## 4 Discussion  
This study analyzed whether game-based digital therapeutic content is effective in improving the cognitive abilities of children with ADHD. This study aimed to determine whether the effects of digital therapeutic interventions differ based on the type of content used. Recently, digital content aimed at increasing accessibility and motivation for the treatment and training of children with ADHD has been developed, primarily in the form of games [35]. For game-based content, incorporating an appropriate storyline into the \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline  & & \multicolumn{2}{c}{**Experimental Group (N = 20)**} & \multicolumn{2}{c}{**Control Group (N = 20)**} & \multicolumn{1}{c}{\(p\)**-Value**} \\ \cline{3-6}  & & **Mean** & **SD** & **Mean** & **SD** & \\ \hline \multirow{3}{*}{K-ARS Inattention} & Baseline & 10.48 & 0.48 & 9.18 & 0.18 & 0.108 * \\ \cline{2-6}  & Four weeks & 7.18 & 1.10 & 7.10 & 2.48 & 0.908 * \\ \cline{2-6}  & \(p\)-value & & 0.008 ** & & 0.346 ** & 0.498 ** \\ \cline{2-6}  & Change rate & 31.49 & \(-\)129.17 & 22.66 & \(-\)1277.78 & 0.670 * \\ \hline \multirow{3}{*}{K-ARS Hyperactivity-Impulsivity} & Baseline & 9.08 & 1.05 & 6.48 & 2.58 & 0.242 * \\ \cline{2-6}  & Four weeks & 5.01 & 5.18 & 5.24 & 4.03 & 0.729 * \\ \cline{2-6}  & \(p\)-value & & 0.010 ** & & 0.102 ** & 0.18 ** \\ \cline{2-6}  & Change rate & 44.82 & \(-\)393.33 & 20.99 & \(-\)56.20 & 0.002 * \\ \hline \multirow{3}{*}{K-ARS Total Score} & Baseline & 15.77 & 6.18 & 16.04 & 4.28 & 0.108 * \\ \cline{2-6}  & Four weeks & 12.15 & 8.29 & 12.58 & 9.15 & 0.910 * \\ \cline{2-6}  & \(p\)-value & & 0.026 ** & & 0.580 ** & 0.012 ** \\ \cline{2-6}  & Change rate & 22.95 & \(-\)34.14 & 21.57 & \(-\)133.79 & 0.025 * \\ \hline \hline \end{tabular}  
* Independent \(t\)-test, ** paired \(t\)-test (baseline vs. 4 weeks), and *** repeated measures ANOVA. K-ARS: Korean ADHD Rating Scale.  
\end{table} 
Table 4: The change rate of the K-ARS total score. Figure 4: K-ARS scores and change rates. execution process to engage users in the training program should be effective. This study confirmed this hypothesis. There is a digital therapeutic program for ADHD called EndeavorRx, a game software developed in the United States for children aged 8 to 12 years with ADHD [36]. EndeavorRx was approved by the Food and Drug Administration and demonstrated that game-based digital interventions can enhance cognitive function in the targeted children. Recently, functional games using digital media have been developed as adjunct therapies for mental health treatment [37]. Similar products include the autism treatment video game AKL-T01 (Akili Interactive) and an AI-based customized behavioral therapy program for children with developmental disorders, Autism Therapeutic (Cognoa) [38]. Functional game content enhances interest in learning, motivates learning engagement, and leads to improvements in learning abilities [39]. This study confirmed the effectiveness of using story-based digital media over traditional quiz content derived from conventional classroom methods in a group of children undergoing ADHD digital intervention therapy. In particular, story-based content in game-type media has shown a superior effect in enhancing focus and improving learning attitudes, thereby contributing to an increased learning effectivity in children. The effectiveness of story-based content is thought to stem from its ability to foster the prediction of upcoming events. The interest in and enjoyment of content are driven by a sequence of continuous events, and engagement arises during the anticipation of what will happen within those events. Simple quiz-based formats are less predictable and tend to follow a fixed path determined by the creator's intent. By contrast, story-based content allows for variability based on the user's role and decisions. Game-based content used in digital interventions for children with ADHD has a positive effect [23].