Differential effect of cognitive training on executive functions and reading abilities in children with ADHD and in children with ADHD comorbid with reading difficulties

Fifty years of executive control research in attention-deficit/hyperactivity disorder:What we have learned and still need to know

For 50 years, attention-deficit/hyperactivity disorder (ADHD) has been considered a disorder of executive control (EC), the higher-order, cognitive skills that support self-regulation, goal attainment and what we generally call "attention." This review surveys our current understanding of the nature of EC as it pertains to ADHD and considers the evidence in support of eight hypotheses that can be derived from the EC theory of ADHD. This paper provides a resource for practitioners to aid in clinical decision-making. To support theory building, I draw a parallel between the EC theory of ADHD and the common gene-common variant model of complex traits such as ADHD. The conclusion offers strategies for advancing collaborative research.

Multimodal personalised executive function intervention (E-Fit) for school-aged children with complex congenital heart disease: protocol for a randomised controlled feasibility study

INTRODUCTION

Children with congenital heart disease (CHD) are at risk for executive functions (EF) impairments. To date, interventions have limited effects on EF in children and adolescents with complex CHD. Therefore, we developed a new multimodal and personalised EF intervention (E-Fit). This study aims to test the feasibility of this intervention called 'E-Fit' for children with complex CHD and EF impairments.

METHODS AND ANALYSIS

This is a single-centre, single-blinded, randomised controlled feasibility study exploring the E-Fit intervention. We aim to enrol 40 children with CHD aged 10-12 years who underwent infant cardiopulmonary bypass surgery and show clinically relevant EF impairments (T-score ≥60 on any Behaviour Rating Inventory for Executive Function questionnaire summary scale). The multimodal intervention was developed with focus groups and the Delphi method involving children and adolescents with CHD, their parents and teachers, and health professionals. The intervention is composed of three elements: computer-based EF training using CogniFit Inc 2022, performed three times a week at home; weekly EF remote strategy coaching and analogue games. The content of the computer and strategy training is personalised to the child's EF difficulties. The control group follows their daily routines as before and completes a diary about their everyday activities four times a week. Participants will be randomised in a 1:1 ratio. Feasibility is measured by the participants' and providers' ratings of the participants' adherence and exposure to the intervention, recruitment rates and the evaluation of the intended effects of the programme.

ETHICS AND DISSEMINATION

Local ethics committee approval was obtained for the study (BASEC-Nr: 2021-02413). Parents provide written informed consent. Key outputs from the trial will be disseminated through presentations at conferences, peer-reviewed publications and directly to participating families. Furthermore, these results will inform the decision whether to proceed to a randomised controlled trial to investigate effectiveness.

TRIAL REGISTRATION NUMBER

NCT05198583.

Reading Fluency in Chinese Children With Reading Disabilities and/or ADHD: A Key Role for Morphology

The Triangle Model of Reading proposes that phonology, orthography, and semantics are crucial to understand word reading and reading disability (RD). Morphology has been added as a binding agent to this model. However, it is unclear how these variables relate to word reading in children with attention deficit/hyperactivity disorder (ADHD) or comorbid ADHD and RD (ADHD+RD). This study examined the performance of Chinese children with RD, ADHD, or ADHD+RD in phonology, orthography, semantics, and morphology, and investigated whether morphology made an additional contribution beyond the other skills in explaining word reading fluency. Participants were 151 Grade 1 to 3 Chinese students: RD (n = 31), ADHD (n = 43), ADHD+RD (n = 27), and typically developing controls (TD, n = 50). Results indicated that children with ADHD+RD (a) showed similar performance to RD and ADHD in tone awareness, orthographic legality, and homophone morpheme awareness; (b) had similar performance to RD but worse than ADHD in phonology, semantics, and morpheme production; and (c) had more severe deficits than RD and ADHD in orthographic reversal, morpheme identification, and homograph awareness. Morphology significantly predicted word reading fluency beyond the other skills, and its predictive effect was more salient for ADHD+RD, ADHD, and TD. The findings provide evidence of both shared and additive effects of RD and ADHD. Morphology may be an important diagnostic factor in identifying Chinese reading and behavioral deficit groups and a worthwhile target for intervention.

The comparison of sluggish cognitive tempo, processing speed, and executive functions in female children with specific learning disabilities and typically developing female children: A pilot study

This study investigated the association of sluggish cognitive tempo (SCT), processing speed, and executive function (EF) in children with specific learning disabilities (SLD), and the typically developing children (TD) (60 female students aged between 8 and 10). Child and Adolescent Behavior Inventory-Parent Version (CABI), the Barkley Deficits in Executive Functioning Scale-Children and Adolescents (BDEFS-CA), and Wechsler Intelligence Scale for Children-IV (the Processing Speed Index (PSI) were used to assess SCT, processing speed, and EF. The results showed that SCT problems were higher in children with SLD (p < 0.001). In addition, results showed that children with SLD had poorer performance on processing speed (p < 0.001) compared to the TD group. Executive dysfunctioning in self-management to time, self-organization, problem-solving, self-restraint, self-motivation, and self-regulation of emotions were poorer in children with SLD than TD group (p < 0.05). This study provides initial evidence that SCT symptoms are poor in female children with SLD, and associated with executive dysfunction and poor processing speed.

Transcranial Direct Current Stimulation (tDCS) in children with ADHD: A randomized, sham-controlled pilot study

BACKGROUND

ADHD is a common neurodevelopmental disorder with a pediatric prevalence of 5.2%.While medication treatment for ADHD is effective, it does not address all symptoms and a small but notable subgroup does not respond to medications. Adverse effects limit its use and some parents and participants resist use of medication. Thus, limitations of medication treatment for ADHD motivate searching for other therapeutic options. Transcranial Direct Current Stimulation (tDCS) has been suggested as a treatment for children with ADHD, with mixed results to date. Protocol variables employed, including combined use of cognitive training (CT) and scheduling of sessions, may explain diverse findings to date. The aim of this study was to examine safety, feasibility and efficacy of tDCS combined with CT provided three-times-per week for one-month to treat children with ADHD.

METHODS

In a double blind, randomized, sham-controlled pilot study, 25 children with ADHD were randomized to receive 12 sessions of either anodal tDCS or sham-tDCS for 20 min combined with CT three-times-per-week for four weeks. The tDCS anode was over left dorsolateral prefrontal cortex (DLPFC) and cathode over vertex. Assessments were obtained prior to, after 6 sessions, 12 sessions and one-month after intervention.

RESULTS

No significant post-intervention differences were found between those receiving tDCS or sham-tDCS. Both groups demonstrated significant improvement on questionnaire measures of ADHD and executive function with mixed results seen on computerized performance measures. Overall, adverse effects were mild with no significant difference between groups. However, three children, all from the tDCS group, experienced headaches with two requiring temporary cessation and one requiring removal from the study.

CONCLUSIONS

Anodal tDCS to the DLPFC using the above protocol in children with ADHD did not demonstrate additional treatment benefits beyond that of CT.

Program for attention rehabilitation and strengthening (PARS) improves executive functions in children with attention deficit- hyperactivity disorder (ADHD)

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.

Executive Functions in Neurodevelopmental Disorders: Comorbidity Overlaps Between Attention Deficit and Hyperactivity Disorder and Specific Learning Disorders

The present study examines the comorbidity between specific learning disorders (SLD) and attention deficit and hyperactivity disorder (ADHD) by comparing the neuropsychological profiles of children with and without this comorbidity. Ninety-seven schoolchildren from 8 to 14 years old were tested: a clinical sample of 49 children with ADHD (n = 18), SLD (n = 18) or SLD in comorbidity with ADHD (n = 13), and 48 typically-developing (TD) children matched for age and intelligence. Participants were administered tasks and questionnaires to confirm their initial diagnosis, and a battery of executive function (EF) tasks testing inhibition, shifting, and verbal and visuospatial updating. Using one-way ANOVAs, our results showed that all children in the clinical samples exhibited impairments on EF measures (inhibition and shifting tasks) when compared with TD children. A more specific pattern only emerged for the updating tasks. Only children with SLD had significant impairment in verbal updating, whereas children with ADHD, and those with SLD in comorbidity with ADHD, had the worst performance in visuospatial updating. The clinical and educational implications of these findings are discussed.

Intellectual Profiles in Children With ADHD and Comorbid Learning and Motor Disorders

Objective: Neurodevelopmental disorders, including Reading Disorder, Disorder of Written Expression, and Developmental Coordination Disorder, often co-occur with ADHD. Although research has identified increased functional impairment in the presence of these comorbid diagnoses, few direct comparisons of intellectual profiles have been conducted. Thus, the present study examined Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) profiles of children with ADHD alone and with comorbid neurodevelopmental disorders. Method: Participants included 296 children with ADHD, ADHD with Developmental Coordination Disorder, and ADHD with Reading Disorder and/or Disorder of Written Expression. Results: Comparisons of these groups suggests children with ADHD and language-based Learning Disorders have poorer working memory than children with only ADHD. Furthermore, children with ADHD and Developmental Coordination Disorder perform relatively better on verbal compared with perceptual reasoning indexes. Conclusion: These intellectual profiles may have utility in identifying cognitive weaknesses inherent to these disorders and may be used to guide treatment intervention.

Executive Functions in Children with ADHD and/or Reading Difficulty

Abstract The objective of this study was to compare the Executive Functions performance (EFs: inhibitory control, auditory and visuospatial working memory, cognitive flexibility and verbal fluency) between children with ADHD, reading difficulties (RD), comorbidity ADHD/RD and without complaints of ADHD and RD (WRD). Participated 104 children, of both sexes, aged between eight and 11 years old. The results indicated worse performance of ADHD/RD group in the majority EFs. ADHD presented better performance than DL in semantic verbal fluency. The WRD obtained better scores than the ADHD / DL and DL in practically all the evaluated EFs, but did not differ of ADHD.

Executive Functioning Predicts Academic But Not Social Adjustment to University

Objective: Adjusting well academically and socially has been associated with enhanced academic performance and student retention. The purpose of this study was to examine subthreshold levels of ADHD symptoms such as inattention, hyperactivity, and executive functioning as potential predictors of academic and social adjustment in a healthy sample of university students. Method: Participants were 135 undergraduate university students who completed self-report questionnaires. Results: Hierarchical regression analyses revealed that metacognition (an aspect of executive function), gender, and age were significant predictors of academic adjustment beyond hyperactivity, inattention, and depression. Depression was the only significant predictor of social adjustment. Conclusion: The BASC-College form may identify depression symptoms predictive of social adjustment, but symptoms of inattention or hyperactivity are not sufficiently sensitive to predict academic adjustment. Measures of executive function that include metacognition such as the BRIEF-A may be most promising in identifying skills predictive of academic adjustment.

Participation in Peer-Play Activities Among Children With Specific Learning Disability: A Randomized Controlled Trial

OBJECTIVE

Children with a specific learning disability (SLD) have deficits in social and academic competence and executive function (EF). In this study, we used the Model of Human Occupation to investigate the effect of peer-play activities on occupational values and competence as well as EF skills (i.e., behavior regulation and metacognition) in children with SLD.

METHOD

Forty-nine children ages 7-11 yr with SLD were randomly assigned to the peer-play and control groups. Outcome measures were the Behavior Rating Inventory of Executive Function and the Child Occupational Self-Assessment (COSA).

RESULTS

Data analysis showed that the effects of the intervention on EF skills were medium to large. The occupational values and competence did not change according to the COSA.

CONCLUSION

Occupational therapy practitioners can use peer-play activities to enhance EF in children with SLD; however, perceived occupational values and competence may not show any changes with the peer-play intervention using a self-assessment instrument.

Novel reading index for identifying disordered reading skill development: A preliminary study

Children with ADHD are at high risk of developing a Reading Disability (RD), although the reasons remain unclear. ADHD-associated impairments, including processing speed, can complicate clinical evaluation for a co-occurring RD diagnosis. We propose a novel metric to (a) assess reading development and (b) provide an alternative method to classifying readers that may aid investigations for etiologies of RD in ADHD. Specifically, as both phonological decoding and word recognition skills are important precursors of reading fluency, we propose a new quantitative method comparing these skills after accounting for variations in perception, motor response, or processing speeds. Forty boys (14 control, 15 ADHD, 11 ADHD/ + RD) completed a lexical decision task testing decoding and another assessing word recognition. Response time data was modeled using a Drift Diffusion approach to estimate the underlying reading skills. Using these reading skill estimates, we calculated a novel Reading Tendency Index and classified participants into three reading groups (Decoders, Balanced Readers, and Sight Readers). The reading and cognitive performance of these groups were consistent with theoretical predictions and subsequently provided external validity for the novel Reading Tendency Index classification. Our findings demonstrate a potential classification tool for readers based on individual's developed, reading tendencies.

Effect of Play-based Therapy on Meta-cognitive and Behavioral Aspects of Executive Function: A Randomized, Controlled, Clinical Trial on the Students With Learning Disabilities

Introduction:

Although the effect of educational methods on executive function (EF) is well known, training this function by a playful method is debatable. The current study aimed at investigating if a play-based intervention is effective on metacognitive and behavioral skills of EF in students with specific learning disabilities.

Methods:

In the current randomized, clinical trial, 49 subjects within the age range of 7 to 11 years with specific learning disabilities were randomly assigned into the intervention (25 subjects; mean age 8.5±1.33 years) and control (24 subjects; mean age 8.7±1.03 years) groups. Subjects in the intervention group received EF group training based on playing activities; subjects in the control group received no intervention. The behavior rating inventory of executive function (BRIEF) was administered to evaluate the behavioral and cognitive aspects of EF. The duration of the intervention was 6 hours per week for 9 weeks. Multivariate analysis of covariance was used to compare mean changes (before and after) in the BRIEF scores between the groups.

Results:

The assumptions of multivariate analysis of covariance were examined. After controlling pre-test conditions, the intervention and control groups scored significantly differently on both the metacognition (P=0.002; effect size=0.20) and behavior regulation indices (P=0.01; effect size=0.12) of BRIEF.

Conclusion:

Play-based therapy is effective on the metacognitive and behavioral aspects of EF in students with specific learning disabilities. Professionals can use play-based therapy rather than educational approaches in clinical practice to enhance EF skills.