Effect of Telerehabilitation on Handwriting Performance in Children With Attention Deficit Hyperactivity Disorder: Randomized Controlled Trial.

No follow-up after the programme ended, so nothing here shows whether the handwriting gains lasted. The control group was a waitlist receiving only their usual medication. No children were having face-to-face occupational therapy, so the trial cannot say whether online delivery matches or beats in-person treatment. The programme depended on a mother being present and hands-on for all 24 sessions. The authors themselves note the results might not have been as good without that support. Handwriting difficulty was accepted on the parents' word alone; no handwriting measure was used to decide who got in, which the authors say would have made the method stronger. Several outcome variables broke the assumption of equal variance-covariance matrices (Box's M test p < 0.01), which the authors say may limit how far the results generalise. Only the inattentive subtype of ADHD was studied, only children aged 6 to 8, and all were already on stable medication, so the findings do not automatically carry over to other subtypes, older children or children not on medication. Single centre in Turkey, and the children were already reported by their families to have handwriting problems, so all were motivated to take part.

The authors declare no conflicts of interest. Ethics approval came from Ankara City Hospital Clinical Research Ethics Committee and the trial was registered (NCT04697771). No funding source is named in the text supplied.

Do not read this as evidence that online therapy works as well as face-to-face therapy. The comparison group received nothing but their usual medication, with no follow-up afterwards, so the trial only shows the online programme beat a waitlist. Do not assume the fine motor training alone did the work, either. A mother sat beside each child for all 24 sessions carrying out the therapist's instructions, and the authors say the results might not have been as effective without that support.