Digital tools for assessing attention and executive functions in adults: a systematic review of validity and accessibility
Vincenzo Livoti, Matteo Vitacca, Mario BonatoAbstract
Objectives:
Digital testing is being regularly used in neuropsychological research. However, critical questions remain regarding its psychometric robustness, availability, and usability, potentially limiting its clinical impact.
Methods:
This systematic review focused on the characteristics of digital tools for assessing attention and executive functions (EFs), two cognitive domains particularly suitable for being digitally tested. A systematic search was performed across three electronic databases (PubMed, Scopus, Embase). We only included studies performed on adults with validated tools.
Results:
Of 2,583 identified records, 236 studies met the inclusion criteria. From those, we extracted information about 107 distinct digital tools, ranging from computerized versions of traditional paper-and-pencil tests to emerging technologies such as virtual reality and eye-tracking hybrid systems. Most tools were administered in person (85%), while only 12% involved remote unsupervised assessment. Information on licensing, normative data, or source code availability was reported for approximately one-third of tools (34.9%). Most operated under paid licensing models, and only 6.5% were freely accessible. Only one had also source code available.
Conclusions:
Several tools are available for assessing attention and EFs; however, most are not widely used. We discuss an imbalance between accessibility and validity whereby standardized batteries are often commercial and not necessarily more validated than less commonly adopted free-access tools. The limited validation of emerging technologies currently prevents their broader implementation. Overall, distinct digital tools offer complementary strengths rather than a single optimal solution. More standardized validation approaches and broader adoption of Open Science practices might support their integration into routine clinical practice.