Effect of Cognitive Training Programs Based on Computer Systems on Executive Functions in Children With ADHD: A Systematic Review

Exploring the potential of Braingame Brian for executive function improvement in Spanish-speaking children with ADHD: A pilot study

Considering the implications of executive function (EF) in the core symptoms of attention deficit hyperactivity disorder (ADHD), further research is required on strategies such as therapies, treatments, and rehabilitation programs focused on improving EF. This study aimed to assess the potential of an EF training program called "Braingame Brian" in improving working memory, inhibition, and cognitive flexibility in children with ADHD. The programme was developed in the Netherlands and has been shown to be effective in pilot studies of ADHD populations conducted in this country. However, it has not been used before in the Spanish-speaking population. A total of 41 children (aged 8-12 years) were assigned to the EF training or waitlist control groups. The intervention consisted of a 25-session training programme of approximately 45 min per day for nine consecutive weeks. Treatment outcomes were assessed using cognitive tasks of the trained EF, as well as evaluations of EF behaviors by parents and teachers. The initial findings suggest that the implementation of the Braingame Brian programme may be associated with improvements in working memory, inhibition, and cognitive flexibility. These preliminary results also indicate the potential for enhancements in parents' and teachers' perceptions of EF difficulties in children with ADHD.

Working memory related functional connectivity in adult ADHD and its amenability to training: A randomized controlled trial

BACKGROUND

Working memory (WM) deficits are among the most prominent cognitive impairments in attention deficit hyperactivity disorder (ADHD). While functional connectivity is a prevailing approach in brain imaging of ADHD, alterations in WM-related functional brain networks and their malleability by cognitive training are not well known. We examined whole-brain functional connectivity differences between adults with and without ADHD during n-back WM tasks and rest at pretest, as well as the effects of WM training on functional and structural brain connectivity in the ADHD group.

METHODS

Forty-two adults with ADHD and 36 neurotypical controls performed visuospatial and verbal n-back tasks during functional magnetic resonance imaging (fMRI). In addition, seven-minute resting state fMRI data and diffusion-weighted MR images were collected from all participants. The adults with ADHD continued into a 5-week randomized controlled WM training trial (experimental group training on a dual n-back task, n = 21; active control group training on Bejeweled II video game, n = 21), followed by a posttraining MRI. Brain connectivity was examined with Network-Based Statistic.

RESULTS

At the pretest, adults with ADHD had decreased functional connectivity compared with the neurotypical controls during both n-back tasks in networks encompassing fronto-parietal, temporal, occipital, cerebellar, and subcortical brain regions. Furthermore, WM-related connectivity in widespread networks was associated with performance accuracy in a continuous performance test. Regarding resting state connectivity, no group differences or associations with task performance were observed. WM training did not modulate functional or structural connectivity compared with the active controls.

CONCLUSION

Our results indicate large-scale abnormalities in functional brain networks underlying deficits in verbal and visuospatial WM commonly faced in ADHD. Training-induced plasticity in these networks may be limited.

Computerized cognitive retraining (ReadON.ai) among children diagnosed with attention deficit hyperactivity disorder

Background

ADHD affects 8% of children and adolescents globally, marked by significant deficits in cognitive abilities, which leads to various emotional, behavioral, and adjustment issues. Traditional methods like medication and behavior therapy fall short in managing ADHD's cognitive domains, urging the adoption of innovative approaches like cognitive training programs specifically adopting the emerging technology such as ReadON.ai. However, the precise influence of computerized cognitive retraining on ADHD remains understudied.

Aim

To study the feasibility of computerized cognitive retraining (ReadON.ai) in enhancing cognitive abilities in children diagnosed with attention deficit hyperactivity disorder.

Materials and Methods

The study employs a pre- and post-intervention design including six participants (7-11 years), diagnosed with ADHD according to DSM-5 criteria. Each participant underwent 30 hours of computerized cognitive retraining (ReadON.ai) over ten weeks, targeting attention and concentration, working memory, memory and learning, perceptual abilities, and reasoning skills. Assessments before and after intervention included tools like Conners' 4TM Parent version and ReadON.ai CSA. Statistical analysis was conducted using IBM SPSS version 28.

Results

Paired t-test results revealed a significant difference in pre-test and post-test means of attention and concentration (t = -6.873, P < 0.001), working memory (t = -5.771, P < 0.001), learning and memory (t = -12.491, P < 0.001), perception (t = 14.398, P < 0.004), reasoning (t = -3.464, P < 0.018), hyperactivity (t = 11.073, P < 0.001), impulsivity (t = 11.948, P < 0.001), emotional dysregulation (t = 8.242, P < 0.001), anxious thoughts (t = 2.67 P = 0.219), depressed mood (t = 2.924, P = 0.020), school work (t = 7.387, P = 0.001) and peer interaction (t = 4.632, P = 0.006) with medium to large effect size.

Conclusion

Computerized cognitive retraining through ReadON.ai is feasible in enhancing cognitive abilities like attention and concentration, working memory, memory and learning, perception, and reasoning among children with ADHD.

Effectiveness of a Serious Video Game (MOON) for Attention Deficit Hyperactivity Disorder: Protocol for a Randomized Clinical Trial

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood and adolescence, with a prevalence of 5% and associated difficulties and worse prognosis if undetected. Multimodal treatment is the treatment of choice. However, sometimes treatment can be insufficient or have drawbacks.

OBJECTIVE

This study protocol aims to demonstrate the effectiveness of cognitive training through the serious video game The Secret Trail of Moon (MOON) in improving emotional regulation in people with ADHD.

METHODS

This is a prospective, unicenter, randomized, unblinded, pre- and postintervention study. The groups will be randomized (MOON vs control) via an electronic case report form. The MOON intervention will be performed 2 times per week for 10 weeks (30 minutes per session). The first 5 weeks (10 sessions) will be conducted face-to-face at the Puerta de Hierro University Hospital, and the remaining weeks will be conducted via the internet at the participants' homes. The total sample consists of 152 patients aged between 7 and 18 years. All participants have a clinical diagnosis of ADHD under pharmacological treatment. Data collection will be used to obtain demographic and clinical data. The data will be recorded using REDCap. Measures will be made through clinical scales for parents and objective tests of cognitive functioning in patients. Additional information on academic performance will be collected. The study has a power greater than 80% to detect differences. Student t test, 2-factor analysis of variance (ANOVA), and Mann-Whitney analyses will be performed according to each variable's characteristics.

RESULTS

The study was approved by the Research Ethics Committee of the Puerta de Hierro University Hospital on December 14, 2022. As of September 26, 2023, we have enrolled 62 participants, and 31 participants have completed the study. This clinical trial was funded by the Comunidad de Madrid (IND2020/BMD-17544). The approximate completion date is March 2024.

CONCLUSIONS

Serious video games such as MOON can be motivational tools that complement multimodal treatment for ADHD.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT06006871; https://clinicaltrials.gov/study/NCT06006871.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53191.

Improving Cognitive Abilities in School-Age Children via Computerized Cognitive Training: Examining the Effect of Extended Training Duration

Critical neuropsychological capabilities such as working memory, cognitive flexibility, and processing speed are foundational to many daily activities. For children, such skills are essential for school success. Thus, children who demonstrate weaknesses in these abilities may experience impaired academic performance; this is especially true for students identified with learning differences who often exhibit less developed cognitive abilities. The purpose of this project was to examine the efficacy of a cognitive training program implemented during the school day to improve abilities predictive of academic achievement. Ninety-five children completed two training activities that were counterbalanced across participants. Analyses of baseline working memory, cognitive flexibility, and processing speed performance relative to those following training showed a strong treatment effect. Moreover, there is notable evidence of greater intervention efficacy with extended engagement with the training program. Implications for neuropsychological research and practice are discussed.