Training attention-switching ability in adults with ADHD

[Formula: see text] Does training working memory or inhibitory control produce far-transfer improvements in set shifting for children with ADHD? A randomized controlled trial

Children with ADHD show impairments in set shifting task performance. However, the limited available evidence suggests that directly training shifting may not improve shifting performance in this population. We hypothesized that this incongruence may be because impairments exhibited by children with ADHD during shifting tasks are due to deficits in other executive functions, as shifting tasks also engage children's working memory and/or inhibitory control abilities. This randomized controlled trial examined the extent to which neurocognitive training of working memory vs. inhibitory control can produce downstream (far-transfer) improvements in set shifting task performance. Children with ADHD ages 8-12 (M = 10.41, SD = 1.46; 12 girls; 74% White/Non-Hispanic) were randomized to either central executive training (CET; n = 25) or inhibitory control training (ICT; n = 29), two next-generation digital therapeutics previously shown to improve their intended neurocognitive targets. Two criterion set shifting tests were administered at pre- and post-treatment. Results indicated that ICT was superior to CET for improving shifting accuracy (treatmentxtime: p = .03, BF10 = 3.01, η2 = .09, d = 0.63). ICT was also superior to CET for improving shifting speed, albeit on only one of the two outcome tasks (p = .02, BF10 = 4.53, η2 = .08, d = 0.59). CET did not produce improvements in shifting speed or accuracy on either task (p > .52, BF01 > 2.62), but showed evidence for more general (non-shifting-specific) improvement in response times on one of the outcome tasks (shift trials, d = 0.70; non-shift trials, d = 0.68). Taken together, these findings confirm that inhibitory control is important for successful performance on shifting tests, and suggest that training inhibitory control may reflect a method for improving set shifting difficulties in children with ADHD.

Effects and feasibility of psychological interventions to reduce inattention symptoms in adults with ADHD: a systematic review

BACKGROUND

Adult ADHD is common, highly comorbid, and restricts daily functioning. However, only a minority of patients receive appropriate treatment.

AIMS

Primary objective: To identify psychological interventions that diminish inattention symptoms in adults with ADHD. Secondary objective: To evaluate feasibility aspects.

METHODS

A search in PubMed, Cochrane Library, PsycInfo, PSYNDEX, and Eric was conducted. Interventions were grouped in: ADHD coaching, neuro feedback, cognitive training, psychoeducation, and behavioral therapy. Inattention symptoms were evaluated using standardized mean differences. Study quality was rated with the Cochrane Risk of Bias tool. Feasibility was assessed by number and time of sessions, setting, and qualification of the provider.

RESULTS

A total of N = 2229 results were identified, 19 randomized controlled studies were included in the analysis. Behavioral therapy showed effects on inattention symptoms [SMD: 0.44-1.71] when compared to inactive controls. In terms of feasibility, longer interventions did not outperform shorter ones and individual sessions were not superior to group sessions. No effects were given for neuro feedback, cognitive training, and psychoeducation in comparison to controls.

CONCLUSION

For adults with ADHD behavioral therapy seems an effective intervention to reduce inattention symptoms. In terms of feasibility, brief interventions may be valuable for a primary care setting.

Perspectives on heterogeneity-informed cognitive training for attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (AD/HD) is a heterogeneous neurodevelopmental condition, posing a severe threat to quality of life. Pharmacological therapies are the front-line treatment; however, their shortages encourage the development of alternative treatments for AD/HD. One promising method of developing alternative treatments is cognitive training (CT). A CT-based therapy was recently approved by the US Food and Drug Administration. However, due to heterogeneity in AD/HD, a CT protocol is unlikely to provide a one-size-fits-all solution for all patients with AD/HD. Therefore, this article highlights key aspects that need to be considered to further develop CT protocols for AD/HD, regarding training content, timing, suitability, and delivery mode. The perspectives presented here contribute to optimizing CT as an alternative option for treating AD/HD.

Altered neural flexibility in children with attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood, and is often characterized by altered executive functioning. Executive function has been found to be supported by flexibility in dynamic brain reconfiguration. Thus, we applied multilayer community detection to resting-state fMRI data in 180 children with ADHD and 180 typically developing children (TDC) to identify alterations in dynamic brain reconfiguration in children with ADHD. We specifically evaluated MR derived neural flexibility, which is thought to underlie cognitive flexibility, or the ability to selectively switch between mental processes. Significantly decreased neural flexibility was observed in the ADHD group at both the whole brain (raw p = 0.0005) and sub-network levels (p < 0.05, FDR corrected), particularly for the default mode network, attention-related networks, executive function-related networks, and primary networks. Furthermore, the subjects with ADHD who received medication exhibited significantly increased neural flexibility (p = 0.025, FDR corrected) when compared to subjects with ADHD who were medication naïve, and their neural flexibility was not statistically different from the TDC group (p = 0.74, FDR corrected). Finally, regional neural flexibility was capable of differentiating ADHD from TDC (Accuracy: 77% for tenfold cross-validation, 74.46% for independent test) and of predicting ADHD severity using clinical measures of symptom severity (R2: 0.2794 for tenfold cross-validation, 0.156 for independent test). In conclusion, the present study found that neural flexibility is altered in children with ADHD and demonstrated the potential clinical utility of neural flexibility to identify children with ADHD, as well as to monitor treatment responses and disease severity.

Assessing sustained attention of children with ADHD in a class flow video task

OBJECTIVE

The aim of the study was to evaluate sustained attention performance of children with ADHD and effect of distractors on sustained attention through an eye-tracking during a class-flow video task.

METHOD

Data were collected using an eye-tracking during a class-flow task conducted with 60 children (ADHD and control groups). Two areas of interest were determined in the task, these are relevant (teacher and whiteboard) and irrelevant (any regions outside the relevant area) areas. The task also included distractors in relevant and irrelevant areas, comprising a brief conversation and dropping of a pencil, respectively. Proportion of total fixation duration on areas of interest (PFDAOI) was used to assess sustained attention.

RESULTS

Children with ADHD had lower PFDAOI in the relevant area during the whole class than children in the control group. After the relevant area distractor, PFDAOI increased in relevant area in ADHD group, indicating these children may have better attention after the distractor. However, children with ADHD also showed increased PFDAOI in the irrelevant area following the irrelevant area distractor, indicating that it negatively affected them. There was no significant change in the control group following the distractors.

CONCLUSION

These findings indicate that children with ADHD have poor sustained attention performance during the whole class. Moreover, distractors in distinct areas could affect children with ADHD differently. Thus, students with ADHD could benefit from increased stimuli in the relevant area and this can be a guide for classroom arrangements to improve the academic functionality of these children.

The Effects of Cognitive-Affective Switching With Unpredictable Cues in Adults and Adolescents and Their Relation to "Cool" Executive Functioning and Emotion Regulation

The impact of emotion on executive functioning is gaining interest. It has led to the differentiation of "cool" Executive Functioning (EF) processes, such as cognitive flexibility, and "hot" EF processes, such as affective flexibility. But how does affective flexibility, the ability to switch between cognitive and affective information, vary as a function of age and sex? How does this construct relate to "cool" executive functioning and cognitive-emotion regulation processes? In this study, 266 participants, including 91 adolescents (M = 16.08, SD = 1.42 years old) and 175 adults (M = 25.69, SD = 2.17 years old), completed a cognitive-affective switching task with specific (as opposed to general) unpredictable switches, as well as measures of inhibition, attention, and cognitive-emotion coping strategies. We expected cognitive to affective switching to be more costly than affective to cognitive switching in females versus males, as well as higher switch costs in adolescents. Using linear mixed modelling, we analysed the effect of age, sex, and types of switching on reaction time. Results show that adolescents are slower switchers than adults, and demonstrate that females, although faster switchers than males, are slower when switching from cognitive to affective content than when they are switching from affective to cognitive content. Multiple regression analyses revealed age-specific associations between cognitive-affective switching and inhibition. These results converge with reported developmental and gender specificities in EF and emotion processing, respectively. Additionally, affective flexibility could relate to differences in vigilance and inhibition.

The Time Varying Networks of the Interoceptive Attention and Rest

Focused attention to spontaneous sensations is a dynamic process that demands interoceptive abilities. Failure to control it has been linked to neuropsychiatric disorders like illness-anxiety disorder. Regulatory strategies, such as focused attention meditation (FAM), may enhance the ability to control focused attention particularly to body sensations, which can be reflected on functional neuroanatomy. The functional connectivity (FC) related to focused attention has been described, however, the dynamic brain organization associated to this process and the differences to the resting state remains to be studied. To quantify the cerebral dynamic counterpart of focused attention to interoception, we examined fifteen experienced meditators while performing a 20-min attentional task to spontaneous sensations. Subjects underwent three scanning sessions obtaining a resting-state scan before and after the task. Sliding window dynamic FC (DFC) and k-means clustering identified five recurrent FC patterns along the dorsal attention network (DAN), default mode network (DMN), and frontoparietal network (FPN). Subjects remained longer in a low connectivity brain pattern during the resting conditions. By contrast, subjects spent a higher proportion of time in complex patterns during the task than rest. Moreover, a carry-over effect in FC was observed following the interoceptive task performance, suggestive of an active role in the learning process linked to cognitive training. Our results suggest that focused attention to interoceptive processes, demands a dynamic brain organization with specific features that distinguishes it from the resting condition. This approach may provide new insights characterizing the neural basis of the focused attention, an essential component for human adaptability.

Can Attention and Working Memory Impairments of Intimate Partner Perpetrators Explain Their Risky Decision Making?

Intimate partner violence (IPV) perpetrators commonly exhibit deficits in a wide range of cognitive domains, such as attention, memory, and executive functions. Executive dysfunctions tend to be related to a preference for disadvantageous decisions, which could be explained by a pattern of focusing on positive outcomes (gains) while disregarding negative ones. Nonetheless, it is less clear whether risk-taking and decision-making problems should be attributed to motivational and/or emotional causes or to cognitive deficits in attention and/or working memory. The main goal of the present study was to examine whether IPV perpetrators can be distinguished from non-violent controls based on their performance on attention, working memory, and decision-making tests from a computerized battery of tests. In addition, this study investigated the potential relationship between attention and working memory impairments in the decision-making abilities of IPV perpetrators. Our data indicated that IPV perpetrators perform worse than controls on measures of attention and sustained attention, processing speed, working memory, spatial span, and decision making. Moreover, IPV perpetrators' preference for disadvantageous and risky decisions could be partially explained by attention and working memory impairments. Our study has enabled us to explore the cognitive deficits underlying IPV perpetration as key factors in reducing IPV risky decisions. Moreover, it reinforces the need to develop specific neuropsychological training in the attention-switching ability in general and working memory, which could lead to improvements in decision-making processes or other executive functions.

Exploring N-Back Cognitive Training for Children With ADHD

Objective: The efficacy of n-back training for children with attention deficit hyperactivity disorder (ADHD) was tested in a randomized controlled trial. Method: 41 children aged 7 to 14 years with ADHD were trained on an n-back task, and their performance was compared with that of an active control group (n = 39) who were trained on a general knowledge and vocabulary task. Results: The experimental group demonstrated transfer of training to a nontrained n-back task as well as to a measure of inhibitory control. These effects were correlated with the magnitude of training gains. Conclusion: Our results suggest that n-back training may be useful in addressing some of the cognitive and behavioral issues associated with ADHD.

Efficacy of Nonpharmacological Treatments on Comorbid Internalizing Symptoms of Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Background: Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid in adulthood. This meta-analysis was aimed at ascertaining the efficacy of different psychotherapies in improving comorbid internalizing symptoms in adults with ADHD. Method: Twenty randomized controlled trials and 12 uncontrolled pretest-posttest studies were included and combined using the inverse variance method. Risk of bias and heterogeneity assessment and moderator analyses were performed. Results: Cognitive-behavioral therapy (CBT) improved quality of life (QoL), emotional dysregulation (ED), depression, and anxiety symptoms, particularly at follow-up, which was predicted by core symptoms reduction. A significant between-group effect was obtained only on QoL, ED, and self-esteem for dialectical behavior therapy (DBT), mindfulness-based therapies (MBTs), and neurofeedback, respectively. Conclusion: Results support CBT efficacy for treating comorbid internalizing symptoms. More research is needed to determine the effectiveness of DBT, MBT, and neurofeedback. The small number of studies evaluating some therapies and the high risk of bias observed might limit these results.

Attentional Mechanisms in Autism, ADHD, and Autism-ADHD Using a Local-Global Paradigm

OBJECTIVE

Cognitive flexibility or attentional set-shifting capacity has long been considered a core area of executive dysfunction for individuals with autism. Whether these difficulties are due to higher-level attentional difficulties associated with comorbid ADHD remains unclear.

METHOD

The current study compared the performance of 48 participants with autism, ADHD, autism-ADHD, and a comparison group ( N = 12 per group) on a set-shifting task, which included a local-global paradigm.

RESULTS

Results of this study revealed that participants with attentional difficulties (autism + ADHD and ADHD alone) exhibited a significant shifting cost (difference between maintaining and shifting attention).

CONCLUSION

Attentional difficulties associated with ADHD may be associated with an enhanced attentional shifting cost. Implications of these results were discussed in relation to screening for ADHD symptoms in studies of individuals with autism which seek to determine the neuropsychological profile of this condition.

Selective impairment of attentional set shifting in adults with ADHD

Background

Task switch protocols are frequently used in the assessment of cognitive control, both in clinical and non-clinical populations. These protocols frequently confound task switch and attentional set shift. The current study investigated the ability of adult ADHD patients to shift attentional set in the context of switching tasks.

Method

We tested 38 adults with ADHD and 39 control adults with an extensive diagnostic battery and a task switch protocol without proactive interference. The experiment combined orthogonally task-switch vs. repetition, and attentional set shift vs. no shift. Each experimental stimulus had global and local features (Hierarchical/“Navon” stimuli), associated with corresponding attentional sets.

Results

ADHD patients were slower than controls in task switch trials with a simultaneous shift of attention between global/local attentional sets. This also correlated significantly with diagnostic scales for ADHD symptoms. The patients had more variable reaction times, but when the attentional set was kept constant neither were they significantly slower nor showed higher task switch costs.

Conclusion

ADHD is associated with a deficit in flexible deployment of attention to varying sources of stimulus information.

Training and transfer effects of extensive task-switching training in students

The capacity to switch between tasks is a central component of executive functioning. Previous studies assessing effects of task-switch training have revealed mixed results, both in terms of processes that may be improved and the extent of beneficial effects on non-trained tasks. These studies primarily used few training sessions, which may have limited training and transfer effects. Here, 31 students were trained for 21 days on a cued switching task. Both the trained group and an active control group (n = 29) performed a number of cognitive tasks before and after training. Training reduced both switch and mixing costs, which mostly reached an asymptote after approximately four to six training sessions, although there were residual costs at the end of training. The switch cost reduction was restricted to trials with a short cue–stimulus onset interval (CSI). Training benefitted performance on another switching task, reflecting near transfer. However, this benefit was limited to the switch cost and to trials with a short CSI. There were no beneficial effects on far-transfer tasks measuring interference control, response inhibition, working memory, and general IQ. The results suggest that the present extensive training protocol, implicating overtraining, specifically enhanced the efficiency of processes involved in preparing for the relevant upcoming task set and/or inhibition of the previous task set. However, the lack of beneficial far-transfer effects is in line with previous cognitive training studies employing fewer training sessions, suggesting that the extent of training is not critical for (not) finding transfer effects.

The Correlation Between Cognitive and Movement Shifting and Brain Activity in Children With ADHD

OBJECTIVE

We assessed the correlation between the deficits of cognition, movement, and brain activity in children with Attention Deficit Hyperactvity Disorder (ADHD).

METHOD

We recruited 15 children with ADHD and 15 age- and sex-matched healthy control participants. Clinical symptoms, cognitive shifting, movement shifting, and brain activity were assessed using the Korean ADHD Rating Scale, the Wisconsin Card Sorting Test (WCST), the 7- and 14-ring drill test with hop jumps (7 HJ and 14 HJ), and 3.0 Tesla functional magnetic resonance imaging scanner, respectively.

RESULTS

ADHD children showed an increased distance traveled and decreased speed on the 14 HJ task. In response to the WCST task, ADHD children showed decreased activation within right gyrus. Total distance on the 14 HJ task was negatively correlated with the mean β value of Cluster 2 in ADHD children.

CONCLUSION

These results suggested that children with ADHD showed difficulty with attention shifting as well as with movement shifting.

The Efficacy of Computerized Cognitive Training in Adults With ADHD: A Randomized Controlled Trial

OBJECTIVE

This is a randomized control trial examining the efficiency of computerized cognitive training (CCT) for adults with ADHD, comparing two training conditions with graded levels of executive cognitive demands.

METHOD

Adults with ADHD (n = 60) were randomized into study (n = 34) and control (n = 26) groups. Training was conducted with the computerized AttenFocus program. Control group received a simple, non-hierarchical version with less executive demands.

RESULTS

Significant positive changes in symptoms ratings, ecological measures of executive functions, and occupational performance were found in both groups. No significant changes were found in variables of neurocognitive performance battery and quality of life. No significant time by group interaction effects were found.

CONCLUSION

No benefits of the intervention were found relative to the control. Lack of interaction effects may be due to insufficient power, non-specific cognitive training or placebo effects. Results demonstrate some positive findings for general CCT, yet do not support the inclusion of specific higher level executive training.

Neuroelectric and Behavioral Effects of Acute Exercise on Task Switching in Children with Attention-Deficit/Hyperactivity Disorder

The main purpose of this two-part study was to examine the effects of acute, moderate intensity exercise on task switching in children with attention-deficit/hyperactivity disorder (ADHD). In Study 1, we compared the task switching performance of children with and without ADHD. Twenty children with ADHD and 20 matched controls performed the task switching paradigm, in which the behavioral indices and P3 component of event-related potentials elicited by task-switching were assessed simultaneously. The amplitude and latency of P3 reflected the amount of attention resource allocated to task-relevant stimulus in the environment and the efficiency of stimulus detection and evaluation, respectively. The task switching included two conditions; the pure condition required participants to perform the task on the same rule (e.g., AAAA or BBBB) whereas the mixed condition required participants to perform the task on two alternating rules (e.g., AABBAA…). The results indicated that children with ADHD had significantly longer RTs, less accuracy, and larger global switch cost for accuracy than controls. Additionally, ADHD participants showed smaller amplitudes and longer P3 latencies in global switch effects. In Study 2, we further examined the effects of an acute aerobic exercise session on task switching in children with ADHD. Thirty-four children with ADHD performed a task switching paradigm after 30 min of moderate-intensity aerobic exercise on a treadmill and after control sessions (watching videos while seated). The results revealed that following exercise, children with ADHD exhibited smaller global switch costs in RT compared with after control sessions. The P3 amplitude only increased following exercise in the mixed condition relative to the pure condition, whereas no effects were found in the control session. These findings suggest that single bouts of moderate intensity aerobic exercise may have positive effects on the working memory of children with ADHD.

Cognitive remediation: potential novel brain-based treatment for bipolar disorder in children and adolescents

Bipolar disorder (BD) is among the most impairing psychiatric disorders affecting children and adolescents, despite our best psychopharmacological and psychotherapeutic treatments. Cognitive remediation, defined as a behavioral intervention designed to improve cognitive functions so as to reduce psychiatric illness, is an emerging brain-based treatment approach that has thus far not been studied in pediatric BD. The present article reviews the basic principles of cognitive remediation, describes what is known about cognitive remediation in psychiatric disorders, and delineates potential brain/behavior alterations implicated in pediatric BD that might be targets for cognitive remediation. Emerging data show that cognitive remediation may be useful in children and adults with schizophrenia, ADHD, and anxiety disorders, and in adults with BD. Potential targets for cognitive remediation in pediatric BD include face processing, response inhibition, frustration, and cognitive flexibility. Further study is warranted to determine if cognitive remediation for these targets, or others, may serve as a novel, brain-based treatment for pediatric BD.

Improving executive functioning in children with ADHD: training multiple executive functions within the context of a computer game. a randomized double-blind placebo controlled trial

INTRODUCTION

Executive functions (EFs) training interventions aimed at ADHD-symptom reduction have yielded mixed results. Generally, these interventions focus on training a single cognitive domain (e.g., working memory [WM], inhibition, or cognitive-flexibility). However, evidence suggests that most children with ADHD show deficits on multiple EFs, and that these EFs are largely related to different brain regions. Therefore, training multiple EFs might be a potentially more effective strategy to reduce EF-related ADHD symptoms.

METHODS

Eighty-nine children with a clinical diagnosis of ADHD (aged 8-12) were randomized to either a full-active-condition where visuospatial WM, inhibition and cognitive-flexibility were trained, a partially-active-condition where inhibition and cognitive-flexibility were trained and the WM-training task was presented in placebo-mode, or to a full placebo-condition. Short-term and long-term (3-months) effects of this gamified, 25-session, home-based computer-training were evaluated on multiple outcome domains.

RESULTS

During training compliance was high (only 3% failed to meet compliance criteria). After training, only children in the full-active condition showed improvement on measures of visuospatial short-term-memory (STM) and WM. Inhibitory performance and interference control only improved in the full-active- and the partially-active condition. No Treatment-condition x Time interactions were found for cognitive-flexibility, verbal WM, complex-reasoning, nor for any parent-, teacher-, or child-rated ADHD behaviors, EF-behaviors, motivational behaviors, or general problem behaviors. Nonetheless, almost all measures showed main Time-effects, including the teacher-ratings.

CONCLUSIONS

Improvements on inhibition and visuospatial STM and WM were specifically related to the type of treatment received. However, transfer to untrained EFs and behaviors was mostly nonspecific (i.e., only interference control improved exclusively in the two EF training conditions). As such, in this multiple EF-training, mainly nonspecific treatment factors - as opposed to the specific effects of training EFs-seem related to far transfer effects found on EF and behavior.

TRIAL REGISTRATION

trialregister.nl NTR2728. Registry name: improving executive functioning in children with ADHD: training executive functions within the context of a computer game; registry number: NTR2728.

A pilot study of the efficacy of a computerized executive functioning remediation training with game elements for children with ADHD in an outpatient setting: outcome on parent- and teacher-rated executive functioning and ADHD behavior

OBJECTIVE

This pilot study tested the short- and long-term efficacy (9 weeks follow-up) of an executive functioning (EF) remediation training with game elements for children with ADHD in an outpatient clinical setting, using a randomized controlled wait-list design. Furthermore, in a subsample, that is, those treated with methylphenidate, additive effects of the EF training were assessed.

METHOD

A total of 40 children (aged 8-12 years) were randomized to the EF training or wait-list. The training consisted of a 25-session training of inhibition, cognitive flexibility, and working memory. Treatment outcome was assessed by parent- and teacher-rated EF, ADHD, oppositional deviant disorder, and conduct disorder symptoms.

RESULTS

Children in the EF training showed significantly more improvement than those in the wait-list condition on parent-rated EF and ADHD behavior in the total sample and in the subsample treated with methylphenidate. Effects were maintained at follow-up.

CONCLUSION

This pilot study shows promising evidence for the efficacy of an EF training with game elements.

Assessment of the feasibility of a rehabilitation intervention program for breast cancer survivors with cognitive complaints

To assess the feasibility of a cognitive rehabilitation program in breast cancer survivors (BCS) with persistent post-treatment cognitive complaints. BCS with cognitive complaints, 18-months to 5-years post-treatment, were recruited for a once-weekly, five-week, group cognitive training intervention. Outcome measures included self-reported mood and cognitive function, and neurocognitive tests administered at pre-intervention, immediate-, two-month and four-month post-intervention. A sub-study in eight participants evaluated resting state quantitative electroencephalography (qEEG) changes from pre- to immediate post-intervention in relationship to post-intervention changes in cognitive complaints. Twenty-seven BCS completed the protocol and tolerated the intervention well. We observed significant reductions in total and memory-specific cognitive complaints from pre-intervention to immediate post-intervention (p = 0.031 and p = 0.009, respectively) and at four-months post-intervention (p < 0.0001 and p < 0.001, respectively). Significant improvement in neurocognitive tests were found for Symbol Digit, Stroop, and Trails A tests (df = 26, all p's <0.05). Effect sizes for changes from pre-intervention to immediate and to four-month post intervention ranged from 0.429 to 0.607, and from 0.439 to 0.741, respectively. Increase in qEEG absolute alpha power over the course of the intervention was associated with reduced complaints at immediate post-intervention (r = -0.78, p = 0.021), two-months (r range = -0.76 to -0.82, p-value range 0.004 to 0.03), and four-months (r = -0.71, p = 0.048). A five-week group cognitive training intervention is feasible and well tolerated. Cognitive complaints and neurocognitive test performances showed positive changes. qEEG may serve as a potential biomarker for improvement in self-reported complaints. A randomized clinical trial is underway to test the efficacy of the intervention.

Multi-domain computerized cognitive training program improves performance of bookkeeping tasks: a matched-sampling active-controlled trial

Cognitive skills are important predictors of job performance, but the extent to which computerized cognitive training (CCT) can improve job performance in healthy adults is unclear. We report, for the first time, that a CCT program aimed at attention, memory, reasoning and visuo-spatial abilities can enhance productivity in healthy younger adults on bookkeeping tasks with high relevance to real-world job performance. 44 business students (77.3% female, mean age 21.4 ± 2.6 years) were assigned to either (a) 20 h of CCT, or (b) 20 h of computerized arithmetic training (active control) by a matched sampling procedure. Both interventions were conducted over a period of 6 weeks, 3-4 1-h sessions per week. Transfer of skills to performance on a 60-min paper-based bookkeeping task was measured at three time points-baseline, after 10 h and after 20 h of training. Repeated measures ANOVA found a significant Group X Time effect on productivity (F = 7.033, df = 1.745; 73.273, p = 0.003) with a significant interaction at both the 10-h (Relative Cohen's effect size = 0.38, p = 0.014) and 20-h time points (Relative Cohen's effect size = 0.40, p = 0.003). No significant effects were found on accuracy or on Conners' Continuous Performance Test, a measure of sustained attention. The results are discussed in reference to previous findings on the relationship between brain plasticity and job performance. Generalization of results requires further study.

A cross-cultural investigation of inhibitory control, generative fluency, and anxiety symptoms in Romanian and Russian preschoolers

The current study focused on the early development of inhibitory control in 5- to 7-year-old children attending kindergarten in two Eastern-European countries, Romania and Russia. These two countries share many aspects of child-rearing and educational practices, previously documented to influence the development of inhibitory control. Using the Lurian-based developmental approach offered by the Developmental Neuropsychological Assessment battery, the study aimed to contribute to cross-cultural developmental neuropsychology by exploring (a) early interrelationships between subcomponents of inhibitory control (response suppression and attention control) and generative fluency (verbal and figural) in these two cultures, as well as (b) the predictive value of external factors (culture and maternal education) and individual differences (age, gender, nonverbal intelligence, trait anxiety) on inhibitory control and fluency outcomes in children from both countries. First, findings in both culture samples suggest that even at this young age, the construct of inhibitory control cannot be considered a unitary entity. Second, differences in maternal education were not predictive of either inhibitory control or fluency scores. However, children's attention control performance varied as a function of culture, and the direction of these cultural effects differed by whether the target outcome involved performance accuracy versus efficiency as an output. Findings also confirmed the previously documented intensive developmental improvement in preschoolers' inhibitory control during this period, influencing measures of response suppression and particularly attention control. Finally, the results further stress the importance of individual differences effects in trait anxiety on attention control efficiency across cultures.

Cognitive flexibility in ASD; task switching with emotional faces

Children with autism spectrum disorders (ASDs) show daily cognitive flexibility deficits, but laboratory data are unconvincing. The current study aimed to bridge this gap. Thirty-one children with ASD (8–12 years) and 31 age- and IQ-matched typically developing children performed a gender emotion switch task. Unannounced switches and complex stimuli (emotional faces) improved ecological validity; minimal working memory-load prevented bias in the findings. Overall performance did not differ between groups, but in a part of the ASD group performance was slow and inaccurate. Moreover, within the ASD group switching from emotion to gender trials was slower than vice versa. Children with ASD do not show difficulties on an ecological valid switch task, but have difficulty disengaging from an emotional task set.

Executive function training with game elements for obese children: a novel treatment to enhance self-regulatory abilities for weight-control

For obese children behavioral treatment results in only small changes in relative weight and frequent relapse. The current study investigated the effects of an Executive Functioning (EF) training with game-elements on weight loss maintenance in obese children, over and above the care as usual in an inpatient treatment program. Forty-four children (aged 8-14 years) who were in the final months of a 10-months inpatient treatment program in a medical paediatric centre were randomized to either the 6 week EF-training condition or to a care as usual only control group. The EF-training consisted of a 25-session training of inhibition and working memory. Treatment outcomes were child performances on cognitive tasks of inhibition and working memory and childcare worker ratings on EF-symptoms as well as weight loss maintenance after leaving the clinic. Children in the EF-training condition showed significantly more improvement than the children in the care as usual only group on the working memory task as well as on the childcare worker reports of working memory and meta-cognition. They were also more capable to maintain their weight loss until 8 weeks post-training. This study shows promising evidence for the efficacy of an EF-training as weight stabilization intervention in obese children.

To what extent are task-switching deficits in children with attention-deficit/hyperactivity disorder independent of impaired inhibition?

Executive functions, higher-order cognitive functions needed for goal-directed behavior, have been studied extensively in the search for endophenotypes for ADHD, yet results have been inconclusive. We examine the performance of children with ADHD in task switching as an as yet understudied potential endophenotype. A group of 20 children with ADHD and a group of 23 children without ADHD (ages 7-12) performed a task-switching paradigm and a Go/No-Go Task. Children with ADHD displayed significantly greater specific switch costs, that is, compared to control children they were especially impaired directly after task switches. There were no group differences with respect to the general switch costs, which are estimated by comparing performance on single task blocks to the block where both tasks are intermixed. Specific switch costs and Go/No-Go error rate were significantly correlated; yet, group differences in the task-switching paradigm remained significant even when inhibition was controlled for. This pattern of results suggests that children with ADHD are neither generally impaired in executive function nor only impaired with respect to inhibition. Instead, they display a highly specific deficit with regard to the flexible suppression and amplification of different task rules according to the context. Our conclusion that task switching has the potential to be added to the list of ADHD endophenotypes is strengthened by the independence of task-switching deficits and inhibition.

Cognitive control in adults with attention-deficit/hyperactivity disorder

The objective of the present study was to investigate the ability of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) to direct their attention and exert cognitive control in a forced instruction dichotic listening (DL) task. The performance of 29 adults with ADHD was compared with 58 matched controls from the Bergen Dichotic Listening Database (N>1500). Participants in the Bergen DL task listen to and report from conflicting consonant-vowel combinations (two different syllables presented simultaneously, one to each ear). They are asked to report the syllable they hear (non-forced condition), or to focus and report either the right- or left-ear syllable (forced-right and forced-left condition). This procedure is presumed to tap distinct cognitive processes: perception (non-forced condition), orienting of attention (forced-right condition), and cognitive control (forced-left condition). Adults with ADHD did not show significant impairment in the conditions tapping perception and attention orientation, but were significantly impaired in their ability to report the left-ear syllable during the forced-left instruction condition, whereas the control group showed the expected left-ear advantage in this condition. This supports the hypothesis of a deficit in cognitive control in the ADHD group, presumably mediated by a deficit in a prefrontal neuronal circuitry. Our results may have implications for psychosocial adjustment for persons with ADHD in educational and work environments.

Autism and ADHD symptoms in patients with OCD: are they associated with specific OC symptom dimensions or OC symptom severity?

In obsessive-compulsive disorder (OCD), the relationship between autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD) symptom, and obsessive-compulsive (OC) symptom dimensions and severity has scarcely been studied. Therefore, 109 adult outpatients with primary OCD were compared to 87 healthy controls on OC, ADHD and ASD symptoms. OCD patients showed increased ADHD and autism symptom frequencies, OCD + ADHD patients reporting more autism symptoms (particularly attention switching and social skills problems) than OCD − ADHD patients. Attention switching problems were most significant predictors of OC symptom dimensions (except hoarding) and of symptom severity. Hoarding was not associated with elevated autism scale scores, but with inattention. In conclusion, attention switching problems may reflect both symptom overlap and a common etiological factor underlying ASD, ADHD and OCD.

Short cognitive behavioral therapy and cognitive training for adults with ADHD - a randomized controlled pilot study

In clinical practice, a growing need exists for effective non-pharmacological treatments of adult attention-deficit/hyperactivity disorder (ADHD). Here, we present the results of a pilot study of 10 adults with ADHD participating in short-term individual cognitive- behavioral therapy (CBT), 9 adults participating in cognitive training (CT), and 10 controls. Self-report questionnaires, independent evaluations, and computerized neurocognitive testing were collected before and after the treatments to evaluate change. There were distinctive pre-hypotheses regarding the treatments, and therefore the statistical comparisons were conducted in pairs: CBT vs control, CT vs control, and CBT vs CT. In a combined ADHD symptom score based on self-reports, 6 participants in CBT, 2 in CT and 2 controls improved. Using independent evaluations, improvement was found in 7 of the CBT participants, 2 of CT participants and 3 controls. There was no treatment-related improvement in cognitive performance. Thus, in the CBT group, some encouraging improvement was seen, although not as clearly as in previous research with longer interventions. In the CT group, there was improvement in the trained tasks but no generalization of the improvement to the tasks of the neurocognitive testing, the self- report questionnaires, or the independent evaluations. These preliminary results warrant further studies with more participants and with more elaborate cognitive testing.

Individual differences in executive functions are almost entirely genetic in origin

Recent psychological and neuropsychological research suggests that executive functions--the cognitive control processes that regulate thought and action--are multifaceted and that different types of executive functions are correlated but separable. The present multivariate twin study of 3 executive functions (inhibiting dominant responses, updating working memory representations, and shifting between task sets), measured as latent variables, examined why people vary in these executive control abilities and why these abilities are correlated but separable from a behavioral genetic perspective. Results indicated that executive functions are correlated because they are influenced by a highly heritable (99%) common factor that goes beyond general intelligence or perceptual speed, and they are separable because of additional genetic influences unique to particular executive functions. This combination of general and specific genetic influences places executive functions among the most heritable psychological traits. These results highlight the potential of genetic approaches for uncovering the biological underpinnings of executive functions and suggest a need for examining multiple types of executive functions to distinguish different levels of genetic influences.

Review of cognitive, cognitive-behavioral, and neural-based interventions for Attention-Deficit/Hyperactivity Disorder (ADHD)

Primary evidence-based treatment approaches for ADHD involve pharmacological and behavioral treatments. However, there continue to be investigations of cognitive-behavioral, cognitive, and neural-based intervention approaches that are not considered evidence-based practice. These particular treatments are summarized, as they all involve training in cognitive skills or cognitive strategies. We identified 26 studies (six cognitive-behavioral, six cognitive, and 14 neural-based), and calculated effect sizes where appropriate. Overall, our analysis suggests that further research is needed to determine the efficacy of these approaches on both cognitive and behavioral outcome measures, but that some of these methods show promise for treating ADHD. We discuss some important conceptual and methodological issues that need to be taken into account for future research in order to evaluate the clinical efficacy of these approaches.

Cognitive switching processes in young people with attention-deficit/hyperactivity disorder

Patients with attention-deficit/hyperactivity disorder (ADHD) can be slow at switching between stimuli, or between sets of stimuli to control behaviour appropriate to changing situations. We examined clinical and experimental parameters that may influence the speed of such processes measured in the trail-making (TMT) and switch-tasks in cases with ADHD combined type, their non-affected siblings and unrelated healthy controls. The latency for completion of the trail-making task controlling for psychomotor processing (TMT-B-A) was longer for ADHD cases, and correlated with Conners' ratings of symptom severity across all subjects. The effect decreased with age. Switch-task responses to questions of "Which number?" and "How many?" between sets of 1/111 or 3/333 elicited differential increases in latency with condition that affected all groups. But there was evidence for increased symptom-related intra-individual variability among the ADHD cases, and across all subjects. Young siblings showed familiality for some measures of TMT and switch-task performance but these were modest. The potential influences of moderator variables on the efficiency of processing stimulus change rather than the speed of processing are discussed.

New potential leads in the biology and treatment of attention deficit-hyperactivity disorder

PURPOSE OF REVIEW

This review highlights recent neuroimaging and genetic studies of attention deficit-hyperactivity disorder that may inform biologically targeted interventions and treatments.

RECENT FINDINGS

The findings suggest that attention deficit-hyperactivity disorder is characterized by specific learning and cognitive deficits due to abnormalities in dopamine-rich prefrontal circuitry, of genetic or environmental origins. In addition to prefrontal cortical areas, the basal ganglia, cerebellum, and parietal cortex have been implicated in the condition. These regions are part of unique circuits that project both to and from the prefrontal cortex, thus providing a means for signaling prefrontal regions when top-down control of behavior needs to be imposed. Ineffective signaling of control systems by any one of these regions can lead to poor regulation of behavior. Likewise, intact signaling but inefficient top-down control could result in poor regulation of behavior.

SUMMARY

Identification of which cognitive and neural processes are altered in attention deficit-hyperactivity disorder and acknowledgement of different casuses of the condition will lead to more individualized, biologically targeted interventions and treatments. This new direction in research and treatment has occurred as the result of a shift from diagnosis as a phenotype, to refined phenotypes of core cognitive deficits that can be more easily tied to the underlying biology.