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Leung WSW, Pei J, Rasmussen C. A working memory intervention for children with prenatal alcohol exposure: Pilot study. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-9. [PMID: 38593749 DOI: 10.1080/21622965.2024.2328672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Cogmed© is a computerized working memory training program designed to improve attention and working memory. We examined the short- and long-term impacts of a 25-session Cogmed© intervention on working memory and other cognitive and learning domains in children with prenatal alcohol exposure (PAE) and typically developing children. Participants included 38 children (4 - 13 years old) from Alberta, Canada in two groups: PAE (n = 20) and typically developing (n = 18). Significant improvements in areas of working memory and attentional control for both the PAE and the typically developing group were reported immediately after intervention completion (short-term impact). The gains on some measures were retained at five-week follow up (long-term impact). Preliminary findings indicate that computerized interventions may positively impact WM and attention control and that these changes may be maintained after a delay period.
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Affiliation(s)
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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Corti C, Oldrati V, Papini M, Strazzer S, Poggi G, Romaniello R, Borgatti R, Urgesi C, Bardoni A. Randomized clinical trial on the effects of a computerized cognitive training for pediatric patients with acquired brain injury or congenital malformation. Sci Rep 2023; 13:14559. [PMID: 37666983 PMCID: PMC10477344 DOI: 10.1038/s41598-023-41810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
Both acquired injuries and congenital malformations often cause lifelong disabilities in children, with a significant impact on cognitive abilities. Remote computerized cognitive training (CCT) may be delivered in ecological settings to favour rehabilitation continuity. This randomized clinical trial (RCT) evaluated the efficacy of an 8-week multi-domain, home-based CCT in a sample of patients aged 11-16 years with non-progressive acquired brain injury (ABI), brain tumor (BT) and congenital brain malformation (CBM). Following a stepped-wedge research design, patients were randomized into two groups: Training-first group, which started the CCT immediately after baseline assessment and Waiting-first group, which started the CCT after a period of time comparable to that required by the training (8 weeks). Post-training and long-term (6 months) changes were assessed. Both groups improved on visual-spatial working memory after the CCT, with benefits maintained after 6 months, while no other changes in cognitive or psychological measures were found. These findings suggest that a multi-domain CCT can generate benefits in visual-spatial working memory, in accordance with data from extant literature reporting that computer games heavily engage visuo-spatial abilities. We speculate that is tapping on the same cognitive ability with a prolonged training that may generate the greatest change after a CCT.
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Affiliation(s)
- Claudia Corti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Viola Oldrati
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | - Marta Papini
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Sandra Strazzer
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Geraldina Poggi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Renato Borgatti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
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Qiu H, Liang X, Wang P, Zhang H, Shum DHK. Efficacy of non-pharmacological interventions on executive functions in children and adolescents with ADHD: A systematic review and meta-analysis. Asian J Psychiatr 2023; 87:103692. [PMID: 37450981 DOI: 10.1016/j.ajp.2023.103692] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Although front-line doctors recommend medications, this kind of treatment has limited efficacy in improving executive functions (EFs) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). This study explored the effects of non-pharmacological intervention on EFs in children and adolescents with ADHD. METHODS In accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, we searched seven electronic databases: APA PsycINFO, CINAHL Complete, EMBASE, ERIC, Medline, Pubmed, and Web of Science, from inception to March 2022. Two authors independently screened studies for eligibility, extracted data, and assessed bias risk using the Physiotherapy Evidence Database scale. Our analyses included randomized controlled trials and non-randomized comparison studies of non-pharmacological interventions and assessed EFs through neurocognitive tasks in children and adolescents between 5 and 18 years. RESULTS Sixty-seven studies with 3147 participants met the inclusion criteria. The final meta-analysis included 74 independent interventions categorized into six categories: cognitive training, EF-specific curriculum, game-based training, mindfulness practice, neurofeedback training, and physical exercise. Overall, non-pharmacological interventions (combined) produced significant moderate to large effects on overall EFs in children and adolescents with ADHD (g=0.673). Physical exercise had a large positive effect on domain-specific EFs, including inhibitory control (g=0.900) and cognitive flexibility (g=1.377). Cognitive training had a large training effect on working memory (g=0.907), and an EF-specific curriculum had a small to moderate beneficial effect on planning performance (g=0.532). CONCLUSION Non-pharmacological interventions, particularly physical exercise, cognitive training, and an EF-specific curriculum, appear to have beneficial effects on EFs in children and adolescents with ADHD.
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Affiliation(s)
- Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiao Liang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
| | - Peng Wang
- Center for Lifestyle Medicine, Fuwai Hospital, Chinese Academy of Medical, Sciences & Peking Union Medical College, Beijing, China
| | - Hui Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China; Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - David H K Shum
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
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He F, Qi Y, Zhou Y, Cao A, Yue X, Fang S, Zheng Y. Meta-analysis of the efficacy of digital therapies in children with attention-deficit hyperactivity disorder. Front Psychiatry 2023; 14:1054831. [PMID: 37260755 PMCID: PMC10228751 DOI: 10.3389/fpsyt.2023.1054831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that commonly occurs in childhood. The aim of this meta-analysis was to summarize the available evidence for the efficacy of digital therapeutics in children and adolescents with ADHD. Methods We searched the MEDLINE, EMBASE, Cochrane Library (Cochrane Database of Systematic Reviews), and Web of Science (science and social science citation index) databases for relevant studies and used Stata 15.0 software to carry out the meta-analysis. Results A total of 31 studies involving 2169 participants (1665 boys and 504 girls) aged 4-17 years old were included in the final analysis. The meta-analysis results showed that digital interventions improved the symptoms of inattention with an effect value of -0.20 (95% confidence interval [CI] -0.36, -0.04) and decreased the continuous performance task (CPT) reaction time (effect, -0.40, 95% CI -0.73, -0.07) in ADHD patients. The score for impulsive hyperactivity was slightly decreased (effect, -0.07, 95% CI -0.23, 0.09). Moreover, executive function was improved (effect, 0.71, 95% CI 0.37, 1.04). The capability of working memory appeared to be increased (effect, 0.48, 95% CI 0.21, 0.76) between the two groups. Visual appraisal of the sensitivity analysis suggested the absence of heterogeneity, and no obvious publication bias was detected. Discussion Based on the existing literature evidence, we conclude that digital therapy can be a promising therapeutic strategy for ADHD patients.
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Affiliation(s)
- Fan He
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yanjie Qi
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yuanyue Zhou
- Department of Medical Psychology, The First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China
| | - Aihua Cao
- Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Xin Yue
- MaiDeHaiKe Technology, Beijing, China
| | - Shuanfeng Fang
- Children's Hospital Affiliated, Zhengzhou University, Zhengzhou, Henan, China
| | - Yi Zheng
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
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Kim SA, Kasari C. Brief Report: Longitudinal Trajectory of Working Memory in School-Aged Children on the Autism Spectrum: Period of High Plasticity and "Late Bloomers". J Autism Dev Disord 2023:10.1007/s10803-023-05960-5. [PMID: 37022582 DOI: 10.1007/s10803-023-05960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE While working memory (WM) is a powerful predictor for children's school outcomes, autistic children are more likely to experience delays. This study compared autistic children and their neurotypical peers' WM development over their elementary school years, including relative growth and period of plasticity. METHODS Using a nationally-representative dataset, latent growth models were built to examine periods of high plasticity and the relationship between children's performance upon school entry and their relative growth. RESULTS While both groups made steeper gains during the early school years, autistic children's period of highest plasticity was prolonged by 1 year, which suggests a larger window for interventions. Further, autistic children who started kindergarten with poorer WM were more likely to make rapid growth during the last 3 years of elementary school, which is when their neurotypical peers' development started to plateau. CONCLUSION Findings should prompt various stakeholders to examine interventions and instructions to maximize autistic children's growth in WM. Further, the continued support and monitoring by educators throughout autistic children's late childhood can be particularly beneficial for the "late-bloomers."
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Affiliation(s)
- Sohyun An Kim
- Department of Education, University of California, Los Angeles, Moore Hall, 457 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Connie Kasari
- Department of Education, University of California, Los Angeles, Moore Hall, 457 Portola Plaza, Los Angeles, CA, 90095, USA
- Semel Institute for Neuroscience, University of California, Los Angeles, CA, USA
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Goodrich JM, Peng P, Bohaty J, Leiva S, Thayer L. Embedding Executive Function Training Into Early Literacy Instruction for Dual Language Learners: A Pilot Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:573-588. [PMID: 36630944 DOI: 10.1044/2022_jslhr-22-00253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Early literacy skills are key indicators of future reading development for young dual language learners (DLLs). Additionally, emerging evidence indicates that young children's executive function (EF) skills are uniquely associated with elementary school reading outcomes (Ribner et al., 2017). Therefore, the purpose of this pilot study was to evaluate the potential for embedding strategies to support EF development within evidence-based early language and literacy instruction for young DLLs. METHOD Sixty-nine preschool DLLs were randomly assigned to one of three treatment groups: a business-as-usual control group (BAU), a group that received early literacy instruction only (EL group), and a group that received early literacy instruction with embedded EF strategies (EL + EF group). The intervention focused on improving children's early literacy skills, including letter-name knowledge, phonological awareness, and oral language. Children completed assessments of early literacy and EF immediately before and after the intervention. RESULTS The EL and EL + EF groups significantly outperformed the BAU control group for two early literacy outcomes, and effects of evidence-based early literacy instruction were strongest for children with poor EF skills. Results indicated that there were no significant differences between the EL + EF and EL groups. CONCLUSIONS This pilot study indicated that there was no significant benefit to adding supports for EF skills within evidence-based early literacy instruction. Additional research is needed with larger samples to replicate observed effects. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21834465.
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Calub CA, Benyakorn S, Sun S, Iosif AM, Boyle LH, Solomon M, Hessl D, Schweitzer JB. Working Memory Training in Youth With Autism, Fragile X, and Intellectual Disability: A Pilot Study. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:369-389. [PMID: 36018768 PMCID: PMC9915337 DOI: 10.1352/1944-7558-127.5.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 08/03/2021] [Indexed: 06/15/2023]
Abstract
This pilot study sought to identify potential markers of improvement from pre-post treatment in response to computerized working memory (WM) training for youth (ages 8-18) with autism spectrum disorder (ASD) and comorbid intellectual disability (ID) in a single arm, pre-post design. Participants included 26 children with ASD and 18 with comorbid ASD and fragile X syndrome (ASD+FXS). Analyses were adjusted for age and IQ. The ASD group demonstrated greater improvement on WM training relative to the ASD+FXS group. Participants improved on WM and far transfer outcomes, however, there were no significant group differences in improvement except for repetitive behavior. Higher hyperactivity/impulsivity ratings predicted lower performance on visuospatial WM. Findings suggest cognitive training may be beneficial for youth with ASD and ID, warranting further exploration.
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Lee S, Hill TR, Johnson B, Testa R, Priya V, Spencer-Smith M, Coghill D. Can Neurocognitive Outcomes Assist Measurement-Based Care for Children with Attention-Deficit/Hyperactivity Disorder? A Systematic Review and Meta-Analyses of the Relationships Among the Changes in Neurocognitive Functions and Clinical Outcomes of Attention-Deficit/Hyperactivity Disorder in Pharmacological and Cognitive Training Interventions. J Child Adolesc Psychopharmacol 2022; 32:250-277. [PMID: 35704876 DOI: 10.1089/cap.2022.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental conditions among school-age children. Early intervention and ongoing evaluation of treatment effectiveness are essential to minimize the life-long negative impact of ADHD. Neurocognitive functions have been reported to improve with pharmacological and cognitive training interventions for children with ADHD. We evaluated the value of measuring change in neurocognitive functions following ADHD interventions as a treatment outcome. We systematically reviewed randomized control trials of two distinctive types of ADHD interventions-pharmacological treatments and cognitive training-and summarized the changes in neurocognitive and clinical outcomes using a series of meta-analyses. Both pharmacological and cognitive training interventions showed positive effects on some aspects of neurocognitive functions. However, there were no significant correlations between changes in neurocognitive function (e.g., inhibition) and changes in ADHD behavioral symptoms (e.g., impulsive behavior). Although the associations between changes in neurocognitive function and clinical outcomes are not well studied, based on current findings, it is not suitable to use change in neurocognitive outcomes as a proxy for change in ADHD clinical symptom-based outcomes. There is, however, notable value in monitoring changes in neurocognitive function associated with ADHD interventions to achieve the following aims: (1) understanding full treatment effect on children with ADHD, (2) identifying ancillary indicators of subclinical changes, and (3) provision of objective and less biased measures of treatment effects. These findings are important evidence that changes in neurocognitive function could be a co-occurring objective indication that parallels the clinical effects of ADHD treatments.
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Affiliation(s)
- Seungjae Lee
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Thomas R Hill
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Beth Johnson
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Renee Testa
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Vishnu Priya
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Megan Spencer-Smith
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - David Coghill
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
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Tang H, Riley MR, Singh B, Qi XL, Blake DT, Constantinidis C. Prefrontal cortical plasticity during learning of cognitive tasks. Nat Commun 2022; 13:90. [PMID: 35013248 PMCID: PMC8748623 DOI: 10.1038/s41467-021-27695-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Training in working memory tasks is associated with lasting changes in prefrontal cortical activity. To assess the neural activity changes induced by training, we recorded single units, multi-unit activity (MUA) and local field potentials (LFP) with chronic electrode arrays implanted in the prefrontal cortex of two monkeys, throughout the period they were trained to perform cognitive tasks. Mastering different task phases was associated with distinct changes in neural activity, which included recruitment of larger numbers of neurons, increases or decreases of their firing rate, changes in the correlation structure between neurons, and redistribution of power across LFP frequency bands. In every training phase, changes induced by the actively learned task were also observed in a control task, which remained the same across the training period. Our results reveal how learning to perform cognitive tasks induces plasticity of prefrontal cortical activity, and how activity changes may generalize between tasks. It remains unclear whether improvements in one cognitive task transfer to other tasks. Here, the authors show that changes in prefrontal neuronal activation, firing rate, and local field potentials induced during active learning of a working memory task are also evident in a control task.
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Affiliation(s)
- Hua Tang
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.,Center for Neuropsychiatric Diseases, Institute of Life Science, Nanchang University, Nanchang, 330031, Jiangxi, China.,Laboratory of Neuropsychology, National Institutes of Mental Health, NIH, Bethesda, MD, 20892, USA
| | - Mitchell R Riley
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Balbir Singh
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
| | - Xue-Lian Qi
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - David T Blake
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Christos Constantinidis
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. .,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA. .,Neuroscience Program, Vanderbilt University, Nashville, TN, 37235, USA. .,Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
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Al-Saad MSH, Al-Jabri B, Almarzouki AF. A Review of Working Memory Training in the Management of Attention Deficit Hyperactivity Disorder. Front Behav Neurosci 2021; 15:686873. [PMID: 34366803 PMCID: PMC8334010 DOI: 10.3389/fnbeh.2021.686873] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Working memory deficits underlie many of the behavioural symptoms of ADHD. Alongside psychostimulant medications, strategies to improve working memory may play an important adjuvant role in the management of ADHD. In this study, we review the role of working memory deficits in ADHD, the evidence surrounding working memory training strategies in the management of the condition, and the factors affecting the success of these strategies in alleviating ADHD symptoms. More specifically, we review several non-pharmacological interventions that target working memory deficits in ADHD, with special emphasis on cognitive working memory training. We conclude that the development of evidence-based interventions such as computerised cognitive training (CCT) could provide an alternative or adjunct to the use of psychostimulants, especially in cases where side effects are a major issue.
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Affiliation(s)
- Maha Saleh Habsan Al-Saad
- Faculty of Medicine, Department of Clinical Physiology, King Abdulaziz University, Jeddah, Saudi Arabia.,Public Health Sector, General Directorate of Health Affairs in Najran, Ministry of Health, Najran, Saudi Arabia
| | - Basma Al-Jabri
- Faculty of Medicine, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abeer F Almarzouki
- Faculty of Medicine, Department of Clinical Physiology, King Abdulaziz University, Jeddah, Saudi Arabia
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Wexler BE, Vitulano LA, Moore C, Katsovich L, Smith SD, Rush C, Grantz H, Dong J, Leckman JF. An integrated program of computer-presented and physical cognitive training exercises for children with attention-deficit/hyperactivity disorder. Psychol Med 2021; 51:1524-1535. [PMID: 32090720 DOI: 10.1017/s0033291720000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study integrated an experimental medicine approach and a randomized cross-over clinical trial design following CONSORT recommendations to evaluate a cognitive training (CT) intervention for attention deficit hyperactivity disorder (ADHD). The experimental medicine approach was adopted because of documented pathophysiological heterogeneity within the diagnosis of ADHD. The cross-over design was adopted to provide the intervention for all participants and make maximum use of data. METHODS Children (n = 93, mean age 7.3 +/- 1.1 years) with or sub-threshold for ADHD were randomly assigned to CT exercises over 15 weeks, before or after 15 weeks of treatment-as-usual (TAU). Fifteen dropped out of the CT/TAU group and 12 out of the TAU/CT group, leaving 66 for cross-over analysis. Seven in the CT/TAU group completed CT before dropping out making 73 available for experimental medicine analyses. Attention, response inhibition, and working memory were assessed before and after CT and TAU. RESULTS Children were more likely to improve with CT than TAU (27/66 v. 13/66, McNemar p = 0.02). Consistent with the experimental medicine hypotheses, responders improved on all tests of executive function (p = 0.009-0.01) while non-responders improved on none (p = 0.27-0.81). The degree of clinical improvement was predicted by baseline and change scores in focused attention and working memory (p = 0.008). The response rate was higher in inattentive and combined subtypes than hyperactive-impulsive subtype (p = 0.003). CONCLUSIONS Targeting cognitive dysfunction decreases clinical symptoms in proportion to improvement in cognition. Inattentive and combined subtypes were more likely to respond, consistent with targeted pathology and clinically relevant heterogeneity within ADHD.
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Affiliation(s)
- Bruce E Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Christina Moore
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, University of Delaware, Newark, DE, USA
| | | | - Stephanie D Smith
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Cindy Rush
- Department of Statistics, Columbia University, New York, NY, USA
| | - Heidi Grantz
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | | | - James F Leckman
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Sauce B, Wiedenhoeft J, Judd N, Klingberg T. Change by challenge: A common genetic basis behind childhood cognitive development and cognitive training. NPJ SCIENCE OF LEARNING 2021; 6:16. [PMID: 34078902 PMCID: PMC8172838 DOI: 10.1038/s41539-021-00096-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/12/2021] [Indexed: 06/02/2023]
Abstract
The interplay of genetic and environmental factors behind cognitive development has preoccupied multiple fields of science and sparked heated debates over the decades. Here we tested the hypothesis that developmental genes rely heavily on cognitive challenges-as opposed to natural maturation. Starting with a polygenic score (cogPGS) that previously explained variation in cognitive performance in adults, we estimated its effect in 344 children and adolescents (mean age of 12 years old, ranging from 6 to 25) who showed changes in working memory (WM) in two distinct samples: (1) a developmental sample showing significant WM gains after 2 years of typical, age-related development, and (2) a training sample showing significant, experimentally-induced WM gains after 25 days of an intense WM training. We found that the same genetic factor, cogPGS, significantly explained the amount of WM gain in both samples. And there was no interaction of cogPGS with sample, suggesting that those genetic factors are neutral to whether the WM gains came from development or training. These results represent evidence that cognitive challenges are a central piece in the gene-environment interplay during cognitive development. We believe our study sheds new light on previous findings of interindividual differences in education (rich-get-richer and compensation effects), brain plasticity in children, and the heritability increase of intelligence across the lifespan.
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Affiliation(s)
- Bruno Sauce
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - John Wiedenhoeft
- Core Facility Medical Biometry and Statistical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Nicholas Judd
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Torkel Klingberg
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden.
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Nejati V. Program for attention rehabilitation and strengthening (PARS) improves executive functions in children with attention deficit- hyperactivity disorder (ADHD). RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 113:103937. [PMID: 33756252 DOI: 10.1016/j.ridd.2021.103937] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/21/2020] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Attention is improved through cognitive rehabilitation. The purpose of the present study was the evaluation of the effect of a paper and pencil program for attention rehabilitation and strengthening (PARS) in children with ADHD. Thirty children with ADHD were randomly divided into two equal intervention and control groups. The intervention group received 12-15 sessions of intervention through PARS. Sustained, selective, and shifting attention, inhibitory control, and working memory were assessed by Persian attention registration, Stroop, color trail making, Go/No-Go, and 1- back tests. Analyses indicated that the experimental group, in comparison with the control group, showed improved selective and sustained attention and the training effects transfers to executive functions, inhibitory control and working memory. The result is discussed in the light of transferability of training effects from attention to executive functions.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, PO Box: 1983969411, Tehran, Iran.
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de Oliveira Rosa V, Rosa Franco A, Abrahão Salum Júnior G, Moreira-Maia CR, Wagner F, Simioni A, de Fraga Bassotto C, R Moritz G, Schaffer Aguzzoli C, Buchweitz A, Schmitz M, Rubia K, Paim Rohde LA. Effects of computerized cognitive training as add-on treatment to stimulants in ADHD: a pilot fMRI study. Brain Imaging Behav 2021; 14:1933-1944. [PMID: 31218531 DOI: 10.1007/s11682-019-00137-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The neurofunctional effects of Cognitive training (CT) are poorly understood. Our main objective was to assess fMRI brain activation patterns in children with ADHD who received CT as an add-on treatment to stimulant medication. We included twenty children with ADHD from a clinical trial of stimulant medication and CT (10 in medication + CT and 10 in medication + non-active training). Between-group differences were assessed in performance and in brain activation during 3 fMRI paradigms of working memory (N-back: 0-back, 1-back, 2-back, 3-back), sustained attention (Sustained Attention Task - SAT: 2 s, 5 s and 8 s delays) and inhibitory control (Go/No-Go). We found significant group x time x condition interactions in working memory (WM) and sustained attention on brain activation. In N-back, decreases were observed in the BOLD signal change from baseline to endpoint with increasing WM load in the right insula, right putamen, left thalamus and left pallidum in the CT compared to the non-active group; in SAT - increases in the BOLD signal change from baseline to endpoint with increasing delays were observed in bilateral precuneus, right insula, bilateral associative visual cortex and angular gyrus, right middle temporal, precentral, postcentral, superior frontal and middle frontal gyri in the CT compared to the non-active group. CT in ADHD was associated with changes in activation in task-relevant parietal and striato-limbic regions of sustained attention and working memory. Changes in brain activity may precede behavioral performance modifications in working memory and sustained attention, but not in inhibitory control.
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Affiliation(s)
- Virginia de Oliveira Rosa
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. .,ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil.
| | - Alexandre Rosa Franco
- Center for Biomedical Imaging and Neuromodulation, The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.,Center for the Developing Brain, Child Mind Institute, New York, NY, USA
| | - Giovanni Abrahão Salum Júnior
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Carlos Renato Moreira-Maia
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil
| | - Flávia Wagner
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil
| | - André Simioni
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil
| | - Caroline de Fraga Bassotto
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil
| | - Guilherme R Moritz
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil
| | | | - Augusto Buchweitz
- BraIns, Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Schmitz
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil
| | - Katya Rubia
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luis Augusto Paim Rohde
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Serviço de Psiquiatria. Ramiro Barcelos, 2350. Bairro Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
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15
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Hardy SJ, Bills SE, Meier ER, Schatz JC, Keridan KJ, Wise S, Hardy KK. A Randomized Controlled Trial of Working Memory Training in Pediatric Sickle Cell Disease. J Pediatr Psychol 2021; 46:1001-1014. [PMID: 33824980 DOI: 10.1093/jpepsy/jsab030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Youth with sickle cell disease (SCD) are at risk for neurocognitive deficits including problems with working memory (WM), but few interventions to improve functioning exist. This study sought to determine the feasibility and efficacy of home-based, digital WM training on short-term memory and WM, behavioral outcomes, and academic fluency using a parallel group randomized controlled trial design. METHODS 47 children (7-16 years) with SCD and short-term memory or WM difficulties were randomized to Cogmed Working Memory Training at home on a tablet device (N = 24) or to a standard care Waitlist group (N = 23) that used Cogmed after the waiting period. Primary outcomes assessed in clinic included performance on verbal and nonverbal short-term memory and WM tasks. Secondary outcomes included parent-rated executive functioning and tests of math and reading fluency. RESULTS In the evaluable sample, the Cogmed group (N = 21) showed greater improvement in visual WM compared with the Waitlist group (N = 22; p = .03, d = 0.70 [CI95 = 0.08, 1.31]). When examining a combined sample of participants, those who completed ≥10 training sessions exhibited significant improvements in verbal short-term memory, visual WM, and math fluency. Adherence to Cogmed was lower than expected (M = 9.07 sessions, SD = 7.77), with 19 participants (41%) completing at least 10 sessions. Conclusions: Visual WM, an ability commonly affected by SCD, is modifiable with cognitive training. Benefits extended to verbal short-term memory and math fluency when patients completed a sufficient training dose. Additional research is needed to identify ideal candidates for training and determine whether training gains are sustainable and generalize to real-world outcomes.
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Affiliation(s)
- Steven J Hardy
- Division of Hematology, Children's National Hospital.,Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences
| | - Sarah E Bills
- Division of Hematology, Children's National Hospital
| | | | | | | | - Shane Wise
- Division of Hematology, Children's National Hospital
| | - Kristina K Hardy
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences.,Division of Neuropsychology, Children's National Hospital
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16
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Jurigova BG, Gerdes MR, Anguera JA, Marco EJ. Sustained benefits of cognitive training in children with inattention, three-year follow-up. PLoS One 2021; 16:e0246449. [PMID: 33539468 PMCID: PMC7861383 DOI: 10.1371/journal.pone.0246449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
The goal of this study was to test for long-term benefits three years after the completion of a cognitive training intervention (Project: EVO™) in a subset of children with Sensory Processing Dysfunction (SPD). Our initial findings revealed that children with SPD who also met research criteria for Attention Deficit Hyperactivity Disorder (SPD+IA) showed a significant decrease in parent-observed inattentive behaviors, which remained stable in a nine-month follow-up assessment. Forty nine caregivers of participants who completed the Project: EVO™ training were contacted to be included in this follow up study. Each was emailed an invitation to complete the Vanderbilt ADHD Diagnostic Parent Rating Scale, which yielded a completion rate of 39/49 (80%). A Generalized Estimating Equations analysis was used to assess changes in symptoms over time, specifically to determine whether the initial improvements were retained. The SPD+IA cohort continued to show sustained benefits on their parent-reported scores of inattention, with 54% of SPD+IA individuals no longer meeting criteria for ADHD three years following intervention. These findings provide initial insights into the potential long-term benefits of a digital health intervention for children with attention-based issues.
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Affiliation(s)
- Barbora G. Jurigova
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, California, United States of America
| | - Molly R. Gerdes
- Research Division, Cortica Healthcare, San Rafael, California, United States of America
| | - Joaquin A. Anguera
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
| | - Elysa J. Marco
- Research Division, Cortica Healthcare, San Rafael, California, United States of America
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17
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Di Lieto MC, Pecini C, Brovedani P, Sgandurra G, Dell'Omo M, Chilosi AM, Guzzetta A, Perazza S, Sicola E, Cioni G. Adaptive Working Memory Training Can Improve Executive Functioning and Visuo-Spatial Skills in Children With Pre-term Spastic Diplegia. Front Neurol 2021; 11:601148. [PMID: 33551960 PMCID: PMC7854548 DOI: 10.3389/fneur.2020.601148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
Pre-term spastic diplegia (pSD) due to periventricular leukomalacia is a form of cerebral palsy in which weaknesses in executive functions are reported beyond the core visuo-spatial deficits. The study aimed at improving executive functioning and visuo-spatial skills with an evidence-based training focused on working memory in children with pSD. The intervention study followed a stepped wedge design. 19 children with pSD (11 female and 8 male; age range: 4;1–13;1 years), mild to moderate upper limb impairment and Verbal Intelligence Quotient (VIQ) >80 participated to the study. The children were trained with a home-based adaptive working memory training (CogMed®) over a 5-week period. The primary outcome measure was the CogMed Improvement index; pre- and post-test explorative neuropsychological assessment was conducted with a subset of tests from the NEPSY-II battery. Working memory training in children with pSD significantly improved trained working memory abilities (CogMed indices) as well as non-trained skills, such as visuo-spatial skills, inhibition of automatic responses and phonological processing. The results suggest that standard rehabilitation schedules for children with pSD should be integrated with trainings on executive functions.
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Affiliation(s)
- Maria Chiara Di Lieto
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Chiara Pecini
- Department of Education, Language, Interculture and Psychology, University of Florence, Florence, Italy
| | - Paola Brovedani
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Dell'Omo
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Anna Maria Chilosi
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Perazza
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Elisa Sicola
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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18
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Spencer-Smith M, Quach J, Mensah F, Roberts G, Gathercole S, Wake M, Anderson PJ. The Effectiveness of Working Memory Training for Children With Low Working Memory. Pediatrics 2020; 146:peds.2019-4028. [PMID: 33159002 DOI: 10.1542/peds.2019-4028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Subgroups of children may benefit more from working memory training than others. In this study, we aimed to examine whether response to the Cogmed Working Memory Training program differed for children with low IQ and elevated attention-deficit/hyperactivity disorder, emotional and behavioral symptoms, special health care needs, or by sex. METHODS We used data from the Memory Maestros trial, a population-based randomized controlled trial of the Cogmed program delivered at school (n = 226) compared to usual teaching (n = 226) in grade 1 children (mean age 6.9 years; SD 0.4) with low working memory. Cogmed comprises 20 to 25 sessions of 45-minute duration over 5 to 7 weeks. Children completed subtests from the Automated Working Memory Assessment to measure change in working memory from baseline to 6 months postrandomization. RESULTS After training, improved working memory standard scores (>1 SD) from baseline to 6 months were observed for approximately one-third of the children, with more than half maintaining stable scores (within 1 SD). However, similar outcomes were observed for children receiving usual teaching. Differential effect of Cogmed versus usual teaching was evident for children with elevated hyperactivity and/or inattention, who were less likely to show improved visuospatial working memory, but not for other subgroups studied. CONCLUSIONS Children with elevated hyperactivity and/or inattention were less likely to show clinically meaningful improvement after Cogmed; however, differential effects were not evident for children with low IQ and elevated emotional and behavioral symptoms, special health care needs, or by sex. More research is needed to determine if training can improve working memory and, if so, for whom.
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Affiliation(s)
- Megan Spencer-Smith
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; .,Clinical Sciences Theme
| | - Jon Quach
- Population Health Theme, and.,Melbourne Graduate School of Education, The University of Melbourne, Carlton, Victoria, Australia
| | - Fiona Mensah
- Population Health Theme, and.,Department of Paediatrics and
| | - Gehan Roberts
- Population Health Theme, and.,Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics and
| | - Susan Gathercole
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom; and
| | - Melissa Wake
- Population Health Theme, and.,Department of Paediatrics and.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Clinical Sciences Theme
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19
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Computer-based inhibitory control training in children with Attention-Deficit/Hyperactivity Disorder (ADHD): Evidence for behavioral and neural impact. PLoS One 2020; 15:e0241352. [PMID: 33253237 PMCID: PMC7703966 DOI: 10.1371/journal.pone.0241352] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/14/2020] [Indexed: 12/21/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed psychological disorder of childhood. Medication and cognitive behavioral therapy are effective treatments for many children; however, adherence to medication and therapy regimens is low. Thus, identifying effective adjunct treatments is imperative. Previous studies exploring computerized training programs as supplementary treatments have targeted working memory or attention. However, many lines of research suggest inhibitory control (IC) plays a central role in ADHD pathophysiology, which makes IC a potential intervention target. In this randomized control trial (NCT03363568), we target IC using a modified stop-signal task (SST) training designed by NeuroScouting, LLC in 40 children with ADHD, aged 8 to 11 years. Children were randomly assigned to adaptive treatment (n = 20) or non-adaptive control (n = 20) with identical stimuli and task goals. Children trained at home for at least 5 days a week (about 15m/day) for 4-weeks. Relative to the control group, the treatment group showed decreased relative theta power in resting EEG and trending improvements in parent ratings of attention (i.e. decreases in inattentive behaviors). Both groups showed improved SST performance. There was not evidence for treatment effects on hyperactivity or teacher ratings of symptoms. Results suggest training IC alone has potential to positively impact symptoms of ADHD and provide evidence for neural underpinnings of this impact (change in theta power; change in N200 latency). This shows promising initial results for the use of computerized training of IC in children with ADHD as a potential adjunct treatment option for children with ADHD.
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20
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Rossignoli-Palomeque T, Perez-Hernandez E, González-Marqués J. Training effects of attention and EF strategy-based training "Nexxo" in school-age students. Acta Psychol (Amst) 2020; 210:103174. [PMID: 32919092 DOI: 10.1016/j.actpsy.2020.103174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Given the importance of attention and executive functions in children's behavior, programs directed to improve these processes are of interest. Nexxo-training combines the use of the Nexxo touchscreen application (go/no-go and stop signal tasks) with procedural metacognitive strategies. The present paper reports a test of Nexxo's impact on children aged 6-7 and 8-9 years. We conducted a randomized active-controlled trial involving 108 typically-developing children: 1st grade (N = 61, M = 6.46 years, SD = 0.35) and 3rd grade (N = 47, M = 8.5 years, SD = 0.27), randomly assigned to: (1) experimental, (2) active-control, or (3) passive-control groups. A 2-month follow-up was carried out after the intervention. The 3rd grade experimental group displayed a significant reduction in attentional problems at follow-up compared to both control groups. Executive Function problems were also reduced at follow-up in the experimental group. Participants in this group improved in Supervision (self-monitoring) at post-intervention and follow-up compared to passive-controls. Although group effect was not significant at t1, it was significant at post measures in experimental group compared to passive-controls. Nexxo-training revealed a trend-level improvement in attention and executive functions for children in the 3rd grade.
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Affiliation(s)
| | - E Perez-Hernandez
- Department of Development and Educational Psychology, Autonomous University of Madrid, Madrid, Spain
| | - J González-Marqués
- Department of Basic Psychology II, Complutense University of Madrid, Madrid, Spain
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21
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Scott H, Harvey DJ, Li Y, McLennan YA, Johnston CK, Shickman R, Piven J, Schweitzer JB, Hessl D. Cognitive Training Deep Dive: The Impact of Child, Training Behavior and Environmental Factors within a Controlled Trial of Cogmed for Fragile X Syndrome. Brain Sci 2020; 10:brainsci10100671. [PMID: 32992879 PMCID: PMC7601580 DOI: 10.3390/brainsci10100671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022] Open
Abstract
Children with fragile X syndrome (FXS) exhibit deficits in a variety of cognitive processes within the executive function domain. As working memory (WM) is known to support a wide range of cognitive, learning and adaptive functions, WM computer-based training programs have the potential to benefit people with FXS and other forms of intellectual and developmental disability (IDD). However, research on the effectiveness of WM training has been mixed. The current study is a follow-up “deep dive” into the data collected during a randomized controlled trial of Cogmed (Stockholm, Sweden) WM training in children with FXS. Analyses characterized the training data, identified training quality metrics, and identified subgroups of participants with similar training patterns. Child, parent, home environment and training quality metrics were explored in relation to the clinical outcomes during the WM training intervention. Baseline cognitive level and training behavior metrics were linked to gains in WM performance-based assessments and also to reductions in inattention and other behaviors related to executive functioning during the intervention. The results also support a recommendation that future cognitive intervention trials with individuals with IDD such as FXS include additional screening of participants to determine not only baseline feasibility, but also capacity for training progress over a short period prior to inclusion and randomization. This practice may also better identify individuals with IDD who are more likely to benefit from cognitive training in clinical and educational settings.
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Affiliation(s)
- Haleigh Scott
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (H.S.); (Y.A.M.); (C.K.J.); (R.S.); (J.B.S.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Danielle J. Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA 95616, USA; (D.J.H.); (Y.L.)
| | - Yueju Li
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA 95616, USA; (D.J.H.); (Y.L.)
| | - Yingratana A. McLennan
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (H.S.); (Y.A.M.); (C.K.J.); (R.S.); (J.B.S.)
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Cindy K. Johnston
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (H.S.); (Y.A.M.); (C.K.J.); (R.S.); (J.B.S.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Ryan Shickman
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (H.S.); (Y.A.M.); (C.K.J.); (R.S.); (J.B.S.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Julie B. Schweitzer
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (H.S.); (Y.A.M.); (C.K.J.); (R.S.); (J.B.S.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - David Hessl
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (H.S.); (Y.A.M.); (C.K.J.); (R.S.); (J.B.S.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95817, USA
- Correspondence: ; Tel.: +1-916-703-0249
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22
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Dentz A, Guay M, Gauthier B, Romo L, Parent V. Is the Cogmed program effective for youths with attention deficit/hyperactivity disorder under pharmacological treatment? APPLIED COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1002/acp.3631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amélie Dentz
- Department of PsychologyUniversity of Fribourg Fribourg Switzerland
| | - Marie‐Claude Guay
- Department of PsychologyUniversity of Quebec at Montreal (UQAM) Montreal Quebec Canada
| | - Bruno Gauthier
- Department of PsychologyUniversity of Montreal (Udem) Montreal Quebec Canada
| | - Lucia Romo
- Department of PsychologyUniversity of Paris‐Nanterre Nanterre France
| | - Véronique Parent
- Department of PsychologyUniversity of Sherbrooke Sherbrooke Quebec Canada
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23
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Smith SD, Vitulano LA, Katsovich L, Li S, Moore C, Li F, Grantz H, Zheng X, Eicher V, Guloksuz SA, Zheng Y, Dong J, Sukhodolsky DG, Leckman JF. A Randomized Controlled Trial of an Integrated Brain, Body, and Social Intervention for Children With ADHD. J Atten Disord 2020; 24:780-794. [PMID: 27178060 PMCID: PMC5107355 DOI: 10.1177/1087054716647490] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: This study evaluated the efficacy of an Integrated Brain, Body, and Social (IBBS) intervention for children with ADHD. Treatment consisted of computerized cognitive remediation training, physical exercises, and a behavior management strategy. Method: Ninety-two children aged 5 to 9 years with ADHD were randomly assigned to 15 weeks of IBBS or to treatment-as-usual. Primary outcome measures included blinded clinician ratings of ADHD symptoms and global clinical functioning. Secondary outcome measures consisted of parent and teacher ratings of ADHD and neurocognitive tests. Results: No significant treatment effects were found on any of our primary outcome measures. In terms of secondary outcome measures, the IBBS group showed significant improvement on a verbal working memory task; however, this result did not survive correction for multiple group comparisons. Conclusion: These results suggest that expanding cognitive training to multiple domains by means of two training modalities does not lead to generalized improvement of ADHD symptomatology.
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Affiliation(s)
- Stephanie D. Smith
- Yale School of Medicine, New Haven, CT, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | - Shuaixing Li
- Beijing Physical Education & Skill College, People’s Republic of China
| | - Christina Moore
- Yale School of Medicine, New Haven, CT, USA
- University of Delaware, Newark, DE, USA
| | - Fenghua Li
- Chinese Academy of Sciences, Beijing, People’s Republic of China
| | | | - Xixi Zheng
- Peking Union Medical College, Beijing, People’s Republic of China
| | | | | | - Yi Zheng
- Capital Medical University, Beijing, People’s Republic of China
| | - Jinxia Dong
- Peking University, Beijing, People’s Republic of China
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Nejati V. Cognitive rehabilitation in children with attention deficit- hyperactivity disorder: Transferability to untrained cognitive domains and behavior. Asian J Psychiatr 2020; 49:101949. [PMID: 32114377 DOI: 10.1016/j.ajp.2020.101949] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/29/2019] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Abstract
Transferability of cognitive rehabilitation is a crucial point for efficacy. The purpose of the present study is to determine the transfer effect of cognitive rehabilitation to the untrained cognitive domains and behavior in children with attention deficit- hyperactivity disorder (ADHD). Thirty children with ADHD randomly allocated into two intervention and control groups. The intervention group received cognitive rehabilitation in 12-15 sessions. Analyses indicated that the experimental group shows an improvement in the trained domain. The result found a lack of near transfer to selective attention and inhibitory control with a successful far transfer effect to the risky decision making and delay discounting. Furthermore, the transfer occurred to behavioral symptoms of the intervention group. Attention and working memory training decrease delay discounting and delay discounting. The near transfer is not a prerequisite of far transfer. Cognitive rehabilitation can transfer horizontally to other cognitive domains at the same level and vertically to behaviors in a top-down manner.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Velenjak, PO. Box: 1983969411, Tehran, Iran.
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25
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Veloso A, Vicente SG, Filipe MG. Effectiveness of Cognitive Training for School-Aged Children and Adolescents With Attention Deficit/Hyperactivity Disorder: A Systematic Review. Front Psychol 2020; 10:2983. [PMID: 32010026 PMCID: PMC6971402 DOI: 10.3389/fpsyg.2019.02983] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/16/2019] [Indexed: 01/09/2023] Open
Abstract
Problems with executive functions (EF) are hallmark characteristics of Attention Deficit/Hyperactivity Disorder (ADHD). Therefore, this review analyzed the efficacy of cognitive training for EF in reducing ADHD symptomatology and improving educational, interpersonal, and occupational outcomes in children and adolescents with this disorder. A systematic search, using a PICO (population/participant, intervention/indicator, comparator/control, outcome) framework was carried out. From 2008 to 2018, resorting to EBSCOhost, the following databases were searched: Academic Search Complete, ERIC, MEDLINE with Full Text, PsycARTICLES, PsycINFO, and Psychology and Behavioral Sciences Collection. Twenty-two studies were included in this review. Of the 18 studies that reported performance-based measures of EF, 13 found improvements and five did not. Overall, 17 studies showed positive transfer effects on ADHD symptomatology, EF, academic improvement, reduced off-task behavior, and/or enhanced social skills. Of the nine studies that performed follow-up sessions, seven concluded that the treatment effects were maintained over time. In sum, results showed that cognitive training can be an effective intervention for children and adolescents with ADHD and might be a complementary treatment option for this disorder.
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Affiliation(s)
- Andreia Veloso
- Faculty of Psychology and Education Sciences, Centre for Psychology, University of Porto, Porto, Portugal
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26
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Early Attentional Modulation by Working Memory Training in Young Adult ADHD Patients during a Risky Decision-Making Task. Brain Sci 2020; 10:brainsci10010038. [PMID: 31936483 PMCID: PMC7017173 DOI: 10.3390/brainsci10010038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/17/2019] [Accepted: 01/03/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Working memory (WM) deficits and impaired decision making are among the characteristic symptoms of patients affected by attention deficit/hyperactivity disorder (ADHD). The inattention associated with the disorder is likely to be due to functional deficits of the neural networks inhibiting irrelevant sensory input. In the presence of unnecessary information, a good decisional process is impaired and ADHD patients tend to take risky decisions. This study is aimed to test the hypothesis that the level of difficulty of a WM training (WMT) is affecting the top-down modulation of the attentional processes in a probabilistic gambling task. Methods: Event-related potentials (ERP) triggered by the choice of the amount wagered in the gambling task were recorded, before and after WMT with a the dual n-back task, in young ADHD adults and matched controls. For each group of participants, randomly assigned individuals were requested to perform WMT with a fixed baseline level of difficulty. The remaining participants were trained with a performance-dependent adaptive n-level of difficulty. Results: We compared the ERP recordings before and after 20 days of WMT in each subgroup. The analysis was focused on the time windows with at least three recording sites showing differences before and after training, after Bonferroni correction ( p < 0.05 ). In ADHD, the P1 wave component was selectively affected at frontal sites and its shape was recovered close to controls' only after adaptive training. In controls, the strongest contrast was observed at parietal level with a left hemispheric dominance at latencies near 900 ms, more after baseline than after adaptive training. Conclusion: Partial restoration of early selective attentional processes in ADHD patients might occur after WMT with a high cognitive load. Modified frontal sites' activities might constitute a neural marker of this effect in a gambling task. In controls, conversely, an increase in late parietal negativity might rather be a marker of an increase in transfer effects to fluid intelligence.
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Suivi à long terme des effets d’un entraînement de la mémoire de travail (Cogmed) auprès d’enfants présentant un TDA/H. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.neurenf.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Bioulac S, Micoulaud-Franchi JA, Maire J, Bouvard MP, Rizzo AA, Sagaspe P, Philip P. Virtual Remediation Versus Methylphenidate to Improve Distractibility in Children With ADHD: A Controlled Randomized Clinical Trial Study. J Atten Disord 2020; 24:326-335. [PMID: 29562853 DOI: 10.1177/1087054718759751] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Virtual environments have been used to assess children with ADHD but have never been tested as therapeutic tools. We tested a new virtual classroom cognitive remediation program to improve symptoms in children with ADHD. Method: In this randomized clinical trial, 51 children with ADHD (7-11 years) were assigned to a virtual cognitive remediation group, a methylphenidate group, or a psychotherapy group. All children were evaluated before and after therapy with an ADHD Rating Scale, a Continuous Performance Test (CPT), and a virtual classroom task. Results: After therapy by virtual remediation, children exhibited significantly higher numbers of correct hits on the virtual classroom and CPT. These improvements were equivalent to those observed with methylphenidate treatment. Conclusion: Our study demonstrates for the first time that a cognitive remediation program delivered in a virtual classroom reduces distractibility in children with ADHD and could replace methylphenidate treatment in specific cases.
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Affiliation(s)
- Stéphanie Bioulac
- University of Bordeaux, SANPSY, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Clinique du sommeil, France
| | - Jean-Arthur Micoulaud-Franchi
- University of Bordeaux, SANPSY, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Clinique du sommeil, France
| | - Jenna Maire
- University of Bordeaux, INSERM U1219, Bordeaux, France
| | - Manuel P Bouvard
- Pôle Universitaire Psychiatrie Enfants et Adolescents, Bordeaux, France
| | | | - Patricia Sagaspe
- University of Bordeaux, SANPSY, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Clinique du sommeil, France
| | - Pierre Philip
- University of Bordeaux, SANPSY, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Clinique du sommeil, France
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29
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van Houdt CA, Aarnoudse-Moens CSH, van Wassenaer-Leemhuis AG, Laarman ARC, Koopman-Esseboom C, van Kaam AH, Oosterlaan J. Effects of Executive Function Training on Attentional, Behavioral and Emotional Functioning and Self-Perceived Competence in Very Preterm Children: A Randomized Controlled Trial. Front Psychol 2019; 10:2100. [PMID: 31572276 PMCID: PMC6753219 DOI: 10.3389/fpsyg.2019.02100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/29/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Very preterm children have poorer attentional, behavioral and emotional functioning than term-born children. Problems on these domains have been linked to poorer executive function (EF). This study examined effects of a game-formatted, comprehensive EF training on attentional, behavioral and emotional functioning and self-perceived competence in very preterm children. STUDY DESIGN Eighty-five children participated in a multi-center, double-blind, placebo and waitlist-controlled randomized trial. Children were recruited from neonatal follow-up units of two academic medical centers in The Netherlands. Eligible for inclusion were 8-12 year old children born very preterm (<30 weeks of gestation) and/or with extremely low birthweight (<1000 g) with parent reported attention problems. Children were randomly assigned to one of three treatment arms: EF training, placebo training or waitlist. The EF and placebo training involved a 6 weeks, 25 (30-45 min) sessions training program. Attentional functioning (Attention Network Test), behavioral and emotional functioning (parent and teacher Strengths and Difficulties questionnaire) and self-perceived competence (Self-Perception Profile for Children) were assessed at baseline, at the end of the training program and 5 months after the training was finished. Data analyses involved linear mixed model analyses. RESULTS Children in the EF training arm significantly improved on all training tasks over the course of the EF training program. Despite these improvements on the EF training tasks, there were no significant differences over time on any of the outcome measures between the three treatment arms, indicating that this computerized EF training program had no beneficial effects. CONCLUSION Although there were significant improvements in the EF training tasks, there was no generalization of these improvements to any of the outcome measures. Thus, our findings do not support the use of computerized EF training programs. Future research should investigate effectivity of more ecologically valid, real-world like EF training programs.
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Affiliation(s)
- Carolien A. van Houdt
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Emma Neuroscience Group, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Cornelieke S. H. Aarnoudse-Moens
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Emma Neuroscience Group, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Psychosocial Department, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - A. R. Céleste Laarman
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Anton H. van Kaam
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Pediatrics, Amsterdam Reproduction and Development, Emma Neuroscience Group, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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30
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Coleman B, Marion S, Rizzo A, Turnbull J, Nolty A. Virtual Reality Assessment of Classroom - Related Attention: An Ecologically Relevant Approach to Evaluating the Effectiveness of Working Memory Training. Front Psychol 2019; 10:1851. [PMID: 31481911 PMCID: PMC6711453 DOI: 10.3389/fpsyg.2019.01851] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/29/2019] [Indexed: 12/12/2022] Open
Abstract
Computerized cognitive interventions to improve working memory also purport to improve ADHD-related inattention and off task behavior. Such interventions have been shown to improve working memory, executive functioning, and fluid reasoning on standardized neuropsychological measures. However, debate continues as to whether such programs lead to improvement on ecologically relevant outcomes, such as classroom behavior. This study sought to propose a novel, ecologically relevant approach to evaluate the effectiveness of working memory training on real-world attention performance. Participants included 15 children, aged 6-15, identified as having attention problems were assessed via the virtual classroom continuous performance task (VCCPT) before and after completing 5 weeks of Cogmed working memory training. The VCCPT is a validated measure of sustained and selective attention set within a virtual reality (VR) environment. Several key areas of attention performance were observed to improve, including omission errors, reaction time, reaction time variability, and hit variability. Results suggest that working memory training led to substantial improvements in sustained attention in a real-life scenario of classroom learning. Moreover, the use of psychometrically validated VR measurement provides incremental validity beyond that of teacher or parent report of behavior. Observing such improvements on ecologically relevant measures of attention adds to the discussion around how to evaluate the effectiveness of working memory training as it pertains to real-life improvements and serves to inform consumer awareness of such products and their claims.
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Affiliation(s)
- Benjamin Coleman
- College of Extended Learning, Point Loma Nazarene University, San Diego, CA, United States
| | - Sarah Marion
- Northwest Nazarene University, Nampa, ID, United States
| | - Albert Rizzo
- Institute of Creative Technologies, University of Southern California, Los Angeles, CA, United States
| | - Janiece Turnbull
- Fuller Graduate School of Psychology, Pasadena, CA, United States
| | - Anne Nolty
- Fuller Graduate School of Psychology, Pasadena, CA, United States
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31
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Minder F, Zuberer A, Brandeis D, Drechsler R. Specific Effects of Individualized Cognitive Training in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): The Role of Pre-Training Cognitive Impairment and Individual Training Performance. Dev Neurorehabil 2019; 22:400-414. [PMID: 31021250 DOI: 10.1080/17518423.2019.1600064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: We investigated the impact of the pre-training neuropsychological (NP) impairment and of the training progress on the NP and behavioural outcome after computerized cognitive training (CogT) in children with ADHD. Method: Thirty-one participants underwent individualized CogT (focussing on one or two cognitive domains: working memory, inhibition, attention) over 12 weeks. NP tests and behaviour ratings served as outcome measures. Results: After CogT, significant improvements emerged according to parents' ratings, but only on very few NP test measures. Children with milder/no pre-training NP impairment showed larger improvements on behavioural ratings than more impaired children. A steeper training performance slope was related to better behavioural outcomes. Conclusion: We find partial support for specific effects of CogT, but the assumption that an individually tailored selection of training tasks would be particularly beneficial for children with ADHD with NP deficits was not confirmed. Trial registration number: NCT02358941.
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Affiliation(s)
- Franziska Minder
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University Hospital of Psychiatry, University of Zurich , Zurich , Switzerland
| | - Agnieszka Zuberer
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University Hospital of Psychiatry, University of Zurich , Zurich , Switzerland
| | - Daniel Brandeis
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University Hospital of Psychiatry, University of Zurich , Zurich , Switzerland.,b Neuroscience Center Zurich , University of Zurich and ETH Zurich , Zurich , Switzerland.,c Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health , Medical Faculty Mannheim/Heidelberg University , Mannheim , Germany.,d Center for Integrative Human Physiology , University of Zurich , Zurich , Switzerland
| | - Renate Drechsler
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University Hospital of Psychiatry, University of Zurich , Zurich , Switzerland
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32
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Smith S, Crowley M, Ferrey A, Ramsey K, Wexler B, Leckman J, Sukhodolsky D. Effects of Integrated Brain, Body, and Social (IBBS) intervention on ERP measures of attentional control in children with ADHD. Psychiatry Res 2019; 278:248-257. [PMID: 31233935 PMCID: PMC6637759 DOI: 10.1016/j.psychres.2019.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 11/26/2022]
Abstract
A primary goal of this study was to examine the impact of an Integrated Brain, Body, and Social (IBBS) intervention (multi-faceted treatment consisting of computerized cognitive training, physical exercise, and behavior management) on ERPs of attentional control (P3 & N2) in children with ADHD. The secondary goal was to test the differences between children with and without ADHD on ERP and Go/No-Go behavioral measures. A total of twenty-nine participants (M age = 7.14 years; 52% male; 41.4% white) recruited from the IBBS efficacy study comparing IBBS to Treatment-As-Usual (TAU) completed a Go/No-Go task before and after treatment as brain activity was recorded using EEG. Thirty-four matched healthy controls (HC) completed the same EEG procedures at a single time point. Following treatment, the Go P3 latency was significantly earlier for the IBBS group relative to the TAU group. No treatment effects were found on any behavioral measures. Prior to treatment, there was a significant difference between the ADHD group and HC group for the N2 difference wave. Children with ADHD also showed slower reaction times on behavioral measures. Although this pilot study did not reveal robust treatment effects, it suggests that IBBS may prevent the worsening of attentional systems in the brain and larger studies are needed for replication purposes.
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Affiliation(s)
- Stephanie Smith
- Department of Psychology, University of Southern
Mississippi, Hattiesburg, MS, USA,Child Study Center, Yale School of Medicine, New Haven, CT,
USA,Corresponding Author: The University
of Southern Mississippi, Department of Psychology, 118 College Drive, #5025,
Hattiesburg, MS, 39406. . Telephone:
601-266-6256. Fax: 601-266-5580
| | - Michael Crowley
- Child Study Center, Yale School of Medicine, New Haven, CT,
USA
| | - Anne Ferrey
- Nuffield Department of Primary Care Health Sciences,
University of Oxford, Oxford, England
| | - Kathleen Ramsey
- Department of Psychology, University of Southern
Mississippi, Hattiesburg, MS, USA
| | - Bruce Wexler
- Department of Psychiatry, Yale School of Medicine, New
Haven, CT, USA
| | - James Leckman
- Child Study Center, Yale School of Medicine, New Haven, CT,
USA
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Savcı U, Tufan AE, Öztürk Y, Cansız MA. Dikkat Eksikliği ve Hiperaktivite Bozukluğu Tanılı Çocuk ve Ergenlerde Yürütücü İşlev Sorunları ve Tedavisi. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2019. [DOI: 10.18863/pgy.424793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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34
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Dovis S, Maric M, Prins PJM, Van der Oord S. Does executive function capacity moderate the outcome of executive function training in children with ADHD? ACTA ACUST UNITED AC 2019; 11:445-460. [PMID: 31123915 DOI: 10.1007/s12402-019-00308-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/15/2019] [Indexed: 12/21/2022]
Abstract
Executive functioning (EF) training interventions aimed at ADHD-symptom reduction have limited results. However, EF training might only be effective for children with relatively poor EF capacity. This randomized double-blind placebo-controlled study examined whether pre-training EF capacity moderates the outcome of an EF-training intervention on measures of near transfer (EF performance) and far transfer (ADHD symptoms and parent-rated EF behavior) immediately after treatment and at 3-month follow-up. Sixty-one children with ADHD (aged 8-12) were randomized either to an EF-training condition where working memory, inhibition and cognitive flexibility were trained, or to a placebo condition. Single moderation models were used. All significant moderation outcomes had small effect sizes. After Bonferroni correction, there were no significant moderators of treatment outcome. Children with poor EF capacity do not benefit more from EF training than from placebo training. Training only EF-impaired children will probably not improve outcomes of EF training studies.
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Affiliation(s)
- Sebastiaan Dovis
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1001 NK, Amsterdam, The Netherlands.,Cognitive Science Center Amsterdam, University of Amsterdam, Nieuwe Achtergracht 129B, 1001 NK, Amsterdam, The Netherlands
| | - Marija Maric
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1001 NK, Amsterdam, The Netherlands.,Cognitive Science Center Amsterdam, University of Amsterdam, Nieuwe Achtergracht 129B, 1001 NK, Amsterdam, The Netherlands
| | - Pier J M Prins
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1001 NK, Amsterdam, The Netherlands.,Cognitive Science Center Amsterdam, University of Amsterdam, Nieuwe Achtergracht 129B, 1001 NK, Amsterdam, The Netherlands
| | - Saskia Van der Oord
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1001 NK, Amsterdam, The Netherlands. .,Cognitive Science Center Amsterdam, University of Amsterdam, Nieuwe Achtergracht 129B, 1001 NK, Amsterdam, The Netherlands. .,Clinical Psychology, KU Leuven, Tiensestraat 102, bus 3720, 3000, Leuven, Belgium.
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35
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Activating adolescents’ “hot” executive functions in a digital game to train cognitive skills: The effects of age and prior abilities. COGNITIVE DEVELOPMENT 2019. [DOI: 10.1016/j.cogdev.2018.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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36
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Khemiri L, Brynte C, Stunkel A, Klingberg T, Jayaram-Lindström N. Working Memory Training in Alcohol Use Disorder: A Randomized Controlled Trial. Alcohol Clin Exp Res 2018; 43:135-146. [PMID: 30462837 PMCID: PMC6587824 DOI: 10.1111/acer.13910] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/14/2018] [Indexed: 11/29/2022]
Abstract
Background Alcohol use disorder (AUD) is associated with cognitive deficits such as impaired executive functions, which are hypothesized to contribute to the progression of the disease and worsen treatment outcome. Training of working memory (WM) to improve cognitive functions and thereby reduce alcohol use has been proposed as a novel treatment strategy. Methods Patients with AUD (n = 50) who were recruited to an outpatient addiction clinic were randomized to receive 5 weeks of active WM training or control training. Participants had weekly follow‐up visits, and all cognitive training sessions were done online at home. Primary outcomes were WM function and change in self‐reported heavy drinking. Secondary outcomes were craving, other drinking outcomes, and performance on a range of neuropsychological tasks from the Cambridge Neuropsychological Test Automated Battery. Results The active training group demonstrated a significantly greater improvement in verbal WM compared with the control group. No statistically significant effect of training was found on the primary drinking outcome, but a trend was observed indicating that WM training reduces the number of drinks per drinking occasion. WM training had no statistically significant effect on any of the other neuropsychological tasks. Conclusions Cognitive training can improve WM function in individuals with AUD, suggesting that such interventions are feasible to administer in this patient population. The results do not support an effect of WM training on heavy drinking or transfer effects to other cognitive domains. Future studies should evaluate WM training as an adjunct to evidence‐based treatments for AUD to assess potential synergistic effects.
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Affiliation(s)
- Lotfi Khemiri
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Angela Stunkel
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Torkel Klingberg
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Ackermann S, Halfon O, Fornari E, Urben S, Bader M. Cognitive Working Memory Training (CWMT) in adolescents suffering from Attention-Deficit/Hyperactivity Disorder (ADHD): A controlled trial taking into account concomitant medication effects. Psychiatry Res 2018; 269:79-85. [PMID: 30145306 DOI: 10.1016/j.psychres.2018.07.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/26/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
Although, cognitive working memory training (CWMT) has been reported to enhance working memory functioning in youths with attention-deficit/ hyperactivity disorder (ADHD), few studies take into account the concomitant effects of medication. Sixty adolescents aged from 11 to 15 years were randomly assigned to CWMT treatment, whereas medication was either continued or not introduced (no randomization performed). Results revealed beneficial effects of CWMT on the different components of working memory (WM), namely the phonological loop, the visuospatial sketchpad and the central executive. In particular, CWMT allowed participants to obtain a level of performance similar to the typically-developing adolescents for the phonological loop (i.e., forward digit span) as well as for the visuospatial sketchpad (i.e., board span). For the central executive (i.e., backward digit span) the concomitant effects of CWMT and medication allows participants to obtain the performance level of the typically-developing adolescents. Although, no transfers were observed with respect to other cognitive functions, in medicated patients with ADHD, CWMT reduced hyperactivity / impulsivity symptoms at 2-month follow-up. The present study gives evidence of the efficacy of CWMT to enhance WM performance, as well as, to reduce symptoms. The overall results highlight the usefulness of multimodal interventions.
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Affiliation(s)
- Sandie Ackermann
- University Service of Child and Adolescent Psychiatry, University Hospital of Lausanne, Switzerland
| | - Olivier Halfon
- University Service of Child and Adolescent Psychiatry, University Hospital of Lausanne, Switzerland
| | - Eleonora Fornari
- Biomedical Imaging Center (CIBM), Department of Radiology, University Hospital of Lausanne, Switzerland
| | - Sébastien Urben
- University Service of Child and Adolescent Psychiatry, University Hospital of Lausanne, Switzerland
| | - Michel Bader
- University Service of Child and Adolescent Psychiatry, University Hospital of Lausanne, Switzerland.
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Powell L, Parker J, Harpin V. What is the level of evidence for the use of currently available technologies in facilitating the self-management of difficulties associated with ADHD in children and young people? A systematic review. Eur Child Adolesc Psychiatry 2018; 27:1391-1412. [PMID: 29222634 DOI: 10.1007/s00787-017-1092-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
Abstract
A number of technologies to help self-manage attention deficit hyperactivity disorder (ADHD) in children and young people (YP) have been developed. This review will assess the level of evidence for the use of such technologies. The review was undertaken in accordance with the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. 7545 studies were screened. Fourteen studies of technology that aim to self-manage difficulties associated with ADHD in children and YP were included. Primary outcome measures were measures that assessed difficulties related to ADHD. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, the Cochrane Library, ProQuest ASSIA, PsycINFO and Scopus. The methodological quality of the studies was assessed. This review highlights the potential for the use of technology in paediatric ADHD management. However, it also demonstrates that current research lacks robustness; using small sample sizes, non-validated outcome measures and little psychoeducation component. Future research is required to investigate the value of technology in supporting children and YP with ADHD and a focus psychoeducation is needed.
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Affiliation(s)
- Lauren Powell
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Jack Parker
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Valerie Harpin
- Ryegate Children's Centre, Tapton Crescent Road, Sheffield, S10 5DD, UK
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Minder F, Zuberer A, Brandeis D, Drechsler R. A Review of the Clinical Utility of Systematic Behavioral Observations in Attention Deficit Hyperactivity Disorder (ADHD). Child Psychiatry Hum Dev 2018; 49:572-606. [PMID: 29214372 DOI: 10.1007/s10578-017-0776-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review evaluates the clinical utility of tools for systematic behavioral observation in different settings for children and adolescents with ADHD. A comprehensive search yielded 135 relevant results since 1990. Observations from naturalistic settings were grouped into observations of classroom behavior (n = 58) and of social interactions (n = 25). Laboratory observations were subdivided into four contexts: independent play (n = 9), test session (n = 27), parent interaction (n = 11), and peer interaction (n = 5). Clinically relevant aspects of reliability and validity of employed instruments are reviewed. The results confirm the usefulness of systematic observations. However, no procedure can be recommended as a stand-alone diagnostic method. Psychometric properties are often unsatisfactory, which reduces the validity of observational methods, particularly for measuring treatment outcome. Further efforts are needed to improve the specificity of observational methods with regard to the discrimination of comorbidities and other disorders.
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Affiliation(s)
- Franziska Minder
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Agnieszka Zuberer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland.,Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland.
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Benyakorn S, Calub CA, Riley SJ, Schneider A, Iosif AM, Solomon M, Hessl D, Schweitzer JB. Computerized Cognitive Training in Children With Autism and Intellectual Disabilities: Feasibility and Satisfaction Study. JMIR Ment Health 2018; 5:e40. [PMID: 29802090 PMCID: PMC5993974 DOI: 10.2196/mental.9564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Researchers are increasingly interested in testing and developing computerized cognitive training interventions for individuals with autism spectrum disorder due to the limited accessibility of treatments for this disorder. Understanding the feasibility of testing cognitive interventions for this population is critical, especially for individuals with ASD who have low to moderate intellectual ability. OBJECTIVE The aim of the study was to evaluate the feasibility of computerized cognitive training as measured by attrition rate and a parent satisfaction survey. METHODS A total of 26 participants aged 8-17 years with an autism spectrum disorder diagnosis and significant intellectual impairment were enrolled (mean age 11.1 years). They were instructed to complete 25 sessions of Cogmed Working Memory Training in 5 to 6 weeks with coach assistance. Attrition rate and parent satisfaction surveys were measured after the completion of training. RESULTS Most participants (96%, 25/26) completed the training and indicated high satisfaction (>88%). However, among the participants who completed the training, 5 participants (19%) were unable to finish in 6 weeks, the recommended training period by Cogmed. Parents noted various positive (eg, voice-overs) and negative (eg, particular graphic and sounds associated with a stimulus) features of the game that they thought affected their child's response. CONCLUSIONS Children with autism spectrum disorder and intellectual impairments can successfully participate in computerized cognitive training interventions but may require additional weeks to complete the training beyond the time needed for children without intellectual impairments. The overall completion rate, with extended time to complete the training, was high. Developers of cognitive training programs for this population should take into account potential issues regarding the noise level of stimuli and characteristics of the visual graphics.
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Affiliation(s)
- Songpoom Benyakorn
- Department of Psychiatry, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States.,MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Catrina A Calub
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States.,MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Steven J Riley
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States.,MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Andrea Schneider
- MIND Institute, University of California, Davis, Sacramento, CA, United States.,Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
| | - Marjorie Solomon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States.,MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - David Hessl
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States.,MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States.,MIND Institute, University of California, Davis, Sacramento, CA, United States
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Rossignoli-Palomeque T, Perez-Hernandez E, González-Marqués J. Brain Training in Children and Adolescents: Is It Scientifically Valid? Front Psychol 2018; 9:565. [PMID: 29780336 PMCID: PMC5946581 DOI: 10.3389/fpsyg.2018.00565] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/04/2018] [Indexed: 01/14/2023] Open
Abstract
Background: Brain training products are becoming increasingly popular for children and adolescents. Despite the marketing aimed at their use in the general population, these products may provide more benefits for specific neurologically impaired populations. A review of Brain Training (BT) products analyzing their efficacy while considering the methodological limitations of supporting research is required for practical applications. Method: searches were made of the PubMed database (until March 2017) for studies including: (1) empirical data on the use of brain training for children or adolescents and any effects on near transfer (NT) and/or far transfer (FT) and/or neuroplasticity, (2) use of brain training for cognitive training purposes, (3) commercially available training applications, (4) computer-based programs for children developed since the 1990s, and (5) relevant printed and peer-reviewed material. Results: Database searches yielded a total of 16,402 references, of which 70 met the inclusion criteria for the review. We classified programs in terms of neuroplasticity, near and far transfer, and long-term effects and their applied methodology. Regarding efficacy, only 10 studies (14.2%) have been found that support neuroplasticity, and the majority of brain training platforms claimed to be based on such concepts without providing any supporting scientific data. Thirty-six studies (51.4%) have shown far transfer (7 of them are non-independent) and only 11 (15.7%) maintained far transfer at follow-up. Considering the methodology, 40 studies (68.2%) were not randomized and controlled; for those randomized, only 9 studies (12.9%) were double-blind, and only 13 studies (18.6%) included active controls in their trials. Conclusion: Overall, few independent studies have found far transfer and long-term effects. The majority of independent results found only near transfer. There is a lack of double-blind randomized trials which include an active control group as well as a passive control to properly control for contaminant variables. Based on our results, Brain Training Programs as commercially available products are not as effective as first expected or as they promise in their advertisements.
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Affiliation(s)
- Teresa Rossignoli-Palomeque
- Department of Basic Psychology II, Complutense University of Madrid, Madrid, Spain.,Department of Psychology and Education, Centro Universitario Cardenal Cisneros, Alcalá de Henares, Madrid, Spain
| | - Elena Perez-Hernandez
- Department of Development and Educational Psychology, Autonomous University of Madrid, Madrid, Spain
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Chacko A, Bedard ACV, Marks D, Gopalan G, Feirsen N, Uderman J, Chimiklis A, Heber E, Cornwell M, Anderson L, Zwilling A, Ramon M. Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children. Child Neuropsychol 2018; 24:427-450. [PMID: 28277151 PMCID: PMC6224162 DOI: 10.1080/09297049.2017.1282450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- A Chacko
- a Department of Applied Psychology , New York University , NY , USA
| | - A-C V Bedard
- b Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education , University of Toronto , Canada
| | - D Marks
- c Department of Child and Adolescent Psychiatry , New York University School of Medicine , NY , USA
| | - G Gopalan
- d Department of Social Work , University of Maryland at Baltimore , MD , USA
| | - N Feirsen
- e Department of Psychology , City University of New York , NY , USA
| | - J Uderman
- e Department of Psychology , City University of New York , NY , USA
| | - A Chimiklis
- e Department of Psychology , City University of New York , NY , USA
| | - E Heber
- e Department of Psychology , City University of New York , NY , USA
| | - M Cornwell
- e Department of Psychology , City University of New York , NY , USA
| | - L Anderson
- e Department of Psychology , City University of New York , NY , USA
| | - A Zwilling
- e Department of Psychology , City University of New York , NY , USA
| | - M Ramon
- e Department of Psychology , City University of New York , NY , USA
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Qian Y, Chen M, Shuai L, Cao QJ, Yang L, Wang YF. Effect of an Ecological Executive Skill Training Program for School-aged Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Clinical Trial. Chin Med J (Engl) 2018. [PMID: 28639564 PMCID: PMC5494912 DOI: 10.4103/0366-6999.208236] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Ying Qian
- Clinical Psychological Center, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Min Chen
- Child Psychiatric Research Center, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Lan Shuai
- Child Psychiatric Research Center, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Qing-Jiu Cao
- Child Psychiatric Research Center, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Li Yang
- Child Psychiatric Research Center, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Yu-Feng Wang
- Child Psychiatric Research Center, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
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Etherton JL, Oberle CD, Rhoton J, Ney A. Effects of Cogmed working memory training on cognitive performance. PSYCHOLOGICAL RESEARCH 2018; 83:1506-1518. [DOI: 10.1007/s00426-018-1012-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/12/2018] [Indexed: 11/25/2022]
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Simons DJ, Boot WR, Charness N, Gathercole SE, Chabris CF, Hambrick DZ, Stine-Morrow EAL. Do "Brain-Training" Programs Work? Psychol Sci Public Interest 2018; 17:103-186. [PMID: 27697851 DOI: 10.1177/1529100616661983] [Citation(s) in RCA: 559] [Impact Index Per Article: 93.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Daniel J Simons
- Department of Psychology, University of Illinois at Urbana-Champaign
| | | | - Neil Charness
- Department of Psychology, Florida State University Institute for Successful Longevity, Florida State University
| | - Susan E Gathercole
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK School of Clinical Medicine, University of Cambridge
| | | | | | - Elizabeth A L Stine-Morrow
- Department of Educational Psychology, University of Illinois at Urbana-Champaign Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
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Training Working Memory: Anatomy Matters. J Neurosci 2018; 36:7805-6. [PMID: 27466326 DOI: 10.1523/jneurosci.1513-16.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/21/2016] [Indexed: 11/21/2022] Open
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L’entraînement de la mémoire de travail est-il bénéfique pour les enfants présentant un trouble déficit de l’attention/hyperactivité ? ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.neurenf.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Talbot KDS, Müller U, Kerns KA. Prospective memory in children with attention deficit hyperactivity disorder: a review. Clin Neuropsychol 2017; 32:783-815. [PMID: 29065807 DOI: 10.1080/13854046.2017.1393563] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The objective of the paper is to synthesize the research on prospective memory (PM) in children with attention-deficit/hyperactivity disorder (ADHD). METHOD Research on PM and ADHD in youth was synthesized according to the PRISMA guidelines and a summary of the types of PM deficits typically seen in these children, as well as the methods currently available to assess and treat these deficits is provided. Suggestions on ways to better manage PM deficits in children's everyday lives are also discussed. RESULTS Six studies have investigated PM in children with ADHD. The majority of these studies found a deficit in time-based PM, but not event-based PM. The mechanisms underlying this deficit, however, are still unknown. There are currently no specific measures available to clinically assess PM in children and there are no specific evidence-based interventions available that specifically target PM deficits in children with ADHD. CONCLUSION Remediation strategies aimed at compensating for these PM deficits in daily life may be most useful. Nevertheless, more research is necessary to better understand PM in children with ADHD.
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Affiliation(s)
| | - Ulrich Müller
- a Department of Psychology , University of Victoria , Victoria , Canada
| | - Kimberly A Kerns
- a Department of Psychology , University of Victoria , Victoria , Canada
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Mawjee K, Woltering S, Lai N, Gotlieb H, Kronitz R, Tannock R. Working Memory Training in ADHD: Controlling for Engagement, Motivation, and Expectancy of Improvement (Pilot Study). J Atten Disord 2017; 21:956-968. [PMID: 25501356 DOI: 10.1177/1087054714557356] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Steven Woltering
- 1 University of Toronto, Ontario, Canada.,2 Texas A&M University, Texas, USA
| | - Nathan Lai
- 1 University of Toronto, Ontario, Canada
| | | | - Reena Kronitz
- 3 Jewish Vocational Services Toronto, Ontario, Canada
| | - Rosemary Tannock
- 1 University of Toronto, Ontario, Canada.,4 Hospital for Sick Children, Toronto, Ontario, Canada
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