention because they target multiple factors underlying
one’s capacity to sustain attention. However, notably, none of the
reviewed physical activity or mindfulness studies included a follow up
testing occasion. As a result, it is unclear whether these interventions
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Neuroscience and Biobehavioral Reviews 137 (2022) 104633
produce potential long-lasting effects. Given that these interventions
largely work upon the systems which influence sustained attention (i.e.,
arousal & salience networks) rather than the sustained attention system
itself (i.e., frontoparietal network), and given that they likely typically
function to modulate sustained attention, it is possible that enduring
effects are unlikely. Frequent engagement in these interventions may be
necessary to modulate sustained attention when needed or as a matter of
routine. However, this is an open research question which needs to be
determined by future research.
This is a timely review with many strengths (e.g., inclusion of mul­
tiple interventions to enhance sustained attention, critical analysis and
recommendations to improve the evidence base). However, it is
important to acknowledge its weaknesses. Only 10% of title and ab­
stracts / full text articles were screened by two reviewers. This was done
due to limited time and resources. While single screening has been used
in other recent systematic reviews in the health and medical research
field (e.g., Gram et al., 2019; Sato et al., 2021), this approach can miss
more eligible studies than double screening (Waffenschmidt et al.,
2019). Best practice is for the screening process to be conducted by two
independent reviewers (Gartlehner et al., 2020). Moreover, only one
reviewer completed data extraction and quality assessment. It is rec­
ommended that more than one reviewer extract data and complete
quality assessment to minimise errors and reduce potential bias (Bou­
tron et al., 2022; Li et al., 2022). In the current review, dual screening,
data extraction and quality assessment would have strengthened our
results and conclusions.
5. Conclusion
We found limited evidence that it is possible to train children’s
ability to sustain attention. Cognitive attention training did not reliably
improve sustained attention capacity. The evidence for mindfulness
training and physical activity was somewhat more promising though
these effects should be considered preliminary. Moving forward, medi­
tation training and physical activity intervention studies should adhere
to best methodological practices in order to determine the true effect of
these interventions on sustained attention. These practices include use
of prospective pre-registration and data analysis plans, more precise
terminology around the type of intervention study being conducted,
randomised designs, adequately powered sample sizes, matched groups
at baseline, an appropriate control group aligned to the aims of the
study, multiple measures of sustained attention and long-term follow up.
Declarations of interest
None.
Data availability
Data will be made available on request.
Appendix A
See Table A1.
 E.J. Slattery et al.
Table A1
PEDro scores for each intervention study.
Rias of biasing according to the PEDro scale

Eligibility Random Concealed Baseline Blind Blind Blind Adequate Intention-to- Between-group Point estimates / Score
Criteria Allocation Allocation comparability Subjects Therapists Assessors Follow up treat comparison variability

Cognitive Attention Training

Nejati (2021) 1 1 0 1 0 0 0 0 0 1 1 4
Slattery et al. (2021) 1 1 0 1 1 0 0 1 1 1 1 7
Kollins et al. (2020) 1 1 0 1 1 0 1 1 1 1 1 8
Kirk et al. (2019) 1 1 1 1 0 0 1 1 1 1 1 8
Bikic et al. (2018) 1 1 1 1 0 0 1 1 1 1 1 8
Tullo et al. (2018) 1 1 0 1 0 0 0 1 1 1 1 6
Bikic et al. (2017) 1 1 1 1 1 1 1 1 0 1 1 9
(Kirk et al., 2016) 1 1 1 1 1 1 1 1 1 1 1 10
Mishra et al. (2016) 1 1 1 0 1 1 1 0 0 1 1 7
Sarzyńska et al. (2017) 0 0 0 0 1 0 0 1 0 1 1 4
Schrieff-Elson et al. (2017) 1 1 1 1 0 1 0 1 0 1 1 7
Rueda et al. (2012) 1 1 0 1 0 0 0 1 1 1 1 6
Tucha et al. (2011) 0 1 0 1 1 0 0 0 0 1 1 5
Kerns et al. (1999) 1 0 0 1 1 0 0 1 0 1 0 4
Meditation Training
Bauer et al. (2020) 0 1 0 1 1 0 1 0 0 1 1 6
Mishra et al. (2020) 1 1 0 1 1 1 1 1 0 1 1 8
18

Tarrasch (2018) 1 0 0 1 0 0 0 1 0 1 1 4
Kiani et al. (2017) 1 1 0 1 0 0 0 1 1 1 1 6
Wimmer et al. (2016) 0 1 0 1 0 0 0 0 0 1 1 4
Ricarte et al. (2015) 0 1 0 1 0 0 0 1 1 1 1 6
Leonard et al. (2013) 0 1 0 1 1 0 0 0 0 1 1 5
Napoli et al. (2005) 0 1 0 0 0 0 0 1 0 1 1 4
Physical Activity
Meijer et al., 2021 0 1 1 1 0 0 0 1 0 1 1 6
Cherriere et al. (2020) 1 0 0 1 0 0 0 1 1 1 1 5
Duarte et al. (2020) 1 1 0 1 0 0 0 0 0 1 0 3
García-Hermoso et al. (2020) 1 1 0 1 0 0 0 1 1 1 1 6
Hedayatjoo et al. (2020) 1 1 0 0 0 0 2 0 0 1 1 4

Neuroscience and Biobehavioral Reviews 137 (2022) 104633

Månsson et al. (2019) 1 0 0 0 0 0 0 1 1 1 1 4
Buchele Harris et al. (2018) 0 0 0 0 0 0 0 1 0 1 1 3
Rezaei et al. (2018) 0 1 0 0 0 0 0 0 0 1 1 3
Chou and Huang (2017) 1 0 0 1 0 0 0 1 0 1 1 4
Sabel et al. (2017) 1 0 0 1 0 0 1 1 1 0 1 5
Gallotta et al. (2015) 1 1 0 0 0 0 0 1 0 1 1 5
Zach et al. (2015) 0 0 0 0 0 0 0 0 0 1 1 2
Verret et al. (2012) 1 0 0 0 0 0 0 1 0 1 1 3
Spitzer and Hollmann (2013) 0 0 0 0 0 0 0 1 0 1 0 2
Study 1
Spitzer and Hollmann (2013) 0 0 0 0 0 0 0 1 1 1 0 3
Study 2
E.J. Slattery et al.
Appendix B. Summary of Each Study
Study 1: Nejati (2021)
Children with ADHD aged 8–14 years were randomly assigned to a
training (n = 15) or passive control group (n = 15). The training group
received a programme for attention rehabilitation and strengthening
(PARS) over 4–5 weeks. The programme targeted sustained attention,
selective attention and attention shifting using non-computerised ac­
tivities. Both groups completed assessments of sustained attention
(Persian Attention Registration Test; 3 measures), selective attention
(Stroop Test; 4 measures), attention shifting (Trail Making Test; 2
measures), inhibitory control (Go/No-Go Test; 3 measures) and working
memory (1- Back Task; 2 measures) before and after the intervention.
The results showed significant group × time interaction effects for some
measures including omission errors (p = .001, ηp2 =.424) and commis­
sion errors (p = .014, ηp2 =.218) on the Persian Attention Registration
Test, incongruent stage speed (p = .041, ηp2 =.163) and the selective
attention index (p = .036, ηp2 =.170) on the Stroop Test, go reaction
time (p = .013, ηp2 =.097) and no-go accuracy (p = .021, ηp2 =.196) on
the Go/No-Go Test, and accuracy (p = .016, ηp2 =.211) on the 1- Back
Test. This study had several methodological limitations including no
correction for multiple comparisons (at least 14 different variables
analysed), a passive control and a relatively small sample size.
Study 2: Slattery et al. (2021)
In this cluster-randomised preliminary study, children aged 9–11
years were assigned to the Keeping Score! attention training group
(n = 18) or an active control group (n = 18). Training was based on
sustained updating and required participants to silently keep score
during an interactive game of table tennis. Both groups completed
cognitive assessments of sustained attention (Vigil, Cerberus and Sus­
tained Attention to Response Task subtests of the TEA-Ch2; 3 measures),
short-term memory (Forward Span task WISC-V; 1 measure) and
working memory (Digit Span Backward subtest of the WISC-5 and the
Operation Span and Symmetry Span subtests of the Adaptive Composite
Complex Span; 3 measures) at baseline, post-test and 6-week follow up.
Parents also completed ratings of executive function behaviour (BRIEF;
4 measures). There were no significant time by group interaction effects
for any objective or subjective outcome measure.
Study 3: Kollins et al. (2020)
In this large randomised controlled trial, children with ADHD aged
8–12 years were assigned to a digital intervention group (n = 180) or an
active control group (n = 168). Participants in the intervention group
received the AKL-T01 programme designed to train attention and
cognitive control using video game-based activities at home over 4
weeks. The active control group completed activities that required
participants to spell as many words as possible, by connecting letters in a
game-like grid. The results showed a statistically significant improve­
ment in the primary outcome, sustained attention, assessed using TOVA
Attention Performance Index in the intervention group compared to the
control. No intervention effects were found for secondary outcomes,
including the Impairment Rating Scale, ADHD-RS-IV (3 measures),
Clinical Global Impressions-Improvement and the BRIEF (3 measures).
No intervention effects were found for minor secondary efficacy end­
points, working memory (CANTAB-spatial working memory; 8 mea­
sures) or inhibitory function (TOVA; 1 measure). Study strengths include
a large sample size, a sample of participants with deficits in cognitive
attention and prospective pre-registration.
Study 4: Kirk et al. (2019)
Children (5–9 years) were cluster-randomised to the training group
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(n = 39), active control (n = 35), or passive control (n = 33). The
training group completed adaptive game-based exercises from the Tali
Train programme designed to train sustained, selective, and executive
attention. The active control completed non-adaptive game-based ex­
ercises that required minimal attention skills. Sessions were held in
school over a 5-week period. All groups were tested on near transfer
measures (visual sustained attention, visual/auditory selective atten­
tion, executive attention) and far transfer measures (verbal/visuospatial
working memory, numeracy, and inattention/hyperactivity) at pre-test,
post-test and 6-month follow up. The results indicated the training group
made significantly greater improvements in visual sustained attention
from baseline to follow up compared to the passive control. In contrast,
the passive control group made greater gains in auditory selective
attention from baseline to post-training compared to the intervention
group. No other effects were found for objective measures. A number of
significant intervention effects were reported for rating scale measures.
Specifically, the training group demonstrated significantly greater im­
provements in teacher-rated inattention and hyperactivity from baseline
to post-training compared to the active and passive control groups.
Parents reported significantly larger improvements in hyperactivity
from baseline to post-training compared to the passive control. Im­
provements were maintained for teacher ratings of hyperactivity at
follow up compared to the passive control. The study concluded that
classroom-based attention training has select benefits in reducing inat­
tention and hyperactivity but may not promote gains in cognitive or
academic skills in primary school children. However, this conclusion is
at odds with the underlying rationale of cognitive attention training, as
effects of training on behaviour are typically seen as dependent on in­
creases in cognitive capacity. Study strengths include the inclusion of
both an active and passive control group, fairly large sample size, long-
term follow up and prospective pre-registration.
Study 5: Bikic et al. (2018)
Children with ADHD aged 6–13 years were randomly assigned a
training group (n = 35) or passive control (n = 35). The training group
completed the computer programme ACTIVATE™ at home. Participants
completed 40-minute sessions six days a week for 8 weeks. The pro­
gramme trained multiple cognitive functions simultaneously, including
sustained attention, working memory, speed of information processing,
response inhibition, cognitive flexibility, category formation, and
pattern recognition. All exercises were adaptive, and the programme
included an in-built reward system. The results showed no significant
improvements in the primary outcome, sustained attention, or second­
ary outcomes, executive function/attentional behaviour after 8, 12 or 24
weeks. However, the training group showed significant improvements in
one exploratory measure, planning ability, from pre- to post-training
compared to the control (p = .006). This effect was maintained at both
the 12-week (p = .035) and 24-week (p = .017) follow up.
Study 6: Tullo et al. (2018)
In this randomised-controlled trial, students with neuro­
developmental conditions (6–18 years) were assigned to a training
group (n = 43), active control (n = 43) or passive control (n = 43). The
training group received NeuroTracker training designed to trained vi­
sual attention including sustained and selective attention. Training was
adaptive. Participants completed a total of 15 sessions over 5 weeks at
school. Sessions lasted 7 min. The active control completed the com­
puter game 2048. Groups were matched on age and two WASI subscales.
Sustained attention was assessed using d prime scores from the Conners’
Continuous Performance Test at pre- and post-test. The results showed a
significant difference in standardised change CPT-3 d prime scores be­
tween the training group and active control (p = .033, d = 0.524) and
between the training group and passive control (p = .048, d = 0.497).
There was no significant difference between the active and passive
E.J. Slattery et al.
controls. Though this study did not assess far transfer or long-term ef­
fects, it had a number of strengths including a large sample size, rand­
omised design, and active/passive control groups.
Study 7: Bikic et al. (2017)
This double-blind randomised pilot allocated participants to an
intervention group (n = 9) or active control (n = 9). The intervention
group completed exercises from the Scientific Brain Training pro­
gramme for 30-minutes five days a week for seven weeks at home. The
exercises were adaptive and trained numerous cognitive functions,
including sustained attention and working memory. The control group
played a non-adaptive version of Tetris. The Cambridge Neuropsycho­
logical Test Automated Battery and ADHD rating scale were completed
at pre- and post-training. The test battery included measures of sus­
tained attention, processing speed, visual memory, short-term memory,
spatial working memory, planning and rule acquisition/visual discrim­
ination/attention shifting. There were no significant differences be­
tween the groups on sustained attention (assessed using a Rapid Visual
Information Processing task) or any other cognitive / behavioural
measure. However, there were some within-group differences from pre-
to post-training. In the training group, scores on two sustained attention
variables improved, A prime (the ability to detect the target sequence;
p = .003, d = 1.5) and probability of hit (p = .005, d = 1.3). In contrast,
the control group improved on one spatial working memory variable
(between errors; p = 0.042, d = 0.88).
Study 8: Kirk et al. (2016)
Results of this single intervention are reported separately in Kirk
et al. (2016; attention outcomes; 7 different variables) and Kirk et al.
(2017; academic, executive functioning and behavioural/emotional
problems outcomes; 20 different variables). In this study, children with a
diagnosis of intellectual disability and attentional difficulties (aged 4–11
years) were randomly assigned to receive Tali Train (n = 38) or an
active control (n = 38). Outcome measures were completed at baseline,
post-training and 3-month follow up. Participants in the training group
showed significantly greater improvements in some aspects of selective
attention from baseline to post-training (d = 0.24) and baseline to 3-
month follow up (d = 0.26) compared to participants in the control
group. Training did not have an immediate effect on academic outcomes
but participants in the training group showed significantly greater im­
provements in numeracy skills from baseline to follow up compared to
participants in the control (d = 0.15). The training was not effective in
improving sustained attention, attention control, cardinality, vocabu­
lary, phonological abilities, inattentive/hyperactive behaviour, working
memory behaviour, executive function behaviour or behavioural prob­
lems. Although this study had a fairly large sample size and included an
active control group, it did not correct for multiple comparisons.
Correction for multiple comparisons would have been appropriate as
over 20 different variables were investigated. Therefore, the results
should be interpreted cautiously.
Study 9: Mishra et al. (2016)
In this study, children with ADHD were randomly assigned to an
intervention group (n = 21) or active control (n = 10). The intervention
group completed adaptive online cognitive exercises that focused on
attended-signal training or distractor-suppression training over a 6-
month period. The exercises targeted sustained attention, working
memory and response inhibition. The active control played the online
Hoyle puzzle game. Both groups completed assessments of sustained
attention (first 10 min of the TOVA; 1 measure), response inhibition
(second half of the TOVA; 1 measure), short-term memory (spatial ca­
pacity task and verbal capacity task; 2 measures) and executive function
(Stroop Colour and Word Interference Test; 1 measure) at baseline and
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post-test. Parents rated ADHD symptom severity and clinicians
completed the Clinical Global Impression (CGI) of Severity of Illness
Scale at baseline, mid-intervention, post-intervention and at a 6-month
follow up. The results indicated that change in ADHD symptom severity
for the intervention group vs the control group from baseline to mid-/
post-intervention did not reach between-group significance but was
significant at follow-up (p = 0.04, d = 0.36). Within-group ANOVAs
applied over the four assessment time points (baseline, mid-, post-,
follow up) showed that symptom severity ratings changed significantly
in the intervention group (p = 0.003) but not in the control group.
Nonparametric ANOVA over the four assessed time points did not find a
significant effect in the intervention group for CGI but did find a sig­
nificant effect in the control group (p < 0.007). The training group
demonstrated statistically significant improvements in response inhibi­
tion and Stroop interference compared to the control group. No other
effects reached statistical significance.
Study 10: Sarzyńska et al. (2017)
Sarzyńska et al. (2017) reported near transfer to sustained attention
but no far transfer to fluid intelligence in a sample of 8-year-old chil­
dren. In this non-randomised study, participants were assigned to an
intervention (n = 30) or active control (n = 24) group. The training
group completed computerised tasks designed to train multiple atten­
tional functions. The difficulty of the tasks was adjusted according to the
child’s performance and a token system encouraged motivation. The
control group completed computerised tasks that targeted problem
solving and perceptual skills. Both groups completed a total of 10 ses­
sions 2 or 3 times a week. Each session lasted 30 min. Outcome measures
of attention (d2 Attention test; 7 different variables) and intelligence
(Raven’s Progressive Matrices Test) were completed at baseline,
post-test and 3-month follow up (training group only). The results
showed significant group × time interaction effects for some d2 vari­
ables, including false alarms (p = .0003, ηp2 = 0.06), discriminability
(p = 0.001, ηp2 =.05) and bias (p = .02, ηp2 = 0.03).
Study 11: Schrieff-Elson et al. (2017)
Fifteen low socioeconomic status children aged 7–13 years were
assigned to an intervention group (n = 5), active control (n = 5) or
passive control (n = 5). The intervention group received the Pay
Attention! training programme, which consisted of four non-
computerised tasks designed to train sustained, selective, alternating,
and divided attention. The active control played physical games like
hopscotch. Participants received two 45-minute sessions per week for 10
weeks. Tests of attention, working memory and inhibition were
completed before and after the intervention. Training was not effective
in improving sustained attention (assessed using the Score! subtest from
the Test of Everyday Attention for Children and Numbers Forward from
the Children’s Memory Scale) or any other outcome. The active control
displayed higher inhibition scores compared to the passive control at
post-test (p = .036). Within-group analyses indicated that the inter­
vention group improved in aspects of selective attention, attentional
control and inhibition from pre- to post-test. In contrast, both controls
improved in aspects of selective attention. Given the very small sample
size, all findings should be interpreted cautiously.
Study 12: Rueda et al. (2012)
In this study, 5-year-old children were pseudo-randomly assigned to
a training group (n = 19) or control group (n = 18) matched for gender,
IQ and flanker inference scores on the Attention Network Test (ANT).
The training group completed computerised exercises designed to train
tracking, discrimination, conflict resolution, inhibition, and sustained
attention. All exercises were adaptive. Training took place twice weekly
for 45 min over 5 weeks. The active control watched cartoons. The
E.J. Slattery et al.
following measures were completed at pre- and post-training: ANT,
delay gratification task, gambling task and Kaufman Brief Intelligence
Test. There were no significant differences between the training and
control group in sustained attention (alerting scores from the ANT) or
any other cognitive outcome over time (i.e., no significant time × group
interaction effects). However, a number of significant differences were
found in planned contrast analysis. In the training group, there was a
significant improvement in IQ matrices from baseline to post-training
and significant improvements in a gambling task from baseline to
follow up. Both groups showed significant improvements in some
outcome measures from a delay of gratification task from baseline to
post-training and baseline to follow up. However, to show a training
benefit relative to the control, improvements in the training group must
be compared directly to improvements in the control group (time ×
group intervention effects were not statistically significant).
Study 13: Tucha et al. (2011)
The results from this study are reported in both Tucha et al. (2011)
and Lange et al. (2012). Children with ADHD were randomly assigned to
an AixTent attention training group (n = 16) or active control (n = 16).
AixTent is an adaptive computerised programme designed to trained
sustained, selective, and divided attention. Participants completed two
sessions a week for four weeks. Each session lasted 1 h. The control
group completed visual perception training. The intervention and con­
trol groups underwent tests of tonic and phasic alertness, vigilance, se­
lective attention, divided attention, and flexibility before and after
training. The training group demonstrated improvements in some as­
pects of vigilance (commission errors; p = .011, d = 0.59), divided
attention (commission errors; p = .002, d = 1.28), and flexibility
(commission errors; p = .050, d = 0.84) from baseline to post-training
(15 paired t-tests). In contrast, the control group show no changes (15
paired t-tests). At post-training, there was one statistically significance
difference between the training and active control in divided attention
(commission errors; p = .003) out of 15 comparisons. Differences in
ipsative scores (change from pre- to post-assessment) were also calcu­
lated for both groups. The training group demonstrated significantly
greater ipsative change compared to the control in aspects of vigilance
(errors of commission; p = .047) and divided attention (errors of com­
mission; p = .014; 15 comparisons). However, no correction for multiple
comparisons was applied despite the large number of pairwise
comparisons.
Study 14: Kerns et al. (1999)
In this early influential study, Kerns et al. (1999) reported im­
provements in sustained attention following training with the Pay
Attention! programme in children with ADHD. Participants (aged 7–11
years) were assigned to the intervention (n = 7) group or active control
(n = 7). Pay Attention! trained sustained, selective, alternating and
divided attention using various non-computerised tasks. All tasks were
adaptive, and participants received feedback on their performance. The
control group played computer games. Both groups completed 16
30-minute sessions over 8 weeks. Participants in the intervention and
control groups underwent cognitive tests (attention, executive function
and academic efficacy; at least 13 different variables) and paren­
t/teachers completed ratings of ADHD symptoms. The training group
demonstrated improvements in auditory sustained attention (p < .001;
Attention Capacity Test), planning (p = .010; Mazes subtest WISC-III),
inhibition (p = .005; Day Night Stroop), selective attention (p = 0.15;
Underlying Task) and academic efficiency (p = .015) when compared to
the control group. No intervention effects were found for sustained
attention (Children’s Continuous Performance Test), impulsivity
(Matching Familiar Figures Test), freedom from distractibility (Coding
and Digit Span subtests WISC-III), spatial ability (Hooper Visual Orga­
nisation Test), or inattentive/hyperactive behaviours (Attention Deficit
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Disorder Evaluation). The authors concluded that attention training
interventions “may be a valuable treatment option for improving
cognitive efficiency in children with ADHD”. However, given the many
methodological concerns (e.g., small sample size, adequacy of the active
control, no correction for multiple comparisons (at least 14 between
group comparisons conducted), no follow up assessment and no ran­
domisation), this conclusion seems far-reaching.
Study 15: Bauer et al. (2020)
Bauer et al. (2020) found that a school-based mindfulness pro­
gramme improves aspects of sustained attention in 6th grade students.
The study reports a small subset of data (n = 31) from participants who
completed an fMRI protocol as part of a larger RCT (N = 96). The pro­
gramme was designed to train focused attention and change students’
mindsets about their stress over 8 weeks. The control group received
coding training which matched the time commitment and engagement
of the mindfulness intervention. Sustained attention was assessed using
a SART pre- and post-training. The results indicated that the mindfulness
group displayed significantly better Go-accuracy scores after the inter­
vention compared to the coding group (p = .01, Cohen f2 =.47). There
were no significant differences between the groups in RT variability or
No-Go accuracy after the intervention. Given the small sample size and
study design (i.e., participants self-selected to take part in the fMRI
protocol), the results should be interpreted cautiously.
Study 16: Mishra et al. (2020)
Adolescents with childhood neglect (aged 10–18 years) were cluster
randomised to either an internal attention intervention (IAI; n = 15),
external attention intervention (EAI; n = 15) or a passive control
(treatment-as-usual; n = 15). The internal attention group used the app
Meditrain to practice attending to the sensations of their breath. The
external attention group completed exercises from brainhq.com
designed to train focused attention, divided attention, selective atten­
tion and working memory. Participants in both groups completed 30
sessions over 6 weeks. Sessions lasted 30 min. Participants in the
intervention and control groups underwent tests of sustained attention
(test modelled after the Test of Variables of Attention; response time
variability) and interference control (Flanker Test; RT on incongruent
trials minus RT on congruent trials) before and after the intervention.
Caregivers rated ADHD symptoms at pre-test, post-test and 1-year follow
up and teachers rated students’ academic performance after the inter­
vention and at 1-year follow up. There was a significant time × group
interaction effect following the intervention for both outcomes, sus­
tained attention (p = .01, η2 = 0.17) and interference resolution
(p = .03, η2 = 0.16). Post hoc within group tests showed that these
outcomes improved from baseline to post-training in only the internal
attention group (p = .01 and p = .015). There were no significant
changes in the external attention group. The passive control showed a
significant decline in sustained attention at post-test (p = .03). There
was no significant difference between groups in ratings of inattention/
hyperactivity at post-training but significant improvements in hyper­
activity were found from baseline to 1-year follow up in the internal
attention group (p = .005) and from post-test to follow up (p = .038).
There was a significant difference between the groups after the inter­
vention on teacher-rated academic performance (p = .04, η2 = 0.15),
with the paper reporting that the IAI group had high ratings relative to
the EAI and treatment-as-usual groups though the results of these pair­
wise comparisons are not reported.
Study 17: Tarrasch (2018)
Tarrasch et al. (2018) reported that mindfulness training was effec­
tive in improving sustained attention in children aged 8–11 years. In this
non-randomised study, participants were assigned to mindfulness
E.J. Slattery et al.
training (n = 58) or a passive control (education as usual; n = 43). The
training group received 10 sessions of mindfulness-based stress reduc­
tion (MBSR) in a group setting. Both groups were tested in a pre- and
post-test using a CPT (sustained attention) and Conjunctive Visual
Search Task (selective attention). At pre-test, the intervention group
demonstrated a significantly higher CPT commissions (p < .05) and
Conjunctive Search accuracy (for trials including 8 displays with and
without targets, ps < .05) compared to the control. A significant time
× group interaction effect for CPT commissions (p < .01, ηp2 = 0.124)
was found with post hoc Tukey’s HSD indicating the mindfulness group
demonstrated improvements from baseline to post-training (p < .001,
d = 0.89). No effects were found for CPT omissions or RTSD. Some
significant improvements were reported for aspects of selective atten­
tion from pre- to post-test in both the mindfulness and control groups
(depended on whether the target was included and the number of items
in the display). This was a non-randomised study and groups were not
equivalent before training on some outcome variables (which were not
accounted for in the analyses), which makes the findings difficult to
interpret.
Study 18: Kiani et al. (2017)
In this study, female adolescents with elevated ADHD symptoms
were randomly assigned to a mindfulness training group (n = 15) or a
passive control (n = 15). The intervention group received mindfulness
training with sessions focusing on attention and the five senses. Sessions
were held weekly for 8 weeks. Both groups completed assessments of
sustained attention (CPT; 3 measures), working memory (Digit Span
subtest and Letter-Number Sequencing subtest of the WISC-IV; 5 mea­
sures), inhibition (Stroop Word-Colour Interference Test; 1 measure)
and planning (Tower of London Test; 1 measure) at baseline and one-
month after the intervention. The results indicated that the mindful­
ness group demonstrated statistically significant improvements in inhi­
bition (p = .01, ηp2 =.22) and planning (p = .04, ηp2 =.15) compared to
the control group. No other between group differences were found.
Within group analyses indicated that the training group improved on
working memory from pre- to post-test (p = .004).
Study 19: Wimmer et al. (2016)
Children were assigned to an intervention group (n = 16), active
control (n = 8) or passive control (n = 10). The intervention group
received MBSR training 25 times over 18 weeks. The active control
received concentration skills training. Groups completed a vigilance
task, reversible figure task, Stroop Colour-Word Interference task,
recognition task, visual search task and the WSCT-64 at pre- and post-
test. In the paper, results are reported at p < .10 due to the “small
sample size and pilot character of the study”. A number of intervention
effects are reported at this significance level; however, only two of these
effects are significant at p < .05 (vigilance task accuracy in no-responses
and visual search RT in blank trials). The passive control group accuracy
in no-responses scores significantly worsened from pre- to post-test
(p = .05), whereas the interaction and active control remained un­
changed. This finding is interpreted as “partly” confirming the hypoth­
esis that mindfulness and concentration training are associated with
improvements in sustained attention. However, it provides very weak
evidence of an intervention effect as there was no direct comparison
between groups and a decline in performance in the control does not
represent a sensible transfer pattern. Regarding RT in blank trials on the
visual search task, the mindfulness improved compared to the passive
control (p = .02) and the passive control improved compared to the
active control (p = .03). Note, children were not randomly assigned to
the passive control.
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Study 20: Ricarte et al. (2015)
Ricarte et al. (2015) found a school-based adaption of the Mindful­
ness Emotional Intelligence Training Programme improved concentra­
tion and immediate auditory-verbal memory in children aged 6–13
years. The intervention group (n = 45) received mindfulness training
every day for 6 weeks and was compared to a passive control group
(n = 45). Sustained attention (Trail Making Test Part A), focused
attention (Perception of Differences Test), mental flexibility (Trial
Making Test Part B), concentration (Digit Span subtest WISC-III total
score), auditory-verbal memory (Digit Span Forward) and working
memory (Digit Span Backward) were compared between the two groups.
Immediately after training, the intervention but not the control group
showed improvements in concentration (p < .001, ηp2 =.12) and
auditory-verbal memory (p < .001, ηp2 =.13). No training effects were
found for any other cognitive measure. Study strengths include its fairly
large sample size and randomised design, but the intervention group
likely had a greater expectation of improvement than the passive
control.
Study 21: Leonard et al. (2013)
This cluster-randomised controlled trial assigned two hundred and
sixty-four incarcerated youths (aged 16–18 years) to a cognitive
behavioural/mindfulness intervention group or active control. The
intervention combined aspects of cognitive behavioural therapy with
the attentional and response modification elements of mindfulness
meditation. The active control completed cognitive perception training.
Both conditions completed 750 min of training in small groups over 3–5
weeks. The ANT was administered pre- and post-training (9 different
variables). There was a significant time × group interaction effect for
overall ANT performance (% correct; p < .001, ηp2 =.06). At post-
training, scores were significantly higher in the intervention group
compared to the control (p = .04, d = 0.30). There was a time × group
interaction effect for response variability (p = .02, ηp2 =.03). At T2,
response variability was lower (responses were more stable) in the
intervention group compared to the control (p = .02, d = 0.34). No
significant effects were found for alerting, orienting or conflict moni­
toring (RT or % correct).
Study 22: Napoli et al. (2005)
Primary school children were randomly assigned to a mindfulness
intervention (n = 114) group or control (n = 114). The intervention
group completed the Attention Academy Programme designed to help
students improve their quality of life through practicing mindfulness.
The control group completed “reading and other quiet activities”. Both
groups had twelve 45-min sessions over 24 weeks. Sustained attention
(TEA-Ch Score!, Walk, Don’t Walk and Code Transmission subtests),
selective attention (TEA-Ch Sky Search and Map Mission subtests) and
ADHD symptoms (ACTeRS) were assessed at baseline and post-training.
A series of t tests were used to examine pre-to-post-test differences be­
tween groups. No intervention effects were found for sustained atten­
tion. The mindfulness group demonstrated significant improvements in
selective attention (total score from the TEA-Ch; p < .001, d = 0.60) and
attentional behaviour (p = .001, d = 0.49). Limitations include the lack
of clarity and/or consistency of control activities, no long-term follow up
and unclear what statistical analyses were conducted (e.g., “paired t-
tests (…) between groups”).
Study 23: Meijer et al. (2021)
In this cluster-randomised controlled trial, children were assigned to
an aerobic exercise group (n = 221), cognitively demanding exercise
group (n = 240) or a passive control group (n = 430). The aerobic ex­
ercise group consisted of activities designed to target moderate-to-
E.J. Slattery et al.
vigorous intensity while avoiding high cognitive demands. The focus
was on highly repetitive and automated exercises (e.g., running, squats
etc.). The cognitively demanding exercise group consisted of team
games or exercises that required complex movement, strategic play,
cooperation between children, anticipating behaviour and dealing with
changing task demands. Both groups received four sessions per week
over 14 weeks. Participants completed the ANT (5 measures), Digit Span
Task (2 measures), Grid Task (2 measures), Stop Signal Task (1 measure)
at baseline and post-test. Principal components analysis was used to
derive composite scores. Six components were extracted: 1) information
processing and control (information processing speed, lapses of atten­
tion and motor inhibition), 2) interference control (speed and accuracy
of interference control), 3) attention accuracy (accuracy of alerting
attention and spatial orientation), 4) visuospatial working memory
(visuospatial working memory and visuospatial short-term memory), 5)
verbal working memory (verbal working memory and verbal short-term
memory), and 6) attention efficiency (speed of alerting attention and
spatial attention to information). The results indicated no statistically
significant differences between the two intervention groups and the
control group for any of the components. Study strengths include its
large sample size and extensive cognitive test battery.
Study 24: Cherriere et al. (2020)
In this non-randomised study, children with Charcot-Marie-Tooth
disease aged 7–12 years were assigned to a dance group (n = 5) or a
passive control (n = 4). Participants in the dance group received
training in various complex dance forms (e.g., jazz, break dance and tap)
twice weekly for 10 weeks. Both groups completed measures of sus­
tained attention (Score! subtest and Score DT subtest of the TEA-Ch)
short-term memory (Forward Span subtest of the WISC-IV) and work­
ing memory (Backward Span subtest of the WISC-IV) at baseline and
post-test. The intervention group demonstrated greater improvements in
sustained attention (Score! subtest; p = .03) compared to the control
group. No other between group effects were statistically significant.
Serious methodological limitations include the small sample size and
non-randomised design.
Study 25: Duarte et al. (2020)
Adolescents aged 12–14 years were cluster-randomised to a Qigong
group (n = 22), active control group (n = 22) or passive control group
(n = 22). Qigong integrates movement and breathing exercises that
require and induce a special kind of mental state of ‘awareness’ or
‘attention’. The Qigong group performed the White Ball Qigong exercise,
according to the Heidelberg Model of Traditional Chinese Medicine. The
active control group performed a sham Qigong. Both groups performed
their respective activities for 5 min, twice a week, over a 4-week period.
They were also encouraged to repeat the exercises at home on a daily
basis. Participants completed the d2 test of attention at baseline, after
two weeks and four weeks of training. The following measures were
extracted: total number of items processed (TN), total hits (TH), total
number of items minus error scores (TN-E), concentration performance
(CP) and fluctuation rate (FR). The Qigong group demonstrated signif­
icant improvements in the total number of items processed (TN), total
hits (TH), total number of items minus error scores (TN-E) and con­
centration performance (CP) compared to both the active and passive
control groups after four weeks of practice.
Study 26: García-Hermoso et al. (2020)
In this cluster-randomised controlled trial, children from schools
with low socioeconomic status were assigned to the Active-Start pro­
gramme (n = 100) or a passive control (n = 70). Participants in the
Active-Start programme completed physical games focused on group
cooperation. The intensity of the main part of the sessions was moderate-
23
Neuroscience and Biobehavioral Reviews 137 (2022) 104633
to-vigorous. The d2 Test of Attention (2 measures) and academic per­
formance (numeric grade scores ranging from 7 excellent to 1 not suf­
ficient) were administered. No statistically significant intervention
effects were found for concentration (d =.08, p = .535) or selective
attention (d =.04, p = .124). However, significant changes were found
for language performance (d =.83, p < .001) and mathematics perfor­
mance (d =.60, p < .001).
Study 27: Hedayatjoo et al. (2020)
Thirty-six children with hearing deficits (7–12 years) were randomly
assigned to an intervention group (n = 18) or passive control group
(n = 18). The intervention group completed balance exercises over a 4-
week period. Both groups completed a CPT to assess sustained attention
before and after the intervention. The results indicated that the inter­
vention group improved significantly from pre- to post-test on CPT
performance (p = .002) though it was not clear what CPT outcome
measure was used in the analysis. In contrast, the control group did not
significantly improve from pre- to post-test (p = .906). In addition, the
pre- to post-test difference was compared between groups and indicated
a significant difference between the groups (p = .017).
Study 28: Månsson et al. (2019)
In this non-randomised study, children (those with ADHD and those
with ADHD symptoms) aged 10–14 years were assigned to a physical
activity group (n = 64) or passive control (n = 66). The physical activity
group participated in target shooting practice for a period of 6-months
(1 h session each week). Participants in both groups completed the
cognitive tests of attention QbTest™ (2 sustained attention variables
and 2 hyperactivity variables) and parents/teachers completed a rating
scale measures of ADHD symptoms (ADHD Rating Scale; 1 variable),
behaviour problems (Strengths and Difficulties Questionnaire; 1 vari­
able), and quality of life (KIDSCREEN-27; 1 variable) before and after
the intervention. The physical activity group demonstrated greater im­
provements in the two measures of sustained attention, Qb reaction time
variance (p = .013) and Qb omission errors (p = .019), parent-rated
ADHD symptoms (p = .024) and parent-rated behavioural problems
(p = .027). However, there was a significant difference between the
groups at baseline on QB omissions, which complicates the interpreta­
tion of intervention-related improvements in this outcome. Further­
more, it is likely the parents of children in the intervention group likely
had a greater expectation of improvement than parents of children in the
control group.
Study 29: Buchele Harris et al. (2018)
Buchele Harris et al. (2018) concluded that daily brief
coordinated-bilateral physical activities (CBPA) can improve attention
and concentration in fifth grade students. In this study, participants were
assigned to a CBPA training + Fitbit group (n = 31), Fitbit only group
(n = 29), or passive control (n = 56). The CBPA group received CBPA
breaks (6 min × 5 days) during the school day and were given fitness
trackers to wear Monday to Friday over 4 weeks. Sustained attention
was assessed pre- and post-training using outcome measures from the d2
Test of Attention (processing speed, focused attention, concentration
performance and attention span). At pre-test, the control group had
significantly higher processing speed, focused attention, and concen­
tration performance scores than the CBPA and Fitbit only group. Post
hoc comparisons revealed significant improvements in the CBPA group
in speed (p = .010), focused attention (p = .02), concentration perfor­
mance (p < .001) and attention span (p < .001) compared to the passive
control. There were also significant improvements in the CBPA group in
concentration performance (p < .001) and attention span (p = .011)
compared to the Fitbit only group. These findings suggest the
coordinated-bilateral physical activities may improve sustained
E.J. Slattery et al.
attention though results should be interpreted cautiously given the
many study limitations. Limitations include no randomisation and sig­
nificant differences between groups at pre-test which were not
accounted for in the analyses.
Study 30: Rezaei et al. (2018)
In this study, 21 children aged 7–11 years were assigned to a yoga
group (n = 7), neurofeedback group (n = 7) or passive control (n = 7).
The yoga group consisted of yoga and relaxation exercises. The neuro­
feedback training consisted of theta/beta training. Both groups received
24 training sessions over 8 weeks. Various measures of attention (7
different variables) were administered before and after the intervention.
The authors first compared each intervention group to the control group
and then compared the two intervention groups. For the purposes of this
review, we only report yoga-control comparisons. In relation to the
yoga-control comparison, an ANCOVA (not clear what was controlled
for) indicated a significant effect of group on CPT correct detection
(p = .001, ηp2 =.878), CPT errors of omission (p = .008, ηp2 = .722), CPT
errors of commission (p = .001, ηp2 =.888), WISC number sequencing
(p = .004, ηp2 =.772) and WISC Coding (p = .015, ηp2 =.652). The yoga
group seemed to demonstrate improvements in all these variables except
for CPT errors of commissions, which were lower in the control group.
Given the small sample used, the results should be interpreted
cautiously.
Study 31: Chou and Huang (2017)
In this non-randomised study, the intervention group received 8
weeks of yoga with two sessions per week and was compared to a passive
control group. Participants were assigned to a yoga exercise intervention
(n = 25) or treatment as usual (n = 25). Each yoga session consisted of
10-minutes of stretching and warming up followed by a 20-min yoga
activity, which included concentration and balance, improved attention
and breath and body awareness, and a 10-min cool down. Both groups
completed a sustained attention task (Visual Pursuit Test) and a
discrimination task at baseline and within one week of completing the
intervention. At post-test, the yoga group showed improvements in
sustained attention, Visual Pursuit Accuracy Rate (p = .010, d = 0.78)
and RT (p < .001, d = − 1.20) compared to the control. Improvements in
the Discrimination task Response Accuracy (p < .001, d = 1.09) and RT
(p < .001, d = − 1.25) were also found in the yoga group compared to
the control group at post-test. Overall, these findings suggest that a yoga
exercise intervention may improve sustained attention in children with
ADHD; however, the study has many methodological limitations (e.g.,
non-randomised design, passive control and no long-term follow up for
cognitive measures), which restrict the interpretation of results.
Study 32: Sabel et al. (2017)
Sabel et al. (2017) found that active video gaming improved motor
and process skills but not sustained attention in thirteen childhood brain
tumour survivors aged 7–17 years. Participants were randomised to
either an intervention or waitlist control group. After 10–12 weeks the
groups crossed over. The intervention involved active video gaming
using Nintendo Wii (5 days per week) and weekly online coaching ses­
sions for 10–12 weeks. Training had no effect on the primary cognitive
outcome measures which included (among others) sustained attention,
working memory, long-term memory, information processing speed and
executive function. Parallel group analysis indicated that the interven­
tion group demonstrated significantly improved Process scores on the
Activities of Daily Living assessment (p = .030), suggesting they became
more independent in their daily lives (secondary outcome). However,
we cannot draw conclusions about the impact of active video gaming on
attention due to the small sample size and cross over design.
24
Neuroscience and Biobehavioral Reviews 137 (2022) 104633
Study 33: Gallotta et al. (2015)
In this cluster-randomised trial, normal and overweight children
aged 8–11 years were assigned to a traditional physical activity group
(n = 78), a coordinative physical activity group (n = 83) or a passive
control (school as usual; n = 69). The traditional physical activity group
primarily focused on endurance, strength, flexibility exercises and cir­
cuit training for cardiovascular health. The coordinative physical ac­
tivity intervention was focused on improving the coordination and
dexterity of participants. Interventions were administered in school over
5 months. Both groups completed two 1-hour sessions per week over a
five-month period. The d2 Test of Attention was administered at pre-
and post-test. Three outcome measures were extracted: items processed,
concentration and % errors. Within group analyses indicated that the
traditional physical activity group improved in all measures from pre- to
posttest and the coordinative physical activity group improved in con­
centration and % errors. No improvements were found in the control
from pre- to post-test. Analyses were also conducted with the absolute
variation and the percentage variation (i.e., post-intervention score –
pre-intervention score). The traditional physical activity group led to a
higher improvement of total number of items processed compared to the
coordinative group, while coordinative physical activity led to higher
improvements in concentration and % error scores than the traditional
physical activity and control group (exact p values not reported).
Study 34: Zach et al. (2015)
In this study, class groups (aged 4–5 years) were assigned to a dance
group (n = 40), orienteering group (n = 44) or passive control (n = 39).
Both intervention groups received 9 weekly sessions. Participants
completed MOXO Continuous Performance Test (8 variables) and a
spatial perception task (at least 4 variables). Note, two versions of the
MOXO CPT task were used in the study. The orienteering group
completed an interactive version, while the dance group and control
group completed a non-interactive version. A series of ANOVAs
comparing the dance to the control group indicated there was a signif­
icant time by group interaction effect on CPT attention (p < .05, η2
=.062) and CPT impulsivity (p < .01, η2 =.126) when the stimuli were
accompanied by disturbances (no follow up tests reported). A paired
samples t-test indicated the orienteering group improved its perfor­
mance on the interactive version of the MOXO (Timing; p = .046). A
number of significant time × group interaction effects were found for
the spatial perception task but again no post hoc tests were reported.
Strengths of the study included a fairly large sample size though lack of
randomisation, no correction for multiple comparisons and no active
control group limit conclusions.
Study 35: Spitzer and Hollmann (2013; Study 1)
In this non-randomised study, two sixth grade classes were assigned
to an intervention group (n = 24) or passive control (n = 20). The
intervention group received three extra exercise lessons (e.g., basketball,
soccer, dance) for 30-min during the first hour of the school day over a 4-
month period (36 sessions). The control group received education as
usual. Participants completed the d2 Test of Attention (4 different sus­
tained attention variables) and teachers completed ratings of social and
studying behaviour (10 subscales). Academic grades in maths, German
and English were also used as study outcomes. No intervention effects
were reported for sustained attention. However, there was a significant
interaction effect found for teacher ratings of accurateness while
studying (p = .01). The authors reported that scores in the intervention
improved after the intervention while scores in the control group
decreased (post hoc tests and descriptive results were not reported).
There was also a significant interaction effect on German grades. Grades
in the intervention group improved at post-test whereas grades in the
control group worsened (again post hoc tests and descriptive results
E.J. Slattery et al.
were not reported).
Study 36: Spitzer and Hollmann (2013; Study 2)
One-hundred and forty-eight sixth grade children were initially
assigned to an intervention or passive control according to class groups.
However, one school subsequently dropped out, which resulted in a final
sample of 88 children. The intervention group received 30 extra exercise
lessons for 30-minutes at the start of the school day. Participants took
part in various games that could be played with 3–4 members on each
team. This study used the same outcome measures as Spitzer and Holl­
mann (2013; Study 1). The results indicated a group by time interaction
effect on concentration performance (d2 Test of Attention; p = .01). The
authors reported that pre-to-post improvement was greater in the
physical activity group than in the control (tests and descriptive results
were not reported). There was also a significant time by group interac­
tion effect on maths grades. The authors reported that the control
group’s grades worsened while the physical activity group’s grades
improved (again tests were not reported). In relation to teacher ratings,
the authors reported that the “prosocial behaviour of the intervention
group changed positively” though again these results were not reported.
Study 37: Verret et al. (2012)
In this study, children with ADHD (7–12 years) were assigned to the
intervention (n = 10, 9 boys) or control group (n = 11, 10 boys). The
intervention group received 30 physical activity training sessions over
10 weeks. Various physical activities were used such as basketball,
soccer, and tag. The main objective of each session was to maintain
moderate to vigorous intensity. Participants in both groups completed
cognitive tests of attention and response inhibition (assessed using the
Test of Everyday Attention for Children; 5 different variables) and
parent/teachers completed a measure of behaviour problems (Child
Behaviour Checklist; 11 different variables) before and after the inter­
vention. The intervention group demonstrated better sustained attention
(Score; p = .03) and visual search (Sky Search Time Target; p = .05) at
post-test compared to the control. Participants in the physical activity
group had significantly lower parent ratings for Child Behaviour
Checklist total problems (p = .038), social problems (p = .033), thought
problems (p = 0.19) and attention problems (p = .01) after the inter­
vention compared to the control. For teacher ratings, the physical ac­
tivity group had a significantly lower anxiety-depression score (p = .01)
and fewer social problems (p = .05) after the intervention compared to
the control. As noted by the authors, a key limitation of the study was
that both parents and teachers were aware of the treatment and prob­
ably had expectations for changes.
References
*References marked with an asterisk denote studies included in the review.
(*) Bauer, C.C., Rozenkrantz, L., Caballero, C., Nieto-Castanon, A., Scherer, E., West, M.
R., Mrazek, M., Phillips, D.T., Gabrieli, J.D., Whitfield-Gabrieli, S., 2020.
Mindfulness training preserves sustained attention and resting state anticorrelation
between default-mode network and dorsolateral prefrontal cortex: a randomized
controlled trial. Hum. Brain Mapp. 41 (18), 5356–5369. https://doi.org/10.1002/
hbm.25197.
Bender, R., Lange, S., 2001. Adjusting for multiple testing—when and how? J. Clin.
Epidemiol. 54 (4), 343–349. https://doi.org/10.1016/S0895-4356(00)00314-0.
Best, J.R., 2010. Effects of physical activity on children’s executive function:
contributions of experimental research on aerobic exercise. Dev. Rev. 30 (4),
331–351. https://doi.org/10.1016/j.dr.2010.08.001.
Betts, J., McKay, J., Maruff, P., Anderson, V., 2006. The development of sustained
attention in children: the effect of age and task load. Child Neuropsychol. 12 (3),
205–221. https://doi.org/10.1080/09297040500488522.
(*) Bikic, A., Christensen, T.O., Leckman, J.F., Bilenberg, N., Dalsgaard, S., 2017.
A double-blind randomized pilot trial comparing computerized cognitive exercises to
Tetris in adolescents with attention-deficit/hyperactivity disorder. Nord. J.
Psychiatry 71 (6), 455–464. https://doi.org/10.1080/08039488.2017.1328070.
(*) Bikic, A., Leckman, J.F., Christensen, T.O., Bilenberg, N., Dalsgaard, S., 2018.
Attention and executive functions computer training for attention-deficit/
hyperactivity disorder (ADHD): results from a randomized, controlled trial. Eur.
25
Neuroscience and Biobehavioral Reviews 137 (2022) 104633
Child Adolesc. Psychiatry 27 (12), 1563–1574. https://doi.org/10.1007/s00787-
018-1151-y.
Bishop, S.R., Lau, M., Shapiro, S., Carlson, L., Anderson, N.D., Carmody, J., Segal, Z.V.,
Abbey, S., Speca, M., Velting, D., 2004. Mindfulness: a proposed operational
definition. Clin. Psychol. Sci. Pract. 11 (3), 230–241. https://doi.org/10.1093/
clipsy.bph077.
Boutron, I., Page, M.J., Higgins, J.P.T., Altman, D.G., Lundh, A., Hróbjartsson, A., 2022.
Chapter 7: Considering bias and conflicts of interest among the included studies. In:
Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., Welch, V.
A. (Eds.), Cochrane Handbook for Systematic Reviews of Interventions (Version 6.3).
Cochrane. www.training.cochrane.org/handbook.
Bowie, C.R., Harvey, P.D., 2006. Administration and interpretation of the Trail Making
Test. Nat. Protoc. 1 (5), 2277. https://doi.org/10.1038/nprot.2006.390.
Breslau, J., Miller, E., Breslau, N., Bohnert, K., Lucia, V., Schweitzer, J., 2009. The impact
of early behavior disturbances on academic achievement in high school. Pediatrics
123 (6), 1472–1476. https://doi.org/10.1542/peds.2008-1406.
(*) Buchele Harris, H., Cortina, K.S., Templin, T., Colabianchi, N., Chen, W., 2018.
Impact of coordinated-bilateral physical activities on attention and concentration in
school-aged children. Biomed. Res. Int. 2018, 2539748. https://doi.org/10.1249/01.
mss.0000538293.60019.1f.
Buckner, R.L., DiNicola, L.M., 2019. The brain’s default network: updated anatomy,
physiology and evolving insights. Nat. Rev. Neurosci. 20 (10), 593–608. https://doi.
org/10.1038/s41583-019-0212-7.
Button, K.S., Ioannidis, J.P.A., Mokrysz, C., Nosek, B.A., Flint, J., Robinson, E.S.J.,
Munafò, M.R., 2013. Power failure: why small sample size undermines the reliability
of neuroscience. Nat. Rev. Neurosci. 14 (5), 365–376. https://doi.org/10.1038/
nrn3475.
Cashin, A.G., McAuley, J.H., 2019. Clinimetrics: physiotherapy evidence database
(PEDro) scale. J. Physiother. 66 (1) https://doi.org/10.1016/j.jphys.2019.08.005.
(*) Cherriere, C., Martel, M., Fortin, S., Raymond, M.J., Veilleux, L.N., Lemay, M., 2020.
An adapted dance program for children with Charcot-Marie-Tooth disease: an
exploratory study. J. Bodyw. Mov. Ther. 24 (2), 85–91. https://doi.org/10.1016/j.
jbmt.2019.09.009.
(*) Chou, C.C., Huang, C.J., 2017. Effects of an 8-week yoga program on sustained
attention and discrimination function in children with attention deficit hyperactivity
disorder. Peerj 5. https://doi.org/10.7717/peerj.2883.
Cotman, C.W., Berchtold, N.C., Christie, L.-A., 2007. Exercise builds brain health: key
roles of growth factor cascades and inflammation. Trends Neurosci. 30 (9), 464–472.
https://doi.org/10.1016/j.tins.2007.06.011.
Coull, J.T., Frith, C.D., Frackowiak, R.S.J., Grasby, P.M., 1996. A fronto-parietal network
for rapid visual information processing: a PET study of sustained attention and
working memory. Neuropsychologia 34 (11), 1085–1095. https://doi.org/10.1016/
0028-3932(96)00029-2.
Crowe, S.F., 1998. The differential contribution of mental tracking, cognitive flexibility,
visual search, and motor speed to performance on parts A and B of the trail making
test. J. Clin. Psychol. 54 (5), 585–591. https://doi.org/10.1002/(SICI)1097-4679
(199808)54:5<585::AID-JCLP4>3.0.CO;2-K.
Diamond, A., Ling, D.S., 2016. Conclusions about interventions, programs, and
approaches for improving executive functions that appear justified and those that,
despite much hype, do not. Dev. Cogn. Neurosci. 18, 34–48. https://doi.org/
10.1016/j.dcn.2015.11.005.
Döpfner, M., Breuer, D., Wille, N., Erhart, M., Ravens-Sieberer, U., 2008. How often do
children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder
and hyperkinetic disorder? Parent-based prevalence rates in a national
sample–results of the BELLA study. Eur. Child Adolesc. Psychiatry 17 (1), 59–70.
https://doi.org/10.1007/s00787-008-1007-y.
(*) Duarte, L., Gonçalves, M., Mendes, P., Matos, L.C., Greten, H.J., Machado, J., 2020.
Can Qigong improve attention in adolescents? a prospective randomised controlled
trial. J. Bodyw. Mov. Ther. 24 (1), 175–181. https://doi.org/10.1016/j.
jbmt.2019.05.005.
Duncan, G.J., Dowsett, C.J., Claessens, A., Magnuson, K., Huston, A.C., Klebanov, P.,
Pagani, L.S., Feinstein, L., Engel, M., Brooks-Gunn, J., 2007. School readiness and
later achievement. Dev. Psychol. 43 (6), 1428. https://doi.org/10.1037/0012-
1649.43.6.1428.
Esterman, M., Rothlein, D., 2019. Models of sustained attention. Curr. Opin. Psychol. 29,
174–180. https://doi.org/10.1016/j.copsyc.2019.03.005.
Esterman, M., Noonan, S.K., Rosenberg, M., DeGutis, J., 2013. In the zone or zoning out?
Tracking behavioral and neural fluctuations during sustained attention. Cereb.
Cortex 23 (11), 2712–2723. https://doi.org/10.1093/cercor/bhs261.
Esterman, M., Rosenberg, M.D., Noonan, S.K., 2014. Intrinsic fluctuations in sustained
attention and distractor processing. J. Neurosci. 34 (5), 1724–1730. https://doi.org/
10.1523/JNEUROSCI.2658-13.2014.
(*) Gallotta, M.C., Emerenziani, G.P., Iazzoni, S., Meucci, M., Baldari, C., Guidetti, L.,
2015. Impacts of coordinative training on normal weight and overweight/obese
children’s attentional performance. Front. Hum. Neurosci. 9. https://doi.org/
10.3389/fnhum.2015.00577.
(*) García-Hermoso, A., Hormazábal-Aguayo, I., Fernández-Vergara, O., González-
Calderón, N., Russell-Guzmán, J., Vicencio-Rojas, F., Chacana-Cañas, C., Ramírez-
Vélez, R., 2020. A before-school physical activity intervention to improve cognitive
parameters in children: the Active-Start study. Scand. J. Med. Sci. Sports 30 (1),
108–116. https://doi.org/10.1111/sms.13537.
Gartlehner, G., Hansen, R.A., Nissman, D., Lohr, K.N., Carey, T.S., 2006. A simple and
valid tool distinguished efficacy from effectiveness studies. J. Clin. Epidemiol. 59
(10), 1040–1048. Available from. 〈https://www.ncbi.nlm.nih.gov/sites/books/NB
K44029/〉.
E.J. Slattery et al.
Gartlehner, G., Affengruber, L., Titscher, V., Noel-Storr, A., Dooley, G., Ballarini, N.,
König, F., 2020. Single-reviewer abstract screening missed 13 percent of relevant
studies: a crowd-based, randomized controlled trial. J. Clin. Epidemiol. 121, 20–28.
https://doi.org/10.1016/j.jclinepi.2020.01.005.
Gillberg, M., Åkerstedt, T., 1998. Sleep loss and performance: no “safe” duration of a
monotonous task. Physiol. Behav. 64 (5), 599–604. https://doi.org/10.1016/S0031-
9384(98)00063-8.
Gram, L., Fitchett, A., Ashraf, A., Daruwalla, N., Osrin, D., 2019. Promoting women’s and
children’s health through community groups in low-income and middle-income
countries: a mixed-methods systematic review of mechanisms, enablers and barriers.
BMJ Glob. Health 4 (6), e001972. https://doi.org/10.1136/bmjgh-2019-001972.
de Greeff, J.W., Bosker, R.J., Oosterlaan, J., Visscher, C., Hartman, E., 2018. Effects of
physical activity on executive functions, attention and academic performance in
preadolescent children: a meta-analysis. J. Sci. Med. Sport 21 (5), 501–507. https://
doi.org/10.1016/j.jsams.2017.09.595.
Green, C.S., Bavelier, D., Kramer, A.F., Vinogradov, S., Ansorge, U., Ball, K.K., Bingel, U.,
Chein, J.M., Colzato, L.S., Edwards, J.D., 2019. Improving methodological standards
in behavioral interventions for cognitive enhancement. J. Cogn. Enhanc. 3 (1), 2–29.
https://doi.org/10.1007/s41465-018-0115-y.
(*) Hedayatjoo, M., Rezaee, M., Zarei, M.A., Mirzakhany, N., Nazeri, A., Baghban, A.A.,
Hedayatjoo, Z., Dezfoly, R.M., 2020. Effect of balance training on balance
performance, motor coordination, and attention in children with hearing deficits.
Arch. Neurosci. 7 (1). https://doi.org/10.5812/ans.84869.
Hillman, C.H., Erickson, K.I., Kramer, A.F., 2008. Be smart, exercise your heart: exercise
effects on brain and cognition. Nat. Rev. Neurosci. 9 (1), 58–65. https://doi.org/
10.1038/nrn2298.
Kabat-Zinn, J., 2003. Mindfulness-based interventions in context: past, present, and
future. Clin. Psychol. Sci. Pract. 10 (2), 144–156. https://doi.org/10.1093/clipsy.
bpg016.
Katz, B., Shah, P., Meyer, D.E., 2018. How to play 20 questions with nature and lose:
reflections on 100 years of brain-training research. Proc. Natl. Acad. Sci. USA 115
(40), 9897–9904. https://doi.org/10.1073/pnas.1617102114.
Katz, B., Jones, M.R., Shah, P., Buschkuehl, M., Jaeggi, S.M., 2021. Individual differences
in cognitive training research. In: Strobach, T., Karbach, J. (Eds.), Cognitive
Training: An Overview of Features and Applications, 2nd ed. Springer, pp. 107–123.
(*) Kerns, K.A., Eso, K., Thomson, J., 1999. Investigation of a direct intervention for
improving attention in young children with ADHD. Dev. Neuropsychol. 16 (2),
273–295. https://doi.org/10.1207/S15326942DN1602_9.
(*) Kiani, B., Hadianfard, H., Mitchell, J.T., 2017. The impact of mindfulness meditation
training on executive functions and emotion dysregulation in an Iranian sample of
female adolescents with elevated attention-deficit/hyperactivity disorder symptoms.
Aust. J. Psychol. 69 (4), 273–282. https://doi.org/10.1111/ajpy.12148.
(*) Kirk, H., Gray, K., Ellis, K., Taffe, J., Cornish, K., 2017. Impact of attention training on
academic achievement, executive functioning, and behavior: a randomized
controlled trial. Am. J. Intellect. Dev. Disabil. 122 (2), 97–117. https://doi.org/
10.1352/1944-7558-122.2.97.
(*) Kirk, H.E., Gray, K.M., Ellis, K., Taffe, J., Cornish, K.M., 2016. Computerised attention
training for children with intellectual and developmental disabilities: a randomised
controlled trial. J. Child Psychol. Psychiatry 57 (12), 1380–1389. https://doi.org/
10.1111/jcpp.12615.
(*) Kirk, H.E., Spencer-Smith, M., Wiley, J.F., Cornish, K.M., 2019. Gamified attention
training in the primary school classroom: a cluster-randomized controlled trial.
J. Atten. Disord. 25 (8), 1146–1159. https://doi.org/10.1177/1087054719887435.
Kirk, H.E., Raber, A., Richmond, S., Cornish, K.M., 2020. Examining potential predictors
of attention training outcomes in children with intellectual and developmental
disorders. J. Intellect. Dev. Disabil. 1–7. https://doi.org/10.3109/
13668250.2020.1821939.
(*) Kollins, S.H., DeLoss, D.J., Cañadas, E., Lutz, J., Findling, R.L., Keefe, R.S., Epstein, J.
N., Cutler, A.J., Faraone, S.V., 2020. A novel digital intervention for actively
reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial.
Lancet Digit. Health 2 (4), e168–e178. https://doi.org/10.1016/S2589-7500(20)
30017-0.
Lange, K.W., Tucha, L., Hauser, A., Hauser, J., Lange, K.M., Stasik, D., Tucha, O., 2012.
Attention training in attention deficit hyperactivity disorder. Aula Abiert. 40 (3),
55–60.
Langner, R., Eickhoff, S.B., 2013. Sustaining attention to simple tasks: a meta-analytic
review of the neural mechanisms of vigilant attention. Psychol. Bull. 139 (4), 870.
https://doi.org/10.1037/a0030694.
(*) Leonard, N.R., Jha, A.P., Casarjian, B., Goolsarran, M., Garcia, C., Clel, C.M.,
Gwadz, M.V., Massey, Z., 2013. Mindfulness training improves attentional task
performance in incarcerated youth: a group randomized controlled intervention
trial. Front. Psychol. 4. https://doi.org/10.3389/fpsyg.2013.00792.
Lewis, F.C., Reeve, R.A., Kelly, S.P., Johnson, K.A., 2017. Sustained attention to a
predictable, unengaging Go/No-Go task shows ongoing development between 6 and
11 years. Atten. Percept. Psychophys. 79 (6), 1726–1741. https://doi.org/10.3758/
s13414-017-1351-4.
Li, G., Taljaard, M., Van den Heuvel, E.R., Levine, M.A., Cook, D.J., Wells, G.A.,
Thabane, L., 2017. An introduction to multiplicity issues in clinical trials: the what,
why, when and how. Int. J. Epidemiol. https://doi.org/10.1093/ije/dyw320.
Li, T., Higgins, J.P.T., Deeks, J.J., 2022. Chapter 5: Collecting data. In: Higgins, J.P.T.,
Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., Welch, V.A. (Eds.),
Cochrane Handbook for Systematic Reviews of Interventions (Version 6.3).
Cochrane. Available from. www.training.cochrane.org/handbook.
Lin, C.C., Hsiao, C.K., Chen, W.J., 1999. Development of sustained attention assessed
using the continuous performance test among children 6–15 years of age. J. Abnorm.
Child Psychol. 27 (5), 403–412. https://doi.org/10.1023/A:1021932119311.
26
Neuroscience and Biobehavioral Reviews 137 (2022) 104633
Lundervold, A.J., Bøe, T., Lundervold, A., 2017. Inattention in primary school is not good
for your future school achievement—A pattern classification study. PLoS One 12
(11), e0188310. https://doi.org/10.1371/journal.pone.0188310.
Mackworth, N.H., 1948. The breakdown of vigilance during prolonged visual search.
Q. J. Exp. Psychol. 1 (1), 6–21. https://doi.org/10.1080/17470214808416738.
Mak, C., Whittingham, K., Cunnington, R., Boyd, R.N., 2018. Efficacy of mindfulness-
based interventions for attention and executive function in children and
adolescents—A systematic review. Mindfulness 9 (1), 59–78. https://doi.org/
10.1007/s12671-017-0770-6.
(*) Månsson, A.G., Elmose, M., Mejldal, A., Dalsgaard, S., Roessler, K.K., 2019. The
effects of practicing target-shooting sport on the severity of inattentive, hyperactive,
and impulsive symptoms in children: a non-randomised controlled open-label study
in Denmark. Nord. J. Psychiatry 73 (4–5), 233–243. https://doi.org/10.1080/
08039488.2019.1612467.
McAvinue, L.P., Habekost, T., Johnson, K.A., Kyllingsbæk, S., Vangkilde, S.,
Bundesen, C., Robertson, I.H., 2012. Sustained attention, attentional selectivity, and
attentional capacity across the lifespan. Atten. Percept. Psychophys. 74 (8),
1570–1582. https://doi.org/10.3758/s13414-012-0352-6.
McAvinue, L.P., Vangkilde, S., Johnson, K.A., Habekost, T., Kyllingsbæk, S.,
Bundesen, C., Robertson, I.H., 2015. A componential analysis of visual attention in
children with ADHD. J. Atten. Disord. 19 (10), 882–894. https://doi.org/10.1177/
1087054712461935.
(*) Meijer, A., Königs, M., van der Fels, I.M.J., Visscher, C., Bosker, R.J., Hartman, E.,
Oosterlaan, J., 2021. The effects of aerobic versus cognitively demanding exercise
interventions on executive functioning in school-aged children: a cluster-randomized
controlled trial. J. Sport Exerc. Psychol. 1–13. https://doi.org/10.1123/jsep.2020-
0034.
(*) Mishra, J., Sagar, R., Joseph, A., Gazzaley, A., Merzenich, M., 2016. Training sensory
signal-to-noise resolution in children with ADHD in a global mental health setting.
Transl. Psychiatry 6 (4). https://doi.org/10.1038/tp.2016.45.
(*) Mishra, J., Sagar, R., Parveen, S., Kumaran, S., Modi, K., Maric, V., Ziegler, D.,
Gazzaley, A., 2020. Closed-loop digital meditation for neurocognitive and behavioral
development in adolescents with childhood neglect. Transl. Psychiatry 10 (1).
https://doi.org/10.1038/s41398-020-0820-z.
Moreau, D., 2021. How malleable are cognitive abilities? A critical perspective on
popular brief interventions. PsyArXiv. https://doi.org/10.31234/osf.io/sxwah.
Moreau, D., Conway, A.R., 2013. Cognitive enhancement: a comparative review of
computerized and athletic training programs. Int. Rev. Sport Exerc. Psychol. 6 (1),
155–183. https://doi.org/10.1080/1750984X.2012.758763.
Moreau, D., Kirk, I.J., Waldie, K.E., 2016. Seven pervasive statistical flaws in cognitive
training interventions. Front. Hum. Neurosci. 10, 153. https://doi.org/10.3389/
fnhum.2016.00153.
(*) Napoli, M., Krech, P.R., Holley, L.C., 2005. Mindfulness training for elementary
school students: the attention academy. J. Appl. Sch. Psychol. 21 (1), 99–125.
https://doi.org/10.1300/J370v21n01_05.
(*) Nejati, V., 2021. Program for attention rehabilitation and strengthening (PARS)
improves executive functions in children with attention deficit- hyperactivity
disorder (ADHD). Res. Dev. Disabil. 113, 103937. https://doi.org/10.1016/j.
ridd.2021.103937.
Parasuraman, R., 1979. Memory load and event rate control sensitivity decrements in
sustained attention. Science 205 (4409), 924–927. https://doi.org/10.1126/
science.472714.
Parker, R.A., Weir, C.J., 2020. Non-adjustment for multiple testing in multi-arm trials of
distinct treatments: rationale and justification. Clin. Trials 17 (5), 562–566. https://
doi.org/10.1177/1740774520941419.
Paus, T., Zatorre, R.J., Hofle, N., Caramanos, Z., Gotman, J., Petrides, M., Evans, A.C.,
1997. Time-related changes in neural systems underlying attention and arousal
during the performance of an auditory vigilance task. J. Cogn. Neurosci. 9 (3),
392–408. https://doi.org/10.1162/jocn.1997.9.3.392.
Peng, P., Miller, A.C., 2016. Does attention training work? A selective meta-analysis to
explore the effects of attention training and moderators. Learn. Individ. Differ. 45,
77–87. https://doi.org/10.1016/j.lindif.2015.11.012.
Petersen, S.E., Posner, M.I., 2012. The attention system of the human brain: 20 years
after. Annu. Rev. Neurosci. 35 (1), 73–89. https://doi.org/10.1146/annurev-neuro-
062111-150525.
Pingault, J.-B., Tremblay, R.E., Vitaro, F., Carbonneau, R., Genolini, C., Falissard, B.,
Côté, S.M., 2011. Childhood trajectories of inattention and hyperactivity and
prediction of educational attainment in early adulthood: a 16-year longitudinal
population-based study. Am. J. Psychiatry 168 (11), 1164–1170. https://doi.org/
10.1176/appi.ajp.2011.10121732.
Posner, M.I., Rothbart, M.K., Tang, Y.-Y., 2015. Enhancing attention through training.
Curr. Opin. Behav. Sci. 4, 1–5. https://doi.org/10.1016/j.cobeha.2014.12.008.
Rabiner, D.L., Malone, P.S., 2004. The impact of tutoring on early reading achievement
for children with and without attention problems. J. Abnorm. Child Psychol. 32 (3),
273–284. https://doi.org/10.1023/B:JACP.0000026141.20174.17.
Rapport, M.D., Orban, S.A., Kofler, M.J., Friedman, L.M., 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. Clin. Psychol. Rev. 33 (8), 1237–1252. https://doi.org/10.1016/j.
cpr.2013.08.005.
Raz, A., Buhle, J., 2006. Typologies of attentional networks. Nat. Rev. Neurosci. 7 (5),
367–379. https://doi.org/10.1038/nrn1903.
Redick, T.S., Shipstead, Z., Wiemers, E.A., Melby-Lervåg, M., Hulme, C., 2015. What’s
working in working memory training? An educational perspective. Educ. Psychol.
Rev. 27 (4), 617–633. https://doi.org/10.1007/s10648-015-9314-6.
E.J. Slattery et al.
(*) Rezaei, M., Kamarzard, T.S., Razavi, M.N., 2018. The effects of neurofeedback, yoga
interventions on memory and cognitive activity in children with attention deficit/
hyperactivity disorder: a randomized controlled trial. Ann. Appl. Sport Sci. 6 (4),
17–27. https://doi.org/10.29252/aassjournal.6.4.17.
(*) Ricarte, J.J., Ros, L., Latorre, J.M., Beltrán, M.T., 2015. Mindfulness-based
intervention in a rural primary school: effects on attention, concentration and mood.
Int. J. Cogn. Ther. 8 (3), 258–270. https://doi.org/10.1521/ijct_2015_8_03.
Robertson, I.H., Manly, T., Andrade, J., Baddeley, B.T., Yiend, J., 1997. Oops!’:
performance correlates of everyday attentional failures in traumatic brain injured
and normal subjects. Neuropsychologia 35 (6), 747–758. https://doi.org/10.1016/
S0028-3932(97)00015-8.
(*) Rueda, M.R., Checa, P., Cómbita, L.M., 2012. Enhanced efficiency of the executive
attention network after training in preschool children: immediate changes and
effects after two months. Dev. Cogn. Neurosci. 2, S192–S204. https://doi.org/
10.1016/j.dcn.2011.09.004.
(*) Sabel, M., Sjolund, A., Broeren, J., Arvidsson, D., Saury, J.M., Gillenstr, J.,
Emanuelson, I., Blomgren, K., Lannering, B., 2017. Effects of physically active video
gaming on cognition and activities of daily living in childhood brain tumor
survivors: A randomized pilot study. Neuro-Oncol. Pract. 4 (2), 98–110. https://doi.
org/10.1093/nop/npw020.
Sarter, M., Givens, B., Bruno, J.P., 2001. The cognitive neuroscience of sustained
attention: Where top-down meets bottom-up. Brain Res. Rev. 35 (2), 146–160.
https://doi.org/10.1016/S0165-0173(01)00044-3.
(*) Sarzyńska, J., Żelechowska, D., Falkiewicz, M., Nęcka, E., 2017. Attention training in
schoolchildren improves attention but fails to enhance fluid intelligence. Stud.
Psychol. 59 (1), 50–65. https://doi.org/10.21909/sp.2017.01.730.
Sato, Y., Saijo, Y., Yoshioka, E., 2021. Work stress and oral conditions: a systematic
review of observational studies. BMJ Open 11 (5), e046532. https://doi.org/
10.1136/bmjopen-2020-046532.
(*) Schrieff-Elson, L.E., Ockhuizen, J.H., During, G., Thomas, K.G.F., 2017. Attention-
training with children from socioeconomically disadvantaged backgrounds in Cape
Town. J. Child Adolesc. Ment. Health 29 (2), 147–167. https://doi.org/10.2989/
17280583.2017.1372285.
Seeley, W.W., Menon, V., Schatzberg, A.F., Keller, J., Glover, G.H., Kenna, H., Reiss, A.L.,
Greicius, M.D., 2007. Dissociable intrinsic connectivity networks for salience
processing and executive control. J. Neurosci. 27 (9), 2349. https://doi.org/
10.1523/JNEUROSCI.5587-06.2007.
Shipstead, Z., Redick, T.S., Engle, R.W., 2012. Is working memory training effective.
Psychol. Bull. 138 (4), 628–654. https://doi.org/10.1037/a0027473.
Simmons, J.P., Nelson, L.D., Simonsohn, U., 2011. False-positive psychology: undisclosed
flexibility in data collection and analysis allows presenting anything as significant.
Psychol. Sci. 22 (11), 1359–1366. https://doi.org/10.1177/0956797611417632.
Simons, D.J., Boot, W.R., Charness, N., Gathercole, S.E., Chabris, C.F., Hambrick, D.Z.,
Stine-Morrow, E.A., 2016. Do “brain-training” programs work? Psychol. Sci. Public
Interest 17 (3), 103–186. https://doi.org/10.1177/1529100616661983.
(*) Slattery, E.J., Ryan, P., Fortune, D., McAvinue, L.P., 2021. Evaluation of a School-
based Attention Training Programme for Improving Sustained Attention.
Department of Psychology, University of Limerick, Ireland [Manuscript submitted
for publication].
Slattery, E.J., Ryan, P., Fortune, D.G., McAvinue, L.P., 2022. Unique and overlapping
contributions of sustained attention and working memory to parent and teacher
ratings of inattentive behavior. Child Neuropsychol. 1–23. https://doi.org/10.1080/
09297049.2021.2022112.
(*) Spitzer, U.S., Hollmann, W., 2013. Experimental observations of the effects of
physical exercise on attention, academic and prosocial performance in school
settings. Trends Neurosci. Educ. 2 (1), 1–6. https://doi.org/10.1016/j.
tine.2013.03.002.
Sridharan, D., Levitin, D.J., Menon, V., 2008. A critical role for the right fronto-insular
cortex in switching between central-executive and default-mode networks. Proc.
Natl. Acad. Sci. USA 105 (34), 12569–12574. https://doi.org/10.1073/
pnas.0800005105.
27
Neuroscience and Biobehavioral Reviews 137 (2022) 104633
Steinmayr, R., Ziegler, M., Träuble, B., 2010. Do intelligence and sustained attention
interact in predicting academic achievement? Learn. Individ. Differ. 20 (1), 14–18.
https://doi.org/10.1016/j.lindif.2009.10.009.
Sturm, W., Willmes, K., 2001. On the functional neuroanatomy of intrinsic and phasic
alertness. Neuroimage 14 (1), S76–S84. https://doi.org/10.1006/nimg.2001.0839.
Tamm, L., Epstein, J.N., Peugh, J.L., Nakonezny, P.A., Hughes, C.W., 2013. Preliminary
data suggesting the efficacy of attention training for school-aged children with
ADHD. Dev. Cogn. Neurosci. 4, 16–28. https://doi.org/10.1016/j.dcn.2012.11.004.
Tang, Y.-Y., Posner, M.I., 2009. Attention training and attention state training. Trends
Cogn. Sci. 13 (5), 222–227. https://doi.org/10.1016/j.tics.2009.01.009.
(*) Tarrasch, R., 2018. The effects of mindfulness practice on attentional functions
among primary school children. J. Child Fam. Stud. 27 (8), 2632–2642. https://doi.
org/10.1007/s10826-018-1073-9.
(*) Tucha, O., Tucha, L., Kaumann, G., König, S., Lange, K.M., Stasik, D., Streather, Z.,
Engelschalk, T., Lange, K.W., 2011. Training of attention functions in children with
attention deficit hyperactivity disorder. Atten. Defic. Hyperact Disord. 3 (3),
271–283. https://doi.org/10.1007/s12402-011-0059-x.
(*) Tullo, D., Guy, J., Faubert, J., Bertone, A., 2018. Training with a three-dimensional
multiple object-tracking (3D-MOT) paradigm improves attention in students with a
neurodevelopmental condition: a randomized controlled trial. Dev. Sci. 21 (6), 1–11.
https://doi.org/10.1111/desc.12670.
Unsworth, N., Robison, M.K., 2017. A locus coeruleus-norepinephrine account of
individual differences in working memory capacity and attention control. Psychon.
Bull. Rev. 24 (4), 1282–1311. https://doi.org/10.3758/s13423-016-1220-5.
Unsworth, N., Robison, M.K., 2020. Working memory capacity and sustained attention: a
cognitive-energetic perspective. J. Exp. Psychol. Learn. Mem. Cogn. 46 (1), 77.
https://doi.org/10.1037/xlm0000712.
Vater, C., Gray, R., Holcombe, A.O., 2021. A critical systematic review of the
Neurotracker perceptual-cognitive training tool. Psychon. Bull. Rev. https://doi.org/
10.3758/s13423-021-01892-2.
Vazou, S., Pesce, C., Lakes, K., Smiley-Oyen, A., 2019. More than one road leads to Rome:
a narrative review and meta-analysis of physical activity intervention effects on
cognition in youth. Int. J. Sport Exerc. Psychol. 17 (2), 153–178. https://doi.org/
10.1080/1612197X.2016.1223423.
(*) Verret, C., Guay, M.-C., Berthiaume, C., Gardiner, P., Béliveau, L., 2012. A physical
activity program improves behavior and cognitive functions in children with ADHD:
an exploratory study. J. Atten. Disord. 16 (1), 71–80. https://doi.org/10.1177/
1087054710379735.
Vickerstaff, V., Omar, R.Z., Ambler, G., 2019. Methods to adjust for multiple comparisons
in the analysis and sample size calculation of randomised controlled trials with
multiple primary outcomes. BMC Med. Res. Methodol. 19 (1), 1–13. https://doi.org/
10.1186/s12874-019-0754-4.
Waffenschmidt, S., Knelangen, M., Sieben, W., Bühn, S., Pieper, D., 2019. Single
screening versus conventional double screening for study selection in systematic
reviews: a methodological systematic review. BMC Med. Res. Methodol. 19 (1), 1–9.
https://doi.org/10.1186/s12874-019-0782-0.
(*) Wimmer, L., Bellingrath, S., von Stockhausen, L., 2016. Cognitive effects of
mindfulness training: results of a pilot study based on a theory driven approach.
Front. Psychol. 7. https://doi.org/10.3389/fpsyg.2016.01037.
Yan, C., Zhou, H., Wei, W., Wang, Y.-j, Cui, L., Chan, R.C., Deng, C., 2018.
Developmental trajectories of attention in typically developing Chinese children: a
four-wave longitudinal study. Dev. Neuropsychol. 43 (6), 479–496. https://doi.org/
10.1080/87565641.2018.1487442.
Yerkes, R.M., Dodson, J.D., 1908. The relation of strength of stimulus to rapidity of habit
formation. J. Comp. Neurol. Psychol. 18.
(*) Zach, S., Inglis, V., Fox, O., Berger, I., Stahl, A., 2015. The effect of physical activity
on spatial perception and attention in early childhood. Cogn. Dev. 36, 31–39.
https://doi.org/10.1016/j.cogdev.2015.08.003.
Zelazo, P.D., Lyons, K.E., 2012. The potential benefits of mindfulness training in early
childhood: a developmental social cognitive neuroscience perspective. Child Dev.
Perspect. 6 (2), 154–160. https://doi.org/10.1111/j.1750-8606.2012.0024.