Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2016-0039
Trends in Psychiatry and Psychotherapy
Original Article

Computerized cognitive training in children and adolescents with attention deficit/hyperactivity disorder as add-on treatment to stimulants: feasibility study and protocol description

Treinamento cognitivo para crianças e adolescentes com transtorno de déficit de atenção/hiperatividade como tratamento complementar aos psicoestimulantes: estudo de viabilidade e descrição de protocolo

Virginia de Oliveira Rosa; Marcelo Schmitz; Carlos Renato Moreira-Maia; Flavia Wagner; Igor Londero; Caroline de Fraga Bassotto; Guilherme Moritz; Caroline dos Santos de Souza; Luis Augusto Paim Rohde

Downloads: 1
Views: 397

Abstract

Abstract Background Cognitive training has received increasing attention as a non-pharmacological approach for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents. Few studies have assessed cognitive training as add-on treatment to medication in randomized placebo controlled trials. The purpose of this preliminary study was to explore the feasibility of implementing a computerized cognitive training program for ADHD in our environment, describe its main characteristics and potential efficacy in a small pilot study. Methods Six ADHD patients aged 10-12-years old receiving stimulants and presenting residual symptoms were enrolled in a randomized clinical trial to either a standard cognitive training program or a controlled placebo condition for 12 weeks. The primary outcome was core ADHD symptoms measured using the Swanson, Nolan and Pelham Questionnaire (SNAP-IV scale). Results We faced higher resistance than expected to patient enrollment due to logistic issues to attend face-to-face sessions in the hospital and to fill the requirement of medication status and absence of some comorbidities. Both groups showed decrease in parent reported ADHD symptoms without statistical difference between them. In addition, improvements on neuropsychological tests were observed in both groups – mainly on trained tasks. Conclusions This protocol revealed the need for new strategies to better assess the effectiveness of cognitive training such as the need to implement the intervention in a school environment to have an assessment with more external validity. Given the small sample size of this pilot study, definitive conclusions on the effects of cognitive training as add-on treatment to stimulants would be premature.

Keywords

Attention deficit/hyperactivity disorder (ADHD), treatment, cognitive training

Resumo

Resumo Introdução O treinamento cognitivo tem recebido atenção especial como abordagem não medicamentosa para o tratamento do transtorno de déficit de atenção/hiperatividade (TDAH) em crianças e adolescentes. Poucos estudos avaliaram o treinamento cognitivo como abordagem complementar à medicação em ensaios clínicos randomizados controlados por placebo. O objetivo deste estudo foi explorar a viabilidade para a implementação de um programa de treinamento cognitivo computadorizado, descrever suas características principais e potencial eficácia em um pequeno estudo piloto. Métodos Seis pacientes com TDAH entre 10-12 anos de idade, em uso de psicoestimulantes e apresentando sintomas residuais, foram recrutados e randomizados para um dos dois grupos (treinamento cognitivo ou placebo) por 12 semanas. O desfecho principal foram os sintomas nucleares do TDAH avaliados através do Questionário de Swanson, Nolan e Pelham (SNAP-IV). Resultados Encontramos maior resistência do que a esperada no recrutamento dos pacientes em função de problemas logísticos para atender às sessões presenciais no hospital assim como para preencherem os critérios de status medicamentoso e ausência de algumas comorbidades. Ambos os grupos apresentaram diminuição nos escores dos sintomas de TDAH reportados pelos pais, mas sem diferença estatística entre eles. Além disso, foi observada melhora nos testes neuropsicológicos em ambos os grupos – principalmente nas tarefas treinadas pelo programa. Conclusão Este protocolo revelou a necessidade de novas estratégias para melhor avaliar a eficácia do treinamento cognitivo tal como a necessidade de implementar a intervenção no ambiente escolar a fim de obter uma avaliação com maior validade externa. Devido ao pequeno tamanho amostral deste estudo, conclusões definitivas sobre os efeitos do treinamento cognitivo como abordagem complementar aos psicoestimulantes seriam prematuras.

Palavras-chave

Transtorno de déficit de atenção/hiperatividade (TDAH), tratamento, treinamento cognitivo

References

Dias TG, Kieling C, Graeff-Martins AS, Moriyama TS, Rohde LA, Polanczyk GV. Developments and challenges in the diagnosis and treatment of ADHD. Rev Bras Psiquiatr. 2013;35:S40-50.

Polanczyk G, Lima MS de, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164:942-8.

Diagnostic and Statistical Manual of Mental Disorders. 2013.

Biederman J, Petty CR, Woodworth KY, Lomedico A, Hyder LL, Faraone SV. Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. J Clin Psychiatry. 2012;73:941-50.

Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry. 2013;170:275-89.

Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Med. 2012;10.

Danckaerts M, Sonuga-Barke EJ, Banaschewski T, Buitelaar J, Döpfner M, Hollis C. The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry. 2010;19:83-105.

Lichtenstein P, Halldner L, Zetterqvist J, Sjölander A, Serlachius E, Fazel S. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2012;367:2006-14.

Durston S, Van Belle J, De Zeeuw P. Differentiating frontostriatal and fronto-cerebellar circuits in attention-deficit/hyperactivity disorder. Biol Psychiatry. 2011;69:1178-84.

Barkley RA, Murphy KR. Impairment in occupational functioning and adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Arch Clin Neuropsychol. 2010;25:157-73.

Faraone SV, Buitelaar J. Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. Eur Child Adolesc Psychiatry. 2010;19:353-64.

Carlson GA, Dunn D, Kelsey D, Ruff D, Ball S, Ahrbecker L. A pilot study for augmenting atomoxetine with methylphenidate: safety of concomitant therapy in children with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatry Ment Health. 2007;1.

Rueda MR, Fan J, McCandliss BD, Halparin JD, Gruber DB, Lercari LP. Development of attentional networks in childhood. Neuropsychologia. 2004;42:1029-40.

Rutledge KJ, Bos W van den, McClure SM, Schweitzer JB. Training cognition in ADHD: current findings, borrowed concepts, and future directions. Neurotherapeutics. 2012;9:542-58.

Melby-Lervåg M, Hulme C. Is working memory training effective? A meta-analytic review. Dev Psychol. 2013;49:270-91.

Tajik-Parvinchi D, Wright L, Schachar R. Cognitive rehabilitation for attention deficit/hyperactivity disorder (ADHD): promises and problems. J Can Acad Child Adolesc Psychiatry. 2014;23:207-17.

Chacko A, Bedard AC, Marks DJ, Feirsen N, Uderman JZ, Chimiklis A. A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. J Child Psychol Psychiatry. 2014;55:247-55.

Dovis S, Van Der Oord S, Wiers RW, Prins PJ. Improving executive functioning in children with ADHD: training multiple executive functions within the context of a computer game. A randomized double-blind placebo controlled trial. PLoS One. 2015;10.

Green CT, Long DL, Green D, Iosif AM, Dixon JF, Miller MR. Will working memory training generalize to improve off-task behavior in children with attention-deficit/hyperactivity disorder?. Neurotherapeutics. 2012;9:639-48.

Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlström K. Computerized training of working memory in children with ADHD--a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry. 2005;44:177-86.

Wechsler D. The Wechsler intelligence scale for children. 2004.

DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD rating scale-IV: checklists, norms, and clinical interpretation. 1998.

Conners CK. Conners’ continuous performance test (CPT II). 2000.

Luciana M. Practitioner review: computerized assessment of neuropsychological function in children: clinical and research applications of the Cambridge Neuropsychological Testing Automated Battery (CANTAB). J Child Psychol Psychiatry. 2003;44:649-63.

Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary. 2006.

Owen AM, McMillan KM, Laird AR, Bullmore E. N-back working memory paradigm: a meta-analysis of normative functional neuroimaging studies. Hum Brain Mapp. 2005;25:46-59.

Jaeggi SM, Buschkuehl M, Perrig WJ, Meier B. The concurrent validity of the N -back task as a working memory measure. Memory. 2010;18:394-412.

Hogan AM, Vargha-Khadem F, Kirkham FJ, Baldeweg T. Maturation of action monitoring from adolescence to adulthood: an ERP study. Dev Sci. 2005;8:525-34.

Bauermeister JJ, Shrout PE, Ramírez R, Bravo M, Alegría M, Martínez-Taboas A. ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. J Abnorm Child Psychol. 2007;35:883-98.

Dalsgaard S, Østergaard SD, Leckman JF, Mortensen PB, Pedersen MG. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet. 2015;385:2190-6.

Seixas M, Weiss M, Müller U. Systematic review of national and international guidelines on attention-deficit hyperactivity disorder. J Psychopharmacol. 2012;26:753-65.

Holmes J, Gathercole SE, Place M, Dunning DL, Hilton KA, Elliott JG. Working memory deficits can be overcome: impacts of training and medication on working memory in children with ADHD. Appl Cogn Psychol. 2010;24:827-36.

Gray SA, Chaban P, Martinussen R, Goldberg R, Gotlieb H, Kronitz R. Effects of a computerized working memory training program on working memory, attention, and academics in adolescents with severe LD and comorbid ADHD: a randomized controlled trial. J Child Psychol Psychiatry. 2012;53:1277-84.

Rapport MD, Orban SA, Kofler MJ, Friedman LM. Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clin Psychol Rev. 2013;33:1237-52.

Shipstead Z, Redick TS, Engle RW. Is working memory training effective?. Psychol Bull. 2012;138:628-54.

Chacko A, Feirsen N, Bedard AC, Marks D, Uderman JZ, Chimiklis A. Cogmed working memory training for youth with ADHD: a closer examination of efficacy utilizing evidence-based criteria. J Clin Child Adolesc Psychol. 2013;42:769-83.

Mohammadi MR, Soleimani AA, Farahmand Z, Keshavarzi S, Ahmadi N. A comparison of effectiveness of regulation of working memory function and methylphenidate on remediation of attention deficit hyperactivity disorder (ADHD). Iran J Psychiatry. 2014;9:25-30.

Donk ML van der, Hiemstra-Beernink AC, Tjeenk-Kalff AC, Leij A van der, Lindauer RJ. Predictors and moderators of treatment outcome in cognitive training for children with ADHD. J Atten Disord. 2016.

Roberts G, Quach J, Spencer-Smith M, Anderson PJ, Gathercole S, Gold L. Academic outcomes 2 years after working memory training for children with low working memory. JAMA Pediatr. 2016;170.

Steiner NJ, Sheldrick RC, Gotthelf D, Perrin EC. Computer-based attention training in the schools for children with attention deficit/hyperactivity disorder: a preliminary trial. Clin Pediatr. 2011;50:615-22.

Conti MA, Jardim AP, Hearst N, Cordás TA, Tavares H, Abreu CN de. Avaliação da equivalência semântica e consistência interna de uma versão em português do Internet Addiction Test (IAT). Rev Psiquiatr Clin. 2012;39:106-10.

Cortese S, Ferrin M, Brandeis D, Buitelaar J, Daley D, Dittmann RW. Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry. 2015;54:164-74.

Donk M van der, Hiemstra-Beernink AC, Tjeenk-Kalff A, Leij A van der, Lindauer R. Cognitive training for children with ADHD: a randomized controlled trial of cogmed working memory training and “paying attention in class”. Front Psychol. 2015;6.

Manly T, Robertson IH, Anderson V, Nimmo-Smith I. Test of Everyday Attention for Children (TEA-Ch). 1998.

Turner L, Shamseer L, Altman DG, Weeks L, Peters J, Kober T. Consolidated standards of reporting trials (CONSORT) and the completeness of reporting of randomised controlled trials (RCTs) published in medical journals. Cochrane database of systematic reviews. 2012.

Cubillo A, Smith AB, Barrett N, Giampietro V, Brammer M, Simmons A. Drug-specific laterality effects on frontal lobe activation of atomoxetine and methylphenidate in attention deficit hyperactivity disorder boys during working memory. Psychol Med. 2014;44:633-46.

Daly E, Ecker C, Hallahan B, Deeley Q, Craig M, Murphy C. Response inhibition and serotonin in autism: a functional MRI study using acute tryptophan depletion. Brain. 2014;137:2600-10.

Christakou A, Murphy CM, Chantiluke K, Cubillo AI, Smith AB, Giampietro V. Disorder-specific functional abnormalities during sustained attention in youth with Attention Deficit Hyperactivity Disorder (ADHD) and with autism. Mol Psychiatry. 2013;18:236-44.

6169cdbaa95395543a0a2812 trends Articles
Links & Downloads

Trends Psychiatry Psychother

Share this page
Page Sections