Measuring and Improving Executive Functioning in the Classroom

Cognitive training for children with ADHD: composite cognitive score outcome in a randomized controlled trial

PURPOSE OF THE ARTICLE

Cognitive training for Attention Deficit/Hyperactivity Disorder (ADHD) has shown promising, although mixed results. In post-hoc analyses, we evaluate effects of cognitive training using a novel composite cognition score as the outcome for children attending at least 16 sessions of training, dose-response of training and associations between symptoms and cognitive functioning.

MATERIALS AND METHODS

Children (age 6-13) with ADHD were randomized to intervention (n = 26) or control (n = 34). For the current analysis, we restricted the intervention group to children, who completed at least 16 sessions of cognitive training (n = 26) and examined a dose response within that group.

RESULTS

Cognition improved significantly in the intervention, but not control group. Amount of the completed training sessions correlated significantly with the amount of cognitive improvement.

CONCLUSION

Variations in dose and frequency of training may be an important source of the variance in previous studies.

Artificial Cognitive Systems Applied in Executive Function Stimulation and Rehabilitation Programs: A Systematic Review

This article presents a systematic review of studies on cognitive training programs based on artificial cognitive systems and digital technologies and their effect on executive functions. The aim has been to identify which populations have been studied, the characteristics of the implemented programs, the types of implemented cognitive systems and digital technologies, the evaluated executive functions, and the key findings of these studies. The review has been carried out following the PRISMA protocol; five databases have been selected from which 1889 records were extracted. The articles were filtered following established criteria, to give a final selection of 264 articles that have been used for the purposes of this study in the analysis phase. The findings showed that the most studied populations were school-age children and the elderly. The most studied executive functions were working memory and attentional processes, followed by inhibitory control and processing speed. Many programs were commercial, customizable, gamified, and based on classic tasks. Some more recent initiatives have begun to incorporate user-machine interfaces, robotics, and virtual reality, although studies on their effects remain scarce. The studies recognize multiple benefits of computerized neuropsychological stimulation and rehabilitation programs for executive functions in different age groups, but there is a lack of studies in specific population sectors and with more rigorous research designs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13369-022-07292-5.

Higher-Order Executive Function in Middle School: Training Teachers to Enhance Cognition in Young Adolescents

The epoch of adolescent brain development is an ideal time to train complex thinking skills, and middle schools provide an ideal environment to train and foster this acquisition. Unfortunately, few teachers are equipped with enough knowledge of the science of learning and evidence-based methodology, to ensure all students are given sufficient opportunity to develop their cognitive capacity to the fullest. Using our evidenced-based higher-order executive function training program, we trained current teachers to provide cognitive training to their students. The results of this study demonstrate the efficacy of teacher-implemented intervention for immediate improvement in high-level executive function capacities such as gist-reasoning and interpretive statement production. More importantly, we found evidence of far transfer via students' improved academic performance in all standardized test content areas (Reading, Mathematics, Science, and Social Studies) when compared to their untrained peers. Our findings support the importance of providing intensive professional development that afford educators with a greater understanding of the brain, how we learn, and the importance of evidence-based programs to advance and instill high-level executive function in all students.

An integrated program of computer-presented and physical cognitive training exercises for children with attention-deficit/hyperactivity disorder

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.

Risk‐Taking Patterns of Children, Associated Cognitive Weaknesses, and Prevention of Negative Outcomes

Objective

Accidents, drug use, and unsafe sex associated with greater propensity for risk‐taking are leading causes of illness and death among adolescents. This study aimed to help identify and further characterize children with maladaptive risk‐taking to improve primary prevention interventions.

Methods

Two scores from the Bubblegum Analog Risk‐Taking Task for Children (BART‐C), total points and average inflations of unpopped bubbles, were used in a cluster analysis to identify distinct patterns of risk‐taking among 6,267 kindergarten through eighth‐grade children. Clusters were compared with the Flanker Test of Focused Attention, the Go/No‐Go test of inhibition, and the List Sorting Working Memory Test.

Results

Both BART‐C scores made significant (p<0.001) contributions in defining three clusters of children: reckless, risk avoidant, and adaptive risk‐taking. Clusters differed significantly on Flanker Test measures of incongruent accuracy (p=0.004) and reaction time (p<0.001), Go/No‐Go inhibition (p=0.001), and List Sorting Working Memory Test scores (p<0.001). The reckless cluster had lower Flanker accuracy and Go/No‐Go inhibition than did the other groups and lower working memory than the adaptive risk‐taking group. Compared with adaptive risk‐takers, the risk‐avoidant group was slower (p<0.001), showed a nonsignificant trend toward greater accuracy on the Flanker test, and had lower working memory scores (p<0.001).

Conclusions

The BART‐C defined two maladaptive risk‐taking clusters: reckless and risk avoidant. Significant differences in cognitive function between these groups and the adaptive risk‐taking group provides external validation of and further characterizes the clusters. Early intervention may prevent future health‐compromising behaviors among reckless children and may promote fuller learning and development among risk‐avoidant children.

Risk‐taking is a part of adaptive human development but may evolve to maladaptive risk‐taking with detrimental effects on future health and well‐being.

Distinct patterns of maladaptive risk‐taking (i.e., recklessness and risk‐avoidance) are significantly associated with cognitive weaknesses.

Identifying children with different maladaptive risk‐taking behaviors and cognitive weaknesses can help primary prevention programs reduce risk‐associated behaviors with negative health consequences.