Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes

Working memory training and perceptual discrimination training impact overlapping and distinct neurocognitive processes: Evidence from event-related potentials and transfer of training gains

There is emerging evidence that working memory (WM) can potentially be enhanced via targeted training protocols. However, the differential effects of targeted training of WM vs. training of general attentional processes on distinct neurocognitive mechanisms is not well understood. In the present study, we compared adaptive n-back WM training to an adaptive visual search training task that targeted perceptual discrimination, in the absence of demands on WM. The search task was closely matched to the n-back task on difficulty and participant engagement. The training duration for both protocols was 20 sessions over approximately 4 weeks. Before and after training, young adult participants were tested on a battery of cognitive tasks to examine transfer of training gains to untrained tests of WM, processing speed, cognitive control, and fluid intelligence. Event-related brain potential (ERP) measures obtained during a Letter 3-Back task and a Search task were examined to determine the neural processes that were affected by each training protocol. Both groups improved on measures of cognitive control and fluid intelligence at post- compared to pretest. However, n-back training resulted in more pronounced transfer effects to tasks involving WM compared to search training. With respect to ERPs, both groups exhibited enhancement of P3 amplitude following training, but distinct changes in neural responses were also observed for the two training protocols. The search training group exhibited earlier ERP latencies at post- compared to pretest on the Search task, indicating generalized improvement in processing speed. The n-back group exhibited a pronounced enhancement and earlier latency of the N2 ERP component on the Letter 3-back task, following training. Given the theoretical underpinnings of the N2, this finding was interpreted as an enhancement of conflict monitoring and sequential mismatch identification. The findings provide evidence that n-back training enhances distinct neural processes underlying executive aspects of WM.

Zur Bedeutung auffälliger Exekutivfunktionen in der Diagnostik einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung

Zusammenfassung. Defizite in Exekutivfunktionen und insbesondere in der Inhibitionsfähigkeit gelten verschiedenen Modellen zufolge als Kerndefizite einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS). Die Defizite sind sowohl auf einer Verhaltensebene als auch auf neurobiologischer Ebene belegt, finden aber bislang kaum Einzug in die klinische Diagnostik. Verschiedene Erhebungsverfahren werden vorgestellt und die Probleme im Bereich der klinischen Diagnostik skizziert. Viele Aufgaben messen nicht eine spezifische Exekutivfunktion, sondern umfassen immer auch andere kognitive Prozesse wie zum Beispiel Aufmerksamkeit oder Test- und Leistungsmotivation. Die Sensitivität vieler Aufgaben ist aufgrund der Heterogenität von ADHS durch verschiedene Entwicklungspfade oft nicht gewährleistet und Defizite in Exekutivfunktionen und der Inhibitionsfähigkeit sind auch nicht spezifisch für ADHS. Dennoch ist eine Diagnostik auffälliger Exekutivfunktionen und insbesondere von Defiziten in der Inhibitionsfähigkeit angebracht, da nur so Aussagen über zugrunde liegende Prozesse und Ursachen einer ADHS getroffen werden können, welche die Voraussetzung für gezielte Interventionen darstellen, wie zum Beispiel Inhibitionstrainings oder Neurofeedback.

Attention-deficit hyperactivity disorder (ADHD): progress and controversy in diagnosis and treatment

Knowledge about attention-deficit hyperactivity disorder (ADHD) is rapidly accumulating. Recent advances in diagnosis, genetics, neuroimaging, drug and non-drug treatments are considered, and the results are related to the critical attack on the ADHD diagnosis, which argues it a medicalising social construct, unhelpfully sustaining power relationships. The advances reviewed suggest that, while this attack can be conclusively dismissed as wrong and misleading, the phenomenological definition of ADHD is no longer sufficient for construct validity, though continues to be valuable as a guide for clinicians. The humanising and individualising concerns underlying the attack on the diagnosis could usefully be redirected to improving effective measurement of patient outcomes.

Are Episodic Buffer Processes Intact in ADHD? Experimental Evidence and Linkage with Hyperactive Behavior

Working memory deficits are present in a substantial proportion of children with ADHD, and converging evidence links these deficits with ADHD-related behavioral and functional impairments. At the same time, working memory is not a unitary construct, and evidence is lacking regarding the role of several components of this system in ADHD. Preclinical behavioral studies are needed to fractionate the multicomponent working memory system, determine which specific subcomponent(s) are impaired in ADHD, and more importantly link these subcomponent(s) with specific ADHD-related behavioral symptoms/functional impairments. The current study reflects one piece of that puzzle, and focuses on the episodic buffer component of working memory. Across multiple testing days, a well-characterized sample of 86 children ages 8-13 (M=10.52, SD=1.54; 34 girls; 64% Caucasian/Non-Hispanic) with ADHD (n=49) and without ADHD (n=37) completed three counterbalanced working memory tests that were identical in all aspects except the key subcomponent process (phonological, visuospatial, episodic buffer). Gross motor movement during these and control tasks were measured using 4 high-precision actigraphs. There was no evidence of group differences in gender, age, SES, or IQ. Bayesian mixed-model ANOVAs indicated that the ADHD group performed significantly worse on all three working memory tests (d=1.17-1.44) and was significantly more hyperactive than controls (d=0.66-1.05) during the visuospatial and episodic buffer tests. In contrast, the ADHD and Non-ADHD groups were equivalent with regard to effects of episodic buffer demands on performance and hyperactive behavior. The most parsimonious conclusion is that the episodic buffer is likely intact in ADHD, and unrelated to ADHD hyperactivity symptoms.

Mindfulness for children with ADHD and Mindful Parenting (MindChamp): Protocol of a randomised controlled trial comparing a family Mindfulness-Based Intervention as an add-on to care-as-usual with care-as-usual only

BACKGROUND

Self-control in childhood has been linked to long-term and cascading effects on health, academic, criminality, wealth and parenting outcomes. Hence it is important to target self-control deficits early in life. Self-control deficits are a hallmark of Attention Deficit/Hyperactivity Disorder (ADHD). Even after receiving care-as-usual (CAU) for ADHD, impaired self-control often remains. Pharmacotherapy can be hampered by side-effects, low adherence and short-term effectiveness. Other limitations of CAU are decreased effectiveness when parents have ADHD and little effect on parental well-being. Mindfulness-Based Interventions (MBIs) are an emerging non-pharmacological approach with potential to improve self-control and well-being in both children and parents. However, there is a lack of sufficiently powered randomised controlled trials (RCTs) to establish their effects in families with ADHD. This study protocol describes an RCT to investigate the effectiveness of a family MBI as an add-on to CAU in treatment of youth with ADHD, and is described in accordance with Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT).

METHODS/DESIGN

An RCT will be conducted in N = 100 children (aged 8-16 years) with ADHD and their parents. The experimental condition will consist of a family MBI (MYmind): 8-week group-based MBI for youth combined with parallel group-based Mindful Parenting for their parents, as an add-on to CAU. The control condition will consist of CAU-only. Assessments will take place at baseline, end of treatment (3 months later), 2 and 6 months' follow-up. Primary outcome measure will be an ecologically valid assessment of child self-control with the parent-rated Behaviour Rating Inventory of Executive Function (BRIEF). Secondary child outcome measures will be teacher-rated BRIEF, computerised self-control tasks and questionnaires on psychological symptoms (e.g. ADHD, symptoms of autism), well-being and mindfulness. For parental outcomes, secondary measures will be self-rated BRIEF, computerised self-control tasks and questionnaires on psychological symptoms, well-being and mindful parenting.

DISCUSSION

The proposed RCT will take account of methodological limitations of previous studies on MBIs in child ADHD populations. The current study will provide valuable information on family MBI as a potential effective intervention in targeting self-control deficits for youth with ADHD and their parents.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03220308 . Retrospectively registered 18 July 2017.

Prefrontal cortex executive processes affected by stress in health and disease

Prefrontal cortical executive functions comprise a number of cognitive capabilities necessary for goal directed behavior and adaptation to a changing environment. Executive dysfunction that leads to maladaptive behavior and is a symptom of psychiatric pathology can be instigated or exacerbated by stress. In this review we survey research addressing the impact of stress on executive function, with specific focus on working memory, attention, response inhibition, and cognitive flexibility. We then consider the neurochemical pathways underlying these cognitive capabilities and, where known, how stress alters them. Finally, we review work exploring potential pharmacological and non-pharmacological approaches that can ameliorate deficits in executive function. Both preclinical and clinical literature indicates that chronic stress negatively affects executive function. Although some of the circuitry and neurochemical processes underlying executive function have been characterized, a great deal is still unknown regarding how stress affects these processes. Additional work focusing on this question is needed in order to make progress on developing interventions that ameliorate executive dysfunction.

Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits

This is a clinical intervention study of children with executive function (EF) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EXecutive function and ATtention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6-12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants' parents and teachers completed the Conners' Rating Scales-Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT. The parents reported statistically significant decreases with medium effect sizes for the CPRS-R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ, and simultaneous learning support. In conclusion, EXAT - a structured multilevel group intervention - has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.

Kindergarten Children's Executive Functions Predict Their Second-Grade Academic Achievement and Behavior

Whether and to what extent kindergarten children's executive functions (EF) constitute promising targets of early intervention is currently unclear. This study examined whether kindergarten children's EF predicted their second-grade academic achievement and behavior. This was done using (a) a longitudinal and nationally representative sample (N = 8,920, M_age  = 97.6 months), (b) multiple measures of EF, academic achievement, and behavior, and (c) extensive statistical control including for domain-specific and domain-general lagged dependent variables. All three measures of EF-working memory, cognitive flexibility, and inhibitory control-positively and significantly predicted reading, mathematics, and science achievement. In addition, inhibitory control negatively predicted both externalizing and internalizing problem behaviors. Children's EF constitute promising targets of experimentally evaluated interventions for increasing academic and behavioral functioning.

A Systematic Review of Commercial Cognitive Training Devices: Implications for Use in Sport

Background: Cognitive training (CT) aims to develop a range of skills, like attention and decision-making, through targeted training of core cognitive functions. While CT can target context specific skills, like movement anticipation, much CT is domain general, focusing on core abilities (e.g., selective attention) for transfer to a range of real-world tasks, such as spotting opponents. Commercial CT (CCT) devices are highly appealing for athletes and coaches due to their ease of use and eye-catching marketing claims. The extent to which this training transfers to performance in the sporting arena is, however, unclear. Therefore, this paper sought to provide a systematic review of evidence for beneficial training effects of CCT devices and evaluate their application to sport. Methods: An extensive search of electronic databases (PubMed, PsychInfo, GoogleScholar, and SportDiscus) was conducted to identify peer-reviewed evidence of training interventions with commercially available CT devices. Forty-three studies met the inclusion criteria and were retained for quality assessment and synthesis of results. Seventeen studies assessed transfer effects beyond laboratory cognitive tests, but only 1 directly assessed transfer to a sporting task. Results: The review of evidence showed limited support for far transfer benefits from CCT devices to sporting tasks, mainly because studies did not target the sporting environment. Additionally, a number of methodological issues with the CCT literature were identified, including small sample sizes, lack of retention tests, and limited replication of findings by researchers independent of the commercial product. Therefore, evidence for sporting benefits is currently limited by the paucity of representative transfer tests and a focus on populations with health conditions. Conclusions: Currently there is little direct evidence that the use of CCT devices can transfer to benefits for sporting performance. This conclusion, however, stems more from a lack of experimental studies in the sporting field and a lack of experimental rigor, rather than convincing null effects. Subsequently, there is an opportunity for researchers to develop more reliable findings in this area through systematic assessment in athletic populations and major methodological improvements.

Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children

The present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent-child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study's limitations, and future directions for research are further discussed.

Effect of an Ecological Executive Skill Training Program for School-aged Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Clinical Trial

Background:

As medication does not normalize outcomes of children with attention deficit hyperactivity disorder (ADHD), especially in real-life functioning, nonpharmacological methods are important to target this field. This randomized controlled clinical trial was designed to evaluate the effects of a comprehensive executive skill training program for school-aged children with ADHD in a relatively large sample.

Methods:

The children (aged 6–12 years) with ADHD were randomized to the intervention or waitlist groups. A healthy control group was composed of gender- and age-matched healthy children. The intervention group received a 12-session training program for multiple executive skills. Executive function (EF), ADHD symptoms, and social functioning in the intervention and waitlist groups were evaluated at baseline and the end of the final training session. The healthy controls (HCs) were only assessed once at baseline. Repeated measures analyses of variance were used to compare EF, ADHD symptoms, and social function between intervention and waitlist groups.

Results:

Thirty-eight children with ADHD in intervention group, 30 in waitlist group, and 23 healthy children in healthy control group were included in final analysis. At posttreatment, intervention group showed significantly lower Behavior Rating Inventory of Executive Function (BRIEF) total score (135.89 ± 16.80 vs. 146.09 ± 23.92, P = 0.04) and monitoring score (18.05 ± 2.67 vs. 19.77 ± 3.10, P = 0.02), ADHD-IV overall score (41.11 ± 7.48 vs. 47.20 ± 8.47, P < 0.01), hyperactivity-impulsivity (HI) subscale score (18.92 ± 5.09 vs. 21.93 ± 4.93, P = 0.02), and inattentive subscale score (22.18 ± 3.56 vs. 25.27 ± 5.06, P < 0.01), compared with the waitlist group. Repeated measures analyses of variance revealed significant interactions between time and group on the BRIEF inhibition subscale (F = 5.06, P = 0.03), working memory (F = 4.48, P = 0.04), ADHD-IV overall score (F = 21.72, P < 0.01), HI subscale score (F = 19.08, P < 0.01), and inattentive subscale score (F = 12.40, P < 0.01). Multiple-way analysis of variance showed significant differences on all variables of BRIEF, ADHD-rating scale-IV, and WEISS Functional Impairment Scale-Parent form (WFIRS-P) among the intervention and waitlist groups at posttreatment and HCs at baseline.

Conclusions:

This randomized controlled study on executive skill training in a relatively large sample provided some evidences that the training could improve EF deficits, reduce problematic symptoms, and potentially enhance the social functioning in school-aged children with ADHD.

Clinical Trial Registration:

http://www.clinicaltrials.gov; NCT02327585.

Pattern of executive functioning in adolescents with epilepsy: A multimethod measurement approach

Youth with epilepsy demonstrate deficits in executive functioning (EF), the skills necessary for goal-directed behavior (e.g., problem-solving, initiating, monitoring, organization, planning, and working memory). Despite 30-50% of youth with epilepsy demonstrating EF deficits, no extant studies have utilized both performance and questionnaire-based measures to examine the pattern of EF deficits in adolescents with epilepsy. Study aims were to 1) identify the pattern of EF deficits in adolescents with epilepsy and 2) identify which assessment tools are most sensitive to EF deficits in this population (adolescents, ages 13-17, with epilepsy). An exploratory aim was to examine group differences on measures of EF by epilepsy type. Standard performance-based neuropsychological measures (Wechsler Intelligence Scale for Children - Version V or Wechsler Adult Intelligence Scale Working Memory Index-Version IV, Delis Kaplan Executive Functioning System, NIH Toolbox, Test of Everyday Attention for Children) and the Behavior Rating Inventory of Executive Functioning (BRIEF) comprised the multimethod assessment battery. Depending on the measure, 30% of adolescents with epilepsy had deficits in working memory, 17% in cognitive flexibility/problem solving, 6% in inhibition, and 18% in planning/organization. Attention was a significant problem for 15% of adolescents with epilepsy. Correlations among the various EF measures were quite poor. Across various EF domains, results indicated that adolescents with localization-related epilepsy demonstrated better EF skills compared to adolescents with unclassified epilepsy. Overall, our findings suggest that executive functioning deficits are selective and different from those observed in other neurological populations (e.g., attention deficit hyperactivity disorder (ADHD), traumatic brain injury) where problems with self-regulation (i.e., inhibition, planning/organization) are more pronounced. These findings support utilizing multiple measures, including both performance-based neuropsychological tests and parent- and self-reports, to assess executive functioning difficulties in adolescents with epilepsy as they are uniquely sensitive to executive functioning domains. Adolescents with unclassified epilepsy also appear to be at higher risk for EF deficits and thus represent an important group to target for intervention.

Metacognitive interventions in text production and working memory in students with ADHD

This study compared the effects of two metacognitive interventions on writing, working memory (WM), and behavioral symptoms of students with attention-deficit/hyperactivity disorder (ADHD). The disorder was clinically diagnosed by a multidisciplinary team according to DSM-IV criteria. The first approach consisted of a combined intervention in text production and WM while the second focused only on WM. Participants were 47 students from the fifth to ninth grades of two public elementary schools in Porto Alegre (Brazil), randomized to one of the two interventions groups. Writing and WM were assessed before, immediately after, and 3 months after the interventions. The results suggest that both interventions contributed to improving behavior and school performance, whereas only the combined intervention increased the overall quality of narrative text, organization of paragraphs, and denouement.

Do "Brain-Training" Programs Work?

In 2014, two groups of scientists published open letters on the efficacy of brain-training interventions, or "brain games," for improving cognition. The first letter, a consensus statement from an international group of more than 70 scientists, claimed that brain games do not provide a scientifically grounded way to improve cognitive functioning or to stave off cognitive decline. Several months later, an international group of 133 scientists and practitioners countered that the literature is replete with demonstrations of the benefits of brain training for a wide variety of cognitive and everyday activities. How could two teams of scientists examine the same literature and come to conflicting "consensus" views about the effectiveness of brain training?In part, the disagreement might result from different standards used when evaluating the evidence. To date, the field has lacked a comprehensive review of the brain-training literature, one that examines both the quantity and the quality of the evidence according to a well-defined set of best practices. This article provides such a review, focusing exclusively on the use of cognitive tasks or games as a means to enhance performance on other tasks. We specify and justify a set of best practices for such brain-training interventions and then use those standards to evaluate all of the published peer-reviewed intervention studies cited on the websites of leading brain-training companies listed on Cognitive Training Data (www.cognitivetrainingdata.org), the site hosting the open letter from brain-training proponents. These citations presumably represent the evidence that best supports the claims of effectiveness.Based on this examination, we find extensive evidence that brain-training interventions improve performance on the trained tasks, less evidence that such interventions improve performance on closely related tasks, and little evidence that training enhances performance on distantly related tasks or that training improves everyday cognitive performance. We also find that many of the published intervention studies had major shortcomings in design or analysis that preclude definitive conclusions about the efficacy of training, and that none of the cited studies conformed to all of the best practices we identify as essential to drawing clear conclusions about the benefits of brain training for everyday activities. We conclude with detailed recommendations for scientists, funding agencies, and policymakers that, if adopted, would lead to better evidence regarding the efficacy of brain-training interventions.

Targeting self-regulation to promote health behaviors in children

Poor self-regulation (i.e., inability to harness cognitive, emotional, motivational resources to achieve goals) is hypothesized to contribute to unhealthy behaviors across the lifespan. Enhancing early self-regulation may increase positive health outcomes. Obesity is a major public health concern with early-emerging precursors related to self-regulation; it is therefore a good model for understanding self-regulation and health behavior. Preadolescence is a transition when children increase autonomy in health behaviors (e.g., eating, exercise habits), many of which involve self-regulation. This paper presents the scientific rationale for examining self-regulation mechanisms that are hypothesized to relate to health behaviors, specifically obesogenic eating, that have not been examined in children. We describe novel intervention protocols designed to enhance self-regulation skills, specifically executive functioning, emotion regulation, future-oriented thinking, and approach bias. Interventions are delivered via home visits. Assays of self-regulation and obesogenic eating behaviors using behavioral tasks and self-reports are implemented and evaluated to determine feasibility and psychometrics and to test intervention effects. Participants are low-income 9-12 year-old children who have been phenotyped for self-regulation, stress, eating behavior and adiposity through early childhood. Study goals are to examine intervention effects on self-regulation and whether change in self-regulation improves obesogenic eating.

Low Working Memory rather than ADHD Symptoms Predicts Poor Academic Achievement in School-Aged Children

This study examined whether working memory (WM), inattentive symptoms, and/or hyperactive/impulsive symptoms significantly contributed to academic, behavioral, and global functioning in 8-year-old children. One-hundred-sixty 8-year-old children (75.6% male), who were originally recruited as preschoolers, completed subtests from the Wechsler Intelligence Scale for Children-Fourth Edition, Integrated and Wechsler Individual Achievement Test-Second Edition to assess WM and academic achievement, respectively. Teachers rated children's academic and behavioral functioning using the Vanderbilt Rating Scale. Global functioning, as rated by clinicians, was assessed by the Children's Global Assessment Scale. Multiple linear regressions were completed to determine the extent to which WM (auditory-verbal and visual-spatial) and/or inattentive and hyperactive/impulsive symptom severity significantly contributed to academic, behavioral, and/or global functioning. Both auditory-verbal and visual-spatial WM but not ADHD symptom severity, significantly and independently contributed to measures of academic achievement (all p < 0.01). In contrast, both WM and inattention symptoms (p < 0.01), but not hyperactivity-impulsivity (p > 0.05) significantly contributed to teacher-ratings of academic functioning. Further, inattention and hyperactivity/impulsivity (p < 0.04), but not WM (p > 0.10) were significantly associated with teacher-ratings of behavioral functioning and clinician-ratings of global functioning. Taken together, it appears that WM in children may be uniquely related to academic skills, but not necessarily to overall behavioral functioning.

Proof-of-concept study of an at-home, engaging, digital intervention for pediatric ADHD

OBJECTIVE

Pharmacological and behavioral therapies have limited impact on the distinct neurocognitive impairments associated with ADHD, and existing cognitive training programs have shown limited efficacy. This proof-of-concept study assessed treatment acceptability and explored outcomes for a novel digital treatment targeting cognitive processes implicated in ADHD.

METHOD

Participants included 40 children with ADHD and 40 children without ADHD. Following psychiatric screening, ADHD ratings, and baseline neuropsychological measures, participants completed 28-days of at-home treatment. Neuropsychological assessment was repeated at end-of-study along with treatment satisfaction measures.

RESULTS

Eighty-four percent of treatment sessions were completed and ratings showed strong intervention appeal. Significant improvements were observed on a computerized attention task for the ADHD group and a highly impaired ADHD High Severity subgroup. There was no change for the non-ADHD group. Spatial working memory also improved for the ADHD group and the ADHD High Severity subgroup.

CONCLUSION

Findings provide preliminary support that this treatment may improve attention, working memory, and inhibition in children with ADHD. Future research requires larger-scale randomized controlled trials that also evaluate treatment impact on functional impairments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01943539.

No Medication for My Child! A Naturalistic Study on the Treatment Preferences for and Effects of Cogmed Working Memory Training Versus Psychostimulant Medication in Clinically Referred Youth with ADHD

In this naturalistic clinical study, we explored the applicability and clinical effectiveness of Cogmed WMT, pharmacotherapy, and their combination for clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Ninety youth with ADHD (ages 6-16 years) and their parents were offered the possibility to choose one of the three interventions. The motives for choosing various interventions were quite different. Medication was chosen because this treatment was expected to be most effective, but also because the Cogmed WMT program was regarded as too taxing. The choice for Cogmed WMT was mainly negatively motivated: participants tended to be strongly against the use of medication, found it a too rigorous step, or feared side effects and addiction problems. The choice for the combination treatment was strongly positively motivated: parents and youth indicated that they wanted to receive the best possible intervention and part of them also had high expectations of Cogmed WMT. In terms of clinical effectiveness, pharmacotherapy with stimulant medication and the combination treatment produced larger reductions in ADHD symptomatology than Cogmed WMT. Further, results indicated that Cogmed WMT selectively enhanced working memory performance. Finally, after conducting Cogmed WMT, youths and parents were more 'open' to accept pharmacotherapy as intervention, probably because the training increased greater insight in and awareness of the problematic features of ADHD.

Working memory and organizational skills problems in ADHD

BACKGROUND

This study tested model-driven predictions regarding working memory's role in the organizational problems associated with ADHD.

METHOD

Children aged 8-13 (M = 10.33, SD = 1.42) with and without ADHD (N = 103; 39 girls; 73% Caucasian/Non-Hispanic) were assessed on multiple, counterbalanced working memory tasks. Parents and teachers completed norm-referenced measures of organizational problems (Children's Organizational Skills Scale; COSS).

RESULTS

Results confirmed large magnitude working memory deficits (d = 1.24) and organizational problems in ADHD (d = 0.85). Bias-corrected, bootstrapped conditional effects models linked impaired working memory with greater parent- and teacher-reported inattention, hyperactivity/impulsivity, and organizational problems. Working memory predicted organization problems across all parent and teacher COSS subscales (R2  = .19-.23). Approximately 38%-57% of working memory's effect on organization problems was conveyed by working memory's association with inattentive behavior. Unique effects of working memory remained significant for both parent- and teacher-reported task planning, as well as for teacher-reported memory/materials management and overall organization problems. Attention problems uniquely predicted worse organizational skills. Hyperactivity was unrelated to parent-reported organizational skills, but predicted better teacher-reported task planning.

CONCLUSIONS

Children with ADHD exhibit multisetting, broad-based organizational impairment. These impaired organizational skills are attributable in part to performance deficits secondary to working memory dysfunction, both directly and indirectly via working memory's role in regulating attention. Impaired working memory in ADHD renders it extraordinarily difficult for these children to consistently anticipate, plan, enact, and maintain goal-directed actions.

Assessing working memory in children with ADHD: Minor administration and scoring changes may improve digit span backward's construct validity

BACKGROUND

Pediatric ADHD is associated with impairments in working memory, but these deficits often go undetected when using clinic-based tests such as digit span backward.

AIMS

The current study pilot-tested minor administration/scoring modifications to improve digit span backward's construct and predictive validities in a well-characterized sample of children with ADHD.

METHODS AND PROCEDURES

WISC-IV digit span was modified to administer all trials (i.e., ignore discontinue rule) and count digits rather than trials correct. Traditional and modified scores were compared to a battery of criterion working memory (construct validity) and academic achievement tests (predictive validity) for 34 children with ADHD ages 8-13 (M=10.41; 11 girls).

OUTCOMES AND RESULTS

Traditional digit span backward scores failed to predict working memory or KTEA-2 achievement (allns). Alternate administration/scoring of digit span backward significantly improved its associations with working memory reordering (r=.58), working memory dual-processing (r=.53), working memory updating (r=.28), and KTEA-2 achievement (r=.49).

CONCLUSIONS AND IMPLICATIONS

Consistent with prior work, these findings urge caution when interpreting digit span performance. Minor test modifications may address test validity concerns, and should be considered in future test revisions. Digit span backward becomes a valid measure of working memory at exactly the point that testing is traditionally discontinued.

Cognitive performance change of pediatric patients after conducting frontal transcortical approach to treat lateral ventricular tumor

OBJECTIVE

Applying frontal transcortical approach to treat lateral ventricular tumor is one of the most common neurosurgical manipulations. The frontal transcortical approach generally passes through the middle frontal gyrus in which there is no major function involved in the traditional sense. However, current researches have suggested that the prefrontal cortex (PFC) plays a central role in the whole network of the brain cognitive frame. In addition, cognitive function is crucial in growing and developmental stages and essential for the educational achievement, especially for children. Based on this, the authors in this study analyzed cognitive performance change of pediatric patients who had accepted frontal transcortical operation in 1-year follow-up and discussed the possibility of higher cognitive functions of the damaged region.

PATIENTS AND METHODS

In this single-center study, 15 pediatric patients (median age at surgery, 9.21 years old; range, 6.42-14.17 years old) who had been treated with frontal transcortical approach for lateral ventricular tumors were selected as research objects. The cognitive function assessment was conducting by adopting the revised Wechsler Intelligence Scale for Children-fourth edition (WISC-IV). In addition, the resting-state functional magnetic resonance imaging (resting-state fMRI) and diffusion tensor imaging (DTI) were carried out to measure the level of co-activation and to explore the functional connectivity between the brain regions at the preoperative period and 1-year follow-up after surgery.

RESULTS

GTR was achieved in all patients, and all patients were in good condition after surgery. Compared to the preoperative indices of WISC-IV, patients generally had a lower level of indices of the WISC-IV after surgery, for example, the total IQ was declined to M = 83.60, SD = 9.500 from M = 95.33, SD = 13.844 within 1 year convalescence. The data of perceptual reasoning (t = - 2.392, p = 0.016), processing speed (t = - 2.121, p = 0.033), and total IQ (t = -2.638, p = 0.008) before and after surgery showed statistically significance. Furthermore, decreased functional connectivity and disconnected neural fasciculus were revealed by the size of activation regions in the resting-state fMRI and the reconstruction of three-dimensional images of white matter tracts in the DTI pre- and post-operative.

CONCLUSION

The PFC was not regarded as a major functional area in the past, but the researches at present have shown that the interactions between PFC and other posterior brain regions serve as the basis of the higher cognitive functions. According to imaging manifestations and WISC-IV tasks in this paper, we found that the PFC injury caused by the frontal transcortical approach led to damaged brain structure and impaired the performance of cognitive function. On this basis, we detected that the perceptual reasoning and processing speed maybe have more extensive connections with the middle frontal gyrus.

Inattention in primary school is not good for your future school achievement-A pattern classification study

Inattention in childhood is associated with academic problems later in life. The contribution of specific aspects of inattentive behaviour is, however, less known. We investigated feature importance of primary school teachers’ reports on nine aspects of inattentive behaviour, gender and age in predicting future academic achievement. Primary school teachers of n = 2491 children (7–9 years) rated nine items reflecting different aspects of inattentive behaviour in 2002. A mean academic achievement score from the previous semester in high school (2012) was available for each youth from an official school register. All scores were at a categorical level. Feature importances were assessed by using multinominal logistic regression, classification and regression trees analysis, and a random forest algorithm. Finally, a comprehensive pattern classification procedure using k-fold cross-validation was implemented. Overall, inattention was rated as more severe in boys, who also obtained lower academic achievement scores in high school than girls. Problems related to sustained attention and distractibility were together with age and gender defined as the most important features to predict future achievement scores. Using these four features as input to a collection of classifiers employing k-fold cross-validation for prediction of academic achievement level, we obtained classification accuracy, precision and recall that were clearly better than chance levels. Primary school teachers’ reports of problems related to sustained attention and distractibility were identified as the two most important features of inattentive behaviour predicting academic achievement in high school. Identification and follow-up procedures of primary school children showing these characteristics should be prioritised to prevent future academic failure.

Working Memory Training Improves Alcohol Users' Episodic Future Thinking: A Rate-Dependent Analysis

BACKGROUND

Episodic thinking, whether past or future, uses similar neural machinery, and individuals with alcohol dependence have clear challenges with both. Moreover, alcohol-dependent individuals' narrowed temporal window likely gives rise to greater valuation of immediate rewards. We aimed to strengthen working memory (WM) in alcohol-dependent individuals and measure performance on near-transfer (novel WM) and far-transfer delay discounting (DD) tasks, including episodic future thinking (EFT) performance. Importantly, heterogeneous intervention responses could obscure a treatment effect due to individuals' baseline differences. Therefore, we considered WM, DD, and EFT DD scores using rate-dependent analyses.

METHODS

A total of 50 alcohol-dependent individuals received either 20 active (Trained) or sham (Control) WM training sessions using the Cogmed adaptive WM training program. Participants completed a near-transfer novel WM task and far-transfer DD and EFT DD tasks before and after training.

RESULTS

Active WM training improved performance on the near-transfer task. As determined by Oldham's correlation [r_{mean(x,y),y-x}], initially low near-transfer task scores improved more than initially high scores (i.e., rate dependence) in the Trained group only. Moreover, Trained group individuals with the highest rates of EFT DD at baseline rate-dependently decreased following training, whereas WM training had no effect on DD alone.

CONCLUSIONS

These data support the notion that WM training improves near-transfer task performance and may enhance the effects of EFT DD in a subset of alcohol-dependent individuals trapped within the narrowest temporal window. Rate-dependent changes highlight that we should attend to baseline performance to better identify individuals who would most benefit from an intervention.

Parent Rated Symptoms of Inattention in Childhood Predict High School Academic Achievement Across Two Culturally and Diagnostically Diverse Samples

Objective: To investigate parent reports of childhood symptoms of inattention as a predictor of adolescent academic achievement, taking into account the impact of the child’s intellectual functioning, in two diagnostically and culturally diverse samples.

Method: Samples: (a) an all-female sample in the U.S. predominated by youth with ADHD (Berkeley Girls with ADHD Longitudinal Study [BGALS], N = 202), and (b) a mixed-sex sample recruited from a Norwegian population-based sample (the Bergen Child Study [BCS], N = 93). Inattention and intellectual function were assessed via the same measures in the two samples; academic achievement scores during and beyond high school and demographic covariates were country-specific.

Results: Childhood inattention predicted subsequent academic achievement in both samples, with a somewhat stronger effect in the BGALS sample, which included a large subgroup of children with ADHD. Intellectual function was another strong predictor, but the effect of early inattention remained statistically significant in both samples when intellectual function was covaried.

Conclusion: The effect of early indicators of inattention on future academic success was robust across the two samples. These results support the use of remediation procedures broadly applied. Future longitudinal multicenter studies with pre-planned common inclusion criteria should be performed to increase our understanding of the importance of inattention in primary school children for concurrent and prospective functioning.

Reading Comprehension in Boys with ADHD: The Mediating Roles of Working Memory and Orthographic Conversion

Reading comprehension difficulties in children with ADHD are well established; however, limited information exists concerning the cognitive mechanisms that contribute to these difficulties and the extent to which they interact with one another. The current study examines two broad cognitive processes known to be involved in children's reading comprehension abilities-(a) working memory (i.e., central executive processes [CE], phonological short-term memory [PH STM], and visuospatial short-term memory [VS STM]) and (b) orthographic conversion (i.e., conversion of visually presented text to a phonological code)-to elucidate their unique and interactive contribution to ADHD-related reading comprehension differences. Thirty-one boys with ADHD-combined type and 30 typically developing (TD) boys aged 8 to 12 years (M = 9.64, SD = 1.22) were administered multiple counterbalanced tasks assessing WM and orthographic conversion processes. Relative to TD boys, boys with ADHD exhibited significant deficits in PH STM (d = -0.70), VS STM (d = -0.92), CE (d = -1.58), and orthographic conversion (d = -0.93). Bias-corrected, bootstrapped mediation analyses revealed that CE and orthographic conversion processes modeled separately mediated ADHD-related reading comprehension differences partially, whereas PH STM and VS STM did not. CE and orthographic conversion modeled jointly mediated ADHD-related reading comprehension differences fully wherein orthographic conversion's large magnitude influence on reading comprehension occurred indirectly through CE's impact on the orthographic system. The findings suggest that adaptive cognitive interventions designed to improve reading-related outcomes in children with ADHD may benefit by including modules that train CE and orthographic conversion processes independently and interactively.

Cognitive Functioning in Adolescents with Self-Reported ADHD and Depression: Results from a Population-Based Study

This study aims to assess cognitive functioning differences among adolescents with retrospectively self-reported: ADHD and an onset of depression, only ADHD, only depression, and neither ADHD nor depression. Data from the Tracking Adolescents’ Individual Lives Survey (TRAILS) cohort was used in this study. Neuropsychological functioning was assessed in 1549 adolescents, at baseline and follow-up (mean ages 11 and 19 years). The Composite International Diagnostic Interview was used to classify adolescents into 4 groups: ADHD with onset of depression, only ADHD, only depression, and neither ADHD nor depression. Linear mixed effects models were used to analyse group differences in cognitive functioning at baseline and follow-up, and the change in cognitive functioning between these 2 time-points. Results showed a significant main effect of group on response time variability at baseline, working memory maintenance at follow up, and change in response time variability scores between baseline and follow-up. As compared to the healthy and depressed-only groups, adolescents with only ADHD showed longer response time variability at baseline and, which declined between baseline and follow-up. Adolescents with ADHD plus depression showed higher reaction time for working memory maintenance than the depressed only and healthy groups at follow-up. In conclusion, adolescents with self-reported ADHD show poorer cognitive functioning than healthy adolescents and those with only depression. Amongst adolescents with ADHD, specific cognitive domains show poor functioning depending on the presence or absence of comorbid depression. While adolescents with only ADHD have lower reaction time variability, those with comorbid depression have poorer working memory maintenance.

Working Memory Training in ADHD: Controlling for Engagement, Motivation, and Expectancy of Improvement (Pilot Study)

OBJECTIVE

The aim of this study was to evaluate whether a shortened-length session of CogMed Working Memory Training (CWMT) would be a suitable active control group and evaluate study protocol to aid in design refinements for a larger randomized controlled trial (RCT).

METHOD

Thirty-eight post-secondary students diagnosed with ADHD were randomized into 25 sessions of standard (45 min/session) or shortened (15 min/session) CWMT, or into a waitlist control group.

RESULTS

There was no significant difference in completion rate or training index score between the standard- and shortened-length groups indicating that both groups showed improvement and put forth good effort during training.

CONCLUSION

Preliminary findings suggest that shorter training sessions may induce similar levels of engagement, motivation, and expectancy of improvement in participants. We conclude that a larger scale RCT that utilizes shortened-length training as an active control group is warranted, but that a few modifications to the study protocol will be required.

ADHD and Vision Problems in the National Survey of Children's Health

PURPOSE

To compare the prevalence of attention deficit/hyperactivity disorder (ADHD) in children with normal vision and with vision problems not correctable with glasses or contact lenses (vision problems) as determined by parent report in a nationwide telephone survey.

METHODS

This cross-sectional study included 75,171 children without intellectual impairment aged 4 to 17 years participating in the 2011 to 2012 National Survey of Children's Health, conducted by the U.S. Centers for Disease Control and Prevention. Demographic information and information regarding vision and ADHD status were obtained by parent interview. Questions asked whether they had ever been told by a doctor or health care provider that the child had a vision problem not correctable with glasses or contact lenses, ADHD, intellectual impairment, or one of 13 other common chronic conditions of childhood. A follow-up question asked about condition severity. The main outcome measure was current ADHD.

RESULTS

The prevalence of current ADHD was greater (p < 0.0001) among children with vision problems (15.6%) compared with those with normal vision (8.3%). The odds of ADHD compared with those of children with normal vision were greatest for those with moderate vision problems (odds ratio [OR], 2.6; 95% confidence interval [95% CI], 1.7 to 4.4) and mild vision problems (OR, 1.8; 95% CI, 1.1 to 2.9). Children with severe vision problems had similar odds of ADHD to those of children with normal vision perhaps because of the small numbers in this group (OR, 1.6; 95% CI, 0.8 to 3.1). In multivariable analysis adjusting for confounding variables, vision problems remained independently associated with current ADHD (OR, 1.8; 95% CI, 1.2 to 2.7).

CONCLUSIONS

In this large nationally representative sample, the prevalence of ADHD was greater among children with vision problems not correctable with glasses or contacts. The association between vision problems and ADHD remains even after adjusting for other factors known to be associated with ADHD.

A double-blind randomized pilot trial comparing computerized cognitive exercises to Tetris in adolescents with attention-deficit/hyperactivity disorder

BACKGROUND

The purpose of this trial was to examine the feasibility and efficacy of computerized cognitive exercises from Scientific Brain Training (SBT), compared to the computer game Tetris as an active placebo, in a pilot study of adolescents with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Eighteen adolescents with ADHD were randomized to treatment or control intervention for 7 weeks. Outcome measures were cognitive test, symptom, and motivation questionnaires.

RESULTS

SBT and Tetris were feasible as home-based interventions, and participants' compliance was high, but participants perceived both interventions as not very interesting or helpful. There were no significant group differences on cognitive and ADHD-symptom measures after intervention. Pre-post intra-group measurement showed that the SBT had a significant beneficial effect on sustained attention, while the active placebo had significant beneficial effects on working memory, both with large effect sizes.

CONCLUSION

Although no significant differences were found between groups on any measure, there were significant intra-group changes for each group.

Academic Outcomes in Individuals With Childhood-Onset Epilepsy: Mediating Effects of Working Memory

OBJECTIVES

Academic difficulties are common in children with epilepsy, although little is known about the effect of various seizure-related and cognitive variables. Given that persistent seizures may negatively impact academics, and that working memory is predictive of academic abilities, we examined the effects of recent seizures and working memory on word reading, spelling, and arithmetic in pediatric epilepsy. We hypothesized that persistent seizures would be associated with lower working memory ability, which would in turn result in poorer academic performance.

METHODS

Our sample consisted of 91 children with epilepsy being treated at the Hospital for Sick Children in Toronto, Canada, who underwent neuropsychological testing between 2002 and 2009 to help determine surgical candidacy. Four to 11 years later, follow-up testing was conducted on both surgical (n=61) and non-surgical (n=30) patients. Seizure status was defined by the presence or absence of seizures within the preceding 12 months.

RESULTS

5000 bias-corrected bootstrap resamples with replacement were used to calculate the 95% confidence intervals (CIs) for the indirect effect of seizure status on academics through working memory, controlling for baseline academic functioning. Persistent seizures were associated with reduced working memory, which was in turn associated with lower reading (B=-4.64, 95% CI [-10.21, -1.30]), spelling (B=-7.09, 95% CI [-13.97, -2.56], and arithmetic scores (B=-8.04, 95% CI [-13.66, -3.58] at follow-up.

CONCLUSIONS

For children with intractable epilepsy, working memory deficits present a significant barrier to the development of academic skills. Working memory interventions may be a helpful adjunct to academic remediation in this population to facilitate academic progress. (JINS, 2017, 23, 594-604).

Computerized cognitive training in children and adolescents with attention deficit/hyperactivity disorder as add-on treatment to stimulants: feasibility study and protocol description

Abstract Background Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups – mainly on trained tasks. Conclusions This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.

Linking ADHD to the Neural Circuitry of Attention

Attention deficit hyperactivity disorder (ADHD) is a complex condition with a heterogeneous presentation. Current diagnosis is primarily based on subjective experience and observer reports of behavioral symptoms - an approach that has significant limitations. Many studies show that individuals with ADHD exhibit poorer performance on cognitive tasks than neurotypical controls, and at least seven main functional domains appear to be implicated in ADHD. We discuss the underlying neural mechanisms of cognitive functions associated with ADHD, with emphasis on the neural basis of selective attention, demonstrating the feasibility of basic research approaches for further understanding cognitive behavioral processes as they relate to human psychopathology. The study of circuit-level mechanisms underlying executive functions in nonhuman primates holds promise for advancing our understanding, and ultimately the treatment, of ADHD.

A Clinician's Guide to Co-occurring ADHD among Adolescent Substance Users: Comorbidity, Neurodevelopmental Risk, and Evidence-based Treatment Options

This article introduces neurodevelopmental and clinical considerations for treating adolescents with co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) and substance use (ASU) in outpatient settings. We first describe neurobiological impairments common to ADHD and ASU, including comorbidity with conduct disorder, that evoke a profile of multiplicative developmental risk. We then present two evidence-based options for targeting ADHD-related problems during ASU treatment. Medication integration interventions utilize family ADHD psychoeducation to prompt decision-making about ADHD medication and integrate medication management into behavioral services. Clinic-based academic training interventions utilize family interventions to improve the home academic environment and boost organization skills. We conclude with recommendations for ADHD assessment and intervention sequencing.

Working memory training in children with neuropsychiatric disorders and mild to borderline intellectual functioning, the role of coaching; a double-blind randomized controlled trial

BACKGROUND

Working memory training (WMT) has been shown to offer therapeutic benefits to both patients with Attention-Deficit Hyperactivity Disorder (ADHD) and patients with mild to borderline Intellectual Disabilities (MBID; 60 < IQ < 85). However, robust evidence for transfer effects and treatment benefits of WMT over placebo training are lacking. Owing to the nature of double-blind research designs in RCTs, children have received non-specific coaching not based on their actual training performance. Active coaching based on individual training results (such as in clinical practice) might enhance the efficacy of Cogmed WMT. Furthermore, clinical experience and the general treatment approach to these vulnerable children has shown that the intensity and duration of WMT is often too stressful. This study therefore investigated the efficacy of a less intensive, but more prolonged Cogmed WMT (including active personalized coaching and feedback) in reducing behavioral symptoms and improving neurocognitive functioning and academic achievements in children with MBID and neuropsychiatric disorders.

METHODS/DESIGN

A double-blind RCT with children (age 10.0-13.11) with neuropsychiatric disorders (ADHD and/or autism spectrum disorder (ASD)) and MBID (IQ: 60 < IQ < 85). Two groups (each n = 26) will receive Cogmed WMT (version R/M) at home or at school for 8 weeks, 4 days a week, at 30 min a day. One group will receive active personalized coaching and feedback based on their actual individual performance during Cogmed training. The other group will only receive general non-personalized coaching (i.e. no receive personalized coaching and feedback). Both groups will undergo a neurocognitive assessment (working memory, executive functioning, academic achievements) before and after training and complete several questionnaires (behavioral problems, parenting style) with a 6 months follow-up.

DISCUSSION

This study will add to the literature since the role of coaching in Cogmed WMT has not been studied before. It will also provide opportunities to investigate an alternative version of WMT in a large group of vulnerable children, for whom few evidence-based treatments are available. Ultimately, this will allow us to advise mental health care professionals and special education schools about the use of this type of intervention for children with MBID and neuropsychiatric disorders.

TRIAL REGISTRATION

Dutch Trial Register. NTR5223 . Registration date 06-09-2015.

Effects of a working memory training program in preschoolers with symptoms of attention-deficit/hyperactivity disorder

INTRODUCTION

Preschoolers with attention-deficit/hyperactivity disorder (ADHD) have been found to exhibit impairments on neuropsychological measures of working memory (WM). As WM is an important predictor of future learning abilities, early intervention could help to prevent severe problems. The purpose of this research was to ascertain the efficacy of an intervention for training WM in 5-year-old children with symptoms of ADHD.

METHOD

Thirty-four children with symptoms of ADHD were randomly divided into two groups: One was assigned to the WM training condition, and the other continued normal class activities. The training was provided at school in small groups that also included typically developing children.

RESULTS

The trained group showed a significant improvement in tasks measuring their WM and other controlled processes at conclusion of study, whereas no significant improvement was found in the control group.

CONCLUSIONS

We concluded that early intervention on WM may be effective in children with symptoms of ADHD.

Executive Function Training for Children with Attention Deficit Hyperactivity Disorder

BACKGROUND

Accumulating evidence indicates that attention deficit hyperactivity disorder (ADHD) is associated with core deficits in executive function (EF) which predicts poorer academic and occupational functioning. This makes early intervention targeting EF impairments important to prevent long-term negative outcomes. Cognitive training is a potential ADHD treatment target. The present study aimed to explore the efficacy, feasibility, and acceptability of a cognitive training program (targeting child's multiple EF components and involving parent support in daily life), as a nonpharmacological intervention for children with ADHD.

METHODS

Forty-four school -age children with ADHD and their parents participated in 12 sessions of EF training (last for 12 weeks) and 88 health controls (HC) were also recruited. Training effects were explored using both neuropsychological tests (Stroop color-word test, Rey-Osterrieth complex figure test, trail making test, tower of Hanoi, and false-belief task) and reports of daily life (ADHD rating scale-IV, Conners' parent rating scale, and behavior rating inventory of executive function [BRIEF]) by analysis of paired sample t-test and Wilcoxon signed-rank test. The differences on EF performances between children with ADHD after training and HC were explored using multivariate analysis.

RESULTS

The results (before vs. after EF training) showed that after intervention, the children with ADHD presented better performances of EF both in neuropsychological tests (word interference of Stroop: 36.1 ± 14.6 vs. 27.1 ± 11.1, t = 4.731, P < 0.001; shift time of TMT: 194.9 ± 115.4 vs. 124.8 ± 72.4, Z = -4.639, P < 0.001; false-belief task: χ2 = 6.932, P = 0.008) and reports of daily life (global executive composite of BRIEF: 148.9 ± 17.5 vs. 127.8 ± 17.5, t = 6.433, P < 0.001). The performances on EF tasks for children with ADHD after EF training could match with the level of HC children. The ADHD symptoms (ADHD rating scale total score: 32.4 ± 8.9 vs. 22.9 ± 8.2, t = 6.331, P < 0.001) and behavioral problems of the children as reported by parents also reduced significantly after the intervention. Participants reported that the EF training program was feasible to administer and acceptable.

CONCLUSIONS

The EF training program was feasible and acceptable to children with ADHD and parents. Although replication with a larger sample and an active control group are needed, EF training program with multiple EF focus and parent involving in real-life activities could be a potentially promising intervention associated with significant EF (near transfer) and ADHD symptoms improvement (far transfer).

The Effects of Cognitive Training on Cognitive Abilities and Everyday Function: A 10-Week Randomized Controlled Trial

With a random groups design, the current study examined whether a 10-week cognitive training could improve healthy older adult's cognitive functions and everyday problem-solving and whether high ecological validity trainings would have greater positive impact upon everyday problem-solving than low ecological validity trainings. Eighty-six healthy Chinese older adult participants were assigned randomly to five groups, including one control group receiving no training and four groups receiving low ecological memory training, high ecological memory training, low ecological reasoning training, and high ecological reasoning training, respectively. Participants were measured pre- and posttraining on spatial working memory, numerical working memory, reasoning, and everyday problem-solving. Results of this study showed that cognitive training significantly improved targeted cognitive functions and everyday problem-solving performance in all the intervention groups. However, high ecological cognitive trainings failed to show superior impact upon everyday problem-solving compared with low ecological cognitive trainings.

Impact of Attention Training on Academic Achievement, Executive Functioning, and Behavior: A Randomized Controlled Trial

Children with intellectual and developmental disabilities (IDD) experience significant difficulties in attention, learning, executive functions, and behavioral regulation. Emerging evidence suggests that computerized cognitive training may remediate these impairments. In a double blind controlled trial, 76 children with IDD (4-11 years) were randomized to either an attention training (n = 38) or control program (n = 38). Both programs were completed at home over a 5-week period. Outcome measures assessed literacy, numeracy, executive functioning, and behavioral/emotional problems, and were conducted at baseline, post-training, and 3-month follow-up. No training effects were observed at post-training; however, children in the training group showed greater improvements in numeracy skills at the 3-month follow-up. These results suggest that attention training may be beneficial for children with IDD; however, the modest nature of the intervention effects indicate that caution should be taken when interpreting clinical significance.

Game-based combined cognitive and neurofeedback training using Focus Pocus reduces symptom severity in children with diagnosed AD/HD and subclinical AD/HD

Previous studies report reductions in symptom severity after combined working memory (WM) and inhibitory control (IC) training in children with AD/HD. Based on theoretical accounts of the role of arousal/attention modulation problems in AD/HD, the current study examined the efficacy of combined WM, IC, and neurofeedback training in children with AD/HD and subclinical AD/HD. Using a randomized waitlist control design, 85 children were randomly allocated to a training or waitlist condition and completed pre- and post-training assessments of overt behavior, trained and untrained cognitive task performance, and resting and task-related EEG activity. The training group completed twenty-five sessions of training using Focus Pocus software at home over a 7 to 8-week period. Trainees improved at the trained tasks, while enjoyment and engagement declined across sessions. After training, AD/HD symptom severity was reduced in the AD/HD and subclinical groups according to parents, and in the former group only according to blinded teachers and significant-others. There were minor improvements in two of six near-transfer tasks, and evidence of far-transfer of training effects in four of five far-transfer tasks. Frontal region changes indicated normalization of atypical EEG features with reduced delta and increased alpha activity. It is concluded that technology developments provide an interesting a vehicle for delivering interventions and that, while further research is needed, combined WM, IC, and neurofeedback training can reduce AD/HD symptom severity in children with AD/HD and may also be beneficial to children with subclinical AD/HD.