Abstract
Background and Objectives: Attention-Deficit Hyperactivity Disorder (ADHD) is a neurological condition characterized by cognitive task difficulty, impulsivity, hyperactivity and loss of attention. This study compared four approaches for improving attention and related skills in school-age children: COGO Brain-Computer Interface (BCI)-based attention training, methylphenidate, citicoline, and their combined use. Materials and Methods: A quasi-experimental pre-post design was used with four groups: COGO + methylphenidate (n = 44), COGO + citicoline (n = 44), COGO-only (n = 44), and citicoline-only (n = 42). Children completed baseline and post-treatment assessments, including the CPT-3 and several behavioral and emotional rating scales. Analyses included paired t-tests, ANCOVA, and repeated-measures ANOVA, adjusting for age. Results: The strongest improvements appeared in the COGO + methylphenidate group, especially in measures of sustained attention and reaction time consistency. The COGO + citicoline group showed clearer gains in inhibitory control (fewer commission errors) and reductions in anxiety/emotional symptoms. The COGO-only and citicoline-only groups showed little to no measurable change. Despite these within-group patterns, there were no significant differences between groups on CPT-3 outcomes or behavioral/emotional scales. Conclusions: This trial showed that combining COGO-based attention training with medication is both feasible and well-tolerated in children with attention and executive function difficulties. Moreover, the integrated approach produced measurable improvements across attentional performance and behavioral regulation domains.