Serious games and physical exercise show promise in boosting executive function in young people with neurodevelopmental disorders

A comprehensive review of 118 trials reveals that engaging digital games and demanding physical activities may be the most effective non-drug strategies to improve mental skills such as attention, memory, and impulse control in children and adolescents with neurodevelopmental challenges.

A large new analysis suggests that two types of activity stand out as the most promising non-drug ways to strengthen thinking skills in children and adolescents with neurodevelopmental disorders: serious digital games and cognitively demanding exercise. The review, published in eClinicalMedicine and based on 118 randomised trials involving 5,863 young people, compared a wide range of approaches aimed at improving executive functions, the mental skills children use to focus attention, remember instructions, control impulses and shift between tasks. According to the authors, the findings offer the clearest picture yet of which interventions appear to work best across different aspects of executive functioning.

The review found that non-pharmacological interventions overall were linked to better performance on task-based measures of executive function, with physical activity training producing the strongest average benefit across broader categories. Computerised cognitive training, executive function training, neurofeedback and mindfulness also showed gains, although the evidence was uneven. A separate meta-analysis indexed by PubMed found that physical activity interventions significantly improved overall executive function in children and adolescents with neurodevelopmental disorders, with factors such as session length, number of weeks and total sessions helping to shape results. Another review in the same area also reported benefits from physical-motor programmes for both executive function and emotional regulation. Taken together, the research suggests that repeated, structured activity matters more than any single short-term session.

When the researchers looked at specific executive function domains, the pattern became more precise. Serious games ranked highest for cognitive flexibility, working memory and planning, while cognitively engaging exercise ranked best for inhibitory control. The review’s authors argue that game-based formats may be especially effective because they are interactive, motivating and require children to practise updating information, monitoring actions and switching between rules. For exercise, the likely explanation is different: movement appears to support brain development through mechanisms such as increased blood flow and neuroplasticity, while also demanding attention, self-control and rapid decision-making. A Bayesian network meta-analysis focused on attention and executive function in children with ADHD reached broadly similar conclusions, finding that several non-drug approaches, including cognitive training, physical activity and neurofeedback, can help.

The findings may be encouraging for parents, but the authors are careful not to oversell them. Most of the evidence base still comes from children with ADHD, while far fewer studies have examined autism, intellectual disability, developmental coordination disorder or learning disorders. The samples were also mostly male, and many trials were judged to have at least some risk of bias. In addition, the certainty of the evidence for many of the detailed comparisons was low or very low, which means the rankings should be treated as provisional rather than definitive. The review also suggests that more sessions tend to produce stronger effects, a reminder that consistency is likely to matter as much as programme type.

Even so, the overall message is cautiously optimistic. The broader literature, including recent meta-analyses of chronic exercise and physical-motor interventions, points in the same direction: well-designed non-drug programmes can improve executive functioning in young people with neurodevelopmental disorders, especially when they are engaging and repeated over time. That leaves families and clinicians with a practical takeaway. For children who struggle with impulse control, working memory or flexible thinking, the most useful interventions may be the ones that keep them active, interested and practising long enough for the benefits to build.