###### Abstract  
The content in digital intervention therapies for children with attention deficit hyperactivity disorder (ADHD) requires various technical elements to interest and motivate the children. Their structure is often quiz-based, which allows easy access to quantitative assessments. However, in this study, I verify the effectiveness of digital intervention therapy by implementing story-based game content with active participation. In this study, 48 children aged 6 to 13 years diagnosed with ADHD were recruited and assigned to experimental (story-based content) and control (quiz-based content) groups; their attention improvements were compared. The improvement in attention was assessed by comparing the change rate of the Comprehension Attention Test (CAT) and Korean ADHD Rating Scale (K-ARS) scores before and after the intervention. At 4 weeks, the CAT score change rate was significantly different between the groups (\(p=0.039\), \(p=0.040\)); the CAT score change rate before and after the intervention was significantly greater in the experimental than in the control group (\(p=0.038\)). After adjusting for the baseline, the experimental group showed a significantly greater reduction in the K-ARS impulsivity and total K-ARS scores compared with the control group (\(p=0.018\), \(p=0.012\)). Therefore, story-based content is more effective than quiz-based content in digital intervention therapy for children with ADHD. digital intervention therapy; digital content; game-based content; story-based content; ADHD +
Footnote †: journal: Applied sciences  
0000-0002-4800-3773-3800]J.S.S. Digital therapeutic interventions, also referred to as digital therapeutics (DTx), involve direct participation in virtual activities through video content and stimulating and training sensory behaviors through the content [9]. Particularly for children, the use of familiar visuals and engaging game-based content enhances their subjective motivation during the training process, fostering a sense of an active challenge. This approach increases the immersion in a task and contributes to improved attention [10]. Although numerous previous studies have demonstrated the effectiveness of digital therapeutic interventions in improving attention in children with ADHD [11; 12; 13], the influence of game-based content, specifically the structure and progression of content targeting children, has not been extensively reported. The game-based content used in digital therapeutic interventions represents a step forward from simple quiz formats to incorporating learning objectives and performance tasks that record or challenge learners to achieve quantitative target scores [14]. This study aimed to move beyond repetitive learning methods that require simple quantitative proficiency and develop a creative, story-based content approach integrated with game elements, comparing its effectiveness in digital therapeutic interventions. Traditional quiz game content can improve learners' quantitative outcomes through repeated practice and is typically structured in a step-by-step level-up format that requires repetitive single actions from the learner. In contrast, story-based game content adopts a problem-solving approach that relies on character immersion. This approach requires children to make numerous decisions and recall memories during the process, forming patterns based on the situational context, resulting in a greater number of scenarios. Consequently, compared with quiz formats, story-based content demands the development of a wider range of situation-specific content. The content used in digital therapeutic interventions is fundamentally designed with a level-based difficulty tailored to the abilities of the target individual [15]. Problem-solving abilities are evaluated based on criteria such as accuracy rates or the time required to complete tasks, and progression to the next level is determined accordingly.