Effects of a multi-modal management model incorporating executive function-targeted intervention for pediatric attention-deficit/hyperactivity disorder with comorbid emotional dysregulation

Abstract

BACKGROUND

In pediatric populations, attention-deficit/hyperactivity disorder (ADHD) is among the most frequently diagnosed neurodevelopmental disorders. Emotional dysregulation is not only integral to its core symptomatology but also crucial in determining clinical prognosis.

AIM

To investigate the efficacy of a multimodal management model incorporating executive function-targeted intervention for children with ADHD and comorbid emotional dysregulation, and to provide empirical evidence for clinical management innovation by evaluating changes in executive function, emotion regulation, core ADHD symptoms, and social function.

METHODS

A total of 112 children aged 6-12 years with ADHD and comorbid emotional dysregulation between March 2024 and January 2025 were included in this study and divided into a conventional group (58 cases receiving methylphenidate hydrochloride prolonged-release tablets + basic behavior log feedback) and an observation group (54 cases managed with a multimodal management model in addition to routine treatment). The main assessment tools included Behavior Rating Inventory of Executive Function-2^nd Edition (BRIEF-2) for executive function, Child Behavior Checklist (CBCL)/Multidimensional Anxiety Scale for Children (MASC) for emotional disorders, Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV) for ADHD symptoms, Social Skills Rating System (SSRS) for social function, and Emotion Regulation Questionnaire (ERQ) for emotional regulation strategy). All children underwent dynamic follow-up assessments at 1, 3, and 6 months postintervention.

RESULTS

After 6 months of follow-up, the observation group showed significantly lower BRIEF-2 total score (P < 0.001), CBCL Emotional Problems factor score (P = 0.023), MASC total score (P = 0.018), and SNAP-IV total score (P < 0.001), as well as higher SSRS total score (P < 0.001) and ERQ cognitive reappraisal score (P = 0.009) than in the conventional group (all P < 0.05). No significant between-group differences were observed in medication compliance (81.03% vs 88.89%) or adverse reaction incidence (15.52% vs 11.11%; P > 0.05).

CONCLUSION

The multimodal management model incorporating executive function-targeted intervention systematically addresses the cognitive, emotional, and behavioral challenges of children with ADHD and comorbid emotional dysregulation, demonstrating sustained intervention effects.

Key Words: Attention-deficit/hyperactivity disorder; Emotional dysregulation; Executive function; Multimodal intervention; Cognitive-behavioral-ecological approach

Core Tip: This retrospective cohort study explored the efficacy of a multimodal management model centered on executive function-targeted intervention for children aged 6-12 years with attention-deficit/hyperactivity disorder (ADHD) and comorbid emotional dysregulation. The model integrates medication, behavioral therapy, and family-school ecological support. It significantly improved executive function, emotional regulation ability, core ADHD symptoms, and social function while maintaining safety and medication compliance comparable to routine intervention. This cognitive-behavioral-ecological intervention paradigm provides an evidence-based foundation for transforming ADHD management from symptom control to functional rehabilitation and warrants clinical promotion with personalized stratification.

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in childhood, with a global prevalence of approximately 5%-10%[1]. Emotional dysregulation (e.g., irritability, anxiety, depression, and difficulty regulating emotions), observed in up to 30%-70% of children with ADHD, predisposes them to academic failure, peer conflicts, and strained parent-child relationships, while increasing the risk of mental disorders such as anxiety and depression in adulthood[2]. As an important component of the clinical manifestations of ADHD, emotional dysregulation is closely associated with clinical outcomes. However, its intervention is often ignored or only addressed as a secondary therapeutic goal[3]. Therefore, exploring effective intervention models for ADHD with comorbid emotional dysregulation has great clinical value.

Currently, ADHD management mainly relies on medication and behavioral therapy. However, both approaches have limited targeting for emotional dysregulation. Although medication can improve attention deficits, its direct effect on emotional regulation remains limited[4]. Traditional behavior therapy focuses mainly on explicit behavior management and lacks interventions targeting the underlying cognitive-affective processing mechanisms[5]. In recent years, executive function—encompassing cognitive flexibility related to inhibitory control, working memory, and emotional adjustment—has been recognized as the core cognitive defect in ADHD and a potential bridge between core symptoms and emotional dysregulation. For instance, impaired inhibitory control may lead to emotional impulsivity, whereas deficits in working memory may weaken an individual’s ability to integrate emotional clues[6]. However, executive function training in existing interventions is mostly delivered as isolated cognitive tasks rather than being systematically integrated into a multidimensional support system[7]. Additionally, a targeted intervention model addressing the pathogenesis of “executive function-emotional regulation” has not yet reached consensus[8]. Moreover, insufficient participation of ecological systems such as families and schools further limits the sustainability of intervention effects. These gaps contribute to limitations in current interventions for childhood ADHD with concurrent emotional dysregulation, which often emphasize symptom management rather than underlying mechanisms and focus on single intervention dimensions while ignoring integrative approaches. Most interventions also lack long-term dynamic follow-up mechanisms and individualized stratification strategies for different executive function impairment subtypes. Consequently, the sustainability of symptom improvement remains limited, and intervention effects are difficult generalize to real-life ecological contexts such as families and schools. Additionally, insufficient multidisciplinary collaboration among pediatricians, psychologists, and educators often results in discontinuous intervention measures and prevents the establishment of a synergistic support system for children with ADHD.

Therefore, this study innovatively constructs a multimodal management model centered on executive function-targeted interventions and integrates medication, behavioral therapy, family intervention, and school support. In this framework, medication stabilizes core symptoms, behavioral therapy strengthens adaptive responses, family intervention optimizes the parenting environment, and school support promotes recovery of social function, collectively forming a ”cognitive-behavioral-ecological” synergistic intervention network. This approach introduces executive function-targeted intervention into comprehensive management as the core mechanism for improving emotional dysregulation. Meanwhile, the development of a cross-scene, multiagent integrated intervention program may help clarify the mediating effect of executive function improvement on emotional regulation, thereby providing a new perspective for mechanism-oriented research. These findings can offer a more accurate and systematic intervention paradigm for children with ADHD and comorbid emotional dysregulation. If demonstrated to enhance executive function, emotional control, and social functioning, this model may provide an evidence-based foundation for clinical practice, helping to reduce the long-term psychological and social burden associated with comorbidity and facilitating the transition of ADHD management from “symptom control” to “functional rehabilitation”.

MATERIALS AND METHODS

Research design

Executive function enhancement and alleviation of emotional dysregulation postintervention served as the primary endpoints in this study. Referring to similar studies[9,10], we assumed an intergroup difference of 8 ± 10 points in the total executive function score and 5 ± 7 points in emotional disorder factor scores. With a two-tailed α = 0.05 and test efficiency (1 - β) = 0.8, calculations using G*Power 3.1 indicated a minimum requirement of 48 cases per group. Considering a 15% dropout rate, ≥ 55 patients per group were required. Based on this estimation, 112 children with ADHD and comorbid emotional dysregulation admitted between March 2024 and January 2025 were included. This study was approved by the Ethic Committee of Hangzhou Linping District Maternal & Child Health Care Hospital (Approval No. LLSC-KYKT-2025-0072-A), which strictly followed the Helsinki Declaration.

Inclusion and exclusion criteria

Inclusion criteria: (1) Age 6-12 years old, regardless of sex; meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ADHD diagnostic criteria (diagnosed by a child psychiatrist, with core symptoms ≥ 6, lasting ≥ 6 months, and affecting social function); (2) Comorbid emotional dysregulation defined as Child Behavior Checklist (CBCL) Emotional Problems factor score ≥ 60 or the average global score of Multidimensional Anxiety Scale for Children (MASC) score ≥ 50; and (3) Normal intelligence (total intelligence quotient ≥ 70 based on the Wechsler Intelligence Scale for Children, Fifth Edition).

Exclusion criteria: (1) Autism spectrum disorder, Tourette’s disorder, schizophrenia, or other neuropsychiatric disorders; (2) Recent (within 3 months) systematic executive function training, emotional intervention, or medication; serious physical diseases (e.g., epilepsy and brain injury) or intellectual disability; and (3) Inability to cooperate with the scale evaluation or intervention (e.g., refusal to participate or frequent absences).

Grouping and intervention

A retrospective cohort design was adopted in this study. Eligible children admitted from March 2024 to August 2024 were assigned to the conventional group (n = 58) and received standard clinical intervention, whereas those admitted from September 2024 to January 2025 were assigned to the observation group (n = 54) and received the multimodal management model incorporating executive function-targeted intervention. The same inclusion and exclusion criteria were applied to both cohorts to ensure comparability. In the conventional group, 58 children received routine treatment after admission. Methylphenidate hydrochloride prolonged-release tablets were administered (initial dose: 5-10 mg/day, adjusted to 0.3-0.6 mg/kg/day according to the therapeutic response). Additionally, teachers completed behavior logs and provided feedback on classroom attention and emotional problems, without targeted intervention. The children underwent a 12-week intensive intervention phase, followed by dynamic follow-up assessments at 1-, 3-, and 6-months postintervention to monitor long-term symptom changes and intervention efficacy.

Based on the routine treatment, 54 children in the observation group received multimodal comprehensive management incorporating executive function-targeted intervention: (1) Executive function-targeted intervention (30 minutes/session, three sessions/week for 12 weeks): Based on executive function subtype impairment assessment using the Behavior Rating Inventory of Executive Function-2^nd Edition (BRIEF-2) subscales, a tiered intervention using “computerized training and gamified tasks” was implemented. For inhibitory control deficits, the Cogmed QM working memory training system was used (customized inhibitory control modules such as reverse counting and interference tasks), combined with physical card games (e.g., the stop-signal task). To address emotion regulation-related insufficient cognitive flexibility, emotion card sorting (e.g., what you can/cannot do when angry) and scenario simulations (e.g., coping strategies when being teased by classmates) were used to train flexible thinking. For children with weak working memory, the digit-figure span task (i.e., reciting numbers after listening and drawing from memory) and daily task decomposition exercises (e.g., organizing the schoolbag in three steps: Textbooks - stationery - water bottle) were adopted. Certified rehabilitation therapists guided the training, and parents recorded home practice (10 minutes daily) through an application; (2) Behavioral therapy (once weekly for 12 weeks): Parents received management training and learned techniques such as positive reinforcement and extinction methods to improve parent-child interactions (e.g., using a “calm corner” during emotional outbursts). Through role-playing and video demonstrations, children were taught emotional recognition (e.g., distinguishing facial expressions of anger vs sadness) and expressing needs (e.g., “I don’t like this, please stop”); and (3) Ecological system support (throughout the intervention): Monthly family group supervision (6-8 families) was conducted to address issues in intervention implementation (e.g., poor parental compliance and adjustment of training difficulty). Additionally, communication with the child’s class teacher was established to develop an “Emotion-Behavior Support Plan” (e.g., establishing a classroom emotion corner and peer support during breaks), with progress feedback every 2 weeks.

Endpoints

Scale surveys and clinical assessments were conducted at baseline (preintervention), postintensive intervention (12 weeks), and during follow-up (1-, 3-, and 6-months postintervention). The primary analysis was based on the 6-months follow-up data, with dynamic comparisons across all time points. The following assessments were conducted before and after intervention.

The BRIEF-2 (total score 0-189): A widely used parent-rated scale with good reliability and validity for children aged 5-18 years, evaluating children’s executive function across inhibitory control, cognitive flexibility, emotional control, planning and organization domains[11]. Higher scores indicate more severe executive dysfunction.

The CBCL (total score 0-113) and MASC (total score 27-135): The CBCL is a validated parent-report scale assessing emotional and behavioral problems in children aged 6-18 years[12]. The MASC is a self-report scale with well-established psychometric properties for assessing anxiety symptoms in children and adolescents aged 8-19 years[13]. Higher scores on CBCL and MASC indicate greater mood instability and clinically significant anxiety, respectively.

The Swanson, Nolan, and Pelham Rating Scale-IV (total score 0-54): This is used to evaluate core ADHD symptoms across inattention, hyperactivity/impulsivity, and oppositional defiant domains. Higher scores indicate more severe ADHD symptoms[14].

The Social Skills Rating System (total score 28-140): This is used to evaluate social function across family support, school support, and peer support domains[15]. Higher scores indicate better social functioning.

The Emotion Regulation Questionnaire: This assesses emotional regulation strategies, including cognitive reappraisal (total score 6-60; higher scores indicate greater use of cognitive adjustment) and expressive suppression (total score 4-40; higher scores indicate greater tendency to suppress emotional expression)[16].

Medication compliance and incidence of adverse reactions during the intervention period were statistically recorded.

Statistical analysis

Data were analyzed using SPSS 32.0. Categorical variables were compared using the χ² test. For continuous variables, the Shapiro-Wilk test was first used to assess data distribution. For normally distributed data, comparisons were performed using the independent samples t-test (between groups) and the paired t-test (within groups). For nonnormally distributed data, the Mann-Whitney U (between groups) and Wilcoxon rank-sum (within groups) tests were used. A P value < 0.05 was considered statistically significant.

RESULTS

Baseline data of study participants

Comparison of patients’ baseline data, including age, sex, and family history, revealed no statistically significant intergroup difference (P > 0.05). The calculation of the standard mean difference for each variable yielded values within 0.2, indicating a low influence of confounding factors between groups and supporting group comparability (Table 1).

Table 1 Clinical baseline data of the two study groups, n (%)/mean ± SD.

	Conventional (n = 58)	Observation (n = 54)	Statistical value (t/χ2)	P value	SMD
Age (year)	8.64 ± 1.94	8.94 ± 2.02	0.818	0.415	0.152
Gender			0.275	0.600	0.100
Male	34 (58.62)	29 (53.70)
Female	24 (41.38)	25 (46.30)
Family history of ADHD			0.025	0.874	0.031
Yes	7 (12.07)	6 (11.11)
No	51 (87.93)	48 (88.89)
The one-child			0.297	0.586	0.103
Yes	46 (79.31)	45 (83.33)
No	12 (20.69)	9 (16.67)
CBCL score	76.64 ± 5.53	76.17 ± 5.12	0.467	0.641	0.088
Duration (month)	9.97 ± 2.62	9.63 ± 2.52	0.691	0.491	0.133
Single-parent family			0.243	0.622	0.102
Yes	21 (36.21)	22 (40.74)
No	37 (63.79)	32 (59.26)

ADHD: Attention-deficit/hyperactivity disorder; CBCL: Child Behavior Checklist.

Improvement of executive function

According to the survey results, both groups demonstrated a reduction in the global BRIEF-2 score posttreatment, with a greater decrease observed in the observation group than in the conventional group (P < 0.05). Specifically, the scores for all BRIEF-2 dimensions (inhibitory control, cognitive flexibility, emotional control, and planning and organization) in the observation group decreased postintervention (P < 0.05), whereas the conventional group showed a reduction only in the inhibitory control domain (P < 0.05; Figure 1).

Figure 1 Comparison of the survey results of the Behavior Rating Inventory of Executive Function-2^nd Edition scale between the two groups before and after the intervention. Behavior Rating Inventory of Executive Function-2^nd Edition includes four domains of inhibitory control, cognitive flexibility, emotional control, and planning and organization. Higher scores indicate more severe executive dysfunction. ^aP < 0.05 for intra-group comparisons; ^bP < 0.05 for inter-group comparisons. BRIEF-2: Behavior Rating Inventory of Executive Function-2^nd Edition.

Relief of emotional dysregulation

Relief of emotional dysregulation was subsequently compared. The results showed reductions in both the CBCL Emotional Problems factor and MASC scores from baseline in both groups (P < 0.05), with even lower scores observed in the observation group (P < 0.05; Figure 2).

Figure 2 Comparison of the survey results before and after the intervention in the two groups. A: Child Behavior Checklist (CBCL) scale; B: Multidimensional Anxiety Scale for Children (MASC) scale. Higher CBCL and MASC indicated more emotional instability and anxiety. ^aP < 0.05 for intra-group comparisons; ^bP < 0.05 for inter-group comparisons. CBCL: Child Behavior Checklist; MASC: Multidimensional Anxiety Scale for Children.

Control of core ADHD symptoms

Compared with the conventional group, the observation group demonstrated significantly greater reductions in Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV) total score and all subscale scores (inattention, hyperactivity/impulsivity, and oppositional defiant) postintervention (P < 0.05). Specifically, 92.59% of the observation group achieved normal symptom levels postintervention, which was significantly higher than the 55.17% in the conventional group (P < 0.001). Only four children (7.41%) in the observation group remained with marginal symptoms, compared with 26 children (44.83%) in the conventional group, and no children in either group had moderate symptoms postintervention (Table 2).

Table 2 Comparison of the survey results of the Swanson, Nolan, and Pelham Rating Scale-IV scale before and after the intervention between the two groups, n (%)/mean ± SD.

SNAP-IV		Conventional (n = 58)	Observation (n = 54)	Statistical value (t/χ2)	P value
Inattention	Baseline	11.36 ± 2.94	11.44 ± 6.89	0.163	0.871
	After	8.07 ± 2.93a	6.89 ± 2.17a	2.408	0.018
Hyperactivity/impulsivity	Baseline	11.84 ± 8.62	11.69 ± 6.81	0.286	0.776
	After	8.62 ± 2.84a	6.81 ± 2.67a	3.460	< 0.001
Oppositional defiant	Baseline	10.38 ± 3.11	10.63 ± 3.09	0.427	0.670
	After	7.98 ± 2.62a	6.57 ± 2.59a	2.860	0.005
Total score	Baseline	33.59 ± 4.68	33.76 ± 4.49	0.199	0.842
	After	24.67 ± 5.30a	20.28 ± 4.00a	4.927	< 0.001
Baseline	Normal	0 (0.00)	0 (0.00)	0.463	0.496
	Marginal	50 (86.21)	44 (81.48)
	Moderate	8 (13.79)	10 (18.52)
After	Normal	32 (55.17)	50 (92.59)	Fisher’s exact test	< 0.001
	Marginal	26 (44.83)	4 (7.41)
	Moderate	0 (0.00)	0 (0.00)

^aP < 0.05 for intra-group comparisons.

SNAP-IV: Swanson, Nolan, and Pelham Rating Scale-IV.

Social function recovery

Regarding social functioning, the observation group showed increased scores in family support, school support, and peer support, as well as the global Social Skills Rating System (SSRS) scale, postintervention (P < 0.05). In contrast, the conventional group showed improvements only in the family support dimension and the total SSRS score (P < 0.05). The intergroup comparison revealed higher scores in peer relationship and school adaptation dimensions, as well as the global SSRS scale, in the observation group (P < 0.05; Figure 3).

Figure 3 Comparison of the survey results of the Social Skills Rating System scale before and after the intervention between the two groups. Social Skills Rating System includes family support, school support, peer support and other dimensions, and higher scores indicate better social functioning. ^aP < 0.05 for intra-group comparisons; ^bP < 0.05 for inter-group comparisons. SSRS: Social Skills Rating System.

Optimization of emotion regulation strategies

The EQR survey results showed that the cognitive reappraisal factor score in the observation group increased postintervention (P < 0.05), changing from “infrequently using positive strategies” to “frequently using”, while the expressive suppression factor score decreased (P < 0.05), changing from “frequently suppressing emotions” to “occasionally suppressing”. Conversely, the Emotion Regulation Questionnaire (ERQ) scale results in the conventional group showed no significant change before and after the intervention (P > 0.05; Figure 4).

Figure 4 Comparison of the survey results of the Emotion Regulation Questionnaire scale before and after the intervention between the two groups. The Emotion Regulation Questionnaire includes two dimensions: Cognitive reappraisal and expressive suppression. ^aP < 0.05 for intra-group comparisons; ^bP < 0.05 for inter-group comparisons. ERQ: Emotion Regulation Questionnaire.

Intervention compliance and safety

The medication compliance rate exceeded 80% in both groups, with no significant difference between them (P > 0.05). Adverse reactions, including loss of appetite and insomnia, occurred in both groups; however, the total incidence differed insignificantly (P > 0.05; Table 3).

Table 3 Statistical results for compliance and adverse effects, n (%).

	Noncompliance	Compliance	Decreased appetite	Insomnia	Abdominal pain/diarrhea	Overall incidence
Conventional (n = 58)	11 (18.97)	47 (81.03)	4 (6.90)	3 (5.17)	2 (3.45)	15.52
Observation (n = 54)	6 (11.11)	48 (88.89)	3 (5.56)	2 (3.70)	1 (1.85)	11.11
χ2	1.340					0.468
P value	0.247					0.494

DISCUSSION

The intervention of ADHD-emotional dysregulation comorbidity has long been a clinical challenge. Although the traditional intervention model can partially control the core symptoms, measures targeting emotional dysregulation remain insufficient, resulting in poor long-term prognosis of children with this comorbidity[17]. Recent studies have suggested that executive dysfunction may be the key pathological mechanism linking core ADHD symptoms with emotional dysregulation[18]. In this study, a multimodal comprehensive management model of “executive function-targeted interventions as the core, combined with medication, behavioral, family, and school support” was innovatively constructed, aiming to repair cognitive deficits, optimize the ecological environment, and achieve systematic improvement of emotional regulation ability.

First, decreased scores of the global BRIEF-2 scale and the inhibitory control, cognitive flexibility, and emotional control dimensions were observed in the observation group, verifying the direct role of executive function-targeted intervention. Previous studies have shown a positive correlation between inhibitory control deficits and emotional impulsiveness, as well as a direct influence of working memory capacity on the ability to integrate emotional cues[19]. In this study, computerized training may reshape the neuroplasticity of related brain regions by repeatedly strengthening specific cognitive modules. For instance, functional magnetic resonance imaging research shows that executive function training can enhance the functional connectivity between the prefrontal cortex and amygdala, thereby improving the neural basis of emotional regulation[20]. Compared with single cognitive task training, this study incorporated gamified tasks to improve intervention enjoyment, potentially enhancing children’s participation motivation and consequently improving training efficacy. From a neurodevelopmental perspective, delayed prefrontal cortex myelination in children with ADHD leads to executive dysfunction[21]. This study directly intervened in the damaged neural circuits through hierarchical training, consistent with the theory that “cognitive training should match the neurodevelopmental stage” proposed by Ben-Zeev et al[22]. Noteworthy, the improvement in the emotional control dimension in the observation group may also be related to the enhanced activation of the ventromedial prefrontal cortex, an area that plays a key role in expressive suppression and decision-making.

Additionally, the observation group showed greater reductions in the CBCL Emotional Problems factor score and the mean global MASC score than the conventional group, suggesting that the improvement of executive function may be a core intermediary variable in emotional regulation optimization. For example, cognitive flexibility training helps children develop flexible problem-solving strategies through scenario simulation and reduces negative emotions induced by rigid thinking. This finding echoes Xie et al’s emotional regulation process model[23]—by training cognitive reappraisal strategies, children can become involved in the emotional response chain and reduce the intensity of emotional arousal. Furthermore, support from the family and school ecosystems provides a stable emotional regulation environment, further consolidating training outcomes. Robles’s ecosystem theory[24] highlights the importance of micro-system support for children’s behavior development. In this study, family supervision and school interventions established a multilevel support network, enabling the generalization of emotion regulation skills in real-life contexts. In the observation group, the ERQ cognitive reappraisal factor score increased significantly, whereas the expressive suppression factor score decreased. These findings also suggest that the multimodal intervention implemented broadens the range of emotional regulation strategies and may modify the neurocognitive model of emotional coping, consistent with the findings of Robles Bermejo[25]. Conversely, simple behavior management can restrain explicit behavior only temporarily and fails to fundamentally reconstruct the cognitive framework of emotional regulation.

Furthermore, a greater decrease in the global SNAP-IV score was determined in the observation group, accompanied by a greater number of children with restored social function. This result is consistent with the bidirectional theory of “emotion regulation-behavioral performance”: Alleviation of emotional dysregulation reduces behavioral problems caused by impulsivity or anxiety, while improvements in behavioral performance further enhance children’s self-confidence and social adaptability[26]. Moreover, parents reported that children receiving the multimodal intervention were less frequently criticized for losing control of their emotions in class, thereby forming a positive behavioral reinforcement cycle. From the perspective of social information processing[27], children with ADHD often display hostile attribution bias in social settings, leading to aggressive reactions. The emotional regulation training adopted in this study may help correct this cognitive bias and encourage children to adopt more adaptive strategies.

Based on the above findings, the following measures are recommended for clinical practice: (1) Multidisciplinary team-based diagnosis and treatment: Developmental-behavioral specialists, psychiatrists, and educational experts should jointly formulate intervention plans to ensure the synchronized implementation of executive function training, medication adjustment, and ecological support; (2) Personalized stratified intervention: Tools such as BRIEF-2 can be used to assess subtypes of executive function impairment, allowing targeted selection of training modules; (3) Family empowerment program: Regular parent workshops should be conducted to teach emotion management skills, and training progress can be visually monitored through an APP; and (4) School environment optimization: Workshops with teachers can be organized to develop ”emotional-behavior support plans”, and strategies such as peer assistance during breaks and the establishment of an emotional corner are recommended to promote the generalization of social functions.

However, this study requires further refinement. For example, it targeted ethnic Han children in urban areas and did not include groups from different cultural backgrounds or economic levels, potentially affecting result generalizability. Second, although the 6-month follow-up showed sustained effects, the long-term efficacy still requires further verification. Additionally, the conventional group received only methylphenidate hydrochloride prolonged-release tablets plus basic behavior log feedback, and the potential influence of dose adjustments on the results was not completely excluded. Finally, the BRIEF-2 is a parent-report questionnaire, which may be subject to reporting bias. Future studies should objectively assess cognitive function changes by combining neuropsychological tests.

CONCLUSION

The multimodal comprehensive management model, which focuses on targeted intervention of executive function and combines medication, behavioral, family, and school support, can improve the executive function, emotional regulation ability, and social function in children with ADHD and comorbid emotional dysregulation, with sustainable effects. This model provides evidence-based support for the clinical transition from symptom control to functional rehabilitation. In the future, it will be necessary to further expand the sample size, extend the follow-up period, and explore neuroimaging mechanisms to enhance the precision and generalizability of the intervention program.