Intervention for executive functions in attention deficit and hyperactivity disorder

Efficacy of non-pharmacological interventions on executive functions in children and adolescents with ADHD: A systematic review and meta-analysis

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.

The effect of comprehensive working memory training on executive functions and behavioral symptoms in children with attention deficit-hyperactivity disorder (ADHD)

This study aimed to evaluate the effect of working memory training on executive functions and behavioral symptoms in children with ADHD. Thirty children with ADHD were randomly assigned to active control or Active Memory Intervention (AMIN) group. Executive functions and rating scales were used for assessment in three baseline, post-intervention, and 1-month follow-up sessions. The results show AMIN improves working memory and inhibitory control as well as ameliorates ADHD symptoms at home and school. Working memory training is beneficial and transferable intervention in children with ADHD.

Evidence for modulation of planning and working memory capacities by transcranial direct current stimulation in a sample of adults with attention deficit hyperactivity disorder

BACKGROUND AND OBJECTIVE

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects up to 2.8% of the adult population. Albeit pharmacological and behavioral therapies alleviate some core symptoms of ADHD, they do not avail cognitive dysfunction adequately. Executive dysfunction has been considered to have a principal role in ADHD and has previously been linked to activity alterations in the prefrontal cortex. Transcranial Direct Current Stimulation (tDCS) is a noninvasive brain stimulation technique that may modulate prefrontal cortex activity and induce neuroplasticity, with preliminary results in ADHD. The aim of the present study is to assess the effect of repeated tDCS on measures of executive functions in adults with ADHD.

METHOD

In this randomized double-blind sham-controlled study, 22 adults with ADHD were allocated into two groups and were administered five consecutive sessions of 2 mA active/sham tDCS over the dorsolateral prefrontal cortex (right anodal/left cathodal). A neuropsychological test battery was administered before the first session and immediately after the last session.

RESULTS

The maximum number of digits and the total number of correct trials in the Digit Span Backward test increased in the active group (p = 0.017). The total move score in the Tower of London test decreased (p = 0.033), suggesting better planning ability. However, no significant differences were observed on Stroop Test and Trail Making Test after tDCS.

DISCUSSION

The present study corroborates the modulating effects of tDCS on planning and working memory in a small group of adults with ADHD. Our results highlighted that cognitive functions are modulable using tDCS in adults with ADHD.

Effectiveness of Cognitive Training for School-Aged Children and Adolescents With Attention Deficit/Hyperactivity Disorder: A Systematic Review

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.

Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and is associated with significant risk of educational failure, interpersonal problems, mental illness, and delinquency. Despite a number of comparative and comprehensive reviews on the effects of ADHD treatments on ADHD core symptoms, evidence synthesizing the effects of ADHD interventions on cognitive difficulties is limited. In this meta-analysis, the neuropsychological effects of non-pharmacological interventions for ADHD were examined across studies published between 1980 and 2017. Data were extracted from studies that used objective cognitive measures (either computerized or pencil-and-paper), and multiple meta-analyses were conducted to compare the effectiveness across these interventions. Publication bias was assessed, as well as quality of the evidence, using Cochrane risk of bias tool for randomized control trials studies. Our final meta-analysis included 18 studies with interventions that were categorized into four categories: neurofeedback, cognitive-behavioral therapy, cognitive training, and physical exercises. Physical exercises demonstrated the highest average effect size (Morris d = 0.93). A further evaluation of cognitive functions yielded 49 effect sizes for the five categories, including attention, inhibition, flexibility, and working memory. Analyses demonstrated a homogenous, medium to large, effect size of improvement across interventions, with inhibition demonstrating the largest average effect size (Morris d = 0.685). This study highlights the positive effect of psychological interventions on ADHD cognitive symptomology and supports the inclusion of non-pharmacological interventions in conjunction with the commonly used pharmacological treatments.

Cognitive changes in nurses working in intensive care units

OBJECTIVE

To measure the levels of stress, anxiety, and depression of nurses working in ICUs, relating them to levels of attention before and after 24 hours.

METHOD

An observational, quantitative, analytical study with 18 nurses undergoing an inventory of stress, anxiety, and depression, as well as assessment of attention levels and psychomotor functioning.

RESULTS

Sixty-one percent showed positive for stress. Depression was observed in 33%; and anxiety in 99.9%. A strong correlation between stress and depression (ρ = 0.564 with p <0.05) and anxiety (ρ = 1 with p <0.05) was observed. There was a weak correlation between stress and task execution time in M2 (ρ = 0.055) for TMT A, a fact that did not occur in M0 (ρ = -0.249).

CONCLUSION

The study shows that the workload of the nurses working in 24-hour shifts in the ICU is correlated with high levels of stress, decreases in the attention process, and psychomotor decline.