Background <p>Inattention and distractibility in children with attention-deficit/hyperactivity disorder (ADHD) often hinder sustained engagement in therapeutic interventions, limiting their effectiveness. Innovative approaches are needed to enhance motivation and improve functional outcomes in this population. Virtual reality provides engaging, interactive environments that can promote adherence to rehabilitation, and reward-based mechanisms may further strengthen therapeutic benefits. This randomized controlled trial investigated the transient efficacy and impact of a fixed, reward-based virtual reality program on cognitive function, static balance, and motivation in male children.</p> Methods <p>Sixty boys (mean age 8.7 ± 0.7 years) with a confirmed ADHD diagnosis were randomly assigned to either a reward-based therapy group or a conventional physiotherapy control group. Both groups participated in 45-min balance and coordination exercises three times per week. The reward group’s intervention incorporated a fixed virtual reality-based reward system. All outcomes were assessed at baseline and after 3 and 6 weeks. </p> Results <p>After 3 weeks of intervention, the reward-based therapy group demonstrated significantly greater improvements in cognitive function, static balance, and motivation compared to the control group (all p &lt; 0.05). However, these benefits were not sustained. By the 6-week assessment, no statistically significant differences were observed between the groups in any of the measured outcomes.</p> Conclusions <p>A fixed, reward-based physiotherapy program is effective for short-term improvements in cognition, motor skills, and motivation in children with ADHD. However, the diminishing effect of the fixed reward system highlights a significant limitation for long-term rehabilitation. These findings underscore the critical need for adaptive and dynamic reward strategies in extended interventions to sustain therapeutic gains.</p> <p><i>ClinicalTrials.gov Identifier</i> NCT06798337.</p>