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Bikic A, Dalsgaard S, Pittman B, Leckman JF, Wexler B. Cognitive training for children with ADHD: composite cognitive score outcome in a randomized controlled trial. Nord J Psychiatry 2024; 78:87-91. [PMID: 37905332 DOI: 10.1080/08039488.2023.2270954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
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.
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Affiliation(s)
- Aida Bikic
- Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
- Child and Adolescent Psychiatric Services Southern Jutland, Aabenraa, Denmark
| | - Søren Dalsgaard
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Bruce Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Robledo-Castro C, Castillo-Ossa LF, Corchado JM. Artificial Cognitive Systems Applied in Executive Function Stimulation and Rehabilitation Programs: A Systematic Review. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022; 48:2399-2427. [PMID: 36185593 PMCID: PMC9516512 DOI: 10.1007/s13369-022-07292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Carolina Robledo-Castro
- Currículo, Universidad y Sociedad Research Group, Universidad del Tolima, Calle 42 1-02, 730006299 Ibagué, Colombia
- Ingeniería del Software Research Group, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, 170001 Manizales, Colombia
| | - Luis F. Castillo-Ossa
- Ingeniería del Software Research Group, Universidad Autónoma de Manizales, Antigua Estación del Ferrocarril, 170001 Manizales, Colombia
- Inteligencia Artificial Research Group, Universidad de Caldas, Calle 65 26-10, 170002 Manizales, Colombia
- Departamento de Ingeniería Indutrial, Universidad Nacional de Colombia Sede Manizales, Campus La Nubia, 170001 Manizales, Colombia
| | - Juan M. Corchado
- BISITE Research Group, University of Salamanca, Calle Espejo s/n, 37007 Salamanca, Spain
- Air Institute, IoT Digital Innovation Hub, 37188 Salamanca, Spain
- Department of Electronics, Information and Communication, Osaka Institute of Technology, 535-8585 Osaka, Japan
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Gamino JF, Frost C, Riddle R, Koslovsky J, Chapman SB. Higher-Order Executive Function in Middle School: Training Teachers to Enhance Cognition in Young Adolescents. Front Psychol 2022; 13:867264. [PMID: 35592149 PMCID: PMC9111740 DOI: 10.3389/fpsyg.2022.867264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Jacquelyn F Gamino
- The University of Texas at Dallas, Center for BrainHealth, Richardson, TX, United States
| | - Courtney Frost
- The University of Texas at Dallas, Center for BrainHealth, Richardson, TX, United States
| | - Russell Riddle
- The University of Texas at Dallas, Center for BrainHealth, Richardson, TX, United States
| | - Janet Koslovsky
- The University of Texas at Dallas, Center for BrainHealth, Richardson, TX, United States
| | - Sandra B Chapman
- The University of Texas at Dallas, Center for BrainHealth, Richardson, TX, United States
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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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Imal AE, O’Leary S, Wexler BE. Risk‐Taking Patterns of Children, Associated Cognitive Weaknesses, and Prevention of Negative Outcomes. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2020; 2:34-40. [PMID: 36101890 PMCID: PMC9175884 DOI: 10.1176/appi.prcp.2020.20190020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/04/2019] [Accepted: 03/11/2020] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Bruce E. Wexler
- Department of PsychiatryNew HavenConnecticut
- Yale UniversityC8 SciencesNew HavenConnecticut
- Connecticut Mental Health CenterNew HavenConnecticut
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Rabipour S, Morrison C, Crompton J, Petrucelli M, de Oliveira Gonçalves Germano M, Popescu A, Davidson PSR. Few Effects of a 5-Week Adaptive Computerized Cognitive Training Program in Healthy Older Adults. JOURNAL OF COGNITIVE ENHANCEMENT 2019. [DOI: 10.1007/s41465-019-00147-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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