Executive functions mediate the association between ADHD symptoms and anxiety in a clinical adolescent population

Assessment of executive functions using a 3D-video game in children and adolescents with ADHD

Objective

Executive functions are important factors that affect the well-being of children with ADHD. Therefore, inclusion of a convenient assessment of executive dysfunction in diagnosis and treatment of ADHD patients is warranted. However, executive dysfunction assessment presently relies on lab-based neuropsychological tests and symptom rating scales. The present study examined the potential of a 3-D action puzzle video game to reflect ecologically valid executive functioning in pediatric ADHD patients.

Methods

Participant gameplay metrics were compared to both their Cambridge Neuropsychological Test Automated Battery (CANTAB) and Conners 3 Parent Form's executive functioning subscale scores. Participants consisted of 33 ADHD and non-ADHD patients aged 8-21.

Results

Metrics from gameplay were associated with distinct CANTAB test scores, and a composite score from gameplay was significantly correlated with executive dysfunction from Conners 3.

Conclusion

For children with ADHD, cognitive domains related to executive function and overall real-life executive functioning appear to both be measurable via video games. It may be possible to develop individualized behavioral therapy based on the quantitative data obtained from the video game used in this study.

Improvement of anxiety in ADHD following goal-focused cognitive remediation: a randomized controlled trial

Introduction

Despite the high prevalence and detrimental consequences of cognitive and executive dysfunction in ADHD, the evidence base of cognitive remediation in the adult ADHD population is sparse. Executive problems can increase both anxiety and depression in ADHD. Thcus, it is important to develop treatment options for adults with ADHD, aiming to improve goal-directed behavior and mood. Goal Management Training (GMT) is an intervention that has received empirical support in improving executive functions and mood in normal aging and for various neurological and psychiatric conditions. The present randomized controlled trial investigated the effects of a goal-focused intervention combining 1) group-based GMT incorporating psychoeducation about ADHD and 2) guidance in implementing individual goals for coping with executive problems in everyday life, compared to treatment as usual (TAU). The primary outcome was perceived executive functioning in everyday life. Secondary outcomes included psychological well-being (anxiety, depression, and coping with ADHD symptoms).

Methods

We recruited 81 adult participants with a verified ADHD diagnosis (Mage   = 31 years). Inclusion was based upon the presence of executive functioning complaints. The participants were randomly assigned to either the intervention or TAU. The intervention group (n = 41) received 16 hours of GMT and psychoeducation, in addition to 4 individual sessions focusing on formulating goals. The goals were assessed in 6 bi-weekly phone calls in the first three months following the group sessions. Participants in the TAU group (n = 40) received standard, individually-adapted follow-up in an outpatient psychiatric health care setting. All participants were assessed at baseline, post-intervention, and at 8-month follow-up (main measurement time point).

Results

Significant improvements in everyday executive functioning, psychological wellbeing, and symptoms of ADHD from baseline to 8-month follow-up were reported in both groups. The intervention group reported a significantly higher reduction in symptoms of anxiety compared to TAU. Conclusions. Our findings provide support for considering cognitive remediation as a treatment option for patients with ADHD.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04638283?term=NCT04638283&rank=1, identifier: NCT04638283.