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An integrated program of computer-presented and physical cognitive training exercises for children with attention-deficit/hyperactivity disorder

Published online by Cambridge University Press:  24 February 2020

Bruce E. Wexler Open the ORCID record for Bruce E. Wexler [Opens in a new window] ,
Lawrence A. Vitulano ,
Christina Moore ,
Liliya Katsovich ,
Stephanie D. Smith ,
Cindy Rush ,
Heidi Grantz ,
Jinxia Dong  and
James F. Leckman
Bruce E. Wexler*
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Lawrence A. Vitulano
Affiliation:
Child Study Center, Yale School of Medicine, New Haven, CT, USA
Christina Moore
Affiliation:
Child Study Center, Yale School of Medicine, New Haven, CT, USA Department of Psychology, University of Delaware, Newark, DE, USA
Liliya Katsovich
Affiliation:
Child Study Center, Yale School of Medicine, New Haven, CT, USA
Stephanie D. Smith
Affiliation:
Child Study Center, Yale School of Medicine, New Haven, CT, USA Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
Cindy Rush
Affiliation:
Department of Statistics, Columbia University, New York, NY, USA
Heidi Grantz
Affiliation:
Child Study Center, Yale School of Medicine, New Haven, CT, USA
Jinxia Dong
Affiliation:
Peking University, Beijing, P.R. China
James F. Leckman
Affiliation:
Child Study Center, Yale School of Medicine, New Haven, CT, USA
*
Author for correspondence: Bruce E. Wexler, E-mail: bruce.wexler@yale.edu
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Abstract

Background

This study integrated an experimental medicine approach and a randomized cross-over clinical trial design following CONSORT recommendations to evaluate a cognitive training (CT) intervention for attention deficit hyperactivity disorder (ADHD). The experimental medicine approach was adopted because of documented pathophysiological heterogeneity within the diagnosis of ADHD. The cross-over design was adopted to provide the intervention for all participants and make maximum use of data.

Methods

Children (n = 93, mean age 7.3 +/− 1.1 years) with or sub-threshold for ADHD were randomly assigned to CT exercises over 15 weeks, before or after 15 weeks of treatment-as-usual (TAU). Fifteen dropped out of the CT/TAU group and 12 out of the TAU/CT group, leaving 66 for cross-over analysis. Seven in the CT/TAU group completed CT before dropping out making 73 available for experimental medicine analyses. Attention, response inhibition, and working memory were assessed before and after CT and TAU.

Results

Children were more likely to improve with CT than TAU (27/66 v. 13/66, McNemar p = 0.02). Consistent with the experimental medicine hypotheses, responders improved on all tests of executive function (p = 0.009–0.01) while non-responders improved on none (p = 0.27–0.81). The degree of clinical improvement was predicted by baseline and change scores in focused attention and working memory (p = 0.008). The response rate was higher in inattentive and combined subtypes than hyperactive-impulsive subtype (p = 0.003).

Conclusions

Targeting cognitive dysfunction decreases clinical symptoms in proportion to improvement in cognition. Inattentive and combined subtypes were more likely to respond, consistent with targeted pathology and clinically relevant heterogeneity within ADHD.

Keywords

attention deficit hyperactivity disordercognitive trainingnon-pharmacologic treatmentphysical exercise
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 9 , July 2021 , pp. 1524 - 1535
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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