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ADHDNCT07262853

Dual Executive Function Training Package

A study testing Executive Function Training in people with ADHD and Dyslexia, run by Education University of Hong Kong at 1 site in Hong Kong.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Executive function (EF) refers to the cognitive processes that enable goal-directed regulation of thoughts, emotions, and behaviours. Two interrelated domains are commonly distinguished: "cool" EF, which involves abstract cognitive processes, and "hot" EF, which involves regulation in emotionally or motivationally… Read more about this study

Who is it for?
Ages 6 to 11 years
Conditions the study is for
ADHD, Dyslexia, Autism
What is being tested?
Executive Function Training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
288 participants
Where
1 siteHong Kong
Study dates
13 Oct 2025to 30 Sep 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 to 11 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • aged between 6 and 11 years
  • studying at primary schools in HK
  • confirmed or suspected ADHD, ASD, or SpLD

Who cannot join

  • received executive function training
  • comorbid conditions

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Hong Kong1 site, 1 recruiting
  • EdUHK

    Tai Po

    Recruiting

Other trials in Hong Kong

About this study

Official title: Examining the Effectiveness of a Dual Executive Function Training Package: Protocol for a Randomised Controlled Trial

Executive function (EF) refers to the cognitive processes that enable goal-directed regulation of thoughts, emotions, and behaviours. Two interrelated domains are commonly distinguished: "cool" EF, which involves abstract cognitive processes, and "hot" EF, which involves regulation in emotionally or motivationally charged contexts. Children with special educational needs (SENs) frequently show difficulties across both domains, yet most interventions target one in isolation. The present study aims to evaluate the effectiveness of a dual EF training package for three of the most prevalent SENs groups: attention-deficit/hyperactivity disorder (ADHD), specific learning difficulties (SpLD), and autism spectrum disorder (ASD). A total of 288 primary school students aged 6-12 years with a diagnosis of ADHD, ASD, or SpLD will be recruited. Participants will be randomly assigned to either an intervention or waitlist control group, stratified by diagnosis. Each intervention group (n = 48) will receive the dual EF training programme, while corresponding waitlist controls (n = 48) will receive it after the study. Pre- and post-intervention assessments will include neuropsychological tests of EF, teacher- and parent-reported behavioural ratings, and measures of disability impact, school satisfaction, and social participation.

Read the detailed description

Executive functions (EF) are a set of higher-order cognitive processes that enable children to regulate their thoughts, emotions, and behaviours in pursuit of goals. Core domains include working memory, inhibitory control, and cognitive flexibility, often referred to as cool EF because they are typically measured in abstract, decontextualised contexts. Cold EFs are top-down cognitive processes that are logically based or mechanistic and operate in affectively neutral contexts. In contrast, hot EF refers to regulation in affectively or motivationally charged situations, encompassing delay discounting, affective/risky decision-making, and interpersonal and social behaviour. Both domains are crucial for children's learning, adaptation, and participation, but they rely on partially distinct neural systems and show different developmental trajectories. Importantly, recent models emphasise that hot and cool EF should not be viewed as isolated constructs but rather as interconnected components along a continuum. In real-world learning and social contexts, cognitive and affective demands are often intertwined. For example, sustaining working memory while managing frustration, or planning actions while negotiating peer dynamics, highlighting the need for interventions that address both hot and cool domains simultaneously.

EF difficulties are particularly salient in the context of special educational needs (SENs). Children with SENs are disproportionately likely to present with impairments in both hot and cool EF, which underpin many of the learning and behavioural challenges they face in schools. Among these, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and specific learning difficulties (SpLD) are the three most prevalent conditions worldwide, and they are consistently associated with executive dysfunction. ADHD, ASD, and SpLD are all characterised by combined hot and cool EF deficits. In ADHD, cool EF weaknesses in working memory, inhibition, and sustained attention are compounded by hot EF problems such as poor delay of gratification, impulsivity, and emotional dysregulation. ASD presents with cool EF impairments in flexibility, planning, and working memory. It also shows hot EF deficits in emotional regulation, reward processing, and theory of mind. SpLD is often framed as academic skill deficits. However, it also involves cool EF challenges in working memory, processing speed, and attention as well as hot EF challenges related to frustration tolerance and motivation. Despite this dual profile, many existing interventions have focused disproportionately on one side of the EF spectrum, typically emphasising cool EF while neglecting hot EF. To provide meaningful support for children with SENs, a more comprehensive approach is needed, one that systematically integrates both domains.

Existing EF interventions provide partial solutions but leave important gaps. Cognitive training studies, such as Re et al. (2015) have demonstrated that children with ADHD symptoms can improve in attention, inhibition, and working memory following structured training. These domains reflect cool EF, and while the programme successfully enhanced cognitive performance, the gains were largely confined to laboratory tasks, with modest evidence of generalisation to socio-emotional or classroom functioning. Hot EF, such as emotional regulation or social reasoning, was not directly addressed. A more ecological approach is seen in the Cognitive-Functional (Cog-Fun) intervention for ADHD. Cog-Fun is an occupational therapy programme that emphasises metacognitive strategy use, planning, organisation, and self-monitoring in daily life. Parents are also coached to support the application of strategies at home. While Cog-Fun is effective in improving organisation, homework performance, and children's self-directed behaviour, its focus remains on cool EF, with only indirect influence on hot EF domains such as emotional regulation and motivation through parent involvement.

More recent work has explicitly attempted to integrate hot EF. Shuai et al. (2017) developed an EF training package for children with ADHD that included not only core cool EF skills (working memory, inhibition, planning, flexibility, and verbal fluency) but also hot EF components such as emotional regulation. Their results showed improvements in both cognitive control and social understanding, underscoring the value of a dual-domain approach. However, the scope of hot EF was narrow, confined to Theory of Mind tasks and behavioural ratings of emotional control, and the programme was delivered in a clinic-based format, limiting scalability and ecological validity in school contexts. Similarly, Jasni et al. (2025) implemented a psychosocial group intervention combining cognitive skills training with social skills and emotional regulation exercises. Although not framed explicitly in hot-cool EF terms, the programme recognised the importance of targeting both domains. Children showed improvements in EF performance and social behaviour. Yet, the hot EF elements were integrated only loosely with cognitive training, and the lack of a systematic framework to connect the two domains limited the intervention's conceptual clarity and generalisability.

Research on EF interventions in ASD and specific learning disabilities (SpLD) reveals similar limitations. For ASD, interventions often focus on improving planning, flexibility, and organisation through structured tasks or cognitive-behavioural strategies, targeting cool EF deficits. Some studies incorporate social skills training, which overlaps with hot EF, but these are typically run as separate programmes rather than integrated EF training. This fragmented approach fails to address the interdependence of cognitive and socio-emotional regulation, both of which are impaired in ASD. In SpLD, interventions predominantly target working memory, inhibition, or attention to support reading or mathematics performance. These cool EF-focused programmes have demonstrated efficacy in improving task-related outcomes, but they neglect hot EF processes such as self-regulation, frustration tolerance, and motivational control, which are equally important for sustaining learning in students with SpLD. The absence of a hot EF component leaves a gap in addressing the broader challenges faced by students with SpLD in daily classroom participation.

Together, these findings demonstrate that while ADHD, ASD, and SpLD are all characterised by combined deficits in hot and cool EF, most existing interventions are narrow in scope, either focusing almost exclusively on cool EF or including only partial and unsystematic coverage of hot EF. Furthermore, interventions are often delivered in clinical rather than classroom contexts, which constrains ecological validity and limits opportunities for students to practise EF in authentic academic and social environments. These limitations highlight the need for a comprehensive, classroom-based intervention that systematically integrates both hot and cool EF domains, such as the Dual EF Training Package described in the present study.

Existing EF interventions have tended to adopt a fragmented architecture, with cool and hot EF components treated as separate strands rather than as interdependent processes. Cognitive training programmes often prioritise laboratory-based tasks of working memory, inhibition, or flexibility, while socio-emotional curricula focus on behavioural regulation or social skills, but the two are rarely integrated within a coherent structure. This separation is at odds with contemporary models conceptualising EF as a continuum, where cognitive and affective regulation are dynamically interlinked. In everyday contexts, children must simultaneously hold information in mind, resist distraction, and adapt flexibly, while also regulating frustration, negotiating peer relationships, and maintaining motivation. An intervention that addresses only one side of this continuum risks producing narrow, domain-bound effects with limited generalisation.

Theoretical and empirical precedents suggest that integration is both necessary and feasible. Frameworks such as the expected value of control model highlight how motivational and affective signals shape the allocation of cognitive control, underscoring the need to co-train these systems under one united topic. Similarly, approaches in self-regulated learning and early childhood curricula such as Tools of the Mind demonstrate the benefits of coupling cognitive strategies with emotion regulation and motivational scaffolding under the same area of focus. Yet, most existing efforts remain partial, addressing affect only indirectly or situating cognitive and affective training in parallel modules rather than within a unified sequence.

Taken together, prior studies demonstrate that EF is malleable and that both cognitive and socio-emotional interventions can yield measurable benefits. However, they also reveal persistent limitations: most interventions either focus narrowly on cool EF or address hot EF only incidentally, and few are implemented in ecologically valid, classroom-based contexts. The current study seeks to evaluate the effectiveness of a dual EF Training Package designed to address these gaps by explicitly integrating cool and hot EF within a coherent, school-based curriculum. The programme adopts a theme-based, paired structure in which each cool EF skill is systematically linked to its hot EF counterpart within the same chapter. To our knowledge, it represents the first intervention to employ a systematically matched hot-cool EF design across an entire curriculum. This theoretically grounded and ecologically valid model is expected to yield improvements not only in core EF performance but also in broader functional outcomes most relevant to children with SENs.

Conditions
ADHD, Dyslexia, Autism
Being tested
Executive Function Training
Keywords
Executive Functions, intervention, attention-deficit/hyperactivity disorder, specific learning difficulties, autism spectrum disorder
Medical subject headings
Attention Deficit Disorder with Hyperactivity, Dyslexia, Autistic Disorder, Autism Spectrum Disorder

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Executive Function TrainingOther

    All students will participate in a structured EF training program designed to support those with SENs. The EF training program will include weekly group training sessions lasting one hour each, which will be organised in small groups of six students to foster interaction and peer support.

Study groups in NCT07262853
Study groupRoleWhat they receive
Experimental: ADHD GroupExperimentalThis experimental group will receive the executive function training in primary schools in Hong Kong.
Receives: Other: Executive Function Training
Experimental: RD GroupExperimentalThis experimental group will receive the executive function training in primary schools in Hong Kong.
Receives: Other: Executive Function Training
Experimental: ASD GroupExperimentalThis experimental group will receive the executive function training in primary schools in Hong Kong.
Receives: Other: Executive Function Training
Waitlist Control: ADHD GroupNo interventionStudents assigned to the waitlist control group will receive the executive function training program after the experimental group has completed it.
Waitlist Control: RD GroupNo interventionStudents assigned to the waitlist control group will receive the executive function training program after the experimental group has completed it.
Waitlist Control: ASD GroupNo interventionStudents assigned to the waitlist control group will receive the executive function training program after the experimental group has completed it.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Verbal Working Memory

    Verbal working memory will be assessed using the backward digit spans subtest from the third edition of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III).

    Measured: One week before the intervention

  2. Verbal Working Memory

    Verbal working memory will be assessed using the backward digit spans subtest from the third edition of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III).

    Measured: One week after the intervention

  3. Inhibition

    The Stroop color and word test is a widely used assessment for measuring inhibition. In this test, participants will be presented with colour words printed in mismatched ink colors (for example, the word "red" written in blue ink). They will be instructed to quickly name the ink colour of each word while ignoring the word's meaning. This effort to suppress the meaning of the word to identify the ink colour consistently leads to longer response times compared to naming the colour of congruent stimuli (such as "red" printed in red ink).

    Measured: One week before the intervention

  4. Inhibition

    The Stroop color and word test is a widely used assessment for measuring inhibition. In this test, participants will be presented with colour words printed in mismatched ink colors (for example, the word "red" written in blue ink). They will be instructed to quickly name the ink colour of each word while ignoring the word's meaning. This effort to suppress the meaning of the word to identify the ink colour consistently leads to longer response times compared to naming the colour of congruent stimuli (such as "red" printed in red ink).

    Measured: One week after the intervention

  5. Attentional Control and Cognitive Flexibility

    The contingency naming test will assess attentional control and cognitive flexibility through four rules of increasing difficulty, using a stimulus set that includes nine practice items and 27 test items. Each stimulus will consist of an outer shape (circle, triangle, or square) in various colors (blue, yellow, or red), along with a smaller independent shape (circle, triangle, or square) inside the outer shape. Some stimuli will feature a backward arrow positioned directly above the outer shape. Participants will be instructed to name the stimuli based on the rule level within a set time limit.

    Measured: One week before the intervention

  6. Attentional Control and Cognitive Flexibility

    The contingency naming test will assess attentional control and cognitive flexibility through four rules of increasing difficulty, using a stimulus set that includes nine practice items and 27 test items. Each stimulus will consist of an outer shape (circle, triangle, or square) in various colors (blue, yellow, or red), along with a smaller independent shape (circle, triangle, or square) inside the outer shape. Some stimuli will feature a backward arrow positioned directly above the outer shape. Participants will be instructed to name the stimuli based on the rule level within a set time limit.

    Measured: One week after the intervention

  7. School Satisfaction

    School satisfaction will be assessed using six items derived from the Longitudinal Study of Australian Children. Respondents will rate each item on a four-point Likert scale ranging from strongly agree to strongly disagree.

    Measured: One week before the intervention

  8. School Satisfaction

    School satisfaction will be assessed using six items derived from the Longitudinal Study of Australian Children. Respondents will rate each item on a four-point Likert scale ranging from strongly agree to strongly disagree.

    Measured: One week after the intervention

  9. Executive Function

    A short form of the Behavior Rating Inventory of Executive Function (BRIEF) includes questionnaires for both parents and teachers aimed at evaluating EF in home and school settings. The BRIEF contains 24 items, which produce eight scales: Initiate, working memory, plan/organise, organisation of materials, monitor, inhibit, shift, and emotional control. Parents and teachers will rate their child or student's behaviour on a 3-point Likert scale, ranging from 1 (never) to 3 (often).

    Measured: One week before the intervention

  10. Executive Function

    A short form of the Behavior Rating Inventory of Executive Function (BRIEF) includes questionnaires for both parents and teachers aimed at evaluating EF in home and school settings. The BRIEF contains 24 items, which produce eight scales: Initiate, working memory, plan/organise, organisation of materials, monitor, inhibit, shift, and emotional control. Parents and teachers will rate their child or student's behaviour on a 3-point Likert scale, ranging from 1 (never) to 3 (often).

    Measured: One week after the intervention

  11. Social Participation

    The Social Participation Questionnaire consists of 24 statements distributed across four subscales: Friendships/relationships (five items), contacts/interactions (nine items), student's social self-perception (five items), and acceptance by classmates (five items). Class teachers will complete the SPQ for the students by responding to the statements on a 5-point Likert-type scale, with options ranging from 1 (this does not apply at all) to 5 (this strongly applies).

    Measured: One week before the intervention

  12. Social Participation

    The Social Participation Questionnaire consists of 24 statements distributed across four subscales: Friendships/relationships (five items), contacts/interactions (nine items), student's social self-perception (five items), and acceptance by classmates (five items). Class teachers will complete the SPQ for the students by responding to the statements on a 5-point Likert-type scale, with options ranging from 1 (this does not apply at all) to 5 (this strongly applies).

    Measured: One week after the intervention

  13. Severity of Disability

    The severity of disability will be measured based on the seven domains of life: material well-being, health, safety, productive activity, place in community, intimacy, and emotional well-being. The seven items will be rated on a 5-point Likert scale, ranging from 1 (not at all affected) to 5 (extremely affected).

    Measured: One week before the intervention

  14. Severity of Disability

    The severity of disability will be measured based on the seven domains of life: material well-being, health, safety, productive activity, place in community, intimacy, and emotional well-being. The seven items will be rated on a 5-point Likert scale, ranging from 1 (not at all affected) to 5 (extremely affected).

    Measured: One week after the intervention

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Dec 2025
  2. Study start13 Oct 2025
  3. Primary completion30 Jun 2026 (estimated)
  4. Study completion30 Sep 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
A randomised controlled trial will be adopted in which all assessors are blinded to the treatment condition of the students. Participants will be randomly assigned to either an experimental or a waitlist control group, stratified by diagnosis. Each intervention group (n = 48) will receive the dual EF training programme, while corresponding waitlist controls (n = 48) will receive it after the study.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
288 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07262853
Sponsor's protocol ID
The Good Shepherd Project
Status last verified
Nov 2025
First submitted
23 Nov 2025
Last updated
4 Dec 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: The decision to share IPD is not yet finalized due to ethical consideration.

Questions about this trial

What is this clinical trial studying?

A study testing Executive Function Training in people with ADHD and Dyslexia, run by Education University of Hong Kong at 1 site in Hong Kong.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 4 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Hong Kong. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Kean Poon (+61 2 9348 8143, kean.poon@unsw.edu.au), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Verbal Working Memory (time frame: One week before the intervention). The study lists 14 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Dec 2025.

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