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Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials

Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials
Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials
Objective: the authors performed meta-analyses of randomized controlled trials to examine the effects of cognitive training on attention-deficit/hyperactivity disorder (ADHD) symptoms, neuropsychological deficits, and academic skills in children/adolescents with ADHD.

Method: the authors searched Pubmed, Ovid, Web of Science, ERIC, and CINAHAL databases through May 18, 2014. Data were aggregated using random-effects models. Studies were evaluated with the Cochrane risk of bias tool.

Results: sixteen of 695 nonduplicate records were analyzed (759 children with ADHD). When all types of training were considered together, there were significant effects on total ADHD (standardized mean difference [SMD] = 0.37, 95% CI = 0.09–0.66) and inattentive symptoms (SMD = 0.47, 95% CI = 0.14–0.80) for reports by raters most proximal to the treatment setting (i.e., typically unblinded). These figures decreased substantially when the outcomes were provided by probably blinded raters (ADHD total: SMD = 0.20, 95% CI = 0.01–0.40; inattention: SMD = 0.32, 95% CI = ?0.01 to 0.66). Effects on hyperactivity/impulsivity symptoms were not significant. There were significant effects on laboratory tests of working memory (verbal: SMD = 0.52, 95% CI = 0.24–0.80; visual: SMD = 0.47, 95% CI = 0.23–0.70) and parent ratings of executive function (SMD = 0.35, 95% CI = 0.08–0.61). Effects on academic performance were not statistically significant. There were no effects of working memory training, specifically on ADHD symptoms. Interventions targeting multiple neuropsychological deficits had large effects on ADHD symptoms rated by most proximal assessors (SMD = 0.79, 95% CI = 0.46–1.12).

Conclusion: despite improving working memory performance, cognitive training had limited effects on ADHD symptoms according to assessments based on blinded measures. Approaches targeting multiple neuropsychological processes may optimize the transfer of effects from cognitive deficits to clinical symptoms
ADHD, nonpharmacological, working memory, executive functions, evidence-based psychiatry
1527-5418
164-174
Cortese, Samuele
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Ferrin, Maite
1cf8f421-afd8-4e49-8490-19cc35b470fe
Brandeis, Daniel
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Buitelaar, Jan
0a7a93a0-884f-4fe1-9cd8-6c9f9c5df4da
Daley, David
651d0b29-8790-4a13-aa18-ad9a499d34e8
Dittmann, Ralf W.
e2d36a60-d6c5-485d-8ce5-852d5a1b9bfd
Holtmann, Martin
511fa11b-f2cb-413f-880e-50c3b04ad9d3
Santosh, Paramala
c1ac98e0-83b9-4583-a3ce-ca82085ffde4
Stevenson, Jim
0c85d29b-d294-43cb-ab8d-75e4737478e1
Stringaris, Argyris
b813012e-7b67-432b-9799-2187bf675c30
Zuddas, Alessandro
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Sonuga-Barke, Edmund J.S.
bc80bf95-6cf9-4c76-a09d-eaaf0b717635
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Ferrin, Maite
1cf8f421-afd8-4e49-8490-19cc35b470fe
Brandeis, Daniel
58d13628-f513-4af5-822c-7401cf5dbfd4
Buitelaar, Jan
0a7a93a0-884f-4fe1-9cd8-6c9f9c5df4da
Daley, David
651d0b29-8790-4a13-aa18-ad9a499d34e8
Dittmann, Ralf W.
e2d36a60-d6c5-485d-8ce5-852d5a1b9bfd
Holtmann, Martin
511fa11b-f2cb-413f-880e-50c3b04ad9d3
Santosh, Paramala
c1ac98e0-83b9-4583-a3ce-ca82085ffde4
Stevenson, Jim
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Stringaris, Argyris
b813012e-7b67-432b-9799-2187bf675c30
Zuddas, Alessandro
51df7133-8494-4309-902d-bbf088341e46
Sonuga-Barke, Edmund J.S.
bc80bf95-6cf9-4c76-a09d-eaaf0b717635

Cortese, Samuele, Ferrin, Maite, Brandeis, Daniel, Buitelaar, Jan, Daley, David, Dittmann, Ralf W., Holtmann, Martin, Santosh, Paramala, Stevenson, Jim, Stringaris, Argyris, Zuddas, Alessandro and Sonuga-Barke, Edmund J.S. (2015) Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child and Adolescent Psychiatry, 54 (3), 164-174. (doi:10.1016/j.jaac.2014.12.010). (PMID:25721181)

Record type: Article

Abstract

Objective: the authors performed meta-analyses of randomized controlled trials to examine the effects of cognitive training on attention-deficit/hyperactivity disorder (ADHD) symptoms, neuropsychological deficits, and academic skills in children/adolescents with ADHD.

Method: the authors searched Pubmed, Ovid, Web of Science, ERIC, and CINAHAL databases through May 18, 2014. Data were aggregated using random-effects models. Studies were evaluated with the Cochrane risk of bias tool.

Results: sixteen of 695 nonduplicate records were analyzed (759 children with ADHD). When all types of training were considered together, there were significant effects on total ADHD (standardized mean difference [SMD] = 0.37, 95% CI = 0.09–0.66) and inattentive symptoms (SMD = 0.47, 95% CI = 0.14–0.80) for reports by raters most proximal to the treatment setting (i.e., typically unblinded). These figures decreased substantially when the outcomes were provided by probably blinded raters (ADHD total: SMD = 0.20, 95% CI = 0.01–0.40; inattention: SMD = 0.32, 95% CI = ?0.01 to 0.66). Effects on hyperactivity/impulsivity symptoms were not significant. There were significant effects on laboratory tests of working memory (verbal: SMD = 0.52, 95% CI = 0.24–0.80; visual: SMD = 0.47, 95% CI = 0.23–0.70) and parent ratings of executive function (SMD = 0.35, 95% CI = 0.08–0.61). Effects on academic performance were not statistically significant. There were no effects of working memory training, specifically on ADHD symptoms. Interventions targeting multiple neuropsychological deficits had large effects on ADHD symptoms rated by most proximal assessors (SMD = 0.79, 95% CI = 0.46–1.12).

Conclusion: despite improving working memory performance, cognitive training had limited effects on ADHD symptoms according to assessments based on blinded measures. Approaches targeting multiple neuropsychological processes may optimize the transfer of effects from cognitive deficits to clinical symptoms

Other
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More information

Accepted/In Press date: 24 December 2014
e-pub ahead of print date: 29 December 2014
Published date: March 2015
Keywords: ADHD, nonpharmacological, working memory, executive functions, evidence-based psychiatry
Organisations: Clinical Neuroscience

Identifiers

Local EPrints ID: 376603
URI: http://eprints.soton.ac.uk/id/eprint/376603
ISSN: 1527-5418
PURE UUID: 6e6223ac-66ff-4a5d-9295-37a9a222f2b2
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 30 Apr 2015 13:09
Last modified: 15 Mar 2024 03:52

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Contributors

Author: Samuele Cortese ORCID iD
Author: Maite Ferrin
Author: Daniel Brandeis
Author: Jan Buitelaar
Author: David Daley
Author: Ralf W. Dittmann
Author: Martin Holtmann
Author: Paramala Santosh
Author: Jim Stevenson
Author: Argyris Stringaris
Author: Alessandro Zuddas
Author: Edmund J.S. Sonuga-Barke

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