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

麦克内马尔试验 注意缺陷多动障碍 认知训练 认知 工作记忆训练 医学 工作记忆 随机对照试验 执行职能 临床试验 物理疗法 临床心理学 精神科 内科学 数学 统计
作者
Bruce E. Wexler,Lawrence A. Vitulano,Christina Moore,Liliya Katsovich,Stephanie D. Smith,Cindy Rush,Heidi Grantz,Dong Jinxia,James F. Leckman
出处
期刊:Psychological Medicine [Cambridge University Press]
卷期号:51 (9): 1524-1535 被引量:16
标识
DOI:10.1017/s0033291720000288
摘要

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.
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