Abstract
BACKGROUND: Executive function (EF) deficits are core features of neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Executive function interventions for preschool and school-age children could serve as an important primary prevention and adjunct rehabilitation strategy. OBJECTIVE: To systematically evaluate the efficacy of evidence-based executive function interventions on working memory, inhibitory control, and cognitive flexibility in Chinese children and to explore their potential for clinical translation. METHODS: Randomized controlled trials (RCTs) on executive function interventions in Chinese children were searched from PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases from inception to October 1, 2025. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Network meta-analysis (NMA) was performed using RevMan 5.4 software, and NMA was conducted using R software with the netmeta package. RESULTS: Fifty-two RCTs enrolling 2,986 Chinese children (3-12 years) met inclusion criteria. Network meta-analyses demonstrated significant, domain-specific improvements in all three core executive-function components. Working memory was most enhanced by Treatment 2 (SMD = 0.073, 95% CI = 0.037-0.109), whereas inhibitory control and cognitive flexibility were both maximized by Treatment 3 (IC: SMD = 0.093, 95% CI = 0.071-0.115; CF: SMD = 0.097, 95% CI = 0.069-0.126). CONCLUSION: Current evidence indicates that structured executive function interventions have statistically significant but modest effects on Chinese children. These findings offer preliminary support for considering non-pharmacological cognitive interventions in preventive public health strategies and rehabilitation programs for neurodevelopmental disorders in children, with further large-scale, long-term validation needed before widespread implementation. These findings offer preliminary support for integrating non-pharmacological cognitive interventions into preventive public health strategies and clinical rehabilitation programs for children with neurodevelopmental disorders, with further large-scale, long-term validation required prior to their widespread implementation in clinical and educational settings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251266663.