Cognitive Training in Children and Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD)

Bidragets oversatte titel: Kognitiv træning for børn og unge med ADHD

Publikation: AfhandlingPh.d.-afhandling


Background: Many individuals with attention deficit hyperactivity disorder (ADHD) continue to experience impaired cognitive functions despite medical treatment. Inadequate medical compliance and uncertain long-term effects of treatment make it necessary to explore supplementary treatments for ADHD. Lately, several trials have shown that training with cognitive computer programs can reduce severity of symptoms and improve cognitive functions.

Method: This dissertation investigates the effects of cognitive training conducted at home in children and adolescents with ADHD. The effect of cognitive training was investigated in two randomized and controlled clinical trials with a focus on specific cognitive, severity of symptoms, and functional outcomes.

Trial 1: In a pilot study, 18 adolescents with ADHD were randomized to cognitive training or active placebo treatment. They received the interventions for 7 weeks and were assessed at baseline
and after the intervention.
Trial 2: In the second trial, 70 children with ADHD were randomized to an intervention targeting broader cognitive functions or a treatment-as-usual control group. Assessments were performed at baseline, after 8 weeks of intervention, and after 12 and 24 weeks of follow-up post- intervention.

Outcome measures: Participants' cognitive functions were assessed with the Cambridge Neurocognitive Automated Battery (CANTAB), and with symptom and behavioral measures before and after the intervention. The first study also focused on the feasibility of the intervention. The first trial was exploratory and based on the results, the primary outcome measure in the second trial was sustained attention.

Results: In the pilot trial with adolescents with ADHD, we found that it was feasible to use the intervention at home, but that the adolescents did not perceive the specific intervention as very interesting. There were no significant group differences in terms of cognitive and ADHD symptom measures after the intervention. Pre-post intra-group measurement showed that the intervention group had a significant, beneficial effect on sustained attention, while the active placebo had significant, beneficial effects on working memory, both with large effect sizes.

In the second trial, we found no significant differences on our primary or secondary outcome measures indicating no effects on sustained attention, ADHD symptoms or executive functions ratings by parents and teachers. In our exploratory analysis we found a significant difference on an objective measures of planning ability that was sustained at both follow-up points. Additionally we found some interesting effects at the subgroup level regarding the age of participants, ADHD subtypes, and the number of training sessions completed.

Conclusions: We found no beneficial effects of cognitive training in our trials for the broader ADHD population. However our results indicate that certain subgroups of patients with ADHD, like older individuals and the ADHD inattentiv subtype, may benefit more from cognitive training than others. Additionally the effect of broader cognitive interventions on ability to plan should be investigated further. These hypotheses need to be tested in future trials.
Bidragets oversatte titelKognitiv træning for børn og unge med ADHD
StatusUdgivet - sep. 2016