Effectiveness of a Serious Video Game (MOON) for Attention Deficit Hyperactivity Disorder: Protocol for a Randomized Clinical Trial.
JMIR research protocols
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.
10.2196/53191
Decreased impulsiveness and MEG normalization after AI-digital therapy in ADHD children: a RCT.
Npj mental health research
Attention-deficit/hyperactivity disorder (ADHD) presents with symptoms like impulsiveness, inattention, and hyperactivity, often affecting children's academic and social functioning. Non-pharmacological interventions, such as digital cognitive therapy, are emerging as complementary treatments for ADHD. The randomized controlled trial explored the impact of an AI-driven digital cognitive program on impulsiveness, inattentiveness, and neurophysiological markers in 41 children aged 8-12 with ADHD. Participants received either 12 weeks of AI-driven therapy or a placebo intervention. Assessments were conducted pre- and post-intervention and magnetoencephalography (MEG) analyzed brain activity. Results showed significant reductions in impulsiveness and inattentiveness scores in the treatment group, associated with normalized MEG spectral profiles, indicating neuromaturation. Notably, improvements in inhibitory control correlated with spectral profile normalization in the parieto-temporal cortex. Improvements in inhibitory control, linked to normalized spectral profiles, suggest AI-driven digital cognitive therapy can reduce impulsiveness in ADHD children by enhancing neurophysiological efficiency. This emphasizes personalized, technology-driven ADHD treatment, using neurophysiological markers for assessing efficacy.
10.1038/s44184-024-00111-9
The Effect of Mobile Neurofeedback Training in Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Trial.
Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology
Objective:: To examine the effect of mobile neurofeedback training on the clinical symptoms, attention abilities, and execution functions of children with attention deficit hyperactivity disorder (ADHD). Methods:: The participants were 74 children with ADHD aged 8-15 years who visited the Department of Child and Adolescent Psychiatry at Seoul National University Children's Hospital. The participants were randomly assigned to the mobile neurofeedback (n = 35) or control (sham; n = 39) group. Neurofeedback training was administered using a mobile app (equipped with a headset with a 2-channel electroencephalogram [EEG] sensor) for 30 min/day, 3 days/week, for 3 months. Children with ADHD were individually administered various neuropsychological tests, including the continuous performance test, Children's Color Trails Test-1 and 2, and Stroop Color and Word Tests. The effects of mobile neurofeedback were evaluated at baseline and at 3 and 6 months after treatment initiation. Results:: Following treatment, both mobile neurofeedback-only and sham-only groups showed significant improvements in attention and response inhibition. In the visual continuous performance test, omission errors decreased to the normal range in the mobile neurofeedback-only group after training, suggesting that mobile neurofeedback effectively reduced inattention in children with ADHD. In the advanced test of attention, auditory response times decreased in the mobile neurofeedback + medication group after training, but increased in the sham+medication group. Overall, there were no significant between-group differences in other performance outcomes. Conclusion:: Mobile neurofeedback may have potential as an additional therapeutic option alongside medication for children with ADHD.
10.9758/cpn.23.1054
PKSolver: An add-in program for pharmacokinetic and pharmacodynamic data analysis in Microsoft Excel.
Zhang Yong,Huo Meirong,Zhou Jianping,Xie Shaofei
Computer methods and programs in biomedicine
This study presents PKSolver, a freely available menu-driven add-in program for Microsoft Excel written in Visual Basic for Applications (VBA), for solving basic problems in pharmacokinetic (PK) and pharmacodynamic (PD) data analysis. The program provides a range of modules for PK and PD analysis including noncompartmental analysis (NCA), compartmental analysis (CA), and pharmacodynamic modeling. Two special built-in modules, multiple absorption sites (MAS) and enterohepatic circulation (EHC), were developed for fitting the double-peak concentration-time profile based on the classical one-compartment model. In addition, twenty frequently used pharmacokinetic functions were encoded as a macro and can be directly accessed in an Excel spreadsheet. To evaluate the program, a detailed comparison of modeling PK data using PKSolver and professional PK/PD software package WinNonlin and Scientist was performed. The results showed that the parameters estimated with PKSolver were satisfactory. In conclusion, the PKSolver simplified the PK and PD data analysis process and its output could be generated in Microsoft Word in the form of an integrated report. The program provides pharmacokinetic researchers with a fast and easy-to-use tool for routine and basic PK and PD data analysis with a more user-friendly interface.
10.1016/j.cmpb.2010.01.007
The effectiveness of child-centered play therapy for executive functions in children with attention-deficit/hyperactivity disorder.
Clinical child psychology and psychiatry
INTRODUCTION:Child-centered play therapy (CCPT) is a practical and recommended non-medication intervention for children with Attention-deficit/hyperactivity disorder (ADHD) but the mechanism in between is unclear. AIM:This study proposed to examine the effectiveness of CCPT on neuropsychological deficits and behavioral symptoms in ADHD. METHODS:Participants with ADHD diagnosis were referred from senior child and adolescent psychiatrists, and typical developmental children (TD) were recruited from community as a control group. All participants' executive functions were evaluated using Cambridge Neuropsychological Test Automated Battery. First of all, the participants were evaluated using Child Behavior Checklist (CBCL) by their parents. The ADHD participants were assigned into CCPT (ADHDc) and waitlist (ADHDw) group; and the ADHDc group then received CCPT weekly for 12 sessions, while the ADHDw continuously received their regular treatment (i.e., medication treatment or other alternative treatments) as usual. RESULTS:Total 52 participants were recruited (17 with ADHD and 35 typically developed children, TD). The results showed that overall the ADHD groups had worse neuropsychological performance and more behavioural disturbance than did the TD ( < .05). After receiving the CCPT, the results showed that the ADHDc group had significant improvement in the cognitive flexibility ( < .05); while the ADHDw group had no changes.
10.1177/13591045221128399
Effectiveness of a game-based high-intensity interval training on executive function and other health indicators of children with ADHD: A three-arm partially-blinded randomized controlled trial.
Journal of exercise science and fitness
Background:Children with ADHD demand for effective intervention with minimum side effect to improve executive function (EF) and health well-being. Method:This study used a three-arm partially-blinded randomized controlled trial to test the effects of two different kinds of 8-week game-based training programs (game-based HIIT program, GameHIIT; and game-based structured aerobic exercise program, GameSAE) on EF and other health indicators of children with ADHD, which was compared with a non-treatment control group. Results:A total of 49 children with ADHD completed the program. Analyses of EF tests and parental survey indicated that (i) there is no significant intragroup difference among all measures between pre-/post-intervention tests for two game-based intervention groups. The only significant intergroup difference was observed in self-monitor score of parent-reported child's EF between GameSAE group and the control (large effect). Similarly, cerebral hemodynamic responses also found no significant group effect for all EF tests. However, the time effects were observed in several channels in the GameHIIT group in two EF tests (Color Words Stroop Test and Tower of London Test). No significant change of participants' overall ADHD symptoms was found in the pre-/post-tests for three groups. Nonetheless, further analyses revealed that both of two game-based training programs exhibited the significant positive effects on child's PA levels and the large effects on levels of physical fitness, when they were compared to the control. Conclusion:By this study, a significant enhancement in physical fitness and PA levels were found in both game-based PA interventions when they were compared with control group. However, the effectiveness of game-based PA interventions on improving EF or reducing ADHD symptoms remains unclear. This implies that a larger intervention dosage or a tailored intervention design may be warranted to improve the EF of children with ADHD.
10.1016/j.jesf.2024.09.001
Study protocol of a randomised controlled trial of the effects of near-infrared spectroscopy neurofeedback training coupled with virtual reality technology in children with ADHD.
BMJ open
BACKGROUND:The rise in the number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) highlights the need for effective interventions targeting attentional control. Although recent research has demonstrated the potential of neurofeedback training (NFT) for children with ADHD, most studies have been conducted in laboratory settings, raising questions about their real-world applicability. To address this issue, virtual reality (VR) may offer a solution to the ecological validity challenges encountered in NFT. By coupling NFT with VR, individuals can engage in self-regulating brain activity within a simulated, realistic environment. This study aims to investigate the efficacy of near-infrared spectroscopy (NIRS)-based NFT combined with VR in alleviating ADHD symptoms among children, addressing the need for interventions with practical relevance and effectiveness. METHODS:This study aims to recruit 138 children aged 7-12 diagnosed with ADHD. Following baseline assessment, participants will be randomly assigned to one of three conditions: (1) NIRS-based NFT in a VR classroom setting; (2) conventional computerised cognitive training (active control) or (3) a waitlist control group. On completion of intervention sessions in the two training groups, all groups will undergo an assessment at time 2, with a follow-up assessment scheduled 2 months post-training for all participants. Primary outcomes will include measures of executive function, such as attentional control, response inhibition and working memory, along with changes in oxygenated and deoxygenated haemoglobin levels monitored by functional NIRS. Secondary outcome measures will comprise ratings of children's ADHD symptoms and executive function behaviours in daily life, reported by parents and teachers. DISCUSSION:The three-arm randomised controlled trial will address research gaps regarding the effectiveness of NIRS-based NFT for children with ADHD, particularly when integrated with immersive VR technology. By combining NFT and VR, this study aims to simulate a real-world environment, potentially amplifying intervention effects. The findings from the study will provide evidence for the efficacy of this innovative intervention in improving executive function and alleviating ADHD symptoms. ETHICS AND DISSEMINATION:Ethical approval was obtained from the Human Research Ethics Committee at the University of Hong Kong (Reference: EA200247). Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER:NCT05906485.
10.1136/bmjopen-2024-093183
The effects of a four-month skateboarding intervention on motor, cognitive, and symptom levels in children with ADHD.
Frontiers in pediatrics
Objectives and methods:This study aimed to investigate whether a four-month skateboarding workshop can positively affect attention-focusing skills and postural control in terms of static and dynamic balance in addition to symptoms of ADHD in school-aged children ( = 58). Kinematic and kinetic movement analysis, attention-focusing tests as well as symptom questionnaires were employed to measure differences caused by the skateboarding intervention. A weekly skateboarding workshop was conducted with children diagnosed with ADHD which intended to encourage children to autonomously engage in physical activity. Group differences were analyzed using a generalized linear mixed model. A partial correlation was used to investigate possible relationships between the variables. Results:A preceding analysis confirmed that children with ADHD perform statistically significantly inferior in the employed tests of balance and concentration ability than unaffected peers of the same age. The main analysis showed that after the skateboarding intervention, children with ADHD were able to improve cognitive and motor test performances as well as symptom expression significantly. Significant improvements were likewise found in the waitlist control group, these were however less pronounced compared to those of the skateboarding intervention group. The correlation analysis revealed that there is no reciprocal influence between cognitive and motor skills, nor between motor skills and ADHD symptomatology in the present patient group. Possible explanations are discussed. Conclusion:Skateboarding as a form of movement intervention can be considered an effective method for children with ADHD to deal with their symptoms and deficits. An intervention period of four months has helped children with ADHD discover and embrace an informal sport like skateboarding, thereby finding enjoyment in movement and practice a skill from intrinsic motivation. To retain the benefits, it is advisable to practice a sport on a long-term basis. Thorough conceptualizations to implement this type of therapy await further research.
10.3389/fped.2024.1452851
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
INTRODUCTION:Executive functions (EFs) training interventions aimed at ADHD-symptom reduction have yielded mixed results. Generally, these interventions focus on training a single cognitive domain (e.g., working memory [WM], inhibition, or cognitive-flexibility). However, evidence suggests that most children with ADHD show deficits on multiple EFs, and that these EFs are largely related to different brain regions. Therefore, training multiple EFs might be a potentially more effective strategy to reduce EF-related ADHD symptoms. METHODS:Eighty-nine children with a clinical diagnosis of ADHD (aged 8-12) were randomized to either a full-active-condition where visuospatial WM, inhibition and cognitive-flexibility were trained, a partially-active-condition where inhibition and cognitive-flexibility were trained and the WM-training task was presented in placebo-mode, or to a full placebo-condition. Short-term and long-term (3-months) effects of this gamified, 25-session, home-based computer-training were evaluated on multiple outcome domains. RESULTS:During training compliance was high (only 3% failed to meet compliance criteria). After training, only children in the full-active condition showed improvement on measures of visuospatial short-term-memory (STM) and WM. Inhibitory performance and interference control only improved in the full-active- and the partially-active condition. No Treatment-condition x Time interactions were found for cognitive-flexibility, verbal WM, complex-reasoning, nor for any parent-, teacher-, or child-rated ADHD behaviors, EF-behaviors, motivational behaviors, or general problem behaviors. Nonetheless, almost all measures showed main Time-effects, including the teacher-ratings. CONCLUSIONS:Improvements on inhibition and visuospatial STM and WM were specifically related to the type of treatment received. However, transfer to untrained EFs and behaviors was mostly nonspecific (i.e., only interference control improved exclusively in the two EF training conditions). As such, in this multiple EF-training, mainly nonspecific treatment factors - as opposed to the specific effects of training EFs-seem related to far transfer effects found on EF and behavior. TRIAL REGISTRATION:trialregister.nl NTR2728. Registry name: improving executive functioning in children with ADHD: training executive functions within the context of a computer game; registry number: NTR2728.
10.1371/journal.pone.0121651
Aerobic exercise and attention deficit hyperactivity disorder: brain research.
Choi Jae Won,Han Doug Hyun,Kang Kyung Doo,Jung Hye Yeon,Renshaw Perry F
Medicine and science in sports and exercise
PURPOSE:As adjuvant therapy for enhancing the effects of stimulants and thereby minimizing medication doses, we hypothesized that aerobic exercise might be an effective adjunctive therapy for enhancing the effects of methylphenidate on the clinical symptoms, cognitive function, and brain activity of adolescents with attention deficit hyperactivity disorder (ADHD). METHODS:Thirty-five adolescents with ADHD were randomly assigned to one of two groups in a 1/1 ratio; methylphenidate treatment + 6-wk exercise (sports-ADHD) or methylphenidate treatment + 6-wk education (edu-ADHD). At baseline and after 6 wk of treatment, symptoms of ADHD, cognitive function, and brain activity were evaluated using the Dupaul attention deficit hyperactivity disorder rating scale--Korean version (K-ARS), the Wisconsin Card Sorting Test, and 3-T functional magnetic resonance imaging, respectively. RESULTS:The K-ARS total score and perseverative errors in the sports-ADHD group decreased compared with those in the edu-ADHD group. After the 6-wk treatment period, the mean β value of the right frontal lobe in the sports-ADHD group increased compared with that in the edu-ADHD group. The mean β value of the right temporal lobe in the sports-ADHD group decreased. However, the mean β value of the right temporal lobe in the edu-ADHD group did not change. The change in activity within the right prefrontal cortex in all adolescents with ADHD was negatively correlated with the change in K-ARS scores and perseverative errors. CONCLUSIONS:The current results indicate that aerobic exercise increased the effectiveness of methylphenidate on clinical symptoms, perseverative errors, and brain activity within the right frontal and temporal cortices in response to the Wisconsin card sorting test stimulation.
10.1249/MSS.0000000000000373
Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial.
Steeger Christine M,Gondoli Dawn M,Gibson Bradley S,Morrissey Rebecca A
Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence
This study examined the individual and combined effects of two nonpharmacological treatments for attention deficit/hyperactivity disorder (ADHD): Cogmed working memory training (CWMT) for adolescents and behavioral parent training (BPT) for mothers. Ninety-one adolescents (ages 11-15) and their mothers were randomized to one of four CWMT and BPT treatment and active control (placebo) group combinations of 5-week interventions. At pre- and posttest, mothers and teachers completed rating forms, and adolescents completed neuropsychological measures of working memory (WM). Individual intervention effects showed that treatment CWMT significantly improved WM spans, whereas there were no significant differences for treatment or control BPT on reports of parent-related outcomes. Combined treatment effects indicated an overall pattern of greatest improvements for the control CWMT/treatment BPT group, as compared to the other three groups, on adolescent WM deficit, behavioral regulation problems, and global executive deficit. Most significant effects for outcomes were main effects of improvements over time. A combination of CWMT and BPT did not result in increased treatment gains. However, potential effects of combined treatment may have been masked by greater perceived benefits arising from lack of struggle in the nonadaptive, CWMT active control condition. Future combined intervention research should focus on specific, theoretically driven WM deficits among individuals with ADHD, should include possible adaptations to the standard CWMT program, should examine effectiveness of cognitive treatments combined with contextual interventions and should utilize appropriate control groups to fully understand the unique and combined effects of interventions.
10.1080/09297049.2014.994485
Effects of a psychosocial intervention on the executive functioning in children with ADHD.
Miranda Ana,Presentación M Jesús,Siegenthaler Rebeca,Jara Pilar
Journal of learning disabilities
The purpose of this study was to analyze the effects of an intensive psychosocial intervention on the executive functioning (EF) in children with ADHD. The treatment was carried out in a coordinated manner over a period of 10 weeks with 27 children with ADHD aged 7 to 10, their parents, and their teachers. A battery of neuropsychological tasks was applied to evaluate attention, interference control, verbal and visuospatial working memory, planning ability, and flexibility. The comparative analysis of the treated group of ADHD children and an untreated ADHD group showed significant differences that were especially important in visuospatial memory and planning in favor of the treated children, even when the scores in the pretreatment phase were included as covariables. Likewise, improvements were observed in the parents' and teachers' behavioral ratings of hyperactivity or impulsivity and inattention. The conclusion was drawn that psychosocial interventions with children with ADHD can have a positive effect on some executive functions.
10.1177/0022219411427349
A pilot randomized controlled trial comparing computer-assisted cognitive rehabilitation, stimulant medication, and an active control in the treatment of ADHD.
Azami Saeed,Moghadas Alireza,Sohrabi-Esmrood Faramarz,Nazifi Morteza,Mirmohamad Mahdieh,Hemmati Fatemeh,Ahmadi Ameneh,Hamzeh-Poor Pariya,Khari Saeedeh,Lakes Kimberley
Child and adolescent mental health
BACKGROUND:This research aimed to compare computer-assisted cognitive rehabilitation (CACR) psychostimulants (MED) and placebo CACR (PCACR) in the treatment of ADHD using a multiarm parallel design. METHODS:Thirty-four boys with ADHD, aged 7-12, were randomly assigned to either CACR (n = 12), MED (n = 11), or PCACR (n = 11). However, the study was not blinded and medication doses might be suboptimal given the lack of titration. Continuous performance test, Tower-of-London, forward/backward digit span, span board, Raven's progressive matrices, and SNAP-IV were completed at baseline, posttest, and follow-up. RESULTS:Computer-assisted cognitive rehabilitation outperformed both MED and PCACR on backward digit span at posttest and PCACR at follow-up. CACR outperformed PCACR and MED on forward digit span at posttest and PCACR at follow-up. CACR outperformed MED on span board at posttest. CACR outperformed PCACR and MED on Raven's matrices at posttest. CACR and PCACR scored lower than MED on ADHD-PHI at posttest. CACR scored lower than MED on ADHD-C at posttest. CONCLUSIONS:Immediately after interventions, CACR improved certain simple executive functions (EFs) as much as active stimulant medication. On complex EFs, CACR was superior to active stimulant medication and PCACR. CACR reduced behavioral symptoms of ADHD more than active stimulant medication. However, at 3-month follow-up, maintenance of the CACR gains was weak.
10.1111/camh.12157
Effects of a 6 Week Yoga Intervention on Executive Functioning in Women Screening Positive for Adult ADHD: A Pilot Study.
Fritz Kathryn,O'Connor Patrick J
Frontiers in sports and active living
Purpose:Little is known about the effects of yoga training in adults with ADHD symptoms. This pilot study sought to determine the feasibility and selected psychological effects of 6 weeks of yoga training in women screening positive for adult ADHD compared to a wait-list control group. Methods:A randomized trial was conducted with 32 adult women (18-24 years) who volunteered after screening positive for adult ADHD as assessed by the Adult ADHD Self-Report Scale (ASRS). Participants were randomized to 6 weeks of Bikram yoga training or to a wait-list control group. The yoga intervention consisted of two 90-min classes per week. Multilevel models were used to test hypothesized interactions of yoga-induced improvements compared to controls across time (baseline, 3 weeks, and 6 weeks). The primary outcomes assessed inhibitory control, cognitive flexibility and working memory using the NIH Toolbox. Separate models with trait mindfulness, trait anxiety and expectations for change in either attention or working memory as covariates tested whether these variables mediated the changes in the three measures of executive function. Secondary outcomes included mood, perceived functional impairment and motivation for, and hyperactivity during, the cognitive tests. Results:No adverse events were observed. Attendance averaged 91.7% among the 69% of the sample that did not dropout. No significant Group X Time interactions were found for any of the psychological outcomes and the null executive function findings were unchanged when including the covariates. Conclusion:Six-weeks of yoga training twice per week is potentially feasible for women experiencing ADHD symptoms, but an exercise stimulus of this duration and magnitude yields no beneficial cognitive or mood outcomes.
10.3389/fspor.2022.746409
The impacts of a combined exercise on executive function in children with ADHD: A randomized controlled trial.
Scandinavian journal of medicine & science in sports
PURPOSE:The purpose of this study was to examine the effects of aerobic and neurocognitive exercise with moderate-to-vigorous physical activity levels on executive functions (EFs) and sleep quality in children with attention-deficit/hyperactivity disorder (ADHD). METHODS:In a parallel two-group randomized controlled trial (RCT) design, 80 children with ADHD aged 6-12 years (Mage = 8.46 ± 1.50) were assigned to either a 12-week combined aerobic-and neurocognitive-exercise experimental group (EG; three sessions per week for 60-min) or a wait-list control group (CG). Forty children with typical development aged 6-12 years (Mage = 8.49 ± 1.51) were recruited as healthy controls (HC). A Polar heart rate (HR) monitor was used to track the exercise intensity (60%-80% predicted HRmax) throughout the intervention. Three core EFs (inhibitory control [IC], working memory [WM], and cognitive flexibility [CF]) were assessed by computer-based neurocognitive tasks, and sleep quality and physical activity (PA) levels were assessed by self-report questionnaires. RESULTS:The results showed that the exercise intervention was beneficial for improving three core EFs, shortening sleep latency and decreasing sleep disturbances. The intervention effects on EFs and sleep quality appeared to be sustained for at least 12 weeks in EG. In addition, children with ADHD after intervention showed non-significant differences in IC, CF and multiple sleep quality outcomes compared with HC. Furthermore, a significant PA-EFs-sleep correlation was found in children with ADHD after the intervention. CONCLUSION:The findings suggest that a 12-week combined aerobic and neurocognitive exercise intervention appears to be an effective treatment program for EFs and sleep quality in children with ADHD.
10.1111/sms.14192
Will working memory training generalize to improve off-task behavior in children with attention-deficit/hyperactivity disorder?
Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics
Computerized working memory and executive function training programs designed to target specific impairments in executive functioning are becoming increasingly available, yet how well these programs generalize to improve functional deficits in disorders, such as attention-deficit/hyperactivity disorder (ADHD), beyond the training context is not well-established. The aim of this study was to examine the extent to which working memory (WM) training in children with ADHD would diminish a core dysfunctional behavior associated with the disorder, "off-task" behavior during academic task performance. The effect of computerized WM training (adaptive) was compared to a placebo condition (nonadaptive) in a randomized, double-blind, placebo-controlled design in 26 children (18 males; age, 7 to 14 years old) diagnosed with ADHD. Participants completed the training in approximately 25 sessions. The Restricted Academic Situations Task (RAST) observational system was used to assess aspects of off-task behavior during the completion of an academic task. Traditional measures of ADHD symptoms (Conners' Parent Rating Scale) and WM ability (standardized WM tests) were also collected. WM training led to significant reductions in off-task ADHD-associated behavior on the RAST system and improvement on WM tests. There were no significant differences between groups in improvement on parent rating scales. Findings lend insight into the generalizability of the effects of WM training and the relation between deficits in WM and off-task behavioral components of ADHD. These preliminary data suggest WM training may provide a mechanism for indirectly altering academic performance in children with ADHD.
10.1007/s13311-012-0124-y
An RCT into the effects of neurofeedback on neurocognitive functioning compared to stimulant medication and physical activity in children with ADHD.
European child & adolescent psychiatry
Neurofeedback (NFB) is a potential alternative treatment for children with ADHD that aims to optimize brain activity. Whereas most studies into NFB have investigated behavioral effects, less attention has been paid to the effects on neurocognitive functioning. The present randomized controlled trial (RCT) compared neurocognitive effects of NFB to (1) optimally titrated methylphenidate (MPH) and (2) a semi-active control intervention, physical activity (PA), to control for non-specific effects. Using a multicentre three-way parallel group RCT design, children with ADHD, aged 7-13, were randomly allocated to NFB (n = 39), MPH (n = 36) or PA (n = 37) over a period of 10-12 weeks. NFB comprised theta/beta training at CZ. The PA intervention was matched in frequency and duration to NFB. MPH was titrated using a double-blind placebo controlled procedure to determine the optimal dose. Neurocognitive functioning was assessed using parameters derived from the auditory oddball-, stop-signal- and visual spatial working memory task. Data collection took place between September 2010 and March 2014. Intention-to-treat analyses showed improved attention for MPH compared to NFB and PA, as reflected by decreased response speed during the oddball task [η = 0.21, p < 0.001], as well as improved inhibition, impulsivity and attention, as reflected by faster stop signal reaction times, lower commission and omission error rates during the stop-signal task (range η = 0.09-0.18, p values <0.008). Working memory improved over time, irrespective of received treatment (η = 0.17, p < 0.001). Overall, stimulant medication showed superior effects over NFB to improve neurocognitive functioning. Hence, the findings do not support theta/beta training applied as a stand-alone treatment in children with ADHD.
10.1007/s00787-016-0902-x
Swimming training improves mental health parameters, cognition and motor coordination in children with Attention Deficit Hyperactivity Disorder.
Silva Luciano Acordi Da,Doyenart Ramiro,Henrique Salvan Paulo,Rodrigues Welber,Felipe Lopes João,Gomes Karen,Thirupathi Anand,Pinho Ricardo Aurino De,Silveira Paulo Cesar
International journal of environmental health research
The aim of this study was to verify the effects of swimming-learning program of mental health parameters, cognition and motor coordination in students with Attention Deficit Hyperactivity Disorder (ADHD). Thirty-three children of both sexes between 11 and 14 years were randomized into trained group (n = 18) and untrained group (n = 15). The training was performed for 8 weeks. Then, before and after 48 h of training period of both groups were submitted to find the mental health, cognition, motor coordination test, and physical fitness. Our results demonstrate that the aquatic exercise program significantly improved the depression parameters (p = 0.048), stress (p = 0.039), cognitive flexibility (p = 0.042) and selective attention (p = 0.047). In relation to motor coordination and physical fitness, the results showed significant improvements in the coordination of lower limbs laterality (p = 0.05), flexibility (p = 0.049), and abdominal resistance (p = 0.037). Taken together, the results suggest that swimming-learning program significantly improved the mental health, cognition, and motor coordination in children with ADHD.
10.1080/09603123.2019.1612041
Long-term far-transfer effects of working memory training in children with ADHD: a randomized controlled trial.
Bigorra Aitana,Garolera Maite,Guijarro Silvina,Hervás Amaia
European child & adolescent psychiatry
ADHD affects working memory (WM) and other executive functions (EFs) and thereby negatively impacts school performance, clinical symptoms and functional impairment. The main aim of this study was to analyse the efficacy of computerized WM training (CWMT) on EF rating scales. A secondary objective was to assess its efficacy on performance-based measures of EF (PBMEF), learning, clinical symptoms and functional impairment. 66 children with combined-type ADHD between 7 and 12 years of age from the Child and Adolescent Psychiatric Unit (Spain) were included in this randomized, double-blind, placebo-controlled, parallel-group clinical trial. The participants were randomized (1:1) to an experimental group (EG) (CWMT) (n = 36) or a control group (CG) (placebo training). Assessments were conducted at baseline (T0), 1-2 weeks (T1), and 6 months post-intervention (T2) with the administration of EF rating scales, PBMEF, measures of academic achievement, and questionnaires regarding clinical symptoms and functional impairment. Participants, parents, teachers and professionals who performed the cognitive assessments were blinded. Adjusted multiple linear regression analysis showed significant improvements in EF scales-parent version, from T1 to T2, on the metacognition index [p = 0.03, d' = -0.78 (95 % CI -1.28 to -0.27)] and on WM (also significant at T2-T0) and plan/organize subscales. Significant improvements were also noted in EF scales-teacher version, from T0 to T1 and T2, on the metacognitive index [p = 0.05, d' = -0.37 (95 % CI -0.86 to 0.12) T1-T0, p = 0.02, d' = -0.81 (95 % CI -1.31 to -0.30) T2-T0] and on the initiate, WM, monitor and shift subscales. There were also significant improvements in PBMEF, ADHD symptoms, and functional impairment. CWMT had a significant impact on ADHD deficits by achieving long-term far-transfer effects.
10.1007/s00787-015-0804-3
Effects of Physical Exercise Intervention on Motor Skills and Executive Functions in Children With ADHD: A Pilot Study.
Pan Chien-Yu,Tsai Chia-Liang,Chu Chia-Hua,Sung Ming-Chih,Huang Chu-Yang,Ma Wei-Ya
Journal of attention disorders
OBJECTIVE:This study examined the effect of a 12-week table tennis exercise on motor skills and executive functions in children with ADHD. METHOD:Fifteen children with ADHD received the intervention, whereas 15 children with ADHD and 30 typically developing children did not. The Test of Gross Motor Development-2, Stroop, and Wisconsin Card Sorting Test (WCST) were conducted before and after the intervention. RESULTS:After the intervention, the ADHD training group scored significantly higher in the locomotor as well as object-control skills, Stroop Color-Word condition, and WCST total correct performance compared with the ADHD non-training group, and we noted improvements in the locomotor as well as object-control skills, Stroop Color-Word condition, and three aspects of the WCST performances of the ADHD training group over time. CONCLUSION:A 12-week table tennis exercise may have clinical relevance in motor skills and executive functions of children with ADHD.
10.1177/1087054715569282
Translating the matrix.
British journal of pharmacology
LINKED ARTICLES:This article is part of a themed section on Translating the Matrix. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.1/issuetoc.
10.1111/bph.14517
Few effects of far transfer of working memory training in ADHD: a randomized controlled trial.
Egeland Jens,Aarlien Anne Kristine,Saunes Brit-Kari
PloS one
OBJECTIVE:Studies have shown that children with ADHD profit from working memory training, although few studies have investigated transfer effects comprehensively. The current Randomized Controlled Trial analyzes transfer to other neuropsychological (NP) domains, academic performance and everyday functioning at home and school. METHOD:Sixty-seven children with ADHD were randomized into a control group or a training group. The training group underwent Cogmed's RoboMemo program. All participants were assessed pre-training, immediately after and eight months later with a battery of NP tests, measures of mathematical and reading skills, as well as rating scales filled out by parents and teachers. RESULTS:There was a significant training effect in psychomotor speed, but not to any other NP measures. Reading and mathematics were improved. There were no training induced changes in symptom rating scales either at home or at school. The increased reading scores remained significant eight months later. CONCLUSION:The study is the most comprehensive study of transfer effects to date, and with mixed results compared to previous research. More research is needed regarding how to improve the training program and the conditions and thresholds for successful training. TRIAL REGISTRATION:Controlled-Trials.com ISRCTN19133620.
10.1371/journal.pone.0075660
Effects of an aquatic exercise program on inhibitory control in children with ADHD: a preliminary study.
Chang Yu-Kai,Hung Chiao-Ling,Huang Chung-Ju,Hatfield Bradley D,Hung Tsung-Min
Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists
The purpose of this preliminary study was to examine whether an aquatic exercise intervention that involves both aerobic and coordinative exercises influences restraint inhibition in children with ADHD. Thirty participants were assigned to either an aquatic exercise or a wait-list control group. Participants were assessed by Go/Nogo Task and motor ability prior to and after an 8-week exercise intervention (twice per week, 90 min per session) or a control intervention. Significant improvements in accuracy associated with the Nogo stimulus and the coordination of motor skills were observed over time in the exercise group compared with the control group. Only main effects of group were found for reaction time and accuracy associated with the Go stimulus. These findings suggest that an exercise program that involves both quantitative and qualitative exercise characteristics facilitates the restraint inhibition component of behavioral inhibition in children with ADHD.
10.1093/arclin/acu003
1Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD).
Behavioral and brain functions : BBF
BACKGROUND:Although several promising studies on neurofeedback training in Attention Deficit/Hyperactivity Disorder (ADHD) have been performed in recent years, the specificity of positive treatment effects continues to be challenged. METHODS:To evaluate the specificity of a neurofeedback training of slow cortical potentials, a twofold strategy was pursued: First, the efficacy of neurofeedback training was compared to a group training program for children with ADHD. Secondly, the extent of improvements observed in the neurofeedback group in relation to successful regulation of cortical activation was examined. Parents and teachers rated children's behaviour and executive functions before and after treatment. In addition, children underwent neuropsychological testing before and after training. RESULTS:According to parents' and teachers' ratings, children of the neurofeedback training group improved more than children who had participated in a group therapy program, particularly in attention and cognition related domains. On neuropsychological measures children of both groups showed similar improvements. However, only about half of the neurofeedback group learned to regulate cortical activation during a transfer condition without direct feedback. Behavioural improvements of this subgroup were moderately related to neurofeedback training performance, whereas effective parental support accounted better for some advantages of neurofeedback training compared to group therapy according to parents' and teachers' ratings. CONCLUSION:There is a specific training effect of neurofeedback of slow cortical potentials due to enhanced cortical control. However, non-specific factors, such as parental support, may also contribute to the positive behavioural effects induced by the neurofeedback training.
10.1186/1744-9081-3-35